Disease
Streptococcus Pneumo Gram + diplococci
Meningitis
Lower Respiratory Tract Infections
Bronchitis
Community Acquired Pneumonia
Tuberculosis
Infective Endocarditis
Intra-abdominal Infections
Streptococci
Primary Peritonitis (SBP) & Cholecystitis Enteric gram-neg's:
(gallbladder inflamm.)
Secondary Peritonitis & Cholangitis
(infection of common bile duct)
Diabetic Foot Infection
STI's
Syphilis (primary, secondary, or early
latent [<1 yr duration])
Syphilis (Late latent [>1 yr duration],
tertiary, or latent syphilis of unknown
duration)
Gonorrhea
Chlamydia
Trichomoniasis (yellow-green discharge)
Bacterial Vaginosis (fishy odor & basic pH
> 4.5
Ricketssial Disease & Related Infections
Rocky Mountain Spotted Fever
Typhus
Lyme Disease
Ehrlichiosis
Tularemia
Skin & Skin Structure Infections
Impetigo (blister-like rash, honey-colored
crusts)
Folliculitis (hair follicle infection)
Furuncle (boil; hair follicle infection into
surrounding tissue)
Carbuncle (group of infected furuncles)
Cellulitis (mild non-purulent infection)
Abscess (mild-mod. purulent infection)
Severe purulent SSTI - needs IV abx
Necrotizing fasciitis
Diarrhea
Traveler's Diarrhea
C.diff-associated diarrhea
Bug Classification First-line Treatment Duration of Treatment If Beta-Lactam Allergic / Alternatives
1) Dexamethasone given prior to or with 1st dose x10-14 days Moxifloxacin or Levofloxacin + Vanco
Haemophilus influenzae Gram - rod 2) Ceftriaxone 2 g IV q12 hrs OR Cefotaxime 2 g IV q4-6 hrs PLUS Vanco x 7 days ± Bactrim (for Listeria coverage)
Neisseria meningitidis Gram - cocci x 7 days
Listeria monocytogenes Gram + rod If pt is < 1 month old, > 50 y.o., or immunocompromised, add AMPICILLIN for Listeria coverage x 21 days
Abx are only indicated for bacterial exacerbations of chronic bronchitis: Azithromycin OR
RSV, adenovirus, rhinovirus, N/A 1) Augmentin x 5-10 days Doxycycline
coronavirus, influenza, parainfluenza 2) Azithromycin
3) Doxycycline
Healthy outpatients w/out abx use within 90 days (NO RISK FOR DRSP) & no comorbidities: Resp. FQ monotherapy
MONOTHERAPY with: Moxifloxacin
1) Macrolide abx Levofloxacin
Streptococcus Pneumo Gram + diplococci 2) Doxycycline Gemifloxacin
Haemophilus influenzae Gram - rod Unhealthy outpatients w/ abx use within 90 days (↑ RISK FOR DRSP) and/or comorbidities: x 5-7 days
Chlamydia pneumoniae Atypical 1) Beta-lactam (pref: cefpodixime cefdinir) + either a macrolide abx OR doxycycline
Mycoplasma pneumoniae Atypical 2) Resp. FQ MONOTHERAPY (Moxifloxacin, Levofloxacin, Gemifloxacin)
Hospitalized inpatients:
1) Beta-lactam (pref: ceftriaxone, cefotaxime) + azithromycin
2) Reserve for beta-lactam allergic: Resp. FQ MONOTHERAPY (Avelox, Levaquin, Factive)
MYCOBACTERIUM TUBERCULOSIS
(highly contagious) Atypical acid-fast bacili
MSSA Gram + clusters Nafcillin OR Cefazolin x 4-6 weeks PLUS gentamicin (IF PROSTHETIC VALVE) x 2 weeks Vancomycin If bacteria produce a biofilm (slime layer),
When gentamicin used
MRSA Gram + clusters Vancomycin x 4-6 weeks PLUS gentamicin (IF PROSTHETIC VALVE) x 2 weeks for synergy: which is easy to do so on prosthetic valves, use:
Streptococcus viridans Gram + pairs/chains PCN, Ampcillin, OR Ceftriaxone x 4-6 wks ± gentamicin for synergy x 2 weeks Target Pk: 3-4 Vancomycin RIFAMPIN in Staph. prosthetic valve endocarditis -->
Enterococcus Gram + pairs/chains PCN or Ampicillin x 4-6 weeks PLUS gentamicin for synergy x 4-6 weeks Target Tr: < 1 Vancomycin penetrates biofilm
Gram + pairs/chains DoC: Ceftriaxone (Rocephin)
Primary/Secondary SBP Px: Bactrim, cipro, ofloxacin x 5-7 days Alt: Ampicillin, gentamicin, FQ's
Proteus mirabilus Gram - rods
E. coli Gram - rods
Klebsiella Gram - rods
Single Agent (MonoTx
Streptococci Gram + pairs/chains
that covers
Infection Severity: anaerobes): Two Agents:
