Sandbox aparna

### Bacteria  Gram-Negative Bacilli
- Achromobacter xylosoxidans Return to Top
- Acinetobacter baumannii Return to Top
- Acinetobacter baumannii
- Preferred regimen (1): Imipenem 0.5-1 g IV q6h
- Preferred regimen (2): Ampicillin/sulbactam 3 g IV 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 single doses THEN 50 mg IV q12h
- Preferred regimen (6): Amikacin 7.5 mg/kg IV q12h or 15 mg/kg IV q24h
- Preferred regimen (7) (pan-resistant isolates): (Colistin 5 mg/kg/day IV q12h  Imipenem)
- Preferred regimen (8) (pan-resistant isolates): Ampicillin/sulbactam
- Alternative regimen (1): Ceftriaxone 1-2 g IV qd
- Alternative regimen (2): Cefotaxime 2-3 g 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
- Aeromonas hydrophila Return to Top
- Aeromonas hydrophila 
- 1. Diarrhea
- Preferred regimen (if not self-limiting, or if severe): Ciprofloxacin 500 mg PO bid.
- Alternate regimen: TMP-SMX 1DS PO bid
- Note: High resistance to sulfa agents described in Taiwan and Spain
- 2. Skin and soft tissue infection
- 2.1 Mild infection
- Preferred regimen(1): Ciprofloxacin 500 mg PO bid
- Preferred regimen(2): Levofloxacin 500 mg qd
- 2.2 Severe infection or sepsis
- Preferred regimen(1): Ciprofloxacin 400 mg IV q8h
- Preferred regimen(2): Levofloxacin 750 mg IV q24h
- Note(1): For suspicion of water-based injury,empiric coverage for Vibrio doxycycline 100 mg bid, although flouroquinolones may also cover and vancomycin 15 mg/kg IV q12h with or without clindamycin or linezolid for inhibition of gram-positive toxin production
- Note(2): Alternatives to fluoroquinolones for Aeromonas coverage include carbapenems (ertapenem, doripenem, imipenem or meropenem), ceftriaxone, cefepime and aztreonam.
- 3. Prevention
- Preferred regimen: Frequent recommendations include using a Cephalosporin (e.g.,cefuroxime,ceftriaxone or cefixime) OR a Fluoroquinolone (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches.
- Note (1): Duration of antibiotic use is 3-5 days, some recommend continuing until wound or eschar resolves
- Note (2): Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones.
- Bordetella pertussis Return to Top
- Bordetella pertussis
- 1. Whooping cough
- 1.1 Adults
- Preferred regimen (1): Azithromycin 500 mg PO single dose on day 1 THEN 250 mg PO qd on 2-5 days
- Preferred regimen (2): Erythromycin 2 g/day PO qid for 14 days
- Preferred regimen (3): Clarithromycin 1 g PO bid for 7 days.
- Alternative regimen (intolerant of macrolides): Trimethoprim 320 mg/day AND Sulfamethoxazole 1600 mg/day PO bid for 14 days
- 1.2 Infants <6 months of age
- 1.2.1 Infants <1 month
- Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
- Preferred regimen (2) (if azithromycin unavailable): Erythromycin 40-50 mg/kg/day PO q6h for 14 days
- Note: TMP-SMX contraindicated for infants aged < 2 months
- 1.2.2 Infants of 1-5 months of age
- Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
- Preferred regimen (2): Erythromycin 40-50 mg/kg/day PO qid for 14 days
- Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days
- Alternative regimen: For infants aged  2 months TMP 8 mg/kg q24h AND SMX 40 mg/kg/day PO bid for 14 days
- 1.3 Infants 6 months of age-children
- Preferred regimen(1): Azithromycin 10 mg/kg single dose THEN 5 mg/kg (500 mg Maximum) qd for 2-5 days
- Preferred regimen(2): Erythromycin 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
- Preferred regimen(3): Clarithromycin 15 mg/kg PO (1 g daily Maximum) bid for 7 days
- Preferred regimen(4): TMP 8 mg/kg/day AND SMX 40 mg/kg/day bid for 14 days
- 2. Post exposure prophylaxis
- Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
- Note (1):  Post exposure prophylaxis to an asymptomatic contacts within 21 days of onset of cough in the index patient can potentially prevent symptomatic infection
- Note (2): Close contacts include persons who have direct contact with respiratory, oral or nasal secretions from a symptomatic patient (eg: cough, sneeze, sharing food, eating utensils, mouth to mouth resuscitation, or performing a medical examination of the mouth, nose, throat.
- Note (3): Some close contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged < 1 year , persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency and cystic fibrosis.
