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# Mycobacterium terrae
- Mycobacterium terrae 
- 1. In vitro susceptibility
- All six of the isolates from a single center and 90% or more of an additional 22 isolates of M. terrae complex were susceptible to Ciprofloxacin and Sulfonamides. Recently, 11 isolates of M. terrae complex were also shown to be susceptible to Linezolid
- 2. Antimicrobial therapy
- Based on in vitro susceptibility results

# Mycobacterium szulgai
- Mycobacterium szulgai 
- 1. in vitro susceptibility
- M. szulgai is susceptible in vitro to most antituberculous drugs including Quinolones and newer Macrolides
- 2. Infection
- 2.1 Pulmonary infection
- Three- or four-drug regimen based on susceptibility that includes 12 months of negative sputum cultures while on therapy
- 2.2 Extrapulmonary infection
- Combination anti-tuberculous medications based on in vitro susceptibilities for 4-6 months

# Mycobacterium smegmatis
- Mycobacterium smegmatis 
- 1. Mild disease
- Preferred regimen: Doxycycline PO AND Trimethoprim sulfamethoxazole PO
- 2. Severe disease
- Preferred regimen: Amikacin IV OR Imipenem IV

# Mycobacterium mucogenicum
- Mycobacterium mucogenicum 
- In vitro susceptible agents: Aminoglycosides, Cefoxitin, Clarithromycin, Minocycline, Doxycycline, Quinolones, Trimethoprim/sulfamethoxazole, and Imipenem

# Mycobacterium malmoense
- Mycobacterium malmoense
- 1. In vitro
- Susceptible: Ethambutol, Ethionamide, Kanamycin, and Cycloserine
- Resistant: INH, Streptomycin, Rifampin, and Capreomycin
- 2. Pulmonary M. malmoense infection
- Preferred regimen: INH AND Rifampin AND Ethambutol  Quinolones AND Macrolides

# Mycobacterium immunogenum
- Mycobacterium immunogenum 
- In vitro
- Susceptible: Amikacin and Clarithromycin
- Resistant: Ciprofloxacin, Doxycycline, Cefoxitin, Tobramycin, and Sulfamethoxazole
- Note: The optimal therapy for this organism is unknown; however, successful therapy is likely difficult due to the extensive antibiotic resistance of the organism

# Mycobacterium leprae
- Mycobacterium leprae 
- 1. Multibacillary Leprosy (Skin smear positive)
- 1.1 Adult
- Preferred regimen: Dapsone 100 mg/day PO AND Rifampin 600 mg PO 4 times per week AND Clofazimine 50 mg PO qd for 12-24 months
- Note: Clofazimine should be supplemented by loading dose 300 mg PO monthly
- 1.2 Pediatric
- 1.2.1 < 35 kg
- Preferred regimen: Dapsone 1-2 mg/kg/day PO AND Rifampin 450 mg PO for 12-24 months
- 1.2.2 < 20 kg
- Preferred regimen: Dapsone 1-2 mg/kg/day PO AND Rifampin 300 mg PO for 12-24 months
- 1.2.3 < 12 kg
- Preferred regimen: Dapsone 1-2 mg/kg/day PO AND Rifampin 150 mg PO for 12-24 months
- 2. Paucibacillary Leprosy (Skin Smear negative)
- Preferred regimen: Rifampin 600 mg PO once a month for 6 months AND Dapsone 100 mg PO qd for 6 months
- 3. Erythema Nodosum Leprosum (ENL)
- 3.1 Mild
- Preferred regimen: Rest affect limb, analgesics, follow-up twice a week, check for iridocyclitis; Chloroquine OR Aspirin may be useful
- 3.2 Severe (numerous nodules + fever, ulcerating/pustular ENL, visceral involvement, nodules + neuritis, recurrent ENL)
- Preferred regimen: Prednisolone 30-40 mg/day PO for 1-2 weeks THEN taper over 12 weeks
- Alternative regimen (1): (If unresponsive to corticosteroids or if risk of corticosteroids prevent administration) Start Clofazimine 100 mg PO tid for maximum of 12 weeks THEN 100 mg PO bid for 12 weeks THEN 100 mg qd for 12-24 weeks
- Alternative regimen (2): (if not contraindicated) Thalidomide 200-400 mg/day PO, reduced to 50-100 mg/day after 1-2 weeks
- 4. Reversal Reaction
- Preferred regimen: Prednisolone start with 40 mg/day PO THEN taper by 10 mg twice a week for 12 weeks

# Mycobacterium xenopi
- Mycobacterium xenopi 
- 1. The cornerstone of therapy for M. xenopi
- Preferred regimen: Clarithromycin AND Rifampin AND Ethambutol
- Note: Therapy should be continued until the patient has maintained negative sputum cultures while on therapy for 12 months
- 2. Pulmonary disease
- Preferred regimen: INH AND Rifabutin OR Rifampin AND Ethambutol AND Clarithromycin  Streptomycin
- Note: A quinolone, preferably Moxifloxacin, could be substituted for one of the antituberculous drugs
- 3. Extrapulmonary disease
- Note: Therapy for extrapulmonary disease would include the same agents as for pulmonary disease

# Mycobacterium ulcerans
- Mycobacterium ulcerans 
- 1. Preulcerative lesions
- Excision and primary closure, Rifampin monotherapy, or heat therapy
- 2. Established ulcers
- Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice
- 3. Control complications of the ulcer
- Preferred regimen: Clarithromycin AND Rifampin

# Swine influenza
- Swine influenza 
- 1. Condition1: Patients who have severe or progressive clinical illness
- Preferred regimen: Oseltamivir 150 mg PO bid
- Note(1): Treatment duration depends on clinical response
- Note(2): Where the clinical course remains severe or progressive, despite 5 or more days of antiviral treatment, monitoring of virus replication and shedding, and antiviral drug susceptibility testing is desirable
- Note(3): Antiviral treatment should be maintained without a break until virus infection is resolved or there is satisfactory clinical improvement
- Note(4): Patients who have severe or progressive clinical illness, but who are unable to take oral medication may be treated with Oseltamivir administered by nasogastric or orogastric tube
- 2. Condition2: In situations where oseltamivir is not available, or not possible to use, patients who have severe or progressive clinical illness
- Preferred regimen: Zanamivir inhaled
- Note: Zanamivir IV should be considered where available and is recommended for those with serious or progressive illness. If not available, Peramivir IV may be considered
- 3. Condition3: Severely immunosuppressed patients
- Antiviral chemoprophylaxis would be considered by using Oseltamivir OR Zanamivir

