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| ===Central Nervous System===
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| ====Brain abscess {{ID-returntotop-organ}}====
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| * 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><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
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| : Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
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|
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| :* '''Brain abscess in otherwise healthy patients'''
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| ::* 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
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| ::* Alternative regimen: [[Meropenem]] 6 g/day IV q8h
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|
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| :* Brain abscess with comorbidities
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| ::* '''Otitis media, mastoiditis, or sinusitis'''
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| :::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h
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|
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| ::* '''Dental infection'''
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| :::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h
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|
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| ::* '''Penetrating trauma or post-neurosurgy'''
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| :::* 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
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|
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| ::* '''Lung abscess, empyema, or bronchiectasis'''
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| :::* 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
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|
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| ::* '''Bacterial endocarditis'''
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| :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
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|
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| ::* '''Congenital heart disease'''
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| :::* Preferred regimen: [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
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|
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| ::* '''Transplant recipients'''
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| :::* 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)
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|
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| ::* '''Patients with HIV/AIDS'''
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| :::* 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
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|
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| ::* '''Staphylococcus aureus coverage'''
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| :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h
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|
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| ::* '''Mycobacterium tuberculosis coverage'''
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| :::* Preferred regimen: [[Isoniazid]] 300 mg qd {{and}} [[Rifampin]] 600 mg qd {{and}} [[Pyrazinamide]] 15–30 mg qd {{and}} [[Ethambutol]] 15 mg/kg/day qd
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|
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| * 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><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
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| : Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
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| :* Bacteria
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| ::* '''Actinomyces'''
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| :::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h
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| :::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
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|
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| ::* '''Bacteroides fragilis'''
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| :::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day IV q6h
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| :::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
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|
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| ::* '''Enterobacteriaceae'''
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| :::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
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| :::* 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
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|
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| ::* '''Fusobacterium'''
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| :::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
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| :::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
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|
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| ::* '''Haemophilus'''
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| :::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
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| :::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
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|
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| ::* '''Listeria monocytogenes'''
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| :::* Preferred regimen: [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 4 MU IV q4h
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| :::* Alternative regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
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|
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| ::* '''Nocardia'''
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| :::* Preferred regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
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| :::* 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
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|
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| ::* '''Prevotella melaninogenica'''
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| :::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
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| :::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
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|
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| ::* '''Pseudomonas aeruginosa'''
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| :::* Preferred regimen: [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
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| :::* 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
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|
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| ::* '''Staphylococcus aureus, methicillin-resistant (MRSA)'''
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| :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
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| :::* Alternative regimen: [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks {{or}} [[TMP-SMX]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
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| :::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h
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| :::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin.
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|
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| ::* '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
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| :::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
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| :::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
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|
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| ::* '''Streptococcus'''
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| :::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{or}} [[Ampicillin]] 2 g IV q4h
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| :::* Alternative regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
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|
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| :* Fungi
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| ::* '''Aspergillus'''
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| :::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
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| :::* 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
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|
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| ::* '''Candida'''
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| :::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
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| :::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
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|
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| ::* '''Cryptococcus neoformans'''
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| :::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
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| :::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
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|
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| ::* '''Mucorales'''
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| :::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
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| :::* Alternative regimen: [[Posaconazole]] 800 mg/kg/day IV q6–12h
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|
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| ::* '''Pseudallescheria boydii (Scedosporium apiospermum)'''
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| :::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
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| :::* Alternative regimen: [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
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|
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| :* Protozoa
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| ::* '''Toxoplasma gondii'''
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| :::* Preferred regimen: [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd
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| :::* Alternative regimen (1): [[Pyrimethamine]] 25–100 mg/day qd {{and}} [[Clindamycin]] 2400–4800 mg/day IV q6h
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| :::* 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)
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| :::* Alternative regimen (3): [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
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| ====Cerebrospinal fluid shunt infection {{ID-returntotop-organ}}====
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|
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| * '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
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| :* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} ([[Cefepime]] 2 g IV q8h {{or}} [[Ceftazidime]] 2 g IV q8h {{or}} [[Meropenem]] 2 g IV q8h)
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|
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| * Pathogen-directed antimicrobial therapy<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
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| :* '''Enterococcus'''
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| ::* Preferred regimen: ([[Penicillin G]] 4 MU IV q4h {{or}} [[Ampicillin]] 2 g IV q4h) {{and}} [[Gentamicin]] 1–1.7 mg/kg IV q8h
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|
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| :* '''Gram-negative bacilli'''
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| ::* Preferred regimen: [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h {{or}} [[Meropenem]] 2 g IV q8h {{or}} [[Aztreonam]] 2 g IV q6h
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|
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| :* '''Propionibacterium acnes'''
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| ::* Preferred regimen: ([[Penicillin G]] 4 MU IV q4h {{or}} [[Ampicillin]] 2 g IV q4h) {{withorwithout}} [[Gentamicin]] 1–1.7 mg/kg IV q8h
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|
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| :* '''Staphylococcus, coagulase-negative'''
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| ::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{withorwithout}} [[Rifampin]] 600 mg IV/PO q24h
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|
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| :* '''Staphylococcus aureus, methicillin-resistant (MRSA)'''
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| ::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{withorwithout}} [[Rifampin]] 600 mg IV/PO q24h
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| ::: Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
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|
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| :* '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
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| ::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h) {{withorwithout}} [[Rifampin]] 600 mg IV/PO q24h
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|
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| :* '''Streptococcus agalactiae'''
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| ::* Preferred regimen: ([[Penicillin G]] 4 MU IV q4h {{or}} [[Ampicillin]] 2 g IV q4h) {{and}} [[Gentamicin]] 1–1.7 mg/kg IV q8h
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|
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| :* '''Fungi'''
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| ::* Preferred regimen: [[Amphotericin B]] 0.6–1.0 mg/kg IV q24h {{or}} [[Amphotericin B]] liposomal 5 mg/kg/day IV q24h
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|
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| ====Encephalitis {{ID-returntotop-organ}}====
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|
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| * '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1086/589747| issn = 1537-6591| volume = 47| issue = 3| pages = 303–327| last1 = Tunkel| first1 = Allan R.| last2 = Glaser| first2 = Carol A.| last3 = Bloch| first3 = Karen C.| last4 = Sejvar| first4 = James J.| last5 = Marra| first5 = Christina M.| last6 = Roos| first6 = Karen L.| last7 = Hartman| first7 = Barry J.| last8 = Kaplan| first8 = Sheldon L.| last9 = Scheld| first9 = W. Michael| last10 = Whitley| first10 = Richard J.| last11 = Infectious Diseases Society of America| title = The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-08-01| pmid = 18582201}}</ref>
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|
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| :* Preferred regimen: [[Acyclovir]] 10 mg/kg IV q8h for 14–21 days
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| :: Note (1): Acyclovir should be initiated in all patients with suspected encephalitis, pending results of diagnostic studies.
