The Sanford Guide to Antimicrobial Therapy 2016

261 Pages·2016·9.84 MB·English

by  David N. Gilbert et al.

SANFORD GUIDE
,,
The Sanford Guide
To Antimicrobial Therapy
2016
th
46 Edition
David N. Gilbert, M.D.
Henry Chambers, M.D.
F.
George M. Eliopoulos, M.D.
Michael S. Saag, M.D.
Andrew!
Pavia, M.D.
Douglas Black, Pharm.D.
David 0. Freedman, M.D.
Kami Kim, M.D.
Brian S. Schwartz, M.D.
Editorial Note
Toourreaders,
We havemadesignificantimprovements inthis46thedition ofTheSanford GuidetoAntimicrobial
Therapy. First, wethankyou foryourcomments,questionsand reviewsofourcontent.Youarean
integral partofthecollaborative processthat results ineach updated edition ofTheSanford Guide.
Westrivetoprovideyouwiththecurrent rangeofevidence-based optionsfortreatment,
managementand prevention ofinfectiousdiseases.TheSanford Guide reachesa global audience,
which meansyou shouldconsiderour recommendations in lightoflocal resistanceand
susceptibility patterns,availabilityofandvariations informulation ofantimicrobial agents and
otherlocal conditionsthatguidecareforyourpatients.
New materialand areasofsignificantchange inthis46thedition include:
• Table 1:majorupdates includegenitaltractinfections basedon newCDCSTDGuidelines,
kidney& bladderinfections,enterococcal endocarditis (alsoTable5A),empirictherapyfor
pneumonia,aswell asupdated regimensand references.
• Tables4A,4Band4C:Activityspectra(antibacterial,antifungalandantiviral).Thesetables
have been completelyreworked, updatedandare nowcolor-coded.Thecolorcoding
andassociated symbols are intendedtoprovide moredescriptivecategorization ofthe
tabledata.
• Table7:DrugDesensitization. Desensitization methodsforadditional drugsareadded.
• Table8:PregnancyRiskandofAntimicrobialDuringLactation.This newtableaddsdata
on safetyofantimicrobials in lactating mothers.
• Table 10A(andelsewhere):Newantibacterials added:ceftazidime-avibactam and
ceftoozane-tazobactam.
I
• Table 11:Newantifungal drug: Isavuconazoleadded.
• Table 14(HCV): Newdirect-acting agentsand combination agentsand updated HCV
treatmentregimens
• Table 16:PediatricDosing. Reinstated in thisedition isa newtable summarizing dosing
ofantimicrobialsin childrenage28daysandolder.
• Table 17A:DosinginRenalImpairment. Thistable hasalso beenthoroughly reworked
and reviewed forimproved clarity in ourrecommendations.
As always,allcontenthas been updated with new referencesfrom the published literature,
including new practiceandtreatmentguidelines,updated prescribing information and drug
safetyinformation.
Some recommendations suggesttheuseofagentsforindicationsorindoses otherthan found
in product labeling.Such recommendationsarebased on published reports in peer-reviewed
literature;theyarenot based on inputfrom anypharmaceutical manufacturer.Theyare made
withdueconsideration oftheconcernsofthe U.S. Food and Drug Administration (FDA)
regarding''off-label"uses.We provide reference(s)forand, insomecases,annotatesuch
recommendationswith the notation "NAI"meaning notan FDA-approved indication ordose.
The Editors
January2016
SANFORD GUIDE®
The Sanford Guide
To Antimicrobial Therapy
2016
46th Edition

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The Sanford Guide to Antimicrobial Therapy 2016
46th
Edition
Editors
David N. Gilbert, M.D. Henry F. Chambers, M.D.
Chiefof Infectious Diseases Professor of Medicine
Providence Portland Medical Center, Oregon Director, Clinical Research Services
Professor of Medicine, Oregon Health UCSFClinicaland Translational Sciences Institute
Sciences University University of California at San Francisco
George M. Eliopoulos, M.D. Michael S. Saag, M.D.