# Mycobacterium simiae
- Mycobacterium simiae 
- Preferred regimen: Clarithromycin AND Moxifloxacin AND Trimethoprim/sulfamethoxazole

# Mycobacterium foruitum
- Mycobacterium foruitum 
- 1. In vitro isolates
- Susceptible agents: Amikacin (100%), Ciprofloxacin and Ofloxacin (100%), Sulfonamides (100%), Cefoxitin (50%), Imipenem (100%), Clarithromycin (80%), and Doxycycline (50%)
- 2. Disease
- 2.1 M. fortuitum lung disease
- At least two agents with in vitro activity against the clinical isolate should be given for at least 12 months of negative sputum cultures
- 2.2 Serious skin, bone, and soft tissue M fortuitum disease
- At least two agents with in vitro activity against the clinical isolate should be given for a minimum of 4 months; For bone infections, 6 months of therapy is recommended

# Mycobacterium scrofulaceum
- Mycobacterium scrofulaceum 
- Susceptibility data are lacking and standard treatment regimens for M. scrofulaceum are controversial, emphasizing the need to perform susceptibility testing on confirmed disease-producing isolates of M. scrofulaceum

# Mycobacterium marinum
- Mycobacterium marinum 
- 1. In vitro M. marinum isolates
- Susceptible: Rifampin, Rifabutin, Ethambutol, Clarithromycin, Sulfonamides, and Trimethoprim sulfamethoxazole
- Intermediately susceptible: Streptomycin, Doxycycline, and Minocycline
- Resistant: Isoniazid and Pyrazinamide
- Note: Two active agents for 1 to 2 months after resolution of symptoms, typically 3 to 4 months in total
- 2. Infection
- 2.1 skin and soft tissue infections
- Preferred regimen (1): Clarithromycin AND Ethambutol
- Preferred regimen (2): Ethambutol AND Rifampin
- Note: Azithromycin can replace Clarithromycin
- 2.2 osteomyelitis or deep structure infection
- Preferred regimen: Clarithromycin AND Ethambutol AND Rifampin

# Mycobacterium kansasii
- Mycobacterium kansasii 
- 1. pulmonary disease
- Preferred regimen: Rifampin 10 mg/kg/day (Maximum, 600 mg) PO AND Ethambutol 15 mg/kg/ day PO AND Isoniazid 5 mg/kg/day (Maximum 300 mg) PO AND Pyridoxine 50 mg/day PO
- Note: Treatment duration for M. kansasii lung disease should include 12 months of negative sputum cultures
- 2. Rifampin-resistant M. kansasii disease
- Preferred regimen: Clarithromycin OR Azithromycin OR Moxifloxacin OR Ethambutol OR Sulfamethoxazole OR Streptomycin
- Note(1): Use three-drug regimen
- Note(2): Patients undergoing therapy for M. kansasii lung disease should have close clinical monitoring with frequent sputum examinations for mycobacterial culture throughout therapy
- 3. Disseminated M. kansasii disease
- Note: The treatment regimen for disseminated disease should be the same as for pulmonary disease

# Mycobacterium gordonae
- Mycobacterium gordonae 
- Preferred regimen: Ethambutol OR Rifabutin OR Clarithromycin OR Linezolid OR Fluoroquinolones

# Mycobacterium genavense
- Mycobacterium genavense 
- Susceptibility: Amikacin, Rifamycin, Fluoroquinolones, Streptomycin, and Macrolides
- Note(1): Ethambutol has limited activity
- Note(2): Optimal therapy is not determined, but multidrug therapies including Clarithromycin appear to be more effective than those without Clarithromycin

# Mycobacterium haemophilum
- Mycobacterium haemophilum 
- 1. In vitro
- Susceptible: Amikacin, Clarithromycin, Ciprofloxacin, Rifampin, and Rifabutin
- Less susceptible: Doxycycline and Sulfonamides
- 2. Infection
- 2.1 Disseminated disease
- Preferred regimen: Clarithromycin AND Rifampin AND Rifabutin AND Ciprofloxacin

# Mycobacterium chelonae
- Mycobacterium chelonae 
- 1. Localized infections
- Preferred regimen: Clarithromycin 500 mg PO bid
- Alternative regimen: Azithromycin
- 2. Disseminated or extensive disease
- 2.1 monotherapy
- Preferred regimen: Clarithromycin 500 mg PO bid for 6 months
- 2.2 multidrug therapy
- preferred regimen: Clarithromycin 500 mg PO bid AND Tobramycin 5 mg/kg IV q24h OR Imipenem 0.5-1 g IV q6h OR Linezolid 600 mg IV/PO q12h/bid for 4-8 weeks
- Alternative regimen: Moxifloxacin 400 mg PO qd AND Linezolid 600 mg PO bid
- Note(1): During initial treatment, multidrug therapy may prevent development of acquired resistance
- Note(2): Total treatment duration is 6 months
- 3. Keratitis (LASIK-related)
- Preferred regimen: Clarithromycin 500 mg PO bid AND Tobramycin 0.3% 2 gtts q4h AND Gatifloxacin 0.3% 1 gtt q4h OR Moxifloxacin 0.5% 1 gtt q4h

# Mycobacterium celatum
- Mycobacterium celatum 
- Preferred regimen: Clarithromycin AND Ethambutol AND Ciprofloxacin  Rifabutin

