Sandbox mona

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  • Influenza A and B
  • Adults
  • Preferred regimen:Oseltamivir (Tamiflu)75 mg bid for 5 days OR Zanamivir(Relenza) 10 mg (two 5-mg inhalations)bid for 5 days OR Peramivir(Rapivab) One 600 mg dose, via intravenous infusion for 15-30 minutes for 1 day
  • Children
  • Preferred regimen:Oseltamivir If younger than 1 yr old: 3 mg/kg/dose bid If 1 yr or older, dose varies by child’s weight: 15 kg or less, the dose is 30 mg bid; >15 to 23 kg, the dose is 45 mg bid ;>23 to 40 kg, the dose is 60 mg bid; >40 kg, the dose is 75 mg bid for 5 days OR
  • Zanamivir(Relenza) 10 mg (two 5-mg inhalations)bid
  • Note:FDA approved and recommended Peramivir(Rapivab) for use in adults ≥18 yrs
  • Dosing in Adult Patients with Renal Impairment
  • Oral oseltamivir
  • Creatinine clearance 61 to 90 mL/min-75 mg twice a day
  • Creatinine clearance 31 to 60 mL/min-30 mg twice a day
  • Creatinine clearance 10 to 30 mL/min-30 mg once daily
  • ESRD Patients on Hemodialysis
  • Creatinine clearance ≤10 mL/min-30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days
  • ESRD Patients on Continuous Ambulatory Peritoneal Dialysis-A single 30 mg dose administered immediately after a dialysis exchange


  • Intravenous Peramivir (single dose)
  • Creatinine clearance >50 mL/min-600mg
  • Creatinine clearance 30 to 49 mL/min-200mg
  • Creatinine clearance 10 to 29 mL/min-100mg
  • ESRD Patients on Hemodialysis-Dose administered after dialysis at a dose adjusted based on creatinine clearance




  • 2. Acanthamoeba Granulomatous Amebic Encephalitis and Disseminated Disease
  1. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.


  • Primary amoebic meningoencephalitis[1][2]
  • Preferred regimen: Amphotericin B 1.5 mg/kg /day bid for 3 days; then 1 mg/kg/day for 6 days AND1.5 mg/day intrathecal x 2 days; then 1 mg/day intrathecal qd for 8 days.
  • Note: Investigational drug called miltefosine also available for treatment.
  1. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. ↑ Template:Citeweb


avian flu [1]

  • 1.Preferred regimen:Oseltamivir 75 mg PO qd for a minimum 10 days
  • 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:Zanamivir10 mg inhaled bid for minimum 5 days OR Peramivir600 mg IV as a single dose for1 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.[2]
  • 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.
  1. ↑ Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015
  2. ↑ 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


  • Chronic granulomatous meningitis.[1]


  • Chronic granulomatous meningitis.[2]









Babesia microti; babesiosis

  • 1.Mild/moderate disease.[3]
  • 2.Severe babesiosis:
  • Preferred regimen: Clindamycin 600 mg po tid AND Quinine 650 mg po tid for 7–10 days OR Clindamycin 1.2 gm IV bid.
  • Note(1) For overwhelming infection in asplenic patients and immunocompromised patients, treat for 6 or more weeks
  • Note(2)Consider transfusion if 􀂕10% parasitemia


CL

IM SbV at 20 mg/kg/day for 14 days for the treatment of L. major, the national standard for the treatment of CL


