Sandbox g32
- Bacterial meningitis
- Empiric antimicrobial therapy based on specific predisposing factors
- Age
- Age < 1 month
- Common causative pathogens: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species
- Preferred regimen: Ampicillin 12 g/day IV q4h AND (Cefotaxime 812 g/day q46h OR Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Age 123 months
- Common causative pathogens: Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND (Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h)
- Age 250 years
- Common causative pathogens: N . meningitidis, S. pneumoniae
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND (Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h)
- Age > 50 years
- Common causative pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic Gram-negative bacilli
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND Ampicillin 12 g/day IV q4h AND (Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h)
- Head trauma
- Basilar skull fracture
- Common causative pathogens: S. pneumoniae, H. influenzae, group A -hemolytic streptococci
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND (Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h)
- Penetrating trauma
- Common causative pathogens: Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic Gram-negative bacilli (including Pseudomonas aeruginosa)
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- Postneurosurgery
- Common causative pathogens: Aerobic Gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- CSF shunt
- Common causative pathogens: Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic Gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- CSF Gram stain-directed antimicrobial therapy
- Gram positive, lancet-shaped diplococci suggestive of Streptococcus pneumoniae
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND (Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h)
- Alternative regimen: Meropenem 6 g/day IV q8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Gram negative diplococci suggestive of Neisseria meningitidis
- Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Alternative regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h OR Chloramphenicol 46 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Aztreonam 68 g/day IV q68h
- Gram positive, short bacilli suggestive of Listeria monocytogenes
- Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h)  (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Alternative regimen: Trimethoprim-Sulfamethoxazole 1020 mg/kg/day q612h OR Meropenem 6 g/day IV q8h
- Gram positive cocci in short chains suggestive of Streptococcus agalactiae
- Preferred regimen: (Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h)  (Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
- Alternative regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Gram negative coccobacilli suggestive of Haemophilus influenzae
- Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Alternative regimen: Chloramphenicol 46 g/day IV q6h OR Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Gram negative bacilli suggestive of Escherichia coli
- Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Alternative regimen: Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h OR Aztreonam 68 g/day IV q68h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Trimethoprim-Sulfamethoxazole 1020 mg/kg/day q612h
- Pathogen-directed antimicrobial therapy
- Streptococcus pneumoniae
- Penicillin MIC < 0.1 g/mL
- Preferred regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h
- Alternative regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h OR Chloramphenicol 46 g/day IV q6h
- Penicillin MIC 0.11.0 g/mL
- Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Alternative regimen: Cefepime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
- Penicillin MIC  2.0 g/mL
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND (Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h)
- Alternative regimen: Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Cefotaxime or ceftriaxone MIC  1.0 g/mL
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND (Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h)
- Alternative regimen: Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Neisseria meningitidis
- Penicillin MIC < 0.1 g/mL
- Preferred regimen: Penicillin G 24 MU/day IV q4h OR Ampicillin 12 g/day IV q4h
- Alternative regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h OR Chloramphenicol 46 g/day IV q6h