- Burkholderia cepacia Return to Top
- Burkholderia cepacia complex
- Preferred regimen (1): Ceftazidime 2 g IV q8h
- Preferred regimen (2): Imipenem 1 g IV q6h
- Preferred regimen (3): Meropenem 1-2 g IV q8h
- Preferred regimen (4): Minocycline 100 mg IV/PO bid
- Burkholderia pseudomallei Return to Top
- Burkholderia pseudomallei
- 1. Melioidosis
- 1.1 Intial intensive therapy (Minimum of 10-14 days)
- Preferred regimen (1): Ceftazidime 50 mg/kg upto 2 g q6h
- Preferred regimen (2): Meropenem 25 mg/kg upto 1 g q8h
- Preferred regimen (3): Imipenem 25 mg/kg upto 1 g q6h
- Note: Any one of the three may be combined with TMP-SMX 6/30 mg/kg upto 320/1600 mg/kg q12h (recommended for neurologic, bone, joint, cutaneous and prostatic melioidosis)
- 1.2 Eradication therapy (Minimum of 3 months)
- Preferred regimen: TMP-SMX 6/30 mg/kg upto 320/1600 mg/kg q12h
- Campylobacter fetus Return to Top
- Campylobacter fetus
- 1. Serious infections
- Preferred regimen (1): Gentamicin 5 mg/kg IV q24h
- Preferred regimen (2): Imipenem 1 mg IV q6h
- Preferred regimen (3): Ceftriaxone 2 g IV q12h
- 2. Endovascular infections
- Preferred regimen: Aminoglycoside 4-6 weeks AND Carbapenem
- 3. CNS
- preferred regimen (1): Ceftriaxone
- preferred regimen (2): Chloramphenicol for 2-3 weeks
- Campylobacter jejuni Return to Top
- Capnocytophaga canimorsus Return to Top
- Capnocytophaga canimorsus
- 1. Severe cellulitis/sepsis or endocarditis
- Preferred regimen (1) (Beta-lactam/beta-lactamase inhibitor): Ampicillin/sulbactam 3 g IV q6h
- Preferred regimen (2) (Non-beta-lactamase producing): Penicillin G 2-4 MU IV q24h
- Alternative regimen (1): Ceftriaxone 1-2 g IV q24h
- Alternative regimen (2): Meropenem 1 g IV q8h
- Alternative regimen (3) (complicated infections or immunocompromise): Clindamycin 600 mg IV q8h may be combined with above agents
- Note (1): Resistance to aztreonam described, and variable susceptibility reported to TMP-SMX and aminoglycosides
- Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks
- Note (3): For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy
- 2. Mild cellulitis/dog or cat bites
- Preferred regimen (1): Amoxicillin/clavulanate 500 mg PO q8h or 875 mg PO bid
- Preferred regimen (2): Amoxicillin 500 mg PO q8h
- Alternative regimen (1): Clindamycin 300 mg PO q6h
- Alternative regimen (2): Doxycycline 100 mg PO bid
- Alternative regimen (3): Clarithromycin 500 mg PO bid
- Alternative regimen (4): Moxifloxacin 400 mg PO qd
- 3. Meningitis or brain abscess
- Preferred regimen (1): Ceftriaxone 2 g IV q12h AND Ampicillin 2 g IV q4h
- Preferred regimen (2) (if beta-lactamase producing or polymicrobial brain abscess): Imipenem/Cilastin 1000 mg q6-8h AND Clindamycin 600 mg IV q8h
- 4. Prevention
- Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with Amoxicillin/clavulanate for 7-10 days.
- Citrobacter freundii Return to Top
- Citrobacter freundii
- Preferred regimen (1): Meropenem 1-2 g IV q8h
- Preferred regimen (2): Imipenem 1 g IV q6h
- Preferred regimen (3): Doripenem 500 mg IV q8h
- Preferred regimen (4): Cefepime 1-2 g IV q8h
- Preferred regimen (5): Ciprofloxacin 400 mg IV q12h or 500 mg PO bid for UTI
- Preferred regimen (6): Gentamicin 5 mg/kg/day
- Alternate regimen (1): Piperacillin/tazobactam 3.375 mg IV q6h
- Alternate regimen (2): Aztreonam 1-2 g IV q6h
- Alternate regimen (3): TMP-SMX 5 mg/kg q6h IV or DS PO bid for UTI
- Note: Usually carbenicillin sensitive, cephalothin resistant
- Citrobacter koseri Return to Top
- Citrobacter koseri
- Preferred regimen (1): Ceftriaxone 1-2 g IV q12-24h
- Preferred regimen (2): Cefotaxime 1-2 g IV q6h
- Preferred regimen (3): Cefepime 1-2 IV q8h
