Sandbox ID Skin and Soft Tissues

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Acne vulgaris

  • Earliest form, No inflammation
* Preferred regimen (1) : Topical tretinoin (cream 0.025 or 0.05%) or (gel 0.01 or 0.025%) once 24 hrs
* Alternative regimen (1): Topical adapalene 0.1 % gel OR azelaic acid 20% cream OR tazarotene 0.1% cream once 24hrs
  • Mild inflammation
* Preferred regimen (1) : Topical erythro 3% AND benzoyl peroxide 5% bid
* Alternative regimen (1): Topical clindamycin 1% gel bid AND benzoyl peroxide 5% bid
  • Inflammation
* Preferred regimen (1) : Topical erythro 3% AND benzoyl peroxide 5% bid AND/ OR oral antibiotic
* Alternative regimen (1): Oral doxycycline 50mg bid OR minocycline 50 mg bid
* Alternative regimen (2): Expensive extended release: once daily minocycline 1mg/kg/d

Acne rosacea

  • Facial erythema
* Preferred regimen : Brimonidine gel applied to the affected area bid
  • Papulopustular rosacea:
* Preferred regimen : Azelaic acid gel bid topical OR Metronidazole topical cream once daily.

Anthrax, cutaneous

  • Cutaneous anthrax
  • Preferred regimen (1): Penicillin V 500 mg PO qid for 7–10 days
  • Preferred regimen (2): Ciprofloxacin 500 mg PO bid OR Levofloxacin 500 mg IV/PO every 24 hours for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure

Bacillary angiomatosis

  • Bacillary angiomatosis
  • Preferred regimen: Erythromycin 500 mg PO qid for 2 weeks to 2 months OR Doxycycline 100 mg PO bid for 2 weeks to 2 months

Bite wounds

  • Animal bite
  • Preferred regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (2): Ampicillin-sulbactam 1.5–3.0 g IV every 6–8 h (Some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (3): Piperacillin-tazobactam 3.37 g IV every 6–8 h (Misses MRSA)
  • Preferred regimen (4): Doxycycline 100 mg PO bid OR 100 mg IV every 12 h (Excellent activity against Pasteurella multocida; some streptococci are resistant)
  • Preferred regimen (5): Penicillin AND Dicloxacillin 500 mg oral
  • Preferred regimen (6): sulfamethoxazole-Trimethoprim 160–800 mg PO bid OR IV 5–10 mg/kg/day of TMP component (Good activity against aerobes; poor activity against anaerobes)
  • Preferred regimen (7): Metronidazole 250–500 mg PO tid OR 500 mg IV every 8 h (Good activity against anaerobes; no activity against aerobes)
  • Preferred regimen (8): Clindamycin 300 mg PO tid OR 600 mg IV every 6–8 h (Good activity against staphylococci, streptococci, and anaerobes; misses P. multocida)
  • Preferred regimen (9): Cefuroxime 500 mg PO bid OR 1 g IV every 12 h
  • Preferred regimen (10): Cefoxitin 1g IV every 6–8 h
  • Preferred regimen (11): Ceftriaxone 1g IV every 12 h
  • Preferred regimen (12): Cefotaxime 1–2 g IV every 6–8 h
  • Preferred regimen (13): Ciprofloxacin 500–750 mg PO bid OR 400 mg IV every 12 h
  • Preferred regimen (14): Levofloxacin 750 mg PO daily OR 750 mg IV daily
  • Preferred regimen (15): Moxifloxacin 400 mg PO daily OR 400 mg IV daily (Monotherapy; good for anaerobes also)
  • Human bite

