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* Empiric antimicrobial therapy<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>
*1. '''Empiric antimicrobial therapy'''<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>
: Note:  The optimal duration of antimicrobial therapy remains unclear.  A 4- to 6-week course of treatment is usually required.
: Note:  The optimal duration of antimicrobial therapy remains unclear.  A 4- to 6-week course of treatment is usually required.


:* '''Brain abscess in otherwise healthy patients'''
:*1.1 '''Brain abscess in otherwise healthy patients'''
::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day IV q4–6h {{or}} [[Ceftriaxone]] 4 g/day IV q12h) {{and}} [[Metronidazole]] 30 mg/kg/day IV q6h
::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day IV q4–6h {{or}} [[Ceftriaxone]] 4 g/day IV q12h) {{and}} [[Metronidazole]] 30 mg/kg/day IV q6h
::* Alternative regimen: [[Meropenem]] 6 g/day IV q8h
::* Alternative regimen: [[Meropenem]] 6 g/day IV q8h


:* Brain abscess with comorbidities
:*1.2 '''Brain abscess with comorbidities'''
::* '''Otitis media, mastoiditis, or sinusitis'''
::*1.2.1 '''Otitis media, mastoiditis, or sinusitis'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h


::* '''Dental infection'''
::*1.2.2 '''Dental infection'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h


::* '''Penetrating trauma or post-neurosurgy'''
::*1.2.3 '''Penetrating trauma or post-neurosurgy'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{or}} [[Cefepime]] 2 g IV q12h) {{and}} [[Vancomycin]] 30–45 mg/kg/day q8–12h
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{or}} [[Cefepime]] 2 g IV q12h) {{and}} [[Vancomycin]] 30–45 mg/kg/day q8–12h


::* '''Lung abscess, empyema, or bronchiectasis'''
::*1.2.4 '''Lung abscess, empyema, or bronchiectasis'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h


::* '''Bacterial endocarditis'''
::*1.2.5 '''Bacterial endocarditis'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h


::* '''Congenital heart disease'''
::*1.2.6 '''Congenital heart disease'''
:::* Preferred regimen: [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
:::* Preferred regimen: [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h


::* '''Transplant recipients'''
::*1.2.7 '''Transplant recipients'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[Voriconazole]] 8 mg/kg/day q12h {{and}} ([[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h)
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[Voriconazole]] 8 mg/kg/day q12h {{and}} ([[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h)


::* '''Patients with HIV/AIDS'''
::*1.2.8 '''Patients with HIV/AIDS'''
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd


::*  '''Staphylococcus aureus coverage'''
::*1.2.9 '''Staphylococcus aureus coverage'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h


::* '''Mycobacterium tuberculosis coverage'''
::*1.2.10 '''Mycobacterium tuberculosis coverage'''
:::* Preferred regimen: [[Isoniazid]] 300 mg qd {{and}} [[Rifampin]] 600 mg qd {{and}} [[Pyrazinamide]] 15–30 mg qd {{and}} [[Ethambutol]] 15 mg/kg/day qd
:::* Preferred regimen: [[Isoniazid]] 300 mg qd {{and}} [[Rifampin]] 600 mg qd {{and}} [[Pyrazinamide]] 15–30 mg qd {{and}} [[Ethambutol]] 15 mg/kg/day qd


* Pathogen-directed antimicrobial therapy<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><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
*2. '''Pathogen-directed antimicrobial therapy'''<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><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
: Note:  The optimal duration of antimicrobial therapy remains unclear.  A 4- to 6-week course of treatment is usually required.
: Note:  The optimal duration of antimicrobial therapy remains unclear.  A 4- to 6-week course of treatment is usually required.


