Sandbox mona cor

• Avian influenza Return to Top

• 1. Preferred regimen:Oseltamivir 75 mg PO qd for a minimum 10 days

• Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently

• 2. Patients with Avian Influenza who have diarrhea and malabsorption

• Preferred regimen (1): Zanamivir 10 mg inhaled bid for minimum 5 days
• Preferred regimen (2): [[Peramivir] ]600 mg IV as a single dose for 1 day
• Note (1): Preliminary evidence demonstrates that Neuraminidase inhibitor can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
• Note (2): The use of Corticosteroids is not recommended.
• Note (3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
• Note (4): The use of Amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.
• Note (5): Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.

• Coxiella burnetii Return to Top

• Q fever

• 1. Acute Q fever

• 1.1 Adults

• Preferred Regimen: Doxycycline 100 mg PO bid for 14 days

• 1.2 Children

• 1.2.1 Children with age ≥8 years

• Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum 100 mg per dose)

• 1.2.2 Children with age <8 years with high risk criteria

• Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)

• 1.2.3 Children with age <8 years with mild or uncomplicated illness

• Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 5 days (maximum 100 mg per dose).

• 1.2.3 Children with age < 8 years with mild or uncomplicated illness,who remains febrile past 5 days of treatment

• Preferred regimen: Trimethoprim/Sulfamethoxazole 4-20 mg/kg PO bid for 14 days (maximum: 800 mg per dose)

• 1.3 Pregnant women

• Preferred regimen: Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO bid a day throughout pregnancy

• 2. Chronic Q fever

• 2.1 Endocarditis or vascular infection

• Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for ≥18 months
• Note: childern and pregnant women- consultation Recommended

• 2.2 Noncardiac organ disease

• Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid
• Note: childern and pregnant women- consultation Recommended

• 2.3 Postpartumwith serologic profile for chronic Q fever

• Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for 12 months
• Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
• Note (2): Post-Q fever fatigue syndrome- no current recommendation

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• 1. T. vaginalis infection in adults

• Preferred regimen (1): Metronidazole 2 g PO in a single dose
• Preferred regimen (2): Tinidazole 2 g PO in a single dose
• Alternative regimen: Metronidazole 500 mg PO bid for 7 days

• 2. T. vaginalis infection in pregnant and lactating Women

• 2.1 Pregnant women

• Preferred regimen: Metronidazole 2 g PO in a single dose.

• 2.2 Post-partum and Breastfeeding

• Preferred regimen (1): Metronidazole 2 g PO in a single dose.
• Preferred regimen (2): Tinidazole 2 g PO in a single dose
• Note (1): Do not breastfeed for 12-24 hrs following Metronidazole and 72 hrs following Tinidazole
• Note (2): Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment. Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
• Note (3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.

• 3. T. vaginalis infection in patients with HIV

• Preferred regimen: Metronidazole 500 mg PO bid for 7 days

• 4. Persistent or recurrent trichomoniasis

• 4.1 Treatment failure

• Preferred regimen: Metronidazole 500 mg PO bid for 7 days

• 4.2 Treatment failure again

• Preferred regimen (1): Metronidazole 2 g PO for 7 days
• Preferred regimen (2): Tinidazole 2 g PO for 7 days

• 4.3 Nitroimidazole-resistant cases

• Preferred regimen: Tinidazole 2-3 g PO for 14 days

• African trypanosomiasis Return to Top

• Sleeping sickness

• 1. East african trypanosomiasis

• 1.1 T. b. rhodesiense, hemolymphatic stage

• 1.1.1 Adult

• Preferred regimen: Suramin 1 gm IV on days 1,3,5,14, and 21

• 1.1.2 Pediatric

• Preferred regimen: Suramin 20 mg/kg IV on days 1, 3, 5, 14, and 21

• 1.2 T. b. rhodesiense, CNS involvement

• 1.2.1 Adult

• Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.

• 1.2.2 Pediatric

• Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days

• 2. West african trypanosomiasis

• 2.1 T. b. gambiense, hemolymphatic stage

• 2.1.1 Adult

• Preferred regimen: Pentamidine 4 mg/kg/day IM/ IV for 7-10 days

• 2.1.2 Pediatric

• Preferred regimen: Pentamidine 4 mg/kg/day IM/IV for 7-10 days
• Note (1): Pentamidine should be used during pregnancy and lacation only if the potential benefit justifies the potential risk
• Note (2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

• 2.2 T. b. gambiense, CNS involvement

• 2.2.1 Adult

• Preferred regimen: Eflornithine 400 mg/kg/day in 4 doses for 14 days

• 2.2.2 Pediatric

• Preferred regimen: Eflornithine 400 mg/kg/day in 4 doses for 14 days
• Note (1): Eflornithine should be used during pregnancy and lactation, only if the potential benefit justifies the potential risk
• Note (2): The safety of Eflornithine in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. Eflornithine is listed for the treatment of 1st stage African trypanosomiasis inTrypanosoma brucei gambiense infection on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

• American trypanosomiasis Return to Top

• Chagas disease

• 1. Preferred regimen(1):

• Patients of age < 12 years- Benznidazole 5-7.5 mg/kg/ day PO bid for 60 days
• Patients of age 12 years or older- Benznidazole 5-7 mg/kg/day PO bid for 60 days

• 2. Preferred regimen(2):

• Patients of age ≤ 10 years- Nifurtimox 15-20 mg/kg/day PO tid/ qid for 90 days
• Patients of age 11-16 years- Nifurtimox 12.5-15 mg/kg/day PO tid/ qid for 90 days
• Patients of age 17 years or older- Nifurtimox 8-10 mg/kg/day PO tid/ qid for 90 days

• Note: In the United States, Nifurtimox and Benznidazole are not FDA approved and are available only from CDC under investigational protocols.

• 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.