Antibiotics by diagnosis: Difference between revisions

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== Initial antimicrobial therapy for acutely ill  ==
{{Antibiotics by diagnosis navigation}}
 
'''Hospitalized adults pending identification of causative organism'''
 
{| cellspacing="0" cellpadding="2" border="1" class="pbSortable"
|-
| '''Suspected Clinical Diagnosis'''
| '''Likely Etiologic Diagnosis'''
| '''Drugs of Choice'''
|-
| Meningitis, bacterial, community-acquired<sup>6</sup>
| 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
|-
| Meningitis, bacterial, age &gt; 50, community-acquired<sup>6</sup>
| Pneumococcus, meningococcus, ''Listeria monocytogenes''<sup>3</sup>, gram-negative bacilli
| Ampicillin, 2 g IV every 4 hours, plus Cefotaxime or ceftriaxone and vancomycin
|-
| Meningitis, postoperative (or posttraumatic)<sup>6</sup>
| ''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
|-
| 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''<br>
| 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
|-
| Pneumonia, postoperative or nosocomial
| ''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
|-
| Endocarditis, acute (including injection drug user)
| ''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
|-
| Septic thrombophlebitis (eg, IV tubing, IV shunts)
| ''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
|-
| 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''<br>
| 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''<br>
| 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
|}
 
<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>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.
 
<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.
 
<sup>5</sup>Gatifloxacin, levofloxacin, moxifloxacin
 
<sup>6</sup>Remember to give steroids concomitatntly or 15 minutes prior to antibiotics for acute bacterial meningitis
 
 
 
== Antibiotics By Diagnosis<br>  ==
 
{| cellspacing="0" cellpadding="2" border="1" align="left" style="width: 483px; height: 2459px;"
|-
| '''Diagnosis'''<br>
| '''Commonly Used Antibiotic(s)'''<br>
|-
| [[Meningitis]]<br>
|
Vancomycin 750mg (15mg/kg) IV
 
''PLUS''
 
Ceftriaxone 2g (50mg/kg) IV
 
''ADD''
 
Ampicillin 2g (50mg/kg) IV ''if concern for Listeria''
 
|-
| [[Otitis Media (Peds)|Otitis Media]]<br>
|
Amoxicillin 500mg (45mg/kg) PO Q12
 
''OR''
 
Augmentin 500mg (45mg/kg) PO Q12
 
''OR''
 
Cefdinir 600mg (14mg/kg) PO Daily
 
|-
| [[Otitis Externa]]<br>
|
Ciprodex 3gtt Q12
 
''OR''
 
Polysporin otic 5gtt Q6
 
|-
| Pharyngitis<br>
|
Bicillin 1.2 million units (25k/kg) IM
 
''OR''
 
Azithromycin 500mg (12mg/kg) PO Daily
 
|-
| [[Corneal Abrasion]]<br>
|
Erythromycin ophthalmic Q6
 
''OR''
 
Levofloxacin 0.5% 2gtt Q2 ''if patient is a contact user''
 
|-
| [[Orbital Cellulitis]]<br>
| Vancomycin 1g (15mg/kg) IV Q12<br>
|-
| [[Appendicitis]]
|
Zosyn 4.5g (100 mg/kg) IV Q6
 
''OR''
 
Flagyl 500mg (7.5mg/kg) IV Q6
 
''PLUS''
 
Ciprofloxacin 400mg IV Q12
 
|-
| [[Cholecystitis]]<br>
|
Augmentin 3g IV Q6
 
''OR''
 
Imipenem/Cilastin 500mg IV Q6
 
|-
| [[Diverticulitis]]
|
Flagyl 500mg PO Q6
 
''PLUS''
 
Ciprofloxacin 750mg PO Q12
 
|-
| Infectious [[Diarrhea]]
|
Empiric: Cipro 500mg PO Q12 x3d
 
Giardia: Flagyl 500mg PO Q8 x5d
 
C. diff: Flagyl 500mg PO Q8 x14d
 
|-
| [[Epididymitis]]
|
Age &lt;35 (gonorrhea suspected):
 
Doxycycline 100mg PO Q12 x14d
 
''PLUS''
 
Cefixime 400mg PO once
 
Age &gt;35 (gonorrhea not suspected):
 
Ciprofloxacin 500mg PO Q12 x14d
 
|-
| Cervicitis/Urethritis
|
Cefixime 400mg PO once
 
''OR''
 
Azithromycin 1g PO once
 
''ADD''
 
Flagyl 2g PO once ''if concern for trichomoniasis''
 
|-
| [[PID]]<br>
|
Ceftriaxone 250mg 1M once
 
''PLUS''
 
Doxycycline 100 mg PO Q12 x14d
 
|-
| [[UTI]]<br>
|
Macrobid 100mg PO BID x7d
 
''OR''
 
Bactrim DS PO Q12 x3d
 
''OR''
 
Keflex 500mg PO Q6 x7d
 
|-
| [[Pneumonia]]<br>
|
Outpatient:
 
Azithromycin 500mg PO, 250mg PO x3d
 
''OR''
 
Doxycycline 100mg PO Q12 x7d
 
Inpatient, Community Acquired
 
Ceftriaxone 1g IV
 
''PLUS''
 
Azithromycin 500mg IV
 
Inpatient, Health Care Acquired
 
Vancomycin 1g IV ''(MRSA)''
 
''PLUS''
 
Cefepime 2g IV ''(Pseudomonas)''
 
''PLUS''
 
Tobramycin 4mg/kg IV ''(Pseudomonas)''
 
|-
| Cellulitis/Superficial Abscess
|
Bactrim DS 2tab PO Q12 x5-10d
 
''PLUS''
 
Cephalexin 500mg PO Q6 x5-10
 
''OR''
 
Clindamycin 450mg PO Q8 x5-10d
 
Diabetic with systemic toxicity
 
Vancomycin 1g IV
 
''PLUS''
 
Unasyn 3g IV
 
''OR''
 
Zosyn 3.375g IV
 
|-
| [[Neutropenic Fever]]<br>
|
Zosyn 4.5g IV
 
''OR''
 
Meropenem 1g IV
 
''PLUS/MINUS''
 
Gentamicin 2mg/kg IV
 
''ADD''
 
Vancomycin 1g IV ''for catheter related infection, colonization with MRSA, gram-positive culture unknown susceptibility, suspected sepsis''
 
|}
 
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== See Also  ==


==See Also==
*[[Antibiotics (Main)]]  
*[[Antibiotics (Main)]]  
*[[Sepsis (Initial Abx)]]
*[[Antibiotics by organism]]
 
== Source  ==
*CURRENT Medical Dx &amp; Tx
*University of Cincinnati Department of Emergency Medicine "Handbook of EM Fundamentals"


[[Category:ID]] [[Category:Drugs]]
==References==
<references/>
[[Category:ID]] [[Category:Pharmacology]]

Latest revision as of 17:52, 7 May 2016


Antibiotics by diagnosis

For antibiotics by organism see Microbiology (Main)

See Also

References

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