Anti-Infectives Overview

Penicillins
Category Agents Spectrum of Normal Adverse effects Comments
Activity Dose
Natural Penicillins Penicillin G Streptococcus, PCN VK 250-500 Highest incidence of Bactericidal
enterococcus, some mg PO TID/QID hypersensitivity rxns
Penicillin V anaerobic (Type I-IV) DOC for all stages of
(phenoxymeth streptococci, T. Benzathine pcn G syphilis
ylpenicillin) pallidum (syphilis) (Bicillin LA) 2.4 Rare hematological side
million units IMX1 effects Dose adjust for renal
Benzathine for early, primary insufficiency
penicillin G syphilis. Use 2.4 GI side effects
million units Selection of pcn Na+
Crystalline qweek x 3 weeks Interstitial nephritis with or pcn K+ is based on
Penicillin if latent syphilis high doses / prolonged electrolyte status of pt
(Benzyl therapy (i.e. avoid Na+ in CHF
Penicillin) Neurosyphillis pts and K+ in renal
dose is 3-4 mil Jarisch-Herxheimer rxn failure)
units IV q4h x 10- when treating syphilis
14 days MOA: Cell wall agent,
CNS toxicity with higher prevent formation of
Acute doses and accumulation peptidoglycan cross-
Rheumatic (seizures) links by binding
Fever . transpeptidase
Benzathine pcn
G 1.2 mil units x Time-dependent kill
1, then 1.2 mil
units IM qmonth
for 5 years or
until 18 years
old if no history
of carditis.
Prophylaxis for
life if history of
carditis.
Aminopenicillins Ampicillin Retain activity of Ampicillin 1-2 g Hypersensitivity Rxns Bactericidal
Amoxicillin natural as above plus IV q4-6 hours (Type I-IV)
(Amoxil®, have extended Gr (-)
Trimox®) activity (H. influenza, Ampicillin 250- Non-immunologic rash of Amox: DOC for
E. Coli, K. 500 mg PO q6h unknown etiology has otitis media in
pneumoniae) been most commonly children (high dose),
Amoxicillin 250 – seen in patients with enterococcus,
More active against 1000 mg PO TID mononucleosis listeria (ampicillin
enterococcus IV)
GI side effects
Often used in H.
Rare hematological Pylori regimens
effects
Often used for dental
CNS toxicity with higher prophylaxis
doses and accumulation
(seizures) Dose adjust for renal
insufficiency
Amoxicillin has better
PO absorption, is better
tolerated and doesn’t MOA: Cell wall agent
have to be taken on an
empty stomach unlike Time-dependent kill
ampicillin

1
 Category Agents Spectrum of Normal Adverse effects Comments
Activity Dose
β-lactamase Oxacillin Large side group Oxacillin 1-2 g IV Hypersensitivity Rxns Bactericidal
Resistant Nafcillin sterically hinders q4h (Type I-IV)
Penicillins Cloxacillin β-lactamase made DOC for MSSA
Dicloxacillin by S. aureus from Nafcillin 1-2 g IV Rare hematological infection
(Dynapen®) cleaving β-lactam q4h effects
Flucloxacillin ring Dose adjust for
(Floxapen®) Dicloxacillin 250- GI side effects severe hepatic
Anti-staphylococcal, 500 mg four impairment
Methicillin (no good streptococcal times daily with Rare hepatotoxicity with
longer coverage meals oxacillin No adjustment for
available) renal insufficiency
No Gr (-) activity Flucloxacillin 500 CNS toxicity with higher
Ampicillin / mg q6h PO doses and accumulation Adequate blood-brain
cloxacillin (seizures) barrier penetration
(Ampiclox®) Ampicillin/
cloxacillin 500 mg Dicloxacillin has poor
Amoxicillin/ -1 gm q6hi systemic
flucloxacillin bioavailability so its
(Flamox®) use is limited to
uncomplicated
cellulitis

MOA: Cell wall agent

Time-dependent kill

Carboxy- Carbenicillin Excellent Gr (-) Carbenicillin 382- Hypersensitivity Rxns High Na+ content (5-6
penicillins (Geocillin®) activity including 764 mg PO QID mEQ/g ticarcillin)
Ticarcillin Pseudomonas (UTI only) GI side effects
(Ticar®) aeroginosa (T>C) Dose adjusted for
Ticarcillin 3g IV CNS toxicity with higher renal insufficiency
Some Gr (+) activity q4-6h doses (seizures)
retained MOA: Cell wall agent

Ureidopenicillins Piperacillin Significantly better Gr Piperacillin 3-4 g Hypersensitivity Rxns Bactericidal

(Pipracil®) (-) activity, including IV q4-6h
Pseudomonas GI side effects Dose adjusted for
aeruginosa renal insufficiency
CNS toxicity with higher
Some enterococcal doses (seizures) Not frequently used
activity (not as good without a β-lactamase
as ampicillin) inhibitor

Some Gr (-) activity MOA: Cell wall agent

Time-dependent kill

2
 Category Agents Spectrum of Normal Adverse effects Comments
Activity Dose
β-Lactam / β- Ampicillin/ Extended Gr (+) and Amp/sulbactam: Most common side Bactericidal
Lactamase sulbactam Gr (-) activity as well 1.5-3 g IV q4-6h effect: GI (diarrhea,
Inhibitor (Unasyn®) as anaerobes especially with Often used
Combinations Amox/clav: 500- Amox/clav) empirically for
Amoxicillin / Pip/tazo and 875 mg PO BID broad spectrum
clavulanic ticar/clav have Hypersensitivity Rxns coverage
acid better Gr (-) Ticar/clav: 3.1 g
(Augmentin®, coverage than IV q4-6h Interstitial nephritis Timentin is typically
Clavoxil®) amp/sul and the 2nd line agent for
amox/clav which Pip/tazo 4.5 g IV Hematological effects stenotrophomonas
Ticarcillin / lack Pseudomonas q8h or 3.375 g q6 (Thrombocytopenia with
clavulanic coverage Pip/tazo) Very useful in mixed
acid Pip/tazo infections
(Timentin®) Do not cover Pseudomonas CNS toxicity with higher
atypicals dose is 4.5 g IV doses (seizures) Dose adjusted for
Piperacilln / q6h renal insufficiency
Tazobactam
(Zosyn®) β-Lactamase Inhibitor
component does not
cross BBB

