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  • Cytomegalovirus treatment
  • 1. Retinitis
  • In HIV-infected adults

Ganciclovir IV, Valganciclovir PO, Foscarnet IV, Cidofovir IV AND Ganciclovir intraocular implant coupled with Valganciclovir.

  • 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.
  • 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
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
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
  • 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
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.
  • Severe acute respiratory distress syndrome- coronavirus
  • Supportive therapy
Ribavirin—ineffective.
Interferon alfa with or without steroids—small case series.
Pegylated IFN-α effective in monkeys.
Low dose steroids alone successful in one Beijing hospital.
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.
  • Enterovirus treatment
  • Aseptic Meningitis
  • 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
  • Parvovirus B19
  • 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 hydrope
  • 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.



  • Ebola virus treatment[1]
  • 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): Recovery from Ebola depends on good supportive care and the patient’s immune response.
Note (2): 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 (3): Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.


  • Hanta virus treatment[2]
  • 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): Treatment of patients with HPS remains supportive in nature.
Note (3): Patients should receive appropriate, broad-spectrum antibiotic therapy while awaiting confirmation of a diagnosis of HPS. Care during the initial stages of the disease should include antipyretics and analgesia as needed.
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): 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.
  • 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; andexecuting screening, care and treatment.

  • 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.
  • Rhinovirus Return to Top
    *Rhinovirus treatment:* 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.[6] Clemastine (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.[7]Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).[8]:::* Note (1)No antiviral rx indicated . [9]:::* Note (2) Found in 1/2 of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004). [10]:::* Note (3) High rate of rhinovirus identified in children with significant lower resp tract infections [11]


  • 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
  • 2.1.1.1.1 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.
  • 2.1.1.2.1 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.
  • 2.1.1.3.1 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.
  • 2.1.1.4.1 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)
  • 2.2.1 Pediatric dose
  • 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: 10 mg/kg q12h.
  • 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.
  • 2.2.1.3.1 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
  • 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
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.
  • 4.1 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
  • 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 [15][16]
  • 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
  • 6.1 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
  • 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)
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[21]
  • 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)[22]
  • 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 [23]
  • 10.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 11. Appendicitis
11.1 Health Care–Associated Complicated Intra-abdominal Infection [24]
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 [24]
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 [24]
  • 13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
  • 14. Cystic fibrosis [25]
  • 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 [26]
  • 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):::::* Patient's body weight is <50 kg::::::* Preferred regimen: Rifampicin 450 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days :::::* 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)::::::* Patient's body weight is <50 kg: :::::::* Preferred regimen: Rifampicin 450 mg PO qd AND Doxycycline 200 mg PO qd 14 days, ::::::* 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): 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  : Rifampicin 600 mg PO od AND :::::* 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
  • 17. Community-acquired pneumonia[28]
  • 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 OR ::::* 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)
  • 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 plus a fluoroquinolone, TMP/SMX, a tetracycline or Clindamycin for 3 or 6 months for hips and knees, respectively.
  • 21. Hematogenous osteomyelitis
  • 21.1 Adult (>21 yrs)
  • 21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
  • 21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • 21.2 Children (>4 months)-Adult
  • 21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • 21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • Preferred regimen (1): Nafcillin ::::* Preferred regimen (2): Oxacillin 37 q6h (to max. 8–12 gm per day)
Note: Add Ceftazidime 50 q8h or Cefepime 150 div q8h if Gm-neg. bacilli on Gram stain
  • 21.3 Newborn (<4 months.)
  • 21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • 21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • 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[29]
  • 23.1 In adult
  • 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
  • 24. Staphylococcal toxic shock syndrome [30]
  • 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[31]
  • 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.
  • 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[32]
  • 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
  • 2.1.1.1.1 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.
  • 2.1.1.2.1 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.
  • 2.1.1.3.1 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.
  • 2.1.1.4.1 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)
  • 2.2.1 Pediatric dose
  • 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: 10 mg/kg q12h.
  • 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.
  • 2.2.1.3.1 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
  • 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
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.
  • 4.1 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
  • 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 [36][37]
  • 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
  • 6.1 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
  • 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)
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[42]
  • 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)[43]
  • 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 [44]
  • 10.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • 11. Appendicitis
11.1 Health Care–Associated Complicated Intra-abdominal Infection [24]
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 [24]
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 [24]
  • 13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
  • 14. Cystic fibrosis [25]
  • 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 [26]
  • 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):::::* Patient's body weight is <50 kg::::::* Preferred regimen: Rifampicin 450 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days :::::* 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)::::::* Patient's body weight is <50 kg: :::::::* Preferred regimen: Rifampicin 450 mg PO qd AND Doxycycline 200 mg PO qd 14 days, ::::::* 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): 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  : Rifampicin 600 mg PO od AND :::::* 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
  • 17. Community-acquired pneumonia[28]
  • 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 OR ::::* 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)
  • 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 plus a fluoroquinolone, TMP/SMX, a tetracycline or Clindamycin for 3 or 6 months for hips and knees, respectively.
  • 21. Hematogenous osteomyelitis
  • 21.1 Adult (>21 yrs)
  • 21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
  • 21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • 21.2 Children (>4 months)-Adult
  • 21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • 21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • Preferred regimen (1): Nafcillin ::::* Preferred regimen (2): Oxacillin 37 q6h (to max. 8–12 gm per day)
Note: Add Ceftazidime 50 q8h or Cefepime 150 div q8h if Gm-neg. bacilli on Gram stain
  • 21.3 Newborn (<4 months.)
  • 21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • 21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • 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[29]
  • 23.1 In adult
  • 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
  • 24. Staphylococcal toxic shock syndrome [30]
  • 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[31]
  • 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.
  1. ↑ Empty citation (help)
  2. ↑ Template:Citeweb
  3. ↑ Template:Citeweb
  4. ↑ Template:Citeweb
  5. ↑ Template:Citeweb
  6. ↑ Gern JE, Busse WW (1999). "Association of rhinovirus infections with asthma". Clin Microbiol Rev. 12 (1): 9–18. PMC 88904. PMID 9880472.
  7. ↑ Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB (1996). "Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds". Clin Infect Dis. 22 (4): 656–62. PMC url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205 Check |pmc= value (help). PMID 8729205.
  8. ↑ Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA; et al. (2003). "Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials". Clin Infect Dis. 36 (12): 1523–32. doi:10.1086/375069. PMID 12802751.
  9. ↑ Turner RB (2005). "New considerations in the treatment and prevention of rhinovirus infections". Pediatr Ann. 34 (1): 53–7. PMID 15693216.
  10. ↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
  11. ↑ Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T; et al. (2009). "Rhinovirus associated with severe lower respiratory tract infections in children". Pediatr Infect Dis J. 28 (4): 337–9. doi:10.1097/INF.0b013e31818ffc1b. PMID 19258921.
  12. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  13. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  17. ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
  18. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  19. ↑ 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.
  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. ↑ 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.
  23. ↑ 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.
  24. ↑ 24.0 24.1 24.2 24.3 24.4 24.5 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.
  25. ↑ 25.0 25.1 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.
  26. ↑ 26.0 26.1 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.
  27. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  28. ↑ 28.0 28.1 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.
  29. ↑ 29.0 29.1 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.
  30. ↑ 30.0 30.1 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.
  31. ↑ 31.0 31.1 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.
  32. ↑ 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.
  33. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  34. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  35. ↑ 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.
  36. ↑ 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.
  37. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  38. ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
  39. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  40. ↑ 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.
  41. ↑ 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.
  42. ↑ 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.
  43. ↑ 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.
  44. ↑ 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.
  45. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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