Sandbox/Alejandro

Neutropenic Patients

▸ Click on the following categories to expand treatment regimens.

Neutropenia   ▸  Gram-Negative Bacteria   ▸  Gram-Positive Bacteria   ▸  Fungi

Gram-Negative Bacteria Preferred Regimen ▸ Meropenem 0.5-1 g IV q8h (infuse over 15-30 min or in bolus over 3-5 min) OR ▸ Imipenem/cilastatin 1-2 g/day divided q6-8h (max: 50mg/kg/day) OR ▸ Cefepime 2g IV q8h OR ▸ Piperacillin/tazobactam 12-18 g/day IV divided q4-6 h (maximum 24 g/day) Alternative Regimen 1 aminoglycoside PLUS ▸ Cefepime 2g IV q8h OR ▸ Piperacillin/tazobactam 12-18 g/day IV divided q4-6 h (maximum 24 g/day) Alternative Regimen 2 ▸ Piperacillin/tazobactam 12-18 g/day IV divided q4-6 h (maximum 24 g/day) PLUS ▸ Ciprofloxacin Gram-Positive Bacteria Preferred Regimen ▸ Vancomycin 15-20 mg/kg IV q8-12h Alternative Regimen ▸ Linezolid 600 mg IV/PO q12h OR ▸ Daptomycin 4mg/kg IV q24h Fungi Preferred Regimen ▸ Liposomal Amphotericin B 3 mg/kg/day IV × 1-2 weeks OR ▸ Amphotericin B deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg/day IV × 1-2 weeks Alternative Regimen ▸ Voriconazole 6 mg/kg IV q12h x 1 day, followed by 3 mg/kg IV or 200 mg PO q12h OR ▸ Caspofungin 70 mg IV once, then 50 mg IV q24h x ≥ 14 days

Cellular Immune Deficient Patients

Bacteria   ▸  Nocardia spp   ▸  Atypical mycobacteria Fungi   ▸  Cryptococcus spp   ▸  Histoplasma spp Viruses   ▸  Varicella-zoster virus   ▸  Herpes simplex virus   ▸  Cytomegalovirus

Nocardia spp Preferred Regimen ▸ TMP-SMX x 3-12 months Alternative Regimen 1 ▸ Sulfadiazine 2-4 g PO 1 dose FOLLOWED BY ▸ Sulfadiazine 2-4 g/day PO q4-8h x 3-12 months Alternative Regimen 1 ▸ Imipenem 250-500 mg IV q6-8h x 3-12 months Atypical mycobacteria Preferred Regimen ▸ [[ Alternative Regimen ▸ [[ Cryptococcus spp Preferred Regimen Moderate Severe to Severe Disease ▸ Liposomal Amphotericin B 3 mg/kg/day IV × 1-2 weeks OR ▸ Amphotericin B deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg/day IV × 1-2 weeks FOLLOWED BY ▸ Itraconazole 200 mg PO q12h x ≥12 months Mild to Moderate Disease ▸ Itraconazole 200 mg PO q12h x ≥12 months Adapted from Clin Infect Dis. 2007;45(7):807-25. Histoplasma spp Preferred Regimen ▸ Liposomal Amphotericin B 3 mg/kg/day x 1- 2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg/day x 1- 2 weeks FOLLOWED BY ▸ Itraconazole 200mg q8h x 3 days FOLLOWED BY ▸ Itraconazole 200mg q12h x 6-12 months Varicella-zoster virus Preferred Regimen ▸ Acyclovir 10-12 mg/kg IV (infusion over 1 hour) q8h x 7-10 days Alternative Regimen ▸ Famciclovir 500 mg PO x 7-10 days OR ▸ Valacyclovir 500 mg PO x 7-10 days Herpes simplex virus Preferred Regimen ▸ Acyclovir 10 mg/kg IV (infusion over 1 hour) q8h x 7-10 days Alternative Regimen ▸ Famciclovir 500 mg PO x 7 days OR ▸ Valacyclovir 500 mg PO x 7 days Cytomegalovirus Preferred Regimen ▸ Ganciclovir 5 mg/kg IV q12h x 21 days Alternative Regimen ▸ Valganciclovir 900 mg PO q12h x 21 days