- Alternate regimen (1): Ciprofloxacin 400 mg IV q12h or 500 mg PO q12h for UTI
- Alternate regimen (2): Imipenem 1 g IV q6h
- Alternate regimen (3): Doripenem 500 mg IV q8h
- Alternate regimen (4): Meropenem 1-2 g IV q8h
- Alternate regimen (5): Aztreonam 1-2 g IV q6h
- Alternate regimen (6): TMP-SMX 5 mg/kg IV q6h  or DS PO bid for UTI
- Note: Usually Ampicillin resistant, but may be sensitive to first generation cephalosporins
- Elizabethkingia meningoseptica Return to Top
- Enterobacter aerogenes Return to Top
- Enterobacter species
- 1. Severe infections
- Preferred regimen (1): Piperacillin-tazobactam 3.375-4.5 g IV q6h AND (Aminoglycoside (gentamicin,tobramycin or amikacin) OR Fluoroquinolone,e.g.,ciprofloxacin 400 mg IV q8-12hrs
- Preferred regimen (2) (for coverage of ESBLs): Imipenem 500 mg IV q6h
- Preferred regimen (3) (for coverage of ESBLs): Meropenem 500-1000 mg IV q8h
- Preferred regimen (4) (for coverage of ESBLs): Doripenem 500 mg IV q8h
- Preferred regimen (5) : Cefepime 2 g IV q8h
- 2. UTI without systemic symptoms
- Preferred regimen: Ciprofloxacin 250 mg PO bid OR agent based upon susceptibility profile
- Enterobacter cloacae Return to Top
- Enterobacter cloacae
- Escherichia coli Return to Top
- Escherichia coli
- 1. Meningitits
- Preferred regimen (1): Ceftriaxone 4 g IV q1224h
- Preferred regimen (2): Cefotaxime 812 g/day IV q46h
- Alternative regimen (1): Aztreonam 68 g/day IV q68h
- Alternative regimen (2): Gatifloxacin 400 mg/day IV q24h
- Alternative regimen (3): Moxifloxacin 400 mg/day IV q24h
- Alternative regimen (4): Meropenem 6 g/day IV q8h
- Alternative regimen (5): Trimethoprim-Sulfamethoxazole 1020 mg/kg/day IV q612h
- Alternative regimen (6): Ampicillin 12 g/day IV q4h
- 2. Uncomplicated urinary tract infection
- Preferred agents (IDSA/AUA Guidelines): TMP-SMX DS PO bid for 3 days
- Alternative regimen (1): Ciprofloxacin 250 mg PO bid
- Alternative regimen (2): Ciprofloxacin 500 mg XR qd for 3 days
- Alternative regimen (3): Levofloxacin 250 mg PO qd for 3 days.
- Alternative regimen (4): Nitrofurantoin 100 mg PO q6h
- Alternative regimen (5): Nitrofurantoin macrocrystals 100 mg PO bid for 7 days
- Alternative regimen (6): Fosfomycin 3 g sachet PO single dose
- Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.
- 3. Pyelonephritis
- 3.1 Acute uncomplicated pyelonephritis
- Preferred regimen (1): Ciprofloxacin 500 mg bid PO for 5-7 days
- Preferred regimen (2): Ciprofloxacin-Erythromycin 1000 mg q24h
- Preferred regimen (3): Levofloxacin 750 mg q24h
- Preferred regimen (4): Ofloxacin 400 mg bid
- Preferred regimen (5): Moxifloxacin 400 mg q24h
- Alternative regimen (1): Amoxicillin-Clavulanic acid 875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid
- Alternative regimen (2): Oral Cephalosporins
- Alternative regimen (3): TMP-SMX 2 mg/kg IV q6h PO for 14 days
- 3.2 Acute pyelonephritis (Hospitalized)
- Preferred regimen (1): Ciprofloxacin 400 mg IV q12h
- Preferred regimen (2): Ampicillin and Gentamicin
- Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q4-6h for 14 days
- Alternative regimen (1): Ticarcillin-Clavulanate 3.1 g IV q6h
- Alternative regimen (2): Ampicillin-Sulbactam 3 g IV q6h
- Alternative regimen (3): Piperacillin-Tazobactam 3.375 g IV q4-6h
- Alternative regimen (4): Ertapenem 1 g IV q24h
- Alternative regimen (5): Doripenem 500 mg q8h for 14 days
- 4. Travelers diarrhea
- Preferred regimen (1): Ciprofloxacin 750 mg PO qd for 1-3 days or other Fluoroquinolones
- Preferred regimen (2) (pediatrics & pregnancy): Azithromycin 10 mg/kg/day single dose
- Preferred regimen (3) (pediatrics & pregnancy): Ceftriaxone 50 mg/kg/day IV qd for 3 days
- Note: Avoid fluoroquinolones in pediatrics and pregnancy.