# Mycobacterium avium complex
- 1. Treatment of MAC pulmonary disease 
- 1.1 Patients with nodular/bronchiectatic disease
- Preferreday regimen: Clarithromycin 1,000 mg three times weekly OR Azithromycin 500600 mg three times weekly AND Ethambutol 25 mg/kg three times weekly AND Rifampin 600 mg three times weekly
- Note: Patients should be treated until culture negative on therapy for 1 year
- 1.2 Patients with fibrocavitary or severe nodular/bronchiectatic disease
- Preferreday regimen: Clarithromycin 5001,000 mg/day OR Azithromycin 250300 mg/day OR Rifampin 600 mg/day OR Rifabutin 150300 mg/day AND Ethambutol 15 mg/kg/day
- Note(1): Amikacin OR Streptomycin threetimes-weekly can be used early in therapy
- Note(2): Patients should be treated until culture negative on therapy for 1 year
- 2. Disseminateday MAC disease
- Preferreday regimen: Clarithromycin 1,000 mg/day OR Azithromycin 250 mg/day AND Ethambutol 15 mg/kg/day  Rifabutin 150350 mg/day

# Mycobacterium bovis
- Mycobacterium bovis 
- Note: Is intrinsically resistant to Pyrazinamide (PZA). The treatment of M. bovis is extrapolated from experience with the treatment of PZA-resistant M. tuberculosis
- 1. Pulmonary and most extrapulmonary disease
- Preferred regimen: Isoniazid AND Rifampin AND Ethambutol for 2 months, followed by Isoniazid AND Rifampin for 7 months
- 2. Meningitis
- Preferred regimen: Isoniazid AND Rifampin AND Ethambutol for 2 months, followed by Isoniazid AND Rifampin for 10 months

# Mycobacterium abscessus
- 1.Limited, localized extrapulmonary disease  
- Preferred regimen: Clarithromycin 500 mg PO bid  Amikacin 10-15 mg/kg/day IV or 25 mg/kg three times weekly for 4 months
- Alternative regimen (1): Amikacin AND Cefoxitin 12 g/day PO for two weeks
- Note: until clinical improvement in severe cases
- Alternative regimen (2): Amikacin AND Imipenem 500 mg IV q6-8h for two weeks
- Note(1): Until clinical improvement in severe cases
- Note(2): Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed
- 2.Pulmonary or serious extrapulmonary disease
- Preferred regimen: Clarithromycin 500 mg PO bid AND Amikacin 15 mg/kg/day IV AND Cefoxitin 2g IV q4h OR Imipenem 1g IV q6h for at least 2-4 months
- Note: If limited by adverse effects, then switch to Clarithromycin 500 mg PO bid or 1000 mg XR qd OR Azithromycin 250 mg PO qd
- Alternative regimen(1): Tigecycline 100 mg IV loading dose, then 50 mg IV q12h
- Note: could be substituted as one of the injectables
- Alternative regimen(2): Linezolid 600 mg PO bid or 600 mg PO qd AND Clarithromycin
- Note: Could replace parental tx if not tolerated or feasible

# Mycobacterium tuberculosis
- 1. Standard Regimens for new patients 
- 1.1 Adult
- 1.1.1 Initial phase
- Preferred regimen: Isoniazid 300 mg PO (5 mg/kg/day) qd for 8 weeks AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 8 weeks AND Pyrazinamide 2 g PO (25 mg/kg/day) qd for 8 weeks AND Ethambutol 1.6 g PO (15 mg/kg/day) qd for 8 weeks
- Alternative regimen (1): Isoniazid 300 mg/day PO for 2 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO for 2 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO for 2 weeks (25 mg/kg/day) AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day), followed by Isoniazid 300 mg/day PO twice weekly for 6 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly for 6 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO twice weekly for 6 weeks AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day)
- Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 8 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO thrice weekly for 8 weeks (10 mg/kg/day) AND Pyrazinamide 2g/day PO thrice weekly for 8 week (25 mg/kg/day) AND Ethambutol 1.6 g PO thrice weekly for 8 weeks (15 mg/kg/day)
- 1.1.2 Continuation phase
- Preferred regimen (1): Isoniazid 300 mg PO (5 mg/kg/day) qd AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 18 weeks
- Preferred regimen (2): Isoniazid 300 mg PO twice weekly (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks
- Alternative regimen (1): Isoniazid 300 mg/day PO biweekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO biweekly for 18 weeks (10 mg/kg/day)
- Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO thrice weekly for 18 weeks (10 mg/kg/day)
- 1.2 Pediatric
- 1.2.1 Initial phase
- Preferred regimen: Isoniazid 10 mg/kg PO (Maximum, 300 mg/day) AND Rifampicin 15 mg/kg PO (Maximum, 600 mg/day) AND Pyrazinamide 35 mg/kg PO (Maximum, 2 g/day) AND Ethambutol 20 mg/kg PO (Maximum, 1.6 g/day), each for 8 weeks
- 1.2.2 Continuation phase
- Preferred regimen: Isoniazid 10 mg/kg PO (Maximum, 300 mg/day) AND Rifampicin 15 mg/kg PO (Maximum, 600 mg/day), each drug daily for 18 weeks
- 2. MDR Tuberculosis 
- 2.1 Adult
- Preferred regimen: 4 agents combination
- Agent 1: Pyrazinamide 2030 mg/kg OR Ethambutol 1525 mg/kg OR Rifabutin 5 mg/kg
- Agent 2: Capreomycin 15 mg/kg OR Kanamycin 15 mg/kg OR Amikacin 7.5-10 mg/kg OR Streptomycin 1218 mg/kg
- Agent 3: Levofloxacin 500-1000 mg OR Moxifloxacin 400 mg OR Ofloxacin 400 mg
- Agent 4: Ethionamide 15-20 mg/kg OR Protionamide 15-20 mg/kg OR Cycloserine 10-15 mg/kg OR Terizidone 10-20 mg/kg OR Para-aminosalicylic acid 8-12 g/day IV q8-12h
- 2.2 Pediatric
- Preferred regimen: 4 agents combination
- Agent 1: Pyrazinamide 20-30 mg/kg (Maximum: 600 mg) OR Ethambutol 15-20 mg/kg OR Rifabutin 5 mg/kg
- Agent 2: Capreomycin 15-30 mg/kg (Maximum: 1000 mg) OR Kanamycin 15-30 mg/kg (Maximum: 1000 mg) OR Amikacin 15-22.5 mg/kg (Maximum: 1000 mg) OR Streptomycin 12-18 mg/kg AND
- Agent 3: Levofloxacin 7.5-10 mg/kg OR Moxifloxacin 7.5-10 mg/kg OR Ofloxacin 15-20 mg/kg/day q12h (Maximum: 800 mg)
- Agent 4: Ethionamide 15-20 mg/kg/day q12h (Maximum: 1000 mg) OR Protionamide 15-20 mg/kg/day q12h (Maximum: 1000 mg) OR Cycloserine 10-20 mg/kg (Maximum: 1000 mg) OR Terizidone 10-20 mg/kg (Maximum: 1000 mg) OR Para-aminosalicylic acid 150 mg/kg/day q8-12h(Maximum: 12,000 mg)
- 3. XDR Tuberculosis 
- 3.1 Adult
- Preferred regimen: 3 agents combination
- Agent 1: Pyrazinamide 2030 mg/kg OR Ethambutol 1525 mg/kg OR Rifabutin 5 mg/kg
- Agent 2: Ethionamide 15-20 mg/kg OR Protionamide 15-20 mg/kg OR Cycloserine 10-15 mg/kg OR Terizidone 10-20 kg/mg OR Para-aminosalicylic acid 8-12 g/day q8-12h
- Agent 3: Clofazimine 50 mg/d AND 300 mg once a month OR Amoxicillin/clavulanate 500 mg/125 mg q12h OR Linezolid 300-600 mg OR Imipenem 500mg q6h OR Clarithromycin 500-1000 mg q12h OR Thioacetazone 2.5 mg/kg OR Isoniazid (high-dose) 1620 mg/kg
- 3.2 Pediatric
- Preferred regimen: 3 agents combination
- Agent 1: Pyrazinamide 20-30 mg/kg (Maximum: 600 mg) OR Ethambutol 15 mg/kg OR Rifabutin 5 mg/kg
- Agent 2: Ethionamide 15-20 mg/kg (Maximum: 1000 mg) OR Protionamide 15-20 mg/kg (Maximum: 1000 mg) OR Cycloserine 10-20 mg/kg (Maximum: 1000 mg) OR Terizidone 10-20 mg/kg (Maximum: 1000 mg) OR Para-aminosalicylic acid 150 mg/kg/day q8-12h
- Agent 3: Clofazimine 50 mg/d AND 300 mg once a month OR Amoxicillin/clavulanate OR Linezolid 300-600 mg OR Imipenem 500mg q6h OR Clarithromycin 500-1000 mg q12h OR Thioacetazone 2.5 mg/kg OR Isoniazid (high-dose) 1620 mg/kg