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| :: Note (2): Other empiric antimicrobial agents should be administered on the basis of specific epidemiologic or clinical clues.
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|
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| * '''Specific epidemiologic considerations'''<ref>{{Cite journal| doi = 10.1086/589747| issn = 1537-6591| volume = 47| issue = 3| pages = 303–327| last1 = Tunkel| first1 = Allan R.| last2 = Glaser| first2 = Carol A.| last3 = Bloch| first3 = Karen C.| last4 = Sejvar| first4 = James J.| last5 = Marra| first5 = Christina M.| last6 = Roos| first6 = Karen L.| last7 = Hartman| first7 = Barry J.| last8 = Kaplan| first8 = Sheldon L.| last9 = Scheld| first9 = W. Michael| last10 = Whitley| first10 = Richard J.| last11 = Infectious Diseases Society of America| title = The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-08-01| pmid = 18582201}}</ref>
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| :* Agammaglobulinemia — Enteroviruses, Mycoplasma pneumoniae
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| :* Age
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| ::* Neonates — Herpes simplex virus type 2, cytomegalovirus, rubella virus, Listeria monocytogenes, Treponema pallidum, Toxoplasma gondii
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| ::* Infants and children — Eastern equine encephalitis virus, Japanese encephalitis virus, Murray Valley encephalitis virus, influenza virus, La Crosse virus
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| ::* Elderly persons — Eastern equine encephalitis virus, St. Louis encephalitis virus, West Nile virus, sporadic CJD, L. monocytogenes
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|
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| :* Animal contact
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| ::* Bats — Rabies virus, Nipah virus
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| ::* Birds — West Nile virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, Cryptococcus neoformans (bird droppings)
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| ::* Cats — Rabies virus, Coxiella burnetii, Bartonella henselae, T. gondii
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| ::* Dogs — Rabies virus
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| ::* Horses — Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, Hendra virus
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| ::* Old World primates — B virus
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| ::* Raccoons — Rabies virus, Baylisascaris procyonis
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| ::* Rodents — Eastern equine encephalitis virus (South America), Venezuelan equine encephalitis virus, tickborne encephalitis virus, Powassan virus (woodchucks), La Crosse virus (chipmunks and squirrels), Bartonella quintana
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| ::* Sheep and goats — C. burnetii
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| ::* Skunks — Rabies virus
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| ::* Swine — Japanese encephalitis virus, Nipah virus
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| ::* White-tailed deer — Borrelia burgdorferi
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|
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| :* Immunocompromised persons — Varicella zoster virus, cytomegalovirus, human herpesvirus 6, West Nile virus, HIV, JC virus, L. monocytogenes, Mycobacterium tuberculosis, C. neoformans, Coccidioides species, Histoplasma capsulatum, T. gondii
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|
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| :* Ingestion
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| ::* Raw or partially cooked meat — T. gondii
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| ::* Raw meat, fish, or reptiles — Gnanthostoma species
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| ::* Unpasteurized milk — Tickborne encephalitis virus, L. monocytogenes, C. burnetii
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|
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| :* Insect contact
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| ::* Mosquitoes — Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, West Nile virus, La Crosse virus, Plasmodium falciparum
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| ::* Sandflies — Bartonella bacilliformis
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| ::* Ticks — Tickborne encephalitis virus, Powassan virus, Rickettsia rickettsii, Ehrlichia chaffeensis, Anaplasma phagocytophilum, C. burnetii (rare), B. burgdorferi
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| ::* Tsetse flies — Trypanosoma brucei gambiense, Trypanosoma brucei rhodesiense
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|
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| :* Occupation
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| ::* Exposure to animals — Rabies virus, C. burnetii, Bartonella species
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| ::* Exposure to horses — Hendra virus
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| ::* Exposure to Old World primates — B virus
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| ::* Laboratory workers — West Nile virus, HIV, C. burnetii, Coccidioides species
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| ::* Physicians and health care workers — Varicella zoster virus, HIV, influenza virus, measles virus, M. tuberculosis
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| ::* Veterinarians — Rabies virus, Bartonella species, C. burnetii
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|
| |
| :* Person-to-person transmission — Herpes simplex virus (neonatal), varicella zoster virus, Venezuelan equine encephalitis virus (rare), poliovirus, nonpolio enteroviruses, measles virus, Nipah virus, mumps virus, rubella virus, Epstein-Barr virus, human herpesvirus 6, B virus, West Nile virus (transfusion, transplantation, breast feeding), HIV, rabies virus (transplantation), influenza virus, M. pneumoniae, M. tuberculosis, T. pallidum
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|
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| :* Recent vaccination — Acute disseminated encephalomyelitis
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|
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| :* Recreational activities
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| ::* Camping/hunting — Agents transmitted by mosquitoes and ticks
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| ::* Sexual contact — HIV, T. pallidum
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| ::* Spelunking — Rabies virus, H. capsulatum
