Sandbox ID2

# Bacteria  Gram-Positive Cocci
- Enterococci
- Enterococcus faecalis
- Bacteremia
- Ampicillin or Penicillin susceptible : Ampicillin 2 g IV q4-6h OR (Ampicillin AND Gentamicin 1 mg/kg q8h).
- Ampicillin resistant and vancomycin susceptible or Penicillin allergy : (Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg q8h) OR Linezolid 600 mg q12h OR Daptomycin 6 mg/kg per day.
- Ampicillin and Vancomycin resistant : Linezolid 600 mg q12h OR Daptomycin 6 mg/kg IV per day
- Endocarditis in Adults 
- Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen : (Ampicillin 12 g/day IV for 46weeks OR Aqueous crystalline penicillin G sodium 1830 MU/day IV for 46weeks) AND Gentamicin sulfate 3 mg/kg/day IV/IM for 46 weeks
- Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness 3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
- Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen : (Ampicillin 12 g/day IV for 46 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV for 46weeks)AND Streptomycin sulfate 15 mg/kg/day IV/IM for 46weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV 6weeks AND Streptomycin sulfate 15 mg/kg per 24 h IV/IM for 6weeks
- Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
-  Lactamaseproducing strain
- Preferred regimen : Ampicillin-sulbactam 12 g/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM 6weeks
- Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- Intrinsic penicillin resistance : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen : (Imipenem OR Cilastatin 2 g/day IV for  8weeks AND Ampicillin 12 g/day IV for  8weeks) OR (Ceftriaxone sodium 4 g/day IV/IM for  8weeks AND Ampicillin 12 g/day IV for  8weeks)
- Endocarditis in Pediatrics
- Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen : (Ampicillin 300 mg/kg/day IV for 46 weeks OR Penicillin 300,000U/kg/day IV for 46 weeks) AND Gentamicin 3 mg/kg per 24 h IV/IM 46 weeks
- Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness 3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen : (Ampicillin 300 mg/kg/day IV for 46 weeks OR Penicillin 300,000 U/kg/day IV for 46 weeks) AND Streptomycin 2030 mg/kg/day IV/IM for 46 weeks
- Alternate regimen: Vancomycin hydrochloride 40 mg/kg/day IV for 6weeks AND Streptomycin sulfate 15 mg/kg/day IV/IM for 6weeks
- Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
-  Lactamaseproducing strain
- Preferred regimen : Ampicillin-sulbactam 300 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Intrinsic penicillin resistance : Vancomycin 40 mg/kg/day IV AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen : Imipenem/cilastatin 60100 mg/kg/day IV for  8weeks AND Ampicillin 300 mg/kg/day IVfor  8weeks
- Alternate regimen : Ceftriaxone 100 mg/kg/day IV/IM  AND Ampicillin 300 mg/kg/day IV for  8weeks
- Meningitis
- 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
- Urinary tract infections 
- Preferred regimen : Nitrofurantoin 100 mg PO q6h for 5 days OR Fosfomycin 3 g PO single dose OR Amoxicillin 875 mg-1 g PO q12h for 5 days
- Intra abdominal or Wound infections 
- Penicillin or Ampicillin are preferred agents, Vancomycin in setting of penicillin allergy or high-level penicillin resistance.
- For complicated skin-skin structure and intra-abdominal infection : Tigecycline 100 mg IV single dose and 50 mg IV q12h
- Enterococcus faecium
- Bacteremia
- Ampicillin or Penicillin susceptible : Ampicillin 2 g IV q4-6h OR (Ampicillin AND Gentamicin 1 mg/kg q8h).
- Ampicillin resistant and vancomycin susceptible or Penicillin allergy : (Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg q8h) OR Linezolid 600 mg q12h OR Daptomycin 6 mg/kg per day.
- Ampicillin and Vancomycin resistant : Linezolid 600 mg q12h OR Daptomycin 6 mg/kg IV per day
- Endocarditis in Adults 
- Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen : (Ampicillin 12 g/day IV for 46weeks OR Aqueous crystalline penicillin G sodium 1830 MU/day IV for 46weeks) AND Gentamicin sulfate 3 mg/kg/day IV/IM for 46 weeks
- Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness 3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
- Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen : (Ampicillin 12 g/day IV for 46 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV for 46weeks)AND Streptomycin sulfate 15 mg/kg/day IV/IM for 46weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV 6weeks AND Streptomycin sulfate 15 mg/kg per 24 h IV/IM for 6weeks
- Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
-  Lactamaseproducing strain
- Preferred regimen : Ampicillin-sulbactam 12 g/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM 6weeks
- Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- Intrinsic penicillin resistance : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen : Linezolid 1200 mg/day IV/PO 8weeks OR Quinupristin-Dalfopristin22.5 mg/kg/day IV 8weeks
- Endocarditis in Pediatrics
- Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen : (Ampicillin 300 mg/kg/day IV for 46 weeks OR Penicillin 300,000U/kg/day IV for 46 weeks) AND Gentamicin 3 mg/kg per 24 h IV/IM 46 weeks
- Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness 3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen : (Ampicillin 300 mg/kg/day IV for 46 weeks OR Penicillin 300,000 U/kg/day IV for 46 weeks) AND Streptomycin 2030 mg/kg/day IV/IM for 46 weeks
- Alternate regimen: Vancomycin hydrochloride 40 mg/kg/day IV for 6weeks AND Streptomycin sulfate 15 mg/kg/day IV/IM for 6weeks
- Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
-  Lactamaseproducing strain
- Preferred regimen : Ampicillin-sulbactam 300 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Intrinsic penicillin resistance : Vancomycin 40 mg/kg/day IV AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen : Linezolid 30 mg/kg/day IV/PO  8weeks OR Quinupristin-Dalfopristin22.5 mg/kg/day IV  8weeks
- Meningitis
- 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
- Urinary tract infections 
- Preferred regimen : Nitrofurantoin 100 mg PO q6h for 5 days OR Fosfomycin 3 g PO single dose OR Amoxicillin 875 mg-1 g PO q12h for 5 days
- Intra abdominal or Wound infections 
- Penicillin or Ampicillin are preferred agents, Vancomycin in setting of penicillin allergy or high-level penicillin resistance.
- For complicated skin-skin structure and intra-abdominal infection : Tigecycline 100 mg IV single dose and 50 mg IV q12h
- Staphylococci
- Staphylococcus aureus
- (1)Infectious endocarditis
- In adults
- Preferred regimen: Vancomycin, 15-20 mg/kg IV q8-12h OR Daptomycin 6mg/kg/dose IV qd
- (2) Intravascular catheter-related infections
- Methicillin susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Nafcillin  2 g IV q6h OR Oxacillin, 2 g IV q6h.
- Alternative regimen: Cefazolin, 2 g IV q8h OR Vancomycin, 15 mg/kg IV q12h.
- Pediatric dose:
- Nafcillin
- Neonates
- 04 weeks of age and 1200 g- 50 mg/kg/day  q12h.
- 7 days and 12002000 g- 50 mg/kg/day  q12h.
- >7 days of age and <2000g- 75 mg/kg/day  q8h.
- >7 days of age and >1200 g - 100 mg/kg/day  q6h.
- Oxacillin
- Neonates
- 04 weeks of age and 1200 g - 50 mg/kg/day q12h.
- Postnatal age <7 days and 12002000 g- 50100 mg/kg/day q12h.
- Postnatal age 2000 g, 75150 mg/kg/day q8h.
- Postnatal age 7 days and 12002000 g- 75150 mg/kg/day q8h.
- Postnatal age 7 days and >2000 g, 100200 mg/kg/day q6h.
- Infants and children Nafcillin 100200 mg/kg/day q46h.
- Cefazolin
- Neonates
- Postnatal age 7 days: 40 mg/kg/day q12h.
- Postnatal age >7 days and 2000 g: 40 mg/kg/day q12h.
- Postnatal age >7 days and 12000 g: 60 mg/kg/day q8h.
- Infants and children: 50 mg/kg/day q8h.
- Vancomycin
- Neonates
- Postnatal age 7 days and <1200 g, 15 mg/kg/day q24h.
- Postnatal age 7 days and 12002000 g, 1015 mg/kg q1218h.
- Postnatal age 7 days and >2000 g, 1015 mg/kg q812h.
- Postnatal age >7 days and <1200 g, 15 mg/kg/day q24h.
- Postnatal age >7 days and 12002000 g, 1015 mg/kg q812h.
- Postnatal age >7 days and >2000 g, 1520 mg/kg q8h.
- Infants and children: 40 mg/kg/day q68h.
- Methicillin resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin, 15 mg/kg IV q12h OR Daptomycin, 68 mg/kg per day IV, or Linezolid 10 mg/kg q 12 hr IV or PO ; OR Vancomycin 15 mg/kg IV q12h AND (Rifampicin IV or Gentamycin IV); or Trimethoprim-Sulfamethoxazole 612 mg TMP/kg/day in divided doses q12h alone (if susceptible).
- Pediatric dose
- Linezolid 10 mg/kg IV or PO q12h
- Neonates
- 04 weeks of age and birthweight <1200 g: 10 mg/kg q812h (note: q12h in patients <34 weeks gestation and <1 week of age).
- 1200 g, 10 mg/kg q812h (note: q12h in patients <34 weeks gestation and <1 week of age).
- 7 days and birthweight >1200 g, 10 mg/kg q8h.
- Infants and children <12 years of age: 10 mg/kg q8h Children 12 years of age and adolescents: 10 mg/kg q12h.
- Gentamycin
- Neonates
- Premature neonates and <1000 g, 3.5 mg/kg q24h; 04 weeks and <1200 g, 2.5 mg/kg q18-24h.
- Postnatal age 7 days: 2.5 mg/kg q12h.
- Postnatal age 17 days and 12002000 g, 2.5 mg/kg q8-12h.
- Postnatal age 17 days and 12000 g, 2.5 mg/kg q8h.
- Once daily dosing for premature neonates with normal renal function, 3.54 mg/kg q24h.
- Once daily dosing for term neonates with normal renal function, 3.55 mg/kg q24h.
- Infants and children <5 years of age: 2.5 mg/kg q8h; qd dosing in patients with normal renal function, 57.5 mg/kg q24h.
- Children >5 years of age: 22.5 mg/kg q8h; qd s with normal renal function, 57.5 mg/kg every 24 h.
- Trimethoprim-Sulfamethoxazole
- Infants 12 months of age and children: mild-to-moderate infections, 612 mg TMP/kg/day  q12h; serious infection, 1520 mg TMP/kg/day  q6-8h.
- (3) Purulent cellulitis (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)
- In adults
- Preferred regimen: Clindamycin 300450 mg PO TID OR Trimethoprim-Sulfamethoxazole 12 DS tab PO BID OR Doxycycline 100 mg PO BID OR Minocycline 200 mg as a single dose, then 100 mg PO BID OR Linezolid 600 mg PO BID
- In childern
- Preferred regimen: Clindamycin 1013 mg/kg/dose PO q68 h, not to exceed 40 mg/kg/day OR Trimethoprim 46 mg/kg, Sulfamethoxazole 2030 mg/kg PO q12h OR Doxycycline If patient body weight <45kg: 2 mg/kg/dose PO q12 h.
- Nonpurulent cellulitis (defined as cellulitis with no purulent drainage or exudate and no associated abscess)
- In adults
- Preferred regimen: Beta-lactam (eg, Cephalexin and Dicloxacillin) 500 mg PO QID OR Clindamycin 300450 mg PO TID OR Amoxicillin 500 PO mg TID OR Linezolid 600 mg PO BID
- In childern
- Preferred regimen: Clindamycin 1013 mg/kg PO q68 h, not to exceed 40 mg/kg/day OR  Trimethoprim 46 mg/kg, Sulfamethoxazole 2030 mg/kg PO q12h OR Linezolid 10 mg/kg PO q8h, not to exceed 600 mg
- (4) Brain abscess
- Methicillin-resistant Staphylococcus aureus (MRSA)
- In adults
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h for 46 weeks
- Alternative regimen: Linezolid 600 mg PO/IV q12h for 46 weeks OR Trimethoprim-Sulfamethoxazole 5 mg/kg/dose PO/IV q812h for 46 weeks
- In childern
- Preferred regimen: Vancomycin15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
- Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
- Alternative regimen: Vancomycin 3045 mg/kg/day IV q812h
- (5) Cerebrospinal fluid shunt infection 
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h AND/OR Rifampin 600 mg IV or PO q24h
- Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: (Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h) AND/OR Rifampin 600 mg IV/PO q24h
- (6) Spinal epidural abscess 
- Penicillin-susceptible Staphylococcus aureus or Streptococcus
- Preferred regimen: Penicillin G 4 MU IV q4h for 24 weeks, then PO to complete 68 weeks
- Methicillin-susceptible Staphylococcus aureus or Streptococcus
- Preferred regimen: Cefazolin 2 g IV q8h for 24 weeks, then PO to complete 68 weeks OR Nafcillin 2 g IV q4h for 24 weeks, then PO to complete 68 weeks OR Oxacillin 2 g IV q4h for 24 weeks, then PO to complete 68 weeks
- Alternative regimen: Clindamycin 600 mg IV q6h for 24 weeks, then PO to complete 68 weeks
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin loading dose 2530 mg/kg IV followed by 1520 mg/kg IV q812h for 24 weeks, then PO to complete 68 weeks
- Alternative regimen: Linezolid 600 mg PO or IV q12h for 46 weeks OR TMP-SMX 5 mg/kg PO or IV q812h for 46 weeks
- Pediatric dose: Vancomycin 15 mg/kg IV q6h OR Linezolid 10 mg/kg PO or IV q8h
- (7) Bacterial meningitis
- Methicillin susceptible Staphylococcus aureus (MSSA)
- 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 Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h
- Alternative regimen: Trimethoprim-Sulfamethoxazole 1020 mg/kg/day q612h OR Linezolid 600 mg IV q12h
- (8) Septic thrombosis of cavernous or dural venous sinus
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 1520 mg/kg IV q812h for 46 weeks
- Alternative regimen: Linezolid 600 mg PO IV q12h for 46 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q812h for 46 weeks
- Pediatric dose: Vancomycin 15 mg/kg IV q6h OR Linezolid 10 mg/kg PO or IV q8h
- (9) Subdural empyema
- Methicillin-resistant Staphylococcus aureus (MRSA)
- In adults
- Preferred regimen: Vancomycin 3045 mg/kg/day IV q812h for 46 weeks
- Alternative regimen: Linezolid 600 mg PO or IV q12h for 46 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q812h for 46 weeks
- In childern
- Preferred regimen: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
- (10) Acute conjunctivitis 
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin ointment 1% qid
- (11) Appendicitis
- (12) Diverticulitis
- Preferred regimen: Vancomycin 1520 mg/kg IV q812h.
- (13) Peritonitis secondary to bowel  perforation, peritonitis secondary to ruptured  appendix, peritonitis secondary to ruptured  appendix, typhlitis
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 1520 mg/kg IV q812h
- (14) Cystic fibrosis 
- Preferred Regimen (Adult)
- If methicillin sensitive staphylococcus aureus: Nafcillin 2 gm IV q4hs OR Oxacillin 2 gm IV q4hs
- If methicillin resistant staphylococcus aureus: Vancomycin 15-20 mg/kg IV q8-12h OR Linezolid 600 mg po/IV q12h
- Preferred regimen (Pediatric)
- If methicillin sensitive staphylococcus aureus: Nafcillin 5 mg/kg q6h (Age >28 days) OR Oxacillin 75 mg/kg q6h (Age >28 days)]]
- If methicillin resistant staphylococcus aureus: Vancomycin 40 mg/kg  q6-8h (Age >28 days) OR Linezolid 10 mg/kg po or IV q8h (up to age 12)
- (15) Bronchiectasis 
- (a) Preferred Regimen in adults
- Recommended first-line treatment and length of treatment
- Recommended second-line treatment and length of treatment
- (b) Preferred Regimen in children
- Recommended first-line treatment and length of treatment
- Recommended second-line treatment and length of treatment
- (B)Long-term oral antibiotic treatment
- (a) Preferred Regimen in adults
- Recommended first-line treatment and length of treatment
- Recommended second-line treatment and length of treatment
- (16) Empyema
- Preferred regimen: Nafcillin  2 gm IV q4h OR oxacillin  2 gm IV q4h if MSSA
