Sandbox g19

Brain abscess

• Empiric antimicrobial therapy

• Brain abscess in otherwise healthy patients

• Preferred regimen: (Cefotaxime 8–12 g/day IV q4–6h OR Ceftriaxone 4 g/day IV q12h) AND Metronidazole 30 mg/kg/day IV q6h
• Alternative regimen: Meropenem 6 g/day IV q8h

• Brain abscess with comorbidities

• Otitis media, mastoiditis, or sinusitis

• Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h

• Dental infection

• Preferred regimen: Penicillin G 4 MU IV q4h AND Metronidazole 30 mg/kg/day q6h

• Penetrating trauma or post-neurosurgy

• Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h OR Cefepime 2 g IV q12h) AND Vancomycin 30–45 mg/kg/day q8–12h

• Lung abscess, empyema, or bronchiectasis

• Preferred regimen: Penicillin G 4 MU IV q4h AND Metronidazole 30 mg/kg/day q6h AND TMP-SMZ 10–20 mg/kg/day q6–12h

• Bacterial endocarditis

• Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h AND Gentamicin 5 mg/kg/day IV q8h

• Congenital heart disease

• Preferred regimen: Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

• Transplant recipients

• Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h AND Voriconazole 8 mg/kg/day q12h AND (TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h)

• Patients with HIV/AIDS

• Preferred regimen: (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Sulfadiazine 4–6 g/day q6h AND Pyrimethamine 25–100 mg/day qd

• Staphylococcus aureus coverage

• Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h

• Mycobacterium tuberculosis coverage

• Preferred regimen: Isoniazid 300 mg qd AND Rifampin 600 mg qd AND Pyrazinamide 15–30 mg qd AND Ethambutol 15 mg/kg/day qd

• Pathogen-directed antimicrobial therapy

• Bacteria

• Actinomyces

• Preferred regimen: Penicillin G 4 MU IV q4h
• Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h

• Bacteroides fragilis

• Preferred regimen: Metronidazole 30 mg/kg/day IV q6h
• Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h

• Enterobacteriaceae

• Preferred regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Cefepime 2 g IV q12h
• Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR TMP-SMZ 10–20 mg/kg/day q6–12h OR Ciprofloxacin 800–1200 mg/day IV q8–12h OR Meropenem 2 g IV q8h

• Fusobacterium

• Preferred regimen: Metronidazole 30 mg/kg/day q6h
• Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h OR Meropenem 2 g IV q8h

• Haemophilus

• Preferred regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Cefepime 2 g IV q12h
• Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR TMP-SMZ 10–20 mg/kg/day q6–12h

• Listeria monocytogenes

• Preferred regimen: Ampicillin 12 g/day q4h OR Penicillin G 4 MU IV q4h
• Alternative regimen: TMP-SMZ 10–20 mg/kg/day q6–12h

• Nocardia

• Preferred regimen: TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h
• Alternative regimen: Meropenem 2 g IV q8h OR Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Amikacin 15 mg/kg/day IV q8h

• Prevotella melaninogenica

• Preferred regimen: Metronidazole 30 mg/kg/day q6h
• Alternative regimen: Clindamycin 2400–4800 mg/day IV q6h OR Meropenem 2 g IV q8h

• Pseudomonas aeruginosa

• Preferred regimen: Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h

• Staphylococcus aureus, methicillin-susceptible

• Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h

• Staphylococcus aureus, methicillin-resistant

• Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h

• Streptococcus, penicillin-susceptible

• Preferred regimen: Penicillin G 4 MU IV q4h OR Ampicillin 2 g IV q4h

• Streptococcus, penicillin-resistant

• Preferred regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Cefepime 2 g IV q12h

• Fungi

• Aspergillus

• Preferred regimen: Voriconazole 8 mg/kg/day q12h

• Candida

• Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

• Cryptococcus neoformans

• Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

• Mucorales

• Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

• Pseudallescheria boydii (Scedosporium apiospermum)

• Preferred regimen: Voriconazole 8 mg/kg/day q12h

• Protozoa

• Toxoplasma gondii

• Preferred regimen: Sulfadiazine 4–6 g/day q6h AND Pyrimethamine 25–100 mg/day qd