Mayo Clinic Antimicrobial Therapy quick guide - part 5 docx

122 Treatment Brucella sp doxycycline plus gentamicin or doxycycline plus streptomycin or doxycycline plus rifampin tmp/smx, ciprofloxacin, chloramphenicol; each with or without either gentamicin or streptomycin or rifampin Burkholderia cepacia Often a colonizer not requiring treatment; tmp/smx ceftazidime, cefepime, carbapenem, b fluoroquinolone, minocycline, tigecycline Campylobacter jejuni erythromycin, azithromycin doxycycline, fluoroquinolone, gentamicin, furazolidone Capnocytophaga sp clindamycin, amoxicillin/ clavulanate erythromycin, fluoroquinolone, carbapenem, b doxycycline, β-lactam/β-lactamase inhibitor c Chlamydophila pneumoniae doxycycline, macrolide d fluoroquinolone, a different tetracycline, tigecycline Citrobacter freundii carbapenem b fluoroquinolone, aminoglycoside, tmp/smx, cefepime, piperacillin/tazobactam, tigecycline, aztreonam Clostridium sp C difficile metronidazole, vancomycin (oral) C perfringens penicillin metronidazole, clindamycin, β-lactam/β-lactamase inhibitor, c carbapenem b C tetani metronidazole plus tetanus immune globulin and tetanus toxoid doxycycline, penicillin Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 122 Monday, April 28, 2008 2:34 PM 123 Treatment Corynebacterium sp C diphtheriae erythromycin plus antitoxin clindamycin, penicillin Group JK vancomycin Base treatment on susceptibility results; consider linezolid, daptomycin, dalfopristin/quinupristin Coxiella burnetii (Q fever) Acute: doxycycline Chronic (eg, endocarditis): doxycycline plus hydroxychloroquine; or doxycycline plus fluoroquinolone Acute: fluoroquinolone, macrolide d Chronic: doxycycline plus fluoroquinolone; or doxycycline plus rifampin Ehrlichia sp doxycycline Eikenella corrodens ampicillin, amoxicillin, 3rd- gen cephalosporin doxycycline, β-lactam/β-lactamase inhibitor, c fluoroquinolone Enterobacter sp carbapenem b fluoroquinolone, tmp/smx, cefepime, piperacillin/tazobactam, aminoglycoside, tigecycline, aztreonam Enterococcus sp f ampicillin-sensitive ampicillin, amoxicillin, penicillin vancomycin, linezolid, β-lactam/β-lactamase inhibitor, c dalfopristin/quinupristin (active for E faecium only), daptomycin, tigecycline ampicillin-resistant, vancomycin- sensitive vancomycin linezolid, daptomycin, f dalfopristin/quinupristin (E faecium only), tigecycline Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 123 Monday, April 28, 2008 2:34 PM 124 Treatment VRE linezolid c daptomycin, f dalfopristin/quinupristin (E faecium only), tigecycline Erysipelothrix rhusiopathiae penicillin cephalosporin, fluoroquinolone, clindamycin, carbapenem b Escherichia coli ceftriaxone, cefotaxime, cefepime ESBL-producing strains: carbapenem b fluoroquinolone, aminoglycoside, another cephalosporin, β-lactam/β-lactamase inhibitor, c ampicillin, tmp/smx, tigecycline, aztreonam Francisella tularensis (tularemia) streptomycin, gentamicin CNS infections: doxycycline plus either gentamicin or streptomycin doxycycline, fluoroquinolone, chloramphenicol Fusobacterium sp penicillin metronidazole, clindamycin, β-lactam/β-lactamase inhibitor, c carbapenem b Gardnerella vaginalis (bacterial vaginosis) metronidazole metronidazole (vaginal) or clindamycin (vaginal or oral) Haemophilus influenzae ceftriaxone, cefotaxime fluoroquinolone, tmp/smx, azithromycin, clarithromycin, β-lactam/β-lactamase inhibitor, c doxycycline, 2nd-, 3rd-, or 4th-gen cephalosporin Klebsiella pneumoniae ceftriaxone, cefotaxime, cefepime ESBL-producing strains: carbapenem b fluoroquinolone, aminoglycoside, tmp/smx, β-lactam/ β-lactamase inhibitor, c carbapenem, b