Sandbox mona cor

• Chlamydia trachomatis Return to Top

• 1 Chlaymydial infections

• 1.1 Chlamydial Infections in Adolescents and Adults

• Preferred regimen(1): Doxycycline 100 mg PO bid for 7 days
• Preferred regimen(2): Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
• Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
• Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.

• 1.2 Chlamydial Infections in patients with HIV Infection

• Preferred regimen(1): Doxycycline 100 mg PO bid for 7 days
• Preferred regimen(2): Azithromycin 1 g PO in a single dose
• Preferred regimen(3): Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
• Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.

• 1.3 Pregancy

• Preferred regimen: Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Amoxicillin 500 mg PO tid for 7 days
• Alternative regimen (2): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (3): Erythromycin base 250 mg PO qid for 14 days
• Alternative regimen (4): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (5): Erythromycin ethylsuccinate 400 mg PO qid for 14 days
• Note:Doxycycline, Ofloxacin, and Levofloxacin are contraindicated in pregnant women

• 1.4 Management of sex partners

• Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
• Preferred regimen (2): Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
• Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
• Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
• Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
• Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
• Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
• Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present

• 2 Chlamydial infection among neonates

• 2.1 Ophthalmia Neonatorumcaused by C. trachomatis

• Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day divided into 4 doses PO daily for 14 days
• Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days
• Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.

• 2.2 Infant Pneumonia

• Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day divided into 4 doses PO daily for 14 days
• Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days

• 3.Chlamydial infection among infants and childern

• 3.1 Infants and childern who weigh < 45 kg

• Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day divided into 4 doses PO daily for 14 days

• 3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years

• Preferred regimen: Azithromycin 1 g PO in a single dose

• 3.3 Infants and childern aged ≥8 years

• Preferred regimen(1): Azithromycin 1 g PO in a single dose
• Preferred regimen(2): Doxycycline 100 mg PO bid for 7 days

• 4. Lymphogranuloma venereum (LGV)
• Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3 '

• Preferred regimen: Doxycycline 100 mg PO bid for 21 days
• Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
• Note (1): Azithromycin 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
• Note (2): Pregnant and lactating women should be treated with Erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
• Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
• Note(4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).

• Neisseria gonorrhoeae, treatment

• 1. Gonococcal infections in adolescents and adults

• 1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum

• Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
• Alternative regimen: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose (if ceftriaxone is not available)

• 1.2 Uncomplicated gonococcal infections of the pharynx

• Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose

• 1.2.1 Management of sex partners

• Expedited partner therapy: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose

Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.

Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.

Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.

• 1.2.2 Allergy, intolerance, and adverse reactions

• Preferred regimen (1): Gemifloxacin 320 mg PO in a single dose AND Azithromycin 2 g PO in a single dose
• Preferred regimen (2): Gentamicin 240 mg IM in a single dose AND Azithromycin 2 g PO in a single dose

Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).

• 1.2.3 Pregnancy

• Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose

• 1.2.4 Suspected cephalosporin treatment failure

• Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
• Alternative regimen (1): Gemifloxacin 320 mg PO single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
• Alternative regimen (2): Gentamicin 240 mg IM single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
• Alternative regimen (3): Ceftriaxone 250 mg IM as a single dose AND Azithromycin 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)

Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.

• 1.3 Gonococcal conjunctivitis

• Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose

Note: Consider one-time lavage of the infected eye with saline solution.

• 1.3.1 Management of sex partners

• Patients should be instructed to refer their sex partners for evaluation and treatment.

• 1.4 Disseminated gonococcal infection

• 1.4.1 Arthritis and arthritis-dermatitis syndrome

• Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days AND Azithromycin 1 g PO in a single dose
• Alternative regimen: Cefotaxime 1 g IV q8h for 7 days OR Ceftizoxime 1 g IV q 8 h for 7 days AND Azithromycin 1 g PO in a single dose

• 1.4.2 Gonococcal meningitis and endocarditis

• Preferred regimen : Ceftriaxone 1-2 g IV q 12-24 h for 10-14 days AND Azithromycin 1 g PO in a single dose

• 2. Gonococcal infections among neonates

• 2.1 Ophthalmia neonatorum caused by N. gonorrhoeae

• Preferred regimen: Ceftriaxone 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg

• 2.1.1 Management of mothers and their sex partners

• Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).

• 2.2 Disseminated gonococcal infection and gonococcal scalp abscesses in neonates

• Preferred regimen: Ceftriaxone 25-50 mg/kg/day IM/IV qd for 7 days OR Cefotaxime 25 mg/kg IV /IM q12h for 7 days.

Note (1): The duration of treatment is 10-14 days if meningitis is documented.

Note (2): Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.

• 2.2.1 Management of mothers and their sex partners

• Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).

• 2.3 Neonates born to mothers who have gonococcal infection

• Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg

• 2.3.1 Management of mothers and their sex partners

• Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.

• 3. Gonococcal infections among infants and children

• 3.1 Infants and children who weigh ≤ 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis

• Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg

• 3.2 Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis

• Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
• Alternative regimen: Cefixime 400 mg PO single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)

• 3.3 Children who weigh ≤ 45 kg and who have bacteremia or arthritis

• Preferred regimen: Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days

• 3.4 Children who weigh > 45 kg and who have bacteremia or arthritis

• Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days

• Klebsiella granulomatis Return to Top

• Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)

• 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

• Chlamydophila psittaci Return to Top

• 1. Pneumonia

• 1.1 Adult

• Preferred regimen(1): Doxycycline 100 mg PO bid daily for 10-21 days
• Preferred regimen(2): Tetracycline 500 mg PO qid for 10-21 days
• Alternative regimen :Minocycline

• 1.2 Pediatric

• Preferred regimen: Azithromycin
• Alternative regimen: fluoroquinolones

• 1.3 Pregnant Patients

• Preferred regimen : Azithromycin
• Alternative regimen: fluoroquinolones

• 2.Endocarditis in valve replacement patients

• Preferred regimen : Doxycycline
• Alternative regimen : fluoroquinolones.

• Legionella Return to Top

• Atypical bacterial pneumonia caused by Legionella

• Preferred Regimen(1): Levofloxacin 750 mg IV q24h
• Preferred Regimen(2): Moxifloxacin 400 mg IV q24h
• Preferred Regimen(3): Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
• Alternate Regimen: Doxycycline 100 mg PO/IV q12h

• Mycoplasma pneumoniae Return to Top

• Atypical pneumonia caused by Mycoplasma pneumoniae

• Preferred regimen (1): Azithromycin 500 mg PO day 1 and 250 mg day 2 to 5
• Preferred regimen (2): Doxycycline 100 mg PO bid for 14 days
• Preferred regimen (3): Moxifloxacin 400 mg PO qd for 14 days

• Mycoplasma genitalium Return to Top

• 1. Urethritis and cervicitis

• Preferred regimen (macrolide-susceptible strains)(1): Azithromycin 1 g PO as a single dose
• Preferred regimen (macrolide-susceptible strains)(2): Azithromycin 500 mg PO as a dose followed by 250 mg PO qd for 4 days
• Preferred regimen (for patients with previous treatment failures): Moxifloxacin 400 mg PO qd for 7–14 days

• 2. Pelvic inflammatory disease (PID)

• Preferred regimen: Moxifloxacin 400 mg PO qd for 14 days

• 3. Specific considerations

• 3.1 Management of sex partners
• Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.

• 3.2 HIV infection
• Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.

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