11/1/23, 4:31 AM Antibiotic treatment of infection due to Vibrio vulnificus - UpToDate

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Antibiotic treatment of infection due to Vibrio vulnificus

Adults Children

Patients with either:

Severe infection: Primary sepsis or serious wound infection
Mild wound infection, in the presence of risk factors for severe disease *

A third- or fourth-generation cephalosporin (one of the following):

Ceftriaxone 1 to 2 g IV every 24 hours 50 to 75 mg/kg IV every 24 hours

(maximum 2 g/day)

Cefotaxime 2 g IV every 6 to 8 hours 50 mg/kg IV every 6 to 8 hours (maximum

8 g/day)

Ceftazidime 1 to 2 g IV every 8 hours 50 mg/kg IV every 8 hours (maximum 6

g/day)

Cefepime 2 g IV every 12 hours 50 mg/kg IV every 12 hours (maximum 4

g/day)

plus either

A tetracycline (preferred; one of the following) ¶

Doxycycline 100 mg IV or orally every 12 2.2 mg/kg IV or orally every 12 hours

hours (maximum 100 mg/dose)

Minocycline 100 mg IV or orally every 12 2 mg/kg IV or orally every 12 hours

hours (maximum 100 mg/dose)

or

A fluroquinolone (alternative agent; one of the following) Δ◊

Ciprofloxacin 400 mg IV twice daily or 500 IV: 10 mg/kg every 12 hours (maximum
to 750 mg orally every 12 400 mg per/dose)
hours
Oral: 10 to 20 mg/kg every 12 hours
(maximum 750 mg/dose)

Levofloxacin 750 mg IV or orally once daily 6 months to 5 years: 8 to 10 mg/kg IV or

orally every 12 hours (maximum 750
mg/day)

≥5 years: 10 mg/kg IV or orally once daily

(maximum 750 mg/day)

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11/1/23, 4:31 AM Antibiotic treatment of infection due to Vibrio vulnificus - UpToDate

Patients with mild wound infection, in the absence of risk factors for severe disease *

A tetracycline (preferred; one of the following) ¶

Doxycycline 100 mg orally twice daily 2.2 mg/kg orally every 12 hours (maximum
100 mg/dose)

Minocycline 100 mg orally twice daily 2 mg/kg orally every 12 hours (maximum
100 mg/dose)

or

A fluroquinolone (alternative agent; one of the following) Δ◊

Ciprofloxacin 500 mg orally twice daily 10 mg/kg orally every 12 hours (maximum
500 mg/dose)

Levofloxacin 750 mg orally once daily 6 months to 5 years: 8 to 10 mg/kg orally

every 12 hours (maximum 750 mg/day)

≥5 years: 10 mg/kg orally once daily

(maximum 750 mg/day)

This table is for use in conjunction with UpToDate content on treatment of infection due to Vibrio
vulnificus. The doses listed are intended for patients with normal kidney function; the doses of
some of these agents must be adjusted in patients with reduced kidney function. Refer to the
Lexicomp drug-specific monographs within UpToDate for dose adjustments.

IV: intravenously.

* Risk factors for severe disease include alcoholic cirrhosis, underlying liver disease including
chronic hepatitis due to alcohol or other causes, moderate to heavy alcohol use (in the absence
of documented liver disease), hereditary hemochromatosis, and chronic diseases (such as
diabetes, thalassemia, renal failure, and immunocompromising conditions).

¶ Doxycycline can be administered for short durations (≤21 days) without regard to patient
age [1] .

Δ For patients who are not able to tolerate tetracyclines, a fluoroquinolone may be used as an
alternative agent; we prefer ciprofloxacin, given limited clinical data for other fluoroquinolones.

◊ Fluoroquinolones should not be used routinely as first-line agents in children <18 years of age
except in specific conditions for which there are no alternative agents and the drug is known to
be effective [2] .

Includes data from: Lexicomp Online. Copyright © 1978-2023 Lexicomp, Inc. All Rights Reserved.

References:
1. American Academy of Pediatrics. Tetracyclines. In: Red Book: 2021-2024 Report of the Committee on Infectious
Diseases, 32nd ed, KimberlinDW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, 2021.
2. American Academy of Pediatrics. Fluoroquinolones. In: Red Book: 2021-2024 Report of the Committee on
Infectious Diseases, 32nd ed, KimberlinDW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of
Pediatrics, 2021.

Graphic 143005 Version 1.0

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