Chief, James L. Tullis Firm, Director, UAB CenterforAIDS Research,
Beth Israel Deaconess Hospital, Professor of Medicine and Director,
Professor of Medicine, Division of Infectious Diseases,
Harvard Medical School, University ofAlabama, Birmingham
Boston, Massachusetts
Andrew T. Pavia, M.D.
George & Esther Gross- Presidential Professor
Chief, Division of Pediat-ric Infectious Diseases
University of Utah, Salt Lake City
Contributing Editors
Douglas Black, Pharm. D. Brian S. Schwartz, M.D. David O. Freedman, M.D.
Associate Professor Associate Professor Director, Travelers Health Clinic,
of Pharmacy, of Medicine Professor of Medicine,
University ofWashington, University ofCalifornia University ofAlabama,
Seattle at San Francisco Birmingham
Kami Kim, M.D.
Professor of Medicine, Microbiology & Immunology, Pathology
Albert Einstein College of Medicine
NewYork, NY
Managing Editor
Jeb C. Sanford
Memoriam
Jay R Sanford, M.D.
1928-1996
Merle A. Sande, M.D.
1935 2007
Robert C. Moellering, Jr., M.D.
1936 2014
Publisher
Antimicrobial Therapy, Inc.
TheSanfordGuidesareupdatedannuallyand published by:
ANTIMICROBIALTHERAPY,INC.
RO. Box276, 11771 Lee Highway
Sperryville, VA 22740-0276 USA
Tel [phone] Fax [phone]
Email: [email protected] www.sanfordguide.com
Copyright © 1969-2016 byAntimicrobial Therapy, Inc.
All rights reserved. No partofthis publication may be may be reproduced, stored in a retrieval
system ortransmitted in anyform or by any means-digital, electronic, mechanical, optical,
photocopying, recording or otherwise-without priorwritten permission from
Antimicrobial Therapy, Inc., 11771 Lee Hwy, P.O. Box276, Sperryville, VA22740-0276 USA
“SanfordGuide” and “HotDisease” logoare® registeredtrademarksofAntimicrobialTherapy, Inc.
Acknowledgements
Thanks to UshuaiaSolutions. SA. Argentina: Alcorn Printing, Harleysville, PAand Fox Bindery,
Quakertown. PAfor design and production ofthis edition ofthe Sanford Guide.
Noteto Readers
Since 1969, the Sanford Guide has been independently prepared and published. Decisions regarding
the content ofthe Sanford Guide are solelythose ofthe editors and the publisher. Wewelcome
questions, comments and feedbackconcerning the Sanford Guide. All ofyour feedback is reviewed
and taken into account in updating the content ofthe Sanford Guide.
Everyeffort is madeto ensure accuracyofthe contentofthisguide. However, currentfull prescribing
information available inthe package insertforeach drug should be consulted before prescribing any
product. Theeditors and publisherare not responsibleforerrors oromissions orforanyconsequences
from application ofthe information in this bookand make nowarranty, express or implied, with respect
tothecurrency, accuracy, orcompletenessofthecontents ofthis publication. Application ofthis
information in a particularsituation remainsthe professional responsibilityofthe practitioner.
