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• 1. Bacteremia

• 1.1 Ampicillin or Penicillin susceptible

• Preferred regimen (1): Ampicillin 2 g IV q4-6h
• Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h

• 1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy

• Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
• Preferred regimen (2): Linezolid 600 mg IV q12h
• Preferred regimen (3): Daptomycin 6 mg/kg IV q24h

• 1.3 Ampicillin and Vancomycin resistant

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

• 2. Endocarditis

• 2.1 Endocarditis in Adults

• 2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

• Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
• Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
• Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
• Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
• Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

• 2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

• Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU IV q24h for 4–6 weeks) ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
• Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

• 2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

• 2.1.3.1 β Lactamase–producing strain

• Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h 6 weeks
• Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

• 2.1.3.2 Intrinsic penicillin resistance

• Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

• 2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

• Preferred regimen (1): (Imipenem OR Cilastatin 2 g/day IV for ≥ 8weeks AND Ampicillin 12 g/day IV for ≥ 8weeks)
• Preferred regimen (2): (Ceftriaxone sodium 4 g IV/IM q24h for ≥ 8weeks AND Ampicillin 12 g IV q24h for ≥ 8weeks)

• 2.2 Endocarditis in Pediatrics

• 2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

• Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
• Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
• Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
• Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
• Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

• 2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

• Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
• Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

• 2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

• 2.2.3.1 β Lactamase–producing strain

• Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
• Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

• 2.2.3.2 Intrinsic penicillin resistance

• Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

• 2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

• Preferred regimen: Imipenem/Cilastatin 60–100 mg/kg IV q24h for ≥ 8weeks AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks
• Alternate regimen: Ceftriaxone 100 mg/kg IV/IM q24h AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks

• 3. Meningitis

• 3.1 Ampicillin susceptible

• Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

• 3.2 Ampicillin resistant

• Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h

• 3.3 Ampicillin and vancomycin resistant

• Preferred regimen: Linezolid 600 mg IV q12h

• 4. Urinary tract infections

• Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
• Preferred regimen (2): Fosfomycin 3 g PO single dose
• Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days

• 5. Intra abdominal or Wound infections

• Preferred regimen(1): Penicillin
• Preferred regimen(2): Ampicillin
• Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
• Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

• Enterococcus faecium

• 1. Bacteremia

• 1.1 Ampicillin or Penicillin susceptible

• Preferred regimen (1): Ampicillin 2 g IV q4-6h
• Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h

• 1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy

• Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
• Preferred regimen (2): Linezolid 600 mg IV q12h
• Preferred regimen (3): Daptomycin 6 mg/kg IV q24h.

• 1.3 Ampicillin and Vancomycin resistant

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

• 2. Endocarditis

• 2.1 Endocarditis in Adults

• 2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

• Preferred regimen: (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU/day IV for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
• Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
• Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
• Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
• Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
• Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

• 2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

• Preferred regimen: (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV q24h for 4–6 weeks) ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
• Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

• 2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

• 2.1.3.1 β Lactamase–producing strain

• Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
• Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

• 2.1.3.2 Intrinsic penicillin resistance

• Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

• 2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

• Preferred regimen(1): Linezolid 1200 mg IV/PO q24h ≥8 weeks
• Preferred regimen(2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks

• 2.2 Endocarditis in Pediatrics

• 2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

• Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
• Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
• Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
• Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
• Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

• 2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

• Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
• Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

• 2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

• 2.2.3.1 β Lactamase–producing strain

• Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
• Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

• 2.2.3.2 Intrinsic penicillin resistance
• Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

• 2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

• Preferred regimen(1): Linezolid 30 mg/kg IV/PO q24h ≥ 8 weeks
• Preferred regimen(2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks

• 3. Meningitis

• 3.1 Ampicillin susceptible

• Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

• 3.2 Ampicillin resistant

• Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h

• 3.3 Ampicillin and vancomycin resistant

• Preferred regimen: Linezolid 600 mg IV q12h

• 4. Urinary tract infections

• Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
• Preferred regimen (2): Fosfomycin 3 g PO single dose
• Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days

• 5. Intra abdominal or Wound infections

• Preferred regimen(1): Penicillin
• Preferred regimen(2): Ampicillin
• Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
• Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

• Aeromonas hydrophila

• 1. Diarrhea

• Preferred regimen(if not self-limiting, or if severe): Ciprofloxacin 500 mg PO bid.
• Alternate regimen: TMP-SMX single dose PO bid
• Note: High resistance to sulfa agents described in Taiwan and Spain

• 2. Skin and soft tissue infection

• 2.1 Mild infection

• Preferred regimen(1): Ciprofloxacin 500 mg PO bid
• Preferred regimen(2): Levofloxacin 500 mg qd.