tigecycline Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 124 Monday, April 28, 2008 2:34 PM 125 Treatment Legionella sp Newer fluoroquinolone, g azithromycin with or without rifampin Another macrolide, d doxycycline, tmp/smx, any of these 3 drugs with or without rifampin Leuconostoc sp ampicillin, amoxicillin, penicillin clindamycin, doxycycline, macrolide d Listeria monocytogenes ampicillin or penicillin with or without gentamicin tmp/smx Moraxella catarrhalis 2nd- or 3rd-gen cephalosporin fluoroquinolone, azithromycin, clarithromycin, tmp/smx, cefepime, b tetracycline, tigecycline, β-lactam/β-lactamase inhibitor c Morganella morganii cefepime, fluoroquinolone carbapenem, b piperacillin/tazobactam, aminoglycoside, tmp/ smx, aztreonam Mycobacterium sp See treatment sections for tuberculosis and nontuberculosis mycobacterial infections (pp. 225, 230) Mycoplasma pneumoniae macrolide d doxycycline, fluoroquinolone, tigecycline Neisseria sp N gonorrhoeae ceftriaxone, cefixime cefotaxime, fluoroquinolone (variable resistance) N meningitidis penicillin, ceftriaxone, cefotaxime ampicillin, fluoroquinolone, tmp/smx Nocardia asteroides tmp/smx minocycline, imipenem with or without amikacin, another sulfonamide, ceftriaxone with or without amikacin, amoxicillin/clavulanate, linezolid Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 125 Monday, April 28, 2008 2:34 PM 126 Treatment Pasteurella multocida penicillin, ampicillin, amoxicillin doxycycline, 2nd- or 3rd-gen cephalosporin, tmp/smx, β-lactam/β-lactamase inhibitor, c carbapenem b Peptostreptococcus sp penicillin, ampicillin, amoxicillin clindamycin, cephalosporin, newer fluoroquinolone, g carbapenem, b vancomycin, β-lactam/β-lactamase inhibitor c Propionibacterium acnes (systemic infection) (Common blood culture contaminant not requiring treatment) penicillin clindamycin, doxycycline, carbapenem b Proteus sp P mirabilis ampicillin, amoxicillin cephalosporin, fluoroquinolone, aminoglycoside, tmp/smx, β-lactam/β-lactamase inhibitor, c carbapenem b P vulgaris carbapenem b fluoroquinolone, aminoglycoside, tmp/smx, β-lactam/ β-lactamase inhibitor, c 3rd- or 4th-gen cephalosporin, aztreonam Providencia sp carbapenem b fluoroquinolone, aminoglycoside, tmp/smx, β-lactam/ β-lactamase inhibitor, c 3rd- or 4th-gen cephalosporin, aztreonam Pseudomonas aeruginosa cefepime, ceftazidime, meropenem or imipenem (not ertapenem); consider addition of aminoglycoside or ciprofloxacin for severe infection or until susceptibilities are known ciprofloxacin, levofloxacin, piperacillin/tazobactam, colistin, aztreonam Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 126 Monday, April 28, 2008 2:34 PM 127 Treatment Rickettsia sp doxycycline fluoroquinolone, chloramphenicol Salmonella sp Treatment not indicated for uncomplicated disease; fluoroquinolone, ceftriaxone amoxicillin, ampicillin, chloramphenicol, tmp/smx, another 3rd- or 4th-gen cephalosporin, furazolidone Serratia sp carbapenem b fluoroquinolone, aminoglycoside, cefepime, tmp/smx, piperacillin/tazobactam, aztreonam Shigella sp fluoroquinolone tmp/smx, azithromycin, furazolidone, 3rd- or 4th-gen cephalosporin Staphylococcus sp h penicillin-sensitive (rare) penicillin Any of the agents listed under first-line or alternate treatment is active below oxacillin/ methicillin- sensitive nafcillin, oxacillin, 1st-gen cephalosporin, dicloxacillin clindamycin (if double-disk diffusion test is negative), tmp/smx, minocycline Broad-spectrum agents with activity against oxacillin-sensitive staphylococci include cefepime, ceftriaxone, β-lactam/β-lactamase inhibitor, c carbapenem, b newer