Sandbox ID Central Nervous System: Difference between revisions

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===Encephalitis===
:* Viruses
::* [[Adenovirus]]
:::* Preferred regimen: supportive
::* [[Influenza|B virus]]
:::'''prophylactic antiviral therapy after bite or scratch'''
::::* Preferred regimen: [[Valacyclovir]]
:::'''established disease'''
::::* Preferred regimen: [[Valacyclovir]] {{or}} [[Acyclovir]] {{or}} [[Ganciclovir]]
::* [[CMV]]
:::* Preferred regimen: [[Ganciclovir]] {{and}} [[foscarnet]]
::* [[Eastern equine encephalitis virus]]
:::* Preferred regimen: supportive
::* [[EBV]]
:::* Preferred regimen: supportive {{and}} [[Corticosteroids]]
::* [[Hendra virus]]
:::* Preferred regimen: supportive
::* [[Human herpesvirus 6|HHV-6]]
:::* Preferred regimen: [[Ganciclovir]] {{or}} [[Foscarnet]]
::* [[HIV]]
:::* Preferred regimen: [[HAART]]
::* [[HSV]]-1 and -2
:::* Preferred regimen: [[Acyclovir]]
::* [[Influenza virus]]
:::* Preferred regimen: [[Oseltamivir]]
::* [[Japanese encephalitis virus]]
:::* Preferred regimen: supportive
::* [[JC virus]]
:::* Preferred regimen: Reversal or control of immunosuppression {{and}} [[HAART]] in patients with [[AIDS]]
::* [[La Crosse virus]]
:::* Preferred regimen: supportive
::* [[Measles virus]]
:::'''life-threatening disease'''
::::* Preferred regimen: [[Ribavirin]]
:::'''SSPE'''
::::* Preferred regimen: [[Ribavirin]] intrathecal
::* [[Mumps virus]]
:::* Preferred regimen: supportive
::* [[Murray Valley encephalitis virus]]
:::* Preferred regimen: supportive
::* [[Nipah virus]]
:::* Preferred regimen: supportive {{and}} [[Ribavirin]]
::* [[Non-Polio enterovirus infections|Nonpolio enteroviruses]]
:::* Preferred regimen: supportive {{and}} Intraventricular γ-globulin (for chronic and/or severe disease)
::* [[Poliovirus]]
:::* Preferred regimen: supportive
::* [[Powassan virus]]
:::* Preferred regimen: supportive
::* [[Rabies virus]]
:::'''postxposure prophylaxis'''
::::* Preferred regimen: rabies immunoglobulin {{and}} vaccine
:::'''after onset of disease'''
::::* Preferred regimen: supportive
::* [[Rubella virus]]
:::* Preferred regimen: supportive
::* St. Louis encephalitis virus
:::* Preferred regimen: supportive
:::* Alternative regimen: IFN-a-2b
::* Tickborne encephalitis virus
:::* Preferred regimen: supportive
::* [[Vaccinia]]
:::* Preferred regimen: supportive {{withorwithout}} [[Corticosteroids]]
::* [[Venezuelan equine encephalitis virus]]
:::* Preferred regimen: supportive
::* [[VZV]]
:::* Preferred regimen: [[Acyclovir]] {{withorwithout}} [[Corticosteroids]]
:::* Preferred regimen: [[Ganciclovir]] {{withorwithout}} [[Corticosteroids]]
::* [[West Nile virus]]
:::* Preferred regimen: supportive
::* [[Western equine encephalitis virus]]
:::* Preferred regimen: supportive
:* Bacteria
::* [[Anaplasma phagocytophilum]] (human granulocytotrophic ehrlichiosis)
:::* Preferred regimen: [[Doxycycline]]
::* [[Bartonella bacilliformis]] ([[Oroya fever]])
:::* Preferred regimen: [[Chloramphenicol]] {{or}} [[Ciprofloxacin]]] {{or}} [[Doxycycline]] {{or}} [[Ampicillin]] {{or}} [[trimethoprim-sulfamethoxazole]]
::* [[Bartonella henselae]] ([[Cat scratch disease]])
:::* Preferred regimen: [[Doxycycline]] {{or}} [[Azithromycin]] {{withorwithout}} [[Rifampin]]
::* [[Borrelia burgdorferi]] ([[Lyme disease]])
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]]
::* [[Coxiella burnetii]] ([[Q fever]])
:::* Preferred regimen:  [[Doxycycline]] {{and}} [[Fluoroquinolone]] {{and}} [[Rifampin]]
::* Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
:::* Preferred regimen: [[Doxycycline]]
::* [[Listeria monocytogenes]]
