Sandbox ID Lower Respiratory Tract: Difference between revisions

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Revision as of 18:22, 10 June 2015

Acute bacterial exacerbations of chronic bronchitis

Bronchiectasis

Bronchiolitis

Bronchitis

Cystic fibrosis

Empyema

Influenza

Inhalational anthrax, Prophylaxis

Inhalational anthrax, Treatment

Pertussis

Pneumonia, Acinetobacter

(H) Acinetobacter species (atypical bacterial pneumonia)

Preferred Regimen : Carbapenem (Imipenem-cilastatin, OR meropenem, OR ertapenem)
Alternate Regimen: Cephalosporin-aminoglycoside OR Ampicillin-sulbactam OR Colistin 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day)

Pneumonia, Actinomycosis

Pneumonia, Anaerobes

Anaerobe (aspiration) pneumonia

Preferred Regimen: Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) OR Ticarcillin clavulanate 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) OR Ampicillin-sulbactam 1500-3000 mg IV q6h OR Amoxicillin-clavulanate 250-500 mg PO q8h or 875 mg q12h OR Clindamycin 150-450 mg PO q6-8h (max: 1800 mg/day)
Alternate Regimen: Carbapenem-(Imipenem-cilastatin, OR meropenem, OR ertapenem)

Pneumonia, Aspiration pneumonia

Aspiration (anaerobe) pneumonia

Preferred Regimen: Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) OR Ticarcillin clavulanate 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) OR Ampicillin-sulbactam 1500-3000 mg IV q6h OR Amoxicillin-clavulanate 250-500 mg PO q8h or 875 mg q12h OR Clindamycin 150-450 mg PO q6-8h (max: 1800 mg/day)
Alternate Regimen: Carbapenem-(Imipenem-cilastatin, OR meropenem, OR ertapenem)

Pneumonia, Chlamydophila

Chlamydophila pneumoniae (atypical bacterial pneumonia)

Preferred Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline 250-500 mg PO q6h
Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h

Pneumonia, community-acquired

Community acquired pneumonia

Empiric therapy in adults

(A) Outpatient treatment

(1) Previously healthy and no use of antimicrobials within the previous 3 months.

Preferred regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Azithromycin 500 mg IV as a single dose OR Clarithromycin 250 mg q12h for 7-14 days OR 1000 mg q24h for 7 days OR Erythromycin 250-500 mg q6-12h (max: 4 g/day)
Alternative regimen : Doxycycline 100 mg PO/IV q12h (Weak recommendation).

(2) Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months (in this case an alternative from a different class should be selected)

Preferred regimen (1) : Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days
Preferred Regimen (2) : (Amoxicillin 875 mg PO q12h or 500 mg q8h OR Amoxicillin-clavulanate 2 g q12h OR Ceftriaxone 1 g IV q24h, (2 g q24h for patients at risk) OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefuroxime 750 mg IM/IV q8h) AND ( Macrolide Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Doxycycline 100 mg PO/IV q12h)

(B) Inpatient Therapy (in regions with a high rate (125%) of infection with high-level (minimum inhibitory concentration 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)

(1) Non-ICU treatment

Preferred Regimen : Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days OR Amoxicillin 1 g q8h OR Amoxicillin-clavulanate 2 g q12h
Alternative Regimen : Ceftriaxone 1 g IV q24h, (2 g q24h for patients at risk) OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefuroxime 750 mg IM/IV q8h

(2) ICU treatment

Preferred Regimen : (Cefotaxime I.M., I.V.: 1 g q12h OR Ceftriaxone 1 g IV q24h, 2 g/day for patients at risk OR Ampicillin-sulbactam 1.5-3 g IV q6h) AND (Azithromycin 500 mg/day PO once, followed by 250 mg q24h for 4 days OR Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin Oral: 320 mg q24h for 5 or 7 days)
Alternative Regimen (For penicillin allergy): (Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 day OR Moxifloxacin 400 mg q24h PO/IV for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days) AND Aztreonam I.V.: 2 g q6-8h (max: 8 g/day)

