Sandbox ID2

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Pathogens of Clinical Relevance

Bacteria – Gram-Positive Cocci

Bacteria – Gram-Positive Bacilli

  • Erysipeloid of Rosenbach (localized cutaneous infection)[1]
  • Diffuse cutaneous infection
  • Preferred regimen: As for localized infection
Note: Assess for endocarditis
  • Bacteremia or endocarditis
  • Preferred regimen: Penicillin G benzathine 2-4 MU IV q4h for 4-6 weeks
  • Alternative regimen (1): Ceftriaxone 2 g IV q24h for 4-6 weeks
  • Alternative regimen (2): Imipenem 500 mg IV q6h for 4-6 weeks
  • Alternative regimen (3): Ciprofloxacin 400 mg IV q12h for 4-6 weeks
  • Alternative regimen (4): Daptomycin 6 mg/kg IV q24h for 4-6 weeks
Note: Recommended duration of therapy for endocarditis is 4 to 6 weeks, although shorter courses consisting of 2 weeks of intravenous therapy followed by 2 to 4 weeks of oral therapy have been successful.
  • Systemic infection[2]
  • Shoulder prosthesis infection
  • Acne vulgaris
  • Rhodococcus equi [3]
  • Preferred regimen:
  • First line: vancomycin 1 g IV q12h (15 mg/kg q12 for >70 kg) OR Imipenem 500 mg IV q6h AND Rifampin 600 mg PO once daily OR Ciprofloxacin 750 mg PO twice daily OR Erythromycin 500 mg PO four times a day for at least 4 weeks or until infiltrate disappears (at least 8 weeks in immunocompromised patients)
  • Oral/maintenance therapy (after infiltrate clears): Ciprofloxacin 750 mg PO twice daily OR Erythromycin 500 mg PO four times a day
  • Alternative regimen: Azithromycin OR TMP-SMX OR Chloramphenicol OR Clindamycin
  • NOTE: Avoid Penicillins/Cephalosporins due to development of resistance; Linezolid effective in vitro, but no clinical reports of use


Bacteria – Gram-Negative Cocci and Coccobacilli

Bacteria – Spirochetes

Bacteria – Gram-Negative Bacilli

  • Enteric flora
  • Non-fermenters

Bacteria – Atypical Organisms

  • Adult
  • Preferred regimen (1): Doxycycline 100 mg PO bid for 14-21 days
  • Preferred regimen (2): Tetracycline 250 mg PO qid for 14-21 days
  • Preferred regimen (3): Azithromycin 500 mg PO for once a day followed by 250 mg/day for 4 days
  • Preferred regimen (4): Clarithromycin 500 mg PO bid for 10 days
  • Preferred regimen (5): Levofloxacin 500 mg IV or PO qd for 7 to 14 days
  • Preferred regimen (6): Moxifloxacin 400 mg PO qd for 10 days.
  • Pediatric
  • Preferred regimen (1):Erythromycin suspension,PO 50 mg/kg per day for 10 to 14 days
  • Preferred regimen (2):Clarithromycin suspension, 15 mg/kg per day for10 days
  • Preferred regimen (3): Azithromycin suspension, PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days
  • Upper respiratory tract infection[5]
  • Bronchitis
  • Antibiotic therapy for C. pneumoniae is not required.
  • Pharyngitis
  • Antibiotic therapy for C. pneumoniae is not required.
  • Sinusitis
  • Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.
  • Adult
  • Pediatric
  • Preferred regimen: Azithromycin
  • Alternative regimen: fluoroquinolones
  • Pregnant Patients
  • Preferred regimen : Azithromycin
  • Alternative regimen: fluoroquinolones
  • Endocarditis in valve replacement patients
  • Preferred regimen : Doxycycline
  • Alternative regimen : fluoroquinolones.

Bacteria – Miscellaneous

Bacteria – Anaerobic Gram-Negative Bacilli

Fungi

  • Mild to moderate pulmonary blastomycosis
  • Preferred regimen: Itraconazole 200 mg PO once or twice per day for 6–12 months
  • Note: Oral Itraconazole, 200 mg 3 times per day for 3 days and then once or twice per day for 6–12 months, is recommended
  • Moderately severe to severe pulmonary blastomycosis
  • Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Preferred regimen(2): Amphotericin B deoxycholate 0.7–1 mg/kg per day for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Note: Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
  • Mild to moderate disseminated blastomycosis
  • Preferred regimen: Itraconazole 200 mg PO once or twice per day for 6–12 months
  • Note(1): Treat osteoarticular disease for 12 months
  • Note(2): Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
  • Moderately severe to severe disseminated blastomycosis
  • Preferred regimen(1): Lipid amphotericin B(Lipid AmB) 3–5 mg/kg per day, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Preferred regimen(2): Amphotericin B deoxycholate 0.7–1 mg/kg per day, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Note: oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
  • CNS disease
  • Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg per day for 4–6 weeks AND an oral azole for at least 1 year
  • Note(1): Step-down therapy can be with Fluconazole, 800 mg per day OR Itraconazole, 200 mg 2–3 times per day OR voriconazole, 200–400 mg twice per day.
  • Note(2): Longer treatment may be required for immunosuppressed patients.
  • Immunosuppressed patients
  • Preferred regimen(1): Lipid amphotericin B (Lipid AmB), 3–5 mg/kg per day, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
  • Preferred regimen(2): Amphotericin B deoxycholate, 0.7–1 mg/kg per day, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
  • Note(1): Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 12 months, is recommended
  • Note(2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
  • Pregnant women
  • Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day
  • Note(1): Azoles should be avoided because of possible teratogenicity
  • Note(2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg per day
  • Children with mild to moderate disease
  • Preferred regimen: Itraconazole 10 mg/kg PO per day for 6–12 months
  • Note: Maximum dose 400 mg per day
  • Children with moderately severe to severe disease
  • Preferred regimen(1): Amphotericin B deoxycholate 0.7–1 mg/kg per day for 1–2 weeks AND Itraconazole 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
  • Preferred regimen(2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks AND Itraconazole 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
  • Note: Children tolerate Amphotericin B deoxycholate better than adults do.


  • Preferred regimen(1): Griseofulvin 10-20 mg/kg/day for minimum 6 weeks
  • Preferred regimen(2): Itraconazole 4-6 mg/kg pulsed dose weekly
  • Preferred regimen(3): Terbinafine if <20 kg: 62.5 mg/day, if 20-40 kg: 125 mg/day, if >40 kg: 250 mg/day
  • Small, well-defined lesions
  • Larger lesionss
  • Athlete's foot
  • Interdigital
  • “Dry type”
  • Preferred regimen: Terbinafine 250 mg/day PO for 2-4 weeks OR Itraconazole 400 mg/day PO for 1 week per month (repeated if necessary) OR Fluconazole 200 mg PO weekly for 4-8 weeks

Mycobacteria

Parasites – Intestinal Protozoa

Parasites – Extraintestinal Protozoa

Parasites – Intestinal Nematodes (Roundworms)

Parasites – Extraintestinal Nematodes (Roundworms)

Parasites – Trematodes (Flukes)

Parasites – Cestodes (Tapeworms)

Parasites – Ectoparasites

Viruses

References

  1. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  3. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  4. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  5. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  6. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  7. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  8. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  9. ↑ 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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