Forthemostcurrentinformation,subscribetowebedition.sanfordguide.com
orSanfordGuidemobiledeviceapplications
Printedinthe United StatesofAmerica
ISBN 978-1-930808-93-5
LibraryEdition (English)
QUICK PAGE GUIDETO THE SANFORD GUIDE
RECOMMENDEDTREATMENT—DIFFERENT SITES/MICROBES:
BYORGAN SYSTEM: 4-68
CAPD Peritonitis 231
BYORGANISM:
Bacteria 69-71
HighlyResistant Bacteria 81
CA-MRSA 82
Fungi 121-133
Mycobacteria 137-147
Parasites 151-161
Non-HIVViruses 166-176
HIV/AIDS 181 - 191
Influenza 173
DURATION OFTREATMENT: 72
ANTIMICROBIAL PROPHYLAXIS:
Pregnancy/Delivery 199
Post-Splenectomy 199
Sexual Exposure 200
SickleCell Disease 200
Surgical 200
Endocarditis 204
ExposuretoHIV/HBV/HCV 205
Transplants: Opportunistic Infections 209
IMMUNIZATIONS:
Anti-tetanus 232
Rabies Post Exposure 233
ANTIMICROBIALS:
Spectra Adverse Dosage/SE
Effects
Antibiotics 73-80 115-116 102
AG-Once DailyDosing 118
Continuous/Prolonged Infusion 119
Desensitization (Pen,TMP-SMX, ceftriaxone) 83
InhalationAntibiotics 120
Pregnancy RiskCategories 85
Antifungals 79 134-136
Antimycobacterials 148-150
Antiparasitics 162-165
Antivirals (Non-HIV) 177-180
192-195
Antiretrovirals
Pediatric Dosinq 211
DOSEADJUSTMENTS:
Renal 214-228
Hepatic 230
Obesity 229
DRUG INFORMATION:
Pharmacologic Features 88
Pharmacodynamics 99
Drug-Drug Interactions 235 - 242 (243ARVDrugs)
Generic/Trade Names 244
MISCELLANEOUS:
Abbreviations 2
ParasitesCausing Eosinophilia 165
ParasiticDrugs: Sources 165
Directoryof Resources 234
91
—TABLEOF CONTENTS—
ABBREVIATIONS 2
TABLE 1 ClinicalApproachtoInitial ChoiceofAntimicrobialTherapy 4
TABLE2 RecommendedAntimicrobialAgentsAgainstSelected Bacteria 69
TABLE3 Suggested DurationofAntibioticTherapyinImmunocompetentPatients 72
TABLE4A Antibacterial ActivitySpectra 73
4B AntifungalActivitySpectra 79
4C AntiviralActivitySpectra 79
TABLE5A TreatmentOptions ForSystemicInfectionDueToMulti-Drug ResistantGram-Positive
Bacteria 81
5B TreatmentOptionsforSystemicInfectionDuetoSelected Multi-Drug Resistant
Gram-Negative Bacilli 81
TABLE6 Suggested ManagementofSuspectedorCulture-PositiveCommunity-Associated
Methicillin-Resistant S. aureusInfections 82
TABLE7 Antibiotic Hypersensitivity Reactions& Drug Desensitizationmethods 83
TABLE8 PregnancyRiskandSafetyinLactation 85
TABLE9A Selected Pharmacologic FeaturesofAntimicrobialAgents 88
9B PharmacodynamicsofAntibacterials 99
9C Enzyme-and Transporter-Mediated InteractionsofAntimicrobials 99
TABLE 10A Antibiotic Dosageand Side-Effects 102
10B SelectedAntibacterialAgents—Adverse Reactions—Overview 115
10C AntimicrobialAgentsAssociatedwith Photosensitivity 117
10D AminoglycosideOnce-Dailyand MultipleDaily Dosing Regimens 118
10E Prolonged orContinuous Infusion Dosing ofSelected Beta Lactams 11
10F InhalationAntibiotics 120
TABLE 11A Treatmentof Fungal Infections—AntimicrobialAgentsofChoice 121
11B Antifungal Drugs: Dosage,Adverse Effects, Comments 134
TABLE 12A Treatmento' Mycobacterial Infections 137
12B DosageandAdverseEffectsofAntimycobacterial Drugs 148
TABLE 13A Treatmento'Parasitic Infections 151
13B DosageandSelectedAdverseEffectsofAntiparasiticDrugs 162
13C ParasitesthatCause Eosinophilia (Eosinophilia InTravelers) 165
13D Sourcesfor Hard-to-Find AntiparasiticDrugs 165
TABLE 14A AntiviralTherapy 166
14B Antiviral Drugs (Non-HIV) 177
14C AntiretroviralTherapy (ART) inTreatment-NaiveAdults (HIV/AIDS) 181
14D Antiretroviral DrugsandAdverseEffects 192
14E HepatitisA& HBVTreatment 196
14F HCVTreatmentRegimensand Response a 197
TABLE15A Antimicrobial ProphylaxisforSelected Bacterial Infections 199
