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WikiDoc Infectious Disease Project — Pathogen-Based Infections

Pathogens of Public Health Significance

3

Pathogens of Clinical Significance

3

Bacteria – Gram-Positive Cocci

Staphylococcus aureus

1. Infectious endocarditis

1.1 In adults

Preferred regimen: Vancomycin, 15-20 mg/kg IV q8-12h OR Daptomycin 6mg/kg/dose IV qd

2. Intravascular catheter-related infections^[1]

2.1 Methicillin susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Nafcillin 2 g IV q6h OR Oxacillin, 2 g IV q6h.
Alternative regimen: Cefazolin, 2 g IV q8h OR Vancomycin, 15 mg/kg IV q12h.
2.1.1 Pediatric dose

2.1.1.1 Nafcillin

2.1.1.1.1 Neonates

0–4 weeks of age and 1200 g- 50 mg/kg/day q12h.
≤7 days and 1200–2000 g- 50 mg/kg/day q12h.
>7 days of age and <2000g- 75 mg/kg/day q8h.
>7 days of age and >1200 g - 100 mg/kg/day q6h.

2.1.1.1.2 Infants and children: Nafcillin 100–200 mg/kg/day q4–6h.

2.1.1.2 Oxacillin

2.1.1.2.1 Neonates

0–4 weeks of age and 1200 g - 50 mg/kg/day q12h.
Postnatal age <7 days and 1200–2000 g- 50–100 mg/kg/day q12h.
Postnatal age <7 days and >2000 g, 75–150 mg/kg/day q8h.
Postnatal age ≥7 days and 1200–2000 g- 75–150 mg/kg/day q8h.
Postnatal age ≥7 days and >2000 g, 100–200 mg/kg/day q6h.

2.1.1.3 Cefazolin

2.1.1.3.1 Neonates

Postnatal age ≤7 days: 40 mg/kg/day q12h.
Postnatal age >7 days and 2000 g: 40 mg/kg/day q12h.
Postnatal age >7 days and 12000 g: 60 mg/kg/day q8h.

2.1.1.3.2 Infants and children: 50 mg/kg/day q8h.

2.1.1.4 Vancomycin

2.1.1.4.1 Neonates

Postnatal age ≤7 days and <1200 g, 15 mg/kg/day q24h.
Postnatal age ≤7 days and 1200–2000 g, 10–15 mg/kg q12–18h.
Postnatal age ≤7 days and >2000 g, 10–15 mg/kg q8–12h.
Postnatal age >7 days and <1200 g, 15 mg/kg/day q24h.
Postnatal age >7 days and 1200–2000 g, 10–15 mg/kg q8–12h.
Postnatal age >7 days and >2000 g, 15–20 mg/kg q8h.

2.1.1.4.2 Infants and children: 40 mg/kg/day q6–8h.

2.2 Methicillin resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin, 15 mg/kg IV q12h OR Daptomycin, 6–8 mg/kg per day IV, or Linezolid 10 mg/kg q 12 hr IV or PO ; OR Vancomycin 15 mg/kg IV q12h AND (Rifampicin IV or Gentamycin IV); or Trimethoprim-Sulfamethoxazole 6–12 mg TMP/kg/day in divided doses q12h alone (if susceptible).
2.2.1 Pediatric dose

2.2.1.1 Linezolid 10 mg/kg IV or PO q12h

2.2.1.1.1 Neonates

0–4 weeks of age and birthweight <1200 g: 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age).
<7 days of age and birthweight >1200 g, 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age).
7 days and birthweight >1200 g, 10 mg/kg q8h.

2.2.1.1.2 Infants and children <12 years of age: 10 mg/kg q8h Children 12 years of age and adolescents: 10 mg/kg q12h.

2.2.1.2 Gentamycin

2.2.1.2.1 Neonates

Premature neonates and <1000 g, 3.5 mg/kg q24h; 0–4 weeks and <1200 g, 2.5 mg/kg q18-24h.
Postnatal age 7 days: 2.5 mg/kg q12h.
Postnatal age 17 days and 1200–2000 g, 2.5 mg/kg q8-12h.
Postnatal age 17 days and 12000 g, 2.5 mg/kg q8h.
Once daily dosing for premature neonates with normal renal function, 3.5–4 mg/kg q24h.
Once daily dosing for term neonates with normal renal function, 3.5–5 mg/kg q24h.

2.2.1.2.2 Infants and children <5 years of age: 2.5 mg/kg q8h; qd dosing in patients with normal renal function, 5–7.5 mg/kg q24h.
2.2.1.2.3 Children >5 years of age: 2–2.5 mg/kg q8h; qd s with normal renal function, 5–7.5 mg/kg every 24 h.

2.2.1.3 Trimethoprim-Sulfamethoxazole

2.2.1.3.1 Infants 12 months of age and children: mild-to-moderate infections, 6–12 mg TMP/kg/day q12h; serious infection, 15–20 mg TMP/kg/day q6-8h.

