Sandbox ID Lower Respiratory Tract: Difference between revisions

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===Acute exacerbations of chronic bronchitis===
===Acute exacerbations of chronic bronchitis===
:* '''Acute exacerbation of chronic bronchitis'''<ref name="pmid15555829">{{cite journal| author=Sethi S, Murphy TF| title=Acute exacerbations of chronic bronchitis: new developments concerning microbiology and pathophysiology--impact on approaches to risk stratification and therapy. | journal=Infect Dis Clin North Am | year= 2004 | volume= 18 | issue= 4 | pages= 861-82, ix | pmid=15555829 | doi=10.1016/j.idc.2004.07.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15555829  }} </ref>
:* '''Acute exacerbation of chronic bronchitis'''<ref name="pmid15555829">{{cite journal| author=Sethi S, Murphy TF| title=Acute exacerbations of chronic bronchitis: new developments concerning microbiology and pathophysiology--impact on approaches to risk stratification and therapy. | journal=Infect Dis Clin North Am | year= 2004 | volume= 18 | issue= 4 | pages= 861-82, ix | pmid=15555829 | doi=10.1016/j.idc.2004.07.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15555829  }} </ref>
::* '''1. Outpatient management'''
::* '''1. Outpatient management'''
:::* Patients with only 1 of the 3 cardinal symptoms of COPD (↑ dyspnea, ↑ sputum volume, ↑ sputum purulence) may not benefit from antibiotics
:::* Patients with only 1 of the 3 cardinal symptoms of COPD (↑ dyspnea, ↑ sputum volume, ↑ sputum purulence) may not benefit from antibiotics
:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 7-10 days {{or}} [[Amoxicillin]] 875 mg PO bid {{or}} [[Amoxicillin]] 500 mg PO tid {{or}} [[Trimethoprim-sulfamethoxazole]] DS 800/160 mg PO bid for 10-14 days
:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7-10 days  
:::* Alternative regimen (1): [[Amoxicillin-clavulanate]] 875/125 mg PO bid for 10-14 days {{or}} [[Amoxicillin-clavulanate]] 500/125 mg PO tid for 10-14 days
:::* Preferred regimen (2): [[Amoxicillin]] 875 mg PO bid
:::* Alternative regimen (2): [[Levofloxacin]] 500 mg PO qd for 7-10 days {{or}} [[Moxifloxacin]] 400 mg PO qd for 5 days {{or}} [[Gemifloxacin]] 320 mg PO qd for 5 days
:::* Preferred regimen (3): [[Amoxicillin]] 500 mg PO tid
:::* Alternative regimen (3): ([[Azithromycin]] 500 mg PO single dose {{then}} 250 mg PO qd for 4 days) {{or}} [[Clarithromycin]] 250-500 mg PO bid for 7-14 days {{or}} [[Clarithromycin]] ER 1000 mg PO qd for 14 days
:::* Preferred regimen (4): [[Trimethoprim-sulfamethoxazole]] DS 800/160 mg PO bid for 10-14 days
:::* Alternative regimen (4): [[Cefpodoxime]] 200 mg PO bid for 10 days {{or}} [[Cefprozil]] 250-500 mg PO bid for 10 days {{or}} [[Cefuroxime]] 250-500 mg PO bid for 10 days {{or}} [[Cefixime]] 400 mg PO qd for 10 days
:::* Alternative regimen (1): [[Amoxicillin-clavulanate]] 875/125 mg PO bid for 10-14 days
:::* Alternative regimen (2): [[Levofloxacin]] 500 mg PO qd for 7-10 days  
:::* Alternative regimen (3): [[Azithromycin]] 500 mg PO single dose {{then}} 250 mg PO qd for 4 days
:::* Alternative regimen (4): [[Cefpodoxime]] 200 mg PO bid for 10 days
:::* Alternative regimen (5): [[Amoxicillin-clavulanate]] 500/125 mg PO tid for 10-14 days
:::* Alternative regimen (6): [[Moxifloxacin]] 400 mg PO qd for 5 days  
:::* Alternative regimen (7): [[Gemifloxacin]] 320 mg PO qd for 5 days
:::* Alternative regimen (8): [[Clarithromycin]] 250-500 mg PO bid for 7-14 days
:::* Alternative regimen (9): [[Clarithromycin]] ER 1000 mg PO qd for 14 days
:::* Alternative regimen (10): [[Cefprozil]] 250-500 mg PO bid for 10 days
:::* Alternative regimen (11): [[Cefixime]] 400 mg PO qd for 10 days
::* '''2. Inpatient management'''
::* '''2. Inpatient management'''
:::* Indications for hospital admission:
:::* Indications for hospital admission:
Line 19: Line 30:
::::* Frequent exacerbations
::::* Frequent exacerbations
::::* Insufficient home support
::::* Insufficient home support
:::* Preferred regimen (Pseudomonas not suspected): [[Moxifloxacin]] 400 mg IV q24h for 5 days {{or}} [[Levofloxacin]] 500 mg IV q24h for 7-10 days
:::* 2.1 '''Treatment of acute exacerbation of chronic bronchitis, when pseudomonas infection not suspected'''
:::* Preferred regimen (Pseudomonas suspected): [[Ceftazidime]] 30-50 mg/kg IV q8hr (maximum dose 6 g/day) {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days {{or}} [[Cefepime]] 1-2 g IV q8-12hr for 7-10 days (extend to 21 days if culture positive for Pseudomonas)
::::* Preferred regimen (1): [[Moxifloxacin]] 400 mg IV q24h for 5 days  
:::* Alternative regimen: [[Ceftriaxone]] 1-2 g IV/IM q12-24h for 4-14 days {{or}} [[Ceftriaxone]] 1-2 g IV/IM q8h for 4-14 days
::::* Preferred regimen (2): [[Levofloxacin]] 500 mg IV q24h for 7-10 days
:::* 2.2 '''Treatment of acute exacerbation of chronic bronchitis, when pseudomonas infection is suspected'''
::::* Preferred regimen (1): [[Ceftazidime]] 30-50 mg/kg IV q8hr (maximum dose 6 g/day)
::::* Preferred regimen (2): [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days  
::::* Preferred regimen (3): [[Cefepime]] 1-2 g IV q8-12hr for 7-10 days (extend to 21 days if culture positive for Pseudomonas)
::::* Alternative regimen (1): [[Ceftriaxone]] 1-2 g IV/IM q12-24h for 4-14 days
::::* Alternative regimen (2): [[Ceftriaxone]] 1-2 g IV/IM q8h for 4-14 days


===Bronchiectasis===
===Bronchiectasis===
*'''Bronchiectasis'''<ref name="pmid20627931">{{cite journal| author=Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group| title=British Thoracic Society guideline for non-CF bronchiectasis. | journal=Thorax | year= 2010 | volume= 65 Suppl 1 | issue=  | pages= i1-58 | pmid=20627931 | doi=10.1136/thx.2010.136119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20627931  }} </ref>
*'''Bronchiectasis'''<ref name="pmid20627931">{{cite journal| author=Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group| title=British Thoracic Society guideline for non-CF bronchiectasis. | journal=Thorax | year= 2010 | volume= 65 Suppl 1 | issue=  | pages= i1-58 | pmid=20627931 | doi=10.1136/thx.2010.136119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20627931  }} </ref>
:*'''1. Acute exacerbations of bronchiectasis'''
:* 1. '''Acute exacerbations of bronchiectasis'''
::*'''1.1 Empiric antimicrobial therapy'''
::* 1.1 '''Empiric antimicrobial therapy'''
:::*Preferred regimen: [[Amoxicillin]] 0.5-1 g PO/IV q8h for 14 days
:::* Preferred regimen: [[Amoxicillin]] 0.5-1 g PO/IV q8h for 14 days
:::*Alternative regimen: [[Ciprofloxacin]] 500-750 mg PO bid for 14 days {{or}} [[Clarithromycin]] 500 mg PO bid for 14 days
:::* Alternative regimen (1): [[Ciprofloxacin]] 500-750 mg PO bid for 14 days  
::*'''1.2 Pathogen-directed antimicrobial therapy'''
:::* Alternative regimen (2): [[Clarithromycin]] 500 mg PO bid for 14 days
:::*'''1.2.1 Streptococcus pneumoniae'''
::* 1.2 '''Pathogen-directed antimicrobial therapy'''
::::*Preferred regimen: [[Amoxicillin]] 500 mg PO tid for 14 days
:::* 1.2.1 '''Streptococcus pneumoniae'''
::::*Alternative regimen: [[Clarithromycin]] 500 mg PO bid 14 days
::::* Preferred regimen: [[Amoxicillin]] 500 mg PO tid for 14 days
:::*'''1.2.2 Haemophilus influenzae (b-lactamase negative)'''
::::* Alternative regimen: [[Clarithromycin]] 500 mg PO bid for 14 days
::::*Preferred regimen: [[Amoxicillin]] 0.5-1 g PO tid for 14 days {{or}} [[Amoxicillin]] 3 g PO bid for 14 days
:::* 1.2.2 '''Haemophilus influenzae (b-lactamase negative)'''
::::*Alternative regimen: [[Clarithromycin]] 500 mg PO bid for 14 days {{or}} [[Ciprofloxacin]] 500 mg PO bid for 14 days {{or}} [[Ceftriaxone]] 2 g IV q24h for 14 days
::::* Preferred regimen (1): [[Amoxicillin]] 0.5-1 g PO tid for 14 days  
:::*'''1.2.3 Haemophilus influenzae (b-lactamase positive)'''
::::* Preferred regimen (2): [[Amoxicillin]] 3 g PO bid for 14 days
::::*Preferred regimen: [[Amoxicillin-Clavulanate]] 625 mg PO tid for 14 days
::::* Alternative regimen (1): [[Clarithromycin]] 500 mg PO bid for 14 days  
::::*Alternative regimen: [[Clarithromycin]] 500 mg PO bid for 14 days {{or}} [[Ciprofloxacin]] 500 mg PO bid for 14 days {{or}} [[Ceftriaxone]] 2 g IV q24h for 14 days
::::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 14 days
:::*'''1.2.4 Moraxella catarrhalis'''
::::* Alternative regimen (3): [[Ceftriaxone]] 2 g IV q24h for 14 days
::::*Preferred regimen: [[Amoxicillin-Clavulanate]] 625 mg PO tid for 14 days
:::* 1.2.3 '''Haemophilus influenzae (b-lactamase positive)'''
::::*Alternative regimen: [[Ciprofloxacin]] 500 mg PO bid for 14 days
::::* Preferred regimen: [[Amoxicillin-Clavulanate]] 625 mg PO tid for 14 days
:::*'''1.2.5 Staphylococcus aureus (MSSA)'''
::::* Alternative regimen (1): [[Clarithromycin]] 500 mg PO bid for 14 days  
::::*Preferred regimen: [[Flucloxacillin]] 500 mg PO qid for 14 days
::::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 14 days  
::::*Alternative regimen: [[Clarithromycin]] 500 mg PO bid 14 days
::::* Alternative regimen (3): [[Ceftriaxone]] 2 g IV q24h for 14 days
:::*'''1.2.6 Staphylococcus aureus (MRSA) (mild-to-moderate)'''
:::* 1.2.4 '''Moraxella catarrhalis'''
::::*Preferred regimen (weight <50 kg): [[Rifampicin]] 450 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bid for 14 days
::::* Preferred regimen: [[Amoxicillin-Clavulanate]] 625 mg PO tid for 14 days
::::*Preferred regimen (weight >50 kg): [[Rifampicin]] 600 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bid for 14 days
::::* Alternative regimen: [[Ciprofloxacin]] 500 mg PO bid for 14 days
::::*Alternative regimen (weight <50 kg): [[Rifampicin]] 450 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
:::* 1.2.5 '''Staphylococcus aureus (MSSA)'''
::::*Alternative regimen (weight >50 kg): [[Rifampicin]] 600 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO qid for 14 days
::::*Alternative regimen: [[Linezolid]] 600 mg PO bid for 14 days (third-line therapy)
::::* Alternative regimen: [[Clarithromycin]] 500 mg PO bid 14 days
:::*'''1.2.7 Staphylococcus aureus (MRSA) (severe)'''
:::* 1.2.6 '''Staphylococcus aureus (MRSA) (mild-to-moderate)'''
::::*Preferred regimen: [[Vancomycin]] 1 g IV q12h (trough levels of 10-20 ng/mL) {{or}} [[Teicoplanin]] 400 mg IV q24h for 14 days
::::* Preferred regimen (weight < 50 kg): [[Rifampicin]] 450 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bid for 14 days
::::*Alternative regimen: [[Linezolid]] 600 mg IV q12h for 14 days  
::::* Preferred regimen (weight > 50 kg): [[Rifampicin]] 600 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bid for 14 days
:::*'''1.2.8 Coliforms (eg, Klebsiella, enterobacter)'''
::::* Alternative regimen (weight < 50 kg): [[Rifampicin]] 450 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
::::*Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid for 14 days
::::* Alternative regimen (weight > 50 kg): [[Rifampicin]] 600 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
::::*Alternative regimen: [[Ceftriaxone]] 2 g IV od 14 days
::::* Alternative regimen: [[Linezolid]] 600 mg PO bid for 14 days (third-line therapy)
:::*'''1.2.9 Pseudomonas aeruginosa'''
:::* 1.2.7 '''Staphylococcus aureus (MRSA) (severe)'''
::::*Preferred regimen: [[Ciprofloxacin]] 500-750 mg PO bid for 14 days
::::* Preferred regimen (1): [[Vancomycin]] 1 g IV q12h (trough levels of 10-20 ng/mL)
::::*Alternative regimen (1): [[Ceftazidime]] 2 g PO tid for 14 days
::::* Preferred regimen (2): [[Teicoplanin]] 400 mg IV q24h for 14 days
::::*Alternative regimen (2): [[Piperacillin-Tazobactam]] 4.5 g PO tid for 14 days
::::* Alternative regimen: [[Linezolid]] 600 mg IV q12h for 14 days  
::::*Alternative regimen (3): [[Aztreonam]] 2 g PO tid for 14 days  
:::* 1.2.8 '''Coliforms (eg, Klebsiella, enterobacter)'''
::::*Alternative regimen (4): [[Meropenem]] 2 g PO tid for 14 days
::::* Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid for 14 days
:::*'''1.2.10 Pediatric Dosing'''
::::* Alternative regimen: [[Ceftriaxone]] 2 g IV od 14 days
::::*[[Amoxicillin]] 20-50 mg/kg/day PO q8-12h
:::* 1.2.9 '''Pseudomonas aeruginosa'''
::::*[[Co-amoxiclav]] 20-45 mg/kg/day PO q8-12h
::::* Preferred regimen: [[Ciprofloxacin]] 500-750 mg PO bid for 14 days
::::*[[Trimethoprim]] 4-6 mg/kg/day PO q12h (Children < 12 yr)
::::* Alternative regimen (1): [[Ceftazidime]] 2 g PO tid for 14 days
::::*[[Trimethoprim]] 100-200 mg PO q12h (Children > 12 yr)
::::* Alternative regimen (2): [[Piperacillin-Tazobactam]] 4.5 g PO tid for 14 days
::::*[[Rifampicin]] 450 mg PO qd (weight <50 kg)
::::* Alternative regimen (3): [[Aztreonam]] 2 g PO tid for 14 days  
::::*[[Rifampicin]] 600 mg PO qd (weight >50 kg)
::::* Alternative regimen (4): [[Meropenem]] 2 g PO tid for 14 days
::::*[[Vancomycin]] 45-60 mg/kg/day IV q8-12h
:::* 1.2.10 '''Pediatric Dosing'''
::::*[[Ciprofloxacin]] 15-30 mg/kg/day PO/IV q12h
::::* [[Amoxicillin]] 20-50 mg/kg/day PO bid or tid
::::*[[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h (maximum daily dose: 200 mg)
::::* [[Co-amoxiclav]] 20-45 mg/kg/day PO bid or tid
::::*[[Linezolid]] 10 mg/kg IV/PO q12h
::::* [[Trimethoprim]] 4-6 mg/kg/day PO bid (Children < 12 yr)
::::*[[Ceftriaxone]] 50-75 mg/kg IV/IM q24h
::::* [[Trimethoprim]] 100-200 mg PO bid (Children > 12 yr)
::::*[[Ceftazidime]] 150 mg/kg/day IV/IM q8h
::::* [[Rifampicin]] 450 mg PO qd (weight < 50 kg)
:*'''2. Long-term antibiotic prophylaxis'''
::::* [[Rifampicin]] 600 mg PO qd (weight > 50 kg)
:*Patients with ≥3 exacerbations/year requiring antibiotic therapy or patients with fewer exacerbations that are causing significant morbidity should be considered for long-term antibiotic prophylaxis
::::* [[Vancomycin]] 45-60 mg/kg/day IV q8-12h
::*'''2.1 Pathogen-directed antimicrobial therapy'''
::::* [[Ciprofloxacin]] 15-30 mg/kg/day PO/IV q12h
:::*'''2.1.1 Streptococcus pneumoniae'''
::::* [[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h (maximum daily dose: 200 mg)
::::*Preferred regimen: [[Amoxicillin]] 500 mg PO bid
::::* [[Linezolid]] 10 mg/kg IV/PO q12h
::::*Alternative regimen: [[Clarithromycin]] 250 mg PO bid
::::* [[Ceftriaxone]] 50-75 mg/kg IV/IM q24h
:::*'''2.1.2 Haemophilus influenzae (b-lactamase negative)'''
::::* [[Ceftazidime]] 150 mg/kg/day IV/IM q8h
::::*Preferred regimen: [[Amoxicillin]] 500 mg PO bid
:* 2. '''Long-term antibiotic prophylaxis'''
::::*Alternative regimen: [[Clarithromycin]] 250 mg PO bid
:* Patients with ≥3 exacerbations/year requiring antibiotic therapy or patients with fewer exacerbations that are causing significant morbidity should be considered for long-term antibiotic prophylaxis
:::*'''2.1.3 Haemophilus influenzae (b-lactamase positive)'''
::* 2.1 '''Pathogen-directed antimicrobial therapy'''
::::*Preferred regimen: [[Amoxicillin-Clavulanate]] 375 mg PO tid
:::* 2.1.1 '''Streptococcus pneumoniae'''
::::*Alternative regimen: [[Clarithromycin]] 250 mg PO bid
::::* Preferred regimen: [[Amoxicillin]] 500 mg PO bid
:::*'''2.1.4 Moraxella catarrhalis'''
::::* Alternative regimen: [[Clarithromycin]] 250 mg PO bid
::::*Preferred regimen: [[Amoxicillin-Clavulanate]] 375 mg PO tid
:::* 2.1.2 '''Haemophilus influenzae (b-lactamase negative)'''
::::*Alternative regimen: [[Clarithromycin]] 250 mg PO bid
::::* Preferred regimen: [[Amoxicillin]] 500 mg PO bid
:::*'''2.1.5 Staphylococcus aureus (MSSA)'''
::::* Alternative regimen: [[Clarithromycin]] 250 mg PO bid
::::*Preferred regimen: [[Flucloxacillin]] 500 mg PO bid
:::* 2.1.3 '''Haemophilus influenzae (b-lactamase positive)'''
::::*Alternative regimen: [[Clarithromycin]] 250 mg PO bid
::::* Preferred regimen: [[Amoxicillin-Clavulanate]] 375 mg PO tid
:*'''3. Pseudomonas eradication (colonization)'''
::::* Alternative regimen: [[Clarithromycin]] 250 mg PO bid
::*'''3.1 Initial therapy'''
:::* 2.1.4 '''Moraxella catarrhalis'''
:::*Preferred regimen: [[Ciprofloxacin]] 750 mg PO bid for 14 days
::::* Preferred regimen: [[Amoxicillin-Clavulanate]] 375 mg PO tid
::*'''3.2 Secondary therapy in case of treatment failure'''
::::* Alternative regimen: [[Clarithromycin]] 250 mg PO bid
:::*Preferred regimen (1): [[Piperacillin-tazobactam]] 4.5 g PO tid for 14 days {{or}} [[Cefepime]] 1-2 g IV q8-12h
:::* 2.1.5 '''Staphylococcus aureus (MSSA)'''
:::*Preferred regimen (2): [[Ciprofloxacin]] 750 mg PO bid for 4 weeks {{and}} [[Colistin]] (Nebulized) 2 MU NEB bid for 3 months
::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO bid
:::*Preferred regimen (3): [[Colistin]] (Nebulized) 2 MU NEB bid for 3 months
::::* Alternative regimen: [[Clarithromycin]] 250 mg PO bid
:* 3. '''Pseudomonas eradication (colonization)'''
::* 3.1 '''Initial therapy'''
:::* Preferred regimen: [[Ciprofloxacin]] 750 mg PO bid for 14 days
::* 3.2 '''Secondary therapy in case of treatment failure'''
:::* Preferred regimen (1): [[Piperacillin-tazobactam]] 4.5 g PO tid for 14 days
:::* Preferred regimen (2): [[Cefepime]] 1-2 g IV q8-12h
:::* Preferred regimen (3): [[Ciprofloxacin]] 750 mg PO bid for 4 weeks {{and}} [[Colistin]] (Nebulized) 2 MU NEB bid for 3 months
:::* Preferred regimen (3): [[Colistin]] (Nebulized) 2 MU NEB bid for 3 months


