Antibiotics by diagnosis

Revision as of 19:26, 19 June 2014 by Ostermayer (talk | contribs)

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]

Alternatives (e.g. penicillin/cephalosporin allergy):

Adult < 50 yr[4]

Adult > 50 yr and Immunocompromised[5]

Post Procedural (or penetrating trauma)[7]

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

Meningitis with VP shunt

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:

(<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

  1. 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
  2. Cefdinir 14mg/kg/day BID x7-10 days
  3. Cefpodoxime 10mg/kg PO daily x7-10 days
  4. Cefuroxime 15mg/kg PO BID x7-10 days
  5. Cefprozil 15mg/kg PO BID x7-10 days

Otitis/Conjunctivitis

  • Suggestive of non-typeable H.flu
  1. 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

  1. Amoxicillin/Clavulanate 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
  2. Ceftriaxone 50mg/kg IM once as single injection x 3 days
    • Use if cannot tolerate PO

Penicillin Allergy

  1. Azithromycin 10mg/kg/day x 1 day and 5mg/kg/day x 4 remaining days
  2. Clarithromycin 7.5mg/kg PO BID x 10 days
  3. Clindamycin 10mg/kg PO three times daily
  • Cephalexin 75-100mg/kg/day PO divided q12h x 10 days; Max: 4,000mg/24h

Otitis Externa

  1. Ofloxacin 5 drops in affected ear BID x 7 days (Floxin otic)[8]
    • Safe with perforations
  2. Ciprofloxacin-hydrocortisone 3 drops in affected ear BID x 7 days
    • Contains hydrocortisone to promote faster healing
    • Not recommended for perforation since non-sterile preparation
  3. Ciprofloxacin-dexamethasone 4 drops in affected ear BID x 7 days
    • Similar to Cipro HC but safe for perforations
    • Often more expensive
  4. Cortisporin otic 4 drops in ear TID-QID x 7days (neomycin/polymixin B/hydrocortisone)
    • Use suspension (NOT solution) if possibility of perforation
    • Animal studies suggest possible toxicity from the neomycin although rigorous data is lacking[9]

Pediatric: Same topical regimens apply to children

  1. Ofloxacin 5 drops (>12yr) or 3 drops (<12yr) in affected ear BID x 7 days
  2. Ciprofloxacin 3-4 drops in affected ear BID x 7 days (with dexamethasone or hydrocortisone)

Streptococcal Pharyngitis

Treatment can be delayed for up to 9 days and still prevent major sequelae

Penicillin Options:

Penicillin allergic (mild):

Penicillin allergic (anaphylaxis):[10]

  • Clindamycin 7 mg/kg/dose TID (maximum = 300 mg/dose) x 10 days[16]
  • Azithromycin 12 mg/kg PO once (maximum = 500 mg), then 6 mg/kg (max=250 mg) once daily for the next 4 days[17]
  • Clarithromycin 7.5 mg/kg/dose PO BID (maximum = 250 mg/dose) x 10 days[18]


Pediatric Dosing:

  • Amoxicillin 50mg/kg PO once daily x 10 days (max 1000mg)
  • Penicillin V <27kg: 250mg PO BID-TID x 10 days; >27kg: 500mg PO BID-TID x 10 days
  • Penicillin G Benzathine <27kg: 600,000 units IM x 1; >27kg: 1.2 million units IM x 1
  • PCN allergy (mild): Cephalexin 20mg/kg PO BID x 10 days (max 500mg/dose)
  • PCN allergy (mild): Cefadroxil 30mg/kg PO daily x 10 days (max 1g)
  • PCN allergy (severe): Azithromycin 12mg/kg PO day 1 (max 500mg), then 6mg/kg daily x 4 days (max 250mg)
  • PCN allergy (severe): Clindamycin 7mg/kg/dose PO TID x 10 days (max 300mg/dose)
  • PCN allergy (severe): Clarithromycin 7.5mg/kg PO BID x 10 days (max 250mg/dose)


Eye

Corneal Abrasion

Erythromycin ophthalmic Q6

OR

Levofloxacin 0.5% 2gtt Q2 if patient is a contact user

Orbital Cellulitis

Pediatric:

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

===Outpatient=== Women, Uncomplicated

  • Nitrofurantoin ER 100mg BID x 5d, OR
  • TMP/SMX DS (160/800mg) 1 tab BID x 3d (Females) x7days (Males), OR
  • Cephalexin 250mg QID x 5d, OR
  • Ciprofloxacin 250mg BID x3d
    • Avoid using fluoroquinolone for the first-line treatment of uncomplicated urinary tract infections (UTIs) in women.[21]
  • Fosfomycin 3 g PO once
    • Lower clinical and microbiologic success compared to nitrofurantoin TID for 5 days [22]

Women, Complicated

Women, Concern for Urethritis

Men


===Inpatient Options=== *Ciprofloxacin 400mg IV q12hr, OR

Pediatric

  • TMP/SMX 6-12mg/kg/day (TMP) PO divided BID x 7-10 days
  • Cephalexin 25-50mg/kg/day PO divided q6-8h x 7-10 days (max 500mg/dose)
  • Nitrofurantoin 5-7mg/kg/day PO divided q6h x 7-10 days; avoid in infants <1 month
  • Cefpodoxime 10mg/kg/day PO divided BID (max 200mg/dose)
  • Cefixime 8mg/kg/day PO daily (max 400mg)

Pediatric Inpatient

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

  • University of Cincinnati Department of Emergency Medicine "Handbook of EM Fundamentals"
  1. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  2. ↑ https://www.aappublications.org/content/early/2015/02/25/aapnews.20150225-1
  3. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  4. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  5. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  6. ↑ [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.
  7. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  8. ↑ Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
  9. ↑ Wright, C. et al. Ototoxicity of neomycin and polymyxin B following middle ear application in the chinchilla and baboon. Am J Otol. 1987 Nov;8(6):495-9.
  10. ↑ 10.0 10.1 10.2 Shulman, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2012;55(10):1279–82
  11. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  12. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  13. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  14. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  15. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  16. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  17. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  18. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  19. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  20. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  21. ↑ Choosing Wisely. American Urogynecologic Society. http://www.choosingwisely.org/societies/american-urogynecologic-society
  22. ↑ Huttner, A., Kowalczyk, A., Turjeman, A., Babich, T., Brossier, C., Eliakim-Raz, N., … Harbarth, S. (2018). Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 319(17), 1781–1789.
Retrieved from "https://www.wikem.org/w/index.php?title=Antibiotics_by_diagnosis&oldid=21856"