- Alternate regimen: Vancomycin  1 gm IV q12h OR Linezolid  600 mg po bid if MRSA
- (17) Community-acquired pneumonia
- Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred Regimen : Nafcillin 1000-2000 mg q4h OR Oxacillin 2 g IV q4h OR Flucloxacillin 250 mg IM/IV q6h
- Alternative Regimen : Cefazolin 500 mg IV q12h OR Clindamycin 150-450 mg PO q6-8h
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR Linezolid 600 mg PO/IV q12h for 10-14 days
- Alternative Regimen: Trimethoprim-Sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h
- (18) Olecranon bursitis or prepatellar bursitis
- Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h OR Dicloxacillin 500 mg PO qid
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 1 g IV q12h OR Linezolid 600 mg PO qd
- (19) Septic arthritis
- In adults
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regime: Vancomycin 1520 mg/kg IV q812h
- Alternative regimen (1): Daptomycin 6 mg/kg IV q24h in adults
- Alternative regimen (2): Linezolid 600 mg PO/IV q12h
- Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
- Alternative regimen (4): TMP-SMX 3.54.0 mg/kg PO/IV q812h
- In childern
- Preferred regimen: Vancomycin 15 mg/kg IV q6h OR Daptomycin 610 mg/kg IV q24h OR Linezolid 10 mg/kg PO/IV q8h OR Clindamycin 1013 mg/kg/dose PO/IV q68h
- Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regime: Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h
- Alternative regime: Cefazolin 0.251 g IV/IM q68h OR Vancomycin 500 mg IV q6h or 1 g IV q12h
- (20)  Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)
- Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Nafcillin 2 g IV q46h OR Oxacillin 2 g IV q46h
- Alternative regimen: Cefazolin 12 g IV q8h OR Ceftriaxone 2 g IV q24h
- Alternative regimen (if allergic to penicillins): Clindamycin 900 mg IV q8h OR Vancomycin 1520 mg/kg IV q812 hours, not to exceed 2 g per dose
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Early-onset (< 2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
- Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300450 mg PO bid for 2 weeks
- Alternative regimen: (Daptomycin 6 mg/kg IV q24h OR Linezolid 600 IV q8h) AND Rifampin 600 mg PO qd or 300450 mg PO bid for 2 weeks
- (21) Hematogenous osteomyelitis
- Adult (>21 yrs)
- Methicillin-resistant Staphylococcus aureus (MRSA) possible
- Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
- Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
- Preferred regimen: Nafcillin OR Oxacillin 2 gm IV q4h
- Children (>4 mos.)-Adult
- Methicillin-resistant Staphylococcus aureus (MRSA) possible
- Preferred regimen: Vancomycin 40 div q68h
- Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
- Preferred regimen: Nafcillin OR Oxacillin 37 q6h (to max. 812 gm per day)
- Newborn (<4 mos.)
- Methicillin-resistant Staphylococcus aureus (MRSA) possible
- Preferred regimen: Vancomycin AND (Ceftazidime 2 gm IV q8h or Cefepime 2 gm IV q12h)
- Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
- Preferred regimen: (Nafcillin OR Oxacillin) AND (Ceftazidime OR Cefepime)
- Specific therapy
- Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Nafcillin OR Oxacillin 2 gm IV q4h OR Cefazolin 2 gm IV q8h
- Alternative regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 1 gm IV q12h
- Alternative regimen: Linezolid 600 mg q12h IV/po  Rifampin 300 mg po/IV bid
- (22) Diabetic foot osteomyelitis
- High Risk for MRSA
- Preferred regimen: Linezolid 600 mg IV/PO q12h OR Daptomycin 4 mg/kg IV q24h OR Vancomycin 1520 mg/kg IV q812h (trough: 1020 mg/L)
- (23) Necrotizing fasciitis
- In adult
- Preferred regimen (1): Nafcillin 12 g IV  q4h (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
- Preferred regimen (2): Oxacillin 12 g IV  q4h
- Preferred regimen (3): Cefazolin 1 g IV  q8h
- Preferred regimen (4): Vancomycin 15 mg/kg IV bid
- Preferred regimen (5): Clindamycin 600900 mg IV  q8h
- In childern
- Preferred regimen (1): Nafcillin 50 mg/kg/dose IV  q6h  (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
- Preferred regimen (2): Oxacillin 50 mg/kg/dose IV q6h
- Preferred regimen (3): Cefazolin 33 mg/kg/dose IV q8h
- Preferred regimen (4): Vancomycin 15 mg/kg/dose IV q6h
- Preferred regimen (5): Clindamycin 1013 mg/kg/dose IV q8h  (Bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)
- (24)  Staphylococcal toxic shock syndrome 
- Methicillin sensitive Staphylococcus aureus
- Preferred regimen: Cloxacillin  250-500 mg PO q6h (max dose: 4 g/24 hr) OR Nafcillin  4-12 g/24 hr divided IV q4-6hr (max dose: 12 g/24 hr) OR Cefazolin 0.5-2g  IV or IM q8h (max dose: 12 g/24 hr), AND Clindamycin 150-600 mg IV, IM, or PO q6-8h  (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
- Alternative regimen (1):Clarithromycin 250-500 mg PO q12h (max dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV, IM, or PO q6-8h  (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
- Alternative regimen (1):Rifampicin, AND Linezolid 600 mg IV or PO q12h  OR Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg  IV q12h
- Methicillin resistant Staphylococcus  aureus
- Preferred regimen: Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) OR Linezolid 600 mg IV or PO q12h AND Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose or Teicoplanin
- Alternative regimen (1):Rifampicin, AND Linezolid 600 mg q12h IV or PO OR Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg q12h IV
- Glycopeptide resistant or intermediate Staphylococcus aureus
- Preferred regimen: Linezolid 600 mg IV or PO q12h AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) (if sensitive)
- Alternative regimen (1):Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg IV q12h
- Prophylaxis for coronary artery bypass graft-associated acute mediastinitis
- Methicillin susceptible staphylococcus aureus (MSSA)
- Preferred regimen: A first- or second-generation Cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.
- Methicillin resistant staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected methicillin-resistant S. aureus colonization
- Staphylococcus, coagulase-negative species (CoNS)
- Staphylococcus epidermidis group (Staphylococcus epidermidis, Staphylococcus haemolyticus)
- 1. Bacteremia: most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h AND Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 2. CSF shunt: meningitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg IV/PO q8h for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg IV/PO q8h.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 3. Peritoneal dialysis catheter: peritonitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 4. Prosthetic joint: septic arthritis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 5. Prosthetic or natural cardiac valve: endocarditis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 6. Post-sternotomy: osteomyelitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 7. Implants (breast, penile, pacemaker) and other prosthetic devices: local infection
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 8. Post-ocular surgery: endophthalmitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 9. Surgical site infections
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Staphylococcus lugdunensis
- 1. Postpartum mastitis with or without abscess 
- Preferred regimen: In outpatient is Dicloxacillin 500 mg po qid OR Cephalexin 500 mg po qid and in inpatient is  Oxacillin OR Nafcillin 2 gm IV q4h
- Alternative regimen: In outpatient is Trimethoprim-Sulfamethoxazole-DS tabs 1-2 po bid or, if susceptible, Clindamycin 300 mg po qid and in inpatient is Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.
- 2.  Non-puerperal mastitis with abscess
- Preferred regimen: In outpatient is Dicloxacillin 500 mg po qid OR Cephalexin 500 mg po qid and in inpatient is  Oxacillin OR Nafcillin 2 gm IV q4h
- Alternative regimen: In outpatient is Trimethoprim-Sulfamethoxazole-DS tabs 1-2 po bid or, if susceptible, Clindamycin 300 mg po qid and in inpatient is Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.
- Staphylococcus saprophyticus
- 1. Urinary tract infection 
- 1.1 Acute uncomplicated urinary tract infection (cystitis-urethritis) in females
- Preferred regimen :  Cephalosporin PO OR  Amoxicillin-Clavulanate 625 mg PO OR Trimethoprim-Sulfamethoxazole-DS bid for 3 days; if sulfa allergy, Nitrofurantoin 100 mg po bid for 5 days OR Fosfomycin 3 gm po as a single dose AND Pyridium.
- Alternative regimen (in sulfa allergy): then 3 days of Ciprofloxacin 250 mg bid OR Ciprofloxacin-Erythromycin 500 mg q24h OR Levofloxacin 250 mg q24h OR Moxifloxacin 400 mg q24h OR Nitrofurantoin 100 mg bid OR Fosfomycin single 3 gm dose AND Phenazopyridine Pyridium 200 mg po tid times 2 days.
- 1.2 Recurrent urinary tract infection in postmenopausal women
- Preferred regimen : Trimethoprim-Sulfamethoxazole-DS bid for 3 days; if sulfa allergy, Nitrofurantoin 100 mg po bid for 5 days OR Fosfomycin 3 gm po as a single dose AND Pyridium.
- Alternative regimen (in sulfa allergy): then 3 days of Ciprofloxacin 250 mg bid OR Ciprofloxacin-Erythromycin 500 mg q24h OR Levofloxacin 250 mg q24h OR Moxifloxacin 400 mg q24h OR Nitrofurantoin 100 mg bid OR Fosfomycin single 3 gm dose AND Phenazopyridine Pyridium 200 mg po tid times 2 days.
- Streptococci
- Streptobacillus moniliformis
- Streptococcus moniliformis treatment
- 1. Migratory arthropathy and arthritis
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 2. Diarrhea, (especially kids) liver or spleen abscess
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 3. Undifferentiated fever
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 4. Endocarditis, myocarditis, pericarditis (cardiac)
- Preferred regimen: Penicillin 20 MU/day IV divided q4h. Optimal duration recommendation for infective endocarditis is 4 weeks.
- Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.
- 5. Meningitis, brain abscess
- Preferred regimen: Penicillin 20 MU/day IV divided q4h.
- Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.
- 6. Anemia
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 7.  Pneumonia
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 8. Amnionitis (pregnancy)
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 9. Renal abscess
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- Streptococcus anginosus
Group comprises 3-15% of streptococcal isolates of endocarditis. See Diagnosis section for Endocarditis module for management, follow viridans Streptococci recommendations.
Dental abscesses, sinusitis, fasciitis of head and neck: can be life threatening and require aggressive surgical management. See appropriate HEENT module for specific management.
Bacteremia often associated with deep-seated abscess. Investigate for abscessmost often intraabdominal. Drainage is usually recommended.
Brain abscesses often polymicrobial, but S. intermedius found in 50-80%. See Brain abscess module for management.
Implicated in aspiration pneumonia, lung abscess and empyema.
- Preferred regimen: Penicillin G 2-4 MU IV q4h .
- Alternative regimen: Ceftriaxone 2 g IV qd; Clindamycin 600-900 mg IV q8h or 300-450 mg PO qid OR Vancomycin 15 mg/kg IV q12h ([[Penicillin-allergic).
- Streptococcus pneumoniae
- Streptococcus pneumonia treatment
- 1. Lung (pneumonia)
- Community-acquired  pneumonia
- Penicillin sensitive (minimum inhibitory concentration  2)
- Preferred regimen: Penicillin G 1-2 MU q6h IV OR Ceftriaxone 2 g IV q24h OR Cefotaxime 1-2 g IV q6-8h.
- Penicillin-resistant (Penicillin minimum inhibitory concentration >8)
- Preferred regimen:: Levofloxacin (Levaquin) 750 mg OR Moxifloxacin (Avelox) 400 mg IV/PO q24h, Telithromycin (Ketek) 800 mg PO qd, Ceftriaxone IV, Cefotaxime IV, Vancomycin 15 mg/kg IV q12h OR Linezolid 600 mg IV/PO q12h.
- 2. Sinuses (sinusitis)
- Sinusitis (empiric therapy)
- Preferred regimen: amoxicillin 500-1000 mg PO tid OR Amoxicillin/Clavulanate 875/125 mg PO bd.
- 3. Middle ear (otitis media)
- (4)Bronchi (acute exacerbation of chronic bronchitis)
- Preferred regimen: amoxicillin 2-3 PO g/day OR Doxycycline 100 mg PO bd.
- (5)CNS (meningitis)
- Empiric therapy
- In age group of 1 months 50 years
Adult dosage: (Cefotaxime 2 gm IV q46h OR Ceftriaxone 2 gm IV q12h) AND Dexamethasone AND  Vancomycin 15 mg/kg/day IV q12h
- Preferred regimen: Vancomycin 15 mg/kg/day IV q12h AND Ceftriaxone 2 g IV q12h OR Cefotaxime 2 g IV q4h or 3 g q6h.
- Penicillin sensitive (minimum inhibitory concentration  0.06)
- Preferred regimen: Ceftriaxone 2 g IV q12h, OR  Cefotaxime 2 g IV q4h or 3 g IV q6h.
- Penicillin resistant (minimum inhibitory concentration  0.12) or beta-lactam hypersensitivity
- Preferred regimen: Vancomycin 30-45 mg/kg/day IV.
- (6)Peritoneum (spontaneous bacterial peritonitis)
- (7)Pericardium (purulent pericarditis)
- (8)Skin (cellulitis)
- (9)Eye (conjunctivitis)
- Streptococcus pyogenes
- (1) Pharyngitis
- Preferred regimen: Penicillin-benzathine]] Penicillin 1.2 mU IM  once OR  Penicillin VK 500 mg PO bd or tid for 10 days.
- Alternative regimen (1): Amoxicillin 750 PO bd or tid for 10 days.
- Alternative regimen (Penicillin allergy): Erythromycin 500 mg PO bd or tid for 10 days OR (Azithromycin 500 mg, then 250 mg for 5 days, Clarithromycin (Biaxin) 1 g XR/day or 500 mg bd for 10 days. Note: 5-10% isolates are macrolide resistant) OR Cefpodoxime proxetil (Vantin) 200 mg bd for 5 days OR Cefdinir 300 mg bd PO for 5 days OR Cefadroxil 500 mg bd PO for 5 days OR Loracarbef 200 mg PO bd for 5 days.
- (2) Skin: erysipelas, lymphangitis, cellulitis
- Preferred regimen: Clindamycin 600 mg IV q8h AND Penicillin G G 4 mU IV q4h. (clindamycin to stop toxin production).
- Alternative regimen: Penicillin G 2-4 mU IV q4h OR Clindamycin 600 mg IV q8h OR Cefazolin 1-2 g IV q6-8h OR Cefotaxime 2-3 g IV q6-8h OR Ceftriaxone 2 g/day IV OR Vancomycin 15 mg/kg IV q12h.
- (3) Soft tissue
- Necrotizing fasciitis: surgical consultation for emergent fasciotomy and debridement; repeat debridements usually necessary.
- (4) Muscle
- Myositis: debirdement
- (5) Endometrium
- (6) Puerperal sepsis
- (7) Lung
- pneumonia with or without early bloody effusion Bacteremia
- (8) Cardiac are endocarditis (very rare in antibiotic era)
- (9) Toxin mediated
- Scarlet fever
- Toxic shock syndrome
- Preferred regimen: Immunoglobulin-G  2 or more doses IV , massive IV fluids (10-20 L/day), Albumin if <2 g/dL, debridement of necrotic tissue.
- (10)Non-suppurative complications are rheumatic fever and glomerulonephritis
- Prophylaxis
- Acute rheumatic fever prophylaxis
- Preferred regimen: Benzathine Penicillin 1.2 mu IM q mo, Penicillin V 250 mg PO bd, Erythromycin 250 mg PO bd until >5 yrs post-acute rheumatic fever and age in 20years.
- Recurrent cellulitis, chronic lymphedema prophylaxis
- Preferred regimen: Clindamycin 150 mg PO qd OR Trimethoprim-Sulfamethoxaole 1 DS PO qd OR stand-by therapy immediate treatment with Penicillin V OR Amoxicillin 500-750 mg PO bd at onset of symptoms.
- Streptococcus agalactiae

