Sandbox ID Lower Respiratory Tract: Difference between revisions

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:::: Note (1): If the patient is allergic to [[Sulfonamides]], desensitization should be performed when possible.
:::: Note (1): If the patient is allergic to [[Sulfonamides]], desensitization should be performed when possible.
:::: Note (2): If the isolate is susceptible to the third-generation cephalosporins ([[Ceftriaxone]], [[Cefotaxime]]), [[Imipenem]] can be switched to one of these agents.
:::: Note (2): If the isolate is susceptible to the third-generation cephalosporins ([[Ceftriaxone]], [[Cefotaxime]]), [[Imipenem]] can be switched to one of these agents.
::: Note (3): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
:::: Note (3): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
::* '''Switch to oral therapy''': A sulfonamide (eg,[[Trimethoprim]]-[[Sulfamethoxazole]]  10 mg/kg/day of the trimethoprim component in 2 or 3 divided doses) {{and}} / {{or}} [[Minocycline]] (100 mg bd) {{and}} / {{or}} [[Amoxicillin]]-[[Clavulanate]] (875 mg bd)
::* '''Switch to oral therapy''': A sulfonamide (eg,[[Trimethoprim]]-[[Sulfamethoxazole]]  10 mg/kg/day of the trimethoprim component in 2 or 3 divided doses) {{and}} / {{or}} [[Minocycline]] (100 mg bd) {{and}} / {{or}} [[Amoxicillin]]-[[Clavulanate]] (875 mg bd)
::: Note (1): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
::: Note (1): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.

Revision as of 20:23, 16 June 2015

Acute bacterial exacerbations of chronic bronchitis

  • Chronic bronchitis with Acute bacterial Exacerbation [1]
  • Preferred Regimen

Bronchiectasis

  • Bronchiectasis

Bronchiolitis

Treatment

Note[2]

Prophylaxis

Note
  • Clinicians should administer palivizumab during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity defined as preterm infants <32 weeks 0 days’ gestation who require >21% oxygen for at least the first 28 days of life.
  • Clinicians should not administer palivizumab to otherwise healthy infants with a gestational age of 29 weeks, 0 days or greater.
  • All people should disinfect hands before and after direct contact with patients, after contact with inanimate objects in the direct vicinity of the patient, and after removing gloves.
  • All people should use alcoholbased rubs for hand decontamination when caring for children with bronchiolitis. When alcoholbased rubs are not available, individuals should wash their hands with soap and water.
  • Clinicians should counsel caregivers about exposing the infant or child to environmental tobacco smoke and smoking cessation when assessing a child for bronchiolitis.

Bronchitis

Cystic fibrosis

  • Pathogen directed antimicrobial therapy [3]
  • Bacterial
  • Pseudomonas aeruginosa
  • Preferred Regimen: Tobramycin 3.3 mg/kg q8h or 12 mg/kg IV q24h AND (Piperacillin 100 mg/kg q6h OR Ticarcillin 100 mg/kg q6h OR Ceftazidime 50 mg/kg IV q8h (to maximum of 6 gm/day))
  • Alternative Regimen: Tobramycin (3.3 mg/kg q8h or 12 mg/kg IV q24h) AND (Aztreonam 50 mg/kg IV q8h OR Tobramycin 3.3 mg/kg q8h or 12 mg/kg IV q24h) AND Imipenem 15-25 mg/kg IV q6. If Tobramycin resistant add Ciprofloxacin Oral : 500-750 mg twice daily for 7-14 days-IV 400 mg every 12 hours for 7-14 days OR Levofloxacin 750 mg every 24 hours for 7-14 days
  • Only in children: Ciprofloxacin Oral :500-750 mg twice daily for 7-14 days-IV 400 mg every 12 hours for 7-14 days AND Ceftazidime IV 500 mg to 1 g every 8 hours.
  • Staphylococcus aureus
  • Preferred Regimen (Adult)
  • IF methicillin sensitive staphylococcus aureus: Nafcillin 2 gm IV q4hs OR Oxacillin 2 gm IV q4hs
  • If methicillin resistant staphylococcus aureus: Vancomycin 15-20 mg/kg IV q8-12h OR Linezolid 600 mg po/IV q12h
  • Preferred regimen (Pediatric)
  • IF methicillin sensitive staphylococcus aureus: Nafcillin 5 mg/kg q6h (Age >28 days) OR Oxacillin 75 mg/kg q6h (Age >28 days)]]
  • If methicillin resistant staphylococcus aureus: Vancomycin 40 mg/kg divided q6-8h (Age >28 days) OR Linezolid 10 mg/kg po/IV q8h (up to age 12)
  • Burkholderia cepacia

