Table Of ContentANTIBIOTIC
ESSENTIALS
Fourteenth Edition
Edited by
Burke A. Cunha, MD, MACP
Chief, Infectious Disease Division
Winthrop-University Hospital
Mineola, New York
Professor of Medicine
State University of New York
School of Medicine
Stony Brook, New York
The Health Sciences Publisher
New Delhi | London | Philadelphia | Panama
Jaypee Brothers Medical Publishers Pvt. Ltd.
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email:
ABOUT THE EDITOR
Burke A. Cunha, MD, MACP, is Chief, Infectious Disease Division at Winthrop-University
Hospital, Mineola, New York; Professor of Medicine, State University of New York School of
Medicine, Stony Brook, New York; and is one of the world’s leading authorities on infectious
diseases. During his career, he has written/edited over 1250 articles, 200 book chapters, and 30
books on infectious diseases. He has received numerous teaching awards, including the
Aesculapius Award for teaching excellence and the Spatz Award for clinical excellence
and teaching excellence. Dr. Cunha is a Fellow of the Infectious Disease Society of America,
American Academy of Microbiology, A merican College of Clinical Pharmacology, Surgical Infection
Society, American College of Chest Physicians and Society of Hospital Epidemiologists of America.
He has had a long interest in clinical syndromic diagnosis, diagnostic reasoning, antimicrobial
therapy and resistance, atypical pneumonias, surgical infections, infections in compromised hosts,
zoonoses, FUOs, meningitis and encephalitis, endocarditis, and nosocomial infections. Dr. Cunha
is a Master of the American College of Physicians, awarded for lifetime achievement as a Master
Clinician and Master Teacher of Infectious Diseases.
DEDICATION
for
Marie
“Grace in her steps,
Heaven in her eye,
In every gesture, dignity and love”
Milton
iv A n t i b i o t i c E s s e n t i a l s
TABLE OF CONTENTS
1. O VERVIEW OF ANTIMICROBIAL Acute Otitis Media .......................................................... 38
THERAPY 1 Mastoiditis ........................................................................... 39
Factors in Antibiotic Selection ...................................2 Suppurative Parotitis ..................................................... 40
Spectrum ............................................................................2 Pharyngitis ........................................................................... 40
Tissue Penetration ........................................................2 Thrush (Oropharyngeal Candidiasis) .................. 43
Antibiotic Resistance ..................................................2 Mouth Ulcers/Vesicles.................................................. 44
Safety Profle .....................................................................4 Deep Neck Infections, Lemierre’s
Cost ........................................................................................4 Syndrome, Severe Dental Infections ............. 46
Factors in Antibiotic Dosing ........................................4 Epiglottitis ............................................................................ 47
Dosing in Renal/Hepatic Insufciency.............5
Lower Respiratory Tract Infections
Routes of Elimination (Renal and Hepatic)....5
Acute Bacterial Exacerbation of
Microbiology and Susceptibility Testing .............6
Chronic Bronchitis ....................................................... 48
In Vitro vs. In Vivo Susceptibility ...........................7
Mediastinitis ....................................................................... 49
PK/PD and Other Considerations in
Community-Acquired Pneumonia ...................... 49
Antim icrobial Therapy ....................................................9
Zoonotic Atypical Pneumonia ................................ 60
Bactericidal vs. Bacteriostatic Therapy .............9
Lung Abscess/Empyema ........................................... 67
Monotherapy vs. Combination Therapy .........9
Nursing Home-Acquired Pneumonia ................ 68
Intravenous vs. Oral Switch Therapy .............. 10
Nosocomial Pneumonia ............................................. 68
Bioavailability of Oral Antibiotics ...................... 11
OPAT ................................................................................... 11
Cardiovascular Infections
Duration of Therapy ................................................. 11
Subacute Bacterial Endocarditis ............................ 70
Empiric vs. Specifc Antibiotic Therapy ............ 12
Acute Bacterial Endocarditis .................................... 74
Positive Blood Cultures vs. Bacteremia
Prosthetic Valve Endocarditis................................... 76
(MSSA, MRSA, CoNS) ................................................ 13
Pericarditis/Myocarditis ............................................... 78
Drug Fever ........................................................................... 13
Central IV Line/Pacemaker Infections ................ 79
Relative Bradycardia ...................................................... 14
Vascular Graft Infections ............................................. 82
Antibiotic Failure ............................................................. 14
