Sandbox Organ-Based Infections: Difference between revisions
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====Hematogenous==== | ====Hematogenous==== | ||
{{Rx|Preferred Regimen}} | {{Rx|Preferred Regimen}} | ||
* MRSA likely – '''[[Vancomycin]]''' {{and2}} ( | * MRSA likely – '''[[Vancomycin]]''' 15–20 mg/kg IV q8–12h {{and2}}( '''[[Ceftriaxone]]''' 1–2 g/day IV/IM q12–24h {{or}} '''[[Ceftazidime]]''' {{or}} '''[[Cefepime]]''') | ||
* MRSA unlikely – ('''[[Nafcillin]]''' {{or}} '''[[Oxacillin]]''') {{and2}} ('''[[ | * MRSA unlikely – ('''[[Nafcillin]]''' {{or}} '''[[Oxacillin]]''') {{and2}} ('''[[Ceftazidime]]''' 2 gm IV q8h {{or}} '''[[Ceftriaxone]]''' {{or}}'''[[Ceftazidime]]''' 2 gm IV q8h {{or}} '''[[Cefepime]]''') | ||
</li> | </li> | ||
{{Rx|Alternative Regimen}} | {{Rx|Alternative Regimen}} | ||
Revision as of 07:27, 10 May 2015
Musculoskeletal
Osteomyelitis
Candidal osteomyelitis
- Fluconazole 400 mg (6 mg/kg) IV/po daily OR Lipid-based Amphotericin B 3-5 mg/kg daily for two weeks, followed by Fluconazole
- Caspofungin 70 mg loading dose, then 50 mg/day IV OR Micafungin 100 mg/day IV or Anidulafungin 200 mg IV loading dose, then 100 mg/day IV
Chronic osteomyelitis
- Systemic antibiotics per culture and susceptibility results AND
- Surgical debridement
Contiguous with vascular insufficiency
- Systemic antibiotics per culture and susceptibility results AND
- Surgical debridement AND
- Revascularization if possible
Contiguous without vascular insufficiency
- Vancomycin 1 gm IV q12h AND
- Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h
- Linezolid 600 mg po/IV bid AND
- Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h
- Ciprofloxacin 750 mg po bid OR Linezolid 600 mg po/IV bid
- Vancomycin 15-20 mg/kg IV q8-12h targeting trough concentrations of 15-20 mg/L
- Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po once daily if susceptible AND
- Rifampin 300-450 mg po bid OR Rifampin 600 mg po once daily if susceptible
Diabetic foot
- Levofloxacin 750 mg IV/PO q24h OR Cefoxitin 1 g IV q4h (or 2 g IV q6–8h) OR Ceftriaxone 1–2 g/day IV/IM q12–24h OR Ampicillin-Sulbactam 1.5–3 g IV/IM q6h OR Moxifloxacin 400 mg IV/PO q24h OR Ertapenem 1 g IV/IM q24h OR Tigecycline 100 mg IV, then 50 mg IV q12h OR Imipenem-Cilastatin 0.5–1 g IV q6–8h
- Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h OR Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
- Piperacillin–Tazobactam 3.375 g IV q6–8h
- (Vancomycin 15–20 mg/kg IV q8–12h OR Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h) AND
- (Piperacillin–Tazobactam 3.375 g IV q6–8h OR Imipenem-Cilastatin 0.5–1 g IV q6–8h OR Ertapenem 1 g IV/IM q24h OR Meropenem 1 g IV/IM q24h) OR (Metronidazole 15 mg/kg IV, then 7.5 mg/kg IV q6h PLUS Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8h OR Aztreonam 2 g IV q6–8h)
Foot bone
- Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po q24h
- Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q8h OR Meropenem 1 gm IV q8h
Foot puncture wound
- Cleanse wound AND
- Tetanus booster if due AND
- X-ray to exclude presence of radio-opaque foreign body
Hematogenous
- MRSA likely – Vancomycin 15–20 mg/kg IV q8–12h AND( Ceftriaxone 1–2 g/day IV/IM q12–24h OR Ceftazidime OR Cefepime)
- MRSA unlikely – (Nafcillin OR Oxacillin) AND (Ceftazidime 2 gm IV q8h OR Ceftriaxone ORCeftazidime 2 gm IV q8h OR Cefepime)
- Linezolid OR Clindamycin OR Daptomycin OR TMP-SMX to replace vancomycin
- Ciprofloxacin OR Levofloxacin OR Aztreonam to replace a third-generation cephalosporin