Empyema

Influenza

Inhalational anthrax, Prophylaxis

  • Oral postexposure prophylaxis for infection with Bacillus anthracis (for adults)[4]
  • (1) For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Ciprofloxacin, 500 mg q12h OR Doxycycline, 100 mg q12h OR Levofloxacin, 750 mg q24h OR Moxifloxacin, 400 mg q24h OR Clindamycin, 600 mg q8h OR
  • (2) Alternatives for penicillin-susceptible strain Amoxicillin, 1 g q8h OR Penicillin VK, 500 mg q6h
Note (1): Preferred drugs are indicated in boldface.
Note (2): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment or if first-line treatment is unavailable.
  • Postexposure Prophylaxis for Bacillus anthracis (for Children 1 Month of Age and Older)[5]
  • (1). For penicillin-resistant strains or prior to susceptibility testing: Ciprofloxacin, 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) OR Doxycycline, <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose) >45 kg: 100 mg/dose, PO, given q12h OR Clindamycin, 30 mg/kg/day, PO, divided q8h (not to exceed 900 mg/dose) OR Levofloxacin, <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h OR
  • (2). For penicillin-susceptible strains: Amoxicillin, 75 mg/kg/day, PO, divided every q8h (not to exceed 1 g/dose) OR Penicillin VK, 50-75 mg/kg/day, PO, divided q6h to q8h
Note (1) : Duration of Therapy is 60 days after exposure
Note (2) : Bold font are preferred antimicrobial agent (when 2 bolded antimicrobial agents are present, both are considered equivalent in overall safety and efficacy).
Note (3) : Normal font are alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
Note (4) : Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
Note (5) : Italicized font: indicates FDA approval for the indication in the pediatric population.
Note (6) : A single 14-day course of doxycycline is not routinely associated with tooth staining, but some degree of staining is likely for a prolonged treatment course of up to 60 days.
Note (7) : Safety data for Levofloxacin in the pediatric population are limited to 14 days for duration therapy.
Note (8) : Be aware of the possibility of emergence of penicillin-resistance during monotherapy with Amoxicillin or Penicillin.

