Sandbox/v45

Empiric Therapy Adapted from Lancet. 2012;380(9854):1693-702. and N Engl J Med. 2010;362(2):146-54.

Community-Acquired   ▸  Newborns, Age <1 Week   ▸  Newborns, Age 1—4 Weeks   ▸  Infants & Children   ▸  Adults, Age <50 Years   ▸  Adults, Age >50 Years   ▸  Immunocompromised   ▸  Recurrent Nosocomial   ▸  Postneurosurgical Infection   ▸  CSF Shunt Infection   ▸  Penetrating Trauma   ▸  Basilar Skull Fracture

Newborns, Age <1 Week Preferred Regimen ▸ Ampicillin 50 mg/kg IV q8h PLUS ▸ Cefotaxime 50 mg/kg IV q8—12h Alternative Regimen ▸ Ampicillin 50 mg/kg IV q8h PLUS ▸ Gentamicin 2.5 mg/kg IV q12h Newborns, Age 1—4 Weeks Preferred Regimen ▸ Ampicillin 200 mg/kg/day IV q6—8h PLUS ▸ Cefotaxime 50 mg/kg IV q6—8h Alternative Regimen ▸ Ampicillin 200 mg/kg/day IV q6—8h PLUS ▸ Gentamicin 2.5 mg/kg IV q8h OR ▸ Tobramycin 2.5 mg/kg IV q8h OR ▸ Amikacin 10 mg/kg IV q8h Infants & Children Preferred Regimen† ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 75 mg/kg IV q6—8h OR ▸ Ceftriaxone 80—100 mg/kg/day IV q12—24h Alternative Regimen† ▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL) PLUS ▸ Meropenem 40 mg/kg IV q8h † Add Ampicillin 75 mg/kg IV q6h if suspecting Listeria monocytogenes. Adults, Age <50 Years Preferred Regimen† ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen† ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Meropenem 2 g IV q8h † Add Ampicillin 2 g IV q4h if suspecting Listeria monocytogenes. Adults, Age >50 Years Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h PLUS ▸ Ampicillin 2 g IV q4h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h PLUS ▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component) Immunocompromised Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h PLUS ▸ Ampicillin 2 g IV q4h Recurrent Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Postneurosurgical Infection Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h CSF Shunt Infection Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h Penetrating Trauma Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h Basilar Skull Fracture Preferred Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL) PLUS ▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h