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| ::* Swimming — Enteroviruses, Naegleria fowleri
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|
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| :* Season
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| ::* Late summer/early fall — Agents transmitted by mosquitoes and ticks, enteroviruses
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| ::* Winter — Influenza virus
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|
| |
| :* Transfusion and transplantation — Cytomegalovirus, Epstein-Barr virus, West Nile virus, HIV, tickborne encephalitis virus, rabies virus, iatrogenic CJD, T. pallidum, A. phagocytophilum, R. rickettsii, C. neoformans, Coccidioides species, H. capsulatum, T. gondii
| |
|
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| :* Travel
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| ::* Africa — Rabies virus, West Nile virus, P. falciparum, T. brucei gambiense, T. brucei rhodesiense
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| ::* Australia — Murray Valley encephalitis virus, Japanese encephalitis virus, Hendra virus
| |
| ::* Central America — Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, P. falciparum, Taenia solium
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| ::* Europe — West Nile virus, tickborne encephalitis virus, A. phagocytophilum, B. burgdorferi
| |
| ::* India, Nepal — Rabies virus, Japanese encephalitis virus, P. falciparum
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| ::* Middle East — West Nile virus, P. falciparum
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| ::* Russia — Tickborne encephalitis virus
| |
| ::* South America — Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, B. bacilliformis (Andes mountains), P. falciparum, T. solium
| |
| ::* Southeast Asia, China, Pacific Rim — Japanese encephalitis virus, tickborne encephalitis virus, Nipah virus, P. falciparum, Gnanthostoma species, T. solium
| |
| ::* Unvaccinated status — Varicella zoster virus, Japanese encephalitis virus, poliovirus, measles virus, mumps virus, rubella virus
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|
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| * '''Specific clinical considerations'''<ref>{{Cite journal| doi = 10.1086/589747| issn = 1537-6591| volume = 47| issue = 3| pages = 303–327| last1 = Tunkel| first1 = Allan R.| last2 = Glaser| first2 = Carol A.| last3 = Bloch| first3 = Karen C.| last4 = Sejvar| first4 = James J.| last5 = Marra| first5 = Christina M.| last6 = Roos| first6 = Karen L.| last7 = Hartman| first7 = Barry J.| last8 = Kaplan| first8 = Sheldon L.| last9 = Scheld| first9 = W. Michael| last10 = Whitley| first10 = Richard J.| last11 = Infectious Diseases Society of America| title = The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-08-01| pmid = 18582201}}</ref>
| |
| :* General findings
| |
| ::* Hepatitis — Coxiella burnetii
| |
| ::* Lymphadenopathy — HIV, Epstein-Barr virus, cytomegalovirus, measles virus, rubella virus, West Nile virus, Treponema pallidum, Bartonella henselae and other Bartonella species, Mycobacterium tuberculosis, Toxoplasma gondii, Trypanosoma brucei gambiense
| |
| ::* Parotitis — Mumps virus
| |
| ::* Rash — Varicella zoster virus, B virus, human herpesvirus 6, West Nile virus, rubella virus, some enteroviruses, HIV, Rickettsia rickettsii, Mycoplasma pneumoniae, Borrelia burgdorferi, T. pallidum, Ehrlichia chaffeensis, Anaplasma phagocytophilum
| |
| ::* Respiratory tract findings — Venezuelan equine encephalitis virus, Nipah virus, Hendra virus, influenza virus, adenovirus, M. pneumoniae, C. burnetii, M. tuberculosis, Histoplasma capsulatum
| |
| ::* Retinitis — Cytomegalovirus, West Nile virus, B. henselae, T. pallidum
| |
| ::* Urinary symptoms — St. Louis encephalitis virus
| |
|
| |
| :* Neurologic findings
| |
| ::* Cerebellar ataxia — Varicella zoster virus (children), Epstein-Barr virus, mumps virus, St. Louis encephalitis virus, Tropheryma whipplei, T. brucei gambiense
| |
| ::* Cranial nerve abnormalities — Herpes simplex virus, Epstein-Barr virus, Listeria monocytogenes, M. tuberculosis, T. pallidum, B. burgdorferi, T. whipplei, Cryptococcus neoformans, Coccidioides species, H. capsulatum
| |
| ::* Dementia — HIV, human transmissible spongiform encephalopathies (sCJD and vCJD), measles virus (SSPE), T. pallidum, T. whipplei
| |
| ::* Myorhythmia — T. whipplei (oculomasticatory)
| |
| ::* Parkinsonism — Japanese encephalitis virus, St. Louis encephalitis virus, West Nile virus, Nipah virus, T. gondii, T. brucei gambiense
| |
| ::* Poliomyelitis-like flaccid paralysis — Japanese encephalitis virus, West Nile virus, tickborne encephalitis virus; enteroviruses (enterovirus-71, coxsackieviruses), poliovirus
| |
| ::* Rhombencephalitis — Herpes simplex virus, West Nile virus, enterovirus 71, L. monocytogenes
| |
|
| |
| * Pathogen-directed antimicrobial therapy<ref>{{Cite journal| doi = 10.1086/589747| issn = 1537-6591| volume = 47| issue = 3| pages = 303–327| last1 = Tunkel| first1 = Allan R.| last2 = Glaser| first2 = Carol A.| last3 = Bloch| first3 = Karen C.| last4 = Sejvar| first4 = James J.| last5 = Marra| first5 = Christina M.| last6 = Roos| first6 = Karen L.| last7 = Hartman| first7 = Barry J.| last8 = Kaplan| first8 = Sheldon L.| last9 = Scheld| first9 = W. Michael| last10 = Whitley| first10 = Richard J.| last11 = Infectious Diseases Society of America| title = The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-08-01| pmid = 18582201}}</ref>
| |
| :* Viruses
| |
| ::* '''Adenovirus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''B virus (herpes B virus)'''
| |
| :::* Established disease
| |
| ::::* Preferred regimen: [[Valacyclovir]] 1,000 mg PO tid {{or}} [[Ganciclovir]] 5 mg/kg IV q12h for ≥ 14 days until resolution of neurologic symptoms, then [[Acyclovir]] 800 mg PO 5 times daily indefinitely {{or}} [[Valacyclovir]] 1 g PO tid indefinitely
| |
| ::::* Alternative regimen: [[Acyclovir]] 15 mg/kg IV q8h for ≥ 14 days until resolution of neurologic symptoms, then [[Acyclovir]] 800 mg PO 5 times daily {{or}} [[Valacyclovir]] 1 g PO tid indefinitely
| |
| :::* Prophylaxis after bite or scratch
| |
| ::::* Preferred regimen: [[Valacyclovir]] 1,000 mg PO tid
| |
|
| |
| ::* '''Cytomegalovirus (CMV)'''
| |
| :::* Preferred regimen: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days, followed by 5 mg/kg IV qd for maintenance {{and}} [[Foscarnet]] 90 mg/kg IV q12h for 14–21 days, followed by 90-120 mg/kg IV qd for maintenance
| |
|
| |
| ::* '''Chikungunya virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Eastern equine encephalitis virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Epstein-Barr virus (EBV)'''
| |
| :::* Preferred regimen: supportive {{withorwithout}} [[Corticosteroids]]
| |
| :::: Note: Acyclovir is not recommended.