  • ===1.Cutaneous Leishmaniasis===
  • 1.1Systemic Therapy (Parenteral)
  • Preferred Regimen: Sodium stibogluconate 20 mg/kg IV/IM once qd for 10-20 days OR Meglumine antimoniate 20 mg/kg IV/IM once qd for 10-20 days
  • Alternative Regimen: Liposomal amphotericin B 3 mg/kg/day IV infusion for 6-10 days OR Pentamidine 2-3 mg/kg/day IV/IM for 4-7 days
  • Note: Data supporting the use of amphotericin B for treatment of cutaneous (and mucosal) leishmaniasis are anecdotal; standard dosage regimens have not been established. In the United States, pentamidine isethionate is uncommonly used for treatment of cutaneous leishmaniasis. Its limitations include the potential for irreversible toxicity and variable effectiveness.
  • 1.2 Systemic Therapy (Oral)
  • Preferred Regimen: In adults and adolescents at least 12 years of age who weigh from 33-44 kg:-Miltefosine 50 mg PO q12h for 28 days
  • Patients who weigh >45 kg:-Miltefosine 50 mg PO q8h for 28 days
  • Alternative Regimen:Ketoconazole 600 mg qd for 28 days OR Fluconazole 200 mg qd for 6 weeks
  • Note:The FDA-approved indications are limited to infection caused by three particular species, all three of which are New World species in the Viannia subgenus—namely, Leishmania (V.) braziliensis, L. (V.) panamensis, and L. (V.) guyanensis. The "azoles" showed modest activity against some Leishmania species in some cases, but are not FDA approved
  • 1.3Local Therapy
  • List of possible local therapies
  • Cryotherapy (with liquid nitrogen OR Thermotherapy (use of localized current field radiofrequency heat) OR Intralesional administration of SbV OR Topical application of paromomycin (such as an ointment containing 15% paromomycin/12% methylbenzethonium chloride in soft white paraffin)
  • 2.Visceral Leishmaniasis
  • 2.1Systemic Therapy (Parenteral)
  • Preferred Regimen: Liposomal amphotericin B 3 mg/kg/day IV for 5 days, then once on day 14 and once on day 21 (Total dose: 21 mg/kg) ORSodium stibogluconate 20 mg/kg IV/IM once daily for 28 days OR Meglumine antimoniate 20 mg/kg IV/IM once daily for 28 days'
  • Alternative Regimen:Amphotericin B deoxycholate 0.5-1 mg/kg IV once daily (Total dose: 15-20 mg/kg)
  • Note: In immunosuppressed patients, dose is 4 mg/kg/day for 5 days, then once on day 10, 17, 24, 31, and 38 (Total dose: 40 mg/kg)
  • 2.2 Systemic Therapy (Oral)
  • Preferred Regimen:In adults and adolescents at least 12 years of age, who weigh from 33-44 kg:Miltefosine 50 mg PO q12h for 28 days Patients who weigh >45 kg:Miltefosine 50 mg PO q8h for 28 days

Plasmodium FalciparumMalaraia

  • 1. Plasmodium Falciparum
  • 1.1 Treatment of uncomplicated P. falciparum malaria
  • 1.1.1 Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)
  • Preferred regimen(1): Artemether 5–24 mg/kg bw PO AND Lumefantrine 29–144 mg/ kg bw PO, Both are given bid for 3 days (total, six doses). The first two doses should, ideally, be given 8 h apart.
  • Preferred regimen(2):Artesunate (2–10) mg/kg bw per day AND Amodiaquine(7.5–15) mg/kg bw per day ,both are given once a day for 3 days. A total therapeutic dose range of 6–30 mg/kg bw per day artesunate and 22.5–45 mg/kg bw per dose amodiaquine is recommended
  • Preferred regimen(3): Artesunate (2–10) mg/kg bw per dayAND Mefloquine (2–10) mg/kg bw per day both are given once a day for 3 days
  • Dosage regimen based on Body weight (kg)
  • Body weight (kg)-5 to < 9- Artesunate 25 (mg) AND Mefloquine 55 (mg) given bid for 3 days;
  • Body weight (kg)-9to < 18- Artesunate 50 (mg) AND Mefloquine 110 (mg) given bid for 3 days;
  • Body weight (kg)-18 to < 36- Artesunate 100 (mg) AND Mefloquine 220 (mg) given bid for 3 days;
  • Body weight (kg)- ≥ 36 - Artesunate 200 (mg) AND Mefloquine 440 (mg) given bid for 3 days;
  • Preferred regimen(4): Artesunate (2–10) mg/kg bw per day given once a day for 3 days AND Sulfadoxine–Pyrimethamine 1.25 (25–70 / 1.25–3.5) mg/kg bw given as a single dose on day 1
  • 1.1.2Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)
  • Preferred regimen: single dose of 0.25 mg/kg bw Primaquine with ACT
  • 1.2Recurrent Falciparum Malaria
  • 1.2.1Failure within 28 days
  • Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.
  • 1.2.2 Failure after 28 days
  • Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used
  • 1.3Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)
  • Note a single dose of 0.25 mg/kg bw Primaquine with ACT
  • 1.4Treating uncomplicated P. falciparum malaria in special risk groups
  • 1.4.1Pregnancy
  • First trimester of pregnancy :Quinine AND Clindamycin PO 10mg/kg bw bid for 7 days
  • Second and third trimesters : Mefloquine is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
  • Note:Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
  • Note:Primaquine and tetracyclines should not be used in pregnancy.
  • 1.4.2 Infants less than 5kg body weight : with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
  • 1.4.3Patients co-infected with HIV:should avoid Artesunate + SP if they are also receiving Co-trimoxazole, and avoid artesunate + amodiaquine if they are also receiving efavirenz or zidovudine.
  • 1.4.4 Large and Obese adults: For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
  • 1.4.5 Patients co-infected with TB: Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults

with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate

  • 1.4.6Non-immune travellers:  : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
  • 1.4.7Uncomplicated hyperparasitaemia:People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT
  • 2. Treatment of uncomplicated malaria caused by P.Vivax, P. ovale, P.Malariae Or P. Knowlesi
  • 2.1 Blood Stage
  • 2.1.1. Uncomplicated malaria caused by P.Vivax
  • 2.1.1.1'In areas with chloroquine-sensitive P. vivax
  • Preferred regimen: Chloroquine PO total dose of 25 mg base/kg bw. Chloroquine is given at an initial dose of 10 mg base/kg bw, followed by 10 mg/kg bw on the second day and 5 mg/kg bw on the third day.
  • 2.1.1.2'In areas with chloroquine-resistant P. vivax
  • Note:ACTs containing piperaquine, mefloquine or lumefantrine are the recommended treatment, although artesunate + amodiaquine may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, dihydroartemisinin + piperaquine provided a longer prophylactic effect than ACTs with shorter half-lives (artemether + lumefantrine, artesunate + amodiaquine), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.
  • 2.1.2 Uncomplicated malaria caused by P. ovale, P.Malariae Or P. Knowlesi malaria
  • Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or chloroquine, as for vivax malaria.
  • 2.1.3 Mixed malaria infections
  • Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.
  • 2.2 Treatment of liver stages( Hypnozoites) of P. Vivax and P.Ovale
  • Note:To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]
  • 2.2.1Primaquine for preventive relapse
  • Preferred regimen: Primaquine PO 0.25–0.5 mg/kg bw per day qd for 14 days
  • 2.2.2Primaquine and glucose-6-phosphate dehydrogenase deficiency
  • Preferred regimen:Primaquine PO 0.75 mg base/kg bw once a week for 8 weeks.
  • Note::The decision to give or withhold primaquine should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.
  • 2.2.3Prevention of relapse in pregnant or lacating women and infants
  • Note:Primaquine is contraindicated in pregnant women, infants < 6months of age and in lactating women (unless the infant is known not to be G6PD deficient).
  • 3.Treatment of sever malaria
  • 3.1Treatment of sever falciparum infection with Artesunate
  • 3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-
  • Preferred regimen: Artesunate IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oraltherapy, complete treatment with 3 days of an ACT (add single dose Primaquine in areas of low transmission).
  • 3.1.2 Young children weighing < 20 kg
  • Preferred regimen:Artesunate (3 mg/kg bw per dose)
  • Alternatives regimen: use Artemether in preference to quinine for treating children and adults with severe malaria
  • 3.2.Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)
  • 3.2.1 Adults and children
  • Preferred regimen: Artesunate IM
  • Alternative regimen: Artemether IMOR Quinine IM
  • 3.2.2 Children < 6 years
  • Preferred regimen: Where intramuscular injections of artesunate are not available , treat with a single rectal dose (10 mg/kg bw) of Artesunate, and refer immediately to an appropriate facility for further care.
  • Note: Do not use rectal artesunate in older children and adults.
  • 3.3 Pregancy
  • Note:Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed
  • 3.4 Treatment of sever P.Vivax infection
  • Note:parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery
  • 3.5 Additional aspects of management in sever malaria
  • Fluid therapy Fluid requirements should be assessed individually. Adults with severe malaria are very vulnerable to fluid overload, while children are more likely to be dehydrated.The fluid regimen must also be adapted to the infusion of antimalarial drugs.Rapid bolus infusion of colloid or crystalloids is contraindicated.As the degree of fluid depletionvaries considerably in patients with severe malaria, it is not possible to give general

recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit

  • Blood Transfusion :In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended
  • Exchange blood transfusion: Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion

toxoplasmosis

  • Persons with ocular disease
  • Maternal and fetal infection
  • First and early second trimesters
  • Late second and third trimesters
  • Infant
  • Note:If the infant is likely to be infected, then treatment with drugs such as Pyrimethamine AND Sulfadiazine ANDLeucovorin is typical. Congenitally infected newborns are generally treated with pyrimethamine, a sulfonamide, and leucovorin for 1 year African trypanosomiasis


African trypanosomiasis

T. b. rhodesiense, hemolymphatic stage Adult Dosage: Suramin 1 gm IV on days 1,3,5,14, and 21 Pediatric Dosage: Suramin 20 mg/kg IV on days 1, 3, 5, 14, and 21


T. b. rhodesiense, CNS involvement Adult Dosage - Melarsoprol 2-3.6 mg/kg/day IV x 3 days.After 7 days, 3.6 mg/kg/day x 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.

Pediatric Dosage-Melarsoprol 2-3.6 mg/kg/day IV x 3 days.After 7 days, 3.6 mg/kg/day x 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days 

T. b. gambiense, Hemolymphatic stage

Adult Dosage- Pentamidine 4 mg/kg/day IM or IV x 7-10 days

Pediatric Dosage- Pentamidine 4 mg/kg/day IM or IV x 7-10 days

T. b. gambiense, CNS involvement Adult Dosage- Eflornithine 400 mg/kg/day in 4 doses x 14 days

Pediatric Dosage- Eflornithine 400 mg/kg/day in 4 doses x 14 days

  1. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  3. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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