Pitfalls in Antibiotic Prescribing .............................. 15 Gastrointestinal Tract Infections
Esophagitis .......................................................................... 84
2. E MPIRIC THERAPY BASED ON CLINICAL Peptic Ulcer Disease ...................................................... 85
SYNDROME 17 Gastric Perforation .......................................................... 85
Diarrhea/Typhoid (Enteric) Fever ............................. 86
CNS Infections
Cholecystitis ....................................................................... 92
Acute Bacterial Meningitis......................................... 18
Cholangitis .......................................................................... 93
Acute Nonbacterial/Chronic Meningitis........... 21
Gallbladder Wall Abscess/Perforation ................ 93
Encephalitis......................................................................... 25
Acute Pancreatitis ........................................................... 94
Brain Abscess/Subdural Empyema/
Pancreatic Abscess/Infected Pancreatic
Cavernous Vein Thrombosis/Intracranial
P seudocyst..................................................................... 95
Suppurative Thrombophlebitis ......................... 27 Liver Abscess...................................................................... 95
Hepatosplenic Candidiasis ........................................ 96
HEENT Infections
Granulomatous Hepatitis ........................................... 96
Facial/Periorbital Cellulitis .......................................... 29
Viral Hepatitis ..................................................................... 97
Bacterial Sinusitis ............................................................. 30
Intraabdominal or Pelvic P eritonitis/
Keratitis .................................................................................. 31
Abscess (Colitis, A ppendicitis,
Conjunctivitis ..................................................................... 32
D iverticulitis, Septic Pelvic
Chorioretinitis .................................................................... 34
Thrombophlebitis, Spontaneous
Endophthalmitis .............................................................. 35 B acterial Peritonitis, CAPD-Associated
External Otitis .................................................................... 37 P eritonitis, TB Peritonitis) .................................... 100
Table of Contents v
Genitourinary Tract Infections Brain Abscess/Mass Lesions .................................... 164
Dysuria-Pyuria Syndrome ....................................... 103 Focal/Segmental Pulmonary
Cystitis ................................................................................. 103 Infltrates ........................................................................ 165
Catheter-Associated Bacteriuria/Candiduria .......104 Difuse Pulmonary Infltrates .................................. 165
Epididymitis ..................................................................... 106 Viral Hepatitis .................................................................... 166
Acute Pyelonephritis .................................................. 107
Toxin-Mediated Infectious Diseases
Chronic Pyelonephritis ............................................. 108
Toxic Shock Syndrome ............................................... 169
Renal TB .............................................................................. 108
Botulism ............................................................................... 170
Renal Abscess (Intrarenal/Perinephric) .......... 109
Tetanus ................................................................................. 170
Prostatitis/Prostatic Abscess .................................. 110
Diphtheria........................................................................... 170
Urosepsis ........................................................................... 111
Pelvic Infammatory Disease, Salpingitis, Bioterrorist Agents
T uboovarian Abscess, Endometritis/ Anthrax ................................................................................. 173
Endomyometritis, Septic Abortion .............. 113 Tularemia Pneumonia ................................................. 173
Pneumonic Plague ........................................................ 174
Sexually Transmitted Diseases
Botulism ............................................................................... 174
Urethritis/Cervicitis ....................................................... 114
Smallpox .............................................................................. 174
Vaginitis/Balanitis ........................................................... 115
Ebola ...................................................................................... 174
Genital Vesicles ................................................................ 116
Genital Ulcers ................................................................... 117 3. A NTIBIOTIC S USCEPTIBILITY P ROFILES
Suppurating Inguinal Adenopathy .................... 118 AND INITIAL T HERAPY OF ISOLATES