| |
|
| |
| ::* '''Hendra virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''HSV-1 and HSV-2'''
| |
| :::* Preferred regimen: [[Acyclovir]] 10 mg/kg IV q8h for 14–21 days
| |
| :::* Preferred regimen (neonates): [[Acyclovir]] 20 mg/kg IV q8h for 21 days
| |
|
| |
| ::* '''Human herpesvirus 6 (HHV-6)'''
| |
| :::* Preferred regimen: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days, followed by 5 mg/kg IV qd for maintenance {{or}} [[Foscarnet]] 90 mg/kg IV q12h for 14–21 days, followed by 90-120 mg/kg IV qd for maintenance
| |
|
| |
| ::* '''Human immunodeficiency virus (HIV)'''
| |
| :::* Preferred regimen: [[HAART]]
| |
|
| |
| ::* '''Influenza virus'''
| |
| :::* Preferred regimen: [[Oseltamivir]] 75 mg PO bid
| |
|
| |
| ::* '''Japanese encephalitis virus'''
| |
| :::* Preferred regimen: supportive
| |
| :::: Note: Interferon alpha is not recommended.
| |
|
| |
| ::* '''JC virus'''
| |
| :::* Preferred regimen: Reversal or control of immunosuppression {{or}} [[HAART]] in patients with AIDS
| |
|
| |
| ::* '''La Crosse virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Louping ill virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Lymphocytic choriomeningitis virus (LCMV)'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Me Tri virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Measles virus'''
| |
| ::::* Preferred regimen: supportive
| |
| ::::: Note: [[Ribavirin]] is not approved by the US Food and Drug Administration (FDA) for this indication, and such use should be considered experimental.
| |
|
| |
| ::* '''Monkeypox virus'''
| |
| :::* Preferred regimen: supportive
| |
| :::* Alternative regimen: [[Cidofovir]] {{or}} vaccinia immune globulin
| |
|
| |
| ::* '''Mumps virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Murray Valley encephalitis virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Nipah virus'''
| |
| :::* Preferred regimen: supportive
| |
| :::* Alternative regimen: [[Ribavirin]]
| |
|
| |
| ::* '''Nonpolio enteroviruses'''
| |
| :::* Preferred regimen: supportive
| |
| :::: Note: Consider intraventricular γ-globulin for chronic and/or severe disease.
| |
|
| |
| ::* '''Poliovirus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Powassan virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Rabies virus'''<ref>{{Cite journal| issn = 1545-8601| volume = 59| issue = RR-2| pages = 1–9| last1 = Rupprecht| first1 = Charles E.| last2 = Briggs| first2 = Deborah| last3 = Brown| first3 = Catherine M.| last4 = Franka| first4 = Richard| last5 = Katz| first5 = Samuel L.| last6 = Kerr| first6 = Harry D.| last7 = Lett| first7 = Susan M.| last8 = Levis| first8 = Robin| last9 = Meltzer| first9 = Martin I.| last10 = Schaffner| first10 = William| last11 = Cieslak| first11 = Paul R.| last12 = Centers for Disease Control and Prevention (CDC)| title = Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2010-03-19| pmid = 20300058}}</ref>
| |
| :::* Not previously vaccinated
| |
| ::::* Preferred regimen (1): Wound cleansing with soap and water followed by povidine-iodine solution irrigation if available.
| |
| ::::* Preferred regimen (2): Human rabies immune globulin (HRIG) 20 IU/kg
| |
| ::::* Preferred regimen (3): Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0, 3, 7, and 14
| |
| :::* Previously vaccinated
| |
| ::::* Preferred regimen (1): Wound cleansing with soap and water followed by povidine-iodine solution irrigation if available.
| |
| ::::* Preferred regimen (2): Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0 and 3
| |
| ::::: Note: If anatomically feasible, the full dose of HRIG should be infiltrated around and into the wounds, and any remaining volume should be administered at an anatomical site intramuscularly distant from vaccine administration. In addition, HRIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.
| |
|
| |
| ::* '''Rocio virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Rubella virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Snowshoe hare virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''St. Louis encephalitis virus'''
| |
| :::* Preferred regimen: supportive
| |
| :::* Alternative regimen: [[IFN-α-2b]]
| |
|
| |
| ::* '''Tickborne encephalitis virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Toscana virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Vaccinia'''
| |
| :::* Preferred regimen: supportive {{withorwithout}} [[Corticosteroids]] (if suggestive of post-immunization)
| |
|
| |
| ::* '''Venezuelan equine encephalitis virus'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ::* '''Varicella zoster virus (VZV)'''
| |
| :::* Preferred regimen: [[Acyclovir]] 10–15 mg/kg IV q8h for 10–14 days {{withorwithout}} [[Corticosteroids]]
| |
| :::* Alternative regimen: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days, followed by 5 mg/kg IV qd for maintenance {{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, Carrion's disease)'''
| |
| :::* 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]] {{and}} [[Gentamicin]]
| |
| :::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]]
| |
|
| |
| ::* '''Mycobacterium tuberculosis'''
| |
| :::* Preferred regimen: ([[Isoniazid]] {{and}} [[Rifampin]] {{and}} [[Pyrazinamide]] {{and}} [[Ethambutol]]) {{withorwithout}} [[Dexamethasone]] (if suggestive of meningitis)
| |
|
| |
| ::* '''Mycoplasma pneumoniae'''
| |
| :::* Preferred regimen: [[Azithromycin]] {{or}} [[Doxycycline]] {{or}} [[Fluoroquinolone]]
| |
|
| |
| ::* '''Rickettsia rickettsii (Rocky Mountain spotted fever)'''
| |
| :::* Preferred regimen: [[Doxycycline]]
| |
| :::* Alternative regimen: [[Chloramphenicol]] (for pregnant patients)
| |
|
| |
| ::* '''Treponema pallidum (syphilis)'''
| |
| :::* Preferred regimen: [[Penicillin G]]
| |
| :::* Alternative regimen: [[Ceftriaxone]]
| |
|
| |
| ::* '''Tropheryma whipplei (Whipple's disease)'''
| |
| :::* Preferred regimen: [[Ceftriaxone]] for 2–4 weeks, followed by [[Trimethoprim-Sulfamethoxazole]] for 1–2 years {{or}} [[Cefixime]] for 1–2 years
| |
|
| |
| :* Fungi
| |
| ::* '''Coccidioides'''
| |
| :::* Preferred regimen: [[Fluconazole]]
| |
| :::* Alternative regimen: [[Itraconazole]] {{or}} [[Voriconazole]] {{or}} [[Amphotericin B]] (intravenous and intrathecal)
| |
|
| |
| ::* '''Cryptococcus neoformans'''
| |
| :::* Preferred regimen (1): [[Amphotericin B]] deoxycholate {{and}} [[Flucytosine]] for 2 weeks, followed by [[Fluconazole]] for 8 weeks
| |
| :::* Preferred regimen (2): [[Amphotericin B]] lipid complex {{and}} [[Flucytosine]] for 2 weeks, followed by [[Fluconazole]] for 8 weeks
| |
| :::* Preferred regimen (3): [[Amphotericin B]] deoxycholate {{and}} [[Flucytosine]] for 6–10 weeks, followed by [[Fluconazole]] for 8 weeks
| |
| :::: Note: Consider placement of lumbar drain or VP shunt.