:::* Preferred regimen: [[Ampicillin]] {{or}} [[Trimethoprim-sulfamethoxazole]] {{and}} [[Gentamicin]]
::* [[Mycobacterium tuberculosis]]
:::'''with meningitis'''
:::* Preferred regimen: [[Dexamethasone]]
:::'''without meningitis'''
:::* Preferred regimen: [[Isoniazid]] {{or}} [[Rifampin]] {{or}} [[Pyrazinamide]] {{or}} [[Ethambutol]]
::* [[Mycoplasma pneumoniae]]
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Doxycycline]] {{or}} [[Fluoroquinolone]]
::* [[Rickettsia rickettsii]] ([[Rocky Mountain spotted fever]])
:::* Preferred regimen: [[Doxycycline]]
:::* Alternative regimen: [[Chloramphenicol]]
::* [[Treponema pallidum]] ([[syphilis]])
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Penicillin G]]
::* [[Tropheryma whipplei]] ([[Whipple's disease]])
:::* Preferred regimen: [[Ceftriaxone]] for 2–4 weeks, followed by [[Trimethoprim-sulfamethoxazole]] {{or}} [[Cefixime]] for 1–2 years
:* Fungi
::* [[Coccidioides posadasii|Coccidioides]]
:::* Preferred regimen: [[Fluconazole]]
:::* Alternative regimen: [[Itraconazole]] {{or}} [[Voriconazole]] {{or}} [[Amphotericin B]] (intravenous and intrathecal)
::* [[Cryptococcus neoformans]]
:::* Preferred regimen: [[Amphotericin B]] [[deoxycholate]] {{and}} [[flucytosine]] for 2 weeks, followed by [[fluconazole]] for 8 weeks {{or}}v 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
::* [[Histoplasma capsulatum]]
:::* Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities
:* Protozoa
::* [[Acanthamoeba]]
:::* Preferred regimen: Trimethoprim-sulfamethoxazole {{and}} [[rifampin]] {{and}} [[ketoconazole]] {{or}} [[Fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[pyrimethamine]]
::* [[Balamuthia mandrillaris]]
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Clarithromycin]] {{and}} [[pentamidine]] {{and}} [[flucytosine]] {{and}} [[fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[thioridazine]] {{or}} [[trifluoperazine]]
::* [[Naegleria fowleri]]
:::* Preferred regimen: Amphotericin B (intravenous and intrathecal) {{and}} rifampin {{and}} [[azithromycin]] {{or}} [[sulfisoxazole]] {{or}} [[miconazole]]
::* [[Plasmodium falciparum]]
:::* 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)
::* [[Toxoplasma gondii]]
:::* Preferred regimen: [[Pyrimethamine]] {{and}} [[Sulfadiazine]] {{or}} [[Clindamycin]] [[and}} [[Pyrimethamine]]
:::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]]
:::* Alternative regimen (2): [[Pyrimethamine]] {{and}} atovaqone {{or}} [[Pyrimethamine]] {{and}} [[clarithromycin]] {{or}} Pyrimethamine {{and}} [[azithromycin]] {{or}} Pyrimethamine {{and}} [[dapsone]]
::* [[Trypanosoma brucei gambiense]] (West African trypanosomiasis)
:::* Preferred regimen: [[Eflornithine]] {{or}} [[Melarsoprol]]
::* [[Trypanosoma brucei rhodesiense]] (East African trypanosomiasis)
:::* Preferred regimen: [[Melarsoprol]]
:* Helminths
::* [[Baylisascaris|Baylisascaris procyonis]]
:::* Preferred regimen: [[Corticosteroids]]
:::* Alternative regimen: [[Albendazole]] {{and}} [[diethylcarbamazine]]
::* [[Gnathostoma spinigerum|Gnathostoma]]
:::* Preferred regimen: [[Albendazole]] {{or}} [[Ivermectin]]
::* [[Taenia solium]] ([[cysticercosis]])
:::* Preferred regimen: [[Albendazole]] {{or}} [[Corticosteroids]]
:::* Alternative regimen: [[Praziquantel]]
:* Prion
::* [[Transmissible spongiform encephalopathy|Human transmissible spongiform encephalopathy]]
:::* Preferred regimen: supportive
----
===Epidural abscess===
===Epidural abscess===


Revision as of 04:52, 7 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

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.
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