Meningitis medical therapy: Difference between revisions
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==Pathogen-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<ref name="van de Beek-2012">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | ==Pathogen-Based Therapy — Bacteria <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<ref name="van de Beek-2012">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | ||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | ||
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<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;"> | <div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
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<div class="mw-customtoggle-table30" style="cursor: pointer; border-radius: 0 0 | <div class="mw-customtoggle-table30" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''''Treponema pallidum''''' | ▸ '''''Treponema pallidum''''' | ||
</font> | </font> | ||
</div> | </div> | ||
| valign=top | | | valign=top | | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Acinetobacter baumannii''}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Acinetobacter baumannii''}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] 1.25 mg/kg IV q6—12h'''''<BR> OR <BR> ▸ '''''[[Polymyxin B]] 0.75—1.25 mg/kg IV q12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] 1.25 mg/kg IV q6—12h'''''<BR> OR <BR> ▸ '''''[[Polymyxin B]] 0.75—1.25 mg/kg IV q12h''''' | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterobacteriaceae''}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterobacteriaceae''}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Negative}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Negative}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Positive}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Positive}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Negative, Ampicillin Resistant}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Negative, Ampicillin Resistant}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes''}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes''}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL> | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''N. meningitidis'', Penicillin MIC <0.1 μg/mL}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''N. meningitidis'', Penicillin MIC <0.1 μg/mL}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h''''' | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''N. meningitidis'', Penicillin MIC ≥0.1 μg/mL}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''N. meningitidis'', Penicillin MIC ≥0.1 μg/mL}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Pseudomonas aeruginosa''}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Pseudomonas aeruginosa''}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h''''' | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h''''' | ||
Line 909: | Line 825: | ||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus'', Methicillin sensitive}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus'', Methicillin sensitive}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5—2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Oxacillin]] 1.5—2 g IV q4h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5—2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Oxacillin]] 1.5—2 g IV q4h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h''''' | ||
Line 919: | Line 835: | ||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus'', Methicillin resistant}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus'', Methicillin resistant}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | ||
Line 927: | Line 843: | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h''''' | ||
Line 942: | Line 858: | ||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus epidermidis''}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus epidermidis''}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | ||
Line 950: | Line 866: | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h''''' | ||
Line 965: | Line 881: | ||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Streptococcus agalactiae''}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Streptococcus agalactiae''}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | ||
Line 973: | Line 889: | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | ||
Line 984: | Line 900: | ||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≤0.06 μg/mL}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≤0.06 μg/mL}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h''''' | ||
Line 994: | Line 910: | ||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC <1.0 μg/mL}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC <1.0 μg/mL}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | ||
Line 1,004: | Line 920: | ||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC ≥1.0 μg/mL}} | ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC ≥1.0 μg/mL}} | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | ||
Line 1,016: | Line 932: | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | ||
|- | |- | ||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | | | style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | ||
Line 1,023: | Line 939: | ||
|- | |- | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | ||
|- | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table28" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Mycobacterium tuberculosis (New Patients)''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Intensive Phase''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 5 mg/kg PO qd × 2 months'''''<BR> OR <BR> ▸ '''''[[Isoniazid]] 10 mg/kg PO 3 times per week × 2 months''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 10 mg/kg PO qd × 2 months'''''<BR> OR <BR> ▸ '''''[[Rifampicin]] 10 mg/kg PO 3 times per week × 2 months''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrazinamide]] 25 mg/kg PO qd × 2 months'''''<BR> OR <BR> ▸ '''''[[Pyrazinamide]] 35 mg/kg PO 3 times per week × 2 months''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]] 15 mg/kg PO qd × 2 months'''''<BR> OR <BR> ▸ '''''[[Streptomycin]] 15 mg/kg PO 3 times per week × 2 months''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Continuation Phase''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 5 mg/kg PO qd × 4 months'''''<BR> OR <BR> ▸ '''''[[Isoniazid]] 10 mg/kg PO 3 times per week × 2 months''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 10 mg/kg PO qd × 4 months'''''<BR> OR <BR> ▸ '''''[[Rifampicin]] 10 mg/kg PO 3 times per week × 2 months''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Treatment of Tuberculosis: Guidelines.''<ref>{{Cite book | last1 = | first1 = | last2 = | first2 = | title = Treatment of tuberculosis : guidelin | date = 2010 | publisher = World Health Organization | location = Geneva | isbn = 978-92-4-154783-3 | pages = }}</ref></SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table29" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Borrelia burgdorferi''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 g IV q24h × 10—28 days''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q8h × 10—28 days'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 3—4 MU IV q4h × 10—28 days'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100—200 mg PO q12h × 10—28 days''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2006;43(9):1089-134.''<ref name="Wormser-2006">{{Cite journal | last1 = Wormser | first1 = GP. | last2 = Dattwyler | first2 = RJ. | last3 = Shapiro | first3 = ED. | last4 = Halperin | first4 = JJ. | last5 = Steere | first5 = AC. | last6 = Klempner | first6 = MS. | last7 = Krause | first7 = PJ. | last8 = Bakken | first8 = JS. | last9 = Strle | first9 = F. | 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 = Clin Infect Dis | volume = 43 | issue = 9 | pages = 1089-134 | month = Nov | year = 2006 | doi = 10.1086/508667 | PMID = 17029130 }}</ref></SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table30" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Treponema pallidum''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Preferred Regimen''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 3—4 MU IV q4h × 10—14 days''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Alternative Regimen''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Procaine penicillin]] 2.4 MU IM q24h × 10—14 days''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Probenecid]] 500 mg PO q6h × 10—14 days''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''MMWR Recomm Rep. 2006;55(RR-11):1-94.''<ref name="Workowski-2006">{{Cite journal | last1 = Workowski | first1 = KA. | last2 = Berman | first2 = SM. | title = Sexually transmitted diseases treatment guidelines, 2006. | journal = MMWR Recomm Rep | volume = 55 | issue = RR-11 | pages = 1-94 | month = Aug | year = 2006 | doi = | PMID = 16888612 }}</ref></SMALL> | |||
|- | |- | ||
|} | |} | ||
Line 1,028: | Line 1,015: | ||
|} | |} | ||
==Pathogen-Based Therapy — Fungi, Helminths, Protozoan, Viruses== | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | |||
{| | |||
| valign=top | | |||
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Fungi''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table31" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Blastomyces dermatitidis''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table32" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Candida spp.''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table33" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Coccidioides immitis''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table34" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Cryptococcus neoformans''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table35" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Histoplasma capsulatum''''' | |||
</font> | |||
</div> | |||
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Helminths''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table36" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Angiostrongylus cantonensis''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table37" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Baylisascaris procyonis''''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table38" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Gnathostoma spinigerum''''' | |||
</font> | |||
</div> | |||
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Protozoan''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table39" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Naegleria fowleri'''''</font> | |||
</div> | |||
