Sandbox ID Gastrointestinal and Intraabdominal
Anthrax, gastrointestinal
- Gastrointestinal anthrax [1]
- Preferred regimen: Ciprofloxacin 400 mg intravenously every 8 h OR Doxycycline 100 mg intravenously every 12 h combined with second agent: Clindamycin 600 mg intravenously every 8 h or Penicillin G 4 MU every 4-6 hours OR Meropenem 1 gm intravenously every 6-8 hours or Rifampin 300 mg every 12 h.
- Note:Treatment for 60 days is recommended to avoid relapse or breakthrough of incubating disease. If initial therapy is intravenous, then convert to oral administration (Ciprofloxacin or Doxycycline) when clinically indicated. Steroids may be considered as an adjunct therapy for patients with severe edema and for meningitis. For pregnant women, avoid Doxycycline. Use Ciprofloxacin and switch to oral penicillin once susceptibilities are known.
Appendicitis
- Community-acquired infection in adults [2]
- Mild-to-moderate severity (perforated or abscessed appendicitis and other infections of mild-to-moderate severity):
- Single agent:
- Preferred regimen: Cefoxitin 2 g every 6 h OR Ertapenem 1 g every 24 h OR Moxifloxacin 400 mg every 24 h OR Tigecycline 100 mg initial dose, then 50 mg every 12 h OR Ticarcillin-clavulanic acid 3.1 g every 6 h; FDA labeling indicates 200 mg/kg/day in divided doses every 6 h for moderate infection
- Combination:
- Preferred regimen(1): Cefazolin 1–2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Cefuroxime 1.5 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ceftriaxone 1–2 g every 12–24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Cefotaxime 1–2 g every 6–8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- High risk or severity (severe physiologic disturbance, advanced age, or immunocompromised state):
- Single agent:
- Preferred regimen: Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h OR Meropenem 1 g every 8 h OR Doripenem 500 mg every 8 h OR Piperacillin-tazobactam 3.375 g every 6 h
- Combination:
- Preferred regimen(1): Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Health Care–Associated Complicated Intra-abdominal Infection [2]
- Less than 20% Resistant Pseudomonas aeruginosa, Extended-spectrum B-lactamase-producing Enterobacteriaceae, Acinetobacter, or other multidrug resistant gram-negative bacilli:
- Preferred regimen(1): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Extended-spectrum B-lactamase-producing Enterobacteriaceae:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Pseudomonas aeruginosa with more than 20% resistant to ceftazidime:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Methicillin-resistant Staphylococcus aureus (MRSA):
- Preferred regimen: Vancomycin 15–20 mg/kg every 8–12 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Community-acquired infection in pediatric patients
- Single agent:
- Preferred regimen: Ertapenem 3 months to 12 years 15 mg/kg twice daily (not to exceed 1 g/day) Every 12 h, older than 13 years 1 g/day Every 24 h OR Meropenem 60 mg/kg/day Every 8 h OR Imipenem-cilastatin 60–100 mg/kg/day Every 6 h OR Ticarcillin-clavulanate 200–300 mg/kg/day of ticarcillin component Every 4–6 h OR Piperacillin-tazobactam 200–300 mg/kg/day of piperacillin component Every 6–8 h
- Combination:
- Preferred regimen(1): Ceftriaxone 50–75 mg/kg/day Every 12–24 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(2): Cefotaxime 150–200 mg/kg/day Every 6–8 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(3): Cefepime 100 mg/kg/day Every 12 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(4): Ceftazidime 150 mg/kg/day Every 8 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(5): (Gentamicin 3–7.5 mg/kg/day Every 2–4 h, AND Metronidazole 30–40 mg/kg/day Every 8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Preferred regimen(6): (Gentamicin 3–7.5 mg/kg/day Every 2–4 h, AND Clindamycin 20–40 mg/kg/day Every 6–8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Preferred regimen(7): (Tobramycin 3.0–7.5 mg/kg/day Every 8–24 h, AND Metronidazole 30–40 mg/kg/day Every 8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Preferred regimen(8): (Tobramycin 3.0–7.5 mg/kg/day Every 8–24 h, AND Clindamycin 20–40 mg/kg/day Every 6–8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
Biliary sepsis
- Community-acquired acute cholecystitis of mild-to-moderate severity [2]
- Preferred regimen: Cefazolin 1–2 g every 8 h OR Cefuroxime 1.5 g every 8 h OR Ceftriaxone 1–2 g every 12–24 h
- Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state [2]
- Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Meropenem 1 g every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Doripenem 500 mg every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Piperacillin-tazobactam 3.375 g every 6 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(7): Cefepime 2 g every 8–12 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Acute cholangitis following bilio-enteric anastamosis of any severity [2]
- Preferred regimen(1):Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2):Meropenem 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3):Doripenem 500 mg every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4):Piperacillin-tazobactam 3.375 g every 6 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5):Ciprofloxacin 400 mg every 12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6):Levofloxacin 750 mg every 24 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(7):Cefepime 2 g every 8–12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Health care-associated biliary infection of any severity [2]
- Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(2): Meropenem 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(3): Doripenem 500 mg every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(4): Piperacillin-tazobactam 3.375 g every 6 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(6): Levofloxacin 750 mg every 24 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(7): Cefepime 2 g every 8–12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
Cholangitis
