Antibiotics by diagnosis
Bone and Joint
Open Fracture
Ancef 2g IV
PLUS
Gentamicin 300 mg (1-1.7mg/kg) IV (especially if wound is dirty)
Cardiovascular
CNS
Meningitis
Neonates (up to 1 month of age)[1]
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[2]
- If suspecting S. pneumoniae or MRSA, add standard neonatal dosing
- Consider acyclovir for HSV
> 1 month old[3]
- 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[4]
- 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[5]
- 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)[6]
Post Procedural (or penetrating trauma)[7]
- 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
ENT
Otitis Media
Initial Treatment
High Dose Amoxicillin
- <2 months
- Amoxicillin 30mg/kg/day PO divided q12h x 10 days
- First Dose: 15mg/kg PO x 1
- 2 months - 5 years
- Amoxicillin 80-90mg/kg/day PO divided q12h x 10 days
- First Dose: 40-45mg/kg PO x 1
- Max: 1000mg/dose
- 6-12 years
- Amoxicillin 80-90mg/kg/day PO divided q12h x 5-10 days
- First Dose: 40-45mg/kg/day PO x 1
- Max: 1000mg/dose
Treatment during prior Month
- If amoxicillin taken in past 30 days, Amoxicillin/Clavulanate
- 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
- Clavulanate increases vomiting/diarrhea
- Cefdinir 14mg/kg/day BID x7-10 days
- Cefpodoxime 10mg/kg PO daily x7-10 days
- Cefuroxime 15mg/kg PO BID x7-10 days
- Cefprozil 15mg/kg PO BID x7-10 days
Otitis/Conjunctivitis
- Suggestive of non-typeable H.flu
- Amoxicillin/Clavulanate
- 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
- Clavulanate increases vomiting/diarrhea
Treatment Failure
defined as treatment during the prior 7-10 days
- Amoxicillin/Clavulanate 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
- Ceftriaxone 50mg/kg IM once as single injection x 3 days
- Use if cannot tolerate PO
Penicillin Allergy
- Azithromycin 10mg/kg/day x 1 day and 5mg/kg/day x 4 remaining days
- Clarithromycin 7.5mg/kg PO BID x 10 days
- Clindamycin 10mg/kg PO three times daily
- Clindamycin does not cover H. influenza and M. catarrhalis and treatment should favor Azithromycin use
- Cephalexin 75-100mg/kg/day PO divided q12h x 10 days; Max: 4,000mg/24h
Otitis Externa
Ciprodex 3gtt Q12
OR
Polysporin otic 5gtt Q6
Pharyngitis
Bicillin 1.2 million units (25k/kg) IM
OR
Azithromycin 500mg (12mg/kg) PO Daily
Eye
Corneal Abrasion
Erythromycin ophthalmic Q6
OR
Levofloxacin 0.5% 2gtt Q2 if patient is a contact user
Orbital Cellulitis
- Vancomycin 15-20mg/kg IV BID + (one of the following)
- Ampicillin/Sulbactam 3 g IV q6hr OR
- Ticarcillin/Clavulanate 3.1 g IV q4h OR
- Piperacillin/Tazobactam 4.5 g IV q6h OR
- Ceftriaxone 2 g IV q12hr OR
- Cefotaxime 2 g IV q4h
Pediatric:
- Vancomycin 15mg/kg IV q6hrs + (one of the following)
- Ampicillin/Sulbactam 50mg/kg IV q6hrs (max 3g/dose) OR
- Piperacillin/Tazobactam 100mg/kg IV q8hrs (max 4.5g) OR
- Ceftriaxone 50mg/kg IV q12hrs (max 2g/dose) OR
- Cefotaxime 50mg/kg IV q6hrs (max 2g/dose)
GI
Appendicitis
Zosyn 4.5g (100 mg/kg) IV Q6
OR
Flagyl 500mg (7.5mg/kg) IV Q6
PLUS
Ciprofloxacin 400mg IV Q12
Cholecystitis
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
GU
Epididymitis
Age <35 (gonorrhea suspected)
Doxycycline 100mg PO Q12 x14d
PLUS
Cefixime 400mg PO once
Age >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
Ceftriaxone 250mg 1M once
PLUS
Doxycycline 100 mg PO Q12 x14d
UTI
Macrobid 100mg PO BID x7d
OR
Bactrim DS PO Q12 x3d
OR
Cephalexin 500mg PO Q6 x7d
Pulmonary
Pneumonia
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)
Skin and Soft Tissue
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
Bioterrorism
Environmental Exposure
Immunocompromised
Neutropenic Fever
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
Post Exposure Prophylaxis
Pediatric
See Antibiotics By Diagnosis (Peds)
Sepsis
Arthropod and Parasitic Infections
See Also
Source
- CURRENT Medical Dx & Tx
- University of Cincinnati Department of Emergency Medicine "Handbook of EM Fundamentals"
- ↑ 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