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| ==Antimicrobial therapy== | | ==Antimicrobial therapy== |
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| :* Streptococcus pneumonia <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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| ::* (1) '''Lung (pneumonia)'''
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| :::* Community-acquired pneumonia
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| ::::* [[Penicillin]] sensitive (minimum inhibitory concentration ≤ 2)
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| :::::* Preferred regimen: [[Penicillin G]] 1-2 MU q6h IV {{or}} [[Ceftriaxone]] 2 g IV q24h {{or}} [[Cefotaxime]] 1-2 g IV q6-8h.
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| :::::: Oral agents: [[Penicillin V]] 500 mg PO qid, [[Amoxicillin]] 500-1000 mg PO tid, [[Cefpodoxime]] 200 mg PO bd, [[Cefprozil]] 500 mg PO bd, [[Cefditoren]] 400 mg PO bd, [[Cefdinir]] 300 mg PO bd, {{or}} [[Doxycycline]] 100 mg PO bd.
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| ::::* [[Penicillin]]-resistant ([[Penicillin]] minimum inhibitory concentration >8)
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| :::::* Preferred regimen:: [[Levofloxacin]] (Levaquin) 750 mg {{or}} [[Moxifloxacin]] (Avelox) 400 mg IV/PO q24h, [[Telithromycin]] (Ketek) 800 mg PO qd, [[Ceftriaxone]] IV, [[Cefotaxime]] IV, [[Vancomycin]] 15 mg/kg IV q12h {{or}} [[Linezolid]] 600 mg IV/PO q12h.
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| ::* (2)'''Sinuses (sinusitis)'''
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| :::* Sinusitis (empiric therapy)
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| ::::* Preferred regimen: [[amoxicillin]] 500-1000 mg PO tid {{or}} [[Amoxicillin]]/[[Clavulanate]] 875/125 mg PO bd.
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| ::* (3)'''Middle ear (otitis media)'''
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| ::* (4)'''Bronchi (acute exacerbation of chronic bronchitis)'''
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| :::* Preferred regimen: [[amoxicillin]] 2-3 PO g/day {{or}} [[Doxycycline]] 100 mg PO bd.
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| ::* (5)'''CNS (meningitis)'''
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| :::* Empiric therapy
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| ::::* Preferred regimen: [[Vancomycin]] 15 mg/kg/day IV q12h {{and}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q4h or 3 g q6h.
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| :::* Penicillin sensitive (minimum inhibitory concentration ≤ 0.06)
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| ::::* Preferred regimen: [[Ceftriaxone]] 2 g IV q12h, {{or}} [[Cefotaxime]] 2 g IV q4h or 3 g IV q6h.
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| :::* Penicillin resistant (minimum inhibitory concentration ≥ 0.12) or beta-lactam hypersensitivity
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| ::::* Preferred regimen: [[Vancomycin]] 30-45 mg/kg/day IV.
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| :::: Dexamethasone 0.15 mg/kg IV q6h for 2-4 days starting 10-20 min before antibiotic.
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| ::* (6)'''Peritoneum (spontaneous bacterial peritonitis)'''
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| ::* (7)'''Pericardium (purulent pericarditis)'''
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| ::* (8)'''Skin (cellulitis)'''
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| ::* (9)'''Eye (conjunctivitis)'''
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| ::* Prevention
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| :::* (1) Pneumovax (23-valent) prevents bacteremia; impact on rates of CAP are modest or nil.
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| :::* (2) Prevnar vaccine for children <2 yrs age prevents invasive pneumococcal infection in adults by herd effect. Impact is impressive with rates of invasive pneumococcal infection down 80% in peds and 20-40% in adults.
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| :::* (3) Risk for bacteremia in splenectomy, HIV, smokers, black race, multiple myeloma, asthma.
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| ==References== | | ==References== |