MOA: Cell wall agent

Sulbactam has
activity against
acinetobacter

Time-dependent kill

Cephalosporins
Category Agents Spectrum of Normal Adverse Comments
Activity Dose effects
First Generation Cefazolin (Ancef®, Very active against Cefazolin 1-2 g IV Highest degree Bactericidal
Kefzol®) Strep and MSSA q8h of cross-
sensitivity in pts Poor CSF penetration
Cephalexin (Keflex®) Limited Gr (-) activity Cephalexin 250- with penicillin
(E. coli, H. influenza, 500 mg PO Q6H allergies Dose adjusted for renal
Cefadroxil (Duricef®) K. pneumoniae) insufficiency
Cefadroxil 500- GI side effects
1000 mg PO BID Cefazolin is commonly
used for surgical
prophylaxis and the
class is widely used for
uncomplicated cellulitis

MOA: Cell wall agent

Time-dependent kill

3
 Category Agents Spectrum of Normal Adverse Comments
Activity Dose effects
Second Cefaclor (Halocef®) Very active against Cefaclor 250-500 GI side effects Bactericidal
Generation: MSSA, strep, and mg PO TID
Group 1 Cefuroxime (Ceftin®) some Gr (-) (E. coli, Variable CSF levels
H. influenzae, K. Cefuroxime axetil
pneumoniae, M. 250-500 mg PO Dose adjusted for renal
catarrhalis) BID insufficiency
No activity against Gr
(-) anaerobes Cefuroxime 750-
1500 mg IV q12h

Second Cefoxitin (Mefoxin®) Less activity against Cefoxitin 1-2 g IV MTT side chain Commonly used for GI
Generation: MSSA q6-8h interferes with surgical prophylaxis
Group 2 Cefotetan (Cefotan®) Enhanced Gr (-) vit K dependent and abdominal
(Cephamycins) activity Cefotetan 1-2 g coagulation. infections
Good activity against IV q12h May increase
Gr (-) anaerobes PT/INR Dose adjusted for renal
insufficiency
Cefoxitin has activity
against some rapid MOA: Cell wall agent
growing
mycobacterium Time-dependent kill

Third Ceftazidime (Fortaz®, Excellent Gr (-) Ceftazidime 1-2 g GI side effects Bactericidal
Generation: Tazicef®, Tazidime®) activity including IV q8h
Anti- Pseudomonas Excellent CSF levels
Pseudomonal Cefoperazone (Cefobid®) aeruginosa; Weak Gr Cefoperazone 2-
(+) activity 4 g IV q12h Dose adjusted for renal
insufficiency

Third Cefotaxime (Claforan®) Excellent Gr (-) Cefotaxime 1-2 g Excellent CSF levels
Generation: Ceftriaxone (Rocephin®) activity (Not IV q8h
Other Cefpodoxime proxetil Pseudomonas Meningitis – 2 g Cefotaxime and
(Vantin®) aeruginosa) IV q4h Ceftriaxone often used
Cefixime (Suprax®) Limited staph activity for meningitis
Excellent strep Ceftriaxone 1-2 g Ceftriaxone can
IV q24h cause Ceftriaxone is
ESBL-producing Meningitis – 2 g cholestasis / commonly used for
Klebsiella, E. Coli, IV q12h biliary sludging CAP in combo with a
and Enterobacter are Gonorrhea - 250 macrolide.
resistant to mg IM x 1
cephalosporins Ceftriaxone is dose
Cefpodoxime adjusted for liver
Cephalosporin proxetil 200- dysfunction
monotherapy for 400mg PO BID
enterobacter induces Avoid ceftriaxone in
ESBL production Cefixime 400 mg neonates
daily (available
only as an oral Cefotaxime, cefixime,
suspension) and cefpodoxime dose
adjusted for renal
insufficiency

Time-dependent kill

4
 Category Agents Spectrum of Normal Adverse Comments
Activity Dose effects
Fourth Cefepime (Maxipime®) Activity against strep, Cefepime 1-2 g GI side effects Bactericidal
Generation: staph, and Gr (-) IV q8-12h
organisms including Dose adjusted for renal
Pseudomonas Febrile insufficiency
aeruginosa Neutropenia
Poor anaerobic dosing – 2 g IV Used empirically in
coverage q8h febrile neutropenia

MOA: Cell wall agent

Time-dependent kill

Miscellaneous β-lactams

Category Agents Spectrum of Normal Adverse Comments

Activity Dose effects
Carbapenems Imipenem / Active against most Gr (+) Imi / cila 500 mg Imi / cila lowers Bactericidal
cilastatin except MRSA, E. faecium IV q6h seizure
(Primaxin®) Active against most Gr (-) threshold to the Most broad spectrum
including Pseudomonas greatest extent agents available
Meropenem aeruginosa Meropenem 500-
(Merrem®) Active against Bacteroides 1000 mg IV q6-8h Provide excellent
fragilis and other anaerobes polymicrobial coverage
No atypical coverage
Class is active against Dose adjusted for renal
certain non-TB rapid insufficiency
growing mycobacterium
Cilastatin prevents
cleavage of Imipenem
Ertapenem Ertapenem is active against Ertapenem 1000 Liver enzyme
(Invance®) Gr (+) except MRSA, E. mg IV/IM q24h elevations Ertapenem does not
faecium provide adequate empiric
Active against most Gr (-) coverage for hospital
but not Pseudomonas acquired infections
aeruginosa
Active against Bacteroides Typically used for
fragilis community infections

Most active class against Dose adjusted for renal

ESBL-producing insufficiency
organisms (i.e. E. Coli,
Klebsiella, and to a lesser MOA: Cell wall agent
extent Enterobacter)
Time-dependent kill

Monobactams Aztreonam Moderate to excellent Aztreonam 1-2 g Bactericidal

(Azactam®) activity against Gr (-)
organisms including
Pseudomonas aeruginosa
No activity against Gr (+)
organisms
Poor anaerobic coverage
IV q8h
Good substitute for
aminoglycosides in
patients at risk for toxicity
Cross allergy with
penicillins unlikely