• 2.2 Severe infection or sepsis

• Preferred regimen(1): Ciprofloxacin 400 mg IV q8h
• Preferred regimen(2): Levofloxacin 750 mg IV q24h
• Note(1): For suspicion of water-based injury,empiric coverage for Vibrio Doxycycline 100mg bid, although Flouroquinolones may also cover AND Vancomycin 15mg/kg IV q12h Template:With or without Clindamycin OR Linezolid for inhibition of Gram-positive toxin production
• Note(2): Alternatives to Fluoroquinolones for Aeromonas coverage include carbapenems (ertapenem, doripenem, imipenem or meropenem),ceftriaxone, cefepime and Aztreonam.

• 3. Prevention

• Preferred regimen: Frequent recommendations include using a Cephalosporin (e.g.,cefuroxime,ceftriaxone or cefixime) OR a Fluoroquinolone (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches.
• Note (1): Duration of antibiotic use is 3-5days, some recommend continuing until wound or eschar resolves
• Note (2): Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones.

Bacteria – Gram-Negative Bacilli

• Achromobacter xylosoxidans Return to Top
• Acinetobacter baumannii Return to Top

• Preferred regimen (1): Imipenem 0.5-1 g IV q6h
• Preferred regimen (2): Ampicillin/sulbactam (Unasyn) 3g q4h
• Preferred regimen (3): Cefepime 1-2 g IV q8h
• Preferred regimen (4): Colistin 2.5 mg/kg IV q12h
• Preferred regimen (5): Tigecycline (Tygacil) 100 mg IV, then 50 mg IV q12h
• Preferred regimen (6): Amikacin 7.5 mg/kg q12h IV or 15 mg/kg/day IV
• Alternative regimen (1): Ceftriaxone 1-2g IV every day
• Alternative regimen (2): Cefotaxime 2-3g IV q6-8h
• Alternative regimen (3): Ciprofloxacin 400 mg IV q8-12h or 750 mg PO bid
• Alternative regimen (4): TMP-SMX 15-20 mg (TMP)/kg/day IV divided 3 or 4 doses/day or 2 DS PO bid

• Aeromonas hydrophila Return to Top

• Aeromonas hydrophila

• 1. Diarrhea

• Preferred regimen (if not self-limiting, or if severe): Ciprofloxacin 500 mg PO bid.
• Alternate regimen: TMP-SMX single dose PO bid
• Note: High resistance to sulfa agents described in Taiwan and Spain

• 2. Skin and soft tissue infection

• 2.1 Mild infection

• Preferred regimen (1): Ciprofloxacin 500 mg PO bid
• Preferred regimen (2): Levofloxacin 500 mg OD.

• 2.2 Severe infection or sepsis

• Preferred regimen (1): Ciprofloxacin 400 mg IV q8h
• Preferred regimen (2): Levofloxacin 750 mg IV q24h
• Note (1): For suspicion of water-based injury,empiric coverage for Vibrio Doxycycline 100mg bid, although Flouroquinolones may also cover AND Vancomycin 15mg/kg IV q12h Template:With/without Clindamycin OR Linezolid for inhibition of Gram-positive toxin production
• Alternative regimen: Alternatives to fluoroquinolones for Aeromonas coverage include (Carbapenems (Ertapenem, Doripenem, Imipenem, Meropenem), Ceftriaxone, Cefepime and Aztreonam.

• 3. Prevention

• Preferred regimen: Frequent recommendations include using a Cephalosporin (e.g.,cefuroxime, ceftriaxoneorcefixime) OR a Fluoroquinolone (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches.
• Note: Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones. Duration of antibiotic use is 3-5days, some recommend continuing until wound or eschar resolves

• Bartonella Return to Top

• Bartonella

• 1. Cat scratch disease

• 1.1 If extensive adenopathy

• Preferred regimen: Azithromycin 500 mg single dose

• 2. Retinitis

• Preferred regimen: Doxycycline 100 mg bid AND Rifampin 300 mg bid PO for 4-6 weeks.

• 3. Bacillary angiomatosis

• Preferred regimen (1): Erythromycin 500 mg PO qid
• Preferred regimen (2): Doxycycline 100mg PO bid for >3 months.

