Sandbox ID Central Nervous System

Brain abscess

Primary or contiguous source

Preferred regimen:(cefotaxime 2 gm IV q4h OR ceftriaxone 2 gm IV q12h) AND (metronidazole 7.5 mg/kg q6h OR 15 mg/kg IV q12h)

Alternative regimen: Penicillin G 3-4 million units IV q4h AND metronidazole 7.5 mg/kg q6h or 15 mg/kg IV q12h

Post-surgical, post-traumatic

Preferred regimen: (Nafcillin OR oxacillin) 2 gm IV q4h AND (cefotaxime 2 gm IV q4h OR ceftriaxone 2 gm IV q12h)

Alternative regimen:

HIV-1 infected (AIDS)

Preferred regimen: (Pyrimethamine 200 mg x 1 po, then 75 mg/day po) AND (sulfadiazine [Wt based dose: 1 gm if <60 kg, 1.5 gm if ≥60 kg] po q6h) AND folinic acid 10–25 mg/day po for minimum of 6 wks after resolution of signs/symptoms OR TMP-SMX 10/50 mg/kg per day po or IV div. q12h x 30 days
Alternative regimen: Pyrimethamine + folinic acid (as in primary regimen) AND 1 of the following: (1) Clindamycin 600 mg po/IV q6h OR (2)TMP-SMX 5/25 mg/kg/day po OR IV bid OR (3)atovaquone 750 mg po q6h for 4–6 wks after resolution of signs/symptoms.

Encephalitis

Viruses

Adenovirus

Preferred regimen: supportive

B virus

prophylactic antiviral therapy after bite or scratch

Preferred regimen: Valacyclovir

established disease

Preferred regimen: Valacyclovir OR Acyclovir OR Ganciclovir

CMV

Preferred regimen: Ganciclovir AND foscarnet

Eastern equine encephalitis virus

Preferred regimen: supportive

EBV

Preferred regimen: supportive AND Corticosteroids

Hendra virus

Preferred regimen: supportive

HHV-6

Preferred regimen: Ganciclovir OR Foscarnet

HIV

Preferred regimen: HAART

HSV-1 and -2

Preferred regimen: Acyclovir

Influenza virus

Preferred regimen: Oseltamivir

Japanese encephalitis virus

Preferred regimen: supportive

JC virus

Preferred regimen: Reversal or control of immunosuppression AND HAART in patients with AIDS

La Crosse virus

Preferred regimen: supportive

Measles virus

life-threatening disease

Preferred regimen: Ribavirin

SSPE

Preferred regimen: Ribavirin intrathecal

Mumps virus

Preferred regimen: supportive

Murray Valley encephalitis virus

Preferred regimen: supportive

Nipah virus

Preferred regimen: supportive AND Ribavirin

Nonpolio enteroviruses

Preferred regimen: supportive AND Intraventricular γ-globulin (for chronic and/or severe disease)

Poliovirus

Preferred regimen: supportive

Powassan virus

Preferred regimen: supportive

Rabies virus

postxposure prophylaxis

Preferred regimen: rabies immunoglobulin AND vaccine

after onset of disease

Preferred regimen: supportive

Rubella virus

Preferred regimen: supportive

St. Louis encephalitis virus

Preferred regimen: supportive
Alternative regimen: IFN-a-2b

Tickborne encephalitis virus

Preferred regimen: supportive

Vaccinia

Preferred regimen: supportive ± Corticosteroids

Venezuelan equine encephalitis virus

Preferred regimen: supportive

VZV

Preferred regimen: Acyclovir ± Corticosteroids
Preferred regimen: Ganciclovir ± Corticosteroids

West Nile virus

Preferred regimen: supportive

Western equine encephalitis virus

Preferred regimen: supportive

Bacteria

Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)

Preferred regimen: Doxycycline

Bartonella bacilliformis (Oroya fever)

Preferred regimen: Chloramphenicol OR Ciprofloxacin] OR Doxycycline OR Ampicillin OR trimethoprim-sulfamethoxazole

Bartonella henselae (Cat scratch disease)

Preferred regimen: Doxycycline OR Azithromycin ± Rifampin

Borrelia burgdorferi (Lyme disease)

preferred regimen: Ceftriaxone OR Cefotaxime OR Penicillin G

Coxiella burnetii (Q fever)

Preferred regimen: Doxycycline AND Fluoroquinolone AND Rifampin

Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)

