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::*1.1 '''Ampicillin or Penicillin susceptible''' | ::*1.1 '''Ampicillin or Penicillin susceptible''' | ||
:::* Preferred regimen (1): [[Ampicillin]] 2 g IV q4-6h | :::* Preferred regimen (1): [[Ampicillin]] 2 g IV q4-6h | ||
:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg q8h | :::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg IV q8h | ||
::*1.2 '''Ampicillin resistant and vancomycin susceptible or Penicillin allergy''' | ::*1.2 '''Ampicillin resistant and vancomycin susceptible or Penicillin allergy''' | ||
:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg q8h | :::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg IV q8h | ||
:::* Preferred regimen (2): [[Linezolid]] 600 mg q12h | :::* Preferred regimen (2): [[Linezolid]] 600 mg q12h | ||
:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV q24h | :::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV q24h | ||
| Line 13: | Line 13: | ||
::*2.1 '''Endocarditis in Adults''' | ::*2.1 '''Endocarditis in Adults''' | ||
:::*2.1.1 '''Strains Susceptible to Penicillin, Gentamicin, and Vancomycin''' | :::*2.1.1 '''Strains Susceptible to Penicillin, Gentamicin, and Vancomycin''' | ||
::::* Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g | ::::* Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU IV q24h for 4–6 weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 4–6 weeks | ||
::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg | ::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks | ||
::::*Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended. | ::::*Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended. | ||
::::*Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended. | ::::*Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended. | ||
| Line 20: | Line 20: | ||
:::*2.1.2 '''Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin''' | :::*2.1.2 '''Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin''' | ||
::::* Preferred regimen: ([[Ampicillin]] 12 g | ::::* Preferred regimen: ([[Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}}[[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU IV q24h for 4–6 weeks){{and}}[[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks | ||
::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg | ::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}}[[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks | ||
:::*2.1.3 '''Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin''' | :::*2.1.3 '''Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin''' | ||
::::*2.1.3.1 '''β Lactamase–producing strain''' | ::::*2.1.3.1 '''β Lactamase–producing strain''' | ||
:::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g | :::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g IV q24h for 6 weeks {{and}}[[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h 6 weeks | ||
:::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for | :::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6 weeks {{and}}[[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6 weeks | ||
::::*2.1.3.2 '''Intrinsic penicillin resistance''' | ::::*2.1.3.2 '''Intrinsic penicillin resistance''' | ||
:::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for | :::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6 weeks {{and}}[[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6 weeks | ||
:::*2.1.4 '''Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin''' | :::*2.1.4 '''Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin''' | ||
::::* Preferred regimen (1): ([[Imipenem]] {{or}}[[Cilastatin]] 2 g/day IV for ≥ 8weeks {{and}}[[Ampicillin|Ampicillin]] 12 g/day IV for ≥ 8weeks) | ::::* Preferred regimen (1): ([[Imipenem]] {{or}}[[Cilastatin]] 2 g/day IV for ≥ 8weeks {{and}}[[Ampicillin|Ampicillin]] 12 g/day IV for ≥ 8weeks) | ||
Revision as of 15:49, 16 July 2015
- 1. Bacteremia[1]
- 1.1 Ampicillin or Penicillin susceptible
- Preferred regimen (1): Ampicillin 2 g IV q4-6h
- Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV q8h
- 1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV q8h
- Preferred regimen (2): Linezolid 600 mg q12h
- Preferred regimen (3): Daptomycin 6 mg/kg IV q24h
- 1.3 Ampicillin and Vancomycin resistant
- Preferred regimen (1): Linezolid 600 mg q12h
- Preferred regimen (2): Daptomycin 6 mg/kg IV q24h
- 2.1 Endocarditis in Adults
- 2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
- Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
- Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
- Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
- 2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks ORAqueous crystalline penicillin G sodium 24 MU IV q24h for 4–6 weeks)ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks
- 2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.1.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks ANDGentamicin sulfate 3 mg/kg IV/IM q24h 6 weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks ANDGentamicin sulfate 3 mg/kg/day IV/IM for 6 weeks
- 2.1.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks ANDGentamicin sulfate 3 mg/kg/day IV/IM for 6 weeks
- 2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen (1): (Imipenem ORCilastatin 2 g/day IV for ≥ 8weeks ANDAmpicillin 12 g/day IV for ≥ 8weeks)
- Preferred regimen (2): (Ceftriaxone sodium 4 g/day IV/IM for ≥ 8weeks ANDAmpicillin 12 g/day IV for ≥ 8weeks)
- 2.2 Endocarditis in Pediatrics
- 2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 300 mg/kg/day IV for 4–6weeks ORPenicillin 300,000 U/kg/day IV for 4–6 weeks) ANDGentamicin 3 mg/kg q24h IV/IM 4–6weeks
- Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks ANDGentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 300 mg/kg/day IV for 4–6weeks ORPenicillin 300,000 U/kg/day IV for 4–6weeks) ANDStreptomycin 20–30 mg/kg/day IV/IM for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 40 mg/kg/day IV for 6weeks ANDStreptomycin sulfate 15 mg/kg/day IV/IM for 6weeks
- 2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.2.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 300 mg/kg/day IV for 6weeks ANDGentamicin 3 mg/kg/day IV/IM for 6weeks
- Alternate regimen: Vancomycin 40 mg/kg/day IV for 6weeks ANDGentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin 40 mg/kg/day IV ANDGentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen: Imipenem/Cilastatin 60–100 mg/kg/day IV for ≥ 8weeks ANDAmpicillin 300 mg/kg/day IV for ≥ 8weeks
- Alternate regimen: Ceftriaxone 100 mg/kg/day IV/IM ANDAmpicillin 300 mg/kg/day IV for ≥ 8weeks
- 3. Meningitis[4]
- 3.1 Ampicillin susceptible
- Preferred regimen: Ampicillin 12 g/day IV q4h ANDGentamicin 5 mg/kg/day IV q8h
- 3.2 Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h ANDGentamicin 5 mg/kg/day IV q8h
- 3.3 Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid 600 mg IV q12h
- 4. Urinary tract infections [5]
- Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
- Preferred regimen (2): Fosfomycin 3 g PO single dose
- Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days
- 5. Intra abdominal or Wound infections [6]
- Preferred regimen(1): Penicillin
- Preferred regimen(2): Ampicillin
- Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
- Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h
- 1. Bacteremia[7]
- 1.1 Ampicillin or Penicillin susceptible
- Preferred regimen (1): Ampicillin 2 g IV q4-6h
- Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg q8h
- 1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg q8h
- Preferred regimen (2): Linezolid 600 mg q12h
- Preferred regimen (3): Daptomycin 6 mg/kg/day.