Enteric gram-neg's: Gram - rods Cefoxitin Cefazolin, Cefuroxime,
Bacteroides fragilis Gram - anaerobe Mild-Mod. Ertapenem Ceftriaxone, PLUS Flagyl (covers anaerobes) x 4-7 days
maybe Enterococcus Gram + pairs/chains Moxifloxacin Cipro, Levo None
CAPES (severe ICU cases): Carbapenem Cefepime, Ceftazidime x 7-14 days
Citrobacter Gram - Severe (in ICU) (except Ertapenem) Cipro, Levo PLUS Flagyl (covers anaerobes) If intra-abdom. abscess
Acinetobacter Gram - Zosyn Aztreonam, AMG present: ≥ 14 days
Pseudomonas Gram -
Enterobacter Gram -
Serratia Gram -
Staphylococcus Gram + clusters MonoTx options: Combo Tx: VANCOMYCIN PLUS x 7-14 days
Streptococcus Gram + pairs/chains Unasyn Ceftaizidime (FORTAZ, TAZICEF)
MRSA Gram + clusters Zosyn Cefepime (MAXIPIME) Deep Tissue Infection:
Pseudomonas aeruginosa Gram - rods Primaxin Zosyn x 2-4 weeks None
Peptostreptococcus clostridium Gram + anaerobe Merrem Azactam
Bacteroides fragilis Gram - anaerobe Invanz Any carbapenem Osteomyelitis:
Polymicrobial Tigecycline (TYGACIL) Consider adding Flagyl if ceftazidime, cefepime, or azactam x4-6 weeks
Moxifloxacin (AVELOX) were chosen for anaerobic coverage
1) Doxy 100 mg PO BID x 14 days OR 2)
PCN G benzathine 2.4 million units IM x 1 dose (NEVER ADM. BICILLIN L-A IV --> SEIZURES/DEATH) Tetracycline 500 mg PO QID x 14 days
Treponema pallidum Gram - spirochete
1) Doxy 100 mg PO BID x 28 days OR 2)
PCN G benzathine 7.2 million units total adm. as 3 2.4 million units IM q. week for three doses x 3 weeks Tetracycline 500 mg PO QID x 28 days
Beta-Lactam allergy: Zithromax 2 g PO x1 dose
PLUS EITHER gemiflox. 320 mg PO x1 dose OR
Neisseria gonorrhoeae Gram - diplococci x 1 dose Gentamicin 240 mg IM x1 dose w/ a test for cure
Ceftriaxone 250 mg IM x1 dose PLUS EITHER (also covers Chlamydia co-infection) in 1 week
Alt: Cefixime 400 mg PO x1 dose +
Azithromycin 1 g PO x1 dose OR Doxy 100 mg PO BID x7 days Zithromax/Doxy with a test for cure in 1 week
Chlamydia trachomatis Gram - Azithromycin 1 g PO x1 dose OR Doxy 100 mg PO BID x7 days x1 dose Erythromycin, Levofloxacin, Ofloxacin
Flagyl 2 g PO x1 dose OR Tinidazole 2 g PO x1 dose Alt: Flagyl 500 mg PO BID x 7 days
Trichomonas vaginalis Protozoan x1 dose
Cleocin intravaginal 2% cream, Cleocin ovules
Idk dunno Flagyl 500 mg PO BID x7 days OR Flagyl 0.75% gel 5g intravaginally QD x 5 days (weakens condoms), Tindazole 1 g or 2 g
Rickettsia rickettsii Gram - coccobacillus Doxycycline 100 mg PO/IV BID x 5-7 days None
Rickettsia typhi Gram - Doxycycline 100 mg PO/IV BID x 7 days None
Amoxil 500 mg PO TID x 14-21 days OR
Borrelia burgdorferi Gram - spirochete Doxycycline 100 mg PO BID x 10-21 days Cefuroxime 500 mg PO BID x 14-21 days
Ehrlichia chaffeensis Gram - Doxycycline 100 mg PO/IV BID x 7-14 days None
Francisella tularensis Gram - aerobic coccobacilli Gentamicin IV 5 mg/kg/day TDD DIVIDED q8 hrs OR Tobramycin IV 5 mg/kg/day TDD DIVIDED q8 hrs x 7-14 days None
Impetigo: Topical Mupirocin (BACTROBAN) OR retapamulin (ALTABAX) OR
Streptococcus Gram + pairs/chains No duration given
MSSA Gram + clusters if numerous lesions: Cephalexin (KEFLEX)
Folliculitis, Furuncles, & Carbuncles:
Staphylococcus aureus, incl. MRSA Gram + clusters 1) Cephalexin (for MSSA) OR No duration given
2) Bactrim (for CA-MRSA) OR
3) Doxycycline (for CA-MRSA)
None
Streptococcus pyogenes Gram + pairs/chains Mild Cellulitis: PO abx must cover both Strep. & MSSA:
x 5 days
Staphylococcus aureus Gram + clusters Cephalexin, Clindamycin, PCN VK, Dicloxacillin
CA-MRSA Gram + clusters Single abscess, no systemic sx: I&D No duration given
Systemic sx present, or multiple sites: Bactrim, Doxy, Minocycline, or Clindamycin
none given N/A Use IV abx that cover MRSA: Vanco, Dapto, Linezolid/Tedizolid, Ceftaroline, x 7-14 days
Telavancin/Dalbavancin/Oritavancin. Transition pt to PO abx once stable.