• 4. Peliosis hepatitis

• Preferred regimen (1): Erythromycin 500 mg PO qid
• Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months.

• 5. Oroya fever

• Preferred regimen: Ciprofloxacin 500 mg PO bid for 10 days.

• 6. Endocarditis

• Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g/day IV for 6weeks Template:With/without Doxycycline 100 mg PO bid for 6 weeks.

• Bordetella pertussis Return to Top

• Bordetella pertussis ::*1. Whooping cough

• 1.1 Adults

• Preferred regimen (1): Azithromycin 500 mg PO single dose then 250 mg PO qd for 2-5days
• Preferred regimen (2): Clarithromycin 500 mg bid for 7 days.
• Alternative regimen(Intolerant of macrolides): Trimethoprim-sulfamethoxazole DS bid PO for 14 days
• Alternative regimen (2): Erythromycin 250 mg PO qid for 14 days

• 1.2 Infants <6 months of age

• 1.2.1 Infants <1 month

• Preferred regimen: Azithromycin 10 mg/kg/day for 5 days
• Note: Erythromycin, Clarithromycin and TMP-SMX not recommended

• 1.2.2 Infants of 1-5 months of age

• Preferred regimen(1): Azithromycin 10 mg/kg/day for 5 days
• Preferred regimen(2): Clarithromycin 15mg/kg bid for 7 days
• Preferred regimen(3): Erythromycin 10 mg/kg PO qid for 14 days,
• Note: TMP-SMX contraindicated.

• 1.3 Infants >6 months of age-children

• Preferred regimen(1): Azithromycin 10 mg/kg (500 mg max) qd for 5 days
• Preferred regimen(2): Clarithromycin 15 mg/kg (1 g daily max) bid for 7 days
• Preferred regimen(3): Erythromycin 10mg/kg PO (2g daily max) qid for 14 days
• Preferred regimen(4): TMP-SMX 4 mg/40 mg/kg bid for 14 days.
• Note(1): TMP-SMX should only be used in patients ≥2 months of age who are allergic or intolerant of macrolides or who have a macrolide-resistant strain.
• Note(2): Although fluoroquinolones have excellent in vitro sensitivity profiles, clinical experience for B. pertussis is limited.

• Burkholderia cepacia Return to Top

• Burkholderia cepacia

• Preferred regimen : Ceftazidime 2 g IV q8h OR Imipenem 1 g IV q6h OR Meropenem 1-2g IV q8h OR Minocycline 100 mg IV/PO bid.

• Burkholderia pseudomallei Return to Top

• Burkholderia pseudomallei

• 1.Melioidosis

• 1.1.Intial intensive therapy (Minimum of 10-14 days)

• Preferred regimen : Ceftazidime 50 mg/kg upto 2 g q6h OR Meropenem 25mg/kg upto 1g q8h OR Imipenem 25 mg/kg upto 1g
• Note : Any one of the three may be combined with TMP-SMX6/30 mg/kg upto 320/1600 mg/kg q12h (recommended for neurologic, bone, joint, cutaneous and prostatic melioidosis)

• 1.2.Eradication therapy (Minimum of 3months)

• Preferred regimen : TMP-SMX6/30 mg/kg upto 320/1600 mg/kg q12h

• Campylobacter Return to Top
• Campylobacter fetus Return to Top

• Campylobacter fetus

• Serious infections

• Preferred regimen : Gentamicin 5mg/kg/day IV OR Imipenem 1mg IV q6h OR Ceftriaxone 2g IV q12h.

• Endovascular infections

• Preferred regimen : Aminoglycoside4-6weeks combined with Carbapenem.

• CNS

• preferred regimen : Ceftriaxone OR Chloramphenicol for 2-3weeks.

• Campylobacter jejuni Return to Top

• Capnocytophaga canimorsus Return to Top

• Capnocytophaga canimorsus

• 1.Severe Cellulitis/Sepsis or Endocarditis

• Preferred regimen

• Beta-lactam/beta-lactamase inhibitor : Ampicillin/sulbactam 3 g IV q6h
• Non-beta-lactamase producing : Penicillin G 2-4MU q4h IV

• Alternative regimen : Ceftriaxone 1-2 g IV q24h OR Meropenem 1 g IV q8h.

• 2.Complicated infections or Immunocompromise

• Preferred regimen : Clindamycin 600 mg IV q8h may be combined with above agents
• Note (1): Resistance to aztreonam described, and variable susceptibility reported to TMP-SMX and aminoglycosides.
• Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks. For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy.