# Bacteria  Gram-Positive Bacilli
- Actinomyces israelii
- Arcanobacterium haemolyticum
- Bacillus
- Bacillus anthracis, treatment
- (A) Treatment for cutaneous anthrax, without systemic involvement
- Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown): Ciprofloxacin 500 mg PO q12h OR Doxycycline 100 mg PO q12h OR Levofloxacin 750 mg PO q24h OR Moxifloxacin 400 mg PO q24h
- Alternative regimen: Clindamycin 600 mg PO q8h OR Amoxicillin 1 g PO q8h (for penicillin-susceptible strains) OR Penicillin VK 500 mg PO q6h (for penicillin-susceptible strains)
- (B) Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck
- (B-1) Systemic anthrax with possible/confirmed meningitis
- (1) Bactericidal agent (fluoroquinolone): Ciprofloxacin 400 mg IV q8h (OR Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h) AND
- (2) Bactericidal agent (-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Meropenem 2 g IV q8h OR Imipenem 1 g IV q6h OR Doripenem 500 mg IV q8h OR Penicillin G 4 MU IV q4h (for penicillin-susceptible strains) OR Ampicillin 3 g IV q6h (for penicillin-susceptible strains) AND
- (3) Protein synthesis inhibitor: Linezolid 600 mg IV q12h OR Clindamycin 900 mg IV q8h OR Rifampin 600 mg IV q12h OR Chloramphenicol 1 g IV q6-8h
- (B-2) Systemic anthrax when meningitis has been excluded
- (1) Bactericidal agent: Ciprofloxacin 400 mg IV q8h OR Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg q24h OR Meropenem 2 g IV q8h OR Imipenem 1 g IV q6h OR Doripenem 500 mg IV q8h OR Vancomycin 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 g/mL) OR Penicillin G 4 MU IV q4h (penicillin-susceptible strains) OR Ampicillin 3 g IV q6h (penicillin-susceptible strains) AND
- (2) Protein synthesis inhibitor: Clindamycin 900 mg IV q8h OR Linezolid 600 mg IV q12h OR Doxycycline 200 mg IV initially, then 100 mg IV q12h OR Rifampin 600 mg IV q12h
- Specific considerations
- Treatment of anthrax for pregnant Women
- (A) Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis 
- (1) A Bactericidal Agent (Fluoroquinolone): Ciprofloxacin 400 mg IV q8h is preferred, OR  Levofloxacin 750 mg IV q24h, OR
- (2). A Bactericidal Agent (-lactam)
- (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : Meropenem 2 g q8h,OR
- (b). Alternatives for penicillin-susceptible strains: Ampicillin 3 g IV q6h,OR Penicillin G 4 million units IV q4h, OR
- (3). A Protein Synthesis Inhibitor: Clindamycin 900 IV mg q8h,OR  Rifampin 600 IV mg q12h
- (B) Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded
- (1). A Bactericidal Antimicrobial: Ciprofloxacin 400 mg IV q8h is preferred, OR  Levofloxacin 750 mg IV q24h, OR
- (2). A Bactericidal Agent (-lactam)
- (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : Meropenem 2 g q8h,OR
- (b). Alternatives for penicillin-susceptible strains:Ampicillin 3 g IV q6h,OR Penicillin G 4 million units IV q4h, OR
- (3). A Protein Synthesis Inhibitor:Clindamycin 900 IV mg q8h,OR  Rifampin 600 IV mg q12h
- (C) Oral antimicrobial treatment for cutaneous anthrax without systemic involvement
- (a).For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Ciprofloxacin 400 mg IV q8h is preferred.
- Treatment for anthrax in children 
- (1). Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)
- (A). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown : Ciprofloxacin, 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) OR Doxycycline, 50 kg: 500 mg, PO, given q24h OR
- (B). Alternatives for penicillin-susceptible strains: Amoxicillin, 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose) OR Penicillin VK, 50-75 mg/kg/day, PO, divided q6h to q8h
- (2). Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)
- (A). A bactericidal antimicrobial
- (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Ciprofloxacin, 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose) OR Meropenem, 60 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) OR Levofloxacin 50 kg: 500 mg, IV, q24h OR Imipenem/Cilastatin,a 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) OR Vancomycin, 60 mg/kg/day, IV, divided q8h (follow serum concentrations)
- (b). Alternatives for penicillin-susceptible strains: Penicillin G, 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose) OR Ampicillin, 200 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) AND
- (B). A Protein Synthesis Inhibitor: Clindamycin, 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose) OR Linezolid (non-CNS infection dose): <12 y old: 30 mg/kg/day, IV, divided q8h 12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) OR Doxycycline <45 kg: 4.4 mg/kg/day, IV, loading dose (not to exceed 200 mg); 45 kg: 200 mg, IV, loading dose then <45 kg: 4.4 mg/kg/day, IV, divided q12h   (not to exceed 100 mg/dose); 45 kg: 100 mg, IV, given q12h OR Rifampin,d 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)
- (3).Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older
- (A). A bactericidal antimicrobial (fluoroquinolone): Ciprofloxacin, 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose)OR Levofloxacin 50 kg: 500 mg, IV, q24h OR Moxifloxacin 3 months to <2 years: 12 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
- (B). A bactericidal antimicrobial (-lactam or glycopeptide)
- (a). For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown : Meropenem, 120 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) OR Imipenem/Cilastatin, 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) OR Doripenem, 120 mg/kg/day, IV, divided q8h (not to exceed 1 g/dose) OR Vancomycin, 60 mg/kg/day, IV, divided q8h
- (b). Alternatives for penicillin-susceptible strains: Penicillin G, 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose) OR Ampicillin, 400 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) AND
- (C). A Protein Synthesis Inhibitor: Linezolid <12 y old: 30 mg/kg/day, IV, divided every 8 h12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) OR Clindamycin, 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose)  OR Rifampin, 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)  OR Chloramphenicol, 100 mg/kg/day, IV, divided q6h
- (4).Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)
- (A). A bactericidal antimicrobial
- (B). A protein synthesis inhibitor: Clindamycin 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) OR Doxycycline <45 kg: 4.4 mg/kg/day, PO, divided q12h (not exceed 100 mg/dose) 45 kg: 100 mg, PO, given q12h OR Linezolid (non-CNS infection dose):
- (5). Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)
- (A). Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)
- (1). Bactericidal antimicrobial (fluoroquinolone) therapy
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (2). A bactericidal antimicrobial (-lactam)
- a. For all strains, regardless of penicillin susceptibility or if susceptibility is unknown :
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- b. Alternatives for penicillin-susceptible strains
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (3).A protein synthesis inhibitor
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (B). Therapy for severe anthrax when meningitis can be ruled out
- (1).A bactericidal antimicrobial
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (2).A protein synthesis inhibitor
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (C). Oral follow-up combination therapy for severe anthrax
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (D).Treatment of cutaneous anthrax without systemic involvement
- (1).For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (2).Alternatives for penicillin-susceptible strains
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- Bacillus anthracis, postexposure prophylaxis
- For adults
- (1) For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: Ciprofloxacin, 500 mg q12h OR Doxycycline, 100 mg q12h OR Levofloxacin, 750 mg q24h OR Moxifloxacin, 400 mg q24h OR Clindamycin, 600 mg q8h OR
- (2) Alternatives for penicillin-susceptible strain Amoxicillin, 1 g q8h OR Penicillin VK, 500 mg q6h
- For children  1 month
- (1) For penicillin-resistant strains or prior to susceptibility testing: Ciprofloxacin, 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) OR Doxycycline, 45 kg: 100 mg/dose, PO, given q12h OR Clindamycin, 30 mg/kg/day, PO, divided q8h (not to exceed 900 mg/dose) OR Levofloxacin, 50 kg: 500 mg, PO, given q24h OR
- (2) For penicillin-susceptible strains: Amoxicillin, 75 mg/kg/day, PO, divided every q8h (not to exceed 1 g/dose) OR Penicillin VK, 50-75 mg/kg/day, PO, divided q6h to q8h
- For children < 1 month
- (1) For all strains, regardless of penicillin susceptibility or if susceptibility is unknown
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- (2) Alternatives for penicillin-susceptible strains
- (a) For 3234 weeks gestational age
- (b) For 3437 week gestational age
- (c) Term Newborn Infant
- Bacillus cereus
- Bacillus cereus 
- (1) Food poisoning
- Preferred treatment: Food poisoning is self-limited, no antibiotics necessary. Treatment is Supportive therapy, hydration, and anti-emetics. Prevention is by fried/boiled rice should be maintained >60 C or rapidly cooled <8  C to avoid room temperature germination of spores and toxin.
- (2) Bacteremia
- Preferred regimen:  Vancomycin 15 mg/kg IV q12h.
- Alternative regimen: Clindamycin 600 mg IV q8h
- (3) Meningitis, brain abscess
- Preferred regimen: Vancomycin 15 mg/kg IV q12h.
- Alternative regimen: Clindamycin 600 mg IV q8h.
- (4) Endophthalmitis
- Preferred regimen: Clindamycin 450 mcg intravitreal AND Gentamicin 400 mcg intravitreal OR Dexamethasone intravitreal AND Vancomycin 15 mg/kg IV q12h.
- Alternative regimen: Clindamycin 600 mg IV q8h
- (5) Endocarditis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h OR Clindamycin 600 mg IV q8h.
- (6) Soft tissue
- Preferred regimen: Vancomycin 15 mg/kg IV q12h.
- Alternative regimen: Clindamycin 600 mg IV q8h.
- (7) Pneumonia
- Preferred regimen: Vancomycin 15 mg/kg IV q12h.
- Alternative regimen: Clindamycin 600 mg IV q8h.
- Bacillus subtilis
- 1. Food poisoning
- Preferred regimen: supportive treatment
- 2. Other infections
- Preferred regimen: Vancomycin OR Clindamycin
- Alternative regimen: Ciprofloxacin OR Imipenem
- Clostridium
- Clostridium botulinum
- Clostridium difficile
- Clostridium perfringens
- Clostridium tetani
- Corynebacterium
- Corynebacterium diphtheriae
- Diphtheria treatment
- Antitoxin
- Preferred regimen: 20,000-40,000 U pharyngeal disease 72 hrs; Adiminister IV (severe disease) or IM
- Antibiotics:
- Preferred regimen: Procaine Penicillin G (20 lbs: 600,000 U) IM q12h until patient can swallow then Penicillin VK 125-250 mg PO QID OR Erythromycin 125-500 mg PO QID for 14 days total.
- Alternative regimen (1): Erythromycin 20-25mg/kg IV q6h (max 4g/day; -lactam allergic patients)
- Alternative regimen (2): Clindamycin 600 mg IV q8h
- C. diphtheriae carrier
- Preferred regimen: Erythromycin 250-500 mg PO QID
- Alternative regimen: Benzathine Penicillin G 600,000-1,200,000 units IM single dose
- Endocarditis treatment
- Preferred regimen: Penicillin G OR Ampicillin IV for 4-6 weeks  Aminoglycoside
- Corynebacterium jeikeium
- Corynebacterium urealyticum
- Coxiella burnetii
- Adults:
- Preferred Regimen: DoxycyclinePO 100 mg bid for 14 days
- Children
- Children with age  8 years:
- Preferred regimen:Doxycycline PO 2.2 mg/kg per dose bid for 14 days (maximum 100 mg per dose)
- children with age <8 years with high risk criteria
- Preferred regimen:Doxycycline PO  2.2 mg/kg per dose bid for 14 days (maximum: 100 mg per dose)
- children with age < 8 years with mild or uncomplicated illness:
- Preferred regimen:Doxycycline PO  2.2 mg/kg per dose bid for 5 days (maximum 100 mg per dose). If patient remains febrile past 5 days of treatment: Trimethoprim/Sulfamethoxazole 4-20 mg/kg bid for 14 days (maximum: 800 mg per dose)
- Pregnant women
- Preferred regimen: Trimethoprim/sulfamethoxazole PO 160 mg/800 mg bid a day throughout pregnancy
- Endocarditis or vascular infection
- Preferred regimen:Doxycycline PO 100 mg bid and hydroxychloroquine  PO 200 mg tid  for 18 months
- Note: childern and pregnant women- consultation  Recommended
- Noncardiac organ disease
- Preferred regimen: Doxycycline PO 100 mg bid and hydroxychloroquine PO  200 mg tid
- Note: childern and pregnant women- consultation  Recommended
- Postpartumwith serologic profile for chronic Q fever
- Preferred regimen:Doxycycline PO 100 mg bid and hydroxychloroquine PO  200 mg tid for 12 months
- Note: Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer 1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
- Note:Post-Q fever fatigue syndrome- no current recommendation
- Ehrlichia
- Human Monocytic Ehrlichiosis or Human Granulocytic Anaplasmosis (adult)  
- Preferred regimen: Doxycycline 100 mg PO/IV q12h for 7-14 days
- NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
- Alternative regimen: Chloramphenicol 500mg QID OR Rifampin 600 mg PO/IV daily for 7-10 days
- Human Monocytic Ehrlichiosis or Human Granulocytic Anaplasmosis (pediatric)
- 8 years old
- Preferred regimen: Doxycycline 2 mg/kg IV/PO q12h (max 200 mg/day) for 10 days
- <8 years old without Lyme disease
- Preferred regimen: Doxycycline 2 mg/kg IV/PO q12h (max 200 mg/day) for 4-5 days (or 3 days after resolution of fever)
- co-infected with Lyme disease
- Preferred regimen: At the conclusion of Doxycycline then give Amoxicillin 50 mg/kg in 3 divided doses (max 500 mg/dose) OR Cefuroxime 30 mg/kg in 2 divided doses (max 500 mg/dose) for 14 days
- Erysipelothrix rhusiopathiae
- Erysipeloid of Rosenbach (localized cutaneous infection)
- Preferred regimen (1): Penicillin G benzathine 1.2 MU IV as a single dose
- Preferred regimen (2): Penicillin VK 250 mg PO qid for 5-7 days
- Preferred regimen (3): Procaine penicillin 0.6-1.2 MU IM qd for 5-7 days
- Alternative regimen (1): Erythromycin 250 mg PO qid for 5-7 days
- Alternative regimen (2): Doxycycline 100 mg PO bid for 5-7 days
- Diffuse cutaneous infection
- Preferred regimen: As for localized infection
- Bacteremia or endocarditis
- Preferred regimen: Penicillin G benzathine 2-4 MU IV q4h for 4-6 weeks
- Alternative regimen (1): Ceftriaxone 2 g IV q24h for 4-6 weeks
- Alternative regimen (2): Imipenem 500 mg IV q6h for 4-6 weeks
- Alternative regimen (3): Ciprofloxacin 400 mg IV q12h for 4-6 weeks
- Alternative regimen (4): Daptomycin 6 mg/kg IV q24h for 4-6 weeks
- Listeria monocytogenes
- Meningitis 
- Preferred regimen: Ampicillin 2g IV q4-6h  Gentamicin 1.7 mg/kg IV q8h for more than 3 weeks
- Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for more than 3 weeks
- Bacteremia
- Preferred regimen: Ampicillin 2g IV q4-6h  Gentamicin 1.7 mg/kg IV q8h for 2 weeks
- Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 2 weeks
- Brain abscess or rhomboencephalitis
- Preferred regimen: Ampicillin 2g IV q4-6h  Gentamicin 1.7 mg/kg IV q8h for 4-6 weeks
- Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 4-6 weeks
- Gastroenteritis
- Preferred regimen: Amoxicillin OR TMP-SMX for 7 days
- Lactobacillus
- Endovascular Infection 
- Preferred regiemn (1): Penicillin G 20 Million units/day for 6 weeks
- Preferred regiemn (2): Gentamicin 1.3 mg/kg IV q8h (trough <1.5 mg/L) AND Polychlorinated naphthalene
- Odontogenic Infection
- Preferred regiemn: Clindamycin 450 mg PO q6h
- Intrabdominal Abscess
- Preferred regiemn: Clindamycin 450 mg PO q6h
- Leuconostoc
- Preferred regimen: Penicillin G OR Ampicillin
- Alternative regimen: Clindamycin OR Erythromycin OR  Minocycline
- Nocardia
- Sulfonamide-based therapies 
- Pulmonary
- Preferred regimen: TMP-SMX 10 mg/kg/day (TMP) in 2-4 doses IV for 3-6 weeks, then PO (2 DS BID) for >5 months
- Pulmonary alternatives
- Preferred regimen: Sulfisoxazole OR Sulfadiazine OR Trisulfapyrimidine 3-6 g/day PO 2- 4 doses OR TMP-SMX 2 DS twice daily up to 2 DS TID
- CNS (AIDS, severe or disseminated disease)
- Preferred regimen: TMP-SMX 15 mg/kg/day (TMP) IV for 3-6 weeks, then PO (3 DS BID) for 6-12 months
- CNS alternatives
- Preferred regimen: Imipenem 1000 mg IV q8h OR Ceftriaxone 2 g IV q12h OR Cefotaxime 2-3 g IV q6h AND Amikacin
- Severe disease, compromised host, multiple sites
- Preferred regimen: TMP-SMX IV (above doses) AND Amikacin 7.5 mg/kg q12h (adjust per levels) OR Sulfonamide PO 6-12 m/day
- Sporotrichoid (cutaneous)
- Preferred regimen: TMP-SMX 1 DS BID for 4-6 months
- NOTE(1): Immunocompetent medicine use for 6 months; Immunosuppressed medicine for 12 months
- NOTE(2): Treat based on host, site of disease and in vitro activity; Sulfonamide usually preferred, must treat for 6-12 months; Preferred drugs for resistant strains are Amikacin and/or Imipenem
- NOTE(3): Seriously ill usually treated with IV Imipenem or Sulfonamide or Cefotaxime all potentially combined with Amikacin; less seriously ill treated with oral agents especially TMP-SMX or Minocycline
- Sulfonamide alternatives
- Severe
- Preferred regimen(1): (AIDS) (Imipenem 1000mg IV q8h OR Meropenem (CNS) 2g q8h) AND Amikacin 7.5 mg/kg q12h IV
- Preferred regimen(2): Cefotaxime 2-3g q6-8h OR Ceftriaxone 2 g/day IV  Amikacin
- Mild
- Preferred regimen: Minocycline 100 mg BID for > 6 months (initial treatment of local disease or maintenance)
- Alternative regimen: Amoxicillin/Clavulanate 875/125 mg BID OR Doxycycline OR Erythromycin OR Clarithromycin OR Linezolid OR Fluoroquinolone OR combinations for >6 months
- Propionibacterium acnes
- Systemic infection
- Preferred regimen: Penicillin G 2 MU IV q4h for 2-4 weeks
- Alternative regimen: Clindamycin 600 mg IV q8h for 2-4 weeks OR Vancomycin 15 mg/kg IV q12h for 2-4 weeks
- Shoulder prosthesis infection
- Preferred regimen: Amoxicillin AND Rifampin for 3-6 months
- Acne vulgaris
- Topical antibiotics: Erythromycin OR Clindamycin
- Systemic antibiotics: Minocycline OR Doxycycline OR Trimethoprim-Sulfamethoxazole
- Rhodococcus equi
- Rhodococcus equi 
- Preferred regimen:
- First line: vancomycin 1 g IV q12h (15 mg/kg q12 for >70 kg) OR Imipenem 500 mg IV q6h AND Rifampin 600 mg PO once daily OR Ciprofloxacin 750 mg PO twice daily OR Erythromycin 500 mg PO four times a day for at least 4 weeks or until infiltrate disappears (at least 8 weeks in immunocompromised patients)
- Oral/maintenance therapy (after infiltrate clears): Ciprofloxacin 750 mg PO twice daily OR Erythromycin 500 mg PO four times a day
- Alternative regimen: Azithromycin OR TMP-SMX OR Chloramphenicol OR Clindamycin
- NOTE: Avoid Penicillins/Cephalosporins due to development of resistance; Linezolid effective in vitro, but no clinical reports of use
- Rickettsia
- Rickettsia rickettsii 
- Preferred regimen: Doxycycline 200 mg load (severe disease) and then 100 mg PO/IV BID for 3-7 days after defervescence
- Alternative regimen: Chloramphenicol 500 mg PO QID for 3-7 days after defervescence
- Pediatric regimen: Doxycycline 2-4 mg/kg/day (up to 200 mg/day) q12h OR Tetracycline 25-50 mg/kg/day PO in 4 divided doses OR Chloramphenicol 50-75 mg/kg/day PO in 4 divided doses

