Sandbox g23
Encephalitis
- Empiric antimicrobial therapy[1]
- Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days
- Note (1): Acyclovir should be initiated in all patients with sus- pected encephalitis, pending results of diagnostic studies.
- Note (2): Other empirical antimicrobial agents should be initiated on the basis of specific epidemiologic or clinical clues.
- Specific considerations
- Pathogen-directed antimicrobial therapy[2]
- Viruses
-
- Preferred regimen: supportive
- prophylactic antiviral therapy after bite or scratch
- Preferred regimen: Valacyclovir
- established disease
- Preferred regimen: Valacyclovir OR Acyclovir OR Ganciclovir
- Preferred regimen: Ganciclovir AND foscarnet
- Preferred regimen: supportive
- Preferred regimen: supportive AND Corticosteroids
- Preferred regimen: supportive
- Preferred regimen: Ganciclovir OR Foscarnet
- Preferred regimen: HAART
-
- Preferred regimen: Oseltamivir
- Preferred regimen: supportive
- Preferred regimen: supportive
- Preferred regimen: supportive
- Preferred regimen: supportive
- Preferred regimen: supportive AND Ribavirin
- Preferred regimen: supportive AND Intraventricular γ-globulin (for chronic and/or severe disease)
- Preferred regimen: supportive
- Preferred regimen: supportive
- postxposure prophylaxis
- Preferred regimen: rabies immunoglobulin AND vaccine
- after onset of disease
- Preferred regimen: supportive
- Preferred regimen: supportive
- St. Louis encephalitis virus
- Preferred regimen: supportive
- Alternative regimen: IFN-a-2b
- Tickborne encephalitis virus
- Preferred regimen: supportive
- Preferred regimen: supportive ± Corticosteroids
- Preferred regimen: supportive
-
-
- Preferred regimen: Acyclovir 10–15 mg/kg IV q8h for 10-14 days ± Corticosteroids
- Alternative regimen: Ganciclovir ± Corticosteroids
-
-
- Preferred regimen: supportive
- Preferred regimen: supportive
-
- Bacteria
- Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)
- Preferred regimen: Doxycycline
- Preferred regimen: Chloramphenicol OR Ciprofloxacin] OR Doxycycline OR Ampicillin OR trimethoprim-sulfamethoxazole
- Preferred regimen: Doxycycline OR Azithromycin ± Rifampin
- preferred regimen: Ceftriaxone OR Cefotaxime OR Penicillin G
- Preferred regimen: Doxycycline AND Fluoroquinolone AND Rifampin
- Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
- Preferred regimen: Doxycycline
- Preferred regimen: Ampicillin OR Trimethoprim-sulfamethoxazole AND Gentamicin
- with meningitis
- Preferred regimen: Dexamethasone
- without meningitis
- Preferred regimen: Isoniazid OR Rifampin OR Pyrazinamide OR Ethambutol
- Preferred regimen: Azithromycin OR Doxycycline OR Fluoroquinolone
- Preferred regimen: Doxycycline
- Alternative regimen: Chloramphenicol
- preferred regimen: Ceftriaxone OR Penicillin G
- Preferred regimen: Ceftriaxone for 2–4 weeks, followed by Trimethoprim-sulfamethoxazole OR Cefixime for 1–2 years
- Fungi
-
- Preferred regimen: Fluconazole
- Alternative regimen: Itraconazole OR Voriconazole OR Amphotericin B (intravenous and intrathecal)
- Preferred regimen: Amphotericin B deoxycholate AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks ORv Lipid formulation of amphotericin B AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks OR Amphotericin B AND flucytosine for 6–10 weeks
- Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities
- Protozoa
-
- Preferred regimen: Trimethoprim-sulfamethoxazole AND rifampin AND ketoconazole OR Fluconazole AND sulfadiazine AND pyrimethamine
- Preferred regimen: Azithromycin OR Clarithromycin AND pentamidine AND flucytosine AND fluconazole AND sulfadiazine AND thioridazine OR trifluoperazine
- Preferred regimen: Amphotericin B (intravenous and intrathecal) AND rifampin AND azithromycin OR sulfisoxazole OR miconazole
- Preferred regimen: Quinine OR quinidine OR artesunate OR artemether
- Alternative regimen: Atovaquone OR proguanil OR Exchange transfusion (less than 10% parasitemia or cere- bral malaria)
- Preferred regimen: Pyrimethamine AND Sulfadiazine OR Clindamycin [[and}} Pyrimethamine
- Alternative regimen (1): Trimethoprim-sulfamethoxazole
- Alternative regimen (2): Pyrimethamine AND atovaqone OR Pyrimethamine AND clarithromycin OR Pyrimethamine AND azithromycin OR Pyrimethamine AND dapsone
- Trypanosoma brucei gambiense (West African trypanosomiasis)
- Preferred regimen: Eflornithine OR Melarsoprol
- Trypanosoma brucei rhodesiense (East African trypanosomiasis)
- Preferred regimen: Melarsoprol
- Helminths
-
- Preferred regimen: Corticosteroids
- Alternative regimen: Albendazole AND diethylcarbamazine
- Preferred regimen: Albendazole OR Ivermectin
- Preferred regimen: Albendazole OR Corticosteroids
- Alternative regimen: Praziquantel
- Prion
-
- Preferred regimen: supportive
- ↑ Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
- ↑ Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.