Sandbox ID Skin and Soft Tissues

Acne vulgaris

• 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

• 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

• 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 h (Some gram-negative rods are resistant; misses MRSA)
• Preferred regimen (3): Doxycycline PO 100 mg bid (Good activity against Eikenella species, staphylococci, and anaerobes; some streptococci are resistant)

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

• Preferred regimen: Streptomycin 15 mg/kg IM every 12 hours OR Doxycycline 100 mg bid PO OR Gentamicin could be substituted for streptomycin

Carbuncle

• Mild  : Incision and Drainage

• Moderate

• Empiric treatment :TMP-SMX OR Doxycycline
• Culture directed treatment

• MSSA : TMP-SMX
• MRSA : dicloxacillin OR cephalexin

• Severe

• Empiric treatment :Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline
• Culture directed treatment

• MSSA : Nafcillin OR cefazolin OR clindamycin
• MRSA :Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline

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

• Non purulent :

• Mild : Typical cellulitis/erysipelas with no focus of purulence

• Preferred treatment : Pencillin VK OR cephalosporin OR dicloxacillin OR clindamycin

• Moderate : Typical cellulitis/erysipelas with systemic signs of infection

• Preferred treatment : Pencillin VK OR ceftriaxone OR cefazolin OR clindamycin

• Severe : patients who have failed incision and drainage plus oral antibiotics or those with systemic signs of infection such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/µL), or immunocompromised patients

• Empiric treatment: Vancomycin AND piperacillin-tazobactam

• Purulent :

• Mild : Typical cellulitis/erysipelas with no focus of purulence

• Preferred treatment : Incision and Drainage

• Moderate : Typical cellulitis/erysipelas with systemic signs of infection.

• Incision and Drainage
• Empiric treatment : TMP-SMX OR doxycycline
• MRSA : TMP-SMX
• MSSA : Dicloxacillin OR cephalexin

• Severe infection: patients who have failed oral antibiotic treatment or those with systemic signs of infection (as defined above under purulent infection), or those who are immunocompromised, or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction.

• Incision and Drainage
• Empiric treatment : Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline
• MRSA : Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline

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

• Preferred regimen: Penicillin 500 mg qid for 7–10 days OR Amoxicillin 500 mg tid for 7–10 days

Erythrasma

• Localized infection

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

• Widespread infection

• Preferred regimen : clarithromycin 500mg PO bid OR erythromycin 250mg PO bid for 14 days

Fournier gangrene

• Streptococcus or clostridia : Pencillin G
• Polymicrobial : Doripenem OR imipenem OR meropenem
• MRSA suspected :vancomycin OR daptomycin

Furuncle

• Mild  : Incision and Drainage

• Moderate

  Empiric treatment :TMP-SMX OR Doxycycline

  Culture directed treatment

  MSSA : TMP-SMX

  MRSA : dicloxacillin OR cephalexin

• Severe

  Empiric treatment :Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline

  Culture directed treatment

  MSSA : Nafcillin OR cefazolin OR clindamycin

  MRSA :Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline

Gas gangrene

• Empiric antimicrobial therapy

• Preferred regimen : vancomycin1gm IV q12h AND (piperacillin-tazobactam3.375 gm q6h OR ampicillin-sulbactam3 gm IV q6h OR carbapenem)

• Culture directed antimicrobial therapy

• Clostridium perfringens

• Preferred regimen  : penicillin G 24 million units/day divided q4-6h IV AND clindamycin 900 mg IV q8h
• Alternative regimen : erythromycin1 gm q6h IV OR ceftriaxone 2gm IV q12h

Glanders

• Glanders

• Preferred regimen: Ceftazidime OR Gentamicin OR Imipenem OR Doxycycline OR Ciprofloxacin is recommended based on in vitro susceptibility

Impetigo

• Impetigo, adult

• Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)

• Limited number of lesions

• Preferred regimen: Mupirocin topically bid for 5 days OR Retapamulin topically bid for 5 days

• Numerous lesions or outbreaks of post streptococcal glomerulonephritis

• Preferred regimen: Dicloxacillin 250 mg PO qid for 7 days OR Amoxicillin-Clavulanate 875/125 mg PO bid for 7 days OR Cephalexin 250 mg PO qid for 7 days
• Alternative regimen (for penicillin-allergic patients): Doxycycline 100 mg PO bid for 7 days OR Clindamycin 300–400 mg PO qid for 7 days OR Sulfamethoxazole-Trimethoprim 1–2 double-strength tablets PO bid for 7 days

• 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

• Preferred regimen: Doxycycline 100 mg PO bid for 7 days OR Clindamycin 300–450 mg PO qid for 7 days OR Sulfamethoxazole-Trimethoprim 1–2 double-strength tablets PO bid for 7 days

• Impetigo, pediatric

• Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)