fluoroquinolone g oxacillin-resistant (MRSA, MRSE) vancomycin, linezolid, daptomycin f tigecycline; or, depending on susceptibility for mild to moderate infections or step-down therapy: tmp/smx, minocycline, newer fluoroquinolone, g dalfopristin/quinupristin Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 127 Monday, April 28, 2008 2:34 PM 128 Treatment vancomycin- intermediate or vancomycin- resistant (VISA, VRSA) Notify infection control immediately; obtain infectious diseases consultation Stenotrophomonas maltophilia tmp/smx (consider adding ticarcillin/clavulanate for severe infection) ticarcillin/clavulanate, tigecycline, fluoroquinolone, minocycline Streptococcus sp S pneumoniae penicillin- susceptible (MIC <0.1) penicillin, ampicillin cephalosporin, macrolide, d clindamycin, doxycycline, newer fluoroquinolone, g or any of the agents listed below under first- line or alternate treatment, tmp/smx penicillin- intermediate (MIC 0.1 to ≤2) ceftriaxone, cefotaxime, newer fluoroquinolone g ; high-dose penicillin, ampicillin, or amoxicillin cefepime, vancomycin, linezolid, tigecycline, carbapenem b ; variable resistance may be seen with macrolides, d clindamycin, tmp/smx penicillin high- level resistance (MIC >2) Meningitis: vancomycin plus either ceftriaxone or cefotaxime with or without rifampin Other infections: Newer fluoroquinolone, g vancomycin with or without cefotaxime or ceftriaxone linezolid, dalfopristin/quinupristin, tigecycline Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 128 Monday, April 28, 2008 2:34 PM 129 Treatment a Depending on susceptibility. b Carbapenems: meropenem, imipenem, ertapenem; ertapenem has minimal activity against Pseudomonas, Acinetobacter, and Enterococcus spp. c β-Lactam/β-lactamase inhibitors: piperacillin/tazobactam, ampicillin/sulbactam, amoxicillin/clavulanate, ticarcillin/clavulanate. Group A, B, C, or G penicillin, cephalosporin Another penicillin class drug, macrolide d or clindamycin (variable resistance), vancomycin, linezolid, daptomycin, tigecycline Viridans group penicillin, cephalosporin; for endocarditis and infections in immunocompromised patients, base treatment on susceptibility testing vancomycin, newer fluoroquinolone, g β-lactam/β-lactamase inhibitor c Treponema pallidum (syphilis) penicillin doxycycline, ceftriaxone Ureaplasma sp macrolide, d doxycycline Vibrio sp V cholerae doxycycline fluoroquinolone, tmp/smx V vulnificus doxycycline ceftriaxone, cefotaxime, ciprofloxacin Yersinia sp Y enterocolitica fluoroquinolone, gentamicin, tmp/smx, doxycycline chloramphenicol, ceftriaxone, cefotaxime Y pestis (plague) streptomycin tmp/smx, gentamicin, doxycycline, chloramphenicol, ciprofloxacin Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 129 Monday, April 28, 2008 2:34 PM 130 Treatment d Macrolides include erythromycin, clarithromycin, and azithromycin. e Add gentamicin or streptomycin when cidal activity is required (eg, for infective endocarditis) and agents are susceptible for synergy. f Insufficient data exist for use of daptomycin for serious enterococcal infections; do not use for pneumonia (high failure rates, inactivated by surfactant). g Newer (respiratory) fluoroquinolones include moxifloxacin, levofloxacin, and gemifloxacin. h Consider addition of rifampin for deep-seated staphylococcal infections (eg, infective endocarditis) that do not respond well or are in the presence of prosthetic material. S coagulase-negative bacteria is a common contaminant that can also cause serious infection. Modified from Choice of antibacterial drugs. Treat Guidel Med Lett. 2007;5:33-50. Erratum in: Treat Guidel Med Lett. 