Sandbox g32

Jump to navigation Jump to search

Bacterial meningitis^[1]

Empiric antimicrobial therapy based on specific predisposing factors

Age

Age < 1 month

Common causative pathogens: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species
Preferred regimen: Ampicillin 12 g/day IV q4h AND (Cefotaxime 8–12 g/day q4–6h OR Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)

Age 1–23 months

Common causative pathogens: Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)

Age 2–50 years

Common causative pathogens: N . meningitidis, S. pneumoniae
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)

Age > 50 years

Common causative pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic Gram-negative bacilli
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Ampicillin 12 g/day IV q4h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)

Head trauma

Basilar skull fracture

Common causative pathogens: S. pneumoniae, H. influenzae, group A β-hemolytic streptococci
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)

Penetrating trauma

Common causative pathogens: Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic Gram-negative bacilli (including Pseudomonas aeruginosa)
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h

Postneurosurgery

Common causative pathogens: Aerobic Gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h

CSF shunt

Common causative pathogens: Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic Gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h

CSF Gram stain-directed antimicrobial therapy

Gram positive, lancet-shaped diplococci suggestive of Streptococcus pneumoniae

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
Alternative regimen: Meropenem 6 g/day IV q8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h

Gram negative diplococci suggestive of Neisseria meningitidis

Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
Alternative regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h OR Chloramphenicol 4–6 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Aztreonam 6–8 g/day IV q6–8h

Gram positive, short bacilli suggestive of Listeria monocytogenes

Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h) ± (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
Alternative regimen: Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Meropenem 6 g/day IV q8h

Gram positive cocci in short chains suggestive of Streptococcus agalactiae

Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h) ± (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h

Gram negative coccobacilli suggestive of Haemophilus influenzae

Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
Alternative regimen: Chloramphenicol 4–6 g/day IV q6h OR Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h

Gram negative bacilli suggestive of Escherichia coli

Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
Alternative regimen: Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h OR Aztreonam 6–8 g/day IV q6–8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h

Pathogen-directed antimicrobial therapy

Streptococcus pneumoniae

Penicillin MIC < 0.1 μg/mL

Preferred regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h
Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h OR Chloramphenicol 4–6 g/day IV q6h

Penicillin MIC 0.1–1.0 μg/mL

Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
Alternative regimen: Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h

Penicillin MIC ≥ 2.0 μg/mL

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
Alternative regimen: Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h

Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
Alternative regimen: Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h

Neisseria meningitidis

Penicillin MIC < 0.1 μg/mL

Preferred regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h
Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h OR Chloramphenicol 4–6 g/day IV q6h

Penicillin MIC 0.1–1.0 μg/mL

Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
Alternative regimen: Chloramphenicol 4–6 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h

Listeria monocytogenes

Preferred regimen: Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h
Alternative regimen: Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Meropenem 6 g/day IV q8h

Streptococcus agalactiae

Preferred regimen: Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h
Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h

Escherichia coli and other Enterobacteriaceae

Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h OR Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Ampicillin 12 g/day IV q4h

Pseudomonas aeruginosa

Preferred regimen: Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h
Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR Ciprofloxacin 800–1200 mg IV q8–12h OR Meropenem 6 g/day IV q8h

Haemophilus influenzae

β-Lactamase negative

Preferred regimen: Ampicillin 12 g/day IV q4h
Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h OR Cefepime 6 g/day IV q8h OR Chloramphenicol 4–6 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h

β-Lactamase positive

Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
Alternative regimen: Cefepime 6 g/day IV q8h OR Chloramphenicol 4–6 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h

Staphylococcus aureus

Methicillin susceptible

Preferred regimen: Nafcillin 9–12 g/day IV q4h OR Oxacillin 9–12 g/day IV q4h
Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h OR Meropenem 6 g/day IV q8h

Methicillin resistant

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen: Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Linezolid 600 mg IV q12h

Staphylococcus epidermidis

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen: Linezolid 600 mg IV q12h

Enterococcus species

Ampicillin susceptible

Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

Ampicillin resistant

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h

Ampicillin and vancomycin resistant

Preferred regimen: Linezolid 600 mg IV q12h

Pediatric dose:

Amikacin

Neonates age 0–7 days: 15–20 mg/kg/day q12h
Neonates age 8–28 days: 30 mg/kg/day q8h
Infants and children: 20–30 mg/kg/day q8h

Ampicillin

Neonates age 0–7 days: 150 mg/kg/day q8h
Neonates age 8–28 days: 200 mg/kg/day q6–8h
Infants and children: 300 mg/kg/day q6h

Cefepime

Infants and children: 150 mg/kg/day q8h

Cefotaxime

Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
Infants and children: 225–300 mg/kg/day q6–8h

Ceftazidime

Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
Neonates age 8–28 days: 150 mg/kg q8h
Infants and children: 150 mg/kg

Ceftriaxone

Infants and children: 80–100 mg/kg/day q12–24h

Chloramphenicol

Neonates age 0–7 days: 25 mg/kg/day q24h
Neonates age 8–28 days: 50 mg/kg/day q12–24h
Infants and children: 75–100 mg/kg/day q6h

Gentamicin

Neonates age 0–7 days: 5 mg/kg/day q12h
Neonates age 8–28 days: 7.5 mg/kg/day q8h
Infants and children: 7.5 mg/kg/day q8h

Meropenem

Infants and children: 120 mg/kg/day q8h

Nafcillin

Neonates age 0–7 days: 75 mg/kg/day q8–12h
Neonates age 8–28 days: 100–150 mg/kg/day q6–8h
Infants and children: 200 mg/kg/day q6h

Oxacillin

Neonates age 0–7 days: 75 mg/kg/day q8–12h
Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
Infants and children: 200 mg/kg/day q6h

Penicillin G

Neonates age 0–7 days: 0.15 MU/kg/day q8–12h
Neonates age 8–28 days: 0.2 MU/kg/day q6–8h
Infants and children: 0.3 MU/kg/day q4–6h

Rifampin

Neonates age 8–28 days: 10–20 mg/kg/day q12h
Infants and children: 10–20 mg/kg/day q12–24h

Tobramycin

Neonates age 0–7 days: 5 mg/kg/day q12h
Neonates age 8–28 days: 7.5 mg/kg/day q8h
Infants and children: 7.5 mg/kg/day q8h

Trimethoprim-Sulfamethoxazole

Infants and children: 10–20 mg/kg q6–12h

Vancomycin

Neonates age 0–7 days: 20–30 mg/kg/day q8–12h
Neonates age 8–28 days: 30–45 mg/kg/day q6–8h
Infants and children: 60 mg/kg/day q6h

↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.

Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox_g32&oldid=1107449"

Cookies help us deliver our services. By using our services, you agree to our use of cookies.