Sandbox/AL

Pathogen-Based Therapy — Bacteria Adapted from

▸ Click on the following categories to expand treatment regimens.

Bacteria

▸ Staphylococcus aureus

▸ Staphylococcus epidermidis

▸ Methicillin-resistant S. aureus

▸ Streptococcus groups A, B, C, G

▸ Enterococcus feacalis

Staphylococcus aureus
Preferred Regimen
▸ Nafcillin 2 g IV q6h
Alternative Regimen
▸ Vancomycin OR ▸ Cefazolin OR ▸ Clindamycin

Staphylococcus epidermidis
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q12h
Alternative Regimen
▸ TMP-SMX OR

Methicillin-resistant S. aureus
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q12h
Alternative Regimen
▸ TMP-SMX OR ▸ Doxycycline OR ▸ Linezolid

Streptococcus groups A, B, C, G
Preferred Regimen
▸ Penicillin G 2 MU IV q4h
Alternative Regimen
▸ Vancomycin OR ▸ Cefazolin OR ▸ Erythromycin

Enterococcus faecalis
Preferred Regimen
▸ Penicillin G 2 MU IV q4h OR ▸ Ampicillin 2 g IV q6h
PLUS
▸ Gentamicin 1 mg/kg IV or IM q8h
Alternative Regimen
Vancomycin
PLUS
▸ Gentamicin 1 mg/kg IV or IM q8h
N. meningitidis, Penicillin MIC ≥0.1 μg/mL
Preferred Regimen
▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h
Alternative Regimen
▸ Cefepime 2 g IV q8h OR ▸ Chloramphenicol 1—1.5 g IV q6h OR ▸ Moxifloxacin 400 mg IV q24h OR ▸ Meropenem 2 g IV q8h

Pseudomonas aeruginosa
Preferred Regimen
▸ Ceftazidime 2 g IV q8h OR ▸ Cefepime 2 g IV q8h
PLUS
▸ Gentamicin 1.7 mg/kg IV q8h
Alternative Regimen
▸ Aztreonam 2 g IV q6—8h OR ▸ Meropenem 2 g IV q8h OR ▸ Ciprofloxacin 400 mg IV q8—12h
PLUS
▸ Gentamicin 1.7 mg/kg IV q8h

Staphylococcus aureus, Methicillin sensitive
Preferred Regimen
▸ Nafcillin 1.5—2 g IV q4h OR ▸ Oxacillin 1.5—2 g IV q4h
Alternative Regimen
▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) OR ▸ Linezolid 600 mg IV q12h OR ▸ Daptomycin 6 mg/kg IV q24h

▸ Click on the following categories to expand treatment regimens.

Gram-Positive

▸ Gram-Positive Cocci

Gram-Negative

▸ Gram-Negative Cocci

▸ Gram-Negative Rods

▸ Negative Gram Stain

Gram-Positive Cocci
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
Alternative Regimen For patients allergic to vancomycin
▸ Linezolid OR ▸ Daptomycin

Gram-Negative Cocci
Preferred Regimen
▸ Ceftriaxone 1 g IV q24h

Gram-Negative Rods
Preferred Regimen
▸ Ceftazidime 2 g IV q8h OR ▸ Cefepime 2g IV q12h
Alternative Regimen
▸ piperacillin-tazobactam 4.5 g q6h OR ▸ Imipenem 500 mg IV q6h OR ▸ Meropenem 1 g IV q8h

Negative Gram Stain
Preferred Regimen
▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h
Alternative Regimen
▸ Penicillin G 4 MU IV q4h OR ▸ Ampicillin 2 g IV q4h OR ▸ Chloramphenicol 1—1.5 g IV q6h OR ▸ Moxifloxacin 400 mg IV q24h OR ▸ Aztreonam 2 g IV q6—8h