Dose adjusted for renal

insufficiency

MOA: Cell wall agent

Time-dependent kill

5
Aminoglycosides
Agents Spectrum of Activity Normal Dose Adverse Comments
Effects
Gentamicin Very active against Gr (-) Dosing is variable and Nephrotoxicity Bactericidal
Tobramycin organisms including Pseudomonas depends on type of (associated with
Amikacin aeruginosa (A&T>>>G) infection (see table prolonged high Less nephrotoxicity
Streptomycin below) troughs), with once daily dosing
Synergistic activity against MSSA, ototoxicity
MRSA, enterococcus when used *Dose must be based on IBW (associated with Once daily dosing not
or adjusted body weight for
with cell-wall active agents (most obese
high peaks, recent recommended in ICU,
data with gent) literature suggests pregnant, or pediatric
Goal tobra/gent increased risk with patients or if they have
No anaerobic activity troughs are <1 Gent), enhanced CF, ascites, burns
mcg/mL neuromuscular (>20%), or renal failure
Has activity against some rapid blockade or if treating UTI’s
growing mycobacterium (typically Typical amikacin
concentration goals Avoid in myasthenia Dose adjust for renal
amikacin) gravis insufficiency per PK
Cpk = 20-30 mcg/mL
Ctr = 5-10 mcg/mL parameters
Streptomycin IV/IM is a 2nd line (Gent/tobra x 3)
agent for mTB typically reserved MOA: Binds to 30S
MDR TB ribosomal unit

Concentration
dependent kill with post
antibiotic effect

Site Peak Dosing

UTI (simple) 2-4 1-1.5 mg/kg q12h
Synergy for GPC for endocarditis – 4-5 1.5 mg/kg q12h
dose at around the same time as or
other antibiotic 3 mg/kg q24h
UTI (comp), septicemia, 6-8 2-2.5 mg/kg
bacteremia, soft tissue
PNA, immunocompromised pts 8-10 2.5-3 mg/kg q12h
PNA in CF pt or w/ bronchiectasis 10-12 4 mg/kg q12h
Macrolides/Azalides
Agents Spectrum of Activity Normal Dose Adverse Comments
Effects
Erythromycin (E- Good activity against gram-positives Erythromycin 250- GI side effects Bacteriostatic
mycin®, E.E.S.®, Ery- and gram-negatives 500 mg PO q6h/q8h (especially
Tab®, Eryc®) No activity against gram-negative Erythromycin 500- with Multiple CYP 450 drug
Clarithromycin anaerobes 1000 mg IV q6-8h erythromycin) interactions (less with
(Biaxin®, Biaxin XL®) Very good activity against atypical Azithromycin)
Azithromycin pathogens including Mycoplasma Clarithromycin 500 Taste
(Zithromax®, Tri-Pak®, pneumoniae, C. trachomatis, H. mg PO BID perversion is Theophylline, digoxin,
Z-pak®, Z-max®) pylori, and Legionella spp Clarithro XL 1000 mg common with tacrolimus, warfarin,
Activity against Mycobacterium daily clarithromycin phenytoin, and valproate
avium complex (azithromycin and levels are increased with
clarithromycin) Azithromycin 250- Hepatotoxicity concurrent administration
Active against certain rapid growing 500 mg PO/IV daily
mycobacterium (10-21 days for Risk for QT Azithro commonly used as
legionella) prolongation for anti-inflammatory
Has some activity against syphilis properties in CF pts
and gonorrhea with 2 gm dose. Z-pak – 500 mg on
Azithro 2 gm x 1 was efficacious in day 1, 250 mg days Erythromycin is often used
treating African patients with early 2-5 as a GI motility agent
syphilis. However, Macrolide
resistance rates are increasing in Zmax – 2 gm PO x 1 MOA: Binds to 50S
America ribosomal unit
Rheumatic Fever
Used for prophylaxis Time-dependent kill
in pts with pcn
allergy. 250 mg BID
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Ketolides
Agents Spectrum of Activity Normal Dose Adverse Comments
Effects
Telithromycin (Ketek®) Covers Strep (including multi-drug 800 mg PO q24h GI side effects, Dose adjusted for renal
resistant Strep pneumoniae), H. (available as 400 mg and rare visual insufficiency
influenzae, M. catarrhalis, and tablets) disturbances
atypicals Multiple CYP450 drug
New reports of interactions
Indicated for acute bacterial severe
exacerbations of chronic bronchitis, hepatotoxicity Binds domain 2
acute bacterial sinusitis, and (macrolides don’t) and
community acquired pneumonia Risk for QT domain 5 of the bacterial
prolongation ribosome with higher
affinity conferring potential
for activity against
resistant pathogens

MOA: Binds to 50S

ribosomal subunit

Time-dependent kill

Tetracyclines
Agents Spectrum of Activity Normal Dose Adverse Comments
Effects
Doxycycline (Doryx®, Good activity against gram-positive Doxycycline 100 mg GI upset and Bacteriostatic
Vibramycin®) and gram-negatives (Not P PO/IV q12h photosensitivity
Minocycline aeruginosa) Used in acne, SSTI,
(Dynacin®, Minocin®) No anaerobic activity Minocycline 100 mg Use during tooth tick borne illness,
Tetracycline Very good against atypical PO q12h development may pneumonia, and
(Sumycin®) pathogens including Ehrlichia (tick cause permanent malaria
borne), Borrelia burgdoferi (lyme Tetracycline 250-500 discoloration of teeth proph/treatment
disease), Ricketsia ricketsii mg PO q6h
(RMSF), Chlamydia, Bartonella, Tetracycline 500-1000 Minocycline has the Tetra has > urinary
Leptospira, Yersinia, malaria, mg IV q12h highest association penetration than
Burkholderia, Nocardia with vertigo others
(mino>others) and Mycoplasma Oral absorption
decreased by di- and Doxycycline is
Have activity against trivalent cations hepatically eliminated
Stenotrophomonas (milk, antacids,
sucralfate) MOA: Binds to 30S
Have some activity against CA- and blocks entry of
MRSA (mino > doxy>tetra) aminoacyl-tRNA

For OSSA (doxy/mino>tetra)

Covers some enterococcus

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Lincosamides
Agents Spectrum of Activity Normal Dose Adverse Effects Comments
Clindamycin Very active against strep, MSSA Clindamycin 300-450 GI upset (specifically Bacteriostatic
(Cleocin®) Active against Gr (+) and Gr (-) mg PO q8h pseudomembranous
anaerobes Clindamycin 600-900 colitis due to C. dificile Good alternative for
Good coverage for above mg IV q6-8h overgrowth) cellulitis in PCN
diaphragm aspiration allergy
No Gr (-) activity Oral dose is reduced
Good activity against from IV to PO to limit Dose adjusted for
Toxoplasmosis gondii GI side effects hepatic dysfunction

Alternative agent for PCP Higher dose for Gr (+)

treatment in combination with toxic shock
primaquine syndromes to prevent
toxin product (inhibits
B frag resistance is increasing M protein synthesis)
(20-30%)
MOA: Binds to 50S
Often used for CA-MRSA and inhibits peptidyl
transferase activity