===Bronchiolitis===
===Bronchiolitis===
*'''Breonchiolitis'''<ref name="pmid25349312">{{cite journal| author=Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM et al.| title=Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. | journal=Pediatrics | year= 2014 | volume= 134 | issue= 5 | pages= e1474-502 | pmid=25349312 | doi=10.1542/peds.2014-2742 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25349312  }} </ref>
*'''Bronchiolitis'''<ref name="pmid25349312">{{cite journal| author=Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM et al.| title=Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. | journal=Pediatrics | year= 2014 | volume= 134 | issue= 5 | pages= e1474-502 | pmid=25349312 | doi=10.1542/peds.2014-2742 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25349312  }} </ref>
:*'''1. Treatment'''
:* 1. '''Treatment'''
::* Preferred regimen: Supportive care. No antimicrobial therapy recommended.
::* Preferred regimen: Supportive care. No antimicrobial therapy recommended.
:*'''2. Prophylaxis'''
:* 2. '''Prophylaxis'''
::*Indications for prophylaxis:
::*Indications for prophylaxis:
:::*First year of life during RSV season in infants with hemodynamically significant heart disease  
:::*First year of life during RSV season in infants with hemodynamically significant heart disease  
:::*First year of life during RSV season in preterm infants <32 weeks 0 days’ gestation who require >21% oxygen for at least the first 28 days of life
:::*First year of life during RSV season in preterm infants < 32 weeks 0 days’ gestation who require > 21% oxygen for at least the first 28 days of life
::* Preferred regimen: [[Palivizumab]] 15 mg/kg IM monthly for 5 months
::* Preferred regimen: [[Palivizumab]] 15 mg/kg IM monthly for 5 months


===Bronchitis===
===Bronchitis===
* '''Acute bronchitis'''<ref name="pmid16428698">{{cite journal| author=Braman SS| title=Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. | journal=Chest | year= 2006 | volume= 129 | issue= 1 Suppl | pages= 95S-103S | pmid=16428698 | doi=10.1378/chest.129.1_suppl.95S | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16428698  }} </ref>
:* 1.'''Treatment of acute bronchitis with no suspicion of pertussis'''


* '''Exacerbations of chronic obstructive pulmonary disease (COPD)'''<ref name="pmid11316667">{{cite journal| author=Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee| title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. | journal=Am J Respir Crit Care Med | year= 2001 | volume= 163 | issue= 5 | pages= 1256-76 | pmid=11316667 | doi=10.1164/ajrccm.163.5.2101039 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11316667  }} </ref>
::* Preferred regimen: Supportive care. Antimicrobial therapy not recommended.
:* Empiric antimicrobial therapy
:* 2.'''Treatment of acute bronchitis with suspected or confirmed pertussis'''
::* Indications: antibiotics should be administered to patients (1) with cardinal symptoms: increased dyspnea, increased sputum volume, increased sputum purulence; (2) with increased sputum purulence and one other cardinal symptom; and (3) who require mechanical ventilation.
::* Preferred regimen (1): [[Erythromycin]] 15 mg/kg PO tid for 5-14 days  
::* Preferred regimen: [[Amoxicillin-Clavulanate]] 875 mg PO bid or 500 mg PO tid for 5-10 days {{or}} [[Ampicillin]] {{or}} [[Macrolide]] {{or}} [[Tetracycline]] {{or}} [[Levofloxacin]] 500 mg PO qd for 5-10 days
::* Preferred regimen (2): [[Azithromycin]] 500 mg PO single dose {{then}} [[Azithromycin]] 250 mg PO qd for 4 days
::: Note (1): The use of antibiotics is not recommended except for treatment of infectious exacerbations and other bacterial infections.
::: Note (2): Systemic corticosteroids and antibiotics can shorten recovery time, improve lung function (FEV1) and arterial hypoxemia (PaO2), and reduce the risk of early relapse, treatment failure, and length of hospital stay.
 
* '''Acute bronchitis'''<ref name="pmid16428698">{{cite journal| author=Braman SS| title=Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. | journal=Chest | year= 2006 | volume= 129 | issue= 1 Suppl | pages= 95S-103S | pmid=16428698 | doi=10.1378/chest.129.1_suppl.95S | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16428698  }} </ref>
:* Empiric antimicrobial therapy
::* Acute bronchitis is primarily a viral illness, routine treatment with antibiotics is <u>'''not'''</u> recommended.
::* Children and adult patients with confirmed and probable whooping cough should receive a [[Macrolide]] antibiotic and should be isolated for 5 days from the start of treatment.
::: Note: Bacteria that have been causally linked to acute bronchitis in otherwise healthy individuals include Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis, and Bordetella parapertussis.


===Cystic fibrosis===
===Cystic fibrosis===
*'''Cystic Fibrosis'''
* '''Cystic Fibrosis'''
:* Pathogen-directed antimicrobial therapy <ref name="pmid23540878">{{cite journal| author=Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB et al.| title=Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. | journal=Am J Respir Crit Care Med | year= 2013 | volume= 187 | issue= 7 | pages= 680-9 | pmid=23540878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23540878  }} </ref>
:* 1.'''Pathogen-directed antimicrobial therapy''' <ref name="pmid23540878">{{cite journal| author=Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB et al.| title=Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. | journal=Am J Respir Crit Care Med | year= 2013 | volume= 187 | issue= 7 | pages= 680-9 | pmid=23540878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23540878  }} </ref>
:* Bacterial
::* 1.1 '''Pseudomonas aeruginosa'''
::* '''Pseudomonas aeruginosa'''
:::* 1.1.1 '''Adults'''
:::* Preferred Regimen: [[Tobramycin]] 3.3 mg/kg q8h or 12 mg/kg IV q24h {{and}} ([[Piperacillin]] 100 mg/kg q6h {{or}} [[Ticarcillin]] 100 mg/kg q6h {{or}} [[Ceftazidime]] 50 mg/kg IV q8h (to maximum of 6 gm/day)
::::* Preferred regimen (1): [[Tobramycin]] 3.3 mg/kg PO tid {{or}} [[Tobramycin]] 12 mg/kg IV q24h {{and}} ([[Piperacillin]] 100 mg/kg PO qid
:::* Alternative Regimen: [[Tobramycin]] (3.3 mg/kg q8h or 12 mg/kg IV q24h) {{and}} ([[Aztreonam]] 50 mg/kg IV q8h {{or}} [[Tobramycin]] 3.3 mg/kg q8h or 12 mg/kg IV q24h) {{and}} Imipenem 15-25 mg/kg IV q6. If Tobramycin resistant add [[Ciprofloxacin]] Oral : 500-750 mg twice daily for 7-14 days-IV 400 mg every 12 hours for 7-14 days {{or}} [[Levofloxacin]] 750 mg every 24 hours for 7-14 days
::::* Preferred regimen (2): [[Ticarcillin]] 100 mg/kg PO qid
:::* Only in children: [[Ciprofloxacin ]]Oral :500-750 mg twice daily for 7-14 days-IV 400 mg every 12 hours for 7-14 days {{and}} [[Ceftazidime]] IV 500 mg to 1 g every 8 hours.
::::* Preferred regimen (3): [[Ceftazidime]] 50 mg/kg IV q8h (to maximum of 6 g/day)
 
::::* Alternative regimen (1): ([[Tobramycin]] 3.3 mg/kg PO tid {{or}} [[Tobramycin]] 12 mg/kg IV q24h) {{and}} [[Aztreonam]] 50 mg/kg IV q8h  
::*'''Staphylococcus aureus'''
::::* Alternative regimen (2): ([[Tobramycin]] 3.3 mg/kg PO tid {{or}} [[Tobramycin]] 12 mg/kg IV q24h) {{and}} [[Imipenem]] 15-25 mg/kg IV q6h
:::* Preferred Regimen (Adult)
::::* Note: If [[Tobramycin]] resistant add [[Ciprofloxacin]] 500-750 mg PO bid for 7-14 days {{or}} [[Ciprofloxacin]] 400 mg IV q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg PO qd for 7-14 days
::::* If methicillin sensitive staphylococcus aureus: [[Nafcillin]] 2 gm IV q4hs {{or}} [[Oxacillin]] 2 gm IV q4hs
:::* 1.1.2 '''Children'''
::::* If methicillin resistant staphylococcus aureus: [[Vancomycin]] 15-20 mg/kg IV q8-12h {{or}} [[Linezolid]] 600 mg po/IV q12h
::::* Preferred regimen: ([[Ciprofloxacin ]] 500-750 mg PO bid for 7-14 days {{or}} [[Ciprofloxacin ]] 400 mg IV q12h for 7-14 days) {{and}} [[Ceftazidime]] 0.5-1 g IV q8h
:::* Preferred regimen (Pediatric)
::* 1.2 '''Staphylococcus aureus'''
::::* If methicillin sensitive staphylococcus aureus: [[Nafcillin]] 5 mg/kg q6h (Age >28 days) {{or}} [[Oxacillin]] 75 mg/kg q6h (Age >28 days)]]
:::* 1.2.1 '''Adults'''
::::* If methicillin resistant staphylococcus aureus: [[Vancomycin]] 40 mg/kg divided q6-8h (Age >28 days) {{or}} [[Linezolid]] 10 mg/kg po/IV q8h (up to age 12)
::::* 1.2.1.1 '''Methicillin sensitive staphylococcus aureus'''
 
:::::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
::* '''Burkholderia cepacia'''
::::* 1.2.1.2 '''Methicillin resistant staphylococcus aureus'''
:::* Preferred Regimen: [[Trimethoprim-sulfamethoxazole]] 5 mg/kg (TMP component) IV q6h
:::::* Preferred regimen: [[Vancomycin]] 15-20 mg/kg IV q8-12h {{or}} [[Linezolid]] 600 mg PO/IV q12h
:::* Alternate Regimen : [[Chloramphenicol]] 15–20 mg/kg IV/po q6h
:::* 1.2.2 '''Children'''
::::* 1.2.2.1 '''Methicillin sensitive staphylococcus aureus'''
:::::* Preferred regimen: [[Nafcillin]] 5 mg/kg IV q6h (age > 28 days) {{or}} [[Oxacillin]] 75 mg/kg IV q6h (age > 28 days)
::::* 1.2.2.2 '''Methicillin resistant staphylococcus aureus'''
:::::* Preferred regimen: [[Vancomycin]] 40 mg/kg IV divided q6-8h (age >28 days) {{or}} [[Linezolid]] 10 mg/kg PO/IV q8h (up to age 12)
::* 1.3 '''Burkholderia cepacia'''
:::* Preferred regimen: [[Trimethoprim-sulfamethoxazole]] 5/25 mg/kg IV q6h
:::* Alternative regimen: [[Chloramphenicol]] 15–20 mg/kg PO/IV q6h


===Empyema===
===Empyema===
'''Culture Negative Pleural Infection'''
*'''Empyema'''<ref>{{cite book | last = LastName | first = FirstName | title = Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Place of publication not identified | year = 2007 | isbn = 9781930808386 }}</ref>
:* Preferred regimen: [[Cefuroxime]] 1.5 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8h {{or}} [[Benzyl penicillin]] 1.2 g IV q6h {{and}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Meropenem]] 1 g IV q8h {{plus}} [[Metronidazole]] 500 mg q8h.<ref name="pmid21157522">{{cite journal| author=Ahmed AE, Yacoub TE| title=Empyema thoracis. | journal=Clin Med Insights Circ Respir Pulm Med | year= 2010 | volume= 4 | issue=  | pages= 1-8 | pmid=21157522 | doi= | pmc=PMC2998927 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21157522  }} </ref>
:* 1. '''Empiric antimicrobial therapy or culture negative therapy'''
 
:::*Causative pathogens:
:* Preferred regimen(2): [[Amoxicillin]] 1 g oral q8h {{plus}} [[Clavulanic acid]] 125 mg oral q8h {{plus}} [[Metronidazole]] 400mg oral q8h {{or}} [[Clindamycin]] 300 mg oral q8h.<ref>{{cite book | last = LastName | first = FirstName | title = Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Place of publication not identified | year = 2007 | isbn = 9781930808386 }}</ref>
::::*Streptococcus milleri
 
::::*Streptococcus pneumoniae
'''For Culture Negative Hospital Acquired Infection'''
::::*Streptococcus intermedius
 
::::*Staphylococcus aureus
:* Preferred regimen: [[Piperacillin]] 3 gm IV q4h {{plus}} [[Tazobactam]] 4.5g IV q6h {{or}} [[Ceftazidime]] 2g IV q8h {{or}} [[Meropenem]] 1g IV q8h {{plus}} [[Metronidazole]] 500mg q8h.
::::*Enterobacteriaceae
::::*Escherichia coli
<u>Pathogen based empyema</u>
::::*Fusobacterium spp.
 
::::*Bacteroides spp.
'''Streptococcus pneumoniae, Group A streptrococcus  '''
::::*Peptostreptococcus spp.
:* Preferred regimen(1):[[Ceftriaxone]] ≤30 days old, 75 mg/kg IV/IM q24h (use with caution in infants with [[jaundice]]) or >30 days old 100 mg/kg IV/IM q24h
:::* Preferred regimen (1): [[Cefuroxime]] 1.5 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8h
'''Staphylococcus aureus'''  
:::* Preferred regimen (2): [[Ceftriaxone]] 1.5 g IV q8h {{and}} [[Metronidazole]] 500 mg IV q8h
 
:::* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{or}} [[Ticarcillin-clavulanate]] 3.1 g IV q4h {{or}} [[Ampicillin-Sulbactam]] 2/1 g IV q6h
:* Preferred regimen(1): [[Nafcillin]] 2 gm IV q4h {{or}} [[Oxacillin]] 2 gm IV q4h if methicillin sensitive staphylococcus aureus.
:::* Preferred regimen (4): [[Meropenem]] 1 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h
:* Alternate regimen(1): [[Vancomycin]]  1 gm IV q12h {{or}} [[Linezolid]]  600 mg po bid if methicillin resistent staphylococcus aureus.
:::* Note: Consider coverage for MRSA if high suspicion exists.
'''Hemophilus influenzae'''  
:* 2. '''Pathogen-based therapy'''
:* Preferred regimen: [[Ceftriaxone]] 75 mg/kg IV/IM q24h
::* 2.1 '''Acute empyema'''
:* Alternate regimen: [[TMP-SMX]] Oral 5 days/week or [[Ampicillin-Sulbactum]]
:::* 2.1.1 '''Streptococcus pneumoniae, Group A streptrococcus  '''
 
::::* Preferred regimen: [[Ceftriaxone]] 1.5 g IV/IM q24h
'''Subacute/chronic empyema'''  
:::* 2.1.2 '''Staphylococcus aureus'''
 
::::* 2.1.2.1 '''MSSA'''
'''Anaerobic streptococcus, Streptococcus milleri, Bacteroides species, Enterobacteriaceae, Mycobacterium tuberculosis'''  
:::::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
:* Preferred regimen: [[Clindamycin]] 450–900 mg IV q8h + [[Ceftriaxone]]
::::* 2.1.2.2 '''MRSA'''
:* Alternate regimen: [[Cefoxitin]] {{or}} [[Imepenem]] {{or}} [[Ticarcillin]] and [[Clavulonic acid]] {{or}} [[Piperacillin-Tazobactum]] {{or}} [[Ampicillin-Sulbactum]]
:::::* Preferred regimen: [[Vancomycin]] 1 g IV q12h {{or}} [[Linezolid]] 600 mg PO/IV q12h
 
:::* 2.1.3 '''Hemophilus influenzae'''  
===Inhalational anthrax, Prophylaxis===
::::* Preferred regimen: [[Ceftriaxone]] 1.5 g IV/IM q24h
*''' Oral postexposure prophylaxis for infection with Bacillus anthracis (for adults)'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
::::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 8-20 mg TMP/kg/day IV q6-12h or [[Ampicillin-Sulbactam]] 2/1 g IV q6h
:* (1) For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Ciprofloxacin]], 500 mg q12h''' {{or}} '''Doxycycline, 100 mg q12h''' {{or}} Levofloxacin, 750 mg q24h {{or}} Moxifloxacin, 400 mg q24h {{or}} Clindamycin, 600 mg q8h {{or}}
::* 2.2 '''Subacute/chronic empyema'''  
 
:::* 2.2.1 '''Anaerobic streptococcus, Streptococcus milleri, Bacteroides species, Enterobacteriaceae, Mycobacterium tuberculosis'''  
:* (2) Alternatives for penicillin-susceptible strain Amoxicillin, 1 g q8h {{or}} Penicillin VK, 500 mg q6h
::::* Preferred regimen: [[Clindamycin]] 450–900 mg IV q8h {{and}} [[Ceftriaxone]] 1.5 g IV/IM q24h
:: Note (1): Preferred drugs are indicated in boldface.
::::* Alternative regimen: [[Imipenem]] 500 mg IV q6h {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{or}} [[Ticarcillin-clavulanate]] 3.1 g IV q4h {{or}} [[Ampicillin-Sulbactam]] 2/1 g IV q6h
:: Note (2): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment or if first-line treatment is unavailable.
 