15B Antibiotic Prophylaxisto PreventSurgical Infectionsin Adults 200
15C Antimicrobial ProphylaxisforthePreventionofBacterial Endocarditisin Patientswith
UnderlyingCardiacConditions 204
15D ManagementofExposureto HIV-1 and Hepatitis Band C 205
15E PreventionofSelectedOpportunisticInfectionsin Human Hematopoietic Cell
Transplantation (HCT)orSolidOrganTransplantation (SOT) inAdultsWith Normal
Renal Function 209
TABLE 16 Pediatric dosing (AGE > 28DAYS) 21
TABLE 17A DosagesofAntimicrobialDrugsinAdultPatientswithRenal Impairment 214
17B No DosageAdjustmentwith Renal InsufficiencybyCategory 229
17C Antimicrobial Dosing in Obesity 229
TABLE 18 Antimicrobialsand Hepatic Disease: DosageAdjustment 230
TABLE 19 TreatmentofCAPD PeritonitisinAdults 231
TABLE20A Anti-TetanusProphylaxis,WoundClassification, Immunization 232
20B Rabies Postexposure Prophylaxis 233
TABLE21 Selected DirectoryofResources 234
TABLE22A Anti-Infective Drug-Drug Interactions 235
22B Drug-Drug InteractionsBetween Non-Nucleoside ReverseTranscriptase Inhibitors
(NNRTIS) and Protease Inhibitors 243
TABLE23 ListofGenericandCommonTradeNames 244
INDEXOF MAJOR ENTITIES 246
ABBREVIATIONS
3TC = lamivudine CSF = cerebrospinalfluid IM= intramuscular
AB,% = percentabsorbed CXR = chestx-ray IMP = imipenem-cilastatin
AAAABDBBLCC=CD=a=f=atebaarammcdppaihavholiotyrseiBrsilciipnidBcocmolplloeidxaldispersion ddDDca4BpTP=tC=odTis=st=cadovanduptodiutinbonulmeeey-cbilnindplacebo-controlledtrial IIIIPTnNvH====iinnittinrrsvaaoetpnsheiteriacigzatailotdnieoanlal
AADGF==amaidenfoogvliyrcoside ddddlC==dziadlacniotsabiinnee IItVra==inittrraavceonnoauzsole
AIDS = AcquiredImmuneDeficiencySyndrome DIC = disseminatedintravascularcoagulation IVDU = intravenousdruguser
AM-CL = amoxicillin-clavulanate div = divided IVIG = intravenousimmuneglobulin
AAMM-KCL=-EamRik=acaimnoxicillin-clavulanateextendedrelease DDOLRVI==dedloarviirpdeinneem Kkget=o =kilkoegtroacmonazole
AAAmmMpoPhx=o=aBmapm=iocxiialcmlipilhnlointericinB DDDoROxTy===deddlioraexycyetcdlyycrolebilnseeaesrevedtherapy LLLACCBRM===llliiygpmaopssheoomccahylatiiancmrpcehhaocortiiBoomneningitisvirus
AAAAARPRMP-FDA=SSG=Ba==ta=ocaavucanatumteqptiuierpochsnireeeeluuslmppdiairnotro-miagsotcuuonalrfanbyeliavldceaitrmsatimrneosgslsyyconsdirdoeme EEDDEFEBSRZSVS=P===d=eoeEfurpadbysvrttliuehergire-nsonr-tmzeBrysaecirnisrgnttavhenittrhuySsl.spuncecuinmaotneiae mMMLLPeeED/vgRRRo(====ormllmpoeuegpvlr)iotnfoial=-pvodiexrrmanu/icgeircminrrteoosngiarsvtaiarmnt
ASA= aspirin ELV= elvitegravir Metro= metronidazole
ATS=AmericanThoracicSociety EMB = ethambutol Mino = minocycline
AATUVC==aatraezaanuanvdierrthecurve EERNT==exetnteencdaevdirrelease mMoLxi==milmloilxiitefrloxacin
Azithro =azithromycin ERTA =ertapenem MQ = mefloquine
bid =2xperday Erythro =erythromycin MSM = menwhohavesexwithmen
BBBLSW/AB=L=Ibb=ooddbyeywtseaui-rglfhaatccteama/rbeeata-lactamaseinhibitor EEESSSBRRLD=s=e=reyentxdhtrsoetcnaydgteeedsrseenpdaeilmcetdnirtsuaemtai(soeWnacrattaemases MNMBTSSB=A=/nMaMmRyceSoAbbraa=cntdmeertihuicmiltluibne-rscenusliotsiivse/resistantS.aureus
C&S = culture&sensitivity Flu = fluconazole NF = nitrofurantoin
CCCCCeeAADffPRCtpaDBoz=d==o=Cxecccnoae=tnfrettbrciaasenzpfiufepdooirounmsdeDeomiaxssmiebmauesleaptrCoooxrneyttriploelritonealdialysis FFFFGlTOQu=CSc=-yg=tAefnlP-eeuVmortfrirl=ociuqccufiyiottnsaoobsaliimonnpneereenavir NNNNNARNSFITRARITI==ID=snn=onet=lunfcFoinlDnnoeaAn-vo--nissruaitcpdelpereroroioesdvviaeedlrdese(rietnvrdeairncsasetcirtoirnpatnoasrscderoiispntehai)bsietoirnhibitor
CCeFpBh==cceefpthoabilporsoploerin GGaAtiS-=gGartiofulpoxAaciSntrep NNVUPS==nneovtiarvaapiilnaebleintheU.S.
