Sandbox/v47

Pathogen-Based Therapy — Bacteria Adapted from Lancet. 2012;380(9854):1693-702. and Clin Infect Dis. 2004;39(9):1267-84.

▸ Click on the following categories to expand treatment regimens.

Bacteria   ▸  Acinetobacter baumannii   ▸  Enterobacteriaceae   ▸  Haemophilus influenzae   ▸  Listeria monocytogenes   ▸  Neisseria meningitidis   ▸  Pseudomonas aeruginosa   ▸  Staphylococcus aureus   ▸  Staphylococcus epidermidis   ▸  Streptococcus agalactiae   ▸  Streptococcus pneumoniae Mycobacteria   ▸  Mycobacterium tuberculosis Spirochetes   ▸  Borrelia burgdorferi   ▸  Treponema pallidum

Acinetobacter baumannii Preferred Regimen ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Colistin 1.25 mg/kg IV q6—12h OR ▸ Polymyxin B 0.75—1.25 mg/kg IV q12h Enterobacteriaceae Preferred Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Aztreonam 2 g IV q6—8h OR ▸ Moxifloxacin 400 mg IV q24h OR ▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component) OR ▸ Meropenem 2 g IV q8h OR ▸ Ampicillin 2 g IV q4h H. influenzae, β-lactamase Negative Preferred Regimen ▸ Ampicillin 2 g IV q4h Alternative Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h OR ▸ Cefepime 2 g IV q8h OR ▸ Chloramphenicol 1—1.5 g IV q6h OR ▸ Aztreonam 2 g IV q6—8h OR ▸ Moxifloxacin 400 mg IV q24h H. influenzae, β-lactamase Positive Preferred Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Cefepime 2 g IV q8h OR ▸ Chloramphenicol 1—1.5 g IV q6h OR ▸ Aztreonam 2 g IV q6—8h OR ▸ Moxifloxacin 400 mg IV q24h H. influenzae, β-lactamase Negative, Ampicillin Resistant Preferred Regimen ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Moxifloxacin 400 mg IV q24h Listeria monocytogenes Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 1.7 mg/kg IV q8h Alternative Regimen ▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component) N. meningitidis, Penicillin MIC <0.1 μg/mL Preferred Regimen ▸ Penicillin G 4 MU IV q4h OR ▸ Ampicillin 2 g IV q4h Alternative Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h OR ▸ Chloramphenicol 1—1.5 g IV q6h N. meningitidis, Penicillin MIC ≥0.1 μg/mL Preferred Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Cefepime 2 g IV q8h OR ▸ Chloramphenicol 1—1.5 g IV q6h OR ▸ Moxifloxacin 400 mg IV q24h OR ▸ Meropenem 2 g IV q8h Pseudomonas aeruginosa Preferred Regimen ▸ Ceftazidime 2 g IV q8h OR ▸ Cefepime 2 g IV q8h PLUS ▸ Gentamicin 1.7 mg/kg IV q8h Alternative Regimen ▸ Aztreonam 2 g IV q6—8h OR ▸ Meropenem 2 g IV q8h OR ▸ Ciprofloxacin 400 mg IV q8—12h PLUS ▸ Gentamicin 1.7 mg/kg IV q8h Staphylococcus aureus, Methicillin sensitive Preferred Regimen ▸ Nafcillin 1.5—2 g IV q4h OR ▸ Oxacillin 1.5—2 g IV q4h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) OR ▸ Linezolid 600 mg IV q12h OR ▸ Daptomycin 6 mg/kg IV q24h Staphylococcus aureus, Methicillin resistant Preferred Regimen ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Rifampin 600 mg IV q24h Alternative Regimen ▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component) OR ▸ Linezolid 600 mg IV q12h OR ▸ Daptomycin 6 mg/kg IV q24h PLUS ▸ Rifampin 600 mg IV q24h Staphylococcus epidermidis Preferred Regimen ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Rifampin 600 mg IV q24h Alternative Regimen ▸ Linezolid 600 mg IV q12h PLUS ▸ Rifampin 600 mg IV q24h Streptococcus agalactiae Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 1.7 mg/kg IV q8h Alternative Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h OR ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) S. pneumoniae, Penicillin MIC ≤0.06 μg/mL Preferred Regimen ▸ Penicillin G 4 MU IV q4h OR ▸ Ampicillin 2 g IV q4h Alternative Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h OR ▸ Chloramphenicol 1—1.5 g IV q6h S. pneumoniae, Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC <1.0 μg/mL Preferred Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Cefepime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h S. pneumoniae, Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC ≥1.0 μg/mL Preferred Regimen ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h PLUS ▸ Rifampin 600 mg IV q24h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Moxifloxacin 400 mg IV q24h Mycobacterium tuberculosis (New Patients) Intensive Phase ▸ Isoniazid 5 mg/kg PO qd × 2 months OR ▸ Isoniazid 10 mg/kg PO 3 times per week × 2 months PLUS ▸ Rifampicin 10 mg/kg PO qd × 2 months OR ▸ Rifampicin 10 mg/kg PO 3 times per week × 2 months PLUS ▸ Pyrazinamide 25 mg/kg PO qd × 2 months OR ▸ Pyrazinamide 35 mg/kg PO 3 times per week × 2 months PLUS ▸ Streptomycin 15 mg/kg PO qd × 2 months OR ▸ Streptomycin 15 mg/kg PO 3 times per week × 2 months Continuation Phase ▸ Isoniazid 5 mg/kg PO qd × 4 months OR ▸ Isoniazid 10 mg/kg PO 3 times per week × 2 months PLUS ▸ Rifampicin 10 mg/kg PO qd × 4 months OR ▸ Rifampicin 10 mg/kg PO 3 times per week × 2 months Adapted from Treatment of Tuberculosis: Guidelines. Borrelia burgdorferi Preferred Regimen ▸ Ceftriaxone 2 g IV q24h × 10—28 days Alternative Regimen ▸ Cefotaxime 2 g IV q8h × 10—28 days OR ▸ Penicillin G 3—4 MU IV q4h × 10—28 days OR ▸ Doxycycline 100—200 mg PO q12h × 10—28 days Adapted from Clin Infect Dis. 2006;43(9):1089-134. Treponema pallidum Preferred Regimen ▸ Penicillin G 3—4 MU IV q4h × 10—14 days Alternative Regimen ▸ Procaine penicillin 2.4 MU IM q24h × 10—14 days PLUS ▸ Probenecid 500 mg PO q6h × 10—14 days Adapted from MMWR Recomm Rep. 2006;55(RR-11):1-94.

