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| === Anaplasmosis ===
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| * Human granulocytic anaplasmosis, suspected or symptomatic <ref name="pmid17029130">{{cite journal| author=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al.| title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 9 | pages= 1089-134 | pmid=17029130 | doi=10.1086/508667 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17029130 }} </ref>
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| :* Preferred regimen: [[Doxycycline]] 100 mg orally bid (or intravenously for those patients unable to take an oral medication) for 10 days
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| :* 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)
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| :* 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)
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| : 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
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| : 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
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| : NOTE: [[Rifampin]] is not effective therapy for Lyme disease, patients coinfected with ''B. burgdorferi'' should also be treated with [[Amoxicillin]] {{or}} [[Cefuroxime]] axetil
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| ===Brucellosis===
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| * Uncomplicated brucellosis in adults and children eight years of age and older <ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>
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| :* Preferred regimen: [[Doxycycline]] 100 mg bid for six weeks {{or}} [[Tetracycline]] 500 mg every six hours orally administered for at least six weeks
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| :* 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
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| :* Alternative regimen (1): [[Doxycycline]] 200 mg/day orally {{and}} [[Rifampicin]] 600–900 mg/day orally, both drugs administered for six weeks
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| :* Alternative regimen (2): Fluoroquinolones
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| :* NTOE: Quinolones should always be used in combination with other drugs, such as Doxycycline or Rifampicin
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| :* Alternative regimen (3): [[TMP/SMZ]] in a fixed ratio of 1:5 (80 mg TMP/400 mg SMZ)
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| :* NOTE: TMP/SMZ should always be used in combination with another agent, such as Doxycycline, Rifampicin or Streptomycin
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|
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| * Complications of brucellosis
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| :* Spondylitis
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| ::* Preferred regimen: Continuation of [[Doxycycline]] for eight weeks or more; Surgical drainage is rarely necessary.
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| :* Neurobrucellosis
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| ::* 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
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| :* Brucella endocarditis
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| ::* 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
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| ::* NOTE: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
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| * For children less than eight years of age
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| :* 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
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| :* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day orally each administered for 6 weeks
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| :* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
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| ===Ehrlichiosis===
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| * Ehrlichiosis, suspected <ref name=CDC centers for the disease control and prevention>{{cite web | title =Ehrlichiosis CDC centers for the disease control and prevention| url= http://www.cdc.gov/ehrlichiosis/symptoms/index.html#treatment }}</ref>
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| :* Preferred regimen: [[Doxycycline]] 100 mg every 12 hours for 7-14 days
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| :* Alternative regimen: [[Chloramphenicol]] {{or}} [[Rifampin]]
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| :* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg body weight given twice a day (Children under 45 kg (100 lbs)) for 7-14 days
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| :* NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
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| ===Tularemia===
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| * For treatment and prophylaxis <ref>{{cite book | last = LastName | first = FirstName | title = WHO guidelines on tularaemia epidemic and pandemic alert and response | publisher = World Health Organization | location = Geneva | year = 2007 | isbn = 9789241547376 }}</ref>
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| :* Preferred regimen: [[Gentamicin]] 5 mg/kg daily, divided into two doses
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| :* Alternative regimen (1): [[Streptomycin]] intramuscular 2 g daily, divided in two doses, for 10 days
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| :* Alternative regimen (2): [[Ciprofloxacin]] 800–1000 mg daily, divided into two doses intravenously or orally, for 10–14 days
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| :* Alternative regimen (3): [[Doxycycline]], 200 mg daily, divided in two, orally for at least 15 days
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| :* Pediatric regimen: [[Gentamicin]] 5–6 mg/kg divided into two or three doses for at least 10 days; [[Streptomycin]] 15 mg/kg twice daily (up to 2 g daily) for at least 10 days; [[Ciprofloxacin]] 15 mg/kg twice daily (up to 1 g daily) for at least 10 days
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|
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| ===Typhoid fever===
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| * Uncomplicated typhoid fever<ref>{{ cite web | title = The diagnosis, treatment and prevention of typhoid fever | url = http://www.who.int/rpc/TFGuideWHO.pdf }}</ref>
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| :* Fully sensitive
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| ::* Preferred regimen: [[Ofloxacin]] {{or}} [[Ciprofloxacin]] 15 mg/kg daily dose for 5-7 days
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| ::* Alternative regimen (1): [[Chloramphenicol]] 50-75 mg/kg daily dose for 14-21 days
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| ::* Alternative regimen (2): [[Amoxicillin]] 75-100 mg/kg daily dose for 14 days
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| ::* Alternative regimen (3): [[TMP-SMX]] 8-40 mg/kg daily dose for 14 days