3. Cellulitis

3.1 Purulent cellulitis (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)

3.1.1 In adults

Preferred regimen: Clindamycin 300–450 mg PO TID OR Trimethoprim-Sulfamethoxazole 1–2 DS tab PO BID OR Doxycycline 100 mg PO BID OR Minocycline 200 mg as a single dose, then 100 mg PO BID OR Linezolid 600 mg PO BID

3.1.2 In childern

Preferred regimen: Clindamycin 10–13 mg/kg/dose PO q6–8 h, not to exceed 40 mg/kg/day OR Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h OR Doxycycline If patient body weight <45kg: 2 mg/kg/dose PO q12 h.

Doxycycline If patient body weight 45kg: adult dose OR Minocycline 4 mg/kg PO 200 mg as a single dose, then 2 mg/kg/dose PO q12h OR Linezolid 10 mg/kg PO q8h, not to exceed 600 mg/dose

3.2 Nonpurulent cellulitis (defined as cellulitis with no purulent drainage or exudate and no associated abscess)

3.2.1 In adults

Preferred regimen: Beta-lactam (eg, Cephalexin and Dicloxacillin) 500 mg PO QID OR Clindamycin 300–450 mg PO TID OR Amoxicillin 500 PO mg TID OR Linezolid 600 mg PO BID

Note: Empirical therapy for b-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to b-lactam therapy and may be considered in those with systemic toxicity.

Note: Provide coverage for both b-hemolytic streptococci and CA-MRSA b-lactam (eg, amoxicillin) and/or TMP-SMX or a tetracycline

3.2.2 In childern

Preferred regimen: Clindamycin 10–13 mg/kg PO q6–8 h, not to exceed 40 mg/kg/day OR Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h OR Linezolid 10 mg/kg PO q8h, not to exceed 600 mg

Note (1): Clindamycin causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents.

Note (2): Trimethoprim-Sulfamethoxazole not recommended for women in the third trimester of pregnancy and for children ,2 months of age.

Note (3): Tetracyclines are not recommended for children under 8 years of age and are pregnancy category D.

4. Brain abscess^[2]^[3]^[4]

4.1 Methicillin-resistant Staphylococcus aureus (MRSA)

4.1.1 In adults

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR Trimethoprim-Sulfamethoxazole 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks

4.1.2 In childern

Preferred regimen: Vancomycin15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h

Note: Consider the addition of Rifampin 600 mg qd OR 300–450 mg bid to Vancomycin.

4.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h

5. Cerebrospinal fluid shunt infection ^[5]^[6]

5.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND/OR Rifampin 600 mg IV or PO q24h

Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.

5.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: (Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h) AND/OR Rifampin 600 mg IV/PO q24h

6. Spinal epidural abscess ^[7]^[8]^[9]^[10]

6.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus

Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks

6.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus

Preferred regimen: Cefazolin 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks OR Nafcillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR Oxacillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks

6.3 Methicillin-resistant Staphylococcus aureus (MRSA)

6.3.1 In adults

Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
Alternative regimen: Linezolid 600 mg PO or IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg PO or IV q8–12h for 4–6 weeks

6.3.2 Pediatric dose

Preferred regimen: Vancomycin 15 mg/kg IV q6h OR Linezolid 10 mg/kg PO or IV q8h

Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.

7. Bacterial meningitis

7.1 Methicillin susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Nafcillin 9–12 g/day IV q4h OR Oxacillin 9–12 g/day IV q4h
Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h OR Meropenem 6 g/day IV q8h

7.2 Methicillin resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen: Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Linezolid 600 mg IV q12h

Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.

8. Septic thrombosis of cavernous or dural venous sinus^[11]

8.1 Methicillin-resistant Staphylococcus aureus (MRSA)

8.1.1 In adults

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h for 4–6 weeks
Alternative regimen: Linezolid 600 mg PO IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks

8.1.2 Pediatric dose

Preferred regimen: Vancomycin 15 mg/kg IV q6h OR Linezolid 10 mg/kg PO or IV q8h

Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.

Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.

9. Subdural empyema

9.1 Methicillin-resistant Staphylococcus aureus (MRSA)^[12]

9.1.1 In adults

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
Alternative regimen: Linezolid 600 mg PO or IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks

9.1.2 In childern

Preferred regimen: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h

Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.

10. Acute conjunctivitis ^[13]

10.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin ointment 1% qid

11. Appendicitis

11.1 Health Care–Associated Complicated Intra-abdominal Infection ^[14]

11.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

12. Diverticulitis

12.1 Health Care–Associated Complicated Intra-abdominal Infection ^[14]

12.1.1Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h.

13. Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured appendix, typhlitis

13.1 Health Care–Associated Complicated Intra-abdominal Infection ^[14]

13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

14. Cystic fibrosis ^[15]

14.1 Preferred Regimen (Adult)

If methicillin sensitive staphylococcus aureus: Nafcillin 2 gm IV q4hs OR Oxacillin 2 gm IV q4hs
If methicillin resistant staphylococcus aureus: Vancomycin 15-20 mg/kg IV q8-12h OR Linezolid 600 mg po/IV q12h

14.2 Preferred regimen (Pediatric)

If methicillin sensitive staphylococcus aureus: Nafcillin 5 mg/kg q6h (Age >28 days) OR Oxacillin 75 mg/kg q6h (Age >28 days)]]
If methicillin resistant staphylococcus aureus: Vancomycin 40 mg/kg q6-8h (Age >28 days) OR Linezolid 10 mg/kg po or IV q8h (up to age 12)

15. Bronchiectasis ^[16]

15.1 Preferred Regimen in adults

15.1.1 Recommended first-line treatment and length of treatment

15.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA): Flucloxacillin 500 mg oral qds for 14 days

15.1.1.2 Methicillin-resistant Staphylococcus aureus (MRSA): Patient's body weight is <50 kg: Rifampicin 450 mg oral od AND Trimethoprim 200 mg oral bd for 14 days ; Patient's body weight is >50 kg: Rifampicin 600 mg oral od AND Trimethoprim 200 mg oral bd for 14 days

15.1.1.3 Methicillin-resistant Staphylococcus aureus (MRSA): Vancomycin 1 g IV bd (monitor serum levels and adjust dose accordingly) OR Teicoplanin 400 mg od for 14 days

15.1.2 Recommended second-line treatment and length of treatment

15.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA): Clarithromycin 500 mg oral bd 14 days

15.1.2.2 Methicillin-resistant Staphylococcus aureus (MRSA): Patient's body weight is <50 kg: Rifampicin 450 mg oral od AND Doxycycline 200 mg oral od 14 days, Patient's body weight is >50 kg: Rifampicin 600 mg oral AND Doxycycline 200 mg oral od 14 days. Third-line: Linezolid 600 mg bd 14 days

15.1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA): Linezolid 600 mg IV bd 14 days

15.2 Preferred Regimen in children

15.2.1 Recommended first-line treatment and length of treatment

15.2.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA): Flucloxacillin

15.2.1.2 Methicillin-resistant Staphylococcus aureus (MRSA): Children (< 12 yr): Trimethoprim 4-6 mg/kg/24 hr divided q 12 hr PO Children (> 12 yr) : Trimethoprim 100-200 mg q 12 hr PO. Rifampicin 450 mg oral od : Rifampicin 600 mg oral od AND

15.2.1.3 Methicillin-resistant Staphylococcus aureus (MRSA): Vancomycin 45-60 mg/kg/24 hr divided q 8-12 hr IV OR Teicoplanin

15.2.2 Recommended second-line treatment and length of treatment

15.2.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA): Clarithromycin 15 mg/kg/24 hr divided q 12 hr PO

15.2.2.2 Methicillin-resistant Staphylococcus aureus (MRSA): Rifampicin AND Doxycycline 2-5 mg/kg/24 hr divided q 12-24 hr PO or IV (max dose: 200 mg/24 hr) ; Rifampicin AND Doxycycline 2-5 mg/kg/24 hr divided q 12-24 hr PO or IV (max dose: 200 mg/24 hr) . Third-line: Linezolid 10 mg/kg q 12 hr IV or PO

15.2.2.3 Methicillin-resistant Staphylococcus aureus (MRSA): Linezolid 10 mg/kg q 12 hr IV or PO

15.3 Long-term oral antibiotic treatment

15.3.1 Preferred Regimen in adults

15.3.1.1 Recommended first-line treatment and length of treatment

15.3.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA): Flucloxacillin 500 mg oral bd

15.3.1.2 Recommended second-line treatment and length of treatment

15.3.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA): Clarithromycin 250 mg oral bd

16. Empyema

Preferred regimen: Nafcillin 2 gm IV q4h OR oxacillin 2 gm IV q4h if MSSA
Alternate regimen: Vancomycin 1 gm IV q12h OR Linezolid 600 mg po bid if MRSA

17. Community-acquired pneumonia

17.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

17.2 Methicillin-resistant Staphylococcus aureus (MRSA)

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

18. Olecranon bursitis or prepatellar bursitis

18.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h OR Dicloxacillin 500 mg PO qid

18.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 1 g IV q12h OR Linezolid 600 mg PO qd

Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.

19. Septic arthritis

19.1 In adults

19.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
Alternative regimen (1): Daptomycin 6 mg/kg IV q24h in adults
Alternative regimen (2): Linezolid 600 mg PO/IV q12h
Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h

19.2 In childern

Preferred regimen: Vancomycin 15 mg/kg IV q6h OR Daptomycin 6–10 mg/kg IV q24h OR Linezolid 10 mg/kg PO/IV q8h OR Clindamycin 10–13 mg/kg/dose PO/IV q6–8h

19.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
Alternative regimen: Cefazolin 0.25–1 g IV/IM q6–8h OR Vancomycin 500 mg IV q6h or 1 g IV q12h

20. Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)

20.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Nafcillin 2 g IV q4–6h OR Oxacillin 2 g IV q4–6h
Alternative regimen: Cefazolin 1–2 g IV q8h OR Ceftriaxone 2 g IV q24h
Alternative regimen (if allergic to penicillins): Clindamycin 900 mg IV q8h OR Vancomycin 15–20 mg/kg IV q8–12 hours, not to exceed 2 g per dose

20.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Early-onset (< 2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)

Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Alternative regimen: (Daptomycin 6 mg/kg IV q24h OR Linezolid 600 IV q8h) AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks

Note: The above regimen should be followed by Rifampin plus a fluoroquinolone, TMP/SMX, a tetracycline or Clindamycin for 3 or 6 months for hips and knees, respectively.