# Bacteria  Gram-Negative Cocci and Coccobacilli
- Aggregatibacter aphrophilus
- Bordetella pertussis
- Brucella
- Eikenella corrodens
- Haemophilus ducreyi
- Chancroid Treatment 
- Preferred Regimen: Azithromycin 1 g PO in a single dose OR Ceftriaxone 250 mg IM in a single dose OR Ciprofloxacin 500 mg PO bid for 3 days OR Erythromycin base 500 mg PO three tid for 7 days
- Note(1): Regardless of whether symptoms of the disease are present, sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patients onset of symptoms.
- Note(2):Persons with HIV infection might require repeated or longer courses of therapy, and treatment failures can occur with any regimen.
- Haemophilus influenzae
- Neisseria gonorrhoeae
- Neisseria gonorrhoeae, treatment
- 1. Gonococcal infections in adolescents and adults
- 1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- Alternative regimen: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose (if ceftriaxone is not available)
- 1.2 Uncomplicated gonococcal infections of the pharynx
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- 1.2.1 Management of sex partners
- Expedited partner therapy: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose
- 1.2.2 Allergy, intolerance, and adverse reactions
- Preferred regimen (1): Gemifloxacin 320 mg PO in a single dose AND Azithromycin 2 g PO in a single dose
- Preferred regimen (2): Gentamicin 240 mg IM in a single dose AND Azithromycin 2 g PO in a single dose
- 1.2.3 Pregnancy
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- 1.2.4 Suspected cephalosporin treatment failure
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- Alternative regimen (1): Gemifloxacin 320 mg PO  single dose  AND Azithromycin 2 g PO  single dose (when isolates have elevated cephalosporin MICs)
- Alternative regimen (2): Gentamicin 240 mg IM  single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
- Alternative regimen (3): Ceftriaxone 250 mg IM as a single dose AND Azithromycin 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
- 1.3 Gonococcal conjunctivitis
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- 1.3.1 Management of sex partners
- Patients should be instructed to refer their sex partners for evaluation and treatment.
- 1.4 Disseminated gonococcal infection
- 1.4.1 Arthritis and arthritis-dermatitis syndrome
- Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days AND Azithromycin 1 g PO in a single dose
- Alternative regimen: Cefotaxime 1 g IV q8h for 7 days OR Ceftizoxime 1 g IV q 8 h  for 7 days AND Azithromycin 1 g PO in a single dose
- 1.4.2 Gonococcal meningitis and endocarditis
- Preferred regimen : Ceftriaxone 1-2 g IV  q 12-24 h  for 10-14 days AND Azithromycin 1 g PO in a single dose
- 2. Gonococcal infections among neonates
- 2.1 Ophthalmia neonatorum caused by N. gonorrhoeae
- Preferred regimen: Ceftriaxone 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg
- 2.1.1 Management of mothers and their sex partners
- Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
- 2.2 Disseminated gonococcal infection and gonococcal scalp abscesses in neonates
- Preferred regimen: Ceftriaxone 25-50 mg/kg/day  IM/IV qd for 7 days OR Cefotaxime 25 mg/kg IV /IM  q12h for 7 days.
- 2.2.1 Management of mothers and their sex partners
- Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
- 2.3 Neonates born to mothers who have gonococcal infection
- Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
- 2.3.1 Management of mothers and their sex partners
- Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.
- 3. Gonococcal infections among infants and children
- 3.1 Infants and children who weigh  45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis
- Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
- 3.2 Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
- Alternative regimen: Cefixime 400 mg PO  single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)
- 3.3 Children who weigh  45 kg and who have bacteremia or arthritis
- Preferred regimen: Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days
- 3.4 Children who weigh > 45 kg and who have bacteremia or arthritis
- Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days
- Neisseria gonorrhoeae, prophylaxis
- 1. Ophthalmia neonatorum
- Preferred regimen: Erythromycin 0.5% ophthalmic ointment in each eye in a single application at birth
- Alternative regimen: Ceftriaxone 2550 mg/kg IV/IM in a single dose, not to exceed 125 mg (if erythromycin ointment is not available)
- Neisseria meningitidis
- Meningococcal Meningitis or Bacteremia 
- Antimicrobials:
- Preferred regimen : Ceftriaxone 2 g IV q24h OR Cefotaxime 2 g IV q4-6h for  7-10 days.
- Alternatives regimen (1): Chloramphenicol  4-6 g/day for 7-10 days
- Alternatives regimen (2): Penicillin 18-24 MU/day IV
- Alternatives regimen (3): Ampicillin 12 g/day IV
- Alternatives regimen (4): Aztreonam 6-8 g/day IV OR moxifloxacin 400 mg/day IV.
- Steroids: Dexamethasone 10 mg IV q6h for 2-4 days starting before or with first dose.
- Moraxella catarrhalis
- Pasteurella multocida