*'''Postexposure Prophylaxis for Bacillus anthracis (for Children 1 Month of Age and Older)'''<ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
:* (1). For penicillin-resistant strains or prior to susceptibility testing: '''[[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose)''' {{or}} '''[[Doxycycline]], <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose)''' >45 kg: 100 mg/dose, PO, given q12h {{or}} [[Clindamycin]], 30 mg/kg/day, PO, divided q8h (not to exceed 900 mg/dose) {{or}} [[Levofloxacin]], <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h {{or}}
 
:* (2). For penicillin-susceptible strains: '''[[Amoxicillin]], 75 mg/kg/day, PO, divided every q8h (not to exceed 1 g/dose)''' {{or}} [[Penicillin VK]], 50-75 mg/kg/day, PO, divided q6h to q8h
:: Note (1) : '''Duration of Therapy is 60 days after exposure'''
:: Note (2) : Bold font are  preferred antimicrobial agent (when 2 bolded antimicrobial agents are present, both are considered equivalent in overall safety and efficacy).
:: Note (3) : Normal font are alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
:: Note (4) : Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
:: Note (5) : Italicized font: indicates FDA approval for the indication in the pediatric population.
:: Note (6) : A single 14-day course of doxycycline is not routinely associated with tooth staining, but some degree of staining is likely for a prolonged treatment course of up to 60 days.
:: Note (7) : Safety data for [[Levofloxacin]] in the pediatric population are limited to 14 days for duration therapy.
:: Note (8) : Be aware of the possibility of emergence of penicillin-resistance during monotherapy with [[Amoxicillin]] or [[Penicillin]].
 
===Inhalational anthrax, Treatment===
* '''Treatment for anthrax in adults''' <ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
:* Pathogen-directed antimicrobial therapy
:* '''(1) Intravenous therapy for systemic anthrax with possible/confirmed meningitis'''
::* Preferred regimen
:::* (1) Bactericidal agent (fluoroquinolone): '''[[Ciprofloxacin]], 400 mg IV q8h''' ({{or}} [[Levofloxacin]], 750 mg IV q24h {{or}} [[Moxifloxacin]], 400 mg IV q24h) {{and}}
:::* (2) Bactericidal agent (β-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Meropenem]], 2 g IV q8h''' {{or}} [[Imipenem]], 1 g IV q6h {{or}} [[Doripenem]], 500 mg IV q8h {{or}}
:::* (3) Alternatives for penicillin-susceptible strains : [[Penicillin G]], 4 million units q4h {{or}} [[Ampicillin]], 3 g q6h {{and}}
:::* (4) Protein synthesis inhibitor : '''[[Linezolid]], 600 mg q12h''' {{or}} [[Clindamycin]], 900 mg q8h {{or}} [[Rifampin]], 600 mg q12h {{or}} [[Chloramphenicol]], 1 g q6h or q8h.
::: Note (1): Duration of treatment: ≥2-3 weeks until clinical criteria for stability are met.(Preferred drugs are indicated in boldface)
::: Note (2): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
::: Note (3): Systemic anthrax includes anthrax meningitis; inhalation, injection, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck. Preferred drugs are indicated in boldface.
::: Note (4): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
::: Note (5):Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
::: Note (6): [[Linezolid]] should be used with caution in patients with thrombocytopenia because it might exacerbate it. [[Linezolid]] use for >14 days has additional hematopoietic toxicity.
::: Note (7): [[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
::: Note (8): [[Chloramphenicol]]Should only be used if other options are not available because of toxicity concerns.
 
:*'''(2) Intravenous therapy for systemic anthrax when meningitis has been excluded'''
::* Preferred regimen:
:::* Bactericidal drug
::::* (1) For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Ciprofloxacin]], 400 mg q8h''' ({{or}} [[Levofloxacin]], 750 mg q24h {{or}} [[Moxifloxacin]], 400 mg q24h) {{or}} [[Meropenem]], 2 g q8h {{or}} [[Imipenem]], 1 g q6h {{or}} [[Doripenem]], 500 mg q8h {{or}} [[Vancomycin]], 60 mg/kg/d IV divided q8h (maintain serum trough concentrations of 15-20 µg/mL) {{or}}
::::*(2) Alternatives for penicillin-susceptible strains: [[Penicillin G]], 4 million units q4h {{or}} [[Ampicillin]], 3 g q6h {{and}}
::::* (3) Protein synthesis inhibitor: '''[[Clindamycin]], 900 mg q8h''' {{or}} '''[[Linezolid]], 600 mg q12h''' {{or}} [[Doxycycline]], 200 mg initially, then 100 mg q12h {{or}} [[Rifampin]], 600 mg q12h
:::: Note (1): Duration of treatment: for 2 weeks until clinical criteria for stability are met. (Preferred drugs are indicated in boldface).
:::: Note (2):Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
:::: Note (3):Systemic anthrax includes anthrax meningitis; inhalation, injection, and gastrointestinal anthrax and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
:::: Note (4):Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
:::: Note (5):Increased risk for seizures associated with imipenem/cilastatin treatment.
:::: Note (6):Linezolid should be used with caution in patients with thrombocytopenia because it might exacerbate it.Linezolid use for >14 d has additional hematopoietic toxicity.
:::: Note (7):A single 10-14 days course of [[Doxycycline]] is not routinely associated with tooth staining.
:::: Note (8):[[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobials drugs on the basis of its in vitro synergy.
 
:* '''(3) Oral treatment for cutaneous anthrax without systemic involvement'''
::* (1) For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Ciprofloxacin]], 500 mg q12h''' {{or}} '''[[Doxycycline]], 100 mg q12h''' {{or}} '''[[Levofloxacin]], 750 mg q24h''' {{or}} '''[[Moxifloxacin]], 400 mg q24h''' {{or}} [[Clindamycin]], 600 mg q8h {{or}}
::* (2) Alternatives for penicillin-susceptible strains: [[Amoxicillin]], 1 g q8h {{or}} [[Penicillin VK]], 500 mg q6h
:: Note (1): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable. (Preferred drugs are indicated in boldface).
:: Note (2): Duration of treatment is 60 days  for bioterrorism-related cases and 7-10 days for naturally acquired cases.
 
* '''Treatment for anthrax in childern''' <ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
:* '''(1). Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)'''
::* (A). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose)''' {{or}} [[Doxycycline]], <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose) ≥45 kg: 100 mg/dose, PO, given q12h {{or}} [[Clindamycin]], 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) {{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h {{or}}
 
::* (B). Alternatives for penicillin-susceptible strains: '''[[Amoxicillin]], 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose)''' {{or}} [[Penicillin VK]], 50-75 mg/kg/day, PO, divided q6h to q8h
::: Note (1): Duration of therapy for naturally acquired infection: 7-10 days and for a biological weapon-related event: will require additional prophylaxis for inhaled spores, to complete an antimicrobial course of up to 60 days from onset of illness.
::: Note (2): Bold font for preferred antimicrobial agent.
::: Note (3): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or first-line therapy is unavailable.
::: Note (4): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
::: Note (5): Italicized font indicates FDA approval for the indication in the pediatric population.
::: Note (6): A single 10- to 14-day course of doxycycline is not routinely associated with tooth staining.
::: Note (7): Be aware of the possibility of emergence of penicillin-resistance during monotherapy with amoxicillin or penicillin.
 
:* '''(2). Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)'''
::* (A). A bactericidal antimicrobial
:::* (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Ciprofloxacin]], 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose)''' {{or}} [[Meropenem]], 60 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) {{or}} [[Levofloxacin]] <50 kg: 20 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose >50 kg: 500 mg, IV, q24h {{or}} [[Imipenem]]/[[Cilastatin]],a 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) {{or}} [[Vancomycin]], 60 mg/kg/day, IV, divided q8h (follow serum concentrations)
:::* (b). Alternatives for penicillin-susceptible strains: '''[[Penicillin G]], 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose)''' {{or}} [[Ampicillin]], 200 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) {{and}}
 
::* (B). A Protein Synthesis Inhibitor: '''[[Clindamycin]], 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose)''' {{or}} [[Linezolid]] (non-CNS infection dose): <12 y old: 30 mg/kg/day, IV, divided q8h ≥12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) {{or}} [[Doxycycline]] <45 kg: 4.4 mg/kg/day, IV, loading dose (not to exceed 200 mg); ≥45 kg: 200 mg, IV, loading dose then <45 kg: 4.4 mg/kg/day, IV, divided q12h  (not to exceed 100 mg/dose); ≥45 kg: 100 mg, IV, given q12h {{or}} Rifampin,d 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)
::: Note (1): Duration of therapy for 14 days or longer until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
::: Note (2): Systemic anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
::: Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. A normal CSF may not completely exclude deep brain hemorrhage/abscess.
::: Note (4): Bold font for preferred antimicrobial agent.
::: Note (5): Normal font for  alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
::: Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
::: Note (7): Increased risk of seizures associated with [[Imipenem]]/[[Cilastatin]] therapy.
::: Note (8): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it.[[Linezolid]] use for >14 days carries additional hematopoietic toxicity.
::: Note (9): A single 14-day course of [[Doxycycline]] is not routinely associated with tooth staining.
::: Note (10): [[Rifampin]] is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy
 
:* '''(3).Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older'''
::* (A). A bactericidal antimicrobial (fluoroquinolone): [[Ciprofloxacin]], 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose){{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose); >50 kg: 500 mg, IV, q24h {{or}} [[Moxifloxacin]] 3 months to <2 years: 12 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
::::2-5 years: 10 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
::::6–11 years: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
::::12–17 years, ≥45 kg body weight: 400 mg, IV, once daily
::::12–17 years, <45 kg body weight: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose) {{and}}
 
::* (B). A bactericidal antimicrobial (β-lactam or glycopeptide)
:::* (a). For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown : [[Meropenem]], 120 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) {{or}} [[Imipenem]]/[[Cilastatin]], 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) {{or}} [[Doripenem]], 120 mg/kg/day, IV, divided q8h (not to exceed 1 g/dose) {{or}} [[Vancomycin]], 60 mg/kg/day, IV, divided q8h
:::* (b). Alternatives for penicillin-susceptible strains: [[Penicillin G]], 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose) {{or}} [[Ampicillin]], 400 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) {{and}}
 
::* (C). A Protein Synthesis Inhibitor: [[Linezolid]] <12 y old: 30 mg/kg/day, IV, divided every 8 h≥12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) {{or}} [[Clindamycin]], 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose)  {{or}} [[Rifampin]], 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)  {{or}} [[Chloramphenicol]], 100 mg/kg/day, IV, divided q6h
::: Note (1): Duration of therapy for 2–3 wk or greater, until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
::: Note (2): Systemic anthrax includes anthrax meningitis; inhalation anthrax; or injection, gastrointestinal, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
::: Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. Normal CSF may not completely exclude deep brain hemorrhage/abscess.
::: Note (4): Bold font for preferred antimicrobial agent.
::: Note (5): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
::: Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
::: Note (7):  A 400-mg dose of [[Ciprofloxacin]], IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.
::: Note (8): Increased risk of seizures associated with [[Imipenem]]/[[Cilastatin]] therapy.
::: Note (9): [[Doripenem]] is approved in Japan at this dose for the treatment of community-acquired bacterial meningitis.
::: Note (10): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it. Linezolid use for >14 days carries additional hematopoietic toxicity.
::: Note (11): [[Rifampin]] is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy for some strains of staphylococci. Not evaluated for Bacillus anthracis.
::: Note (12) : [[Chloramphenicol]] Should be used only if other options are not available, because of toxicity concerns.
 
:* (4).'''Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)'''
::* (A). A bactericidal antimicrobial
::: (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: [[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) {{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) ≥50 kg: 500 mg, PO, given q24h {{or}}
::: (b). Alternatives for penicillin-susceptible strains: [[Amoxicillin]], 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose) {{or}} [[Penicillin VK]], 50–75 mg/kg/day, PO, divided q6h-q8h {{and}}
 
::* (B). A protein synthesis inhibitor: [[Clindamycin]] 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) {{or}} [[Doxycycline]] <45 kg: 4.4 mg/kg/day, PO, divided q12h (not exceed 100 mg/dose) ≥45 kg: 100 mg, PO, given q12h {{or}} [[Linezolid]] (non-CNS infection dose):
:::: <12 y old: 30 mg/kg/day, PO, divided q8h
:::: ≥12 years old: 30 mg/kg/day, PO, divided q12h (not to exceed 600 mg/dose)
::: Note (1): Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
::: Note (2): Severe anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
::: Note (3): Bold font for  preferred antimicrobial agent.
::: Note (4): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
::: Note (5): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
::: Note (6):  A single 14-day course of doxycycline is not routinely associated with tooth staining.
::: Note (7): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it. [[Linezolid]] use for >14 days carries additional hematopoietic toxicity.
 
:* (5).''' Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)'''
::* (A). Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)
:::* Antimicrobial therapy
::::* (1). '''Bactericidal antimicrobial (fluoroquinolone) therapy'''
:::::* (a) For 32–34 weeks gestational age 
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
:::::: For 1–4 weeks of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 wk of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
:::::: For 1–4 wk of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 10 mg/kg/day, q24h
:::::: For 1–4 weeks of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 10 mg/kg/day, q24h {{and}}
 
::::* (2). '''A bactericidal antimicrobial (β-lactam)'''
:::::a. For all strains, regardless of penicillin susceptibility or if susceptibility is unknown :
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
:::::: For 1–4 wk of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age: '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h {{or}}
:::::b. Alternatives for penicillin-susceptible strains
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Penicillin G]]''' 200000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 100 mg/kg/day divided q12h,
:::::: For 1–4 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
:::::: For 1–4 week of Age : '''[[Penicillin G]]''' 400000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 200 mg/kg/day divided q12h,
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
:::::: For 1–4 week of Age : '''[[Penicillin G]]''' 400000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 200 mg/kg/day divided q12h, {{and}}
 
::::* (3).'''A protein synthesis inhibitor'''
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Linezolid]]''' 20 mg/kg/day,divided q12h, {{or}} [[Clindamycin]] 10 mg/kg/day,divided q12h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h , {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
:::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
:::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 20 mg/kg/day,divided q6h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
:::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 20 mg/kg/day,divided q6h {{or}} {[Rifampin]] 20 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
:::::: Note :Duration of therapy For ≥2–3 week, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.
 
::* (B). Therapy for severe anthrax when meningitis can be ruled out
:::* (1).'''A bactericidal antimicrobial'''
:::: (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}} [[Meropenem]] IV 40 mg/kg/day,divided q8h {{or}} [[Imipenem]] IV 40 mg/kg/day,divided q12h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h'''  {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 50 mg/kg/day,divided q12h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 50 mg/kg/day,divided q12h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}}  [[Imipenem]] 75 mg/kg/day,divided q8h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}}  [[Imipenem]] 50 mg/kg/day,divided q12h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 75 mg/kg/day,divided q8h {{or}}
:::::: [[Vancomycin]] IV (dosing based on serum creatinine for infants ≥32 wk gestational age). Follow vancomycin serum concentrations to modify dose.
:::::: If  Serum creatinine <0.7 then [[Vancomycin]] IV 15 mg/kg/dose q12h
:::::: If Serum creatinine 0.7 -0.9 then  [[Vancomycin]] IV 20 mg/kg/dose q24h
:::::: If Serum creatinine 1–1.2 then [[Vancomycin]] IV 15 mg/kg/dose q24h
:::::: If Serum creatinine 1.3–1.6 then  [[Vancomycin]] IV 10 mg/kg/dose q24h
:::::: If Serum creatinine >1.6 15 then [[Vancomycin]] IV mg/kg/dose q48h
::::::: Note : Begin treatment with a 20-mg/kg loading dose {{or}}
:::: (b). Alternatives for penicillin-susceptible strains
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : [[Penicillin G]] IV 200000 U/kg/day,divided q12h, {{or}} [[Ampicillin]] IV 100 mg/kg/day,divided q12h
:::::: For 1–4 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}} [[Ampicillin]] IV 150 mg/kg/day,divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}}  [[Ampicillin]] IV 150 mg/kg/day,divided q8h
:::::: For 1–4 week of Age : [[Penicillin G]] IV 400000 U/kg/day,divided q6h, {{or}} [[Ampicillin]] IV 200 mg/kg/day,divided q6h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}} [[Ampicillin]] IV 150 mg/kg/day,divided q8h
:::::: For 1–4 week of Age : [[Penicillin G]] IV 400000 U/kg/day,divided q6h, {{or}} [[Ampicillin]] IV 200 mg/kg/day,divided q6h {{and}}
 
:::*(2).'''A protein synthesis inhibitor'''
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : [[Clindamycin]] IV 10 mg/kg/day, divided q12h, {{or}} [[Linezolid]] IV 20 mg/kg/day, divided q12h, {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
:::::: For 1–4 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}}  [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
:::::: For 1–4 week of Age : [[Clindamycin]] IV 20 mg/kg/day, divided q6h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}}  [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}} [[Doxycycline]] IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg)  {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
:::::: For 1–4 week of Age : [[Clindamycin]] IV 20 mg/kg/day, divided q6h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}} [[Doxycycline]] IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg)  {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
:::::: Note: Duration of therapy: For ≥2–3 wk, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness
 
::*(C). Oral follow-up combination therapy for severe anthrax
:::(1).'''A bactericidal antimicrobial'''
::::(a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 30 mg/kg/day, divided q12h'''
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 30 mg/kg/day, divided q12h''' {{or}}
::::(b). Alternatives for penicillin-susceptible strains
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h, {{or}} Penicillin VK PO 50 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} Penicillin VK PO  50 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q6–8h  {{and}}
:::(2).'''A protein synthesis inhibitor'''
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Clindamycin]] PO 10 mg/kg/day, divided q12h''' {{or}} [[Linezolid]] PO 20 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : '''[[Clindamycin]] PO 20 mg/kg/day, divided q6h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg)  {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
:::::: For 1–4 week of Age :'''[[Clindamycin]] PO 20 mg/kg/day, divided q6h''' {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg) {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h  {{or}}
::::: Note: Duration of therapy: to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.
 
::*(D).Treatment of cutaneous anthrax without systemic involvement
:::*(1).'''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 10 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
:::*(2).'''Alternatives for penicillin-susceptible strains'''
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} [[Penicillin Vk]] PO 50 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h  {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} [[Penicillin Vk]] PO 50 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q8h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q6–8h
::::: Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.
 