Fluoroquinolones
Agents Spectrum of Activity Normal Dose Adverse Comments
Effects
“Older” FQ Very active against Gr (-) Ciprofloxacin 250-500 FQ use in Bactericidal
Ciprofloxacin (Cipro®) including Pseudomonas mg PO q12h children < 18 not
Ofloxacin (Floxin®) – aeruginosa Ciprofloxacin 400 mg IV recommended Excellent bone
(otic formulation is Minimal activity against Gr (+) q8-12h (q8h for penetration
formulary) No anaerobic activity Pseudomonas coverage) Class warning
Norfloxacin (Noroxin®) Good activity against atypicals Ciprofloxacin 750 mg PO for QT Alternate agents for
q12h for Pseudomonas prolongation meningitis
(more so with
Ofloxacin 200-400 mg respiratory FQ) CYP 450 drug
Gati and Moxi retain similar Gr (-) PO/IV q12h interactions possible
activity as older with the Tendonitis and especially with
“Newer/Respiratory” exception of Pseudomonas Levofloxacin 250-750 arthropathy ciprofloxacin (warfarin,
FQ’s aeruginosa mg PO/IV daily cyclosporine,
Levofloxacin Levo at higher doses covers (750 mg dose for P Some tacrolimus)
(Levaquin®) Pseudomonas aeruginosa aeroginosa, 7-21 days photosensitivity
Enhanced Gr (+) activity for legionella) Moxifloxacin is good for
Moxifloxacin (Avelox®) Moxifloxacin has activity against Risk for mixed infections and
anaerobes Gatifloxacin 200-400 mg dysglycemia aspiration pneumonia.
Gatifloxacin (Tequin®) PO/IV daily It is also hepatically
[Removed from FQ’s (esp. moxi/gati) have cleared so no renal
market due to activity against some rapid Moxifloxacin 400 mg adjustments are
dysglycemias] growing mycobacterium and mTB PO/IV daily necessary and it is
avoided in UTIs
Levo has activity against Take all FQ’s at least
legionella and may be superior to two hours before any Epidemiologically may
macrolides di- or tri- valent cations increase incidence of
MRSA
Good PO bioavailabilty
MOA: binds to DNA
gyrase and
topoisomerase

Concentration
dependent killing with
post antibiotic effect

8
Glycopeptides
Agents Spectrum of Activity Normal Dose Adverse Effects Comments
Vancomycin Gr (+) activity only (including Vancomycin 15 Red Man’s syndrome Mixed bacteriostatic
MRSA, enterococcus, and coag(-) mg/kg q12h (dose (infusion rate related) (enterococcus) and
staph) based on actual bactericidal dependent on
body weight and Rare toxicities: organism
Enterococcus faecium has high interval based on Nephrotoxicity
rates of resistance to vanco. renal function) (interstitial nephritis), Slower kill than pcns

Vancomycin 125 Ototoxicity at high peaks Oral regimen for local

PO q6h (>60) effect on GI infections –
C. dificile & S. aureus
Neutropenia enterocolitis ONLY
(PO form has a BA of <
5%)

Dose adjust for renal

insufficiency based on PK
Goal troughs of 10-15 for
most infections. Consider
using troughs of 15-20 for
pneumonia, meningitis
and osteomyelitis

Not significantly removed

by HD

MOA: Cell wall agent by

binding to D-Ala-D-Ala
terminus of peptidoglycan

Time dependent kill

Nitromidazoles
Agents Spectrum of Activity Normal Dose Adverse Effects Comments
Metronidazole Excellent activity against Gr (-) Metronidazole Metallic taste DOC for C. dificile
(Flagyl®) anaerobes (Bacteroides 250-500 mg PO
fragilis) and Gr (+) anaerobes BID-QID Drug-induced Used for protozoal
(C. dificile) Metronidazole pancreatitis infections (i.e.
Coverage for below diaphragm 500 mg IV q6- amebiasis,
aspiration 12h Drug-induced seizures trichomoniasis,
amoebic dysentery,
Disulfiram rxn if giardia)
alcohol is consumed
Used for acne rosacea

Increases warfarin conc

MOA: Inhibits
anaerobic electron
transport proteins and
leads to DNA nucleic
acid synthesis
dysfunction

9
Rifamycins
Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
Rifampin (Rifadin®, Extremely active against Rifampin 300-600 mg PO GI upset Bactericidal or Bacteristatic
Rimactane®) Gr (+) cocci daily
Rifabutin Rifampin 10-20 mg/kg IV Reddish- Potent INDUCER of CYP 450:
(Mycobutin®) Moderate Gr (-) activity daily (max of 600 mg daily) orange Many drug interactions (less
(not Pseudomonas discoloration with Rifabutin-still requires
aeruginosa) Rifabutin 150-300 mg daily of bodily fluids HAART dosage adjustments)
(urine, sweat,
Active against M. contact lens), Often used in synergy with cell
tuberculosis and M. avium wall active agents for serious
complex Allergic Gr (+) infections (Endocarditis,
hepatitis osteomyelitis). Has limited
Active against Brucella (monitor liver clinical data extrapolated from
enzymes) coag (-) staph endocarditis

Hepatoxicity Used for N. meningitides

(esp. in combo prophylaxis
with other
hepatoxic First line agent in the treatment
agents) of TB

MOA: Binds to bacterial RNA

polymerase

Chloramphenicol
Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
Chloramphenicol Good activity against Gr Chloramphenicol 50-100 Bone marrow Bacteriostatic
(+) and Gr (-) organisms mg/kg PO/IV given in divided suppression,
(NOT Pseudomonas doses q6h Dose adjusted for hepatic
aeruginosa) aplastic anemia dysfxn
(rare)
Good activity against B. Rarely used due to risk for
fragilis Gray baby serious adverse effects
syndrome
Sometimes used for VRE Unavailable in most
institutions
Used for bacterial
meningitis in resource poor MOA: Binds to 50S
ribosomal unit

