Neuro antibiotics
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Bell's Palsy
Eye Protection
- Cornea eye protection (Level X)[1]
- Artificial tears qhr while patient is awake
- Ophthalmic ointment at night
- Eye should be taped shut at night
- Protective glasses or goggles
Steroids
Should be started within 72hrs of symptom onset[2]
- Prednisone 60-80mg qday x1wk[3] (Level B Evidence)[4]
Antivirals
Most likely no added benefit when combined with steroids.[5] However also little harm associated with antivirals especially in patients with normal renal function[4]
- Valacyclovir 1000mg TID x1 week OR
- Acyclovir 400mg 5x per day x1 week
Antibiotics
- Consider empiric empiric dosing if high index of suspicion for Lyme based on clinical presentation or lab data
Brain abscess
Otogenic source
- Cefotaxime 2gm IV q6hr + 500mg IV q6hr
Sinogenic or odontogenic source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Penetrating trauma or neurosurgical procedures
- Vancomycin 15mg/kg IV q12hr + 2gm IV q8hr
Hematogenous source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
No obvious source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Pediatric
- Cefotaxime 50mg/kg IV q6hrs (max 2g/dose) + Metronidazole 7.5mg/kg IV q6hrs (max 500mg)
- If post-surgical/trauma: Vancomycin 15mg/kg IV q6hrs + Ceftazidime 50mg/kg IV q8hrs (max 2g/dose)
Encephalitis
Often it is unclear which type of encephalitis is present and starting Acyclovir empirically is appropriate. In addition to the pathogens below, possible causes can include West Nile Virus, EBV, HIV, toxoplasmosis, or rabies.
HSV encephalitis
- Acyclovir 10mg/kg (10-15mg/kg for pediatrics) every 8hrs
HZV encephalitis
- Acyclovir 10mg/kg every 8hr
CMV encephalitis
- Ganciclovir 5mg/kg IV every 12hr OR
- Foscarnet 90mg/kg IV every 12 hrs
Tick Associated (Borrelia burgdorferi, Ehrlichiosis or Rickettsia)
- Doxycycline 200 mg IV once followed by 100 mg IV twice daily
Pediatric
HSV Encephalitis
- Acyclovir 20mg/kg IV q8hrs x 21 days (neonates); 10-15mg/kg IV q8hrs x 14-21 days (children)
CMV Encephalitis
- Ganciclovir 5mg/kg IV q12hrs
Tick Associated
- Doxycycline 2.2mg/kg IV q12hrs (max 100mg/dose)
Epidural Abscess
- Target Staph, Strep, and Gram-negative bacilli[6]
- Vancomycin 15-20mg/kg BID + 500mg (7.5mg/kg) q6 hrs + (Cefotaxime or standard dosing or Ceftazidime)
- Ceftazidime is preferred if pseudomonas is considered likely
- Can substitute Nafcillin or Oxacillin for Vancomycin if not MRSA
Treat for 6-8 weeks
Pediatric
- Vancomycin 15mg/kg IV q6hrs + Ceftriaxone 50-75mg/kg IV daily (max 2g) + Metronidazole 7.5mg/kg IV q6hrs (max 500mg)
- Treat for 6-8 weeks
Meningitis
Neonates (up to 1 month of age)[7]
MRSA is uncommon in the neonate
- Ampicillin 75mg/kg IV q6hrs PLUS
- Cefotaxime 50mg/kg IV q6hrs OR 2.5mg/kg IV q8hrs
- Per AAP, ceftazidime 50mg/kg IV (q12hr for babies < 8 days of age, q8hr for >7 days old) is a reasonable alternative to cefotaxime, offering virtually the same coverage for enteric bacilli and is FDA approved for all age groups[8]
- If suspecting S. pneumoniae or MRSA, add standard neonatal dosing
- Consider acyclovir for HSV
> 1 month old[9]
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily
- Vancomycin is for resistant Pneumococcus
Alternatives (e.g. penicillin/cephalosporin allergy):
- Meropenem 40mg/kg IV q8hrs (max 2g/dose)
- Chloramphenicol 75-100mg/kg/day IV divided q6h (max 4g/day)
Adult < 50 yr[10]
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily
- Vancomycin is for resistant Pneumococcus
Adult > 50 yr and Immunocompromised[11]
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily PLUS
- Ampicillin 2gm IV q4h (hourly if listeria suspected)[12]
Post Procedural (or penetrating trauma)[13]
- Vancomycin 15-20mg/kg IV BID daily PLUS
- Cefepime 2g (50mg/kg) IV q8 hours daily OR Ceftazidime 2g (50mg/kg) IV q8 hours daily OR Meropenem 2gm (40mg/kg) IV q8 hours daily
Cryptococcosis Meningitis
Options
- Amphotericin B 1mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
- Amphotericin B 5mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
Meningitis with severe PCN allergy
- Chloramphenicol 1g IV q6h + 15mg/kg q8-12hr
Meningitis with VP shunt
- Coverage for skin contaminants (S. epidermis, S. aureus)
- Vancomycin plus ceftriaxone plus shunt removal
Neisseria meningitidis Prophylaxis
- Ceftriaxone 250mg IM once
- Ceftriaxone 125mg IM once (if <=15yr)
- Ciprofloxacin 500mg PO once
- Rifampin 600 mg PO BID x 2 days
- Rifampin <1mo: 5mg/kg PO BID x 2 days; >=1mo: 10mg/kg PO BID x 2 days
- Ampicillin/Sulbactam 400mg ampicillin/kg/day IM/IV divided q6 hours; First Dose: 100mg ampicillin/kg IM/IV x 1 (150mg Unasyn/kg IM/IV x 1); Max: 2000mg ampicillin (3000mg Unasyn) per DOSE
- Meropenem 2g IV every 8 hours.
- Nafcillin 100-200mg/kg/day IV divided q4-6h; Max: 12 g/day
Tetanus
- Metronidazole 500 mg IV every 6 hours
(<1200g)
- 7.5 mg/kg PO/IV q48h
- First Dose: 7.5 mg/kg PO/IV x 1
(>1200g AND <1 Month Old)
- <7 days old
- 7.5-15 mg/kg/day PO/IV q12-24h
- First Dose: 7.5-15 mg/kg PO/IV x 1
- >7 days old
- 15-30 mg/kg/day PO/IV q12h
- First Dose: 7.5-15 mg/kg PO/IV x 1
(>1 Month Old)
- 30 mg/kg/day PO/IV q6h
- First Dose: 7.5 mg/kg PO/IV x 1
- Max: 4 g/day
See Also
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
References
- ↑ Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013;149(3 Suppl):S1-S27.
- ↑ Vargish L. For Bell's palsy, start steroids early; no need for an antiviral. J Fam Pract. Jan 2008; 57(1): 22–25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183838/pdf/JFP-57-22.pdf
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ 4.0 4.1 Gronseth GS, Paduga R. Evidence-based guideline update: Steroids and antivirals for Bell palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012Full Text
- ↑ Lockhart et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869.
- ↑ Rigamonti D. et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 1999; 52:189-96
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ https://www.aappublications.org/content/early/2015/02/25/aapnews.20150225-1
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ [Guideline] Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul. 15(7):649-59.
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702