Initial Antibiotics in Sepsis - Uncited: Difference between revisions
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| Meningitis, bacterial, community-acquired<sup>6</sup> | | Meningitis, bacterial, community-acquired<sup>6</sup> | ||
| Pneumococcus<sup>1</sup>, meningococcus | | Pneumococcus<sup>1</sup>, meningococcus | ||
| Cefotaxime<sup>2</sup>, 2–3 g IV every 6 hours; '''or''' [[ceftriaxone]], 2 g IV every 12 hours plus vancomycin, 10 mg/kg IV every 8 hours | | Cefotaxime<sup>2</sup>, 2–3 g IV every 6 hours; '''or''' [[ceftriaxone]], 2 g IV every 12 hours plus [[vancomycin]], 10 mg/kg IV every 8 hours | ||
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| Meningitis, bacterial, age > 50, community-acquired<sup>6</sup> | | Meningitis, bacterial, age > 50, community-acquired<sup>6</sup> | ||
| Pneumococcus, meningococcus, ''Listeria monocytogenes''<sup>3</sup>, gram-negative bacilli | | Pneumococcus, meningococcus, ''Listeria monocytogenes''<sup>3</sup>, gram-negative bacilli | ||
| Ampicillin, 2 g IV every 4 hours, plus Cefotaxime or [[ceftriaxone]] and vancomycin | | Ampicillin, 2 g IV every 4 hours, plus Cefotaxime or [[ceftriaxone]] and [[vancomycin]] | ||
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| Meningitis, postoperative (or posttraumatic)<sup>6</sup> | | Meningitis, postoperative (or posttraumatic)<sup>6</sup> | ||
| ''S aureus,'' gram-negative bacilli (pneumococcus, in posttraumatic)<br> | | ''S aureus,'' gram-negative bacilli (pneumococcus, in posttraumatic)<br> | ||
| Vancomycin, 10 mg/kg IV every 8 hours, plus ceftazidime, 3 g IV every 8 hours | | [[Vancomycin]], 10 mg/kg IV every 8 hours, plus ceftazidime, 3 g IV every 8 hours | ||
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| Brain abscess | | Brain abscess | ||
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| Pneumonia, postoperative or nosocomial | | Pneumonia, postoperative or nosocomial | ||
| ''S aureus,'' mixed anaerobes, gram-negative bacilli<br> | | ''S aureus,'' mixed anaerobes, gram-negative bacilli<br> | ||
| Cefapime, 2 g IV every 8 hours; '''or ''' , 2 g IV every 8 hours; '''or''' piperacillin-tazobactam, 45 g IV every 6 hours; '''or''' imipenem, 500 mg IV every 6 hours; '''or''' meropenem, 1 g IV every 8 hours plus tobramycin, 5 mg/kg IV every 24 hours; '''or ''' ciprofloxacin, 400 mg IV every 12 hours; '''or ''' levofloxacin, 500 mg IV every 24 hours plus vancomycin, 15 mg/kg IV every 12 hours | | Cefapime, 2 g IV every 8 hours; '''or ''' , 2 g IV every 8 hours; '''or''' piperacillin-tazobactam, 45 g IV every 6 hours; '''or''' imipenem, 500 mg IV every 6 hours; '''or''' meropenem, 1 g IV every 8 hours plus tobramycin, 5 mg/kg IV every 24 hours; '''or ''' ciprofloxacin, 400 mg IV every 12 hours; '''or ''' levofloxacin, 500 mg IV every 24 hours plus [[vancomycin]], 15 mg/kg IV every 12 hours | ||
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| Endocarditis, acute (including injection drug user) | | Endocarditis, acute (including injection drug user) | ||
| ''S aureus, E faecalis,'' gram-negative aerobic bacteria, viridans streptococci<br> | | ''S aureus, E faecalis,'' gram-negative aerobic bacteria, viridans streptococci<br> | ||
| vancomycin, 15 mg/kg IV every 12 hours, plus gentamicin, 1 mg/kg every 8 hours | | [[vancomycin]], 15 mg/kg IV every 12 hours, plus gentamicin, 1 mg/kg every 8 hours | ||
|- | |- | ||
| Septic thrombophlebitis (eg, IV tubing, IV shunts) | | Septic thrombophlebitis (eg, IV tubing, IV shunts) | ||
| ''S aureus,'' gram-negative aerobic bacteria<br> | | ''S aureus,'' gram-negative aerobic bacteria<br> | ||
| Vancomycin, 15 mg/kg IV every 12 hours plus ciprofloxacin, 400 mg IV every 12 hours; '''or''' levofloxacin, 500 mg IV every 24 hours; '''or''' [[ceftriaxone]], 1 g IV every 24 hours | | [[Vancomycin]], 15 mg/kg IV every 12 hours plus ciprofloxacin, 400 mg IV every 12 hours; '''or''' levofloxacin, 500 mg IV every 24 hours; '''or''' [[ceftriaxone]], 1 g IV every 24 hours | ||
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| Osteomyelitis | | Osteomyelitis | ||
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<sup>1</sup>Some strains may be resistant to penicillin. Vancomycin can be used with or without rifampin. | <sup>1</sup>Some strains may be resistant to penicillin. [[Vancomycin]] can be used with or without rifampin. | ||