- 5. Malacoplakia
- Preferred regimen (1): Bethanechol chloride AND Ciprofloxacin 400 mg IV q12h
- Preferred regimen (2): TMP-SMX 2 mg/kg (TMP component IV q6h)
- 6. Bacteremia/pneumonia
- Preferred regimen (1): Ceftriaxone 1-2 g IV q24h
- Preferred regimen (2): Ciprofloxacin 400 mg IV q12h or 500 mg PO q12h
- Preferred regimen (3): Levofloxacin 500 mg PO/IV q24h
- Preferred regimen (4): Moxifloxacin 400 mg IV/PO q24h
- Preferred regimen (5): Ampicillin 2 g IV q6h (if sensitive)
- Preferred regimen (6): TMP-SMX 5-10 mg/kg/day for q6-8h IV (if sensitive)
- Alternative regimen (1): Imipenem, Meropenem, Ertapenem, Doripenem; Ceftazidime, Cefepime; Cefazolin or Cefuroxime (if sensitive); Aztreonam; Ticarcillin, Piperacillin; Piperacillin-Tazobactam
- Alternative regimen (2): Ampicillin-sulbactam 3 g IV q6h AND (Gentamicin 1.5 mg/kg IV q8h or 5-7 mg/kg/day IV OR Tobramycin 5 mg/kg/day IV)
- Note (1): A 7- to 14-day course of antibiotic therapy is usually recommended.
- Note (2): The choice of antimicrobial agents should be based on susceptibility results.
- Note (3): Monotherapy with aminoglycosides is generally not recommended for bacteremia or pneumonia.
- Francisella tularensis Return to Top
- Francisella tularensis
- 1. Tularemia
- Preferred regimen (1): Streptomycin 1 g IM bid
- Preferred regimen (2): Gentamicin 5 mg/kg IV q24h for 10 days
- Preferred regimen (3) (pregnancy): Gentamicin 5 mg/kg IV q24h for 10 days
- Alternative regimen (1): Doxycycline 100 mg IV  bid
- Alternative regimen (2): Chloramphenicol 1 g IV q6h
- Alternative regimen (3): Ciprofloxacin 400 mg IV bid until stable THEN PO for 14-21 days (total)
- Helicobacter pylori Return to Top
- Helicobacter pylori
- 1. Peptic ulcer disease
- 1.1 Regimens for Initial Treatment
- 1.1.1 Triple therapy
- Preferred regimen: PPI (standard dose twice daily) AND Amoxicillin 1 g bid AND Clarithromycin 500 mg bid  for 7-14 days
- 1.1.2 Quadruple therapy
- Preferred regimen: PPI (standard dose twice daily) AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
- 1.1.3 Sequential therapy
- Preferred regimen: PPI (standard dose twice daily) AND Amoxicillin 1 g bid for 1-5 days AND Clarithromycin 500 mg bid AND Tinidazole 500 mg bid for  6-10 days
- 1.2 Second-Line Therapies
- 1.2.1 Triple therapy
- Preferred regimen: PPI (standard dose twice daily) AND Amoxicillin 1 g bid AND Metronidazole 500 mg bid
- Alternative regimen (1) (allergy to amoxicillin): (PPI AND Clarithromycin AND Metronidazole)
- Alternative regimen (2) (allergy to amoxicillin): (PPI AND Tetracycline AND Metronidazole).
- 1.2.2 Quadruple therapy
- Preferred regimen: PPI (standard dose twice daily) AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
- 1.2.3 Levofloxacin triple therapy
- Preferred regimen: PPI (standard dose twice daily) AND Amoxicillin 1 g bid  AND  Levofloxacin 500 mg bid for 10 days
- 1.2.4 Rifabutin triple therapy
- Preferred regimen: PPI (standard dose twice daily)  AND Amoxicillin  1 g bid AND Rifabutin 150-300 mg/day for 10 days
- Klebsiella granulomatis Return to Top
- Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)
- 1. Granuloma inguinale (donovanosis)
- Preferred regimen: Azithromycin 1 g PO once a week or 500 mg qd for 3 weeks THEN until all lesions have completely healed
- Alternative regimen (1): Doxycycline 100 mg PO bid for 3 weeks THEN until all lesions have completely healed
- Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks THEN until all lesions have completely healed
- Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks THEN until all lesions have completely healed
- Alternative regimen (4): Trimethoprim-sulfamethoxazole DS (160 mg/800 mg) tablet PO bid for at least 3 weeks THEN until all lesions have completely healed
- Klebsiella pneumoniae Return to Top
- Klebsiella pneumoniae
- 1. Severe, nosocomial infections
- 1.1 Non-ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections
- Preferred regimen (1): Cefepime 2 g IV q8h
- Preferred regimen (2): Ceftazidime 2 g IV q8h
- Preferred regimen (3): Imipenem 500 mg IV q6h
- Preferred regimen (4): Meropenem 1 g IV q8h
- Preferred regimen (5): Piperacillin-tazobactam 4.5 g IV q6h AND Aminoglycoside
- Alternative regimen (1): Ceftriaxone 1 g IV q24h AND Metronidazole 500 mg IV q6h or 1 g IV q12h
- Alternative regimen (2): Moxifloxacin 400 mg IV/PO q24h
- 1.2 ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections
- Preferred regimen (1): Imipenem 500 mg IV q6h
- Preferred regimen (2): Meropenem 1 g IV q8h
- Preferred regimen (3): Ertapenem 1 g IV q24h
- Preferred regimen (4): Doripenem 500 mg IV q8h
- Note: In ESBLs, inconsistent activity is seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins.