(C) Special Concerns

(1) Pseudomonas

Preferred Regimen (1): (Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days OR Cefepime 1-2 g q12h for 10 days OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 day)
Preferred Regimen (2): (Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days OR Cefepime 1-2 g q12h for 10 days OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND Aminoglycoside AND (Azithromycin Oral: 500 mg on day 1 followed by 250 mg q24h on days 2-5 OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Moxifloxacin 400 mg PO/IV q24h for 7-14 days OR Gemifloxacin 320 mg PO q24h for 5 or 7 days)

Note : For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (maximum 8 g/day)

(2) Methicillin resistant staphylococcus aureus ,Add the following to the selected regimen

Preferred regimen: Vancomycin 45-60 mg/kg/day divided q8-12h OR Linezolid 600 mg PO/IV q12h for 10-14 days.

Empiric therapy in neonates ( Age < 1 month)

Preferred regimen: Ampicillin 500 mg/day for 7-14 days or 750 mg/day for 5 days OR Gentamicin 400 mg/day PO/IV for 7-14 days With or without Cefotaxime 320 mg PO q24h for 5 or 7 days

Note (1) : If methicillin resistant staphylococcus aureus is suspected, add the following Vancomycin 10 mg/kg q8h

Note (2) : If Chlamydia trachomatis is suspected, add the following Erythromycin 12.5 mg/kg PO or IV qid for 14 days OR Azithromycin 10 mg/kg PO/IV on day one then 5 mg/kg PO/IV q24h for 4 days.

Alternate Regimen (If methicillin resistant staphylococcus aureus is suspected): Vancomycin 10 mg/kg q8h OR Linezolid 10 mg/kg q8h

Empiric therapy,Children (> 3 months) Outpatient Therapy

Preferred Regimen: Amoxicillin 90 mg/kg/day q12h for 5 days OR Azithromycin 10 mg/kg PO 1 dose (max 500 mg), then 5 mg/kg (max 250 mg) PO for 4 days
Alternate Regimen: Amoxicillin-clavulanate 90 mg/kg/day OR Clarithromycin 15 mg/kg/day q12h for 7-14 days

pathogen directed antimicrobial therapy
Bacterial

(A) Streptococcus pneumoniae

(1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL

Preferred Regimen : Penicillin G 2-3 million units IV q4h OR Amoxicillin 875 mg PO q12h or 500 mg q8h
Alternative Regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefprozil 500 mg PO q12h for 10 days OR Cefuroxime 750 mg PO/IV q8h OR Cefdinir 300 mg PO q12h for 10 days OR Cefditoren 400 mg PO q12h for 14 day OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR Cefotaxime 1 g IM/IV q12h OR Clindamycin 150-450 mg PO q6-8h (maximum: 1800 mg/day) OR Clindamycin 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) OR Doxycycline 100 mg PI/IV q12h ORlevofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h.

(2) Penicillin resistant; minimum inhibitory concentration > 2 mg / mL

Preferred Regimen (Agents chosen on the basis of susceptibililty) : Cefotaxime 1 g IM/IV q12h OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
Alternative Regimen: Vancomycin 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity OR Linezolid 600 mg PO/IV q12h for 10-14 days OR Amoxicillin 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)

(B)Haemophilus influenzae

(1) Non-beta lactamase producing

Preferred Regimen: Amoxicillin 875 mg PO q12h or 500 mg q8h
Alternative Regimen : levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Doxycycline 100 mg PO/IV q12h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Clarithromycin 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days

(2) Beta lactamase producing

Preferred Regimen: 2nd or 3rd Generation Cephalosporin OR Amoxicillin-clavulanate 2 g q12h
Alternative Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Doxycycline 100 mg PO/IV q12h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Clarithromycin 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days

(C) Bacillus anthracis (inhalation)

