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Pathogen-Based Therapy Adapted from Lancet. 2012;380(9854):1693-702.[1] and Clin Infect Dis. 2004;39(9):1267-84.[2]

Bacteria

  ▸  Acinetobacter baumannii

  ▸  Enterobacteriaceae

  ▸  Haemophilus influenzae

  ▸  Listeria monocytogenes

  ▸  Neisseria meningitidis

  ▸  Pseudomonas aeruginosa

  ▸  Staphylococcus aureus

  ▸  Staphylococcus epidermidis

  ▸  Streptococcus agalactiae

  ▸  Streptococcus pneumoniae

Acinetobacter baumannii
Preferred Regimen
Meropenem 2 g IV q8h
Alternative Regimen
Colistin 1.25 mg/kg IV q6—12h
OR
Polymyxin B 0.75—1.25 mg/kg IV q12h
Enterobacteriaceae
Preferred Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Aztreonam 2 g IV q6—8h
OR
Moxifloxacin 400 mg IV q24h
OR
TMP/SMZ 5 mg/kg IV q6—12h (TMP component)
OR
Meropenem 2 g IV q8h
OR
Ampicillin 2 g IV q4h
H. influenzae, β-lactamase Negative
Preferred Regimen
Ampicillin 2 g IV q4h
Alternative Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
OR
Cefepime 2 g IV q8h
OR
Chloramphenicol 1—1.5 g IV q6h
OR
Aztreonam 2 g IV q6—8h
OR
Moxifloxacin 400 mg IV q24h
H. influenzae, β-lactamase Positive
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
Aztreonam 2 g IV q6—8h
OR
Moxifloxacin 400 mg IV q24h
H. influenzae, β-lactamase Negative, Ampicillin Resistant
Preferred Regimen
Meropenem 2 g IV q8h
Alternative Regimen
Moxifloxacin 400 mg IV q24h
Listeria monocytogenes
Preferred Regimen
Ampicillin 2 g IV q4h
OR
Penicillin G 4 MU IV q4h
PLUS
Gentamicin 1.7 mg/kg IV q8h
Alternative Regimen
TMP/SMZ 5 mg/kg IV q6—12h (TMP component)
N. meningitidis, Penicillin MIC <0.1 μg/mL
Preferred Regimen
Penicillin G 4 MU IV q4h
OR
Ampicillin 2 g IV q4h
Alternative Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
OR
Chloramphenicol 1—1.5 g IV q6h
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
Staphylococcus aureus, Methicillin resistant
Preferred Regimen
Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
Rifampin 600 mg IV q24h
Alternative Regimen
TMP/SMZ 5 mg/kg IV q6—12h (TMP component)
OR
Linezolid 600 mg IV q12h
OR
Daptomycin 6 mg/kg IV q24h
PLUS
Rifampin 600 mg IV q24h
Staphylococcus epidermidis
Preferred Regimen
Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
Rifampin 600 mg IV q24h
Alternative Regimen
Linezolid 600 mg IV q12h
PLUS
Rifampin 600 mg IV q24h
Streptococcus agalactiae
Preferred Regimen
Ampicillin 2 g IV q4h
OR
Penicillin G 4 MU IV q4h
PLUS
Gentamicin 1.7 mg/kg IV q8h
Alternative Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
OR
Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
S. pneumoniae, Penicillin MIC ≤0.06 μg/mL
Preferred Regimen
Penicillin G 4 MU IV q4h
OR
Ampicillin 2 g IV q4h
Alternative Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
OR
Chloramphenicol 1—1.5 g IV q6h
S. pneumoniae, Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC <1.0 μg/mL
Preferred Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Cefepime 2 g IV q8h
OR
Meropenem 2 g IV q8h
S. pneumoniae, Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC ≥1.0 μg/mL
Preferred Regimen
Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
PLUS
Rifampin 600 mg IV q24h
Alternative Regimen
Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
Moxifloxacin 400 mg IV q24h


References

  1. van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter |month= ignored (help)
  2. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: [1]