<div class="mw-customtoggle-table40" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Toxoplasma gondii'''''</font> | |||
</div> | |||
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Viruses''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table41" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''''Herpesvirus'''''</font> | |||
</div> | |||
| valign=top | | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table31" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Blastomyces dermatitidis''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 5mg/kg/day IV × 4—6 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY | |||
|- | |||
| style="font-size: 85%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 800 mg PO qd × ≥12 months until CSF abnl resolves'''''<BR> OR <BR> ▸ '''''[[Itraconazole]] 200 mg PO bid—tid × ≥12 months until CSF abnl resolves'''''<BR> OR <BR> ▸ '''''[[Voriconazole]] 200—400 mg PO bid × ≥12 months until CSF abnl resolves''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2008;46(12):1801-12.''<ref name="Chapman-2008">{{Cite journal | last1 = Chapman | first1 = SW. | last2 = Dismukes | first2 = WE. | last3 = Proia | first3 = LA. | last4 = Bradsher | first4 = RW. | last5 = Pappas | first5 = PG. | last6 = Threlkeld | first6 = MG. | last7 = Kauffman | first7 = CA. | title = Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 46 | issue = 12 | pages = 1801-12 | month = Jun | year = 2008 | doi = 10.1086/588300 | PMID = 18462107 }}</ref></SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table32" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Candida spp.''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 3—5 mg/kg/day IV''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Flucytosine]] 25 mg/kg PO qid''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 85%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400—800 mg PO qd (6—12 mg/kg IV q24h)'''''<BR> OR <BR> ▸ '''''[[Voriconazole]] 400 mg PO bid × 2 doses''''' FOLLOWED BY '''''200 mg PO bid'''''<BR> OR <BR> ▸ '''''[[Voriconazole]] 6 mg/kg IV q12h × 2 doses''''' FOLLOWED BY '''''3 mg/kg IV q12h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2009;48(5):503-35.''<ref name="Pappas-2009">{{Cite journal | last1 = Pappas | first1 = PG. | last2 = Kauffman | first2 = CA. | last3 = Andes | first3 = D. | last4 = Benjamin | first4 = DK. | last5 = Calandra | first5 = TF. | last6 = Edwards | first6 = JE. | last7 = Filler | first7 = SG. | last8 = Fisher | first8 = JF. | last9 = Kullberg | first9 = BJ. | title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 48 | issue = 5 | pages = 503-35 | month = Mar | year = 2009 | doi = 10.1086/596757 | PMID = 19191635 }}</ref></SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table33" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Coccidioides immitis''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400 mg PO qd''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO bid—tid''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2005;41(9):1217-23.''<ref name="Galgiani-2005">{{Cite journal | last1 = Galgiani | first1 = JN. | last2 = Ampel | first2 = NM. | last3 = Blair | first3 = JE. | last4 = Catanzaro | first4 = A. | last5 = Johnson | first5 = RH. | last6 = Stevens | first6 = DA. | last7 = Williams | first7 = PL. | title = Coccidioidomycosis. | journal = Clin Infect Dis | volume = 41 | issue = 9 | pages = 1217-23 | month = Nov | year = 2005 | doi = 10.1086/496991 | PMID = 16206093 }}</ref></SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table34" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''C. neoformans, HIV–infected''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Preferred Regimen 1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] 0.7—1.0 mg/kg IV q24h for ≥2 weeks'''''<BR> OR <BR> ▸ '''''[[Liposomal Amphotericin B]] 3—4 mg/kg IV q24h for ≥2 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg IV q24h for ≥2 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Flucytosine]] 25 mg/kg PO q6h for ≥2 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Preferred Regimen 2 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] 0.7—1.0 mg/kg IV q24h for 4—6 weeks'''''<BR> OR <BR> ▸ '''''[[Liposomal Amphotericin B]] 3—4 mg/kg IV q24h for 4—6 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg IV q24h for 4—6 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Alternative Regimen 1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] 0.7 mg/kg IV q24h for 2 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 800 mg PO q24h for 2 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Alternative Regimen 2 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 1200 mg PO q24h for 6 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Flucytosine]] 100 mg/kg PO q24h for 6 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Alternative Regimen 3 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 800—2000 mg PO q24h for 10—12 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Alternative Regimen 4 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h for 10—12 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Consolidation Therapy''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400 mg PO q24h for 8 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Maintenance Therapy''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 200 mg PO q24h for ≥1 year'''''<BR> OR <BR> ▸ '''''[[Itraconazole]] 400 mg PO q24h for ≥1 year'''''<BR> OR <BR> ▸ '''''[[Amphotericin B]] 1.0 mg/kg/week IV for ≥1 year''''' | |||
|- | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''C. neoformans, Organ Transplant Recipients''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 3—4 mg/kg IV q24h for ≥2 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg IV q24h for ≥2 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Flucytosine]] 25 mg/kg PO q6h for ≥2 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 3—4 mg/kg IV q24h for 4—6 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg IV q24h for 4—6 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Consolidation Therapy''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400—800 mg PO q24h for 8 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Maintenance Therapy''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 200—400 mg PO q24h for 6—12 months''''' | |||
|- | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''C. neoformans, Non–HIV-Infected and Nontransplant Hosts''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Induction Therapy:''' Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] 0.7—1.0 mg/kg IV q24h for 4—6 weeks'''''<BR> OR <BR> ▸ '''''[[Liposomal Amphotericin B]] 3—4 mg/kg IV q24h for 4—6 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg IV q24h for 4—6 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Flucytosine]] 25 mg/kg PO q6h for 4—6 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Consolidation Therapy''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400—800 mg PO q24h for 8 weeks''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | '''Maintenance Therapy''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 200 mg PO q24h for 6—12 months''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2010;50(3):291-322.''<ref name="Perfect-2010">{{Cite journal | last1 = Perfect | first1 = JR. | last2 = Dismukes | first2 = WE. | last3 = Dromer | first3 = F. | last4 = Goldman | first4 = DL. | last5 = Graybill | first5 = JR. | last6 = Hamill | first6 = RJ. | last7 = Harrison | first7 = TS. | last8 = Larsen | first8 = RA. | last9 = Lortholary | first9 = O. | title = Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. | journal = Clin Infect Dis | volume = 50 | issue = 3 | pages = 291-322 | month = Feb | year = 2010 | doi = 10.1086/649858 | PMID = 20047480 }}</ref></SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table35" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Histoplasma capsulatum''}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; text-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 5 mg/kg IV q24h for 4—6 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO bid—tid for ≥12 months''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2007;45(7):807-25.''<ref name="Wheat-2007">{{Cite journal | last1 = Wheat | first1 = LJ. | last2 = Freifeld | first2 = AG. | last3 = Kleiman | first3 = MB. | last4 = Baddley | first4 = JW. | last5 = McKinsey | first5 = DS. | last6 = Loyd | first6 = JE. | last7 = Kauffman | first7 = CA. | title = Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 45 | issue = 7 | pages = 807-25 | month = Oct | year = 2007 | doi = 10.1086/521259 | PMID = 17806045 }}</ref></SMALL> | |||
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==References== | ==References== |
Revision as of 19:14, 20 February 2014
Meningitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3], Sheng Shi, M.D. [4]
Overview
Acute bacterial meningitis is a medical emergency; commence empiric treatment after obtaining blood and/or cerebrospinal fluid (CSF) cultures if the possibility of bacterial meningitis becomes evident. Once a bacterial etiology has been identified on a CSF Gram stain, treatment regimen should be optimized accordingly. Further modifications may be required after the culture and/or in vitro susceptibility results are available. Neuroimaging (such as CT scan and MRI) or lumbar puncture must not delay antimicrobial therapy.
Principles of Therapy for Bacterial Meningitis
Factors Determining Antimicrobial Activity
- Factors determine the acitivity of antimicrobial agents include pharmacodynamics, pharmacokinetics, penetration into the CSF, and bactericidal activity within the CSF.[1]
- Beta-lactams, aminoglycosides, glycopeptides, linezolid, and daptomycin are considered to have poor penetration into the CSF, while fluoroquinolones, chloramphenicol, aztreonam, and tigecycline generally achieve minimum inhibitory concentration (MIC) in the CSF at standard dosage.[2]
- Aminoglycosides and fluoroquinolones express a concentration-dependent manner of bactericidal activity; beta-lactams typically follow a a time-dependent antimicrobial pattern (i.e., the activity is dependent on the time that CSF concentration exceeds MIC as a proportion of the dosing interval).
- Penetration into the CSF is less prominent for drugs with a high molecular weight, high protein-binding ability, low lipid solubility, and drugs that are subject to active transport in the choroid plexus such as penicillins and cephalosporins. Toxicity due to dose escalation may limit the usage the aminoglycosides, glycopeptides, and polymyxins, thus intrathecal or intraventricular administration might be occasionally required (see table below).