Inhalational anthrax, Treatment

  • Treatment for anthrax in adults [4]
  • Pathogen-directed antimicrobial therapy
  • (1) Intravenous therapy for systemic anthrax with possible/confirmed meningitis
  • Preferred regimen
Note (1): Duration of treatment: ≥2-3 weeks until clinical criteria for stability are met.(Preferred drugs are indicated in boldface)
Note (2): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
Note (3): Systemic anthrax includes anthrax meningitis; inhalation, injection, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck. Preferred drugs are indicated in boldface.
Note (4): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
Note (5):Increased risk for seizures associated with Imipenem/Cilastatin treatment.
Note (6): Linezolid should be used with caution in patients with thrombocytopenia because it might exacerbate it. Linezolid use for >14 days has additional hematopoietic toxicity.
Note (7): Rifampin is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
Note (8): ChloramphenicolShould only be used if other options are not available because of toxicity concerns.
  • (2) Intravenous therapy for systemic anthrax when meningitis has been excluded
  • Preferred regimen:
  • Bactericidal drug
Note (1): Duration of treatment: for 2 weeks until clinical criteria for stability are met. (Preferred drugs are indicated in boldface).
Note (2):Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
Note (3):Systemic anthrax includes anthrax meningitis; inhalation, injection, and gastrointestinal anthrax and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
Note (4):Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
Note (5):Increased risk for seizures associated with imipenem/cilastatin treatment.
Note (6):Linezolid should be used with caution in patients with thrombocytopenia because it might exacerbate it.Linezolid use for >14 d has additional hematopoietic toxicity.
Note (7):A single 10-14 days course of Doxycycline is not routinely associated with tooth staining.
Note (8):Rifampin is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobials drugs on the basis of its in vitro synergy.
  • (3) Oral treatment for cutaneous anthrax without systemic involvement
Note (1): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable. (Preferred drugs are indicated in boldface).
Note (2): Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.
  • Treatment for anthrax in childern [5]
  • (1). Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)
  • (A). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : Ciprofloxacin, 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) OR Doxycycline, <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose) ≥45 kg: 100 mg/dose, PO, given q12h OR Clindamycin, 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) OR Levofloxacin <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h OR
  • (B). Alternatives for penicillin-susceptible strains: Amoxicillin, 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose) OR Penicillin VK, 50-75 mg/kg/day, PO, divided q6h to q8h
Note (1): Duration of therapy for naturally acquired infection: 7-10 days and for a biological weapon-related event: will require additional prophylaxis for inhaled spores, to complete an antimicrobial course of up to 60 days from onset of illness.
Note (2): Bold font for preferred antimicrobial agent.
Note (3): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or first-line therapy is unavailable.
Note (4): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
Note (5): Italicized font indicates FDA approval for the indication in the pediatric population.
Note (6): A single 10- to 14-day course of doxycycline is not routinely associated with tooth staining.
Note (7): Be aware of the possibility of emergence of penicillin-resistance during monotherapy with amoxicillin or penicillin.
  • (2). Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)
  • (A). A bactericidal antimicrobial
  • (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Ciprofloxacin, 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose) OR Meropenem, 60 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) OR Levofloxacin <50 kg: 20 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose >50 kg: 500 mg, IV, q24h OR Imipenem/Cilastatin,a 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) OR Vancomycin, 60 mg/kg/day, IV, divided q8h (follow serum concentrations)
  • (b). Alternatives for penicillin-susceptible strains: Penicillin G, 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose) OR Ampicillin, 200 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) AND
  • (B). A Protein Synthesis Inhibitor: Clindamycin, 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose) OR Linezolid (non-CNS infection dose): <12 y old: 30 mg/kg/day, IV, divided q8h ≥12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) OR Doxycycline <45 kg: 4.4 mg/kg/day, IV, loading dose (not to exceed 200 mg); ≥45 kg: 200 mg, IV, loading dose then <45 kg: 4.4 mg/kg/day, IV, divided q12h (not to exceed 100 mg/dose); ≥45 kg: 100 mg, IV, given q12h OR Rifampin,d 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)
Note (1): Duration of therapy for 14 days or longer until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
Note (2): Systemic anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. A normal CSF may not completely exclude deep brain hemorrhage/abscess.
Note (4): Bold font for preferred antimicrobial agent.
Note (5): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
Note (7): Increased risk of seizures associated with Imipenem/Cilastatin therapy.
Note (8): Linezolid should be used with caution in patients with thrombocytopenia, as it may exacerbate it.Linezolid use for >14 days carries additional hematopoietic toxicity.
Note (9): A single 14-day course of Doxycycline is not routinely associated with tooth staining.
Note (10): Rifampin is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy
  • (3).Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older