- Community-acquired acute cholecystitis of mild-to-moderate severity [2]
- Preferred regimen: Cefazolin 1–2 g every 8 h OR Cefuroxime 1.5 g every 8 h OR Ceftriaxone 1–2 g every 12–24 h
- Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state [2]
- Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Meropenem 1 g every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Doripenem 500 mg every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Piperacillin-tazobactam 3.375 g every 6 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(7): Cefepime 2 g every 8–12 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Acute cholangitis following bilio-enteric anastamosis of any severity [2]
- Preferred regimen(1):Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2):Meropenem 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3):Doripenem 500 mg every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4):Piperacillin-tazobactam 3.375 g every 6 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5):Ciprofloxacin 400 mg every 12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6):Levofloxacin 750 mg every 24 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(7):Cefepime 2 g every 8–12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Health care-associated biliary infection of any severity [2]
- Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(2): Meropenem 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(3): Doripenem 500 mg every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(4): Piperacillin-tazobactam 3.375 g every 6 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(6): Levofloxacin 750 mg every 24 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(7): Cefepime 2 g every 8–12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
Cholecystitis
- Community-acquired acute cholecystitis of mild-to-moderate severity [2]
- Preferred regimen: Cefazolin 1–2 g every 8 h OR Cefuroxime 1.5 g every 8 h OR Ceftriaxone 1–2 g every 12–24 h
- Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state [2]
- Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Meropenem 1 g every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Doripenem 500 mg every 8 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Piperacillin-tazobactam 3.375 g every 6 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(7): Cefepime 2 g every 8–12 h, AND metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Acute cholangitis following bilio-enteric anastamosis of any severity [2]
- Preferred regimen(1):Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2):Meropenem 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3):Doripenem 500 mg every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4):Piperacillin-tazobactam 3.375 g every 6 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5):Ciprofloxacin 400 mg every 12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6):Levofloxacin 750 mg every 24 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(7):Cefepime 2 g every 8–12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Health care-associated biliary infection of any severity [2]
- Preferred regimen(1): Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h OR 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(2): Meropenem 1 g every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(3): Doripenem 500 mg every 8 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(4): Piperacillin-tazobactam 3.375 g every 6 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(6): Levofloxacin 750 mg every 24 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Preferred regimen(7): Cefepime 2 g every 8–12 h, AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h AND Vancomycin 15–20 mg/kg every 8–12 h added to regimen
- Note(1): Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Note(2): Patients undergoing cholecystectomy for acute cholecystitis should have antimicrobial therapy discontinued within 24 h unless there is evidence of infection outside the wall of the gallbladder.
Diverticulitis
- Community-acquired infection in adults [2]
- Mild-to-moderate severity (perforated or abscessed appendicitis and other infections of mild-to-moderate severity):
- Single agent:
- Preferred regimen: Cefoxitin 2 g every 6 h OR Ertapenem 1 g every 24 h OR Moxifloxacin 400 mg every 24 h OR Tigecycline 100 mg initial dose, then 50 mg every 12 h OR Ticarcillin-clavulanic acid 3.1 g every 6 h; FDA labeling indicates 200 mg/kg/day in divided doses every 6 h for moderate infection
- Combination:
- Preferred regimen(1): Cefazolin 1–2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Cefuroxime 1.5 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ceftriaxone 1–2 g every 12–24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Cefotaxime 1–2 g every 6–8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- High risk or severity (severe physiologic disturbance, advanced age, or immunocompromised state):
- Single agent:
- Preferred regimen: Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h OR Meropenem 1 g every 8 h OR Doripenem 500 mg every 8 h OR Piperacillin-tazobactam 3.375 g every 6 h
- Combination:
- Preferred regimen(1): Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Health Care–Associated Complicated Intra-abdominal Infection [2]
- Less than 20% Resistant Pseudomonas aeruginosa, Extended-spectrum B-lactamase-producing Enterobacteriaceae, Acinetobacter, or other multidrug resistant gram-negative bacilli:
- Preferred regimen(1): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Extended-spectrum B-lactamase-producing Enterobacteriaceae:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Pseudomonas aeruginosa with more than 20% resistant to ceftazidime:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Methicillin-resistant Staphylococcus aureus (MRSA):
- Preferred regimen: Vancomycin 15–20 mg/kg every 8–12 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
Esophagitis
The selection of pharmacologic agent should be directed against the specific causative pathogen.
