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Brucella

  • 1.Uncomplicated brucellosis in adults and children ≥8yrs of age[3], [4]
  • 2. Complications of brucellosis
  • 2.1 Spondylitis
  • 2.2 Neurobrucellosis
  • 2.3 Brucella endocarditis
  • 3. Pregnancy
  • Preferred regimen:Rifampin 900 mg PO qd for 6 weeks
  • Note: Adding Trimethoprim-sulfamethoxazole can be considered, but this option should probably be avoided preceding the 13th week and after the 36th week of gestation because of concern about teratogenicity and kernicterus.
  • 4.For children < 8 yrs of age







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  • Note: Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently
  • 2. Patients with Avian Influenza who have diarrhea and malabsorption
  • Preferred regimen (1): Zanamivir 10 mg inhaled bid for minimum 5 days
  • Preferred regimen (2): Peramivir600 mg IV as a single dose for 1 day
  • Note (1): Preliminary evidence demonstrates that Neuraminidase inhibitor can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
  • Note (2): The use of Corticosteroids is not recommended.
  • Note (3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
  • Note (4): The use of Amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.[7]
  • Note (5): Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.


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  • Neisseria gonorrhoeae, treatment[8]
  • 1. Gonococcal infections in adolescents and adults
  • 1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
  • Alternative regimen: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose (if ceftriaxone is not available)
  • 1.2 Uncomplicated gonococcal infections of the pharynx
  • 1.2.1 Management of sex partners
  • Expedited partner therapy: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose
  • Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
  • Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
  • Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
  • 1.2.2 Allergy, intolerance, and adverse reactions
  • Preferred regimen (1): Gemifloxacin 320 mg PO in a single dose AND Azithromycin 2 g PO in a single dose
  • Preferred regimen (2): Gentamicin 240 mg IM in a single dose AND Azithromycin 2 g PO in a single dose
  • Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).
  • 1.2.3 Pregnancy
  • 1.2.4 Suspected cephalosporin treatment failure
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Gemifloxacin 320 mg PO single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
  • Alternative regimen (2): Gentamicin 240 mg IM single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
  • Alternative regimen (3): Ceftriaxone 250 mg IM as a single dose AND Azithromycin 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
  • Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.
  • 1.3 Gonococcal conjunctivitis
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
  • Note: Consider one-time lavage of the infected eye with saline solution.
  • 1.3.1 Management of sex partners
  • Patients should be instructed to refer their sex partners for evaluation and treatment.
  • 1.4 Disseminated gonococcal infection
  • 1.4.1 Arthritis and arthritis-dermatitis syndrome
  • 1.4.2 Gonococcal meningitis and endocarditis
  • 2. Gonococcal infections among neonates
  • 2.1 Ophthalmia neonatorum caused by N. gonorrhoeae
  • Preferred regimen: Ceftriaxone 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg
  • 2.1.1 Management of mothers and their sex partners
  • Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
  • 2.2 Disseminated gonococcal infection and gonococcal scalp abscesses in neonates
  • Preferred regimen (1): Ceftriaxone 25-50 mg/kg/day IM/IV qd for 7 days
  • Preferred regimen (2): Cefotaxime 25 mg/kg IV /IM q12h for 7 days.
  • Note (1): The duration of treatment is 10-14 days if meningitis is documented.
  • Note (2): Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.
  • 2.2.1 Management of mothers and their sex partners
  • Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
  • 2.3 Neonates born to mothers who have gonococcal infection
  • Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
  • 2.3.1 Management of mothers and their sex partners
  • Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.
  • 3. Gonococcal infections among infants and children
  • 3.1 Infants and children who weigh ≤ 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis
  • Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
  • 3.2 Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis
  • Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
  • Alternative regimen: Cefixime 400 mg PO single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)
  • 3.3 Children who weigh ≤ 45 kg and who have bacteremia or arthritis
  • Preferred regimen: Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days
  • 3.4 Children who weigh > 45 kg and who have bacteremia or arthritis
  • Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days

