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::* '''Nocardia'''
::* '''Nocardia'''
:::* Preferred regimen: ([[TMP-SMX]] 15 mg/kg/day of TMP component and 75 mg/kg/day of SMX component IV/PO q6–12h {{and}} [[Imipenem]] 500 mg IV q6h) {{withorwithout}} [[Amikacin]] 7.5 mg/kg IV q12h (if multiple organ involvement)
:::* Preferred regimen: ([[TMP-SMX]] 15 mg/kg/day of TMP component and 75 mg/kg/day of SMX component IV/PO q6–12h {{and}} [[Imipenem]] 500 mg IV q6h) {{withorwithout}} [[Amikacin]] 7.5 mg/kg IV q12h (if multiple organ involvement)
:::* Alternative regimen: [[Linezolid]] 600 mg IV/PO q12h {[and}} [[Meropenem]] 2 gm IV q8h


* Brain abscess, tuberculous
* Brain abscess, tuberculous

Revision as of 20:56, 1 June 2015

Epidural abscess

  • Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks AND Ceftriaxone 2 g Iv q24h for 2–4 weeks, then PO to complete 6–8 weeks
Note (1): Decompressive laminectomy in conjunction with long-term antibiotic therapy tailored to culture results is required.
Note (2): For critically ill patients, a vancomycin loading dose of 20–25 mg/kg may be considered.
  • Culture-directed antimicrobial therapy
  • Penicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
  • Methicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen: Cefazolin 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks OR Nafcillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR Oxacillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
  • Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
  • Methicillin-resistant Staphylococcus aureus
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
  • Streptococcus
  • Preferred regimen: Penicillin G 3–4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR Ampicillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
  • Enterococcus
  • Preferred regimen: Penicillin G 3–4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR Ampicillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
  • Enterobacteriaceae
  • Preferred regimen: Ceftriaxone 1–2 g IV q12h for 2–4 weeks, then PO to complete 6–8 weeks OR Cefotaxime 2 g IV q6–8h for 2–4 weeks, then PO to complete 6–8 weeks
  • Gram-negative bacteria
  • Preferred regimen:Ceftazidime 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks OR Cefepime 2 g IV q12h for 2–4 weeks, then PO to complete 6–8 weeks
  • Alternative regimen: Ciprofloxacin 400 mg IV q12h for 2–4 weeks, then PO to complete 6–8 weeks {{or]] Levofloxacin 750 mg IV q24h for 2–4 weeks, then PO to complete 6–8 weeks OR Moxifloxacin 400 mg IV q24h for 2–4 weeks, then PO to complete 6–8 weeks
  • Anaerobes
  • Preferred regimen: Metronidazole 500 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
  • Staphylococcus, Gram-negative bacteria, and anaerobes (mixed infection)
  • Preferred regimen: Ampicillin-Sulbactam 3 g IV q6h for 2–4 weeks, then PO to complete 6–8 weeks OR Ticarcillin-Clavulanate 3.1 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR Piperacillin-Tazobactam 3.375 g IV q4–6h for 2–4 weeks, then PO to complete 6–8 weeks
  • Alternative regimen: Imipenem 500–1000 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks OR Meropenem 1–2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks

Brain abscess

  • Brain abscess, bacterial[4]
  • Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h for 6–8 weeks, then orally for 2–3 months AND (Cefotaxime 2 g IV q4h for 6–8 weeks, then orally for 2–3 months OR Ceftriaxone 2 g IV q12h for 6–8 weeks, then orally for 2–3 months) AND Metronidazole 7.5 mg/kg IV q6h or 15 mg/kg IV q12h for 6–8 weeks, then orally for 2–3 months
  • Alternative regimen: Penicillin G 3–4 MU IV q4h for 6–8 weeks, then orally for 2–3 months AND (Cefotaxime 2 g IV q4h for 6–8 weeks, then orally for 2–3 months OR Ceftriaxone 2 g IV q12h for 6–8 weeks, then orally for 2–3 months) AND Metronidazole 7.5 mg/kg IV q6h or 15 mg/kg IV q12h for 6–8 weeks, then orally for 2–3 months
  • Culture-directed antimicrobial therapy
  • Nocardia
  • Preferred regimen: (TMP-SMX 15 mg/kg/day of TMP component and 75 mg/kg/day of SMX component IV/PO q6–12h AND Imipenem 500 mg IV q6h) ± Amikacin 7.5 mg/kg IV q12h (if multiple organ involvement)
  • Alternative regimen: Linezolid 600 mg IV/PO q12h {[and}} Meropenem 2 gm IV q8h
  • Brain abscess, tuberculous
  • Brain abscess, fungal

References

  1. ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
  2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  3. ↑ Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.
  4. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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