Lyme disease, cutaneous

  • Preferred oral regimens adults
* Preferred regimen (1): Amoxicillin 500 mg 3 times per day
* Preferred regimen (2): Doxycycline 100 mg twice per day
* Preferred regimen (3): Cefuroxime axetil 500 mg twice per day 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)
  • Alternative oral regimens adults
* Preferred regimen (1): Doxycycline, 200 mg in a single dose
  • Preferred parenteral regimen adults
* Preferred regimen (1): Ceftriaxone 2 g intravenously once per day
  • Alternative parenteral regimens adults
* Preferred regimen (1): Cefotaxime 2 g intravenously every 8 hd d
* Preferred regimen (2): Penicillin G 18–24 million U per day intravenously, divided every 4 h
  • Preferred oral regimens pediatrics
* Preferred regimen (1): Amoxicillin 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose)
* Preferred regimen (2): Doxycycline Not recommended for children aged !8 years. For children aged 8 years, 4 mg/kg per day in 2 divided doses (maximum, 100 mg per dose)
* Preferred regimen (3): Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)
  • Alternative oral regimens pediatrics
* Preferred regimen (1): Doxycycline, (4 mg/kg in children <8 years of age)
  • Preferred parenteral regimen pediatrics
* Preferred regimen (1): Ceftriaxone 50–75 mg/kg intravenously per day in a single dose (maximum, 2 g)
  • Alternative parenteral regimens pediatrics
* Preferred regimen (1): Cefotaxime 150–200 mg/kg per day intravenously in 3–4 divided doses (maximum, 6 g per day)
* Preferred regimen (2): Penicillin G 200,000–400,000 U/kg per day divided every 4 h (not to exceed 18–24 million U per day)

Bubonic plague

  • Bubonic Plague

Carbuncle

  • Mild  : Incision and Drainagee
  • Moderate
    Empiric treatment

Cat scratch disease

  • Cat scratch disease in patients > 45 kg
  • Preferred regimen: Azithromycin 500 mg on day 1 followed by 250 mg for 4 additional days
  • Cat scratch disease in patients < 45 kg
  • Preferred regimen: Azithromycin 10 mg/kg on day 1 and 5 mg/kg for 4 more days

Cellulitis

Ecthyma

Erysipelas

  • Erysipelas (Adults)
* Oral therapy
  • Preferred regimen (1): Penicillin 500 mg orally every six hours
  • Preferred regimen (2): Amoxicillin 500 mg orally every eight hours
  • Preferred regimen (3): Erythromycin 250 mg orally every six hours
  • Parenteral therapy
  • Preferred regimen (1): Ceftriaxone 1g intravenously every 24 hours
  • Preferred regimen (2): Cefazolin 1 to 2 g intravenously every eight hours
  • Erysipelas (pediatrics)
  • Oral therapy
  • Preferred regimen (1): Penicillin 25 to 50 mg/kg per day orally in three or four doses
  • Preferred regimen (2): Amoxicillin 25 to 50 mg/kg per day orally in three doses
  • Preferred regimen (3): Erythromycin 30 to 50 mg/kg per day orally in two to four doses
  • Parenteral therapy
  • Preferred regimen (1): Ceftriaxone 50 to 75 mg/kg per day intravenously in one or two doses
  • Preferred regimen (2): Cefazolin 100 mg/kg per day intravenously in three doses

Erysipeloid

Erythrasma

  • Localized infection
  • Preferred regimen : Topical clindamycin 2-3 times daily for 7-14 days
  • Widespread infection

Fournier gangrene

Furuncle

Gas gangrene

  • Empiric antimicrobial therapy
  • Culture directed antimicrobial therapy
  • Clostridium perfringens

Glanders

  • Glanders

Impetigo

  • Impetigo, adult
  • Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)
  • Limited number of lesions
  • Numerous lesions or outbreaks of post streptococcal glomerulonephritis
  • Culture-directed antimicrobial therapy
  • Streptococcus alone
  • Preferred regimen: Penicillin V 250–500 mg PO qid for 7 days
  • Alternative regimen (for penicillin-allergic patients): Erythromycin 250 mg PO qid for 7 days OR Clindamycin 300–400 mg PO qid for 7 days
  • Methicillin-resistant Staphylococcus aureus
  • Impetigo, pediatric
  • Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)
  • Limited number of lesions
  • Numerous lesions or outbreaks of poststreptococcal glomerulonephritis
  • Culture-directed antimicrobial therapy
  • Streptococcus alone
  • Preferred regimen: Penicillin V 60,000–100,000 U/kg PO qid for 7 days
  • Alternative regimen (for penicillin-allergic patients): Erythromycin 40 mg/kg/day PO tid–qid for 7 days OR Clindamycin 20 mg/kg/day PO tid for 7 days
  • Methicillin-resistant Staphylococcus aureus

