Template:ID-Brain abscess: Difference between revisions
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:::* Alternative regimen (3): [[Vancomycin]] 30–45 mg/kg/day IV q8–12h | :::* Alternative regimen (3): [[Vancomycin]] 30–45 mg/kg/day IV q8–12h | ||
:* | :*2.2 '''Fungi''' | ||
::* | ::*2.2.1 '''Aspergillus''' | ||
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h | :::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h | ||
:::* Alternative regimen (1): [[Amphotericin B]] deoxycholate 0.6–1.0 mg/kg/day IV q24h | :::* Alternative regimen (1): [[Amphotericin B]] deoxycholate 0.6–1.0 mg/kg/day IV q24h | ||
| Line 108: | Line 108: | ||
:::* Alternative regimen (4): [[Posaconazole]] 800 mg/kg/day IV q6–12h | :::* Alternative regimen (4): [[Posaconazole]] 800 mg/kg/day IV q6–12h | ||
::* | ::*2.2.2 '''Candida''' | ||
:::* Preferred regimen (1): [[Amphotericin B]] lipid complex 5 mg/kd/day q24h | :::* Preferred regimen (1): [[Amphotericin B]] lipid complex 5 mg/kd/day q24h | ||
| Line 114: | Line 114: | ||
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h | :::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h | ||
::* | ::*2.2.3 '''Cryptococcus neoformans''' | ||
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h | :::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h | ||
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h | :::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h | ||
::* | ::*2.2.4 '''Mucorales''' | ||
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h | :::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h | ||
:::* Alternative regimen: [[Posaconazole]] 800 mg/kg/day IV q6–12h | :::* Alternative regimen: [[Posaconazole]] 800 mg/kg/day IV q6–12h | ||
::* | ::*2.2.5 '''Pseudallescheria boydii (Scedosporium apiospermum)''' | ||
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h | :::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h | ||
:::* Alternative regimen: [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h | :::* Alternative regimen: [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h | ||
:* | :*2.3 '''Protozoa''' | ||
::* | ::*2.3.1 '''Toxoplasma gondii''' | ||
:::* Preferred regimen: [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd | :::* Preferred regimen: [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd | ||
:::* Alternative regimen (1): [[Pyrimethamine]] 25–100 mg/day qd {{and}} [[Clindamycin]] 2400–4800 mg/day IV q6h | :::* Alternative regimen (1): [[Pyrimethamine]] 25–100 mg/day qd {{and}} [[Clindamycin]] 2400–4800 mg/day IV q6h | ||
:::* Alternative regimen (2): [[Pyrimethamine]] 25–100 mg/day qd {{and}} ([[Azithromycin]] 1200–1500 mg/day IV q24h {{or}} [[Atovaquone]] 750 mg IV q6h {{or}} [[Dapsone]] 100 mg PO q24h) | :::* Alternative regimen (2): [[Pyrimethamine]] 25–100 mg/day qd {{and}} ([[Azithromycin]] 1200–1500 mg/day IV q24h {{or}} [[Atovaquone]] 750 mg IV q6h {{or}} [[Dapsone]] 100 mg PO q24h) | ||
:::* Alternative regimen (3): [[TMP-SMZ]] 10–20 mg/kg/day q6–12h | :::* Alternative regimen (3): [[TMP-SMZ]] 10–20 mg/kg/day q6–12h | ||
Revision as of 20:41, 28 July 2015
- Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
- 1.1 Brain abscess in otherwise healthy patients
- Preferred regimen: (Cefotaxime 8–12 g/day IV q4–6h OR Ceftriaxone 4 g/day IV q12h) AND Metronidazole 30 mg/kg/day IV q6h
- Alternative regimen: Meropenem 6 g/day IV q8h
- 1.2 Brain abscess with comorbidities
- 1.2.1 Otitis media, mastoiditis, or sinusitis
- Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h
- 1.2.2 Dental infection
- Preferred regimen: Penicillin G 4 MU IV q4h AND Metronidazole 30 mg/kg/day q6h
- 1.2.3 Penetrating trauma or post-neurosurgy
- Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h OR Cefepime 2 g IV q12h) AND Vancomycin 30–45 mg/kg/day q8–12h
- 1.2.4 Lung abscess, empyema, or bronchiectasis
- Preferred regimen: Penicillin G 4 MU IV q4h AND Metronidazole 30 mg/kg/day q6h AND TMP-SMZ 10–20 mg/kg/day q6–12h
- 1.2.5 Bacterial endocarditis
- Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h AND Gentamicin 5 mg/kg/day IV q8h
- 1.2.6 Congenital heart disease
- Preferred regimen: Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
- 1.2.7 Transplant recipients
- Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h AND Voriconazole 8 mg/kg/day q12h AND (TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h)
- 1.2.8 Patients with HIV/AIDS
- Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Sulfadiazine 4–6 g/day q6h AND Pyrimethamine 25–100 mg/day qd
- 1.2.9 Staphylococcus aureus coverage
- Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h
- 1.2.10 Mycobacterium tuberculosis coverage
- Preferred regimen: Isoniazid 300 mg qd AND Rifampin 600 mg qd AND Pyrazinamide 15–30 mg qd AND Ethambutol 15 mg/kg/day qd
- Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
- 2.1 Bacteria
- 2.1.1 Actinomyces
- Preferred regimen: Penicillin G 4 MU IV q4h
- Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h
- 2.1.2 Bacteroides fragilis
- Preferred regimen: Metronidazole 30 mg/kg/day IV q6h
- Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h
- 2.1.3 Enterobacteriaceae
- Preferred regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Cefepime 2 g IV q12h
- Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR TMP-SMZ 10–20 mg/kg/day q6–12h OR Ciprofloxacin 800–1200 mg/day IV q8–12h OR Meropenem 2 g IV q8h
- 2.1.4 Fusobacterium
- Preferred regimen: Metronidazole 30 mg/kg/day q6h
- Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h OR Meropenem 2 g IV q8h
- 2.1.5 Haemophilus
- Preferred regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Cefepime 2 g IV q12h
- Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR TMP-SMZ 10–20 mg/kg/day q6–12h
- 2.1.6 Listeria monocytogenes
- Preferred regimen: Ampicillin 12 g/day q4h OR Penicillin G 4 MU IV q4h
- Alternative regimen: TMP-SMZ 10–20 mg/kg/day q6–12h
- 2.1.7 Nocardia
- Preferred regimen: TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h
- Alternative regimen: Meropenem 2 g IV q8h OR Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Amikacin 15 mg/kg/day IV q8h
- 2.1.8 Prevotella melaninogenica
- Preferred regimen: Metronidazole 30 mg/kg/day q6h
- Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h OR Meropenem 2 g IV q8h
- 2.1.9 Pseudomonas aeruginosa
- Preferred regimen: Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h
- Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR Ciprofloxacin 800–1200 mg/day IV q8–12h OR Meropenem 2 g IV q8h
- 2.1.10 Staphylococcus aureus, methicillin-resistant (MRSA)
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
- Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
- Pediatric dose: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
- Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin.
- 2.1.11 Staphylococcus aureus, methicillin-susceptible (MSSA)
- Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
- Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
- 2.1.12 Streptococcus
- Preferred regimen (1): Penicillin G 4 MU IV q4h
- Preferred regimen (2): Ampicillin 2 g IV q4h
- Alternative regimen (1): Cefotaxime 2 g IV q4-6h
- Alternative regimen (2): Ceftriaxone 2 g IV q12h
- Alternative regimen (3): Vancomycin 30–45 mg/kg/day IV q8–12h
- 2.2 Fungi
- 2.2.1 Aspergillus
- Preferred regimen: Voriconazole 8 mg/kg/day q12h
- Alternative regimen (1): Amphotericin B deoxycholate 0.6–1.0 mg/kg/day IV q24h
- Alternative regimen (2): Amphotericin B lipid complex 5 mg/kg/day IV q24h
- Alternative regimen (3): Itraconazole 400–600 mg/day IV q12h
- Alternative regimen (4): Posaconazole 800 mg/kg/day IV q6–12h
- 2.2.2 Candida
- Preferred regimen (1): Amphotericin B lipid complex 5 mg/kd/day q24h
- Preferred regimen (2): Amphotericin B deoxycholate 15 mg/kg/day q8h
- Alternative regimen: Fluconazole 400–800 mg/day IV q24h
- 2.2.3 Cryptococcus neoformans
- Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Alternative regimen: Fluconazole 400–800 mg/day IV q24h
- 2.2.4 Mucorales
- Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Alternative regimen: Posaconazole 800 mg/kg/day IV q6–12h
- 2.2.5 Pseudallescheria boydii (Scedosporium apiospermum)
- Preferred regimen: Voriconazole 8 mg/kg/day q12h
- Alternative regimen: Itraconazole 400–600 mg/day IV q12h OR Posaconazole 800 mg/kg/day IV q6–12h
- 2.3 Protozoa
- 2.3.1 Toxoplasma gondii
- Preferred regimen: Sulfadiazine 4–6 g/day q6h AND Pyrimethamine 25–100 mg/day qd
- Alternative regimen (1): Pyrimethamine 25–100 mg/day qd AND Clindamycin 2400–4800 mg/day IV q6h
- Alternative regimen (2): Pyrimethamine 25–100 mg/day qd AND (Azithromycin 1200–1500 mg/day IV q24h OR Atovaquone 750 mg IV q6h OR Dapsone 100 mg PO q24h)
- Alternative regimen (3): TMP-SMZ 10–20 mg/kg/day q6–12h
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.