Sandbox g19

# Brain abscess
- Empiric antimicrobial therapy
- Brain abscess in otherwise healthy patients
- Preferred regimen: (Cefotaxime 812 g/day IV q46h OR Ceftriaxone 4 g/day IV q12h) AND Metronidazole 30 mg/kg/day IV q6h
- Alternative regimen: Meropenem 6 g/day IV q8h
- Brain abscess with comorbidities
- Otitis media, mastoiditis, or sinusitis
- Preferred regimen: (Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h
- Dental infection
- Preferred regimen: Penicillin G 4 MU IV q4h AND Metronidazole 30 mg/kg/day q6h
- Penetrating trauma or post-neurosurgy
- Preferred regimen: (Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h OR Cefepime 2 g IV q12h) AND Vancomycin 3045 mg/kg/day q812h
- Lung abscess, empyema, or bronchiectasis
- Preferred regimen: Penicillin G 4 MU IV q4h AND Metronidazole 30 mg/kg/day q6h AND TMP-SMZ 1020 mg/kg/day q612h
- Bacterial endocarditis
- Preferred regimen: Vancomycin 3045 mg/kg/day q812h AND Gentamicin 5 mg/kg/day IV q8h
- Congenital heart disease
- Preferred regimen: Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h
- Transplant recipients
- Preferred regimen: (Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h AND Voriconazole 8 mg/kg/day q12h AND (TMP-SMZ 1020 mg/kg/day q612h OR Sulfadiazine 46 g/day q6h)
- Patients with HIV/AIDS
- Preferred regimen: (Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h) AND Sulfadiazine 46 g/day q6h AND Pyrimethamine 25100 mg/day qd
- Staphylococcus aureus coverage
- Preferred regimen: Vancomycin 3045 mg/kg/day q812h
- Mycobacterium tuberculosis coverage
- Preferred regimen: Isoniazid 300 mg qd AND Rifampin 600 mg qd AND Pyrazinamide 1530 mg qd AND Ethambutol 15 mg/kg/day qd
- Pathogen-directed antimicrobial therapy
- Bacteria
- Actinomyces
- Preferred regimen: Penicillin G 4 MU IV q4h
- Alternative regimen: Clindamycin 24004800 mg/day IV q6h
- Bacteroides fragilis
- Preferred regimen: Metronidazole 30 mg/kg/day IV q6h
- Alternative regimen: Clindamycin 24004800 mg/day IV q6h
- Enterobacteriaceae
- Preferred regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Cefepime 2 g IV q12h
- Alternative regimen: Aztreonam 68 g/day IV q68h OR TMP-SMZ 1020 mg/kg/day q612h OR Ciprofloxacin 8001200 mg/day IV q812h OR Meropenem 2 g IV q8h
- Fusobacterium
- Preferred regimen: Metronidazole 30 mg/kg/day q6h
- Alternative regimen: Clindamycin 24004800 mg/day IV q6h OR Meropenem 2 g IV q8h
- Haemophilus
- Preferred regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Cefepime 2 g IV q12h
- Alternative regimen: Aztreonam 68 g/day IV q68h OR TMP-SMZ 1020 mg/kg/day q612h
- Listeria monocytogenes
- Preferred regimen: Ampicillin 12 g/day q4h OR Penicillin G 4 MU IV q4h
- Alternative regimen: TMP-SMZ 1020 mg/kg/day q612h
- Nocardia
- Preferred regimen: TMP-SMZ 1020 mg/kg/day q612h OR Sulfadiazine 46 g/day q6h
- Alternative regimen: Meropenem 2 g IV q8h OR Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Amikacin 15 mg/kg/day IV q8h
- Prevotella melaninogenica
- Preferred regimen: Metronidazole 30 mg/kg/day q6h
- Alternative regimen: Clindamycin 24004800 mg/day IV q6h OR Meropenem 2 g IV q8h
- Pseudomonas aeruginosa
- Preferred regimen: Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h
- Alternative regimen: Aztreonam 68 g/day IV q68h OR Ciprofloxacin 8001200 mg/day IV q812h OR Meropenem 2 g IV q8h
- Staphylococcus aureus, methicillin-susceptible
- Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
- Alternative regimen: Vancomycin 3045 mg/kg/day IV q812h
- Staphylococcus aureus, methicillin-resistant
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h
- Alternative regimen: TMP-SMZ 1020 mg/kg/day q612h
- Streptococcus
- Preferred regimen: Penicillin G 4 MU IV q4h OR Ampicillin 2 g IV q4h
- Alternative regimen: Cefotaxime 2 g IV q4-6h OR Ceftriaxone 2 g IV q12h OR Vancomycin 3045 mg/kg/day IV q812h
- Fungi
- Aspergillus
- Preferred regimen: Voriconazole 8 mg/kg/day q12h
- Alternative regimen: Amphotericin B deoxycholate 0.61.0 mg/kg/day IV q24h OR Amphotericin B lipid complex 5 mg/kg/day IV q24h OR Itraconazole 400600 mg/day IV q12h OR Posaconazole 800 mg/kg/day IV q612h
- Candida
- Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Alternative regimen: Fluconazole 400800 mg/day IV q24h
- Cryptococcus neoformans
- Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Alternative regimen: Fluconazole 400800 mg/day IV q24h
- Mucorales
- Preferred regimen: Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Alternative regimen: Posaconazole 800 mg/kg/day IV q612h
- Pseudallescheria boydii (Scedosporium apiospermum)
- Preferred regimen: Voriconazole 8 mg/kg/day q12h
- Alternative regimen: Itraconazole 400600 mg/day IV q12h OR Posaconazole 800 mg/kg/day IV q612h
- Protozoa
- Toxoplasma gondii
- Preferred regimen: Sulfadiazine 46 g/day q6h AND Pyrimethamine 25100 mg/day qd
- Alternative regimen (1): Pyrimethamine 25100 mg/day qd AND Clindamycin 24004800 mg/day IV q6h
- Alternative regimen (2): Pyrimethamine 25100 mg/day qd AND (Azithromycin 12001500 mg/day IV q24h OR Atovaquone 750 mg IV q6h OR Dapsone 100 mg PO q24h)
- Alternative regimen (3): TMP-SMZ 1020 mg/kg/day q612h