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Bacteria – Gram-Positive Cocci

Enterococcus faecalis Return to Top

1. Bacteremia^[1]

1.1 Ampicillin or Penicillin susceptible

Preferred regimen (1): Ampicillin 2 g IV q4-6h
Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h

1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
Preferred regimen (2): Linezolid 600 mg IV q12h
Preferred regimen (3): Daptomycin 6 mg/kg IV q24h

1.3 Ampicillin and Vancomycin resistant

Preferred regimen (1): Linezolid 600 mg IV q12h
Preferred regimen (2): Daptomycin 6 mg/kg IV q24h

2. Endocarditis^[2]^[3]

2.1 Endocarditis in Adults

2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU IV q24h for 4–6 weeks) ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

2.1.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h 6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

Preferred regimen (1): (Imipenem OR Cilastatin 2 g/day IV for ≥ 8weeks AND Ampicillin 12 g/day IV for ≥ 8weeks)
Preferred regimen (2): (Ceftriaxone sodium 4 g IV/IM q24h for ≥ 8weeks AND Ampicillin 12 g IV q24h for ≥ 8weeks)

2.2 Endocarditis in Pediatrics

2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

2.2.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

Preferred regimen: Imipenem/Cilastatin 60–100 mg/kg IV q24h for ≥ 8weeks AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks
Alternate regimen: Ceftriaxone 100 mg/kg IV/IM q24h AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks

3. Meningitis^[4]

3.1 Ampicillin susceptible

Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

3.2 Ampicillin resistant

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

3.3 Ampicillin and vancomycin resistant

Preferred regimen: Linezolid 600 mg IV q12h

4. Urinary tract infections ^[5]

Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
Preferred regimen (2): Fosfomycin 3 g PO single dose
Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days

5. Intra abdominal or Wound infections ^[6]

Preferred regimen(1): Penicillin
Preferred regimen(2): Ampicillin
Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

Enterococcus faecium Return to Top

1. Bacteremia^[7]

1.1 Ampicillin or Penicillin susceptible

Preferred regimen (1): Ampicillin 2 g IV q4-6h
Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h

1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
Preferred regimen (2): Linezolid 600 mg IV q12h
Preferred regimen (3): Daptomycin 6 mg/kg IV q24h.

1.3 Ampicillin and Vancomycin resistant

Preferred regimen (1): Linezolid 600 mg IV q12h
Preferred regimen (2): Daptomycin 6 mg/kg IV q24h

2. Endocarditis

2.1 Endocarditis in Adults

2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

Preferred regimen: (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU/day IV for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

Preferred regimen: (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV q24h for 4–6 weeks) ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

2.1.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

Preferred regimen(1): Linezolid 1200 mg IV/PO q24h ≥8 weeks
Preferred regimen(2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks

2.2 Endocarditis in Pediatrics

2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin

2.2.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.3.2 Intrinsic penicillin resistance
Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin

Preferred regimen(1): Linezolid 30 mg/kg IV/PO q24h ≥ 8 weeks
Preferred regimen(2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks

3. Meningitis^[4]

3.1 Ampicillin susceptible

Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

3.2 Ampicillin resistant

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

3.3 Ampicillin and vancomycin resistant

Preferred regimen: Linezolid 600 mg IV q12h

4. Urinary tract infections^[8]

Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
Preferred regimen (2): Fosfomycin 3 g PO single dose
Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days

5. Intra abdominal or Wound infections ^[9]

Preferred regimen(1): Penicillin
Preferred regimen(2): Ampicillin
Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

Staphylococcus aureus Return to Top

Staphylococcus aureus treatment

1. Infectious endocarditis

1.1 In adults

Preferred regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
Preferred regimen (2): Daptomycin 6mg/kg/dose IV qd

2. Intravascular catheter-related infections^[10]

2.1 Methicillin susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q6h
Preferred regimen (2): Oxacillin 2 g IV q6h
Alternative regimen (1): Cefazolin 2 g IV q8h
Alternative regimen (2): 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 is 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 is 50 mg/kg/day q12h
Postnatal age <7 days and 1200–2000 g is 50–100 mg/kg/day q12h
Postnatal age <7 days and >2000 g is 75–150 mg/kg/day q8h
Postnatal age ≥7 days and 1200–2000 g is 75–150 mg/kg/day q8h
Postnatal age ≥7 days and >2000 g is 100–200 mg/kg/day q6h

2.1.1.3 Cefazolin

2.1.1.3.1 Neonates

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

2.1.1.3.2 Infants and children is 50 mg/kg/day q8h

2.1.1.4 Vancomycin

2.1.1.4.1 Neonates

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

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

2.2 Methicillin resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h
Preferred regimen (2): Daptomycin 6–8 mg/kg/day IV
Preferred regimen (3): Linezolid 10 mg/kg q12h IV or PO
Preferred regimen (4): Vancomycin 15 mg/kg IV q12h AND (Rifampicin IV or Gentamycin IV)
Preferred regimen (5): 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 is 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 is 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age)
7 days and birthweight >1200 g is 10 mg/kg q8h

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

2.2.1.2 Gentamycin

2.2.1.2.1 Neonates

Premature neonates and <1000 g is 3.5 mg/kg q24h; 0–4 weeks and <1200 g is 2.5 mg/kg q18-24h
Postnatal age 7 days is 2.5 mg/kg q12h
Postnatal age 17 days and 1200–2000 g is 2.5 mg/kg q8-12h
Postnatal age 17 days and 12000 g is 2.5 mg/kg q8h
Premature neonates with normal renal function is 3.5–4 mg/kg q24h
Term neonates with normal renal function is 3.5–5 mg/kg q24h

2.2.1.2.2 Infants and children <5 years of age is 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 is 2–2.5 mg/kg q8h; qd with normal renal function, 5–7.5 mg/kg q24h

2.2.1.3 Trimethoprim-Sulfamethoxazole

2.2.1.3.1 Infants 12 months of age and children of mild-to-moderate infections is 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 (1): Clindamycin 300–450 mg PO tid
Preferred regimen (2): Trimethoprim-Sulfamethoxazole 1–2 DS tab PO bid
Preferred regimen (3): Doxycycline 100 mg PO bid
Preferred regimen (4): Minocycline 200 mg as a single dose, then 100 mg PO bid
Preferred regimen (5): Linezolid 600 mg PO bid

3.1.2 In children

Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
Preferred regimen (3)

3.1 If patient body weight <45kg then Doxycycline 2 mg/kg PO q12h
3.2 If patient body weight 45kg then Doxycycline adult dose

Preferred regimen (4): Minocycline 4 mg/kg PO 200 mg as a single dose, then 2 mg/kg PO q12h
Preferred regimen (5): Linezolid 10 mg/kg PO q8h, not to exceed 600 mg

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

3.2.1 In adults

Preferred regimen (1): Beta-lactam (eg, Cephalexin and Dicloxacillin) 500 mg PO qid
Preferred regimen (2): Clindamycin 300–450 mg PO tid
Preferred regimen (3): Amoxicillin 500 PO mg tid
Preferred regimen (4): Linezolid 600 mg PO bid

Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity

Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, Amoxicillin) with or without Trimethoprim-Sulfamethoxazole or a Tetracycline

3.2.2 In children

Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
Preferred regimen (3): 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^[11]^[12]^[13]

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 (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks

4.1.2 In children

Preferred regimen (1): Vancomycin15 mg/kg/dose IV q6h
Preferred regimen (2): 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 (1): Nafcillin 2 g IV q4h
Preferred regimen (2): Oxacillin 2 g IV q4h
Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h

5. Cerebrospinal fluid shunt infection ^[14]^[15]

5.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h with or without 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 (1): Nafcillin 2 g IV q4h with or without Rifampin 600 mg IV/PO q24h
Preferred regimen (2): Oxacillin 2 g IV q4h

6. Spinal epidural abscess ^[16]^[17]^[18]^[19]

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 (1): Cefazolin 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks
Preferred regimen (2): Nafcillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
Preferred regimen (3): 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 (1): Linezolid 600 mg PO or IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO or IV q8–12h for 4–6 weeks

6.3.2 Pediatric dose

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): 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 (1): Nafcillin 9–12 g/day IV q4h
Preferred regimen (2): Oxacillin 9–12 g/day IV q4h
Alternative regimen (1): Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen (2): 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 (1): Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h
Alternative regimen (2): 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^[20]

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 (1): Linezolid 600 mg PO or IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg/dose PO or IV q8–12h for 4–6 weeks

8.1.2 Pediatric dose

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): 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)^[21]

9.1.1 In adults
Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
Alternative regimen (1): Linezolid 600 mg PO or IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO or IV q8–12h for 4–6 weeks

9.1.2 In children

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Linezolid 10 mg/kg PO or IV q8h

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

10. Acute conjunctivitis ^[22]

10.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin ointment 1% qid

11. Appendicitis

11.1 Health Care–Associated Complicated Intra-abdominal Infection ^[23]

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 ^[23]

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 ^[23]

13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

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

14. Cystic fibrosis ^[24]

14.1 Adults

14.1.1 If methicillin sensitive staphylococcus aureus

Preferred Regimen (1): Nafcillin 2 gm IV q4h
Preferred Regimen (2): Oxacillin 2 gm IV q4h

14.1.2 If methicillin resistant staphylococcus aureus

Preferred Regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
Preferred Regimen (2): Linezolid 600 mg PO or IV q12h

14.2 Pediatric

14.2.1 If methicillin sensitive staphylococcus aureus

Preferred Regimen (1): Nafcillin 5 mg/kg q6h (Age >28 days)
Preferred Regimen (2): Oxacillin 75 mg/kg q6h (Age >28 days)

14.2.2 If methicillin resistant staphylococcus aureus

Preferred Regimen (1): Vancomycin 40 mg/kg q6-8h (Age >28 days)
Preferred Regimen (2): Linezolid 10 mg/kg PO or IV q8h (up to age 12)

15. Bronchiectasis ^[25]

15.1 In adults

15.1.1 Recommended first-line treatment and length of treatment

15.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg oral qds for 14 days

15.1.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

15.1.1.2.1 Patient's body weight is <50 kg

Preferred regimen: Rifampicin 450 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days

15.1.1.2.2 Patient's body weight is >50 kg

Preferred regimen: Rifampicin 600 mg PO qdAND Trimethoprim 200 mg PO bd for 14 days

15.1.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 1 g IV bd (monitor serum levels and adjust dose accordingly)
Preferred regimen (2): Teicoplanin 400 mg qd for 14 days

15.1.2 Recommended second-line treatment and length of treatment

15.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 500 mg oral bd 14 days

15.1.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

15.1.2.2.1 Patient's body weight is <50 kg

Preferred regimen: Rifampicin 450 mg PO qd AND Doxycycline 200 mg PO qd 14 days,

15.1.2.2.2 Patient's body weight is >50 kg

Preferred regimen: Rifampicin 600 mg PO AND Doxycycline 200 mg PO qd 14 days

Third-line is Linezolid 600 mg bd 14 days

15.1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Linezolid 600 mg IV bd 14 days

15.2 In children

15.2.1 Recommended first-line treatment and length of treatment

15.2.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin

15.2.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

15.2.1.2.1 Children (< 12 yr)

Preferred regimen: Trimethoprim 4-6 mg/kg/day divided q12h PO

15.2.1.2.2 Children (> 12 yr)

Preferred regimen (1): Trimethoprim 100-200 mg q12hr PO
Preferred regimen (2): Rifampicin 450 mg PO od

15.2.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 45-60 mg/kg/day divided q8-12h IV
Preferred regimen (2): Teicoplanin

15.2.2 Recommended second-line treatment and length of treatment

15.2.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 15 mg/kg/24 hr divided q12h PO

15.2.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Rifampicin AND Doxycycline 2-5 mg/kg/day divided q12-24h PO or IV (max dose: 200 mg/24 hr)
Preferred regimen (2): Rifampicin AND Doxycycline 2-5 mg/kg/day divided q12-24h PO or IV (max dose: 200 mg/24 hr)
Third-line: Linezolid 10 mg/kg q12h IV or PO

15.2.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Linezolid 10 mg/kg q12h IV or PO

15.3 Long-term oral antibiotic treatment

15.3.1 In adults

15.3.1.1 Recommended first-line treatment and length of treatment

15.3.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg PO bd

15.3.1.2 Recommended second-line treatment and length of treatment

15.3.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 250 mg PO bd

16. Empyema^[26]

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^[27]

17.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred Regimen (1): Nafcillin 1000-2000 mg q4h
Preferred Regimen (2): Oxacillin 2 g IV q4h
Preferred Regimen (3): Flucloxacillin 250 mg IM/IV q6h
Alternative Regimen (1): Cefazolin 500 mg IV q12h
Alternative Regimen (2): Clindamycin 150-450 mg PO q6-8h

17.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred Regimen (1): Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days
Preferred Regimen (2): 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 (1): Nafcillin 2 g IV q4h
Preferred regimen (2): Oxacillin 2 g IV q4h
Preferred regimen (3): Dicloxacillin 500 mg PO qid

18.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 1 g IV q12h
Preferred regimen (2): 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 or IV q12h
Alternative regimen (3): Clindamycin 600 mg PO or IV q8h
Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO or IV q8–12h

19.2 In childern

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Daptomycin 6–10 mg/kg IV q24h
Preferred regimen (3): Linezolid 10 mg/kg PO or IV q8h
Preferred regimen (4): Clindamycin 10–13 mg/kg PO or IV q6–8h
19.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
Preferred regimen (1): Nafcillin 2 g IV q6h
Preferred regimen (2): Clindamycin 900 mg IV q8h
Alternative regimen (1): Cefazolin 0.25–1 g IV/IM q6–8h
Alternative regimen (2): 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 (1): Nafcillin 2 g IV q4–6h
Preferred regimen (2): Oxacillin 2 g IV q4–6h
Alternative regimen (1): Cefazolin 1–2 g IV q8h
Alternative regimen (2): Ceftriaxone 2 g IV q24h
Alternative regimen (if allergic to penicillins) (3): Clindamycin 900 mg IV q8h
Alternative regimen (if allergic to penicillins) (4): Vancomycin 15–20 mg/kg IV q8–12h, 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 (1): Daptomycin 6 mg/kg IV q24h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Alternative regimen (2): 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 and Fluoroquinolone, Trimethoprim/Sulfamethoxazole, 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 (1): Nafcillin
Preferred regimen (2): Oxacillin 2 gm IV q4h

21.2 Children (>4 months)-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 (1): Nafcillin
Preferred regimen (2): Oxacillin q6h (to max. 8–12 gm per day)

Note: Add Ceftazidime 50 mg q8h or Cefepime 150 mg q8h if gram negative bacilli on Gram stain

21.3 Newborn (<4 months.)

21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen (1): Vancomycin AND Ceftazidime 2 gm IV q8h
Preferred regimen (2): Vancomycin AND Cefepime 2 gm IV q12h

21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen (1): Nafcillin AND Ceftazidime
Preferred regimen (2): Oxacillin AND Cefepime

21.4 Specific therapy

21.4.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin
Preferred regimen (2): Oxacillin 2 gm IV q4h
Preferred regimen (3): 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 or PO with or without Rifampin 300 mg PO or IV bid

22. Diabetic foot osteomyelitis

High risk for MRSA

Preferred regimen (1): Linezolid 600 mg IV or PO q12h
Preferred regimen (2): Daptomycin 4 mg/kg IV q24h
Preferred regimen (3): Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)

23. Necrotizing fasciitis^[28]

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 ^[29]

24.1 Methicillin sensitive Staphylococcus aureus

Preferred regimen (1): Cloxacillin 250-500 mg PO q6h (max dose: 4 g/24 hr)
Preferred regimen (2): Nafcillin 4-12 g/24 hr divided IV q4-6hr (max dose: 12 g/24 hr)
Preferred regimen (3): 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 (2): Rifampicin, AND Linezolid 600 mg IV or PO q12h
Alternative regimen (3): Daptomycin ::::* Alternative regimen (4): Tigecycline 100 mg loading dose followed by 50 mg IV q12h

24.2 Methicillin resistant Staphylococcus aureus

Preferred regimen (1): 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)
Preferred regimen (2): Linezolid 600 mg IV or PO q12h AND Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
Preferred regimen (3): Teicoplanin
Alternative regimen (1): Rifampicin, AND Linezolid 600 mg q12h IV or PO
Alternative regimen (2): Daptomycin
Alternative regimen (3): 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
Alternative regimen (2): 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^[30]

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.

Staphylococcus epidermidis Return to Top
Staphylococcus haemolyticus Return to Top

Staphylococcus, coagulase-negative species (CoNS)

Staphylococcus epidermidis group (Staphylococcus epidermidis, Staphylococcus haemolyticus)

1. Bacteremia: most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h AND Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: Site sepcific recommendation for peripheral line is to remove line, antibiotics for 5-7 days and for central line may often keep line and systemic antibiotics for 2 wks with antibiotics lock.

2. CSF shunt: meningitis

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg IV/PO q8h for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg IV/PO q8h.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: Shunt removal usually recommended but variable. Vancomycin 22.5 mg/kg IV q12h and rifampin PO/IV and possible intraventricular antibiotics: Vancomycin 20 mg/day with or without Gentamicin 4-8 mg/day is recommended.

3. Peritoneal dialysis catheter: peritonitis

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: Site sepcific recommendation is to keep dialysis catheter (at least for first effort) and IV Vancomycin (usually 2 g IV/wk and redose when level <15 mcg/mL) with antibiotics lock for 10-14 days.

4. Prosthetic joint: septic arthritis

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: Site sepcific recommendation is typically remove joint (two stage more common than single stage replacement), antibiotics for 6 wks. If very early infection (less than 3 wks post-op, debridement and retention an option).

5. Prosthetic or natural cardiac valve: endocarditis

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: Site sepcific recommendation is consider valve replacement and antibiotics for 6 wks.

6. Post-sternotomy: osteomyelitis

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

7. Implants (breast, penile, pacemaker) and other prosthetic devices: local infection

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: Site sepcific recommendation for vascular graft is to remove graft, antibiotics for 6 wks.

8. Post-ocular surgery: endophthalmitis

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

9. Surgical site infections

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: only assume Methicillin susceptible if multiple isolates are so identified.

Staphylococcus lugdunensis Return to Top

Staphylococcus lugdunensis
1. Postpartum mastitis with or without abscess ^[31]

Preferred regimen: In outpatient is Dicloxacillin 500 mg po qid OR Cephalexin 500 mg po qid and in inpatient is Oxacillin OR Nafcillin 2 gm IV q4h
Alternative regimen: In outpatient is Trimethoprim-Sulfamethoxazole-DS tabs 1-2 po bid or, if susceptible, Clindamycin 300 mg po qid and in inpatient is Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.

Note (1): Mastitis with no abscess- increase frequency of nursing may hasten response.

Note (2): Mastitis with abscess- needle aspiration reported successful. Resume breast feeding from affected breast as soon as pain allows.

2. Non-puerperal mastitis with abscess

Preferred regimen: In outpatient is Dicloxacillin 500 mg po qid OR Cephalexin 500 mg po qid and in inpatient is Oxacillin OR Nafcillin 2 gm IV q4h
Alternative regimen: In outpatient is Trimethoprim-Sulfamethoxazole-DS tabs 1-2 po bid or, if susceptible, Clindamycin 300 mg po qid and in inpatient is Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.

Note (1): If subareolar & odoriferous, most likely anaerobes; need to add Metronidazole 500 mg IV/po tid.

Note (2): If not subareolar, staph. Need pretreatment aerobic/anaerobic cultures. Surgical drainage for abscess.

Note (3):Staphylococcus lugdunensis usually susceptible to gentamicin. 75% are penicillin-susceptible.

Staphylococcus saprophyticus Return to Top

Staphylococcus saprophyticus treatment
1. Urinary tract infection ^[32]

1.1 Acute uncomplicated urinary tract infection (cystitis-urethritis) in females

Preferred regimen : Cephalosporin PO OR Amoxicillin-Clavulanate 625 mg PO OR Trimethoprim-Sulfamethoxazole-DS bid for 3 days; if sulfa allergy, Nitrofurantoin 100 mg po bid for 5 days OR Fosfomycin 3 gm po as a single dose AND Pyridium.
Alternative regimen (in sulfa allergy): then 3 days of Ciprofloxacin 250 mg bid OR Ciprofloxacin-Erythromycin 500 mg q24h OR Levofloxacin 250 mg q24h OR Moxifloxacin 400 mg q24h OR Nitrofurantoin 100 mg bid OR Fosfomycin single 3 gm dose AND Phenazopyridine Pyridium 200 mg po tid times 2 days.

Note (1): Pyridium non-prescription—may relieve dysuria. Hemolysis if G6PD deficient.

Note (2): >7-day treatment recommended in pregnancy [discontinue or do not use sulfonamides (Trimethoprim-Sulfamethoxazole) near term (2 weeks before EDC) because of potential increase in kernicterus]. If failure on 3-day course, culture and treat for 2 weeks.

1.2 Recurrent urinary tract infection in postmenopausal women

Preferred regimen : Trimethoprim-Sulfamethoxazole-DS bid for 3 days; if sulfa allergy, Nitrofurantoin 100 mg po bid for 5 days OR Fosfomycin 3 gm po as a single dose AND Pyridium.
Alternative regimen (in sulfa allergy): then 3 days of Ciprofloxacin 250 mg bid OR Ciprofloxacin-Erythromycin 500 mg q24h OR Levofloxacin 250 mg q24h OR Moxifloxacin 400 mg q24h OR Nitrofurantoin 100 mg bid OR Fosfomycin single 3 gm dose AND Phenazopyridine Pyridium 200 mg po tid times 2 days.

Note (1): Recurrent urinary tract infection definition is ≥3 culture and symptomatic urinary tract infection in 1 year or 2 urinary tract infection in 6 months. Evaluate for potentially correctable urologic factors like (1) cystocele (2) incontinence (3) increased residual urine volume (≥50 mL).

Note (2): Nitrofurantoin more effective than vaginal cream in decreasing frequency, but adverse effect is pulmonary fibrosis with long-term Nitrofurantoin treatment.

Streptobacillus moniliformis Return to Top

Streptococcus moniliformis treatment^[33]

1. Migratory arthropathy and arthritis

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

2. Diarrhea, (especially kids) liver or spleen abscess

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

3. Undifferentiated fever

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

4. Endocarditis, myocarditis, pericarditis (cardiac)

Preferred regimen: Penicillin 20 MU/day IV divided q4h. Optimal duration recommendation for infective endocarditis is 4 weeks.
Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.

5. Meningitis, brain abscess

Preferred regimen: Penicillin 20 MU/day IV divided q4h.
Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.

6. Anemia

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

7. Pneumonia

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

8. Amnionitis (pregnancy)

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

9. Renal abscess

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

Streptococcus anginosus Return to Top

Streptococcus anginosus treatment^[34]

Preferred regimen: Penicillin G 2-4 MU IV q4h .
Alternative regimen: Ceftriaxone 2 g IV qd; Clindamycin 600-900 mg IV q8h or 300-450 mg PO qid OR Vancomycin 15 mg/kg IV q12h ([[Penicillin-allergic)

Note (1): Endocarditis caused by Steptococcus anginosus module for management is follow viridans Streptococci recommendations.

Note (2): Dental abscesses,sinusitis,fasciitis of head and neck caused by Steptococcus anginosus can be life threatening and require aggressive surgical management and appropriate HEENT module for specific management.

Note (3): Bacteremia caused by Steptococcus anginosus often associated with deep-seated abscess—most often intraabdominal investigation for abscess is required.Drainage is usually recommended.

Note (4): Brain abscesses caused by Steptococcus anginosus is often polymicrobial,but S.intermedius found in 50-80%.

Note (5): Infection caused by Steptococcus anginosus is implicated in aspiration pneumonia,lung abscess and empyema.

Streptococcus pneumoniae Return to Top

Streptococcus pneumonia treatment

1. Lung (pneumonia)

Community-acquired pneumonia ^[27]

1.1 Penicillin sensitive (minimum inhibitory concentration ≤ 2)

Preferred regimen: Penicillin G 1-2 MU q6h IV OR Amoxicillin 500-1000 mg PO tid
Alternative regimen: Macrolides and Oral Cephalosporins-Cefpodoxime 200 mg PO bd, (Cefprozil 500 mg PO bd, Cefditoren 400 mg PO bd, Cefdinir 300 mg PO bd), OR parenteral Cephalosporins-Ceftriaxone 2 g IV q24h (or Cefotaxime 1-2 g IV q6-8h), Clindamycin, Doxycycline 100 mg PO bd, respiratory flouroquniolones.

1.2 Penicillin-resistant (Penicillin minimum inhibitory concentration >8)

Preferred regimen:: Ceftriaxone 2 g IV q24h (or Cefotaxime 1-2 g IV q6-8h) OR respiratory flouroquniolones Levofloxacin (Levaquin) 750 mg OR Moxifloxacin (Avelox) 400 mg IV/PO q24h,OR Doxycycline 100 mg PO bd

Alternative regimen: Vancomycin 15 mg/kg IV q12h OR Linezolid 600 mg IV/PO q12h, high-dose Amoxicillin (3 g qd with Penicillin minimum concentration of inhibitory 4 mcg/mL).

2.Endocarditis^[35]

Preferred regimen (1): Aqueous crystalline Penicillin-G 6 MU q4-6h IV for 4 weeks

Preferred regimen (2) (who are unable to tolerate beta lactams therapy): Vancomycin 15 mg/kg/day IV q12h

Preferred regimen (3) (If the isolate is resistant (MIC 2 g/mL) to cefotaxime): Cefotaxime 1-2 g q8-12h IV or IM (max dose: 12 g/24 hr) AND Vancomycin 15 mg/kg/day IV q12h AND Rifampin

Alternative regimen: Cefazolin 0.5-2 g q8h IV or IM (max dose: 12 g/24 hr) OR Ceftriaxone 2 g IV q12h

Note : S pneumoniae with intermediate doses Minimum inhibitory concentration (MIC) 0.12 g/mL–0.5 g/mL penicillin resistance (MIC 0.1 to 1.0 g/mL) or high penicillin resistance (MIC 2.0 g/mL) is being recovered from patients with bacteremia.

3. Sinuses (sinusitis)^[36]

Sinusitis (empiric therapy)

Preferred regimen: amoxicillin 500-1000 mg PO tid OR Amoxicillin/Clavulanate 875/125 mg PO bd.

4. Bronchi (acute exacerbation of chronic bronchitis)^[37]

Preferred regimen: amoxicillin 2-3 PO g/day OR Doxycycline 100 mg PO bd.

5. CNS (meningitis)^[4]

Empiric therapy

Preferred regimen: Vancomycin 15 mg/kg/day IV q12h AND a third-generation cephalosporin (Ceftriaxone 2 g IV q12h OR Cefotaxime 2 g IV q4h or 3 g q6h).
Alternative regimen: Meropenem, fluoroquinolones

Note: Middle ear infections (otitis media), peritoneum infections (spontaneous bacterial peritonitis), pericardium infections (purulent pericarditis), skin infections (cellulitis) and eye infections (conjunctivitis) caused by Streptococcus pneumonia.

Prevention

1. Pneumovax (23-valent) prevents bacteremia; impact on rates of CAP are modest or nil.
2. Prevnar vaccine for children <2 yrs age prevents invasive pneumococcal infection in adults by herd effect. Impact is impressive with rates of invasive pneumococcal infection down 80% in peds and 20-40% in adults.
3. Risk for bacteremia in splenectomy, HIV, smokers, black race, multiple myeloma, asthma.

Streptococcus pyogenes Return to Top

Streptococcus pyogenes treatment^[38]

1. Pharynx

1.1 Pharyngitis

Preferred regimen: Penicillin-benzathine]] Penicillin 1.2 mU IM once OR Penicillin VK 500 mg PO bd or tid for 10 days.
Alternative regimen (1): Amoxicillin 750 PO bd or tid for 10 days.
Alternative regimen (Penicillin allergy) (2): Erythromycin 500 mg PO bd or tid for 10 days OR (Azithromycin 500 mg, then 250 mg for 5 days, Clarithromycin (Biaxin) 1 g XR/day or 500 mg bd for 10 days. Note: 5-10% isolates are macrolide resistant) OR Cefpodoxime proxetil (Vantin) 200 mg bd for 5 days OR Cefdinir 300 mg bd PO for 5 days OR Cefadroxil 500 mg bd PO for 5 days OR Loracarbef 200 mg PO bd for 5 days.

1.2 Epiglottitis in childern

Preferred regimen: Cefotaxime 50 mg/kg IV q8h OR Ceftriaxone 50 mg/kg IV q24h
alternative regimen: Amoxicillin-SB 100–200 mg/kg qd q6h OR Trimethoprim-Sulfamethoxazole 8–12 mg Trimethoprim/kg qd div q12h

Note: Have tracheostomy set “at bedside.” Chloro is effective, but potentially less toxic alternative agents available.

2. Skin

2.1 Erysipelas, lymphangitis, cellulitis

Preferred regimen (1): Clindamycin 600 mg IV q8h AND Penicillin G G 4 mU IV q4h. (clindamycin to stop toxin production).
Preferred regimen (2) topical antimicrobials: Retapamulin (Altabax) 1% ointment 5, 10 & 15 gm bid tubes.

Note: Microbiologic success with Retapamulin (Altabax) 1% ointment in 90% S. aureus infections and 97% of S. pyogenes infections(do not use for MRSA)

Alternative regimen: Penicillin G 2-4 mU IV q4h OR Clindamycin 600 mg IV q8h OR Cefazolin 1-2 g IV q6-8h OR Cefotaxime 2-3 g IV q6-8h OR Ceftriaxone 2 g/day IV OR Vancomycin 15 mg/kg IV q12h.

2.2 Burn wound sepsis

Preferred regimen: Vancomycin 1 gm IV q12h) AND (Amikacin 10 mg/kg IV loading dose then 7.5 mg/kg IV q12h) AND [ Piperacillin 4 gm IV q4h (give ½ q24h dose of Piperacillin into subeschar tissues with surgical eschar removal within 12 hours)]. Can use Piperacillin-Tazobactam if Piperacillin not available.

Note: Erythema multiformedue to Herpes simplex type 1, mycoplasma, Streptococcus pyogenes, drugs (sulfonamides, phenytoin, penicillins)

3. Soft tissue

Note: For necrotizing fasciitis, surgical consultation for emergent fasciotomy and debridement; repeat debridements usually necessary.

4. Muscle

Note: For myositis-debirdement is recommended.

5. Toxin mediated

5.1 Toxic shock syndrome

Preferred regimen (1): Penicillin G 24 MU qd IV AND Clindamycin 900 mg IV q8h
Preferred regimen (2): Immunoglobulin-G IV 1 gm/kg day 1, then 0.5 gm/kg days 2 & 3.,massive IV fluids (10-20 L/day), Albumin if <2 g/dL, debridement of necrotic tissue
Alternative regimen: Ceftriaxone 2 gm IV q24h AND Clindamycin 900 mg IV q8h

Note (1): Surgery usually required.

Note (2): Mortality with fasciitis 30–50%, myositis 80% even with early treatment.

Note (3): Clindamycin decreases toxin production.

Note (4): Use of NSAID may predispose to TSS.

Note (5): For reasons Penicillin G may fail in fulminant Streptococcus pyogenes infections

Note (6):Immunoglobulin-G IV associated with decreased in sepsis-related organ failure. IVIG preparations vary in neutralizing antibody content.

6. Breast implant infection

Preferred regimen for acute infection: Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm q12h.

Note: Acute infection caused by Staphylococcus aureus, Sreptococcus pyogenes. Toxic shock syndrome reported.

Preferred regimen for chronic infection:

Note (1): For chronic infections look for rapidly growing Mycobacteria

Note (2): For chronic infections wait for culture results.

7. Acute mastoiditis

7.1 Outpatient treatment

7.1.1 Adult doses for sinusitis

Preferred regimen: Amoxicillin-Clavulanate-ES 2000/125 mg PO bid OR Amoxicillin HD high dose 1 gm PO tid OR Clarithromycin 500 mg PO bid or Clarithromycin ext. release 1 gm PO q24h OR Doxycycline 100 mg PO bid, respiratory Fluoroquinolones (Gatifloxacin 400 mg PO q24h (not available in USA) due to hypo/hyperglycemia OR Gemifloxacin 320 mg PO q24h (not FDA indication but should work) OR Levofloxacin 750 mg PO q24h for 5 days OR Moxifloxacin 400 mg PO q24h) OR Cephalosporins (Cefdinir 300 mg PO q12h or 600 mg PO q24h OR Cefpodoxime 200 mg PO bid OR Cefprozil 250–500 mg PO bid OR Cefuroxime 250 mg PO bid), OR Trimethoprim-Sulfamethoxazole 1 double-strength (Trimethoprim 160 mg PO) bid (results after 3- and 10-day treatment similar).

7.1.2 Pediatric doses for sinusitis

Preferred regimen: Amoxicillin HD high dose 90 mg/kg PO q8h or q12h OR Amoxicillin-Clavulanate-ES (extra strength) pediatric susp 90 mg Amoxicillin/kg/day PO qd q12h OR Azithromycin 10 mg/kg PO qd, then 5 mg/kg PO qd 3 days OR Clarithromycin 15 mg/kg PO qd q12h OR Cefpodoxime 10 mg/kg PO qd (max. 400 mg) q12–24h OR Cefuroxime axetil 30 mg/kg PO qd q12h OR Cefdinir 14 mg/kg PO qd q24h or bid OR Trimethoprim-Sulfamethoxazole 8–12 mg Trimethoprim/40–60 mg Sulfamethoxazole/kg PO qd q12h

Note: need Vancomycin OR Nafcillin/Oxacillin if culture positive for Staphylococcus aureus.

7.2 Hospitalized treatment

Preferred regimen: Cefotaxime 1–2 gm IV q4–8h (depends on severity) OR Ceftriaxone 1 gm IV q24h)

8. Eye

8.1 Keratitis

8.1.1 Acute bacterial keratitis

Preferred regimen: Moxifloxacin eye gtts. 1 gtt tid for 7 days
Alternative therapy: Gatifloxacin eye gtts. 1-2 gtts q2h while awake for 2 days, then q4h for 3-7 days.

Note: Prefer Moxifloxacin due to enhanced lipophilicity and penetration into aqueous humor (1 gtt = 1 drop).

8.1.2 Keratitis due to dry cornea, diabetes, immunosuppression

Preferred regimen: Cefazolin (50 mg/mL) AND (Gentamicin OR Tobramycin (14 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction)
Alternative therapy: Vancomycin (50 mg/mL) AND Ceftazidime (50 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction.

Note: Specific therapy guided by results of alginate swab culture and sensitivity. Ciprofloxacin 0.3% found clinically equivalent to CefazolinAND Tobramycin; only concern was efficacy of Ciprofloxacin vs S. pneumoniae

8.2 Dacryocystitis (lacrimal sac)

Preferred regimen: Moxifloxacin eye gtts. 1 gtt tid for 7 days OR Cefazolin (50 mg/mL) (1 gtt = 1 drop)

9. Suppurative phlebitis

Preferred regimen: Vancomycin 15 mg/kg IV q12h (normal weight):::* Alternative regimen: Daptomycin 6 mg/kg IV q12h:::: Note: Retrospective study for suppurative phlebitis recommends 2-3 weeks IV therapy and 2 weeks PO therapy.

10. Infected prosthetic joint

Preferred regimen: Penicillin G 2 MU IV q4h OR Ceftriaxone 2 gm IV q24h for 4 wks.

Note: Debridement & prosthesis retention with intravenous antibiotics.

11. “Hot” tender parotid swelling

Preferred regimen: Nafcillin OR Oxacillin 2 gm IV q4h

Note: Predisposing factors are stone(s) in Stensen’s duct, dehydration. Therapy depends on ID of specific etiologic organism.

12. Diabetic foot ulcer (ulcer with <2 cm of superficial inflammation)

Preferred regimen: (Trimethoprim-Sulfamethoxazole-DS 1-2 tabs PO bid OR Minocycline 100 mg PO bid) AND ([[Penicillin VK 500 mg PO qidOR selected Cephalosporins 2, 3 generation - cefprozil 500 mg PO q12h OR cefuroxime axetil 500 mg PO q12h OR cefdinir 300 mg PO q12h or 600 mg PO q24h OR cefpodoxime 200 mgPO q12h OR Fluoroquinolones Levo 750 mg po q24h).

Note (1): Common infections are bacterial pharyngitis and cellulitis. Rare but devastating are toxic shock syndrome, necrotizing fasciitis.

Note (2): Diagnosis recovery from normally sterile site, ASO antibody response (rheumatic fever),anti-DNAase B (pyoderma). Supportive are positive throat culture or rapid strep antigen test.

Note (3): Cellulitis is very hard to detect Group A streptococcus by culture (needle aspiration or blood culture).

Note (4): Ecologic niche is pharynx. 2-3% of adults colonized, 15-20% school children. Virulence depends on proteins that represent toxins, mimic host macromolecules and after immune responses.

Note (5): Predisposing factors: soft tissue (IDU, diabetes, surgery, trauma, varicella, vein donor, lymphedema); pneumonia (influenza), contacts w/ gas (pharyngitis and fasciitis).

Note (6): Mastoiditis has become a rare entity, presumably as result of the aggressive treatment of acute otitis media.

Streptococcus pyogenes prophylaxis

1. Acute rheumatic fever prophylaxis

Preferred regimen: Benzathine Penicillin 1.2 mu IM q mo, Penicillin V 250 mg PO bd, Erythromycin 250 mg PO bd until >5 yrs post-acute rheumatic fever and age in 20years.

2. Recurrent cellulitis, chronic lymphedema prophylaxis

Preferred regimen: Clindamycin 150 mg PO qd OR Trimethoprim-Sulfamethoxaole 1 DS PO qd OR “stand-by therapy” immediate treatment with Penicillin V OR Amoxicillin 500-750 mg PO bd at onset of symptoms.

Streptococcus agalactiae Return to Top

Streptococcus agalactiae treatment ^[39]

1. Bacteremia, soft tissue infections

Preferred regimen: Penicillin G 10-12 MU/day for 10 days [e.g., give 2 MU q4h or six divided doses/day].

2. Meningitis (Adult)

Preferred regimen: Penicillin G 20-24 MU/day for 14-21 days.

3. Osteomyelitis

Preferred regimen: Penicillin G 10-20 MU/d for 21-28 days.

4. Endocarditis

Preferred regimen: Penicillin G 20-24 MU/day for 4-6 wks AND Gentamicin 1 mg/kg q8h for first 2 wks.