# Bacteroides fragilis
- Bacteroides fragilis 
- 1. Monotherapy
- Preferred regimen (1): Imipenem
- Preferred regimen (2): Ertapenem
- Preferred regimen (3): Meropenem
- Preferred regimen (4): Doripenem 0.5-1.0 g IV q6h
- Preferred regimen (5): Piperacillin-tazobactam 3.375 g IV q6h
- Preferred regimen (6): Ampicillin-sulbactam 1-2 g IV q6h
- Preferred regimen (7): Tigecycline 100 mg IV THEN 50 mg IV q12h
- 2. 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

# Acinetobacter baumannii
- Acinetobacter baumannii 
- Preferred regimen (1): Imipenem 0.5-1 g IV q6h
- Preferred regimen (2): Ampicillin/sulbactam 3 g q4h
- Preferred regimen (3): Cefepime 1-2 g IV q8h
- Preferred regimen (4): Colistin 2.5 mg/kg IV q12h
- Preferred regimen (5): Tigecycline 100 mg IV THEN 50 mg IV q12h
- Preferred regimen (6): Amikacin 7.5 mg/kg q12h IV or 15 mg/kg/day IV
- Alternative regimen (1): Ceftriaxone 1-2g IV every day
- Alternative regimen (2): Cefotaxime 2-3g IV q6-8h
- Alternative regimen (3): Ciprofloxacin 400 mg IV q8-12h or 750 mg PO bid
- Alternative regimen (4): TMP-SMX 15-20 mg (TMP)/kg/day IV q6-8h or 2 DS PO bid

# Vibrio vulnificus
- Vibrio vulnificus 
- Note: If V. vulnificus is suspected, treatment should be initiated immediately because antibiotics improve survival
- Preferred regimen: Doxycycline 100 mg PO/IV bid for 7-14 days AND Ceftazidime 1-2 g IV/IM q8h
- Note: A single agent regimen with a fluoroquinolone such as Levofloxacin, Ciprofloxacin or Gatifloxacin, has been reported to be at least as effective in an animal model as combination drug regimens with Doxycycline and a Cephalosporin
- Pediatric regimen: Doxycycline AND Fluoroquinolones; trimethoprim-sulfamethoxazole AND an Aminoglycoside

# Vibrio parahaemolyticus
- Vibrio parahaemolyticus 
- 1. Mild to Moderate
- Treatment is not necessary in most cases of V. parahaemolyticus infection
- There is no evidence that antibiotic treatment decreases the severity or the length of the illness
- Patients should drink plenty of liquids to replace fluids lost through diarrhea
- 2. Severe or prolonged illnesses
- Preferred regimen: Tetracycline OR Ciprofloxacin

