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Dysenteric Diarrhea Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping. Patient may be febrile and toxic.	Shigella Salmonella Campylobacter Yersinia E. coli 0157:H7 'C.difficile'	Ciprofloxacin 500 mg PO BID OR Ciprofloxacin 750 mg daily x 3 days (avoid in cases of E. coli O157:H7 as it may increase the risk of hemolytic-uremic syndrome) Recent antibiotic exposure: consider C. difficile Antimotility drugs should not be used in C.difficile. C. difficile - Metronidazole 500 mg PO TID x 10-14 days. If no response at 5 days, switch to Vancomycin 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent C. difficile infection and/or policy on C. difficile management.	Empiric therapy is generally indicated if patient is toxic appearing, elderly or immunocompromised.  If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures Azithromycin should be used for pregnancy and suspected quinolone resistant Campylobacter. Antimotility drugs improve symptoms and can be used if patient is not toxic.   Antimicrobial treatment may worsen outcomes in patients with E. coli0157:H7 E. histolytica - Metronidazole 750 mg PO TID x 7-10 days then Iodoquinol 650 mg PO TID x 20 days or Paromomycin5 25-35 mg/kg/day in 3 divided doses x 7 days
Nondysenteric Diarrhea Large volume, nonbloody, watery diarrhea. Patient may have nausea, vomiting, and abdominal cramping but fever often absent.	Viruses Giardia Enterotoxigenic E. coli Enterotoxin-producing bacteria	General Care: Observation Oral rehydration Antimotility agents Giardia – especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – Metronidazole 250 mg PO TID x 5 days.	Generally, empiric therapy and stool cultures are not indicated. Most disease is self-limiting and can be treated with antimotility agents If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P. Metronidazole resistance seen in 20% giardia cases. Check C. difficile toxin if recent history of antibiotic use or hospitalization.
Traveler’s diarrhea Empiric treatment while abroad	Toxigenic E. coli Salmonella Shigella Campylobacter Amebiasis	Ciprofloxacin 500 mg PO BID x 1-3 days Pregnancy or fluoroquinolone-resistant campylobacter: Azithromycin 1 g x 1 dose EITHER WITH or WITHOUT: Loperamide 4 mg PO x 1; then 2 mg after each loose stool, MAX 16 mg/day	Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate. Prophylaxis generally not recommended.

Diverticulitis

Enterobacteriaceae Bacteroides fragilis 'Enterococcus'

Amoxicillin/clavulanate  875 mg/125 mg PO BID OR MoxifloxacinID-R: SFGH 400 mg PO daily OR the combination of: Metronidazole 500 mg PO TID PLUS ONE OF: Ciprofloxacin 500 mg PO BID OR LevofloxacinID-R: VASF  500 mg PO daily

Duration of treatment should be until patient is afebrile for 3-5 days. Surgical evaluation and follow up is advised.

'Acute Bronchitis'	Viral	No drug therapy required
Acute bacterial exacerbation of chronic bronchitis (COPD)	S. pneumoniae H. influenzae  Moraxellacatarrhalis	Doxycycline 100 mg PO BID X 10 days	Azithromycin 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days
Community-acquired Pneumonia (CAP)	S. pneumoniae M. pneumoniae C. pneumoniae Respiratory viruses Legionella spp. C. psittaci 'H. influenzae (if patient has co-morbidity)	No recent antibiotic therapy: Doxycycline 100 mg PO BID X 7 days OR Azithromycin 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days Recent antibiotic therapy or patients with co-morbidities: Levofloxacin 750 mg PO daily X 5 days OR MoxifloxacinID-R: SFGH 400 mg PO daily X 7 days	Previous antibiotic therapy within last 3 month should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa. Careful follow-up highly recommended.
Anerobic infection		Amoxicillin/clavulanate 875 mg/125 mg PO BID OR Clindamycin 300 mg PO TID
Acute otitis media OR 'Otitis media with effusion' (OME) with signs or symptoms of acute infection	S. pneumoniae H. influenzae M. catarrhalis Group A Strep.	Amoxicillin 1 g PO BID x 5-7 days OR 500 mg PO TID x 5-7 days	For severe PCN allergy: Azithromycin 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days OR Doxycycline 100 mg PO BID for 5-7 days Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis. High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant S. pneumoniae. OME in the absence of acute signs and symptom of infection does not require antibiotics. For recurrent prolonged otitis consider ENT referral.
Pharyngitis	Viral (EBV, rhinovirus, coronavirus, adenovirus etc) Group A Streptococcus (5-20%)	Penicillin VK 250 mg PO TID-QID x 10 days	For severe PCN allergy: Clindamycin300 mg PO TID x 7-10 days Most pharyngitis is viral thus antibiotics should not be used. Treatment with PCN prevents rheumatic fever. Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present. Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.
Acute Sinusitis	Viruses S. pneumoniae H. influenzae M. catarrhalis	Amoxicillin 500 mg PO TID X 5-7 days	For severe PCN allergy: Doxycycline 100 mg PO BID X 5-7 days Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.
Chronic Sinusitis	Viruses S. pneumoniae H. influenzae M. catarrhalis Anaerobes Staph. aureus Enterobacteriacae	Amoxicillin/clavulanate 875 mg/125 mg PO BID X 10-14 days OR Amoxicillin/clavulanate CR 2 g BID X 10-14 days if drug-resistant Streptococcus pneumonia	For severe PCN allergy: Ciprofloxacin 500 mg PO BID OR Levofloxacin 500 mg PO daily x 10-14 days EITHER OF ABOVE WITH OR WITHOUT*: Clindamycin 300 mg PO TID Consider otolaryngology consult to rule out anatomic abnormality. If acute exacerbation, treat as acute sinusitis. HIV positive patients may need a 2-3 week course.
Treatment of active tuberculosis		Isoniazid 300 mg PO daily x 6 months PLUS Rifampin 600 mg PO daily x 6 months PLUS Pyrazinamide 25 mg/kg PO daily x 2 months PLUS Ethambutol 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established PLUS: Pyridoxine (Vitamin B-6) 50 mg PO daily for 6 months
Latent TB		'Isoniazid' 300 mg PO daily x 9 months	Rifampin 600 mg PO daily x 4 months