Note (1):Gentamicin 1 mg/kg q8h IV additionally for any serious group B Streptococcus infection.

Note (2): Penicillin allergic may substitute Vancomycin 15 mg/kg IV q12h for Penicillin.

Note (3): Clindamycin can be considered, but rates of resistance vary. Consider confirming absence of inducible Clindamycin resistance (typically associated with macrolide resistance) before using as monotherapy.

Note (4): Streptococcus agalactiae causes neonatal sepsis or meningitis, puerperal sepsis, chorioamnionitis; also bacteremia (often without clear source), skin and soft-tissue infections, septic arthritis. Found in gastrointestinal,genitourinary tracts. More common in adults >65 years and those with comorbidities.

↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)
↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
↑ ^4.0 ^4.1 ^4.2 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ 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)
↑ ^23.0 ^23.1 ^23.2 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.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ ^27.0 ^27.1 Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
↑ 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.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

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

[Baddour-2005-2] Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)

[3] "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".

[pmid15494903-4] 4.0 ^4.1 ^4.2 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.

[5] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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

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

[8] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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

[pmid19489710-10] 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.

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

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

[13] 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.

[14] 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.

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

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

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

[18] 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.

[19] 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.

[20] 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.

[21] 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.

[22] 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)

[pmid20034345-23] 23.0 ^23.1 ^23.2 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.

[pmid23540878-24] 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.

[pmid20627931-25] 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.

[26] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid17278083-27] 27.0 ^27.1 Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.

[pmid24947530-28] 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.

[pmid19393958-29] 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.

[pmid22070836-30] 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.

[31] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[32] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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

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

[pmid15956145-35] Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.

