Sandbox ID Central Nervous System: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 1: Line 1:
===Brain abscess===
* Empiric antimicrobial therapy<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* '''Brain abscess in otherwise healthy patients'''
::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day IV q4–6h {{or}} [[Ceftriaxone]] 4 g/day IV q12h) {{and}} [[Metronidazole]] 30 mg/kg/day IV q6h
::* Alternative regimen: [[Meropenem]] 6 g/day IV q8h
:* Brain abscess with comorbidities
::* '''Otitis media, mastoiditis, or sinusitis'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h
::* '''Dental infection'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h
::* '''Penetrating trauma or post-neurosurgy'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{or}} [[Cefepime]] 2 g IV q12h) {{and}} [[Vancomycin]] 30–45 mg/kg/day q8–12h
::* '''Lung abscess, empyema, or bronchiectasis'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
::* '''Bacterial endocarditis'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
::* '''Congenital heart disease'''
:::* Preferred regimen: [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
::* '''Transplant recipients'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[Voriconazole]] 8 mg/kg/day q12h {{and}} ([[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h)
::* '''Patients with HIV/AIDS'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd
::*  '''Staphylococcus aureus coverage'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h
::* '''Mycobacterium tuberculosis coverage'''
:::* Preferred regimen: [[Isoniazid]] 300 mg qd {{and}} [[Rifampin]] 600 mg qd {{and}} [[Pyrazinamide]] 15–30 mg qd {{and}} [[Ethambutol]] 15 mg/kg/day qd
* Pathogen-directed antimicrobial therapy<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* Bacteria
::* '''Actinomyces'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
::* '''Bacteroides fragilis'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day IV q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
::* '''Enterobacteriaceae'''
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h
::* '''Fusobacterium'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
::* '''Haemophilus'''
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
::* '''Listeria monocytogenes'''
:::* Preferred regimen: [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 4 MU IV q4h
:::* Alternative regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
::* '''Nocardia'''
:::* Preferred regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
:::* Alternative regimen: [[Meropenem]] 2 g IV q8h {{or}} [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Amikacin]] 15 mg/kg/day IV q8h
::* '''Prevotella melaninogenica'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
::* '''Pseudomonas aeruginosa'''
:::* Preferred regimen: [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h
::* '''Staphylococcus aureus, methicillin-susceptible'''
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
:::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::* '''Staphylococcus aureus, methicillin-resistant'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
:::* Alternative regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
::* '''Streptococcus'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{or}} [[Ampicillin]] 2 g IV q4h
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
:* Fungi
::* '''Aspergillus'''
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Alternative regimen: [[Amphotericin B]] deoxycholate 0.6–1.0 mg/kg/day IV q24h {{or}} [[Amphotericin B]] lipid complex 5 mg/kg/day IV q24h {{or}} [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
::* '''Candida'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
::* '''Cryptococcus neoformans'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
::* '''Mucorales'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Posaconazole]] 800 mg/kg/day IV q6–12h
::* '''Pseudallescheria boydii (Scedosporium apiospermum)'''
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Alternative regimen: [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
:* Protozoa
::* '''Toxoplasma gondii'''
:::* Preferred regimen: [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd
:::* Alternative regimen (1): [[Pyrimethamine]] 25–100 mg/day qd {{and}} [[Clindamycin]] 2400–4800 mg/day IV q6h
:::* Alternative regimen (2): [[Pyrimethamine]] 25–100 mg/day qd {{and}} ([[Azithromycin]] 1200–1500 mg/day IV q24h {{or}} [[Atovaquone]] 750 mg IV q6h {{or}} [[Dapsone]] 100 mg PO q24h)
:::* Alternative regimen (3): [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
===Cerebrospinal fluid shunt infection===
===Cerebrospinal fluid shunt infection===