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| :* Multidrug resistance
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| ::* Preferred regimen: [[Fluoroquinolone]] 15 mg/kg daily dose for 5-7 days {{or}} [[Cefixime]] 15-20 mg/kg daily dose for 7-14 days
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| ::* Alternative regimen (1): [[Azithromycin]] 8-10 mg/kg daily dose for 7 days
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| ::* Alternative regimen (2): [[Cefixime]] 15-20 mg/kg daily dose for 7-14 days
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| :* Quinolone resistance
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| ::* Preferred regimen: [[Azithromycin]] 8-10 mg/kg daily dose for 7 days {{or}} [[Ceftriaxone]] 75 mg/kg daily dose for 10-14 days
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| ::* Alternative regimen: [[Cefixime]] 20 mg/kg daily dose for 7-14 days
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| * Severe typhoid fever
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| :* Fully sensitive
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| ::* Preferred regimen: [[Ofloxacin]] 15 mg/kg daily dose for 10-14 days
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| ::* Alternative regimen (1): [[Chloramphenicol]] 100 mg/kg daily dose for 14-21 days
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| ::* Alternative regimen (2): [[Amoxicillin]] 100 mg/kg daily dose for 14 days
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| ::* Alternative regimen (3): [[TMP-SMX]] 8-40 mg/kg daily dose for 14 days
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| :* Multidrug resistant
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| ::* Preferred regimen: [[Fluoroquinolone]] 15 mg/kg daily dose for 10-14 days
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| ::* Alternative regimen (1): [[Ceftriaxone]] 60 mg/kg daily dose for 10-14 days
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| ::* Alternative regimen (2): [[Cefotaxime]] 80 mg/kg daily dose for 10-14 days
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| :* Quinolone resistant
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| ::* Preferred regimen: [[Ceftriaxone]] 60 mg/kg daily dose for 10-14 days {{or}} [[Cefotaxime]] 80 mg/kg daily dose for 10-14 days
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| ::* Alternative regimen: [[Fluoroquinolone]] 20 mg/kg daily dose for 7-14 days
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| ===Kawasaki syndrome===
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| * Initial treatment
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| :* Preferred regimen: [[IVIG]] 2 g/kg in a single infusion within the first 7-10 days of illness {{and}} [[Aspirin]] 80-100 mg/kg per day in 4 doses , reduce the aspirin dose after the child has been afebrile for 48 to 72 hours, then begin low-dose aspirin (3 to 5 mg/kg per day) and maintain it until the patient shows no evidence of coronary changes by 6 to 8 weeks after the onset of illness
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| :* NOTE (1): Other clinicians continue highdose aspirin until day 14 of illness and 48 to 72 hours after fever cessation
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| :* NOTE (2): For children who develop coronary abnormalities, aspirin may be continued indefinitely
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|
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| * Treatment of Patients Who Failed to Respond to Initial Therapy (persistent or recrudescent fever ≥36 hours after completion of the initial IVIG infusion)
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| :* Preferred regimen: [[IVIG]] 2 g/kg {{or}} intravenous pulse [[Methylprednisolone]] 30 mg/kg for 2 to 3 hours, administered once daily for 1 to 3 days
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| ===Leptospirosis===
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| * Severe <ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref>
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| :* Preferred regimen: High doses of intravenous [[Penicillin]]
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| * Less severe
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| :* Preferred regimen: [[Amoxycillin]] {{or}} [[Ampicillin]] {{or}} [[Doxycycline]] {{or}} [[Erythromycin]] orally
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| :* Alternative regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Quinolone]] orally
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| :* NOTE (1): Treatment with effective antibiotics should be initiated as soon as the diagnosis of leptospirosis is suspected and preferably before the fifth day after the onset of illness
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| :* NOTE (2): Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of illness, and cultures may not become positive for several weeks.
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|
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| ===Rocky Mountain spotted fever===
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| * ''R. rickettsii'' <ref name=CDC centers for disease control and prevention>{{cite web | title = Rocky Mountain Spotted Fever (RMSF)
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| | url =http://www.cdc.gov/rmsf/symptoms/index.html#treatment }}</ref>
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| :* Preferred regimen: [[Doxycycline]] 100 mg every 12 hours
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| :* Alternative regimen: [[Chloramphenicol]]
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| :* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg body weight given twice a day (under 45 kg (100 lbs))
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| :* NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. Standard duration of treatment is 7-14 days.
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|
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| ===Relapsing fever===
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| * Tick-borne Relapsing Fever <ref name=CDC centers for disease control and prevention>{{cite web | title = Relapsing Fever CDC centers of disease control and prevention| url =http://www.cdc.gov/relapsing-fever/clinicians/#treatment }}</ref>
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| :* patients without central nervous system involvement
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| ::* Preferred regimen: [[Tetracycline]] 500 mg orally every 6 hours for 10 days
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| ::* Alternative regimen: [[Erythromycin]] 500 mg (or 12.5 mg/kg every 6 hours for 10 days
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| :* patients with central nervous system involvement
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| ::* Preferred regimen: [[Ceftriaxone]] 2 mg per day for 10-14 days
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| * Louse-borne Relapsing Fever
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| : ''Borrelia recurrentis''
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| :* Preferred regimen: LBRF can be treated effectively with a single dose of antibiotics.