- Penicillin MIC 0.11.0 g/mL
- Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Alternative regimen: Chloramphenicol 46 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h
- Listeria monocytogenes
- Preferred regimen: Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h
- Alternative regimen: Trimethoprim-Sulfamethoxazole 1020 mg/kg/day q612h OR Meropenem 6 g/day IV q8h
- Streptococcus agalactiae
- Preferred regimen: Ampicillin 12 g/day IV q4h OR Penicillin G 24 MU/day IV q4h
- Alternative regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Escherichia coli and other Enterobacteriaceae
- Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Alternative regimen: Aztreonam 68 g/day IV q68h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h OR  Trimethoprim-Sulfamethoxazole 1020 mg/kg/day q612h OR Ampicillin 12 g/day IV q4h
- Pseudomonas aeruginosa
- Preferred regimen: Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h
- Alternative regimen: Aztreonam 68 g/day IV q68h OR Ciprofloxacin 8001200 mg IV q812h OR Meropenem 6 g/day IV q8h
- Haemophilus influenzae
- -Lactamase negative
- Preferred regimen: Ampicillin 12 g/day IV q4h
- Alternative regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h OR Cefepime 6 g/day IV q8h OR Chloramphenicol 46 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- -Lactamase positive
- Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- Alternative regimen: Cefepime 6 g/day IV q8h OR Chloramphenicol 46 g/day IV q6h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h
- Staphylococcus aureus
- Methicillin susceptible
- Preferred regimen: Nafcillin 912 g/day IV q4h OR Oxacillin 912 g/day IV q4h
- Alternative regimen: Vancomycin 3045 mg/kg/day IV q812h OR Meropenem 6 g/day IV q8h
- Methicillin resistant
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h
- Alternative regimen: Trimethoprim-Sulfamethoxazole 1020 mg/kg/day q612h OR Linezolid 600 mg IV q12h
- Staphylococcus epidermidis
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h
- Alternative regimen: Linezolid 600 mg IV q12h
- Enterococcus species
- Ampicillin susceptible
- Preferred regimen: Ampicillin 12 g/day IV q4h AND  Gentamicin 5 mg/kg/day IV q8h
- Ampicillin resistant
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND  Gentamicin 5 mg/kg/day IV q8h
- Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid 600 mg IV q12h
- Pediatric dose:
- Amikacin
- Neonates age 07 days: 1520 mg/kg/day q12h
- Neonates age 828 days: 30 mg/kg/day q8h
- Infants and children: 2030 mg/kg/day q8h
- Ampicillin
- Neonates age 07 days: 150 mg/kg/day q8h
- Neonates age 828 days: 200 mg/kg/day q68h
- Infants and children: 300 mg/kg/day q6h
- Cefepime
- Infants and children: 150 mg/kg/day q8h
- Cefotaxime
- Neonates age 07 days: 100150 mg/kg/day q812h
- Neonates age 828 days: 150200 mg/kg/day q68h
- Infants and children: 225300 mg/kg/day q68h
- Ceftazidime
- Neonates age 07 days: 100150 mg/kg/day q812h
- Neonates age 828 days: 150 mg/kg q8h
- Infants and children: 150 mg/kg
- Ceftriaxone
- Infants and children: 80100 mg/kg/day q1224h
- Chloramphenicol
- Neonates age 07 days: 25 mg/kg/day q24h
- Neonates age 828 days: 50 mg/kg/day q1224h
- Infants and children: 75100 mg/kg/day q6h
- Gentamicin
- Neonates age 07 days: 5 mg/kg/day q12h
- Neonates age 828 days: 7.5 mg/kg/day q8h
- Infants and children: 7.5 mg/kg/day q8h
- Meropenem
- Infants and children: 120 mg/kg/day q8h
- Nafcillin
- Neonates age 07 days: 75 mg/kg/day q812h
- Neonates age 828 days: 100150 mg/kg/day q68h
- Infants and children: 200 mg/kg/day q6h
- Oxacillin
- Neonates age 07 days: 75 mg/kg/day q812h
- Neonates age 828 days: 150200 mg/kg/day q68h
- Infants and children: 200 mg/kg/day q6h
- Penicillin G
- Neonates age 07 days: 0.15 MU/kg/day q812h
- Neonates age 828 days: 0.2 MU/kg/day q68h
- Infants and children: 0.3 MU/kg/day q46h
- Rifampin
- Neonates age 828 days: 1020 mg/kg/day q12h
- Infants and children: 1020 mg/kg/day q1224h
- Tobramycin
- Neonates age 07 days: 5 mg/kg/day q12h
- Neonates age 828 days: 7.5 mg/kg/day q8h
- Infants and children: 7.5 mg/kg/day q8h
- Trimethoprim-Sulfamethoxazole
- Infants and children: 1020 mg/kg q612h
- Vancomycin
- Neonates age 07 days: 2030 mg/kg/day q812h
- Neonates age 828 days: 3045 mg/kg/day q68h
- Infants and children: 60 mg/kg/day q6h
-  Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 12671284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903..mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}