:* Bacteria
:*2.1 '''Bacteria'''
::* '''Actinomyces'''
::*2.1.1 '''Actinomyces'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h


::* '''Bacteroides fragilis'''
::*2.1.2 '''Bacteroides fragilis'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day IV q6h
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day IV q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h


::* '''Enterobacteriaceae'''
::*2.1.3 '''Enterobacteriaceae'''
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h


::* '''Fusobacterium'''
::*2.1.4 '''Fusobacterium'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h


::* '''Haemophilus'''
::*2.1.5 '''Haemophilus'''
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h


::* '''Listeria monocytogenes'''
::*2.1.6 '''Listeria monocytogenes'''
:::* Preferred regimen: [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 4 MU IV q4h
:::* Preferred regimen: [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 4 MU IV q4h
:::* Alternative regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
:::* Alternative regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h


::* '''Nocardia'''
::*2.1.7 '''Nocardia'''
:::* Preferred regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
:::* Preferred regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
:::* Alternative regimen: [[Meropenem]] 2 g IV q8h {{or}} [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Amikacin]] 15 mg/kg/day IV q8h
:::* Alternative regimen: [[Meropenem]] 2 g IV q8h {{or}} [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Amikacin]] 15 mg/kg/day IV q8h


::* '''Prevotella melaninogenica'''
::*2.1.8 '''Prevotella melaninogenica'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h


::* '''Pseudomonas aeruginosa'''
::*2.1.9 '''Pseudomonas aeruginosa'''
:::* Preferred regimen: [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
:::* Preferred regimen: [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h


::* '''Staphylococcus aureus, methicillin-resistant (MRSA)'''
::*2.1.10 '''Staphylococcus aureus, methicillin-resistant (MRSA)'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
:::* Alternative regimen: [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks {{or}} [[TMP-SMX]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
:::* Alternative regimen: [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks {{or}} [[TMP-SMX]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
:::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h
:::* Pediatric dose: [[Vancomycin]] 15 mg/kg/dose IV q6h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV q8h
:::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin.
:::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to vancomycin.


::* '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
::*2.1.11 '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
:::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
:::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h


::* '''Streptococcus'''
::*2.1.12 '''Streptococcus'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{or}} [[Ampicillin]] 2 g IV q4h
:::* Preferred regimen (1): [[Penicillin G]] 4 MU IV q4h  
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Vancomycin]] 30–45 mg/kg/day IV q8–12h


:* Fungi
:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4h
::* '''Aspergillus'''
:::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q4-6h
 
:::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q12h 
 
:::* Alternative regimen (3): [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
 
:*3. '''Fungi'''
::*3.1 '''Aspergillus'''
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Alternative regimen: [[Amphotericin B]] deoxycholate 0.6–1.0 mg/kg/day IV q24h {{or}} [[Amphotericin B]] lipid complex 5 mg/kg/day IV q24h {{or}} [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
:::* Alternative regimen (1): [[Amphotericin B]] deoxycholate 0.6–1.0 mg/kg/day IV q24h
 
:::* Alternative regimen (2): [[Amphotericin B]] lipid complex 5 mg/kg/day IV q24h
 
:::* Alternative regimen (3): [[Itraconazole]] 400–600 mg/day IV q12h
 
:::* Alternative regimen (4): [[Posaconazole]] 800 mg/kg/day IV q6–12h
 
::*3.2 '''Candida'''
:::* Preferred regimen (1): [[Amphotericin B]] lipid complex 5 mg/kd/day q24h 


::* '''Candida'''
:::* Preferred regimen (2): [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h


::* '''Cryptococcus neoformans'''
::*3.3 '''Cryptococcus neoformans'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h


::* '''Mucorales'''
::*3.4 '''Mucorales'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Posaconazole]] 800 mg/kg/day IV q6–12h
:::* Alternative regimen: [[Posaconazole]] 800 mg/kg/day IV q6–12h


::* '''Pseudallescheria boydii (Scedosporium apiospermum)'''
::*3.5 '''Pseudallescheria boydii (Scedosporium apiospermum)'''
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Alternative regimen: [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
:::* Alternative regimen: [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h