• Limited number of lesions

• Preferred regimen: Mupirocin topically bid for 5 days OR Retapamulin topically bid for 5 days

• Numerous lesions or outbreaks of poststreptococcal glomerulonephritis

• Preferred regimen: Amoxicillin-Clavulanate 25 mg/kg/day of amoxicillin component PO bid for 7 days OR Cephalexin 25–50 mg/kg/day PO tid–qid for 7 days
• Alternative regimen (for penicillin-allergic patients): Clindamycin 25–30 mg/kg/day PO tid for 7 days OR Sulfamethoxazole-Trimethoprim 8–12 mg/kg/day PO bid for 7 days

• 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

• Preferred regimen: Clindamycin 25–30 mg/kg/day PO tid for 7 days OR Sulfamethoxazole-Trimethoprim 8–12 mg/kg/day PO bid for 7 days

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

• Preferred regimen (1): Piperacillin-tazobactam 3.37 g every 6–8 h IV AND vancomycin IV 30 mg/kg/d in 2 divided doses (Severe Pencillin allergy: Clindamycin or metronidazole with an aminoglycoside or fluoroquinolone)
• Preferred regimen (2): Imipenem-cilastatin 1 g every 6–8 h IV
• Preferred regimen (3): Meropenem 1 g every 8 h IV
• Preferred regimen (4): Ertapenem 1 g daily IV
• Preferred regimen (5): Cefotaxime2 g every 6 h IV AND (metronidazole500 mg every 6 h IV OR clindamycin600–900 mg every 8 h IV)

• Mixed infections, pediatric

• Preferred regimen (1): Piperacillin-tazobactam 60–75 mg/kg/dose of the piperacillin component every 6 h IV AND vancomycin 10–13 mg/kg/dose every 8 h IV (Severe Pencillin allergy: Clindamycin or metronidazole with an aminoglycoside or fluoroquinolone)
• Preferred regimen (2): Meropenem 20 mg/kg/dose every 8 h IV
• Preferred regimen (3): Ertapenem 15 mg/kg/dose every 12 h IV for children 3 mo-12 y
• Preferred regimen (4): Cefotaxime50 mg/kg/dose every 6 h IVAND (metronidazole7.5 mg/kg/dose every 6 h IVOR clindamycin10–13 mg/kg/dose every 8 h IV)

• Streptococcus, adult

• Preferred regimen: Penicillin 2–4 million units every 4–6 h IV (adult) AND clindamycin 600–900 mg every 8 h IV (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)

• Streptococcus, pediatric

• Preferred regimen: Penicillin60 000–100 000 units/kg/dose every 6 h IV AND clindamycin 10–13 mg/kg/dose every 8 h IV (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)

• Staphylococcus aureus, adult

• Preferred regimen (1): Nafcillin 1–2 g every 4 h IV (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
• Preferred regimen (2): Oxacillin 1–2 g every 4 h IV
• Preferred regimen (3): Cefazolin 1 g every 8 h IV
• Preferred regimen (4): Vancomycin 30 mg/kg/d in 2 divided doses IV
• Preferred regimen (5): Clindamycin 600–900 mg every 8 h IV

• Staphylococcus aureus, pediatric

• Preferred regimen (1): Nafcillin 50 mg/kg/dose every 6 h IV (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
• Preferred regimen (2): Oxacillin 50 mg/kg/dose every 6 h IV
• Preferred regimen (3): Cefazolin 33 mg/kg/dose every 8 h IV
• Preferred regimen (4): Vancomycin 15 mg/kg/dose every 6 h IV
• Preferred regimen (5): Clindamycin 10–13 mg/kg/dose every 8 h IV (Bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)

• 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

• Preferred regimen: Doxycycline 100 mg every 12 h IV AND (ciprofloxacin 500 mg every 12 h IV OR ceftriaxone 1 to 2 g every 24 h IV)

• Aeromonas hydrophila, pediatric

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

• Vibrio vulnificus, adult

• Preferred regimen: Doxycycline 100 mg every 12 h IV AND ceftriaxone 1 g qid IV OR cefotaxime 2 g tid IV

• 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

• Preferred regimen : nafcillin OR oxacillin 2 gm IV q4h OR cefazolin 2gm IV q8h (If MSSA)
• Alternate regimen : vancomycin 1gm IV q 12h (If MRSA)

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

• Preferred regimen: Lithium succinate AND zinc sulfate Ointment containing 8% lithium succinate plus 0.05% zinc sulfate
• Preferred regimen: Lithium gluconate 8% in gel Areas other than scalp: twice daily

Skin and soft tissue infection in neutropenic fever

• Initial episode

• Empiric treatment : vancomycin AND (Carbapenem OR imipenem OR meropenem OR doripenem OR piperacillin-tazobactam)