Antimicrobial Agent | Daily Intraventricular Dose |
▸ Vancomycin | 5—20 mg |
▸ Gentamicin | 4—8 mg |
▸ Tobramycin | 5—20 mg |
▸ Amikacin | 5—50 mg |
▸ Polymyxin B | 5 mg |
▸ Colistin | 10 mg |
▸ Quinupristin/Dalfopristin | 2—5 mg |
▸ Teicoplanin | 5—40 mg |
▸ Amphotericin B | 0.1—0.5 mg/day |
Duration of Antimicrobial Therapy
- The duration of therapy in patients with bacterial meningitis has not been well-supported by evidence-based data.
- The IDSA Practice Guideline provides recommendations on the duration of antimicrobial agents based on microorganisms (see table below). However, the duration of antimicrobial therapy should be individualized in accordance with patient's clinical response.
- Maximum parenteral dosage should be maintained throughout the recommended duration of therapy to ensure adequate bactericidal concentrations are attained since antimicrobial entry attenuates as meningeal inflammation subsides, especially when dexamethasone is co-administered.
Microorganism | Duration of Therapy |
▸ Neisseria meningitidis | 7 days |
▸ Haemophilus influenzae | 7 days |
▸ Streptococcus pneumoniae | 10—14 days |
▸ Streptococcus agalactiae | 14—21 days |
▸ Aerobic Gram-negative bacilli | 21 days |
▸ Listeria monocytogenes | ≥21 days |
Adjunctive Dexamethasone Therapy
- Evidences for beneficial effects of dexamethasone are variable. In some studies, adjunctive use of dexamethasone for bacterial meningitis in selected groups are associated with an improved survival or prognosis.[7][8][9][10][11][12] However, other studies fail to demonstrate a substantial reduction of death or neurological disability.[3][13][14][15] The occurrence of delayed cerebral thrombosis with dexamethasone therapy has been reported.[16]
- In infants and children with Haemophilus influenzae type b meningitis, the IDSA Practice Guideline supports the use of adjunctive Dexamethasone at 0.15 mg/kg q6h for 2—4 days with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose.[6]
- In adults with suspected or proven Streptococcus pneumoniae meningitis, the IDSA also recommends Dexamethasone at 0.15 mg/kg q6h for 2—4 days with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose. Dexamethasone should only be continued if the CSF Gram stain reveals Gram-positive diplococci, or if blood or CSF cultures are positive for S. pneumoniae. In this scenario, certain authorities advocate the addition of rifampin to the empirical combination of vancomycin plus a third-generation cephalosporin pending culture results and in vitro susceptibility testing.[6][17]
- Dexamethasone should not be given to patients who have already received animicrobial therapy because it is unlikely to improve clinical outcome.[6]
Empiric Therapy Adapted from Lancet. 2012;380(9854):1693-702.[18] and N Engl J Med. 2010;362(2):146-54.[3]
▸ Click on the following categories to expand treatment regimens.
Community-Acquired ▸ Newborns, Age <1 Week ▸ Newborns, Age 1—4 Weeks ▸ Infants & Children ▸ Adults, Age <50 Years ▸ Adults, Age >50 Years ▸ Immunocompromised ▸ Recurrent Nosocomial ▸ Postneurosurgical Infection ▸ CSF Shunt Infection ▸ Penetrating Trauma ▸ Basilar Skull Fracture |
|
CSF Gram Stain-Based Therapy Adapted from Lancet. 2012;380(9854):1693-702.[18] and Clin Infect Dis. 2004;39(9):1267-84.[6]
▸ Click on the following categories to expand treatment regimens.
Gram-Positive ▸ Gram-Positive Cocci in Chains ▸ Gram-Positive Cocci in Pairs ▸ Gram-Positive (Cocco-)Bacilli Gram-Negative ▸ Gram-Negative Cocci in Pairs ▸ Gram-Negative Coccobacilli ▸ Gram-Negative Bacilli |
|
Pathogen-Based Therapy — Bacteria Adapted from Lancet. 2012;380(9854):1693-702.[18] and Clin Infect Dis. 2004;39(9):1267-84.[6]
▸ 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 |
|
Pathogen-Based Therapy — Fungi, Helminths, Protozoan, Viruses
▸ Click on the following categories to expand treatment regimens.