Preferred regimen: Doxycycline

Listeria monocytogenes

Preferred regimen: Ampicillin OR Trimethoprim-sulfamethoxazole AND Gentamicin

Mycobacterium tuberculosis

with meningitis

Preferred regimen: Dexamethasone

without meningitis

Preferred regimen: Isoniazid OR Rifampin OR Pyrazinamide OR Ethambutol

Mycoplasma pneumoniae

Preferred regimen: Azithromycin OR Doxycycline OR Fluoroquinolone

Rickettsia rickettsii (Rocky Mountain spotted fever)

Preferred regimen: Doxycycline
Alternative regimen: Chloramphenicol

Treponema pallidum (syphilis)

preferred regimen: Ceftriaxone OR Penicillin G

Tropheryma whipplei (Whipple's disease)

Preferred regimen: Ceftriaxone for 2–4 weeks, followed by Trimethoprim-sulfamethoxazole OR Cefixime for 1–2 years

Fungi

Coccidioides

Preferred regimen: Fluconazole
Alternative regimen: Itraconazole OR Voriconazole OR Amphotericin B (intravenous and intrathecal)

Cryptococcus neoformans

Preferred regimen: Amphotericin B deoxycholate AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks ORv Lipid formulation of amphotericin B AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks OR Amphotericin B AND flucytosine for 6–10 weeks

Histoplasma capsulatum

Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities

Protozoa

Acanthamoeba

Preferred regimen: Trimethoprim-sulfamethoxazole AND rifampin AND ketoconazole OR Fluconazole AND sulfadiazine AND pyrimethamine

Balamuthia mandrillaris

Preferred regimen: Azithromycin OR Clarithromycin AND pentamidine AND flucytosine AND fluconazole AND sulfadiazine AND thioridazine OR trifluoperazine

Naegleria fowleri

Preferred regimen: Amphotericin B (intravenous and intrathecal) AND rifampin AND azithromycin OR sulfisoxazole OR miconazole

Plasmodium falciparum

Preferred regimen: Quinine OR quinidine OR artesunate OR artemether
Alternative regimen: Atovaquone OR proguanil OR Exchange transfusion (less than 10% parasitemia or cere- bral malaria)

Toxoplasma gondii

Preferred regimen: Pyrimethamine AND Sulfadiazine OR Clindamycin [[and}} Pyrimethamine
Alternative regimen (1): Trimethoprim-sulfamethoxazole
Alternative regimen (2): Pyrimethamine AND atovaqone OR Pyrimethamine AND clarithromycin OR Pyrimethamine AND azithromycin OR Pyrimethamine AND dapsone

Trypanosoma brucei gambiense (West African trypanosomiasis)

Preferred regimen: Eflornithine OR Melarsoprol

Trypanosoma brucei rhodesiense (East African trypanosomiasis)

Preferred regimen: Melarsoprol

Helminths

Baylisascaris procyonis

Preferred regimen: Corticosteroids
Alternative regimen: Albendazole AND diethylcarbamazine

Gnathostoma

Preferred regimen: Albendazole OR Ivermectin

Taenia solium (cysticercosis)

Preferred regimen: Albendazole OR Corticosteroids
Alternative regimen: Praziquantel

Prion

Human transmissible spongiform encephalopathy

Preferred regimen: supportive

Epidural abscess

Lyme neuroborreliosis

Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines^[1]

Early neurologic disease

Cranial nerve palsy (adult)

Preferred regimen: Amoxicillin 500 mg PO tid for 14 (14–21) days OR Doxycycline 100 mg PO bid for 14 (14–21) days OR Cefuroxime 500 mg PO bid for 14 (14–21) days
Alternative regimen: Azithromycin 500 mg PO qd for 7–10 days OR Clarithromycin 500 mg PO bid for 14–21 days (not for pregnant) OR Erythromycin 500 mg PO qid for 14–21 days

Cranial nerve palsy (pediatric)

Preferred regimen: Amoxicillin 50 mg/kg/day PO in 3 divided doses, max 500 mg/dose for 14 (14–21) days OR Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO q12h, max 100 mg/dose for 14 (14–21) days OR Cefuroxime 30 mg/kg/day PO q12h, max 500 mg/dose for 14 (14–21) days
Alternative regimen: Azithromycin 10 mg/kg/day PO, max 500 mg/dose for 7–10 days OR Clarithromycin 7.5 mg/kg PO bid, max 500 mg/dose for 14–21 days OR Erythromycin 12.5 mg/kg PO aid, max 500 mg/dose for 14–21 days

Meningitis or radiculopathy (adult)

Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days.
Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days

Note: for nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV q12h may be considered.

