Sandbox/Alejandro

Neutropenia and Cellular Immune Deficient Patients

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Neutropenia   ▸  Gram-Negative Bacteria   ▸  Gram-Positive Bacteria   ▸  Fungi Cellular Immune Deficiency Bacteria   ▸  Nocardia spp   ▸  Atypical mycobacteria Fungi   ▸  Cryptococcus spp   ▸  Histoplasma spp Viruses   ▸  Varicella-zoster virus   ▸  Herpes simplex virus   ▸  Cytomegalovirus

Buccal Cellulitis (H. influenzae) Preferred Regimen ▸ Ceftriaxone 1-2 g IV q24h Alternative Regimen ▸ Meropenem 0.5-1 g IV q8h (infuse over 15-30 min or in bolus over 3-5 min) OR ▸ Imipenem/cilastatin 250-1000 mg IV (max: 50mg/kg/day) Adapted from N Engl J Med 2004;350:904-12. Orbital Cellulitis Preferred Regimen 1 ▸ Vancomycin 15-20 mg/kg IV q8-12h (trough 15—20 μg/mL) PLUS ▸ Ceftriaxone 2g IV q24h PLUS ▸ Metronidazole 1g IV q12h Preferred Regimen 2 ▸ Vancomycin 15-20 mg/kg IV q8-12h (trough 15—20 μg/mL) PLUS ▸ Piperacillin-tazobactam 4.5g IV q8h Alternative Regimen (if penicillin or cephalosporin allergic) ▸ Vancomycin 15-20 mg/kg IV q8-12h (trough 15—20 μg/mL) PLUS ▸ Levofloxacin 750 mg IV q24h Facial Cellulitis Preferred Regimen ▸ Vancomycin 15-20 mg/kg IV q8-12h (trough 15—20 μg/mL) Alternative Regimen ▸ Daptomycin 4 mg/kg IV q24h OR ▸ Linezolid 600mg IV q12h Salt Water Wound Exposure (Vibrio vulnificus) Preferred Regimen ▸ Doxycycline 200 mg IV initial dose, then 50-100 mg IV q12h Alternative Regimen ▸ Cefotaxime 1-2 g IV/IM q8-12 (up to 2 g q4-6h) OR ▸ Ciprofloxacin 400 mg IV q8-12h x 7-14 days OR ▸ Ciprofloxacin 500-750 mg PO q8-12h x 7-14 days Fresh Water Wound Exposure (Aeromonas spp) Preferred Regimen ▸ Ciprofloxacin 400mg IV q12h OR ▸ Ceftazidime 0.5 -2 g IV q8h PLUS ▸ Gentamicin 3-5 mg/kg/day IV/IM divided q6-8h or 4-7 mg/kg IV q24h Alternative Regimen ▸ Meropenem 0.5-1 g IV q8h (infuse over 15-30 min or in bolus over 3-5 min) OR ▸ Imipenem/cilastatin 250-1000 mg IV (max: 50mg/kg/day) Butcher, Fisherman, Veterinarian (Erysipelothrix rhusiopathiae) Preferred Regimen ▸ Amoxicillin 500 mg PO q8hr Alternative Regimen ▸ Cefotaxime 1-2 g IV/IM q8-12 (up to 2 g q4-6h) OR ▸ Ciprofloxacin 400 mg IV q8-12h x 7-14 days OR ▸ Ciprofloxacin 500-750 mg PO q8-12h x 7-14 days OR ▸ Imipenem-cilastatin 250-1000 mg IV (max: 50mg/kg/day)