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===Brain abscess===
===Brain abscess===


* Empiric antimicrobial therapy
* Empiric antimicrobial therapy<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* '''Brain abscess in otherwise healthy patients'''
:* '''Brain abscess in otherwise healthy patients'''
::* Preferred regimen
::* 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
:::* [[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
::* Alternative regimen
:::* [[Meropenem]] 6 g/day IV q8h


:* Brain abscess with comorbidities
:* Brain abscess with comorbidities
::* '''Otitis media, mastoiditis, or sinusitis'''
::* '''Otitis media, mastoiditis, or sinusitis'''
:::* Preferred regimen
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h
::::* [[Cefotaxime]] 8–12 g/day q4–6h {{or [[Ceftriaxone]] 4 g/day q12h {{and}} [[Metronidazole]] 30 mg/kg/day q6h


::* '''Dental infection'''
::* '''Dental infection'''
:::* Preferred regimen
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h
::::* [[Penicillin G]] 24 MU q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h


::* '''Penetrating trauma or post-neurosurgy'''
::* '''Penetrating trauma or post-neurosurgy'''
:::* Preferred regimen
:::* 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
::::* ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Vancomycin]] 30–45 mg/kg/day q8–12h


::* '''Lung abscess, empyema, or bronchiectasis'''
::* '''Lung abscess, empyema, or bronchiectasis'''
:::* Preferred regimen
:::* 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
::::* [[Penicillin G]] 24 MU q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h


::* '''Bacterial endocarditis'''
::* '''Bacterial endocarditis'''
:::* Preferred regimen
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
::::* [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h


::* '''Congenital heart disease'''
::* '''Congenital heart disease'''
:::* Preferred regimen
:::* Preferred regimen: [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
::::* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h


::* '''Transplant recipients'''
::* '''Transplant recipients'''
:::* Preferred regimen
:::* 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)
::::* ([[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)


::* '''Patients with HIV/AIDS'''
::* '''Patients with HIV/AIDS'''
:::* Preferred regimen
:::* 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
::::* ([[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


::*  '''Staphylococcus aureus coverage'''
::*  '''Staphylococcus aureus coverage'''
:::* Preferred regimen
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h
::::* [[Vancomycin]] 30–45 mg/kg/day q8–12h


::* '''Mycobacterium tuberculosis coverage'''
::* '''Mycobacterium tuberculosis coverage'''
::::* [[Isoniazid]] 300 mg qd {{and}} [[Rifampin]] 600 mg qd {{and}} [[Pyrazinamide]] 15–30 mg qd {{and}} [[Ethambutol]] 15 mg/kg/day qd
:::* Preferred regimen: [[Isoniazid]] 300 mg qd {{and}} [[Rifampin]] 600 mg qd {{and}} [[Pyrazinamide]] 15–30 mg qd {{and}} [[Ethambutol]] 15 mg/kg/day qd
 
* Pathogen-directed antimicrobial therapy<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* Bacteria
::* '''Actinomyces'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
 
::* '''Bacteroides fragilis'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day IV q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
 
::* '''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
 
::* '''Fusobacterium'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
 
::* '''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
 
::* '''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
 
::* '''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
 
::* '''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
 
::* '''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
 
::* '''Staphylococcus aureus, methicillin-susceptible'''
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
:::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
 
::* '''Staphylococcus aureus, methicillin-resistant'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
:::* Alternative regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
 
::* '''Streptococcus'''
:::* 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}} [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
 
:* Fungi
::* '''Aspergillus'''
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Alternative regimen: [[Amphotericin B]] deoxycholate 0.6–1.0 mg/kg/day IV q24h {{or}} [[Amphotericin B]] lipid complex 5 mg/kg/day IV q24h {{or}} [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
 
::* '''Candida'''
:::* 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
 
::* '''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
 
::* '''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
 
::* '''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
 
:* Protozoa
::* '''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
 
==References==
{{reflist}}

Latest revision as of 07:08, 5 June 2015

Brain abscess

  • Empiric antimicrobial therapy[1]
  • Brain abscess in otherwise healthy patients
  • Brain abscess with comorbidities
  • Otitis media, mastoiditis, or sinusitis
  • Dental infection
  • Penetrating trauma or post-neurosurgy
  • Lung abscess, empyema, or bronchiectasis
  • Bacterial endocarditis
  • Congenital heart disease
  • Transplant recipients
  • Patients with HIV/AIDS
  • Staphylococcus aureus coverage
  • Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h
  • Mycobacterium tuberculosis coverage
  • Pathogen-directed antimicrobial therapy[2]
  • Bacteria
  • Actinomyces
  • Bacteroides fragilis
  • Enterobacteriaceae
  • Fusobacterium
  • Haemophilus
  • Listeria monocytogenes
  • Nocardia
  • Prevotella melaninogenica
  • Pseudomonas aeruginosa
  • Staphylococcus aureus, methicillin-susceptible
  • Staphylococcus aureus, methicillin-resistant
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
  • Alternative regimen: TMP-SMZ 10–20 mg/kg/day q6–12h
  • Streptococcus
  • Fungi
  • Aspergillus
  • Candida
  • Cryptococcus neoformans
  • Mucorales
  • Pseudallescheria boydii (Scedosporium apiospermum)
  • Protozoa
  • Toxoplasma gondii

References

  1. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  2. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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