10
Trimethoprim / Sulfamethoxazole
Agents Spectrum of
Activity
TMP/SMX (Bactrim Good activity against Gr
DS® 800 mg SMX / (+) and Gr (-) organisms
160 mg TMP, (some MRSA)
Bactrim SS® 400 /
80 mg, Septra Exceptions:
SS®, Septra DS®, Pseudomonas
Cotrim®, aeruginosa, Group A
Sulfatrim®) strep, enterococcus
SMX:TMP is in a No activity against gram-
5:1 ratio in all negative anaerobes
formulations
Very active against
Pneumocystis carinii
Active against
Stenotrophomonas,
Nocardia, Shigella, and
typhoid fever
Normal Dose
TMP-SMX 10 mg (of TMP)
per kg PO/IV daily given in
2-4 divided doses
UTI dose: 1 TMP/SMX DS
PO q12h
CA MRSA: 2 TMP/SMX DS
PO q12h (5 mg/kg q12h)
PCP dose: TMP/SMX 15-
20 mg (of TMP) per kg
PO/IV daily given in 2-4
divided doses
In renal failure consider
using 10 mg/kg IV in 3
divided doses
Use adjunctive steroids in
severe PCP if Pa02 <70
Adverse Effects Comments
GI upset Bacteriostatic
Rash can progress to DOC for PCP and
SJS and TEN Stenotrophomonas
Thrombocytopenia, Often used for community
acquired MRSA
Bone marrow
suppression, Commonly used for UTIs
Hyperkalemia (due to Dose adjusted for renal
TMP) dysfxn
Not to be used in pts
with severe G6PD
deficiency
MOA: Inhibits folic acid
synthesis

Streptogramins
Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
Quinupristin / Excellent activity against 7.5 mg/kg IV q8-12h Phlebitis Bacteriostatic against E.
dalfopristin Gr (+) (MRSA, MRSE, (especially with faecium and bactericidal
(Synercid®) DRSP, VRE faecium) peripheral IV against MSSA and MRSA
Not active against E. admin)
faecalis CYP 3A4 inhibitor – many
Very limited activity against Myalgias, drug interactions
Gr (-) organisms and arthralgias
anaerobes No dose adjustment for renal
Some activity against or hepatic impairment
atypicals
MOA: Works on the 50S
bacterial ribosome.
Dalfopristin inhibits early
stage protein synthesis and
quinupristin inhibits late
stage protein synthesis

11
Oxazolidinones
Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
Linezolid (Zyvox®) Excellent activity against Gr 600 mg PO/IV q12h Diarrhea Bacteriostatic
(+) organisms including
MRSA, MRSE, drug Oral BA=96-99% taste perversion No dose adjustment for
resistant Strep. renal or hepatic
Pneumoniae, VRE faecium Thrombocytopenia impairment
and faecalis (3-20%, 50 mg vit
B6 may blunt this Indicated for nos.
effect) and bone pneumonia, ventilator
marrow suppression associated pneumonia,
skin and soft tissue
Increased liver infections,
enzymes Diabetic foot infections,
CAP
Lactic acidosis
May also be effective for
Peripheral meningitis as linezolid
neuropathy hasbeen concentrations are ~30-
reported. 60% in the CSF from
various case reports
Weak monoamine
oxidase inhibitor MOA: prevents formation
(watch for additive of the 70S and 30S
serotonergic initiation complex by
activation with binding 23S
SSRI’s or additive
serotonergic drugs)

Lipopeptides
Agents Spectrum of Normal Dose
Activity
Daptomycin Gr (+) including staph, Complicated skin and soft
(Cubicin®) strep, VRE, VRSA, and tissue infections:
MRSA 4 mg/kg IV every 24hr
Bacteremia/Endocarditis:
6 mg/kg IV every 24hr
Total body weight should be
used; in HD patients use
patient’s dry weight.
Dose reductions for CrCl <30
ml/min (including HD):
Change dosing interval to
every 48hr
Higher doses are currently
being studied
Adverse Comments
Effects
CPK levels at Cidal against almost all
higher doses in susceptible organisms
trials
Used in complicated skin
If CK>10 x ULN, infections
discontinue drug
Approval expected for
If CK>5 x ULN bacteremia and native valve
and symptomatic, endocarditis.
discontinue drug
Ineffective against
Daptomycin was pulmonary infections due
originally studied to pulmonary surfactants
at 4 mg/kg every which inactivate the drug
12 hr; this regimen
had an increased No dose adjustment for renal
risk of muscle pain or hepatic impairment
and damage
secondary to MOA: Daptomycin binds to
muscle bacterial membranes and
breakdown. causes a rapid depolarization
of the membrane potential.
Requires calcium for activity

Falsely elevates INR in

certain lab assays based on
the agent used to measure
the PT

12
Glycylcycline
Agents Spectrum of
Activity
Tigecycline Gr (+) activity including
(Tygacil®) OSSA, ORSA,
enterococcus (including
VRE), streptococcus
Gram (-) activity including
E. Coli, Klebsiella spp. ,
Enterobacter spp.,
Acinetobacter spp.,
Citrobacter spp., H.
Influenzae, M. Catarrhalis,
Neisseria spp., Salmonella
spp., Shigella spp.
Anaerobic Coverage
including Bacteroides spp.,
C. perfringens
No activity against
Pseudomonas spp.,
Proteus spp., B. cepacia,
S. maltophilia &
Legionella
Normal Dose
100 mg IV loading dose (Day
1) followed by 50 mg IV
every 12 hours (starting 12
hours post loading dose)
Hepatic dose adjustment
(Child-Pugh C):
100 mg IV loading dose (Day
1) followed by 25 mg IV
every 12 hours (starting Day
2)
33% excreted unchanged in
the urine.
59% excreted in the bile
13
Adverse Comments
Effects
~25% of patients Bacteriostatic
developed
nausea/vomiting; Indicated for use in
premedication complicated skin and soft
with an antiemetic tissue infections and
may be warranted complicated intraabdominal
infections
Thrombocytopenia
in 6% Should be infused over at
least 30 to 60 mins (60 mins
May cause is preferable as it may help
profound improve rates of
hypotension if nausea/vomiting)
antibiotic is
administered too MOA: Binds to 30S and
rapidly. blocks entry of aminoacyl-
tRNA
Not recommended
for use in pediatric Not indicated for blood
(<18 years of age) stream infections
or pregnant
women as this On-going studies for
drug is derived pneumonia
from tetracyclines.
 Anti-Fungal Agents
Polyenes
Agents Spectrum of Activity Normal Dose Adverse Comments
Effects
Amphotericin B Fungicidal; broad spectrum 0.5-1 mg/kg IV daily Nephrotoxicity Preferred amphotericin
deoxycholate MAX 1.5 mg/kg IV daily formulation for urinary tract
(Amphocin) Candida (except lusitaniae), (Aspergillus) Infusion-related infections, bladder
Aspergillus, reactions irrigation, dialysis
(Currently on Zygomyces, Cryptococcus, Pre-medicate with (less with lipid dependent, and short-
restriction) dimorphic fungi acetaminophen and products), courses of antifungal
diphenhydramine therapy
Not active against Give pre-bolus prior to Electrolyte
Scedosporium or Aspergillus dose abnormalities (K+ MOA: Binds to sterols in the
terreus Consider use of Demerol and Mg+2) cell wall to inhibit growth
or Dantrolene for rigors
Rigors