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

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

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

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

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

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@@ Line 1: / Line 1: @@
-{{ID2}}
 ====Bacteria – Gram-Positive Cocci====
   {{PBI|Enterococcus faecalis}}
@@ Line 91: / Line 89: @@
 ::::*Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g/day IV for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU/day IV for 4–6 weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 4–6 weeks
 ::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks ::::*Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-::::*Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
-::::*Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
+::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
+::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
+::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
 :::*2.1.2 '''Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin'''
 ::::* Preferred regimen: ([[Ampicillin]] 12 g/day IV for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU/day IV q24h for 4–6 weeks) {{and}}[[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks
@@ Line 104: / Line 104: @@
 :::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
 :::*2.1.4 '''Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin'''
-::::*Preferred regimen(1): [[Linezolid]] 1200 mg IV/PO q24h ≥8 weeks
+::::* Preferred regimen(1): [[Linezolid]] 1200 mg IV/PO q24h ≥8 weeks
-::::*Preferred regimen(2): [[Quinupristin]]-[[Dalfopristin]] 22.5 mg/kg IV q24h ≥ 8 weeks
+::::* Preferred regimen(2): [[Quinupristin]]-[[Dalfopristin]] 22.5 mg/kg IV q24h ≥ 8 weeks
 ::*2.2 '''Endocarditis in Pediatrics'''
 :::*2.2.1 '''Strains Susceptible to Penicillin, Gentamicin, and Vancomycin'''
@@ Line 843: / Line 843: @@
 :::: Note (3): [[Clindamycin]] can be considered, but rates of resistance vary. Consider confirming absence of inducible [[Clindamycin]] resistance (typically associated with macrolide resistance) before using as monotherapy.
 :::: Note (4): Streptococcus agalactiae causes neonatal sepsis or meningitis, puerperal sepsis, chorioamnionitis; also bacteremia (often without clear source), skin and soft-tissue infections, septic arthritis. Found in gastrointestinal,genitourinary tracts. More common in adults >65 years and those with comorbidities.
-====Bacteria – Gram-Positive Bacilli====
-{{PBI|Actinomyces israelii}}
-:* Actinomyces israelii treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Penicillin G]] 6 MU q4-6h IV or IM {{or}} [[Ampicillin]] 250-500 mg q4-8h IV or IM / [[Amoxicillin]] 250-500 mg q8-12h PO {{or}} antipseudomonal [[Penicillin]] {{or}}  most [[Cephalosporins]] {{or}} [[Macrolides]] {{or}} [[Tetracycline]] {{or}} [[Imipenem]] {{or}} [[Clindamycin]]
-{{PBI|Arcanobacterium haemolyticum}}
-:* Arcanobacterium haemolyticum treatment
-::* Preferred regimen: [[Erythromycin]] Base: 333 mg PO q8h; estolate/stearate/base: 250-500 mg q6h PO
-::* Alternative regimen: [[Benzathine Penicillin G]] 1.2 MU IM q3-4 weeks
-::: Note: Arcanobacterium haemolyticum is sensitivity to most drugs but resistent to [[Trimethoprim]]-[[Sulfamethoxazole]]
-{{PBI|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
-{{PBI|Bacillus cereus}}
-:* [[Bacillus cereus]]
-::*Bacillus cereus treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* 1. '''Food poisoning'''
-::::* Preferred treatment: Food poisoning is self-limited, no antibiotics necessary. Treatment is Supportive therapy, hydration, and anti-emetics. Prevention is by fried/boiled rice should be maintained >60° C or rapidly cooled <8 ° C to avoid room temperature germination of spores and toxin.
-::::: Note (1): Bacillus cereus with two forms.(a) Emetic phase: 1-6 hrs after ingestion contaminated usually starchy food, e.g., fried rice. (b) Diarrheal phase: 10-12 hrs after eating e.g. tainted meats, milk, vegetables, etc. with watery diarrhea, tenesmus lasting <2-10 days.
-:::* 2. '''Bacteremia'''
-::::* Preferred regimen:  [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
-::::: Note (1): Bacillus cereus often resistant to beta-lactams.
-::::: Note (2): Uncommon, may complicate mixed infections including surgical wounds or infected necrotic tumors.
-::::: Note (3): Source of pseudobacteremia is contaminated blood cultures, gloves, syringes, etc. Often transient bacteremia of no significance in intravenous drug user population.
-:::* 3. '''Meningitis, brain abscess'''
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
-::::: Note (1): Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.
-::::: Note(2):  Uncommon presentations, may complicate otitis, mastoiditis, neurosurgical procedures, and shunts.
-:::* 4. '''Endophthalmitis'''
-::::* Preferred regimen: [[Clindamycin]] 450 mcg intravitreal {{and}} [[Gentamicin]] 400 mcg intravitreal {{or}} [[Dexamethasone]] intravitreal {{and}} [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
-::::: Note (1): Prognosis for sight retention poor.
-::::: Note (2): Rapid, massive destruction of vitreous/retina in intravenous drug user or posttraumatic with ringabscess within 48 hrs. Pathognomic Bacillus cereus panophthalmitis.
-::::: Note (3): Early ophthalmological consultation, culture ocular fluids. Early vitrectomy and intravitreal antibiotics is advocated.
-::::: Note (4): Ocular infections devastating and require quick intervention.
-::::: Note (5): primary pathogen of post-traumatic , risk factor also intravenous drug use. May also cause keratitis, orbital abscess, conjunctivitis, dacryocystitis.
-:::* 5. '''Endocarditis'''
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::: Note (1):  Well-described but rare complication seen in intravenous drug user . Most blood cultures in intravenous drug user positive for bacillus are contaminates or represent transient bacteremia.
-::::: Note (2): Evidence of valvular involvement should be sought by echocardiography to prove endocarditis. Tricuspid valve involvement most common. Course indolent.
-::::: Note (3): Tricuspid valve endocarditis mostly indolent in nature.
-:::* 6. ''' Soft tissue'''
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
-::::: note:  rare reports of fasciitis.
-:::* 7. '''Pneumonia'''
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
-::::: Note: rare pathogen of compromised host. May mimic Bacillus anthracis-type presentation.
-----
-{{PBI|Bacillus subtilis}}
-:* Bacillus subtilis infection treatment<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>{{Cite journal| issn = 0305-7453| volume = 49| issue = 6| pages = 1040–1042| last1 = Andrews| first1 = J. M.| last2 = Wise| first2 = R.| title = Susceptibility testing of Bacillus species| journal = The Journal of Antimicrobial Chemotherapy| date = 2002-06| pmid = 12039902}}</ref>
-::* 1. Food poisoning
-:::* Preferred regimen: supportive treatment
-::* 2. Other infections
-:::* Preferred regimen: [[Vancomycin]] {{or}} [[Clindamycin]]
-:::* Alternative regimen: [[Ciprofloxacin]] {{or}} [[Imipenem]]
-:::* Note: Distinguish clinically significant infection from contamination before administering antibiotics.
-----
-{{PBI|Clostridium botulinum}}
-*'''1.Antitoxin''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:* Preferred regimen: Trivalent antitoxin (A 7,500 IU, B 5,000 IU, and E 5,000 IU) 1 vial diluted 1:10, IV infusion over 30 min
-:* Alternative regimen: Equine antitoxin
-*'''2.General Therapy'''
-:* Preferred regimen: Mechanical ventilation; IV hydration; tube feedings
-{{PBI|Clostridium difficile}}
-{{PBI|Clostridium perfringens}}
-:* Clostridium perfringens <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* Preferred regimen: [[Penicillin G]] {{withorwithout}} [[Clindamycin]]
-::* Alternative regimen: [[Doxycycline]]
-{{PBI|Clostridium tetani}}
-:* 1. '''General measures''' <ref name=World Health Organization>{{cite web | title = Current recommendations for treatment of tetanus during humanitarian emergencies| url =http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/ }}</ref>
-::* Preferred regimen: Patients should be placed in a quiet shaded area and protected from tactile and auditory stimulation as much as possible; All wounds should be cleaned and debrided as indicated
-:* 2. '''Immunotherapy'''
-::* Preferred regimen: Human TIG 500 units by intramuscular injection or intravenously as soon as possible {{and}} Age-appropriate TT-containing vaccine, 0.5 cc by intramuscular injection at a separate site
-::* NOTE: patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6–12 months later
-:* 3. '''Antibiotic treatment'''
-::* Preferred regimen: [[Metronidazole]] 500 mg intravenously or orally every six hours {{or}} [[Penicillin G]] 100,000–200,000 IU/kg/day intravenously, given in 2–4 divided doses
-::* Alternative regimen: [[Tetracyclines]] {{or}} [[Macrolides]] {{or}} [[Clindamycin]] {{or}} [[Cephalosporins]] {{or}} [[Chloramphenicol]]
-:* 4. '''Muscle spasm control'''
-::* Preferred regimen: [[Diazepam]] 5 mg intravenous {{or}} [[Lorazepam]] 2 mg titrating to achieve spasm control without excessive sedation and hypoventilation
-::* Alternative regimen (1): [[Magnesium]] sulphate 5 gm (or 75mg/kg) intravenous loading dose, then 2–3 grams per hour until spasm control is achieved {{withorwithout}} [[Benzodiazepines]]
-::* NOTE: Monitor patellar reflex as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range (4mmol/L). If areflexia develops, dose should be decreased
-::* Alternative regimen (2): [[Baclofen]] {{or}} [[Dantrolene]] 1–2 mg/kg intravenous/orally every 4 hours
-::* Alternative regimen (3): [[Barbiturates]] 100–150 mg every 1–4 hours by any route
-::* Alternative regimen (4): [[Chlorpromazine]] 50–150 mg by intramuscular injection every 4–8 hours
-::* Pediatric regimen: [[Lorazepam]] 0.1–0.2 mg/kg every 2–6 hours, titrating upward as needed; [[Barbiturates]] 6–10 mg/kg in children by any route; [[Chlorpromazine]] 4–12 mg every by intramuscular injection every 4–8 hours
-::* NOTE: As for [[Benzodiazepines]], large amounts may be required (up to 600 mg/day); Oral preparations could be used but must be accompanied by careful monitoring to avoid respiratory depression or arrest
-:* 5. '''Autonomic dysfunction control'''
-::* Preferred regimen: [[Magnesium]] sulphate {{or}} [[Morphine]] {{or}} [[Esmolol]]
-{{PBI|Corynebacterium diphtheriae}}
-:*'''1.Diphtheria treatment'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*'''1.1 Antitoxin '''
-:::* Preferred regimen: 20,000-40,000 U pharyngeal disease <48 hrs; 40-60,000 U nasopharyngeal; 80-120,000 U for extensive disease, brawny neck or sx >72 hrs; Adiminister IV (severe disease) or IM
-::*'''1.2 Antibiotics: '''
-:::* Preferred regimen: [[Penicillin G procaine|Procaine Penicillin G]] (<20 lbs: 300,000 U; >20 lbs: 600,000 U) IM q12h until patient can swallow then [[Penicillin VK]] 125-250 mg PO QID {{or}} [[Erythromycin]] 125-500 mg PO QID for 14 days total.
-:::* Alternative regimen (1): [[Erythromycin]] 20-25mg/kg IV q6h (max 4g/day; β-lactam allergic patients)
-:::* Alternative regimen (2): [[Clindamycin]] 600 mg IV q8h
-:*'''2.C. diphtheriae carrier'''
-::* Preferred regimen: [[Erythromycin]] 250-500 mg PO QID
-::* Alternative regimen: [[Penicillin G benzathine|Benzathine Penicillin G]] 600,000-1,200,000 units IM single dose
-:*'''3.Endocarditis treatment'''
-::* Preferred regimen: [[Penicillin G]] {{or}} [[Ampicillin]] IV for 4-6 weeks {{withorwithout}} [[Aminoglycoside]]
-{{PBI|Corynebacterium jeikeium}}
-:*Corynebacterium jeikeium<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen : [[Vancomycin]] 1gm IV q12h
-::*Alternative regimen : [[Penicillin G]] {{and}} Antipseudomonal aminoglycosides like [[Tobramycin]], [[Gentamicin]], [[Amikacin]]
-{{PBI|Corynebacterium urealyticum}}
-:*Corynebacterium urealyticum<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen : [[Vancomycin]] 1gm IV q12h {{or}} [[Teicoplanin]] 6mg/kg/day IV q24h
-{{PBI|Coxiella burnetii}}
-* '''Q fever''' <ref>{{cite web | title =q fever | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm   }}</ref>
-:*1.'''Acute Q fever'''
-::*1.1 Adults
-:::* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for 14 days
-::*1.2 Children
-:::*1.2.1 Children with age  ≥8 years:
-::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 14 days (maximum 100 mg per dose)
-:::*1.2.2 Children with age <8 years with high risk criteria
-::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)
-:::*1.2.3 Children with age <8 years with mild or uncomplicated illness
-::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 5 days (maximum 100 mg per dose). If patient remains febrile past 5 days of treatment: [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg bid for 14 days (maximum: 800 mg per dose)
-::*1.3 Pregnant women
-:::* Preferred regimen: [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg  PO bid a day throughout pregnancy
-:*2. '''Chronic Q fever'''
-::*2.1 '''Endocarditis or vascular infection'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid  for ≥18 months
-:::* Note: childern and pregnant women- consultation  Recommended
-::*2.2 '''Noncardiac organ disease'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid
-:::* Note: childern and pregnant women- consultation  Recommended
-::*2.3 ''' Postpartumwith serologic profile for chronic Q fever'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid for 12 months
-:::* Note: Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
-:::* Note:Post-Q fever fatigue syndrome- no current recommendation
-{{PBI|Ehrlichia}}
-:*1. [[Ehrlichiosis|Human Monocytic Ehrlichiosis]] or [[Human Granulocytic Anaplasmosis]] (adult) <ref name=CDC centers for the disease control and prevention>{{cite web | title =Ehrlichiosis CDC centers for the disease control and prevention| url= http://www.cdc.gov/ehrlichiosis/symptoms/index.html#treatment }}</ref> <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Doxycycline]] 100 mg PO/IV q12h for 7-14 days
-::* NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
-::* Alternative regimen: [[Chloramphenicol]] 500mg QID {{or}} [[Rifampin]] 600 mg PO/IV daily for 7-10 days
-:*2. [[Ehrlichiosis|Human Monocytic Ehrlichiosis]] or [[Human Granulocytic Anaplasmosis]] (pediatric)
-::*2.1 ≥8 years old
-:::* Preferred regimen: [[Doxycycline]] 2 mg/kg IV/PO q12h (max 200 mg/day) for 10 days
-::*2.2 <8 years old without Lyme disease
-:::* Preferred regimen: [[Doxycycline]] 2 mg/kg IV/PO q12h (max 200 mg/day) for 4-5 days (or 3 days after resolution of fever)
-::*2.3 co-infected with Lyme disease
-:::* Preferred regimen: At the conclusion of [[Doxycycline]] then give [[Amoxicillin]] 50 mg/kg in 3 divided doses (max 500 mg/dose) {{or}} [[Cefuroxime]] 30 mg/kg in 2 divided doses (max 500 mg/dose) for 14 days
-{{PBI|Erysipelothrix rhusiopathiae}}
-:*1. Erysipeloid of Rosenbach (localized cutaneous infection)<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): [[Penicillin G benzathine]] 1.2 MU IV as a single dose
-::* Preferred regimen (2): [[Penicillin VK]] 250 mg PO qid for 5-7 days
-::* Preferred regimen (3): [[Procaine penicillin]] 0.6-1.2 MU IM qd for 5-7 days
-::* Alternative regimen (1): [[Erythromycin]] 250 mg PO qid for 5-7 days
-::* Alternative regimen (2): [[Doxycycline]] 100 mg PO bid for 5-7 days
-:*2. Diffuse cutaneous infection
-::* Preferred regimen: As for localized infection
-::: Note: Assess for endocarditis
-:*3. Bacteremia or endocarditis
-::* Preferred regimen: [[Penicillin G benzathine]] 2-4 MU IV q4h for 4-6 weeks
-::* Alternative regimen (1): [[Ceftriaxone]] 2 g IV q24h for 4-6 weeks
-::* Alternative regimen (2): [[Imipenem]] 500 mg IV q6h for 4-6 weeks
-::* Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV q12h for 4-6 weeks
-::* Alternative regimen (4): [[Daptomycin]] 6 mg/kg IV q24h for 4-6 weeks
-::: Note: Recommended duration of therapy for endocarditis is 4 to 6 weeks, although shorter courses consisting of 2 weeks of intravenous therapy followed by 2 to 4 weeks of oral therapy have been successful.
-{{PBI|Listeria monocytogenes}}
-:*1. Meningitis <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for more than 3 weeks
-::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for more than 3 weeks
-:*2. Bacteremia
-::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 2 weeks
-::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 2 weeks
-:*3. Brain abscess or rhomboencephalitis
-::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 4-6 weeks
-::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 4-6 weeks
-:*4. Gastroenteritis
-::* Preferred regimen: [[Amoxicillin]] {{or}} [[TMP-SMX]] for 7 days
-{{PBI|Lactobacillus}}
-:*1. Endovascular Infection <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regiemn (1): [[Penicillin G]] 20 Million units/day for 6 weeks
-::* Preferred regiemn (2): [[Gentamicin]] 1.3 mg/kg IV q8h (trough <1.5 mg/L) {{and}} [[Polychlorinated naphthalene]]
-:*2. Odontogenic Infection
-::* Preferred regiemn: [[Clindamycin]] 450 mg PO q6h
-:*3. Intrabdominal Abscess
-::* Preferred regiemn: [[Clindamycin]] 450 mg PO q6h
-{{PBI|Leuconostoc}}
-:* Preferred regimen: [[Penicillin G]] {{or}} [[Ampicillin]]
-:* Alternative regimen: [[Clindamycin]] {{or}} [[Erythromycin]] {{or}}  [[Minocycline]]
-{{PBI|Nocardia}}
-:*1. Sulfonamide-based therapies <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1.1 Pulmonary
-:::* Preferred regimen: [[TMP-SMX]] 10 mg/kg/day (TMP) in 2-4 doses IV for 3-6 weeks, then PO (2 DS BID) for >5 months
-::*1.2 Pulmonary alternatives
-:::* Preferred regimen: [[Sulfisoxazole]] {{or}} [[Sulfadiazine]] {{or}} Trisulfapyrimidine 3-6 g/day PO 2- 4 doses {{or}} [[TMP-SMX]] 2 DS twice daily up to 2 DS TID
-::*1.3 CNS (AIDS, severe or disseminated disease)
-:::* Preferred regimen: [[TMP-SMX]] 15 mg/kg/day (TMP) IV for 3-6 weeks, then PO (3 DS BID) for 6-12 months
-::*1.4 CNS alternatives
-:::* Preferred regimen: [[Imipenem]] 1000 mg IV q8h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2-3 g IV q6h {{and}} [[Amikacin]]
-::*1.5 Severe disease, compromised host, multiple sites
-:::* Preferred regimen: [[TMP-SMX]] IV (above doses) {{and}} [[Amikacin]] 7.5 mg/kg q12h (adjust per levels) {{or}} [[Sulfonamide]] PO 6-12 m/day
-::*1.6 Sporotrichoid (cutaneous)
-:::* Preferred regimen: [[TMP-SMX]] 1 DS BID for 4-6 months
-::* NOTE(1): Immunocompetent medicine use for 6 months; Immunosuppressed medicine for 12 months
-::* NOTE(2): Treat based on host, site of disease and in vitro activity; Sulfonamide usually preferred, must treat for 6-12 months; Preferred drugs for resistant strains are [[Amikacin]] and/or [[Imipenem]]
-::* NOTE(3): Seriously ill usually treated with IV [[Imipenem]] or [[Sulfonamide]] or [[Cefotaxime]] all potentially combined with [[Amikacin]]; less seriously ill treated with oral agents— especially [[TMP-SMX]] or [[Minocycline]]
-:*2. Sulfonamide alternatives
-::*2.1 Severe
-:::* Preferred regimen(1): (AIDS) ([[Imipenem]] 1000mg IV q8h {{or}} [[Meropenem]] (CNS) 2g q8h) {{and}} [[Amikacin]] 7.5 mg/kg q12h IV
-:::* Preferred regimen(2): [[Cefotaxime]] 2-3g q6-8h {{or}} [[Ceftriaxone]] 2 g/day IV {{withorwithout}} [[Amikacin]]
-::*2.2 Mild
-:::* Preferred regimen: [[Minocycline]] 100 mg BID for > 6 months (initial treatment of local disease or maintenance)
-:::* Alternative regimen: [[Amoxicillin]]/[[Clavulanate]] 875/125 mg BID {{or}} [[Doxycycline]] {{or}} [[Erythromycin]] {{or}} [[Clarithromycin]] {{or}} [[Linezolid]] {{or}} [[Fluoroquinolone]] {{or}} combinations for >6 months
-{{PBI|Propionibacterium acnes}}
-:*1. Systemic infection<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Penicillin G]] 2 MU IV q4h for 2-4 weeks
-::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h for 2-4 weeks {{or}} [[Vancomycin]] 15 mg/kg IV q12h for 2-4 weeks
-:*2. Shoulder prosthesis infection
-::* Preferred regimen: [[Amoxicillin]] {{and}} [[Rifampin]] for 3-6 months
-:*3. Acne vulgaris
-::*3.1 Topical antibiotics: [[Erythromycin]] {{or}} [[Clindamycin]]
-::*3.2 Systemic antibiotics: [[Minocycline]] {{or}} [[Doxycycline]] {{or}} [[Trimethoprim-Sulfamethoxazole]]
-{{PBI|Rhodococcus equi}}
-:* Rhodococcus equi <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1. Preferred regimen:
-:::*1.1 First line: [[vancomycin]] 1 g IV q12h (15 mg/kg q12 for >70 kg) {{or}} [[Imipenem]] 500 mg IV q6h {{and}} [[Rifampin]] 600 mg PO once daily {{or}} [[Ciprofloxacin]] 750 mg PO twice daily {{or}} [[Erythromycin]] 500 mg PO four times a day for at least 4 weeks or until infiltrate disappears (at least 8 weeks in immunocompromised patients)
-:::*1.2 Oral/maintenance therapy (after infiltrate clears): [[Ciprofloxacin]] 750 mg PO twice daily {{or}} [[Erythromycin]] 500 mg PO four times a day
-::*2. Alternative regimen: [[Azithromycin]] {{or}} [[TMP-SMX]] {{or}} [[Chloramphenicol]] {{or}} [[Clindamycin]]
-::* NOTE: Avoid Penicillins/Cephalosporins due to development of resistance; Linezolid effective in vitro, but no clinical reports of use
-{{PBI|Rickettsia prowazekii}}
-{{PBI|Rickettsia rickettsii}}
-:* ''Rickettsia rickettsii'' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Doxycycline]] 200 mg load (severe disease) and then 100 mg PO/IV BID for 3-7 days after defervescence
-::* Alternative regimen: [[Chloramphenicol]] 500 mg PO QID for 3-7 days after defervescence
-::* Pediatric regimen: [[Doxycycline]] 2-4 mg/kg/day (up to 200 mg/day) q12h {{or}} [[Tetracycline]] 25-50 mg/kg/day PO in 4 divided doses {{or}} [[Chloramphenicol]] 50-75 mg/kg/day PO in 4 divided doses
-{{PBI|Rickettsia typhi}}
-====Bacteria – Gram-Negative Cocci and Coccobacilli====
-{{PBI|Aggregatibacter aphrophilus}}
-{{PBI|Bordetella pertussis}}
-{{PBI|Brucella}}
-*'''Brucellosis ''' <ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>, <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-:* 1.'''Uncomplicated brucellosis in adults and children ≥8yrs of age  '''<ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>, <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Preferred regimen: [[Doxycycline]] 100 mg  PO bid for 6 weeks {{and}} [[Streptomycin]] 1 g/day IM  for  2-3 weeks
-::* Alternative regimen (1): [[Doxycycline]] 100 mg/day PO for six weeks {{and}}[[Gentamicin]] 5mg/kg IM  for 7-days
-::* Alternative regimen (2): [[Gentamicin]] 5mg/kg/dayIV/ IM  for 7-10 days  {{and}} [[Rifampicin]] 600–900 mg/day PO for six weeks
-:*2.'''Complications of brucellosis'''
-::*2.1Spondylitis
-:::*Preferred regimen:[[ Doxycycline]] for 3 months  {{and}} [[Streptomycin]] for 2 to 3 weeks.
-::*2.2  Neurobrucellosis
-:::* Preferred regimen: [[Ceftriaxone]] 2 mg IV bid for 1 month {{and}} Doxycycline 100 mg PO bid for 4-5 month {{and}} [[Rifampicin]] 600–900 mg/day PO for  4-5 month
-::*2.3 Brucella endocarditis
-:::* Preferred regimen: [[Doxycycline]] {{and}} an [[Aminoglycoside]] for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
-:::* Note: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
-:*3. '''Pregnancy'''
-::* Preferred regimen:[[Rifampin]] 900 mg PO qd  for 6 weeks
-::* Note: Adding [[Trimethoprim-sulfamethoxazole]] can be considered, but this option should probably be avoided preceding the 13th week and after the 36th week of gestation because of concern about teratogenicity and kernicterus.
-:* 4.'''For children < 8 yrs of age'''
-::* Preferred regimen (1): [[TMP/SMZ]] 8/40 mg/ kg/day bid PO  for 6 weeks {{and}} [[Streptomycin]] 30 mg/kg/day IM qd  for 3 weeks
-::* Preferred regimen (2): [[Gentamicin]] 5 mg/kg/day IM/ IV qd  for 7-10 days
-::* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day PO for 6 weeks
-::* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
-{{PBI|Eikenella corrodens}}
-:*1. '''Human bite/soft tissue infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1.1 Severe
-:::* Preferred regimen: [[Ampicillin]]/[[Sulbactam]] 1.5-3 g IV q6h
-:::* Alternative regimen: [[Doxycycline]] 100 mg IV BID {{or}} [[Moxifloxacin]] 400 mg IV OD {{or}} [[Levofloxacin]] 500 mg IV OD
-::*1.2 Mild
-:::* Preferred regimen: [[Amoxicillin]]/[[Clavulanate]] 250-500 mg TID or 875/125 mg PO BID
-:::* Alternative regimen: [[Doxycycline]] 100 mg PO BID {{or}} [[Moxifloxacin]] 400 mg PO OD {{or}} [[Levofloxacin]] 500 mg PO OD
-:*2. '''Head and neck infections '''
-::*2.1 Severe
-:::* Preferred regimen: [[Ampicillin]]/[[Sulbactam]] 1.5-3 g IV q6h
-:::* Alternative regimen: [[Doxycycline]] 100 mg IV BID {{or}} [[Moxifloxacin]] 400 mg IV OD {{or}} [[Levofloxacin]] 500 mg IV OD
-::*2.2 Mild
-:::* Preferred regimen: [[Amoxicillin]]/[[Clavulanate]] 250-500 mg TID or 875/125 mg PO BID
-:::* Alternative regimen: [[Doxycycline]] 100 mg PO BID {{or}} [[Moxifloxacin]] 400 mg PO OD {{or}} [[Levofloxacin]] 500 mg PO OD
-:*3. '''Endocarditis'''
-::* Preferred regimen: [[Ceftriaxone]] 1g IV q12h {{or}} [[Cefotaxime]] 1-2 g IV q8h {{or}} [[Cefepime]] 1-2g IV q8h
-----
-{{PBI|Haemophilus ducreyi}}
-* 1. '''Chancroid (Haemophlius ducreyi infection)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:* Preferred Regimen(1): [[Azithromycin]] 1 g PO in a single dose
-:* Preferred Regimen(2): [[Ceftriaxone]] 250 mg IM in a single dose
-:* Preferred Regimen(3): [[Ciprofloxacin]] 500 mg PO bid for 3 days
-:* Preferred Regimen(4): [[Erythromycin]] base 500 mg PO tid for 7 days
-:* Note: Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.
-::* 1.1 '''Follow-up'''
-:::* Patients should be re-examined 3–7 days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within 3 days and objectively within 7 days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial.
-:::* Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy. Although needle aspiration of buboes is a simpler procedure, incision and drainage might be preferred because of reduced need for subsequent drainage procedures.
-::* 1.2 '''Management of sex partners'''
-:::* 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.
-::* 1.3 '''Pregnancy'''
-:::* Ciprofloxacin presents a low risk to the fetus during pregnancy, with a potential for toxicity during breastfeeding. Alternative drugs should be used during pregnancy and lactation
-::* 1.4 '''HIV Infection'''
-:::* Persons with HIV infection who have chancroid should be monitored closely because they are more likely to experience treatment failure and to have ulcers that heal slowly. Persons with HIV infection might require repeated or longer courses of therapy, and treatment failures can occur with any regimen.
-----
-{{PBI|Haemophilus influenzae}}
-*Haemophilus influenzae<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:*'''1.Non-threatening infections'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::1.1.Adults
-:::*Preferred regimen (1) : [[Amoxicillin-clavulanate]] 500mg PO tid or 875mg PO bid.
-:::*Preferred regimen (2) : [[Amoxicillin]] 500mg PO tid.
-:::*Preferred regimen (3) : [[TMP-SMX]] DS PO bid.
-:::*Preferred regimen (4) : [[Cefuroxime]] 250-500mg PO bid.
-:::*Preferred regimen (5) : [[Moxifloxacin]] 400mg PO OD,
-:::*Preferred regimen (6) : [[Levofloxacin]] 500mg PO daily
-:::*Preferred regimen (7) : [[Azithromycin]] 500mg PO single dose then 250mg for 4days {{or}} [[Clarithromycin]] 500mg bid or XL 500mg/day.
-:::*Note: Treatment duration of Otitis media is 10-14days, Acute exacerbation of Chronic Bronchitis is (5days[quinolone]-14days), Sinusitis is 10-14days.
-:*'''2.Meningitis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*Preferred regimen : [[Dexamethasone]] (0.15mg/kg)15-20min before first dose of abx and then q6h for 4days.
-:::*2.1.Adults
-::::*Preferred regimen (1) : [[Ceftriaxone]] 2g IV q12h(4gmax).
-::::*Preferred regimen (2) : [[Cefotaxime]] 2g IV q4-6h(12gmax).
-::::*Preferred regimen (3) :[[Ampicillin]] 2g IV q4h if sensitive.
-::::*Beta-lactamalternative : Ciprofloxacin 400mg IV q8h {{or}} other Fluoroquinolones.
-:::*2.2.Pediatric
-::::*2.2.1.Neonates <7days
-:::::*2.2.1.1.<2kg : [[Cefotaxime]] 50mg/kg IVq12h for 10-14days
-:::::*2.2.1.2.>2kg : [[Cefotaxime]] 50mg/kg IVq8h {{or}} [[Ceftriaxone]] 50mg/kg IV q24h for 10-14days
-::::*2.2.2.Neonates >7days
-:::::*2.2.2.1.>2kg: [[Cefotaxime]] 50mg/kg IV q6-8h {{or}} [[Ceftriaxone]] 75mg/kg IV q24h for 10-14days
-::::*2.2.3.Children: [[Cefotaxime]] 200mg/kg/day IV q6h {{or}}  [[Ceftriaxone]] 100mg/kg IV q12-24h for 10-14days
-::*2.3.Post-meningitis exposure prophylaxis : [[Rifampin]] 600mg PO OD for 4days <ref name="pmid6819447">{{cite journal| author=Centers for Disease Control (CDC)| title=Prevention of secondary cases of Haemophilus influenzae type b disease. | journal=MMWR Morb Mortal Wkly Rep | year= 1982 | volume= 31 | issue= 50 | pages= 672-4, 679-80 | pmid=6819447 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6819447  }} </ref>
-:*'''3.Severe infections'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*3.1.Adults
-:::*Preferred regimen : [[Ceftriaxone]] 1-2g IV q24 or q12h {{or}} [[Cefotaxime]] 2g IV q6h.
-:::*Pencillin alternative : [[Ciprofloxacin]] 400mg IV q8h {{or}} other [[Fluoroquinolones]] {{or}}Use [[Ampicillin]] 2g IV q6h if sensitive.
-{{PBI|Neisseria gonorrhoeae}}
-:* '''Neisseria gonorrhoeae, treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::* 1. '''Gonococcal infections in adolescents and adults'''
-:::* 1.1 '''Uncomplicated gonococcal infections of the cervix, urethra, and rectum'''
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::* Alternative regimen: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose (if ceftriaxone is not available)
-:::* 1.2 '''Uncomplicated gonococcal infections of the pharynx'''
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-:::::* 1.2.1 '''Management of sex partners'''
-::::::* Expedited partner therapy: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::::*Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
-::::::*Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
-::::::* Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
-:::::* 1.2.2  '''Allergy, intolerance, and adverse reactions'''
-::::::* Preferred regimen (1): [[Gemifloxacin]] 320 mg PO in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
-::::::* Preferred regimen (2): [[Gentamicin]] 240 mg IM in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
-::::::* Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).
-:::::* 1.2.3 '''Pregnancy'''
-::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-:::::* 1.2.4 '''Suspected cephalosporin treatment failure'''
-::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::::* Alternative regimen (1): [[Gemifloxacin]] 320 mg PO  single dose  {{and}} [[Azithromycin]] 2 g PO  single dose (when isolates have elevated cephalosporin MICs)
-::::::* Alternative regimen (2): [[Gentamicin]] 240 mg IM  single dose {{and}} [[Azithromycin]] 2 g PO single dose (when isolates have elevated cephalosporin MICs)
-::::::* Alternative regimen (3): [[Ceftriaxone]] 250 mg IM as a single dose {{and}} [[Azithromycin]] 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
-::::::* Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.
-:::* 1.3 '''Gonococcal conjunctivitis'''
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::: Note: Consider one-time lavage of the infected eye with saline solution.
-:::::* 1.3.1 '''Management of sex partners'''
-::::::* Patients should be instructed to refer their sex partners for evaluation and treatment.
-:::* 1.4 '''Disseminated gonococcal infection'''
-:::::* 1.4.1 '''Arthritis and arthritis-dermatitis syndrome '''
-::::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::::* Alternative regimen: [[Cefotaxime]] 1 g IV q8h for 7 days {{or}} [[Ceftizoxime]] 1 g IV q 8 h  for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
-:::::* 1.4.2 '''Gonococcal meningitis and endocarditis'''
-::::::* Preferred regimen : [[Ceftriaxone]] 1-2 g IV  q 12-24 h  for 10-14 days {{and}} [[Azithromycin]] 1 g PO in a single dose
-::* 2. '''Gonococcal infections among neonates'''
-:::* 2.1 '''Ophthalmia neonatorum caused by N. gonorrhoeae'''
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg
-:::::* 2.1.1 '''Management of mothers and their sex partners'''
-::::::* Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
-:::* 2.2 '''Disseminated gonococcal infection and gonococcal scalp abscesses in neonates'''
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg/day  IM/IV qd for 7 days {{or}} [[Cefotaxime]] 25 mg/kg IV /IM  q12h for 7 days.
-::::* Note (1): The duration of treatment is 10-14 days if meningitis is documented.
-::::* Note (2): Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.
-:::::* 2.2.1 '''Management of mothers and their sex partners'''
-::::::* Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
-:::* 2.3 '''Neonates born to mothers who have gonococcal infection'''
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
-:::::* 2.3.1 '''Management of mothers and their sex partners'''
-::::::* Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.
-::* 3. '''Gonococcal infections among infants and children'''
-:::* 3.1 '''Infants and children who weigh ≤ 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis'''
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
-:::* 3.2 '''Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis'''
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1g PO in a single dose
-::::* Alternative regimen: [[Cefixime]] 400 mg PO  single dose {{and}} [[Azithromycin]] 1 g PO single dose.(If ceftriaxone is not available)
-:::* 3.3 '''Children who weigh ≤ 45 kg and who have bacteremia or arthritis'''
-::::* Preferred regimen: [[Ceftriaxone]] 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days
-:::* 3.4 '''Children who weigh > 45 kg and who have bacteremia or arthritis'''
-::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days
-{{PBI|Neisseria meningitidis}}
-:*''' Meningococcal Meningitis or Bacteremia''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 7-10 days.
-::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q4-6h for 7-10 days.
-::* Alternatives regimen (1): [[Chloramphenicol]]  4-6 g/day for 7-10 days
-::* Alternatives regimen (2): [[Penicillin]] 18-24 MU/day IV
-::* Alternatives regimen (3): [[Ampicillin]] 12 g/day IV
-::* Alternatives regimen (4): [[ Aztreonam]] 6-8 g/day IV
-::* Alternatives regimen (5): [[Moxifloxacin]] 400 mg/day IV.
-::* Steroids: [[Dexamethasone]] 10 mg IV q6h for 2-4 days starting before or with first dose.
-{{PBI|Moraxella catarrhalis}}
-{{PBI|Pasteurella multocida}}
-:* [[Pasteurella multocida]] <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): [[Amoxicillin]]/clavulanate 500 mg PO TID or 875 mg PO BID with food (also preferred empirical coverage of animal bite wounds)
-::* Preferred regimen (2): [[Ampicillin]]/sulbactam 3g IV q6h
-::* Preferred regimen (3): [[Ciprofloxacin]] 500 mg PO BID or 400 mg IV q12h {{or}} [[Levofloxacin]] 500 mg PO qd or IV q24h
-::* Alternative regimen (1): [[Doxycycline]] 100 mg PO BID {{or}} [[TMP-SMX]] DS PO BID (for beta-lactam allergic patients )
-::* Alternative regimen (2): [[Penicillin]] 500 mg PO QID or 4 million units IV q4h (use only if isolate known to be susceptible)
-====Bacteria – Spirochetes====
-{{PBI|Borrelia burgdorferi}}
-::* Lyme disease
-:::* 1. Early Lyme Disease
-::::* 1.1 Erythema migrans
-:::::* Preferred regimen: [[Doxycycline]] 100 mg twice per day for 10-21 days {{or}} [[Amoxicillin]] 500 mg 3 times per day for 14-21 days {{or}} [[Cefuroxime axetil]] 500 mg twice per day for 14-21 days
-:::::* Alternatie regimen: : [[Azithromycin]] 500 mg PO per day for 7–10 days {{or}} [[Clarithromycin]] 500 mg PO twice per day for 14–21 days (if the patient is not pregnant) {{or}} [[Erythromycin]] 500 mg PO 4 times per day for 14–21 days
-:::::* Pediatric regimen (1): (children <8 years of age) [[Amoxicillin]] 50 mg/kg per day in 3 divided doses [maximum of 500 mg per dose] {{or}} [[Cefuroxime axetil]] 30 mg/kg per day in 2 divided doses （maximum of 500 mg per dose)
-:::::* Pediatric regimen (2):（children ≥8 years of age）[[Doxycycline]] 4 mg/kg per day in 2 divided doses（maximum of 100 mg per dose）
-:::::* Pediatric regimen (3): [[Azithromycin]] 10 mg/kg per day (maximum of 500 mg per day) {{or}} [[Clarithromycin]] 7.5 mg/kg twice per day (maximum of 500 mg per dose) {{or}} [[Erythromycin]] 12.5 mg/kg 4 times per day (maximum of 500 mg per dose)
-::::* 1.2 When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis
-:::::* Preferred regimen: [[Amoxicillin]]–clavulanic acid 500 mg 3 times per day;
-:::::* Pediatric regimen；[[Amoxicillin]]–clavulanic acid 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose)
-::::* 1.3 Lyme meningitis and other manifestations of early neurologic Lyme disease
-:::::* Preferred regimen: [[Ceftriaxone]] 2g once per day IV for 10–28 days
-:::::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h {{or}} [[Penicillin G]] 18–24 million U q4h per day for patients with normal renal function
-:::::* Alternative regimen (2): [[Doxycycline]] 200–400 mg per day in 2 divided doses PO for 10–28 days
-:::::* Pediatric regimen (1): [[Ceftriaxone]] 50–75 mg/kg per day in a single daily intravenous dose (maximum, 2g)
-:::::* Pediatric regimen (2): [[Cefotaxime]] 150–200 mg/kg per day divided into 3 or 4 intravenous doses per day (maximum, 6 g per day)
-:::::* Pediatric regimen (3): [[Penicillin G]] 200,000–400,000 units/kg per day (maximum, 18–24 million U per day) divided into doses given intravenously q4h for those with normal renal function
-:::::* Pediatric regimen (4): (≥8 years old) [[Doxycycline]] 4–8 mg/kg PO per day in 2 divided doses (maximum, 100–200 mg per dose)
-::::* 1.4 Lyme carditis
-:::::* Preferred regimen: [[Ceftriaxone]] 2g once per day IV for 10–28 days
-:::::* NOTE: patients with advanced heart block, a temporary pacemaker may be required; expert consultation with a cardiologist is recommended; Use of the pacemaker may be discontinued when the advanced heart block has resolved; An oral antibiotic treatment regimen should be used for completion of therapy and for outpatients, as is used for patients with erythema migrans without carditis (see above)
-::::* 1.5 Borrelial lymphocytoma
-:::::* Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)
-:::* Late Lyme Disease
-::::* 1.6 Lyme arthritis
-:::::* Preferred regimen: [[Doxycycline]] 100 mg twice per day {{or}} [[Amoxicillin]] 500 mg 3 times per day
-:::::* Alternative regimen: [[Cefuroxime axetil]] 500 mg twice per day for 28 days
-:::::* Pediatric regimen: [[Amoxicillin]] 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose) {{or}} [[Cefuroxime axetil]] 30 mg/kg per day in 2 divided doses (maximum of 500 mg per dose) {{or}} (≥8 years of age) [[Doxycycline]] 4 mg/ kg per day in 2 divided doses (maximum of 100 mg per dose)
-:::::* NOTE: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of [[Ceftriaxone]] IV
-::::* 1.7 patients with arthritis and objective evidence of neurologic disease
-:::::* Preferred regimen: [[Ceftriaxone]] IV for 2–4 weeks
-:::::* Alternative regimen: [[Cefotaxime]] {{or}} [[Penicillin G]] IV
-:::::* Pediatric regime: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]] IV
-::::* 1.8 Late neurologic Lyme disease
-:::::* Preferred regimen: [[Ceftriaxone]] IV for 2 to 4 weeks
-:::::* Alternative regimen: [[Cefotaxime]] {{or}} [[Penicillin G]] IV
-:::::* Pediatric regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]]
-::::* 1.9 Acrodermatitis chronica atrophicans
-:::::* Preferred regimen: [[Doxycycline]] 100 mg twice per day {{or}} [[Amoxicillin]] 500 mg 3 times per day {{or}} [[Cefuroxime axetil]] 500 mg twice per day for 21 days
-:::* 2. Post–Lyme Disease Syndromes
-:::::* Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)
-{{PBI|Borrelia recurrentis}}
-::* 1. Tick-Borne Relapsing Fever <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO twice daily for 5-10 days
-:::* Alternative regimen: [[Erythromycin]] 500 mg PO four times a day for 5-10 days
-:::* NOTE: If meningitis/encephalitis present, use [[Ceftriaxone]] 2 g IV q12h for 14 days
-::* 2. Louse-Borne Relapsing Fever
-:::* Preferred regimen: single dose [[Tetracycline]] 500 mg PO
-:::* Alternative regimen: single dose [[Erythromycin]] 500 mg PO
-{{PBI|Leptospira}}
-::* 1. Treatment
-:::* 1.1 Severe <ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::::* Preferred regimen: [[Penicillin]] 1.5 million units IV q6hr for 5-7 days
-:::* 1.2 Less severe
-::::* Preferred regimen: [[Amoxycillin]] {{or}} [[Ampicillin]] {{or}} [[Doxycycline]] 100 mg BID IV or PO for 5-7 days {{or}} [[Erythromycin]] {{or}} [[Ceftriaxone]] 1g IV per day for 5-7 days {{or}} [[Cefotaxime]] {{or}} [[Quinolone]] PO
-::* 2. Prophylaxis
-:::* ''Leptospira interrogans'' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::::* Preferred regimen: [[Doxycycline]] 200 mg PO once per week
-{{PBI|Treponema pallidum}}
-::* 1. '''Syphilis Among non-HIV-Infected Persons'''<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm |issn=}}</ref>
-:::* 1.1 Primary and Secondary Syphilis
-::::* Preferred regimen (adult): Benzathine penicillin G 2.4 million units IM in a single dose
-::::* Preferred regimen (pediatric): Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
-:::* 1.2 Latent Syphilis
-::::* 1.2.1 Early Latent Syphilis
-:::::* Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose
-:::::* Pediatric regimen: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
-::::* 1.2.2 Late Latent Syphilis or Latent Syphilis of Unknown Duration
-:::::* Preferred regimen: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervalspediatric
-:::::* Pediatric regimen: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)
-:::* 1.3 Tertiary Syphilis
-::::* Preferred regimen: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
-:::* 1.4 Neurosyphilis and ocular syphilis
-::::* Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
-::::* Alternative regimen: Procaine penicillin 2.4 million units IM once daily {{and}} Probenecid 500 mg orally four times a day, both for 10--14 days
-::* 2. '''Syphilis Among HIV-Infected Persons'''
-:::* 2.1 Primary and Secondary Syphilis Among HIV-Infected Persons
-::::* Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
-:::* 2.2 Latent Syphilis Among HIV-Infected Persons
-::::* 2.2.1 early latent
-:::::* Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
-::::* 2.2.2 late latent
-:::::* Preferred regimen: Benzathine penicillin G at weekly doses of 2.4 million units for 3 weeks.
-:::* 2.3 Neurosyphilis Among HIV-Infected Persons
-::::* Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
-::::* Alternative regimen: Procaine penicillin 2.4 million units IM once daily {{and}} Probenecid 500 mg orally four times a day, both for 10--14 days
-::* 3. '''Syphilis During Pregnancy'''
-:::* Preferred regimen: Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection
-::* 4. '''Congenital Syphilis in neonates'''