  • (A). A bactericidal antimicrobial (fluoroquinolone): Ciprofloxacin, 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose)OR Levofloxacin <50 kg: 16 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose); >50 kg: 500 mg, IV, q24h ORMoxifloxacin 3 months to <2 years: 12 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
2-5 years: 10 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
6–11 years: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
12–17 years, ≥45 kg body weight: 400 mg, IV, once daily
12–17 years, <45 kg body weight: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose) AND
  • (B). A bactericidal antimicrobial (β-lactam or glycopeptide)
  • (a). For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown : Meropenem, 120 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) OR Imipenem/Cilastatin, 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) OR Doripenem, 120 mg/kg/day, IV, divided q8h (not to exceed 1 g/dose) OR Vancomycin, 60 mg/kg/day, IV, divided q8h
  • (b). Alternatives for penicillin-susceptible strains: Penicillin G, 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose) OR Ampicillin, 400 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) AND
  • (C). A Protein Synthesis Inhibitor: Linezolid <12 y old: 30 mg/kg/day, IV, divided every 8 h≥12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) OR Clindamycin, 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose) OR Rifampin, 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose) OR Chloramphenicol, 100 mg/kg/day, IV, divided q6h
Note (1): Duration of therapy for 2–3 wk or greater, until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
Note (2): Systemic anthrax includes anthrax meningitis; inhalation anthrax; or injection, gastrointestinal, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. Normal CSF may not completely exclude deep brain hemorrhage/abscess.
Note (4): Bold font for preferred antimicrobial agent.
Note (5): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
Note (7): A 400-mg dose of Ciprofloxacin, IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.
Note (8): Increased risk of seizures associated with Imipenem/Cilastatin therapy.
Note (9): Doripenem is approved in Japan at this dose for the treatment of community-acquired bacterial meningitis.
Note (10): Linezolid should be used with caution in patients with thrombocytopenia, as it may exacerbate it. Linezolid use for >14 days carries additional hematopoietic toxicity.
Note (11): Rifampin is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy for some strains of staphylococci. Not evaluated for Bacillus anthracis.
Note (12) : Chloramphenicol Should be used only if other options are not available, because of toxicity concerns.
  • (4).Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)
  • (A). A bactericidal antimicrobial
(a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Ciprofloxacin, 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) OR Levofloxacin <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) ≥50 kg: 500 mg, PO, given q24h OR
(b). Alternatives for penicillin-susceptible strains: Amoxicillin, 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose) OR Penicillin VK, 50–75 mg/kg/day, PO, divided q6h-q8h AND
  • (B). A protein synthesis inhibitor: Clindamycin 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) OR Doxycycline <45 kg: 4.4 mg/kg/day, PO, divided q12h (not exceed 100 mg/dose) ≥45 kg: 100 mg, PO, given q12h OR Linezolid (non-CNS infection dose):
<12 y old: 30 mg/kg/day, PO, divided q8h
≥12 years old: 30 mg/kg/day, PO, divided q12h (not to exceed 600 mg/dose)
Note (1): Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
Note (2): Severe anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
Note (3): Bold font for preferred antimicrobial agent.
Note (4): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
Note (5): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
Note (6): A single 14-day course of doxycycline is not routinely associated with tooth staining.
Note (7): Linezolid should be used with caution in patients with thrombocytopenia, as it may exacerbate it. Linezolid use for >14 days carries additional hematopoietic toxicity.
  • (5). Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)
  • (A). Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)
  • Antimicrobial therapy
  • (1). Bactericidal antimicrobial (fluoroquinolone) therapy
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Ciprofloxacin IV 20 mg/kg/day, divided q12h OR Moxifloxacin IV 5 mg/kg/day, q24h
For 1–4 weeks of Age : Ciprofloxacin IV 20 mg/kg/day, divided q12h OR Moxifloxacin IV 5 mg/kg/day, q24h
  • (b) For 34–37 week gestational age
For 0–1 wk of Age : Ciprofloxacin IV 20 mg/kg/day, divided q12h OR Moxifloxacin IV 5 mg/kg/day, q24h
For 1–4 wk of Age : Ciprofloxacin IV 20 mg/kg/day, divided q12h OR Moxifloxacin IV 5 mg/kg/day, q24h
  • (c) Term Newborn Infant
For 0–1 week of Age : Ciprofloxacin IV 30 mg/kg/day, divided q12h OR Moxifloxacin IV 10 mg/kg/day, q24h
For 1–4 weeks of Age : Ciprofloxacin IV 30 mg/kg/day, divided q12h OR Moxifloxacin IV 10 mg/kg/day, q24h AND
  • (2). A bactericidal antimicrobial (β-lactam)
a. For all strains, regardless of penicillin susceptibility or if susceptibility is unknown :
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Meropenem IV 60 mg/kg/day, divided q8h OR Imipenem IV 50 mg/kg/day, divided q12h OR Doripenem IV 20 mg/kg/day, divided q12h
For 1–4 wk of Age : Meropenem IV 90 mg/kg/day, divided q8h OR Imipenem IV 75 mg/kg/day, divided q8h OR Doripenem IV 30 mg/kg/day,divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Meropenem IV 60 mg/kg/day, divided q8h OR Imipenem IV 50 mg/kg/day, divided q12h OR Doripenem IV 20 mg/kg/day, divided q12h
For 1–4 week of Age : Meropenem IV 90 mg/kg/day, divided q8h OR Imipenem IV 75 mg/kg/day, divided q8h OR Doripenem IV 30 mg/kg/day,divided q8h
  • (c) Term Newborn Infant
For 0–1 week of Age: Meropenem IV 60 mg/kg/day, divided q8h OR Imipenem IV 50 mg/kg/day, divided q12h OR Doripenem IV 20 mg/kg/day, divided q12h
For 1–4 week of Age : Meropenem IV 90 mg/kg/day, divided q8h OR Imipenem IV 75 mg/kg/day, divided q8h OR Doripenem IV 30 mg/kg/day,divided q8h OR