::*(E).Post exposure prophylaxis for Bacillus anthracis
::::(1). '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 10 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h  {{or}}
::::(2).'''Alternatives for penicillin-susceptible strains'''
:::::* (a) For 32–34 weeks gestational age
:::::: For 0–1 week of Age : [[Amoxicillin]] PO 50 mg/kg/day, divided q12h {{or}} [[Penicillin Vk]] PO 50 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q8h
:::::* (b) For 34–37 week gestational age
:::::: For 0–1 week of Age : [[Amoxicillin]] PO 50 mg/kg/day, divided q12h {{or}} [[Penicillin Vk]] PO 50 mg/kg/day, divided q12h
:::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q8h
:::::* (c) Term Newborn Infant
:::::: For 0–1 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q8h
:::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} [[Penicillin Vk]] PO 75 mg/kg/day, divided q6–8h
:::: Note: Duration of therapy is  60 days from exposure
 
:* '''Treatment of anthrax for pregnant Women''' 
::* (A) Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis <ref name="pmid24457117">{{cite journal| author=Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA et al.| title=Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24457117 | doi=10.3201/eid2002.130611 | pmc=PMC3901460 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24457117  }} </ref>
:::* (1)''' A Bactericidal Agent (Fluoroquinolone)''': '''[[Ciprofloxacin]]''' 400 mg IV q8h is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
:::* (2).''' A Bactericidal Agent (β-lactam)'''
::::* (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Meropenem]] 2 g q8h''',{{or}}
::::* (b). Alternatives for penicillin-susceptible strains: [[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
:::* (3).''' A Protein Synthesis Inhibitor''': '''[[Clindamycin]] 900 IV mg q8h''',{{or}}  [[Rifampin]] 600 IV mg q12h
:::: Note (1): At least one antibiotic with transplacental passage is recommended.
:::: Note (2): Duration of treatment is for ≥2–3 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
 
::* (B) Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded
:::* (1).''' A Bactericidal Antimicrobial''': '''[[Ciprofloxacin]] 400 mg IV q8h''' is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
:::* (2).''' A Bactericidal Agent (β-lactam)'''
::::* (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : '''[[Meropenem]] 2 g q8h''',{{or}}
::::* (b). Alternatives for penicillin-susceptible strains:[[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
:::* (3).''' A Protein Synthesis Inhibitor''':[[Clindamycin]] 900 IV mg q8h,{{or}}  [[Rifampin]] 600 IV mg q12h
::::Note (1): At least one antibiotic with transplacental passage is recommended.
::::Note (2):Duration of treatment: for ≥2 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness
 
::*(C) Oral antimicrobial treatment for cutaneous anthrax without systemic involvement
:::* (a).For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: '''[[Ciprofloxacin]] 400 mg IV q8h''' is preferred.
:::: Note (1): duration of treatment is 60 days
:::: Note (2): Recommendations are specific to cutaneous anthrax in the setting of bioterrorism.
 
===Pertussis===
:*'''Bordetella pertussis''' (whooping cough) <ref name="pmid16340941">{{cite journal| author=Tiwari T, Murphy TV, Moran J, National Immunization Program, CDC| title=Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. | journal=MMWR Recomm Rep | year= 2005 | volume= 54 | issue= RR-14 | pages= 1-16 | pmid=16340941 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16340941  }} </ref>
::* Preferred Regimen
:::* Infant (age < 1 month): [[Azithromycin]] 10 mg/kg/d for 5 days  {{or}} [[Trimethoprim-sulfamethoxazole]] (8/40 mg/kg/day) in two divided doses x 14 days
:::* Infant 1-5 months of age: [[Azithromycin]] 10 mg/kg/d for 5 days {{or}} [[Trimethoprim-sulfamethoxazole]] 40 mg/kg/d in 4 divided doses for 14 days
:::* Infant (age > 6 months): [[Azithromycin]] children: 10 mg/kg on day 1, then 5 mg/kg/d for days 2-5 (max dose 500 mg {{or}} [[Erythromycin]] children: 40 mg/kg/d in 4 divided doses for 14 days (max dose 2000 mg/day)
:::* Adult: [[Azithromycin]] 500 mg day 1, then 250 mg days 2-5 {{or}} [[Erythromycin]] 500 mg 4 times daily for 14 days
::* Alternate Regimen
:::* Infant 1-5 mo of age: [[Clarithromycin]] 15 mg/kg/d in two divided doses for 7 days {{or}} [[Trimethoprim-Sulfamethoxazole]] contraindicated for age < 2 months (8/40 mg/kg/day) in two divided doses for 14 days
:::* Infant (age > 6 months): [[Clarithromycin]] 15 mg/kg/d in two divided doses (maximum dose 1 gm/day) for 7 days {{or}} [[Trimethoprim-Sulfamethoxazole]] 8/40 mg/kg/day in two divided doses for 14 days)
:::* Adult: [[Clarithromycin]] 500 mg 2 times/day for 7 days {{or}} [[Trimethoprim-Sulfamethoxazole]] 320/1600 mg/day in two divided doses for 14 days
:::: Note: Clarithromycin and Trimethoprim-Sulfamethoxazole are contraindicated in children below 6 mths and 2 mths respectively
 
===Pneumonia, Acinetobacter===
:*''' Acinetobacter''' species (atypical bacterial pneumonia) <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::* Preferred Regimen : [[Carbapenem]] ([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]])
:::* Alternate Regimen: [[Cephalosporin]]-[[Aminoglycoside]]  {{or}} [[Ampicillin-sulbactam]] {{or}} [[Colistin]] 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day)
 
===Pneumonia, Actinomycosis===
:* Preferred regimen (1): [[Penicillin]] V 1 g po qid 2-6 wk.<ref name="pmid20582172">{{cite journal| author=Song JU, Park HY, Jeon K, Um SW, Kwon OJ, Koh WJ| title=Treatment of thoracic actinomycosis: A retrospective analysis of 40 patients. | journal=Ann Thorac Med | year= 2010 | volume= 5 | issue= 2 | pages= 80-5 | pmid=20582172 | doi=10.4103/1817-1737.62470 | pmc=PMC2883202 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20582172  }} </ref><ref name="pmidPMID: 14727221">{{cite journal| author=Sudhakar SS, Ross JJ| title=Short-term treatment of actinomycosis: two cases and a review. | journal=Clin Infect Dis | year= 2004 | volume= 38 | issue= 3 | pages= 444-7 | pmid=PMID: 14727221 | doi=10.1086/381099 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727221  }} </ref>
 
:* Alternative regimen: [[Tetracycline]] 500 mg po q 6 h {{or}} [[Doxycycline]] 100 mg q 12 h may be given instead of [[Penicillin]].
 
:: Note: [[Minocycline]], [[Clindamycin]], and [[Erythromycin]] have also been successful.
 
===Pneumonia, Anaerobes===
: Anaerobe (aspiration) pneumonia <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
::* Preferred Regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) {{or}} [[Ticarcillin-Clavulanate]] 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) {{or}} [[Ampicillin-Sulbactam]] 1500-3000 mg IV q6h {{or}} [[Amoxicillin-clavulanate]] 250-500 mg PO q8h or 875 mg q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (max: 1800 mg/day)
::* Alternate Regimen: [[Carbapenem]]-([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]])
 
===Pneumonia, Aspiration pneumonia===
:* Aspiration (anaerobe) pneumonia <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
::* Preferred Regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) {{or}} [[Ticarcillin -Clavulanate]] 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) {{or}} [[Ampicillin-Sulbactam]] 1500-3000 mg IV q6h {{or}} [[Amoxicillin-Clavulanate]] 250-500 mg PO q8h or 875 mg q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (max: 1800 mg/day)
::* Alternate Regimen: [[Carbapenem]]-([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]])
 
===Pneumonia, Chlamydophila===
:* '''Chlamydophila pneumoniae''' (atypical bacterial pneumonia) <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
::* Preferred Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] 250-500 mg PO q6h
::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
 
===Pneumonia, community-acquired===
* '''Community acquired pneumonia'''
:*''' Empiric therapy in adults''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
::* (A) Outpatient treatment
:::*(1) Previously healthy and no use of antimicrobials within the previous 3 months.
::::* Preferred regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Azithromycin]] 500 mg IV as a single dose {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days {{or}} 1000 mg q24h for 7 days {{or}} [[Erythromycin]] 250-500 mg q6-12h (max: 4 g/day)
::::* Alternative regimen : [[Doxycycline]] 100 mg PO/IV q12h (Weak recommendation).
:::*(2) Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; or use of antimicrobials within the previous 3 months (in this case an alternative from a different class should be selected)
::::* Preferred regimen (1) :  [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}}  [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days
::::* Preferred Regimen (2) : ([[Amoxicillin]] 875 mg PO q12h or 500 mg q8h {{or}} [[Amoxicillin-clavulanate]] 2 g q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, (2 g q24h for patients at risk) {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h) {{and}} ( Macrolide [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Doxycycline]] 100 mg PO/IV q12h)
 
::* (B) Inpatient Therapy (in regions with a high rate (125%) of infection with high-level (minimum inhibitory concentration 16 mg/mL) macrolide-resistant Streptococcus pneumoniae)
:::* (1) Non-ICU treatment
::::* Preferred Regimen : [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days {{or}} [[Amoxicillin ]]1 g q8h {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
::::* Alternative Regimen : [[Ceftriaxone]] 1 g IV q24h, (2 g q24h for patients at risk) {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h
:::* (2) ICU treatment
::::* Preferred Regimen : ([[Cefotaxime]] I.M., I.V.: 1 g q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g/day for patients at risk {{or}} [[Ampicillin-sulbactam]] 1.5-3 g IV q6h) {{and}} ([[Azithromycin]] 500 mg/day PO once, followed by 250 mg q24h for 4 days {{or}} [[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}}  [[Levofloxacin ]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] Oral: 320 mg q24h for 5 or 7 days)
::::* Alternative Regimen (For penicillin allergy): ([[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 day {{or}} [[Moxifloxacin]] 400 mg q24h PO/IV for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days) {{and}} [[Aztreonam]] I.V.: 2 g q6-8h (max: 8 g/day)
 
::* (C) Special Concerns
:::* (1) '''Pseudomonas'''
::::* Preferred Regimen (1): ([[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h) {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 day)
::::* Preferred Regimen (2): ([[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h) {{and}} Aminoglycoside {{and}} ([[Azithromycin]] Oral: 500 mg on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5 or 7 days)
:::: Note : For penicillin-allergic patients, substitute the B-lactam for Aztreonam 2 g IV q6-8h (maximum 8 g/day)
:::* (2) Methicillin resistant staphylococcus aureus ,Add the following to the selected regimen
::::* Preferred regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days.
 
:*''' Empiric therapy in neonates''' ( Age < 1 month)
::* Preferred regimen: [[Ampicillin]] 500 mg/day for 7-14 days or 750 mg/day for 5 days {{or}} [[Gentamicin]] 400 mg/day PO/IV for 7-14 days With or without [[Cefotaxime]] 320 mg PO q24h for 5 or 7 days
::: Note (1) : If methicillin resistant staphylococcus aureus  is suspected, add the following [[Vancomycin]] 10 mg/kg q8h
::: Note (2) : If Chlamydia trachomatis is suspected, add the following [[Erythromycin]] 12.5 mg/kg PO or IV qid for 14 days {{or}} [[Azithromycin]] 10 mg/kg PO/IV on day one then 5 mg/kg PO/IV q24h for 4 days.
::* Alternate Regimen (If methicillin resistant staphylococcus aureus  is suspected): [[Vancomycin]] 10 mg/kg q8h {{or}} [[Linezolid]] 10 mg/kg q8h
 
:*'''Empiric therapy,Children (> 3 months) Outpatient Therapy'''
::* Preferred Regimen: [[Amoxicillin]] 90 mg/kg/day q12h for 5 days {{or}} [[Azithromycin]] 10 mg/kg PO 1 dose (max 500 mg), then 5 mg/kg (max 250 mg) PO for 4 days
::* Alternate Regimen: [[Amoxicillin-Clavulanate]] 90 mg/kg/day {{or}} [[Clarithromycin]] 15 mg/kg/day q12h for 7-14 days
 
:* '''pathogen directed antimicrobial therapy'''
:* Bacterial
::* (A) '''Streptococcus pneumoniae'''
:::* (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
::::* Preferred Regimen : [[Penicillin G]] 2-3 million units IV q4h {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::* Alternative Regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefprozil]] 500 mg PO q12h for 10 days {{or}} [[Cefuroxime]] 750 mg PO/IV q8h {{or}} [[Cefdinir]] 300 mg PO q12h for 10 days {{or}} [[Cefditoren]] 400 mg PO q12h for 14 day {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (maximum: 1800 mg/day) {{or}} [[Clindamycin]] 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) {{or}} [[Doxycycline]] 100 mg PI/IV q12h {{or}}[[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h.
:::* (2) Penicillin resistant;  minimum inhibitory concentration > 2 mg / mL
::::* Preferred Regimen (Agents chosen on the basis of susceptibililty) : [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
::::* Alternative Regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)
 
::* (B)'''Haemophilus influenzae'''
:::* (1) Non-beta lactamase producing
::::* Preferred Regimen: [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::* Alternative Regimen : [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
:::* (2) Beta lactamase producing
::::* Preferred Regimen: 2nd or 3rd Generation [[Cephalosporin]] {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
::::* Alternative Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
 
::* (C) '''Bacillus anthracis''' (inhalation)
:::* Preferred Regimen  :[[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Doxycycline]] 100 mg PO/IV q12h
:::* Alternate Regimen : Other [[Fluoroquinolones]] {{or}} B-lactam (if susceptible) {{or}} [[Rifampin]] 600 mg PO/IV q24h for 4 days {{or}} [[Clindamycin]] 150-450 mg PO q6-8h {{or}} [[Chloramphenicol]] 50-100 mg/kg/day IV in divided q6h
 
::* (D) '''Enterobacteriaceae'''
:::* Preferred Regimen: 3rd generation cephalosporin {{or}} Carbapenem- ([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]]) (drug of choice if extended-spectrum b-lactamase producer)
:::* Alternate Regimen : b-Lactam / b-lactamase inhibitor- ([[Piperacillin-Tazobactam]] for gram-negative bacilli, {{or}} [[Ticarcillin-Clavulanate]] {{or}} [[Ampicillin-Sulbactam]] {{or}} [[Amoxicillin-Clavulanate]]) {{or}} ([[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h) 
 
::* (E)'''Pseudomonas aeruginosa'''
:::* Preferred Regimen: ([[Ticarcillin]] 200-300 mg/kg/day in divided doses q4-6h (maximum: 18 g/day) {{or}} [[Piperacillin]] 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h {{or}} [[Ceftazidime]] 500 mg to 1 g q8h {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Aztreonam]] 2 g IV q6-8h (maximum: 8 g/day) {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h) {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily {{or}} [[Aminoglycoside]])
:::* Alternate Regimen: [[Aminoglycoside]] {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily)
 
::* (F)'''Staphylococcus aureus'''
:::* (1) Methicillin susceptible
::::* Preferred Regimen : [[Nafcillin]] 1000-2000 mg q4h {{or}} [[Oxacillin]] 2 g IV q4h {{or}} [[Flucloxacillin]] 250 mg IM/IV q6h
::::* Alternative Regimen : [[Cefazolin]] 500 mg IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h
:::* (2) Methicillin resistant
::::* Preferred Regimen : [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
::::* Alternative Regimen: [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
 
::* (G)'''Bordetella pertussis'''
:::* Preferred Regimen:[[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:::* Alternate Regimen: [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
 
::* (H) Anaerobe (aspiration)
:::* Preferred Regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) {{or}} [[Ticarcillin Clavulanate]] 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) {{or}} [[Ampicillin-Sulbactam]] 1500-3000 mg IV q6h {{or}} [[Amoxicillin-Clavulanate]] 250-500 mg PO q8h or 875 mg q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (max: 1800 mg/day)
:::* Alternate Regimen: [[Carbapenem]] -([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]])
 
::* (I) '''Mycobacterium tuberculosis'''
:::* Preferred Regimen:
::::* Intensive phase: [[Isoniazid]] 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) {{and}} [[Rifampin]] 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) {{and}} [[Ethambutol]] 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) {{and}} [[Pyrazinamide]] 1000 - 2000 mg / day daily for 2 months.
::::* Continuation phase: [[Isoniazid]] 300 mg/day PO daily for 4 months (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO daily for 4 months (10 mg/kg/day).
 
:::* Alternate regimen (1):
::::* Intensive phase: [[Isoniazid]] 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day)  {{and}} [[Rifampin]] 10 mg/kg/day daily for 2 months (maximum: 600 mg / day)  {{and}} [[Ethambutol]] 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g)  {{and}} [[Pyrazinamide]] 1000 - 2000 mg / day daily for 2 months.
::::* Continuation phase: [[Isoniazid]] 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day).
:::: Note : Acceptable alternative for any new TB patient receiving directly observed therapy
 
:::* Alternate regimen (2)
::::* Intensive phase:[[Isoniazid]] 5 mg/kg/day q24h 3 times per week for 2 months (usual dose: 300 mg/day)  {{and}} [[Rifampin]] 10 mg/kg/day 3 times per week for 2 months (maximum: 600 mg / day) s {{and}} [[Ethambutol]] 5-25 mg/kg (maximum dose: 1.6 g) 3 times per week for 2 months  {{and}} [[Pyrazinamide]] 1000 - 2000 mg / day 3 times per week for 2 months.
::::*Continuation phase: [[Isoniazid]] 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day).
:::: Note : Acceptable alternative provided that the patient is receiving directly observed therapy and is not living with HIV or living in an HIV prevalent setting.
 