# Bacteria  Spirochetes
- Borrelia
- Borrelia burgdorferi
- Lyme disease
- Early Lyme Disease
- Erythema migrans
- Preferred regimen: Doxycycline 100 mg twice per day for 10-21 days OR Amoxicillin 500 mg 3 times per day for 14-21 days OR Cefuroxime axetil 500 mg twice per day for 14-21 days
- Alternatie regimen: : Azithromycin 500 mg PO per day for 710 days OR Clarithromycin 500 mg PO twice per day for 1421 days (if the patient is not pregnant) OR Erythromycin 500 mg PO 4 times per day for 1421 days
- Pediatric regimen (1): (children <8 years of age) Amoxicillin 50 mg/kg per day in 3 divided doses  OR Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum of 500 mg per dose)
- Pediatric regimen (2):(children 8 years of age)Doxycycline 4 mg/kg per day in 2 divided doses(maximum of 100 mg per dose)
- Pediatric regimen (3): Azithromycin 10 mg/kg per day (maximum of 500 mg per day) OR Clarithromycin 7.5 mg/kg twice per day (maximum of 500 mg per dose) OR Erythromycin 12.5 mg/kg 4 times per day (maximum of 500 mg per dose)
- When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis
- Preferred regimen: Amoxicillinclavulanic acid 500 mg 3 times per day;
- Pediatric regimen;Amoxicillinclavulanic acid 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose)
- Lyme meningitis and other manifestations of early neurologic Lyme disease
- Preferred regimen: Ceftriaxone 2g once per day IV for 1028 days
- Alternative regimen (1): Cefotaxime 2 g IV q8h OR Penicillin G 1824 million U q4h per day for patients with normal renal function
- Alternative regimen (2): Doxycycline 200400 mg per day in 2 divided doses PO for 1028 days
- Pediatric regimen (1): Ceftriaxone 5075 mg/kg per day in a single daily intravenous dose (maximum, 2g)
- Pediatric regimen (2): Cefotaxime 150200 mg/kg per day divided into 3 or 4 intravenous doses per day (maximum, 6 g per day)
- Pediatric regimen (3): Penicillin G 200,000400,000 units/kg per day (maximum, 1824 million U per day) divided into doses given intravenously q4h for those with normal renal function
- Pediatric regimen (4): (8 years old) Doxycycline 48 mg/kg PO per day in 2 divided doses (maximum, 100200 mg per dose)
- Lyme carditis
- Preferred regimen: Ceftriaxone 2g once per day IV for 1028 days
- NOTE: patients with advanced heart block, a temporary pacemaker may be required; expert consultation with a cardiologist is recommended; Use of the pacemaker may be discontinued when the advanced heart block has resolved; An oral antibiotic treatment regimen should be used for completion of therapy and for outpatients, as is used for patients with erythema migrans without carditis (see above)
- Borrelial lymphocytoma
- Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)
- Late Lyme Disease
- Lyme arthritis
- Preferred regimen: Doxycycline 100 mg twice per day OR Amoxicillin 500 mg 3 times per day
- Alternative regimen: Cefuroxime axetil 500 mg twice per day for 28 days
- Pediatric regimen: Amoxicillin 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose) OR Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum of 500 mg per dose) OR (8 years of age) Doxycycline 4 mg/ kg per day in 2 divided doses (maximum of 100 mg per dose)
- NOTE: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 24-week course of Ceftriaxone IV
- patients with arthritis and objective evidence of neurologic disease
- Preferred regimen: Ceftriaxone IV for 24 weeks
- Alternative regimen: Cefotaxime OR Penicillin G IV
- Pediatric regime: Ceftriaxone OR Cefotaxime OR Penicillin G IV
- Late neurologic Lyme disease
- Preferred regimen: Ceftriaxone IV for 2 to 4 weeks
- Alternative regimen: Cefotaxime OR Penicillin G IV
- Pediatric regimen: Ceftriaxone OR Cefotaxime OR Penicillin G
- Acrodermatitis chronica atrophicans
- Preferred regimen: Doxycycline 100 mg twice per day OR Amoxicillin 500 mg 3 times per day OR Cefuroxime axetil 500 mg twice per day for 21 days
- PostLyme Disease Syndromes
- Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)
- Borrelia recurrentis
- Tick-Borne Relapsing Fever 
- Preferred regimen: Doxycycline 100 mg PO twice daily for 5-10 days
- Alternative regimen: Erythromycin 500 mg PO four times a day for 5-10 days
- NOTE: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days
- Louse-Borne Relapsing Fever
- Preferred regimen: single dose Tetracycline 500 mg PO
- Alternative regimen: single dose Erythromycin 500 mg PO
- Leptospira
- Treatment
- Severe  
- Preferred regimen: Penicillin 1.5 million units IV q6hr for 5-7 days
- Less severe
- Preferred regimen: Amoxycillin OR Ampicillin OR Doxycycline 100 mg BID IV or PO for 5-7 days OR Erythromycin OR Ceftriaxone 1g IV per day for 5-7 days OR Cefotaxime OR Quinolone PO
- Prophylaxis
- Leptospira interrogans 
- Preferred regimen: Doxycycline 200 mg PO once per week
- Treponema pallidum
- Syphilis Among non-HIV-Infected Persons
- Primary and Secondary Syphilis
- Preferred regimen (adult): Benzathine penicillin G 2.4 million units IM in a single dose
- Preferred regimen (pediatric): Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
- Latent Syphilis
- Early Latent Syphilis
- Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose
- Pediatric regimen: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
- Late Latent Syphilis or Latent Syphilis of Unknown Duration
- Preferred regimen: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervalspediatric
- Pediatric regimen: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)
- Tertiary Syphilis
- Preferred regimen: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
- Neurosyphilis and ocular syphilis
- Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
- Alternative regimen: Procaine penicillin 2.4 million units IM once daily AND Probenecid 500 mg orally four times a day, both for 10--14 days
- Syphilis Among HIV-Infected Persons
- Primary and Secondary Syphilis Among HIV-Infected Persons
- Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
- Latent Syphilis Among HIV-Infected Persons
- early latent
- Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
- late latent
- Preferred regimen: Benzathine penicillin G at weekly doses of 2.4 million units for 3 weeks.
- Neurosyphilis Among HIV-Infected Persons
- Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
- Alternative regimen: Procaine penicillin 2.4 million units IM once daily AND Probenecid 500 mg orally four times a day, both for 10--14 days
- Syphilis During Pregnancy
- Preferred regimen: Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection
- Congenital Syphilis in neonates
- condition 1 : Infants with proven or highly probable disease and (1)an abnormal physical examination that is consistent with congenital syphilis;(2)a serum quantitative nontreponemal serologic titer that is fourfold higher than the mother's titer; or(3)a positive darkfield test of body fluid(s).
- Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days OR Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days
- NOTE: If more than 1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding the use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis. The use of agents other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history of infection with T. pallidum and treatment for syphilis must be considered when evaluating and treating the infant.
- condition 2: Infants who have a normal physical examination and a serum quantitive nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was not treated, inadequately treated, or has no documentation of having received treatment; (2)mother was treated with erythromycin or another nonpenicillin regimen; or (3)mother received treatment < 4 weeks before delivery.
- Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days OR Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days OR Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
- NOTE:If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered.
- condition 3:Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and (2)mother has no evidence of reinfection or relapse.
- Preferred regimen: Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
- condition 4: Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother's treatment was adequate before pregnancy and (2)mother's nontreponemal serologic titer remained low and stable before and during pregnancy and at delivery (VDRL <1:2; RPR <1:4).
- Preferred regimen: No treatment is required; however, benzathine penicillin G 50,000 units/kg as a single IM injection might be considered, particularly if follow-up is uncertain.
- Congenital Syphilis in infants and children
- Preferred regimen: Aqueous crystalline penicillin G 50,000 U/kg q46h for 10 days