-:::* 4.1 condition 1 : Infants with proven or highly probable disease and (1)an abnormal physical examination that is consistent with congenital syphilis;（2）a serum quantitative nontreponemal serologic titer that is fourfold higher than the mother's titer;¶ or（3）a positive darkfield test of body fluid(s).
-::::* Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days {{or}} Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days
-::::* NOTE: If more than 1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding the use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis. The use of agents other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history of infection with T. pallidum and treatment for syphilis must be considered when evaluating and treating the infant.
-:::* 4.2 condition 2: Infants who have a normal physical examination and a serum quantitive nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was not treated, inadequately treated, or has no documentation of having received treatment; (2)mother was treated with erythromycin or another nonpenicillin regimen;†† or (3)mother received treatment &lt; 4 weeks before delivery.
-::::* Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days {{or}} Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days {{or}} Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
-::::* NOTE:If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered.
-:::* 4.3 condition 3:Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and (2)mother has no evidence of reinfection or relapse.
-::::* Preferred regimen: Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
-:::* 4.4 condition 4: Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother's treatment was adequate before pregnancy and (2)mother's nontreponemal serologic titer remained low and stable before and during pregnancy and at delivery (VDRL <1:2; RPR <1:4).
-::::* Preferred regimen: No treatment is required; however, benzathine penicillin G 50,000 units/kg as a single IM injection might be considered, particularly if follow-up is uncertain.
-::* 5.''' Congenital Syphilis in infants and children'''
-::::* Preferred regimen: Aqueous crystalline penicillin G 50,000 U/kg q4–6h for 10 days
-====Bacteria – Gram-Negative Bacilli====
-{{PBI|Achromobacter xylosoxidans}}
-{{PBI|Acinetobacter baumannii}}
-::* Preferred regimen (1): [[Imipenem]] 0.5-1 g IV q6h
-::* Preferred regimen (2): [[Ampicillin/sulbactam]] (Unasyn) 3g q4h
-::* Preferred regimen (3): [[Cefepime]] 1-2 g IV q8h
-::* Preferred regimen (4): [[Colistin]] 2.5 mg/kg IV q12h
-::* Preferred regimen (5): [[Tigecycline]] (Tygacil) 100 mg IV, then 50 mg IV q12h
-::* Preferred regimen (6): [[Amikacin]] 7.5 mg/kg q12h IV or 15 mg/kg/day IV
-::* Alternative regimen (1): [[Ceftriaxone]] 1-2g IV every day
-::* Alternative regimen (2): [[Cefotaxime]] 2-3g IV q6-8h
-::* Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV q8-12h or 750 mg PO bid
-::* Alternative regimen (4): [[TMP-SMX]] 15-20 mg (TMP)/kg/day IV divided 3 or 4 doses/day or 2 DS PO bid
-{{PBI|Aeromonas hydrophila}}
-:* Aeromonas hydrophila<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1. '''Diarrhea'''
-:::* Preferred regimen (if not self-limiting, or if severe): [[Ciprofloxacin]] 500 mg PO bid.
-:::* Alternate regimen: [[TMP-SMX]] single dose PO bid
-:::* Note: High resistance to sulfa agents described in Taiwan and Spain
-::*2. '''Skin and soft tissue infection'''
-:::*2.1 '''Mild infection'''
-::::* Preferred regimen (1): [[Ciprofloxacin]] 500 mg PO bid
-::::* Preferred regimen (2): [[Levofloxacin]] 500 mg OD.
-:::*2.2 '''Severe infection or sepsis'''
-::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q8h
-::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h
-::::* Note (1): For suspicion of water-based injury,empiric coverage for Vibrio [[Doxycycline]] 100mg bid, although Flouroquinolones may also cover {{and}}  [[Vancomycin]] 15mg/kg IV q12h {{with/without}}  [[Clindamycin]] {{or}}  [[Linezolid]] for inhibition of Gram-positive toxin production
-::::* Alternative regimen: Alternatives to [[fluoroquinolones]] for Aeromonas coverage include ([[Carbapenems]] ([[Ertapenem]], [[Doripenem]], [[Imipenem]], [[Meropenem]]), [[Ceftriaxone]], [[Cefepime]] and [[Aztreonam]].
-::*3. '''Prevention'''
-:::* Preferred regimen: Frequent recommendations include using a [[Cephalosporin]] (e.g.,cefuroxime, ceftriaxoneorcefixime) {{or}} a [[Fluoroquinolone]] (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches.
-:::* Note: Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones. Duration of antibiotic use is 3-5days, some recommend continuing until wound or eschar resolves
-{{PBI|Bartonella}}
-:* Bartonella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1. '''Cat scratch disease'''
-:::*1.1 '''If extensive adenopathy'''
-::::* Preferred regimen: [[Azithromycin]] 500 mg single dose
-::*2. '''Retinitis'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg bid {{and}}  [[Rifampin]] 300 mg bid PO for 4-6 weeks.
-::*3. '''Bacillary angiomatosis'''
-:::* Preferred regimen (1): [[Erythromycin]] 500 mg PO qid
-:::* Preferred regimen (2): [[Doxycycline]] 100mg PO bid for >3 months.
-::*4. '''Peliosis hepatitis'''
-:::* Preferred regimen (1): [[Erythromycin]] 500 mg PO qid
-:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months.
-::*5. '''Oroya fever'''
-:::* Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid for 10 days.
-::*6. '''Endocarditis'''
-:::* Preferred regimen: [[Gentamicin]] 3 mg/kg/day IV q8h for 14 days {{and}}  [[Ceftriaxone]] 2 g/day IV for 6weeks {{with/without}} [[Doxycycline]] 100 mg PO bid for 6 weeks.
-{{PBI|Bordetella pertussis}}
-:*Bordetella pertussis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> ::*1. '''Whooping cough'''
-::::*1.1 '''Adults'''
-:::::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose then 250 mg PO qd for 2-5days
-:::::* Preferred regimen (2): [[Clarithromycin]] 500 mg bid for 7 days.
-:::::* Alternative regimen(Intolerant of macrolides): [[Trimethoprim-sulfamethoxazole]] DS bid PO for 14 days
-:::::* Alternative regimen (2): [[Erythromycin]] 250 mg PO qid for 14 days
-::::*1.2 '''Infants <6 months of age'''
-:::::*1.2.1 '''Infants <1 month'''
-::::::* Preferred regimen: [[Azithromycin]] 10 mg/kg/day for 5 days
-::::::* Note: [[Erythromycin]], [[Clarithromycin]] and [[TMP-SMX]] not recommended
-:::::*1.2.2 '''Infants of 1-5 months of age'''
-::::::* Preferred regimen(1): [[Azithromycin]] 10 mg/kg/day for 5 days
-::::::* Preferred regimen(2): [[Clarithromycin]] 15mg/kg bid for 7 days
-::::::* Preferred regimen(3): [[Erythromycin]] 10 mg/kg PO qid for 14 days,
-::::::* Note: [[TMP-SMX]] contraindicated.
-::::*1.3 '''Infants >6 months of age-children'''
-::::::* Preferred regimen(1): [[Azithromycin]] 10 mg/kg (500 mg max) qd for 5 days
-::::::* Preferred regimen(2): [[Clarithromycin]] 15 mg/kg (1 g daily max) bid for 7 days
-::::::* Preferred regimen(3): [[Erythromycin]] 10mg/kg PO (2g daily max) qid for 14 days
-::::::* Preferred regimen(4): [[TMP-SMX]] 4 mg/40 mg/kg bid for 14 days.
-::::::* Note(1): [[TMP-SMX]] should only be used in patients ≥2 months of age who are allergic or intolerant of macrolides or who have a macrolide-resistant strain.
-::::::* Note(2): Although fluoroquinolones have excellent in vitro sensitivity profiles, clinical experience for B. pertussis is limited.
-{{PBI|Burkholderia cepacia}}
-::* Burkholderia cepacia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen : [[Ceftazidime]] 2 g IV q8h {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Meropenem]] 1-2g IV q8h {{or}} [[Minocycline]] 100 mg IV/PO bid.
-{{PBI|Burkholderia pseudomallei}}
-::* Burkholderia pseudomallei
-:::*'''1.Melioidosis'''<ref name="pmid22970946">{{vcite2 journal |vauthors=Wiersinga WJ, Currie BJ, Peacock SJ |title=Melioidosis |journal=N. Engl. J. Med. |volume=367 |issue=11 |pages=1035–44 |year=2012 |pmid=22970946 |doi=10.1056/NEJMra1204699 |url= |issn=}}</ref>
-::::*1.1.Intial intensive therapy (Minimum of 10-14 days)
-:::::* Preferred regimen : [[Ceftazidime]] 50 mg/kg upto 2 g q6h {{or}} [[Meropenem]] 25mg/kg upto 1g q8h {{or}} [[Imipenem]] 25 mg/kg upto 1g
-:::::* Note : Any one of the three may be combined with [[TMP-SMX]]6/30 mg/kg upto 320/1600 mg/kg q12h (recommended for neurologic, bone, joint, cutaneous and prostatic melioidosis)
-::::*1.2.Eradication therapy (Minimum of 3months)
-:::::* Preferred regimen : [[TMP-SMX]]6/30 mg/kg upto 320/1600 mg/kg q12h
-{{PBI|Campylobacter}}
-{{PBI|Campylobacter fetus}}
-::*Campylobacter fetus<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Serious infections
-::::*Preferred regimen : [[Gentamicin]] 5mg/kg/day IV {{or}} [[Imipenem]] 1mg IV q6h {{or}} [[Ceftriaxone]] 2g IV q12h.
-:::*Endovascular infections
-::::*Preferred regimen : [[Aminoglycoside]]4-6weeks combined with [[Carbapenem]].
-:::*CNS
-::::*preferred regimen : [[Ceftriaxone]] {{or}} [[Chloramphenicol]] for 2-3weeks.
-{{PBI|Campylobacter jejuni}}
-{{PBI|Capnocytophaga canimorsus}}
-::*Capnocytophaga canimorsus<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Severe Cellulitis/Sepsis or Endocarditis'''
-::::*Preferred regimen
-:::::*Beta-lactam/beta-lactamase inhibitor : [[Ampicillin]]/[[sulbactam]] 3 g IV q6h
-:::::*Non-beta-lactamase producing : [[Penicillin G]] 2-4MU q4h IV
-::::*Alternative regimen : [[Ceftriaxone]] 1-2 g IV q24h {{or}} [[Meropenem]] 1 g IV q8h.
-:::*'''2.Complicated infections or Immunocompromise'''
-::::*Preferred regimen : [[Clindamycin]] 600 mg IV q8h may be combined with above agents
-::::*Note (1): Resistance to aztreonam described, and variable susceptibility reported to [[TMP-SMX]] and aminoglycosides.
-::::*Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks. For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy.
-:::*'''3.Mild Cellulitis/Dog or Cat Bites'''
-::::*Preferred regimen : [[Amoxicillin/clavulanate]] 500 mg PO q8h or 875 mg PO bid {{or}} [[Amoxicillin]] 500 mg PO q8h.
-::::*Alternative regimen : [[Clindamycin]] 300 mg PO q6h {{or}} [[Doxycycline]] 100 mg PO bid {{or}} [[Clarithromycin]] 500 mg PO bid {{or}} [[Moxifloxacin]] 400 mg PO OD.
-:::*'''4.Meningitis or brain abscess'''
-::::*Preferred regimen : Use [[Ceftriaxone]] 2 g IV q12h {{and}} [[Ampicillin]] 2 g IV q4h
-::::*If Beta-lactamase producing or polymicrobial brain abscess : [[Imipenem]]/[[cilastin]] 1000 mg q6-8h {{and}} [[Clindamycin]] 600 mg IV q8h
-:::*'''5.Prevention'''
-::::*Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with [[amoxicillin/clavulanate]] for 7-10 days.
-{{PBI|Citrobacter freundii}}
-::* Citrobacter freundii<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Meropenem]] 1-2 g IV q8h {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IVq8h{{or}} [[Cefepime]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h(or 500 mg PO bid for UTI) {{or}} [[Gentamicin]] 5 mg/kg/day.
-:::* Alternate regimen: [[Piperacillin]]/[[tazobactam]] 3.375 mg q6h IV {{or}} [[Aztreonam]] 1-2 g IV q6h {{or}} [[TMP-SMX]] 5 mg/kg q6h IV (or DS PO bid for UTI).
-{{PBI|Citrobacter koseri}}
-::* Citrobacter koseri<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Ceftriaxone]] 1-2 g IV q12-24 {{or}} [[Cefotaxime]] 1-2 g IV q6h {{or}} [[Cefepime]] 1-2 IV q8h.
-:::* Alternate regimen: [[Ciprofloxacin]] 400 mg IV q12h (or 500 mg PO q12h for UTI){{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Meropenem]] 1-2 g IV q8h {{or}} [[Aztreonam]] 1-2 g IV q6h{{or}} [[TMP-SMX]] 5 mg/kg q6h IV (or DS PO bid for UTI).
-:::*Note: Usually [[Ampicillin]] resistant, but may be sensitive to [[Cephalosporins|first generation cephalosporins]]
-{{PBI|Elizabethkingia meningoseptica}}
-{{PBI|Enterobacter aerogenes}}
-:* [[Enterobacter aerogenes]]
-::*'''1.UTI'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen: [[Ciprofloxacin]] 250 mg PO bid
-{{PBI|Enterobacter cloacae}}
-:* [[Enterobacter cloacae]]
-::*'''1.UTI'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen: [[Ciprofloxacin]] 250 mg PO bid {{PBI|Escherichia coli}}
-::* Escherichia coli<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*1.'''Meningitits'''
-::::*1.1.Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
-::::*1.2.Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}}  [[Ampicillin]] 12 g/day IV q4h
-:::*'''2.Uncomplicated urinary tract infection'''
-::::*2.1.Preferred agents (IDSA/AUA Guidelines): [[TMP-SMX]] DS PO bid for 3-day
-::::*2.2.Alternative regimen(1): [[Ciprofloxacin]] 250 mg PO bid {{or}} [[Ciprofloxacin]] 500 mg XR once daily for 3 days {{or}} [[Levofloxacin]] 250 mg PO OD for 3 days.
-::::*2.3.Alternative regimen(2): [[Nitrofurantoin]] 100 mg PO q6h {{or}} [[Nitrofurantoin]] macrocrystals (Macrobid) 100 mg PO bid for 7 days.
-::::*2.4.Alternative regimen(3): [[Fosfomycin]] 3 g sachet PO single dose.
-::::: Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.
-:::*'''3.Pyelonephritis'''
-::::*3.1.'''Acute uncomplicated pyelonephritis'''
-:::::*Preferred regimen: [[Ciprofloxacin]] 500 mg bid PO for 5-7 days {{or}} [[Ciprofloxacin]]-[[Erythromycin]] 1000 mg q24h {{or}} [[Levofloxacin]] 750 mg q24h {{or}} [[Ofloxacin]] 400 mg bid, [[Moxifloxacin]] 400 mg q24h
-:::::*Alternative regimen: [[Amoxicillin-Clavulanic acid]]875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid {{or}} Oral Cephalosporins {{or}} [[TMP-SMX]] 2 mg/kg IV q6h PO for 14 days
-::::*3.1.'''Acute pyelonephritis (Hospitalized)'''
-:::::*Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Ampicillin]] and [[Gentamicin]] {{or}} [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h for 14 days.
-:::::*Alternative regimen: [[Ticarcillin-Clavulanate]]3.1 gm IV q6h or [[Ampicillin]]-[[Sulbactam]] 3 gm IV q6h or [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h {{or}} [[Ertapenem]] 1 gm IV q24h or [[Doripenem]] 500 mg q8h for 14 days.
-:::*4.'''Traveler’s diarrhea'''
-::::*Preferred regimen : [[Ciprofloxacin]] 750 mg PO OD for 1-3 days or other Fluoroquinolones
-::::*Pediatrics & pregnancy: [[Azithromycin]] 10 mg/kg/day single dose {{or}} [[Ceftriaxone]] 50 mg/kg/day IV OD for 3 days.
-::::Avoid Fluoroquinolones in Pediatrics and pregnancy.
-:::*5.'''Malacoplakia'''
-::::*[[Bethanechol chloride]] {{and}} ([[Ciprofloxacin]] 400 mg IV q12h {{or}} [[TMP-SMX]] 2 mg/kg (TMP component) IV q6h)
-:::*'''6.Bacteremia/Pneumonia'''
-::::*Preferred regimen : [[Ceftriaxone]] 1-2g IV q24h {{or}} other third or fourth generation cephalosporin {{or}} [[Ciprofloxacin]] 400mg IV q12h or 500mg PO q12h {{or}} [[Levofloxacin]] 500mg PO/IV q24h {{or}} [[Moxifloxacin]] 400mg IV/PO q24h {{or}} [[Ampicillin]](if sensitive) 2g IV q6h {{or}} [[TMP-SMX]](if sensitive) 5-10mg/kg/day for q6-8hIV
-::::*Alternative regimen (1): [[Imipenem]], [[Meropenem]], [[Ertapenem]], [[Doripenem]], [[Ceftazidime]], [[Cefepime]], [[Cefazolin]] or [[Cefuroxime]](if sensitive), [[Aztreonam]], [[Ticarcillin]], [[Piperacillin]], [[Piperacillin]]-[[Tazobactam]], [[Aminoglycosides]], [[Tigecycline]](intra-abd or skin/softtissue).
-::::*Alternative regimen (2): [[Ampicillin-sulbactam]] 3g IV q6h {{and}}[[Gentamicin]] 1.5mg/kg/q8h or 5-7mg/kg/dayIV {{or}} [[Gentamicin]] 5mg/kg/day {{or}} [[Tobramycin]] 5mg/kg/dayIV for 7-14days
-::::*Note: Monotherapy generally not recommended for bacteremia/pneumonia
-{{PBI|Francisella tularensis}}
-::*Francisella tularensis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Tularemia'''
-::::*Preferred regimen : [[Streptomycin]] 1 g IM bid {{or}} [[Gentamicin]] 5 mg/kg/day IV for 10 days.
-::::*Alternative regimen : [[Doxycycline]] 100 mg IV  bid {{or}} [[Chloramphenicol]] 1 g IV q6h {{or}} [[Ciprofloxacin]] 400 mg IV bid until stable then PO for 14-21 days (total).
-::::*1.1.Pregnancy
-:::::*Preferred regimen : [[Gentamicin]] 5 mg/kg/day IV for 10 days.
-:::::*Alternative regimen : [[Ciprofloxacin]].
-{{PBI|Helicobacter pylori}}
-::* Helicobacter pylori<ref name="pmid22491499">{{vcite2 journal |vauthors=Malfertheiner P, Megraud F, O'Morain CA, et al. |title=Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report |journal=Gut |volume=61 |issue=5 |pages=646–64 |year=2012 |pmid=22491499 |doi=10.1136/gutjnl-2012-302084 |url= |issn=}}</ref>
-:::* '''1.Peptic ulcer disease'''
-::::*1.1.Regimens for Initial Treatment
-:::::*1.1.1.Triple therapy : PPI(standard dose twice daily) {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Clarithromycin]] 500 mg bid  for 7-14 days
-:::::*1.1.2.Quadruple therapy: PPI (standard dose twice daily) {{and}} [[Metronidazole]]  250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} Bismuth (dose depends on preparation) for 10-14 days
-:::::*1.1.3.Sequential therapy: PPI (standard dose twice daily){{and}} [[Amoxicillin]]  1 g bid for 1-5 days followed by PPI (standard dose twice daily){{and}} [[Clarithromycin]] 500 mg bid {{and}} [[Tinidazole]] 500 mg bid for  6-10 days
-::::*1.2. Second-Line Therapies
-:::::*1.2.1.Triple therapy: PPI (standard dose twice daily) {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Metronidazole]] 500 mg bid
-:::::*1.2.2.Quadruple therapy: PPI (standard dose twice daily){{and}} [[Metronidazole]] 250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} Bismuth (dose depends on preparation) for 10-14 days
-:::::*1.2.3.Levofloxacin triple therapy: PPI (standard dose twice daily) {{and}} [[Amoxicillin]] 1 g bid  {{and}}  [[Levofloxacin]] 500 mg bid for 10 days
-:::::*1.2.4.Rifabutin triple therapy: PPI (standard dose twice daily)  and  [[Amoxicillin]]  1 g bid {{and}} [[Rifabutin]] 150-300 mg/day  for 10 days
-::::*1.3.Alternative triple therapies appropriate for patients with an allergy to Amoxicillin include (PPI {{and}} [[Clarithromycin]] {{and}} [[Metronidazole]]){{ or}} ([[PPI]] {{and}} [[Tetracycline]] {{and}} [[Metronidazole]]).
-----
-{{PBI|Klebsiella granulomatis}}
-:* '''Klebsiella granulomatis''' (formly known as Calymmatobacterium granulomatis)
-::*1. '''Granuloma inguinale (donovanosis)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:::* Preferred regimen: [[Azithromycin]] 1 g PO once a week or 500 mg qd for 3 weeks and until all lesions have completely healed
-:::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for 3 weeks and until all lesions have completely healed
-:::* Alternative regimen (2): [[Ciprofloxacin]] 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
-:::* Alternative regimen (3): [[Erythromycin]] base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
-:::* Alternative regimen (4): [[Trimethoprim-sulfamethoxazole]] one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
-----
-{{PBI|Klebsiella pneumoniae}}
-::* Klebsiella pneumoniae<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Severe,nosocomial infection'''
-::::*Preferred regimen : [[Cefepime]] 2g IV q8h {{or}} [[Ceftazidime]] 2g IV q8h {{or}} [[Imipenem]] 500mg IV q6h {{or}} [[Meropenem]] 1g IV q8h {{or}} [[Piperacillin]]-[[tazobactam]] 4.5 g IV q6h {{and}} [[Aminoglycoside]] {{or}} Respiratory fluoroquinolone
-::::*For coverage of ESBLs in pneumonia,sepsis,complicated UTI or intra-abdominal infections :[[Imipenem]] 500mg IV q6h {{or}} [[Meropenem]] 1g IV q8h {{or}} [[Ertapenem]] 1g IV q24h {{or}} [[Doripenem]] 500mg IV q8h
-::::*In ESBLs,inconsistent activity seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins
-::::*Alternate regimen : ([[Ceftriaxone]] 1 gm IV q24h {{and}} [[Metronidazole]] 500 mg IV q6h or 1 gm IV q12h) {{or}} [[Moxifloxacin]] 400 mg IV/po q24h
-----
-{{PBI|Klebsiella rhinoscleromatis}}
-::* '''1. Rhinoscleroma'''<ref>{{Cite journal| doi = 10.1007/s00405-013-2649-z| issn = 1434-4726| volume = 271| issue = 7| pages = 1851–1856| last1 = Mukara| first1 = B. K.| last2 = Munyarugamba| first2 = P.| last3 = Dazert| first3 = S.| last4 = Löhler| first4 = J.| title = Rhinoscleroma: a case series report and review of the literature| journal = European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery| date = 2014-07| pmid = 23904142}}</ref><ref>{{Cite journal| doi = 10.1086/592966| issn = 1537-6591| volume = 47| issue = 11| pages = 1396–1402| last1 = de Pontual| first1 = Loïc| last2 = Ovetchkine| first2 = Philippe| last3 = Rodriguez| first3 = Diana| last4 = Grant| first4 = Audrey| last5 = Puel| first5 = Anne| last6 = Bustamante| first6 = Jacinta| last7 = Plancoulaine| first7 = Sabine| last8 = Yona| first8 = Laurent| last9 = Lienhart| first9 = Pierre-Yves| last10 = Dehesdin| first10 = Danièle| last11 = Huerre| first11 = Michel| last12 = Tournebize| first12 = Régis| last13 = Sansonetti| first13 = Philippe| last14 = Abel| first14 = Laurent| last15 = Casanova| first15 = Jean Laurent| title = Rhinoscleroma: a French national retrospective study of epidemiological and clinical features| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-12-01| pmid = 18947330}}</ref><ref>{{Cite journal| doi = 10.3109/00016489.2010.539264| issn = 1651-2251| volume = 131| issue = 4| pages = 440–446| last1 = Gaafar| first1 = Hazem A.| last2 = Gaafar| first2 = Alaa H.| last3 = Nour| first3 = Yasser A.| title = Rhinoscleroma: an updated experience through the last 10 years| journal = Acta Oto-Laryngologica| date = 2011-04| pmid = 21198342}}</ref>
-:::* Preferred regimen (1): [[Ciprofloxacin]] 500–750 mg PO bid for 2–3 months {{or}} [[Levofloxacin]] 750 mg PO qd for 2–3 months
-:::* Preferred regimen (2): [[Trimethoprim-Sulfamethoxazole]] 1 DS tab PO bid for 3 months {{and}} [[Rifampicin]] 300 mg PO bid for 3 months
-:::* Alternative regimen: [[Tetracycline]] {{or}} [[Streptomycin]] {{or}} [[Doxycycline]]  {{or}} [[Ceftriaxone]] {{or}} [[Ofloxacin]]
-:::* Note (1): The optimal duration of antimicrobial therapy remains unclear. A 6-week to 6-month cours of antibiotics until histology exams and cultures are negative may be required.
-:::* Note (2): Use of topical antiseptics such as [[Acriflavinium]] and [[Rifampin]] ointment has been reported with resolution of symptoms.<ref>{{Cite journal| doi = 10.1007/s00405-013-2649-z| issn = 1434-4726| volume = 271| issue = 7| pages = 1851–1856| last1 = Mukara| first1 = B. K.| last2 = Munyarugamba| first2 = P.| last3 = Dazert| first3 = S.| last4 = Löhler| first4 = J.| title = Rhinoscleroma: a case series report and review of the literature| journal = European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery| date = 2014-07| pmid = 23904142}}</ref>
-----
-{{PBI|Legionella pneumophila}}<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Levofloxacin]] 750mg PO/IV OD for 7-10days {{or}} [[Moxifloxacin]] 400mg PO/IV OD for 7-10 days {{or}} [[Azithromycin]] 500mg PO/IV OD for 7-10days {{or}} [[Rifampin]] 300mg PO/IV bid(optional) {{and}} any other agent listed.
-:::* Alternative regimen: [[Erythromycin]] 1g IV q6h and then 500mg PO q6h for 7-10days {{or}} [[Ciprofloxacin]]400mg IV q12h then 750mg PO bid 7-10days
-{{PBI|Moraxella catarrhalis}}
-:::* Pneumonia
-::::* Preferred regimen:[[Amoxicillin-Clavulanate]](Augmentin)875/125mg PO bid or XL 2000/125 PO bid {{or}}Oral cephalosporins such as [[Cefprozil]](Cefzil)200-500mg bid {{or}} [[Cefpodoxime]](Vantin)200-400mg bid {{or}} [[Cefuroxime]](Ceftin)250-500mg bid {{or}} [[Cefdinir]](Omnicef)300mg bid {{or}} Parenteral cephalosporins such as [[Cefuroxime]] {{or}} [[Cefotaxime]] {{or}} [[Ceftriaxone]] {{or}} Macrolides such as [[Erythromycin]] 500mg PO q6h  {{or}} [[Clarithromycin]] 500mg bid or XL 1g PO {{or}} [[Azithromycin]] 500mg single dose then 250mg PO, {{or}} Flouroquinolones such as [[Moxifloxacin]](Avelox) 400mg IV/PO OD {{or}} [[Levofloxacin]](Levaquin)500mg IV/PO OD {{or}} [[TMP-SMX]] DS PO bid
-{{PBI|Morganella morganii}}
-::*Morganella morganii<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen : [[Imipenem]] 500mg IV q6h {{or}} [[Meropenem]] 1.0g IV q8h (adjustdose if necessary for renalfunction).
-:::*Note (1): [[Carbapenems]] are considered first line therapy due to inducible cephalosporinases, and presence of extended-spectrum beta-lactamases in some isolates.
-:::*Note (2): Duration of treatment for UTI(generallycomplicated) is 7days and Duration of treatment for bacteremia is 14days.
-:::*Note (3): [[Tigecycline]] is not reliably effective
-:::*Alternative Regimen (1) : [[Cefepime]] 2.0 g IV q8-12h {{or}} [[Ciprofloxacin]] 500 mg PO/400mg IV q12h {{or}} [[Piperacillin]] 3g IV q6h {{or}} [[Ticarcillin]] 3g IV q4h
-:::*Alternative Regimen (2) : [[Aminoglycosides]] can be used alone for treatment of UTI,[[Gentamicin]] {{or}} [[Tobramycin]] 1mg/kg/day IV {{or}} [[Amikacin]] 3mg/kg/day
-{{PBI|Plesiomonas shigelloides}}
-::*Plesiomonas shigelloides<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Immunocompetent Hosts or Severe Infection'''
-::::*Preferred regimen : [[Ciprofloxacin]] 500mg PO bid or 400mg IV q12h.
-::::*Alternative regimen (1): [[Ofloxacin]] 300mg PO bid {{or}} [[Norfloxacin]] 400mg PO bid {{or}} [[TMP-SMX]] DS PO bid for 3days.
-::::*Alternative regimen (2): [[Ceftriaxone]] 1-2g IV OD used successfully in severe cases.
-:::*'''2.Immunocompromised Hosts'''
-::::*Preferred regimen : [[Ciprofloxacin]] 500mg PO bid for 3days.
-::::*Alternative regimen : [[Ofloxacin]] 300mg PO bid {{or}} [[Norfloxacin]] 400mg PO bid {{or}} [[TMP-SMX]] DS PO(if susceptible) bid for 3days
-{{PBI|Proteus mirabilis}}
-::*Proteus mirabilis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen (1): [[Ampicillin]] 500 mg PO q6h or 2 g IV q6h.
-:::* Preferred regimen (2): [[Cefuroxime]] 250 mg PO bid or 750 mg IV q8h.
-:::* Preferred regimen (3): [[Ciprofloxacin]] 250-500 mg PO bid or 400 mg IV q12h.
-:::* Preferred regimen (4): [[Levofloxacin]] 500 mg PO OD or 500 mg IV q24h.
-:::* Note: Uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia 7-14 days.
-{{PBI|Indole positive Proteus species}}
-::*Indole positive Proteus species<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen (1): [[Ceftriaxone]] 1 g IV q24h.
-:::* Preferred regimen (2): [[Imipenem]] 500 mg IV q6h.
-:::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q12h or 250-500 mg PO bid.
-:::* Preferred regimen (4): [[Levofloxacin]] 500 mg IV/PO q24h.
-{{PBI|Providencia}}
-::*Providencia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Complicated UTI/Bacteremia/Acute prostatitis
-::::*Preferred regimen : [[Ciprofloxacin]] 500-750mg PO q12h or 400 mg IV q8-12h {{or}} [[Levofloxacin]] 500mg IV/PO q24h {{or}} [[Piperacillin]]-[[Tazobactam]] 3.375 mg IV q6h {{or}}[[Ceftriaxone]] 1-2g IV q24h (donot use if ESBL suspected or critically ill){{or}} [[Meropenem]] 1g IV q8h (consider if critically ill or ESBL suspected){{or}}[[Amikacin]] 7.5mg/kg IV q12h {{or}} [[Gentamicin]] {{or}} [[Tobramycin]] acceptable if susceptible but many species are resistant.
-::::*Note (1) : Duration of treatment for (UTI)is 7days common or 3-5days after defervescence or control/elimination of complicating factors (e.g.,removal of foreign material catheter).
-::::*Note (2) : Duration of treatment for (bacteremia)is 10-14days or 3-5days after defervescence or control/elimination of complicatingfactors.
-::::*Note (3) : Duration for acute prostatitis(2weeks), shorter than chronic prostatitis(4-6wks)
-::::*Alternative regimen : [[TMP-SMX]](Bactrim)DS1 PO q12h for 10-14days {{or}} TMP 5-10 mg/kg/day IV q6h.
-{{PBI|Pseudomonas aeruginosa}}
-::*Pseudomonas aeruginosa<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen (1) : [[Cefepime]] 2g IV q8h {{or}} [[Ceftazidime]] 2g IV q8h {{or}} [[Piperacillin]] 3-4g IV q4h in (no benefit for pseudomonas from beta-lactamase inhibitor){{or}} [[Ticarcillin]] 3-4g IV q4h(no benefit for pseudomonas from beta-lactamase inhibitor).
-:::*Preferred regimen (2) : [[Imipenem]] 500mg—1g IV q6h {{or}} [[Meropenem]] 1g IV q8h {{or}} [[Doripenem]] 500mg IV q8h {{or}} [[Ciprofloxacin]] 400mg IV q8h {{or}}750mg PO q12h(for less serious infections). [[Aztreonam]] 2g IV q6-8h.[[Colistin]] 2.5 mg/kg IV q12h. [[Polymyxin B]] 0.75-1.25 mg/kg IV q12h [[Gentamicin]] {{or}} [[Tobramycin]] 1.7-2.0 mg/Kg IV q8h or 5-7mg/kg IV {{or}} [[Amikacin]] 2.5mg/kg IV q12h.Usually used in combination with other antimicrobials(preferably beta-lactams).
-::::* Note : [[Amikacin]] > [[Tobramycin]] > [[Gentamicin]] with respect to P.aeruginosa susceptibility percentages at most institutions.
-{{PBI|Salmonella}}
-::*Salmonella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Gastroenteritis'''
-::::*Preferred treatment
-:::::*Immunocompetent : [[TMP-SMX]] DS PO bid {{or}} [[Ciprofloxacin]] 500mg PO bid {{or}} [[Ceftriaxone]] 2gIV/day for 5-7days.
-:::::*Immunosuppressed : [[TMP-SMX]] DS PO bid {{or}} [[Ciprofloxacin]] 500mg PO bid {{or}} [[Ceftriaxone]] 2gIV/day for ≥14days.
-:::*'''2.Typhoidfever'''
-::::*Preferred regimen : [[Ceftriaxone]] 1-2g IV q24h then [[Cefixime]] 400mg PO for 10-14days {{or}} [[Ciprofloxacin]] 400mg IV q12h or 500mg PO bid.
-:::*'''3.Non-typhoid(seriousinfection)'''
-::::*Preferred regimen : [[Cephalosporin|3rd generation Cephalosporin]] (Ceftriaxone/Cefotaxime){{or}} [[Fluoroquinolone]]([[Ciprofloxacin]], [[Levofloxacin]])
-:::*'''4.Bacteremia'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IV q6-8h for 7-14days {{or}} [[Ciprofloxacin]] 400mg IV q12h for 7-14days
-:::*'''5.Vascular prosthesis infection'''
-::::*Preferred regimen : [[Ceftriaxone]], [[Cefotaxime]] {{or}} [[Ciprofloxacin]] 400mg IV q12h for 6wks
-:::*'''6.Osteomyelitis'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IV q6-8h {{or}} [[Ciprofloxacin]] 750mg PO bid for ≥4wks
-:::*'''7.Arthritis'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IVq 6-8h for 6weeks.
-:::*'''8.Endocarditis'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IV q6-8h for 6weeks.
-:::*'''9.UTI'''
-::::*Preferred regimen : [[Ceftriaxone]], [[Cefotaxime]] {{or}} [[Ciprofloxacin]] IV for 1-2weeks, then [[Ciprofloxacin|oral Ciprofloxacin]] {{or}} [[TMP-SMX]] for 6weeks
-:::*'''10.HIV and salmonellosis'''
-::::*Preferred regimen : IV [[Cephalosporin]] {{or}} IV [[Fluoroquinolone]], then oral Flouroquinolones([[Ciprofloxacin]] 500-750mg PO bid for 4weeks).
-::::*Note : If relapse occurs within 6weeks give life-long abx or until immune recovery post-ART
-:::*'''11.Carrier state''' : [[Ciprofloxacin]] 500mg PO bid for 4-6weeks {{or}} [[TMP-SMX]] 1DS bid PO for 6weeks{{or}} [[Amoxicillin]] 500mg PO for 6weeks.
-{{PBI|Serratia marcescens}}
-::*Serratia marcescens<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Bacteremia,Pneumonia or SeriousInfections'''
-::::*Preferred regimen : [[Cefepime]] 1-2 g IV q8h {{or}} [[Imipenem]] 0.5-1.0 g IV q6h {{or}} [[Ciprofloxacin]] 400mg IV q8h.
-::::*Alternative regimen : [[Aztreonam]], [[Gentamicin]] {{or}} [[Amikacin]] {{or}} [[Piperacillin]]/[[tazobactam]] also often effective.
-::::*Note : Duration depends on clinical response,usually 7-14days.
-:::*'''2.Endocarditis'''
-::::*Preferred regimen : Choice dictated by sensitivities. 4to6 week duration of parenteral therapy.
-:::*'''3.Osteomyelitis'''
-::::*Preferred regimen : Choice dictated by sensitivity profile. Treat for 6-12weeks depending upon response. Use IV treatment until stable/clinically improved(10-14days min)then may convert to PO therapy if appropriate
-:::*'''4.UTI'''
-::::*Preferred regimen : [[Ciprofloxacin]] 250mg PO bid or 400mg IV q12h {{or}} [[Levofloxacin]] 250mg PO everyday or 500mg IV q24h
-::::*Note : Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs(e.g.,[[Beta-lactam]] and [[Aminoglycoside]] {{or}} [[Fluoroquinolones]] {{and}} [[Carbapenem]])until susceptibilities known.
-{{PBI|Shigella}}
-::*Shigella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen
-::::*If known sulfa sensitive : TMP(160mg)/SMX(800mg) PO q12h for 3-5days.
-::::*Pediatric dose :  TMP5mg/SMX 25mg/kg PO bid.
-::::*If TMP/SMX resistant or unknown susceptibility : [[Ciprofloxacin]] 500mg {{or}} [[Norfloxacin]] 400mg {{or}} [[Ofloxacin]] 200mg PO bid for 3-5days.
-:::*Alternative regimen : [[Ceftriaxone]] 1g IV q24h {{or}}} [[Azithromycin]] 500mg PO single dose, then 250mg PO for 4days {{or}} [[Nalidixicacid]] 250mg PO q6h or pediatric dose 55kg/day) {{or}} [[Ampicillin]](500mg PO q6h depending on susceptibility patterns.
-:::*Note : In southeast Asia, growing resistance seen to fluoroquinolones, azithromycin maybe preferred.
-{{PBI|Stenotrophomonas maltophilia}}
-::*Stenotrophomonas maltophilia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred treatment : [[TMP-SMX]] 15-20(TMP component)mg/kg/day IV/PO q8h.
-:::*Alternative treatment (1) : [[Ceftazidime]] 2g IV q8h {{or}} [[Ticarcillin]]/[[clavulanate]] 3.1g IV q4h {{or}} [[Tigecycline]] 100mg IV Single dose,then 50mg IV q12h.
-:::*Alternative treatment (2) : [[Ciprofloxacin]] 500-750mg PO /400mg IV q12h {{or}} [[Moxifloxacin]] 400mg PO/IV {{or}} [[Levofloxacin]] 750mg PO/IV .
-:::*Alternative treatment (3) : Multiply-resistantance [[Colistin]] 2.5mg/kg q12h IV.
-:::*Note : Treatment duration uncertain,but usually ≥14days
-{{PBI|Vibrio cholerae}}
-{{PBI|Vibrio parahaemolyticus}}
-{{PBI|Vibrio vulnificus}}
-----
-====Bacteria – Atypical Organisms====
-{{PBI|Chlamydophila pneumoniae}}
-:* 1. '''Atypical pneumonia caused by Chlamydophila pneumoniae''' <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* 1.1 ''' Adult'''
-:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 14-21 days
-:::* Preferred regimen (2): [[Tetracycline]] 250  mg PO qid for 14-21 days
-:::* Preferred regimen (3): [[Azithromycin]] 500 mg PO as a single dose, followed by 250 mg PO qd for 4 days
-:::* Preferred regimen (4): [[Clarithromycin]] 500 mg  PO bid for 10 days
-:::* Preferred regimen (5): [[Levofloxacin]] 500 mg IV or PO qd for 7 to 14 days
-:::* Preferred regimen (6): [[Moxifloxacin]] 400 mg PO qd for 10 days.
-::* 1.2 '''Pediatric'''
-:::* Preferred regimen (1): [[ Erythromycin]] suspension,PO 50 mg/kg/day for 10 to 14 days
-:::* Preferred regimen (2): [[ Clarithromycin]] suspension, 15 mg/kg/day for 10 days
-:::* Preferred regimen (3): [[Azithromycin ]]suspension, PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days
-:* 2. '''Upper respiratory tract infection'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* 2.1 '''Bronchitis'''
-:::* Antibiotic therapy for C. pneumoniae is not required.
-::* 2.2 '''Pharyngitis'''
-:::* Antibiotic therapy for C. pneumoniae is not required.
-::* 2.3 '''Sinusitis'''
-:::* Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.
-----
-{{PBI| Chlamydia trachomatis}}
-* 1 '''Chlaymydial infections '''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:* 1.1 '''Chlamydial Infections in Adolescents and Adults'''
-::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
-::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
-::* Alternative regimen (1): [[ Erythromycin]] base 500  mg PO qid for 7 days
-::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO  qid for 7 days
-::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
-::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
-::* Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.
-:* 1.2 '''Chlamydial Infections in patients with HIV Infection'''
-::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
-::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
-::* Preferred regimen (3): [[Azithromycin]] 1 g PO in a single dose
-::* Alternative regimen (1): [[ Erythromycin]] base 500  mg PO qid for 7 days
-::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO  qid for 7 days
-::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
-::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
-:* 1.3 '''Pregancy'''
-::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
-::* Alternative regimen (1): [[ Amoxicillin]]  500  mg PO tid for 7 days
-::* Alternative regimen (2): [[ Erythromycin]] base 500  mg PO qid for 7 days
-::* Alternative regimen (3): [[Erythromycin]] base 250 mg PO  qid for 14 days
-::* Alternative regimen (4): [[ Erythromycin]] ethylsuccinate 800  mg PO qid for 7 days
-::* Alternative regimen (5): [[Erythromycin]] ethylsuccinate 400 mg PO qid for 14 days
-::* Note:[[ Doxycycline]], [[Ofloxacin]], and [[Levofloxacin]] are contraindicated in pregnant women
-:* 1.4 '''Management of sex partners'''
-::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
-::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
-::* Alternative regimen (1): [[ Erythromycin]] base 500  mg PO qid for 7 days
-::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO qid for 7 days
-::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
-::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
-::* Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia  diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
-::* Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
-::* Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present
-* 2 '''Chlamydial infection among neonates'''
-:* 2.1 '''Ophthalmia Neonatorum'''caused by ''C. trachomatis''
-::* Preferred regimen: [[ Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day divided into 4 doses PO daily for 14 days
-::* Alternative regimen: [[Azithromycin ]]suspension 20 mg/kg /day PO qd for 3 days
-::* Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
-:* 2.2 '''Infant Pneumonia'''
-::* Preferred regimen: [[ Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day divided into 4 doses  PO daily for 14 days
-::* Alternative regimen: [[Azithromycin ]]suspension 20 mg/kg /day PO qd for 3 days
-* 3.'''Chlamydial infection among infants and childern'''
-:* 3.1 Infants and childern who weigh < 45 kg
-::* Preferred regimen: [[Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day divided into 4 doses  PO daily for 14 days
-:* 3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years
-::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
-:* 3.3 Infants and childern aged  ≥8 years
-::* Preferred regimen (1): [[Azithromycin]] 1 g PO in a single dose
-::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 7 days
-* 4. '''Lymphogranuloma venereum (LGV) '''
-* Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3   '<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 21 days
-:* Alternative regimen: [[ Erythromycin]] base 500  mg PO qid for 21 days
-:* Note (1): [[Azithromycin]] 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
-:* Note (2): Pregnant and lactating women should be treated with [[Erythromycin]]. [[Azithromycin]] might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. [[Doxycycline]] is contraindicated in pregnant women.
-:* Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
-:* Note(4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( [[Azithromycin]] 1 g PO single dose {{or}} [[Doxycycline]] 100 mg PO bid for 7 days).
-----
-{{PBI|Chlamydophila psittaci}}
-:* 1. '''Pneumonia'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* 1.1 '''Adult'''
-:::* Preferred regimen : [[Doxycycline]] 100 mg PO bid daily {{or}}  [[Tetracycline]] 500  mg PO qid for 10-21 days
-:::* Alternative regimen :[[Minocycline]]
-::* 1.2 '''Pediatric '''
-:::* Preferred regimen: [[Azithromycin ]]
-:::* Alternative  regimen: fluoroquinolones
-::* 1.3 '''Pregnant Patients'''
-:::* Preferred regimen : [[Azithromycin ]]
-:::* Alternative  regimen: fluoroquinolones
-::* 2.'''Endocarditis in valve replacement patients'''
-:::* Preferred regimen : [[Doxycycline]]
-:::* Alternative regimen : fluoroquinolones.
-----
-{{PBI|Coxiella burnetii}}
-* '''1. Acute Q fever''' <ref>{{cite web | title =q fever | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm   }}</ref>
-:* '''1.1 Adults''':
-::* Preferred Regimen: [[Doxycycline]] PO 100 mg bid for 14 days
-:* '''1.2 Children'''
-:* 1.2.1 Children with age  ≥8 years:
-::* Preferred regimen:[[Doxycycline]] PO 2.2 mg/kg per dose bid for 14 days (maximum 100 mg/dose)
-:* 1.2.2 Children with age <8 years with high risk criteria
-::* Preferred regimen:[[Doxycycline]] PO  2.2 mg/kg per dose bid for 14 days (maximum: 100 mg/dose)
-:* 1.2.3 Children with age < 8 years with mild or uncomplicated illness:
-::* Preferred regimen:[[Doxycycline]] PO  2.2 mg/kg per dose bid for 5 days (maximum 100 mg/dose). If patient remains febrile past 5 days of treatment: [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg bid for 14 days (maximum: 800 mg/dose)
-:* '''1.3 Pregnant women'''
-::* Preferred regimen: [[Trimethoprim/sulfamethoxazole]] PO 160 mg/800 mg bid a day throughout pregnancy
-* '''2. Chronic Q fever'''
-:* '''2.1 Endocarditis or vascular infection'''
-::* Preferred regimen:[[Doxycycline]] PO 100 mg bid and [[hydroxychloroquine]]  PO 200 mg tid  for ≥18 months
-::* Note: childern and pregnant women- consultation  Recommended
-:* '''2.2 Noncardiac organ disease'''
-::* Preferred regimen: [[Doxycycline]] PO 100 mg bid and [[hydroxychloroquine]] PO  200 mg tid
-::* Note: childern and pregnant women- consultation  Recommended
-:* '''2.3 Postpartumwith serologic profile for chronic Q fever'''
-::* Preferred regimen:[[Doxycycline]] PO 100 mg bid and [[hydroxychloroquine]] PO  200 mg tid for 12 months
-::* Note(1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
-::* Note(2):Post-Q fever fatigue syndrome- no current recommendation
-{{PBI|Legionella}}
-:* Atypical bacterial pneumonia caused by Legionella <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
-::* Preferred Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
-::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h
-----
-{{PBI|Mycoplasma pneumoniae}}
-* 1. '''Community-acquired pneumonia'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:* Preferred regimen (1): [[Azithromycin]] 500 mg PO qd on day 1 and 250 mg PO qd on days 2 to 5
-:* Preferred regimen (2): [[Clarithromycin]] 500 mg PO qd for 14 days
-:* Preferred regimen (3): [[Doxycycline]] 100 mg PO bid for 14 days
-:* Preferred regimen (4): [[Moxifloxacin]] 400 mg PO qd for 14 days
-:* Preferred regimen (5): [[Levofloxacin]] 750 mg PO qd for 14 days
-----
-{{PBI|Mycoplasma genitalium}}
-:* '''1. Urethritis and cervicitis'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::* Preferred regimen (macrolide-susceptible strains): [[Azithromycin]] 1 g PO as a single dose {{or}} [[Azithromycin]] 500 mg PO as a dose followed by 250 mg PO qd for 4 days
-::* Preferred regimen (for patients with previous treatment failures): [[Moxifloxacin]] 400 mg PO qd for 7–14 days
-:* '''2. Pelvic inflammatory disease (PID)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::* Preferred regimen: [[Moxifloxacin]] 400 mg PO qd for 14 days
-:* '''3. Specific considerations'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::* '''3.1 Management of sex partners'''
-:::* Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.
-::* '''3.2 HIV infection'''
-:::* Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.
-----
-====Bacteria – Miscellaneous====
-{{PBI|Gardnerella vaginalis}}
-:*'''1.Bacterial Vaginosis''''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:::*Gardnerella vaginalis is one of the anaerobic bacteria causing Bacterial Vaginosis,which is a polymicrobial clinical syndrome
-:::*Preferred regimen: [[Metronidazole]] 500 mg PO bid for 7 days {{or}} [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days {{or}} [[Clindamycin]]cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
-:::*Alternative regimen: [[Tinidazole]] 2 g PO qd for 2 days {{or}} [[Tinidazole]] 1 g  PO qd for 5 days {{or}} [[Clindamycin]] 300 mg  PO bid for 7 days {{or}} [[Clindamycin]] ovules 100 mg intravaginally once at bedtime for 3 days