Streptococcus pyogenes Gram + pairs/chains Refer to SICU. No duration given
Clostridium spp. Gram + anaerobe Empiric Tx: Vancomycin + beta-lactam (Zosyn, Primaxin, Merrem)
Bacterial causes: Pref. treatment if fever, bloody stools, dysentery, or pt is PREGNANT or PEDIATRIC (NO FQ's!!)
E. coli Gram - rods 1) Azithromycin 1 g PO x1 dose OR
Campylobacter jejuni Gram - spirochete 2) Azithromycin 500 mg PO QD x1-3 days
Shigella Gram - rods
Salmonella Gram - rods Otherwise, if pt doesn't have any of the above characteristics, choose one of the following:
Viral causes: 1) Ciprofloxacin 750 mg PO x1 dose OR Cipro 500 mg PO BID x 3 days OR
Norovirus N/A 2) Levo 500 mg PO x1 dose OR Levo 500 mg QD x1-3 days OR
Rotavirus N/A 3) Ofloxacin 400 mg PO x1 dose OR 400 mg BID x3 days OR See previous column None
Protozoal causes: 4) Rifaximin 200 mg PO TID x3 days
Found on surfaces/food/water
Giardia contaminated with feces from
infected humans/animals Protozoal Infections (ex. Giardia or Cryptosporidium):
Entamoeba histolytica Anaerobic parasitic amoeba 1) Flagyl OR AVOID ANTIMOTILITY AGENTS IN
Cryptosporidium Apicomplexan parasitic alveolates 2) Tinidazole OR BLOODY DIARRHEA OR FEBRILE PTS.
Cyclospora Apicomplexan parasitic alveolates 3) Nitazoxnid
D/C ALL ABX. D/c all meds that could cause diarrhea. FLAGYL IS NO LONGER REC.
DO NOT USE ANTI-MOTILITY AGENTS: AS 1ST-LINE TMT FOR C. DIFF
(Loperamide [IMODIUM], atropine/diphenoxylate [LOMOTIL], or opioids)
Infection Severity: 1st inf(x): 2nd inf(x)/1st recurrence: 3rd inf(x)/2nd recurrence:
Mild-Mod. If vancomycin was used to
treat 1st inf(x) -->
Vancomycin 125 mg VANCO TAPER/PULSE
PO QID OR Vanco Taper/Pulse Tx:
Clostridium difficile Gram + obligate anaerobe OR Fidaxomycin 200 mg 125 mg PO QID x 10-14 days, See previous column None
Severe: Fidaxomycin 200 mg PO BID x 10 days then BID x 1 week,
WBC ≥ 15,000 or PO BID x 10 days then QD x 1 week,
SCr ≥ 1.5x baseline If Flagyl was used to then q2-3 days x 2-8 weeks
Severe & Complicated: Vanco 500 mg PO QID treat 1st inf(x) -->
HypoTN, shock, ileus, PLUS Flagyl IV 500 mg Vancomycin 125 mg
or toxic megacolon q8 hrs PO QID x 10 days
Options for recurring C.diff inf(x) or pts at high risk for recurrence (immunosupp. or receiving chemoTx):
1) Fidaxomicin (DIFICID)
2) Fecal stool transplant
3) Bezlotoxumab (ZINPLAVA) - binds to C.diff toxin B. Adm. as 1x IV infusion.