21. Hematogenous osteomyelitis

21.1 Adult (>21 yrs)

21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)

21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen: Nafcillin OR Oxacillin 2 gm IV q4h

21.2 Children (>4 mos.)-Adult

21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin 40 div q6–8h

21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen: Nafcillin OR Oxacillin 37 q6h (to max. 8–12 gm per day)

Note: Add Ceftazidime 50 q8h or Cefepime 150 div q8h if Gm-neg. bacilli on Gram stain

21.3 Newborn (<4 mos.)

21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin AND (Ceftazidime 2 gm IV q8h or Cefepime 2 gm IV q12h)

21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen: (Nafcillin OR Oxacillin) AND (Ceftazidime OR Cefepime)

21.4 Specific therapy

21.4.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Nafcillin OR Oxacillin 2 gm IV q4h OR Cefazolin 2 gm IV q8h
Alternative regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)

21.4.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 1 gm IV q12h
Alternative regimen: Linezolid 600 mg q12h IV/po ± Rifampin 300 mg po/IV bid

22. Diabetic foot osteomyelitis

High Risk for MRSA

Preferred regimen: Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h OR Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)

23. Necrotizing fasciitis^[17]

23.1 In adult

Preferred regimen (1): Nafcillin 1–2 g IV q4h (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
Preferred regimen (2): Oxacillin 1–2 g IV q4h
Preferred regimen (3): Cefazolin 1 g IV q8h
Preferred regimen (4): Vancomycin 15 mg/kg IV bid
Preferred regimen (5): Clindamycin 600–900 mg IV q8h

23.2 In childern

Preferred regimen (1): Nafcillin 50 mg/kg/dose IV q6h (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
Preferred regimen (2): Oxacillin 50 mg/kg/dose IV q6h
Preferred regimen (3): Cefazolin 33 mg/kg/dose IV q8h
Preferred regimen (4): Vancomycin 15 mg/kg/dose IV q6h
Preferred regimen (5): Clindamycin 10–13 mg/kg/dose IV q8h (Bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)

24. Staphylococcal toxic shock syndrome ^[18]

24.1 Methicillin sensitive Staphylococcus aureus

Preferred regimen: Cloxacillin 250-500 mg PO q6h (max dose: 4 g/24 hr) OR Nafcillin 4-12 g/24 hr divided IV q4-6hr (max dose: 12 g/24 hr) OR Cefazolin 0.5-2g IV or IM q8h (max dose: 12 g/24 hr), AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
Alternative regimen (1):Clarithromycin 250-500 mg PO q12h (max dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
Alternative regimen (1):Rifampicin, AND Linezolid 600 mg IV or PO q12h OR Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg IV q12h

24.2 Methicillin resistant Staphylococcus aureus

Preferred regimen: Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) OR Linezolid 600 mg IV or PO q12h AND Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose or Teicoplanin
Alternative regimen (1):Rifampicin, AND Linezolid 600 mg q12h IV or PO OR Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg q12h IV

24.3 Glycopeptide resistant or intermediate Staphylococcus aureus

Preferred regimen: Linezolid 600 mg IV or PO q12h AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) (if sensitive)
Alternative regimen (1):Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg IV q12h

Note: Incidence increasing. Geographical patterns highly variable.

Staphylococcus aureus ,prophylaxis

1. Prophylaxis for coronary artery bypass graft-associated acute mediastinitis^[19]

1.1 Methicillin susceptible staphylococcus aureus (MSSA)

Preferred regimen: A first- or second-generation Cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.

1.2 Methicillin resistant staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected methicillin-resistant S. aureus colonization

Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.

Note (2): The use of intranasal Mupirocin is reasonable in nasal carriers of Staphylococcus aureus.

Bacteria – Gram-Positive Bacilli

Bacillus anthracis, treatment

1. Treatment for cutaneous anthrax, without systemic involvement^[20]

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown): Ciprofloxacin 500 mg PO q12h OR Doxycycline 100 mg PO q12h OR Levofloxacin 750 mg PO q24h OR Moxifloxacin 400 mg PO q24h
Alternative regimen: Clindamycin 600 mg PO q8h OR Amoxicillin 1 g PO q8h (for penicillin-susceptible strains) OR Penicillin VK 500 mg PO q6h (for penicillin-susceptible strains)

Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.

2. Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck^[20]

2.1 Systemic anthrax with possible/confirmed meningitis

2.1.1 Bactericidal agent (fluoroquinolone): Ciprofloxacin 400 mg IV q8h (OR Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h) AND
2.1.2 Bactericidal agent (ß-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 Penicillin G 4 MU IV q4h (for penicillin-susceptible strains) OR Ampicillin 3 g IV q6h (for penicillin-susceptible strains) AND
2.1.3 Protein synthesis inhibitor: Linezolid 600 mg IV q12h OR Clindamycin 900 mg IV q8h OR Rifampin 600 mg IV q12h OR Chloramphenicol 1 g IV q6-8h

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): 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 (4): Increased risk for seizures associated with Imipenem/Cilastatin treatment.