# Vibrio cholerae
- 1. WHO  
- Note: Antibiotic treatment for cholera patients with severe dehydration only
- Adults
- Preferred regimen: Doxycycline 300 mg po single dose
- Alternative regimen: Tetracycline 12.5 mg/kg PO qid for 3 days
- Pediatric
- Under 12 years old
- Preferred regimen: Erythromycin 12.5 mg/kg PO qid for 3 days
- Over 12 years old
- Preferred regimen: Doxycycline 300 mg po single dose
- Alternative regimen: Tetracycline 12.5 mg/kg PO qid for 3 days
- 2. Pan American Health Organization 
- Note: Antibiotic treatment for cholera patients with moderate or severe dehydration
- 2.1 Adult
- Preferred regimen: Doxycycline 300 mg po single dose
- Alternative regimen (1): Ciprofloxacin 1 g PO single dose
- Alternative regimen (2): Azithromycin 1 g PO single dose
- 2.2 Pediatric
- 2.2.1 Children over 3 year, who can swallow tablets
- Preferred regimen (1): Erythromycin 12.5 mg/kg/ PO qid for 3 days
- Preferred regimen (2): Azithromycin 20 mg/kg PO in a single dose
- Alternative regimen (1): Ciprofloxacin suspension or tablets 20 mg/kg PO single dose
- Alternative regimen (2): Doxycycline suspension or tablets 2-4 mg/kg PO single dose
- Note: Although doxycycline has been associated with a low risk of yellowing of the teeth in children, its benefits outweigh its risks
- 2.2.2 Children under 3 year, or infants who cannot swallow tablets
- Preferred regimen (1): Erythromycin suspension 12.5 mg/kg/ PO qid for 3 days
- Preferred regimen (2): Azithromycin suspension 20 mg/kg PO single dose
- Alternative regimen (1): Ciprofloxacin suspension 20 mg/kg PO single dose
- Alternative regimen (2): Doxycycline syrup 2-4 mg/kg PO single dose
- 2.3 Pregnancy
- Preferred regimen (!): Erythromycin 500 mg/ PO qid for 3 days
- Preferred regimen (2): Azithromycin 1 g PO single dose

# Treponema pallidum
- 1. Syphilis Among non-HIV-Infected Persons 
- 1.1 Primary and Secondary Syphilis
- Preferred regimen: Benzathine penicillin G 2.4 MU IM single dose
- Pediatric regimen: Benzathine penicillin G 50,000 U/kg (Maximum, 2.4 MU) IM single dose
- 1.2 Latent Syphilis
- 1.2.1 Early Latent Syphilis
- Preferred regimen: Benzathine penicillin G 2.4 MU IM in a single dose
- Pediatric regimen: Benzathine penicillin G 50,000 U/kg (Maximum, 2.4 MU) IM single dose
- 1.2.2 Late Latent Syphilis or Latent Syphilis of Unknown Duration
- Preferred regimen: Benzathine penicillin G 7.2 MU total, administered as 3 doses of 2.4 MU IM each at 1 week intervals
- Pediatric regimen: Benzathine penicillin G 50,000 U/kg IM (Maximum, 2.4 MU), administered as 3 doses at 1 week intervals (total 150,000 U/kg up to the adult total dose of 7.2 MU)
- 1.3 Tertiary Syphilis
- Preferred regimen: Benzathine penicillin G 7.2 MU total, administered as 3 doses of 2.4 MU IM each at 1 week intervals
- 1.4 Neurosyphilis and ocular syphilis
- Preferred regimen: Aqueous crystalline penicillin G 18-24 MU per day, administered as 3-4 MU IV q4h or continuous infusion, for 10-14 days
- Alternative regimen: Procaine penicillin 2.4 MU IM q24h AND Probenecid 500 mg PO qid for 10-14 days
- 2. Syphilis Among HIV-Infected Persons
- 2.1 Primary and Secondary Syphilis Among HIV-Infected Persons
- Preferred regimen: Benzathine penicillin G 2.4 MU IM single dose
- 2.2 Latent Syphilis Among HIV-Infected Persons
- 2.2.1 early latent
- Preferred regimen: Benzathine penicillin G 2.4 MU IM single dose
- 2.2.2 late latent
- Preferred regimen: Benzathine penicillin G 2.4 MU once a week for 3 weeks
- 2.3 Neurosyphilis Among HIV-Infected Persons
- Preferred regimen: Aqueous crystalline penicillin G 18-24 MU per day, administered as 3-4 MU IV q4h or continuous infusion, for 10-14 days
- Alternative regimen: Procaine penicillin 2.4 MU IM q24h AND Probenecid 500 mg PO qid  for 10-14 days
- 3. Syphilis During Pregnancy
- Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection
- 4. Congenital Syphilis in neonates
- 4.1 condition1: 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 (1): Aqueous crystalline penicillin G 100,000-150,000 U/kg/day, administered as 50,000 U/kg/dose IV q12h during the first 7 days of life and q8h thereafter for a total of 10 days
- Preferred regimen (2): Procaine penicillin G 50,000 U/kg/dose IM q24h 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.
- 4.2 condition2: 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 (1): Aqueous crystalline penicillin G 100,000-150,000 U/kg/day, administered as 50,000 U/kg/dose IV q12h during the first 7 days of life and q8h thereafter for a total of 10 days
- Preferred regimen (2): Procaine penicillin G 50,000 U/kg/dose IM q24h for 10 days
- Preferred regimen (3): Benzathine penicillin G 50,000 U/kg/dose IM single dose
- Note: If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered
- 4.3 condition3: 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 U/kg/dose IM single dose
- 4.4 condition4: 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).
- No treatment is required
- Benzathine penicillin G 50,000 U/kg IM single dose might be considered, particularly if follow-up is uncertain.
- 5. Congenital Syphilis in infants and children
- Preferred regimen: Aqueous crystalline penicillin G 50,000 U/kg q46h for 10 days

# Leptospira
- Leptospira 
- Preferred regimen: Doxycycline 200 mg PO once a week

# Borrelia recurrentis
- 1. Tick-Borne Relapsing Fever 
- Preferred regimen: Doxycycline 100 mg PO bid for 5-10 days
- Alternative regimen: Erythromycin 500 mg PO qid for 5-10 days
- Note: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days
- 2. Louse-Borne Relapsing Fever
- Preferred regimen: Tetracycline 500 mg PO single dose
- Alternative regimen: Erythromycin 500 mg PO single dose