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|
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| ===Tetanus===
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| * General measures <ref name=World Health Organization>{{cite web | title = Current recommendations for treatment of tetanus during humanitarian emergencies| url =http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/ }}</ref>
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| :* Preferred regimen: Patients should be placed in a quiet shaded area and protected from tactile and auditory stimulation as much as possible; All wounds should be cleaned and debrided as indicated
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| * Immunotherapy
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| :* Preferred regimen: Human TIG 500 units by intramuscular injection or intravenously as soon as possible {{and}} Age-appropriate TT-containing vaccine, 0.5 cc by intramuscular injection at a separate site
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| :* NOTE: patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6–12 months later
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| * Antibiotic treatment
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| :* Preferred regimen: [[Metronidazole]] 500 mg intravenously or orally every six hours {{or}} [[Penicillin G]] 100,000–200,000 IU/kg/day intravenously, given in 2–4 divided doses
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| :* Alternative regimen: [[Tetracyclines]] {{or}} [[Macrolides]] {{or}} [[Clindamycin]] {{or}} [[Cephalosporins]] {{or}} [[Chloramphenicol]]
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| * Muscle spasm control
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| :* Preferred regimen: [[Diazepam]] 5 mg intravenous {{or}} [[Lorazepam]] 2 mg titrating to achieve spasm control without excessive sedation and hypoventilation
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| :* Alternative regimen (1): [[Magnesium]] sulphate 5 gm (or 75mg/kg) intravenous loading dose, then 2–3 grams per hour until spasm control is achieved {{withorwithout}} [[Benzodiazepines]]
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| :* NOTE: Monitor patellar reflex as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range (4mmol/L). If areflexia develops, dose should be decreased
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| :* Alternative regimen (2): [[Baclofen]] {{or}} [[Dantrolene]] 1–2 mg/kg intravenous/orally every 4 hours
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|
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| :* Alternative regimen (3): [[Barbiturates]] 100–150 mg every 1–4 hours by any route
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|
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| :* Alternative regimen (4): [[Chlorpromazine]] 50–150 mg by intramuscular injection every 4–8 hours
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| :* Pediatric regimen: [[Lorazepam]] 0.1–0.2 mg/kg every 2–6 hours, titrating upward as needed; [[Barbiturates]] 6–10 mg/kg in children by any route; [[Chlorpromazine]] 4–12 mg every by intramuscular injection every 4–8 hours
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| :* NOTE: As for [[Benzodiazepines]], large amounts may be required (up to 600 mg/day); Oral preparations could be used but must be accompanied by careful monitoring to avoid respiratory depression or arrest
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| * Autonomic dysfunction control
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| :* Preferred regimen: [[Magnesium]] sulphate {{or}} [[Morphine]] {{or}} [[Esmolol]]
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|
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| === Lymphadenitis ===
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|
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| * Lymphadenitis
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| :* Pathogen-directed antimicrobial therapy
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| ::* '''Nocardia'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
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| :::* Preferred regimen: [[TMP-SMX]] 5–10 mg/kg/day (TMP component) IV/PO divided in 2–4 doses for 3 months
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| :::* Alternative regimen: [[Sulfisoxazole]] 2 g PO qid for 3 months {{or}} [[Minocycline]] 100-200 mg PO bid for 3 months
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|
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| ::* '''Bartonella henselae (cat-scratch disease)'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
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| :::* Preferred regimen (adult): [[Azithromycin]] 500 mg PO for 1 dose, then 250 mg/day for 4 days
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| :::* Preferred regimen (pediatric): [[Azithromycin]] liquid 10 mg/kg PO for 1 dose, then 5 mg/kg per day x 4 days
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| ===Sepsis, adult===
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|
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| * Sepsis, adult