Lyme disease, cutaneous

Mastitis

  • Preferred regimen (1): Amoxicillin/clavulanate (Augmentin), 875 mg twice daily
  • Preferred regimen (2): Cephalexin (Keflex),500 mg four times daily
  • Preferred regimen (3): Ciprofloxacin (Cipro),500 mg twice daily
  • Preferred regimen (4): Clindamycin (Cleocin),300 mg four times daily
  • Preferred regimen (5): Dicloxacillin (Dynapen, brand no longer available in the United States), 500 mg four times daily
  • Preferred regimen (6): Trimethoprim/sulfamethoxazole (Bactrim, Septra),*† 160 mg/800 mg twice daily

Necrotizing fasciitis

  • Mixed infections, adult
  • Mixed infections, pediatric
  • Streptococcus, adult
  • Streptococcus, pediatric
  • Staphylococcus aureus, adult
  • Staphylococcus aureus, pediatric
  • Clostridium species, adult
  • Preferred regimen: Clindamycin 600–900 mg every 8 h IV AND penicillin 2–4 million units every 4–6 h IV
  • Clostridium species, pediatric
  • Preferred regimen: Clindamycin 10–13 mg/kg/dose every 8 h IV AND penicillin 60 000–100 00 units/kg/dose every 6 h IV
  • Aeromonas hydrophila, adult
  • Aeromonas hydrophila, pediatric

(Not recommended for children but may need to use in life-threatening situations)

  • Vibrio vulnificus, adult
  • Vibrio vulnificus, pediatric

Not recommended for children but may need to use in life-threatening situation

Pilonidal cyst

  • Preferred regimen : A 5-10 day course of antibiotic active against pathogens isolated.

Pyomyositis

Seborrheic dermatitis

  • Antifungal agents
  • Preferred regimen (1): Ketoconazole 2% in shampoo, foam, gel, or cream‡ Scalp: twice/wk for clearance, then once/wk or every other wk for maintenance; other areas: from twice daily to twice/wk for clearance, then from twice/wk to once every other wk for maintenance
  • Preferred regimen (2): Bifonazole 1% in shampoo or cream Scalp: 3 times/wk for clearance; other areas: once daily for clearance
  • Preferred regimen (3): Ciclopirox olamine (also called ciclopirox) 1.0% or 1.5% in shampoo or cream Scalp: twice to 3 times/wk for clearance, then once/wk or every 2 wk for maintenance; other areas: twice daily for clearance, then once daily for maintenance
  • Corticosteroids
  • Preferred regimen (1): Hydrocortisone 1% in cream Areas other than scalp: once or twice daily
  • Preferred regimen (2): Betamethasone dipropionate 0.05% in lotion Scalp and other areas: once or twice daily
  • Preferred regimen (3): Clobetasol 17- butyrate 0.05% in cream Areas other than scalp: once or twice daily
  • Preferred regimen (4): Clobetasol dipro- pionate 0.05% in shampoo Scalp: twice weekly in a short- contact fashion (up to 10 min application, then washing)
  • Preferred regimen (5): Desonide 0.05% in lotion Scalp and other areas of skin: twice daily
  • Lithium salts

Skin and soft tissue infection in neutropenic fever

Skin and soft tissue infection in cellular immunodeficiency

Surgical site infection

  • Surgery of intestinal or genitourinary tract
  • Single-drug regimens
  • Combination regimens
  • Surgery of trunk or extremity away from axilla or perineum
  • Preferred regimen (1): Oxacillin or nafcillin 2 g every 6 h IV
  • Preferred regimen (2): Cefazolin 0.5–1 g every 8 h IV
  • Preferred regimen (3): Cephalexin 500 mg every 6 h po
  • Preferred regimen (4): SMX-TMP 160–800 mg po every 6 h
  • Preferred regimen (5): Vancomycin 15 mg/kg every 12 h IV
  • Surgery of axilla or perineum

Tularemia

  • Tularemia

Vascular insufficieny ulcer

  • Preferred regimen : Imipenem OR meropenem OR doripenem OR ticarcillin-clavulanate

Vibrio infection

Wound infection

  • Mild to moderate
* Preferred regimen : TMP-SMX double strength 1-2 tabs PO bid OR clindamycin 300-450 mg PO tid
* Alternate regimen : Minocycline 100mg PO bid OR linezolid 600mg PO bid
  • Febrile with sepsis
* Preferred regimen : (Ticarcillin-clavulanate 3.1 gm IV q4-6hr OR piperacillin-tazobactam 3.375 gm q 6hr OR doripenem500 mg IV q 8hr OR imipenem OR meropenem OR ertapenem 1gm IV q24 hr) AND vancomycin 1gm IV q12h
* Alternate regimen : (vancomycin 1gm IV q12h OR daptomycin 6mg/kg iv q24h OR ceftaroline 600mg IV q12h OR telavancin 10mg/kg IV q24h) AND (ciprofloxacin OR levofloxacin 750mg IV q24h

