Sandbox g56

• Staphylococcus haemolyticus Return to Top

• 1. Methicillin-susceptible strain

• Preferred regimen (1): Nafcillin 1–2 g IV q4-6h (maximum 12 g/day)
• Preferred regimen (2): Oxacillin 1–2 g IVq4-6h (maximum 12 g/day)
• Preferred regimen (3): Cefazolin 0.5–2 g IV q6-8h
• Alternative regimen (1): TMP-SMX 4–5 mg/kg IV q6–12h
• Alternative regimen (2): Doxycycline 100–200 mg IV q12-24h

• 2. Methicillin-resistant, Glycopeptide-susceptible strain

• Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

• 3. Methicillin-resistant, Glycopeptide-resistant strain

• Preferred regimen (1): Daptomycin 4–6 mg/kg IV q24h
• Preferred regimen (2): Linezolid 600 mg PO/IV q12h

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• Staphylococcus saprophyticus Return to Top

• 1. Urinary tract infections

• Preferred regimen (1): Cephalexin 500 mg PO qid
• Preferred regimen (2): Amoxicillin-Clavulanate 875/125 mg PO bid
• Preferred regimen (3): TMP-SMX 160–800 mg PO bid
• Alternative regimen: Levofloxacin 500 mg PO qd

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• Streptococcus anginosus Return to Top

• 1. Dental abscess

• Preferred regimen: Penicillin V 500 mg PO qid
• Alternative regimen: Vancomycin 15–20 mg/kg IV q8–12h

• 2. Brain abscess

• Preferred regimen (1): Penicillin G 18–24 MU/day IV q4–6h
• Preferred regimen (2): Ceftriaxone 2 g IV q12h
• Alternative regimen: Vancomycin 15–20 mg/kg IV q8–12h

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• Bacillus cereus Return to Top

• 1. Food poisoning

• Preferred regimen: Food poisoning is usually self-limited and requires no antibiotic therapy.

• 2. Bacteremia

• Preferred regimen: Vancomycin 15 mg/kg IV q12h
• Alternative regimen: Clindamycin 600 mg IV q8h
• Note (1): Bacillus cereus is commonly resistant to beta-lactams.
• Note (2): Pseudobacteremia is transient and usually results from contaminated blood cultures, gloves, or syringes.

• 3. Meningitis or brain abscess

• Preferred regimen: Vancomycin 15 mg/kg IV q12h
• Alternative regimen: Clindamycin 600 mg IV q8h
• Note: Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.

• 4. Endophthalmitis

• Preferred regimen: Clindamycin 450 μg intravitreal AND Gentamicin 400 μg intravitreal OR Dexamethasone intravitreal AND Vancomycin 15 mg/kg IV q12h
• Alternative regimen: Clindamycin 600 mg IV q8h
• Note: Ophthalmological consultation, culture ocular fluids, early vitrectomy, and intravitreal antibiotics are necessary.

• 5. Endocarditis

• Preferred regimen: Vancomycin 15 mg/kg IV q12h
• Note: Most blood cultures in intravenous drug users are contaminates or represent transient bacteremia.

• 6. Soft tissue infection

• Preferred regimen: Vancomycin 15 mg/kg IV q12h
• Alternative regimen: Clindamycin 600 mg IV q8h

• 7. Pneumonia

• Preferred regimen: Vancomycin 15 mg/kg IV q12h
• Alternative regimen: Clindamycin 600 mg IV q8h

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• Elizabethkingia meningoseptica Return to Top

• 1. Bacteremia

• Preferred regimen (1): Levofloxacin 750 mg IV/PO q24h

• Preferred regimen (2): TMP-SMX 8–10 mg/kg/day IV divided q6–8h
• Alternative regimen (1): Ciprofloxacin 400 mg IV q12h
• Alternative regimen (2): TMP-SMX 8–10 mg/kg/day IV divided q6-8h