-:::*Note:Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.
-::*'''2.Management of Sex Partners'''
-:::*Routine treatment of sex partners is not recommended.
-::*'''3.Special Considerations'''
-::*'''3.1 Allergy, Intolerance, or Adverse Reactions'''
-:::*Intravaginal clindamycin cream is preferred in case of allergy or intolerance to metronidazole or tinidazole. Intravaginal metronidazole gel can be considered for women who are not allergic to metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.
-::*'''3.2 Pregnancy'''
-:::*Preferred regimen: [[Metronidazole]] 500 mg PO bid for 7 days {{or}} [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
-:::*Note: [[Tinidazole]] should be avoided during pregnancy
-::*'''3.3 HIV Infection'''
-:::*Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.
-{{PBI|Eikenella corrodens}}
-{{PBI|Bordetella pertussis}}
-{{PBI|Bartonella}}
-{{PBI|Stenotrophomonas maltophilia}}
-{{PBI|Acinetobacter baumannii}}
-====Bacteria – Anaerobic Gram-Negative Bacilli====
-{{PBI|Bacteroides fragilis}}
-::* 1.''' Monotherapy''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Imipenem]] (Primaxin) {{or}} [[Ertapenem]] {{or}} [[Meropenem]] {{or}} [[Doripenem]] 0.5-1.0 g IV q6h {{or}} [[Piperacillin-tazobactam]] (Zosyn) 3.375 g IV q6h {{or}} [[Ampicillin-sulbactam]] (Unasyn) 1-2 g IV q6h {{or}} [[Tigecycline]] (Tygacil) 100 mg IV, then 50 mg IV q12h
-::* 2.''' Combination therapy'''
-:::* Preferred regimen: [[Metronidazole]] 0.75-1.0 g IV q12h {{and}} [[Cefotaxime]] 1.5-2 g IV q6h {{or}} [[Aztreonam]] 1-2 g IV q8h {{or}} [[Ceftriaxone]] 1 g IV q12h
-{{PBI|Fusobacterium necrophorum}}
-====Fungi====
-{{PBI|Aspergillosis}}<ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-* '''1. Invasive pulmonary aspergillosis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-* '''2. Invasive sinus aspergillosis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-* '''3. Tracheobronchial aspergillosis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-* '''4. Chronic necrotizing pulmonary aspergillosis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-* '''5. Aspergillosis of the CNS'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Note: There are drug interactions with anticonvulsant therapy.
-* '''6. Aspergillus infections of the heart (endocarditis, pericarditis, and myocarditis)'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Note: endocardial lesions generally require surgical treatment. Aspergillus pericarditis usually requires pericardiectomy.
-* '''7. Aspergillus osteomyelitis and septic arthritis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Note: Surgical resection of devitalized bone and cartilage is important for curative intent.
-* '''8. Aspergillus infections of the eye (endophthalmitis and keratitis)'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Note: Topical therapy is indicated for keratitis, ophthalmologic intervention and management is recommended for all forms of ocular infection. Systemic therapy may be beneficial when treating aspergillus endophthalmitis.
-* '''9. Cutaneous aspergillosis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Note: Surgical resection is indicated when feasible.
-* '''10. Aspergillus peritonitis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-* '''11. Prophylaxis against invasive aspergillosis'''
-:*Preferred regimen: [[Posaconazole]] PO 200mg tid.
-:*Alternative regimen: (1) [[Itraconazole]] 200mg IV bid for 2 days then 200mg IV qd {{or}} [[Itraconazole]] PO 200mg bid.
-:*Alternative regimen: (2) [[Micafungin]] 50mg/day PO qd.
-* '''12. Aspergilloma'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen: [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-* '''13. Chronic cavitary pulmonary aspergillosis'''
-:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, followed by 4 mg/kg IV q12h or PO 200 mg q12h.
-:*Alternative regimen (1): Liposomal [[Amphotericin B]](L-AMB) 3–5 mg/kg/day IV qd.
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd.
-:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose followed by 50 mg/day IV qd.
-:*Alternative regimen (4): [[Micafungin]] 100–150 mg/day PO qd.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-::*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
-:*Alternative regimen (5): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
-:*Alternative regimen (6): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Note: long-term therapy might be needed.
-*'''14. Allergic bronchopulmonary Itraconazole aspergillosis'''
-:*Preferred regimen: [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Alternative regimen (1): [[Voriconazole]] PO 200 mg bid.
-:*Alternative regimen (2): [[Posaconazole]] PO 400 mg bid.
-:*Note: Corticosteroids are a cornerstone of the therapy.
-*'''15. Allergic aspergillus sinusitis'''
-:*Preferred regimen: None or [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, followed by 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, followed by 200 mg IV qd.
-:*Note: Few data available for other agents.
-*'''16. Relative indications for surgical treatment of invasive aspergillosis'''
-:*Pulmonary lesion in proximity to great vessels or pericardium;
-:*Pericardial infection;
-:*Invasion of chest wall from contiguous pulmonary lesion;
-:*Aspergillus empyema;
-:*Persistent hemoptysis from a single cavitary lesion;
-:*Infection of skin and soft tissues;
-:*Infected vascular catheters and prosthetic devices;
-:*Endocarditis;
-:*Osteomyelitis;
-:*Sinusitis;
-:*Cerebral lesions.
-{{PBI|Blastomycosis}}
-*[[Blastomycosis]]<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107  }} </ref>
-:* '''1. Mild to moderate pulmonary blastomycosis'''
-::* Preferred regimen: [[Itraconazole]] 200 mg PO once or twice per day for 6–12 months
-::* Note: Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then once or twice per day for 6–12 months, is recommended
-:* '''2. Moderately severe to severe pulmonary blastomycosis'''
-::* Preferred regimen (1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Preferred regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Note: Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
-:* '''3. Mild to moderate disseminated blastomycosis'''
-::* Preferred regimen: [[Itraconazole]] 200 mg PO once or twice per day for 6–12 months
-::* Note (1): Treat osteoarticular disease for 12 months
-::* Note (2): Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
-:* '''4. Moderately severe to severe disseminated blastomycosis'''
-::* Preferred regimen (1): Lipid amphotericin B(Lipid AmB) 3–5 mg/kg per day, for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Preferred regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg per day, for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Note: oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
-:* '''5. CNS disease'''
-::* Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg per day for 4–6 weeks {{and}} an oral azole for at least 1 year
-::* Note (1): Step-down therapy can be with [[Fluconazole]], 800 mg per day {{or}} [[Itraconazole]], 200 mg 2–3 times per day {{or}} voriconazole, 200–400 mg twice per day.
-::* Note (2): Longer treatment may be required for immunosuppressed patients.
-:* '''6. Immunosuppressed patients'''
-::* Preferred regimen (1): Lipid amphotericin B (Lipid AmB), 3–5 mg/kg per day, for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg PO bid for 12 months
-::* Preferred regimen (2): [[Amphotericin B]] deoxycholate, 0.7–1 mg/kg per day, for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg PO bid for 12 months
-::* Note (1): Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 12 months, is recommended
-::* Note (2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
-:* '''7. Pregnant women'''
-::* Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day
-::* Note (1): Azoles should be avoided because of possible teratogenicity
-::* Note (2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg per day
-:* '''8. Children with mild to moderate disease'''
-::* Preferred regimen: [[Itraconazole]] 10 mg/kg PO per day for 6–12 months
-::* Note: Maximum dose 400 mg per day
-:* '''9. Children with moderately severe to severe disease'''
-::* Preferred regimen (1): Amphotericin B deoxycholate 0.7–1 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
-::* Preferred regimen (2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
-::* Note: Children tolerate Amphotericin B deoxycholate better than adults do.
-{{PBI|Paracoccidioidomycosis}}
-:* Preferred regimen (1): <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
-::* Adults: [[Itraconazole]] 200 mg/day PO.
-::* Children: [[Itraconazole]] (<30/kg and >5 yr) 5-10 mg/kg/day PO.
-::*Note: Treatment duration based on organ involvement:
-:::*Mild involvement: 6-9 months.
-:::*Moderate involvement: 12-18 months
-:* Preferred regimen (2): <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
-::* Adults [[Trimethoprim/sulfamethoxazole]] (TMP/SMX)  TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid.
-::* Children [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid.
-::* Note (1): Treatment duration based on organ involvement:
-:::* Minor involvement: 12 months
-:::* Moderate involvement: 18-24 months
-::*Note (2): Preferred treatment in children due to larger experience.
-::*Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
-:* Preferred regimen (3): [[Amphotericin B]] deoxycholate mg/kg/day IV until patient improves and can be treated by the oral route.<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
-::*Note: Preferred in severe forms of the disease.<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
-:* Alternative regimen (4): [[Ketoconazole]] 200-400 mg/day PO for 9-12 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-:* Alternative regimen (5): [[Voriconazole]] initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Note: Diminish the dose to 50% if weight is <40 kg.
-{{PBI|Candidiasis}}
-{{PBI|Chromoblastomycosis}}
-:*'''1. If lesions small and few'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* surgical excision or cryosurgery with liquid nitrogen.
-:*'''2. If lesions chronic, extensive, burrowing'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen: [[Itraconazole]] 200-400 mg PO q24h {{or}} 400 mg pulse therapy once daily for 1 week monthly for 6-12 months
-{{PBI|Coccidioidomycosis}}
-{{PBI|Cryptococcosis}}
-{{PBI|Cryptococcus}}
-:* 1. '''Cryptococcus neoformans'''
-::* 1.1 '''Cryptococcus neoformans meningitis in HIV infected patients'''<ref name="pmid20047480">{{cite journal| author=Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ et al.| title=Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 3 | pages= 291-322 | pmid=20047480 | doi=10.1086/649858 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20047480  }} </ref>
-:::*Preferred regimen for induction and consolidation: ([[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) {{or}} [[Liposomal AmB]] 3-4mg/kg IV qd {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd) {{plus}} [[Flucytosine]] 100mg/kg/day PO or IV qid for at least 2 weeks followed by [[Fluconazole]] 400mg (6mg/kg) PO qd for at least 8 weeks.
-:::*Alternative regimen for induction and consolidation (1): [[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd {{or}} [[Liposomal AmB]] 3-4 mg/kg IV qd {{or}} AmB lipid complex 5mg/kg IV qd for 4-6 weeks.
-:::*Alternative regimen for induction and consolidation (2): [[Amphotericin B]] deoxycholate 0.7 mg/kg IV qd {{plus}} [[Fluconazole]] 800mg PO qd for 2 weeks, followed by [[Fluconazole]] 800mg PO qd for at least 8 weeks.
-:::*Alternative regimen for induction and consolidation (3): [[Fluconazole]] (>800 mg PO qd, 1200mg PO qd is favored) {{plus}} [[Flucytosine]] (100mg/kg/day PO qid) for 6 weeks.
-:::*Alternative regimen for induction and consolidation (4): [[Fluconazole]] PO 800-2000mg qd for 10-12 weeks.
-:::*Preferred regimen for maintenance and prophylactic therapy: Initiate HAART 2-10 weeks after commencing initial antifungal therapy {{and}} [[Fluconazole]] 200mg PO qd.
-:::*Alternative regimen for maintenance and prophylactic therapy: [[Itraconazole]] 200mg PO bid - monitor drug-level {{or}} [[Amphotericin B]] deoxycholate (1 mg/kg) per week IV (should be used in azole-intolerant patients).
-:::* Note (1): Consider discontinuing supressive therapy if CD4 count is higher than 100 cells/uL {{and}} undetectable {{or}} very low HIV RNA level for more than 3 months. Consider reinstitution of maintenance therapy if CD4 count <100 cels/uL.
-:::* Note (2): Do not use [[acetazolamide]] {{or}} [[mannitol]] {{or}} [[corticosteroids]] to treat increased intracranial pressure, instead it should be used lombar puncture in the absence of focal neurologic signs or impaired mentation (which, if present, patient must be submitted to CT or MRI scan first).
-::'''1.2. Cerebral cryptococcomas'''
-:::*Preferred regimen for induction and consolidation: ([[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) {{or}} [[Liposomal AmB]] 3-4mg/kg IV qd {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd) {{plus}} [[Flucytosine]] 100mg/kg/day PO or IV qid for at least 2 weeks followed by [[Fluconazole]] 400mg (6mg/kg) PO qd for at least 8 weeks.
-:::*Note: Consider surgery if lesions are larger than 3cm, accessible lesions with mass effect or lesions that are enlarging and not explained by IRIS.
-::'''1.3. Cryptococcus neoformans meningitis in HIV negative patients'''
-:::*Preferred regimen: [[Amphotericin B deoxycholate]] 0.7-1.0 mg/kg IV qd {{plus}} [[Flucytosine]] 100mg/kg/day PO or IV qid for at least 4 weeks (which may be extended to 6 weeks if there is any neurological complication) followed by [[Fluconazole]] 400mg PO qd for 8 weeks. If there's toxicity to AmBd, consider changing to LFAmB in the second 2 weeks.
-:::*Note (1): After induction and consolidation therapy, start [[Fluconazole]] 200mg (3mg/kg) PO qd for 6-12 months.
-:::*Note (2): If [[Flucytosine]] is not given, consider lengthening the induction therapy for at least 2 weeks.
-::'''1.4. Cryptococcus neoformans pulmonary disease - immunosupressed'''
-:::*Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
-::::*Preferred regimen: [[Fluconazole]] 400mg PO qd for 6-12 months.
-:::*Severe pneumonia or disseminated disease or CNS infection:
-::::*Preferred regimen: treat like CNS cryptococcosis.
-:::*Note (1): In HIV- infected patients, treatment should be stopped after 1 year if CD4 count is >100 and a cryptococcal antigen titer is <1:512 and not increasing.
-:::*Note (2): Consider [[corticosteroid]] if [[ARDS]] is present in a context which it might be attributed to [[IRIS]].
-::'''1.5 Cryptococcus neoformans pulmonary disease - non-immunosupressed'''
-:::*Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
-::::*Preferred regimen: [[Fluconazole]] 400mg PO qd for 6-12 months.
-::::*Alternative regimen: if [[Fluconazole]] is unavailable or contraindicated, [[Itraconazole]] 200mg PO bid, [[Voriconazole]] 200 mg PO bid, and [[Posaconazole]] 400mg PO bid.
-:::*If there's severe pneumonia, disseminated disease or CNS infection:
-::::*Preferred regimen: treat like CNS cryptococcosis for 6-12 months.
-::'''1.6 Cryptococcus neoformans non-lung, non-CNS infection'''
-:::*Cryptococcemia or disseminated cryptococcic disease  (involvement of at least 2 noncontiguous sites or cryptococcal antigen titer >1:512):
-::::*Preferred regimen: treat like CNS infection.
-:::*If infection occurs at a single site and no immunosupressive risk factors
-::::*Preferred regimen: [[Fluconazole]] 400mg PO qd for 6-12 months.
-::'''1.7. Cryptococcosis in Children'''
-::::*Preferred regimen for induction and consolidation: [[Amphotericin B]] deoxycholate 1.0 mg/kg qd IV {{plus}} [[Flucytosine]] 100mg/kg PO or IV qid for 2 weeks followed by [[Fluconazole]] 10-12mg/kg PO qd for 8 weeks.
-::::*Alternative regimen: patients with renal dysfunction: change [[Amphotericin B]] deoxycholate by [[Liposomal AmB]] 5mg/kg IV qd or [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd.
-::::*Preferred regimen for maintenance: Fluconazole 6mg/kg PO qd. Discontinuation of maintenance therapy is poorly studied and should be individualized.
-:::*Cryptococcal pneumonia:
-::::*Preferred regimen Fluconazole 6-12mg/kg PO qd for 6-12 months.
-::'''1.8. Cryptococcosis in Pregnant Women'''
-:::*Preferred regimen for induction and consolidation: [[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction - [[Liposomal AmB]] 3-4mg/kg IV qd {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd. Consider using [[Flucytosine]] in relationship to benefit risk basis, since it is a Category C drug for pregnancy. Start [[Fluconazole]] after delivery. Avoid use during first trimester and consider use in the last 2 trimesters with the need for continuous antifungal therapy during pregnancy.
-:::*Note: If pulmonary cryptococcosis: perform close follow-up and administer fluconazole after delivery.
-:'''2. Cryptococcus gatti'''
-::*Disseminated cryptococcosis or CNS disease:
-:::*Preferred regimen: treatment is the same as C. neoformans.
-::*Pulmonary disease: single and small cryptococcoma:
-:::*Preferred regimen: [[Fluconazole]] 400mg per day PO for 6-18months.
-::*Pulmonary disease: Very large or multiple cryptococcomas:
-:::*Preferred regimen: administer [[Flucytosine]] {{and}} [[AmB deocycholate]] for 4-6 weeks, followed by fluconazole for 6-18 months.
-:::*Note: Surgery should be considered if there is compression of vital structures {{or}} failure to reduce the size of the cryptococcoma after 4 weeks of therapy.
-----
-{{PBI|Tinea cruris}}
-:*'''Tinea Cruris'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Preferred regimen: Interdigital: Topical cream/ointment: [[terbinafine]], [[imidazoles]] ([[miconazole]], [[econazole]], [[clotrimazole]]), [[Griseofulvin]] 250mg tid PO for 14 days should be used in resistant to topic therapy cases.
-----
-{{PBI|Tinea corporis}}
-:* '''Tinea Corporis'''
-::*2.1 Small, well-defined lesions:
-:::* Preferred regimen: Topical cream/ointment: [[terbinafine]], [[imidazoles]] ([[miconazole]], [[econazole]], [[clotrimazole]]).
-::*2.2 Larger lesions:
-:::*Preferred regimen: Larger lesions: [[terbinafine]] PO 250mg/day for 2 weeks; [[itraconazole]] PO 200mg/day for 1 week, [[fluconazole]] PO 250mg weekly for 2-4 weeks.
-----
-{{PBI|Tinea pedis}}
-:*'''1. Tinea Pedis'''
-::*Preferred regimen: Interdigital: Topical cream/ointment: [[terbinafine]], [[imidazoles]] ([[miconazole]], [[econazole]], [[clotrimazole]]), [[undecenoic acid]], [[tolnaftate]].
-::*Note (1): If "Dry type": Oral: [[terbinafine]] PO 250mg/day for 2-4 weeks, [[itraconazole]] PO 400mg/day for 1 week per month (repeat if necessary), [[fluconazole]] PO 200mg weekly for 4-8 weeks.
-----
-{{PBI|Tinea capitis}}
-:*'''Tinea Capitis'''
-::*Preferred regimen: [[Griseofulvin]] PO 10-20mg/kg/day for at least 6 weeks (Preferred for children).
-::*Alternative regimens: [[Terbinafine]] PO 62.5mg/day if <20kg; 125 mg/day if 20-40kg; 250mg/day if >40kg {{or}} [[Itraconazole]] PO 4-6mg/kg pulsed dose weekly.
-:::*Note: [[Nistatin]] is not effective in the treatment of dermatophytosis.
-----
-{{PBI|Tinea barbae}}
-:*'''Tinea Barbae'''
-::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 4 weeks.
-::*Alternative regimen: [[Itraconazole]] PO 200mg/day for 2 weeks.
-----
-{{PBI|Tinea incognito}}
-:*'''Tinea Incognito'''
-::*Preferred regimen: Stop topical [[steroids]] and treat with topical 1% [[terbinafine]] cream for 6 weeks.
-----
-{{PBI|Tinea manuum}}
-:*'''Tinea Manuum'''
-::*Preferred regimen: topical or systemic [[terbinafine]] PO 250 mg/day por 2-4 weeks.
-----
-{{PBI|Tinea versicolor}}
-:*'''Tinea Versicolor'''
-::*Preferred regimen: [[Itraconazole]] 200mg daily for a week.
-::*Alternative regimen: [[Ketoconazole]] 200mg daily for 4 weeks.
-----
-{{PBI|Majocchi's granuloma}}
-:*'''Majocchi's Granuloma'''
-::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 2-4 weeks.
-::*Alternative regimen: [[Itraconazole]] 200mg PO bid for 1 week, per month for 2 months.
-----
-{{PBI|Onychomycosis}}
-:*'''Onychomycosis'''<ref name="pmid19439745">{{cite journal| author=de Berker D| title=Clinical practice. Fungal nail disease. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 20 | pages= 2108-16 | pmid=19439745 | doi=10.1056/NEJMcp0804878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19439745  }} </ref>
-:::*10.1 Fingernails
-::::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 6 weeks {{or}} [[Itraconazole]] PO 200mg twice a day for a week a month for 2 months (European guidelines).
-:::*10.2 Toenails
-::::*Preferred regimen: Toenails [[Terbinafine]] PO 250mg/day for 12 weeks {{or}} [[Itraconazole]] PO 200mg/day for 12 weeks (U.S. guidelines) {{or}} [[Itraconazole]] PO 200mg twice a day for a week a month for 3 months (European guidelines).
-:::*Note (1): There is no evidence that combining systemic and topic treatments has any benefit to the patient.
-----
-{{PBI|Histoplasmosis}}
-{{PBI|Mucormycosis}}
-{{PBI|Penicilliosis}}
-{{PBI|Sporotrichosis}}
-{{PBI|Pneumocystis jiroveci}}
-:*'''1. Preventing First Episode of PCP (Primary Prophylaxis)'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
-}}</ref>
-::*Preferred regimen: [[TMP-SMX]] 1 Double-Strength(DS) PO daily {{or}} [[TMP-SMX]] 1 Single-Strength(SS) PO daily
-::*Alternative regimen (1): [[TMP-SMX]] 1 Double-Strength(DS) tid weekly {{or}} [[Dapsone]] 100 mg PO daily or 50 mg PO BID
-::*Alternative regimen (2): [[Dapsone]] 50 mg PO daily {{and}} ([[Pyrimethamine]] 50 mg + [[Leucovorin]] 25 mg) PO weekly
-::*Alternative regimen (3): [[Dapsone]] 200 mg {{and}} [[Pyrimethamine]] 75 mg {{and}} [[Leucovorin]] 25 mg PO weekly
-::*Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
-::*Alternative regimen (5): [[Atovaquone]] 1500 mg PO daily with food
-::*Alternative regimen (6): [[Atovaquone]] 1500 mg {{and}} [[Pyrimethamine]] 25 mg {{and}} [[Leucovorin]] 10 mg PO daily with food
-:*'''2. Treatment of Pneumocystis Pneumonia'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
-}}</ref>
-::*'''2.1. Moderate to Severe PCP'''
-:::*Preferred regimen: [[TMP-SMX]] (TMP 15–20 mg and SMX 75–100 mg)/kg/day IV given q6h or q8h
-:::*Note: May switch to PO after clinical improvement
-:::*Alternative regimen (1): [[Pentamidine]] 4 mg/kg IV once daily infused over at least 60 minutes
-:::*Note: May reduce the dose to 3 mg/kg IV once daily because of toxicities.
-:::*Alternative regimen (2): [[Primaquine]] 30 mg (base) PO once daily {{and}} ([[Clindamycin]] [IV 600 mg q6h or 900 mg q8h] or [PO 450 mg q6h or 600 mg q8h])
-::*Note (1): Duration of PCP treatment is 21 days
-::*Note (2): Adjunctive corticosteroid may be indicated in some moderate to severe cases.Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy) (AI):
-::*Note (3): Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy)
-:::*Days 1–5 40 mg PO BID
-:::*Days 6–10 40 mg PO daily
-:::*Days 11–21 20 mg PO daily
-::*'''2.2. Mild to Moderate PCP'''
-:::*Preferred regimen: [[TMP-SMX]] (TMP 15–20 mg/kg/day and SMX 75–100 mg/kg/day), given PO in 3 divided doses {{or}} [[TMP-SMX]] Double-Strength(DS) - 2 tablets tid
-:::*Alternative regimen (1): [[Dapsone]] 100 mg PO daily {{and}} [[TMP]] 15 mg/kg/day PO (3 divided doses)
-:::*Alternative regimen (2): [[Primaquine]] 30 mg (base) PO daily {{and}} [[Clindamycin]] PO (450 mg q6h or 600 mg q8h)
-:::*Alternative regimen (3): [[Atovaquone]] 750 mg PO BID with food
-::*Note: Duration of PCP treatment is 21 days
-:*'''3. Preventing Subsequent Episode of PCP (Secondary Prophylaxis)'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
-}}</ref>
-::*Preferred regimen: [[TMP-SMX]] 1 Double-Strength(DS) PO daily {{or}} [[TMP-SMX]] 1 Single-Strength(SS) PO daily
-::*Alternative regimen (1): [[TMP-SMX]] 1 Double-Strength(DS) tid weekly {{or}} [[Dapsone]] 100 mg PO daily or 50 mg PO BID
-::*Alternative regimen (2): [[Dapsone]] 50 mg PO daily {{and}} ([[Pyrimethamine]] 50 mg + [[Leucovorin]] 25 mg) PO weekly
-::*Alternative regimen (3): [[Dapsone]] 200 mg {{and}} [[Pyrimethamine]] 75 mg {{and}} [[Leucovorin]] 25 mg PO weekly
-::*Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
-::*Alternative regimen (5): [[Atovaquone]] 1500 mg PO daily with food
-::*Alternative regimen (6): [[Atovaquone]] 1500 mg {{and}} [[Pyrimethamine]] 25 mg {{and}} [[Leucovorin]] 10 mg PO daily with food
-====Mycobacteria====
-{{PBI|Mycobacterium tuberculosis}}
-{{PBI|Mycobacterium abscessus}}
-::* 1.'''Limited, localized extrapulmonary disease ''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily {{withorwithout}} [[Amikacin]] 10-15 mg/kg/day IV or 25 mg/kg three times weekly  for 4 months
-:::* Alternative regimen (1): [[Amikacin]] {{and}} [[Cefoxitin]] 12 g/day typically for two weeks until clinical improvement in severe cases
-:::* Alternative regimen (2): [[Amikacin]] {{and}} [[Imipenem]] 500 mg IV q6-8h for two weeks until clinical improvement in severe cases
-:::* NOTE: Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed
-::* 2.'''Pulmonary or serious extrapulmonary disease'''
-:::* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily {{and}} [[Amikacin]] 15 mg/kg/day IV {{and}} [[Cefoxitin]] 2g q4h IV {{or}} [[Imipenem]] 1g q6h IV for at least 2-4 months, if limited by adverse effects, then switch to[[Clarithromycin]] 500 mg PO BID or 1000 mg XR OD {{or}} [[Azithromycin]] 250 mg PO OD
-:::* Alternative regimen(1): [[Tigecycline]] 100 mg IV load then 50 mg IV q12h could be substituted as one of the injectables
-:::* Alternative regimen(2): [[Linezolid]] 600 mg PO q12h or 600 mg PO OD {{and}} [[Clarithromycin]] could replace parental tx if not tolerated or feasible
-{{PBI|Mycobacterium bovis}}
-{{PBI|Mycobacterium avium-intracellulare}}
-{{PBI|Mycobacterium celatum}}
-{{PBI|Mycobacterium chelonae}}
-*1.''' Localized infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily
-:* Alternative regimen: [[Azithromycin]]
-*2. '''Disseminated or extensive disease'''
-:*2.1 monotherapy
-::* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily
-:*2.2 multidrug therapy
-::* preferred regimen: [[Clarithromycin]] 500 mg PO BID {{and}} [[Tobramycin]] 5 mg IV/kg/day {{or}} [[Imipenem]] 0.5-1 g IV q6h {{or}} [[Linezolid]] 600 mg IV/PO BID for 4-8 weeks
-::* Alternative regimen: [[Moxifloxacin]] 400 mg daily {{and}} [[Linezolid]] 600 mg twice daily
-:* NOTE: Total treatment duration is 6 months
-*3. '''Keratitis (LASIK-related)'''
-:* Preferred regimen: [[Clarithromycin]] 500 mg PO BID {{and}} topicals ([[Tobramycin]] 0.3%, 2 gtts q4h {{and}} [[Gatifloxacin]] 0.3%, 1 gtt q4h {{or}} [[Moxifloxacin]] 0.5%, 1 gtt q4h)
-{{PBI|Mycobacterium foruitum}}
-{{PBI|Mycobacterium haemophilum}}
-{{PBI|Mycobacterium genavense}}
-{{PBI|Mycobacterium gordonae}}
-{{PBI|Mycobacterium kansasii}}
-{{PBI|Mycobacterium marinum}}
-{{PBI|Mycobacterium scrofulaceum}}
-{{PBI|Mycobacterium simiae}}
-:* [[Mycobacterium simiae]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* Preferred regimen: [[Clarithromycin]] {{and}} [[Moxifloxacin]] {{and}} [[Trimethoprim/sulfamethoxazole]]
-{{PBI|Mycobacterium ulcerans}}
-:* [[Mycobacterium ulcerans]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-:* 1. '''Preulcerative lesions'''
-::* Preferred regimen: Excision and primary closure, [[Rifampin]] monotherapy, or heat therapy
-:* 2. '''Established ulcers'''
-::* Preferred regimen: Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice
-:* 3. '''Control complications of the ulcer'''
-::* Preferred regimen: [[Clarithromycin]] {{and}} [[Rifampin]]
-{{PBI|Mycobacterium xenopi}}
-:* [[Mycobacterium xenopi]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-:* 1. '''The cornerstone of therapy for M. xenopi'''
-::* Preferred regimen: A combination of [[Clarithromycin]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]]. Therapy should be continued until the patient has maintained negative sputum cultures while on therapy for 12 months
-:* 2. '''Pulmonary disease'''
-::* Preferred regimen: [[INH]] {{and}} [[Rifabutin]] {{or}} [[Rifampin]] {{and}} [[Ethambutol]] {{and}} [[Clarithromycin]] {{withorwithout}} an initial course of [[Streptomycin]]. A quinolone, preferably [[Moxifloxacin]], could be substituted for one of the antituberculous drugs
-:* 3. '''Extrapulmonary disease'''
-::* Therapy for extrapulmonary disease would include the same agents as for pulmonary disease
-{{PBI|Mycobacterium leprae}}
-:* [[Mycobacterium leprae]] <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* 1. '''Multibacillary Leprosy (Skin smear positive) '''
-:::* Preferred regimen: [[Dapsone]] 100 mg/day PO {{and}} [[Rifampin]] 600 mg PO 4 times per week {{and}} [[Clofazimine]] 50 mg/day PO supplemented by [[Clofazimine]] 300 mg PO loading dose monthly
-:::* Pediatric regimen: [[Dapsone]] 1-2 mg/kg/day PO {{and}} [[Rifampin]] 450 mg PO <35 kg, 300 mg PO <20 kg, 150 mg PO <12 kg
-:::* Length of treatment: 12-24 months
-::* 2. '''Paucibacillary Leprosy (Skin Smear negative)'''
-:::* Preferred regimen: [[Rifampin]] 600 mg PO once a month for 6 months {{and}} [[Dapsone]] 100 mg/day PO for 6 months
-::* 3. '''Erythema Nodosum Leprosum (ENL)'''
-:::* Continue anti-leprosy drugs throughout
-:::* 3.1 Mild
-::::* Preferred regimen: Rest affect limb, analgesics, follow-up twice a week, check for iridocyclitis; [[Chloroquine]] {{or}} [[Aspirin]] may be useful
-:::* 3.2 Severe (numerous nodules + fever, ulcerating/pustular ENL, visceral involvement, nodules + neuritis, recurrent ENL)
-::::* Preferred regimen: [[Prednisolone]] 30-40 mg/day PO (not to exceed 1 mg/kg) for 1-2 weeks, then taper over 12 weeks
-::::* Alternative regimen (1): (If unresponsive to corticosteroids or if risk of corticosteroids prevent administration) Start [[Clofazimine]] 100 mg PO TID for maximum of 12 weeks, taper the dose to 100 mg PO BID for 12 weeks and then 100 mg qd for 12-24 weeks
-::::* Alternative regimen (2): (if not contraindicated) [[Thalidomide]] 200-400 mg/day PO, reduced to 50-100 mg/day after 1-2 weeks
-::* 4. '''Reversal Reaction'''
-:::* Preferred regimen: [[Prednisolone]] start with 40 mg/day PO then taper by 10 mg twice a week for 12 weeks
-{{PBI|Mycobacterium smegmatis}}
-:* [[Mycobacterium smegmatis]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* 1. '''Mild disease'''
-:::* Preferred regimen: [[Doxycycline]] PO {{and}} [[ Trimethoprim sulfamethoxazole]] PO
-::* 2. '''Severe disease'''
-:::* Preferred regimen: [[Amikacin]] IV {{or}} [[Imipenem]] IV
-{{PBI|Mycobacterium immunogenum}}
-:* [[Mycobacterium immunogenum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* In vitro
-:::* susceptible: [[Amikacin]] {{and}} [[Clarithromycin]] but
-:::* resistant: [[Ciprofloxacin]], [[Doxycycline]], [[Cefoxitin]], [[Tobramycin]], and [[Sulfamethoxazole]]
-:::* NOTE: The optimal therapy for this organism is unknown; however, successful therapy is likely difficult due to the extensive antibiotic resistance of the organism
-{{PBI|Mycobacterium malmoense }}
-:* [[Mycobacterium malmoense]]<ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* in vitro
-:::* Susceptible: [[Ethambutol]], [[Ethionamide]], [[Kanamycin]], and [[Cycloserine]]
-:::* Resistant: [[INH]], [[Streptomycin]], [[Rifampin]], and [[Capreomycin]]
-::* Pulmonary M. malmoense infection
-:::* Preferred regimen: [[INH]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]] {{withorwithout}} [[Quinolones]] {{and}} [[Macrolides]]
-{{PBI|Mycobacterium mucogenicum}}
-:* [[Mycobacterium mucogenicum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* In vitro susceptible agents: [[Aminoglycosides]], [[Cefoxitin]], [[Clarithromycin]], [[Minocycline]], [[Doxycycline]], [[Quinolones]], [[Trimethoprim/sulfamethoxazole]], and [[Imipenem]]
-{{PBI|Mycobacterium szulgai}}
-:* [[Mycobacterium szulgai]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref><ref>{{Cite journal| issn = 0903-1936| volume = 11| issue = 4| pages = 975–977| last1 = Tortoli| first1 = E.| last2 = Besozzi| first2 = G.| last3 = Lacchini| first3 = C.| last4 = Penati| first4 = V.| last5 = Simonetti| first5 = M. T.| last6 = Emler| first6 = S.| title = Pulmonary infection due to Mycobacterium szulgai, case report and review of the literature| journal = The European Respiratory Journal| date = 1998-04| pmid = 9623706}}</ref>
-::* '''1. in vitro susceptibility'''
-:::* M. szulgai is susceptible in vitro to most antituberculous drugs including [[Quinolones]] and newer [[Macrolides]].
-::* '''2. Pulmonary infection'''
-:::* Preferred regimen: three- or four-drug regimen based on susceptibility that includes 12 months of negative sputum cultures while on therapy
-::* '''3. Extrapulmonary infection'''
-:::* Preferred regimen: combination anti-tuberculous medications based on in vitro susceptibilities for 4 to 6 months
-{{PBI|Mycobacterium terrae}}
-:* [[Mycobacterium terrae]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* 1. '''In vitro susceptibility'''
-:::* All six of the isolates from a single center and 90% or more of an additional 22 isolates of M. terrae complex were susceptible to [[Ciprofloxacin]] and [[Sulfonamides]]. Recently, 11 isolates of M. terrae complex were also shown to be susceptible to [[Linezolid]]
-::* 2. '''Antimicrobial therapy'''
-:::* Preferred regimen: [[Macrolide]] {{and}} [[Ethambutol]] or other agent based on in vitro susceptibility results
-====Parasites – Intestinal Protozoa====
-{{PBI|Balantidium coli}}
-{{PBI|Blastocystis hominis}}
-{{PBI|Cryptosporidium parvum}}
-::* '''1. Immunocompetent'''<ref name="pmid11398117">{{cite journal| author=Rossignol JF, Ayoub A, Ayers MS| title=Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. | journal=J Infect Dis | year= 2001 | volume= 184 | issue= 1 | pages= 103-6 | pmid=11398117 | doi=10.1086/321008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11398117  }} </ref>
-:::* Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: [[Nitazoxanide]] 500 mg PO bid for 3 days.
-::* '''2. HIV'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days
-::* '''3. HIV and Immunodeficiency'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: Effective antiretroviral therapy
-:::* Note: Nitazoxanide is not licensed for immunodeficient patients
-{{PBI|Cryptosporidium hominis}}
-::* '''1. Immunocompetent'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: [[Nitazoxanide]] 500 mg PO bid for 3 days.<ref name="pmid15640710">{{cite journal| author=Smith HV, Corcoran GD| title=New drugs and treatment for cryptosporidiosis. | journal=Curr Opin Infect Dis | year= 2004 | volume= 17 | issue= 6 | pages= 557-64 | pmid=15640710 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640710  }} </ref>
-::* '''2. HIV'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days
-::* '''3. HIV and Immunodeficiency'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: Effective antiretroviral therapy
-:::* Note: Nitazoxanide is not licensed for immunodeficient patients
-{{PBI|Cyclospora cayetanensis}}
-::* Preferred regimen: [[Trimethoprim-sulfamethoxazole]] one double-strength tablet PO bid for 7-10 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Alternative regimen(1): [[Ciprofloxacin]] 500 mg PO bid for 7 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Alternative regimen(2): [[Nitazoxanide]] 500 mg PO bid for 7 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Note(1): One double-strength tablet (160 mg TMP/800 mg SMX) .
-::* Note(2): Treatment is continued for 7 days in immunocompetent hosts and for 7 to 10 days in patients with HIV infection.
-{{PBI|Dientamoeba fragilis}}
-{{PBI|Entamoeba histolytica}}
-:* '''1. Amebic Liver Abscess'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Preferred regimen: ([[Metronidazole]] 750 mg PO tid for 10 days {{or}} [[Tinidazole]] 2 g PO qd for 5 days) {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days).
-::*Alternative regimen (1): [[Nitazoxanide]] 500mg bid for 10 days {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days).
-::* Alternative regimen (2): [[Tinidazole]] 2 g PO qd for 5 days {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days).
-::* Alternative regimen (2): [[Tinidazole]] 2 g PO qd for 5 days.
-:* '''2. Amebic Colitis'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Preferred regimen: [[Metronidazole]] 500-750mg PO tid for 7-10 days. Pediatric dose: 35-50mg/kg per day tid {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days).
-::* Alternative regimen: [[Tinidazole]] 2 g PO qd for 5 days {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days).
-:* '''3. Asymptomatic Intestinal Colonization'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Preferred regimen: [[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days.
-::* Alternative regimen (1): [[Diloxanide furoate]] 500 mg PO tid for 10 days.
-::* Alternative regimen (2): [[Diiodohydroxyquin]] 650 mg PO tid for 20 days for adults and 30 to 40 mg/kg per day tid for 20 days for children.
-----
-{{PBI|Giardia lamblia}}
-here
-----
-{{PBI|Cystoisospora belli}}
-:* 1. '''Cystoisospora belli treatment'''<ref>{{cite web | title = CDC - Cystoisosporiasis | url = http://www.cdc.gov/parasites/cystoisospora/health_professionals/index.html }}</ref>
-::* 1.1 '''Immunocompetent hosts'''
-:::* In the immunocompetent hosts, symptoms of Cystoisospora infection are usually self-limited.
-:::* Antimicrobial therapy to immunocompetent patients may be considered if symptoms do not start to resolve spontaneously after 5 to 7 days (depending upon severity)
-:::* Prefered regimen: [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO bid for 7-10 days
-:::* Alternative regimen (1) (for patients who are allergic to or intolerant of TMP-SMX): [[Pyrimethamine]] 50-75 mg/day PO qd or divided in 2 equal doses {{and}} [[Leucovorin]] 10–25 mg PO qd
-:::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 7 days (second-line alternative)
-::::* 1.1.1 '''In pregnancy'''
-:::::* TMP-SMX should be avoided near-term because of the potential for hyperbilirubinemia and kernicterus in the newborn.
-:::::* Ciprofloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
-::::* 1.1.2 '''During lactation'''
-:::::* TMP-SMX generally should be avoided by women when nursing infants who are premature, jaundiced, ill, or stressed, or who have glucose-6-phosphate dehydrogenase deficiency.
-:::::* The American Academy of Pediatrics classifies Ciprofloxacin as usually compatible with breastfeeding, whereas the World Health Organization recommends avoiding Ciprofloxacin while breastfeeding and CDC recommends Ciprofloxacin should be used during lactation only if the potential benefit justifies the potential risk to the fetus.
-::::* 1.1.3 '''In pediatric patients'''
-:::::* The use of TMP-SMX in children less than 2 months of age generally is not recommended.
-:::::* Available evidence is conflicting regarding the potential for growth defects and arthropathies in exposed children. Use of Ciprofloxacin in children requires assessment of potential risks and benefits.
-::* 1.2 '''Immunocompromised hosts'''
-:::* Preferred regimen (1): [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO/IV qid for 10 days
-:::* Preferred regimen (2): [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO/IV bid for 7-10 days
-:::* Note (1): One approach is to start with TMP-SMX (160 mg/800 mg) bid regimen first, and increase daily dose and/or duration (up to 3–4 weeks) if symptoms worsen or persist.
-:::* Note (2): IV therapy is recommended for patients with potential or documented malabsorption.
-:::* Alternative regimen (1): [[Pyrimethamine]] 50–75 mg PO qd {{and}} [[Leucovorin]] 10–25 mg PO qd
-:::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 7 days
-:* 2. '''Cystoisospora belli prophylaxis'''<ref>{{cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf }}</ref>
-::* 2.1 '''Primary prophylaxis'''
-:::* Insufficient evidence is available to support a general recommendation for primary prophylaxis for Cystoisosporiasis per se, especially for U.S. travelers in isoporiasis-endemic areas.
-::* 2.2 '''Secondary prophylaxis (preventing recurrence in patients with CD4 count < 200 cells/mm<sup>3</sup>)'''
-:::* Prefered regimen: [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO 3 times weekly
-:::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO qd
-:::* Alternative regimen (2): [[Trimethoprim-sulfamethoxazole]] 320 mg/1600 mg PO 3 times weekly
-:::* Alternative regimen (3): [[Pyrimethamine]] 25 mg PO qd {{and}} [[Leucovorin]] 5–10 mg PO qd
-:::* Alternative regimen (4): [[Ciprofloxacin]] 500 mg PO 3 times weekly (second-line alternative)
-:::* Note (1): Criteria for discontinuation of chronic maintenance therapy: sustained increase in CD4 count > 200 cells/mm<sup>3</sup> for > 6 months in response to ART and without evidence of active Cystoisospora belli infection
-:::* Note (2): Because of concerns about possible teratogenicity associated with first-trimester drug exposure, clinicians may withhold secondary prophylaxis during the first trimester and treat only symptomatic infection.
-----
-{{PBI|Microsporidiosis}}
-:* '''1. Ocular'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* Preferred regimen: [[Albendazole]] 400 mg PO bid for 3 weeks {{and}} [[Fumagillin]] eye drops.
-:* '''2. Intestinal (diarrhea)'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* Preferred regimen:
-:::* Adult: [[Albendazole]] 400 mg PO bid for 3 weeks  for E. intestinalis.
-:::* Pediatric: [[Albendazole]] 15 mg/kg per day divided into 2 daily doses for 7 days  for E. intestinalis.
-::* Note: [[Fumagillin]] 20 mg PO tid is the only reported effective treatment for E. bieneusi.
-:* '''3. Disseminated'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen: [[Albendazole]] 400 mg po bid for 3 weeks.
-====Parasites – Extraintestinal Protozoa====
-{{PBI|Acanthamoeba}}
-::*1.'''Keratitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::*Preferred regimen: [[Miltefosine]] {{or}}  [[Voriconazole]].
-::*2. '''Acanthamoeba Granulomatous Amebic Encephalitis and Disseminated Disease'''
-:::*Preferred regimen: Adults: Success with IV [[Pentamidine]] {{and}}  [[Sulfadiazine]] {{and}} [[ Flucytosine]] {{and}} ([[ Fluconazole]]  {{or}}   [[Itraconazole]] )
-:::*Note: 2 children responded to PO rx: [[TMP-SMX]] {{and}} [[ Rifampin]] {{and}} [[ Ketoconazole]]
-{{PBI|Balamuthia mandrillaris}}
-::*'''Chronic granulomatous meningitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::*Preferred regimen: [[Pentamidine]] {{and}} ([[Clarithromycin]]  {{or}} [[Azithromycin]]) {{and}} [[ Fluconazole]] {{and}} [[Sulfadiazine]] {{and}} [[ Flucytosine]]
-{{PBI|Naegleria fowleri}}
-::*'''Primary amoebic meningoencephalitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>{{Citeweb|title=PAM | url=http://www.cdc.gov/parasites/naegleria/index.html }}</ref>
-:::*Preferred regimen: [[Amphotericin B]] 1.5 mg/kg /day bid for 3 days; then 1 mg/kg/day for 6 days {{and}}1.5 mg/day intrathecal x 2 days; then 1 mg/day intrathecal qd for 8 days.
-:::*Note: Investigational drug called miltefosine  also available for treatment.
