Infectious Disease Project Organ-Based Infections Musculoskeletal System: Difference between revisions
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<div style="clear: both; width: 98%; border: 0px solid #999999; padding: 1em 1em 1em 1em; font-size: 100%; background: #F9F9F9; -webkit-user-select: none;"> | <div style="clear: both; width: 98%; border: 0px solid #999999; padding: 1em 1em 1em 1em; font-size: 100%; background: #F9F9F9; -webkit-user-select: none;"> | ||
==''WikiDoc Infectious Disease Project'' — Organ-Based Infections== | ==''WikiDoc Infectious Disease Project'' — Organ-Based Infections== | ||
''' | ===Osteomyelitis=== | ||
====Candidal osteomyelitis==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[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]]''' | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
: | * '''[[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 | ||
</li> | |||
====Chronic osteomyelitis==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Systemic antibiotics]]''' per culture and susceptibility results {{and}} | |||
* '''[[Surgical debridement]]''' | |||
</li> | |||
====Contiguous with vascular insufficiency==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Systemic antibiotics]]''' per culture and susceptibility results {{and}} | |||
* '''[[Surgical debridement]]''' {{and}} | |||
* '''[[Revascularization]]''' if possible | |||
</li> | |||
====Contiguous without vascular insufficiency==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Vancomycin]]''' 1 gm IV q12h {{and}} | |||
* '''[[Ceftazidime]]''' 2 gm IV q8h {{or}} '''[[Cefepime]]''' 2 gm IV q12h | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Linezolid]]''' 600 mg po/IV bid {{and}} | |||
* '''[[Ceftazidime]]''' 2 gm IV q8h {{or}} '''[[Cefepime]]''' 2 gm IV q12h | |||
</li> | |||
{{Rx|Gram-negative bacilli}} | |||
* '''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Linezolid]]''' 600 mg po/IV bid | |||
</li> | |||
{{Rx|Staphylococcus aureus (MRSA/MSSA)}} | |||
* '''[[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 | |||
</li> | |||
{{Rx|MSSA}} | |||
* '''[[Nafcillin]]''' 2 gm IV q4h {{or}} '''[[Oxacillin]]''' 2 gm IV q4h {{or}} '''[[Cefazolin]]''' 2 gm IV q8h | |||
</li> | |||
{{Rx|MRSA}} | |||
* '''[[Vancomycin]]''' 15-20 mg/kg IV q8-12h targeting trough concentrations of 15-20 mg/L | |||
</li> | |||
====Diabetic foot==== | |||
{{Rx|Chronic infection}} | |||
* '''[[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 | |||
</li> | |||
{{Rx|Recent antibiotic use}} | |||
* '''[[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 | |||
</li> | |||
{{Rx|High Risk for MRSA}} | |||
* '''[[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) | |||
</li> | |||
{{Rx|High Risk for Pseudomonas aeruginosa}} | |||
* '''[[Piperacillin–Tazobactam]]''' 3.375 g IV q6–8h | |||
</li> | |||
{{Rx|Polymicrobial Infection}} | |||
* ('''[[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) | |||
</li> | |||
====Foot bone==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg po q24h | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Ceftazidime]]''' 2 gm IV q8h {{or}} '''[[Cefepime]]''' 2 gm IV q8h {{or}} '''[[Meropenem]]''' 1 gm IV q8h | |||
</li> | |||
====Foot puncture wound==== | |||
{{Rx|Preferred Regimen}} | |||
* '''Cleanse wound''' {{and}} | |||
* '''Tetanus booster''' if due {{and}} | |||
* '''X-ray''' to exclude presence of radio-opaque foreign body | |||
</li> | |||