| |
|
| |
| ::* '''Histoplasma capsulatum'''
| |
| :::* Preferred regimen: [[Amphotericin B]] liposomal for 4–6 weeks, followed by [[Itraconazole]] for at least 1 year and until resolution of CSF abnormalities
| |
|
| |
| :* Protozoa
| |
| ::* '''Acanthamoeba'''
| |
| :::* Preferred regimen (1): [[Trimethoprim-Sulfamethoxazole]] {{and}} [[Rifampin]] {{and}} [[Ketoconazole]]
| |
| :::* Preferred regimen (2): [[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 (1): [[Atovaquone-Proguanil]]
| |
| :::* Alternative regimen (2): Exchange transfusion (for > 10% parasitemia or cerebral malaria)
| |
|
| |
| ::* '''Toxoplasma gondii'''
| |
| :::* Preferred regimen: [[Pyrimethamine]] {{and}} [[Sulfadiazine]] {{or}} [[Clindamycin]]
| |
| :::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]]
| |
| :::* Alternative regimen (2): [[Pyrimethamine]] {{and}} ([[Atovaquone]] {{or}} [[Clarithromycin]] {{or}} [[Azithromycin]] {{or}} [[Dapsone]]
| |
|
| |
| ::* '''Trypanosoma brucei gambiense (West African trypanosomiasis)'''
| |
| :::* Preferred regimen: [[Eflornithine]] {{or}} [[Melarsoprol]]
| |
|
| |
| ::* '''Trypanosoma brucei rhodesiense (East African trypanosomiasis)'''
| |
| :::* Preferred regimen: [[Melarsoprol]]
| |
|
| |
| :* Helminths
| |
| ::* '''Baylisascaris procyonis'''
| |
| :::* Preferred regimen: [[Albendazole]] {{and}} [[Diethylcarbamazine]] {{and}} [[Corticosteroids]]
| |
|
| |
| ::* '''Gnathostoma'''
| |
| :::* Preferred regimen: [[Albendazole]] {{or}} [[Ivermectin]]
| |
|
| |
| ::* '''Taenia solium (cysticercosis)'''
| |
| :::* Preferred regimen: [[Albendazole]] {{and}} [[Corticosteroids]]
| |
| :::* Alternative regimen: [[Praziquantel]] {{and}} [[Corticosteroids]]
| |
|
| |
| :* Prion
| |
| ::* '''Human transmissible spongiform encephalopathy'''
| |
| :::* Preferred regimen: supportive
| |
|
| |
| ====Epidural abscess {{ID-returntotop-organ}}====
| |
|
| |
| * Spinal epidural abscess<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1056/NEJMra055111| issn = 1533-4406| volume = 355| issue = 19| pages = 2012–2020| last = Darouiche| first = Rabih O.| title = Spinal epidural abscess| journal = The New England Journal of Medicine| date = 2006-11-09| pmid = 17093252}}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
| |
| :* '''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.
| |
|
| |
| :* Pathogen-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 (MRSA)'''
| |
| :::* 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
| |
| :::* Alternative regimen: [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks {{or}} [[TMP-SMX]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
| |
| :::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h
| |
| :::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin.
| |
|
| |
| ::* '''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 {{ID-returntotop-organ}}====
| |
|
| |
| * Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines<ref>{{Cite journal| doi = 10.1086/508667| issn = 1537-6591| volume = 43| issue = 9| pages = 1089–1134| last1 = Wormser| first1 = Gary P.| last2 = Dattwyler| first2 = Raymond J.| last3 = Shapiro| first3 = Eugene D.| last4 = Halperin| first4 = John J.| last5 = Steere| first5 = Allen C.| last6 = Klempner| first6 = Mark S.| last7 = Krause| first7 = Peter J.| last8 = Bakken| first8 = Johan S.| last9 = Strle| first9 = Franc| last10 = Stanek| first10 = Gerold| last11 = Bockenstedt| first11 = Linda| last12 = Fish| first12 = Durland| last13 = Dumler| first13 = J. Stephen| last14 = Nadelman| first14 = Robert B.| title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2006-11-01| pmid = 17029130}}</ref>
| |
| :* Early neurologic disease
| |
| ::* '''Cranial nerve palsy (adult)'''
| |
| :::* Preferred regimen: [[Amoxicillin]] 500 mg PO tid for 14 (14–21) days {{or}} [[Doxycycline]] 100 mg PO bid for 14 (14–21) days {{or}} [[Cefuroxime]] 500 mg PO bid for 14 (14–21) days
| |
| :::* Alternative regimen: [[Azithromycin]] 500 mg PO qd for 7–10 days {{or}} [[Clarithromycin]] 500 mg PO bid for 14–21 days (not for pregnant) {{or}} [[Erythromycin]] 500 mg PO qid for 14–21 days
| |
|
| |
| ::* '''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<ref>{{Cite journal| doi = 10.1212/01.wnl.0000265517.66976.28| issn = 1526-632X| volume = 69| issue = 1| pages = 91–102| last1 = Halperin| first1 = J. J.| last2 = Shapiro| first2 = E. D.| last3 = Logigian| first3 = E.| last4 = Belman| first4 = A. L.| last5 = Dotevall| first5 = L.| last6 = Wormser| first6 = G. P.| last7 = Krupp| first7 = L.| last8 = Gronseth| first8 = G.| last9 = Bever| first9 = C. T.| last10 = Quality Standards Subcommittee of the American Academy of Neurology| title = Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology| journal = Neurology| date = 2007-07-03| pmid = 17522387}}</ref>
| |
| :* '''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'''
| |
| ::* 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
| |
| ::* 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
| |
|
| |
| :* '''Encephalopathy'''
| |
| ::* 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
| |
| ::* 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
| |
|
| |
| :* '''Post-treatment Lyme syndrome'''
| |
| ::* Preferred regimen: symptomatic management
| |
| ::: Note: Antibiotic therapy is not indicated.