# Borrelia burgdorferi
- Lyme disease 
- 1. Early Lyme Disease
- 1.1 Erythema migrans
- 1.1.1 Adult
- Preferred regimen (1): Doxycycline 100 mg PO bid for 10-21 days
- Preferred regimen (2): Amoxicillin 500 mg PO tid for 14-21 days
- Preferred regimen (3): Cefuroxime axetil 500 mg bid for 14-21 days
- Alternatie regimen (1): Azithromycin 500 mg PO qd for 710 days
- Alternatie regimen (2): Clarithromycin 500 mg PO bid for 1421 days (if the patient is not pregnant)
- Alternatie regimen (3): Erythromycin 500 mg PO qid for 1421 days
- 1.1.2 Pediatric
- 1.1.2.1 children <8 years of age
- Preferred regimen (1): Amoxicillin 50 mg/kg/day PO q8h (Maximum of 500 mg per dose)
- Preferred regimen (2): Cefuroxime axetil 30 mg/kg/day PO q12h(Maximum, 500 mg per dose)
- 1.1.2.2 children 8 years of age
- Preferred regimen (1): Doxycycline 4 mg/kg/day PO q12h(Maximum, 100 mg per dose)
- Preferred regimen (2): Azithromycin 10 mg/kg PO qd (Maximum, 500 mg qd)
- Preferred regimen (3): Clarithromycin 7.5 mg/kg PO bid (Maximum, 500 mg per dose)
- Preferred regimen (4): Erythromycin 12.5 mg/kg PO qid (Maximum, 500 mg per dose)
- 1.2 When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis
- Preferred regimen: Amoxicillin-Clavulanate 500 mg PO tid
- Pediatric regimen: Amoxicillin-Clavulanate 50 mg/kg/day q8h (Maximum, 500 mg per dose)
- 1.3 Lyme meningitis and other manifestations of early neurologic Lyme disease
- 1.3.1 Adult
- Preferred regimen: Ceftriaxone 2 g IV q24h for 1028 days
- Alternative regimen (1): Cefotaxime 2 g IV q8h
- Alternative regimen (2): Penicillin G 1824 MU q4h (for patients with normal renal function)
- Alternative regimen (3): Doxycycline 200400 mg/day PO bid for 1028 days
- 1.3.2 Pediatric
- Preferred regimen (1): Ceftriaxone 5075 mg/kg IV single dose (Maximum, 2 g)
- Preferred regimen (2): Cefotaxime 150200 mg/kg/day IV q6-8h (Maximum, 6 g per day)
- Alternative regimen (1): Penicillin G 200,000400,000 units/kg/day IV  q4h (for normal renal function) (maximum, 1824 MU per day)
- Alternative regimen (2): Doxycycline 48 mg/kg/day PO bid (maximum, 100200 mg per dose) (8 years old)
- 1.4 Lyme carditis
- Preferred regimen: Ceftriaxone 2 g IV q24h 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)
- 1.5 Borrelial lymphocytoma
- Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)
- 2. Late Lyme Disease
- 2.1 Lyme arthritis
- Preferred regimen (1): Doxycycline 100 mg PO bid
- Preferred regimen (2): Amoxicillin 500 mg PO tid
- Alternative regimen: Cefuroxime axetil 500 mg PO bid for 28 days
- Pediatric regimen: Amoxicillin 50 mg/kg/day tid (Maximum, 500 mg per dose); Cefuroxime axetil 30 mg/kg/day bid (Maximum,500 mg per dose); (8 years of age) Doxycycline 4 mg/kg/day bid (Maximum, 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 weeks course of Ceftriaxone IV
- 2.2 patients with arthritis and objective evidence of neurologic disease
- Preferred regimen: Ceftriaxone IV for 24 weeks
- Alternative regimen (1): Cefotaxime IV
- Alternative regimen (1): Penicillin G IV
- Pediatric regime: Ceftriaxone; Cefotaxime; Penicillin G IV
- 2.3 Late neurologic Lyme disease
- Preferred regimen: Ceftriaxone IV for 2 to 4 weeks
- Alternative regimen (1): Cefotaxime IV
- Alternative regimen (2): Penicillin G IV
- Pediatric regimen: Ceftriaxone; Cefotaxime; Penicillin G
- 2.4 Acrodermatitis chronica atrophicans
- Preferred regimen (1): Doxycycline 100 mg PO bid for 21 days
- Preferred regimen (2): Amoxicillin 500 mg PO tid for 21 days
- Preferred regimen (3): Cefuroxime axetil 500 mg PO bid for 21 days
- 3. 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)

# Pasteurella multocida
- Pasteurella multocida 
- Preferred regimen (1): Amoxicillin clavulanate 500 mg PO tid or 875 mg PO bid with food
- Note: Its also a preferred empirical coverage of animal bite wounds
- Preferred regimen (2): Ampicillin sulbactam 3 g IV q6h
- Preferred regimen (3): Ciprofloxacin 500 mg PO bid or 400 mg IV q12h
- Preferred regimen (4): Levofloxacin 500 mg PO qd or IV q24h
- Alternative regimen (1): Doxycycline 100 mg PO bid
- Alternative regimen (2): TMP-SMX DS PO bid (for beta-lactam allergic patients )
- Alternative regimen (3): Penicillin 500 mg PO qid or 4 MU IV q4h (use only if isolate known to be susceptible)

# Moraxella catarrhalis
- Moraxella catarrhalis 
- Preferred regimen(1): TMP-SMX 1DS PO bid
- Preferred regimen(2): Erythromycin 500 mg PO qid
- Preferred regimen(3): Clarithromycin 500 mg PO bid or XL 1 g PO qd
- Preferred regimen(4): Azithromycin 500 mg PO single dose THEN 250 mg PO qd
- Preferred regimen(5): Doxycycline 100 mg PO/IV bid/q12h
- Preferred regimen(6): Cefprozil 200-500 mg PO bid
- Preferred regimen(7): Cefpodoxime 200-400 mg PO bid
- Preferred regimen(8): Cefuroxime 250-500 mg PO bid
- Preferred regimen(9): Cefdinir 300 mg PO bid
- Preferred regimen(10): Moxifloxacin 400 mg IV/PO qd
- Preferred regimen(11): Levofloxacin 500 mg IV/PO qd
- Preferred regimen(12): Amoxicillin clavulanate 875/125 mg PO bid or XL 2000/125 PO bid