====Hematogenous==== | |||
{{Rx|Preferred Regimen}} | |||
* MRSA likely – '''[[Vancomycin]]''' 15–20 mg/kg IV q8–12h {{and2}} ('''[[Ceftriaxone]]''' 1–2 g/day IV/IM q12–24h {{or}} '''[[Ceftazidime]]''' 2 gm IV q8h {{or}} '''[[Cefepime]]''' 2 gm IV q12h) | |||
* MRSA unlikely – ('''[[Nafcillin]]''' {{or}} '''[[Oxacillin]]''') {{and2}} ('''[[Ceftriaxone]]''' 1–2 g/day IV/IM q12–24h {{or}} '''[[Ceftazidime]]''' 2 gm IV q8h {{or}} '''[[Cefepime]]''' 2 gm IV q12h) | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Linezolid]]''' 600 mg po/IV bid {{or}} '''[[Daptomycin]]''' 4 mg/kg IV q24h to replace vancomycin | |||
* '''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg IV/PO q24h {{or}} '''[[Aztreonam]]''' 2 g IV q6–8h to replace a third-generation cephalosporin | |||
</li> | |||
====Hemoglobinopathy==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Ciprofloxacin]]''' 400 mg IV q12h {{or}} '''[[Ceftriaxone]]''' 2 gm IV q24h | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Ciprofloxacin]]''' 750 mg po bid for 6 weeks {{or}} '''[[Levofloxacin]]''' 750 mg po q24h for 6 weeks | |||
</li> | |||
====Prosthetic joint infection==== | |||
{{Rx|MSSA/MSSE}} | |||
* ('''[[Nafcillin]]''' 2 gm IV q4h {{or}} '''[[Oxacillin]]''' 2 gm IV q4h IV) {{plus}} '''[[Rifampin]]''' 300 mg po bid {{or2}} | |||
* '''[[Cefazolin]]''' 2 gm IV q8h {{plus}} '''[[Rifampin]]''' 300 mg po bid for 2-6 weeks followed by ('''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg po q24h) {{plus}} '''[[Rifampin]]''' 300 mg po bid for 3-6 months | |||
</li> | |||
{{Rx|MRSA/MRSE}} | |||
* '''[[Vancomycin]]''' 15-20 mg/kg IV q8-12h {{plus}} '''[[Rifampin]]''' 300 mg po bid for 2-6 weeks followed by ('''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg po q24h) {{plus}} '''[[Rifampin]]''' 300 mg po bid for 3-6 months | |||
</li> | |||
{{Rx|Streptococcus}} | |||
* '''[[Penicillin G]]''' 20 million units IV continuous infusion q24h or in 6 divided doses {{or}} '''[[Ceftriaxone]]''' 2 gm IV q24h x 4-6 weeks | |||
</li> | |||
{{Rx|Enterococcus}} | |||
* Penicillin-susceptible – '''[[Ampicillin]]''' 12 gm IV {{or}} '''[[Penicillin G]]''' 20 million units IV continuous infusion q24h or in 6 divided doses x 4-6 weeks | |||
* Penicillin-resistant – '''[[Vancomycin]]''' 15 mg/kg IV q12h x 4-6 week | |||
</li> | |||
{{Rx|Propionibacterium acnes}} | |||
* '''[[Penicillin G]]''' 20 million units IV continuous infusion or in 6 divided doses {{or}} '''[[Ceftriaxone]]''' 2 gm IV q24h x 4-6 weeks | |||
</li> | |||
{{Rx|Gram-negative enteric bacilli}} | |||
* '''[[Ertapenem]]''' 1 gm q24h IV {{or}} '''[[Ceftriaxone]]''' 2 gm IV q24h {{or}} '''[[Cefepime]]''' 2 gm IV q12h for 4-6 weeks | |||
</li> | |||
{{Rx|Pseudomonas aeruginosa}} | |||
* '''[[Cefepime]]''' 2 gm IV q12h {{or}} '''[[Meropenem]]''' 1 gm IV q8h for 4-6 weeks {{and}} | |||
* '''[[Tobramycin]]''' 5.1 mg/kg once daily IV for 4-6 weeks | |||
</li> | |||
====Spinal implant==== | |||
{{Rx|MSSA/MSSE}} | |||
* ('''[[Nafcillin]]''' 2 gm IV q4h {{or}} '''[[Oxacillin]]''' 2 gm IV q4h IV) {{plus}} '''[[Rifampin]]''' 300 mg po bid {{or2}} | |||
* '''[[Cefazolin]]''' 2 gm IV q8h {{plus}} '''[[Rifampin]]''' 300 mg po bid for 2-6 weeks followed by ('''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg po q24h) {{plus}} '''[[Rifampin]]''' 300 mg po bid for 3-6 months | |||
</li> | |||
{{Rx|MRSA/MRSE}} | |||