<sup>2</sup>Cefotaxime, [[ceftriaxone]], ceftazidime, or ceftizoxime can be used. Most studies on meningitis have been with cefotaxime or ceftriaxone (see text). | <sup>2</sup>Cefotaxime, [[ceftriaxone]], ceftazidime, or ceftizoxime can be used. Most studies on meningitis have been with cefotaxime or ceftriaxone (see text). | ||
Revision as of 04:57, 3 March 2014
Hospitalized adults pending identification of causative organism
| Suspected Clinical Diagnosis | Likely Etiologic Diagnosis | Drugs of Choice |
|---|---|---|
| Meningitis, bacterial, community-acquired6 | Pneumococcus1, meningococcus | Cefotaxime2, 2–3 g IV every 6 hours; or ceftriaxone, 2 g IV every 12 hours plus vancomycin, 10 mg/kg IV every 8 hours |
| Meningitis, bacterial, age > 50, community-acquired6 | Pneumococcus, meningococcus, Listeria monocytogenes3, gram-negative bacilli | Ampicillin, 2 g IV every 4 hours, plus Cefotaxime or ceftriaxone and vancomycin |
| Meningitis, postoperative (or posttraumatic)6 | S aureus, gram-negative bacilli (pneumococcus, in posttraumatic) |
Vancomycin, 10 mg/kg IV every 8 hours, plus ceftazidime, 3 g IV every 8 hours |
| Brain abscess | Mixed anaerobes, pneumococci, streptococci | Penicillin G, 4 million units IV every 4 hours, plus metronidazole, 500 mg orally every 8 hours; or Cefotaxime or ceftriaxone plus metronidazole, 500 mg orally every 8 hours |
| Pneumonia, acute, community-acquired, severe | Pneumococci, M pneumoniae, 'Legionella', C pneumoniae |
Doxycycline, 100 mg IV or orally every 12 hours (or azithromycin), plus Cefotaxime, 2 g IV every 8 hours (or ceftriaxone, 1 g IV every 24 hours); or a fluoroquinolone5 alone |
| Pneumonia, postoperative or nosocomial | S aureus, mixed anaerobes, gram-negative bacilli |
Cefapime, 2 g IV every 8 hours; or , 2 g IV every 8 hours; or piperacillin-tazobactam, 45 g IV every 6 hours; or imipenem, 500 mg IV every 6 hours; or meropenem, 1 g IV every 8 hours plus tobramycin, 5 mg/kg IV every 24 hours; or ciprofloxacin, 400 mg IV every 12 hours; or levofloxacin, 500 mg IV every 24 hours plus vancomycin, 15 mg/kg IV every 12 hours |
| Endocarditis, acute (including injection drug user) | S aureus, E faecalis, gram-negative aerobic bacteria, viridans streptococci |
vancomycin, 15 mg/kg IV every 12 hours, plus gentamicin, 1 mg/kg every 8 hours |
| Septic thrombophlebitis (eg, IV tubing, IV shunts) | S aureus, gram-negative aerobic bacteria |
Vancomycin, 15 mg/kg IV every 12 hours plus ciprofloxacin, 400 mg IV every 12 hours; or levofloxacin, 500 mg IV every 24 hours; or ceftriaxone, 1 g IV every 24 hours |
| Osteomyelitis | S aureus | Nafcillin, 2 g IV every 4 hours; or cefazolin, 2 g IV every 8 hours |
| Septic arthritis | S aureus, N gonorrhoeae | Ceftriaxone, 1–2 g IV every 24 hours |
| Pyelonephritis with flank pain and fever (recurrent urinary tract infection) | E coli, Klebsiella, Enterobacter, Pseudomonas |
Ceftriaxone, 1g IV every 24 hours; or ciprofloxacin, 400 mg IV every 12 hours (500 mg orally); or levofloxacin, 500 mg once daily (IV/PO) |
| Fever in neutropenic patient receiving cancer chemotherapy | S aureus, Pseudomonas, Klebsiella, E coli |
Ceftazidime, 2 g IV every 8 hours; or cefepime, 2 g IV every 8 hours |
| Intra-abdominal sepsis (eg, postoperative, peritonitis, cholecystitis) | Gram-negative bacteria, Bacteroides, anaerobic bacteria, streptococci, clostridia | Piperacillin-tazobactam or ticarcillin-clavulanate, 3.1 g IV every 6 hours; or ertapenem, 1 g every 24 hours; or moxifloxacin, 400 mg IV every 24 hours |
1Some strains may be resistant to penicillin. Vancomycin can be used with or without rifampin.
2Cefotaxime, ceftriaxone, ceftazidime, or ceftizoxime can be used. Most studies on meningitis have been with cefotaxime or ceftriaxone (see text).
3TMP-SMZ can be used to treat Listeria monocytogenes in patients allergic to penicillin in a dosage of 15–20 mg/kg of TMP in three or four divided doses.
4Depending on local drug susceptibility pattern, use tobramycin, 5 mg/kg/d, or amikacin, 15 mg/kg/d, in place of gentamicin.
5Gatifloxacin, levofloxacin, moxifloxacin
6Remember to give steroids concomitatntly or 15 minutes prior to antibiotics for acute bacterial meningitis