b. Alternatives for penicillin-susceptible strains
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Penicillin G 200000 Units/kg/day divided q12h,OR Ampicillin 100 mg/kg/day divided q12h,
For 1–4 week of Age : Penicillin G 300000 Units/kg/day divided q12h,OR Ampicillin 150 mg/kg/day divided q12h,
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Penicillin G 300000 Units/kg/day divided q12h,OR Ampicillin 150 mg/kg/day divided q12h,
For 1–4 week of Age : Penicillin G 400000 Units/kg/day divided q12h,OR Ampicillin 200 mg/kg/day divided q12h,
  • (c) Term Newborn Infant
For 0–1 week of Age : Penicillin G 300000 Units/kg/day divided q12h,OR Ampicillin 150 mg/kg/day divided q12h,
For 1–4 week of Age : Penicillin G 400000 Units/kg/day divided q12h,OR Ampicillin 200 mg/kg/day divided q12h, AND
  • (3).A protein synthesis inhibitor
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Linezolid 20 mg/kg/day,divided q12h, OR Clindamycin 10 mg/kg/day,divided q12h OR Rifampin 10 mg/kg/day,divided q12h , OR Chloramphenicol 25 mg/kg/day,q24h
For 1–4 week of Age : Linezolid 30 mg/kg/day,divided q8h, OR Clindamycin 15 mg/kg/day,divided q8h OR Rifampin 10 mg/kg/day,divided q12h, OR Chloramphenicol 50 mg/kg/day,q12h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Linezolid 30 mg/kg/day,divided q8h, OR Clindamycin 15 mg/kg/day,divided q8h OR Rifampin 10 mg/kg/day,divided q12h, OR Chloramphenicol 25 mg/kg/day,q24h
For 1–4 week of Age : Linezolid 30 mg/kg/day,divided q8h, OR Clindamycin 20 mg/kg/day,divided q6h OR Rifampin 10 mg/kg/day,divided q12h, OR Chloramphenicol 50 mg/kg/day,q12h
  • (c) Term Newborn Infant
For 0–1 week of Age : Linezolid 30 mg/kg/day,divided q8h, OR Clindamycin 15 mg/kg/day,divided q8h OR Rifampin 10 mg/kg/day,divided q12h, OR Chloramphenicol 25 mg/kg/day,q24h
For 1–4 week of Age : Linezolid 30 mg/kg/day,divided q8h, OR Clindamycin 20 mg/kg/day,divided q6h OR {[Rifampin]] 20 mg/kg/day,divided q12h, OR Chloramphenicol 50 mg/kg/day,q12h
Note :Duration of therapy For ≥2–3 week, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.
  • (B). Therapy for severe anthrax when meningitis can be ruled out
  • (1).A bactericidal antimicrobial
(a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Ciprofloxacin IV 20 mg/kg/day,divided q12h OR Meropenem IV 40 mg/kg/day,divided q8h OR Imipenem IV 40 mg/kg/day,divided q12h
For 1–4 week of Age : Ciprofloxacin IV 20 mg/kg/day,divided q12h OR Meropenem IV 60 mg/kg/day,divided q8h OR Imipenem 50 mg/kg/day,divided q12h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Ciprofloxacin IV 20 mg/kg/day,divided q12h OR Meropenem IV 60 mg/kg/day,divided q8h OR Imipenem 50 mg/kg/day,divided q12h
For 1–4 week of Age : Ciprofloxacin IV 20 mg/kg/day,divided q12h OR Meropenem IV 60 mg/kg/day,divided q8h OR Imipenem 75 mg/kg/day,divided q8h
  • (c) Term Newborn Infant
For 0–1 week of Age : Ciprofloxacin IV 30 mg/kg/day,divided q12h OR Meropenem IV 60 mg/kg/day,divided q8h OR Imipenem 50 mg/kg/day,divided q12h
For 1–4 week of Age : Ciprofloxacin IV 30 mg/kg/day,divided q12h OR Meropenem IV 60 mg/kg/day,divided q8h OR Imipenem 75 mg/kg/day,divided q8h OR
Vancomycin IV (dosing based on serum creatinine for infants ≥32 wk gestational age). Follow vancomycin serum concentrations to modify dose.
If Serum creatinine <0.7 then Vancomycin IV 15 mg/kg/dose q12h
If Serum creatinine 0.7 -0.9 then Vancomycin IV 20 mg/kg/dose q24h
If Serum creatinine 1–1.2 then Vancomycin IV 15 mg/kg/dose q24h
If Serum creatinine 1.3–1.6 then Vancomycin IV 10 mg/kg/dose q24h
If Serum creatinine >1.6 15 then Vancomycin IV mg/kg/dose q48h
Note : Begin treatment with a 20-mg/kg loading dose OR
(b). Alternatives for penicillin-susceptible strains
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Penicillin G IV 200000 U/kg/day,divided q12h, OR Ampicillin IV 100 mg/kg/day,divided q12h
For 1–4 week of Age : Penicillin G IV 300000 U/kg/day,divided q8h, OR Ampicillin IV 150 mg/kg/day,divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Penicillin G IV 300000 U/kg/day,divided q8h, OR Ampicillin IV 150 mg/kg/day,divided q8h
For 1–4 week of Age : Penicillin G IV 400000 U/kg/day,divided q6h, OR Ampicillin IV 200 mg/kg/day,divided q6h
  • (c) Term Newborn Infant
For 0–1 week of Age : Penicillin G IV 300000 U/kg/day,divided q8h, OR Ampicillin IV 150 mg/kg/day,divided q8h
For 1–4 week of Age : Penicillin G IV 400000 U/kg/day,divided q6h, OR Ampicillin IV 200 mg/kg/day,divided q6h AND
  • (2).A protein synthesis inhibitor
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Clindamycin IV 10 mg/kg/day, divided q12h, OR Linezolid IV 20 mg/kg/day, divided q12h, OR Rifampin IV 10 mg/kg/day, q24h
For 1–4 week of Age : Clindamycin IV 15 mg/kg/day, divided q8h, OR Linezolid IV 30 mg/kg/day, divided q8h, OR Rifampin IV 10 mg/kg/day, q24h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Clindamycin IV 15 mg/kg/day, divided q8h, OR Linezolid IV 30 mg/kg/day, divided q8h, OR Rifampin IV 10 mg/kg/day, q24h
For 1–4 week of Age : Clindamycin IV 20 mg/kg/day, divided q6h, OR Linezolid IV 30 mg/kg/day, divided q8h, OR Rifampin IV 10 mg/kg/day, q24h
  • (c) Term Newborn Infant
For 0–1 week of Age : Clindamycin IV 15 mg/kg/day, divided q8h, OR Linezolid IV 30 mg/kg/day, divided q8h, OR Doxycycline IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg) OR Rifampin IV 10 mg/kg/day, q24h
For 1–4 week of Age : Clindamycin IV 20 mg/kg/day, divided q6h, OR Linezolid IV 30 mg/kg/day, divided q8h, OR Doxycycline IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg) OR Rifampin IV 10 mg/kg/day, q24h
Note: Duration of therapy: For ≥2–3 wk, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness
  • (C). Oral follow-up combination therapy for severe anthrax
(1).A bactericidal antimicrobial
(a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h
For 1–4 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h
For 1–4 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h
  • (c) Term Newborn Infant
For 0–1 week of Age : Ciprofloxacin PO 30 mg/kg/day, divided q12h
For 1–4 week of Age : Ciprofloxacin PO 30 mg/kg/day, divided q12h OR
(b). Alternatives for penicillin-susceptible strains