• 3.Mild Cellulitis/Dog or Cat Bites

• Preferred regimen : Amoxicillin/clavulanate 500 mg PO q8h or 875 mg PO bid OR Amoxicillin 500 mg PO q8h.
• Alternative regimen : Clindamycin 300 mg PO q6h OR Doxycycline 100 mg PO bid OR Clarithromycin 500 mg PO bid OR Moxifloxacin 400 mg PO OD.

• 4.Meningitis or brain abscess

• Preferred regimen : Use Ceftriaxone 2 g IV q12h AND Ampicillin 2 g IV q4h
• If Beta-lactamase producing or polymicrobial brain abscess : Imipenem/cilastin 1000 mg q6-8h AND Clindamycin 600 mg IV q8h

• 5.Prevention

• Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with amoxicillin/clavulanate for 7-10 days.

• Citrobacter freundii Return to Top

• Citrobacter freundii

• Preferred regimen: Meropenem 1-2 g IV q8h OR Imipenem 1 g IV q6h OR Doripenem 500 mg IVq8hOR Cefepime 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h(or 500 mg PO bid for UTI) OR Gentamicin 5 mg/kg/day.
• Alternate regimen: Piperacillin/tazobactam 3.375 mg q6h IV OR Aztreonam 1-2 g IV q6h OR TMP-SMX 5 mg/kg q6h IV (or DS PO bid for UTI).

• Citrobacter koseri Return to Top

• Citrobacter koseri

• Preferred regimen: Ceftriaxone 1-2 g IV q12-24 OR Cefotaxime 1-2 g IV q6h OR Cefepime 1-2 IV q8h.
• Alternate regimen: Ciprofloxacin 400 mg IV q12h (or 500 mg PO q12h for UTI)OR Imipenem 1 g IV q6h OR Doripenem 500 mg IV q8h OR Meropenem 1-2 g IV q8h OR Aztreonam 1-2 g IV q6hOR TMP-SMX 5 mg/kg q6h IV (or DS PO bid for UTI).
• Note: Usually Ampicillin resistant, but may be sensitive to first generation cephalosporins

• Elizabethkingia meningoseptica Return to Top
• Enterobacter aerogenes Return to Top

• Enterobacter aerogenes

• 1.UTI

• Preferred regimen: Ciprofloxacin 250 mg PO bid

• Enterobacter cloacae Return to Top

• Enterobacter cloacae

• 1.UTI

• Preferred regimen: Ciprofloxacin 250 mg PO bid

• Escherichia coli Return to Top

• Escherichia coli

• 1.Meningitits

• 1.1.Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
• 1.2.Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h OR Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Ampicillin 12 g/day IV q4h

• 2.Uncomplicated urinary tract infection

• 2.1.Preferred agents (IDSA/AUA Guidelines): TMP-SMX DS PO bid for 3-day
• 2.2.Alternative regimen(1): Ciprofloxacin 250 mg PO bid OR Ciprofloxacin 500 mg XR once daily for 3 days OR Levofloxacin 250 mg PO OD for 3 days.
• 2.3.Alternative regimen(2): Nitrofurantoin 100 mg PO q6h OR Nitrofurantoin macrocrystals (Macrobid) 100 mg PO bid for 7 days.
• 2.4.Alternative regimen(3): Fosfomycin 3 g sachet PO single dose.

Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.

• 3.Pyelonephritis

• 3.1.Acute uncomplicated pyelonephritis

• Preferred regimen: Ciprofloxacin 500 mg bid PO for 5-7 days OR Ciprofloxacin-Erythromycin 1000 mg q24h OR Levofloxacin 750 mg q24h OR Ofloxacin 400 mg bid, Moxifloxacin 400 mg q24h
• Alternative regimen: Amoxicillin-Clavulanic acid875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid OR Oral Cephalosporins OR TMP-SMX 2 mg/kg IV q6h PO for 14 days

• 3.1.Acute pyelonephritis (Hospitalized)

• Preferred regimen: Ciprofloxacin 400 mg IV q12h OR Ampicillin and Gentamicin OR Piperacillin-Tazobactam 3.375 gm IV q4-6h for 14 days.
• Alternative regimen: Ticarcillin-Clavulanate3.1 gm IV q6h or Ampicillin-Sulbactam 3 gm IV q6h or Piperacillin-Tazobactam 3.375 gm IV q4-6h OR Ertapenem 1 gm IV q24h or Doripenem 500 mg q8h for 14 days.