Anemia

Lipid complex Similar to Amphotericin B 3-5 mg/kg IV daily Similar to UNC Hospitals preferred
Amphotericin deoxycholate deoxycholate, but lipid amphotericin
(Abelcet) renal dysfunction formulation
and infusion-related
reactions occur less MOA: Binds to sterols in the
frequently cell wall to inhibit growth

Liposomal Similar to Amphotericin B 3-5 mg/kg IV daily Same as above Liposomal products take 1
amphotericin deoxycholate day to unravel from lipid
(Ambisome) complex – clinical
significance unknown

MOA: Binds to sterols in the

cell wall to inhibit growth

Azoles
Agents Spectrum of Activity Normal Dose Adverse Comments
Effects
Ketoconazole Tinea sp., cutaneous Rub gently into the affected Severe irritation Primarily topical use
(Nizoral) recalcitrant dermatophytoses; area once to twice daily
Candidiasis Pruritus High doses (400-800 mg
TID) have hormone
Stinging suppression qualities -
can be used in refractory
prostate cancer

MOA: inhibition of fungal

cytochrome P-450-
mediated 14 alpha-
lanosterol demethylation
required for membrane
generation

14
 Agents Spectrum of Activity
Fluconazole Candida albicans,
(Diflucan®) Cryptococcus,
NOT active against:
Aspergillus, Zygomycetes,
mold
Candida glabrata has
developed increased
resistance to fluconazole
Candida krusei is intrinsically
resistant to fluconazole
Itraconazole Candida albicans,
(Sporanox) Aspergillus, Histoplasma,
Blastomyces, Cryptococcus,
(IV formulation is Onychomycosis of toenails
non-formulary)
Voriconazole Aspergillus, Candida sp. (not
(Vfend) C. rugosa), Scedosporium,
Fusarium, Blastomycosis,
Cryptococcus, Coccidioides
NOT active against:
Zygomycetes
Normal Dose
Vaginal candidiasis 150-
200 mg PO x 1
Oropharyngeal /
esophageal candidiasis 200
mg x 1, then 100 mg daily
for at least 2 wks (3 wks for
esophageal)
Systemic candidiasis 800
mg/day (>6 mg/kg)
Cryptococcal meningitis
400 mg/day (suppression
dose for AIDS pts is 200
mg/day)
200-400 mg PO/IV q24h
IV loading dose:
6 mg/kg IV q12h x 2 doses,
then 4 mg/kg IV q12h
Oral Maintenance dose:
200 mg PO q12h
(weight>40 kg)
100 mg PO q12h
(weight<40 kg)
Consider PO load (400 MG
PO BID x 2) despite lack of
clinical evidence
15
Adverse Comments
Effects
Generally well- Excellent PO absorption
tolerated
Dose adjusted for renal
 LFTs insufficiency
Possesses CYP450 drug
interactions at higher
doses but to a lesser
extent than other azoles
Good CSF penetration
(~75%)
MOA: inhibition of fungal
cytochrome P-450-
mediated 14 alpha-
lanosterol demethylation
required for membrane
generation
GI distress, N/V, Poor and variable
absorption with PO
Rash capsules – requires
acidic environment –
 LFTs oral suspension has better
absorption
Avoid IV formulation
in kidney Multiple drug interactions
dysfunction due to due to CYP450
accumulation of
cyclodextrin vehicle MOA: inhibition of fungal
cytochrome P-450-
mediated 14 alpha-
lanosterol demethylation
required for membrane
generation
Transient visual Excellent PO absorption,
changes (up to 30%) multiple drug
typically with initial interactions (especially
infusion-often self with immunosuppressive
limiting drugs), use in caution in
pts with liver dysfunction
Skin rash
Poor urinary
N/V penetration, avoid use
in fungal UTI
 LFTs
MOA: inhibition of fungal
Try to avoid IV cytochrome P-450-
formulation in pts mediated 14 alpha-
with renal lanosterol demethylation
dysfunction, due to required for membrane
accumulation of generation
SBECD vehicle
Decent CSF penetration
(~40%)
Pyrimidines
Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
5-flucytosine Limited spectra; Flucytosine 25 mg/kg/dose Bone marrow Dose adjust for renal
(5-FC) (Ancobon®) Candida, q6h PO daily suppression dysfunction
Cryptococcus neoformans
Severe colitis Used in combination for
cryptococcal meningitis

Converted to 5-FU in vivo

MOA: non-competitive
inhibitor of thymidylate
synthetase which is
involved in DNA synthesis

Echinocandins
Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
Caspofungin Candida sp., Aspergillus Caspofungin 70 mg IV Well tolerated Not metabolized through
(Cancidas®) (fungistatic) sp., loading dose then 50 mg IV CYP-450, therefore fewer
Histoplastoma, daily Fever drug interactions than with
NOT active against: azoles
Zygomycetes, For severe hepatic N/V
Trichosporon, dysfunction use 70 mg x 1 Decreases tacro levels by
Pseudallescheria, followed by 35 mg IV daily Flushing 20%, caspo levels may be
Cryptococcus (they lack β increased by 35% with
(1,3) D-glucan) Hypokalemia cyclosporine.

 LFTs Poor urinary penetration,

avoid use in fungal UTI

Low CSF concentrations

MOA: Inhibits β (1,3) D-

glucan in the fungal cell wall

Micafungin Similar spectrum to Micafungin 150 mg IV q24h Well tolerated Does not interact with
(Mycamine) caspofungin for esophageal candidiasis cyclosporine or tacro
Hyperbilirubinemia
More extensive data in Micafungin 50 mg IV q24h Rifampin does not decrease
children for prophylaxis of pre- Nausea, diarrhea concentrations
engraftment phase of HSCT
Poor urinary penetration,
avoid use in fungal UTI

Low CSF concentrations

MOA: Inhibits β (1,3) D-

glucan in the fungal cell wall

16
 Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
Anidulafungin Similar spectrum to 100 mg IV daily Well tolerated Anidulafungin clearance was
(Eraxis®) caspofungin not affected by concomitant
No dosage adjustments Rare infusion treatment with substrates,
needed for renal or liver related reactions inhibitors, or inducers of the
dysfunction seen in trials CYP metabolic pathway
including rifampin.

Anidulafungin AUC was

increased by cyclosporine by
21% without consequence

Poor urinary penetration,

avoid use in fungal UTI

Low CSF concentrations

MOA: Inhibits β (1,3) D-

glucan in the fungal cell wall

17
 Anti-TB Drugs
Agents WHO Normal Dose Adverse Effects Comments
class
Isoniazid Group 1 - 1st Wt. <33 33-50 51-70 >70 ↑ LFTs (10-20%) No renal adjustment
(INH) line oral agent (kg) Hepatotox ↑ w/ EtOH, liver Check baseline LFT’s
Daily 4-6 200- 300 300 dx, ↑ age, postpartum,
mg/kg 300 and Hispanic ♀ Part of fixed dose
mg Peripheral neuropathy – combination (Rihaze,
TIW 8-12 450- 600 600 give vit B6 25 mg/day Rifafour)
mg/kg 600 CNS effects-rare
Lupus-<1% risk

Rifampicin Group 1 - 1st Wt <33 33-50 51-70 >70 ↑ LFTs especially in No renal adjustment
(RIF) line oral agent (kg) combination with other Check baseline LFT’s
Daily 10-20 450- 600 600 hepatoxic meds Stains contact lenses
mg/kg 600 Body fluid discoloration and sweat
(common), GI upset, Very potent inducer of
itching (6%), flu-like illness CYP450 enzymes
(0.4-0.6%), blood CI with PI’s and NVP
dyscresias (<0.1%) Part of fixed dose
combination (Rihaze,
Rifafour)
Ethambutol Group 1 - 1st Wt. <33 33-50 51-70 >70 Optic neuritis (1-6%) and Adjust for renal
(ETH) line oral agent (kg) decreased red-green insufficiency
Daily 15-20 800- 1200- 1600- vision Obtain baseline and
mg/kg 1200 1600 2000 Rash (0.2-0.7%) monthly vision exam
Typically avoided in
children due to lack of
ability to test for ocular
SE’s
Part of fixed dose
combination (Rihaze,
Rifafour)
Pyrazinamide Group 1 - 1st Wt. <33 33-50 51-70 >70 GI upset (2-5%), Adjust for renal
line oral agent Hepatoxicity (<1%), insufficiency
Daily 30-40 1000- 1750- 2000- Arthralgias (40%), Avoid in pregnancy
mg/kg 1750 2000 2500 Hyperuricemia (common), Avoid in pts with pre-
mg Gout (rare) existing gout.
Part of fixed dose
combination (Rihaze,
Rifafour)
Streptomycin Group 2 - Wt. <33 33-50 51-70 >70 Ototoxicity, Neurotoxicity, Adjust for renal
injectable Nephrotoxicity insufficiency Used as
agent (IM) Daily 15- 500- 1000 1000 one of the main drugs
(Bactericidal) 20mg/ 750 mg mg for patients requiring
kg mg retreatment.
Kanamycin Group 2 - Wt. <33 33-50 51-70 >70 Ototoxicity, Neurotoxicity, Adjust for renal
Injectable Daily 15- 500- 1000 1000 Nephrotoxicity insufficiency
agents (IM) 20mg/ 750 mg mg Penetrates only
aminoglycosi kg mg inflamed meninges
de Avoid in pregnancy
(Class D)
Monitor for vestibular
and nephrotoxicity
Bactericidal
Amikacin Group 2 - Wt <33 33-50 51-70 >70 Ototoxicity, Neurotoxicity, Adjust for renal
(Am) Injectable (kg) Nephrotoxicity insufficiency
agents (IM) Daily 15-20 500- 1000 1000 Penetrates only
Aminoglycosi mg/kg 750 mg mg inflamed meninges
de mg Avoid in pregnancy
(Class D)
Monitor for vestibular
and nephrotoxicity
Bactericidal

18
 Agents WHO Normal Dose Adverse Effects Comments
class
Capreomycin Group 2 - Wt <33 33-50 51-70 >70 Nephrotoxicity (20-25%), Adjust for renal
(Cm) Injectable (kg) Ototoxicity, electrolyte insufficiency
agents (IM) abnormalities Bactericidal. MOA is
Cyclic similar to AG’s
polypeptide Daily 15-20 500- 1000 1000 Nocross-resistance with
mg/kg 750 mg mg the aminoglycosides. 50–
mg 60% excreted via
glomerulofiltration.
Penetrates only
inflamed meninges
Avoid in pregnancy
(class C)
Monitor for vestibular
and nephrotoxicity
Bactericidal

Ethionamide Group 4 - Wt <33 33-50 51-70 >70 GI , Hepatitis,

Oral Neurotoxicity, Endocrine
bacteriostatic Daily 15-20 500- 1000 1000 abnormalities
2nd line agent mg/kg 750 mg mg
mg
Protionamide Group 4 - Wt <33 33-50 51-70 >70
Oral Daily 15-20 500- 1000 1000
bacteriostatic mg/kg 750 mg mg
2nd line mg
agents

Cycloserine Group 4 - Wt <33 33-50 51-70 >70

Oral
bacteriostatic
2nd line Daily 15-20 500- 1000 1000
agents mg/kg 750 mg mg
mg
P- Group 4 - Wt <33 33-50 51-70 >70
aminosalicylic Oral
acid, bacteriostatic
2nd line Daily 150 8 gm 8 gm 8 gm
agents mg/kg

Thioacetazone Group 4 - Usual Dose =150mg

Oral
bacteriostatic
2nd line
agents

Terizidone Group 4 - Wt <33 33-50 51-70 >70

Oral Daily 15-20 600 600 900
bacteriostatic mg/kg mg mg mg
2nd line
agents

Ciprofloxacin Group 3 - Wt <33 33-50 51-70 >70 MOA: DNA gyrase

Fluoroquinolo /topoisomerase
Daily 20-30 1500 1500 1500
nes
mg/kg mg mg mg
Moxifloxacin =
gatifloxacin >
levofloxacin > ofloxacin
= ciprofloxacin
Ofloxacin Group 3 - Usual dose = 800mg daily
Fluoroquinolo
nes
Levofloxacin Group 3 – Usual dose=750mg daily
Fluoroquinolo
nes
19
 Agents WHO Normal Dose Adverse Effects Comments
class
Moxifloxacin Group 3 - Usual dose =400mg daily
Fluoroquinolo
nes

20
 Anti-viral Agents

Agents Spectrum of Normal Dose Adverse Comments

Activity Effects
Acyclovir HSV 1, 2 Encephalitis (HSV1)- Acyclovir 10 Acute renal failure Acyclovir-poor BA~15-30%
(Zovirax®) VZV mg/kg IV q8h for 14-21 days, treat with high doses and
immediately poor hydration Valacyclovir BA~54%
Provides minimal (drug cyrstalization
Valacyclovir coverage against Varicella (VZV) in adolescents and and ppt) Ensure patients receive
(Valtrex®) CMV for adults – Acyclovir 800 mg PO 5 adequate hydration and
prophylaxis in low times/day x 5-7 days OR HA dose adjust for renal
risk patients Valacyclovir 1 gm PO TID x 5-7 days dysfunction
(start within 24 hours of rash) GI upset
Acyclovir is converted to
Shingles (VZV) Acyclovir 800 mg PO 5 Seizures acyclovir monophosphate
times/day x 7 days OR by virus-specific thymidine
Valacyclovir 1 gm PO TID x 7 days Caustic, often kinase then further
(Consider adding steroids if caught causes phlebitis converted to acyclovir
early) triphosphate by other
If severe disseminated zoster (>1 cellular enzymes. Acyclovir
dermatome, neuralgia) consider IV triphosphate inhibits DNA
acyclovir 10 mg/kg IV q8h synthesis and viral
replication by competing
Molleret’s meningitis (HSV2)-no with deoxyguanosine
definitive evidence for tx benefit triphosphate for viral DNA
polymerase and being
incorporated into viral DNA
Foscarnet Acyclovir resistant Acyclovir resistant HSV encephalitis Nephrotoxicity IV only
(Foscavir®) HSV and HHV6 Encephalitis – 60 mg/kg IV
HHV6 q8h Electrolyte Ensure adequate hydration
abnormalities (K+,
Resistant HSV lesions – 60 mg/kg IV Mg+2, Ca+2 are Dose adjust for renal
q12h wasted) dysfunction

Bone marrow MOA: Pyrophosphate

suppression analogue which acts as a
noncompetitive inhibitor of
Depression many viral RNA and DNA
polymerases as well as
HIV reverse transcriptase.
Similar to ganciclovir,
foscarnet is a virostatic
agent. It does not require
activation by thymidine
kinase.
Famciclovir HSV 250 mg PO TID for genital herpes, 1st Similar to acyclovir BA~77%, PO only
(Famvir®) VZV episode
Metabolized to penciclovir
500 mg PO q8h for VZV

21
 Agents Spectrum of Normal Dose Adverse Comments
Activity Effects
Cidofovir Resistant HSV Optimal dosing regimen is unclear Nephrotoxicity Probenecid and hydration
(Vistide®) CMV Dose-dependent are added to decrease
BKV Potential options: proximal tubule nephrotoxicity
JCV 1 mg/kg/dose IV 3 times/week injury (Fanconi like
Adenovirus 3 mg/kg/dose IV twice weekly syndrome) – Dose adjust for renal
5 mg/kg/dose IV once weekly probenecid may dysfunction
offer some
protection MOA: Converted to
Ensure adequate hydration cidofovir diphosphate
Nausea which is the active
Consider adding: intracellular metabolite;
Oral probenecid 1.25 g/m2/dose is Alopecia cidofovir diphosphate
administered 3 hours prior to and 1 suppresses CMV
hour and 8 hours after completion Bone marrow replication by selective
of each 1-hour cidofovir infusion. suppression inhibition of viral DNA
synthesis. Incorporation of
cidofovir into growing viral
DNA chain results in
reductions in the rate of
viral DNA synthesis
Ganciclovir CMV Ganciclovir (IV only) Bone marrow Dose adjust for renal
(Cytovene®) Very limited activity Induction 5 mg/kg IV q12h suppression dysfunction
Valganciclovir against EBV Maintenance 5 mg/kg IV q24h
(Valcyte®) Fever MOA: Phosphorylated to a
Valganciclovir (PO only) substrate which
Induction 900 mg PO q12h Rash competitively inhibits the
Maintenance 900 mg PO q24h binding of deoxyguanosine
GI upset triphosphate to DNA
polymerase resulting in
inhibition of viral DNA
synthesis
Ribavirin Respiratory Aerosolized – Administer 20 mg/mL at Anemia Indicated for RSV in
(Virazole®) Syncytial Virus a rate of 12.5 L/minute for 12-18 aerosolized form
hours/day for at least 3 but no more Fatigue
May consider using than 7 days Healthcare workers are
for influenzae A and Insomnia often exposed and
B and adenovirus Oral dose for HCV is 400 – 600 mg PO experience side effects
BID but dosing is variable and based Many more side from inhaling vapors (HA,
Human on pt characteristics effects with oral fatigue)
metapneumovirus administration
Pregnancy cat X
Capsules used in
combo with peg MOA: Inhibits replication of
interferon for HCV RNA and DNA viruses;
inhibits influenza virus
RNA polymerase activity
and inhibits the initiation
and elongation of RNA
fragments resulting in
inhibition of viral protein
synthesis

22
 Genital Herpes (CDC 2002 Treatment Guidelines)
Infection
First Clinical Episode of Genital Herpes
Episodic Therapy for Recurrent Genital
Herpes
Suppressive Therapy for Recurrent
Genital Herpes
Recommended Regimens for Episodic
Infection in Persons Infected with HIV
Recommended Regimens for Daily
Suppressive Therapy in Persons
Infected with HIV
Recommended Regimens
Acyclovir 400 mg orally three times a day for 7-10 days,
OR
Acyclovir 200 mg orally five times a day for 7-10 days,
OR
Famciclovir 250 mg orally three times a day for 7-10 days,
OR
Valacyclovir 1 g orally twice a day for 7-10 days.
Acyclovir 400 mg orally three times a day for 5 days,
OR
Acyclovir 200 mg orally five times a day for 5 days,
OR
Acyclovir 800 mg orally twice a day for 5 days,
OR
Famciclovir 125 mg orally twice a day for 5 days,
OR
Valacyclovir 500 mg orally twice a day for 3-5 days,
OR
Valacyclovir 1.0 g orally once a day for 5 days.
Acyclovir 400 mg orally twice a day,
OR
Famciclovir 250 mg orally twice a day,
OR
Valacyclovir 500 mg orally once a day,
OR
Valacyclovir 1.0 gram orally once a day.
Acyclovir 400 mg orally three times a day for 5-10 days,
OR
Acyclovir 200 mg five times a day for 5-10 days,
OR
Famciclovir 500 mg orally twice a day for 5-10 days,
OR
Valacyclovir 1.0 g orally twice a day for 5-10 days.
Acyclovir 400--800 mg orally twice to three times a day,
OR
Famciclovir 500 mg orally twice a day,
OR
Valacyclovir 500 mg orally twice a day.
23