* '''[[Vancomycin]]''' 15-20 mg/kg IV q8-12h {{plus}} '''[[Rifampin]]''' 300 mg po bid for 2-6 weeks followed by ('''[[Ciprofloxacin]]''' 750 mg po bid {{or}} '''[[Levofloxacin]]''' 750 mg po q24h) {{plus}} '''[[Rifampin]]''' 300 mg po bid for 3-6 months | |||
</li> | |||
{{Rx|Streptococcus}} | |||
* '''[[Penicillin G]]''' 20 million units IV continuous infusion q24h or in 6 divided doses {{or}} '''[[Ceftriaxone]]''' 2 gm IV q24h x 4-6 weeks | |||
</li> | |||
{{Rx|Enterococcus}} | |||
* Penicillin-susceptible – '''[[Ampicillin]]''' 12 gm IV {{or}} '''[[Penicillin G]]''' 20 million units IV continuous infusion q24h or in 6 divided doses x 4-6 weeks | |||
* Penicillin-resistant – '''[[Vancomycin]]''' 15 mg/kg IV q12h x 4-6 week | |||
</li> | |||
{{Rx|Propionibacterium acnes}} | |||
* '''[[Penicillin G]]''' 20 million units IV continuous infusion or in 6 divided doses {{or}} '''[[Ceftriaxone]]''' 2 gm IV q24h x 4-6 weeks | |||
</li> | |||
{{Rx|Gram-negative enteric bacilli}} | |||
* '''[[Ertapenem]]''' 1 gm q24h IV {{or}} '''[[Ceftriaxone]]''' 2 gm IV q24h {{or}} '''[[Cefepime]]''' 2 gm IV q12h for 4-6 weeks | |||
</li> | |||
{{Rx|Pseudomonas aeruginosa}} | |||
* '''[[Cefepime]]''' 2 gm IV q12h {{or}} '''[[Meropenem]]''' 1 gm IV q8h for 4-6 weeks {{and}} | |||
* '''[[Tobramycin]]''' 5.1 mg/kg once daily IV for 4-6 weeks | |||
</li> | |||
====Sternal==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Vancomycin]]''' 15-30 mg/kg IV q 8-12h targeting trough of 15-20 μg/mL {{or}} '''[[Nafcillin]]''' 2 gm IV q4h | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Linezolid]]''' 600 mg IV/po bid | |||
</li> | |||
===Bursitis=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
===Lyme arthritis=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
===Reactive arthritis=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Reiter's syndrome==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Post-streptococcal arthritis==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
===Septic arthritis=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Brucellosis==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Candida==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Gonococcal, disseminated infection==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Gram-negative bacilli==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Histoplasmosis==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Lyme disease==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Mycobacterium tuberculosis==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Pneumococcal==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Staphylococcal==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Streptococcal==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Post-intraarticular injection==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
===Gangrene=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
===Myonecrosis=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
===Necrotizing fascitis=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Clostridial==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Staphylococcal==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Streptococcal==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
====Synergistic==== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
===Pyomyositis=== | |||
{{Rx|Preferred Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
{{Rx|Alternative Regimen}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration {{and}} | |||