• 4.Traveler’s diarrhea

• Preferred regimen : Ciprofloxacin 750 mg PO OD for 1-3 days or other Fluoroquinolones
• Pediatrics & pregnancy: Azithromycin 10 mg/kg/day single dose OR Ceftriaxone 50 mg/kg/day IV OD for 3 days.

Avoid Fluoroquinolones in Pediatrics and pregnancy.

• 5.Malacoplakia

• Bethanechol chloride AND (Ciprofloxacin 400 mg IV q12h OR TMP-SMX 2 mg/kg (TMP component) IV q6h)

• 6.Bacteremia/Pneumonia

• Preferred regimen : Ceftriaxone 1-2g IV q24h OR other third or fourth generation cephalosporin OR Ciprofloxacin 400mg IV q12h or 500mg PO q12h OR Levofloxacin 500mg PO/IV q24h OR Moxifloxacin 400mg IV/PO q24h OR Ampicillin(if sensitive) 2g IV q6h OR TMP-SMX(if sensitive) 5-10mg/kg/day for q6-8hIV
• Alternative regimen (1): Imipenem, Meropenem, Ertapenem, Doripenem, Ceftazidime, Cefepime, Cefazolin or Cefuroxime(if sensitive), Aztreonam, Ticarcillin, Piperacillin, Piperacillin-Tazobactam, Aminoglycosides, Tigecycline(intra-abd or skin/softtissue).
• Alternative regimen (2): Ampicillin-sulbactam 3g IV q6h ANDGentamicin 1.5mg/kg/q8h or 5-7mg/kg/dayIV OR Gentamicin 5mg/kg/day OR Tobramycin 5mg/kg/dayIV for 7-14days
• Note: Monotherapy generally not recommended for bacteremia/pneumonia

• Francisella tularensis Return to Top

• Francisella tularensis

• 1.Tularemia

• Preferred regimen : Streptomycin 1 g IM bid OR Gentamicin 5 mg/kg/day IV for 10 days.
• Alternative regimen : Doxycycline 100 mg IV bid OR Chloramphenicol 1 g IV q6h OR Ciprofloxacin 400 mg IV bid until stable then PO for 14-21 days (total).
• 1.1.Pregnancy

• Preferred regimen : Gentamicin 5 mg/kg/day IV for 10 days.
• Alternative regimen : Ciprofloxacin.

• Helicobacter pylori Return to Top

• Helicobacter pylori

• 1.Peptic ulcer disease

• 1.1.Regimens for Initial Treatment

• 1.1.1.Triple therapy : PPI(standard dose twice daily) AND Amoxicillin 1 g bid AND Clarithromycin 500 mg bid for 7-14 days
• 1.1.2.Quadruple therapy: PPI (standard dose twice daily) AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
• 1.1.3.Sequential therapy: PPI (standard dose twice daily)AND Amoxicillin 1 g bid for 1-5 days followed by PPI (standard dose twice daily)AND Clarithromycin 500 mg bid AND Tinidazole 500 mg bid for 6-10 days

• 1.2. Second-Line Therapies

• 1.2.1.Triple therapy: PPI (standard dose twice daily) AND Amoxicillin 1 g bid AND Metronidazole 500 mg bid
• 1.2.2.Quadruple therapy: PPI (standard dose twice daily)AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
• 1.2.3.Levofloxacin triple therapy: PPI (standard dose twice daily) AND Amoxicillin 1 g bid AND Levofloxacin 500 mg bid for 10 days
• 1.2.4.Rifabutin triple therapy: PPI (standard dose twice daily) and Amoxicillin 1 g bid AND Rifabutin 150-300 mg/day for 10 days

• 1.3.Alternative triple therapies appropriate for patients with an allergy to Amoxicillin include (PPI AND Clarithromycin AND Metronidazole)OR (PPI AND Tetracycline AND Metronidazole).