:* Protozoa
:*4 '''Protozoa'''
::* '''Toxoplasma gondii'''
::*4.1 '''Toxoplasma gondii'''
:::* Preferred regimen: [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd
:::* Preferred regimen: [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd
:::* Alternative regimen (1): [[Pyrimethamine]] 25–100 mg/day qd {{and}} [[Clindamycin]] 2400–4800 mg/day IV q6h
:::* Alternative regimen (1): [[Pyrimethamine]] 25–100 mg/day qd {{and}} [[Clindamycin]] 2400–4800 mg/day IV q6h
:::* Alternative regimen (2): [[Pyrimethamine]] 25–100 mg/day qd {{and}} ([[Azithromycin]] 1200–1500 mg/day IV q24h {{or}} [[Atovaquone]] 750 mg IV q6h {{or}} [[Dapsone]] 100 mg PO q24h)
:::* Alternative regimen (2): [[Pyrimethamine]] 25–100 mg/day qd {{and}} ([[Azithromycin]] 1200–1500 mg/day IV q24h {{or}} [[Atovaquone]] 750 mg IV q6h {{or}} [[Dapsone]] 100 mg PO q24h)
:::* Alternative regimen (3): [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
:::* Alternative regimen (3): [[TMP-SMZ]] 10–20 mg/kg/day q6–12h

Revision as of 20:34, 28 July 2015

  • 1. Empiric antimicrobial therapy[1][2]
Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
  • 1.1 Brain abscess in otherwise healthy patients
  • 1.2 Brain abscess with comorbidities
  • 1.2.1 Otitis media, mastoiditis, or sinusitis
  • 1.2.2 Dental infection
  • 1.2.3 Penetrating trauma or post-neurosurgy
  • 1.2.4 Lung abscess, empyema, or bronchiectasis
  • 1.2.5 Bacterial endocarditis
  • 1.2.6 Congenital heart disease
  • 1.2.7 Transplant recipients
  • 1.2.8 Patients with HIV/AIDS
  • 1.2.9 Staphylococcus aureus coverage
  • Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h
  • 1.2.10 Mycobacterium tuberculosis coverage
  • 2. Pathogen-directed antimicrobial therapy[3][4][5]
Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
  • 2.1 Bacteria
  • 2.1.1 Actinomyces
  • 2.1.2 Bacteroides fragilis
  • 2.1.3 Enterobacteriaceae
  • 2.1.4 Fusobacterium
  • 2.1.5 Haemophilus
  • 2.1.6 Listeria monocytogenes
  • 2.1.7 Nocardia
  • 2.1.8 Prevotella melaninogenica
  • 2.1.9 Pseudomonas aeruginosa
  • 2.1.10 Staphylococcus aureus, methicillin-resistant (MRSA)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
  • Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
  • Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin.
  • 2.1.11 Staphylococcus aureus, methicillin-susceptible (MSSA)
  • 2.1.12 Streptococcus
  • Alternative regimen (3): Vancomycin 30–45 mg/kg/day IV q8–12h
  • 3. Fungi
  • 3.1 Aspergillus
  • Alternative regimen (2): Amphotericin B lipid complex 5 mg/kg/day IV q24h
  • Alternative regimen (3): Itraconazole 400–600 mg/day IV q12h
  • Alternative regimen (4): Posaconazole 800 mg/kg/day IV q6–12h
  • 3.2 Candida
  • Preferred regimen (2): Amphotericin B deoxycholate 15 mg/kg/day q8h
  • Alternative regimen: Fluconazole 400–800 mg/day IV q24h
  • 3.3 Cryptococcus neoformans
  • 3.4 Mucorales
  • 3.5 Pseudallescheria boydii (Scedosporium apiospermum)
  • 4 Protozoa
  • 4.1 Toxoplasma gondii
  1. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  3. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  4. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  5. ↑ 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.
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