Yaws


Staphylococcal and streptococcal skin and soft tissue infections

  • Impetigo (Staphylococcus and Streptococcus), adult
  • Preferred regimen (1): Dicloxacillin 250 mg PO qid
  • Preferred regimen (2): Cephalexin 250 mg PO qid
  • Preferred regimen (3): Erythromycin 250 mg qid PO (some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
  • Preferred regimen (4): Clindamycin 300–400 mg qid PO
  • Preferred regimen (5): Amoxicillin-Clavulanate 875/125 mg bid po
  • Preferred regimen (6): Retapamulin ointment applied to lesions bid (for patients with limited number of lesions)
  • Preferred regimen (7): Mupirocin ointment applied to lesions bid (for patients with limited number of lesions)
  • Impetigo (Staphylococcus and Streptococcus), pediatric
  • Preferred regimen (1): Cephalexin 25–50 mg/kg/d in 3–4 divided doses PO
  • Preferred regimen (2): Erythromycin 40 mg/kg/d in 3–4 divided doses PO (some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
  • Preferred regimen (3): Clindamycin 20 mg/kg/d in 3 divided doses PO
  • Preferred regimen (4): Amoxicillin-Clavulanate 25 mg/kg/d of the Amoxicillin component in 2 divided doses PO
  • Preferred regimen (5): Retapamulin ointment applied to lesions bid (for patients with limited number of lesions)
  • Preferred regimen (6): Mupirocin ointment applied to lesions bid (for patients with limited number of lesions)
  • MSSA SSTI, adult
  • Preferred regimen (1): Nafcillin 1-2 g every 4 h IV OR Oxacillin 1-2 g every 4 h IV (parental drug of choice; inactive against MRSA)
  • Preferred regimen (2): Cefazolin 40 mg/kg/d in 3–4 divided doses PO (some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
  • Preferred regimen (3): Clindamycin 600 mg every 8 h IV OR 300–450 mg qid po (bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
  • Preferred regimen (4): Dicloxacillin 500 mg qid po (Oral agent of choice for methicillin-susceptible strains in adults. Not used much in pediatrics)
  • Preferred regimen (5): Cephalexin 500 mg qid po (for penicillin-allergic patients except those with immediate hypersensitivity reactions. The availability of a suspension and requirement for less frequent dosing)
  • Preferred regimen (6): Doxycycline OR Minocycline 100 mg bid po (bacteriostatic; limited recent clinical experience)
  • Preferred regimen (7): Trimethoprim-Sulfamethoxazole 1–2 double strength tablets bid po (bactericidal; efficacy poorly documented)
  • MSSA SSTI, pediatric
  • Preferred regimen (1): Nafcillin 100–150 mg/kg/d in 4 divided doses IV OR Oxacillin 100–150 mg/kg/d in 4 divided doses IV (parental drug of choice; inactive against MRSA)
  • Preferred regimen (2): Cefazolin 40 mg/kg/d in 3–4 divided doses PO (some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
  • Preferred regimen (3): Clindamycin 25–40 mg/kg/d in 3 divided doses IV OR 25–30 mg/kg/d in 3 divided doses po (bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
  • Preferred regimen (4): Dicloxacillin 25–50 mg/kg/d in 4 divided doses po (oral agent of choice for methicillin-susceptible strains in adults; not used much in pediatrics)
  • Preferred regimen (5): Cephalexin 25–50 mg/kg/d 4 divided doses po (for penicillin-allergic patients except those with immediate hypersensitivity reactions; the availability of a suspension and requirement for less frequent dosing)
  • Preferred regimen (6): Doxycycline OR Minocycline (not recommended for age < 8 y; bacteriostatic; limited recent clinical experience)
  • Preferred regimen (7): Trimethoprim-Sulfamethoxazole 8–12 mg/kg (based on Trimethoprim component) in either 4 divided doses IV or 2 divided doses po (bactericidal; efficacy poorly documented)
  • MRSA SSTI, adult
  • Preferred regimen (1): Vancomycin 30 mg/kg/d in 2 divided doses IV (for penicillin allergic patients; parenteral drug of choice for treatment of infections caused by MRSA)
  • Preferred regimen (2): Linezolid 600 mg every 12 h IV or 600 mg bid po (bacteriostatic; limited clinical experience; no crossresistance with other antibiotic classes; expensive)
  • Preferred regimen (3): Clindamycin 600 mg every 8 h IV or 300–450 mg qid po (bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
  • Preferred regimen (4): Daptomycin 4 mg/kg every 24 h IV (bactericidal; possible myopathy)
  • Preferred regimen (5): Ceftaroline 600 mg bid IV (bactericidal)
  • Preferred regimen (6): Doxycycline OR Minocycline 100 mg bid po (bacteriostatic; limited recent clinical experience)
  • Preferred regimen (7): Trimethoprim-Sulfamethoxazole 1–2 double strength tablets bid po (bactericidal; limited published efficacy data)
  • MRSA SSTI, pediatric
  • Preferred regimen (1): Vancomycin 40 mg/kg/d in 4 divided doses IV (for penicillin allergic patients; parenteral drug of choice for treatment of infections caused by MRSA)
  • Preferred regimen (2): Linezolid 10 mg/kg every 12 h IV or po for children < 12 y (bacteriostatic; limited clinical experience; no crossresistance with other antibiotic classes; expensive)
  • Preferred regimen (3): Clindamycin 25–40 mg/kg/d in 3 divided doses IV or 30–40 mg/kg/d in 3 divided doses po (bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA; important option for children)
  • Preferred regimen (4): Doxycycline OR Minocycline (not recommended for age < 8 y; bacteriostatic; limited recent clinical experience)
  • Preferred regimen (5): Trimethoprim-Sulfamethoxazole 8–12 mg/kg/d (based on Trimethoprim component) in either 4 divided doses IV or 2 divided doses po
  • Streptococcal skin infections, adult
  • Preferred regimen (1): Penicillin 2–4 million units every 4–6 h IV
  • Preferred regimen (2): Clindamycin 600–900 mg every 8 h IV
  • Preferred regimen (3): Nafcillin 1–2 g every 4– 6 h IV
  • Preferred regimen (4): Cefazolin 1 g every 8 h IV
  • Preferred regimen (5): Penicillin VK 250–500 mg every 6 h po
  • Preferred regimen (6): Cephalexin 500 mg every 6 h po
  • Streptococcal skin infections, pediatric
  • Preferred regimen (1): Penicillin 60,000–100,000 units/kg/dose q6h