# Eikenella corrodens
- 1. Human bite/soft tissue infections 
- 1.1 Severe
- Preferred regimen: Ampicillin sulbactam 1.5-3 g IV q6h
- Alternative regimen (1): Doxycycline 100 mg IV bid
- Alternative regimen (2): Moxifloxacin 400 mg IV q24h
- Alternative regimen (3): Levofloxacin 500 mg IV q24h
- 1.2 Mild
- Preferred regimen: Amoxicillin clavulanate 250-500 mg tid or 875/125 mg PO bid
- Alternative regimen (1): Doxycycline 100 mg PO bid
- Alternative regimen (2): Moxifloxacin 400 mg PO qd
- Alternative regimen (3): Levofloxacin 500 mg PO qd
- 2. Head and neck infections
- 2.1 Severe
- Preferred regimen: Ampicillin sulbactam 1.5-3 g IV q6h
- Alternative regimen (1): Doxycycline 100 mg IV bid
- Alternative regimen (2): Moxifloxacin 400 mg IV q24h
- Alternative regimen (3): Levofloxacin 500 mg IV q24h
- 2.2 Mild
- Preferred regimen: Amoxicillin clavulanate 250-500 mg tid or 875/125 mg PO bid
- Alternative regimen (1): Doxycycline 100 mg PO bid
- Alternative regimen (2): Moxifloxacin 400 mg PO qd
- Alternative regimen (3): Levofloxacin 500 mg PO qd
- 3. Endocarditis
- Preferred regimen (1): Ceftriaxone 1 g IV q12h
- Preferred regimen (1): Cefotaxime 1-2 g IV q8h
- Preferred regimen (1): Cefepime 1-2g IV q8h

# Rickettsia rickettsii
- 1. Adult  
- Preferred regimen: Doxycycline 100 mg q12h
- Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. Standard duration of treatment is 7-14 days
- Alternative regimen: Chloramphenicol 500 mg PO qid for 7 days or stop 3 days after defervescence
- 2. Pediatric (under 45 kg (100 lbs))
- Preferred regimen: Doxycycline 2.2 mg/kg bid
- Note: The recommended dose and duration of medication needed to treat RMSF has not been shown to cause staining of permanent teeth, even when five courses are given before the age of eight. Healthcare providers should use doxycycline as the first-line treatment for suspected Rocky Mountain spotted fever in patients of all ages

# Rhodococcus equi
- Rhodococcus equi 
- First line:
- Preferred regimen: Vancomycin 1 g IV q12h (15 mg/kg q12 for >70 kg) OR Imipenem 500 mg IV q6h AND Rifampin 600 mg PO qd OR Ciprofloxacin 750 mg PO bid OR Erythromycin 500 mg PO qid for at least 4 weeks or until infiltrate disappears
- Note: Should be administrated at least 8 weeks in immunocompromised patients
- Oral/maintenance therapy (after infiltrate clears):
- Preferred regimen (1): Ciprofloxacin 750 mg PO bid
- Preferred regimen (2): Erythromycin 500 mg PO qid
- 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

# Propionibacterium acnes
- Propiobacterium acnes 
- 1. Systemic infection
- Preferred regimen: Penicillin G 2 MU IV q4h for 2-4 weeks
- Alternative regimen (1): Clindamycin 600 mg IV q8h for 2-4 weeks
- Alternative regimen (2): Vancomycin 15 mg/kg IV q12h for 2-4 weeks
- 2. Shoulder prosthesis infection
- Preferred regimen: Amoxicillin AND Rifampin for 3-6 months
- 3. Acne vulgaris
- Topical antibiotics: Erythromycin OR Clindamycin
- Systemic antibiotics: Minocycline OR Doxycycline OR Trimethoprim-Sulfamethoxazole

# Nocardia
- 1. Sulfonamide-based therapies 
- 1.1 Pulmonary
- Preferred regimen: TMP-SMX 10 mg/kg/day (TMP) IV q6-12h for 3-6 weeks, then 2 DS PO bid for at least 5 months
- 1.2 Pulmonary alternatives
- Preferred regimen: Sulfisoxazole OR Sulfadiazine OR Trisulfapyrimidine 3-6 g/day PO bid-qid OR TMP-SMX 2 DS bid up to 2 DS tid
- 1.3 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
- 1.4 CNS alternatives
- Preferred regimen: Imipenem 1000 mg IV q8h OR Ceftriaxone 2 g IV q12h OR Cefotaxime 2-3 g IV q6h AND Amikacin
- 1.5 Severe disease, compromised host, multiple sites
- Preferred regimen: TMP-SMX 15 mg/kg/day (TMP) IV AND Amikacin 7.5 mg/kg q12h OR Sulfonamide 6-12 mg/day PO
- 1.6 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
- 2. Sulfonamide alternatives
- 2.1 Severe
- Preferred regimen (1): (For AIDS) (Imipenem 1000 mg IV q8h OR Meropenem 2 g q8h AND Amikacin 7.5 mg/kg q12h IV
- Preferred regimen (2): Cefotaxime 2-3 g q6-8h OR Ceftriaxone 2 g/day IV  Amikacin
- 2.2 Mild
- Preferred regimen: Minocycline 100 mg bid for at least 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 at least 6 months

# Leuconostoc
- Leuconostoc 
- Preferred regimen (1): Penicillin G
- Preferred regimen (2): Ampicillin
- Alternative regimen (1): Clindamycin
- Alternative regimen (2): Erythromycin
- Alternative regimen (3): Minocycline

# Lactobacillus
- 1. Endovascular Infection 
- Preferred regiemn (1): Penicillin G 20 MU/day for 6 weeks
- Preferred regiemn (2): Gentamicin 1.3 mg/kg IV q8h (trough <1.5 mg/L) AND Polychlorinated naphthalene
- 2. Odontogenic Infection
- Preferred regiemn: Clindamycin 450 mg PO qid
- 3. Intrabdominal Abscess
- Preferred regiemn: Clindamycin 450 mg PO qid

# Listeria monocytogenes
- 1. 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) IV q6h for more than 3 weeks
- 2. 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
- 3. 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
- 4. Gastroenteritis
- Preferred regimen (1): Amoxicillin 2g IV q4-6h
- Preferred regimen (2): TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 7 days

# Erysipelothrix rhusiopathiae
- Erysipelothrix rhusiopathiae 
- 1. Erysipeloid of Rosenbach (localized cutaneous infection)
- Preferred regimen (1): Penicillin G benzathine 1.2 MU IV 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
- 2. Diffuse cutaneous infection
- Preferred regimen: See localized infection
- 3. 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
- Note: Recommended duration of therapy for endocarditis is 4 to 6 weeks, although shorter courses consisting of 2 weeks of intravenous therapy followed by 2 to 4 weeks of oral therapy have been successful