| |
|
| |
| ====Meningitis {{ID-returntotop-organ}}====
| |
|
| |
| =====Meningitis, bacterial {{ID-returntotop-organ}}=====
| |
|
| |
| * Bacterial meningitis<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref>
| |
|
| |
| :* 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) {{withorwithout}} ([[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) {{withorwithout}} ([[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
| |
| ::* '''Enterococcus species'''
| |
| :::* Ampicillin susceptible
| |
| ::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
| |
|
| |
| :::* Ampicillin resistant
| |
| ::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
| |
|
| |
| :::* Ampicillin and vancomycin resistant
| |
| ::::* Preferred regimen: [[Linezolid]] 600 mg IV q12h
| |
|
| |
| ::* '''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
| |
|
| |
| ::* '''Haemophilus influenzae'''
| |
| :::* β-Lactamase negative
| |
| ::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h
| |
| ::::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Cefepime]] 6 g/day IV q8h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
| |
| :::* β-Lactamase positive
| |
| ::::* 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}} [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
| |
|
| |
| ::* '''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
| |
|
| |
| ::* '''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
| |
|
| |
| ::* '''Pseudomonas aeruginosa'''
| |
| :::* Preferred regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Ceftazidime]] 6 g/day IV q8h
| |
| :::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Ciprofloxacin]] 800–1200 mg IV q8–12h {{or}} [[Meropenem]] 6 g/day IV q8h
| |
|
| |
| ::* '''Staphylococcus aureus'''
| |
| :::* Methicillin susceptible (MSSA)
| |
| ::::* Preferred regimen: [[Nafcillin]] 9–12 g/day IV q4h {{or}} [[Oxacillin]] 9–12 g/day IV q4h
| |
| ::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{or}} [[Meropenem]] 6 g/day IV q8h
| |
|
| |
| :::* Methicillin resistant (MRSA)
| |
| ::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
| |
| ::::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Linezolid]] 600 mg IV q12h
| |
| ::::: Note: The addition of [[Rifampin]] 600 mg qd or [[Rifampin]] 300–450 mg bid to vancomycin may be considered for adult patients.
| |
|
| |
| ::* '''Staphylococcus epidermidis'''
| |
| :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
| |
| :::* Alternative regimen: [[Linezolid]] 600 mg IV q12h
| |
|
| |
| ::* '''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
| |
|
| |
| ::* '''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
| |
|
| |
| :* Pediatric dose:
| |
| ::* [[Amikacin]]
| |
| :::* 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
| |
|
| |
| ::* [[Ampicillin]]
| |
| :::* 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
| |
|
| |
| ::* [[Cefepime]]
| |
| :::* Infants and children: 150 mg/kg/day q8h
| |
|
| |
| ::* [[Cefotaxime]]
| |
| :::* 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
| |
|
| |
| ::* [[Ceftazidime]]
| |
| :::* 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
| |
|
| |
| ::* [[Ceftriaxone]]
| |
| :::* Infants and children: 80–100 mg/kg/day q12–24h
| |
|
| |
| ::* [[Chloramphenicol]]
| |
| :::* 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
| |
|
| |
| ::* [[Gentamicin]]
| |
| :::* 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
| |
|
| |
| ::* [[Meropenem]]
| |
| :::* Infants and children: 120 mg/kg/day q8h
| |
|
| |
| ::* [[Nafcillin]]
| |
| :::* 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
| |
|
| |
| ::* [[Oxacillin]]
| |
| :::* 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
| |
|
| |
| ::* [[Penicillin G]]
| |
| :::* 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
| |
|
| |
| ::* [[Rifampin]]
| |
| :::* Neonates age 8–28 days: 10–20 mg/kg/day q12h
| |
| :::* Infants and children: 10–20 mg/kg/day q12–24h
| |
|
| |
| ::* [[Tobramycin]]
| |
| :::* 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
| |
|
| |
| ::* [[Trimethoprim-Sulfamethoxazole]]
| |
| :::* Infants and children: 10–20 mg/kg q6–12h
| |
|
| |
| ::* [[Vancomycin]]
| |
| :::* 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
| |
|
| |
| =====Meningitis, tuberculous {{ID-returntotop-organ}}=====
| |
|
| |
| * Tuberculous meningitis
| |
| :* '''First-line therapy (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)'''
| |
| ::* [[Isoniazid]]
| |
| ::* [[Rifampin]]
| |
| ::* [[Rifabutin]]
| |
| ::* [[Pyrazinamide]]
| |
| ::* [[Ethambutol]]
| |
|
| |
| :* '''Second-line therapy (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)'''
| |
| ::* [[Cycloserine]]
| |
| ::* [[Ethionamide]]
| |
| ::* [[Streptomycin]]
| |
| ::* [[Amikacin]]
| |
| ::* [[Kanamycin]]
| |
| ::* [[Capreomycin]]
| |
| ::* [[p-Aminosalicylic acid]]
| |
| ::* [[Levofloxacin]]
| |
| ::* [[Moxifloxacin]]
| |
| ::* [[Gatifloxacin]]
| |
|
| |
| :* Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis<ref>{{Cite journal| doi = 10.1164/rccm.167.4.603| issn = 1073-449X| volume = 167| issue = 4| pages = 603–662| last1 = Blumberg| first1 = Henry M.| last2 = Burman| first2 = William J.| last3 = Chaisson| first3 = Richard E.| last4 = Daley| first4 = Charles L.| last5 = Etkind| first5 = Sue C.| last6 = Friedman| first6 = Lloyd N.| last7 = Fujiwara| first7 = Paula| last8 = Grzemska| first8 = Malgosia| last9 = Hopewell| first9 = Philip C.| last10 = Iseman| first10 = Michael D.| last11 = Jasmer| first11 = Robert M.| last12 = Koppaka| first12 = Venkatarama| last13 = Menzies| first13 = Richard I.| last14 = O'Brien| first14 = Richard J.| last15 = Reves| first15 = Randall R.| last16 = Reichman| first16 = Lee B.| last17 = Simone| first17 = Patricia M.| last18 = Starke| first18 = Jeffrey R.| last19 = Vernon| first19 = Andrew A.| last20 = American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society| title = American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis| journal = American Journal of Respiratory and Critical Care Medicine| date = 2003-02-15| pmid = 12588714}}</ref><ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
| |
| ::* '''Intensive phase (adult)'''
| |
| :::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months
| |
|
| |
| ::* '''Continuation phase (adult)'''
| |
| :::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 7–10 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 7–10 months
| |
|
| |
| ::* '''Intensive phase (pediatric)'''
| |
| :::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months
| |
|
| |
| ::* '''Continuation phase (pediatric)'''
| |
| :::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 7–10 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 7–10 months
| |
| :::: Note (1): World Health Organization guidelines recommend that Ethambutol should be replaced by Streptomycin in tuberculous meningitis.<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref> Streptomycin is contraindicated in pregnancy.