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• Klebsiella granulomatis Return to Top

• Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)

• 1. Granuloma inguinale (donovanosis)

• Preferred regimen: Azithromycin 1 g PO once a week or 500 mg qd for 3 weeks and until all lesions have completely healed
• Alternative regimen (1): Doxycycline 100 mg PO bid for 3 weeks and until all lesions have completely healed
• Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
• Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
• Alternative regimen (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed

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• Klebsiella pneumoniae Return to Top

• Klebsiella pneumoniae

• 1.Severe,nosocomial infection

• Preferred regimen : Cefepime 2g IV q8h OR Ceftazidime 2g IV q8h OR Imipenem 500mg IV q6h OR Meropenem 1g IV q8h OR Piperacillin-tazobactam 4.5 g IV q6h AND Aminoglycoside OR Respiratory fluoroquinolone
• For coverage of ESBLs in pneumonia,sepsis,complicated UTI or intra-abdominal infections :Imipenem 500mg IV q6h OR Meropenem 1g IV q8h OR Ertapenem 1g IV q24h OR Doripenem 500mg IV q8h
• In ESBLs,inconsistent activity seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins
• Alternate regimen : (Ceftriaxone 1 gm IV q24h AND Metronidazole 500 mg IV q6h or 1 gm IV q12h) OR Moxifloxacin 400 mg IV/po q24h

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• Klebsiella rhinoscleromatis Return to Top

• 1. Rhinoscleroma

• Preferred regimen (1): Ciprofloxacin 500–750 mg PO bid for 2–3 months OR Levofloxacin 750 mg PO qd for 2–3 months
• Preferred regimen (2): Trimethoprim-Sulfamethoxazole 1 DS tab PO bid for 3 months AND Rifampicin 300 mg PO bid for 3 months
• Alternative regimen: Tetracycline OR Streptomycin OR Doxycycline OR Ceftriaxone OR Ofloxacin
• Note (1): The optimal duration of antimicrobial therapy remains unclear. A 6-week to 6-month cours of antibiotics until histology exams and cultures are negative may be required.
• Note (2): Use of topical antiseptics such as Acriflavinium and Rifampin ointment has been reported with resolution of symptoms.

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• Legionella pneumophila Return to Top

• Preferred regimen: Levofloxacin 750mg PO/IV OD for 7-10days OR Moxifloxacin 400mg PO/IV OD for 7-10 days OR Azithromycin 500mg PO/IV OD for 7-10days OR Rifampin 300mg PO/IV bid(optional) AND any other agent listed.
• Alternative regimen: Erythromycin 1g IV q6h and then 500mg PO q6h for 7-10days OR Ciprofloxacin400mg IV q12h then 750mg PO bid 7-10days

• Moraxella catarrhalis Return to Top

• Pneumonia

• Preferred regimen:Amoxicillin-Clavulanate(Augmentin)875/125mg PO bid or XL 2000/125 PO bid OROral cephalosporins such as Cefprozil(Cefzil)200-500mg bid OR Cefpodoxime(Vantin)200-400mg bid OR Cefuroxime(Ceftin)250-500mg bid OR Cefdinir(Omnicef)300mg bid OR Parenteral cephalosporins such as Cefuroxime OR Cefotaxime OR Ceftriaxone OR Macrolides such as Erythromycin 500mg PO q6h OR Clarithromycin 500mg bid or XL 1g PO OR Azithromycin 500mg single dose then 250mg PO, OR Flouroquinolones such as Moxifloxacin(Avelox) 400mg IV/PO OD OR Levofloxacin(Levaquin)500mg IV/PO OD OR TMP-SMX DS PO bid

• Morganella morganii Return to Top

• Morganella morganii

• Preferred regimen : Imipenem 500mg IV q6h OR Meropenem 1.0g IV q8h (adjustdose if necessary for renalfunction).
• Note (1): Carbapenems are considered first line therapy due to inducible cephalosporinases, and presence of extended-spectrum beta-lactamases in some isolates.
• Note (2): Duration of treatment for UTI(generallycomplicated) is 7days and Duration of treatment for bacteremia is 14days.
• Note (3): Tigecycline is not reliably effective
• Alternative Regimen (1) : Cefepime 2.0 g IV q8-12h OR Ciprofloxacin 500 mg PO/400mg IV q12h OR Piperacillin 3g IV q6h OR Ticarcillin 3g IV q4h
• Alternative Regimen (2) : Aminoglycosides can be used alone for treatment of UTI,Gentamicin OR Tobramycin 1mg/kg/day IV OR Amikacin 3mg/kg/day

• Plesiomonas shigelloides Return to Top

• Plesiomonas shigelloides

• 1.Immunocompetent Hosts or Severe Infection

• Preferred regimen : Ciprofloxacin 500mg PO bid or 400mg IV q12h.
• Alternative regimen (1): Ofloxacin 300mg PO bid OR Norfloxacin 400mg PO bid OR TMP-SMX DS PO bid for 3days.
• Alternative regimen (2): Ceftriaxone 1-2g IV OD used successfully in severe cases.