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  • 1. Meningococcal meningitis or meningococcemia, treatment[9][10]
  • 1.1 Adults
  • 1.1.1 Penicillin MIC < 0.1 mcg/mL
  • Preferred regimen (1): Penicillin G 4 MU IV q4h for 7 days
  • Preferred regimen (2): Ampicillin 2 g IV q4h for 7 days
  • Alternative regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
  • Alternative regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
  • Alternative regimen (3): Chloramphenicol 4-6 g/day IV q6h for 7 days
  • 1.1.2 Penicillin MIC 0.1-1.0 mcg/mL
  • Preferred regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
  • Preferred regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
  • Alternative regimen (1): Cefepime 2 g IV q8h for 7 days
  • Alternative regimen (2): Chloramphenicol 4-6 g/day IV q6h for 7 days
  • Alternative regimen (3): Moxifloxacin 400 mg IV q24h for 7 days
  • Alternative regimen (4): Meropenem 2 g IV q8h for 7 days
  • 1.2 Neonates (birth-7 days old)
  • 1.2.1 Penicillin MIC < 0.1 mcg/mL
  • Preferred regimen (1): Penicillin G 0.15 MU/kg/day q8-12h for 7 days
  • Preferred regimen (2): Ampicillin 150 mg/kg/day q8h for 7 days
  • Alternative regimen (1): Cefotaxime 100-150 mg/kg/day IV q8-12h for 7 days
  • Alternative regimen (2): Chloramphenicol 25 mg/kg/day IV q24h for 7 days
  • 1.2.2 Penicillin MIC 0.1-1.0 mcg/mL
  • Preferred regimen: Cefotaxime 100-150 mg/kg/day IV q8-12h for 7 days
  • Alternative regimen: Chloramphenicol 25 mg/kg/day IV q24h for 7 days
  • 1.3 Neonates (8-28 days old)
  • 1.3.1 Penicillin MIC < 0.1 mcg/mL
  • Preferred regimen (1): Penicillin G 4 MU IV q4h for 7 days
  • Preferred regimen (2): Ampicillin 2 g IV q4h for 7 days
  • Alternative regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
  • Alternative regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
  • Alternative regimen (3): Chloramphenicol 4-6 g/day IV q6h for 7 days
  • 1.3.2 Penicillin MIC 0.1-1.0 mcg/mL
  • Preferred regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
  • Preferred regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
  • Alternative regimen (1): Cefepime 2 g IV q8h for 7 days
  • Alternative regimen (2): Chloramphenicol 4-6 g/day IV q6h for 7 days
  • Alternative regimen (3): Moxifloxacin 400 mg IV q24h for 7 days
  • Alternative regimen (4): Meropenem 2 g IV q8h for 7 days
  • 1.4 Infants and children
  • 1.4.1 Penicillin MIC < 0.1 mcg/mL
  • Preferred regimen (1): Penicillin G 4 MU IV q4h for 7 days
  • Preferred regimen (2): Ampicillin 2 g IV q4h for 7 days
  • Alternative regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
  • Alternative regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
  • Alternative regimen (3): Chloramphenicol 4-6 g/day IV q6h for 7 days
  • 1.4.2 Penicillin MIC 0.1-1.0 mcg/mL
  • Preferred regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
  • Preferred regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
  • Alternative regimen (1): Cefepime 2 g IV q8h for 7 days
  • Alternative regimen (2): Chloramphenicol 4-6 g/day IV q6h for 7 days
  • Alternative regimen (3): Moxifloxacin 400 mg IV q24h for 7 days
  • Alternative regimen (4): Meropenem 2 g IV q8h for 7 days
  • Note (1): Dexamethasone has not been shown to be beneficial in meningococcal meningitis and should be discontinued once this diagnosis is established.[11][12]
  • Note (2): Clinical data are limited on the use of fluoroquinolones for therapy for meningococcal meningitis but may be considered in patients not responding to standard therapy or when disease is caused by resistant organisms.
  • 2. Meningococcal meningitis, prophylaxis for household and close contacts[13]
  • 2.1 Adults
  • Preferred regimen (1):
  • Preferred regimen (2):
  • Preferred regimen (3):
  • 2.2 Children < 15 years
  • Preferred regimen:
  • 2.3 Children ≥ 1 month
  • Preferred regimen:
  • 2.4 Children < 1 month
  • Preferred regimen:

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  • 1. Acute Q fever
  • 1.1 Adults
  • Preferred Regimen: Doxycycline 100 mg PO bid for 14 days
  • 1.2 Children
  • 1.2.1 Children with age ≥8 years
  • Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum 100 mg per dose)
  • 1.2.2 Children with age <8 years with high risk criteria
  • Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)
  • 1.2.3 Children with age <8 years with mild or uncomplicated illness
  • Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 5 days (maximum 100 mg per dose).
  • 1.2.3 Children with age < 8 years with mild or uncomplicated illness,who remains febrile past 5 days of treatment
  • 1.3 Pregnant women
  • 2. Chronic Q fever
  • 2.1 Endocarditis or vascular infection
  • Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for ≥18 months
  • Note: childern and pregnant women- consultation Recommended
  • 2.2 Noncardiac organ disease
  • 2.3 Postpartumwith serologic profile for chronic Q fever
  • Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for 12 months
  • Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
  • Note (2): Post-Q fever fatigue syndrome- no current recommendation