Preferred Regimen :Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 500 mg q24h for 7-14 days or 750 mg q24h for 5 days OR Doxycycline 100 mg PO/IV q12h
Alternate Regimen : Other fluoroquinolones OR B-lactam (if susceptible) OR Rifampin 600 mg PO/IV q24h for 4 days OR Clindamycin 150-450 mg PO q6-8h OR Chloramphenicol 50-100 mg/kg/day IV in divided q6h

(D) Enterobacteriaceae

Preferred Regimen: 3rd generation cephalosporin OR Carbapenem- (Imipenem-cilastatin, OR meropenem, OR ertapenem) (drug of choice if extended-spectrum b-lactamase producer)
Alternate Regimen : b-Lactam / b-lactamase inhibitor- (Piperacillin-tazobactam for gram-negative bacilli, OR ticarcillin-clavulanate OR ampicillin-sulbactam OR amoxicillin-clavulanate) OR (levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h)

(E)Pseudomonas aeruginosa

Preferred Regimen: (Ticarcillin 200-300 mg/kg/day in divided doses q4-6h (maximum: 18 g/day) OR Piperacillin 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h OR Ceftazidime 500 mg to 1 g q8h OR Cefepime 1-2 g q12h for 10 days OR Aztreonam 2 g IV q6-8h (maximum: 8 g/day) OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily OR Aminoglycoside)
Alternate Regimen: Aminoglycoside AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily)

(F)Staphylococcus aureus

(1) Methicillin susceptible

Preferred Regimen : Nafcillin 1000-2000 mg q4h OR Oxacillin 2 g IV q4h OR Flucloxacillin 250 mg IM/IV q6h
Alternative Regimen : Cefazolin 500 mg IV q12h OR Clindamycin 150-450 mg PO q6-8h

(2) Methicillin resistant

Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR Linezolid 600 mg PO/IV q12h for 10-14 days
Alternative Regimen: Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h

(G)Bordetella pertussis

Preferred Regimen:Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
Alternate Regimen: Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h

(H) Anaerobe (aspiration)

Preferred Regimen: Piperacillin-tazobactam 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) OR Ticarcillin clavulanate 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) OR Ampicillin-sulbactam 1500-3000 mg IV q6h OR Amoxicillin-clavulanate 250-500 mg PO q8h or 875 mg q12h OR Clindamycin 150-450 mg PO q6-8h (max: 1800 mg/day)
Alternate Regimen: Carbapenem -(Imipenem-cilastatin, OR meropenem, OR ertapenem)

(I) Mycobacterium tuberculosis

Preferred Regimen:

Intensive phase: Isoniazid 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) AND Ethambutol 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) AND Pyrazinamide 1000 - 2000 mg / day daily for 2 months.
Continuation phase: Isoniazid 300 mg/day PO daily for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO daily for 4 months (10 mg/kg/day).

Alternate regimen (1):

Intensive phase: Isoniazid 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) AND Ethambutol 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) AND Pyrazinamide 1000 - 2000 mg / day daily for 2 months.
Continuation phase: Isoniazid 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day).

Note : Acceptable alternative for any new TB patient receiving directly observed therapy

Alternate regimen (2)

Intensive phase:Isoniazid 5 mg/kg/day q24h 3 times per week for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day 3 times per week for 2 months (maximum: 600 mg / day) s AND Ethambutol 5-25 mg/kg (maximum dose: 1.6 g) 3 times per week for 2 months AND Pyrazinamide 1000 - 2000 mg / day 3 times per week for 2 months.
Continuation phase: Isoniazid 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day).

Note : Acceptable alternative provided that the patient is receiving directly observed therapy and is not living with HIV or living in an HIV prevalent setting.