Meningitis or radiculopathy (pediatric)

Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h, max 2 g/day for 14 (10–28) days
Alternative regimen: Cefotaxime 150–200 mg/kg/day IV in 3–4 divided doses, max 6 g/day for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days

Note: for children ≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered.

Late neurologic disease

Central or peripheral nervous system disease (adult)

Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days

Central or peripheral nervous system disease (pediatric)

Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h, max 2 g for 14 (10–28) days.
Alternative regimen: Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days

American Academy of Neurology (AAN) Practice Parameter^[2]

Meningitis

Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
Alternative regimen: Doxycycline 100–200 mg BID for 14 days
Pediatric dose: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day

Any neurologic syndrome with CSF pleocytosis

Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
Alternative regimen: Doxycycline 100–200 mg BID for 14 days
Pediatric dose: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day

Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)

Preferred regimen: Doxycycline 100–200 mg BID for 14 days
Alternative regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
Pediatric dose: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day

Encephalomyelitis

Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
Pediatric dose: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day

Encephalopathy

Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
Pediatric dose: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day

Post-treatment Lyme syndrome

Preferred regimen: symptomatic management; antibiotics not indicated

Meningitis, bacteria

Streptococcus pneumoniae (adult)

Penicillin MIC

<0.1 μg/mL

Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR chloramphenicol 4-6g qid

0.1–1.0 μg/mL

Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
Alternative regimen: Cefepime 6g tid OR meropenem 6g tid

≥2.0 μg/mL

Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND Ceftriaxone 4g bid/OD OR Vancomycin 30–45 mg/kg tid/bid AND cefotaxime 8-12g 4-6 times per day
Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL

Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND Ceftriaxone 4g bid/OD OR Vancomycin 30–45 mg/kg tid/bid AND cefotaxime 8-12g 4-6 times per day
Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

Streptococcus pneumoniae (pediatric)

Penicillin MIC

<0.1 μg/mL

Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children

0.1–1.0 μg/mL

Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
Alternative regimen: Cefepime 150 mg/kg tid for children OR meropenem 120 mg/kg tid for children

≥2.0 μg/mL

Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL

Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

Neisseria meningitidis (adult)

Penicillin MIC

<0.1 μg/mL

Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR chloramphenicol 4-6g qid

0.1–1.0 μg/mL

Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
Alternative regimen: chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 6g tid

Neisseria meningitidis (pediatric)

Penicillin MIC

<0.1 μg/mL

Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children

0.1–1.0 μg/mL

Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
Alternative regimen: chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children

Listeria monocytogenes (adult)

Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid {{or]} meropenem 6g tid

Listeria monocytogenes (pediatric)

Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
Alternative regimen: Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children {{or]} meropenem 120 mg/kg tid for children

Streptococcus agalactiae (adult)

Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day

Streptococcus agalactiae (pediatric)

Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children

Escherichia coli and other Enterobacteriaceae (adult)

Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
Alternative regimen: Aztreonam 6–8 g tid/qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 6g tid OR Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid {{or]} ampicillin 12g 6 times per day

Escherichia coli and other Enterobacteriaceae (pediatric)

Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children OR Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children

Pseudomonas aeruginosa (adult)

Preferred regimen: Cefepime 6g tid OR ceftazidime 6g tid
Alternative regimen: Aztreonam 6–8 g tid/qid OR ciprofloxacin 800–1200 mg bid/tid {or}} meropenem 6g tid

Pseudomonas aeruginosa (pediatric)

Preferred regimen: Cefepime 150 mg/kg tid for children OR ceftazidime 100–150 mg/kg tid/bid for 0-7 days neonates; 150 mg/kg tid for 8-28 days neonates; 150 mg/kg tid for children
Alternative regimen: meropenem 120 mg/kg tid for children

Haemophilus influenzae (adult)

β-Lactamase negative

Preferred regimen: ampicillin 12g 6 times per day
Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

β-Lactamase positive

Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
Alternative regimen: Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

Haemophilus influenzae (pediatric)

β-Lactamase negative

Preferred regimen:ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

β-Lactamase positive

Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
Alternative regimen: Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD

Staphylococcus aureus (adult)

Methicillin susceptible

Preferred regimen: Nafcillin 9–12 g 6 times per day OR oxacillin 9–12 g 6 times per day
Alternative regimen: Vancomycin 30–45 mg/kg tid/bid OR meropenem 6g tid

