Sandbox mona

Bacteria – Atypical Organisms

• 1. Atypical pneumonia caused by Chlamydophila pneumoniae

• 1.1 Adult

• Preferred regimen (1): Doxycycline 100 mg PO bid for 14-21 days
• Preferred regimen (2): Tetracycline 250 mg PO qid for 14-21 days
• Preferred regimen (3): Azithromycin 500 mg PO as a single dose, followed by 250 mg PO qd for 4 days
• Preferred regimen (4): Clarithromycin 500 mg PO bid for 10 days
• Preferred regimen (5): Levofloxacin 500 mg IV or PO qd for 7 to 14 days
• Preferred regimen (6): Moxifloxacin 400 mg PO qd for 10 days.

• 1.2 Pediatric

• Preferred regimen (1):Erythromycin suspension,PO 50 mg/kg/day for 10 to 14 days
• Preferred regimen (2):Clarithromycin suspension, 15 mg/kg/day for 10 days
• Preferred regimen (3): Azithromycin suspension, PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days

• 2.Upper respiratory tract infection

• Bronchitis

• Antibiotic therapy for C. pneumoniae is not required.

• Pharyngitis

• Antibiotic therapy for C. pneumoniae is not required.

• Sinusitis

• Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.*

• 1 Chlaymydial infections

• 1.1 Chlamydial Infections in Adolescents and Adults

• Preferred regimen : Doxycycline 100 mg PO bid for 7 days OR Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days OR Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (2): Levofloxacin 500 mg PO qd for 7 days OR Ofloxacin 300 mg PO bid for 7 days.
• Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.

• 1.2 Chlamydial Infections in patients with HIV Infection

• Preferred regimen : Doxycycline 100 mg PO bid for 7 days OR Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days OR Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (2): Levofloxacin 500 mg PO qd for 7 days OR Ofloxacin 300 mg PO bid for 7 days.

• 1.3Pregancy

• Preferred regimen :Azithromycin 1 g PO in a single dose
• Alternative regimen (1):Amoxicillin 500 mg PO tid for 7 days
• Alternative regimen (2):Erythromycin base 500 mg PO qid for 7 days OR Erythromycinbase 250 mg PO qid for 14 days
• Alternative regimen (3):Erythromycin ethylsuccinate 800 mg PO qid for 7 days OR Erythromycin ethylsuccinate 400 mg PO four qid for 14days
• Note:Doxycycline, Ofloxacin, and Levofloxacin are contraindicated in pregnant women.

• 2 Chlamydial infection among neonates
• 2.1 Ophthalmia Neonatorumcaused by C. trachomatis

• Preferred regimen :Erythromycin base or ethylsuccinate ,PO 50 mg/kg/ day divided into 4 doses daily for 14 days
• Alternative regimen : Azithromycin suspension, PO 20 mg/kg /day qd for 3 days
• Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.

• 2.2Infant Pneumonia

• Preferred regimen :Erythromycin base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days
• Alternative regimen : Azithromycin suspension, PO 20 mg/kg /day qd for 3 days

• 3.Chlamydial infection among infants and childern
• 3.1 Infants and childern who weigh < 45 kg

• Preferred regimen :Erythromycin base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days

• 3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years

• Preferred regimen :Azithromycin 1 g PO in a single dose

• 3.3 Infants and childern aged ≥8 years

• Preferred regimen :Azithromycin 1 g PO in a single dose OR Doxycycline 100 mg PO bid for 7 days

• Lymphogranuloma venereum (LGV)

• Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3

• Preferred regimen : Doxycycline 100 mg PO bid for 21 days
• Alternative regimen: Erythromycin base 500 mg PO qid for 21 days

• Note (1): azithromycin 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
• Note (2): Patients should be followed clinically until signs and symptoms have resolved.
• Note (2): Pregnant and lactating women should be treated with erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
• Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
• Note(4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).

• 1. Pneumonia

• 1.1 Adult

• Preferred regimen : Doxycycline 100 mg PO bid daily OR Tetracycline 500 mg PO qid for 10-21 days
• Alternative regimen :Minocycline

• 1.2 Pediatric

• Preferred regimen: Azithromycin
• Alternative regimen: fluoroquinolones

• 1.3 Pregnant Patients

• Preferred regimen : Azithromycin
• Alternative regimen: fluoroquinolones

• 2.Endocarditis in valve replacement patients

• Preferred regimen : Doxycycline
• Alternative regimen : fluoroquinolones.