# Bacteria  Gram-Negative Bacilli
- Enteric flora
- Aeromonas hydrophila
- Preferred regimen: (consider if not self-limiting, or if severe), Ciprofloxacin 500 mg PO BID.
- Alternate regimen: TMP-SMX single dose PO BID
- Preferred regimen (mild infection) : Ciprofloxacin 500 mg PO BID OR Levofloxacin 500 mg OD.
- Preferred regimen (severe infection) or sepsis: Ciprofloxacin 400 mg IV q8h OR Levofloxacin 750 mg IV q24
- Citrobacter koseri
- Preferred regimen: Ceftriaxone 1-2 g IV q12-24 OR Cefotaxime 1-2 g IV q6h OR Cefepime 1-2 IV q8h.
- Alternate regimen: Ciprofloxacin 400 mg IV q12h (or 500 mg PO q12h for UTI)OR Imipenem 1 g IV q6h OR Doripenem 500 mg IV q8h OR Meropenem 1-2 g IV q8h OR Aztreonam 1-2 g IV q6hOR TMP-SMX 5 mg/kg q6h IV (or DS PO twice daily for UTI).
- Citrobacter freundii
- Preferred regimen: Meropenem 1-2 g IV q8h OR Imipenem 1 g IV q6h OR Doripenem 500 mg IVq8hOR Cefepime 1-2 g IV q8h, Ciprofloxacin 400 mg IV q12h(or 500 mg PO twice daily for UTI) OR Gentamicin 5 mg/kg/day.
- Alternate regimen: Piperacillin/tazobactam 3.375 mg q6h IV OR Aztreonam 1-2 g IV q6h OR TMP-SMX 5 mg/kg q6h IV (or DS PO twice daily for UTI).
- Enterobacter cloacae
- UTI
- Preferred regimen: Ciprofloxacin 250 mg PO bid
- Enterobacter aerogenes
- UTI
- Preferred regimen: Ciprofloxacin 250 mg PO bid
- Escherichia coli
- 1.Meningitits
- 1.1.Preferred regimen: Ceftriaxone 4 g IV q1224h OR Cefotaxime 812 g/day q46h
- 1.2.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
- 2.Uncomplicated urinary tract infection
- 2.1.Preferred agents (IDSA/AUA Guidelines): TMP-SMX DS PO bid for 3-day
- 2.2.Alternative regimen(1): Ciprofloxacin 250 mg PO bid OR Ciprofloxacin 500 mg XR once daily for 3 days OR Levofloxacin 250 mg PO OD for 3 days.
- 2.3.Alternative regimen(2): Nitrofurantoin 100 mg PO q6h OR Nitrofurantoin macrocrystals (Macrobid) 100 mg PO bid for 7 days.
- 2.4.Alternative regimen(3): Fosfomycin 3 g sachet PO single dose.
- 3.Pyelonephritis
- 3.1.1.Acute uncomplicated pyelonephritis
- Preferred regimen: Ciprofloxacin 500 mg bid PO for 5-7 days OR Ciprofloxacin-Erythromycin 1000 mg q24h OR Levofloxacin 750 mg q24h OR Ofloxacin 400 mg bid, Moxifloxacin 400 mg q24h
- Alternative regimen: Amoxicillin-Clavulanic acid875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid OR Oral Cephalosporins OR TMP-SMX 2 mg/kg IV q6h PO for 14 days
- 3.1.2.Acute pyelonephritis (Hospitalized)
- Preferred regimen: Ciprofloxacin 400 mg IV q12h OR (Ampicillin Gentami-cin) OR Piperacillin-Tazobactam 3.375 gm IV q4-6h for 14 days.
- Alternative regimen: Ticarcillin-Clavulanate3.1 gm IV q6h or Ampicillin-Salbactam 3 gm IV q6h or Piperacillin-Tazobactam 3.375 gm IV q4-6h OR Ertapenem 1 gm IV q24h or Doripenem 500 mg q8h for 14 days.
- 4.Travelers diarrhea
- Preferred regimen : Ciprofloxacin 750 mg PO OD for 1-3 days or other Fluoroquinolones
- Pediatrics & pregnancy: Azithromycin 10 mg/kg/day single dose OR Ceftriaxone 50 mg/kg/day IV OD for 3 days.
- 5.Malacoplakia
- Bethanechol chloride AND (Ciprofloxacin 400 mg IV q12h OR TMP-SMX 2 mg/kg (TMP component) IV q6h)
- 6.Bacteremia/Pneumonia
- Preferred regimen : Ceftriaxone 1-2g IV q24h OR other third or fourth generation cephalosporin OR Ciprofloxacin 400mg IV q12h or 500mg PO q12h OR Levofloxacin 500mg PO/IV q24h OR Moxifloxacin 400mg IV/PO q24h OR Ampicillin(if sensitive) 2g IV q6h OR TMP-SMX(if sensitive) 5-10mg/kg/day for q6-8hIV
- Alternative regimen : Imipenem, Meropenem, Ertapenem, Doripenem, Ceftazidime, Cefepime, Cefazolin or Cefuroxime(ifsensitive), Aztreonam, Ticarcillin, Piperacillin, Piperacillin-Tazobactam, Aminoglycosides, Tigecycline(intra-abdorskin/softtissue).
- Alternative regimen : Ampicillin-sulbactam 3g IV q6h ANDGentamicin 1.5mg/kg/q8h or 5-7mg/kg/dayIV OR Gentamicin 5mg/kg/day OR Tobramycin 5mg/kg/dayIV for 7-14days
- Klebsiella pneumoniae
- Aspiration Pneumonia
- Preferred regimen : Piperacillin-Tazobactam 3.375 gm IV q6h or 4-hr infusion of 3.375 gm q8h
- Alternate regimen : (Ceftriaxone 1 gm IV q24h AND Metronidazole 500 mg IV q6h or 1 gm IV q12h) OR Moxifloxacin 400 mg IV/po q24h
- Klebsiella rhinoscleromatis
- Morganella morganii
- Proteus vulgaris
- Providencia
- Salmonella
- Serratia marcescens
- Shigella
- Non-fermenters
- Acinetobacter baumannii
- Achromobacter xylosoxidans
- Bordetella pertussis
- Burkholderia cepacia
- Burkholderia pseudomallei
- Stenotrophomonas maltophilia
- Elizabethkingia meningoseptica
- Moraxella catarrhalis
- Bartonella
- Campylobacter
- Campylobacter fetus
- Campylobacter jejuni
- Capnocytophaga
- Francisella tularensis
- Helicobacter pylori
- Legionella
- Plesiomonas shigelloides
- Pseudomonas aeruginosa
- Vibrio
- Vibrio cholerae
- Vibrio parahaemolyticus
- Vibrio vulnificus

# Bacteria  Atypical Organisms
- Chlamydophila pneumoniae
- 1. Pneumonia
- 1.1 Adult
- Preferred regimen (1): Doxycycline 100 mg PO bid for 14-21 days
- Preferred regimen (2): Tetracycline 250  mg PO qid for 14-21 days
- Preferred regimen (3): Azithromycin 500 mg PO as a single dose, followed by 250 mg PO qd for 4 days
- Preferred regimen (4): Clarithromycin 500 mg  PO bid for 10 days
- Preferred regimen (5): Levofloxacin 500 mg IV or PO qd for 7 to 14 days
- Preferred regimen (6): Moxifloxacin 400 mg PO qd for 10 days.
- 1.2 Pediatric
- Preferred regimen (1):Erythromycin suspension,PO 50 mg/kg/day for 10 to 14 days
- Preferred regimen (2):Clarithromycin suspension, 15 mg/kg/day for 10 days
- Preferred regimen (3): Azithromycin suspension, PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days
- 2.Upper respiratory tract infection
- Bronchitis
- Antibiotic therapy for C. pneumoniae is not required.
- Pharyngitis
- Antibiotic therapy for C. pneumoniae is not required.
- Sinusitis
- Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.
- Chlamydia trachomatis
- Chlaymydial infections   
- 1. Chlamydial Infections in Adolescents and Adults
- Preferred regimen : Doxycycline 100 mg PO bid for 7 days OR Azithromycin 1 g PO in a single dose
- Alternative regimen (1):  Erythromycin base 500  mg PO qid for 7 days OR  Erythromycin ethylsuccinate 800 mg PO  qid for 7 days
- Alternative regimen (2): Levofloxacin 500 mg  PO qd for 7 days OR Ofloxacin 300 mg PO bid for 7 days.
- Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.
- 1.1 Chlamydial Infections in patients with HIV Infection
- Preferred regimen : Doxycycline 100 mg PO bid for 7 days OR Azithromycin 1 g PO in a single dose
- Alternative regimen (1):  Erythromycin base 500  mg PO qid for 7 days OR  Erythromycin ethylsuccinate 800 mg PO  qid for 7 days
- Alternative regimen (2): Levofloxacin 500 mg  PO qd for 7 days OR Ofloxacin 300 mg PO bid for 7 days.
- 1.2Pregancy
- Preferred regimen :Azithromycin 1 g PO in a single dose
- Alternative regimen (1):Amoxicillin  500  mg PO tid for 7 days
- Alternative regimen (2):Erythromycin base 500  mg PO qid for 7 days OR  Erythromycinbase 250 mg PO  qid for 14 days
- Alternative regimen (3):Erythromycin  ethylsuccinate 800  mg PO qid for 7 days OR  Erythromycin ethylsuccinate 400 mg PO four qid for 14days
- Note:Doxycycline, Ofloxacin, and Levofloxacin are contraindicated in pregnant women.
- 2 Chlamydial infection among neonates
- 2.1 Ophthalmia Neonatorumcaused by C. trachomatis
- Preferred regimen :Erythromycin  base or ethylsuccinate ,PO 50 mg/kg/ day divided into 4 doses daily for 14 days
- Alternative regimen : Azithromycin suspension, PO 20 mg/kg /day qd for 3 days
- Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
- 2.2Infant Pneumonia
- Preferred regimen :Erythromycin  base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days
- Alternative regimen : Azithromycin suspension, PO 20 mg/kg /day qd for 3 days
- 3.Chlamydial infection among infants and childern
- 3.1 Infants and childern who weigh < 45 kg
- Preferred regimen :Erythromycin  base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days
- 3.2 Infants and childern who weigh 45 kg but who are aged <8 years
- Preferred regimen :Azithromycin 1 g PO in a single dose
- 3.3 Infants and childern aged  8 years
- Preferred regimen :Azithromycin 1 g PO in a single dose OR  Doxycycline 100 mg PO bid for 7 days
- Lymphogranuloma venereum (LGV)
- Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3
- Preferred regimen : Doxycycline 100 mg PO bid for 21 days
- Alternative regimen: Erythromycin base 500  mg PO qid for 21 days
- Note (1): azithromycin 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
- Note (2): Patients should be followed clinically until signs and symptoms have resolved.
- Note (2): Pregnant and lactating women should be treated with erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
- Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
- Note(4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patients symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).
- Chlamydophila psittaci
- 1. Pneumonia
- 1.1 Adult
- Preferred regimen : Doxycycline 100 mg PO bid daily OR  Tetracycline 500  mg PO qid for 10-21 days
- Alternative regimen :Minocycline
- 1.2 Pediatric
- Preferred regimen: Azithromycin
- Alternative  regimen: fluoroquinolones
- 1.3 Pregnant Patients
- Preferred regimen : Azithromycin
- Alternative  regimen: fluoroquinolones
- 2.Endocarditis in valve replacement patients
- Preferred regimen : Doxycycline
- Alternative regimen : fluoroquinolones.
- Coxiella burnetii
- Q fever 
- 1.Acute Q fever
- 1.1 Adults:
- Preferred Regimen: DoxycyclinePO 100 mg bid for 14 days
- 1.2 Children
- 1.2.1Children with age  8 years:
- Preferred regimen:Doxycycline PO 2.2 mg/kg per dose bid for 14 days (maximum 100 mg per dose)
- 1.2.2 children with age <8 years with high risk criteria
- Preferred regimen:Doxycycline PO  2.2 mg/kg per dose bid for 14 days (maximum: 100 mg per dose)
- 1.2.3 children with age <8 years with mild or uncomplicated illness:
- Preferred regimen:Doxycycline PO  2.2 mg/kg per dose bid for 5 days (maximum 100 mg per dose). If patient remains febrile past 5 days of treatment: Trimethoprim/Sulfamethoxazole 4-20 mg/kg bid for 14 days (maximum: 800 mg per dose)
- 1.3 Pregnant women
- Preferred regimen: Trimethoprim/Sulfamethoxazole PO 160 mg/800 mg bid a day throughout pregnancy
- 2. Chronic Q fever
- 2.1 Endocarditis or vascular infection
- Preferred regimen:Doxycycline PO 100 mg bid and Hydroxychloroquine  PO 200 mg tid  for 18 months
- Note: childern and pregnant women- consultation  Recommended
- 2.2 Noncardiac organ disease
- Preferred regimen: Doxycycline PO 100 mg bid and Hydroxychloroquine PO  200 mg tid
- Note: childern and pregnant women- consultation  Recommended
- 2.3 Postpartumwith serologic profile for chronic Q fever
- Preferred regimen:Doxycycline PO 100 mg bid and Hydroxychloroquine PO  200 mg tid for 12 months
- Note: Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer 1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
- Note:Post-Q fever fatigue syndrome- no current recommendation
- Legionella
- Legionella pneumonia (atypical bacterial pneumonia) 
- Preferred Regimen: Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h OR Azithromycin 500 mg PO on day 1 followed by 250 mg q24h
- Alternate Regimen: Doxycycline 100 mg PO/IV q12h
- Mycoplasma pneumoniae
- Atypical pneumonia caused by Mycoplasma pneumoniae
- Preferred regimen (1): Azithromycin 500 mg PO day 1 and 250 mg day 2 to 5
- Preferred regimen (2): Doxycycline 100 mg PO bid for 14 days
- Preferred regimen (3): Moxifloxacin 400 mg PO qd for 14 days
- Mycoplasma genitalium
- 1.Urethritis and cervicitis caused due to Mycoplasma Genitalium
- Preferred regimen: Azithromycin 1 g PO single dose
- Note(1): Resistant strains -Azithromycin PO in 500 mg single dose followed by 250 mg qd for 4 days
- Note(2): previous treatment failures- Moxifloxacin  PO 400 mg qd for 7, 10 or 14 days) has been successfully used to treat both men and women
- 2. PID caused due to Mycoplasma Genitalium
- Preferred regimen: Moxifloxacin PO  400 mg/day for 14 days