2007;5:58. AntimicrobialTherapy.book Page 130 Monday, April 28, 2008 2:34 PM 131 Treatment Bacterial Drug Resistance Issues Table 26. Select Bacterial Resistance Issues Pertinent organisms Resistance issue Treatment EXTENDED-SPECTRUM β-LACTAMASE–PRODUCING (ESBL) GRAM-NEGATIVE BACILLI Escherichia coli, Klebsiella sp Less common: Proteus mirabilis, Enterobacter spp Generally resistant to penicillins and cephalosporins a ; may appear susceptible to piperacillin/tazobactam but with potentially higher failure rate than with a carbapenem First-line: carbapenem (Note: Some regions have seen considerable carbapenem resistance by a different mechanism in Klebsiella sp) Alternates: fluoroquinolone or tigecycline, but there is less clinical experience with these ampC-MEDIATED RESISTANCE IN GRAM-NEGATIVE BACILLI Enterobacter and Citrobacter spp (also may be seen in Morganella morganii, Providencia, Serratia, and indole-positive Proteus spp) 2nd- and 3rd-gen cephalosporin should generally be avoided even if organism is reported to be susceptible, because of potential for induction or selection of ampC- mediated β-lactamase (derepressed β- lactamase production), which can lead to development of resistance during treatment First-line: carbapenem Alternates (depending on susceptibility testing): fluoroquinolone, tmp/smx, tigecycline, piperacillin/tazobactam, aminoglycoside, cefepime (better activity than 3rd-gen cephalosporins b ) If ampC-mediated resistance occurs, a carbapenem is typically the only active β- lactam METHICILLIN-RESISTANT Staphylococcus aureus (MRSA) AntimicrobialTherapy.book Page 131 Monday, April 28, 2008 2:34 PM [...]... vancomycin dosage to obtain a peak (1 hour after infusion) serum level of 3 0-4 5 mcg/mL and a trough level of 1 0-1 5 mcg/mL Modified from Baddour et al Circulation 20 05; 111:e39 4-4 34 Errata in: Circulation 20 05; 112:2373 Circulation 2007;1 15: e408 Used with permission a vancomycind Regimen Infectious Syndromes AntimicrobialTherapy.book Page 152 Monday, April 28, 2008 2:34 PM plus and plus gentamicin rifampin vancomycin... AntimicrobialTherapy.book Page 150 Monday, April 28, 2008 2:34 PM or Duration 12 g/24h IV in 4-6 equally divided 6 wk doses OXACILLIN-SUSCEPTIBLE STRAINS Dosagea and route Infectious Syndromes Clinical benefit of aminoglycosides has not been established 3 -5 days gentamicinb 3 mg/kg/24h IV or IM in 2-3 equally divided doses Avoid cephalosporins in patients with anaphylactoid-type hypersensitivity to β-lactams;... 3 0-4 5 mcg/mL and a trough level of 1 0-1 5 mcg/mL Modified from Baddour et al Circulation 20 05; 111:e39 4-4 34 Errata in: Circulation 20 05; 112:2373 Circulation 2007;1 15: e408 Used with permission a or Duration 6 wk PENICILLIN-RESISTANT (RELATIVELY OR FULLY) STRAIN (MIC >0.12 mcg/mL) 30 mg/kg/24h IV in 2 equally divided doses Dosagea and route 6 wk penicillin G vancomycinb Regimen Infectious Syndromes AntimicrobialTherapy.book... level of 3-4 mcg/mL and a trough level of . infection. Modified from Choice of antibacterial drugs. Treat Guidel Med Lett. 2007 ;5: 3 3 -5 0. Erratum in: Treat Guidel Med Lett. 2007 ;5: 58. AntimicrobialTherapy.book Page 130 Monday, April 28, 2008 2:34 PM 131 Treatment Bacterial. tmp/smx, β-lactam/ β-lactamase inhibitor, c carbapenem, b tigecycline Organisms First-line treatment a Alternate treatment a AntimicrobialTherapy.book Page 124 Monday, April 28, 2008 2:34 PM 1 25 Treatment Legionella. aminoglycoside, tmp/smx, β-lactam/β-lactamase inhibitor, c carbapenem b P vulgaris carbapenem b fluoroquinolone, aminoglycoside, tmp/smx, β-lactam/ β-lactamase inhibitor, c 3rd- or 4th-gen cephalosporin,