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Amoxicillin PO 50 mg/kg/day, divided q12h, OR Penicillin VK PO 50 mg/kg/day, divided q12h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin VK PO 75 mg/kg/day, divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Amoxicillin PO 50 mg/kg/day, divided q12h OR Penicillin VK PO 50 mg/kg/day, divided q12h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin VK PO 75 mg/kg/day, divided q8h
  • (c) Term Newborn Infant
For 0–1 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin VK PO 75 mg/kg/day, divided q8h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin VK PO 75 mg/kg/day, divided q6–8h AND
(2).A protein synthesis inhibitor
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Clindamycin PO 10 mg/kg/day, divided q12h OR Linezolid PO 20 mg/kg/day, divided q12h
For 1–4 week of Age : Clindamycin PO 15 mg/kg/day, divided q8h OR Linezolid PO 30 mg/kg/day, divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Clindamycin PO 15 mg/kg/day, divided q8h OR Linezolid PO 30 mg/kg/day, divided q8h
For 1–4 week of Age : Clindamycin PO 20 mg/kg/day, divided q6h OR Linezolid PO 30 mg/kg/day, divided q8h
  • (c) Term Newborn Infant
For 0–1 week of Age : Clindamycin PO 15 mg/kg/day, divided q8h OR Doxycycline PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg) OR Linezolid PO 30 mg/kg/day, divided q8h
For 1–4 week of Age :Clindamycin PO 20 mg/kg/day, divided q6h OR Doxycycline PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg) OR Linezolid PO 30 mg/kg/day, divided q8h OR
Note: Duration of therapy: to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.
  • (D).Treatment of cutaneous anthrax without systemic involvement
  • (1).For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 10 mg/kg/day, divided q12h
For 1–4 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 15 mg/kg/day, divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 15 mg/kg/day, divided q8h
For 1–4 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 20 mg/kg/day, divided q6h
  • (c) Term Newborn Infant
For 0–1 week of Age : Ciprofloxacin PO 30 mg/kg/day, divided q12h OR Doxycycline PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) OR Clindamycin PO 15 mg/kg/day, divided q8h
For 1–4 week of Age : Ciprofloxacin PO 30 mg/kg/day, divided q12h OR Doxycycline PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) OR Clindamycin PO 20 mg/kg/day, divided q6h
  • (2).Alternatives for penicillin-susceptible strains
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Amoxicillin PO 50 mg/kg/day, divided q12h OR Penicillin Vk PO 50 mg/kg/day, divided q12h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Amoxicillin PO 50 mg/kg/day, divided q12h OR Penicillin Vk PO 50 mg/kg/day, divided q12h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q8h
  • (c) Term Newborn Infant
For 0–1 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q8h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q6–8h
Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.
  • (E).Post exposure prophylaxis for Bacillus anthracis
(1). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 10 mg/kg/day, divided q12h
For 1–4 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 15 mg/kg/day, divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 15 mg/kg/day, divided q8h
For 1–4 week of Age : Ciprofloxacin PO 20 mg/kg/day, divided q12h OR Clindamycin PO 20 mg/kg/day, divided q6h
  • (c) Term Newborn Infant
For 0–1 week of Age : Ciprofloxacin PO 30 mg/kg/day, divided q12h OR Doxycycline PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) OR Clindamycin PO 15 mg/kg/day, divided q8h
For 1–4 week of Age : Ciprofloxacin PO 30 mg/kg/day, divided q12h OR Doxycycline PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) OR Clindamycin PO 20 mg/kg/day, divided q6h OR
(2).Alternatives for penicillin-susceptible strains
  • (a) For 32–34 weeks gestational age
For 0–1 week of Age : Amoxicillin PO 50 mg/kg/day, divided q12h OR Penicillin Vk PO 50 mg/kg/day, divided q12h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q8h
  • (b) For 34–37 week gestational age
For 0–1 week of Age : Amoxicillin PO 50 mg/kg/day, divided q12h OR Penicillin Vk PO 50 mg/kg/day, divided q12h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q8h
  • (c) Term Newborn Infant
For 0–1 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q8h
For 1–4 week of Age : Amoxicillin PO 75 mg/kg/day, divided q8h OR Penicillin Vk PO 75 mg/kg/day, divided q6–8h
Note: Duration of therapy is 60 days from exposure
  • Treatment of anthrax for pregnant Women
  • (A) Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis [6]
  • (1) A Bactericidal Agent (Fluoroquinolone): Ciprofloxacin 400 mg IV q8h is preferred, OR Levofloxacin 750 mg IV q24h, OR
  • (2). A Bactericidal Agent (β-lactam)
  • (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : Meropenem 2 g q8h,OR
  • (b). Alternatives for penicillin-susceptible strains: Ampicillin 3 g IV q6h,OR Penicillin G 4 million units IV q4h, OR
Note (1): At least one antibiotic with transplacental passage is recommended.
Note (2): Duration of treatment is for ≥2–3 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
  • (B) Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded
  • (1). A Bactericidal Antimicrobial: Ciprofloxacin 400 mg IV q8h is preferred, OR Levofloxacin 750 mg IV q24h, OR
  • (2). A Bactericidal Agent (β-lactam)
  • (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : Meropenem 2 g q8h,OR
  • (b). Alternatives for penicillin-susceptible strains:Ampicillin 3 g IV q6h,OR Penicillin G 4 million units IV q4h, OR
Note (1): At least one antibiotic with transplacental passage is recommended.
Note (2):Duration of treatment: for ≥2 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness
  • (C) Oral antimicrobial treatment for cutaneous anthrax without systemic involvement
  • (a).For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Ciprofloxacin 400 mg IV q8h is preferred.
Note (1): duration of treatment is 60 days
Note (2): Recommendations are specific to cutaneous anthrax in the setting of bioterrorism.