# Bacteria  Miscellaneous
- Gardnerella vaginalis
- Eikenella corrodens
- Human bite/soft tissue infections 
- Severe
- Preferred regimen: Ampicillin/Sulbactam 1.5-3 g IV q6h
- Alternative regimen: Doxycycline 100 mg IV BID OR Moxifloxacin 400 mg IV OD OR Levofloxacin 500 mg IV OD
- Mild
- Preferred regimen: Amoxicillin/Clavulanate 250-500 mg TID or 875/125 mg PO BID
- Alternative regimen: Doxycycline 100 mg PO BID OR Moxifloxacin 400 mg PO OD OR Levofloxacin 500 mg PO OD
- Head and neck infections
- Severe
- Preferred regimen: Ampicillin/Sulbactam 1.5-3 g IV q6h
- Alternative regimen: Doxycycline 100 mg IV BID OR Moxifloxacin 400 mg IV OD OR Levofloxacin 500 mg IV OD
- Mild
- Preferred regimen: Amoxicillin/Clavulanate 250-500 mg TID or 875/125 mg PO BID
- Alternative regimen: Doxycycline 100 mg PO BID OR Moxifloxacin 400 mg PO OD OR Levofloxacin 500 mg PO OD
- Endocarditis
- Preferred regimen: Ceftriaxone 1g IV q12h OR Cefotaxime 1-2 g IV q8h OR Cefepime 1-2g IV q8h
- Bordetella pertussis
- Bartonella
- Stenotrophomonas maltophilia
- Acinetobacter baumannii
- Preferred regimen: Imipenem (Primaxin) 0.5-1 g IV q6h OR Ampicillin/sulbactam (Unasyn) 3g q4h OR Cefepime (Maxipime) 1-2 g IV q8h OR Colistin 2.5 mg/kg IV q12h OR Tigecycline (Tygacil) 100 mg IV, then 50 mg IV q12h OR Amikacin 7.5 mg/kg q12h IV or 15 mg/kg/day IV
- Alternative regimen: Ceftriaxone 1-2g IV every day OR Cefotaxime 2-3g IV q6-8h OR Ciprofloxacin (Cipro) 400 mg IV q8-12h or 750 mg PO BID OR TMP-SMX 15-20 mg (TMP)/kg/day IV divided 3 or 4 doses/day or 2 DS PO BID

# Bacteria  Anaerobic Gram-Negative Bacilli
- Bacteroides fragilis
- Monotherapy 
- Preferred regimen: Imipenem (Primaxin) OR Ertapenem OR Meropenem OR Doripenem 0.5-1.0 g IV q6h OR Piperacillin-tazobactam (Zosyn) 3.375 g IV q6h OR Ampicillin-sulbactam (Unasyn) 1-2 g IV q6h OR Tigecycline (Tygacil) 100 mg IV, then 50 mg IV q12h
- Combination therapy
- Preferred regimen: Metronidazole 0.75-1.0 g IV q12h AND Cefotaxime 1.5-2 g IV q6h OR Aztreonam 1-2 g IV q8h OR Ceftriaxone 1 g IV q12h
- Fusobacterium necrophorum