# Ehrlichia
- 1. 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 (1): Chloramphenicol 500mg PO qid
- Alternative regimen (2): Rifampin 600 mg PO/IV qd for 7-10 days
- 2. Human Monocytic Ehrlichiosis or Human Granulocytic Anaplasmosis (pediatric)
- 2.1  8 years old
- Preferred regimen: Doxycycline 2 mg/kg IV/PO q12h (Maximum, 200 mg/day) for 10 days
- 2.2 < 8 years old without Lyme disease
- Preferred regimen: Doxycycline 2 mg/kg IV/PO q12h (Maximum, 200 mg/day) for 4-5 days (or 3 days after resolution of fever)
- 2.3 co-infected with Lyme disease
- Preferred regimen: Doxycycline (see above) THEN Amoxicillin 50 mg/kg/day tid (Maximum, 500 mg/dose) OR Cefuroxime 30 mg/kg/day bid (Maximum, 500 mg/dose) for 14 days

# Coxiella burnetii
- 1. Acute Q fever 
- 1.1 Adults
- Preferred Regimen: Doxycycline 100 mg PO bid for 14 days
- 1.2 Pediatric
- 1.2.1  8 years old
- Preferred regimen:Doxycycline 2.2 mg/kg PO bid for 14 days (Maximum, 100 mg per dose)
- 1.2.2 < 8 years old with high risk criteria
- Preferred regimen:Doxycycline 2.2 mg/kg PO bid for 14 days (Maximum, 100 mg per dose)
- 1.2.3 < 8 years old with mild or uncomplicated illness
- Preferred regimen:Doxycycline 2.2 mg/kg PO bid for 5 days (Maximum, 100 mg per dose)
- Alternative regimen: (If patient remains febrile past 5 days of treatment) Trimethoprim/Sulfamethoxazole 4-20 mg/kg PO bid for 14 days (Maximum, 800 mg per dose)
- 1.3 Pregnant women
- Preferred regimen: Trimethoprim/sulfamethoxazole 160 mg/800 mg PO bid
- Note: Should be given throughout pregnancy
- 2. Chronic Q fever
- 2.1 Endocarditis or vascular infection
- Preferred regimen: Doxycycline 100 mg PO bid AND hydroxychloroquine 200 mg PO tid for 18 months
- Note: Childern and pregnant women consultation recommended
- 2.2 Non-cardiac organ disease
- Preferred regimen: Doxycycline 100 mg PO bid AND hydroxychloroquine 200 mg PO tid
- Note: childern and pregnant women consultation recommended
- 2.3 Postpartumwith serologic profile for chronic Q fever
- Preferred regimen: Doxycycline 100 mg PO bid AND hydroxychloroquine 200 mg PO tid for 12 months
- Note (1): 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 (2): Post-Q fever fatigue syndrome- no current recommendation

# Corynebacterium diphtheriae
- Diphtheria treatment  
- 1. Antitoxin
- 1.1 Pharyngeal disease <48 hrs
- Preferred regimen: 20,000-40,000 U IV/IM
- 1.2 Nasopharyngeal
- Preferred regimen: 40-60,000 U IV/IM
- 1.3 Extensive disease, or >72 hrs
- Preferred regimen: 80-120,000 U IV/IM
- Note: IV administration for severe disease
- 2. Antibiotics
- Preferred regimen: Erythromycin 40 mg/kg/day (Maximum, 2 gm/day) PO/IV for 14 days
- Alternative regimen: Procaine penicillin G 600,000 U/day IM qd for 14 days
- Note: Procaine penicillin G  300,000 U/day for those weighing 10 kg or less
- 3. Preventive antibiotic use
- Note: For close contacts, especially household contacts, a diphtheria booster, appropriate for age, should be given
- Preferred regimen: Benzathine penicillin G
- younger than 6 years old: 600,000 U IM
- 6 years old and older: 1,200,000 U IM
- Alternative regimen: Erythromycin
- Adult: 1 g/day PO 7-10 days
- Pediatric: 40 mg/kg/day PO 7-10 days
- Note (1): If surveillance of contacts cannot be maintained, they should receive benzathine penicillin G
- Note (2): Maintain close surveillance and begin antitoxin at the first signs of illness

# Swine influenza
- Swine influenza 
- 1. Condition1: Patients who have severe or progressive clinical illness
- Preferred regimen: Oseltamivir 150 mg PO bid
- Note (1): Treatment duration depends on clinical response
- Note (2): Where the clinical course remains severe or progressive, despite 5 or more days of antiviral treatment, monitoring of virus replication and shedding, and antiviral drug susceptibility testing is desirable
- Note (3): Antiviral treatment should be maintained without a break until virus infection is resolved or there is satisfactory clinical improvement
- Note (4): Patients who have severe or progressive clinical illness, but who are unable to take oral medication may be treated with oseltamivir administered by nasogastric or orogastric tube
- 2. Condition2: In situations where oseltamivir is not available, or not possible to use, patients who have severe or progressive clinical illness
- Preferred regimen: Zanamivir inhaled
- Note: Zanamivir IV should be considered where available and is recommended for those with serious or progressive illness. If not available, Peramivir IV may be considered
- 3. Condition3: Severely immunosuppressed patients
- Preferred regimen: Antiviral chemoprophylaxis by using Oseltamivir OR Zanamivir

# Trichinella spiralis
- Trichinella spiralis
- Preferred regimen (1): Albendazole 400 mg PO bid for 8-14 days
- Preferred regimen (2): Mebendazole 200-400 mg PO tid for 3 days THEN 400-500 mg PO tid for 10 days
- Note (1): Both treatment schemes are suitable for adult and pediatric dosages
- Note (1): Albendazole and Mebendazole are contraindicated during pregnancy and not recommended in children aged 2 years.
- Alternative regimen (1): (severe symptoms) Prednisone 30 mg/day-60 mg/day for 10-15 days
- Alternative regimen (2): Pyrantel 10-20 mg/kg single dose for 2-3 days