• Recurrent or persistent

• Empiric treatment :
• Antibacterial

• Preferred treatment : Vancomycin 30–60 mg/kg/d IV in 2–4 divided doses (Target serum trough concentrations of 15–20 µg/mL in severe infections)
• Preferred treatment : Daptomycin 4–6 mg/kg/d IV (Covers VRE, strains nonsusceptible to vancomycin may be cross-resistant to daptomycin)
• Preferred treatment : Linezolid 600 mg every 12 h IV (100% oral bioavailability; so oral dose same as IV dose. Covers VRE and MRSA)

• Preferred treatment : Colistin 5 mg/kg load, then 2.5 mg/kg every 12 h IV (Nephrotoxic; does not cover gram-positives or anaerobes, Proteus, Serratia, Burkholderia)

• Antifungal

• Preferred treatment : Fluconazole 100–400 mg PO every 24 h OR 800 mg IV loading dose, then 400 mg daily (Candida krusei and Candida glabrata are resistant)
• Preferred treatment : Voriconazole 400 mg bid × 2 doses PO , then 200 mg every 12 h OR 6 mg/kg IV every 12 h for 2 doses, followed by 4 mg/kg IV every 12 h (Accumulation of cyclodextrin vehicle with IV formulation with renal insufficiency)
• Preferred treatment : Posaconazole 400 mg bid PO with meals (Covers Mucorales)
• Preferred treatment : Lipid complex amphotericin B 5 mg/kg/d IV (Not active against fusaria)
• Preferred treatment : Liposomal amphotericin B 3–5 mg/kg/d IV (Not active against fusaria)

• Culture directed antimicrobial therapy

• Candida
• Aspergillus
• Fusarium
• Dissemianted HSV or VZV

Skin and soft tissue infection in cellular immunodeficiency

• Empiric treatment :

• Antibiotics, antifungal, antivirals should be considered in life threatening situtations

• Culture directed antimicrobial therapy

• Bacteria

• Non tuberculosis mycobacteria
• Nocardia

• Fungus

• Aspergillus

• Histoplasmosis
• Cryptococcus
• Candida

• Virus

• HSV
• VZV

Surgical site infection

• Surgery of intestinal or genitourinary tract

• Single-drug regimens

• Preferred regimen (1): Ticarcillin-clavulanate 3.1 g every 6 h IV
• Preferred regimen (2): Piperacillin-tazobactam 3.375 g every 6 h OR 4.5 g every 8 h IV
• Preferred regimen (3): Imipenem-cilastatin 500 mg every 6 h IV
• Preferred regimen (4): Meropenem 1 g every 8 h IV
• Preferred regimen (5): Ertapenem 1 g every 24 h IV

• Combination regimens

• Preferred regimen (1): Ceftriaxone 1 g every 24 h AND metronidazole 500 mg every 8 h
• Preferred regimen (2): IV Ciprofloxacin 400 mg IV every 12 h or 750 mg po every 12 h AND metronidazole 500 mg every 8 h
• Preferred regimen (3): IV Levofloxacin 750 mg IV every 24 h AND metronidazole 500 mg every 8 h
• Preferred regimen (4): IV Ampicillin-sulbactam 3 g every 6 h AND gentamicin OR tobramycin 5 mg/kg every 24 h IV

• 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

• Preferred regimen: Metronidazole 500 mg every 8 h IV AND (Ciprofloxacin 400 mg IV every 12 h OR Ciprofloxacin 750 mg po every 12 h OR Levofloxacin 750 mg every 24 h IV/PO OR Ceftriaxone 1 g every 24 h)

Tularemia

• Tularemia

• Preferred regimen (1): Streptomycin 15 mg/kg every 12 hours IM OR Gentamicin 1.5 mg/kg every 8 hours IV
• Preferred regimen (2): Tetracycline 500 mg qid OR doxycycline 100 mg bid PO (for mild cases)

Vascular insufficieny ulcer

• Preferred regimen : Imipenem 0.5 gm IV q6hr OR meropenem 1gm IV q24 hr OR doripenem 500mg IV q8hr OR ticarcillin-clavulanate 3.1gm IV q8hr OR piperacillin-tazobactam 3.375gm IV q6hr OR ertapenem 1gm IV q24hr

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

• Preferred regimen (1): Phenoxymethylpenicillin 7–10 d; 12.5 mg/kg q6h (maximum dose, 300 mg q6h)
• Preferred regimen (2): Tetracyclines 15 d; tetracycline 500 mg q6h or doxycycline 100 mg q12h Alternative agents for the treatment of yaws in nonpregnant adults
• Preferred regimen (3): Erythromycin 15 d; 8–10 mg/kg q6h
• Preferred regimen (4): Azithromycin Single-dose; 30 mg/kg (maximum dose 2 g)