-{{PBI|Babesia microti}}
-* '''Babesiosis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:* 1. '''Mild/moderate babesiosis'''
-::*Preferred regimen: [[Atovaquone]] 750 mg PO bid {{and}} [[Azithromycin]] 600 mg PO qd for 7-10 days
-:* 2. '''Severe babesiosis:'''
-::* Preferred regimen (1): [[Clindamycin]] 600 mg PO tid {{and}} [[Quinine]] 650 mg PO tid  for 7–10 days .
-::* Preferred regimen (2): [[Clindamycin]]  1.2 gm  IV bid.
-::*Note (1):  For overwhelming infection in asplenic patients and immunocompromised patients, treat for 6 or more weeks
-::*Note (2): Consider transfusion if 􀂕10% parasitemia
-{{PBI|Leishmania}}
-* ''' Leishmaniasis'''<ref>{{Citeweb|title=leishmaniasis | url=http://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html#tx}}</ref>
-:*1.'''Cutaneous Leishmaniasis'''
-::* Different Leishmania species cause Old World versus New World (American) cutaneous leishmaniasis. In the Old World (the Eastern Hemisphere), the etiologic agents include Leishmania tropica, L. major, and L. aethiopica, as well as L. infantum and L. donovani. The main species in the New World (the Western Hemisphere) are either in the L. mexicana species complex (L. mexicana, L. amazonensis, and L. venezuelensis) or the subgenus Viannia (L. [V.] braziliensis, L. [V.] guyanensis, L. [V.] panamensis, and L. [V.] peruviana). The Viannia subgenus is also referred to as the L. (V.) braziliensis species complex.
-::*1.1 '''Systemic Therapy (Parenteral)'''
-:::* Preferred Regimen (1): [[Sodium stibogluconate]] 20 mg/kg IV/IM once qd for 10-20 days
-:::* Preferred Regimen (2): [[Meglumine antimoniate]] 20 mg/kg IV/IM once qd for 10-20 days
-:::* Alternative Regimen (1): [[Liposomal Amphotericin B]] 3 mg/kg/day IV infusion for 6-10 days
-:::* Alternative Regimen (2): [[Pentamidine]] 2-3 mg/kg/day IV/IM for 4-7 days
-:::* Note: Data supporting the use of amphotericin B for treatment of cutaneous (and mucosal) leishmaniasis are anecdotal; standard dosage regimens have not been established. In the United States, pentamidine isethionate is uncommonly used for treatment of cutaneous leishmaniasis. Its limitations include the potential for irreversible toxicity and variable effectiveness.
-::* 1.2 '''Systemic Therapy (Oral)'''
-:::* '''Adults and adolescents at least 12 years of age  who weigh from 33-44 kg'''
-::::* Preferred Regimen: [[Miltefosine]] 50 mg PO q12h for 28 days
-:::* '''Adults and adolescents at least 12 years of age, who weigh  >45 kg'''
-::::* Preferred Regimen: [[Miltefosine]] 50 mg PO q8h for 28 days
-::::* Alternative Regimen (1): [[Ketoconazole]] 600 mg qd for 28 days  {{or}}  qd for 6 weeks
-::::* Alternative Regimen (2): [[Fluconazole]] 200 mg qd for 6 weeks
-::::* Note:The FDA-approved indications are limited to infection caused by three particular species, all three of which are New World species in the Viannia subgenus—namely, Leishmania (V.) braziliensis, L. (V.) panamensis, and L. (V.) guyanensis.  The "azoles" showed modest activity against some Leishmania species in some cases, but are not FDA approved
-::*1.3 '''Local Therapy'''
-:::* List of possible local therapies
-:::*[[Cryotherapy]] (with [[liquid nitrogen]] {{or}} [[Thermotherapy]] (use of localized current field radiofrequency heat) {{or}} Intralesional administration of [[SbV]] {{or}} Topical application of [[Paromomycin]] (such as an ointment containing 15% [[Paromomycin]]/12% methylbenzethonium chloride in soft white paraffin)
-:*2.'''Visceral Leishmaniasis'''
-::* Visceral leishmaniasis usually is caused by the species L. donovani and L. infantum (L. chagasi generally is considered synonymous with L. infantum)
-::*2.1 '''Systemic Therapy (Parenteral)'''
-:::*Preferred Regimen (1): [[Liposomal Amphotericin B]] 3 mg/kg/day IV for 5 days, then once on day 14 and once on day 21  (Total dose: 21 mg/kg)
-:::*Preferred Regimen (2): [[Sodium Stibogluconate]] 20 mg/kg IV/IM once daily for 28 days
-:::*Preferred Regimen (3): [[Meglumine Antimoniate]] 20 mg/kg IV/IM once daily for 28 days
-:::*Alternative Regimen: [[Amphotericin B]] deoxycholate 0.5-1 mg/kg IV once daily (Total dose: 15-20 mg/kg)
-:::*Note: In immunosuppressed patients, dose is 4 mg/kg/day for 5 days, then once on day 10,  17, 24, 31, and 38  (Total dose: 40 mg/kg)
-::*2.2 '''Systemic Therapy (Oral)'''
-:::* '''Adults and adolescents at least 12 years of age, who weigh from 33-44 kg'''
-:::* Preferred Regimen: [[Miltefosine]] 50 mg PO q12h for 28 days
-:::* '''Adults and adolescents at least 12 years of age, who weigh >45 kg'''
-:::* Preferred Regimen: [[Miltefosine]] 50 mg PO q8h for 28 days
-==={{PBI|Plasmodium}}====
-* 1. '''Plasmodium falciparum'''<ref>{{cite web | title = Guidelines for the treatment of malaria. Third edition April 2015 | url = http://apps.who.int/iris/bitstream/10665/162441/1/9789241549127_eng.pdf?ua=1&ua=1 }}</ref>
-:* 1.1 '''Treatment of uncomplicated P. falciparum malaria'''
-::* 1.1.1 Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)
-:::* '''Preferred regimen (1)''':  [[Artemether]] 5–24 mg/kg bw  PO {{ and}} [[Lumefantrine]] 29–144 mg/ kg bw PO, Both are  given bid for 3 days (total, six doses). The first two doses should, ideally, be given 8 h apart.
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 15-     [[Artemether]] 20 (mg) {{ and}} [[Lumefantrine]] 120(mg)  given bid  for 3 days;
-::::*Body weight (kg)-15 to < 25-    [[Artemether]] 40 (mg) {{ and}} [[Lumefantrine]] 240(mg)  given bid  for 3 days;
-::::*Body weight (kg)-25 to < 35-    [[Artemether]] 60 (mg) {{ and}} [[Lumefantrine]] 360(mg)  given bid  for 3 days;
-::::*Body weight (kg)   ≥ 35-       [[Artemether]] 80 (mg) {{ and}} [[Lumefantrine]] 480(mg)  given bid  for 3 days.
-:::* '''Preferred regimen (2):''' [[Artesunate]] (2–10) mg/kg bw per day  {{ and}} [[Amodiaquine]](7.5–15) mg/kg bw per day ,both are given once a day for 3 days. A total therapeutic dose range of 6–30 mg/kg bw per day artesunate and 22.5–45 mg/kg bw per dose amodiaquine is recommended
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-4.5 to < 9-   [[Artesunate]] 25 (mg) {{ and}} [[Amodiaquine]] 67.5 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-9 to < 18 -   [[Artesunate]] 50 (mg) {{ and}} [[Amodiaquine]] 135 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-18 to < 36-   [[Artesunate]] 100 (mg) {{ and}} [[Amodiaquine]] 270(mg)  given bid  for 3 days;
-::::*Body weight (kg)   ≥ 36 -         [[Artesunate]] 200 (mg) {{ and}} [[Amodiaquine]] 540 (mg)  given bid  for 3 days.
-:::* '''Preferred regimen (3)''': [[Artesunate]] (2–10) mg/kg bw per day{{ and}} [[Mefloquine]] (2–10) mg/kg bw per day both are given once a day for 3 days
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 9-      [[Artesunate]] 25 (mg) {{ and}} [[Mefloquine]] 55 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-9to < 18-      [[Artesunate]] 50 (mg) {{ and}} [[Mefloquine]] 110 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-18 to < 36-   [[Artesunate]] 100 (mg) {{ and}} [[Mefloquine]] 220 (mg)  given bid  for 3 days;
-::::*Body weight (kg)- ≥ 36  -      [[Artesunate]] 200 (mg) {{ and}} [[Mefloquine]] 440 (mg)  given bid  for 3 days;
-:::* '''Preferred regimen (4)''': [[Artesunate]] (2–10) mg/kg bw per day given once a day for 3 days {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]]  1.25 (25–70 / 1.25–3.5) mg/kg bw given as a single dose on day 1
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 10-      [[Artesunate]] 25 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 250/12(mg)  given bid  for 3 days;
-::::*Body weight (kg)-10 to < 25-    [[Artesunate]] 50 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 500 / 25 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-25 to < 50-      [[Artesunate]] 100 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1000 / 50 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-    ≥50-         [[Artesunate]] 200 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1500 / 75 (mg)  given bid  for 3 days;
-:::* '''Preferred regimen (5)''': [[Dihydroartemisinin]] (2–10) mg/kg bw per day  {{ and}}   [[Piperaquine]](16–27) mg/kg bw per day
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 8-     [[Dihydroartemisinin]] 20(mg) {{ and}}  [[Piperaquine]]  160  (mg)  given bid  for 3 days;
-::::*Body weight (kg)-8 to < 11-      [[Dihydroartemisinin]]30 (mg) {{ and}}  [[Piperaquine]] 240 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-11 to < 17 -      [[Dihydroartemisinin]] 40 (mg) {{ and}}  [[Piperaquine]]  320 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-17 to < 25-      [[Dihydroartemisinin]] 60 (mg) {{ and}}  [[Piperaquine]] 480 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-25 to < 36-       [[Dihydroartemisinin]] 80 (mg) {{ and}}  [[Piperaquine]]  640 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-36 to < 60-      [[Dihydroartemisinin]] 120 (mg) {{ and}}  [[Piperaquine]] 960 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-60 < 80 -       [[Dihydroartemisinin]] 160 (mg) {{ and}}  [[Piperaquine]] 1280 (mg)  given bid  for 3 days;
-::::*Body weight (kg)- >80-      Dose of [[Dihydroartemisinin]] 200 (mg) {{ and}}  [[Piperaquine]] 1600 (mg)  given bid  for 3 days;
-::* 1.1.2 '''Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in  patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
-::::*Preferred regimen: single dose of 0.25 mg/kg bw [[Primaquine]] with ACT
-:* 1.2 '''Recurrent Falciparum Malaria'''
-::* 1.2.1 '''Failure within 28 days '''
-:::*Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.
-::* 1.2.2 '''Failure after 28 days'''
-:::*Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used
-:* 1.3 '''Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in  patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
-::* Note: a single dose of 0.25 mg/kg bw [[Primaquine]] with ACT
-:* 1.4 '''Treating uncomplicated P. falciparum malaria in special risk groups'''
-::* 1.4.1 '''Pregnancy '''
-:::* First trimester of pregnancy :[[Quinine]] {{ and}} [[Clindamycin]] PO 10mg/kg bw bid for 7 days
-:::* Second and third trimesters : [[Mefloquine]] is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
-:::* Note: Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
-:::* Note: Primaquine and tetracyclines should not be used in pregnancy.
-::*1.4.2 '''Infants less than 5kg body weight''' :  with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
-::*1.4.3 '''Patients co-infected with HIV''': should avoid [[Artesunate]] + SP if they are also receiving [[Co-trimoxazole]], and avoid artesunate + amodiaquine if they are also receiving efavirenz or zidovudine.
-::*1.4.4 '''Large and Obese adults''': For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
-::*1.4.5 '''Patients co-infected with TB''': Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate
-::*1.4.6 '''Non-immune travellers''' : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
-::*1.4.7 '''Uncomplicated hyperparasitaemia''': People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT
-* 2. '''Treatment of uncomplicated malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi'''
-:* 2.1  '''Blood Stage infection'''
-::* 2.1.1.  '''Uncomplicated malaria caused by P. vivax'''
-:::* 2.1.1.1 '''In areas with chloroquine-sensitive P. vivax'''
-::::* Preferred regimen: [[Chloroquine]] PO  total dose of 25 mg base/kg bw. [[Chloroquine]] is given at an initial dose of 10 mg base/kg bw, followed by 10 mg/kg bw on the second day and 5 mg/kg bw on the third day.
-:::* 2.1.1.2 '''In areas with chloroquine-resistant P. vivax'''
-::::* Note: ACTs containing [[piperaquine]], [[mefloquine]] or [[lumefantrine]] are the recommended treatment, although [[artesunate]] + [[amodiaquine]] may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, [[dihydroartemisinin]] + [[piperaquine]] provided a longer prophylactic effect than ACTs with shorter half-lives ([[artemether]] + [[lumefantrine]], [[artesunate]] + [[amodiaquine]]), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.
-::* 2.1.2 '''Uncomplicated malaria caused by P. ovale, P. malariae or P. knowlesi malaria'''
-:::* Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or [[chloroquine]], as for vivax malaria.
-::* 2.1.3 '''Mixed malaria infections '''
-:::* Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.
-:* 2.2 '''Liver stages (hypnozoites) of P. vivax and P. ovale'''
-::* Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]
-::*2.2.1 '''Primaquine for preventive relapse'''
-:::*Preferred regimen: [[Primaquine]] PO 0.25–0.5 mg/kg bw per day qd for 14 days
-::*2.2.2 '''Primaquine and glucose-6-phosphate dehydrogenase deficiency'''
-:::*Preferred regimen:[[Primaquine]] PO 0.75 mg base/kg bw once a week for 8 weeks.
-:::*Note: The decision to give or withhold [[Primaquine]] should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.
-::*2.2.3 '''Prevention of relapse in pregnant or lacating women and infants'''
-:::*Note: Primaquine is contraindicated in pregnant women, infants < 6months of age and in lactating women (unless the infant is known not to be G6PD deficient).
-*3.'''Treatment of severe malaria'''
-:* 3.1 Treatment of severe falciparum infection with Artesunate
-::* 3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-
-:::* Preferred regimen: [[Artesunate]] IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oraltherapy, complete treatment with 3 days of an ACT (add single dose [[Primaquine]] in areas of low transmission).
-::* 3.1.2 Young children weighing < 20 kg
-:::* Preferred regimen:[[Artesunate]] (3 mg/kg bw per dose)
-:::* Alternatives regimen: use [[Artemether]] in preference to quinine for treating children and adults with severe malaria
-:* 3.2.'''Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)'''
-::*3.2.1 Adults and children
-:::*Preferred regimen: [[Artesunate]] IM
-:::* Alternative regimen: [[Artemether]] IM {{or}} [[Quinine]] IM
-::*3.2.2  Children < 6 years
-:::*Preferred regimen: Where intramuscular injections of artesunate are not available , treat with a single rectal dose (10 mg/kg bw) of [[Artesunate]], and refer immediately to an appropriate facility for further care.
-:::*Note: Do not use rectal artesunate in older children and adults.
-:*3.3 '''Pregancy'''
-::*Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed
-:*3.4 '''Treatment of severe P.Vivax infection'''
-::*Note: parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery
-:*3.5 '''Additional aspects of management in severe malaria'''
-::* '''Fluid therapy''':  It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit
-::* '''Blood Transfusion ''':In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended
-::* '''Exchange blood transfusion''': Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.
-{{PBI|Toxoplasma gondii}}
-{{PBI|Trichomonas vaginalis}}
-: 1.'''T. vaginalis infection''' <ref>{{cite web | title =trichomoniasis | url =  http://www.cdc.gov/std/tg2015/trichomoniasis.htm  }}</ref>
-:* Preferred regimen:[[Metronidazole]] 2 g PO in a single dose {{or}} [[Tinidazole]] 2 g PO in a single dose
-:* Alternative regimen : [[Metronidazole]] 500  mg PO bid for 7 days
-: 2.'''T. vaginalis infection in Pregnant and Lactating Women'''
-:* 2.1 Pregnant women
-:* Preferred regimen:[[Metronidazole]] 2 g PO in a single dose.
-:* 2.2 Post-partum and Breastfeeding
-:* Preferred regimen:[[Metronidazole]] 2 g PO in a single dose.{{or}} [[Tinidazole]] 2 g PO in a single dose
-:* Note(1): do not breastfeed for 12-24 hrs following [[Metronidazole]] and 72 hrs following  [[Tinidazole]]
-:* Note(2)Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment.   Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
-:* Note(3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.
-: 3.'''T. vaginalis infection in patients with HIV'''
-:* Preferred regimen: [[Metronidazole]] 500  mg PO bid for 7 days
-: 4. '''Persistent or Recurrent Trichomoniasis'''
-:* Treatment Failure
-:* Preferred regimen:[[Metronidazole]] 500  mg PO bid for 7 days
-:* Treatment failure again
-:* Preferred regimen:[[Metronidazole]] 2 g PO for 7 days {{or}} [[Tinidazole]] 2 g PO for 7 days
-:* Nitroimidazole-resistant cases
-:* Preferred regimen: [[Tinidazole]] 2-3 g PO for 14 days
-{{PBI|African trypanosomiasis}}
-* ''' Sleeping sickness'''<ref>{{cite web|title=African Trypanosomiasis| url=  http://www.cdc.gov/parasites/sleepingsickness/health_professionals/index.html}}</ref>
-:*1. '''East African trypanosomiasis'''
-:* 1.1'''T. b. rhodesiense, hemolymphatic stage'''
-::* ''' Adult '''
-:::* Preferred regimen: [[Suramin]] 1 gm IV on days 1,3,5,14, and 21
-::* '''Pediatric'''
-:::* Preferred regimen: [[Suramin]]  20 mg/kg IV on days 1, 3, 5, 14, and 21
-:*1.2 '''T. b. rhodesiense, CNS involvement'''
-::* ''' Adult'''
-:::* Preferred regimen: [[Melarsoprol]] 2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.
-::* ''' Pediatric'''
-:::* Preferred regimen: [[Melarsoprol]]  2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days
-:* 2. '''West African trypanosomiasis'''
-:* 2.1 '''T. b. gambiense, Hemolymphatic stage'''
-::* ''' Adult'''
-:::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/ IV for 7-10 days
-::* '''Pediatric'''
-:::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/IV for 7-10 days
-::::* Note (1): Pentamidine should be used during pregnancy and lacation  only if the potential benefit justifies the potential risk
-::::* Note (2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
-:* '''2.2 T. b. gambiense, CNS involvement'''
-::*''' Adult'''
-:::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day in 4 doses for 14 days
-::* '''Pediatric'''
-:::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day in 4 doses for 14 days
-:::*  Note (1): [[Eflornithine]] should be used during pregnancy and lactation, only if the potential benefit justifies the potential risk
-:::*  Note (2): The safety of [[Eflornithine]] in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. [[Eflornithine]] is listed for the treatment of 1st stage African trypanosomiasis inTrypanosoma brucei gambiense infection on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
-{{PBI|American trypanosomiasis}}
-*Chagas disease
-::* 1.Preferred regimen(1):Benznidazole  < 12 years5-7.5 mg/kg per day orally in 2 divided doses for 60 days
-years or older5-7 mg/kg per day orally in 2 divided doses for 60 days
-::* 2.Preferred regimen(2): Nifurtimox ≤ 10 years15-20 mg/kg per day orally in 3 or 4 divided doses for 90 days
--16 years12.5-15 mg/kg per day orally in 3 or 4 divided doses for 90 days
-years or older8-10 mg/kg per day orally in 3 or 4 divided doses for 90 days
-:::*Note: In the United States, nifurtimox and benznidazole are not FDA approved and are available only from CDC under investigational protocols.
-====Parasites – Intestinal Nematodes (Roundworms)====
-{{PBI|Ascaris lumbricoides}}
-::* Preferred regimen: [[Albendazole]] 400mg PO qd {{or}} [[Mebendazole]] 500mg PO qd or 100mg bid for 3 days<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
-:::*Note: [[Albendazole]] dose for children of 1-2 years is 200mg instead of 400mg.
-::* Alternative regimen (1): [[Ivermectin]] 150-200µg/kg PO single dose<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
-::* Alternative regimen (2): [[Nitazoxanide]] 500mg bid for 3 days. <ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117  }} </ref>
-::* Alternative regimen (3): [[Levamisole]] 150mg PO single dose. Pediatric dose: 2.5mg/kg single dose. <ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
-::* Alternative regimen (4): [[Pyrantel]] Pamoate 11mg/kg single dose PO - maximum 1.0g.<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
-::* Alternative regimen (5): [[Piperazine citrate]] 75mg/kg qd for 2 days - maximum 3.5g.<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
-{{PBI|Capillaria philippinensis}}
-::* '''1. Intestinal capillariasis'''<ref>{{Cite journal| issn = 0893-8512| volume = 5| issue = 2| pages = 120–129| last = Cross| first = J. H.| title = Intestinal capillariasis| journal = Clinical Microbiology Reviews| date = 1992-04| pmid = 1576584| pmc = PMC358231}}</ref><ref>{{Cite journal| doi = 10.4269/ajtmh.2012.11-0321| issn = 1476-1645| volume = 86| issue = 1| pages = 126–133| last1 = Attia| first1 = Rasha A. H.| last2 = Tolba| first2 = Mohammed E. M.| last3 = Yones| first3 = Doaa A.| last4 = Bakir| first4 = Hanaa Y.| last5 = Eldeek| first5 = Hanan E. M.| last6 = Kamel| first6 = Shereef| title = Capillaria philippinensis in Upper Egypt: has it become endemic?| journal = The American Journal of Tropical Medicine and Hygiene| date = 2012-01| pmid = 22232463| pmc = PMC3247121}}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[Albendazole]] 400mg/day PO for 10-30 days.
-:::* Alternative regimen: [[Mebendazole]] 200mg PO bid for 20-30 days.
-{{PBI|Enterobius vermicularis}}
-::* Preferred regimen (1): [[Albendazole]] 400mg PO single dose - repeat in 2 weeks.<ref name="pmid3130234">{{cite journal| author=Wang BR, Wang HC, Li LW, Zhang XL, Yue JQ, Wang GX et al.| title=Comparative efficacy of thienpydin, pyrantel pamoate, mebendazole and albendazole in treating ascariasis and enterobiasis. | journal=Chin Med J (Engl) | year= 1987 | volume= 100 | issue= 11 | pages= 928-30 | pmid=3130234 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3130234  }} </ref>
-::* Preferred regimen (2): [[Mebendazole]] 100mg PO single dose - repeat in 2 weeks.
-::* Alternative regimen (1): [[Ivermectin]] 200µg/kg PO single dose - repeat in 10 days<ref name="pmid15344847">{{cite journal| author=Heukelbach J, Wilcke T, Winter B, Sales de Oliveira FA, Sabóia Moura RC, Harms G et al.| title=Efficacy of ivermectin in a patient population concomitantly infected with intestinal helminths and ectoparasites. | journal=Arzneimittelforschung | year= 2004 | volume= 54 | issue= 7 | pages= 416-21 | pmid=15344847 | doi=10.1055/s-0031-1296993 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15344847  }} </ref>
-::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg up to 1.0g PO single dose - repeat in 2 weeks. <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-{{PBI|Necator americanus}}
-::* Preferred regimen: [[Albendazole]] 400mg PO single dose.<ref name="pmid18430913">{{cite journal| author=Keiser J, Utzinger J| title=Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. | journal=JAMA | year= 2008 | volume= 299 | issue= 16 | pages= 1937-48 | pmid=18430913 | doi=10.1001/jama.299.16.1937 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18430913  }} </ref>
-::* Alternative regimen (1): [[Mebendazole]] 100mg PO bid or 500mg qd for 3 days.
-::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg PO qd (maximum 1 g/day) for 3 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-{{PBI|Ancylostoma duodenale}}
-::* Preferred regimen: [[Albendazole]] 400mg PO single dose.<ref name="pmid18430913">{{cite journal| author=Keiser J, Utzinger J| title=Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. | journal=JAMA | year= 2008 | volume= 299 | issue= 16 | pages= 1937-48 | pmid=18430913 | doi=10.1001/jama.299.16.1937 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18430913  }} </ref>
-::* Alternative regimen (1): [[Mebendazole]] 100mg PO bid or 500mg qd for 3 days.
-::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg PO qd (maximum 1 g/day) for 3 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-{{PBI|Strongyloides stercoralis}}
-::* Preferred regimen: [[Ivermectin]] 200mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other.<ref>{{Cite web | title = WGO Practice Guideline Management of Strongyloidiasis| url = http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/15_management_strongyloidiasis_en.pdf}}</ref>
-::* Alternative regimen: [[Albendazole]]400mg PO bid for 3-7 days.<ref name="pmid8483992">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992  }} </ref>
-{{PBI|Trichuris trichiura}}
-::* Preferred regimen: [[Albendazole]] 400mg PO qd for 3 days.
-::* Alternatie regimen (1): [[Mebendazole]] 100mg PO bid for 3 days.
-::* Alternative regimen (2): [[Ivermectin]] 200mcg/kg/day PO qd for 3 days.<ref>{{Cite web | title = Parasites - Trichuriasis| url = http://www.cdc.gov/parasites/whipworm/health_professionals/index.html#tx}}</ref>
-====Parasites – Extraintestinal Nematodes (Roundworms)====
-{{PBI|Ancylostoma braziliense}}
-::* Preferred regimen<ref>{{Cite web | title = Parasites - Zoonotic Hookworm | url = http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html}}</ref>
-:::* Adult: [[Albendazole]] 400mg PO qd for 3-7 days.
-:::* Pediatric: [[Albendazole]] > 2 years 400mg PO qd for 3 days
-:::* Note: This drug is contraindicated in children younger than 2 years.
-::* Alternative regimen<ref>{{Cite web | title = Parasites - Zoonotic Hookworm | url = http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html}}</ref>
-:::* Adult: [[Ivermectin]] 200 mcg/kg PO qd for one or two days.
-:::* Pediatric: [[Ivermectin]] >15 kg give 200mcg/kg single dose.
-{{PBI|Angiostrongylus cantonensis}}
-:*Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60mg qd for 2 weeks) and analgesics<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:*Note: [[Albendazole]] and [[Mebendazole]] are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.<ref name="pmid19706911">{{cite journal| author=Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y| title=Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis. | journal=Am J Trop Med Hyg | year= 2009 | volume= 81 | issue= 3 | pages= 443-5 | pmid=19706911 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19706911  }} </ref>
-{{PBI|Filariasis}}
-:* '''Filariasis'''
-::* 1. '''Lymphatic filariasis- Wuchereria bancrofti, Brugia malayi Brugia timori'''
-::* 2. '''Cutaneous filariasis- Onchocercia volvulus, Loa loa'''
-{{PBI|Onchocerciasis}}
-:* '''Onchoceria volvulus cutaneous filariasis (river blindness) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred regimen: [[Ivermectin]] Single dose of 150mcg/kg po; repeat every 6-12 months until asymptomatic.
-::* Alternative regimen: If [[Ivermectin]] fails, consider [[Suramin]].
-::: Note (1): Onchocercia and  Loa loa may both be present. Check peripheral smear; if Loa loa microfilaria present, treat onchocercia first with [[Ivermectin]] before [[Diethylcarbamazine]] (DEC) for Loa loa.
-::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.
-::: Note (3): Do not use [[Diethylcarbamazine]] (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.
-::* '''Treatment of endosymbiont Wolbachia (bacteria)''' may help clear infection
-:::* Preferred regimen: [[Doxycycline]] 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
-{{PBI|Loiasis}}
-:* '''Loa loa cutaneous filariasis (eyeworm disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred regimen: [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-21, 8-10mg/kg/day in 3 divided dose
-::* Alternative regimen: [[Albendazole]] 200mg po bid for 21 days
-::: Note: If concomitant onchocercia Loa loa, treat oncho first. Ifover 5,000 microfilaria/mL of blood, [[Diethylcarbamazine]] (DEC) can cause encephalopathy. Might start with albendazole for few days with or without steroids, then [[Diethylcarbamazine]] (DEC).
-{{PBI|Wuchereria bancrofti}}
-:* '''Wuchereria bancrofti lymphatic filariasis (elephantiasis) treatment'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): Scaled dose [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. ([[Diethylcarbamazine]](DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).
-::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
-::* Preferred regimen (2):  [[Albendazole]] 400 mg PO single dose regimen {{and}} ([[Ivermectin]] 200 mcg/kg PO {{or}} [[Diethylcarbamazine]] 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.
-::: Note (1): Most symptoms with Wuchereria bancrofti  are due to the adultworm.
-::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.
-::: Note (3): Do not use [[Diethylcarbamazine]] (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.
-::: Note (4): Skin snip technique is  skin snips can be obtained using a corneal  scleral punch, or more simply a scalpel and needle. The sample must be allowed to incubate for 30 minutes to 2 hrs in saline or culture medium, and then examined for microfilariae that would have migrated from the tissue to the liquid phase of the specimen.
-::: Note (5): Site of infection
-:::: 5.1 General: filarial fever includes fever, chills, malaise during acute or recurrent episode.
-:::: 5.2 Lymph:localized lymphadenitis, may be painful(red,warm) or painless, unilateral or bilateral groin swelling. May be due to adult worm or complicating bacterial infection.
-:::: 5.3 Derm:pruritus,dermatitis,subcutaneous nodules.
-:::: 5.4 Genital:scrotal or vulvar swelling/ hydrocele; may be able to visualize adult W.bancrofti worm by ultrasound.
-:::: 5.5 Extremities:unilateral or bilateral swelling, acute or chronic. May be extreme (classic elephantiasis) or mild. May be associated with recurrent bacterial cellulitis (abrupt onset of redness ,fever).
-:::: 5.6 Lungs:tropical pulmonary eosinophilia (miliary pattern on CXR, nocturnal paroxysmal cough, wheezing, accompanied by marked eosinophilia, responds to DEC, usually amicrofilaremic).
-:::: 5.7 Renal: chyluria, hematuria (rupture of dilated lymphatics into urinary excretory system). May see weightloss, hypoproteinemia, lymphopenia, anemia.
-:::: 5.8 Musculoskeletal:acute monoarthritis (knee>ankle) which responds to DEC, tenosynovitis (rare), thrombophlebitis (rare).
-::: Note (6)
-:::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);
-:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.
-:::: Diagnosis 3.skin snips  (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.
-::* '''Treatment of endosymbiont Wolbachia (bacteria)''' may help clear infection
-:::* Preferred regimen: [[Doxycycline]] 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
-{{PBI|Brugia malayi}}
-:* '''Brugia malayi, Brugia timori lymphatic filariasis (elephantiasis) treatment'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): Scaled dose [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. ([[Diethylcarbamazine]](DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).
-::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
-::* Preferred regimen (2):  [[Albendazole]] 400 mg PO single dose regimen {{and}} ([[Ivermectin]] 200 mcg/kg PO {{or}} [[Diethylcarbamazine]] 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.
-::: Note
-:::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);
-:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.
-:::: Diagnosis 3.skin snips  (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.
-{{PBI|Gnathostoma spinigerum}}
-:*'''Eosinophilic Meningitis'''
-:**Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.<ref name="pmid19123863">{{cite journal| author=Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J et al.| title=Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 3 | pages= 322-7 | pmid=19123863 | doi=10.1086/595852 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19123863  }} </ref>
-:*'''Cutaneous disease:'''
-::*Preferred regimen: [[Albendazole]] 400 mg bid for 21 days {{or}} [[Ivermectin]] 200 mcg/kg once daily for 2 days<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
-::*Alternative regimen: [[Albendazole]] 400 mg daily for 21 days {{or}} [[Ivermectin]] 200 mcg/kg once daily for 1 day<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
-{{PBI|Toxocariasis}}
-:*'''1.1.Visceral toxocariasis'''<ref>{{Cite web | title = Parasites - Toxocariasis| url = http://www.cdc.gov/parasites/toxocariasis/health_professionals/index.html}}</ref>
-::*Preferred regimen: [[Albendazole]] 400 mg PO bid for five days (both adult and pediatric dosage)
-::*Alternative regimen: [[Mebendazole]] 100-200 mg PO bid for five days (both adult and pediatric dosage)
-:*'''1.2.Ocular toxocariasis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen: First 4 weeks of illness ([[Prednisone]] 30-60mg PO q24h {{and}} subtenon triamcinolone 40mg/week) for 2 weeks
-{{PBI|Trichinella spiralis}}
-::* Preferred regimen: [[Albendazole]] 400 mg PO bid for 8 to 14 days {{or}} [[Mebendazole]] 200 to 400 mg PO tid for 3 days, then 400 to 500 mg PO tid for 10 days<ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref>
-::* Note(1): Albendazole and Mebendazole are contraindicated during pregnancy and not recommended in children aged 2 years.
-::* Note(2): Prednisone administered at a dose of 30 mg/day to 60 mg/day for 10 to 15 days for severe symptoms
-====Parasites – Trematodes (Flukes)====
-{{PBI|Clonorchis sinensis}}
-:*Preferred regimen: [[Praziquantel]] 75mg/kg/day PO tid for 2 days.<ref>{{Cite web | title =Clonorchis | url = http://www.cdc.gov/parasites/clonorchis/health_professionals/index.html}}</ref>
-:*Alternative regimen (1): [[Albendazole]] 10mg/kg/day PO qd for 7 days.<ref>{{Cite web | title =Clonorchis | url = http://www.cdc.gov/parasites/clonorchis/health_professionals/index.html}}</ref>
-:*Alternative regimen (2): [[Tribendimidine]] 400mg PO single dose.<ref name="pmid23223597">{{cite journal| author=Qian MB, Yap P, Yang YC, Liang H, Jiang ZH, Li W et al.| title=Efficacy and safety of tribendimidine against Clonorchis sinensis. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 7 | pages= e76-82 | pmid=23223597 | doi=10.1093/cid/cis1011 | pmc=PMC3588115 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23223597  }} </ref>
-:* This regimen is still under investigation, but it appears to be as effective as [[Praziquantel]].
-:*Note: Urgent biliary decompression might be required for patients with acute cholangitis.
-{{PBI|Dicrocoelium dendriticum}}
-:*Preferred regimen: [[Praziquantel]] 25 mg/kg PO tid for 2 days<ref>{{Cite web | title =Dicrocoeliasis| url =http://www.cdc.gov/dpdx/dicrocoeliasis/tx.html }}</ref>
-:*Note: [[Praziquantel]] is not approved for treatment of children less than 4 years old.<ref>{{Cite web | title =Dicrocoeliasis| url =http://www.cdc.gov/dpdx/dicrocoeliasis/tx.html }}</ref>
-:*Alternative regimen (1): [[Myrrh]] (commiphora molmol) 12 mg/kg/day PO for 6 days.<ref name="pmid17418062">{{cite journal| author=Rana SS, Bhasin DK, Nanda M, Singh K| title=Parasitic infestations of the biliary tract. | journal=Curr Gastroenterol Rep | year= 2007 | volume= 9 | issue= 2 | pages= 156-64 | pmid=17418062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17418062  }} </ref>
-:*Alternative regimen (2): [[Triclabendazole]] 10 mg/kg PO single dose.<ref name="pmid17418062">{{cite journal| author=Rana SS, Bhasin DK, Nanda M, Singh K| title=Parasitic infestations of the biliary tract. | journal=Curr Gastroenterol Rep | year= 2007 | volume= 9 | issue= 2 | pages= 156-64 | pmid=17418062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17418062  }} </ref>
-{{PBI|Fasciola hepatica}}
-:*Preferred regimen: [[Triclabendazole]] 10 mg/kg PO one dose<ref>{{Cite web | title =Parasites - Fascioliasis| url = http://www.cdc.gov/parasites/fasciola/health_professionals/}}</ref>
-:*Note: Two-dose (double-dose) triclabendazole therapy can be given to patients who have severe or heavy Fasciola infections (many parasites) or who did not respond to single-dose therapy.
-:*Alternative regimen: [[Nitazoxanide]] 500mg PO bid for 7 days.
-{{PBI|Paragonimus westermani}}
-:*Preferred regimen (1): [[Praziquantel]] 25 mg/kg PO tid for 3 days<ref>{{Cite web | title =Parasites - Paragonimiasis| url =http://www.cdc.gov/parasites/paragonimus/health_professionals/index.html }}</ref>
-:*Preferred regimen (2): [[Triclabendazole]] 10 mg/kg PO qd or bid.
-:*Alternative regimen (1): [[Bithinol]] 30-50mg/kg PO on alternate days for 10-15 doses.
-:*Alternative regimen (2): [[Niclosamide]] 2mg/kg PO single dose.
-{{PBI|Schistosomiasis}}
-:*'''1. Schistosoma mansoni, S. haematobium, S. intercalatum'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
-::*Preferred regimen: [[Praziquantel]] 40 mg/kg per day PO in qd or bid for one day.
-::*Alternative regimen (1): [[Oxamniquine]] 20mg/kg PO single dose.<ref>National Center for Biotechnology Information. PubChem Compound Database; CID=4612, https://pubchem.ncbi.nlm.nih.gov/compound/4612 (accessed July 16, 2015).</ref><ref>BINA, J. C.  and  PRATA, A.. Tratamento da esquistossomose com oxamniquine (xarope) em crianças. Rev. Soc. Bras. Med. Trop.[online]. 1975, vol.9, n.4 [cited  2015-07-16], pp. 175-178 . Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86821975000400002&lng=en&nrm=iso>. ISSN 0037-8682.  http://dx.doi.org/10.1590/S0037-86821975000400002.</ref>
-::*Alternative regimen (2): [[Artemisinin]] no dose is established yet.<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
-::*Alternative regimen (3): [[Mefloquine]] 250mg PO single dose.
-::*Note: There is no benefit in associating the alternative therapies to Praziquantel.
-::*Note: Praziquantel is not effective against larval/egg stages of the disease.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref>
-:*'''2. S. japonicum, S. mekongi'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
-::*Preferred regimen: [[Praziquantel]] 60 mg/kg per day PO bid for one day.
-::*Alternative regimen (1): [[Artemisinin]] no dose is established yet.
-::*Alternative regimen (2): [[Mefloquine]] 250mg PO single dose.
-::*Note: There is no benefit in associating the alternative therapies to Praziquantel.
-:*'''3. Katayama Fever'''
-::*Preferred regimen: Prednisone 20-40mg/day PO for 5 days, followed by Praziquantel.<ref name="pmid20222897">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Acute schistosomiasis, a diagnostic and therapeutic challenge. | journal=Clin Microbiol Infect | year= 2010 | volume= 16 | issue= 3 | pages= 225-31 | pmid=20222897 | doi=10.1111/j.1469-0691.2009.03131.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20222897  }} </ref>
-::*Note: Praziquantel should be used after 4-6 weeks of exposure, because it cannot kill the larvae stages of the Schistosoma. Praziquantel should be used after acute schistosomiasis syndrome symptoms have resolved always together with corticosteroids, only when ova are detected in stool or urine samples.<ref name="pmid19292640">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Difficulties in the diagnosis and treatment of acute schistosomiasis. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 8 | pages= 1163-4; author reply 1164-5 | pmid=19292640 | doi=10.1086/597497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19292640  }} </ref>
-:*'''4. Neuroschistosomiasis'''
-::*Preferred regimen: prednisone 1-2mg/kg.
-::*Note: Praziquantel should only be introduced after a few days of the initiation of corticosteroid therapy, due to the risk of increasing the inflammatory response.
-====Parasites – Cestodes (Tapeworms)====
-{{PBI|Echinococcus}}
-:* 1.1 '''Echinococcus granulosus (hydatid disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred regimen: Percutaneous aspiration-injection-reaspiration (PAIR) and [[Albendazole]].Before & after drainage:[[Albendazole]] ≥60 kg, 400 mg PO bid or <60 kg, 15 mg/kg per day divided bid, with meals. Then: Puncture (P) & needle aspirate (A) cyst content. Instill (I) hypertonic saline (15–30%) or absolute alcohol, wait 20–30 min, then re-aspirate (R) with final irrigation.
-::: Note: Continue [[Albendazole]] for 28 days Cure in 96% as comp to 90% patients with surgical resection
-:* 1.2 '''Echinococcus multilocularis (alveolar cyst disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred regimen: [[Albendazole]] ≥60 kg, 400 mg PO bid or <60 kg, 15 mg/kg per day divided bid, with meals.
-::: Note (1): [[Albendazole]] efficacy not clearly demonstrated, can try in dosages used for hydatid disease.
-::: Note (2): Wide surgical resection only reliable treatment; technique evolving.
-{{PBI|Neurocysticercosis}}
-:* '''Neurocysticercosis treatment''' (NCC)<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* 1. '''Larval form of Taenia solium'''
-:::* Preferred regimen: Treat Taenia solium intestinal tapeworms, if present, with [[Praziquante]] l5-10 mg/kg PO for 1 dose for children & adults.
-::* 2. '''Parenchymal neurocysticercosis'''
-:::* Preferred regimen: Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days
-:::: Note : “Viable” cysts by CT/MRI Meta-analysis: treatment associated with cyst resolution, decreased seizures, and decreased seizure recurrence.
-:::* Alternative regimen: ([[Praziquantel]] 100 mg/kg per day in 3 div. doses PO for 1 day, then 50 mg/kg/d in 3 doses and [[Dexamethasone]} {{and}}[[Dexamethasone]] 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
-:::: Note (1): [[Albendazole]] associated with 46% decrease in seizures.
-:::: Note (2): [[Praziquantel]] less cysticidal activity.
-:::: Note (3): Steroids decrease serum levels of [[Praziquantel].
-:::: Note (4): NIH reports [[Methotrexate]] at 20 mg/wk allows a reduction in steroid use.
-::* 3. '''Degenerating cysts'''
-:::* Preferred regimen: Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days
-:::: Note (1): Treatment improves prognosis of associated seizures.
-:::: Note (2): For '''dead calcified cysts''', no treatment indicated
-::* 4. '''Subarachnoid neurocysticercosis'''
-:::* Preferred regimen: (Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) {{and}} shunting for hydrocephalus.
-:::: Note:  Without shunt, 50% died within 9 years.
-::* 5. '''Intraventricular neurocysticercosis'''
-:::* Preferred regimen: (Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) {{and}} perhaps neuroendoscopic removal if obstruction of CSF circulation.
-{{PBI|Sparganosis}}
-:* '''Sparganosis (Spirometra mansonoides) treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses
-::: Note: Source for Spirometra mansonoides larval cysts is frogs or snakes
-====Parasites – Ectoparasites====
-{{PBI|Body lice}}
-:* '''Body lice'''
-::* '''Pediculus humanus, corporis treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-:::* Preferred regimen (1): Success with [[Ivermectin]] in home shelter with 12 mg PO on days 0, 7, & 14
-:::* Preferred regimen (2): Treat clothing with 1% [[Malathion]] powder {{or}} 0.5% [[Permethrin]] powder.
-:::: Note (1): No drugs for the patient.
-:::: Note (2): Organism lives in and deposits eggs in seams of clothing. Discard clothing; if not possible treat clothes with 1% [[Malathion]] powder {{or}} 0.5% [[Permethrin]] powder.
-{{PBI|Head lice}}
-:* '''Head lice'''
-::* '''Pediculus humanus, capitis treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-:::* Preferred regimen: [[Permethrin]] 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days {{or}} [[Malathion]] 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo. 2 doses 7-9 days apart.
-:::* Alternative regimen: [[Ivermectin]] 200 μg/kg PO once; 3 doses at 7 day intervals reported effective. [[Malathion]] 0.5% lotion report that 1–2 20-minutes applications 98% effective.
-::: Note (1):[[Malathion]] in alcohol is potentially flammable.
-::: Note (2): [[Permethrin]] success in 78%.
-::: Note (3): Extra combing of no benefit.
