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| ==Hospitalized adults pending identification of causative organism==
| | #REDIRECT [[Sepsis antibiotics]] |
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| {| cellspacing="0" cellpadding="2" border="1" class="wikitable sortable"
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| !scope="col" |'''Suspected Clinical Diagnosis'''
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| !scope="col" | '''Likely Etiologic Diagnosis'''
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| !scope="col" | '''Drugs of Choice'''
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| | Meningitis, bacterial, community-acquired<sup>6</sup>
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| | Pneumococcus<sup>1</sup>, meningococcus
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| | 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>
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| | Pneumococcus, meningococcus, ''Listeria monocytogenes''<sup>3</sup>, gram-negative bacilli
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| | Ampicillin, 2 g IV every 4 hours, plus Cefotaxime or [[ceftriaxone]] and vancomycin
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| |-
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| | Meningitis, postoperative (or posttraumatic)<sup>6</sup>
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| | ''S aureus,'' gram-negative bacilli (pneumococcus, in posttraumatic)<br>
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| | Vancomycin, 10 mg/kg IV every 8 hours, plus ceftazidime, 3 g IV every 8 hours
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| | Brain abscess
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| | Mixed anaerobes, pneumococci, streptococci
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| | 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
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| | Pneumonia, acute, community-acquired, severe
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| | Pneumococci, ''M pneumoniae, ''''Legionella'''', C pneumoniae''<br>
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| | 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 fluoroquinolone<sup>5</sup> alone
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| | Pneumonia, postoperative or nosocomial
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| | ''S aureus,'' mixed anaerobes, gram-negative bacilli<br>
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| | 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)
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| | ''S aureus, E faecalis,'' gram-negative aerobic bacteria, viridans streptococci<br>
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| | vancomycin, 15 mg/kg IV every 12 hours, plus gentamicin, 1 mg/kg every 8 hours
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| | Septic thrombophlebitis (eg, IV tubing, IV shunts)
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| | ''S aureus,'' gram-negative aerobic bacteria<br>
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| | 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
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| | ''S aureus''
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| | Nafcillin, 2 g IV every 4 hours; '''or''' cefazolin, 2 g IV every 8 hours
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| | Septic arthritis
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| | ''S aureus, N gonorrhoeae''
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| | [[Ceftriaxone]], 1–2 g IV every 24 hours
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| | Pyelonephritis with flank pain and fever (recurrent urinary tract infection)
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| | ''E coli, Klebsiella, Enterobacter, Pseudomonas''<br>
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| | [[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)
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| | Fever in neutropenic patient receiving cancer chemotherapy
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| | ''S aureus, Pseudomonas, Klebsiella, E coli''<br>
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| | Ceftazidime, 2 g IV every 8 hours; '''or''' cefepime, 2 g IV every 8 hours
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| | Intra-abdominal sepsis (eg, postoperative, peritonitis, cholecystitis)
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| | Gram-negative bacteria, ''Bacteroides,'' anaerobic bacteria, streptococci, clostridia
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| | 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
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| |}
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| <sup>1</sup>Some strains may be resistant to penicillin. Vancomycin can be used with or without rifampin.
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| <sup>2</sup>Cefotaxime, [[ceftriaxone]], ceftazidime, or ceftizoxime can be used. Most studies on meningitis have been with cefotaxime or ceftriaxone (see text).
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| <sup>3</sup>[[TMP-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.
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| <sup>4</sup>Depending on local drug susceptibility pattern, use tobramycin, 5 mg/kg/d, or amikacin, 15 mg/kg/d, in place of gentamicin.
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| <sup>5</sup>Gatifloxacin, levofloxacin, moxifloxacin
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| <sup>6</sup>Remember to give steroids concomitatntly or 15 minutes prior to antibiotics for acute bacterial meningitis
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| ==See Also==
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| *[[Initial Antibiotics in Sepsis (Main)]]
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| [[Category:ID]] [[Category:Drugs]]
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