CChFlPor=oc=efcehpliomreamphenicol GGeCmi- g-ognoomrirfhleoaxacin OOflCoexp=ho1f,l2o,xa3ci=n oralcephalosporins
CClIaPri=thcriopr=oflcolxaarciitnh;roCmyIcPi-n;ERER==CIePxetxetnednedderdelreealseease Ggemnt grgaemntamicin PPCCeepphh31,A2P,3=,4pa=renptaerreanltecreaplhcaelpohsaploorsipnosrins
CCCllLiaOnvd==a c=cllaocvfluailznaidnmaaimtnyeecin GGHrNEiBMseOo grhgaremim-sonedeoifgaualltvyiisvniesbacilli PPECPR==ppoowslityt-hmeexarpnaotssieuprsceheaupidrnoopmrhoeynalcaatlxiioasnctivity
CCClQMotV===chccllyoottroroimqmeuagizanoleloepvihroussphate HHHILHVRV hhhuiumghma-anlneviehmlemrurpenesosidvseitfraiuncscieencyvirus PPIIoP==-TpoZrroa=ltedpaoisspeeirniangchiibliltionr-tazobactam
CCCCCCrr/oRSCCSbRDIIiT=n=====ccuccalroCcttebroua-iCnrtscIeticinirsn&itanonatusertcoemhuncassldlieitiraiszevrneeiaaadtnlyscfereorepBlSacAementtherapy HHHIIIAFD/SSNVOV-C==Ti-niijhnhneitdecsheirtternaopfambreevalyirsterooonsafpigomeipnetlt/eiaxcnvtsiirt-ueisnmflcealmlmtartaonrsypldarnutgs PPPPPytTZQRrsLAiC=DT===pp==paprytyipPirrmoeriaasnomztqtse-iuspttnierahncamaetnimisdivpenelearntanldyompmhiozperdolciofnetrraotlilveeddtirisaelsase
ABBREVIATIONS
(2)
qid = 4xperday SM = streptomycin
QQq[uSwxi]nk=hu-=q=duadielonvfisenoerey=wse[uxQel]fk-halDtoyeur=s,quei.ngu.p,rqis8thin=-daelvfeorpryi8sthirns SSSsuSTQbDVc=u==tstss=eeaaxqsduuayuilbnslactyvuaitttreraansneesomruiutsmteldevdeilsease TTTToNPSbVTFra====tttiuupbtmreooarbnrcrauvanlimeiryncrcsoiksniinstfeascttor
RRRRRRiTIFFS=cIFBPVk==r====esrrirrreiRsiiesfitffspacaaapikmnbpireptueratitnattnittosniorinryaeytrsaycntcyitnifaelctviiornus TSSTTTTueaxBEDlizcEFbc=oo====s==ytttstuemrtubnaapeloezntifrboscoocaobevumcpsialstlrocoaapstnmihaisanmgealechocardiography VVVVVUZoTIaLZDrISnVVi=Ac===o=v=iuvvr=zraavoiilrranvdiilanoacrcocvenyaoloucdnltdmoaariy-mzanczcoyetoilcsneiitnenifrnecvttieirroumnsediatelyresistantS.aureus
RTV = ritonavir Telithro =telithromycin
rx = treatment Tetra = tetracycline
SA = Staph,aureussc = subcutaneous tid = 3xperday
SD = serumdruglevelaftersingledose TMP-SMX=trimethoprim-sulfamethoxa/olu
Sens = sensitive(susceptible)
ABBREVIATIONSOFJOURNALTITLES
AAC:AntimicrobialAgents&Chemotherapy Curr Med ResOpin:CurrentMedicalResearchandOpinion JAIDS:JAIDSJournalofAcquiredImmuneDeficiencySyndromes