• 2.Immunocompromised Hosts

• Preferred regimen : Ciprofloxacin 500mg PO bid for 3days.
• Alternative regimen : Ofloxacin 300mg PO bid OR Norfloxacin 400mg PO bid OR TMP-SMX DS PO(if susceptible) bid for 3days

• Proteus mirabilis Return to Top

• Proteus mirabilis

• Preferred regimen (1): Ampicillin 500 mg PO q6h or 2 g IV q6h.
• Preferred regimen (2): Cefuroxime 250 mg PO bid or 750 mg IV q8h.
• Preferred regimen (3): Ciprofloxacin 250-500 mg PO bid or 400 mg IV q12h.
• Preferred regimen (4): Levofloxacin 500 mg PO OD or 500 mg IV q24h.
• Note: Uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia 7-14 days.

• Indole positive Proteus species Return to Top

• Indole positive Proteus species

• Preferred regimen (1): Ceftriaxone 1 g IV q24h.
• Preferred regimen (2): Imipenem 500 mg IV q6h.
• Preferred regimen (3): Ciprofloxacin 400 mg IV q12h or 250-500 mg PO bid.
• Preferred regimen (4): Levofloxacin 500 mg IV/PO q24h.

• Providencia Return to Top

• Providencia

• Complicated UTI/Bacteremia/Acute prostatitis

• Preferred regimen : Ciprofloxacin 500-750mg PO q12h or 400 mg IV q8-12h OR Levofloxacin 500mg IV/PO q24h OR Piperacillin-Tazobactam 3.375 mg IV q6h ORCeftriaxone 1-2g IV q24h (donot use if ESBL suspected or critically ill)OR Meropenem 1g IV q8h (consider if critically ill or ESBL suspected)ORAmikacin 7.5mg/kg IV q12h OR Gentamicin OR Tobramycin acceptable if susceptible but many species are resistant.
• Note (1) : Duration of treatment for (UTI)is 7days common or 3-5days after defervescence or control/elimination of complicating factors (e.g.,removal of foreign material catheter).
• Note (2) : Duration of treatment for (bacteremia)is 10-14days or 3-5days after defervescence or control/elimination of complicatingfactors.
• Note (3) : Duration for acute prostatitis(2weeks), shorter than chronic prostatitis(4-6wks)
• Alternative regimen : TMP-SMX(Bactrim)DS1 PO q12h for 10-14days OR TMP 5-10 mg/kg/day IV q6h.

• Pseudomonas aeruginosa Return to Top

• Pseudomonas aeruginosa

• Preferred regimen (1) : Cefepime 2g IV q8h OR Ceftazidime 2g IV q8h OR Piperacillin 3-4g IV q4h in (no benefit for pseudomonas from beta-lactamase inhibitor)OR Ticarcillin 3-4g IV q4h(no benefit for pseudomonas from beta-lactamase inhibitor).
• Preferred regimen (2) : Imipenem 500mg—1g IV q6h OR Meropenem 1g IV q8h OR Doripenem 500mg IV q8h OR Ciprofloxacin 400mg IV q8h OR750mg PO q12h(for less serious infections). Aztreonam 2g IV q6-8h.Colistin 2.5 mg/kg IV q12h. Polymyxin B 0.75-1.25 mg/kg IV q12h Gentamicin OR Tobramycin 1.7-2.0 mg/Kg IV q8h or 5-7mg/kg IV OR Amikacin 2.5mg/kg IV q12h.Usually used in combination with other antimicrobials(preferably beta-lactams).

• Note : Amikacin > Tobramycin > Gentamicin with respect to P.aeruginosa susceptibility percentages at most institutions.

• Salmonella Return to Top

• Salmonella

• 1.Gastroenteritis

• Preferred treatment

• Immunocompetent : TMP-SMX DS PO bid OR Ciprofloxacin 500mg PO bid OR Ceftriaxone 2gIV/day for 5-7days.
• Immunosuppressed : TMP-SMX DS PO bid OR Ciprofloxacin 500mg PO bid OR Ceftriaxone 2gIV/day for ≥14days.

• 2.Typhoidfever

• Preferred regimen : Ceftriaxone 1-2g IV q24h then Cefixime 400mg PO for 10-14days OR Ciprofloxacin 400mg IV q12h or 500mg PO bid.