-::: Note (4): Resistance increasing.No advantage to 5% permethrin.
-{{PBI|Pubic lice}}
-:* '''Pubic lice'''
-::* '''Phthirus pubis treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-:::* Preferred regimen: Pubic hair with [[Permethrin]] 1% lotion {{or}} [[Malathion]] 0.5% lotion as for head lice
-:::* Alternative regimen: For eyelids apply Petroleum jelly qid for 10 days {{or}} Yellow oxide of mercury 1% qid for 14 days.
-{{PBI|Myiasis}}
-:*Preferred regimen: No medications approved by the FDA are available for treatment<ref>{{Cite web | title =Parasites - Myiasis | url =http://www.cdc.gov/parasites/myiasis/health_professionals/index.html }}</ref>
-:*Note: Fly larvae need to be surgically removed.
-::* '''Fly larvae treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
-::* Preferred treatment (2): When larva migrates, manually remove.
-::*Note (1): Myiasis is due to larvae of flies.
-::*Note (2): Usually cutaneous/subcutaneous nodule with central punctum.
-{{PBI|Scabies}}
-:* '''Scabies'''
-::* '''Sarcoptes scabiei treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-:::* 1. '''Immunocompetent patisent'''
-::::* Preferred regimen: (Primary) [[Permethrin]] 5% cream (ELIMITE).
-::::: Note (1): Apply entire skin from chin down to and including toes with [[Permethrin]] 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.
-::::: Note (2): Safe for children >2 months old.
-::::* Alternative regimen: [[Ivermectin]] 200 μg/kg PO once. As above, second dose if persistent symptoms.
-::::: Note (1): Trim fingernails.
-::::: Note (2): Reapply to hands after hand washing.
-::::: Note (3): Pruritus may persist times 2 weeks after mites gone.
-::::* Alternative regimen (2): Less effective is [[Crotamiton]] 10% cream, apply for 24 hours, rinse off, then reapply for 24 hours.
-:::* 2. '''AIDS patients (CD4 <150 per mm3), debilitated or developmentally disabled patients '''
-:::: * preferred regimen (for Norwegian scabies) : [[Permethrin]] 5% cream-2 or more applications a week apart may be needed. After each [[Permethrin]] dose (days 2-7) apply 6% [[Sulfur]] in petrolatum.
-::::: Note: Apply entire skin from chin down to and including toes with [[Permethrin]] 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.
-::::* Alternative regimen: [[Ivermectin]] 200 mcg/kg PO once is reported effective; may need 2 or more doses separated by 14 days.
-::::: Note: Norwegian scabies in AIDS patients is extensive, crusted. Can mimic psoriasis and not pruritic but highly contagious—isolate.
-====Viruses====
-{{PBI|Adenovirus}}
-:* Adenovirus<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* 1. '''In severe cases of pneumonia or post hematopoietic stem cell transplantation'''
-:::* Preferred regimen (1): [[Cidofovir]] 5 mg/kg/week IV for 2 weeks, then q 2 weeks {{and}} [[Probenecid]] 1.25 g/M<sup>2</sup> PO given 3 hours before [[Cidofovir]] and 3 & 9 hours after each infusion
-:::* Preferred regimen (2): [[Cidofovir]] 1 mg/kg IV 3 times per week
-::* 2. '''For hemorrhagic cystitis'''
-:::* Preferred regimen: [[Cidofovir]] (5 mg/kg in 100 mL saline instilled into bladder) intravesical.
-:::: Note (1): Adenovirus is the cause of respiratory tract infections including fatal pneumonia in children and young adults and 60% mortality in transplant patients.
-:::: Note (2): Adenovirus  is frequent cause of cystitis in transplant patients.
-:::: Note (3): Adenovirus 14 associated with severe pneumonia in otherwise healthy young adults .Findings include fever, decreases liver enzymes, leukopenia, thrombocytopenia, diarrhea, pneumonia, or hemorrhagic cystitis.
-:::: note (4):  [[Cidofovir]] is successful in 3/8 immunosuppressed children and 8 of 10 children with post  Hematopoietic stem cell transplantation. Decrease in virus load predicted response to [[Cidofovir]].
-::* 3. '''Pink eye (viral conjunctivitis)'''
-::: Note (1): Usually unilateral Adenovirus (types 3 & 7 in children, 8, 11 & 19 in adults)
-::: Note (2): No treatment.
-::: Note (3): If symptomatic, cold artificial tears may help.
-::: Note (4): Highly contagious.
-::: Note (5): Onset of ocular pain and photophobia in an adult suggests associated keratitis—rare.
-::* 4.'''Bronchitis'''
-::: '''Infants/children (≤ age 5)'''
-:::< Age 2: Adenovirus;
-:::: Note:Antibiotics indicated only with associated sinusitis or heavy growth on throat culture for S. pneumo., Group A strep, H. influenzae or no improvement in 1 week. Otherwise treatment is symptomatic.
-{{PBI|SARS}}
-:* '''Severe acute respiratory distress syndrome- coronavirus'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Supportive therapy
-:::* [[Ribavirin]]—ineffective.
-:::* Interferon alfa with or without steroids—small case series.
-:::* Pegylated IFN-α effective in monkeys.
-:::* Low dose [[steroids]] alone successful.
-:::* High dose [[steroids]] increases serious fungal infections.
-:::* Inhaled [[Nitric oxide]] improved oxygenation and improved chest x-ray.
-:::: Note (1): Therapy remains predominantly supportive care.Therapy tried or under evaluation
-:::: Note (2):Transmission by close contact: effective infection control practices (mask [changed frequently], eye protection, gown, gloves) key to stopping transmission.
-:::: Note (3):Other coronaviruses  implicated as cause of croup, asthma exacerbations and other RTIs in children.May be associated with Kawasaki disease.
-----
-{{PBI|Cytomegalovirus}}
-:* '''Cytomegalovirus treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* 1.'''Retinitis'''
-:::* 1.1 '''In HIV-infected adults'''
-::::* Preferred regimen (1): [[Ganciclovir]] IV
-::::* Preferred regimen (2): [[Valganciclovir]] PO
-::::* Preferred regimen (3): [[Foscarnet]] IV, [[Cidofovir]] IV {{and}} [[Ganciclovir]] intraocular implant coupled with [[Valganciclovir]].
-:::* 1.2 '''In HIV-infected infants and children '''
-::::* Initial treatment (induction therapy): [[Ganciclovir]] IV  for acquired CMV disease, including CMV retinitis and other end-organ disseminated CMV disease (e.g., colitis, esophagitis, CNS disease).
-:::: Note (1): Oral [[Valganciclovir]], a prodrug of [[Ganciclovir]], is one of the first-line treatments for HIV infected adults with CMV retinitis and is an option in older children who weigh enough to receive the adult dose and tablet formulation of [[Valganciclovir]]. The drug is well absorbed from the GI tract and rapidly metabolized to [[Ganciclovir]] in the intestine and liver.
-:::: Note (2): [[Valganciclovir]] oral solution has not been studied in pediatric patients for treatment of CMV retinitis, but consideration can be given to its use for transitioning from [[Ganciclovir]] IV to [[Valganciclovir]] oral to complete treatment and or for secondary prophylaxis once improvement in retinitis is noted.
-:::* 1.3 '''An alternative drug for treating CMV disease or for use in [[Ganciclovir]]-resistant CMV infections in HIV infected children''' : [[Foscarnet]].
-:::: Note (1): [[Foscarnet]] used as suppressive therapy has been associated with increased length of survival relative to [[Ganciclovir]] in HIV-infected adults. Doses should be modified in patients with renal insufficiency.
-:::: Note (2): [[Cidofovir]] is effective in treating CMV retinitis in adults who are intolerant of other therapies.
-:::: Note (3): Combination therapy with [[Ganciclovir]] and [[Foscarnet]] delays progression of retinitis in certain patients in whom monotherapy fails and can be used as initial therapy in children with sight-threatening disease.
-:::: Note (4): Combination therapy also has been used for adults with retinitis that has relapsed on single-agent therapy.
-::* 2. '''In Transplant patients'''
-:::* Preferred regimen: [[Valganciclovir]]
-:::: Note (1): Use of [[Valganciclovir]] to prevent infections in CMV seronegative recipients who receive organs from a seropositive donor and in seropositive receivers has been highly effective.
-:::: Note (2): Others suggest preemptive treatment when pt develops CMV antigenemia or positive PCR post-transplant.
-::* 3. '''Colitis, Esophagitis'''
-:::* '''Preferred regimen (1)''': [[Valganciclovir]] 900 mg PO q24h.
-:::* '''Preferred regimen (2)''': [[Valganciclovir]] 900 mg PO q12h for 14–21 days, then 900 mg PO q24h for maintenance therapy
-:::* Alternative regimen: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days ,[[Ganciclovir]] as with retinitis except induction period extended for 3–6 wks (No agreement on use of maintenance; may not be necessary except after relapse. Responses less predictable than for retinitis.), then [[Valganciclovir]] 900 mg PO q24h {{or}} [[Foscarnet]] 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14–21 days, then 90–120 mg/kg IV q24h {{or}} [[Cidofovir]] 5 mg/kg IV for 2wks, then 5 mg/kg every other wk; each dose should be administered with IV saline hydration {{and}} oral probenecid {{or}} repeated intravitreal injections with [[Fomivirsen]] (for relapses only, not as initial therapy)
-:::: Note (1): Diagnosis by biopsy of ulcer base or edge  with demonstration of CMV inclusions and other pathogen.
-:::: Note (2): Switch to oral [[Valganciclovir]] when PO tolerated & when symptoms not severe enough to interfere with absorption.
-:::: Note (3): Antiretroviral therapy is essential in long term suppression.
-::* 4. '''Pneumonia'''
-:::* Preferred regimen: : [[Valganciclovir]] 900 mg PO q12h for 14–21 days, then 900 mg PO q24h for maintenance therapy
-:::* Alternative regimen for retinitis: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days, then [[Valganciclovir]] 900 mg PO q24h {{or}} [[Foscarnet]] 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14–21 days, then 90–120 mg/kg IV q24h {{or}} [[Cidofovir]] 5 mg/kg IV for 2wks, then 5 mg/kg every other wk; each dose should be administered with IV saline hydration {{and}} oral probenecid.
-:::: Note (1): CMV pneumonia seen predominantly in transplants (esp. bone marrow), rare in HIV.
-:::: Note (2): Treat only when histological evidence resent in IDS patients and other pathogens not identified.
-:::: Note (3): High rate of CMV reactivation in immunocompetent ICU patients; prolonged hospitalizations and increased mortality.
-:::: Note (4): In bone marrow transplant patients, combination therapy with CMV immune globulin. In bone marrow transplant patients, serial measure of pp65 antigen was useful in establishing early diagnosis of CMV interstitial pneumonia with good results if [[Ganciclovir]] was initiated within 6 days of antigen positivity.
-::* 5. '''Encephalitis, Ventriculitis'''
-::: Note: Treatment not defined, but should be considered the same as retinitis. Disease may develop while taking [[Ganciclovir]] as suppressive therapy.
-::* 6. '''Lumbosacral polyradiculopathy'''
-:::* Preferred regimen: [[Ganciclovir]], as with retinitis. [[Foscarnet]] 40 mg/kg IV q12h another option.Switch to [[Valganciclovir]] when possible.
-:::: Note (1): Diagnosis by CMV DNA in CSF.
-:::: Note (2): Suppression continued until CD4 remains >100/mm3 for 6 months.
-:::: Note (3): About 50% will respond; survival increases (5.4wks to 14.6wks).
-::* 7. '''Mononeuritis multiplex'''
-::: Note (1):  Due to vasculitis and may not be responsive to antiviral therapy
-::: Note (2): Marked decrease in HIV associated CMV infections & death with Highly Active Antiretroviral Therapy. Initial treatment should optimize HAART.
-::: Note (3): Primary prophylaxis not generally recommended. Preemptive therapy in patients with increased in  CMV DNA titers in plasma and CD4 <100/mm3. Recommended by some is  [[Valganciclovir]] 900 mg PO q24h.
-::: Note (4): Risk for developing CMV disease correlates with quantity of CMV DNA in plasma is each log 10. increase associated with 3.1-fold increase in disease.
-::* 8. '''Specific considerations'''
-::: Note (1): Currently, no therapies are available for the treatment of maternal or fetal CMV infection.
-::: Note (2): Antiviral medications such as [[Ganciclovir]], [[Valganciclovir]] and [[Foscarnet]] are approved by the U.S. Food and Drug Administration (FDA) only for treatment of patients with acquired immunodeficiency syndrome (AIDS) or organ transplants.
-:* '''Prevention'''
-::* 1. '''Prevention of opportunistic infections in human stem cell transplantation (HSCT) by CMV''' (Recipient with CMV positive or Donor with CMV  positive /Recipient with negative CMV)
-:::* '''Preemptive therapy''': Monitor ≥1  wk (days 10-100) CMV viremia by PCR or CMV-antigenemia and start treatment if positive. Traditional approach was to use [[Ganciclovir]] 5 mg/kg IV q12h for 7-14 days, then 5 mg/kg IV q24h 5 days/wk to the longer of: d 100 or ≥3 wks.
-:::: Note (1): More recently, [[Valganciclovir]] used more often in those who can take oral medications. Continue therapy until viral load negative (preferably twice).
-:::: Note (2): One study found [[Valganciclovir]] 900 mg po bid comparable to [[Ganciclovir]] 5 mg/kg iv bid in preemptive regimen
-:::: Note (3): [[Valganciclovir]] 900 mg po bid for 2 wks, then 900 mg PO q24h for ≥7 days after negative viral assay, was effective
-:::: Note (4): Preemptive regimen of [[Valganciclovir]] 900 mg po bid×2 wks, then 450 mg po bid, was effective {{or}}
-:::* '''Alternatively Prophylaxis approach''' (for high-risk pts or when CMV detection tests not rapidly available): From engraftment to day 100, ganciclovir 5 mg/kg IV q12h for 7 days, then 5 mg/kg IV q24h 5 to 6 days per week.
-::* 2. '''Prevention of opportunistic infections in Solid organ transplant (SOT) by CMV''' (Recipient with CMV positive or Donor with CMV  positive /Recipient with negative CMV)
-:::* 2.1 '''Kidney, Kidney/Pancreas, Heart'''
-::::* Preferred regimen: [[Valganciclovir]] 900 mg PO q24h; start by day 10 and continue to at least day 100.
-:::* 2.2 '''Liver'''
-::::* Preferred regimen: [[Ganciclovir]] 5 mg/kg IV qd or [[Ganciclovir]] 1 gm PO tid; start by day 10 and continue to at least day 100. Or, with caution, [[Valganciclovir]].
-:::* 2.3 '''Lung'''
-::::* Preferred regimen: [[Ganciclovir]] 5 mg/kg iv q12h for 5-7 days, then [[Valganciclovir]] 900 mg po q24h for 6 mos (or at least 3 months).
-::::: Note (1): With antiviral prophylaxis, onset of CMV is appearing later; optimal duration of prophylaxis under study.
-::::: Note (2): [[Valganciclovir]] does not have FDA indication for CMV prevention in liver or lung transplantation, but commonly used.
-::::: Note (3): In selected cases, some institutions add CMV immune globulin to antiviral drug in high risk cases. Regimen for lung, heart, liver, pancreas: 150 mg/kg within 72h of transplant and at 2, 4, 6 & 8 weeks post-transplant; then 100 mg/kg at weeks 12 & 16.
-::* 3. '''Post treatment suppression for retinitis '''(prophylactic) if CD4 count <100/mm3
-:::* Preferred regimen: [[Valganciclovir]] 900 mg PO q24h.
-:::: Note (1): Discontinue if CD4 >100/mm3 for 6 months on ART.
-:::: Note (2): Patients who discontinue suppression therapy should undergo regular eye examination for early detection of relapses.
-{{PBI|Enterovirus D68}}
-:* '''Enterovirus treatment'''
-::* '''Aseptic Meningitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-:::* Preferred regimen: Immunoglobulins IV typical dose is 2 g/kg IV infused over 24hrs.
-:::* Alternative regimen: [[Pleconaril]]
-:::: Note (1): Pleocytosis of 100s of cells, CSF glucose normal, negative culture for bacteria
-:::: Note (2): Enterovirus is the most common cause of aseptic meningitis.
-:::: Note (3): Rapid CSF PCR test is accurate; reduces costs and hospital stay for infants.
-:::: Note (4): No treatment currently recommended; however,  still under investigation.
-:::: Note (5): Hot tender parotid swelling and vesicular,ulcerative pharyingitis are also caused by Enterovirus.
-{{PBI|Ebola virus}}
-:* Ebola virus treatment<ref>{{cite web|title=Ebola virus treatment|url=http://www.cdc.gov/vhf/ebola/treatment/index.html}}</ref>
-::* Supportive therapy
-::: Providing intravenous fluids (IV) and balancing electrolytes (body salts).
-::: Maintaining oxygen status and blood pressure
-::: Treating other infections if they occur.
-:::: Note (1):  No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola.
-:::: Note (2):  Recovery from Ebola depends on good supportive care and the patient’s immune response.
-:::: Note (3): People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.
-:::: Note (4): Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.
-{{PBI|Marburg virus}}
-{{PBI|Hantavirus}}
-:* Hanta virus treatment<ref>{{citeweb|title=Hanta virus|url=http://www.cdc.gov/hantavirus/technical/hps/treatment.html}}</ref>
-::* Supportive therapy
-:::* ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed.
-:::* Fluids should be administered carefully due to the potential for capillary leakage.
-:::* Supplemental oxygen should be administered if patients become hypoxic.
-:::* Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous.
-:::: Note (1): There is no specific treatment or cure for hantavirus infection.
-:::: Note (2):if the individual is experiencing fever and fatigue and has a history of potential rural rodent exposure, together with shortness of breath, would be strongly suggestive of Hantavirus pulmonary syndrome.
-:::: Note (3): Treatment of patients with Hantavirus pulmonary syndrome remains supportive in nature.
-:::: Note (4): If there is a high degree of suspicion of Hantavirus pulmonary syndrome, patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care.
-:::: Note (5): Patients should receive appropriate, broad-spectrum antibiotic therapy while awaiting confirmation of a diagnosis of Hantavirus pulmonary syndrome. Care during the initial stages of the disease should include antipyretics and analgesia as needed.
-{{PBI|Dengue virus}}
-:* [[Dengue virus]] <ref>{{cite book | last = LastName | first = FirstName | title = Dengue guidelines for diagnosis, treatment, prevention, and control | publisher = TDR World Health Organization | location = Geneva | year = 2009 | isbn = 9789241547871 }}</ref>
-::* 1. '''Patients who may be sent home'''
-:::* These are patients who are able to tolerate adequate volumes of oral fluids and pass urine at least once every six hours, and do not have any of the warning signs, particularly when fever subsides
-:::* Patients who are sent home should be monitored daily by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, signs of plasma leakage and bleeding, haematocrit, and white blood cell and platelet counts
-::* 2. '''Ambulatory patients  with stable haematocrit can be sent home '''
-:::* Encourage oral intake of oral rehydration solution (ORS), fruit juice and other fluids containing electrolytes and sugar to replace losses from fever and vomiting
-:::* Give [[Paracetamol]] for high fever if the patient is uncomfortable. The interval of paracetamol dosing should not be less than six hours. Tepid sponge if the patient still has high fever
-:::* Should be brought to hospital immediately if any of the following occur: no clinical improvement, deterioration around the time of defervescence, severe abdominal pain, persistent vomiting, cold and clammy extremities, lethargy or irritability/restlessness, bleeding (e.g. black stools or coffee-ground vomiting), not passing urine for more than 4–6 hours
-::* 3. '''Patients who should be referred for in-hospital management'''
-:::* Patients may need to be admitted to a secondary health care centre for close observation, particularly as they approach the critical phase. These include patients with warning signs (Abdominal pain or tenderness, Persistent vomiting, Clinical fluid accumulation, Mucosal bleed, Lethargy, restlessness, Liver enlargment >2cm, Laboratory:increase in HCT concurrent with rapid decrease in platelet count), those with co-existing conditions that may make dengue or its management more complicated (such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, chronic haemolytic diseases), and those with certain social circumstances (such as living alone, or living far from a health facility without reliable means of transport)
-::::* 3.1 '''With warning signs'''
-:::::* Obtain a reference haematocrit before fluid therapy. Give only isotonic solutions such as 0.9% saline, Ringer’s lactate, or Hartmann’s solution. Start with 5–7 ml/ kg/hour for 1–2 hours, then reduce to 3–5 ml/kg/hr for 2–4 hours, and then reduce to 2–3 ml/kg/hr or less according to the clinical response
-:::::* Reassess the clinical status and repeat the haematocrit. If the haematocrit remains the same or rises only minimally, continue with the same rate (2–3 ml/kg/hr) for another 2–4 hours. If the vital signs are worsening and haematocrit is rising rapidly, increase the rate to 5–10 ml/kg/hour for 1–2 hours. Reassess the clinical status, repeat the haematocrit and review fluid infusion rates accordingly
-:::::* Give the minimum intravenous fluid volume required to maintain good perfusion and urine output of about 0.5 ml/kg/hr. Intravenous fluids are usually needed for only 24–48 hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient
-:::::* Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital signs and peripheral perfusion (1–4 hourly until the patient is out of the critical phase), urine output (4–6 hourly), haematocrit (before and after fluid replacement, then 6–12 hourly), blood glucose, and other organ functions (such as renal profile, liver profile, coagulation profile, as indicated)
-::::* 3.2 '''Without warning signs'''
-:::::* Encourage oral fluids. If not tolerated, start intravenous fluid therapy of 0.9% saline or Ringer’s lactate with or without dextrose at maintenance rate. For obese and overweight patients, use the ideal body weight for calculation of fluid infusion. Patients may be able to take oral fluids after a few hours of intravenous fluid therapy. Thus, it is necessary to revise the fluid infusion frequently. Give the minimum volume required to maintain good perfusion and urine output. Intravenous fluids are usually needed only for 24–48 hours
-:::::* Patients should be monitored by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, haematocrit, and white blood cell and platelet counts. Other laboratory tests (such as liver and renal functions tests) can be done, depending on the clinical picture and the facilities of the hospital or health centre
-::* 4. '''Severe dengue'''
-:::* Severe dengue: Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress; severe haemorrhages; severe organ impairment (hepatic damage, renal impairment, cardiomyopathy, encephalopathy or encephalitis)
-:::* 4.1 '''Treatment of shock'''
-::::* 4.1.1 '''Compensated shock'''
-:::::* Start intravenous fluid resuscitation with isotonic crystalloid solutions at 5–10 ml/kg/hour over one hour. Then reassess the patient’s condition (vital signs, capillary refill time, haematocrit, urine output). The next steps depend on the situation
-:::::* If the patient’s condition improves, intravenous fluids should be gradually reduced to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, then to 2–3 ml/kg/hr, and then further depending on haemodynamic status, which can be maintained for up to 24–48 hours
-:::::* If vital signs are still unstable (i.e. shock persists), check the haematocrit after the first bolus. If the haematocrit increases or is still high (>50%), repeat a second bolus of crystalloid solution at 10–20 ml/kg/hr for one hour. After this second bolus, if there is improvement, reduce the rate to 7–10 ml/ kg/hr for 1–2 hours, and then continue to reduce as above. If haematocrit decreases compared to the initial reference haematocrit (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible
-:::::* Further boluses of crystalloid or colloidal solutions may need to be given during the next 24–48 hours
-::::* 4.1.2 '''Hypotensive shock'''
-:::::* Initiate intravenous fluid resuscitation with crystalloid or colloid solution (if available) at 20 ml/kg as a bolus given over 15 minutes to bring the patient out of shock as quickly as possible
-:::::* If the patient’s condition improves, give a crystalloid/colloid infusion of 10 ml/kg/hr for one hour. Then continue with crystalloid infusion and gradually reduce to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, and then to 2–3 ml/kg/hr or less, which can be maintained for up to 24–48 hours
-:::::* If vital signs are still unstable (i.e. shock persists), review the haematocrit obtained before the first bolus. If the haematocrit was low (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross- match and transfuse blood as soon as possible (see treatment for haemorrhagic complications)
-:::::* If the haematocrit was high compared to the baseline value (if not available, use population baseline), change intravenous fluids to colloid solutions at 10–20 ml/kg as a second bolus over 30 minutes to one hour. After the second bolus, reassess the patient. If the condition improves, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above. If the condition is still unstable, repeat the haematocrit after the second bolus
-:::::* If the haematocrit decreases compared to the previous value (<40% in children and adult females, less than 45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible (see treatment for haemorrhagic complications). If the haematocrit increases compared to the previous value or remains very high ( more than 50%), continue colloid solutions at 10–20 ml/kg as a third bolus over one hour. After this dose, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above when the patient’s condition improves
-:::::* Further boluses of fluids may need to be given during the next 24 hours. The rate and volume of each bolus infusion should be titrated to the clinical response. Patients with severe dengue should be admitted to the high-dependency or intensive care area
-:::* 4.2 '''Treatment of haemorrhagic complications'''
-::::* Blood transfusion required
-:::::* Give 5–10ml/kg of fresh-packed red cells or 10–20 ml/kg of fresh whole blood at an appropriate rate and observe the clinical response. It is important that fresh whole blood or fresh red cells are given. Oxygen delivery at tissue level is optimal with high levels of 2,3 di-phosphoglycerate (2,3 DPG). Stored blood loses 2,3 DPG, low levels of which impede the oxygen-releasing capacity of haemoglobin, resulting in functional tissue hypoxia. A good clinical response includes improving haemodynamic status and acid-base balance
-:::::* Consider repeating the blood transfusion if there is further blood loss or no appropriate rise in haematocrit after blood transfusion. There is little evidence to support the practice of transfusing platelet concentrates and/or fresh-frozen plasma for severe bleeding. It is being practised when massive bleeding can not be managed with just fresh whole blood/fresh-packed cells, but it may exacerbate the fluid overload
-:::::* Great care should be taken when inserting a naso-gastric tube which may cause severe haemorrhage and may block the airway. A lubricated oro-gastric tube may minimize the trauma during insertion. Insertion of central venous catheters should be done with ultra-sound guidance or by a very experienced person
-::* 5. '''Treatment of complications and other areas of treatment'''
-:::* 5.1 '''Fluid overload'''
-::::* Oxygen therapy should be given immediately
-::::* When the following signs are present, intravenous fluids should be discontinued or reduced to the minimum rate necessary to maintain euglycaemia
-:::::* signs of cessation of plasma leakage; stable blood pressure, pulse and peripheral perfusion; haematocrit decreases in the presence of a good pulse volume; afebrile for more than 24–48 days (without the use of antipyretics); resolving bowel/abdominal symptoms; improving urine output
-::::* The management of fluid overload varies according to the phase of the disease and the patient’s haemodynamic status. If the patient has stable haemodynamic status and is out of the critical phase (more than 24–48 hours of defervescence), stop intravenous fluids but continue close monitoring. If necessary, give oral or intravenous furosemide 0.1–0.5 mg/kg/dose once or twice daily, or a continuous infusion of furosemide 0.1 mg/kg/hour. Monitor serum potassium and correct the ensuing hypokalaemia
-::::* If the patient has stable haemodynamic status but is still within the critical phase, reduce the intravenous fluid accordingly. Avoid diuretics during the plasma leakage phase because they may lead to intravascular volume depletion
-::::* Patients who remain in shock with low or normal haematocrit levels but show signs of fluid overload may have occult haemorrhage. Further infusion of large volumes of intravenous fluids will lead only to a poor outcome. Careful fresh whole blood transfusion should be initiated as soon as possible. If the patient remains in shock and the haematocrit is elevated, repeated small boluses of a colloid solution may help
-:::* 5.2 '''Other complications of dengue'''
-::::* Both hyperglycaemia and hypoglycaemia may occur, even in the absence of diabetes mellitus and/or hypoglycaemic agents. Electrolyte and acid-base imbalances are also common observations in severe dengue and are probably related to gastrointestinal losses through vomiting and diarrhoea or to the use of hypotonic solutions for resuscitation and correction of dehydration. Hyponatraemia, hypokalaemia, hyperkalaemia, serum calcium imbalances and metabolic acidosis (sodium bicarbonate for metabolic acidosis is not recommended for pH ≥ 7.15) can occur. One should also be alert for co-infections and nosocomial infections.
-:::* 5.3 '''Supportive care and adjuvant therapy'''
-::::* renal replacement therapy, with a preference to continuous veno-venous haemodialysis (CWH), since peritoneal dialysis has a risk of bleeding;
-::::* vasopressor and inotropic therapies as temporary measures to prevent life- threatening hypotension in dengue shock and during induction for intubation, while correction of intravascular volume is being vigorously carried out;
-::::* further treatment of organ impairment, such as severe hepatic involvement or encephalopathy or encephalitis;
-::::* further treatment of cardiac abnormalities, such as conduction abnormalities, may occur (the latter usually not requiring interventions)
-{{PBI|West Nile virus}}
-{{PBI|Yellow Fever}}
-:* Yellow fever<ref>{{cite web | title = District guidelines for yellow fever surveillance | url = http://www.who.int/csr/resources/publications/yellowfev/whoepigen9809.pdf?ua=1 }}</ref><ref> name="pmid3547569">{{cite journal| author=Monath TP| title=Yellow fever: a medically neglected disease. Report on a seminar. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 1 | pages= 165-75 |pmid=3547569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3547569  }} </ref>
-::* Preferred regimen: No specific treatment is available for yellow fever. In the toxic phase, supportive treatment includes therapies for treating dehydration and fever. Ribavirin has failed in several studies in the monkey model.
-:::* Note: An international seminar held by WHO in 1984 recommended maintenance of nutrition, prevention of hypoglycemia, maintenance of the blood pressure with fluids and vasoactive drugs, prevention of bleeding with fresh-frozen plasma, dialysis if renal failure, correction of metabolic acidosis, administration of cimetidine IV to avoid gastric bleeding and oxygen if needed.
-{{PBI|Chikungunya virus}}
-::'''Chikungunya Fever''' <ref name="pmid25806915">{{cite journal| author=Weaver SC, Lecuit M| title=Chikungunya virus and the global spread of a mosquito-borne disease. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 13 | pages= 1231-9 | pmid=25806915 | doi=10.1056/NEJMra1406035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25806915  }} </ref>
-::*Preferred regimen: no specific therapeutics agents are available and there are no licensed vaccines to prevent Chikungunya Fever.
-:::* Note: Anti inflammatory drugs can be used to control joint swelling and arthritis.
-{{PBI|Hepatitis A virus}}
-:*Preferred regimen: No therapy recommended. If within 2 wks of exposure, IVIG 0.02 mL per kg IM times 1 protective.
-{{PBI|Hepatitis B virus}}
-*'''Acute Hepatitis B'''
-*Chronic Hepatitis B
-:*'''1. Patients with HBeAg-positive chronic hepatitis B''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-::*'''1.1. HBV DNA >20,000, ALT <2 times upper limit normal (ULN)''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-:::*Observe; consider treatment when ALT becomes elevated.
-:::*Consider biopsy in persons 40 years, ALT persistently high normal >2 times upper limit normal (ULN), or with family history of HCC.
-:::*Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.
-::*'''1.2. HBV DNA >20,000, ALT >2 times upper limit normal (ULN)''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-:::*'''Preferred regimen(1)''': Pegylated IFN-alpha 180 mcg weekly SC for 48 weeks
-:::*'''Preferred regimen(2)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
-:::*'''Preferred regimen(3)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
-:::*'''Alternative regimen(1)''': [[Interferon alpha]](IFNα) 5 MU daily or 10 MU thrice weekly SC for 16 weeks
-:::*'''Alternative regimen(2)''': [[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
-::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
-::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
-:::*'''Alternative regimen(3)''': [[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-::::*If creatinine clearance 30–49 give 10 mg PO every other day
-::::*If creatinine clearance 10–19 10 mg PO every third day
-::::*If hemodialysis patients give 10 mg PO every week following dialysis
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
-:::*'''Alternative regimen(4)''': [[Telbivudine]](LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
-::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
-:::*Notes:
-::::*Observe for 3-6 months and treat if no spontaneous HBeAg loss.
-::::*Consider liver biopsy prior to treatment if compensated.
-::::*Immediate treatment if icteric or clinical decompensation.
-::::*[[Interferon alpha]](IFNα)/ pegylated interferon-alpha(peg-IFNα), [[Lamivudine]](LAM), [[Adefovir]](ADV), [[Entecavir]](ETV), tenofovir disoproxil fumarate(TDF) or [[telbivudine]](LdT) may be used as initial therapy.
-::::*Adefovir(ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
-::::*Lamivudine(LAM) and Telbivudine(LdT) not preferred due to high rate of drug resistance.
-::::*End-point of treatment – Seroconversion from HBeAg to anti-HBe.
-::::*[[Interferon alpha]](IFNα)  non-responders / contraindications to IFNα change to [[Tenofovir]](TDF)/[[Entecavir]](ETV).
-::*'''1.3. Children with elevated ALT greater than 2 times normal''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-:::*Preferred regimen(1): [[Interferon alpha]](IFNα) 6 MU/m2  SC thrice weekly with a maximum of 10 MU
-:::*Preferred regimen(2): [[Lamivudine]](LAM) 3 mg/kg/d PO with a maximum of 100 mg/d.
-:*'''2. Patients with HBeAg-negative chronic hepatitis B''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-::*'''2.1. HBV DNA >20,000 IU/mL and elevated ALT >2 times normal'''
-:::*'''Preferred regimen(1)''': Pegylated IFN-alpha 180 mcg weekly SC for 1 year
-:::*'''Preferred regimen(2)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-::::*Note: duration of treatment is more than 1 year
-:::*'''Preferred regimen(3)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
-::::*Note: duration of treatment is more than 1 year
-:::*'''Alternative regimen(1)''': [[Interferon alpha]](IFNα) 5 MU daily or 10 MU thrice weekly SC for 1 year
-:::*'''Alternative regimen(2)''': [[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
-::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
-::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-::::*Note: duration of treatment is more than 1 year
-:::*'''Alternative regimen(3)''': [[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-::::*If creatinine clearance 30–49 give 10 mg PO every other day
-::::*If creatinine clearance 10–19 10 mg PO every third day
-::::*If hemodialysis patients give 10 mg PO every week following dialysis
-::::*Note: duration of treatment is more than 1 year
-:::*'''Alternative regimen(4)''': [[Telbivudine]](LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
-::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-::::*Note: duration of treatment is more than 1 year
-:::*Notes:
-::::*[[Interferon alpha]](IFNα)/ pegylated interferon-alpha(peg-IFNα), [[Lamivudine]](LAM), [[Adefovir]](ADV), [[Entecavir]](ETV), tenofovir disoproxil fumarate(TDF) or [[telbivudine]](LdT) may be used as initial therapy.
-::::*Adefovir(ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
-::::*[[Lamivudine]](LAM) and [[Telbivudine]](LdT) not preferred due to high rate of drug resistance.
-::::*End-point of treatment – not defined
-::::*[[Interferon alpha]](IFNα)  non-responders / contraindications to IFNα change to [[Tenofovir]](TDF)/[[Entecavir]](ETV).
-:*'''3. HBV DNA >2,000 IU/mL and elevated ALT >1-2 times normal''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-::*Consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.
-:*'''4. HBV DNA <2,000 IU/mL and ALT < upper limit normal (ULN)''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-::*Observe, treat if HBV DNA or ALT becomes higher.
-:*'''5. +/- HBeAg and detectable HBV DNA with Cirrhosis''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-::*'''5.1. Compensated Cirrhosis and HBV DNA >2,000'''
-:::*'''Preferred regimen(1)''': [[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
-::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
-::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-:::*'''Preferred regimen(2)''': [[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-::::*If creatinine clearance 30–49 give 10 mg PO every other day
-::::*If creatinine clearance 10–19 give 10 mg PO every third day
-::::*If hemodialysis patients give 10 mg PO every week following dialysis
-:::*'''Preferred regimen(3)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
-:::*'''Preferred regimen(4)''': [[Telbivudine]](LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
-::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-:::*'''Preferred regimen(5)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-:::*Notes:
-::::*LAM and LdT not preferred due to high rate of drug resistance.
-::::*ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.
-::::*These patients should receive long-term treatment. However, treatment may be stopped in HBeAg-positive patients if they have confirmed HBeAg seroconversion and have completed at least 6 months of consolidation therapy and in HBeAg-negative patients if they have confirmed HBsAg clearance.
-::*'''5.2. Compensated Cirrhosis and HBV DNA <2,000'''
-:::*Consider treatment if ALT elevated.
-::*'''5.3. Decompensated Cirrhosis'''
-:::*'''Preferred regimen(1)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-:::*'''Preferred regimen(2)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
-:::*'''Preferred regimen(3)''': [[Lamivudine]](LAM) {{and}} [[Adefovir]](ADV)
-::::*[[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-:::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
-:::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
-:::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-:::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-:::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-:::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-::::*[[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-:::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-:::::*If creatinine clearance 30–49 give 10 mg PO every other day
-:::::*If creatinine clearance 10–19 give 10 mg PO every third day
-:::::*If hemodialysis patients give 10 mg PO every week following dialysis
-:::*'''Preferred regimen(4)''': [[Telbivudine]](LdT) {{and}} [[Adefovir]](ADV)
-::::*[[Telbivudine]](LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-:::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
-:::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-:::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-:::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-::::*[[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-:::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-:::::*If creatinine clearance 30–49 give 10 mg PO every other day
-:::::*If creatinine clearance 10–19 give 10 mg PO every third day
-:::::*If hemodialysis patients give 10 mg PO every week following dialysis
-:::*Notes:
-::::*Coordinate treatment with transplant center.
-::::*Refer for liver transplant.
-::::*Life-long treatment is recommended.
-:* '''6. +/- HBeAg and undetectable HBV DNA  with Cirrhosis''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-::*Compensated Cirrhosis: Observe
-::*Uncompensated Cirrhosis: Refer for liver transplant
-{{PBI|Hepatitis C virus}}
-Chronic Hepatitis C
-*'''1. Treatment regimens for chronic hepatitis C virus genotype 1''' <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''1.1. Treatment regimens for genotype 1a''':
-::*'''Preferred regimen(1)''': Daily fixed-dose combination of Ledipasvir 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 1a infection
-::*'''Preferred regimen(2)''': Daily fixed-dose combination of Paritaprevir 150 mg {{and}} [[Ritonavir]] 100 mg {{and}} Ombitasvir 25 mg plus twice-daily dosed Dasabuvir 250 mg {{and}} weight-based [[Ribavirin]](RBV) ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) {{or}} 24 weeks (cirrhosis) is recommended for treatment-naive patients with HCV genotype 1a infection.
-::*'''Preferred regimen(3)''': Daily [[Sofosbuvir]] 400 mg plus [[Simeprevir]] 150 mg {{withorwithout}} weight-based [[Ribavirin]](RBV) ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis) is recommended for treatment-naive patients with HCV genotype 1a infection.
-:*'''1.2. Treatment regimens for genotype 1b''':
-::*'''Preferred regimen(1)''': Daily fixed-dose combination of [[Ledipasvir]] 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 1b infection.
-::*'''Preferred regimen(2)''': Daily fixed-dose combination of Paritaprevir 150 mg {{and}} [[Ritonavir]] 100 mg {{and}} Ombitasvir 25 mg plus twice-daily dosed Dasabuvir 250 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 1b infection. The addition of weight-based RBV (1000 mg [<75kg] to 1200 mg [>75 kg]) is recommended in patients with cirrhosis.
-::*'''Preferred regimen(3)''': Daily [[Sofosbuvir]] 400 mg plus [[Simeprevir]] 150 mg for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis) is recommended for treatment-naive patients with HCV genotype 1b infection.
-*'''2. Treatment regimens for chronic hepatitis C virus genotype 2'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily [[sofosbuvir]] 400 mg {{and}} weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks is recommended for treatment-naive patients with HCV genotype 2 infection. Extending treatment to 16 weeks is recommended in patients with cirrhosis.
