Sandbox g32: Difference between revisions
Jump to navigation
Jump to search
Gerald Chi- (talk | contribs) |
Gerald Chi- (talk | contribs) |
||
| Line 92: | Line 92: | ||
xx | xx | ||
::* Listeria monocytogenes | ::* '''Listeria monocytogenes''' | ||
:::* Preferred regimen: [[ | :::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h | ||
:::* Alternative regimen: [[Trimethoprim- | :::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Meropenem]] 6 g/day IV q8h | ||
::* '''Streptococcus agalactiae''' | |||
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h | |||
:::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h | |||
::* | ::* '''Escherichia coli and other Enterobacteriaceae''' | ||
:::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h | |||
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Ampicillin]] 12 g/day IV q4h | |||
:::* Preferred regimen: [[Ceftriaxone]] | |||
:::* Alternative regimen: [[Aztreonam]] 6–8 g | |||
Revision as of 22:29, 8 June 2015
Meningitis, bacteria
- Bacterial meningitis[1]
- Empiric antimicrobial therapy based on specific predisposing factors
- Age
- Age < 1 month
- Common causative pathogens: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species
- Preferred regimen: Ampicillin 12 g/day IV q4h AND (Cefotaxime 8–12 g/day q4–6h OR Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Age 1–23 months
- Common causative pathogens: Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Age 2–50 years
- Common causative pathogens: N . meningitidis, S. pneumoniae
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Age > 50 years
- Common causative pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic Gram-negative bacilli
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Ampicillin 12 g/day IV q4h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Head trauma
- Basilar skull fracture
- Common causative pathogens: S. pneumoniae, H. influenzae, group A β-hemolytic streptococci
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Penetrating trauma
- Common causative pathogens: Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic Gram-negative bacilli (including Pseudomonas aeruginosa)
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- Postneurosurgery
- Common causative pathogens: Aerobic Gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- CSF shunt
- Common causative pathogens: Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic Gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- CSF Gram stain-directed antimicrobial therapy
- Gram positive, lancet-shaped diplococci suggestive of Streptococcus pneumoniae
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Alternative regimen: Meropenem 6 g/day IV q8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Gram negative diplococci suggestive of Neisseria meningitidis
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h OR Chloramphenicol 4–6 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Aztreonam 6–8 g/day IV q6–8h
- Gram positive, short bacilli suggestive of Listeria monocytogenes
- Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h) ± (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Alternative regimen: Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Meropenem 6 g/day IV q8h
- Gram positive cocci in short chains suggestive of Streptococcus agalactiae
- Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h) ± (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Gram negative coccobacilli suggestive of Haemophilus influenzae
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Chloramphenicol 4–6 g/day IV q6h OR Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Gram negative bacilli suggestive of Escherichia coli
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h OR Aztreonam 6–8 g/day IV q6–8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h
- Pathogen-directed antimicrobial therapy
- Streptococcus pneumoniae
- Penicillin MIC < 0.1 μg/mL
- Preferred regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h
- Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h OR Chloramphenicol 4–6 g/day IV q6h
- Penicillin MIC 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- Penicillin MIC ≥ 2.0 μg/mL
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Alternative regimen: Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Alternative regimen: Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Neisseria meningitidis
- Penicillin MIC < 0.1 μg/mL
- Preferred regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h
- Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h OR Chloramphenicol 4–6 g/day IV q6h
- Penicillin MIC 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Chloramphenicol 4–6 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h
xx
- Listeria monocytogenes
- Preferred regimen: Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h
- Alternative regimen: Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Meropenem 6 g/day IV q8h
- Streptococcus agalactiae
- Preferred regimen: Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h
- Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Escherichia coli and other Enterobacteriaceae
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h OR Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Ampicillin 12 g/day IV q4h
- Pseudomonas aeruginosa
- Preferred regimen: Cefepime 6g tid OR ceftazidime 6g tid
- Alternative regimen: Aztreonam 6–8 g tid/qid OR ciprofloxacin 800–1200 mg bid/tid {or}} meropenem 6g tid
- Haemophilus influenzae
- β-Lactamase negative
- Preferred regimen: ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- β-Lactamase positive
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Staphylococcus aureus
- Methicillin susceptible
- Preferred regimen: Nafcillin 9–12 g 6 times per day OR oxacillin 9–12 g 6 times per day
- Alternative regimen: Vancomycin 30–45 mg/kg tid/bid OR meropenem 6g tid
- Methicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
- Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid OR linezolid
- Staphylococcus epidermidis
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
- Alternative regimen: Linezolid
- Enterococcus species
- Ampicillin susceptible
- Preferred regimen: ampicillin 12g 6 times per day AND gentamicin 5 mg/kg tid
- Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND gentamicin 5 mg/kg tid
- Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid
- Pediatric dose:
-
- Neonates age 0–7 days: 15–20 mg/kg/day q12h
- Neonates age 8–28 days: 30 mg/kg/day q8h
- Infants and children: 20–30 mg/kg/day q8h
-
- Neonates age 0–7 days: 150 mg/kg/day q8h
- Neonates age 8–28 days: 200 mg/kg/day q6–8h
- Infants and children: 300 mg/kg/day q6h
-
-
- Infants and children: 150 mg/kg/day q8h
-
-
- Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
- Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
- Infants and children: 225–300 mg/kg/day q6–8h
-
-
- Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
- Neonates age 8–28 days: 150 mg/kg q8h
- Infants and children: 150 mg/kg
-
-
- Infants and children: 80–100 mg/kg/day q12–24h
-
-
- Neonates age 0–7 days: 25 mg/kg/day q24h
- Neonates age 8–28 days: 50 mg/kg/day q12–24h
- Infants and children: 75–100 mg/kg/day q6h
-
-
- Neonates age 0–7 days: 5 mg/kg/day q12h
- Neonates age 8–28 days: 7.5 mg/kg/day q8h
- Infants and children: 7.5 mg/kg/day q8h
-
-
- Infants and children: 120 mg/kg/day q8h
-
-
- Neonates age 0–7 days: 75 mg/kg/day q8–12h
- Neonates age 8–28 days: 100–150 mg/kg/day q6–8h
- Infants and children: 200 mg/kg/day q6h
-
-
- Neonates age 0–7 days: 75 mg/kg/day q8–12h
- Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
- Infants and children: 200 mg/kg/day q6h
-
-
- Neonates age 0–7 days: 0.15 MU/kg/day q8–12h
- Neonates age 8–28 days: 0.2 MU/kg/day q6–8h
- Infants and children: 0.3 MU/kg/day q4–6h
-
-
- Neonates age 8–28 days: 10–20 mg/kg/day q12h
- Infants and children: 10–20 mg/kg/day q12–24h
-
-
- Neonates age 0–7 days: 5 mg/kg/day q12h
- Neonates age 8–28 days: 7.5 mg/kg/day q8h
- Infants and children: 7.5 mg/kg/day q8h
-
-
- Infants and children: 10–20 mg/kg q6–12h
-
-
- Neonates age 0–7 days: 20–30 mg/kg/day q8–12h
- Neonates age 8–28 days: 30–45 mg/kg/day q6–8h
- Infants and children: 60 mg/kg/day q6h
-
References
- ↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.