Pertussis

  • Pertussis (whooping cough)
  • Preferred Regimen
  • Alternate Regimen
Note: Clarithromycin and Trimethoprim-Sulfamethoxazole are contraindicated in children below 6 mths and 2 mths respectively

Pneumonia, Acinetobacter

  • Acinetobacter species (atypical bacterial pneumonia) [7]

Pneumonia, Actinomycosis

Note: Minocycline, Clindamycin, and Erythromycin have also been successful.

Pneumonia, Anaerobes

Anaerobe (aspiration) pneumonia [7]

Pneumonia, Aspiration pneumonia

  • Aspiration (anaerobe) pneumonia [7]

Pneumonia, Chlamydophila

  • Chlamydophila pneumoniae (atypical bacterial pneumonia) [7]

Pneumonia, community-acquired

  • Community acquired pneumonia
  • Empiric therapy in adults [7]
  • (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)
  • (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
  • (2) ICU treatment
  • (C) Special Concerns
  • (1) Pseudomonas
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
  • pathogen directed antimicrobial therapy
  • Bacterial
  • (A) Streptococcus pneumoniae
  • (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
  • (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
  • (2) Beta lactamase producing
  • (C) Bacillus anthracis (inhalation)
  • (D) Enterobacteriaceae
  • (E)Pseudomonas aeruginosa
  • (F)Staphylococcus aureus
  • (1) Methicillin susceptible
  • (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
  • (H) Anaerobe (aspiration)
  • (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
  • Atypical bacteria
  • (A) Mycoplasma pneumoniae
  • (B) Chlamydophila pneumoniae
  • (C) Legionella species
  • (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
  • (G) Burkholderia pseudomallei
  • (H) Acinetobacter species
  • 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
Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection
  • (B) Histoplasmosis
  • (C) Blastomycosis

Pneumonia, concomitant influenza

  • Influenza virus pneumonia [7]
  • 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

  • Preferred regimen (1): Ganciclovir Induction therapy 5 mg/ kg IV every 12 h for normal GFR; maintenance therapy 5 mg/kg IV daily; 1 g orally every 8 h with food.
  • Preferred regimen (2): Valganciclovir Induction therapy 900 mg orally every 12 h; maintenance therapy 900 mg daily.
  • Alternate regimen (1): Foscarnet Induction therapy 60 mg/ kg every 8 h for 14–21 days or 90 mg/kg every 12 h for 14–21 days; maintenance therapy 90–120 mg/kg per day as a single infusion.
  • Alternate regimen (2): Cidofovir Induction therapy 5 mg/ kg per week for 2 weeks, followed by maintenance therapy every 2 weeks.
  • Prophylaxis

Pneumonia, Haemophilus Influenza

  • Haemophilus influenzae pneumonia [7]
  • (1) Non-beta lactamase producing
  • (2) Beta lactamase producing