Note (5): 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 (6): 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 (7): Chloramphenicol should only be used if other options are not available because of toxicity concerns.

2.2 Systemic anthrax when meningitis has been excluded

2.2.1 Bactericidal agent: Ciprofloxacin 400 mg IV q8h OR Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg q24h OR Meropenem 2 g IV q8h OR Imipenem 1 g IV q6h OR Doripenem 500 mg IV q8h OR Vancomycin 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) OR Penicillin G 4 MU IV q4h (penicillin-susceptible strains) OR Ampicillin 3 g IV q6h (penicillin-susceptible strains) AND
2.2.2 Protein synthesis inhibitor: Clindamycin 900 mg IV q8h OR Linezolid 600 mg IV q12h OR Doxycycline 200 mg IV initially, then 100 mg IV q12h OR Rifampin 600 mg IV 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): 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 (4): Increased risk for seizures associated with Imipenem/Cilastatin treatment.

Note (5): 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 (6): 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 (7): A single 10-14 days course of Doxycycline is not routinely associated with tooth staining.

3. Specific considerations

3.1 Treatment of anthrax for pregnant Women

3.1.1 Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis ^[21]

3.1.1.1 A Bactericidal Agent (Fluoroquinolone): Ciprofloxacin 400 mg IV q8h is preferred, OR Levofloxacin 750 mg IV q24h, OR
3.1.1.2 A Bactericidal Agent (ß-lactam)

3.1.1.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Meropenem 2 g q8h,OR
3.1.1.2.2 Alternatives for penicillin-susceptible strains: Ampicillin 3 g IV q6h,OR Penicillin G 4 million units IV q4h, OR

3.1.1.3 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.

3.1.2 Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded

3.1.2.1 A Bactericidal Antimicrobial: Ciprofloxacin 400 mg IV q8h is preferred, OR Levofloxacin 750 mg IV q24h, OR
3.1.2.2 A Bactericidal Agent (ß-lactam)

3.1.2.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Meropenem 2 g q8h,OR
3.1.2.2.2 Alternatives for penicillin-susceptible strains:Ampicillin 3 g IV q6h,OR Penicillin G 4 million units IV q4h, OR

3.1.2.3 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

3.1.3 Oral antimicrobial treatment for cutaneous anthrax without systemic involvement

3.1.3.1 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.

3.2 Treatment for anthrax in childern ^[22]

3.2.1 Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)

3.2.1.1 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

3.2.1.2 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.

3.2.2 Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)

3.2.2.1 A bactericidal antimicrobial

3.2.2.1.1 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)
3.2.2.1.2 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

3.2.2.2 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

3.2.3 Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older

3.2.3.1 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

3.2.3.2 A bactericidal antimicrobial (ß-lactam or glycopeptide)

3.2.3.2.1 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
3.2.3.2.2 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

3.2.3.3 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.

3.2.4 Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)

3.2.4.1 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

3.2.4.2 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.

3.2.5 Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)

3.2.5.1 Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)

3.2.5.1.1 Bactericidal antimicrobial (fluoroquinolone) therapy

3.2.5.1.1.1 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

3.2.5.1.1.2 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

3.2.5.1.1.3 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

3.2.5.1.2 A bactericidal antimicrobial (ß-lactam)

3.2.5.1.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown:

3.2.5.1.2.1.1 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

3.2.5.1.2.1.2 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

3.2.5.1.2.1.3 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

3.2.5.1.2.2 Alternatives for penicillin-susceptible strains

3.2.5.1.2.2.1 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,

3.2.5.1.2.2.2 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,

3.2.5.1.2.2.3 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

3.2.5.1.3 A protein synthesis inhibitor

3.2.5.1.3.1 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

3.2.5.1.3.2 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

3.2.5.1.3.3 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.

3.2.5.2 Therapy for severe anthrax when meningitis can be ruled out

3.2.5.2.1 A bactericidal antimicrobial

3.2.5.2.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.2.1.1.1 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

3.2.5.2.1.1.2 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

3.2.5.2.1.1.3 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

3.2.5.2.1.2 Alternatives for penicillin-susceptible strains

3.2.5.2.1.2.1 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

3.2.5.2.1.2.2 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

3.2.5.2.1.2.3 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

3.2.5.2.2 A protein synthesis inhibitor

3.2.5.2.2.1 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

3.2.5.2.2.2 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

3.2.5.2.2.3 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

3.2.5.3 Oral follow-up combination therapy for severe anthrax

3.2.5.3.1 A bactericidal antimicrobial

3.2.5.3.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.3.1.1.1 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

3.2.5.3.1.1.2 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

3.2.5.3.1.1.3 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

3.2.5.3.1.2 Alternatives for penicillin-susceptible strains

3.2.5.3.1.2.1 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

3.2.5.3.1.2.2 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

3.2.5.3.1.2.3 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

3.2.5.3.2 A protein synthesis inhibitor

3.2.5.3.2.1 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

3.2.5.3.2.2 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

3.2.5.3.2.3 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.

