Sandbox G

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2]

Medical Therapy

▸ Click on the following categories to expand treatment regimens.

Initial episode   ▸  Mild to moderate   ▸  Severe   ▸  Severe complicated   ▸  Adults, Age <50 Years   ▸  Adults, Age >50 Years   ▸  Immunocompromised   ▸  Recurrent Recurrence   ▸  First recurrence   ▸  Second recurrence   ▸  Penetrating Trauma   ▸  Basilar Skull Fracture

Mild to moderate Recommended treatment ▸ Metronidazole 50 mg orally q8h If no improvement in 5-7 days ▸ Vancomycin 125 mg orally q6h Severe Preferred Regimen ▸ Vancomycin 125 mg orally q6h Infants & Children Preferred Regimen† ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 75 mg/kg IV q6—8h OR ▸ Ceftriaxone 80—100 mg/kg/day IV q12—24h Alternative Regimen† ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Meropenem 40 mg/kg IV q8h † Add Ampicillin 75 mg/kg IV q6h if suspecting Listeria monocytogenes. Adults, Age <50 Years Preferred Regimen† ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen† ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Meropenem 2 g IV q8h † Add Ampicillin 2 g IV q4h if suspecting Listeria monocytogenes. Adults, Age >50 Years Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h PLUS ▸ Ampicillin 2 g IV q4h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h PLUS ▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component) Immunocompromised Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h PLUS ▸ Ampicillin 2 g IV q4h Recurrent Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Postneurosurgical Infection Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h CSF Shunt Infection Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h Penetrating Trauma Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h Basilar Skull Fracture Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h

Emperic therapy

References