* '''[[Drug]]''' DosageRouteFrequencyDuration {{or}} '''[[Drug]]''' DosageRouteFrequencyDuration | |||
</li> | |||
</div> | </div> |
Revision as of 02:44, 13 May 2015
WikiDoc Infectious Disease Project — Organ-Based Infections
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
- 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
- Vancomycin 15-20 mg/kg IV q8-12h targeting trough concentrations of 15-20 mg/L
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
- 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 2 gm IV q8h OR Cefepime 2 gm IV q12h)
- MRSA unlikely – (Nafcillin OR Oxacillin) AND (Ceftriaxone 1–2 g/day IV/IM q12–24h OR Ceftazidime 2 gm IV q8h OR Cefepime 2 gm IV q12h)
- Linezolid 600 mg po/IV bid OR Daptomycin 4 mg/kg IV q24h to replace vancomycin
- Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg IV/PO q24h OR Aztreonam 2 g IV q6–8h to replace a third-generation cephalosporin
Hemoglobinopathy
- Ciprofloxacin 400 mg IV q12h OR Ceftriaxone 2 gm IV q24h
- Ciprofloxacin 750 mg po bid for 6 weeks OR Levofloxacin 750 mg po q24h for 6 weeks
Prosthetic joint infection
- (Nafcillin 2 gm IV q4h OR Oxacillin 2 gm IV q4h IV) PLUS Rifampin 300 mg po bid
OR - Cefazolin 2 gm IV q8h PLUS Rifampin 300 mg po bid for 2-6 weeks followed by (Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po q24h) PLUS Rifampin 300 mg po bid for 3-6 months
- Vancomycin 15-20 mg/kg IV q8-12h PLUS Rifampin 300 mg po bid for 2-6 weeks followed by (Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po q24h) PLUS Rifampin 300 mg po bid for 3-6 months
- Penicillin G 20 million units IV continuous infusion q24h or in 6 divided doses OR Ceftriaxone 2 gm IV q24h x 4-6 weeks
- Penicillin-susceptible – Ampicillin 12 gm IV OR Penicillin G 20 million units IV continuous infusion q24h or in 6 divided doses x 4-6 weeks
- Penicillin-resistant – Vancomycin 15 mg/kg IV q12h x 4-6 week
- Penicillin G 20 million units IV continuous infusion or in 6 divided doses OR Ceftriaxone 2 gm IV q24h x 4-6 weeks
- Ertapenem 1 gm q24h IV OR Ceftriaxone 2 gm IV q24h OR Cefepime 2 gm IV q12h for 4-6 weeks
- Cefepime 2 gm IV q12h OR Meropenem 1 gm IV q8h for 4-6 weeks AND
- Tobramycin 5.1 mg/kg once daily IV for 4-6 weeks
Spinal implant
- (Nafcillin 2 gm IV q4h OR Oxacillin 2 gm IV q4h IV) PLUS Rifampin 300 mg po bid
OR - Cefazolin 2 gm IV q8h PLUS Rifampin 300 mg po bid for 2-6 weeks followed by (Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po q24h) PLUS Rifampin 300 mg po bid for 3-6 months
- Vancomycin 15-20 mg/kg IV q8-12h PLUS Rifampin 300 mg po bid for 2-6 weeks followed by (Ciprofloxacin 750 mg po bid OR Levofloxacin 750 mg po q24h) PLUS Rifampin 300 mg po bid for 3-6 months
- Penicillin G 20 million units IV continuous infusion q24h or in 6 divided doses OR Ceftriaxone 2 gm IV q24h x 4-6 weeks
- Penicillin-susceptible – Ampicillin 12 gm IV OR Penicillin G 20 million units IV continuous infusion q24h or in 6 divided doses x 4-6 weeks
- Penicillin-resistant – Vancomycin 15 mg/kg IV q12h x 4-6 week
- Penicillin G 20 million units IV continuous infusion or in 6 divided doses OR Ceftriaxone 2 gm IV q24h x 4-6 weeks
- Ertapenem 1 gm q24h IV OR Ceftriaxone 2 gm IV q24h OR Cefepime 2 gm IV q12h for 4-6 weeks
- Cefepime 2 gm IV q12h OR Meropenem 1 gm IV q8h for 4-6 weeks AND
- Tobramycin 5.1 mg/kg once daily IV for 4-6 weeks
Sternal
- Vancomycin 15-30 mg/kg IV q 8-12h targeting trough of 15-20 μg/mL OR Nafcillin 2 gm IV q4h
- Linezolid 600 mg IV/po bid