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| :* Empiric antimicrobial therapy<ref>{{Cite journal| doi = 10.1097/CCM.0b013e31827e83af| issn = 1530-0293| volume = 41| issue = 2| pages = 580–637| last1 = Dellinger| first1 = R. Phillip| last2 = Levy| first2 = Mitchell M.| last3 = Rhodes| first3 = Andrew| last4 = Annane| first4 = Djillali| last5 = Gerlach| first5 = Herwig| last6 = Opal| first6 = Steven M.| last7 = Sevransky| first7 = Jonathan E.| last8 = Sprung| first8 = Charles L.| last9 = Douglas| first9 = Ivor S.| last10 = Jaeschke| first10 = Roman| last11 = Osborn| first11 = Tiffany M.| last12 = Nunnally| first12 = Mark E.| last13 = Townsend| first13 = Sean R.| last14 = Reinhart| first14 = Konrad| last15 = Kleinpell| first15 = Ruth M.| last16 = Angus| first16 = Derek C.| last17 = Deutschman| first17 = Clifford S.| last18 = Machado| first18 = Flavia R.| last19 = Rubenfeld| first19 = Gordon D.| last20 = Webb| first20 = Steven A.| last21 = Beale| first21 = Richard J.| last22 = Vincent| first22 = Jean-Louis| last23 = Moreno| first23 = Rui| last24 = Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup| title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012| journal = Critical Care Medicine| date = 2013-02| pmid = 23353941}}</ref>
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| ::* '''History of intravenous drug use with high prevalence of MRSA'''
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| :::* Perferred regimen: [[Vancomycin]] 1 g IV q12h
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|
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| ::* '''Sepsis associated with petechiae'''
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| :::* Perferred regimen: [[Ceftriaxone]] 2 g IV q12h
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|
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| ::* '''Biliary source'''
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| :::* Perferred regimen: [[Ampicillin-Sulbactam]] 3 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4h
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|
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| ::* '''Community-acquired pneumonia'''
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| :::* Perferred regimen: ([[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h) {{and}} [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{and}} [[Vancomycin]] 1 g IV q12h
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|
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| ::* '''Unclear infection source'''
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| :::* Perferred regimen: ([[Doripenem]] 500 mg IV q8h {{or}} [[Ertapenem]] 1 g IV q24h {{or}} [[Imipenem]] 0.5 g IV q6h {{or}} [[Meropenem]] 1 g IV q8h) {{and}} [[Vancomycin]] 1 g IV q12h
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|
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| ::* '''Low prevalence of ESBL and/or carbapenemase-producing aerobic GNB'''
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| :::* Perferred regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{and}} [[Vancomycin]] 1 g IV q12h
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|
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| ::* '''High prevalence of ESBL and/or carbapenemase-producing aerobic GNB'''
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| :::* Perferred regimen: [[Colistin]] 2.5 mg/kg for 1 dose followed by 1.5 mg/kg IV q12h {{and}} [[Meropenem]] 1 g IV q8h {{and}} [[Vancomycin]] 1 g IV q12h
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|
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| ===Sepsis, pediatric===
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|
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| * Sepsis, pediatric
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| :* Empiric antimicrobial therapy<ref>{{Cite journal| doi = 10.1097/CCM.0b013e31827e83af| issn = 1530-0293| volume = 41| issue = 2| pages = 580–637| last1 = Dellinger| first1 = R. Phillip| last2 = Levy| first2 = Mitchell M.| last3 = Rhodes| first3 = Andrew| last4 = Annane| first4 = Djillali| last5 = Gerlach| first5 = Herwig| last6 = Opal| first6 = Steven M.| last7 = Sevransky| first7 = Jonathan E.| last8 = Sprung| first8 = Charles L.| last9 = Douglas| first9 = Ivor S.| last10 = Jaeschke| first10 = Roman| last11 = Osborn| first11 = Tiffany M.| last12 = Nunnally| first12 = Mark E.| last13 = Townsend| first13 = Sean R.| last14 = Reinhart| first14 = Konrad| last15 = Kleinpell| first15 = Ruth M.| last16 = Angus| first16 = Derek C.| last17 = Deutschman| first17 = Clifford S.| last18 = Machado| first18 = Flavia R.| last19 = Rubenfeld| first19 = Gordon D.| last20 = Webb| first20 = Steven A.| last21 = Beale| first21 = Richard J.| last22 = Vincent| first22 = Jean-Louis| last23 = Moreno| first23 = Rui| last24 = Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup| title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012| journal = Critical Care Medicine| date = 2013-02| pmid = 23353941}}</ref>
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| ::* '''Children aged > 1 month'''
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| :::* Preferred regimen: ([[Cefotaxime]] 50 mg/kg IV q8h {{or}} [[Ceftriaxone]] 100 mg/kg IV q24h) {{and}} [[Vancomycin]] 15 mg/kg IV q6h
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| :::* Alternative regimen: [[Aztreonam]] 7.5 mg/kg IV q6h {{and}} [[Linezolid]] 10 mg/kg IV q8h
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|
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| ::* '''Children aged < 1 month'''
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| :::* Preferred regimen: [[Ampicillin]] 25 mg/kg IV q8h {{and}} [[Cefotaxime]] 50 mg/kg q12h ± [[Vancomycin]] 15 mg/kg IV q12h (if suspecting [[MRSA]])
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| :::* Alternative regimen: [[Ampicillin]] 25 mg/kg IV q6h {{and}} [[Ceftriaxone]] 75 mg/kg IV q24h ± [[Vancomycin]] 15 mg/kg IV q12h (if suspecting [[MRSA]])
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |