Professional Documents
Culture Documents
Alternative Drug(s)
Gram-negative cocci Cefuroxime, a fluoroquinolone2 Cefotaxime, ceftriaxone, cefuroxime axetil, an erythromycin,3 a tetracycline,4 azithromycin, amoxicillinclavulanic acid, clarithromycin, TMPSMZ5 Cefpodoxime proxetil
Cefixime, ceftriaxone
Neisseria Penicillin6 meningitidis (meningococcu s) Gram-positive cocci Streptococcus Penicillin6 pneumoniae7 (pneumococcu s)
An erythromycin,3 a cephalosporin,8 vancomycin, TMPSMZ,5 clindamycin, azithromycin, clarithromycin, a tetracycline,4 certain fluoroquinolones2 An erythromycin,3 a cephalosporin,8 vancomycin, clindamycin, azithromycin, clarithromycin Cephalosporin,8 vancomycin
Staphylococcu Vancomycin gentamicin rifam TMP-SMZ,5 doxycycline, minocycline, a s, methicillin- pin or Linezolid (MRSA) fluoroquinolone,2 daptomycin, resistant quinupristin-dalfopristin, tigecycline Staphylococcu Penicillin6 s, nonpenicillinaseproducing A cephalosporin,8 clindamycin
Staphylococcu Penicillinase-resistant penicillin9 s, penicillinaseproducing Enterococcus faecalis Enterococcus faecium Ampicillin gentamicin10 Vancomycin gentamicin10
Vancomycin, a cephalosporin,8 clindamycin, amoxicillinclavulanic acid, ampicillin-sulbactam, piperacillin-tazobactam, TMP-SMZ5 Vancomycin gentamicin Linezolid,11 quinupristindalfopristin,11 daptomycin11 tigecycline11
Gram-negative rods Acinetobacter Imipenem, meropenem Tigecycline, ertapenem, minocycline, doxycycline, aminoglycosides,12 colistin Metronidazole
Prevotella, Clindamycin oropharyngeal strains Bacteroides, Metronidazole gastrointestinal strains Brucella Doxycycline + rifampin4
Ticarcillin-clavulanate, ampicillinsulbactam, piperacillin-tazobactam, carbapenem TMP-SMZ5 gentamicin; ciprofloxacin + rifampin Tetracycline,f a fluoroquinolone2 Aminoglycoside, a fluoroquinolone,2 TMPSMZ5 Imipenem13 or meropenem,13 aminoglycosides,12 a fluoroquinolone,2 aztreonam, ticarcillin-clavulanate, ampicillin-sulbactam, piperacillintazobactam TMP-SMZ,5 oral cephalosporin
Campylobacter Erythromycin3 or azithromycin jejuni Enterobacter Ertapenem, imipenem, meropenem, cefepime Cefotaxime, ceftriaxone,
Escherichia Fluoroquinolones,2 nitrofurantoin coli (uncomplicate d outpatient urinary infection) Haemophilus (meningitis Cefotaxime, ceftriaxone
Aztreonam
and other serious infections) Haemophilus (respiratory infections, otitis) Helicobacter pylori Klebsiella13 TMP-SMZ5 Ampicillin, amoxicillin, doxycycline, azithromycin, clarithromycin, cefotaxime, ceftriaxone, cefuroxime, cefuroxime axetil, ampicillin-clavulanate Bismuth subsalicylate + tetracycline + metronidazol e + PPI TMP-SMZ,5 aminoglycoside,12 imipenem13 or meropenem,13 a fluoroquinolone,2 aztreonam, ticarcillinclavulanate, ampicillin-sulbactam, piperacillin-tazobactam Doxycycline rifampin
Legionella species (pneumonia) Proteus mirabilis Proteus vulgaris and other species (Morganella, Providencia) Pseudomonas aeruginosa
Cefotaxime, ceftriaxone
Ciprofloxacin (or levofloxacin) piperacillin-tazobactam; ciprofloxacin (or levofloxacin) ceftazidime; ciprofloxacin (or levofloxacin) cefepime Tetracycline,4 TMP-SMZ,5 amoxicillinclavulanic acid, imipenem or meropenem Chloramphenicol + streptomycin
Streptomycin + tetracycline4
Ceftriaxone Carbapenem
Shigella
A fluoroquinolone2
A tetracycline4
Yersinia pestis Streptomycin a tetracycline4 (plague, tularemia) Gram-positive rods Actinomyces anthrax Penicillin6 ciprofloxacin or doxycycline for anthrax Penicillin6
Chloramphenicol, TMP-SMZ5
Corynebacteri Erythromycin3 um diphtheriae Corynebacteri Vancomycin um jeikeium Listeria Acid-fast rods Mycobacteriu m tuberculosis14 Mycobacteriu m leprae Mycobacteriu m kansasii Mycobacteriu m avium complex Mycobacteriu Isoniazid (INH) + rifampin + pyrazinamide etha mbutol (or streptomycin) Ampicillin aminoglycoside12
Penicillin6
A fluoroquinolone TMP-SMZ5
Dapsone + rifampin clofazimine Minocycline, ofloxacin, clarithromycin INH + rifampin ethambutol Clarithromycin or azithromycin + ethambutol, rifabutin Amikacin + clarithromycin Clarithromycin, azithromycin, ethionamide, cycloserine Amikacin, ciprofloxacin
m fortuitumchelonei Nocardia Spirochetes Borrelia burgdorferi (Lyme disease) Borrelia recurrentis (relapsing fever) Leptospira Treponema pallidum (syphilis) Treponema pertenue (yaws) Doxycycline, amoxicillin, cefuroxime axetil TMP-SMZ5
doxycycline, linezolid Minocycline, imipenem or meropenem, linezolid Ceftriaxone, cefotaxime, penicillin, azithromycin, clarithromycin
Doxycycline4
Penicillin6
Penicillin6 Penicillin6
Penicillin6
Doxycycline
Mycoplasmas Clarithromycin or azithromycin or A fluoroquinolone,2 erythromycin3 doxycycline Chlamydiae C psittaci Doxycycline Chloramphenicol Ofloxacin C trachomatis Doxycycline or azithromycin (urethritis or pelvic inflammatory disease) C pneumoniae Doxycycline4
Rickettsiae Toxoplasmosis
Doxycycline4 PYRIMETHAMINE +SULFONAMIDE with folinic acid (If sulfadiazine toxicity develops replace it with clindamycin) spiramycin
pregnancy
pneumocystis jirovecii
Eflornithine
Melarsoprol
Nifurtimox
American Trypanosomiasi s (Chagas nifurtimox Disease) visceral leishmaniasis Cutaneous leishmaniasis liposomal amphotericin B or sodium stibogluconate
Benznidazole
sodium stibogluconate
Trichomona Giardia
Metronidazole
schistosomiasis Praziquantel Liver and lung flukes noninvasive tapeworm infections Praziquantel
Praziquantel
Niclosamide
neurocysticerco Albendazole sis primary hydatid cyst Albendazole (Echinococcus granulosus) Nematodes (round worms, etc) Albendazole or pyrantal palmoate
Praziquantel
Mebendazole, Praziquantel
Mebendazole
ivermectin
Thiabendazole/albendazole
DEC
Metrodinazole or Vancomycin
Adapted, with permission, from Treat Guide Med Lett. 2007 May;5(57):3350.
Fluoroquinolones include ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, and others (see text). Gemifloxacin, levofloxacin, and moxifloxacin have the best activity against gram-positive organisms, including penicillin-resistant S pneumoniae and methicillin-sensitive S aureus. Activity against enterococci and S epidermidis is variable. Erythromycin estolate is best absorbed orally but carries the highest risk of hepatitis; erythromycin stearate and erythromycin ethylsuccinate are also available. All tetracyclines have similar activity against most microorganisms. Minocycline and doxycycline have increased activity against S aureus.
5 4 3
Penicillin G is preferred for parenteral injection; penicillin V for oral administrationto be used only in treating infections due to highly sensitive organisms. Infections caused by isolates with intermediate resistance may respond to high doses of penicillin, cefotaxime, or ceftriaxone. Infections caused by highly resistant strains should be treated with vancomycin. Many strains of penicillin-resistant pneumococci are resistant to macrolides, cephalosporins, tetracyclines, and TMP-SMZ. Most intravenous cephalosporins (with the exception of ceftazidime) have good activity against gram-positive cocci.
9 8 7
Addition of gentamicin indicated only for severe enterococcal infections (eg, endocarditis, meningitis). Linezolid, daptomycin, tigecycline, quinupristin-dalfopristin should be reserved for the treatment of vancomycin resistant isolates or in patients intolerant of vancomycin. Aminoglycosidesgentamicin, tobramycin, amikacin, netilmicinshould be chosen on the basis of local patterns of susceptibility.
13 12 11
10
Extended beta-lactamaseproducing isolates should be treated with a carbapenem. Resistance is common and susceptibility testing should be done. Ciprofloxacin has inferior antichlamydial activity compared with newer fluoroquinolones.
14
15
Table 355. Drugs for the prevention of malaria in travelers.1 Drug Use2 Adult Dosage (All Oral)3 500 mg weekly 1 tablet (250 mg atovaquone/100 mg proguanil) daily 250 mg weekly 100 mg daily 30 mg base daily for 14 days after travel
Chloroquine Areas without resistant Plasmodium falciparum Malarone Areas with multidrug-resistant P falciparum
Mefloquine Areas with chloroquine-resistant P falciparum Doxycycline Areas with multidrug-resistant P falciparum Primaquine Terminal prophylaxis of Plasmodium vivax and Plasmodium ovale infections; alternative for P falciparum prophylaxis
4
Malaria-Clinical Setting
Chloroquine-sensitive Plasmodium falciparum and Plasmodium malariae infections Plasmodium vivax and Plasmodium ovale infections
Drug Therapy1
Chloroquine phosphate, 1 g, followed by 500 mg at 6, 24, and 48 hoursorChloroquine phosphate, 1 g at 0 and 24 hours, then 0.5 g at 48 hours Chloroquine (as above), then (if G6PD normal) primaquine, 30 mg base daily for 14 days
Alternative Drugs
For infections from Indonesia and Papua New Guinea: therapies listed for uncomplicated chloroquine-resistant P falciparum plus primaquine Mefloquine, 15 mg /kg once or 750 mg, then 500 mg in 68 hours or ASAQ2 (artesunate 100 mg, amodiaquine 270 mg), two tablets daily for 3 days
Uncomplicated infections Coartem (artemether 20 mg, with chloroquine-resistant lumefantrine 120 mg), four tablets P falciparum twice daily for 3 days Malarone, four tablets (total of 1 g atovaquone, 400 mg proguanil) daily for 3 days Quinine sulfate, 650 mg three times daily for 37 days Plus one of the following (when quinine given for < 7 days) Doxycycline, 100 mg twice daily for 7 days or Clindamycin, 600 mg twice daily for 7 days Severe or complicated infections with P falciparum3 Artesunate 2.4 mg/kg IV every 12 hours for 1 day, then daily3,6
Quinidine gluconate,46 10 mg/kg IV over 12 hours, then 0.02 mg/kg IV/min or Quinine dihydrochloride,2,46 20 mg/kg IV over 4 hours, then 10 mg/kg IV every 8 hours or Artemether,2,6 3.2 mg/kg IM, then 1.6 mg/kg/d IM
Drugs of Choice and Adult Dosage Luminal agent: Diloxanide furoate,2 500 mg orally three times daily for 10 days or Iodoquinol, 650 mg orally three times daily for 21 days or Paromomycin, 10 mg/kg orally three times daily for 7 days
Metronidazole, 750 mg orally Luminal agent (see above)plus either three times daily (or 500 mg IV every 6 hours) for 10 days plus Luminal agent (see above) Tetracycline, 250 mg orally three times daily for 10 days or Erythromycin, 500 mg orally four times daily for 10 days
Metronidazole, 750 mg orally Luminal agent (see above) three times daily (or 500 mg IV every 6 hours) for 10 days or plus either
Tinidazole, 2 g orally daily for Tetracycline, 250 mg orally three times daily for 3 days 10 days plus Luminal agent (see above) Hepatic abscess, ameboma, and other extraintestinal disease or Dehydroemetine 3 or emetine,2 1 mg/kg SC or IM for 35 days
Metronidazole, 750 mg orally Dehydroemetine 3 or emetine,2 1 mg/kg SC or three times daily (or 500 mg IM for 810 days, followed by (liver abscess IV every 6 hours) for 10 days only) chloroquine, 500 mg orally twice daily for 2 days, then 500 mg daily for 21 days or Tinidazole, 2 g orally daily for plus 3 days plus Luminal agent (see above) Luminal agent (see above)