Sandbox sc

Anaplasmosis

• Human granulocytic anaplasmosis, suspected or symptomatic

• Preferred regimen: Doxycycline 100 mg orally bid (or intravenously for those patients unable to take an oral medication) for 10 days
• Alternative regimen: Rifampin 300 mg orally bid for 7–10 days (For patients with mild illness due to HGA who are not optimally suited for doxycycline treatment because of a history of drug allergy, pregnancy, or age <8 years)
• Pediatric regimen: Doxycycline 4 mg/kg per day in 2 divided doses (maximum of 100 mg per dose) given orally (or intravenously for children unable to take an oral medication); Rifampin 10 mg/kg bid for children (maximum of 300 mg per dose) (For children age <8 years without Lyme disease)

NOTE (1): Children ≥8 years of age may be treated with a 10-day course of Doxycycline; For severely ill children <8 years of age without concomitant Lyme disease, the panel recommended an abbreviated treatment course of 4–5 days

NOTE (2): If the patient has concomitant Lyme disease, then Amoxicillin 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose) OR Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum of 500 mg per dose) should be initiated at the conclusion of the course of Doxycycline to complete a 14-day total course of antibiotic therapy

NOTE: Rifampin is not effective therapy for Lyme disease, patients coinfected with B. burgdorferi should also be treated with Amoxicillin OR Cefuroxime axetil

Brucellosis

• Uncomplicated brucellosis in adults and children eight years of age and older

• Preferred regimen: Doxycycline 100 mg bid for six weeks OR Tetracycline 500 mg every six hours orally administered for at least six weeks
• NOTE: Streptomycin 1 g/day intramuscularly administered for the first two to three weeks of therapy OR Gentamicin 5mg/kg/day intravenously or intramuscularly for 7-10 days in combination with Doxycycline administered for six weeks
• Alternative regimen (1): Doxycycline 200 mg/day orally AND Rifampicin 600–900 mg/day orally, both drugs administered for six weeks
• Alternative regimen (2): Fluoroquinolones
• NTOE: Quinolones should always be used in combination with other drugs, such as Doxycycline or Rifampicin
• Alternative regimen (3): TMP/SMZ in a fixed ratio of 1:5 (80 mg TMP/400 mg SMZ)
• NOTE: TMP/SMZ should always be used in combination with another agent, such as Doxycycline, Rifampicin or Streptomycin

• Complications of brucellosis

• Spondylitis

• Preferred regimen: Continuation of Doxycycline for eight weeks or more; Surgical drainage is rarely necessary.

• Neurobrucellosis

• Preferred regimen: Rifampicin OR Trimethoprim/sulfamethoxazole, be added to the standard regimen of Doxycycline AND Streptomycin for 6-8 weeks, and possibly longer, depending on the clinical response

• Brucella endocarditis

• Preferred regimen: Doxycycline AND an Aminoglycoside for at least eight weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
• NOTE: Rifampicin OR Trimethoprim/sulfamethoxazole are used for their ability to penetrate cell membranes

• For children less than eight years of age

• Preferred regimen: TMP/SMZ 8/40 mg/ kg/day bid orally administered for six weeks AND Streptomycin 30 mg/kg/day once daily intramuscularly administered for three weeks OR Gentamicin 5 mg/kg/day once daily intravenously or intramuscularly administered for 7-10 days
• Alternative regimen (1): TMP/SMZ AND Rifampicin 15 mg/kg/day orally each administered for 6 weeks

• Alternative regimen (2): Rifampicin AND an Aminoglycoside