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 |
|
References
- ↑ Andes, DR.; Craig, WA. (1999). "Pharmacokinetics and pharmacodynamics of antibiotics in meningitis". Infect Dis Clin North Am. 13 (3): 595–618. PMID 10470557. Unknown parameter
|month=
ignored (help) - ↑ Nau, R.; Sörgel, F.; Eiffert, H. (2010). "Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections". Clin Microbiol Rev. 23 (4): 858–83. doi:10.1128/CMR.00007-10. PMID 20930076. Unknown parameter
|month=
ignored (help) - ↑ 3.0 3.1 3.2 van de Beek, D.; Drake, JM.; Tunkel, AR. (2010). "Nosocomial bacterial meningitis". N Engl J Med. 362 (2): 146–54. doi:10.1056/NEJMra0804573. PMID 20071704. Unknown parameter
|month=
ignored (help) - ↑ Rodríguez Guardado, A.; Blanco, A.; Asensi, V.; Pérez, F.; Rial, JC.; Pintado, V.; Bustillo, E.; Lantero, M.; Tenza, E. (2008). "Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments". J Antimicrob Chemother. 61 (4): 908–13. doi:10.1093/jac/dkn018. PMID 18281693. Unknown parameter
|month=
ignored (help) - ↑ Cruciani, M.; Navarra, A.; Di Perri, G.; Andreoni, M.; Danzi, MC.; Concia, E.; Bassetti, D. (1992). "Evaluation of intraventricular teicoplanin for the treatment of neurosurgical shunt infections". Clin Infect Dis. 15 (2): 285–9. PMID 1387805. Unknown parameter
|month=
ignored (help) - ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: [1]
- ↑ Lebel, MH.; Freij, BJ.; Syrogiannopoulos, GA.; Chrane, DF.; Hoyt, MJ.; Stewart, SM.; Kennard, BD.; Olsen, KD.; McCracken, GH. (1988). "Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials". N Engl J Med. 319 (15): 964–71. doi:10.1056/NEJM198810133191502. PMID 3047581. Unknown parameter
|month=
ignored (help) - ↑ Odio, CM.; Faingezicht, I.; Paris, M.; Nassar, M.; Baltodano, A.; Rogers, J.; Sáez-Llorens, X.; Olsen, KD.; McCracken, GH. (1991). "The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis". N Engl J Med. 324 (22): 1525–31. doi:10.1056/NEJM199105303242201. PMID 2027357. Unknown parameter
|month=
ignored (help) - ↑ Thwaites, GE.; Nguyen, DB.; Nguyen, HD.; Hoang, TQ.; Do, TT.; Nguyen, TC.; Nguyen, QH.; Nguyen, TT.; Nguyen, NH. (2004). "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults". N Engl J Med. 351 (17): 1741–51. doi:10.1056/NEJMoa040573. PMID 15496623. Unknown parameter
|month=
ignored (help) - ↑ Brouwer, MC.; Heckenberg, SG.; de Gans, J.; Spanjaard, L.; Reitsma, JB.; van de Beek, D. (2010). "Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis". Neurology. 75 (17): 1533–9. doi:10.1212/WNL.0b013e3181f96297. PMID 20881273. Unknown parameter
|month=
ignored (help) - ↑ Fritz, D.; Brouwer, MC.; van de Beek, D. (2012). "Dexamethasone and long-term survival in bacterial meningitis". Neurology. 79 (22): 2177–9. doi:10.1212/WNL.0b013e31827595f7. PMID 23152589. Unknown parameter
|month=
ignored (help) - ↑ Peltola, H.; Roine, I.; Fernández, J.; Zavala, I.; Ayala, SG.; Mata, AG.; Arbo, A.; Bologna, R.; Miño, G. (2007). "Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial". Clin Infect Dis. 45 (10): 1277–86. doi:10.1086/522534. PMID 17968821. Unknown parameter
|month=