::* (J) '''Yersinisa pestis'''
:::* Preferred Regimen: [[Streptomycin]] 15 mg/kg/day (max 1 g/day) {{or}} [[Gentamicin]] 7 mg/kg/day
:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
 
:* Atypical bacteria
::* (A) '''Mycoplasma pneumoniae'''
:::* Preferred Regimen:[[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] Oral: 250-500 mg q6h
:::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
 
::* (B) '''Chlamydophila pneumoniae'''
:::* Preferred Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
 
::* (C) '''Legionella species'''
:::* Preferred Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h
 
::* (D)'''Chlamydophila psittaci'''
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:::* Alternate Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h


::* (E)''' Coxiella burnetii'''
===Pneumonia===
:::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
*'''Pneumonia'''
:::* Alternate Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:* 1. '''Community-acquired pneumonia'''
::* 1.1 '''Empiric therapy in adults''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::* 1.1.1 '''Outpatient treatment'''
::::* 1.1.1.1 '''Previously healthy and no use of antimicrobials within the previous 3 months'''
:::::* Preferred regimen (1): ([[Azithromycin]] 500 mg PO single dose for 1 day {{then}} 250 mg PO qd for 4 days) {{or}} [[Azithromycin]] 500 mg IV single dose
:::::* Preferred regimen (2): [[Clarithromycin]] 250 mg PO bid for 7-14 days {{or}} [[Clarithromycin]] 1000 mg PO qd for 7 days
:::::* Preferred regimen (3): [[Erythromycin]] 250-500 mg PO bid or tid (maximum daily dose 4 g)
:::::* Alternative regimen: [[Doxycycline]] 100 mg PO/IV q12h
::::* 1.1.1.2 '''Presence of comorbidities, use of immunosuppressing drugs, or use of antimicrobials within the previous 3 months'''
:::::* Preferred regimen (1): [[Levofloxacin]] 500 mg PO qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg PO qd for 5 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}}  [[Gemifloxacin]] 320 mg PO qd for 5 or 7 days
:::::* Preferred regimen (2): ([[Amoxicillin]] 1 g PO q8h {{or}} [[Amoxicillin-clavulanate]] 1-2 g PO bid {{or}} [[Ceftriaxone]] 1-2 g IV q24h {{or}} [[Cefpodoxime]] 200 mg PO bid for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h) {{and}} either ([[Azithromycin]] 500 mg PO single dose for 1 day {{then}} 250 mg PO qd for 4 days) {{or}} ([[Clarithromycin]] 250 mg PO bid for 7-14 days {{or}} [[Clarithromycin]] 1000 mg PO qd for 7 days) {{or}} [[Erythromycin]] 250-500 mg PO bid or tid (maximum daily dose 4 g)
:::::*Note: In the case of recent (past 3 months) antimicrobial therapy, an alternative from a different class should be selected.
:::* 1.1.2 '''Inpatient treatment'''
::::* 1.1.2.1 '''Non-ICU treatment'''
:::::* Preferred regimen (1): [[Levofloxacin]] 500 mg IV qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV qd for 5 days {{or}} [[Moxifloxacin]] 400 mg IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO qd for 5-7 days
:::::* Preferred regimen (2): ([[Amoxicillin]] 1 g PO q8h {{or}} [[Amoxicillin-clavulanate]] 1-2 g PO bid {{or}} [[Ceftriaxone]] 1-2 g IV q24h {{or}} [[Cefpodoxime]] 200 mg PO bid for 14 days {{or}} [[Cefuroxime]] 750 mg IM/IV q8h) {{and}} either ([[Azithromycin]] 500 mg PO single dose for 1 day {{then}} 250 mg PO qd for 4 days) {{or}} ([[Clarithromycin]] 250 mg PO bid for 7-14 days {{or}} [[Clarithromycin]] 1000 mg PO qd for 7 days) {{or}} [[Erythromycin]] 250-500 mg PO bid or tid (maximum daily dose 4 g)
::::* 1.1.2.2 '''ICU treatment'''
:::::* Preferred regimen (1): ([[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Ceftriaxone]] 1-2 g IV q24h {{or}} [[Ampicillin-sulbactam]] 1.5-3 g IV q6h) {{and}} ([[Levofloxacin ]] 500 mg IV q24h for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5-7 days)
:::::* Alternative regimen (1): ([[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Ceftriaxone]] 1-2 g IV q24h {{or}} [[Ampicillin-sulbactam]] 1.5-3 g IV q6h) {{and}} ([[Azithromycin]] 500 mg IV qd for 2 days (PO for a total of 7-10 days)
:::::* Alternative regimen (2): [[Aztreonam]] 2 g IV q6-8h (maximum daily dose 8 g) {{and}} ([[Levofloxacin ]] 500 mg IV q24h for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg IV q24h for 7-14 days {{or}} [[Gemifloxacin]] 320 mg PO q24h for 5-7 days)
:::* 1.1.3 '''Special considerations'''
::::* 1.1.3.1 '''Suspected Pseudomonas'''
:::::* Preferred regimen (1): [[Piperacillin-Tazobactam]] 3.375-4.5 g IV q6h for 7-14 days {{and}} ([[Ciprofloxacin]] 400 mg IV q8h for 7-14 days {{or}} [[Levofloxacin]] 500 mg IV qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV qd for 5 days)
:::::* Preferred regimen (2): [[Cefepime]] 1-2 g IV q8-12h for 7-10 days {{and}} ([[Ciprofloxacin]] 400 mg IV q8h for 7-14 days {{or}} [[Levofloxacin]] 500 mg IV qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV qd for 5 days)
:::::* Preferred regimen (3): ([[Imipenem]] 500 mg IV q6h for ≤5 days {{or}} [[Meropenem]] 500 mg IV q8hr for ≤5 days) {{and}} ([[Ciprofloxacin]] 400 mg IV q8h for 7-14 days {{or}} [[Levofloxacin]] 500 mg IV qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV qd for 5 days)
:::::* Preferred regimen (4): [[Piperacillin-Tazobactam]] 3.375-4.5 g IV q6h for 7-14 days {{and}} ([[Amikacin]] 20 mg/kg/day IV q8-12h {{or}} [[Gentamicin]] 3-5 mg/kg/day IV/IM q8h {{or}} [[Tobramycin]] 3-6 mg/kg/day IV/IM q8h) {{and}} ([[Azithromycin]] 500 mg PO single dose for 1 day {{then}} 250 mg PO qd for 4 days)
:::::* Preferred regimen (5): [[Cefepime]] {{and}} ([[Amikacin]] 20 mg/kg/day IV q8-12h {{or}} [[Gentamicin]] 3-5 mg/kg/day IV/IM q8h {{or}} [[Tobramycin]] 3-6 mg/kg/day IV/IM q8h) {{and}} ([[Azithromycin]] 500 mg PO single dose for 1 day {{then}} 250 mg PO qd for 4 days)
:::::* Preferred regimen (6): ([[Imipenem]] 500 mg IV q6h for ≤5 days {{or}} [[Meropenem]] 500 mg IV q8hr for ≤5 days) {{and}} ([[Amikacin]] 20 mg/kg/day IV q8-12h {{or}} [[Gentamicin]] 3-5 mg/kg/day IV/IM q8h {{or}} [[Tobramycin]] 3-6 mg/kg/day IV/IM q8h) {{and}} ([[Azithromycin]] 500 mg PO single dose for 1 day {{then}} 250 mg PO qd for 4 days)
:::::* Preferred regimen (7): ([[Imipenem]] 500 mg IV q6h for ≤5 days {{or}} [[Meropenem]] 500 mg IV q8hr for ≤5 days) {{and}} ([[Amikacin]] 20 mg/kg/day IV q8-12h {{or}} [[Gentamicin]] 3-5 mg/kg/day IV/IM q8h {{or}} [[Tobramycin]] 3-6 mg/kg/day IV/IM q8h) {{and}} ([[Ciprofloxacin]] 400 mg IV q8h for 7-14 days {{or}} [[Levofloxacin]] 500 mg PO qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg PO qd for 5 days)
:::::* Preferred regimen (8): [[Piperacillin-Tazobactam]] 3.375-4.5 g IV q6h for 7-14 days {{and}} ([[Ciprofloxacin]] 400 mg IV q8h for 7-14 days {{or}} [[Levofloxacin]] 500 mg IV qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV qd for 5 days)
:::::* Preferred regimen (9): [[Cefepime]] 1-2 g IV q8-12h for 7-10 days {{and}} ([[Amikacin]] 20 mg/kg/day IV q8-12h {{or}} [[Gentamicin]] 3-5 mg/kg/day IV/IM q8h {{or}} [[Tobramycin]] 3-6 mg/kg/day IV/IM q8h) {{and}} ([[Ciprofloxacin]] 400 mg IV q8h for 7-14 days {{or}} [[Levofloxacin]] 500 mg IV qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg IV qd for 5 days)
:::::* Preferred regimen (10): ([[Imipenem]] 500 mg IV q6h for ≤5 days {{or}} [[Meropenem]] 500 mg IV q8hr for ≤5 days) {{and}} ([[Ciprofloxacin]] 400 mg IV q8h for 7-14 days {{or}} [[Levofloxacin]] 500 mg PO qd for 7-14 days {{or}} [[Levofloxacin]] 750 mg PO qd for 5 days)
:::::* Note: For penicillin-allergic patients, substitute the beta-lactam for [[Aztreonam]] 1-2 g IV q6-8h.
::::* 1.1.3.2 '''Suspected methicillin resistant Staphylococcus aureus (add the following)'''
:::::* Preferred regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
::::* 1.1.3.3 '''Neutropenic patient''' <ref name="pmid15699079">{{cite journal| author=American Thoracic Society. Infectious Diseases Society of America| title=Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. | journal=Am J Respir Crit Care Med | year= 2005 | volume= 171 | issue= 4 | pages= 388-416 | pmid=15699079 | doi=10.1164/rccm.200405-644ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15699079  }} </ref>
:::::* 1.1.3.3.1 '''No risk for multi-drug resistance'''
::::::* Preferred regimen: [[Ceftriaxone]] 1-2 g q24h IV or IM (max: 4 g/day) {{or}} [[Levofloxacin]] 750 mg q24h for 7-14 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Ciprofloxacin]] 400 mg PO q8h for 10-14 days {{or}} [[Ampicillin sulbactam]] 1-2 g q6-8h IV/IM (maximum: 8 g/day) {{or}} [[Ertapenem]] 1 g IM/IV q24h for 10-14 days.
:::::* 1.1.3.3.2 '''Risk for multi drug resistance'''
::::::* Preferred Regimen: ([[Cefepime]] 1-2 g q8-12h {{or}} [[Ceftazidime]] 2 g q8h {{or}} [[Imipenem]] 500 mg q6h or 1g q8h {{or}} [[Meropenem]] 1 g q8h {{or}} [[Piperacillin-tazobactam]] 4.5 g q6h) {{and}} ([[Ciprofloxacin]] 400 mg q8h {{or}} [[Levofloxacin]] 750 mg q24h {{or}} [[Amikacin]] 20 mg/kg per day {{or}} [[Gentamycin]] 7 mg/kg per day {{or}} [[Tobramycin]] 7 mg/kg per day) {{and}} ([[Linezolid]] 600 mg q12h {{or}} [[Vancomycin]] 15 mg/kg q12h).
::::::* Note (1) : Trough levels for [[Gentamycin]] and [[Tobramycin]] should be less than 1 g/ml, and for [[Amikacin]] they should be less than 4-5 g/ml.
::::::* Note (2) : Trough levels for [[Vancomycin]] should be 15-20 g/ml
::::::* Note (3) : Hospital or community acquired, neutropenic patient (<500 neutrophils per mm3) [[Vancomycin]] not included in initial therapy unless high suspicion of infected intravenous access or drug-resistant Streptococcus pneumonia. Amphotericin not used unless still febrile after 3 days or high clinical likelihood.


::* (F) '''Francisella tularensis'''
::* 1.2 '''Pathogen-directed antimicrobial therapy'''
:::* Preferred Regimen: [[Doxycycline]] 100 mg PO/IV q12h
:::* 1.2.1 '''Bacterial pathogens'''
:::* Alternate Regimen: [[Gentamicin]] 7 mg/kg/day {{or}} [[Streptomycin]] 15 mg/kg/day (maximum: 1 g)
::::* 1.2.1.1 '''Streptococcus pneumoniae'''
:::::* 1.2.1.1.1 '''Penicillin sensitive (minimum inhibitory concentration < 2 mg/mL)'''
::::::* Preferred regimen : [[Penicillin G]] 2-3 million units IV q4h {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::::* Alternative regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefprozil]] 500 mg PO q12h for 10 days {{or}} [[Cefuroxime]] 750 mg PO/IV q8h {{or}} [[Cefdinir]] 300 mg PO q12h for 10 days {{or}} [[Cefditoren]] 400 mg PO q12h for 14 day {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (maximum: 1800 mg/day) {{or}} [[Clindamycin]] 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) {{or}} [[Doxycycline]] 100 mg PI/IV q12h {{or}}[[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
:::::* 1.2.1.1.2 '''Penicillin resistant (minimum inhibitory concentration > 2 mg/mL)'''
::::::* Preferred regimen (Agents chosen on the basis of susceptibililty) : [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
::::::* Alternative regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)


::* (G) '''Burkholderia pseudomallei'''
::::* 1.2.1.2 '''Haemophilus influenzae'''
:::* Preferred Regimen : [[Carbapenem]] -([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]]) {{or}} [[Ceftazidime]] 0.5-1 g q8h
:::::* 1.2.1.2.1 '''Non-beta lactamase producing'''
:::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
::::::* Preferred regimen: [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
::::::* Alternative regimen : [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
:::::* 1.2.1.2.2 '''Beta lactamase producing'''
::::::* Preferred regimen: 2nd or 3rd Generation [[Cephalosporin]] {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
::::::* Alternative regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days


::* (H) '''Acinetobacter species'''
::::* 1.2.1.2 '''Bacillus anthracis (inhalational)'''
:::* Preferred Regimen : [[Carbapenem]]-([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]])
:::::* Preferred Regimen :[[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 500 mg q24h for 7-14 days or 750 mg q24h for 5 days {{or}} [[Doxycycline]] 100 mg PO/IV q12h
:::* Alternate Regimen: [[Cephalosporin]]-[[Aminoglycoside]] {{or}} [[Ampicillin-Sulbactam]] {{or}} [[Colistin]] 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day)
:::::* Alternate Regimen : Other [[Fluoroquinolones]] {{or}} B-lactam (if susceptible) {{or}} [[Rifampin]] 600 mg PO/IV q24h for 4 days {{or}} [[Clindamycin]] 150-450 mg PO q6-8h {{or}} [[Chloramphenicol]] 50-100 mg/kg/day IV in divided q6h


:* Viral
::::* 1.2.1.3 '''Enterobacteriaceae'''
::* '''Influenza virus'''
:::::* Preferred Regimen: 3rd generation cephalosporin {{or}} Carbapenem- ([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]]) (drug of choice if extended-spectrum b-lactamase producer)
:::* Preferred Regimen: [[Oseltamivir]] 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) {{or}} [[Zanamivir]] Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)
:::::* Alternate Regimen : b-Lactam / b-lactamase inhibitor- ([[Piperacillin-Tazobactam]] for gram-negative bacilli, {{or}} [[Ticarcillin-Clavulanate]] {{or}} [[Ampicillin-Sulbactam]] {{or}} [[Amoxicillin-Clavulanate]]) {{or}} ([[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h)


:* Fungal
::::* 1.2.1.4 '''Pseudomonas aeruginosa'''
::* (A) '''Coccidioides species'''
:::::* Preferred Regimen: ([[Ticarcillin]] 200-300 mg/kg/day in divided doses q4-6h (maximum: 18 g/day) {{or}} [[Piperacillin]] 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h {{or}} [[Ceftazidime]] 500 mg to 1 g q8h {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Aztreonam]] 2 g IV q6-8h (maximum: 8 g/day) {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h) {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily {{or}} [[Aminoglycoside]])
:::* Preferred Regimen: [[Itraconazole]] 200 mg q12h {{or}} [[Fluconazole]] 200-400 mg daily for 3-6 month
:::::* Alternative Regimen: [[Aminoglycoside]] {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily)
:::* Alternate Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day
::::Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection


::* (B) '''Histoplasmosis'''
::::* 1.2.1.5 '''Staphylococcus aureus'''
:::* Preferred Regimen: [[Itraconazole]] 200 mg q12h
:::::* 1.2.1.5.1 '''Methicillin sensitive'''
:::* Alternate Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day
::::::* Preferred Regimen : [[Nafcillin]] 1000-2000 mg q4h {{or}} [[Oxacillin]] 2 g IV q4h {{or}} [[Flucloxacillin]] 250 mg IM/IV q6h
::::::* Alternative Regimen : [[Cefazolin]] 500 mg IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h
:::::* 1.2.1.5.2 '''Methicillin resistant'''
::::::* Preferred Regimen : [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
::::::* Alternative Regimen: [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h


::* (C) '''Blastomycosis'''
:::* Preferred Regimen: [[Itraconazole]] 200 mg q12h
:::* Alternate Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day


===Pneumonia, concomitant influenza===
::::* 1.2.1.6 '''Klebsiella pneumonia'''<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:* '''Influenza virus pneumonia''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue= | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::::* 1.2.1.6.1 '''Resistant to third generation cephalosporins and aztreonam'''
::* Preferred Regimen: [[Oseltamivir]] 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) {{or}} [[Zanamivir]] Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)
::::::* Preferred regimen (1): [[Imipenem]] 0.5 g IV q6h {{or}} [[Meropenem]]  0.5–1 g IV q8h
:::::* 1.2.1.6.2 '''Klebsiella pneumoniae Carbapenemase producers'''
::::::* Preferred regimen (1): [[Colistin]] (='''Polymyxin E''').In USA : '''Colymycin-M '''2.5-5 mg/kg per day of base divided into 2-4 doses 6.7-13.3 mg/kg per day of [[colistimethate sodium]] (max 800 mg/day). Elsewhere: '''Colomycin''' and '''Promixin''' ≤60 kg, 50,000-75,000 IU/kg per day IV in 3 divided doses (=4-6 mg/kg per day of [[colistimethate sodium]]). >60 kg, 1-2 mill IU IV tid (= 80-160 mg IV tid) {{or}} [[Polymyxin B]] (Poly-Rx) 15,000–25,000 units/kg/day divided q12h
::::::* Note (1): some strains which hyperproduce extended spectrum beta-lactamase are primarily resistant to [[Ticarcillin-Clavulanate]], [[Piperacillin]]-[[Tazobactam]]
::::::* Note (2): Extended spectrum beta-lactamases inactivates all [[Cephalosporins]], beta-lactam/beta-lactamase inhibitor drug activation not predictable; co-resistance to all [[Fluoroquinolones]] & often [[Aminoglycosides]].
::::::* Note (3): Can give IM, but need to combine with “caine” anesthetic due to pain.


===Pneumonia, Cytomegalovirus===
::::* 1.2.1.7 '''Moraxella catarrhalis'''
* '''Cytomegalovirus pneumonia''' <ref name="pmid18652557">{{cite journal| author=Torres-Madriz G, Boucher HW| title=Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients. | journal=Clin Infect Dis | year= 2008 | volume= 47 | issue= 5 | pages= 702-11 | pmid=18652557 | doi=10.1086/590934 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18652557  }} </ref>
:::::* Preferred regimen: [[Amoxicillin-Clavulanate]] (Augmentin) 2 tablets po bid ( (or)500/125 mg 1 tablet po tid (or) 875/125 mg 1 tablet po bid) {{or}} [[Cephalosporins]]- [[Cefdinir]] 300 mg po q12h (or) 600 mg q24h, {{or}} ([[Cefditoren pivoxil]] 200–400 mg, 2 tabs po bid,{{or}} [[Cefpodoxime proxetil]] 0.1–0.2 g po q12h, {{or}} [[Cefprozil]] 500 mg po q12h), {{or}} [[Cefoxitin]] 1 g q8h–2 g IV/IM q4h, {{or}} ([[Cefuroxime]] 0.75–1.5 g IV/IM q8h,{{or}}[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h, {{or}} [[Ceftazidime]] 1–2 g IV/IM q8–12h) {{or}} [[Trimethoprim-Sulfamethoxazole]] Single-strength (SS) is [[Trimethoprim]] 80 mg / [[Sulfamethoxazole]] 400 mg ,{{or}} (double-strength (DS) [[Trimethoprim]] 160 mg /[[Sulfamethoxazole]] 800 mg)
:* Preferred regimen (1): [[Ganciclovir]] Induction therapy 5 mg/ kg IV every 12 h for normal GFR; maintenance therapy 5 mg/kg IV daily; 1 g orally every 8 h with food.
:::::*Alternative regimen: [[Azithromycin]] 500 mg IV q24h ,{{or}} [[Clarithromycin]] 0.5 g po q12h, {{or}} [[Telithromycin]] 800 mg po q24h (two 400 mg tabs po q24h).
:* Preferred regimen (2): [[Valganciclovir]] Induction therapy 900 mg orally every 12 h; maintenance therapy 900 mg daily.
:* Alternate regimen (1): [[Foscarnet]] Induction therapy 60 mg/ kg every 8 h for 14–21 days or 90 mg/kg every 12 h for 14–21 days; maintenance therapy 90–120 mg/kg per day as a single infusion.
:* Alternate regimen (2): [[Cidofovir]] Induction therapy 5 mg/ kg per week for 2 weeks, followed by maintenance therapy every 2 weeks.


* Prophylaxis
:* Preferred regimen (1): [[Cytomegalovirus]] [[immunoglobulin]] 150 mg/kg within 72 h; then at 2, 4, 6, and 8 weeks; 100 mg/kg at 12 and 16 weeks after [[transplantation]].