• 3.Non-typhoid(seriousinfection)

• Preferred regimen : 3rd generation Cephalosporin (Ceftriaxone/Cefotaxime)OR Fluoroquinolone(Ciprofloxacin, Levofloxacin)

• 4.Bacteremia

• Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IV q6-8h for 7-14days OR Ciprofloxacin 400mg IV q12h for 7-14days

• 5.Vascular prosthesis infection

• Preferred regimen : Ceftriaxone, Cefotaxime OR Ciprofloxacin 400mg IV q12h for 6wks

• 6.Osteomyelitis

• Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IV q6-8h OR Ciprofloxacin 750mg PO bid for ≥4wks

• 7.Arthritis

• Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IVq 6-8h for 6weeks.

• 8.Endocarditis

• Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IV q6-8h for 6weeks.

• 9.UTI

• Preferred regimen : Ceftriaxone, Cefotaxime OR Ciprofloxacin IV for 1-2weeks, then oral Ciprofloxacin OR TMP-SMX for 6weeks

• 10.HIV and salmonellosis

• Preferred regimen : IV Cephalosporin OR IV Fluoroquinolone, then oral Flouroquinolones(Ciprofloxacin 500-750mg PO bid for 4weeks).
• Note : If relapse occurs within 6weeks give life-long abx or until immune recovery post-ART

• 11.Carrier state : Ciprofloxacin 500mg PO bid for 4-6weeks OR TMP-SMX 1DS bid PO for 6weeksOR Amoxicillin 500mg PO for 6weeks.

• Serratia marcescens Return to Top

• Serratia marcescens

• 1.Bacteremia,Pneumonia or SeriousInfections

• Preferred regimen : Cefepime 1-2 g IV q8h OR Imipenem 0.5-1.0 g IV q6h OR Ciprofloxacin 400mg IV q8h.
• Alternative regimen : Aztreonam, Gentamicin OR Amikacin OR Piperacillin/tazobactam also often effective.
• Note : Duration depends on clinical response,usually 7-14days.

• 2.Endocarditis

• Preferred regimen : Choice dictated by sensitivities. 4to6 week duration of parenteral therapy.

• 3.Osteomyelitis

• Preferred regimen : Choice dictated by sensitivity profile. Treat for 6-12weeks depending upon response. Use IV treatment until stable/clinically improved(10-14days min)then may convert to PO therapy if appropriate

• 4.UTI

• Preferred regimen : Ciprofloxacin 250mg PO bid or 400mg IV q12h OR Levofloxacin 250mg PO everyday or 500mg IV q24h
• Note : Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs(e.g.,Beta-lactam and Aminoglycoside OR Fluoroquinolones AND Carbapenem)until susceptibilities known.

• Shigella Return to Top

• Shigella

• Preferred regimen

• If known sulfa sensitive : TMP(160mg)/SMX(800mg) PO q12h for 3-5days.
• Pediatric dose : TMP5mg/SMX 25mg/kg PO bid.
• If TMP/SMX resistant or unknown susceptibility : Ciprofloxacin 500mg OR Norfloxacin 400mg OR Ofloxacin 200mg PO bid for 3-5days.

• Alternative regimen : Ceftriaxone 1g IV q24h OR} Azithromycin 500mg PO single dose, then 250mg PO for 4days OR Nalidixicacid 250mg PO q6h or pediatric dose 55kg/day) OR Ampicillin(500mg PO q6h depending on susceptibility patterns.
• Note : In southeast Asia, growing resistance seen to fluoroquinolones, azithromycin maybe preferred.

• Stenotrophomonas maltophilia Return to Top

• Stenotrophomonas maltophilia

• Preferred treatment : TMP-SMX 15-20(TMP component)mg/kg/day IV/PO q8h.
• Alternative treatment (1) : Ceftazidime 2g IV q8h OR Ticarcillin/clavulanate 3.1g IV q4h OR Tigecycline 100mg IV Single dose,then 50mg IV q12h.
• Alternative treatment (2) : Ciprofloxacin 500-750mg PO /400mg IV q12h OR Moxifloxacin 400mg PO/IV OR Levofloxacin 750mg PO/IV .
• Alternative treatment (3) : Multiply-resistantance Colistin 2.5mg/kg q12h IV.
• Note : Treatment duration uncertain,but usually ≥14days

• Vibrio cholerae Return to Top
• Vibrio parahaemolyticus Return to Top
• Vibrio vulnificus Return to Top

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