- Klebsiella rhinoscleromatis Return to Top
- 1. Rhinoscleroma
- Preferred regimen (1): Ciprofloxacin 500750 mg PO bid for 23 months
- Preferred regimen (2): Levofloxacin 750 mg PO qd for 23 months
- Preferred regimen (3): Trimethoprim-Sulfamethoxazole 1 DS tab PO bid for 3 months AND Rifampicin 300 mg PO bid for 3 months
- Alternative regimen: Tetracycline OR Streptomycin OR Doxycycline  OR Ceftriaxone OR Ofloxacin
- Note (1): The optimal duration of antimicrobial therapy remains unclear. A 6-week to 6-month course of antibiotics until histology exams and cultures are negative may be required.
- Note (2): Use of topical antiseptics such as Acriflavinium and Rifampin ointment has been reported with resolution of symptoms.
- Legionella pneumophila Return to Top
- Legionella pneumophila
- 1. Pneumonia
- Preferred regimen (1): Levofloxacin 750 mg PO/IV qd for 7-10 days
- Preferred regimen (2): Moxifloxacin 400 mg PO/IV qd for 7-10 days
- Preferred regimen (3): Azithromycin 500 mg PO/IV qd for 7-10 days
- Preferred regimen (4): Rifampin 300 mg PO/IV bid AND any other agents listed
- Alternative regimen (1): Erythromycin 1 g IV q6h and THEN 500 mg PO q6h for 7-10 days (total)
- Alternative regimen (2): Ciprofloxacin 400 mg IV q12h THEN 750 mg PO bid 7-10 days (total)
- 2. Pontiac fever
- Preferred regimen: no antibiotic treatment, usually self limited, and usually only diagnosed by delayed serologic testing
- 3. Endocarditis
- Preferred regimen: (Fluoroquinolones, Levofloxacin 750 mg PO/IV qd for 7-10 days OR Moxifloxacin 400 mg PO/IV qd for 7-10 days) AND Rifampin 300 mg PO bid for 4-6 weeks
- Moraxella catarrhalis Return to Top
- Preferred regimen (1): TMP-SMX 1DS PO bid
- Preferred regimen (2): Erythromycin 500 mg PO q6h
- Preferred regimen (3): Clarithromycin 500 mg bid or XL 1 g PO qd
- Preferred regimen (4): Azithromycin 500 mg single dose THEN 250 mg PO qd
- Preferred regimen (5): Doxycycline 100 mg PO/IV bid
- Preferred regimen (6): Parenteral cephalosporins such as Cefuroxime OR Cefotaxime OR Ceftriaxone
- Preferred regimen (7): Cefprozil 200-500 mg PO bid
- Preferred regimen (8): Cefpodoxime 200-400 mg PO bid
- Preferred regimen (9): Cefuroxime 250-500 mg PO bid
- Preferred regimen (10): Cefdinir 300 mg bid
- Preferred regimen (11): Moxifloxacin 400 mg IV/PO qd
- Preferred regimen (12): Levofloxacin 500 mg IV/PO qd
- Preferred regimen (13): Amoxicillin-Clavulanate 875/125 mg PO bid or XL 2000/125 PO bid
- Morganella morganii Return to Top
- Morganella morganii
- Preferred regimen (1): Imipenem 500 mg IV q6h
- Preferred regimen (2): Meropenem 1.0 g IV q8h (adjust dose if necessary for renal function).
- Note (1): Carbapenems are considered first line therapy due to inducible cephalosporinases, and presence of extended-spectrum beta-lactamases in some isolates.
- Note (2): Duration of treatment for UTI (generally complicated) is 7 days and duration of treatment for bacteremia is 14 days.
- Note (3): Tigecycline is not reliably effective
- Alternative Regimen (1): Cefepime 2.0 g IV q8-12h
- Alternative Regimen (2): Ciprofloxacin 500 mg PO/400 mg IV q12h
- Alternative Regimen (3): Piperacillin 3 g IV q6h
- Alternative Regimen (4): Ticarcillin 3 g IV q4h
- Alternative Regimen (5): Gentamicin
- Alternative Regimen (6): Tobramycin 1 mg/kg IV q24h
- Alternative Regimen (7): Amikacin 3 mg/kg IV q24h
- Note: Aminoglycosides can be used alone for treatment of UTI
- Plesiomonas shigelloides Return to Top
- Plesiomonas shigelloides
- 1. Immunocompetent hosts or severe Infection
- Preferred regimen: Ciprofloxacin 500 mg PO bid OR 400 mg IV q12h
- Alternative regimen (1): Ofloxacin 300 mg PO bid
- Alternative regimen (2): Norfloxacin 400 mg PO bid
- Alternative regimen (3): TMP-SMX DS PO bid for 3 days
- Alternative regimen (4): Ceftriaxone 1-2 g IV qd in severe cases
- 2. Immunocompromised hosts
- Preferred regimen: Ciprofloxacin 500 mg PO bid for 3 days.