Genital/Perianal Warts ................................................ 118 PENDING S USCEPTIBILITY RESULTS 185
Syphilis .................................................................................. 119 Antibiotic Susceptibility Profles (Penicillins,
Macrolides, Tetracyclines, and Others) ........ 186
Bone and Joint Infections
Antibiotic Susceptibility Profles
Septic Arthritis/Bursitis ............................................... 121
(Cephalosporins) ....................................................... 191
Lyme Disease/Lyme Arthritis .................................. 127
Antibiotic Susceptibility Profles
Infected Joint Prosthesis ........................................... 128
(Aminoglycosides, Fluoroquinolones,
Osteomyelitis .................................................................... 129
Carbapenems, and Others) ................................ 198
Skin and Soft Tissue Infections Gram Stain Characteristics of Isolates (by
Cellulitis, Erysipelas, Mastitis.................................... 132 Morphology Arrangement,
Complicated Skin/Skin Structure Oxygen Requirements) ......................................... 203
Infections (cSSSIs) ..................................................... 134 Alphabetical Index of Isolates ................................ 205
Skin Ulcers .......................................................................... 137
Key Factors in Antibiotic Selection (Isolate
Skin Abscesses/Infected Cysts (Skin
Known) ............................................................................ 207
Pustules/Boils, Furunculosis) ............................. 140
Antibiotic Resistance Potential .............................. 207
Skin Vesicles (Non-Genital) ...................................... 142
Aerobic Isolates ............................................................... 208
Wound Infections .......................................................... 144
Capnophilic Isolates ..................................................... 235
Superfcial Fungal Infections Skin/Nail ............. 147
Anaerobic Isolates ......................................................... 236
Skin Infestations .............................................................. 150
Yeast/Fungi ........................................................................ 242
Ischiorectal/Perirectal Abscess .............................. 151
Gram Stain/Giemsa Stain Technique ................. 246
CSF Gram Stain ................................................................ 246
Sepsis/Septic Shock 151
Sputum Gram Stain ...................................................... 248
Urine Gram Stain ............................................................ 248
Febrile Neutropenia 158
Fecal Gram Stain ............................................................. 249
Transplant Infections
4. P ARASITES, FUNGI, UNUSUAL
Bacteremia ......................................................................... 160
ORGANISMS 253
Candidemia ....................................................................... 161
CMV/HHV-6/BK Virus .................................................... 162 Blood Pathogens
EVB/PTLD ............................................................................ 163 Microflaria in Blood...................................................... 254
RSV .......................................................................................... 163 Trypanosomes in Blood ............................................. 255
Adenovirus ......................................................................... 163 Spirochetes in Blood .................................................... 257
Encephalitis/Meningitis ............................................. 164 Intracellular Inclusion Bodies in Blood ............. 258
vi A n t i b i o t i c E s s e n t i a l s
CSF/Brain Pathogens Chronic Medical Prophylaxis/Suppression .........364
Cysts/Mass Lesions in CSF/Brain ........................... 261 HIV Pre-Exposure Prophylaxis (PrEP) ........................365
HIV Post-Exposure Prophylaxis (PEP) .......................366
Lung Pathogens
Pulmonary Cystic Lesions/Masses ....................... 265 HIV Opportunistic Infections .........................................366
Pulmonary Coin Lesions ............................................ 266 Transplant Prophylaxis........................................................367
Pulmonary Infltrates/Mass Lesions .................... 267 Endocarditis Prophylaxis .......................................... 369
Travel Prophylaxis ......................................................... 371
Heart Pathogens
Malaria Prophylaxis ..................................................... 375
Chagas’ Disease ............................................................... 273
Tetanus Prophylaxis .................................................... 377
Liver Pathogens
Immunizations ............................................................... 378
Liver Flukes ......................................................................... 273
Cystic Masses in Liver .................................................. 274 7. P EDIATRIC INFECTIOUS DISEASES
Hepatomegaly ................................................................. 275