Methicillin resistant

Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid OR linezolid

Staphylococcus aureus (pediatric)

Methicillin susceptible

Preferred regimen: Nafcillin 75 mg/kg bid/tid for 0-7 days neonates; 100–150 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children OR oxacillin 75 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children
Alternative regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children OR meropenem 120 mg/kg tid for children

Methicillin resistant

Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid for children OR linezolid

Staphylococcus epidermidis (adult)

Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
Alternative regimen: Linezolid

Staphylococcus epidermidis (pediatric)

Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
Alternative regimen: Linezolid

Enterococcus species (adult)

Ampicillin susceptible

Preferred regimen: ampicillin 12g 6 times per day AND gentamicin 5 mg/kg tid

Ampicillin resistant

Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND gentamicin 5 mg/kg tid

Ampicillin and vancomycin resistant

Preferred regimen: Linezolid

Enterococcus species (pediatric)

Ampicillin susceptible

Preferred regimen: ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children

Ampicillin resistant

Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children

Ampicillin and vancomycin resistant

Preferred regimen: Linezolid

Meningitis, MRSA

Preferred regimen: Vancomycin 15–20 mg/kg/dose IV every 8–12 h for 2 weeks
Alternative regimen: linezolid 600 mg PO/IV bid OR TMP-SMX 5 mg/kg/dose IV every 8–12 h
Pediatric regimen: Vancomycin 15 mg/kg/dose IV every 6 h OR linezolid 10 mg/kg/dose PO/IV every 8 h

NOTE: Some experts recommend the addition of rifampin 600 mg QD or 300–450 mg BID to vancomycin for adult patients. For children >12 years of age, linezolid 600 mg BID

Meningitis, tuberculous

Preferred regimen: 2 months of Isoniazid 5 (4–6)mg/kg OD AND Rifampicin 10 (8–12)mg/kg OD AND Pyrazinamide 25 (20–30)mg/kg OD AND Streptomycin 15 (12–18)mg/kg OD followed by 7-10 months of Isoniazid 5 (4–6)mg/kg OD AND Rifampicin 10 (8–12)mg/kg OD
Alternative regimen (1): 2 months of Isoniazid 5 (4–6)mg/kg OD AND Rifampicin 10 (8–12)mg/kg OD AND Pyrazinamide 25 (20–30)mg/kg OD AND Streptomycin 15 (12–18)mg/kg OD followed by 7-10 months of Isoniazid 10 (8–12)mg/kg 3 times per week AND Rifampicin 10 (8–12)mg/kg 3 times per week
Alternative regimen (2): 2 months of Isoniazid 10 (8–12)mg/kg 3 times per week AND Rifampicin 10 (8–12)mg/kg 3 times per week AND Pyrazinamide 35 (30–40)mg/kg 3 times per week AND Streptomycina 15 (12–18)mg/kg 3 times per week followed by 7-10 months of Isoniazid 10 (8–12)mg/kg 3 times per week AND Rifampicin 10 (8–12)mg/kg 3 times per week

Septic thrombosis of cavernous or dural venous sinus

Cavernous Sinus

Preferred regimen: (Vancomycin 13-20mcg/ml AND ceftriaxone 2mg IV q12h) AND metronidazole 500mg IV q8h (if dental/sinus source)

Alternative regimen: (Daptomycin 8-12mg/kg IV q24h OR Linezolid 600mg IV q12h) AND metronidazole 500mg IV q8h (if dental/sinus source)

Lateral Sinus

Preferred regimen: cefepime 2mg IV q8h AND metronidazole 500mg IV q8h AND vancomycin 15-20 mcg/ml

Alternative regimen: meropenem 1-2mg IV q8h AND Linezolid 600 mg IV q12h

Superior Sagittal Sinus

Preferred regimen: ceftriaxone 2 mg IV q12h AND vancomycin 15-20 mcg/ml AND dexamethasone
Alternative regimen: meropenem 1-2mg IV q8h AND vancomycin 15-20 mcg/ml AND dexamethasone

Septic thrombosis of cavernous or dural venous sinus, MRSA

Preferred regimen: Vancomycin 15–20 mg/kg/dose IV every 8–12 h OR Linezolid 600 mg PO/IV BID
Alternative regimen: TMP-SMX 5 mg/kg/dose PO/IV every 8-12 h
Pediatric regimen: Vancomycin 15 mg/kg/dose IV every 6 h OR Linezolid 10 mg/kg/dose PO/IV every 8 h