Abscess	'S. aureus'	Uncomplicated: Incision and drainage, no antibiotics needed Complicated: Incision and drainage PLUS TMP/SMX 1-2 DS tablets PO BID OR Doxycycline 100 mg PO BID	Give antibiotics for complicated abscess Abscess is large (> 5 cm) or incompletely drained There is significant surrounding cellulitis Systemic signs and symptoms of infection are present Patient is immunocompromised 7-10 days of therapy is generally adequate
Bites Dog and Cat	Streptococci Pasteurella spp.* Staphylococci Oral anaerobes	Amoxicillin/clavulanate 875 mg/125 mg PO BID Prophylaxis – x 5 days Treatment – x 10 days	For severe PCN allergy Clindamycin 300 mg PO TID PLUS ONE OF: Ciprofloxacin 500 mg PO BID OR Levofloxacin 500 mg PO daily Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected. Prophylaxis in high risk patients or in high risk bite only: High risk patient = post splenectomy, immunocompromised  High risk bite = hand or foot P.multocida is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin
Bites Human	Viridans streptococci Eikenella* Oral anaerobes	Amoxicillin/clavulanate 875 mg/125 mg PO BID Prophylaxis – x 5 days Treatment – x 10 days	For severe PCN allergy: Clindamycin 300 mg PO TID PLUS ONE OF: Ciprofloxacin 500 mg PO BID OR Levofloxacin500 mg PO daily OR TMP/SMX One DS tablet PO BID

Cellulitis	β-hemolytic streptococci (most common)  S. aureus (less common)	Cephalexin500 mg PO QID OR Amoxicillin500 mg PO TID OR Clindamycin300 mg PO TID	If the patient does not respond to beta-lactam-based therapy consider adding TMP/SMX or doxycycline for MRSA coverage. Clindamycin monotherapy provides reasonable coverage for both Group A strep and community-acquired MRSA however some isolates may be resistant. Please refer to hospital-specific antibiogram. For cellulitis associated with an abscess treat for complicated abscess (see below). 7-10 days of therapy is generally adequate
Diabetic Foot Ulcer Localized cellulitis without systemic signs or symptoms, no osteomyelitis	S. aureus Streptococci Enterobacteriaceae	Clindamycin 300 mg PO TID If patient has been treated with antibiotics within the past month ADD: LevofloxacinID-R: VASF 750 mg PO daily OR Ciprofloxacin 500 mg PO BID	While infections may be polymicrobial, they frequently respond to Gram-positive coverage alone. Increasing rates of MRSA in the community may be a cause for failure to respond to initial therapy. Consider osteomyelitis especially if there is a failure to respond to therapy. 7-14 days of treatment is generally sufficient, duration should be based on clinical response.
Herpes Zoster	Immunocompetent (Shingles/Zoster) Immunocompromised (Lymphoma, HIV infection, etc) and not severe (one dermatome)	Acyclovir 800 mg PO 5x/day x 7-10 days OR Valacyclovir 1 g PO TID x 7 days	Treatment effective only if initiated within 48-72 hours of onset of lesions. May shorten duration of illness in immunocompetent patients. In patients > 65 years old administration of concomitant corticosteroids may improve quality of life.
Primary Infection in Adults (Chicken Pox)	Acyclovir 800 mg PO 5x/day x 5 days OR 'Valacyclovir' 1 g PO TID x 5 days		Initiate therapy within 24 hours of onset of rash. Vaccination of non-immune close contacts recommended. Acyclovir treatment may also be effective for prophylaxis of at-risk individuals.
Mastitis Postpartum	S. aureus Including MRSA becoming more frequent	Dicloxacillin 500 mg PO QID x 10-14 days OR Cephalexin 500 mg PO QID x 10 -14 days If patient with risk factors for MRSA: TMP/SMX One DS tablet PO BID x 10-14 days OR Clindamycin 300mg PO TID x 10-14 days	For mild PCN allergy: Cephalexin 500 mg PO QID x 10-14 days For severe PCN allergy: Clindamycin 300 mg PO TID x 10-14 days If no abscess, increased frequency of nursing may hasten response. If abscess, I & D required; discontinue nursing. Doxycycline is active against MRSA but should not be used if patient is breastfeeding.