===Pneumonia, Haemophilus Influenza===
::::* 1.2.1.8 '''Stenotrophomonas maltophilia'''
:* '''Haemophilus influenzae pneumonia''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::::* Preferred regimen: [[Trimethoprim-Sulfamethoxazole]] Single-strength (SS) tablet is [[Trimethoprim]] 80 mg / [[Sulfamethoxazole]] 400 mg, double-strength (DS) tablet is [[Trimethoprim]] 160 mg / [[Sulfamethoxazole]] 800 mg {{or}} IV treatment (base on TMP component): standard 8–10 mg per kg per day divided q6h, q8h, or q12h.
::* (1) Non-beta lactamase producing
:::::* Alternative regimen: [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h ([[Ticarcillin]] 3 g, [[Clavulanate]] 0.1 g per vial) {{and}} [[Aztreonam]] 1 g IV q6h (or) 2 g IV q8h
:::* Preferred Regimen: [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
:::::* Note (1): Potential synergy with [[Trimethoprim-Sulfamethoxazole]] {{and}} [[Ticarcillin-Clavulanate]].
:::* Alternative Regimen : [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h  {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days
:::::* Note (2): Stenotrophomonas is one of the microorganisms causing hospital-acquired pneumonia usually with mechanical ventilation.
::* (2) Beta lactamase producing
:::* Preferred Regimen: 2nd or 3rd Generation [[Cephalosporin]] {{or}} [[Amoxicillin-clavulanate]] 2 g q12h
:::* Alternative Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h  {{or}} [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h on days 2-5 {{or}} [[Clarithromycin]] 250 mg q12h for 7-14 days or 1000 mg q24h for 7 days


===Pneumonia, health care-associated===
::::* 1.2.1.9 '''Bordetella pertussis'''
* Health care-associated pneumonia <ref name="pmid15699079">{{cite journal| author=American Thoracic Society. Infectious Diseases Society of America| title=Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. | journal=Am J Respir Crit Care Med | year= 2005 | volume= 171 | issue= 4 | pages= 388-416 | pmid=15699079 | doi=10.1164/rccm.200405-644ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15699079  }} </ref>
:::::* Preferred Regimen:[[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:* Empiric therapy
:::::* Alternative Regimen: [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
::* No Risk Factors for multi drug resistance
:::* Preferred Regimen : [[Ceftriaxone]] 1-2 g q24h IV or IM (max: 4 g/day) {{or}} [[Levofloxacin]] 750 mg q24h for 7-14 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Ciprofloxacin]] 400 mg PO q8h for 10-14 days {{or}} [[Ampicillin sulbactam]] 1-2 g q6-8h IV/IM (maximum: 8 g/day) {{or}} [[Ertapenem]] 1 g IM/IV q24h for 10-14 days.
::*Presence of Risk Factors for multi drug resistance
:::* Preferred Regimen: ([[Cefepime]] 1-2 g q8-12h {{or}} [[Ceftazidime]] 2 g q8h {{or}} [[Imipenem]] 500 mg q6h or 1g q8h {{or}} [[Meropenem]] 1 g q8h {{or}} [[Piperacillin-tazobactam]] 4.5 g q6h) {{and}} ([[Ciprofloxacin]] 400 mg q8h {{or}} [[Levofloxacin]] 750 mg q24h {{or}} [[Amikacin]] 20 mg/kg per day {{or}} [[Gentamycin]] 7 mg/kg per day {{or}} [[Tobramycin]] 7 mg/kg per day) {{and}} ([[Linezolid]] 600 mg q12h {{or}} [[Vancomycin]] 15 mg/kg q12h).
::: Note (1): Health care-associated pneumonia used to designate large diverse population of patients with many co-morbidities who reside in nursing homes, other long-term care facilities, require home intravenous therapy (or) are dialysis patients. Pneumonia in these patients frequently resembles hospital-acquired pneumonia.
::: Note (2) : Trough levels for [[Gentamycin]] and [[Tobramycin]] should be less than 1 g/ml, and for [[Amikacin]] they should be less than 4-5 g/ml.
::: Note (3) : Trough levels for [[Vancomycin]] should be 15-20 g/ml.


===Pneumonia, hospital-acquired===
::::* 1.2.1.10 '''Anaerobes (aspiration pneumonia)'''
:* '''Hospital acquired-usually with mechanical ventilation pneumonia '''(VAP) <ref name="pmid15699079">{{cite journal| author=American Thoracic Society. Infectious Diseases Society of America| title=Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. | journal=Am J Respir Crit Care Med | year= 2005 | volume= 171 | issue= 4 | pages= 388-416 | pmid=15699079 | doi=10.1164/rccm.200405-644ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15699079  }} </ref>
:::::* Preferred Regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q6h for 7-10 days (For gram-negative bacilli) {{or}} [[Ticarcillin Clavulanate]] 200-300 mg/kg/day IV divided q4-6h (max: 18 g/day) {{or}} [[Ampicillin-Sulbactam]] 1500-3000 mg IV q6h {{or}} [[Amoxicillin-Clavulanate]] 250-500 mg PO q8h or 875 mg q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (max: 1800 mg/day)
:* Empiric therapy
:::::* Alternative Regimen: [[Carbapenem]] -([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]])
::* No Risk Factors for multi drug resistance
:::* Preferred Regimen : [[Ceftriaxone]] 1-2 g q24h IV or IM (max: 4 g/day) {{or}} [[Levofloxacin]] 750 mg q24h for 7-14 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Ciprofloxacin]] 400 mg PO q8h for 10-14 days {{or}} [[Ampicillin sulbactam]] 1-2 g q6-8h IV/IM (maximum: 8 g/day) {{or}} [[Ertapenem]] 1 g IM/IV q24h for 10-14 days.
::*Presence of Risk Factors for multi drug resistance
:::* Preferred Regimen: ([[Cefepime]] 1-2 g q8-12h {{or}} [[Ceftazidime]] 2 g q8h {{or}} [[Imipenem]] 500 mg q6h or 1g q8h {{or}} [[Meropenem]] 1 g q8h {{or}} [[Piperacillin-tazobactam]] 4.5 g q6h) {{and}} ([[Ciprofloxacin]] 400 mg q8h {{or}} [[Levofloxacin]] 750 mg q24h {{or}} [[Amikacin]] 20 mg/kg per day {{or}} [[Gentamycin]] 7 mg/kg per day {{or}} [[Tobramycin]] 7 mg/kg per day) {{and}} ([[Linezolid]] 600 mg q12h {{or}} [[Vancomycin]] 15 mg/kg q12h).
::: Note (1) : Trough levels for [[Gentamycin]] and [[Tobramycin]] should be less than 1 g/ml, and for [[Amikacin]] they should be less than 4-5 g/ml.
::: Note (2) : Trough levels for [[Vancomycin]] should be 15-20 g/ml


===Pneumonia, Klebsiella===
::::* 1.2.1.11 '''Mycobacterium tuberculosis'''
* '''Klebsiella pneumonia''' <ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:::::* 1.2.1.11.1 '''Intensive phase'''
::* Pathogen directed antimicrobial therapy
::::::* Preferred Regimen: [[Isoniazid]] 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) {{and}} [[Rifampin]] 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) {{and}} [[Ethambutol]] 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) {{and}} [[Pyrazinamide]] 1000 - 2000 mg / day daily for 2 months.
::* (A) Resistant to [[Ceftazidime]] and other 3rd generation [[Cephalosporins]], [[Aztreonam]]
::::::*Alternative regimen (1): [[Isoniazid]] 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day)  {{and}} [[Rifampin]] 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) {{and}} [[Ethambutol]] 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g)  {{and}} [[Pyrazinamide]] 1000 - 2000 mg / day daily for 2 months.
:::* Preferred regimen (1): [[Imipenem]] 0.5 gm IV q6h {{or}} [[Meropenem]] 0.5–1 gm IV q8h
::::::*Alternative regimen (2): [[Isoniazid]] 5 mg/kg/day q24h 3 times per week for 2 months (usual dose: 300 mg/day)  {{and}} [[Rifampin]] 10 mg/kg/day 3 times per week for 2 months (maximum: 600 mg / day) s {{and}} [[Ethambutol]] 5-25 mg/kg (maximum dose: 1.6 g) 3 times per week for 2 months  {{and}} [[Pyrazinamide]] 1000 - 2000 mg / day 3 times per week for 2 months.
::* (B) Resistant to [[Carbapenems]], 2nd and 3rd generation [[Cephalosporins]] due to KPC enzymes
:::::* 1.2.1.11.2 '''Continuation phase'''
:::* Preferred regimen (2): [[Colistin]] (='''Polymyxin E''').In USA : '''Colymycin-M '''2.5-5 mg/kg per day of base divided into 2-4 doses 6.7-13.3 mg/kg per day of [[colistimethate sodium]] (max 800 mg/day). Elsewhere: '''Colomycin''' and '''Promixin''' ≤60 kg, 50,000-75,000 IU/kg per day IV in 3 divided doses (=4-6 mg/kg per day of [[colistimethate sodium]]). >60 kg, 1-2 mill IU IV tid (= 80-160 mg IV tid) {{or}} [[Polymyxin B]] (Poly-Rx) 15,000–25,000 units/kg/day divided q12h
::::::* Preferred Regimen:[[Isoniazid]] 300 mg/day PO daily for 4 months (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO daily for 4 months (10 mg/kg/day)
:::: Note (1): some strains which hyperproduce extended spectrum beta-lactamase are primarily resistant to [[Ticarcillin-Clavulanate]], [[Piperacillin]]-[[Tazobactam]]
::::::* Alternative regimen (1): [[Isoniazid]] 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day)
:::: Note (2): Extended spectrum beta-lactamases inactivates all [[Cephalosporins]], beta-lactam/beta-lactamase inhibitor drug activation not predictable; co-resistance to all [[Fluoroquinolones]] & often [[Aminoglycosides]].
:::: Note (3): Can give IM, but need to combine with “caine” anesthetic due to pain.


===Pneumonia, Legionella===
::::* 1.2.1.12 '''Yersinisa pestis'''
:* '''Legionella pneumonia''' (atypical bacterial pneumonia) <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::::* Preferred Regimen: [[Streptomycin]] 15 mg/kg/day (max 1 g/day) {{or}} [[Gentamicin]] 7 mg/kg/day
::* Preferred Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:::::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h


===Pneumonia, Lung abscess===
::::* 1.2.1.13 '''Atypical bacteria'''
* '''Aspiration pneumonia and lung abscess'''
:::::* 1.2.1.13.1 '''Mycoplasma pneumoniae'''
:* Empiric therapy <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::::::* Preferred Regimen:[[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] Oral: 250-500 mg q6h
::* Preferred regimen: [[Piperacillin]]-[[Tazobactam]] 3.375 gm IV q6h or 4-hr infusion of 3.375 gm q8h .
::::::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
::* Alternative regimen: [[Ceftriaxone]] 1 gm IV q24h {{and}} [[Metronidazole]] 500 mg IV q6h or 1 gm IV q12h
::* Adjunctive therapy : [[Moxifloxacin]] 400 mg IV/po q24h another option
:::Note (1) : Transthoracic culture  of total isolates is anaerobes 34%, gram positive cocci 26%, St milleri 16%, Klebsiella pneumoniae 25%, Nocardia 3%.


===Pneumonia, Meliodosis===
:::::* 1.2.1.13.2 '''Chlamydophila pneumoniae'''
:*'''Burkholderia pseudomallei (meliodosis) pneumonia'''<ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
::::::* Preferred Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] 250-500 mg PO q6h
::* Pathogen directed antimicrobial activity
::::::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
:::* Preferred Regimen : [[Carbapenem]] -([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]]) {{or}} [[Ceftazidime]] 0.5-1 g q8h
:::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h


===Pneumonia, Moraxella catarrhalis===
:::::* 1.2.1.13.3 '''Legionella spp.'''
* '''Moraxella catarrhalis (branhamella) pneumonia'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::::::* Preferred Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
:* Pathogen-directed antimicrobial therapy
::::::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h
::* Preferred regimen: [[Amoxicillin-Clavulanate]] (Augmentin) 2 tablets po bid ( (or)500/125 mg 1 tablet po tid (or) 875/125 mg 1 tablet po bid) {{or}} [[Cephalosporins]]- [[Cefdinir]] 300 mg po q12h (or) 600 mg q24h, {{or}} ([[Cefditoren pivoxil]] 200–400 mg, 2 tabs po bid,{{or}} [[Cefpodoxime proxetil]] 0.1–0.2 gm po q12h, {{or}} [[Cefprozil]] 500 mg po q12h), {{or}} [[Cefoxitin]] 1 gm q8h–2 gm IV/IM q4h, {{or}} ([[Cefuroxime]] 0.75–1.5 gm IV/IM q8h,{{or}}[[Cefotaxime]] 1 gm q8–12h to 2 gm IV q4h, {{or}} [[Ceftazidime]] 1–2 gm IV/IM q8–12h) {{or}} [[Trimethoprim-Sulfamethoxazole]] Single-strength (SS) is [[Trimethoprim]] 80 mg / [[Sulfamethoxazole]] 400 mg ,{{or}} (double-strength (DS) [[Trimethoprim]] 160 mg /[[Sulfamethoxazole]] 800 mg)
::*Alternative regimen: [[Azithromycin]] 500 mg IV q24h ,{{or}} [[Clarithromycin]] 0.5 gm po q12h, {{or}} [[Telithromycin]] 800 mg po q24h (two 400 mg tabs po q24h).


===Pneumonia, Mycoplasma===
:::::* 1.2.1.13.4 '''Chlamydophila psittaci'''
:* '''Mycoplasma pneumoniae''' (atypical bacterial pneumonia) <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
::::::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
::* Preferred Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Tetracycline]] Oral: 250-500 mg q6h
::::::* Alternate Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h


===Pneumonia, neutropenic patient===
:::::* 1.2.1.13.5 ''' Coxiella burnetii'''
* '''Pneumonia in neutropenic patients''' <ref name="pmid15699079">{{cite journal| author=American Thoracic Society. Infectious Diseases Society of America| title=Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. | journal=Am J Respir Crit Care Med | year= 2005 | volume= 171 | issue= 4 | pages= 388-416 | pmid=15699079 | doi=10.1164/rccm.200405-644ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15699079  }} </ref>
::::::* Preferred Regimen: [[Tetracycline]] 250-500 mg PO q6h
:* Empiric therapy
::::::* Alternate Regimen: [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
::* No Risk Factors for multi drug resistance
:::* Preferred Regimen : [[Ceftriaxone]] 1-2 g q24h IV or IM (max: 4 g/day) {{or}} [[Levofloxacin]] 750 mg q24h for 7-14 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Ciprofloxacin]] 400 mg PO q8h for 10-14 days {{or}} [[Ampicillin sulbactam]] 1-2 g q6-8h IV/IM (maximum: 8 g/day) {{or}} [[Ertapenem]] 1 g IM/IV q24h for 10-14 days.
::*Presence of Risk Factors for multi drug resistance
:::* Preferred Regimen: ([[Cefepime]] 1-2 g q8-12h {{or}} [[Ceftazidime]] 2 g q8h {{or}} [[Imipenem]] 500 mg q6h or 1g q8h {{or}} [[Meropenem]] 1 g q8h {{or}} [[Piperacillin-tazobactam]] 4.5 g q6h) {{and}} ([[Ciprofloxacin]] 400 mg q8h {{or}} [[Levofloxacin]] 750 mg q24h {{or}} [[Amikacin]] 20 mg/kg per day {{or}} [[Gentamycin]] 7 mg/kg per day {{or}} [[Tobramycin]] 7 mg/kg per day) {{and}} ([[Linezolid]] 600 mg q12h {{or}} [[Vancomycin]] 15 mg/kg q12h).
:::: Note (1) : Trough levels for [[Gentamycin]] and [[Tobramycin]] should be less than 1 g/ml, and for [[Amikacin]] they should be less than 4-5 g/ml.
:::: Note (2) : Trough levels for [[Vancomycin]] should be 15-20 g/ml
:::: Note (3) : Hospital or community acquired, neutropenic patient (<500 neutrophils per mm3) [[Vancomycin]] not included in initial therapy unless high suspicion of infected intravenous access or drug-resistant Streptococcus pneumonia. Amphotericin not used unless still febrile after 3 days or high clinical likelihood.


===Pneumonia, Nocardia===
:::::* 1.2.1.13.6 '''Francisella tularensis'''
*'''Nocardia pneumonia'''
::::::* Preferred Regimen: [[Doxycycline]] 100 mg PO/IV q12h
:* Pathogen directed antimicrobial therapy <ref name="pmid8783685">{{cite journal| author=Lerner PI| title=Nocardiosis. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 6 | pages= 891-903; quiz 904-5 | pmid=8783685 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8783685  }} </ref>, <ref name="pmid16614249">{{cite journal| author=Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ| title=Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. | journal=Clin Microbiol Rev | year= 2006 | volume= 19 | issue= 2 | pages= 259-82 | pmid=16614249 | doi=10.1128/CMR.19.2.259-282.2006 | pmc=PMC1471991 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16614249  }} </ref>, <ref name="pmid22170936">{{cite journal| author=Brown-Elliott BA, Biehle J, Conville PS, Cohen S, Saubolle M, Sussland D et al.| title=Sulfonamide resistance in isolates of Nocardia spp. from a US multicenter survey. | journal=J Clin Microbiol | year= 2012 | volume= 50 | issue= 3 | pages= 670-2 | pmid=22170936 | doi=10.1128/JCM.06243-11 | pmc=PMC3295118 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22170936  }} </ref>,
::::::* Alternate Regimen: [[Gentamicin]] 7 mg/kg/day {{or}} [[Streptomycin]] 15 mg/kg/day (maximum: 1 g)
::*'''Initial intravenous therapy''' (inductinal therapy)
:::* Preferred regimen:  [[Trimethoprim]]-[[Sulfamethoxazole]] (15 mg/kg/day IV of the trimethoprim component in 2 to 4 divided doses) for at least three to six weeks  {{and}} [[Amikacin]] (7.5 mg/kg IV  q12h) for at least three to six weeks
:::* Alternative regimen: [[Imipenem]] (500 mg IV q6h) {{and}} [[Amikacin]] (7.5 mg/kg IV q12h)
:::: Note (1): If the patient is allergic to [[Sulfonamides]], desensitization should be performed when possible.
:::: Note (2): If the isolate is susceptible to the third-generation cephalosporins ([[Ceftriaxone]], [[Cefotaxime]]), [[Imipenem]] can be switched to one of these agents.
:::: Note (3): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
::* '''Switch to oral therapy''': A sulfonamide (eg,[[Trimethoprim]]-[[Sulfamethoxazole]]  10 mg/kg/day of the trimethoprim component in 2 or 3 divided doses) {{and}} / {{or}} [[Minocycline]] (100 mg bd) {{and}} / {{or}} [[Amoxicillin]]-[[Clavulanate]] (875 mg bd)
::: Note (1): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
::: Note (2): The duration of intravenous therapy varies with the patient's immune status. In immunocompromised patients, maximal tolerated doses should be given intravenously for at least six weeks and until clinical improvement has occurred; in contrast, immunocompetent patients may be successfully treated with a shorter duration of intravenous therapy. Following the intravenous induction phase, patients may be stepped down to oral antibiotics based upon susceptibility studies
::: Note (3): Serious pulmonary infection is treated for 6 to 12 months or longer.


