Sandbox g14

# Epidural abscess
- Spinal epidural abscess
- Empiric antimicrobial therapy
- 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 AND Ceftriaxone 2 g Iv q24h for 24 weeks, then PO to complete 68 weeks
- Culture-directed antimicrobial therapy
- 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
- 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
- Streptococcus
- Preferred regimen: Penicillin G 34 MU IV q4h for 24 weeks, then PO to complete 68 weeks OR Ampicillin 2 g IV q4h for 24 weeks, then PO to complete 68 weeks
- Enterococcus
- Preferred regimen: Penicillin G 34 MU IV q4h for 24 weeks, then PO to complete 68 weeks OR Ampicillin 2 g IV q4h for 24 weeks, then PO to complete 68 weeks
- Enterobacteriaceae
- Preferred regimen: Ceftriaxone 12 g IV q12h for 24 weeks, then PO to complete 68 weeks OR Cefotaxime 2 g IV q68h for 24 weeks, then PO to complete 68 weeks
- Gram-negative bacteria
- Preferred regimen:Ceftazidime 2 g IV q8h for 24 weeks, then PO to complete 68 weeks OR Cefepime 2 g IV q12h for 24 weeks, then PO to complete 68 weeks
- Alternative regimen: Ciprofloxacin 400 mg IV q12h for 24 weeks, then PO to complete 68 weeks OR Levofloxacin 750 mg IV q24h for 24 weeks, then PO to complete 68 weeks OR Moxifloxacin 400 mg IV q24h for 24 weeks, then PO to complete 68 weeks
- Anaerobes
- Preferred regimen: Metronidazole 500 mg IV q6h for 24 weeks, then PO to complete 68 weeks
- Staphylococcus, Gram-negative bacteria, and anaerobes (mixed infection)
- Preferred regimen: Ampicillin-Sulbactam 3 g IV q6h for 24 weeks, then PO to complete 68 weeks OR Ticarcillin-Clavulanate 3.1 g IV q4h for 24 weeks, then PO to complete 68 weeks OR Piperacillin-Tazobactam 3.375 g IV q46h for 24 weeks, then PO to complete 68 weeks
- Alternative regimen: Imipenem 5001000 mg IV q6h for 24 weeks, then PO to complete 68 weeks OR Meropenem 12 g IV q8h for 24 weeks, then PO to complete 68 weeks

# Brain abscess
- Brain abscess, bacterial
- Empiric antimicrobial therapy (unknown source of infection)
- Preferred regimen: Vancomycin 1520 mg/kg IV q812h for 68 weeks, then orally for 23 months AND (Cefotaxime 2 g IV q4h for 68 weeks, then orally for 23 months OR Ceftriaxone 2 g IV q12h for 68 weeks, then orally for 23 months) AND Metronidazole 7.5 mg/kg IV q6h or 15 mg/kg IV q12h for 68 weeks, then orally for 23 months
- Alternative regimen: Penicillin G 34 MU IV q4h for 68 weeks, then orally for 23 months AND (Cefotaxime 2 g IV q4h for 68 weeks, then orally for 23 months OR Ceftriaxone 2 g IV q12h for 68 weeks, then orally for 23 months) AND Metronidazole 7.5 mg/kg IV q6h or 15 mg/kg IV q12h for 68 weeks, then orally for 23 months
- Specific considerations
- Culture-directed antimicrobial therapy
- Nocardia
- Preferred regimen: (TMP-SMX 15 mg/kg/day of TMP component and 75 mg/kg/day of SMX component IV/PO q612h AND Imipenem 500 mg IV q6h)  Amikacin 7.5 mg/kg IV q12h if multiple organ involvement
- Alternative regimen: Linezolid 600 mg IV/PO q12h AND Meropenem 2 gm IV q8h
- Brain abscess, tuberculous
- Brain abscess, fungal