Sandbox ID Lower Respiratory Tract: Difference between revisions
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::* (1) Penicillin nonresistant; minimum inhibitory concentration < 2 mg / mL | ::* (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 | :::* 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}} | :::* 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 | ::* (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 | :::* 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 |
Revision as of 17:58, 10 June 2015
Acute bacterial exacerbations of chronic bronchitis
Bronchiectasis
Bronchiolitis
Bronchitis
Cystic fibrosis
Empyema
Influenza
Inhalational anthrax, Prophylaxis
Inhalational anthrax, Treatment
Pertussis
Pneumonia, Acinetobacter
Pneumonia, Actinomycosis
Pneumonia, Anaerobes
Pneumonia, Aspiration pneumonia
Pneumonia, Chlamydophila
Pneumonia, community-acquired
- Community acquired pneumonia
- Empiric therapy in adults
- (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 Respiratory 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–B-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) B-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 (max: 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 (max: 8 g/day) ORImipenem 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
- (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
- Preferred Regimen: Tetracycline 250-500 mg PO q6h
- Alternate Regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
- (F) Francisella tularensis
- Preferred Regimen: Doxycycline
- Alternate Regimen: Gentamicin 7 mg/kg/day OR Streptomycin 15 mg/kg/day (maximum: 1 g)
- (G) Burkholderia pseudomallei
- Preferred Regimen : Carbapenem 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
- (H) Acinetobacter species
- Preferred Regimen : Carbapenem
- Alternate Regimen: Cephalosporin-aminoglycoside OR Ampicillin-sulbactam OR Colistin 2.5-5 mg/kg/day IM/IV divided q6-12h (max: 5 mg/kg/day)
- Viral
- 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)
- Fungal
- (A) Coccidioides species
- Preferred Regimen: Itraconazole 200 mg q12h OR Fluconazole 200-400 mg daily for 3-6 month
- 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
- Preferred Regimen: Itraconazole 200 mg q12h
- Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day
- (C) Blastomycosis
- Preferred Regimen: Itraconazole 200 mg q12h
- Alternate Regimen: Amphotericin B 0.5-0.7 mg/kg/day
Pneumonia, concomitant influenza
Pneumonia, Cytomegalovirus
Pneumonia, Haemophilus Influenza
Pneumonia, health care-associated
Pneumonia, hospital-acquired
Pneumonia, Klebsiella
Pneumonia, Legionella
Pneumonia, Lung abscess
Pneumonia, Meliodosis
Pneumonia, Moraxella catarrhalis
Pneumonia, Mycoplasma
Pneumonia, neutropenic patient
Pneumonia, Nocardia
Pneumonia, post-influenza
Pneumonia, Pseuodomonas
- Pseudomonas aeruginosa pneumonia
- 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)
Pneumonia, Staphylococcus aureus
- Staphylococcus aureus pneumonia
- (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
Pneumonia, Stenotrophomonas
Pneumonia, Streptococcus pneumoniae
- 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)