Incisional surgical site infections

(table 3)

  • Surgery of intestinal or genitourinary tract
  • Single-drug regimens
  • Combination regimens
  • Surgery of trunk or extremity away from axilla or perineum
  • Preferred regimen (1): Oxacillin or nafcillin 2 g every 6 h IV
  • Preferred regimen (2): Cefazolin 0.5–1 g every 8 h IV
  • Preferred regimen (3): Cephalexin 500 mg every 6 h po
  • Preferred regimen (4): SMX-TMP 160–800 mg po every 6 h
  • Preferred regimen (5): Vancomycin 15 mg/kg every 12 h IV
  • Surgery of axilla or perineum

Necrotizing infections of the skin, fascia, and muscle

(table 4)

  • Mixed infections, adult
  • Mixed infections, pediatric
  • Streptococcus, adult
  • Streptococcus, pediatric
  • Staphylococcus aureus, adult
  • Staphylococcus aureus, pediatric
  • Clostridium species, adult
  • Preferred regimen: Clindamycin 600–900 mg every 8 h IV AND penicillin 2–4 million units every 4–6 h IV
  • Clostridium species, pediatric
  • Preferred regimen: Clindamycin 10–13 mg/kg/dose every 8 h IV AND penicillin 60 000–100 00 units/kg/dose every 6 h IV
  • Aeromonas hydrophila, adult
  • Aeromonas hydrophila, pediatric

(Not recommended for children but may need to use in life-threatening situations)

  • Vibrio vulnificus, adult
  • Vibrio vulnificus, pediatric

Not recommended for children but may need to use in life-threatening situation

Infections following animal or human bites

(table 5)