AAHdJv:PAImDe:rAidcvaannHceeasrtinJoPuedrinaatlricInfectiousDiseases DDeerrmmatTohlerC:liDne:rmDaetromlaotgoilcogTihcerClaipnyics JJAAMVAM:A:JouJronuarlnaolfotfhethAemVeertiecrainnarMyedMiecdailciAnsesoAcsisaotciioantion
AIDSRes HumRetrovir: AIDSResearch&Human Retroviruses Dig DisSci: DigestiveDiseasesand Sciences JCI:JournalofClinicalInvestigation
AJG:AmericanJournalofGastroenterology DMID: DiagnosticMicrobiologyandInfectiousDisease JCM:JournalofClinical Microbiology
AJM:AmericanJournalofMedicine EID: EmergingInfectiousDiseases JIC: JournalofInfectionandChemotherapy
AJRCCM:AmericanJournalofRespiratoryCriticalCareMedicine EJCMID: EuropeanJournalofClin.Micro.&InfectiousDiseases JID:JournalofInfectiousDiseases
AJTMH:AmericanJournalofTropicalMedicine&Hygiene EurJ Neurol: EuropeanJournalofNeurology JNS:JournalofNeurosurgery
AlimentPharmacolTher:AlimentaryPharmacology&Therapeutics Exp Mol Path: Experimental&MolecularPathology JTMH:JournalofTropical MedicineandHygiene
Am J Hlth Pharm:AmericanJournalofHealth-SystemPharmacy Exp RevAnti InfectTher:ExpertReviewofAnti-InfectiveTherapy Ln: Lancet
AmerJTranspl:AmericanJournalofTransplantation Gastro:Gastroenterology LnID:Lancet InfectiousDisease
AAAAAAAnrnnrnntISIDEniMuMevM:r:irP:rgmhAA:r:aTAncrhnnAhAemnanirraalnvc:lcsaehsosliAotnsvofotehffioIsevfEniIrtomrnSe:fateurlenDrrAraTegngnlharenelermManryaeMlcatdesypiodoycliMficoenigPdenyhieacrinmeacotherapy JHIIIIIJDnpCDfAAtCHCA:IMEP:D:Ne:HSodeIII.:npnn&taffAeIeetrmHncconfteRtlaieir:toocoi:ngtuoJisynoCoIaounDnlnrsfitnJesiraconeotluailMrsoonefuaeadssnlAidDcIioiniDfHsnSCoAeelsniaaptnsniiietdmcaaiCllcHlriuEPonrpmbiaiicacadstnleiomcAfRiegeNoetolrnrootlgvshiyrAomleogryica MMMMNNOFEeaeeMIJpyddWDMho:RLM:eD:yCOtilcNtpaio:MelenlowMn:rTPebrrEdFiMaonidoencgcidrs:talipuylaclMmna&:LadleIyNMtnJMotofeoyerepurtccChratlorlniilionaotoiullycsgooyWgPDfeyriMeosDekceidleaaieylscydeisRisinensepgoTsrrtansplantation
ARRD:AmericanReviewofRespiratoryDisease JAll ClinImmun:JournalofAllergyandClinical Immunology Ped Ann:PediatricAnnals
BMJ: BritishMedicalJournal JAmGerSoc:JournaloftheAmericanGeriatricsSociety Peds: Pediatrics
BMT:BoneMarrowTransplantation JChemother:JournalofChemotherapy Pharmacother: Pharmacotherapy
