Sandbox g55
- Acanthamoeba Return to Top
- 1. Granulomatous amoebic encephalitis, meningitis, and disseminated Acanthamoeba disease
- Preferred regimen (1): Pentamidine AND Itraconazole AND Sulfadiazine AND Flucytosine
- Preferred regimen (2): Sulfadiazine AND Fluconazole AND Pyrimethamine
- Preferred regimen (3): Sulfadiazine AND Flucytosine AND TMP-SMX
- Preferred regimen (4): TMP-SMX AND Rifampin AND Ketoconazole
- Preferred regimen (5): Miltefosine AND Amikacin
- Preferred regimen (6): Miltefosine AND Voriconazole
- Preferred regimen (7): Pentamidine AND Itraconazole AND Flucytosine AND Levofloxacin AND Amphotericin B AND Rifampin
- Preferred regimen (8): Pentamidine AND Fluconazole AND Miltefosine
- Note: The mainstay of successful treatment includes early diagnosis and combination therapy with pentamidine, azole, sulfonamide, miltefosine, and possibly flucytosine.
- 2. Cutaneous acanthamoebiasis
- Preferred regimen: Pentamidine AND Sulfadiazine AND Flucytosine AND (Itraconazole OR Fluconazole) AND Chlorhexidine topical AND Ketoconazole topical
- 3. Acanthamoeba keratitis
- Preferred regimen: (Polyhexamethylene biguanide topical OR Chlorhexidine topical)  (Propamidine topical OR Hexamidine topical)
- Note (1): Azole antifungal drugs (Ketoconazole, Itraconazole, Voriconazole) may be considered as oral or topical adjuncts.
- Note (2): The duration of therapy for Acanthamoeba keratitis may last six months to a year.
- Note (3): Pain control can be helped by topical cyclopegic solutions and oral nonsteroidal medications.
- Note (4): The use of corticosteroids to control inflammation is controversial.
- Note (5): Penetrating keratoplasty may help restore visual acuity.
- Balamuthia mandrillaris Return to Top
- 1. Granulomatous Amebic Encephalitis
- Preferred regimen (1): Pentamidine AND Flucytosine AND Fluconazole AND Sulfadiazine AND (Azithromycin OR Clarithromycin)
- Preferred regimen (2): Pentamidine AND Albendazole AND (Itraconazole OR Fluconazole) AND Miltefosine
- Enterobacter Return to Top
- Enterobacter species including E. aerogenes and E. cloacae
- 1. Empiric antimicrobial therapy pending in vitro susceptibility
- 1.1 Nonlife-threatening infections or MDR-GNB prevalence < 20%
- Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h  Aminoglycosides
- Alternative regimen: Ciprofloxacin 400 mg IV q812h
- 1.2 Life-threatening infections or MDR-GNB prevalence > 20%
- Preferred regimen: Meropenem 0.51 g IV q8h
- Alternative regimen (1): Colistin AND Meropenem 0.51 g IV q8h
- Alternative regimen (2): Colistin AND Imipenem 500 mg IV q6h
- Alternative regimen (3): Colistin AND Doripenem 500 mg IV q8h
- Alternative regimen (4): Colistin AND Ertapenem 1 g IV q24h
- Alternative regimen (5): Colistin AND Fosfomycin 6 g IV q6h
- 2. In vitro susceptibility available
- 2.1 Susceptible to all tested agents
- Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h
- Alternative regimen (1): Ciprofloxacin 400 mg IV q812h
- Alternative regimen (2): Cefepime 2 g IV q8h (if MIC  1 g/mL)
- 2.2 Extended spectrum beta-lactamase (ESBL)-producing Enterobacter spp.
- Preferred regimen: Meropenem 0.51 g IV q8h
- Alternative regimen (1): Imipenem 500 mg IV q6h
- Alternative regimen (2): Doripenem 500 mg IV q8h
- Alternative regimen (3): Ertapenem 1 g IV q24h
- Alternative regimen (4): Cefepime 2 g IV q8h (if MIC  1 g/mL)
- 2.3 Resistant to all tested agents
- Preferred regimen: Colistin AND Meropenem 0.51 g IV q8h
- Alternative regimen (1): Colistin AND Imipenem 500 mg IV q6h
- Alternative regimen (2): Colistin AND Doripenem 500 mg IV q8h
- Alternative regimen (3): Colistin AND Ertapenem 1 g IV q24h
- Alternative regimen (4): Colistin AND Minocycline 100 mg IV q12h