  • Animal bite
  • Preferred regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (2): Ampicillin-sulbactam 1.5–3.0 g IV every 6–8 h (Some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (3): Piperacillin-tazobactam 3.37 g IV every 6–8 h (Misses MRSA)
  • Preferred regimen (4): Doxycycline 100 mg PO bid OR 100 mg IV every 12 h (Excellent activity against Pasteurella multocida; some streptococci are resistant)
  • Preferred regimen (5): Penicillin AND Dicloxacillin 500 mg oral
  • Preferred regimen (6): sulfamethoxazole-Trimethoprim 160–800 mg PO bid OR IV 5–10 mg/kg/day of TMP component (Good activity against aerobes; poor activity against anaerobes)
  • Preferred regimen (7): Metronidazole 250–500 mg PO tid OR 500 mg IV every 8 h (Good activity against anaerobes; no activity against aerobes)
  • Preferred regimen (8): Clindamycin 300 mg PO tid OR 600 mg IV every 6–8 h (Good activity against staphylococci, streptococci, and anaerobes; misses P. multocida)
  • Preferred regimen (9): Cefuroxime 500 mg PO bid OR 1 g IV every 12 h
  • Preferred regimen (10): Cefoxitin 1g IV every 6–8 h
  • Preferred regimen (11): Ceftriaxone 1g IV every 12 h
  • Preferred regimen (12): Cefotaxime 1–2 g IV every 6–8 h
  • Preferred regimen (13): Ciprofloxacin 500–750 mg PO bid OR 400 mg IV every 12 h
  • Preferred regimen (14): Levofloxacin 750 mg PO daily OR 750 mg IV daily
  • Preferred regimen (15): Moxifloxacin 400 mg PO daily OR 400 mg IV daily (Monotherapy; good for anaerobes also)
  • Human bite

Cat scratch disease

  • Cat scratch disease in patients > 45 kg
  • Preferred regimen: Azithromycin 500 mg on day 1 followed by 250 mg for 4 additional days
  • Cat scratch disease in patients < 45 kg
  • Preferred regimen: Azithromycin 10 mg/kg on day 1 and 5 mg/kg for 4 more days

Bacillary angiomatosis

  • Bacillary angiomatosis
  • Preferred regimen: Erythromycin 500 mg PO qid for 2 weeks to 2 months OR Doxycycline 100 mg PO bid for 2 weeks to 2 months

Erysipeloid

  • Erysipeloid

Glanders

  • Glanders

Bubonic plague

  • Bubonic Plague

Tularemia

  • Tularemia

Cutaneous anthrax

  • Cutaneous anthrax
  • Preferred regimen (1): Penicillin V 500 mg PO qid for 7–10 days
  • Preferred regimen (2): Ciprofloxacin 500 mg PO bid OR Levofloxacin 500 mg IV/PO every 24 hours for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure

Seborrheic Dermatitis

  • Antifungal agents
  • Preferred regimen (1): Ketoconazole 2% in shampoo, foam, gel, or cream‡ Scalp: twice/wk for clearance, then once/wk or every other wk for maintenance; other areas: from twice daily to twice/wk for clearance, then from twice/wk to once every other wk for maintenance
  • Preferred regimen (2): Bifonazole 1% in shampoo or cream Scalp: 3 times/wk for clearance; other areas: once daily for clearance
  • Preferred regimen (3): Ciclopirox olamine (also called ciclopirox) 1.0% or 1.5% in shampoo or cream Scalp: twice to 3 times/wk for clearance, then once/wk or every 2 wk for maintenance; other areas: twice daily for clearance, then once daily for maintenance
  • Corticosteroids
  • Preferred regimen (1): Hydrocortisone 1% in cream Areas other than scalp: once or twice daily
  • Preferred regimen (4): Clobetasol dipro- pionate 0.05% in shampoo Scalp: twice weekly in a short- contact fashion (up to 10 min application, then washing)
  • Preferred regimen (5): Desonide 0.05% in lotion Scalp and other areas of skin: twice daily
  • Lithium salts

Mastitis

  • Preferred regimen (2): Cephalexin (Keflex),500 mg four times daily
  • Preferred regimen (4): Clindamycin (Cleocin),300 mg four times daily
  • Preferred regimen (5): Dicloxacillin (Dynapen, brand no longer available in the United States), 500 mg four times daily