AND PEDIATRIC DRUG
Stool/Intestines Pathogens SUMMARIES 386
Intestinal Protozoa......................................................... 276 CNS Infections .............................................................. 387
Intestinal Nematodes (Roundworms) ............... 278
HEENT Infections ........................................................ 391
Intestinal Cestodes (Tapeworms) ........................ 281
Lower Respiratory Tract Infections................... 396
Intestinal Trematodes
Vascular Infections ..................................................... 402
(Flukes/Flatworms) .................................................. 282
Gastrointestinal Infections .................................... 403
Other Intestinal Infections ........................................ 282
Bone and Joint Infections ..................................... 407
Skin/Muscle Pathogens
Skin and Soft Tissue Infections ........................... 411
Infltrative Skin/S ubcutaneous Lesions .......... 283
Common Pediatric Antimicrobial Drugs .......414
Infltrative Skin Lesions ± Ulcers/Sinus
Tracts/Abscesses ..................................................... 284 8. CHEST X-RAY ATLAS 425
Skin Vesicles/Bullae ..................................................... 288
Unilateral Focal Segmental/Lobar Infltrate
Subcutaneous Serpiginous Lesions ................. 288
Without Efusion ....................................................................426
Skin Papules/Nodules/Abscesses ...................... 289
Unilateral Focal Segmental/Lobar
Rickettsia (Fever/Petechial Skin Rash) ............. 294
Other Skin Lesions ....................................................... 297 Infltrate With Efusion ....................................... 431
Myositis .............................................................................. 298 Unilateral Ill-Defned Infltrates Without
E fusion ...................................................................... 436
5. HIV INFECTION 301
Unilateral Ill-Defned Infltrates With
Overview .......................................................................... 302
Efusion .................................................................................443
Stages of HIV Infection ............................................. 303
Bilateral Infltrates Without Efusion ............... 448
Acute (Primary) HIV Infection ............................... 304
Bilateral Infltrates With Efusion ...................... 458
Approach to HIV Testing .......................................... 305
Initial Assessment of HIV Patients ..............................308 Cavitary Infltrates (Thick-Walled) .................... 463
Indications for Treatment of HIV Cavitary Infltrates (Thin-Walled) ...................... 470
Infection ....................................................................... 312
9. I NFECTIOUS DISEASE DIFFERENTIAL
Antiretroviral Treatment ........................................... 313
DIAGNOSIS 474
Antiretroviral Treatment Failure ........................... 316
Opportunistic Infections in HIV Disease ........ 319
10. ANTIBIOTIC PEARLS & PITFALLS 507
Treatment of Opportunistic Infections ........... 323
Treatment of Other Opportunistic 11. ANTIMICROBIAL DRUG SUMMARIES 521
Infections in HIV ....................................................... 338
APPENDIX 720
HIV Coinfections (HBV/HCV) ................................. 344
INDEX 731
6. P ROPHYLAXIS AND
IMMUNIZATIONS 353 COLOR ATLAS OF CSF, SPUTUM, AND
Surgical Prophylaxis .................................................... 354 URINE GRAM STAINS & FUNGAL STAINS
Post-Exposure Prophylaxis...................................... 358
vi
EDITORS
Burke A. Cunha, MD, MACP Cheston B. Cunha, MD
Editor Associate Editor
CONTRIBUTORS
Burke A. Cunha, MD, MACP Cheston B. Cunha, MD
Chief, Infectious Disease Division Director, Antibiotic Stewardship Program
Winthrop-University Hospital Rhode Island Hospital and The Miriam Hospital
Mineola, New York Infectious Disease Division
Professor of Medicine Assistant Professor of Medicine
State University of New York Brown University Alpert School of Medicine
School of Medicine Providence, Rhode Island
Stony Brook, New York Infectious Disease Diferential Diagnosis
All chapters except HIV Infection & Overview of Antimicrobial Therapy
Pediatric ID Empiric Therapy Based of Clinical Syndromes
Antimicrobial Drug Summaries
Jefrey Baron, PharmD
Clinical Pharmacist
Daniel Caplivski, MD
Winthrop-University Hospital
Infectious Disease Division
Mineola, New York
Assistant Professor of Medicine
HBV, HCV, and HIV Guidelines
Mt. Sinai School of Medicine
Antimicrobial Drug Summaries
New York, New York
Edward J. Bottone, PhD Fungal Stain Atlas
Professor of Medicine
Professor of Microbiology Dennis J. Cleri, MD
Professor of Pathology St. Francis Medical Center
Mount Sinai
Professor of Medicine
School of Medicine
Seton Hall University
New York, New York
School of Graduate Medical Education
Medical Microbiology; Parasites,
Trenton, New Jersey
Fungi, Unusual Organisms
Bioterrorism
John L. Brusch, MD
Associate Chief of Medicine Staci A. Fischer, MD
Cambridge Health Alliance Director, Transplant Infectious Diseases
Infectious Disease Service
Rhode Island Hospital