ignored (help) - ↑ Peltola, H.; Roine, I.; Fernández, J.; González Mata, A.; Zavala, I.; Gonzalez Ayala, S.; Arbo, A.; Bologna, R.; Goyo, J. (2010). "Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol". Pediatrics. 125 (1): e1–8. doi:10.1542/peds.2009-0395. PMID 20008417. Unknown parameter
|month=
ignored (help) - ↑ Nguyen, TH.; Tran, TH.; Thwaites, G.; Ly, VC.; Dinh, XS.; Ho Dang, TN.; Dang, QT.; Nguyen, DP.; Nguyen, HP. (2007). "Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis". N Engl J Med. 357 (24): 2431–40. doi:10.1056/NEJMoa070852. PMID 18077808. Unknown parameter
|month=
ignored (help) - ↑ Molyneux, EM.; Walsh, AL.; Forsyth, H.; Tembo, M.; Mwenechanya, J.; Kayira, K.; Bwanaisa, L.; Njobvu, A.; Rogerson, S. (2002). "Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial". Lancet. 360 (9328): 211–8. PMID 12133656. Unknown parameter
|month=
ignored (help) - ↑ Schut, ES.; Brouwer, MC.; de Gans, J.; Florquin, S.; Troost, D.; van de Beek, D. (2009). "Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis". Neurology. 73 (23): 1988–95. doi:10.1212/WNL.0b013e3181c55d2e. PMID 19890068. Unknown parameter
|month=
ignored (help) - ↑ van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) Community-acquired bacterial meningitis in adults. N Engl J Med 354 (1):44-53. DOI:10.1056/NEJMra052116 PMID: 16394301
- ↑ 18.0 18.1 18.2 van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter
|month=
ignored (help) - ↑ Treatment of tuberculosis : guidelin. Geneva: World Health Organization. 2010. ISBN 978-92-4-154783-3.
- ↑ Wormser, GP.; Dattwyler, RJ.; Shapiro, ED.; Halperin, JJ.; Steere, AC.; Klempner, MS.; Krause, PJ.; Bakken, JS.; Strle, F. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130. Unknown parameter
|month=
ignored (help) - ↑ Workowski, KA.; Berman, SM. (2006). "Sexually transmitted diseases treatment guidelines, 2006". MMWR Recomm Rep. 55 (RR-11): 1–94. PMID 16888612. Unknown parameter
|month=
ignored (help) - ↑ Chapman, SW.; Dismukes, WE.; Proia, LA.; Bradsher, RW.; Pappas, PG.; Threlkeld, MG.; Kauffman, CA. (2008). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clin Infect Dis. 46 (12): 1801–12. doi:10.1086/588300. PMID 18462107. Unknown parameter
|month=
ignored (help) - ↑ Pappas, PG.; Kauffman, CA.; Andes, D.; Benjamin, DK.; Calandra, TF.; Edwards, JE.; Filler, SG.; Fisher, JF.; Kullberg, BJ. (2009). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clin Infect Dis. 48 (5): 503–35. doi:10.1086/596757. PMID 19191635. Unknown parameter
|month=
ignored (help) - ↑ Galgiani, JN.; Ampel, NM.; Blair, JE.; Catanzaro, A.; Johnson, RH.; Stevens, DA.; Williams, PL. (2005). "Coccidioidomycosis". Clin Infect Dis. 41 (9): 1217–23. doi:10.1086/496991. PMID 16206093. Unknown parameter
|month=
ignored (help) - ↑ Perfect, JR.; Dismukes, WE.; Dromer, F.; Goldman, DL.; Graybill, JR.; Hamill, RJ.; Harrison, TS.; Larsen, RA.; Lortholary, O. (2010). "Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america". Clin Infect Dis. 50 (3): 291–322. doi:10.1086/649858. PMID 20047480. Unknown parameter
|month=
ignored (help) - ↑ Wheat, LJ.; Freifeld, AG.; Kleiman, MB.; Baddley, JW.; McKinsey, DS.; Loyd, JE.; Kauffman, CA. (2007). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (7): 807–25. doi:10.1086/521259. PMID 17806045. Unknown parameter
|month=
ignored (help)