- Candida[3]
- Preferred regimen
- Fluconazole 100–200 mg/day PO/IV for 14-21 days AND
- Maintenance therapy with Fluconazole 100–200 mg/day PO in AIDS patients
- Alternative regimen: Itraconazole suspension 100–200 mg PO bid OR Voriconazole 200 mg PO bid OR Amphotericin B 0.3–0.7 mg/kg/day IV for 7 days OR Caspofungin 50 mg/day IV following a 70 mg loading dose OR Micafungin 150 mg/day IV OR Anidulafungin 50 mg/day IV following a 100 mg loading dose
- Herpes simplex virus[3]
- Preferred regimen: Acyclovir 5 mg/kg IV q8h for 7–14 days OR Acyclovir 400 mg 5 times daily PO for 14–21 days OR Valacyclovir 1 g PO tid for 14–21 days ± maintenance therapy
- Alternative regimen: Famciclovir 500 mg bid PO for 14–21 days OR Foscarnet 90 mg/kg q12h IV for 7–14 days
- Cytomegalovirus[3]
- Preferred regimen
- Ganciclovir 5 mg/kg IV q12h for 14–21 days AND
- Maintenance therapy with Ganciclovir 5 mg/kg/day IV or 6 mg/kg/day IV 5 days per week in AIDS patients
- Alternative regimen: Foscarnet 90 mg/kg IV q12h for 14–21 days, then Foscarnet 90–120 mg/kg/day IV for maintenance in AIDS patients OR Valganciclovir 900 mg PO bid, then 900 mg PO qd for maintenance in AIDS patients
- Aphthous ulceration in immunocompromised hosts[3]
- Preferred regimen: Prednisone 40 mg/day PO for 14 days, tapered over 4–8 weeks
- Alternative regimen: Thalidomide 200 mg/day PO
Hepatic abscess
Hepatitis A
- The treatment should be conservative and supportive. There is no specific medication for HAV infection. Hygiene is very important, hands should always be washed after bathroom use. The management should focus on treating the symptoms and identifying the small proportion of patients with a particular risk of developing fulminant hepatic failure. Patients over the age of 40 and those with underlying chronic liver disease are most at risk.
- Contacts should be vaccinated.
- Oral contraceptive treatment and hormone replacement therapy should be stopped to avoid cholestasis.
- Alcohol consumption is not advised.[4]
Hepatitis B
- Acute Hepatitis B
- Management
- Spontaneous recovery occurs after acute infection with HBV occurs in 95-99% of previously healthy adults. Antiviral therapy is not therefore likely to improve the rate of recovery and is not required unless the disease is accompanied by a nonhepatic complication such as periarteritis nodosa. In such cases, and in immunocompromised individuals (e.g., those with chronic renal failure), antiviral therapy with lamivudine may be recommended.
- In fulminant hepatitis, meticulous intensive care may improve the survival, but orthotopic liver transplantation is the only therapy that has been shown to improve patient outcomes.
- Full recovery with development of anti-HBs provides long-term protection.
- Prevention
- Vaccination (available since the early 1980s) continues to be the best way for dealing with the condition. Hepatitis B is preventable, and universal vaccination is probably best soloution in countries with a high prevalence.
- Preexposure vaccination:
- This is especially relevant in high-risk groups. There are a number of recombinant vaccines with similar efficacy, although the dosage may differ — for example:
- Recombivax HB (10 µg of HBsAg)
- Child < 11 y with an HbsAg-negative mother: 2.5 µg (babies at birth)
- Child < 11 y with an HBsAg-positive mother: 5 µg
- Child 11–19: 5 µg
- Immunocompetent adult: 10 µg
- Immunosuppressed person: 40 µg
- Renal dialysis patient: 40 µg
- Engerix-B (20 µg of HBsAg)
- Child < 10 y: 10 µg (babies at birth)
- Child > 10 y: 20 µg
- Adult: 20 µg
- Immunosuppressed person: 40 µg
- Dialysis patient: 40 µg 4.6.2
- Postexposure vaccination
- A combination of hepatitis B immunoglobulin (HBIg), when available, and HBV vaccine is recommended. If HBIg is available (in most countries it is not), it should be given to all children of HBs-positive mothers at the time of delivery. This is particularly important in neonates, in whom an immediate start of postexposure immunization will prevent infection in infants of HBV-infected mothers. It is important to vaccinate within 24 hours. There is no evidence of a protective effect if the vaccine is given more than 7 days after delivery.
- Direct exposure (percutaneous inoculation or transmucosal exposure) to HBsAg positive body fluid (e.g., needlestick injury):
- HBIg single intramuscular dose of 0.06 mL/kg (as soon as possible)
- Followed by a complete course of HBV vaccination (initiated within 7 days)
- Direct exposure following sexual contact with an individual with HBV:
- HBIg single intramuscular dose of 0.06 mL/kg (within 14 days; very expensive and not affordable in most places)
- Accompanied by a complete course of HBV vaccination (do not wait!).[5]
Chronic Hepatitis B
- Patients with HBeAg-positive chronic hepatitis B
- HBV DNA >20,000, ALT <2 times upper limit normal (ULN)
- Observe; consider treatment when ALT becomes elevated.
- Consider biopsy in persons 40 years, ALT persistently high normal >2 times upper limit normal (ULN), or with family history of HCC.
- Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.