===Pneumonia, post-influenza===
:::::* 1.2.1.13.7 '''Burkholderia pseudomallei'''
*Preferred regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::::::* Preferred Regimen : [[Carbapenem]] -([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]]) {{or}} [[Ceftazidime]] 0.5-1 g q8h
::::::* Alternate Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h


*Alternative regimen(1): [[Ceftriaxone]] 1 gm IV q24h {{and}} [[Azithromycin]] 500 mg IV q24h <ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:::::* 1.2.1.13.8 '''Acinetobacter species'''
*Alternative regimen(2): [[Ertapenem]] 1gm q24h IV {{and}} [[Azithromycin]] 500 mg IV q24h<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::::::* Preferred Regimen : [[Carbapenem]]-([[Imipenem]]-[[Cilastatin]], {{or}} [[Meropenem]], {{or}} [[Ertapenem]])
::::::* Alternate Regimen: [[Cephalosporin]]-[[Aminoglycoside]] {{or}} [[Ampicillin-Sulbactam]] {{or}} [[Colistin]] 2.5-5 mg/kg/day IM/IV divided q6-12h (maximum: 5 mg/kg/day)


===Pneumonia, Pseuodomonas===
::::* 1.2.1.14 '''Gram-positive filamentous bacteria'''
:* '''Pseudomonas aeruginosa pneumonia''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue= | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083 }} </ref>
:::::* 1.2.1.14.1 '''Actinomyces spp.'''<ref name="pmid20582172">{{cite journal| author=Song JU, Park HY, Jeon K, Um SW, Kwon OJ, Koh WJ| title=Treatment of thoracic actinomycosis: A retrospective analysis of 40 patients. | journal=Ann Thorac Med | year= 2010 | volume= 5 | issue= 2 | pages= 80-5 | pmid=20582172 | doi=10.4103/1817-1737.62470 | pmc=PMC2883202 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20582172  }} </ref><ref name="pmidPMID: 14727221">{{cite journal| author=Sudhakar SS, Ross JJ| title=Short-term treatment of actinomycosis: two cases and a review. | journal=Clin Infect Dis | year= 2004 | volume= 38 | issue= 3 | pages= 444-7 | pmid=PMID: 14727221 | doi=10.1086/381099 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14727221 }} </ref>
::* Preferred Regimen: ([[Ticarcillin]] 200-300 mg/kg/day in divided doses q4-6h (maximum: 18 g/day) {{or}} [[Piperacillin]] 6-8 g/day IM/IV (100-125 mg/kg daily) divided q6-12h {{or}} [[Ceftazidime]] 500 mg to 1 g q8h {{or}} [[Cefepime]] 1-2 g q12h for 10 days {{or}} [[Aztreonam]] 2 g IV q6-8h (maximum: 8 g/day) {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 500 mg IV q8h) {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily {{or}} [[Aminoglycoside]])
::::::* Preferred regimen: [[Penicillin]] V 1 g po qid 2-6 wk
::* Alternate Regimen: [[Aminoglycoside]] {{and}} ([[Ciprofloxacin]] 500-750 mg q12h for 7-14 days {{or}} [[Levofloxacin]] 750 mg daily)
::::::* Alternative regimen: [[Tetracycline]] 500 mg po q 6 h {{or}} [[Doxycycline]] 100 mg q 12 h
::::::* Note: [[Minocycline]], [[Clindamycin]], and [[Erythromycin]] have also been successful.
:::::* 1.2.1.14.2 '''Nocardia spp.'''<ref name="pmid8783685">{{cite journal| author=Lerner PI| title=Nocardiosis. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 6 | pages= 891-903; quiz 904-5 | pmid=8783685 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8783685  }} </ref>, <ref name="pmid16614249">{{cite journal| author=Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ| title=Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. | journal=Clin Microbiol Rev | year= 2006 | volume= 19 | issue= 2 | pages= 259-82 | pmid=16614249 | doi=10.1128/CMR.19.2.259-282.2006 | pmc=PMC1471991 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16614249  }} </ref>, <ref name="pmid22170936">{{cite journal| author=Brown-Elliott BA, Biehle J, Conville PS, Cohen S, Saubolle M, Sussland D et al.| title=Sulfonamide resistance in isolates of Nocardia spp. from a US multicenter survey. | journal=J Clin Microbiol | year= 2012 | volume= 50 | issue= 3 | pages= 670-2 | pmid=22170936 | doi=10.1128/JCM.06243-11 | pmc=PMC3295118 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22170936  }} </ref>
::::::* 1.2.1.14.2.1 '''Initial intravenous therapy''' (induction therapy)
:::::::* Preferred regimen: [[Trimethoprim]]-[[Sulfamethoxazole]] (15 mg/kg/day IV of the trimethoprim component in 2 to 4 divided doses) for at least three to six weeks  {{and}} [[Amikacin]] (7.5 mg/kg IV  q12h) for at least three to six weeks
:::::::* Alternative regimen: [[Imipenem]] (500 mg IV q6h) {{and}} [[Amikacin]] (7.5 mg/kg IV q12h)
:::::::* Note (1): If the patient is allergic to [[Sulfonamides]], desensitization should be performed when possible.
:::::::* Note (2): If the isolate is susceptible to the third-generation cephalosporins ([[Ceftriaxone]], [[Cefotaxime]]), [[Imipenem]] can be switched to one of these agents.
:::::::* Note (3): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
::::::* 1.2.1.14.2.2 '''Oral maintenence therapy'''
:::::::*Preferred regimen: A sulfonamide (eg,[[Trimethoprim]]-[[Sulfamethoxazole]] 10 mg/kg/day of the trimethoprim component in 2 or 3 divided doses) {{and}} / {{or}} [[Minocycline]] (100 mg bd) {{and}} / {{or}} [[Amoxicillin]]-[[Clavulanate]] (875 mg bd)
:::::::* Note (1): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
:::::::* Note (2): The duration of intravenous therapy varies with the patient's immune status. In immunocompromised patients, maximal tolerated doses should be given intravenously for at least six weeks and until clinical improvement has occurred; in contrast, immunocompetent patients may be successfully treated with a shorter duration of intravenous therapy. Following the intravenous induction phase, patients may be stepped down to oral antibiotics based upon susceptibility studies
:::::::* Note (3): Serious pulmonary infection is treated for 6 to 12 months or longer.


===Pneumonia, Staphylococcus aureus===
:::* 1.2.2 '''Viral pathogens'''
:* '''Staphylococcus aureus pneumonia''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue= | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083 }} </ref>
::::* 1.2.2.1 '''Influenza virus'''
::* (1) Methicillin susceptible
:::::* Preferred Regimen: [[Oseltamivir]] 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) {{or}} [[Zanamivir]] Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)
:::* Preferred Regimen : [[Nafcillin]] 1000-2000 mg q4h {{or}} [[Oxacillin]] 2 g IV q4h {{or}} [[Flucloxacillin]] 250 mg IM/IV q6h
::::* 1.2.2.2 '''Cytomegalovirus'''<ref name="pmid18652557">{{cite journal| author=Torres-Madriz G, Boucher HW| title=Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients. | journal=Clin Infect Dis | year= 2008 | volume= 47 | issue= 5 | pages= 702-11 | pmid=18652557 | doi=10.1086/590934 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18652557 }} </ref>
:::* Alternative Regimen : [[Cefazolin]] 500 mg IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h
:::::* Preferred regimen (1): [[Ganciclovir]] Induction therapy 5 mg/ kg IV every 12 h for normal GFR; maintenance therapy 5 mg/kg IV daily; 1 g orally every 8 h with food.
::* (2) Methicillin resistant
:::::* Preferred regimen (2): [[Valganciclovir]] Induction therapy 900 mg orally every 12 h; maintenance therapy 900 mg daily.
:::* Preferred Regimen : [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
:::::* Alternative regimen (1): [[Foscarnet]] Induction therapy 60 mg/ kg every 8 h for 14–21 days or 90 mg/kg every 12 h for 14–21 days; maintenance therapy 90–120 mg/kg per day as a single infusion.
:::* Alternative Regimen: [[Trimethoprim-sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
:::::* Alternative regimen (2): [[Cidofovir]] Induction therapy 5 mg/ kg per week for 2 weeks, followed by maintenance therapy every 2 weeks.


===Pneumonia, Stenotrophomonas===
:::* 1.2.3 '''Fungal pathogens'''
* '''Stenotrophomonas (maltophilia) pneumonia''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::::* 1.2.3.1 '''Coccidioides species'''
:* Pathogen directed antimicrobial activity
:::::* Preferred Regimen: [[Itraconazole]] 200 mg q12h {{or}} [[Fluconazole]] 200-400 mg daily for 3-6 month
::* Preferred regimen: [[Trimethoprim-Sulfamethoxazole]] Single-strength (SS) tablet is [[Trimethoprim]] 80 mg / [[Sulfamethoxazole]] 400 mg, double-strength (DS) tablet is [[Trimethoprim]] 160 mg / [[Sulfamethoxazole]] 800 mg {{or}} IV treatment (base on TMP component): standard 8–10 mg per kg per day divided q6h, q8h, or q12h.
:::::* Alternative Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day
::* Alternative regimen: [[Ticarcillin-Clavulanate]] 3.1 gm IV q4–6h ([[Ticarcillin]] 3 gm, [[Clavulanate]] 0.1 gm per vial) {{and}} [[Aztreonam]] 1 gm IV q6h (or) 2 gm IV q8h
:::::* Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection
::: Note (1): Potential synergy with [[Trimethoprim-Sulfamethoxazole]] {{and}} [[Ticarcillin-Clavulanate]].
::: Note (2): Stenotrophomonas is one of the microorganisms causing hospital-acquired pneumonia usually with mechanical ventilation.


===Pneumonia, Streptococcus pneumoniae===
::::* 1.2.3.2  '''Histoplasmosis'''
:*''' Streptococcus pneumoniae''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::::* Preferred Regimen: [[Itraconazole]] 200 mg q12h
::* (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL
:::::* Alternative Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day
:::* Preferred Regimen : [[Penicillin G]] 2-3 million units IV q4h {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8h
:::* Alternative Regimen : [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h {{or}} [[Cefpodoxime]] 200 mg PO q12h for 14 days {{or}} [[Cefprozil]] 500 mg PO q12h for 10 days {{or}} [[Cefuroxime]] 750 mg PO/IV q8h {{or}} [[Cefdinir]] 300 mg PO q12h for 10 days {{or}} [[Cefditoren]] 400 mg PO q12h for 14 day {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Clindamycin]] 150-450 mg PO q6-8h (maximum: 1800 mg/day) {{or}} [[Clindamycin]] 1.2-2.7 g/day IM/IV in 2-4 divided doses (maximum:4800 mg/day) {{or}} [[Doxycycline]] 100 mg PI/IV q12h {{or}} [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h.
::* (2) Penicillin resistant;  minimum inhibitory concentration > 2 mg / mL
:::* Preferred Regimen (Agents chosen on the basis of susceptibililty) : [[Cefotaxime]] 1 g IM/IV q12h {{or}} [[Ceftriaxone]] 1 g IV q24h, 2 g daily for patients at risk {{or}} [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h
:::* Alternative Regimen: [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity {{or}} [[Linezolid]] 600 mg PO/IV q12h for 10-14 days {{or}} [[Amoxicillin]] 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)


===Pneumonia, Tularemia===
::::* 1.2.3.3  '''Blastomycosis'''
:* '''Francisella tularensis pneumonia''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
:::::* Preferred Regimen: [[Itraconazole]] 200 mg q12h
::* Preferred Regimen: [[Doxycycline]] 100 mg PO/IV q12h
:::::* Alternate Regimen: [[Amphotericin]] B 0.5-0.7 mg/kg/day
::* Alternate Regimen: [[Gentamicin]] 7 mg/kg/day {{or}} [[Streptomycin]] 15 mg/kg/day (maximum: 1 g)


===Pneumonia, Yersinia pestis===
:* 2. '''Health care-associated pneumonia'''<ref name="pmid15699079">{{cite journal| author=American Thoracic Society. Infectious Diseases Society of America| title=Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. | journal=Am J Respir Crit Care Med | year= 2005 | volume= 171 | issue= 4 | pages= 388-416 | pmid=15699079 | doi=10.1164/rccm.200405-644ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15699079 }} </ref>
:* '''Yersinisa pestis pneumonia''' <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue= | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083 }} </ref>
::* 2.1  '''Empiric antimicrobial therapy'''
::* Preferred Regimen: [[Streptomycin]] 15 mg/kg/day (max 1 g/day) {{or}} [[Gentamicin]] 7 mg/kg/day
:::* 2.1.1 '''No risk factors for multi drug resistance'''
::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h {{or}} [[levofloxacin]] 750 mg IV q24h {{or}} [[moxifloxacin]] 400 mg IV q24h
::::* Preferred Regimen : [[Ceftriaxone]] 1-2 g q24h IV or IM (max: 4 g/day) {{or}} [[Levofloxacin]] 750 mg q24h for 7-14 days {{or}} [[Moxifloxacin]] 400 mg PO/IV q24h for 7-14 days {{or}} [[Ciprofloxacin]] 400 mg PO q8h for 10-14 days {{or}} [[Ampicillin sulbactam]] 1-2 g q6-8h IV/IM (maximum: 8 g/day) {{or}} [[Ertapenem]] 1 g IM/IV q24h for 10-14 days.
:::* 2.1.2 '''Risk factors for multi drug resistance'''
::::* Preferred Regimen: ([[Cefepime]] 1-2 g q8-12h {{or}} [[Ceftazidime]] 2 g q8h {{or}} [[Imipenem]] 500 mg q6h or 1g q8h {{or}} [[Meropenem]] 1 g q8h {{or}} [[Piperacillin-tazobactam]] 4.5 g q6h) {{and}} ([[Ciprofloxacin]] 400 mg q8h {{or}} [[Levofloxacin]] 750 mg q24h {{or}} [[Amikacin]] 20 mg/kg per day {{or}} [[Gentamycin]] 7 mg/kg per day {{or}} [[Tobramycin]] 7 mg/kg per day) {{and}} ([[Linezolid]] 600 mg q12h {{or}} [[Vancomycin]] 15 mg/kg q12h).
::::* Note (1): Health care-associated pneumonia used to designate large diverse population of patients with many co-morbidities who reside in nursing homes, other long-term care facilities, require home intravenous therapy (or) are dialysis patients. Pneumonia in these patients frequently resembles hospital-acquired pneumonia.
::::* Note (2): Trough levels for [[Gentamycin]] and [[Tobramycin]] should be less than 1 g/ml, and for [[Amikacin]] they should be less than 4-5 g/ml.
::::* Note (3): Trough levels for [[Vancomycin]] should be 15-20 g/ml.


==References==
==References==
{{reflist}}
{{reflist}}

Latest revision as of 17:27, 6 August 2015

Acute exacerbations of chronic bronchitis

  • Acute exacerbation of chronic bronchitis[1]
  • 1. Outpatient management
  • Patients with only 1 of the 3 cardinal symptoms of COPD (↑ dyspnea, ↑ sputum volume, ↑ sputum purulence) may not benefit from antibiotics
  • Preferred regimen (1): Doxycycline 100 mg PO bid for 7-10 days
  • Preferred regimen (2): Amoxicillin 875 mg PO bid
  • Preferred regimen (3): Amoxicillin 500 mg PO tid
  • Preferred regimen (4): Trimethoprim-sulfamethoxazole DS 800/160 mg PO bid for 10-14 days
  • Alternative regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid for 10-14 days
  • Alternative regimen (2): Levofloxacin 500 mg PO qd for 7-10 days
  • Alternative regimen (3): Azithromycin 500 mg PO single dose THEN 250 mg PO qd for 4 days
  • Alternative regimen (4): Cefpodoxime 200 mg PO bid for 10 days
  • Alternative regimen (5): Amoxicillin-clavulanate 500/125 mg PO tid for 10-14 days
  • Alternative regimen (6): Moxifloxacin 400 mg PO qd for 5 days
  • Alternative regimen (7): Gemifloxacin 320 mg PO qd for 5 days
  • Alternative regimen (8): Clarithromycin 250-500 mg PO bid for 7-14 days
  • Alternative regimen (9): Clarithromycin ER 1000 mg PO qd for 14 days
  • Alternative regimen (10): Cefprozil 250-500 mg PO bid for 10 days
  • Alternative regimen (11): Cefixime 400 mg PO qd for 10 days
  • 2. Inpatient management
  • Indications for hospital admission:
  • Intense symptoms (e.g.: sudden development of resting dyspnea)
  • Old age
  • Severe underlying COPD
  • Cyanosis
  • Peripheral edema
  • Serious comorbidities (e.g.: HF, Afib, renal failure)
  • Failure of outpatient treatment
  • Frequent exacerbations
  • Insufficient home support
  • 2.1 Treatment of acute exacerbation of chronic bronchitis, when pseudomonas infection not suspected
  • Preferred regimen (1): Moxifloxacin 400 mg IV q24h for 5 days
  • Preferred regimen (2): Levofloxacin 500 mg IV q24h for 7-10 days
  • 2.2 Treatment of acute exacerbation of chronic bronchitis, when pseudomonas infection is suspected
  • Preferred regimen (1): Ceftazidime 30-50 mg/kg IV q8hr (maximum dose 6 g/day)
  • Preferred regimen (2): Piperacillin-Tazobactam 3.375 g IV q6h for 7-10 days
  • Preferred regimen (3): Cefepime 1-2 g IV q8-12hr for 7-10 days (extend to 21 days if culture positive for Pseudomonas)
  • Alternative regimen (1): Ceftriaxone 1-2 g IV/IM q12-24h for 4-14 days
  • Alternative regimen (2): Ceftriaxone 1-2 g IV/IM q8h for 4-14 days