CCCCCBrCaaDCiTnntBMIaS:JJDdRI:DCD:reM:iCrteCuCimrodca:racnleJhanB:CrrtdaiaCitrCnaialeesninhnaMDiJJdecaooiadtuulairarncTnnbiaoaaMnlplseeiedoocffisocIfDainenlfSreyIJmcsnotaftuiteeorcomuntlasaiotloDgiuicyssDReieasvseieaesswes JJJJJJCCDHIMnllpeefiit:rdnn:JmVMJoMiouiTirurcrcornrelrano:aola:t:Jl:ooJJfouJoofrouIunurnHrafrnenelanapclalatolitfooofoofCnfllCMiolDneigeidnyrciiamcclaaaltVloiMlrMiooiclgcroirogcobyabilioolTlorogeygaytment QSSPSSIMcJGeDJaMOmJ:n:::dRSQSPeouueJusadrtirIpgathnetfeeIrrrrnyDilfnic:yGsMIy:SJnenoefSdumeeciriccacntnonaaiallldorouisoJgsnfoyaiDuMvniraeinsRndaaeedinlsacpsOJiibeonrsueaJtrtoenoutarrrlyniacoIlfsnfIencfteicotnisousDiseases
CCCCllIMiiDNnn::MMCiliCicclnirrincooiaclaIRnleIfnv:Mf:iCeclcCirtlnoiiiobncuiiascolalDlMoiiMgsciyercaoNrsbeoewibsosilloeoltgotygeyarnRdevIinefwecstion JJJVMPiIeirmdcam:rluonJHooeIulpmro:mngauJylno,uoorf&lnPaIIelnndffioe:afctJtVrioiiourcnarslnaHlepoaftiMtiicsrobiology, TTTSrruRaarSnngMssp:pNlle:TurIrTanorfnlasDn:aiscsSpt:uliraTognrnitascanatoslifpoNltneahunetrRoIolnyofagelcytSioocuiseDtiysoefasMeedsicine
CMAJ:Canadian MedicalAssociationJournal JAC:JournalofAntimicrobialChemotherapy
COID:CurrentOpinioninInfectiousDisease JACC:JournalofAmericanCollegeofCardiology
3
1
TABLE 1 -CLINICALAPPROACH TO INITIALCHOICE OFANTIMICROBIALTHERAPY*
Treatmentbasedonpresumed siteortypeofinfection. In selected instances,treatmentand prophylaxisbased on identification ofpathogens.
Regimensshould bereevaluated basedon pathogen isolated, antimicrobial susceptibilitydetermination,and individual hostcharacteristics. (Abbreviationsonpage2)
ANATOMICSITE/DIAGNOSIS/ ETIOLOGIES SUGGESTED REGIMENS* ADJUNCT DIAGNOSTIC ORTHERAPEUTIC MEASURES
MODIFYING CIRCUMSTANCES (usual) PRIMARY ALTERNATIVE5 ANDCOMMENTS
ABDOMEN: SeePeritoneum, page46; Gallbladder, page 17;andPelvicInflammatoryDisease,page26
BONE: Osteomyelitis. Microbiologicdiagnosisisessential. Ifbloodculturenegative, needcultureofbone(EurJClinMicrobiolInfectDis33:371, 2014). Cultureofsinustractdrainaqenotpredictive
ofboneculture.
Forcomprehensive reviewofantimicrobial penetration intobone,seeClinicalPharmacokinetics48:89, 2009.
HematogenousO—steomyelitis(seeIDSAguidelinesforvertebralosteo:CIDJuly29, 2015)
Empirictherapy Collect boneand blood culturesbeforeempirictherapy
Newborn (<4mos.) S. aureus, Gm-neg.bacilli, MRSApossible:Vanco + MRSAunlikely: (Nafcillinor Severeallergyortoxicity: (LinezolidNA110mg/kg IV/poq8h + aztreonam).