- HBV DNA >20,000, ALT >2 times upper limit normal (ULN)
- Preferred regimen(1): Pegylated IFN-alpha 180 mcg weekly SC for 48 weeks
- Preferred regimen(2): Tenofovir(TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
- If creatinine clearance 30–49 give 300 mg q48 hrs
- If creatinine clearance 10–29 give 300 mg q72-96 hrs
- If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
- If creatinine clearance <10 without dialysis there is no recommendation
- Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
- Preferred regimen(3): Entecavir(ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
- If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
- If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
- If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
- Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
- Alternative regimen(1): Interferon alpha(IFNα) 5 MU daily or 10 MU thrice weekly SC for 16 weeks
- Alternative regimen(2): Lamivudine(LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 100 mg PO qd
- If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
- If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
- If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
- If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
- The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
- Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
- Alternative regimen(3): Adefovir(ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 10 mg PO daily
- If creatinine clearance 30–49 give 10 mg PO every other day
- If creatinine clearance 10–19 10 mg PO every third day
- If hemodialysis patients give 10 mg PO every week following dialysis
- Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
- Alternative regimen(4): Telbivudine(LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 600 mg PO once daily
- If creatinine clearance 30–49 600 give mg PO once every 48 hours
- If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
- If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
- Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
- Notes:
- Observe for 3-6 months and treat if no spontaneous HBeAg loss.
- Consider liver biopsy prior to treatment if compensated.
- Immediate treatment if icteric or clinical decompensation.
- Interferon alpha(IFNα)/ pegylated interferon-alpha(peg-IFNα), Lamivudine(LAM), Adefovir(ADV), Entecavir(ETV), tenofovir disoproxil fumarate(TDF) or telbivudine(LdT) may be used as initial therapy.
- Adefovir(ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
- Lamivudine(LAM) and Telbivudine(LdT) not preferred due to high rate of drug resistance.
- End-point of treatment – Seroconversion from HBeAg to anti-HBe.
- Interferon alpha(IFNα) non-responders / contraindications to IFNα change to Tenofovir(TDF)/Entecavir(ETV).
- Children with elevated ALT greater than 2 times normal
- Preferred regimen(1): Interferon alpha(IFNα) 6 MU/m2 SC thrice weekly with a maximum of 10 MU
- Preferred regimen(2): Lamivudine(LAM) 3 mg/kg/d PO with a maximum of 100 mg/d.
- Patients with HBeAg-negative chronic hepatitis B
- HBV DNA >20,000 IU/mL and elevated ALT >2 times normal
- Preferred regimen(1): Pegylated IFN-alpha 180 mcg weekly SC for 1 year
- Preferred regimen(2): Tenofovir(TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
- If creatinine clearance 30–49 give 300 mg q48 hrs
- If creatinine clearance 10–29 give 300 mg q72-96 hrs
- If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
- If creatinine clearance <10 without dialysis there is no recommendation
- Note: duration of treatment is more than 1 year
- Preferred regimen(3): Entecavir(ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
- If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
- If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine
- If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
- Note: duration of treatment is more than 1 year
- Alternative regimen(1): Interferon alpha(IFNα) 5 MU daily or 10 MU thrice weekly SC for 1 year
- Alternative regimen(2): Lamivudine(LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 100 mg PO qd
- If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
- If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
- If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
- If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
- The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
- Note: duration of treatment is more than 1 year
- Alternative regimen(3): Adefovir(ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 10 mg PO daily
- If creatinine clearance 30–49 give 10 mg PO every other day
- If creatinine clearance 10–19 10 mg PO every third day
- If hemodialysis patients give 10 mg PO every week following dialysis
- Note: duration of treatment is more than 1 year
- Alternative regimen(4): Telbivudine(LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 600 mg PO once daily
- If creatinine clearance 30–49 600 give mg PO once every 48 hours
- If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
- If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
- Note: duration of treatment is more than 1 year
- Notes:
- Interferon alpha(IFNα)/ pegylated interferon-alpha(peg-IFNα), Lamivudine(LAM), Adefovir(ADV), Entecavir(ETV), tenofovir disoproxil fumarate(TDF) or telbivudine(LdT) may be used as initial therapy.
- Adefovir(ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
- Lamivudine(LAM) and Telbivudine(LdT) not preferred due to high rate of drug resistance.
- End-point of treatment – not defined
- Interferon alpha(IFNα) non-responders / contraindications to IFNα change to Tenofovir(TDF)/Entecavir(ETV).
- HBV DNA >2,000 IU/mL and elevated ALT >1-2 times normal
- Consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.
- HBV DNA <2,000 IU/mL and ALT < upper limit normal (ULN)
- Observe, treat if HBV DNA or ALT becomes higher.
- +/- HBeAg and detectable HBV DNA with Cirrhosis
- Compensated Cirrhosis and HBV DNA >2,000
- Preferred regimen(1): Lamivudine(LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 100 mg PO qd
- If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
- If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
- If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
- If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
- The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
- Preferred regimen(2): Adefovir(ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 10 mg PO daily
- If creatinine clearance 30–49 give 10 mg PO every other day
- If creatinine clearance 10–19 give 10 mg PO every third day
- If hemodialysis patients give 10 mg PO every week following dialysis
- Preferred regimen(3): Entecavir(ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
- If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
- If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
- If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
- Preferred regimen(4): Telbivudine(LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 600 mg PO once daily
- If creatinine clearance 30–49 600 give mg PO once every 48 hours
- If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
- If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
- Preferred regimen(5): Tenofovir(TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
- If creatinine clearance 30–49 give 300 mg q48 hrs
- If creatinine clearance 10–29 give 300 mg q72-96 hrs
- If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
- If creatinine clearance <10 without dialysis there is no recommendation
- Notes:
- LAM and LdT not preferred due to high rate of drug resistance.
- ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.
- These patients should receive long-term treatment. However, treatment may be stopped in HBeAg-positive patients if they have confirmed HBeAg seroconversion and have completed at least 6 months of consolidation therapy and in HBeAg-negative patients if they have confirmed HBsAg clearance.
- Compensated Cirrhosis and HBV DNA <2,000
- Consider treatment if ALT elevated.
- Decompensated Cirrhosis
- Preferred regimen(1): Tenofovir(TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
- If creatinine clearance 30–49 give 300 mg q48 hrs
- If creatinine clearance 10–29 give 300 mg q72-96 hrs
- If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
- If creatinine clearance <10 without dialysis there is no recommendation
- Preferred regimen(2): Entecavir(ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
- If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
- If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
- If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
- Preferred regimen(3): Lamivudine(LAM) AND Adefovir(ADV)
- Lamivudine(LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 100 mg PO qd
- If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
- If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
- If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
- If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
- The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
- Adefovir(ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 10 mg PO daily
- If creatinine clearance 30–49 give 10 mg PO every other day
- If creatinine clearance 10–19 give 10 mg PO every third day
- If hemodialysis patients give 10 mg PO every week following dialysis
- Preferred regimen(4): Telbivudine(LdT) {and}} Adefovir(ADV)
- Telbivudine(LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 600 mg PO once daily
- If creatinine clearance 30–49 600 give mg PO once every 48 hours
- If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
- If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
- Adefovir(ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
- If creatinine clearance >50 or normal renal function give 10 mg PO daily
- If creatinine clearance 30–49 give 10 mg PO every other day
- If creatinine clearance 10–19 give 10 mg PO every third day
- If hemodialysis patients give 10 mg PO every week following dialysis
- Notes:
- Coordinate treatment with transplant center.
- Refer for liver transplant.
- Life-long treatment is recommended.
- +/- HBeAg and undetectable HBV DNA with Cirrhosis
- Compensated Cirrhosis: Observe
- Uncompensated Cirrhosis: Refer for liver transplant
Hepatitis C
Acute Hepatitis C
- Most cases of acute hepatitis C are asymptomatic and seldom diagnosed. Nonetheless, acute hepatitis C represents an opportunity to offer effective therapy. Acute hepatitis C is usually diagnosed under three circumstances: documented seroconversion, known exposure (eg, needle-stick exposure) and acute, clinical hepatitis.
- There has been a high rate of spontaneous clearance of virus following acute hepatitis C, which was more than 50% in some studies. The younger the age of the infection, the more likely is spontaneous clearance of the virus. Icteric hepatitis predicts spontaneous clearance with a high accuracy. Clearance usually occurs within 14 weeks of exposure. Most patients clear virus within 12 weeks. However, a single negative HCV RNA is insufficient to confirm clearance, and the test should be repeated at least once.
- Because seroconversion is unpredictable, treatment should be considered in all patients. Treatment is most effective when started before 12 weeks. Sustained virological response (SVR) rates of greater than 90% have been described using pegylated interferon (PEG IFN) monotherapy.
- Recommendations:
- Patients with acute, icteric hepatitis C can be observed for up to 12 weeks to determine whether spontaneous clearance occurs. If clearance has not occurred, treatment should be initiated by 12 weeks.
- In patients with acute, nonicteric hepatitis C, the likelihood of spontaneous clearance is lower, so treatment should start soon after diagnosis.
- Treatment is with PEG IFN-alpha monotherapy. Genotypes 2 and 3 should be treated for 12 weeks, and genotype 1 should be treated for 24 weeks.
Chronic Hepatitis C
Hepatitis D
Hepatitis E
Infectious diarrhea
Immunocompetent
- Bacterial [6]
- Shigella species
- Preferred regimen:
- Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 3 days (if susceptible ) OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 3 days)
- Pediatric dose:TMP-SMZ, 5 and 25 mg/kg, respectively bid for 3 days
- Preferred regimen:
- Adult dose: Nalidixic acid 1 g/d for 5 days OR Ceftriaxone; Azithromycin
- Pediatric dose: Nalidixic acid, 55 mg/kg/d for 5 days
- Non-typhi species of Salmonella
- Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 year old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 5 to 7 days; Ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses
- Campylobacter species
- Preferred regimen:Erythromycin, 500 mg bid for 5 days
- Escherichia coli species
- Enterotoxigenic
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)
- Enteropathogenic
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)
- Enteroinvasive
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)
- Enterohemorrhagic
- Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.