(J) Yersinisa pestis

Preferred Regimen: Streptomycin 15 mg/kg/day (max 1 g/day) OR Gentamicin 7 mg/kg/day
Alternate Regimen: Doxycycline 100 mg PO/IV q12h OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h

Atypical bacteria

(A) Mycoplasma pneumoniae

Preferred Regimen:Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline Oral: 250-500 mg q6h
Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h

(B) Chlamydophila pneumoniae

Preferred Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline 250-500 mg PO q6h
Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h

(C) Legionella species

Preferred Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
Alternate Regimen: Doxycycline 100 mg PO/IV q12h

(D)Chlamydophila psittaci

Preferred Regimen: Tetracycline 250-500 mg PO q6h
Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h

(E) Coxiella burnetii

Preferred Regimen: Tetracycline 250-500 mg PO q6h
Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h

(F) Francisella tularensis

Preferred Regimen: Doxycycline 100 mg PO/IV q12h
Alternate Regimen: Gentamicin 7 mg/kg/day OR Streptomycin 15 mg/kg/day (maximum: 1 g)

(G) Burkholderia pseudomallei

Preferred Regimen : Carbapenem -(Imipenem-cilastatin, OR meropenem, OR ertapenem) OR Ceftazidime 0.5-1 g q8h
Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h

(H) Acinetobacter species

Preferred Regimen : Carbapenem-(Imipenem-cilastatin, OR meropenem, OR ertapenem)
Alternate Regimen: Cephalosporin-aminoglycoside OR Ampicillin-sulbactam OR Colistin 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day)

Viral

Influenza virus

Preferred Regimen: Oseltamivir 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) OR Zanamivir Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)

Fungal

(A) Coccidioides species

Preferred Regimen: Itraconazole 200 mg q12h OR Fluconazole 200-400 mg daily for 3-6 month
Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day

Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection

(B) Histoplasmosis

Preferred Regimen: Itraconazole 200 mg q12h
Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day

(C) Blastomycosis

Preferred Regimen: Itraconazole 200 mg q12h
Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day

Pneumonia, concomitant influenza

Influenza virus pneumonia

Preferred Regimen: Oseltamivir 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) OR Zanamivir Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)

Pneumonia, Cytomegalovirus

Pneumonia, Haemophilus Influenza

Haemophilus influenzae pneumonia

(1) Non-beta lactamase producing

Preferred Regimen: Amoxicillin 875 mg PO q12h or 500 mg q8h
Alternative Regimen : levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Doxycycline 100 mg PO/IV q12h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Clarithromycin 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days

(2) Beta lactamase producing

Preferred Regimen: 2nd or 3rd Generation Cephalosporin OR Amoxicillin-clavulanate 2 g q12h
Alternative Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Doxycycline 100 mg PO/IV q12h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 OR Clarithromycin 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days

Pneumonia, health care-associated

Pneumonia, hospital-acquired

Pneumonia, Klebsiella

Pneumonia, Legionella

Legionella pneumonia (atypical pneumonia)

Preferred Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
Alternate Regimen: Doxycycline 100 mg PO/IV q12h

Pneumonia, Lung abscess

Pneumonia, Meliodosis

Pneumonia, Moraxella catarrhalis

Pneumonia, Mycoplasma

Mycoplasma pneumoniae (atypical pneumonia)

Preferred Regimen:Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Tetracycline Oral: 250-500 mg q6h
Alternate Regimen: levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h

Pneumonia, neutropenic patient

Pneumonia, Nocardia

Pneumonia, post-influenza

Pneumonia, Pseuodomonas

Pseudomonas aeruginosa pneumonia

Preferred Regimen: (Ticarcillin 200-300 mg/kg/day in divided doses q4-6h (maximum: 18 g/day) OR Piperacillin 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h OR Ceftazidime 500 mg to 1 g q8h OR Cefepime 1-2 g q12h for 10 days OR Aztreonam 2 g IV q6-8h (maximum: 8 g/day) OR Imipenem 500 mg IV q6h OR Meropenem 500 mg IV q8h) AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily OR Aminoglycoside)
Alternate Regimen: Aminoglycoside AND (Ciprofloxacin 500-750 mg q12h for 7-14 days OR Levofloxacin 750 mg daily)