- Alternative regimen (1): Ofloxacin 300 mg PO bid
- Alternative regimen (2): Norfloxacin 400 mg PO bid
- Alternative regimen (3): TMP-SMX DS PO bid for 3 days if susceptible
- Proteus mirabilis Return to Top
- Proteus mirabilis
- Preferred regimen (1): Ampicillin 500 mg PO q6h or 2 g IV q6h
- Preferred regimen (2): Cefuroxime 250 mg PO bid or 750 mg IV q8h
- Preferred regimen (3): Ciprofloxacin 250-500 mg PO bid or 400 mg IV q12h
- Preferred regimen (4): Levofloxacin 500 mg PO OD or 500 mg IV q24h
- Note: Duration of treatment for uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia is 7-14 days
- Indole positive Proteus species Return to Top
- Indole positive Proteus species
- Preferred regimen (1): Ceftriaxone 1 g IV q24h
- Preferred regimen (2): Imipenem 500 mg IV q6h
- Preferred regimen (3): Ciprofloxacin 400 mg IV q12h or 250-500 mg PO bid
- Preferred regimen (4): Levofloxacin 500 mg IV/PO q24h
- Providencia Return to Top
- Providencia
- 1. Complicated uti/bacteremia/acute prostatitis
- Preferred regimen (1): Ciprofloxacin 500-750 mg PO q12h or 400 mg IV q8-12h
- Preferred regimen (2): Levofloxacin 500 mg IV/PO q24h
- Preferred regimen (3): Piperacillin-Tazobactam 3.375 mg IV q6h
- Preferred regimen (4): Ceftriaxone 1-2 g IV q24h (donot use if ESBL suspected or critically ill)
- Preferred regimen (5): Meropenem 1 g IV q8h (consider if critically ill or ESBL suspected)
- Preferred regimen (6): Amikacin 7.5 mg/kg IV q12h
- Preferred regimen (7): Gentamicin
- Preferred regimen (8): Tobramycin acceptable if susceptible but many species are resistant.
- Note (1): Duration of treatment for (UTI) is 7 days common or 3-5 days after defervescence or control/elimination of complicating factors (e.g.,removal of foreign material catheter).
- Note (2): Duration of treatment for (bacteremia) is 10-14 days or 3-5 days after defervescence or control/elimination of complicating factors.
- Note (3): Duration for acute prostatitis (2 weeks), shorter than chronic prostatitis (4-6 weeks)
- Alternative regimen: TMP-SMX DS PO q12h for 10-14 days or TMP 5-10 mg/kg/day IV q6h.
- Pseudomonas aeruginosa Return to Top
- Pseudomonas aeruginosa
- Preferred regimen (1): Cefepime 2 g IV q8h
- Preferred regimen (2): Ceftazidime 2 g IV q8h
- Preferred regimen (3): Piperacillin 3-4 g IV q4h in (no benefit for pseudomonas from beta-lactamase inhibitor)
- Preferred regimen (4): Ticarcillin 3-4 g IV q4h (no benefit for pseudomonas from beta-lactamase inhibitor)
- Preferred regimen (5): Imipenem 500 mg1 g IV q6h
- Preferred regimen (6): Meropenem 1 g IV q8h
- Preferred regimen (7): Doripenem 500 mg IV q8h
- Preferred regimen (8): Ciprofloxacin 400 mg IV q8h or 750 mg PO q12h (for less serious infections)
- Preferred regimen (9): Aztreonam 2 g IV q6-8h
- Preferred regimen (10): Colistin 2.5 mg/kg IV q12h
- Preferred regimen (11): Polymyxin B 0.75-1.25 mg/kg IV q12h
- Preferred regimen (12): Gentamicin
- Preferred regimen (13): Tobramycin 1.7-2.0 mg/Kg IV q8h or 5-7 mg/kg IV
- Preferred regimen (14): Amikacin 2.5 mg/kg IV q12h
- Note: Amikacin > Tobramycin > Gentamicin with respect to P.aeruginosa susceptibility percentages at most institutions.

# Salmonella
- Salmonella Return to Top
- 1. Salmonellosis in immunocompetent hosts
- 1.1 Gastroenteritis
- Antimicrobial therapy is usually not recommended for uncomplicated diarrheal illness.