Revision as of 07:11, 5 June 2015

Cerebrospinal fluid shunt infection

Encephalitis

  • Viruses
  • Preferred regimen: supportive
prophylactic antiviral therapy after bite or scratch
established disease
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: Reversal or control of immunosuppression AND HAART in patients with AIDS
  • Preferred regimen: supportive
life-threatening disease
SSPE
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive AND Intraventricular γ-globulin (for chronic and/or severe disease)
  • Preferred regimen: supportive
  • Preferred regimen: supportive
postxposure prophylaxis
  • Preferred regimen: rabies immunoglobulin AND vaccine
after onset of disease
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • St. Louis encephalitis virus
  • Preferred regimen: supportive
  • Alternative regimen: IFN-a-2b
  • Tickborne encephalitis virus
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Bacteria
  • Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
with meningitis
without meningitis
  • Fungi
  • Preferred regimen: Amphotericin B deoxycholate AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks ORv Lipid formulation of amphotericin B AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks OR Amphotericin B AND flucytosine for 6–10 weeks
  • Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities
  • Protozoa
  • Preferred regimen: Quinine OR quinidine OR artesunate OR artemether
  • Alternative regimen: Atovaquone OR proguanil OR Exchange transfusion (less than 10% parasitemia or cere- bral malaria)
  • Helminths
  • Prion
  • Preferred regimen: supportive

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

Lyme neuroborreliosis

  • Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines[4]
  • Early neurologic disease
  • Cranial nerve palsy (adult)
  • Cranial nerve palsy (pediatric)
  • Preferred regimen: Amoxicillin 50 mg/kg/day PO in 3 divided doses, max 500 mg/dose for 14 (14–21) days OR Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO q12h, max 100 mg/dose for 14 (14–21) days OR Cefuroxime 30 mg/kg/day PO q12h, max 500 mg/dose for 14 (14–21) days
  • Alternative regimen: Azithromycin 10 mg/kg/day PO, max 500 mg/dose for 7–10 days OR Clarithromycin 7.5 mg/kg PO bid, max 500 mg/dose for 14–21 days OR Erythromycin 12.5 mg/kg PO aid, max 500 mg/dose for 14–21 days
  • Meningitis or radiculopathy (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days.
  • Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
Note: for nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV q12h may be considered.
  • Meningitis or radiculopathy (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h, max 2 g/day for 14 (10–28) days
  • Alternative regimen: Cefotaxime 150–200 mg/kg/day IV in 3–4 divided doses, max 6 g/day for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days
Note: for children ≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered.
  • Late neurologic disease
  • Central or peripheral nervous system disease (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
  • Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
  • Central or peripheral nervous system disease (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h, max 2 g for 14 (10–28) days.
  • Alternative regimen: Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days
  • American Academy of Neurology (AAN) Practice Parameter[5]
  • Meningitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric dose: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • Any neurologic syndrome with CSF pleocytosis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric dose: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)
  • Preferred regimen: Doxycycline 100–200 mg BID for 14 days
  • Alternative regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Pediatric dose: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • Encephalomyelitis
  • Encephalopathy
  • Post-treatment Lyme syndrome
  • Preferred regimen: symptomatic management; antibiotics not indicated