3.2.5.4 Treatment of cutaneous anthrax without systemic involvement

3.2.5.4.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.4.1.1 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

3.2.5.4.1.2 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

3.2.5.4.1.3 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

3.2.5.4.2 Alternatives for penicillin-susceptible strains

3.2.5.4.2.1 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

3.2.5.4.2.2 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

3.2.5.4.2.3 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.

Bacillus anthracis, postexposure prophylaxis

1. For adults^[20]

1.1 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
1.2 Alternatives for penicillin-susceptible strain: Amoxicillin 1 g q8h OR Penicillin VK 500 mg q6h

Note (1): Preferred drugs are indicated in boldface.

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.

2. For children = 1 month^[22]

2.1 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
2.2 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.

3. For children < 1 month

3.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.1.1 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

3.1.2 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

3.1.3 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

3.2 Alternatives for penicillin-susceptible strains

3.2.1 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

3.2.2 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

3.2.3 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

Bacteria – Gram-Negative Cocci and Coccobacilli

Chancroid Treatment ^[23]

Preferred Regimen: Azithromycin 1 g PO in a single dose OR Ceftriaxone 250 mg IM in a single dose OR Ciprofloxacin 500 mg PO bid for 3 days OR Erythromycin base 500 mg PO three tid for 7 days
Note(1): Regardless of whether symptoms of the disease are present, sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient’s onset of symptoms.
Note(2):Persons with HIV infection might require repeated or longer courses of therapy, and treatment failures can occur with any regimen.

Bacteria – Spirochetes

Bacteria – Gram-Negative Bacilli

Bacteria – Atypical Organisms

Bacteria – Miscellaneous

Bacteria – Anaerobic Gram-Negative Bacilli

Fungi

Mycobacteria

Parasites – Intestinal Protozoa

1.Amebic Liver Abscess

Preferred regiemn: Metronidazole 750 mg PO tid for 10 days OR Tinidazole 2 g PO once daily for 5 days Followed by Paromomycin 30 mg/kg/day PO in three divided doses per day for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days

2.Amebic Colitis

Preferred regimen: Tinidazole 2 g PO once daily for 5 days AND Paromomycin 30 mg/kg/day PO in three divided doses per day for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days

3.Asymptomatic Intestinal Colonization

Preferred regimen: Paromomycin 30 mg/kg/day PO in three divided doses per day for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days

Parasites – Extraintestinal Protozoa

Parasites – Intestinal Nematodes (Roundworms)

Parasites – Extraintestinal Nematodes (Roundworms)

Parasites – Trematodes (Flukes)

Parasites – Cestodes (Tapeworms)

Parasites – Ectoparasites

Viruses

References

↑ Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
↑ Azari, Amir A.; Barney, Neal P. (2013-10-23). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–1729. doi:10.1001/jama.2013.280318. ISSN 1538-3598. PMC 4049531. PMID 24150468.CS1 maint: PMC format (link)
↑ ^14.0 ^14.1 ^14.2 Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.
↑ 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.
↑ 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.
↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
↑ Lappin E, Ferguson AJ (2009). "Gram-positive toxic shock syndromes". Lancet Infect Dis. 9 (5): 281–90. doi:10.1016/S1473-3099(09)70066-0. PMID 19393958.
↑ Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons". J Am Coll Cardiol. 58 (24): e123–210. doi:10.1016/j.jacc.2011.08.009. PMID 22070836.
↑ ^20.0 ^20.1 ^20.2 Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.
↑ Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA; et al. (2014). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130611. PMC 3901460. PMID 24457117.
↑ ^22.0 ^22.1 Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D; et al. (2014). "Pediatric anthrax clinical management". Pediatrics. 133 (5): e1411–36. doi:10.1542/peds.2014-0563. PMID 24777226.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[pmid19489710-1] Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.

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

[3] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[4] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[5] Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.

[6] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[7] Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.

[8] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[9] Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.

[10] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[11] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[12] Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

[13] Azari, Amir A.; Barney, Neal P. (2013-10-23). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–1729. doi:10.1001/jama.2013.280318. ISSN 1538-3598. PMC 4049531. PMID 24150468.CS1 maint: PMC format (link)

[pmid20034345-14] 14.0 ^14.1 ^14.2 Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.

[pmid23540878-15] 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.

[pmid20627931-16] 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.

[pmid24947530-17] Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.

[pmid19393958-18] Lappin E, Ferguson AJ (2009). "Gram-positive toxic shock syndromes". Lancet Infect Dis. 9 (5): 281–90. doi:10.1016/S1473-3099(09)70066-0. PMID 19393958.

[pmid22070836-19] Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons". J Am Coll Cardiol. 58 (24): e123–210. doi:10.1016/j.jacc.2011.08.009. PMID 22070836.

[pmid24447897-20] 20.0 ^20.1 ^20.2 Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.

[pmid24457117-21] Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA; et al. (2014). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130611. PMC 3901460. PMID 24457117.

