Sandbox g32
Meningitis, bacteria
- Bacterial meningitis[1]
- CSF Gram stain-directed antimicrobial therapy against presumptive pathogens
- Streptococcus pneumoniae
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
- Alternative regimen: Meropenem 6 g/day IV q8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Neisseria meningitidis
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h OR Chloramphenicol 4–6 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Aztreonam 6–8 g/day IV q6–8h
- Listeria monocytogenes
- Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h) ± (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Alternative regimen: Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Meropenem 6 g/day IV q8h
- Streptococcus agalactiae
- Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h) ± (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Alternative regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Haemophilus influenzae
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Chloramphenicol OR Cefepime OR Meropenem OR Gatifloxacin OR Moxifloxacin
- Escherichia coli
- Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
- Alternative regimen: Cefepime OR Meropenem OR Aztreonam OR Gatifloxacin OR Moxifloxacin OR Trimethoprim-Sulfamethoxazole
- Pathogen-directed antimicrobial therapy
- Streptococcus pneumoniae (adult)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR chloramphenicol 4-6g qid
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Cefepime 6g tid OR meropenem 6g tid
- ≥2.0 μg/mL
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND Ceftriaxone 4g bid/OD OR Vancomycin 30–45 mg/kg tid/bid AND cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND Ceftriaxone 4g bid/OD OR Vancomycin 30–45 mg/kg tid/bid AND cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Streptococcus pneumoniae (pediatric)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Cefepime 150 mg/kg tid for children OR meropenem 120 mg/kg tid for children
- ≥2.0 μg/mL
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Neisseria meningitidis (adult)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR chloramphenicol 4-6g qid
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 6g tid
- Neisseria meningitidis (pediatric)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children
- Listeria monocytogenes (adult)
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid {{or]} meropenem 6g tid
- Listeria monocytogenes (pediatric)
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children {{or]} meropenem 120 mg/kg tid for children
- Streptococcus agalactiae (adult)
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Streptococcus agalactiae (pediatric)
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Escherichia coli and other Enterobacteriaceae (adult)
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Aztreonam 6–8 g tid/qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 6g tid OR Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid {{or]} ampicillin 12g 6 times per day
- Escherichia coli and other Enterobacteriaceae (pediatric)
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children OR Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Pseudomonas aeruginosa (adult)
- Preferred regimen: Cefepime 6g tid OR ceftazidime 6g tid
- Alternative regimen: Aztreonam 6–8 g tid/qid OR ciprofloxacin 800–1200 mg bid/tid {or}} meropenem 6g tid
- Pseudomonas aeruginosa (pediatric)
- Preferred regimen: Cefepime 150 mg/kg tid for children OR ceftazidime 100–150 mg/kg tid/bid for 0-7 days neonates; 150 mg/kg tid for 8-28 days neonates; 150 mg/kg tid for children
- Alternative regimen: meropenem 120 mg/kg tid for children
- Haemophilus influenzae (adult)
- β-Lactamase negative
- Preferred regimen: ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- β-Lactamase positive
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Haemophilus influenzae (pediatric)
- β-Lactamase negative
- Preferred regimen:ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- β-Lactamase positive
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Staphylococcus aureus (adult)
- Methicillin susceptible
- Preferred regimen: Nafcillin 9–12 g 6 times per day OR oxacillin 9–12 g 6 times per day
- Alternative regimen: Vancomycin 30–45 mg/kg tid/bid OR meropenem 6g tid
- Methicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
- Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid OR linezolid
- Staphylococcus aureus (pediatric)
- Methicillin susceptible
- Preferred regimen: Nafcillin 75 mg/kg bid/tid for 0-7 days neonates; 100–150 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children OR oxacillin 75 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children
- Alternative regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children OR meropenem 120 mg/kg tid for children
- Methicillin resistant
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
- Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid for children OR linezolid
- Staphylococcus epidermidis (adult)
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
- Alternative regimen: Linezolid
- Staphylococcus epidermidis (pediatric)
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
- Alternative regimen: Linezolid
- Enterococcus species (adult)
- Ampicillin susceptible
- Preferred regimen: ampicillin 12g 6 times per day AND gentamicin 5 mg/kg tid
- Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND gentamicin 5 mg/kg tid
- Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid
- Enterococcus species (pediatric)
- Ampicillin susceptible
- Preferred regimen: ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
- Ampicillin resistant
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
- Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid
References
- ↑ 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.