Cambridge Health Alliance
Infectious Disease Division
Medical Director, Somerville Hospital
Associate Professor of Medicine
Assistant Professor of Medicine
Brown University Alpert School of Medicine
Harvard Medical School
Boston, Massachusetts Providence, Rhode Island
Endocarditis: Therapy & Prophylaxis Transplant Infections: Therapy & Prophylaxis
viii A n t i b i o t i c E s s e n t i a l s
Pierce Gardner, MD Leonard R. Krilov, MD
Senior Advisor, Clinical Research and Training Chief, Pediatric Infectious Disease Division
National Institutes of Health Winthrop-University Hospital
John E. Fogarty International Center for Mineola, New York
Advanced Study in the Health Sciences
Professor of Pediatrics
Bethesda, Maryland
State University of New York
Prophylaxis and Immunization
School of Medicine
Stony Brook, New York
Arthur Gran, MD
Pediatric Infectious Diseases
Infectious Disease Division
Winthrop-University Hospital
David W. Kubiak, PharmD
Mineola, New York
Infectious Disease Clinical Pharmacist
State University of New York
Brigham and Women’s Hospital
School of Medicine
Stony Brook, New York Boston, Massachusetts
Antimicrobial Drug Summaries Antiretroviral Drug Summaries
Jean E. Hage, MD Brian R Malone, BS, MS, RPh
Infectious Disease Division Director, Pharmaceutical Services
Winthrop-University Hospital Winthrop-University Hospital
Mineola, New York
Mineola, New York
State University of New York
Adjunct Afliate Professor
School of Medicine
College of Pharmacy St. John’s University
Stony Brook, New York
Queens, New York
Empiric Therapy of Clinical Syndromes;
Pediatric Drug Summaries
Prophylaxis & Immunization;
Parasitic & Fungi; Unusual Organisms;
George H. McCracken, Jr., MD
Antimicrobial Drug Summaries
Distinguished Professor of Pediatric Infectious
Disease and the Sarah M. and Charles E. Seay
Mark H. Kaplan, MD
Chair in Pediatric Infectious Disease
Professor of Medicine
University of Texas Southwestern Medical Center
Infectious Diseases
University of Michigan School of Medicine Dallas, Texas
Ann Arbor, Michigan Pediatric Infectious Diseases
HIV Drug Summaries
James H. McGuire, MD
Master Clinician
Douglas S. Katz, MD
Division of Infectious Diseases
Vice Chairman, Clinical Research and Education
Brigham and Women’s Hospital
Director, Body CT
Winthrop-University Hospital Professor of Medicine
Mineola, New York Harvard Medical School
Professor of Clinical Radiology Boston, Massachusetts
State University of New York School of Medicine Parasites, Fungi, Unusual Organisms
Stony Brook, New York
Nardeen Mickail, MD
Chest X-ray Atlas
Infectious Disease Division
Raymond S. Kof, MD Winthrop-University Hospital
Clinical Professor of Medicine Mineola, New York
University of Connecticut School of Medicine State University of New York
Farmington, Connecticut School of Medicine, Stony Brook, New York
Viral Hepatitis: Therapy & Prophylaxis Antimicrobial Drug Summaries
Contributors ix
Maria D. Mileno, MD Michael F. Rein, MD
Director, Travel Medicine Professor of Medicine (Emeritus)
The Miriam Hospital University of Virginia Health System
Infectious Disease Division Charlottesville, Virginia
Associate Professor of Medicine Sexually Transmitted Diseases
Brown University Alpert School of Medicine
Providence, Rhode Island John H. Rex, MD
Prophylaxis and Immunizations Adjunct Professor of Medicine
University of Texas Medical School
Robert Moore, MD Houston, Texas
Chairman, Department of Radiology Vice-President
Stony Brook University Hospital Medical Director for Infection
Professor of Radiology AstraZeneca Pharmaceuticals
State University of New York School of Medicine Macclesfeld, UK
Stony Brook, New York Antifungal Therapy
Chest X-ray Atlas
Paul E. Sax, MD
Sigridh Muñoz-Gomez, MD Clinical Director
Infectious Disease Division Division of Infectious Diseases and HIV
Winthrop-University Hospital Division of Infectious Diseases
Mineola, New York Brigham and Women’s Hospital
State University of New York Associate Professor of Medicine
School of Medicine Harvard Medical School
Stony Brook, New York Boston, Massachusetts
Antimicrobial Drug Summaries HIV Infection
Ronald L. Nichols, MD David Schlossberg, MD
William Henderson Professor of Surgery Tuberculosis Control Program
Professor of Microbiology and Immunology Philadelphia Department of Health
Tulane University School of Medicine Professor of Medicine
New Orleans, Louisiana Temple University School of Medicine
Surgical Prophylaxis and Therapy Philadelphia, Pennsylvania
Tuberculosis
Genovefa Papanicolaou, MD
Attending Physician, Infectious Disease Service
Paul E. Schoch, PhD
Memorial Sloan Kettering Cancer Center
Director
Associate Professor of Medicine
Clinical Microbiology Laboratory
Weill Cornell Medical College
Winthrop-University Hospital
New York, New York
Mineola, New York
Transplant Infections: Therapy & Prophylaxis
Medical Microbiology and Gram
Muhammed Raza, MBBS Stains Atlas
Infectious Disease Division
Winthrop-University Hospital Daniel S. Siegal, MD
Mineola, New York Department of Radiology
State University of New York Mount Auburn Hospital
School of Medicine Harvard Medical School
Stony Brook, New York Boston, Massachusetts
Antimicrobial Drug Summaries Chest X-ray Atlas