-*'''3. Treatment regimens for chronic hepatitis C virus genotype 3'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily sofosbuvir (400 mg) and weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks is recommended for treatment-naive patients with HCV genotype 3 infection.
-:*'''Alternative regimen''': Daily sofosbuvir 400 mg and weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is an acceptable regimen for IFN-eligible, treatment-naive patients with HCV genotype 3 infection.
-*'''4. Treatment regimens for chronic hepatitis C virus genotype 4'''
-:*'''Preferred regimen(1)''': Daily fixed-dose combination of Ledipasvir 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 4 infection.
-:*'''Preferred regimen(2)''': Daily fixed-dose combination of Paritaprevir 150 mg {{and}} [[Ritonavir]] 100 mg {{and}} Ombitasvir 25 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks is recommended for treatment-naive patients with HCV genotype 4 infection.
-:*'''Preferred regimen(3)''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]]RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks is recommended for treatment-naive patients with HCV genotype 4 infection.
-:*'''Alternative regimen(1)''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is an acceptable regimen for treatment-naive patients with HCV genotype 4 infection.
-:*'''Alternative regimen(2)''': Daily [[Sofosbuvir]] 400 mg plus [[Simeprevir]] 150 mg {{withorwithout}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks is an acceptable regimen for treatment-naive patients with HCV genotype 4 infection.
-*'''5. Treatment regimens for chronic hepatitis C virus genotype 5'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is recommended for treatment-naive patients with HCV genotype 5 infection.
-:*'''Alternative regimen''': Weekly PEG-IFN plus weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 48 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 5 infection.
-*'''6. Treatment regimens for chronic hepatitis C virus genotype 6'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily fixed-dose combination of [[Ledipasvir]] 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 6 infection.
-:*'''Alternative regimen''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 6 infection.
-{{PBI|Hepatitis E virus}}
-* Hepatitis E treatment<ref>{{citeweb|title=Hepatitis E virus|url=http://www.who.int/mediacentre/factsheets/fs280/en/}}</ref>
-:* Supportive therapy
-::* Hepatitis E is usually self-limiting, hospitalization is generally not required.
-::* Hospitalization is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.
-::: Note (1): There is no available treatment capable of altering the course of acute hepatitis.
-::: Note (2): Prevention is the most effective approach against the disease.
-:* '''Prevention'''
-::* ''' The risk of infection and transmission can be reduced by'''
-:::* (1) Maintaining quality standards for public water supplies;
-:::* (2) Establishing proper disposal systems to eliminate sanitary waste.
-::* '''On an individual level, infection risk can be reduced by'''
-:::* (1) Maintaining hygienic practices such as hand washing with safe water, particularly before handling food;
-:::* (2) Avoiding drinking water and/or ice of unknown purity;
-:::* (3) Adhering to WHO safe food practices-determining the mode of transmission; identifying the population specifically exposed to increased risk of infection; eliminating a common source of infection; improving sanitary and hygienic practices to eliminate faecal contamination of food and water raising awareness, promoting partnerships and mobilizing resources;formulating evidence-based policy and data for action;preventing transmission; and executing screening, care and treatment.
-{{PBI|Epstein-Barr virus}}
-:* [[Epstein-Barr Virus]] (EBV) <ref name=CDC>{{cite web | title = Epstein-Barr Virus (EBV) center for disease control and prevention| url =http://www.cdc.gov/epstein-barr/about-ebv.html }}</ref>
-::* There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.
-::* There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including
-:::* drinking fluids to stay hydrated
-:::* getting plenty of rest
-:::* taking over-the-counter medications for pain and fever
-{{PBI|Human herpesvirus 6}}
-:* '''Human herpesvirus 6 treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred regimen: [[Ganciclovir]] decreased viral copies in response to treatment and [[Foscarnet]] therapy improved thrombotic microangiopathy.
-::: Note (1): Human herpesvirus 6 (HHV-6) infects lymphocytes. It is typically acquired in early infancy and causes exanthem subitum (roseola infantum) and other febrile diseases of childhood.
-::: Note (2): Fever & rash documented in transplant patients .
-::: Note (3): Reactivation in hematopoietic stem cell transplant patients associated with delayed monocytes & platelet engraftment.
-::: Note (4): Recognized in assocation with meningoencephalitis in immunocompetent adults.
-::: Note (5): Diagnosis made by positive PCR in CSF.
-{{PBI|Roseola|Human herpesvirus 7}}
-:* '''Human herpesvirus 7 (roseola virus) treatment'''
-::* Supportive therapy
-:::* Most patients with infection with HHV-7 will be asymptomatic. It is unknown whether treatment in asymptomatic patients will lead to a reduction in subsequent infection.<ref name="pmid15504215">{{cite journal| author=| title=Other herpesviruses: HHV-6, HHV-7, HHV-8, HSV-1 and -2, VZV. | journal=Am J Transplant | year= 2004 | volume= 4 Suppl 10 | issue=  | pages= 66-71 | pmid=15504215 | doi=10.1111/j.1600-6135.2004.00697.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15504215  }} </ref>
-:::* Immunocompetent hosts with uncomplicated skin manifestations associated with HHV-7, particularly roseola infantum and pityriasis rosea, need only symptomatic management.<ref name="pmid22819486">{{cite journal| author=Wolz MM, Sciallis GF, Pittelkow MR| title=Human herpesviruses 6, 7, and 8 from a dermatologic perspective. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 10 | pages= 1004-14 | pmid=22819486 | doi=10.1016/j.mayocp.2012.04.010 | pmc=PMC3538396 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22819486  }} </ref>
-:::* For HIV-positive patients, antiretroviral therapy may be advisable.<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* There are no defined circumstances that warrant specific antiviral therapy for HHV-7.<ref name="pmid10578120">{{cite journal| author=Black JB, Pellett PE| title=Human herpesvirus 7. | journal=Rev Med Virol | year= 1999 | volume= 9 | issue= 4 | pages= 245-62 | pmid=10578120 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10578120  }} </ref>
-:::* The most active antiviral compounds against HHV-7 are [[Cidofovir]] and [[Foscarnet]].<ref name="pmid11747000">{{cite journal| author=De Clercq E, Naesens L, De Bolle L, Schols D, Zhang Y, Neyts J| title=Antiviral agents active against human herpesviruses HHV-6, HHV-7 and HHV-8. | journal=Rev Med Virol | year= 2001 | volume= 11 | issue= 6 | pages= 381-95 | pmid=11747000 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11747000  }} </ref>
-::::* Note (1) Ubiquitous virus (>90% of the population is infected by age 3 yrs).
-::::* Note (2) Infects CD4 lymphocytes via CD4 receptor; transmitted via saliva.
-----
-{{PBI|Human herpesvirus 8 (KSHV)}}
-:* 1. '''Mild to moderate Kaposi sarcoma'''<ref>{{ cite web | title = Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf }}</ref>
-::* Preferred regimen: initiate or optimize ART
-:* 2. '''Advanced Kaposi sarcoma (ACTG Stage T1, including disseminated cutaneous or visceral Kaposi sarcoma)'''
-::* Preferred regimen: chemotherapy (per oncology consult) {{and}} ART
-:* 3. '''Primary effusion lymphoma'''
-::* Preferred regimen: chemotherapy (per oncology consult) {{and}} ART
-::* Note: [[Valganciclovir]] PO or [[Ganciclovir]] IV can be used as adjunctive therapy.
-:* 4. '''Multicentric Castleman's disease'''
-::* Preferred regimen (1): [[Valganciclovir]] 900 mg PO bid for 3 weeks
-::* Preferred regimen (2): [[Ganciclovir]] 5 mg/kg IV q12h for 3 weeks
-::* Preferred regimen (3): [[Valganciclovir]] 900 mg PO BID {{and}} [[Zidovudine]] 600 mg PO q6h for 7–21 days
-::* Alternative regimen: [[Rituximab]] 375 mg/m2 given weekly for 4–8 weeks (may be an alternative to or used adjunctively with antiviral therapy)
-----
-{{PBI|Herpes simplex virus}}
-::* 1.'''First Clinical Episode of Genital Herpes'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::::* Preferred Regimens: [[Acyclovir]] 400 mg PO tid for 7–10 days {{or}} [[Acyclovir]] 200 mg PO five times a day for 7–10 days{{or}} [[Valacyclovir]] 1 g PO bid for 7–10 days{{or}}[[ Famciclovir]] 250 mg PO tid  for 7–10 days
-::::* Note:Treatment can be extended if healing is incomplete after 10 days of therapy.
-::* 2.'''Established HSV-2 Infection '''
-::::* 2.1 '''Suppressive Therapy for Recurrent Genital Herpes'''
-::::* Preferred Regimen: [[Acyclovir]] 400 mg PO bid {{or}} [[Valacyclovir]] 500 mg PO qd {{or}} [[Valacyclovir]] 1 g PO qd {{or}} [[Famciclovir]] 250 mg PO bid
-::::* Note(1):daily therapy with  [[Acyclovir]] for as long as 6 years and with [[Valacyclovir]] or [[Famciclovir]] for 1 year
-::::* Note(2):[[Valacyclovir]] 500 mg qd might be less effective than other [[Valacyclovir]] or [[Acyclovir]] dosing regimens in persons who have very frequent recurrences (i.e., ≥10 episodes per year).
-::::* 2.2 '''Episodic Therapy for Recurrent Genital Herpes'''
-::::* Preferred Regimen: [[Acyclovir]] 400 mg PO tid for 5 days {{or}} Acyclovir 800 mg PO bid for 5 days {{or}}  [[Acyclovir]] 800 mg  PO tid for 2 days{{or}} [[Valacyclovir]] 500 mg  PO bid for 3 days{{or}} [[Valacyclovir]] 1 g PO qd for 5 days {{or}} [[Famciclovir]] 125 mg  PO bid  for 5 days{{or}}[[ Famciclovir]] 1 gram  PO bid  for 1 day {{or}} [[Famciclovir]] 500 mg once, followed by 250 mg  PO bid   for 2 days
-::* 3. '''Severe Disease''' (disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g., meningoencephalitis).
-::::* Preferred Regimens: [[ Acyclovir]] 5–10 mg/kg IV q8h  for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy. HSV encephalitis requires 21 days of intravenous therapy. Impaired renal function warrants an adjustment in acyclovir dosage.
-::* 4. '''Special Considerations'''
-::* 4.1'''HIV Infection'''
-::::* 4.1.1 '''Daily Suppressive Therapy in Persons with HIV'''
-::::* Preferred Regimens: [[Acyclovir]] 400–800 mg PO bid /tid  {{or}}[[Valacyclovir]] 500 mg  PO bid {{or}}[[Famciclovir]] 500 mg PO bid
-::::* 4.1.2 '''Episodic Infection in Persons with HIV'''
-::::* Preferred Regimens: [[Acyclovir]] 400 mg  PO tid  for 5–10 days {{or}} [[Valacyclovir]] 1 g PO bid for 5–10 days {{or}} [[Famciclovir]] 500 mg  PO bid for 5–10 days
-::::* Note:For severe HSV disease, initiating therapy with [[Acyclovir]] 5–10 mg/kg IV every 8 hours might be necessary.
-::* 4.2.'''Genital Herpes in Pregnancy'''
-::::* suppressive therapy of pregnant women with recurrent genital herpes *
-::::* Preferred Regimens: [[Acyclovir]] 400–800 mg PO bid /tid  {{or}}[[Valacyclovir]] 500 mg  PO bid
-::::* Note:Treatment recommended starting at 36 weeks of gestation.
-::* 4.3'''Neonatal Herpes '''
-::::* known or suspected neonatal herpes: [[Acyclovir]] 20 mg/kg IV q 8 h
-::::* Note(1):treatment for 14 days if disease is limited to the skin and mucous membranes, or
-::::* Note(2):treatment for 21 days for disseminated disease and that involving the central nervous system.
-::* 4.4''' Acyclovir-resistant genital herpes'''
-::::* Preferred Regimens:[[Foscarnet ]]40–80 mg/kg IV q8 h until clinical resolution is attained
-::::* Alternative Regimens: [[Cidofovir]]  5 mg/kg  IV once weekly might also be effective.
-::::* Alternative Regimens:Imiquimod topical preparations should be applied to the lesions qd for 5 consecutive days.
-::* 4.5'''Management of Sex Partners'''
-::::* Preferred Regimens: [[Acyclovir]] 400 mg PO tid for 7–10 days {{or}} [[Acyclovir]] 200 mg PO five times a day for 7–10 days{{or}} [[Valacyclovir]] 1 g PO bid for 7–10 days{{or}} [[Famciclovir]] 250 mg PO tid  for 7–10 days
-::::* Note:The sex partners of persons who have genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated
-::* 4.6 '''Allergy, Intolerance, and Adverse Reactions'''
-::::* Allergic and other adverse reactions to oral acyclovir, valacyclovir, and famciclovir are rare. Desensitization to acyclovir has been described.
-{{PBI|Varicella-zoster virus}}
-{{PBI|Human papillomavirus}}
-::* 1.'''Preferred regimen for External Anogenital Warts''' (i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)
-::::* 1.1 '''Patient-Applied:''':[[Imiquimod]] 3.75% or 5% cream {{or}}[[Podofilox]] 0.5% solution or gel {{or}} [[Sinecatechins]] 15% ointment
-::::* 1.2 '''Provider-Administered''':Cryotherapy with liquid nitrogen or cryoprobe  {{or}} Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser,or electrosurgery {{or}} [[Trichloroacetic acid]] (TCA) or Bichloroacetic acid (BCA) 80%-90% solution
-::::* Note(1):Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
-::::* Note(2):Might weaken condoms and vaginal diaphragms.
-::* 2.'''Alternative Regimens for External Genital Warts'''
-::::* 2.1 '''Urethral Meatus Warts'''
-::::* Regimens :Cryotherapy with liquid nitrogen {{or}}  Surgical removal
-::::* 2.2'''Vaginal Warts'''
-::::* Regimens:Cryotherapy with liquid nitrogen. {{or}} Surgical removal  {{or}}  TCA or BCA 80%–90% solution
-::::* Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation
-::::* 2.3 '''Cervical Warts'''
-::::* Regimen: Cryotherapy with liquid nitrogen {{or}} Surgical removal {{or}}  TCA or BCA 80%–90% solution
-::::* Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.
-::::* 2.4 '''Intra-anal Warts'''
-::::* Regimens :Cryotherapy with liquid nitrogen {{or}} Surgical removal{{or}} TCA or BCA 80%–90% solution
-::::* Note:Management of intra-anal warts should include consultation with a specialist.
-:* '''3. Specific considerations'''
-::* '''3.1. Follow-up'''
-:::* Most anogenital warts respond within 3 months of therapy. Factors that might affect response to therapy include immunosuppression and treatment compliance. In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment. A new treatment modality should be selected when no substantial improvement is observed after a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy.
-::* '''3.2 Management of sex partners'''
-:::* Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.
-::* '''3.3 Pregnancy'''
-:::* Podofilox (podophyllotoxin), podophyllin, and sinecatechins should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available.
-:::* Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
-:::* Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children (recurrent respiratory papillomatosis).
-::* '''3.4 HIV infection'''
-:::* Data do not support altered approaches to treatment for persons with HIV infection.
-:::* Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases
-::* '''3.5 High-grade squamous intraepithelial lesions'''
-:::* Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract. In this instance, referral to a specialist for treatment is recommended.
-{{PBI|Influenza A}}
-{{PBI|Influenza B}}
-{{PBI|Avian influenza}}
-::*1.Preferred regimen:[[Oseltamivir]] 75 mg PO qd for a minimum 10 days <ref name=":1">Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015</ref><ref>{{Cite web| title= avian influenza| url=http://www.cdc.gov/flu/avianflu/avian-in-humans.htm}} </ref>
-:::*Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently
-::*2 Patients with Avian Influenza who have diarrhea and  malabsorption
-:::*Preferred regimen:[[Zanamivir]]10 mg inhaled bid for minimum 5 days {{or}} [[Peramivir]]600 mg IV as a single dose for1 day
-:::*Note(1)Preliminary evidence demonstrates that [[neuraminidase inhibitor]] can reduce the duration of [[viral replication]] and improve survival among patients with [[avian influenza]]. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
-:::*Note(2)The use of [[corticosteroids]] is not recommended.
-:::*Note(3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
-:::*Note(4):The use of [[amantadine]] is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.<ref>WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/ Accessed on April 22, 2015
-</ref>
-:::*Note(5):Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.
-{{PBI|Swine influenza}}
-* [[Swine influenza]] <ref>{{Cite book| publisher = World Health Organization| title = WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-07-14| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138515/| pmid = 23741777}}</ref>
-:*1. '''Condition1: Patients who have severe or progressive clinical illness'''
-::* Preferred regimen: [[Oseltamivir]] 150 mg PO BID, treatment duration depends on clinical response
-::* NOTE(1): Where the clinical course remains severe or progressive, despite 5 or more days of antiviral treatment, monitoring of virus replication and shedding, and antiviral drug susceptibility testing is desirable
-::* NOTE(2): Antiviral treatment should be maintained without a break until virus infection is resolved or there is satisfactory clinical improvement
-::* NOTE(3): Patients who have severe or progressive clinical illness, but who are unable to take oral medication may be treated with oseltamivir administered by nasogastric or orogastric tube
-:* 2. '''Condition2: In situations where oseltamivir is not available, or not possible to use, patients who have severe or progressive clinical illness'''
-::* Preferred regimen: [[Zanamivir]] inhaled
-::* NOTE: Intravenous [[Zanamivir]] should be considered where available and is recommended for those with serious or progressive illness. If not available, intravenous [[Peramivir]] may be considered
-:* 3. '''Condition3: Severely immunosuppressed patients'''
-::* Preferred regimen: Antiviral chemoprophylaxis by using [[Oseltamivir]] {{or}} [[Zanamivir]]
-{{PBI|Measles}}
-{{PBI|Middle East respiratory syndrome}}
-{{PBI|Parainfluenza virus}}
-:*Parainfluenza virus<ref name="pmid23024295">{{cite journal| author=Hirsch HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P| title=Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 2 | pages= 258-66 | pmid=23024295 | doi=10.1093/cid/cis844 | pmc=PMC3526251 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23024295  }} </ref>
-::*1.Adults
-:::*Preferred regimen : [[Ribavirin]] PO/IV 10 mg/kg q8h
-::::*Day 1: Start with 600 mg loading dose,then 200 mg  q8h
-::::*Day 2: 400 mg q8h
-::::*Day 3: Increase the dose to a maximum of 10 mg/kg q8h
-::*2.In case of adverse events: Decrease dose or Discontinue [[Ribavirin]]
-::*3.Creatinine clearance
-::::*30–50 mL/min : [[Ribavirin]] PO/IV  Maximal 200 mg q8h
-::::*10–30 mL/ min : No recommendation can be given
-{{PBI|Parvovirus B19}}
-:* Parvovirus B19<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* 1. '''Erythema infectiosum'''
-:::* Supportive therapy: Symptomatic treatment only
-::* 2. '''Arthritis/arthalgia '''
-:::* Preferred regimen: Nonsteroidal anti-inflammatory drugs (NSAID)
-::* 3.'''Transient aplastic crisis'''
-:::* Supportive therapy: Transfusions and oxygen
-::* 4. '''Fetal hydrops'''
-:::* Supportive therapy: Intrauterine blood transfusion
-::* 5. '''Chronic infection with anemia'''
-:::* Preferred regimen: IVIG and transfusion
-::* 6.'''Chronic infection without anemia'''
-:::* Preferred regimen: IVIG
-:::: Note (1): Diagnostic tools are IgM and Igb antibody titers.Perhaps better is blood Parvovirus PCR.
-:::: Note (2): Dose of IVIG not standardized; suggest 400 mg/kg IV of commercial IVIG for 5 or 10 days or 1000 mg/kg IV for 3 days.
-:::: Note (3): Most dramatic anemias in pts with pre-existing hemolytic anemia.
-:::: Note (4): Bone marrow shown erythrocyte maturation arrest with giant pronormoblasts.
-{{PBI|BK virus}}
-:* '''Human polyomavirus (BK virus) treatment'''
-::* '''Maintenance regimen consisting of triple immunosuppression therapy''': [[Calcineurin]] inhibitor ([[Cyclosporine]] or [[Tacrolimus]]) {{and}} an antimetabolite ([[Azathioprine]], [[Mycophenolate mofetil]], or [[Mycophenolate sodium]]), {{and}} [[Prednisone]] is to discontinue completely the antimetabolite (usually [[Mycophenolate]]) and decrease the dose of the [[Calcineurin]] inhibitor.
-::* '''Alternative regimen (1)''': Decrease the [[Mycophenolate]] dose by 50 percent, followed by a 50 percent decrease in the [[Calcineurin]] inhibitor at three months if decoy cells persist. If using this approach, the target serum [[Tacrolimus]] trough level is 4 to 6, and the target serum [[Cyclosporine]] trough level is 60 to 100 ng/mL. [[Mycophenolate]] may be discontinued completely if viral activation persists. Maintenance immunosuppression then consists of [[Tacrolimus]] and low-dose [[Prednisone]].
-::* '''Alternative regimen (2)''': Reduce both the [[Calcineurin]] inhibitor and the [[Mycophenolate]], which allows both the targeting of two pathways and lower total immunosuppression.
-:::* Note (1): For those who are hypogammaglobulinemic, we administer intravenous immunoglobulins (IV IG) in replacement doses of 500 mg/kg. Quantitative immunoglobulins should be checked two to three months later to determine whether hypogammaglobulinemia has recurred. Intravenous immunoglobulins (IV IG) is also an option in certain settings, based upon polymerase chain reaction (PCR) and kidney biopsy results. IVIG may contain antibodies against BK and JC virus since these viruses are ubiquitous in the general population.
-:::* Note (2): The goals of decreased immunosuppressive therapy are to restrain viral replication without triggering rejection.
-:::* Note (3): Reduced immunosuppression (defined as lowering mean doses of [[Mycophenolate]] and [[Tacrolimus]]) resulted in the successful elimination of viremia (mean period of six months) and allograft survival.
-:::* Note (4): Alternative approaches to reducing immunosuppression have also been effective
-::::* 4.1 Changing from [[Tacrolimus]] to low-dose [[Cyclosporine]] not only reduces the effect of the [[Calcineurin]] inhibitor, but also reduces [[Mycophenolate]] concentrations.
-::::* 4.2 Replacing the [[Calcineurin]] inhibitor with [[Sirolimus]], with or without discontinuation of the antimetabolite, has the advantage of avoiding the long-term [[Calcineurin]] inhibitor-related nephrotoxic effects.
-::::* 4.3 Lowering the dose of [[Calcineurin]] inhibitors may slow the loss of renal function.
-:* '''Primary Regimens'''
-::* Decrease immunosuppression if possible. (Cornerstone of Treatment)
-::* Suggested antiviral therapy is based on anecdotal data. If progressive renal dysfunction:
-::* Fluoroquinolone {{and}} IVIG 500 mg/kg IV {{and}} Leflunomide 100 mg for daily for 3 days, then 10-20 mg PO daily
-::* If refractory to all of the above, add [[Cidofovir]] 5 mg/kg once per week for 2 weeks, then once every other week  if refractory to all of the above
-:* '''Ancillary Therapies in BK Virus Nephropathy'''
-::* [[Cidofovir]] 0.25-1.0 mg/kg IV biweekly for 8 wk without [[Probenecid]], prehydration recommended
-::* [[Leflunomide]] 100 mg loading dose for 3 days, 20-60 mg/day, goal [[Leflunomide]] trough 50-100 ng/mL (consider lower trough goals of 20-40 ng/mL given hemolysis risk)
-::* IV Ig 1-2 g/kg IV for 1-2 doses or 150 mg/kg  IV biweekly for 8 wk
-::* [[Fluoroquinolones]]-[[Ciproflaxacin]] 500 mg/day, duration dependent on virological response.
-{{PBI|JC virus}}
-:* '''Progressive Multifocal Leukoencephalopathy (PML) caused by JC Virus ( John Cunningham virus) infections'''<ref>{{citeweb|title=JCvirus|url=https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf}}</ref>
-::* There is no specific antiviral therapy for JC virus infection.
-::* The main treatment approach is to reverse the immunosuppression caused by HIV.
-::* Initiate anti retroviral therapy (ART) immediately in ART-naive patients .
-::* Optimize ART in patients who develop Progressive Multifocal Leukoencephalopathy in phase of HIV viremia on ART .
-::* [[Corticosteroids]] may be used for Progressive Multifocal Leukoencephalopathy- immune reconstitution inflammatory syndrome (IRIS) characterized by contrast enhancement, edema or mass effect, and with clinical deterioration
-{{PBI|Rabies}}
-::*Preferred regimen: no specific therapeutics agents are available once the disease is established.
-:::* Note: There are vaccines and immune globulins available for postexposure prophylaxis:
-::::* Postexposure Prophylaxis for non immunized individuals: Wound cleansing, human rabies immune globulin - administer full dose infiltrated around any wound. Administer any remaining volume IM at other site anatomically distant from the wound. Administer vaccine 1,0ml, IM at deltoid area one each on days 0, 3, 7 and 14.
-::::* Postexposure Prophylaxis for immunized individuals: Wound cleansing, do not administer human rabies immune globulin. Administer vaccine 1,0ml, IM at deltoid area one each on days 0 and 3.
-{{PBI|Respiratory Syncytial Virus}}
-* Respiratory syncytial virus treatment
-:* Supportive therapy
-::* Hydration and supplemental oxygen.
-::* Routine use of [[Ribavirin]] not recommended. [[Ribavirin]] therapy associated with small increases in O2 saturation.
-::* No consistent decrease in need for mechanical ventilation or ICU stays. High cost, aerosol administration and potential toxicity<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
-::: Note (1) In adults, Respiratory syncytial virus accounted for 10.6% of hospitalizations for pneumonia, 11.4% for COPD, 7.2% for asthma & 5.4% for CHF in pts >65 yrs of age <ref name="pmid15858184">{{cite journal| author=Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE| title=Respiratory syncytial virus infection in elderly and high-risk adults. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 17 | pages= 1749-59 | pmid=15858184 | doi=10.1056/NEJMoa043951 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15858184  }} </ref>. Respiratory syncytial virus caused 11% of clinically important respiratory illnesses in military recruits<ref name="pmid16007526">{{cite journal| author=O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC| title=Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 3 | pages= 311-7 | pmid=16007526 | doi=10.1086/431591 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16007526  }} </ref>
-::: Note (2) Respiratory Syncytial Virus major cause of morbidity in neonates/infants.
-::: Note (3) Nucleic acid test now approved to detect 12 respiratory viruses (xTAG Respiratory Viral Panel, Luminex Molecular Diagnostics).
-:* '''Prevention of Respiratory syncytial virus'''
-::* 1. In children <24 months old with chronic lung disease of prematurity (formerly broncho-pulmonary dysplasia) requiring supplemental oxygen or
-::* 2. In premature infants (<32 wks gestation) and <6 months old at start of Respiratory syncytial virus season or
-::* 3. In children with selected congenital heart diseases.
-:::* Preferred regimen for prevention of Respiratory syncytial virus: [[Palivizumab]] (Synagis) 15 mg per kg IM q month Nov.-April<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
-:::: Note : Significant reduction in Respiratory syncytial virus hospitalization among children with congenital heart disease<ref name="pmid17727335">{{cite journal| author=Feltes TF, Sondheimer HM| title=Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease. | journal=Expert Opin Biol Ther | year= 2007 | volume= 7 | issue= 9 | pages= 1471-80 | pmid=17727335 | doi=10.1517/14712598.7.9.1471 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17727335  }} </ref>
-{{PBI|Rhinovirus}}
-*'''Rhinovirus treatment (commom cold)'''
-:* '''Supportive therapy'''
-::* Symptomatic treatment-[[Ipratropium bromide]] intranasal (2 sprays tid) {{and}} [[Clemastine]] 1.34 mg 1–2 tab PO bid–tid (over the counter)
-::* Symptomatic relief by [[Ipratropium]] nasal spray decreases rhinorrhea and sneezing vs placebo.<ref name="pmid9880472">{{cite journal| author=Gern JE, Busse WW| title=Association of rhinovirus infections with asthma. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 1 | pages= 9-18 | pmid=9880472 | doi= | pmc=PMC88904 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9880472}}</ref> {{and}} Clemastine (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.<ref name="pmid8729205">{{cite journal| author=Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB| title=Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 4 | pages= 656-62 | pmid=8729205 | doi= | pmc= url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205  }} </ref>{{or}} Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).<ref name="pmid12802751">{{cite journal| author=Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA et al.| title=Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials. | journal=Clin Infect Dis | year= 2003 | volume= 36 | issue= 12 | pages= 1523-32 | pmid=12802751 | doi=10.1086/375069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802751  }} </ref>
-:::* Note (1)No antiviral rx indicated . <ref name="pmid15693216">{{cite journal| author=Turner RB| title=New considerations in the treatment and prevention of rhinovirus infections. | journal=Pediatr Ann | year= 2005 | volume= 34 | issue= 1 | pages= 53-7 | pmid=15693216 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15693216  }} </ref>
-:::* Note (2) Found in 1/2 of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004). <ref name="pmid12517470">{{cite journal| author=Heikkinen T, Järvinen A| title=The common cold. | journal=Lancet | year= 2003 | volume= 361 | issue= 9351 | pages= 51-9 | pmid=12517470 | doi=10.1016/S0140-6736(03)12162-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517470  }} </ref>
-:::* Note (3) High rate of rhinovirus identified in children with significant lower resp tract infections <ref name="pmid19258921">{{cite journal| author=Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T et al.| title=Rhinovirus associated with severe lower respiratory tract infections in children. | journal=Pediatr Infect Dis J | year= 2009 | volume= 28 | issue= 4 | pages= 337-9 | pmid=19258921 | doi=10.1097/INF.0b013e31818ffc1b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19258921  }} </ref>
-{{PBI|Rotavirus}}
-* Rotavirus treatment<ref>{{citeweb|title=Rotavirus|url=http://www.who.int/mediacentre/factsheets/fs330/en/}}</ref>, <ref>{{citeweb|title=Rotavirus|url=http://www.cdc.gov/rotavirus/about/treatment.html}}</ref>
-:* '''Treatment of diarrhoea caused by rotavirus '''
-::* Rehydration with oral rehydration salts (ORS) solution. oral rehydration salts (ORS) solution is a mixture of clean water, salt and sugar. It costs a few cents per treatment. oral rehydration salts (ORS) solution is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.
-::* Zinc supplements-with zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
-::* Rehydration with intravenous fluids in case of severe dehydration or shock.
-::* Nutrient-rich foods the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods  including breast milk during an episode, and by giving a nutritious diet  including exclusive breastfeeding for the first six months of life  to children when they are well.
-::* Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.
-::: Note (1): Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.
-::: Note (2): There is no antiviral drug to treat rotavirus infection. Antibiotic drugs will not help because antibiotics fight against bacteria not viruses.
-::: Note (3): Rotavirus infection can cause severe vomiting and diarrhea. This can lead to dehydration (loss of body fluids). During rotavirus infection, infants and young children, older adults, and people with other illnesses are most at risk becoming dehydrated.
-::: Note (4): Symptoms of dehydration include decrease in urination, dry mouth and throat, feeling dizzy when standing up. A dehydrated child may also cry with few or no tears and be unusually sleepy or fussy.
-:* Prevention
-::* Access to safe drinking-water
-::* Use of improved sanitation
-::* Hand washing with soap
-::* Exclusive breastfeeding for the first six months of life
-::* Good personal and food hygiene
-::* Health education about how infections spread; and Rotavirus vaccination.
-{{PBI|Smallpox}}
-:*Smallpox <ref>{{Cite web | title = DIAGNOSIS AND MANAGEMENT OF SMALLPOX | url = http://www.nejm.org/doi/pdf/10.1056/NEJMra020025 }}</ref>
-::*Supportive care is the mainstay of therapy.
-::*Currently, there are no anti-viral drugs of proven efficacy.
-::*Recently, animal studies suggest that [[cidofovir]] and its cyclic analogues, given at the time of or immediately after exposure, have promise for the prevention of cowpox, vaccinia, and monkeypox.
-::*Patients need adequate hydration and nutrition, because substantial amounts of fluid and protein can be lost by febrile persons with dense, often weeping lesions.
-:::*Secondary baceterial infection
-::*Penicillinase-resistant antimicrobial agents should be used if smallpox lesions are secondarily infected, if bacterial infection endangers the eyes, or if the eruption is very dense and widespread.
-::*Daily eye rinsing is required in severe cases. Topical [[idoxuridine]] (Dendrid, Herplex, or Stoxil) should be considered for the treatment of corneal lesions, although its efficacy is unproved for smallpox.
-{{PBI|HIV/AIDS}}
-* * [[HIV]]/[[AIDS]]
-* [[HIV]]/[[AIDS]]
-* 1.'''Antiretroviral Regimen Options for Treatment-Naive Patients<ref name=AIDSinfoNIH>{{cite web | title = AIDSinfoNIH | url =https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/11/what-to-start }}</ref>'''
-:* 1.1 '''A Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) Based Regimen:'''
-::* Preferred regimen: [[Efavirenz]] 600 mg once-daily {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
-:* 1.2 '''Integrase Strand Transfer Inhibitor-Based Regimens'''
-::* Preferred regimen:
-:::* [[Dolutegravir]] 50 mg once-daily {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg once-daily in patients who are HLA-B*5701-negative.
-:::* [[Dolutegravir]] 50 mg once-daily {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
-:::* [[Elvitegravir]] 150 mg {{or}} [[Cobicistat]] 150 mg {{or}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily in patients with estimated CrCl ≥ 70 mL/min/1.73.
-:::* [[Raltegravir]] 400 mg twice-daily {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
-::* Alternative Regimen
-:::* [[Efavirenz]] 600 mg once-daily/[[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
-:::* [[Rilpivirine]] 25 mg once-daily plus [[Tenofovir]] 300 mg/[[Emtricitabine]] 200 mg once-daily (for patients with CD4 count >200 cells/microL.
-:::* [[Raltegravir]] 400 mg twice-daily  {{and}} [[Abacavir]] 600 mg/[[Lamivudine]] 300 mg once-daily in patients who are HLA-B*5701-negative.
-:* 1.3 '''Protease Inhibitor-Based Regimen'''
-::* Preferred regimen: [[Darunavir]] 800mg-[[Ritonavir]] 100 mg once-daily {{and}} [[Tenofovir]] 300 mg/[[Emtricitabine]] 200 mg once-daily.
-::* Alternative Regimen(1)
-:::* [[Atazanavir]] 300 mg/[[Cobicistat]] 150 mg {{and}} [[Tenofovir]] disoproxil fumarate 300 mg/[[Emtricitabine]] 200 mg once-daily—only for patients with pre-treatment estimated CrCl ≥70 mL/min.
-::* Alternative Regimen(2)
-:::* [[Atazanavir]] 300 mg-[[Ritonavir]] 100 mg once-daily plus [[Tenofovir]] 300 mg/[[Emtricitabine]] 200 mg once-daily.
-::* Alternative Regimen(3)
-:::* [[Darunavir]] 800mg /[[Cobicistat]] 150 mg {{or}} [[Darunavir]] 800mg/[[Ritonavir]] 100mg {{and}} [[Abacavir]] 600 mg/[[Lamivudine]] 300mg —only for patients who are HLA-B*5701 negative.
-::* Alternative Regimen(4)
-:::* [[Darunavir]] 800mg/[[Cobicistat]] 150 mg {{and}} [[Tenofovir]] disoproxil fumarate 300mg/[[Emtricitabine]] 200 mg  —only for patients with pre-treatment estimated CrCl ≥70 mL/min.
-::* Alternate Regimen(5)
-:::* [[Atazanavir]] 300 mg-[[Ritonavir]] 100 mg once-daily {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg once-daily in patients who are HLA-B*5701-negative and with pre-treatment HIV RNA <100,000 copies/mL.
-::* Alternate Regimen(6)
-:::* [[Lopinavir]] 400mg/[[Ritonavir]] 100mg (once or twice daily) {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300mg—only for patients who are HLA-B*5701 negative.
-::* Alternate Regimen(7)
-:::* [[Lopinavir]] 400mg/[[Ritonavir]] 100mg (once or twice daily) {{and}} [[Tenofovir]] disoproxil fumarate 300mg/[[Emtricitabine]] 200 mg.
-:* 1.4 Other Regimen Options
-::* 1.4.1 '''NNRTI-Based Regimen'''
-:::* Preferred regimen: [[Efavirenz]] 600mg {{and}} [[Abacavir]] 600 mg/[[Lamivudine]]—only for patients who are HLA-B*5701 negative and with pre-treatment HIV RNA <100,000 copies/mL.
-::* 1.4.2 '''Other Regimens When Tenofovir or Abacavir  Cannot be Used'''
-:::* [[Darunavir]]-[[Ritonavir]] 100 {{and}} [[Raltegravir]]—only for patients with pre-treatment HIV RNA <100,000 copies/mL and CD4 cell count >200 cells/mm3.
-:::* [[Lopinavir]] 400mg/[[Ritonavir]] 100mg (twice daily) {{and}} [[Lamivudine]] 300mg BID.
-:::: Pediatric dose: [[Abacavir]] 300 mg po BID, [[Didanosine]] 20 to < 25 kg: 200 mg po once daily 25 to < 60 kg: 250 mg po once daily ≥60 kg: 400 mg po once daily; [[Lamivudine]] 4 mg/kg/dose po BID; maximum 150 mg po BID; [[Stavudine]] 1 mg/kg/dose po q12h, [[Tenofovir]] Recommended oral dose is 8 mg/kg; [[Zidovudine]] 180 - 240 mg/m2/dose po q12h or 160 mg/m2/dose po q8h (range 90-180); [[Efavirenz]] 10 to < 15 kg: 200 mg, 15 to <20 kg: 250 mg, 20 to < 25 kg: 300 mg, 25 to < 32.5 kg: 350 mg, 32.5 to <40 kg: 400 mg, ≥ 40 kg: 600 mg; [[Nevirapine]] maximum 200 mg per dose; [[Lopinavir]] 400mg; [[Nelfinavir]] 50 mg/kg/dose po BID; [[Raltegravir]] 300mg
-* 2. '''Pre-Exposure Prophylaxis(PrEP)<ref name=CDC Pre-Exposure Prophylaxis>{{cite web | title = CDC Pre-Exposure Prophylaxis | url =http://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf }}</ref>'''
-:* Preferred regimen- Daily, continuing, oral doses of [[Tenofovir]] disoproxil fumarate 300mg-[[Emtricitabine]] 200 mg, ≤90-day supply.
-:: Note(1): People with high risk behaviour such as men who have sex with men, intravenous drug abusers, HIV-positive sexual partner, recent bacterial STI, high number of sex partners,  history of inconsistent or no condom use, commercial sex work, people in high-prevalence area or network are advised to take pre-exposure prophylaxis of drugs.
-:: Note(2): Follow-up visits at least every 3 months to provide the following: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, pregnancy testing.
-:: Note(3): At 3 months and every 6 months thereafter, assess renal function.
-:: Note(4): Every 6 months, test for bacterial STIs.
-* 3. '''Post- Exposure Prophylaxis<ref name=WHO post exposure prophylaxis>{{cite web | title = WHO postexposureprophylaxis | url =http://www.who.int/hiv/topics/prophylaxis/en/ }}</ref>'''
-:* Preferred HIV PEP regimen- Raltegravir 400 mg BID + [[Tenofovir]] disoproxil fumarate 300mg/[[Emtricitabine]] 200 mg 1 QD.
-:* Preferred '''Basic regimen''' for low-risk exposures (Eg: mucus membrane):
-:** [[Zidovudine]] 100mg {{and}} [[Lamivudine]] 300mg.
-:** [[Zidovudine]] 100mg {{and}} [[Emtricitabine]] 200 mg.
-:** [[Tenofovir]] 300mg {{and}} [[Lamivudine]] 300mg.
-:** [[Tenofovir]] 300mg {{and}} [[Emtricitabine]] 200 mg.
-:* Preferred '''Expanded regimen''' for high-risk exposure (Eg: percutaneous needle stick).
-:** [[Zidovudine]] 100mg {{and}} [[Lamivudine]] 300mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:** [[Zidovudine]] 100mg {{and}} [[Emtricitabine]] 200 mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:** [[Tenofovir]] 300mg {{and}} [[Lamivudine]] 300mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:** [[Tenofovir]] 300mg {{and}} [[Emtricitabine]] 200 mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:* Note: Ideally therapy should be started within hours of exposure and continued for 28 days.
-* 4. '''Perinatal Antiretroviral Regimen<ref name=AIDSinfoNIH Intrapartum car>{{cite web | title = AIDSinfoNIH intrapartum care | url =https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/180/intrapartum-antiretroviral-therapy-prophylaxis }}</ref>'''
-:*4.1 '''Antepartum'''
-::*4.1.1 '''Protease Inhibitor-Based Regimen'''
-:::* Preferred regimen: [[Tenofovir]] 300mg-[[Emtricitabine]] 200mg (fixed dose combination) {{or}} [[Tenofovir]] 300mg-[[Lamivudine]] 300mg {{or}} [[Abacavir]] 600mg-[[Lamivudine]] 300mg {{or}} [[Zidovudine]] 100mg-[[Lamivudine]] 300mg {{and}} [[Atazanavir]]300 mg-[[Ritonavir]] 100mg {{or}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-::*4.1.2 '''A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen:'''
-:::* Preferred regimen-[[Efavirenz]] 600mg-[[Tenofovir]] 300mg-[[Emtricitabine]] 200mg (fixed dose combination) or [[Efavirenz]] 600mg-[[Tenofovir]] 300 mg-[[Lamivudine]] 300mg.
-:::* Alternate regimen-[[Abacavir]] 600mg-[[Lamivudine]] 300mg {{or}} [[Zidovudine]] 100mg-[[Lamivudine]] 300mg {{and}} [[Efavirenz]] 600mg.
-:*4.2 '''Intrapartum'''
-::* HIV RNA <1000 copies/mL and good afherance-Continue the regimen during delivery or cessarean section.
-::* HIV RNA >1000 copies/mL near delivery, possible poor adherence, or unknown HIV RNA levels- Intravenous [[Zidovudine]] 2 mg/kg IV over 1 hr should be given three hours before cesarean section or delivery and then 1 mg/kg/hr IV continuous infusion until umbilical cord clamping.
-:*4.3 '''Postpartum'''
-::Initiate ART and continue after delivery and cessation of breastfeeding
-* 5.'''Infant Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission of HIV<ref name=AIDSinfoNIH postpartum care>{{cite web | title = AIDSinfoNIH postpartumcare | url =https://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf }}</ref>'''
-:*5.1 Preferred regimen: [[Zidovudine]] (ZDV) 100mg given at birth and continued till six weeks.
-::: Note(1): Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
-::: Note(2): ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
-::: Note(3): ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
-:::* <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
-:*5.2 Prophylaxis for HIV-exposed infants of women who received no antepartum antiretroviral prophylaxis
-::* [[Nevirapine]]
-:::* Dose based on birth weight, initiated as soon after birth as possible.
-:::* Birth weight 1.5 to 2 kg: 8 mg/dose orally.
-:::* Birth weight >2 kg: 12 mg/dose orally.
-::: {{and}}
-::: [[Zidovudine]] (ZDV)
-:::* Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
-:::* ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
-:::* ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
-:::* <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
-:::Note(1): Three doses in the first week of life
-:::Note(2): First dose within 48 hours of birth (birth to 48 hrs)
-:::Note(3): Second dose 48 hours after first
-:::Note(4): Third dose 96 hours after second
-----
-==References==
-{{reflist}}

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Bacteria – Gram-Positive Cocci

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