Pathogen-Based Therapy — Fungi, Helminths, Protozoan, Viruses

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Fungi   ▸  Blastomyces dermatitidis   ▸  Candida spp.   ▸  Coccidioides immitis   ▸  Cryptococcus neoformans   ▸  Histoplasma capsulatum Helminths   ▸  Angiostrongylus cantonensis   ▸  Baylisascaris procyonis   ▸  Gnathostoma spinigerum Protozoan   ▸  Naegleria fowleri   ▸  Toxoplasma gondii Viruses   ▸  Herpesvirus

Blastomyces dermatitidis Preferred Regimen ▸ Liposomal Amphotericin B 5mg/kg/day IV × 4—6 weeks FOLLOWED BY ▸ Fluconazole 800 mg PO qd × ≥12 months until CSF abnl resolves OR ▸ Itraconazole 200 mg PO bid—tid × ≥12 months until CSF abnl resolves OR ▸ Voriconazole 200—400 mg PO bid × ≥12 months until CSF abnl resolves Adapted from Clin Infect Dis. 2008;46(12):1801-12. Candida spp. Preferred Regimen ▸ Liposomal Amphotericin B 3—5 mg/kg/day IV WITH OR WITHOUT ▸ Flucytosine 25 mg/kg PO qid Alternative Regimen ▸ Fluconazole 400—800 mg PO qd (6—12 mg/kg IV q24h) OR ▸ Voriconazole 400 mg PO bid × 2 doses FOLLOWED BY 200 mg PO bid OR ▸ Voriconazole 6 mg/kg IV q12h × 2 doses FOLLOWED BY 3 mg/kg IV q12h Adapted from Clin Infect Dis. 2009;48(5):503-35. Coccidioides immitis Preferred Regimen ▸ Fluconazole 400 mg PO qd Alternative Regimen ▸ Itraconazole 200 mg PO bid—tid Adapted from Clin Infect Dis. 2005;41(9):1217-23. C. neoformans, HIV–infected Preferred Regimen ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for ≥2 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks FOLLOWED BY ▸ Flucytosine 6 mg/kg PO q24h for ≥8 weeks Alternative Regimen 1 ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for ≥2 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks PLUS ▸ Fluconazole 800 mg PO q24h for ≥2 weeks FOLLOWED BY ▸ Fluconazole 800 mg PO q24h for ≥8 weeks Alternative Regimen 2 ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for 4—6 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks PLUS ▸ Fluconazole 800 mg PO q24h for 4—6 weeks Alternative Regimen 3 ▸ Fluconazole 1200 mg PO q24h for 6 weeks PLUS ▸ Flucytosine 100 mg/kg PO q24h for 6 weeks Alternative Regimen 4 ▸ Fluconazole 800—2000 mg PO q24h for 10—12 weeks Maintenance Therapy ▸ Fluconazole 200 mg PO q24h for ≥1 year C. neoformans, Organ Transplant Recipients Preferred Regimen ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥2 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks FOLLOWED BY ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for ≥6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥6 weeks Consolidation Therapy ▸ Fluconazole 400—800 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200 mg PO q24h for 6—12 months C. neoformans, Non–HIV-Infected and Nontransplant Hosts Preferred Regimen ▸ Amphotericin B 0.7—1.0 mg/kg IV q24h for 4—6 weeks OR ▸ Liposomal Amphotericin B 3—4 mg/kg IV q24h for 4—6 weeks OR ▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4—6 weeks PLUS ▸ Flucytosine 25 mg/kg PO q6h for 4—6 weeks Consolidation Therapy ▸ Fluconazole 400—800 mg PO q24h for 8 weeks Maintenance Therapy ▸ Fluconazole 200 mg PO q24h for 6—12 months Adapted from Clin Infect Dis. 2010;50(3):291-322.