# Fungi
- Aspergillosis
- Blastomycosis
- 1.Mild to moderate pulmonary blastomycosis
- Preferred regimen: Itraconazole 200 mg PO once or twice per day for 612 months
- Note: Oral Itraconazole, 200 mg 3 times per day for 3 days and then once or twice per day for 612 months, is recommended
- 2.Moderately severe to severe pulmonary blastomycosis
- Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 35 mg/kg per day for 12 weeks AND Itraconazole 200 mg PO bid for 612 months
- Preferred regimen(2): Amphotericin B deoxycholate 0.71 mg/kg per day for 12 weeks AND Itraconazole 200 mg PO bid for 612 months
- Note: Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 612 months, is recommended
- 3.Mild to moderate disseminated blastomycosis
- Preferred regimen: Itraconazole 200 mg PO once or twice per day for 612 months
- Note(1): Treat osteoarticular disease for 12 months
- Note(2): Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 612 months, is recommended
- 4.Moderately severe to severe disseminated blastomycosis
- Preferred regimen(1): Lipid amphotericin B(Lipid AmB) 35 mg/kg per day, for 12 weeks AND Itraconazole 200 mg PO bid for 612 months
- Preferred regimen(2): Amphotericin B deoxycholate 0.71 mg/kg per day, for 12 weeks AND Itraconazole 200 mg PO bid for 612 months
- Note: oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 612 months, is recommended
- 5.CNS disease
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg per day for 46 weeks AND an oral azole for at least 1 year
- Note(1): Step-down therapy can be with Fluconazole, 800 mg per day OR Itraconazole, 200 mg 23 times per day OR voriconazole, 200400 mg twice per day.
- Note(2): Longer treatment may be required for immunosuppressed patients.
- 6.Immunosuppressed patients
- Preferred regimen(1): Lipid amphotericin B (Lipid AmB), 35 mg/kg per day, for 12 weeks, AND Itraconazole, 200 mg PO bid for 12 months
- Preferred regimen(2): Amphotericin B deoxycholate, 0.71 mg/kg per day, for 12 weeks, AND Itraconazole, 200 mg PO bid for 12 months
- Note(1): Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 12 months, is recommended
- Note(2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
- 7.Pregnant women
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 35 mg/kg per day
- Note(1): Azoles should be avoided because of possible teratogenicity
- Note(2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg per day
- 8.Children with mild to moderate disease
- Preferred regimen: Itraconazole 10 mg/kg PO per day for 612 months
- Note: Maximum dose 400 mg per day
- 9.Children with moderately severe to severe disease
- Preferred regimen(1): Amphotericin B deoxycholate 0.71 mg/kg per day for 12 weeks AND Itraconazole 10 mg/kg PO per day to a maximum of 400 mg per day for 612 months
- Preferred regimen(2): Lipid amphotericin B (Lipid AmB) 35 mg/kg per day for 12 weeks AND Itraconazole 10 mg/kg PO per day to a maximum of 400 mg per day for 612 months
- Note: Children tolerate Amphotericin B deoxycholate better than adults do.
- Paracoccidioidomycosis
- Preferred regimen(1):
- Adults Trimethoprim/sulfamethoxazole (TMP/SMX)  TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV divided into two doses per day
- Children Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, divided into two doses per day
- Note: Treatment duration based on organ involvement:
- Minor involvement: 12 months
- Moderate involvement: 18-24 months
- Preferred regimen(2): Ketoconazole 200-400 mg/day PO for 9-12 months
- Preferred regimen(3):
- Adults: Itraconazole 600 mg/day PO for 3 days; continue 200 mg/day PO for 6-9 months
- Children: Itraconazole (5 yr) 5-10 mg/kg/day PO for 6-9 months
- Preferred regimen(4): Voriconazole initial dose 400 mg PO/IV each 12 hr for one day, then 200 mg each 12 hr for 6 months
- Note: Diminish the dose to 50% if weight is <40 kg
- Preferred regimen(5): Amphotericin B deoxycholate mg/kg/day IV until patient improves and can be treated by the oral route
- Candidiasis
- Chromoblastomycosis
- Coccidioidomycosis
- Cryptococcosis
- Dermatophytosis
- Onychomycosis
- Fingernail Treatment Options
- Preferred regimen: Terbinafine 250 mg PO q24h (children 40 kg: 250 mg/day) for 6 weeks OR Itraconazole 200 mg PO q24h for 3 months OR Itraconazole 200 mg PO bid for 1 week/month for 2 months OR Fluconazole 150300 mg PO q week for 36 months
- Toenail Treatment Options
- Preferred regimen: Terbinafine 250 mg PO q24h (children 40 kg: 250 mg/day) for 12 weeks OR Itraconazole 200 mg PO q24h for 3 months OR Itraconazole 200 mg bid for 1 week/month for 34 months OR Fluconazole 150300 mg PO q week for 612 months
- Tinea capitis
- Preferred regimen(1): Griseofulvin 10-20 mg/kg/day for minimum 6 weeks
- Preferred regimen(2): Itraconazole 4-6 mg/kg pulsed dose weekly
- Preferred regimen(3): Terbinafine if 40 kg: 250 mg/day
- Tinea corporis
- Small, well-defined lesions
- Preferred regimen: Topical cream/ointment Terbinafine OR Miconazole OR Econazole OR Clotrimazole
- Larger lesionss
- Preferred regimen:  Terbinafine 250 mg/day PO for 2 weeks OR Itraconazole 200 mg/day PO for 1 wk OR Fluconazole 250 mg PO weekly for 2-4 weeks
- Tinea pedis
- Athlete's foot
- Interdigital
- Preferred regimen: Topical cream/ointment Terbinafine OR Miconazole OR Econazole OR Clotrimazole
- Dry type
- Preferred regimen: Terbinafine 250 mg/day PO for 2-4 weeks OR Itraconazole 400 mg/day PO for 1 week per month (repeated if necessary) OR Fluconazole 200 mg PO  weekly for 4-8 weeks
- Tinea cruris
- Tinea versicolor
- Preferred regimen: Ketoconazole 400 mg PO single dose OR 200 mg q24h for 7 days OR 2% cream once q24h for 2 weeks
- Alternative regimen: Fluconazole 400 mg PO single dose OR Itraconazole 400 mg PO q24h for 37 days
- Histoplasmosis
- Acute pulmonary histoplasmosis
- Moderately severe or severe
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 3.05.0 mg/kg daily for 12 weeks OR Amphotericin B deoxycholate 0.71.0 mg/kg daily for 12 weeks, followed by Itraconazole 200 mg 3 times daily for 3 days and then 200 mg twice daily, for a total of 12 weeks
- Note: Methylprednisolone 0.51.0 mg/kg daily IV during the first 12 weeks of antifungal therapy is recommended for patients who develop respiratory complications, including hypoxemia or significant respiratory distress.
- Mild to moderate
- Preferred regimen:
- For symptoms of <4 weeks, none
- For symptoms of >4 weeks, Itraconazole 200 mg PO 3 times daily for 3 days and then 200 mg once or twice daily for 612 weeks
- Chronic cavitary pulmonary histoplasmosis
- Preferred regimen: Itraconazole 200 mg PO 3 times daily for 3 days and then once or twice daily for at least 1 year
- Pericarditis
- Moderately severe to severe
- Preferred regimen(1): Prednisone 0.51.0 mg/kg daily (maximum, 80 mg daily) in tapering doses over 12 weeks
- Note(1): Itraconazole 200 mg PO 3 times daily for 3 days and then once or twice daily for 612 weeks is recommended if corticosteroids are administered
- Note(2): Tamponade requires drainage of pericardial fluid
- Note(3): Antifungal therapy is given to reduce possible dissemination caused by prednisone induced immunosuppression
- Mild
- Preferred regimen: Nonsteroidal anti-inflammatory agents
- Rheumatologic histoplasmosis
- severe
- Preferred regimen: Prednisone 0.51.0 mg/kg daily (maximum, 80 mg daily) in tapering doses over 12 weeks is recommended in severe cases
- Note: Itraconazole 200 mg 3 times daily for 3 days and then once or twice daily for 612 weeks is recommended if corticosteroids are administered
- Mild
- Preferred regimen: Nonsteroidal anti-inflammatory agents
- Note: Corticosteroids are rarely needed
- Mediastinal lymphadenitis
- Mild symptoms of <4 weeks
- Preferred regimen: None
- Symptoms of >4 weeks
- Preferred regimen: Itraconazole 200 mg 3 times daily for 3 days and then 200 mg once or twice daily for 612 weeks
- Symptoms warranting treatment
- Preferred regimen: Prednisone  0.51.0 mg/kg daily in tapering doses over 12 weeks AND Itraconazole 200 mg 3 times daily for 3 days and then 200 mg once or twice daily for 612 weeks
- Mediastinal granuloma
- Asymptomatic
- Preferred regimen: None
- Symptomatic
- Preferred regimen: Itraconazole 200 mg PO 3 times daily for 3 days and then 200 mg once or twice daily for 612 weeks
- Mediastinal fibrosis
- Preferred regimen: The placement of intravascular stents is recommended for selected patients with pulmonary vessel obstruction
- Note(1): Antifungal treatment is not recommended
- Note(2): Itraconazole 200 mg PO once or twice daily for 12 weeks is recommended if clinical findings cannot differentiate mediastinal fibrosis from mediastinal granuloma
- Broncholithiasis
- Preferred regimen: Antifungal treatment is not recommended
- Bronchoscopic or surgical removal of the broncholith is recommended
- Pulmonary Nodules (Histoplasmomas)
- Preferred regimen: Antifungal treatment is not recommended
- Note: Must be differentiated from malignancy
- Progressive disseminated histoplasmosis
- Moderately severe to severe
- Preferred regimen: Liposomal amphotericin B 3.0 mg/kg daily for 12 weeks, followed by Itraconazole 200 mg PO 3 times daily for 3 days and then 200 mg twice daily for a total of at least 12 months
- Alternative regimen: Amphotericin B deoxycholate 0.71.0 mg/kg daily for 12 weeks, followed by Itraconazole 200 mg PO 3 times daily for 3 days and then 200 mg twice daily for a total of at least 12 months
- Note: Longer treatment may be required in patients with persistent immunodeficiency
- Mild to moderate
- Preferred regimen: Itraconazole 200 mg PO 3 times daily for 3 days and then twice daily for at least 12 months.
- Note: Longer treatment may be required in patients with persistent immunodeficiency.
- CNS histoplasmosis
- Preferred regimen: Liposomal amphotericin B  5.0 mg/kg daily for a total of 175 mg/kg given over 46 weeks followed by Itraconazole 200 mg PO 2 or 3 times daily for at least 12 months and until resolution of CSF abnormalities, including Histoplasma antigen levels.
- Note: Blood levels of itraconazole should be obtained to ensure adequate drug exposure
- Mucormycosis
- Penicilliosis
- Sporotrichosis:
- Lymphocutaneous/cutaneous
- Preferred regimen: Itraconazole 200mg PO/day
- Alternative regimen: Itraconazole 200 mg PO bid OR Terbinafine 500 mg bid OR Saturated solution potassium iodide(SSKI) with increasing doses OR Fluconazole 400800 mg/day OR local hyperthermia
- Note(1): Treat for 24 weeks after lesions resolved
- Note(2): SSKI initiated at a dosage of 5 drops (using a standard eyedropper) 3 times daily, increasing as tolerated to 4050 drops 3 times daily
- Osteoarticular
- Preferred regimen: Itraconazole 200mg PO bid for 12 months
- Alternative regimen: Lipid amphotericin B (Lipid AmB) 35 mg/kg/day OR Amphotericin B deoxycholate 0.71 mg/kg/day
- Note(1): Switch to Itraconazole after favorable response if AmB used
- Note(2): Treat for a total of at least 12 months
- Pulmonary
- Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 35 mg/kg/day for severe or life-threatening pulmonary sporotrichosis, then Itraconazole 200 mg PO bid
- Preferred regimen(2): Itraconazole 200 mg PO bid for 12 months for less severe disease
- Alternative regimen: Amphotericin B deoxycholate 0.71 mg/kg/d, then Itraconazole 200 mg PO bid OR surgical removal
- Note(1): Treat severe disease with an AmB formulation followed by Itraconazole
- Note(2): Treat less severe disease with Itraconazole
- Note(3): Treat for a total of at least 12 monthsSurgery combined with amphotericin B therapy is rec- ommended for localized pulmonary disease
- Meningitis
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg daily for 46 weeks, then Itraconazole 200 mg PO bid
- Alternative regimen: Amphotericin B deoxycholate 0.71 mg/kg/d, then Itraconazole 200 mg PO bid
- Note(1): Length of therapy with AmB not established, but therapy for at least 46 weeks is recommended.
- Note(2): Treat for a total of at least 12 months.
- Note(3): May require long-term suppression with Itraconazole.
- Disseminated
- Preferred regimen: Lipid amphotericin B (Lipid AmB) 35 mg/kg/day, then Itraconazole 200 mg PO bid
- Alternative regimen: Amphotericin B deoxycholate 0.71 mg/kg/day, then Itraconazole 200 mg PO bid
- Note(1): Therapy with AmB should be continued until the patient shows objective evidence of improvement.
- Note(2): Treat for a total of at least 12 months.
- Note(3): May require long-term suppression with Itraconazole.
- Pregnant women
- Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 35 mg/kg/day OR Amphotericin B deoxycholate 0.71 mg/kg/day  for severe sporotrichosis
- Preferred regimen(2): Local hyperthermia for cutaneous disease.
- Note(1): It is preferable to wait until after delivery to treat nonlife-threatening forms of sporotrichosis.
- Note(2): Azoles should be avoided.
- Children
- Preferred regimen:
- Mild disease: Itraconazole 610 mg/kg/day (400 mg/day maximum)
- Severe disease: Amphotericin B deoxycholate 0.7 mg/kg/day followed by Itraconazole 610 mg/kg up to a maximum of 400 mg PO daily, as step-down therapy
- Alternative regimen: Saturated solution potassium iodide(SSKI) with increasing doses for mild disease initiated at a dosage of 1 drop (using a standard eyedropper) 3 times daily and increased as tolerated up to a maximum of 1 drop/kg or 4050 drops 3 times daily, whichever is lowest
- Pneumocystis jiroveci

# Mycobacteria
- Mycobacterium tuberculosis
- Mycobacterium abscessus
- Mycobacterium bovis
- Mycobacterium avium-intracellulare
- Mycobacterium celatum
- Mycobacterium chelonae
- Mycobacterium foruitum
- Mycobacterium haemophilum
- Mycobacterium genavense
- Mycobacterium gordonae
- Mycobacterium kansasii
- Mycobacterium marinum
- Mycobacterium scrofulaceum
- Mycobacterium simiae
- Mycobacterium ulcerans
- Mycobacterium xenopi
- Mycobacterium leprae

# Parasites  Intestinal Protozoa
- Balantidium coli
- Preferred regimen: Tetracycline 500 mg PO qid for 10 days OR Metronidazole 750 mg PO tid for 5 days OR Iodoquinol 650 mg PO tid for 20 days
- Blastocystis hominis
- Preferred regimen: Metronidazole 750 mg PO tid or 1.5 g daily, for 10 days OR Trimethoprim-sulfamethoxazole One double strength tablet bid or two double strength tablets daily for 7 days OR Iodoquinol 650 mg PO tid for 20 days OR Nitazoxanide 500 mg bid for 3 days OR Paromomycin 25-35 mg/kg divided tid for 7 days
- Note(1): Treatment of asymptomatic infections is unnecessary
- Note(2): One double strength tablet contains 160 mg trimethoprim/800 mg sulfamethoxazole
- Cryptosporidium parvum
- Cryptosporidium hominis
- Cyclospora cayetanensis
- Dientamoeba fragilis
- Preferred regimen: Iodoquinol 650 mg PO tid for 20d ays
- Alternative regimen: Tetracycline 500 mg PO qid for 10 days OR Metronidazole 500-750 mg PO tid for 10 days
- Entamoeba histolytica
- Giardia lamblia
- Preferred regimen(1):
- Adult: Tinidazole 2 g, single dose
- Pediatric: Tinidazole 50 mg/kg, single dose (maximum, 2 g)
- Preferred regimen(2):
- Adult: Metronidazole 250 mg tid for 5-7 days
- Pediatric: Metronidazole 5 mg/kg tid for 7 days
- Preferred regimen(3):
- Adult: Nitazoxanide 500 mg bid for 3 days
- Pediatric: Nitazoxanide Age 12-47 months: 100 mg bid for 3 days and for Age 4-11 years: 200 mg bid for 3 days
- Preferred regimen(4):
- Adult: Albendazole 400 mg qd for 5 days
- Pediatric: Albendazole 15 mg/kg/day for 5-7 days (maximum, 400 mg)
- Preferred regimen(5):
- Adult: Paromomycin 500 mg tid for 5-10 days
- Pediatric: Paromomycin 30 mg/kg/day in 3 doses for 5-10 days
- Preferred regimen(6):
- Adult: Quinacrine 100 mg tid for 5-7 days
- Pediatric: Quinacrine 2 mg/kg tid for 7 days
- Preferred regimen(7):
- Adult: Furazolidone 100 mg qid for 7-10 days
- Pediatric: Furazolidone 2 mg/kg qid for 10 days
- Isospora belli
- Microsporidiosis

# Parasites  Extraintestinal Protozoa
- Primary amoebic meningoencephalitis
- Acanthamoeba
- Balamuthia mandrillaris
- Naegleria fowleri
- Babesia microti
- Leishmaniasis
- Plasmodium
- Toxoplasma gondii
- Trichomonas vaginalis
- African trypanosomiasis
- American trypanosomiasis

# Parasites  Intestinal Nematodes (Roundworms)
- Ascaris lumbricoides
- Capillaria philippinensis
- Enterobius vermicularis
- Necator americanus
- Ancylostoma duodenale
- Strongyloides stercoralis
- Trichuris trichiura

# Parasites  Extraintestinal Nematodes (Roundworms)
- Ancylostoma braziliense
- Angiostrongylus cantonensis
- Filariasis
- Onchocerciasis
- Wuchereria bancrofti
- Brugia malayi
- Gnathostoma spinigerum
- Toxocariasis
- Trichinella spiralis

# Parasites  Trematodes (Flukes)
- Clonorchis sinensis
- Dicrocoelium dendriticum
- Fasciola hepatica
- Paragonimus westermani
- Schistosomiasis

# Parasites  Cestodes (Tapeworms)
- Echinococcus
- Neurocysticercosis
- Sparganosis

# Parasites  Ectoparasites
- Body lice
- Head lice
- Pubic lice
- Scabies
- Myiasis

# Viruses
- Adenovirus
- SARS
- Cytomegalovirus
- Enterovirus D68
- Ebola virus
- Marburg virus
- Hantavirus
- Dengue virus
- West Nile virus
- Yellow Fever
- Chikungunya virus
- Hepatitis A virus
- Hepatitis B virus
- Hepatitis C virus
- Hepatitis D virus
- Hepatitis E virus
- Epstein-Barr virus
- Human herpesvirus 6
- Human herpesvirus 7
- Human herpesvirus 8 (KSHV)
- Herpes simplex virus
- Varicella-zoster virus
- Human papillomavirus
- Influenza A
- Influenza B
- Avian influenza
- Swine influenza
- Measles
- Middle East respiratory syndrome
- Paramyxovirus
- Parvovirus B19
- BK virus
- JC virus
- Rabies
- Respiratory Syncytial Virus
- Rhinovirus
- Rotavirus
- Smallpox
- HIV/AIDS