- Aeromonas/Plesiomonas
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)
- Yersinia species
- Preferred regimen: Antibiotics are not usually required; Deferoxamine therapy should be withheld; for severe infections or associated bacteremia treat as for immunocompromised hosts, using combination therapy with Doxycycline, Aminoglycoside, TMP-SMZ, OR Fluoroquinolone
- Vibrio cholerae O1 or O139
- Preferred regimen: Doxycycline, 300-mg single dose; or Tetracycline, 500 mg qid for 3 days; or TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days; or single-dose Fluoroquinolone
- Toxigenic Clostridium difficile
- Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days
- Parasites [6]
- Giardia
- Preferred regimen:Metronidazole, 250-750 mg tid for 7-10 days
- Cryptosporidium species
- Preferred regimen: If severe, consider Paromomycin, 500 mg tid for 7 days
- Isospora species
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 7 to 10 days
- Cyclospora species
- Preferred regimen: TMP/SMZ, 160 and 800 mg, respectively, bid for 7 days
- Microsporidium species
- Preferred regimen: Not determined
- Entamoeba histolytica
- Preferred regimen: Metronidazole, 750 mg tid for 5 to 10 days, plus either Diiodohydroxyquin, 650 mg tid for 20 days, or Paromomycin, 500 mg tid for 7 days
Immunocompromised
- Bacterial [6]
- Shigella species:
- Preferred regimen:
- Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 7 to 10 days (if susceptible ) OR fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 7 to 10 days)
- Pediatric dose:TMP-SMZ, 5 and 25 mg/kg, respectively bid for 7 to 10 days
- Preferred regimen:
- Adult dose: Nalidixic acid 1 g/d for 7 to 10 days OR Ceftriaxone; Azithromycin
- Pediatric dose: Nalidixic acid, 55 mg/kg/d for 7 to 10 days
- Non-typhi species of Salmonella
- Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 14 days (or longer if relapsing); ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses
- Campylobacter species
- Preferred regimen:Erythromycin, 500 mg bid for 5 days (may require prolonged treatment)
- Escherichia coli species
- Enterotoxigenic
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days) (Consider fluoroquinolone as for enterotoxigenic E. coli)
- Enteropathogenic
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)
- Enteroinvasive
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)
- Enterohemorrhagic
- Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.
- Aeromonas/Plesiomonas
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg ofloxacin, 400 mg norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)
- Yersinia species
- Preferred regimen: Doxycycline, Aminoglycoside (in combination) or TMP-SMZ or Fluoroquinolone
- Vibrio cholerae O1 or O139
- Preferred regimen: Doxycycline, 300-mg single dose; or Tetracycline, 500 mg qid for 3 days; or TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days; or single-dose Fluoroquinolone
- Toxigenic Clostridium difficile
- Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days
- Parasites [6]
- Giardia
- Preferred regimen:Metronidazole, 250-750 mg tid for 7-10 days
- Cryptosporidium species
- Preferred regimen: Paromomycin, 500 mg tid for 14 to 28 days, then bid if needed; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS
- Isospora species
- Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly, or weekly Sulfadoxine (500 mg) and Pyrimethamine (25 mg) indefinitely for patients with AIDS
- Cyclospora species
- Microsporidium species
- Preferred regimen: Albendazole, 400 mg bid for 3 weeks; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS
- Entamoeba histolytica
- Preferred regimen: Metronidazole, 750 mg tid for 5 to 10 days, plus either Diiodohydroxyquin, 650 mg tid for 20 days, or Paromomycin, 500 mg tid for 7 days
Leptospirosis
- Management
- Early treatment with antibiotics.
- Severe cases usually treated with high doses of IV Benzylpenicillin (30 mg/kg up to 1.2 g IV 6-hourly for 5-7 days).
- Less severe cases treated orally with antibiotics such as Doxycycline (2 mg/kg up to 100 mg 12-hourly for 5-7 days), Tetracycline, Ampicillin or Amoxicillin.
- Third-generation cephalosporins, such as Ceftriaxone and Cefotaxime, and Quinolone antibiotics may also be effective.
- Jarisch-Herxheimer reactions may occur after the start of antimicrobial therapy.
- Monitoring and supportive care as appropriate, e.g. dialysis, mechanical ventilation.[7]
- Prevention
- Preventing infection or disease in human hosts:
- Antibiotic prophylaxis of exposed persons in areas of high exposures may be effective, e.g. soldiers (Doxycycline 200mg in one weekly dose)
- Raising awareness of the disease and its of modes of transmission.[8]
Pancreatitis
Peliosis hepatitis
Peptic ulcer disease
- Preferred regimen: The current treatment of choice for H. pylori infected patients is a combination of PPI (standard dose twice daily) with Amoxicillin (1 g twice daily) and Clarithromycin (500 mg twice daily) administered for 7-10 days (7-day therapy is approved with Rabeprazole; 10-day therapy is approved with Lansoprazole, Omeprazole, Pantoprazole, and Esomeprazole). Metronidazole (400 mg twice daily) may be substituted for Amoxicillin in this regimen if the patient is allergic to Penicillin.