[pmid24777226-22] 22.0 ^22.1 Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D; et al. (2014). "Pediatric anthrax clinical management". Pediatrics. 133 (5): e1411–36. doi:10.1542/peds.2014-0563. PMID 24777226.

[23] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

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@@ Line 322: / Line 322: @@
 {{pathogen|Arcanobacterium haemolyticum}}
 {{pathogen|Bacillus anthracis}}
+:* [[Bacillus anthracis]], treatment
+::* 1. '''Treatment for cutaneous anthrax, without systemic involvement'''<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>
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown): [[Ciprofloxacin]] 500 mg PO q12h {{or}} [[Doxycycline]] 100 mg PO q12h {{or}} [[Levofloxacin]] 750 mg PO q24h {{or}} [[Moxifloxacin]] 400 mg PO q24h
+:::* Alternative regimen: [[Clindamycin]] 600 mg PO q8h {{or}} [[Amoxicillin]] 1 g PO q8h (for penicillin-susceptible strains) {{or}} [[Penicillin VK]] 500 mg PO q6h (for penicillin-susceptible strains)
+:::: Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.
+::* 2. '''Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck'''<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>
+:::* 2.1 '''Systemic anthrax with possible/confirmed meningitis'''
+::::* 2.1.1 '''Bactericidal agent''' (fluoroquinolone): '''[[Ciprofloxacin]] 400 mg IV q8h''' ({{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h) {{and}}
+::::* 2.1.2 '''Bactericidal agent (ß-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}} [[Penicillin G]] 4 MU IV q4h (for penicillin-susceptible strains) {{or}} [[Ampicillin]] 3 g IV q6h (for penicillin-susceptible strains) {{and}}
+::::* 2.1.3 '''Protein synthesis inhibitor''': '''[[Linezolid]] 600 mg IV q12h''' {{or}} [[Clindamycin]] 900 mg IV q8h {{or}} [[Rifampin]] 600 mg IV q12h {{or}} [[Chloramphenicol]] 1 g IV q6-8h
+::::: 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): 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 (4): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
+::::: Note (5): [[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 (6): [[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 (7): [[Chloramphenicol]] should only be used if other options are not available because of toxicity concerns.
+:::* 2.2 '''Systemic anthrax when meningitis has been excluded'''
+::::* 2.2.1 '''Bactericidal agent''': '''[[Ciprofloxacin]] 400 mg IV q8h''' {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg q24h {{or}} [[Meropenem]] 2 g IV q8h {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Vancomycin]] 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) {{or}} [[Penicillin G]] 4 MU IV q4h (penicillin-susceptible strains) {{or}} [[Ampicillin]] 3 g IV q6h (penicillin-susceptible strains) {{and}}
+::::* 2.2.2 '''Protein synthesis inhibitor''': '''[[Clindamycin]] 900 mg IV q8h''' {{or}} '''[[Linezolid]] 600 mg IV q12h''' {{or}} [[Doxycycline]] 200 mg IV initially, then 100 mg IV q12h {{or}} [[Rifampin]] 600 mg IV 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): 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 (4): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
+::::: Note (5): [[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 (6): [[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 (7): A single 10-14 days course of [[Doxycycline]] is not routinely associated with tooth staining.
+::* 3. '''Specific considerations'''
+:::* 3.1 '''Treatment of anthrax for pregnant Women'''
+::::* 3.1.1 '''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>
+:::::* 3.1.1.1 ''' A Bactericidal Agent (Fluoroquinolone)''': '''[[Ciprofloxacin]]''' 400 mg IV q8h is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
+:::::* 3.1.1.2 ''' A Bactericidal Agent (ß-lactam)'''
+::::::* 3.1.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Meropenem]] 2 g q8h''',{{or}}
+::::::* 3.1.1.2.2 '''Alternatives for penicillin-susceptible strains''': [[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
+:::::* 3.1.1.3 ''' 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.
+::::* 3.1.2 '''Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded'''
+:::::* 3.1.2.1 ''' A Bactericidal Antimicrobial''': '''[[Ciprofloxacin]] 400 mg IV q8h''' is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
+:::::* 3.1.2.2 ''' A Bactericidal Agent (ß-lactam)'''
+::::::* 3.1.2.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Meropenem]] 2 g q8h''',{{or}}
+::::::* 3.1.2.2.2 '''Alternatives for penicillin-susceptible strains''':[[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
+:::::* 3.1.2.3 ''' 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
+::::* 3.1.3 '''Oral antimicrobial treatment for cutaneous anthrax without systemic involvement'''
+:::::* 3.1.3.1 '''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.
+:::* 3.2 '''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>
+::::* 3.2.1 '''Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)'''
+:::::* 3.2.1.1 '''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}}
+:::::* 3.2.1.2 '''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.
+::::* 3.2.2 ''' Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)'''
+:::::* 3.2.2.1 '''A bactericidal antimicrobial'''
+::::::* 3.2.2.1.1 '''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)
+::::::* 3.2.2.1.2 '''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}}
+:::::* 3.2.2.2 '''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
+::::* 3.2.3 '''Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older'''
+:::::* 3.2.3.1 '''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}}
+:::::* 3.2.3.2 '''A bactericidal antimicrobial (ß-lactam or glycopeptide)'''
+::::::* 3.2.3.2.1 '''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
+::::::* 3.2.3.2.2 '''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}}