| |
| :::: Note (2): A 9– to 12–month course of treatment is recommended for tuberculous meningitis.<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
| |
| :::: Note (3): Adjuvant [[Dexamethasone]] 0.3–0.4 mg/kg/day (max: 24 mg) is recommended unless drug resistance is suspected.<ref>{{Cite journal| doi = 10.1056/NEJMoa040573| issn = 1533-4406| volume = 351| issue = 17| pages = 1741–1751| last1 = Thwaites| first1 = Guy E.| last2 = Nguyen| first2 = Duc Bang| last3 = Nguyen| first3 = Huy Dung| last4 = Hoang| first4 = Thi Quy| last5 = Do| first5 = Thi Tuong Oanh| last6 = Nguyen| first6 = Thi Cam Thoa| last7 = Nguyen| first7 = Quang Hien| last8 = Nguyen| first8 = Tri Thuc| last9 = Nguyen| first9 = Ngoc Hai| last10 = Nguyen| first10 = Thi Ngoc Lan| last11 = Nguyen| first11 = Ngoc Lan| last12 = Nguyen| first12 = Hong Duc| last13 = Vu| first13 = Ngoc Tuan| last14 = Cao| first14 = Huu Hiep| last15 = Tran| first15 = Thi Hong Chau| last16 = Pham| first16 = Phuong Mai| last17 = Nguyen| first17 = Thi Dung| last18 = Stepniewska| first18 = Kasia| last19 = White| first19 = Nicholas J.| last20 = Tran| first20 = Tinh Hien| last21 = Farrar| first21 = Jeremy J.| title = Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults| journal = The New England Journal of Medicine| date = 2004-10-21| pmid = 15496623}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
| |
| :::: Note (4): Liaise with microbiology laboratory about genotype testing for drug resistance if there is high risk for MDR-TB.<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
| |
|
| |
| :* Tuberculous meningitis caused by Mycobacterium tuberculosis resistant to isoniazid or rifampin
| |
| ::* '''Isoniazid monoresistance'''<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
| |
| :::* Substitute fluoroquinolone for isoniazid in intensive phase regimen.
| |
| :::* Continue treatment with rifampin, pyrazinamide, and fluoroquinolone for 12 months.
| |
|
| |
| ::* '''Rifampin monoresistance'''<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
| |
| :::* Substitute Fluoroquinolones for Rifampin in intensive phase regimen.
| |
| :::* Continue treatment with isoniazid, pyrazinamide, and fluoroquinolone for 18 months.
| |
|
| |
| ::* '''MDR-TB (resistant to Isoniazid and Rifampin)'''<ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref>
| |
| :::* MDR tuberculosis therapy should be considered if there is a history of prior tuberculosis treatment, contact with a patient with MDR tuberculosis, or a poor clinical response to first-line TB therapy within 2 weeks despite a firm diagnosis and an adequate adherence to treatment.
| |
| :::* Second-line agents such as Aminoglycosides penetrate the BBB only in the presence of inflamed meninges, and Fluoroquinolones, while able to penetrate into the CNS, have lower CSF levels than in the serum or brain parenchyma.
| |
| :::* Consult infectious disease specialist.
| |
|
| |
| ::* '''XDR-TB (resistant to Isoniazid, Rifampin, Fluoroquinolones, and either Capreomycin, Kanamycin, or Amikacin)'''<ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref>
| |
| :::* Consider Ethionamide or Cycloserine to build the treatment regimen.
| |
| :::* Consult infectious disease specialist.
| |
|
| |
| ====Septic thrombosis of cavernous or dural venous sinus {{ID-returntotop-organ}}====
| |
|
| |
| * Septic thrombosis of cavernous or dural venous sinus
| |
| :* '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1161/STR.0b013e31820a8364| issn = 1524-4628| volume = 42| issue = 4| pages = 1158–1192| last1 = Saposnik| first1 = Gustavo| last2 = Barinagarrementeria| first2 = Fernando| last3 = Brown| first3 = Robert D.| last4 = Bushnell| first4 = Cheryl D.| last5 = Cucchiara| first5 = Brett| last6 = Cushman| first6 = Mary| last7 = deVeber| first7 = Gabrielle| last8 = Ferro| first8 = Jose M.| last9 = Tsai| first9 = Fong Y.| last10 = American Heart Association Stroke Council and the Council on Epidemiology and Prevention| title = Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association| journal = Stroke; a Journal of Cerebral Circulation| date = 2011-04| pmid = 21293023}}</ref><ref>{{Cite journal| issn = 0003-9926| volume = 161| issue = 22| pages = 2671–2676| last1 = Ebright| first1 = J. R.| last2 = Pace| first2 = M. T.| last3 = Niazi| first3 = A. F.| title = Septic thrombosis of the cavernous sinuses| journal = Archives of Internal Medicine| date = 2001-12-10| pmid = 11732931}}</ref><ref>{{Cite journal| issn = 0022-2151| volume = 107| issue = 9| pages = 803–808| last = Singh| first = B.| title = The management of lateral sinus thrombosis| journal = The Journal of Laryngology and Otology| date = 1993-09| pmid = 8228594}}</ref><ref>{{Cite journal| issn = 0025-7974| volume = 65| issue = 2| pages = 82–106| last1 = Southwick| first1 = F. S.| last2 = Richardson| first2 = E. P.| last3 = Swartz| first3 = M. N.| title = Septic thrombosis of the dural venous sinuses| journal = Medicine| date = 1986-03| pmid = 3512953}}</ref>
| |
| ::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h) {{and}} ([[Ceftriaxone]] 2 g IV q12h or [[Cefotaxime]] 8–12 g/day IV q4–6h) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h
| |
| ::: Note (1): [[Vancomycin]] 30–45 mg/kg IV q8–12h could be substituted for nafcillin or oxacillin if the risk of MRSA is high.
| |
| ::: Note (2): The optimal duration of therapy remains unclear. A 3– to 4–week course of treatment is usually recommended.
| |
|
| |
| :* Specific anatomic considerations
| |
| ::* '''Cavernous sinus'''
| |
| :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg IV q8–12h {{and}} ([[Ceftriaxone]] 2 g IV q12h or [[Cefotaxime]] 8–12 g/day IV q4–6h) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h
| |
| :::: Note: [[Daptomycin]] 8–12 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV q12h could be considered for patients unable to tolerate vancomycin.