- Alternative regimen: An alternative strategy is the combination of Bismuth, Metronidazole, and Tetracycline (Bismuth subsalicylate 525 mg QID + Metronidazole 250 mg QID + Tetracycline 500 mg QID) combined with a PPI for 14 days. [9]
Peritonitis, secondary to bowel perforation
- Community-acquired infection in adults [2]
- Mild-to-moderate severity (perforated or abscessed appendicitis and other infections of mild-to-moderate severity):
- Single agent:
- Preferred regimen: Cefoxitin 2 g every 6 h OR Ertapenem 1 g every 24 h OR Moxifloxacin 400 mg every 24 h OR Tigecycline 100 mg initial dose, then 50 mg every 12 h OR Ticarcillin-clavulanic acid 3.1 g every 6 h; FDA labeling indicates 200 mg/kg/day in divided doses every 6 h for moderate infection
- Combination:
- Preferred regimen(1): Cefazolin 1–2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Cefuroxime 1.5 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ceftriaxone 1–2 g every 12–24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Cefotaxime 1–2 g every 6–8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- High risk or severity (severe physiologic disturbance, advanced age, or immunocompromised state):
- Single agent:
- Preferred regimen: Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h OR Meropenem 1 g every 8 h OR Doripenem 500 mg every 8 h OR Piperacillin-tazobactam 3.375 g every 6 h
- Combination:
- Preferred regimen(1): Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Health Care–Associated Complicated Intra-abdominal Infection [2]
- Less than 20% Resistant Pseudomonas aeruginosa, Extended-spectrum B-lactamase-producing Enterobacteriaceae, Acinetobacter, or other multidrug resistant gram-negative bacilli:
- Preferred regimen(1): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Extended-spectrum B-lactamase-producing Enterobacteriaceae:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Pseudomonas aeruginosa with more than 20% resistant to ceftazidime:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Methicillin-resistant Staphylococcus aureus (MRSA):
- Preferred regimen: Vancomycin 15–20 mg/kg every 8–12 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
Peritonitis, secondary to dialysis
Peritonitis, secondary to ruptured appendix
- Community-acquired infection in adults [2]
- Mild-to-moderate severity (perforated or abscessed appendicitis and other infections of mild-to-moderate severity):
- Single agent:
- Preferred regimen: Cefoxitin 2 g every 6 h OR Ertapenem 1 g every 24 h OR Moxifloxacin 400 mg every 24 h OR Tigecycline 100 mg initial dose, then 50 mg every 12 h OR Ticarcillin-clavulanic acid 3.1 g every 6 h; FDA labeling indicates 200 mg/kg/day in divided doses every 6 h for moderate infection
- Combination:
- Preferred regimen(1): Cefazolin 1–2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Cefuroxime 1.5 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ceftriaxone 1–2 g every 12–24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Cefotaxime 1–2 g every 6–8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- High risk or severity (severe physiologic disturbance, advanced age, or immunocompromised state):
- Single agent:
- Preferred regimen: Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h OR Meropenem 1 g every 8 h OR Doripenem 500 mg every 8 h OR Piperacillin-tazobactam 3.375 g every 6 h
- Combination:
- Preferred regimen(1): Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Health Care–Associated Complicated Intra-abdominal Infection [2]
- Less than 20% Resistant Pseudomonas aeruginosa, Extended-spectrum B-lactamase-producing Enterobacteriaceae, Acinetobacter, or other multidrug resistant gram-negative bacilli:
- Preferred regimen(1): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Extended-spectrum B-lactamase-producing Enterobacteriaceae:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Pseudomonas aeruginosa with more than 20% resistant to ceftazidime:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Methicillin-resistant Staphylococcus aureus (MRSA):
- Preferred regimen: Vancomycin 15–20 mg/kg every 8–12 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Community-acquired infection in pediatric patients
- Single agent:
- Preferred regimen: Ertapenem 3 months to 12 years 15 mg/kg twice daily (not to exceed 1 g/day) Every 12 h, older than 13 years 1 g/day Every 24 h OR Meropenem 60 mg/kg/day Every 8 h OR Imipenem-cilastatin 60–100 mg/kg/day Every 6 h OR Ticarcillin-clavulanate 200–300 mg/kg/day of ticarcillin component Every 4–6 h OR Piperacillin-tazobactam 200–300 mg/kg/day of piperacillin component Every 6–8 h
- Combination:
- Preferred regimen(1): Ceftriaxone 50–75 mg/kg/day Every 12–24 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(2): Cefotaxime 150–200 mg/kg/day Every 6–8 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(3): Cefepime 100 mg/kg/day Every 12 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(4): Ceftazidime 150 mg/kg/day Every 8 h, AND Metronidazole 30–40 mg/kg/day Every 8 h
- Preferred regimen(5): (Gentamicin 3–7.5 mg/kg/day Every 2–4 h, AND Metronidazole 30–40 mg/kg/day Every 8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Preferred regimen(6): (Gentamicin 3–7.5 mg/kg/day Every 2–4 h, AND Clindamycin 20–40 mg/kg/day Every 6–8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Preferred regimen(7): (Tobramycin 3.0–7.5 mg/kg/day Every 8–24 h, AND Metronidazole 30–40 mg/kg/day Every 8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Preferred regimen(8): (Tobramycin 3.0–7.5 mg/kg/day Every 8–24 h, AND Clindamycin 20–40 mg/kg/day Every 6–8 h) ± Ampicillin 200 mg/kg/day Every 6 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