Pneumonia, Staphylococcus aureus

Staphylococcus aureus pneumonia

(1) Methicillin susceptible

Preferred Regimen : Nafcillin 1000-2000 mg q4h OR Oxacillin 2 g IV q4h OR Flucloxacillin 250 mg IM/IV q6h
Alternative Regimen : Cefazolin 500 mg IV q12h OR Clindamycin 150-450 mg PO q6-8h

(2) Methicillin resistant

Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR Linezolid 600 mg PO/IV q12h for 10-14 days
Alternative Regimen: Trimethoprim-sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h

Pneumonia, Stenotrophomonas

Pneumonia, Streptococcus pneumoniae

Streptococcus pneumoniae

(1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL

Preferred Regimen : Penicillin G 2-3 million units IV q4h OR Amoxicillin 875 mg PO q12h or 500 mg q8h
Alternative Regimen : Azithromycin 500 mg PO on day 1 followed by 250 mg q24h OR Cefpodoxime 200 mg PO q12h for 14 days OR Cefprozil 500 mg PO q12h for 10 days OR Cefuroxime 750 mg PO/IV q8h OR Cefdinir 300 mg PO q12h for 10 days OR Cefditoren 400 mg PO q12h for 14 day OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR Cefotaxime 1 g IM/IV q12h OR Clindamycin 150-450 mg PO q6-8h (maximum: 1800 mg/day) OR Clindamycin 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) OR Doxycycline 100 mg PI/IV q12h OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h.

(2) Penicillin resistant; minimum inhibitory concentration > 2 mg / mL

Preferred Regimen (Agents chosen on the basis of susceptibililty) : Cefotaxime 1 g IM/IV q12h OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h
Alternative Regimen: Vancomycin 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity OR Linezolid 600 mg PO/IV q12h for 10-14 days OR Amoxicillin 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)

Pneumonia, Tularemia

Francisella tularensis pneumonia

Preferred Regimen: Doxycycline 100 mg PO/IV q12h
Alternate Regimen: Gentamicin 7 mg/kg/day OR Streptomycin 15 mg/kg/day (maximum: 1 g)

Pneumonia, Yersinia pestis

Yersinisa pestis pneumonia

Preferred Regimen: Streptomycin 15 mg/kg/day (max 1 g/day) OR Gentamicin 7 mg/kg/day
Alternate Regimen: Doxycycline 100 mg PO/IV q12h OR levofloxacin 750 mg IV q24h OR moxifloxacin 400 mg IV q24h