| |
|
| |
| ::* '''Lateral sinus'''
| |
| :::* Preferred regimen: [[Cefepime]] 2 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8h {{and}} [[Vancomycin]] 15-20 IV mg/kg
| |
| :::* Alternative regimen: [[Meropenem]] 1-2 g IV q8h {{and}} [[Linezolid]] 600 mg IV q12h
| |
|
| |
| ::* '''Superior sagittal sinus'''
| |
| :::* Preferred regimen: [[Ceftriaxone]] 2 g IV q12h {{and}} [[Vancomycin]] 15–20 mg/kg {{and}} [[Dexamethasone]]
| |
| :::* Alternative regimen: [[Meropenem]] 1–2 g IV q8h {{and}} [[Vancomycin]] 15–20 mg/kg {{and}} [[Dexamethasone]]
| |
|
| |
| :* Pathogen-directed antimicrobial therapy
| |
| ::* '''Staphylococcus aureus, methicillin-resistant (MRSA)'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
| |
| :::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg/dose IV q8–12h for 4–6 weeks
| |
| :::* Alternative regimen: [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks {{or}} [[TMP-SMX]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
| |
| :::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h
| |
| :::: Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
| |
| :::: Note (2): Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin.
| |
|
| |
| ====Subdural empyema {{ID-returntotop-organ}}====
| |
|
| |
| * Subdural empyema<ref>{{Cite journal| doi = 10.1016/S1473-3099(06)70688-0| issn = 1473-3099| volume = 7| issue = 1| pages = 62–67| last1 = Osborn| first1 = Melissa K.| last2 = Steinberg| first2 = James P.| title = Subdural empyema and other suppurative complications of paranasal sinusitis| journal = The Lancet. Infectious Diseases| date = 2007-01| pmid = 17182345}}</ref><ref>{{Cite journal| issn = 1092-8480| volume = 5| issue = 1| pages = 13–22| last = Greenlee| first = John E.| title = Subdural Empyema| journal = Current Treatment Options in Neurology| date = 2003-01| pmid = 12521560}}</ref>
| |
| :* Causative pathogens
| |
| ::* More common
| |
| :::* Streptococcus milleri
| |
| :::* Other streptococci and enterococci
| |
| :::* Aerobic Gram-negative bacilli (Haemophilus influenzae, Proteus, Escherichia coli, Pseudomonas, Klebsiella, Acinetobacter, Salmonella, Morganella, Eikenella)
| |
| :::* No growth
| |
| ::* Less common
| |
| :::* Streptococcus pneumoniae
| |
| :::* Staphylococcus aureus, coagulase-negative staphylococci
| |
| :::* Anaerobic Gram-positive cocci (Veillonella, Peptostreptococcus, others)
| |
| :::* Anaerobic Gram-negative bacilli (Bacteroides, Fusobacterium, Prevotella)
| |
|
| |
| :* Empiric antimicrobial therapy
| |
| :: Note (1): The choice of antimicrobial agent should be based on Gram stain results and directed against the likely causative microorganisms in the specific clinical setting.
| |
| :: Note (2): Metronidazole is recommended if anaerobes are suspected. Metronidazole is not necessary for antianaerobic activity if Meropenem is used.
| |
| :: Note (3): For coverage of aerobic Gram-negative bacilli, empiric therapy with Cefepime, Ceftazidime, or Meropenem is appropriate.
| |
| :: Note (4): Depending on the clinical response, parenteral antimicrobial therapy should be administered for 3 to 4 weeks after drainage. Parenteral or oral therapy is frequently continued for up to a total of 6 weeks of therapy.
| |
| :: Note (5): A longer course of treatment (minimum of 6–8 weeks) may be required if the patient has accompanying osteomyelitis.
| |
| :: Note (6): Consider adjunctive medications including prophylactic anticonvulsants, corticosteroids, and mannitol if clinically indicated.
| |
|
| |
| ::* '''Intracranial subdural empyema with unclear source of infection'''
| |
| :::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h) {{and}} ([[Ceftriaxone]] 2 g IV q12h or [[Cefotaxime]] 8–12 g/day IV q4–6h) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h
| |
| :::: Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
| |
|
| |
| ::* '''Intracranial subdural empyema associated with sinusitis or otitis media'''
| |
| :::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h) {{and}} ([[Ceftriaxone]] 2 g IV q12h or [[Cefotaxime]] 8–12 g/day IV q4–6h) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h
| |
| :::: Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
| |
|
| |
| ::* '''Intracranial subdural empyema after cranial trauma'''
| |
| :::* Preferred regimen: [[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h
| |
| :::: Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
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|
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| ::* '''Intracranial subdural empyema after neurosurgical procedures'''
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| :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Ceftazidime]] 2 g IV q8h
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|
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| ::* '''Intracranial subdural empyema in neonates (usually associated with meningitis)'''
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| :::* '''Infants < 1 month'''
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| ::::* Preferred regimen: [[Ampicillin]] 200 mg/kg/day IV q4h {{and}} [[Cefotaxime]] 200 mg/kg/day IV q6h
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|
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| :::* '''Infants 1–3 months'''
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| ::::* Preferred regimen: [[Ampicillin]] 200 mg/kg/day IV q4h {{and}} ([[Cefotaxime]] 200 mg/kg/day IV q6h {{or}} [[Ceftriaxone]] 100 mg/kg/day IV q12h)
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|
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| :::* '''Infants > 3 months'''
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| ::::* Preferred regimen: [[Vancomycin]] 60 mg/kg/day IV q6h {{and}} ([[Cefotaxime]] 200 mg/kg/day IV q6h {{or}} [[Ceftriaxone]] 100 mg/kg/day IV q12h {{or}} [[Cefepime]] 150 mg/kg/day IV q8h)
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|
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| ::* '''Spinal subdural empyema'''
| |
| :::* Preferred regimen: [[Nafcillin]] 2 g IV q4h or [[Oxacillin]] 2 g IV q4h
| |
| :::: Note: [[Vancomycin]] should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
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|
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| :* Pathogen-directed antimicrobial therapy
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| ::* '''Staphylococcus aureus, methicillin-resistant (MRSA)'''
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| :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
| |
| :::* Alternative regimen: [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks {{or}} [[TMP-SMX]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
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| :::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h
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| :::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin.
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|
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| ==References==
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| {{Reflist}}
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