- 1.1.1 Indications for antimicrobial therapy
- severedisease,
- Age > 50 yrs
- Prosthesis
- Presence of valvular heart disease
- Severe atherosclerosis
- Cancer
- Uremia
- Immunosuppression
- 1.1.2 Treatment regimens
- Preferred regimen (1): TMP-SMX DS PO bid for 5-7 days
- Preferred regimen (2): Ciprofloxacin 500 mg PO bid for 5-7 days
- Preferred regimen (3): Ceftriaxone 2 g IV q24h for 5-7 days
- 1.2 Typhoid fever
- 1.2.1 Uncomplicated typhoid
- Preferred regimen (1) (fully susceptible): Fluoroquinolone (e.g., Ofloxacin 15 mg/kg PO qd for 57 days)
- Preferred regimen (2) (multi drug-resistant): Fluoroquinolone (Ofloxacin 15 mg/kg PO qd for 57 days)
- Preferred regimen (3) (quinolone-resistant): Azithromycin 810 mg/kg  PO qd for 7 days
- Preferred regimen (4) (quinolone-resistant): Fluoroquinolone 20 mg/kg PO qd for 10-14 days
- Alternative regimen (1) (fully susceptible): Chloramphenicol 5075 mg/kg PO qd for 14-21 days
- Alternative regimen (2) (fully susceptible): Amoxicillin 75100 mg/kg PO qd for 14 days
- Alternative regimen (3) (fully susceptible): TrimethoprimSulfamethoxazole, 8 mg/kg (trimethoprim) 40 mg/kg (sulfamethoxazole) PO qd for 14 days
- Alternative regimen (4) (multi drug-resistant): Azithromycin 810 mg/kg PO for 7 days
- Alternative regimen (5) (multi drug-resistant): Third-generation cephalosporin, e.g., cefixime 20 mg/kg PO qd for 7-14 days
- Alternative regimen (6) (quinolone-resistant): Third-generation cephalosporin, e.g., cefixime 20 mg/kg PO qd for 7-14 days
- 1.2.2 Severe typhoid
- Preferred regimen (1) (fully susceptible): Fluoroquinolone (e.g., Ofloxacin 15 mg/kg IV qd for 10-14 days)
- Preferred regimen (2) (multi drug-resistant): Fluoroquinolone (Ofloxacin 15 mg/kg IV qd for 10-14 days)
- Preferred regimen (3) (quinolone-resistant): Ceftriaxone 60 mg/kg IV qd for 10-14 days
- Preferred regimen (4) (quinolone-resistant): Cefotaxime 80 mg/kg IV qd for 10-14 days
- Alternative regimen (1) (fully susceptible): Chloramphenicol 100 mg/kg PO qd for 14-21 days
- Alternative regimen (2) (fully susceptible): Ampicillin 100 mg/kg PO qd for 14-21 days
- Alternative regimen (3) (fully susceptible): TrimethoprimSulfamethoxazole, 8 mg/kg (trimethoprim) 40 mg/kg (sulfamethoxazole) IV qd for 10-14 days
- Alternative regimen (4) (multi drug-resistant): Ceftriaxone 60 mg/kg IV qd for 10-14 days
- Alternative regimen (5) (multi drug-resistant): Cefotaxime 80 mg/kg IV qd for 10-14 days
- Alternative regimen (6) (quinolone-resistant): Fluoroquinolone 20 mg/kg IV qd for 10-14 days
- 1.3 Non-typhoid (serious infection)
- Preferred regimen (1): 3rd generation cephalosporin (Ceftriaxone/Cefotaxime)
- Preferred regimen (2): Fluoroquinolone (Ciprofloxacin, Levofloxacin)
- 1.4 Bacteremia
- Preferred regimen (1): Ceftriaxone 2 g IV q24h
- Preferred regimen (2): Cefotaxime 2 g IV q6-8h for 7-14 days
- Preferred regimen (3): Ciprofloxacin 400 mg IV q12h for 7-14 days
- 1.5 Vascular prosthesis infection
- Preferred regimen (1): Ceftriaxone
- Preferred regimen (2): Cefotaxime
- Preferred regimen (3): Ciprofloxacin 400 mg IV q12h for 6 weeks
- 1.6 Osteomyelitis
- Preferred regimen (1): Ceftriaxone 2 g IV q24h
- Preferred regimen (2): Cefotaxime 2 g IV q6-8h
- Preferred regimen (3): Ciprofloxacin 750 mg PO bid for  4 weeks
- 1.7 Arthritis
- Preferred regimen (1): Ceftriaxone 2 g IV q24h
- Preferred regimen (2): Cefotaxime 2 g IV q6-8h for 6 weeks
- 1.8 Endocarditis
- Preferred regimen (1): Ceftriaxone 2 g IV q24h
- Preferred regimen (2): Cefotaxime 2 g IV q6-8h for 6 weeks
- 1.9 UTI
- Preferred regimen (1): Ceftriaxone
- Preferred regimen (2): Cefotaxime
- Preferred regimen (3): Ciprofloxacin IV for 1-2 weeks THEN (oral Ciprofloxacin OR TMP-SMX for 6 weeks)
- 1.10 Carrier state
- Preferred regimen (1): Ciprofloxacin 500 mg PO bid for 4-6 weeks