Pneumonia, health care-associated

Pneumonia, hospital-acquired

  • No Risk Factors for multi drug resistance
  • Presence of Risk Factors for multi drug resistance
Note (1) : Trough levels for gentamicin and tobramycin should be less than 1 g/ml, and for amikacin they should be less than 4-5 g/ml.
Note (2) : Trough levels for vancomycin should be 15-20 g/ml

Pneumonia, Klebsiella

Pneumonia, Legionella

  • Legionella pneumonia (atypical bacterial pneumonia) [7]

Pneumonia, Lung abscess

Pneumonia, Meliodosis

Pneumonia, Moraxella catarrhalis

Pneumonia, Mycoplasma

  • Mycoplasma pneumoniae (atypical bacterial pneumonia) [7]

Pneumonia, neutropenic patient

Pneumonia, Nocardia

Nocardia pneumonia

  • Initial intravenous therapy (inductinal therapy)
  • Preferred therapy: Trimethoprim-Sulfamethoxazole (15 mg/kg/day IV of the trimethoprim component in 2 to 4 divided doses) for at least three to six weeks AND Amikacin (7.5 mg/kg IV q12h) for at least three to six weeks
  • Alternative regimen: Imipenem (500 mg IV q6h) AND Amikacin (7.5 mg/kg IV q12h)
Note (1): If the patient is allergic to Sulfonamides, desensitization should be performed when possible.
Note (2): If the isolate is susceptible to the third-generation cephalosporins (Ceftriaxone, Cefotaxime), Imipenem can be switched to one of these agents.
Note (3): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
Note (1): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
Note (2): The duration of intravenous therapy varies with the patient's immune status. In immunocompromised patients, maximal tolerated doses should be given intravenously for at least six weeks and until clinical improvement has occurred; in contrast, immunocompetent patients may be successfully treated with a shorter duration of intravenous therapy. Following the intravenous induction phase, patients may be stepped down to oral antibiotics based upon susceptibility studies
Note (3): Serious pulmonary infection is treated for 6 to 12 months or longer.

Pneumonia, post-influenza

Pneumonia, Pseuodomonas

  • Pseudomonas aeruginosa pneumonia [7]

Pneumonia, Staphylococcus aureus

  • Staphylococcus aureus pneumonia [7]
  • (1) Methicillin susceptible
  • (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 [7]
  • (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
  • (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 [7]

Pneumonia, Yersinia pestis

  • Yersinisa pestis pneumonia [7]

References

  1. ↑ Rabbat A, Guetta A, Lorut C, Lefebvre A, Roche N, Huchon G (2010). "[Management of acute exacerbations of COPD]". Rev Mal Respir. 27 (8): 939–53. doi:10.1016/j.rmr.2010.08.003. PMID 20965408.
  2. ↑ Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM; et al. (2014). "Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis". Pediatrics. 134 (5): e1474–502. doi:10.1542/peds.2014-2742. PMID 25349312.
  3. ↑ Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB; et al. (2013). "Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health". Am J Respir Crit Care Med. 187 (7): 680–9. PMID 23540878.
  4. ↑ 4.0 4.1 Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.
  5. ↑ 5.0 5.1 Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D; et al. (2014). "Pediatric anthrax clinical management". Pediatrics. 133 (5): e1411–36. doi:10.1542/peds.2014-0563. PMID 24777226.
  6. ↑ Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA; et al. (2014). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130611. PMC 3901460. PMID 24457117.
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
  8. ↑ Song JU, Park HY, Jeon K, Um SW, Kwon OJ, Koh WJ (2010). "Treatment of thoracic actinomycosis: A retrospective analysis of 40 patients". Ann Thorac Med. 5 (2): 80–5. doi:10.4103/1817-1737.62470. PMC 2883202. PMID 20582172.
  9. ↑ Sudhakar SS, Ross JJ (2004). "Short-term treatment of actinomycosis: two cases and a review". Clin Infect Dis. 38 (3): 444–7. doi:10.1086/381099. PMID 14727221 PMID: 14727221 Check |pmid= value (help).
  10. ↑ Torres-Madriz G, Boucher HW (2008). "Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients". Clin Infect Dis. 47 (5): 702–11. doi:10.1086/590934. PMID 18652557.
  11. ↑ Lerner PI (1996). "Nocardiosis". Clin Infect Dis. 22 (6): 891–903, quiz 904-5. PMID 8783685.
  12. ↑ Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ (2006). "Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy". Clin Microbiol Rev. 19 (2): 259–82. doi:10.1128/CMR.19.2.259-282.2006. PMC 1471991. PMID 16614249.
  13. ↑ Brown-Elliott BA, Biehle J, Conville PS, Cohen S, Saubolle M, Sussland D; et al. (2012). "Sulfonamide resistance in isolates of Nocardia spp. from a US multicenter survey". J Clin Microbiol. 50 (3): 670–2. doi:10.1128/JCM.06243-11. PMC 3295118. PMID 22170936.
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