Uncomplicated Cystitis Women	Enterobacteriaceae (E. coli) S. saprophyticus (Coagulase negative staphylococcus) (4%)	Nitrofurantoin 100 mg PO BID x 5-7 days – contraindicated in renal insufficiency (CrCl < 60 ml/min) OR TMP/SMX 1 DS tablet PO BID x 3 days (if no previous antibiotic therapy) OR Fosfomycin 3 g PO x1 dose	Reserve for patients at highest risk of failure (selection for resistant isolates): Ciprofloxacin 500 mg PO BID x 3 days OR Levofloxacin 500 mg PO daily x 3 days Reserve for patients with history of resistant organisms or therapeutic failure (less effective): Cephalexin 500 mg PO QID x 7 days OR Cefpodoxime 200 mg PO BID x 7 days IDSA guidelines state Trimethoprim/ Sulfamethoxazole is appropriate if resistance rates do not exceed 20%. Nitrofurantoin is contraindicated in renal insufficiency (CrCl <60 ml/min).
Recurrent Cystitis	Enterobacteriaceae (E. coli) S. saprophyticus(Coagulase negative staphylococcus) (4%)	Prophylaxis: Either self administration if symptoms occur or prophylactic post-coital antibiotics Post menopausal: topical estrogen
Asymptomatic bacteriuria	E.coli Klebsiella Enterococcus	No treatment required
Pyelonephritis	Enterobacteriaceae (E. coli) Enterococci	Ciprofloxacin 500 mg PO BID X 7-14 days OR LevofloxacinID-R: VASF 500 mg PO daily X 7-14 days OR Trimethoprim/ Sulfamethoxazole 1 DS tablet PO BID X 14 days PLUS Ceftriaxone 1 g IV X 1 dose	Cephalexin 500 mg PO QID X 10-14 days OR Cefpodoxime200 mg PO BID X 10-14 days EITHER OF ABOVE PLUS: Ceftriaxone 1 g IV X 1 dose Urine analysis and urine culture should be performed and therapy adjusted based on culture and sensitivity. Trimethoprim-sulfamethoxazole is preferred if organism is susceptible. Consider a single intravenous dose of ceftriaxone prior to fluoroquinolone therapy if patient is at high risk for fluoroquinolone-resistant organisms.
Prostatitis Acute	Enterobacteriaceae(E. coli)	Cephalexin 500 mg PO QID x 21 days OR Ciprofloxacin 500 mg PO BIDX 2-4 weeks* OR LevofloxacinID-R: VASF 500 mg PO daily x 2-4 weeks*	Trimethoprim/ Sulfamethoxazole 1 DS tablet PO BID Antibiotic penetration in the acute inflammatory state is adequate for most antibiotics. Consider sexually transmitted disease treatment (Gonococcus or C. trachomatis) for appropriate patient populations. Cultures should be obtained and definitive therapy should be based on sensitivities.
Prostatitis Chronic	Enterobacteriaceae(E. coli)	Ciprofloxacin x 2 months* OR LevofloxacinID-R: VASF x 2 months*	Trimethoprim/ Sulfamethoxazole 1 DS tablet PO BID Few drugs penetrate non-inflamed prostate. Fluoroquinolones and trimethoprim/sulfamethoxazole adequately penetrate in non-inflamed state. Consider sexually transmitted disease treatment (Gonococcus or C. trachomatis) for appropriate patient populations.