- Preferred regimen (2): TMP-SMX 1DS bid PO for 6 weeks
- Preferred regimen (3): Amoxicillin 500 mg PO for 6 weeks
- 2. Salmonellosis in immunocompromised hosts
- 2.1 HIV and salmonellosis
- 2.1.1 Gastroenteritis
- Preferred regimen: Ciprofloxacin 500-750 mg PO bid or 400 mg IV q12h, if susceptible
- Alternative regimen (1): Levofloxacin 750 mg PO/IV q24h
- Alternative regimen (2): Moxifloxacin 400 mg PO/IV q24h
- Alternative regimen (3): TMP 160 mg AND SMX 800 mg PO/IV q12h
- Alternative regimen (4): Ceftriaxone 1 g IV q24h
- Alternative regimen (5): Cefotaxime 1 g IV q8h
- Duration of treatment for gastroenteritis without bacteremia
- If CD4 count  200 cells/L: Duration of treatment is 714 days
- If CD4 count < 200 cells/L: Duration of treatment is 26 weeks
- Duration of treatment for gastroenteritis with bacteremia
- If CD4 count  200/L: Duration of treatment is 14 days; longer duration if bacteremia persists or if the infection is complicated (e.g., if metastatic foci of infection are present)
- If CD4 count < 200 cells/L: Duration of treatment is 26 weeks
- Note (1): Secondary prophylaxis should be considered for
- Patients with recurrent Salmonella gastroenteritis with or without bacteremia
- Patients with CD4 < 200 cells/L with severe diarrhea
- Serratia marcescens Return to Top
- Serratia marcescens
- 1. Bacteremia, pneumonia or serious infections
- Preferred regimen (1): Cefepime 1-2 g IV q8h
- Preferred regimen (2): Imipenem 0.5-1.0 g IV q6h
- Preferred regimen (3): Ciprofloxacin 400 mg IV q8h
- Alternative regimen (1): Aztreonam
- Alternative regimen (2): Gentamicin
- Alternative regimen (3): Amikacin
- Alternative regimen (4): Piperacillin-tazobactam also often effective
- Note: Duration depends on clinical response, usually 7-14 days
- 2. Endocarditis
- Note: Choice dictated by sensitivities. 4 to 6 week duration of parenteral therapy.
- 3. Osteomyelitis
- Note (1): Choice dictated by sensitivity profile. Treat for 6-12 weeks depending upon response.
- Note (2): Use IV treatment until stable/clinically improved (10-14 days Minimum) then may convert to PO therapy if appropriate
- 4. UTI
- Preferred regimen (1): Ciprofloxacin 250 mg PO bid or 400 mg IV q12h
- Preferred regimen (2): Levofloxacin 250 mg PO qd or 500 mg IV q24h
- Note: Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs(e.g.,beta-lactam and aminoglycoside or fluoroquinolones and carbapenem)until susceptibilities known.
- Shigella Return to Top
- 1. Shigellosis 
- 1.1 Pediatrics
- Preferred regimen (1): Ciprofloxacin 15 mg/kg PO bid for 3 days
- Alternative regimen (1): Pivmecillinam 20 mg/kg PO qid for 5 days
- Alternative regimen (2): Ceftriaxone 50-100 mg/kg IM qd for 2 to 5 days
- Alternative regimen (3): Azithromycin 6-20 mg/kg PO qd for 1 to 5 days
- 1.2 Adults
- Preferred regimen (1): Ciprofloxacin 500 mg PO bid for 3 days
- Alternative regimen (1): Pivmecillinam 100 mg PO qid for 5 days
- Alternative regimen (2): Azithromycin 1-1.5 g PO qd for 1 to 5 days
- Stenotrophomonas maltophilia Return to Top
- Stenotrophomonas maltophilia
- Preferred treatment: TMP-SMX 15-20 mg/kg/day (TMP component) IV/PO q8h
- Alternative treatment (1): Ceftazidime 2 g IV q8h
- Alternative treatment (2): Ticarcillin-clavulanate 3.1 g IV q4h
- Alternative treatment (3): Tigecycline 100 mg IV single dose THEN 50 mg IV q12h
- Alternative treatment (4): Ciprofloxacin 500-750 mg PO/400 mg IV q12h
- Alternative treatment (5): Moxifloxacin 400 mg PO/IV
- Alternative treatment (6): Levofloxacin 750 mg PO/IV
- Alternative treatment (7) (multiply-resistance): Colistin 2.5 mg/kg IV q12h
- Note: Treatment duration uncertain, but usually  14 days
- Vibrio cholerae Return to Top
- Vibrio parahaemolyticus Return to Top
- Vibrio vulnificus Return to Top