Peritonitis, secondary to ruptured diverticula
- Community-acquired infection in adults [2]
- Mild-to-moderate severity (perforated or abscessed appendicitis and other infections of mild-to-moderate severity):
- Single agent:
- Preferred regimen: Cefoxitin 2 g every 6 h OR Ertapenem 1 g every 24 h OR Moxifloxacin 400 mg every 24 h OR Tigecycline 100 mg initial dose, then 50 mg every 12 h OR Ticarcillin-clavulanic acid 3.1 g every 6 h; FDA labeling indicates 200 mg/kg/day in divided doses every 6 h for moderate infection
- Combination:
- Preferred regimen(1): Cefazolin 1–2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Cefuroxime 1.5 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ceftriaxone 1–2 g every 12–24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Cefotaxime 1–2 g every 6–8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(5): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(6): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- High risk or severity (severe physiologic disturbance, advanced age, or immunocompromised state):
- Single agent:
- Preferred regimen: Imipenem-cilastatin 500 mg every 6 h or 1 g every 8 h OR Meropenem 1 g every 8 h OR Doripenem 500 mg every 8 h OR Piperacillin-tazobactam 3.375 g every 6 h
- Combination:
- Preferred regimen(1): Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(3): Ciprofloxacin 400 mg every 12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(4): Levofloxacin 750 mg every 24 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
- Health Care–Associated Complicated Intra-abdominal Infection [2]
- Less than 20% Resistant Pseudomonas aeruginosa, Extended-spectrum B-lactamase-producing Enterobacteriaceae, Acinetobacter, or other multidrug resistant gram-negative bacilli:
- Preferred regimen(1): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Ceftazidime 2 g every 8 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Preferred regimen(2): (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND Cefepime 2 g every 8–12 h AND Metronidazole 500 mg every 8–12 h or 1500 mg every 24 h
- Extended-spectrum B-lactamase-producing Enterobacteriaceae:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Pseudomonas aeruginosa with more than 20% resistant to ceftazidime:
- Preferred regimen: (meropenem 1 g every 8 h OR Imipenem/cilastatin 500 mg every 6 h or 1 g every 8 h OR Doripenem 500 mg every 8 h) AND Piperacillin-tazobactam 3.375 g every 6 h AND (Gentamicin 5–7 mg/kg every 24 h OR Tobramycin 5–7 mg/kg every 24 h OR Amikacin 15–20 mg/kg every 24 h)
- Methicillin-resistant Staphylococcus aureus (MRSA):
- Preferred regimen: Vancomycin 15–20 mg/kg every 8–12 h
- Note: Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
Peritonitis, spontaneous bacterial
Post-transplant infected biloma
Splenic abscess
Tropical sprue
- Preferred regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND (Tetracycline 250 mg PO qid OR Doxycycline 100 mg PO qd for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease)
- Alternative regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Ampicillin 500 mg bid for ≥ 4 weeks
- Note: Vitamin B12 deficiency may be corrected with Vitamin B12 1000 mcg IM weekly for 4 weeks, followed by monthly for 3 to 6 months.
Typhlitis
Variceal bleeding, prophylaxis
- Short-term antibiotic prophylaxis:
- Norfloxacin 400mg PO BID for max. of 7 days OR Ciprofloxacin 400mg IV every 12 h max. of 7 days (in patients in whom oral administration is not possible) [12]
- In advanced cirrhosis and in a setting with high prevalence of quinolone-resistant organisms :
- Ceftriaxone 1g IV once daily for max. of 7 days [12]
Whipple's disease
- Preferred regimen:(Doxycycline 100mg PO bid + Hydroxychloroquine 200 mg po tid) for 1 year, then Doxycycline 100mg PO bid for life. [13]
References
- ↑ Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ (2011). "Anthrax infection". Am J Respir Crit Care Med. 184 (12): 1333–41. doi:10.1164/rccm.201102-0209CI. PMC 3361358. PMID 21852539.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.
- ↑ 3.0 3.1 3.2 3.3 Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA; et al. (2013). "ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)". Am J Gastroenterol. 108 (5): 679–92, quiz 693. doi:10.1038/ajg.2013.71. PMID 23567357.
- ↑ http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/02_acute_hepatitis.pdf
- ↑ http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/02_acute_hepatitis.pdf
- ↑ 6.0 6.1 6.2 6.3 Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV; et al. (2001). "Practice guidelines for the management of infectious diarrhea". Clin Infect Dis. 32 (3): 331–51. doi:10.1086/318514. PMID 11170940.
- ↑ http://www.who.int/zoonoses/diseases/Leptospirosissurveillance.pdf
- ↑ http://www.who.int/zoonoses/diseases/Leptospirosissurveillance.pdf
- ↑ Talley NJ, Vakil N, Practice Parameters Committee of the American College of Gastroenterology (2005). "Guidelines for the management of dyspepsia". Am J Gastroenterol. 100 (10): 2324–37. doi:10.1111/j.1572-0241.2005.00225.x. PMID 16181387.
- ↑ Guerra, R.; Wheby, M. S.; Bayless, T. M. (1965-10). "Long-term antibiotic therapy in tropical sprue". Annals of Internal Medicine. 63 (4): 619–634. ISSN 0003-4819. PMID 5838328. Check date values in:
|date=
(help) - ↑ Ferri, Fred (2015). Ferri's Clinical Advisor 2016 5 Books in 1. City: Elsevier Science Health Science. ISBN 978-0323280471.
- ↑ 12.0 12.1 Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases. Practice Parameters Committee of the American College of Gastroenterology (2007). "Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis". Hepatology. 46 (3): 922–38. doi:10.1002/hep.21907. PMID 17879356.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.