Bronchiectasis

  • Bronchiectasis[2]
  • 1. Acute exacerbations of bronchiectasis
  • 1.1 Empiric antimicrobial therapy
  • Preferred regimen: Amoxicillin 0.5-1 g PO/IV q8h for 14 days
  • Alternative regimen (1): Ciprofloxacin 500-750 mg PO bid for 14 days
  • Alternative regimen (2): Clarithromycin 500 mg PO bid for 14 days
  • 1.2 Pathogen-directed antimicrobial therapy
  • 1.2.1 Streptococcus pneumoniae
  • 1.2.2 Haemophilus influenzae (b-lactamase negative)
  • Preferred regimen (1): Amoxicillin 0.5-1 g PO tid for 14 days
  • Preferred regimen (2): Amoxicillin 3 g PO bid for 14 days
  • Alternative regimen (1): Clarithromycin 500 mg PO bid for 14 days
  • Alternative regimen (2): Ciprofloxacin 500 mg PO bid for 14 days
  • Alternative regimen (3): Ceftriaxone 2 g IV q24h for 14 days
  • 1.2.3 Haemophilus influenzae (b-lactamase positive)
  • 1.2.4 Moraxella catarrhalis
  • 1.2.5 Staphylococcus aureus (MSSA)
  • 1.2.6 Staphylococcus aureus (MRSA) (mild-to-moderate)
  • Preferred regimen (weight < 50 kg): Rifampicin 450 mg PO qd AND Trimethoprim 200 mg PO bid for 14 days
  • Preferred regimen (weight > 50 kg): Rifampicin 600 mg PO qd AND Trimethoprim 200 mg PO bid for 14 days
  • Alternative regimen (weight < 50 kg): Rifampicin 450 mg PO qd AND Doxycycline 200 mg PO qd for 14 days
  • Alternative regimen (weight > 50 kg): Rifampicin 600 mg PO qd AND Doxycycline 200 mg PO qd for 14 days
  • Alternative regimen: Linezolid 600 mg PO bid for 14 days (third-line therapy)
  • 1.2.7 Staphylococcus aureus (MRSA) (severe)
  • Preferred regimen (1): Vancomycin 1 g IV q12h (trough levels of 10-20 ng/mL)
  • Preferred regimen (2): Teicoplanin 400 mg IV q24h for 14 days
  • Alternative regimen: Linezolid 600 mg IV q12h for 14 days
  • 1.2.8 Coliforms (eg, Klebsiella, enterobacter)
  • 1.2.9 Pseudomonas aeruginosa
  • 1.2.10 Pediatric Dosing
  • 2. Long-term antibiotic prophylaxis
  • Patients with ≥3 exacerbations/year requiring antibiotic therapy or patients with fewer exacerbations that are causing significant morbidity should be considered for long-term antibiotic prophylaxis
  • 2.1 Pathogen-directed antimicrobial therapy
  • 2.1.1 Streptococcus pneumoniae
  • 2.1.2 Haemophilus influenzae (b-lactamase negative)
  • 2.1.3 Haemophilus influenzae (b-lactamase positive)
  • 2.1.4 Moraxella catarrhalis
  • 2.1.5 Staphylococcus aureus (MSSA)
  • 3. Pseudomonas eradication (colonization)
  • 3.1 Initial therapy
  • 3.2 Secondary therapy in case of treatment failure
  • Preferred regimen (1): Piperacillin-tazobactam 4.5 g PO tid for 14 days
  • Preferred regimen (2): Cefepime 1-2 g IV q8-12h
  • Preferred regimen (3): Ciprofloxacin 750 mg PO bid for 4 weeks AND Colistin (Nebulized) 2 MU NEB bid for 3 months
  • Preferred regimen (3): Colistin (Nebulized) 2 MU NEB bid for 3 months

Bronchiolitis

  • Bronchiolitis[3]
  • 1. Treatment
  • Preferred regimen: Supportive care. No antimicrobial therapy recommended.
  • 2. Prophylaxis
  • Indications for prophylaxis:
  • First year of life during RSV season in infants with hemodynamically significant heart disease
  • First year of life during RSV season in preterm infants < 32 weeks 0 days’ gestation who require > 21% oxygen for at least the first 28 days of life
  • Preferred regimen: Palivizumab 15 mg/kg IM monthly for 5 months

Bronchitis

  • Acute bronchitis[4]
  • 1.Treatment of acute bronchitis with no suspicion of pertussis
  • Preferred regimen: Supportive care. Antimicrobial therapy not recommended.
  • 2.Treatment of acute bronchitis with suspected or confirmed pertussis

Cystic fibrosis

  • Cystic Fibrosis
  • 1.Pathogen-directed antimicrobial therapy [5]
  • 1.1 Pseudomonas aeruginosa
  • 1.1.1 Adults
  • 1.1.2 Children
  • 1.2 Staphylococcus aureus
  • 1.2.1 Adults
  • 1.2.1.1 Methicillin sensitive staphylococcus aureus
  • 1.2.1.2 Methicillin resistant staphylococcus aureus
  • 1.2.2 Children
  • 1.2.2.1 Methicillin sensitive staphylococcus aureus
  • Preferred regimen: Nafcillin 5 mg/kg IV q6h (age > 28 days) OR Oxacillin 75 mg/kg IV q6h (age > 28 days)
  • 1.2.2.2 Methicillin resistant staphylococcus aureus
  • Preferred regimen: Vancomycin 40 mg/kg IV divided q6-8h (age >28 days) OR Linezolid 10 mg/kg PO/IV q8h (up to age 12)
  • 1.3 Burkholderia cepacia

Empyema

  • 1. Empiric antimicrobial therapy or culture negative therapy
  • Causative pathogens:
  • Streptococcus milleri
  • Streptococcus pneumoniae
  • Streptococcus intermedius
  • Staphylococcus aureus
  • Enterobacteriaceae
  • Escherichia coli
  • Fusobacterium spp.
  • Bacteroides spp.
  • Peptostreptococcus spp.
  • 2. Pathogen-based therapy
  • 2.1 Acute empyema
  • 2.1.1 Streptococcus pneumoniae, Group A streptrococcus
  • 2.1.2 Staphylococcus aureus
  • 2.1.2.1 MSSA
  • 2.1.2.2 MRSA
  • 2.1.3 Hemophilus influenzae
  • 2.2 Subacute/chronic empyema
  • 2.2.1 Anaerobic streptococcus, Streptococcus milleri, Bacteroides species, Enterobacteriaceae, Mycobacterium tuberculosis

Pneumonia

  • Pneumonia
  • 1. Community-acquired pneumonia
  • 1.1 Empiric therapy in adults [7]
  • 1.1.1 Outpatient treatment
  • 1.1.1.1 Previously healthy and no use of antimicrobials within the previous 3 months
  • Preferred regimen (1): (Azithromycin 500 mg PO single dose for 1 day THEN 250 mg PO qd for 4 days) OR Azithromycin 500 mg IV single dose
  • Preferred regimen (2): Clarithromycin 250 mg PO bid for 7-14 days OR Clarithromycin 1000 mg PO qd for 7 days
  • Preferred regimen (3): Erythromycin 250-500 mg PO bid or tid (maximum daily dose 4 g)
  • Alternative regimen: Doxycycline 100 mg PO/IV q12h
  • 1.1.1.2 Presence of comorbidities, use of immunosuppressing drugs, or use of antimicrobials within the previous 3 months
  • 1.1.2 Inpatient treatment
  • 1.1.2.1 Non-ICU treatment
  • 1.1.2.2 ICU treatment
  • 1.1.3 Special considerations
  • 1.1.3.1 Suspected Pseudomonas
  • 1.1.3.2 Suspected methicillin resistant Staphylococcus aureus (add the following)
  • Preferred regimen: Vancomycin 45-60 mg/kg/day divided q8-12h OR Linezolid 600 mg PO/IV q12h for 10-14 days
  • 1.1.3.3 Neutropenic patient [8]
  • 1.1.3.3.1 No risk for multi-drug resistance
  • 1.1.3.3.2 Risk for multi drug resistance
  • 1.2 Pathogen-directed antimicrobial therapy
  • 1.2.1 Bacterial pathogens
  • 1.2.1.1 Streptococcus pneumoniae
  • 1.2.1.1.1 Penicillin sensitive (minimum inhibitory concentration < 2 mg/mL)
  • 1.2.1.1.2 Penicillin resistant (minimum inhibitory concentration > 2 mg/mL)
  • Preferred regimen (Agents chosen on the basis of susceptibililty) : Cefotaxime 1 g IM/IV q12h OR Ceftriaxone 1 g IV q24h, 2 g daily for patients at risk OR Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h
  • Alternative regimen: Vancomycin 45-60 mg/kg/day divided q8-12h (maximum: 2000 mg/dose) for 7-21 days depending on severity OR Linezolid 600 mg PO/IV q12h for 10-14 days OR Amoxicillin 875 mg PO q12h or 500 mg q8 ( 3 g/day with penicillin ,minimum inhibitory concentration 4 ≤ microgram / mL)
  • 1.2.1.2 Haemophilus influenzae
  • 1.2.1.2.1 Non-beta lactamase producing
  • 1.2.1.2.2 Beta lactamase producing
  • 1.2.1.2 Bacillus anthracis (inhalational)
  • 1.2.1.3 Enterobacteriaceae
  • 1.2.1.4 Pseudomonas aeruginosa
  • 1.2.1.5 Staphylococcus aureus
  • 1.2.1.5.1 Methicillin sensitive
  • 1.2.1.5.2 Methicillin resistant
  • Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR Linezolid 600 mg PO/IV q12h for 10-14 days
  • Alternative Regimen: Trimethoprim-Sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h


  • 1.2.1.6 Klebsiella pneumonia[9]
  • 1.2.1.6.1 Resistant to third generation cephalosporins and aztreonam
  • 1.2.1.6.2 Klebsiella pneumoniae Carbapenemase producers
  • Preferred regimen (1): Colistin (=Polymyxin E).In USA : Colymycin-M 2.5-5 mg/kg per day of base divided into 2-4 doses 6.7-13.3 mg/kg per day of colistimethate sodium (max 800 mg/day). Elsewhere: Colomycin and Promixin ≤60 kg, 50,000-75,000 IU/kg per day IV in 3 divided doses (=4-6 mg/kg per day of colistimethate sodium). >60 kg, 1-2 mill IU IV tid (= 80-160 mg IV tid) OR Polymyxin B (Poly-Rx) 15,000–25,000 units/kg/day divided q12h
  • Note (1): some strains which hyperproduce extended spectrum beta-lactamase are primarily resistant to Ticarcillin-Clavulanate, Piperacillin-Tazobactam
  • Note (2): Extended spectrum beta-lactamases inactivates all Cephalosporins, beta-lactam/beta-lactamase inhibitor drug activation not predictable; co-resistance to all Fluoroquinolones & often Aminoglycosides.
  • Note (3): Can give IM, but need to combine with “caine” anesthetic due to pain.
  • 1.2.1.7 Moraxella catarrhalis


  • 1.2.1.8 Stenotrophomonas maltophilia
  • 1.2.1.9 Bordetella pertussis
  • 1.2.1.10 Anaerobes (aspiration pneumonia)
  • 1.2.1.11 Mycobacterium tuberculosis
  • 1.2.1.11.1 Intensive phase
  • Preferred Regimen: Isoniazid 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) AND Ethambutol 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) AND Pyrazinamide 1000 - 2000 mg / day daily for 2 months.
  • Alternative regimen (1): Isoniazid 5 mg/kg/day q24h daily for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day daily for 2 months (maximum: 600 mg / day) AND Ethambutol 5-25 mg/kg daily for 2 months (maximum dose: 1.6 g) AND Pyrazinamide 1000 - 2000 mg / day daily for 2 months.
  • Alternative regimen (2): Isoniazid 5 mg/kg/day q24h 3 times per week for 2 months (usual dose: 300 mg/day) AND Rifampin 10 mg/kg/day 3 times per week for 2 months (maximum: 600 mg / day) s AND Ethambutol 5-25 mg/kg (maximum dose: 1.6 g) 3 times per week for 2 months AND Pyrazinamide 1000 - 2000 mg / day 3 times per week for 2 months.
  • 1.2.1.11.2 Continuation phase
  • Preferred Regimen:Isoniazid 300 mg/day PO daily for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO daily for 4 months (10 mg/kg/day)
  • Alternative regimen (1): Isoniazid 300 mg/day PO 3 times per week for 4 months (5 mg/kg/day) AND Rifampicin 600 mg/day PO 3 times per week for 4 months (10 mg/kg/day)
  • 1.2.1.12 Yersinisa pestis
  • 1.2.1.13 Atypical bacteria
  • 1.2.1.13.1 Mycoplasma pneumoniae
  • 1.2.1.13.2 Chlamydophila pneumoniae
  • 1.2.1.13.3 Legionella spp.
  • 1.2.1.13.4 Chlamydophila psittaci
  • Preferred Regimen: Tetracycline 250-500 mg PO q6h
  • Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
  • 1.2.1.13.5 Coxiella burnetii
  • Preferred Regimen: Tetracycline 250-500 mg PO q6h
  • Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
  • 1.2.1.13.6 Francisella tularensis
  • 1.2.1.13.7 Burkholderia pseudomallei
  • 1.2.1.13.8 Acinetobacter species
  • 1.2.1.14 Gram-positive filamentous bacteria
  • 1.2.1.14.2.1 Initial intravenous therapy (induction therapy)
  • Preferred regimen: Trimethoprim-Sulfamethoxazole (15 mg/kg/day IV of the trimethoprim component in 2 to 4 divided doses) for at least three to six weeks AND Amikacin (7.5 mg/kg IV q12h) for at least three to six weeks
  • Alternative regimen: Imipenem (500 mg IV q6h) AND Amikacin (7.5 mg/kg IV q12h)
  • Note (1): If the patient is allergic to Sulfonamides, desensitization should be performed when possible.
  • Note (2): If the isolate is susceptible to the third-generation cephalosporins (Ceftriaxone, Cefotaxime), Imipenem can be switched to one of these agents.
  • Note (3): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
  • 1.2.1.14.2.2 Oral maintenence therapy
  • Preferred regimen: A sulfonamide (eg,Trimethoprim-Sulfamethoxazole 10 mg/kg/day of the trimethoprim component in 2 or 3 divided doses) AND / OR Minocycline (100 mg bd) AND / OR Amoxicillin-Clavulanate (875 mg bd)
  • Note (1): Selected patients who clinically improve with induction intravenous therapy and do not have CNS disease may be switched to oral monotherapy (usually after three to six weeks) based upon susceptibility results.
  • Note (2): The duration of intravenous therapy varies with the patient's immune status. In immunocompromised patients, maximal tolerated doses should be given intravenously for at least six weeks and until clinical improvement has occurred; in contrast, immunocompetent patients may be successfully treated with a shorter duration of intravenous therapy. Following the intravenous induction phase, patients may be stepped down to oral antibiotics based upon susceptibility studies
  • Note (3): Serious pulmonary infection is treated for 6 to 12 months or longer.
  • 1.2.2 Viral pathogens
  • 1.2.2.1 Influenza virus
  • Preferred Regimen: Oseltamivir 75 mg PO q12h for 5 days (initiated within 48 hours of onset of symptoms) OR Zanamivir Two inhalations (10 mg total) q12h for 5 days (Doses on first day should be separated by at least 2 hours; on subsequent days, doses should be spaced by ~12 hours)
  • 1.2.2.2 Cytomegalovirus[15]
  • Preferred regimen (1): Ganciclovir Induction therapy 5 mg/ kg IV every 12 h for normal GFR; maintenance therapy 5 mg/kg IV daily; 1 g orally every 8 h with food.
  • Preferred regimen (2): Valganciclovir Induction therapy 900 mg orally every 12 h; maintenance therapy 900 mg daily.
  • Alternative regimen (1): Foscarnet Induction therapy 60 mg/ kg every 8 h for 14–21 days or 90 mg/kg every 12 h for 14–21 days; maintenance therapy 90–120 mg/kg per day as a single infusion.
  • Alternative regimen (2): Cidofovir Induction therapy 5 mg/ kg per week for 2 weeks, followed by maintenance therapy every 2 weeks.
  • 1.2.3 Fungal pathogens
  • 1.2.3.1 Coccidioides species
  • Preferred Regimen: Itraconazole 200 mg q12h OR Fluconazole 200-400 mg daily for 3-6 month
  • Alternative Regimen: Amphotericin B 0.5-0.7 mg/kg/day
  • Note: No therapy is indicated for uncomplicated infection, treat only if complicated infection
  • 1.2.3.2 Histoplasmosis
  • 1.2.3.3 Blastomycosis
  • 2. Health care-associated pneumonia[8]
  • 2.1 Empiric antimicrobial therapy
  • 2.1.1 No risk factors for multi drug resistance
  • 2.1.2 Risk factors for multi drug resistance
  • Preferred Regimen: (Cefepime 1-2 g q8-12h OR Ceftazidime 2 g q8h OR Imipenem 500 mg q6h or 1g q8h OR Meropenem 1 g q8h OR Piperacillin-tazobactam 4.5 g q6h) AND (Ciprofloxacin 400 mg q8h OR Levofloxacin 750 mg q24h OR Amikacin 20 mg/kg per day OR Gentamycin 7 mg/kg per day OR Tobramycin 7 mg/kg per day) AND (Linezolid 600 mg q12h OR Vancomycin 15 mg/kg q12h).
  • Note (1): Health care-associated pneumonia used to designate large diverse population of patients with many co-morbidities who reside in nursing homes, other long-term care facilities, require home intravenous therapy (or) are dialysis patients. Pneumonia in these patients frequently resembles hospital-acquired pneumonia.
  • Note (2): Trough levels for Gentamycin and Tobramycin should be less than 1 g/ml, and for Amikacin they should be less than 4-5 g/ml.
  • Note (3): Trough levels for Vancomycin should be 15-20 g/ml.

References

  1. ↑ Sethi S, Murphy TF (2004). "Acute exacerbations of chronic bronchitis: new developments concerning microbiology and pathophysiology--impact on approaches to risk stratification and therapy". Infect Dis Clin North Am. 18 (4): 861–82, ix. doi:10.1016/j.idc.2004.07.006. PMID 15555829.
  2. ↑ Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group (2010). "British Thoracic Society guideline for non-CF bronchiectasis". Thorax. 65 Suppl 1: i1–58. doi:10.1136/thx.2010.136119. PMID 20627931.
  3. ↑ Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM; et al. (2014). "Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis". Pediatrics. 134 (5): e1474–502. doi:10.1542/peds.2014-2742. PMID 25349312.
  4. ↑ Braman SS (2006). "Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 95S–103S. doi:10.1378/chest.129.1_suppl.95S. PMID 16428698.
  5. ↑ Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB; et al. (2013). "Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health". Am J Respir Crit Care Med. 187 (7): 680–9. PMID 23540878.
  6. ↑ LastName, FirstName (2007). Sanford guide to antimicrobial therapy. Place of publication not identified: Antimicrobial Therapy. ISBN 9781930808386.
  7. ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
  8. ↑ 8.0 8.1 American Thoracic Society. Infectious Diseases Society of America (2005). "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". Am J Respir Crit Care Med. 171 (4): 388–416. doi:10.1164/rccm.200405-644ST. PMID 15699079.
  9. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  10. ↑ Song JU, Park HY, Jeon K, Um SW, Kwon OJ, Koh WJ (2010). "Treatment of thoracic actinomycosis: A retrospective analysis of 40 patients". Ann Thorac Med. 5 (2): 80–5. doi:10.4103/1817-1737.62470. PMC 2883202. PMID 20582172.
  11. ↑ Sudhakar SS, Ross JJ (2004). "Short-term treatment of actinomycosis: two cases and a review". Clin Infect Dis. 38 (3): 444–7. doi:10.1086/381099. PMID 14727221 PMID: 14727221 Check |pmid= value (help).
  12. ↑ Lerner PI (1996). "Nocardiosis". Clin Infect Dis. 22 (6): 891–903, quiz 904-5. PMID 8783685.
  13. ↑ Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ (2006). "Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy". Clin Microbiol Rev. 19 (2): 259–82. doi:10.1128/CMR.19.2.259-282.2006. PMC 1471991. PMID 16614249.
  14. ↑ Brown-Elliott BA, Biehle J, Conville PS, Cohen S, Saubolle M, Sussland D; et al. (2012). "Sulfonamide resistance in isolates of Nocardia spp. from a US multicenter survey". J Clin Microbiol. 50 (3): 670–2. doi:10.1128/JCM.06243-11. PMC 3295118. PMID 22170936.
  15. ↑ Torres-Madriz G, Boucher HW (2008). "Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients". Clin Infect Dis. 47 (5): 702–11. doi:10.1086/590934. PMID 18652557.
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