@@ Line 83: / Line 83: @@
 :::* (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
 ::::* Preferred Regimen : [[Penicillin G]] 2-3 million units IV q4h {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
-::::* Alternative Regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefprozil]] 500 mg PO q12h for 10 days {{or}} [[Cefuroxime]] 750 mg PO/IV q8h {{or}} [[Cefdinir]] 300 mg PO q12h for 10 days {{or}} [[Cefditoren]] 400 mg PO q12h for 14 day {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (maximum: 1800 mg/day) {{or}} [[Clindamycin]] 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) {{or}} [[Doxycycline]] 100 mg PI/IV q12h {{or}} Respiratory [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h.
+::::* Alternative Regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefprozil]] 500 mg PO q12h for 10 days {{or}} [[Cefuroxime]] 750 mg PO/IV q8h {{or}} [[Cefdinir]] 300 mg PO q12h for 10 days {{or}} [[Cefditoren]] 400 mg PO q12h for 14 day {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (maximum: 1800 mg/day) {{or}} [[Clindamycin]] 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) {{or}} [[Doxycycline]] 100 mg PI/IV q12h {{or}}[[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h.
 :::* (2) Penicillin resistant;  minimum inhibitory concentration > 2 mg / mL
 ::::* Preferred Regimen (Agents chosen on the basis of susceptibililty) : [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h
@@ Line 89: / Line 89: @@
 ::* (B)Haemophilus influenzae
-:::* (1) Non–B-lactamase producing
+:::* (1) Non-beta lactamase producing
 ::::* Preferred Regimen: [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
 ::::* Alternative Regimen : [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
-:::* (2) B-lactamase producing
+:::* (2) Beta lactamase producing
 ::::* Preferred Regimen: 2nd or 3rd Generation [[Cephalosporin]] {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
 ::::* Alternative Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
@@ Line 105: / Line 105: @@
 ::* (E)Pseudomonas aeruginosa
-:::* Preferred Regimen: ([[Ticarcillin]] 200-300 mg/kg/day in divided doses q4-6h (max: 18 g/day) {{or}} [[Piperacillin]] 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h {{or}} [[Ceftazidime]] 500 mg to 1 g q8h {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Aztreonam]] 2 g IV q6-8h (max: 8 g/day) {{or}}[[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h) {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily {{or}} [[Aminoglycoside]])
+:::* Preferred Regimen: ([[Ticarcillin]] 200-300 mg/kg/day in divided doses q4-6h (maximum: 18 g/day) {{or}} [[Piperacillin]] 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h {{or}} [[Ceftazidime]] 500 mg to 1 g q8h {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Aztreonam]] 2 g IV q6-8h (maximum: 8 g/day) {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h) {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily {{or}} [[Aminoglycoside]])
 :::* Alternate Regimen: [[Aminoglycoside]] {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily)
@@ Line 122: / Line 122: @@
 ::* (H) Anaerobe (aspiration)
 :::* Preferred Regimen: [[Piperacillin-tazobactam]] 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) {{or}} [[Ticarcillin clavulanate]] 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) {{or}} [[Ampicillin-sulbactam]] 1500-3000 mg IV q6h {{or}} [[Amoxicillin-clavulanate]] 250-500 mg PO q8h or 875 mg q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (max: 1800 mg/day)
-:::* Alternate Regimen: [[Carbapenem]]
+:::* Alternate Regimen: [[Carbapenem]] -([[Imipenem]]-[[cilastatin]], {{or}} [[meropenem]], {{or}} [[ertapenem]])
 ::* (I) Mycobacterium tuberculosis
@@ Line 151: / Line 151: @@
 :::* Preferred Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] 250-500 mg PO q6h
 :::* Alternate Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h
 ::* (C) Legionella species
 :::* Preferred Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
@@ Line 164: / Line 165: @@
 ::* (F) Francisella tularensis
-:::* Preferred Regimen: [[Doxycycline]]
+:::* Preferred Regimen: [[Doxycycline]]  100 mg PO/IV q12h
 :::* Alternate Regimen: [[Gentamicin]] 7 mg/kg/day {{or}} [[Streptomycin]] 15 mg/kg/day (maximum: 1 g)
 ::* (G) Burkholderia pseudomallei
-:::* Preferred Regimen : [[Carbapenem]] {{or}} [[Ceftazidime]] 0.5-1 g q8h
+:::* Preferred Regimen : [[Carbapenem]] -([[Imipenem]]-[[cilastatin]], {{or}} [[meropenem]], {{or}} [[ertapenem]]) {{or}} [[Ceftazidime]] 0.5-1 g q8h
 :::* Alternate Regimen: [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h {{or}} [[Trimethoprim-sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
 ::* (H) Acinetobacter species
-:::* Preferred Regimen : [[Carbapenem]]
+:::* Preferred Regimen : [[Carbapenem]]-([[Imipenem]]-[[cilastatin]], {{or}} [[meropenem]], {{or}} [[ertapenem]])
-:::* Alternate Regimen: [[Cephalosporin]]-[[aminoglycoside]]  {{or}} [[Ampicillin-sulbactam]] {{or}} [[Colistin]] 2.5-5 mg/kg/day IM/IV divided q6-12h (max: 5 mg/kg/day)
+:::* Alternate Regimen: [[Cephalosporin]]-[[aminoglycoside]]  {{or}} [[Ampicillin-sulbactam]] {{or}} [[Colistin]] 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day)
 :* Viral