Yaws

  • Preferred regimen (4): Azithromycin Single-dose; 30 mg/kg (maximum dose 2 g)

Lyme disease

  • Preferred oral regimens adults
* Preferred regimen (1): Amoxicillin 500 mg 3 times per day
* Preferred regimen (2): Doxycycline 100 mg twice per day
* Preferred regimen (3): Cefuroxime axetil 500 mg twice per day 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)
  • Alternative oral regimens adults
* Preferred regimen (1): Doxycycline, 200 mg in a single dose
  • Preferred parenteral regimen adults
* Preferred regimen (1): Ceftriaxone 2 g intravenously once per day
  • Alternative parenteral regimens adults
* Preferred regimen (1): Cefotaxime 2 g intravenously every 8 hd d
* Preferred regimen (2): Penicillin G 18–24 million U per day intravenously, divided every 4 h
  • Preferred oral regimens pediatrics
* Preferred regimen (1): Amoxicillin 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose)
* Preferred regimen (2): Doxycycline Not recommended for children aged !8 years. For children aged 8 years, 4 mg/kg per day in 2 divided doses (maximum, 100 mg per dose)
* Preferred regimen (3): Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)
  • Alternative oral regimens pediatrics
* Preferred regimen (1): Doxycycline, (4 mg/kg in children <8 years of age)
  • Preferred parenteral regimen pediatrics
* Preferred regimen (1): Ceftriaxone 50–75 mg/kg intravenously per day in a single dose (maximum, 2 g)
  • Alternative parenteral regimens pediatrics
* Preferred regimen (1): Cefotaxime 150–200 mg/kg per day intravenously in 3–4 divided doses (maximum, 6 g per day)
* Preferred regimen (2): Penicillin G 200,000–400,000 U/kg per day divided every 4 h (not to exceed 18–24 million U per day)

Bacillary angiomatosis

* Preferred regimen (1): Erythromycin, 30--50 mg/kg body weight (max 2 g/day) per day orally divided into 2--4 doses, or if unable to take oral medication, 15--50 mg/kg body weight (max 2 g/day) per day IV in divided doses 4 times a day (AH)
* Preferred regimen (2): Doxycycline, 2--4 mg/kg body weight (max 100--200 mg/day) per day orally or IV once daily or divided into 2 doses (AII) for 3 mos CNS infections, bacillary peliosis, osteomyelitis
* Alternate regimen (1): Azithromycin, 5--12 mg/kg body weight (max 600 mg/day) orally once daily (BIII)
* Alternate regimen (2): Clarithromycin, 15 mg/kg body weight (max 1 g/day) per day orally divided into 2 doses (BIII)
* Alternate regimen (3): Rifampin, 20 mg/kg body weight (max 600 mg/day) per day orally or IV once daily or divided into 2 doses can be used in combination with erythromycin or doxycycline in patients with more severe infections (BIII)
  • Severe infections:
* Preferred regimen : Doxycycline, 2--4 mg/kg body weight (max 100--200 mg/day) per day orally or IV once daily or divided into 2 doses (AIII) for 4 mos

Acne vulgaris

  • Earliest form, No inflammation
* Preferred regimen (1) : Topical tretinoin (cream 0.025 or 0.05%) or (gel 0.01 or 0.025%) once 24 hrs
* Alternative regimen (1): Topical adapalene 0.1 % gel OR azelaic acid 20% cream OR tazarotene 0.1% cream once 24hrs
  • Mild inflammation
* Preferred regimen (1) : Topical erythromycin 3% AND benzoyl peroxide 5% bid
* Alternative regimen (1): Topical clindamycin 1% gel bid AND benzoyl peroxide 5% bid
  • Inflammation
* Preferred regimen (1) : Topical erythromycin 3% AND benzoyl peroxide 5% bid AND/ OR oral antibiotic
* Alternative regimen (1): Oral doxycycline 50mg bid OR minocycline 50 mg bid
* Alternative regimen (2): Expensive extended release: once daily minocycline 1mg/kg/d

Acne Rosacea

  • Facial erythema
* Preferred regimen : Brimonidine gel applied to the affected area bid
  • Papulopustular rosacea:
* Preferred regimen : Azelaic acid gel bid topical OR Metronidazole topical cream once daily.

References

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