Sandbox g55

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• Acanthamoeba Return to Top

• 1. Granulomatous amoebic encephalitis, meningitis, and disseminated Acanthamoeba disease

• Preferred regimen (1): Pentamidine AND Itraconazole AND Sulfadiazine AND Flucytosine
• Preferred regimen (2): Sulfadiazine AND Fluconazole AND Pyrimethamine
• Preferred regimen (3): Sulfadiazine AND Flucytosine AND TMP-SMX
• Preferred regimen (4): TMP-SMX AND Rifampin AND Ketoconazole
• Preferred regimen (5): Miltefosine AND Amikacin
• Preferred regimen (6): Miltefosine AND Voriconazole
• Preferred regimen (7): Pentamidine AND Itraconazole AND Flucytosine AND Levofloxacin AND Amphotericin B AND Rifampin
• Preferred regimen (8): Pentamidine AND Fluconazole AND Miltefosine
• Note: The mainstay of successful treatment includes early diagnosis and combination therapy with pentamidine, azole, sulfonamide, miltefosine, and possibly flucytosine.

• 2. Cutaneous acanthamoebiasis

• Preferred regimen: Pentamidine AND Sulfadiazine AND Flucytosine AND (Itraconazole OR Fluconazole) AND Chlorhexidine topical AND Ketoconazole topical

• 3. Acanthamoeba keratitis

• Preferred regimen: (Polyhexamethylene biguanide topical OR Chlorhexidine topical) ± (Propamidine topical OR Hexamidine topical)
• Note (1): Azole antifungal drugs (Ketoconazole, Itraconazole, Voriconazole) may be considered as oral or topical adjuncts.
• Note (2): The duration of therapy for Acanthamoeba keratitis may last six months to a year.
• Note (3): Pain control can be helped by topical cyclopegic solutions and oral nonsteroidal medications.
• Note (4): The use of corticosteroids to control inflammation is controversial.
• Note (5): Penetrating keratoplasty may help restore visual acuity.

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• Balamuthia mandrillaris Return to Top

• 1. Granulomatous Amebic Encephalitis

• Preferred regimen (1): Pentamidine AND Flucytosine AND Fluconazole AND Sulfadiazine AND (Azithromycin OR Clarithromycin)
• Preferred regimen (2): Pentamidine AND Albendazole AND (Itraconazole OR Fluconazole) AND Miltefosine

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• Enterobacter Return to Top

• Enterobacter species including E. aerogenes and E. cloacae

• 1. Empiric antimicrobial therapy pending in vitro susceptibility

• 1.1 Non–life-threatening infections or MDR-GNB prevalence < 20%

• Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h ± Aminoglycosides
• Alternative regimen: Ciprofloxacin 400 mg IV q8–12h

• 1.2 Life-threatening infections or MDR-GNB prevalence > 20%

• Preferred regimen: Meropenem 0.5–1 g IV q8h
• Alternative regimen (1): Colistin AND Meropenem 0.5–1 g IV q8h
• Alternative regimen (2): Colistin AND Imipenem 500 mg IV q6h
• Alternative regimen (3): Colistin AND Doripenem 500 mg IV q8h
• Alternative regimen (4): Colistin AND Ertapenem 1 g IV q24h
• Alternative regimen (5): Colistin AND Fosfomycin 6 g IV q6h

• 2. In vitro susceptibility available

• 2.1 Susceptible to all tested agents

• Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h
• Alternative regimen (1): Ciprofloxacin 400 mg IV q8–12h
• Alternative regimen (2): Cefepime 2 g IV q8h (if MIC ≤ 1 μg/mL)

• 2.2 Extended spectrum beta-lactamase (ESBL)-producing Enterobacter spp.

• Preferred regimen: Meropenem 0.5–1 g IV q8h
• Alternative regimen (1): Imipenem 500 mg IV q6h
• Alternative regimen (2): Doripenem 500 mg IV q8h
• Alternative regimen (3): Ertapenem 1 g IV q24h
• Alternative regimen (4): Cefepime 2 g IV q8h (if MIC ≤ 1 μg/mL)

• 2.3 Resistant to all tested agents

• Preferred regimen: Colistin AND Meropenem 0.5–1 g IV q8h
• Alternative regimen (1): Colistin AND Imipenem 500 mg IV q6h
• Alternative regimen (2): Colistin AND Doripenem 500 mg IV q8h
• Alternative regimen (3): Colistin AND Ertapenem 1 g IV q24h
• Alternative regimen (4): Colistin AND Minocycline 100 mg IV q12h