GroupBstrep, Kingella (CeftazorCFP) oxacillin) + (CeftazorCFP)
kingaeinchildren
—
ChiOlsdtreeono(f>e4xtmroesm.i)ty Adult: SG.m-aunreegu.s,baGcirloliuprarAe,stKrienpg.ella 4M0RmSgA/kpgo/sdsaiybldei:vqV6ahnco oMrRoSxaAcilulnilni)ke1ly5:0(mNga/fkcigl/ldiany ASdeuvletrse:aclelfetragzyo2rgtomxicIiVtyq:8hC,liCnFdPao2rgTmMPIV-qS1M2hX.orlinezolidNAI.
(NEJM370:352, 2014) kingaeinchildren divq6h (max 12gm) See Table 10Bforadversereactionstodrugs.
Add CeftazorCFP ifGm-ne;g. bacillionGramstain
Adultdoses below.
Adult(>21 yrs) S. aureusmostcommon but MRSApossible:Vanco MRSAunlikely: Nafcillin Dx:MRIdiagnostictestofchoice,indicatedtoruleoutepiduralabscess.
oV(assebterseetoceI:ebDsrCSasIAlDgo6u1si:dt8ee5lo9i,n±e2se0fp1oi5r)dvuerratelbral vcInaorTimuermtkyoeonyt:heBrruocreglalnai&smMs..TBc tO(1rC5Roe-uf2Cgt0hFrmiPogaf/x21ok5gng-em2I20Vqqgn8ghm8/-O1mqR2L24h+hfor OC(LCeFRevPfootx2ra7icg5ai0mlxlomiqnnge8h22q2gOg4mRmh)IqV2q44hhO+R WFaroherencoboetmvapeirrneehpdoe.snssiibvleereemvpiierwicoaflvetrhteerbarpalyosshtoeuolmydeblietiasdmsieneiNstEeJrMed3a6f2t:e1r1,cu2l0t1u0r.es
Levo750mgq24h)
Blood & bonecultures
essential.
Specifictherapy -Cultureand in\'itrosusceptibilityresultsknowri.SeeCIDJul29, 2015forIDiSAGuidelines
MSSA 22NaggfcmmilIIlVVinqq48orhhooxraccielflaiznolin VfDoaarnptctrooou6g1-5h8-o3fm0g1m/5gk-/2gk0gInVIgqV/2qm4L8h-1OO2RRh O(1)stehTeeMrNPoE-pJStMMioX3n6s82-:i1f10s1um,sg2c/0ek1pg0t/)id:blpoe/IinVvdiitvrqo8ahnd+aRlIlFer3g0y0/t-o4x5i0cimtygibsids:uelsimited
Linezolid600mg IV/po data, particularlyforMRSA(seeAAC53:2672, 2009);2) Levo750 mg po
q12h q24h) + RIF600mgpoq24h; 3) FusidicacidNUS500mg IVq8h + RIF
IMDRSSAAGuidSeeleinTeasblCeID6,5/2»:geeIB8-2; V1a2hncfoort1r5o-u2g0hmogf/1k5g-2I0Vqji8g-/mL LIVi/npeozo±liRdIF603000mmggq1p2o/hIVbid 3(C0I0Dm5g4:5p8o5,bi2d.01(2C)ID(M4S2S:3A94on,ly2)0:06D)u;ra4t)ioCnefotfrtihaexroapnye:26gwmeekIVs,q2p4rhovided
55, 2011;CID52:285-92,201 • RIF300-450mgbid. OR Dapto6mg/kgq24h IV thatepidural orparavertebralabscessescanbedrained;considerlonger
i RIF300-450mgpo/IVbid course inthosewithextensiveinfection orabscessparticularlyifnot
amenabletodrainagebecauseofincreasedriskoftreatmentfailure
(OFIDDec5:1, 2014) (althoughdataarelackingthatthisapproach
improvesefficacyversusa6wkcourse) and >8weeks inpatients
undergoingdevice implantation (CID60:1330, 2015).
DOSAGESSUGGESTEDareforadults(unlessotherwiseindicated)withclinicallysevere(often life-threatening) infections.Dosagesalso assumenormalrenalfunction,
andnotseverehepaticdysfunction.
ALTERNATIVETHERAPY INCLUDESthese considerations: allergy, pharmacology/pharmacokinetics, compliance,costs,local resistanceprofiles.