- 1.3 Ampicillin and Vancomycin resistant
- Preferred regimen (1): Linezolid 600 mg q12h
- Preferred regimen (2): Daptomycin 6 mg/kg/day IV
- 2. Endocarditis
- 2.1 Endocarditis in Adults
- 2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 12 g/day IV for 4–6weeks OR Aqueous crystalline penicillin G sodium 18–30 MU/day IV for 4–6weeks) AND Gentamicin sulfate 3 mg/kg/day IV/IM for 4–6 weeks
- Note : In case of native valve endocarditis, 4-week therapy recommended for patients with symptoms of illness ≤3 months and 6-week therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 week of therapy recommended
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- 2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 12 g/day IV for 4–6 weeks ORAqueous crystalline penicillin G sodium 24 MU/day IV for 4–6weeks)ANDStreptomycin sulfate 15 mg/kg/day IV/IM for 4–6weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV 6weeks AND Streptomycin sulfate 15 mg/kg per 24 h IV/IM for 6weeks
- 2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.1.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 12 g/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM 6weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- 2.1.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- 2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen(1): Linezolid 1200 mg/day IV/PO ≥8weeks
- Preferred regimen(2): Quinupristin-Dalfopristin 22.5 mg/kg/day IV ≥8weeks
- 2.2 Endocarditis in Pediatrics
- 2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 300 mg/kg/day IV for 4–6weeks OR Penicillin 300,000 U/kg/day IV for 4–6 weeks) ANDGentamicin 3 mg/kg q24h IV/IM 4–6weeks
- Note : In case of native valve endocarditis, 4-week therapy recommended for patients with symptoms of illness ≤3 months and 6-week therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 week of therapy recommended
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 300 mg/kg/day IV for 4–6weeks OR Penicillin 300,000 U/kg/day IV for 4–6weeks) ANDStreptomycin 20–30 mg/kg/day IV/IM for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 40 mg/kg/day IV for 6weeks ANDStreptomycin sulfate 15 mg/kg/day IV/IM for 6weeks
- 2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.2.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 300 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Alternate regimen: Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin 40 mg/kg/day IV AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen(1): Linezolid 30 mg/kg/day IV/PO ≥ 8weeks
- Preferred regimen(2): Quinupristin-Dalfopristin22.5 mg/kg/day IV ≥ 8weeks
- 3. Meningitis[4]
- 3.1 Ampicillin susceptible
- Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h
- 3.2 Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h
- 3.3 Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid 600 mg IV q12h
- 4. Urinary tract infections[8]
- Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
- Preferred regimen (2): Fosfomycin 3 g PO single dose
- Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days
- 5. Intra abdominal or Wound infections [9]
- Preferred regimen(1): Penicillin
- Preferred regimen(2): Ampicillin
- Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
- Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h
- Aeromonas hydrophila [10]
- 1. Diarrhea
- Preferred regimen(if not self-limiting, or if severe): Ciprofloxacin 500 mg PO bid.
- Alternate regimen: TMP-SMX single dose PO bid
- Note: High resistance to sulfa agents described in Taiwan and Spain
- 2. Skin and soft tissue infection
- 2.1 Mild infection
- Preferred regimen(1): Ciprofloxacin 500 mg PO bid
- Preferred regimen(2): Levofloxacin 500 mg OD.
- 2.2 Severe infection or sepsis
- Preferred regimen(1): Ciprofloxacin 400 mg IV q8h
- Preferred regimen(2): Levofloxacin 750 mg IV q24h
- Note(1): For suspicion of water-based injury,empiric coverage for Vibrio Doxycycline 100mg bid,although Flouroquinolones may also cover ANDVancomycin 15mg/kg IV q12h Template:With/withoutClindamycin ORLinezolid for inhibition of Gram-positive toxin production
- Note(2): Alternatives to fluoroquinolones for Aeromonas coverage include carbapenems (ertapenem, doripenem, imipenem or meropenem),ceftriaxone, cefepime and Aztreonam.
- 3. Prevention
- Preferred regimen: Frequent recommendations include using a Cephalosporin (e.g.,cefuroxime,ceftriaxoneorcefixime) OR a Fluoroquinolone (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches.
- Note: Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones. Duration of antibiotic use is 3-5days, some recommend continuing until wound or eschar resolves
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
|month=ignored (help) - ↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
- ↑ 4.0 4.1 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.