+::::::* 3.2.3.3 '''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.
+::::* 3.2.4 '''Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)'''
+:::::* 3.2.4.1 '''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}}
+:::::* 3.2.4.2 '''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.
+::::* 3.2.5 ''' Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)'''
+:::::* 3.2.5.1 '''Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)'''
+::::::* 3.2.5.1.1 '''Bactericidal antimicrobial (fluoroquinolone) therapy'''
+:::::::*  3.2.5.1.1.1 '''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
+:::::::*  3.2.5.1.1.2 '''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
+:::::::*  3.2.5.1.1.3 '''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}}
+::::::* 3.2.5.1.2 '''A bactericidal antimicrobial (ß-lactam)'''
+:::::::* 3.2.5.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''':
+::::::::* 3.2.5.1.2.1.1 '''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
+::::::::* 3.2.5.1.2.1.2 '''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
+::::::::* 3.2.5.1.2.1.3 '''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}}
+:::::::* 3.2.5.1.2.2 ''' Alternatives for penicillin-susceptible strains'''
+::::::::* 3.2.5.1.2.2.1 '''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,
+::::::::* 3.2.5.1.2.2.2 '''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,
+::::::::* 3.2.5.1.2.2.3 '''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}}
+::::::* 3.2.5.1.3 '''A protein synthesis inhibitor'''
+:::::::* 3.2.5.1.3.1 '''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
+:::::::* 3.2.5.1.3.2 '''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
+:::::::* 3.2.5.1.3.3 '''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.
+:::::* 3.2.5.2 '''Therapy for severe anthrax when meningitis can be ruled out'''
+::::::* 3.2.5.2.1 '''A bactericidal antimicrobial'''
+:::::::* 3.2.5.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::::::* 3.2.5.2.1.1.1 '''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
+::::::::* 3.2.5.2.1.1.2 '''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
+::::::::* 3.2.5.2.1.1.3 '''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}}
+::::::::* 3.2.5.2.1.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::::* 3.2.5.2.1.2.1 '''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
+:::::::::* 3.2.5.2.1.2.2 '''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
+:::::::::* 3.2.5.2.1.2.3 '''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}}
+::::::* 3.2.5.2.2 '''A protein synthesis inhibitor'''
+:::::::* 3.2.5.2.2.1 '''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
+:::::::* 3.2.5.2.2.2 '''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
+:::::::* 3.2.5.2.2.3 '''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
+:::::* 3.2.5.3 '''Oral follow-up combination therapy for severe anthrax'''
+::::::* 3.2.5.3.1 '''A bactericidal antimicrobial'''
+:::::::* 3.2.5.3.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::::::* 3.2.5.3.1.1.1 '''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'''
+::::::::* 3.2.5.3.1.1.2 '''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'''
+::::::::* 3.2.5.3.1.1.3 '''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}}
+:::::::* 3.2.5.3.1.2 '''Alternatives for penicillin-susceptible strains'''
+::::::::* 3.2.5.3.1.2.1 '''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
+::::::::* 3.2.5.3.1.2.2 '''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
+::::::::* 3.2.5.3.1.2.3 '''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}}
+::::::* 3.2.5.3.2 '''A protein synthesis inhibitor'''
+:::::::* 3.2.5.3.2.1 '''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
+:::::::* 3.2.5.3.2.2 '''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
+:::::::* 3.2.5.3.2.3 '''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.
+:::::* 3.2.5.4 '''Treatment of cutaneous anthrax without systemic involvement'''
+::::::* 3.2.5.4.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::::::* 3.2.5.4.1.1 '''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
+:::::::* 3.2.5.4.1.2 '''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
+:::::::* 3.2.5.4.1.3 '''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
+::::::* 3.2.5.4.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* 3.2.5.4.2.1 '''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
+:::::::* 3.2.5.4.2.2 '''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
+:::::::* 3.2.5.4.2.3 '''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.
+:* [[Bacillus anthracis]], postexposure prophylaxis
+::* 1. '''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>
+:::* 1.1 '''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}}
+:::* 1.2 '''Alternatives for penicillin-susceptible strain''': [[Amoxicillin]] 1 g q8h {{or}} Penicillin VK 500 mg q6h
+:::: Note (1): Preferred drugs are indicated in boldface.
+:::: 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.
+::* 2. '''For children = 1 month'''<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>
+:::* 2.1 '''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}}
+:::* 2.2 '''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]].
+::* 3. '''For children < 1 month'''
+:::* 3.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+::::* 3.1.1 '''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
+::::* 3.1.2 '''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
+::::* 3.1.3 '''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}}
+:::* 3.2 '''Alternatives for penicillin-susceptible strains'''
+::::* 3.2.1 '''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
+::::* 3.2.2 '''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
+::::* 3.2.3 '''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
 {{pathogen|Bacillus cereus}}
 {{pathogen|Bacillus subtilis}}