T.Vaginalis

  • 1. T. vaginalis infection in adults [15]
  • 2. T. vaginalis infection in pregnant and lactating Women
  • 2.1 Pregnant women
  • 2.2 Post-partum and Breastfeeding
  • Preferred regimen (1): Metronidazole 2 g PO in a single dose.
  • Preferred regimen (2): Tinidazole 2 g PO in a single dose
  • Note (1): Do not breastfeed for 12-24 hrs following Metronidazole and 72 hrs following Tinidazole
  • Note (2): Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment. Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
  • Note (3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.
  • 3. T. vaginalis infection in patients with HIV
  • 4. Persistent or recurrent trichomoniasis
  • 4.1 Treatment failure
  • 4.2 Treatment failure again
  • 4.3 Nitroimidazole-resistant cases
  • Preferred regimen: Tinidazole 2-3 g PO for 14 days

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  • Sleeping sickness[16]
  • 1. East african trypanosomiasis
  • 1.1 T. b. rhodesiense, hemolymphatic stage
  • 1.1.1 Adult
  • Preferred regimen: Suramin 1 gm IV on days 1,3,5,14, and 21
  • 1.1.2 Pediatric
  • Preferred regimen: Suramin 20 mg/kg IV on days 1, 3, 5, 14, and 21
  • 1.2 T. b. rhodesiense, CNS involvement
  • 1.2.1 Adult
  • Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.
  • 1.2.2 Pediatric
  • Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days
  • 2. West african trypanosomiasis
  • 2.1 T. b. gambiense, hemolymphatic stage
  • 2.1.1 Adult
  • Preferred regimen: Pentamidine 4 mg/kg/day IM/ IV for 7-10 days
  • 2.1.2 Pediatric
  • Preferred regimen: Pentamidine 4 mg/kg/day IM/IV for 7-10 days
  • Note (1): Pentamidine should be used during pregnancy and lacation only if the potential benefit justifies the potential risk
  • Note (2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
  • 2.2 T. b. gambiense, CNS involvement
  • 2.2.1 Adult
  • Preferred regimen: Eflornithine 400 mg/kg/day in 4 doses for 14 days
  • 2.2.2 Pediatric
  • Preferred regimen: Eflornithine 400 mg/kg/day in 4 doses for 14 days
  • Note (1): Eflornithine should be used during pregnancy and lactation, only if the potential benefit justifies the potential risk
  • Note (2): The safety of Eflornithine in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. Eflornithine is listed for the treatment of 1st stage African trypanosomiasis inTrypanosoma brucei gambiense infection on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

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  • Chagas disease
  • 1. Preferred regimen(1):
  • Patients of age < 12 years- Benznidazole 5-7.5 mg/kg/ day PO bid for 60 days
  • Patients of age 12 years or older- Benznidazole 5-7 mg/kg/day PO bid for 60 days
  • 2. Preferred regimen(2):
  • Patients of age ≤ 10 years- Nifurtimox 15-20 mg/kg/day PO tid/ qid for 90 days
  • Patients of age 11-16 years- Nifurtimox 12.5-15 mg/kg/day PO tid/ qid for 90 days
  • Patients of age 17 years or older- Nifurtimox 8-10 mg/kg/day PO tid/ qid for 90 days
  • Note: In the United States, Nifurtimox and Benznidazole are not FDA approved and are available only from CDC under investigational protocols.

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  • 1.1 Adult
  • 1.2 Pediatric
  • 1.2.1 Mild infection, Infants >3 months
  • Preferred regimen: Azithromycin 10 mg/kg PO qd on day 1, then 5 mg/kg PO q24h for 4 days; (Maximum 500 mg for 1st dose, 250 mg for subsequent doses)
  • 1.2.2 Moderate-severe infection, Infants >3 months
  • Preferred regimen: Azithromycin 10 mg/kg IV q24h for 2 days, then 5 mg/kg PO qd for 3 days; (Maximum 500 mg/dose IV; 250 mg/dose PO)
  • 1.3 Pregnant Patients
  • Preferred regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg qd on days 2-5 OR 500 mg IV as a single dose for at least 2 days, followed by 500 mg PO qd for 7- 10 days
  1. ↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
  2. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  3. ↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
  4. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  5. ↑ Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015
  6. ↑ "avian influenza".
  7. ↑ WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/ Accessed on April 22, 2015
  8. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  9. ↑ 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 15494903.
  10. ↑ 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.
  11. ↑ de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). "Dexamethasone in adults with bacterial meningitis". N Engl J Med. 347 (20): 1549–56. doi:10.1056/NEJMoa021334. PMID 12432041. Review in: ACP J Club. 2003 May-Jun;138(3):60
  12. ↑ Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D (2010). "Corticosteroids for acute bacterial meningitis". Cochrane Database Syst Rev (9): CD004405. doi:10.1002/14651858.CD004405.pub3. PMID 20824838.
  13. ↑ Bilukha OO, Rosenstein N, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC) (2005). "Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Recomm Rep. 54 (RR-7): 1–21. PMID 15917737.
  14. ↑ "q fever".
  15. ↑ "trichomoniasis".
  16. ↑ "African Trypanosomiasis".
  17. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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