Meningitis, bacteria

  • Streptococcus pneumoniae (adult)
  • Penicillin MIC
  • <0.1 μg/mL
  • 0.1–1.0 μg/mL
  • ≥2.0 μg/mL
  • Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
  • Streptococcus pneumoniae (pediatric)
  • Penicillin MIC
  • <0.1 μg/mL
  • Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
  • Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children
  • 0.1–1.0 μg/mL
  • Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • Alternative regimen: Cefepime 150 mg/kg tid for children OR meropenem 120 mg/kg tid for children
  • ≥2.0 μg/mL
  • Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
  • Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
  • Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
  • Neisseria meningitidis (adult)
  • Penicillin MIC
  • <0.1 μg/mL
  • 0.1–1.0 μg/mL
  • Neisseria meningitidis (pediatric)
  • Penicillin MIC
  • <0.1 μg/mL
  • Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
  • Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • 0.1–1.0 μg/mL
  • Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • Alternative regimen: chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children
  • Listeria monocytogenes (adult)
  • Listeria monocytogenes (pediatric)
  • Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
  • Alternative regimen: Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children {{or]} meropenem 120 mg/kg tid for children
  • Streptococcus agalactiae (adult)
  • Streptococcus agalactiae (pediatric)
  • Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
  • Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • Escherichia coli and other Enterobacteriaceae (adult)
  • Escherichia coli and other Enterobacteriaceae (pediatric)
  • Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children OR Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
  • Pseudomonas aeruginosa (adult)
  • Pseudomonas aeruginosa (pediatric)
  • Preferred regimen: Cefepime 150 mg/kg tid for children OR ceftazidime 100–150 mg/kg tid/bid for 0-7 days neonates; 150 mg/kg tid for 8-28 days neonates; 150 mg/kg tid for children
  • Alternative regimen: meropenem 120 mg/kg tid for children
  • Haemophilus influenzae (adult)
  • β-Lactamase negative
  • β-Lactamase positive
  • Haemophilus influenzae (pediatric)
  • β-Lactamase negative
  • Preferred regimen:ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
  • Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
  • β-Lactamase positive
  • Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
  • Alternative regimen: Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
  • Staphylococcus aureus (adult)
  • Methicillin susceptible
  • Methicillin resistant
  • Staphylococcus aureus (pediatric)
  • Methicillin susceptible
  • Preferred regimen: Nafcillin 75 mg/kg bid/tid for 0-7 days neonates; 100–150 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children OR oxacillin 75 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children
  • Alternative regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children OR meropenem 120 mg/kg tid for children
  • Methicillin resistant
  • Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
  • Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid for children OR linezolid
  • Staphylococcus epidermidis (adult)
  • Staphylococcus epidermidis (pediatric)
  • Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
  • Alternative regimen: Linezolid
  • Enterococcus species (adult)
  • Ampicillin susceptible
  • Ampicillin resistant
  • Ampicillin and vancomycin resistant
  • Enterococcus species (pediatric)
  • Ampicillin susceptible
  • Preferred regimen: ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
  • Ampicillin resistant
  • Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
  • Ampicillin and vancomycin resistant

Meningitis, MRSA

  • Preferred regimen: Vancomycin 15–20 mg/kg/dose IV every 8–12 h for 2 weeks
  • Alternative regimen: linezolid 600 mg PO/IV bid OR TMP-SMX 5 mg/kg/dose IV every 8–12 h
  • Pediatric regimen: Vancomycin 15 mg/kg/dose IV every 6 h OR linezolid 10 mg/kg/dose PO/IV every 8 h

NOTE: Some experts recommend the addition of rifampin 600 mg QD or 300–450 mg BID to vancomycin for adult patients. For children >12 years of age, linezolid 600 mg BID

Meningitis, tuberculous

Septic thrombosis of cavernous or dural venous sinus

Cavernous Sinus

Lateral Sinus

Superior Sagittal Sinus

Septic thrombosis of cavernous or dural venous sinus, MRSA

  • Preferred regimen: Vancomycin 15–20 mg/kg/dose IV every 8–12 h OR Linezolid 600 mg PO/IV BID
  • Alternative regimen: TMP-SMX 5 mg/kg/dose PO/IV every 8-12 h
  • Pediatric regimen: Vancomycin 15 mg/kg/dose IV every 6 h OR Linezolid 10 mg/kg/dose PO/IV every 8 h

NOTE: Some experts recommend the addition of rifampin 600 mg QD or 300–450 mg BID to vancomycin for adult patients. For children >12 years of age, linezolid 600 mg BID


Subdural empyema

  • In adult 60–90% are extension of sinusitis or otitis media
  • Rx same as primary brain abscess

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. ↑ Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
  5. ↑ Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T.; Quality Standards Subcommittee of the American Academy of Neurology (2007-07-03). "Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. ISSN 1526-632X. PMID 17522387.
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox_ID_Central_Nervous_System&oldid=1105724"