The Sanford Guide to Antimicrobial Therapy 2016

261 Pages·2016·9.84 MB·English

SANFORD GUIDE ,,
The Sanford Guide
To Antimicrobial Therapy
2016
th
46 Edition
David N. Gilbert, M.D.
Henry F. Chambers, M.D.
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
To our readers,
th
We have made significant improvements in this 46 edition of The Sanford Guide to Antimicrobial
Therapy. First, we thank you for your comments, questions and reviews of our content. You are
an
integral part of the collaborative process that results in each updated edition of The Sanford Guide.
We strive to provide you with the current range of evidence-based options for treatment,
management and prevention of infectious diseases. The Sanford Guide reaches a global aud
ience,
which means you should consider our recommendations in light of local resistance and
susceptibility patterns, availability of and variations in formulation of antimicrobial agents and
other local conditions that guide care for your patients.
New material and areas of significant change in this 46th edition include:
• Table 1: major updates include genital tract infections based on new
CDC STD Guidelines,
kidney & bladder infections, enterococcal endocarditis (also Table 5A), empiric therapy for
pneumonia, as well as updated regimens and references.
• Tables 4A, 4B and 4C: Activity spectra (antibacterial, antifungal an
d antiviral). These tables
have been completely reworked, updated and are now color-coded. The color coding
and associated symbols are intended to provide more descriptive categorization of the
table data.
• Table 7: Drug Desensitization. Desensitization methods for additional drugs are added.
• Table 8: Pregnancy Risk and ofAntimicrobial During Lactation.
This new table adds data
on safety of antimicrobials in lactating mothers.
• Table 10A (and elsewhere): New antibacterials added: ceftazidime-avibactam
and
cefto I oza ne-tazobactam.
• Table 1 1: New antifungal drug: Isavuconazole a
dded.
• Table 14 (HCV): New direct-acting agents and combination
agents and updated HCV
treatment regimens
• Table 16: Pediatric Dosing. Reinstated in this edition is a new table summariz
ing dosing
of antimicrobials in children age 28 days and older.
• Table 1 7A: Dosing in Renal Impairment. This table has also been thoroughly
reworked
and reviewed for improved clarity in our recommendations.
As always, all content has been updated with new references from the published literature,
including new practice and treatment guidelines, updated prescribing information and drug
safety information.
Some recommendations suggest the use of agents for indications or in doses other than found
in product labeling. Such recommendations are based on published reports in peer-reviewed
literature; they are not based on input from any pharmaceutical manufacturer. They are made
with due consideration of the concerns of the U.S. Food and Drug Administration (FDA)
regarding ''off-label" uses. We provide reference(s) for and, in some cases, annotate such
recommendations with the notation "NAI" meaning not an FDA-approved indication or dose.
The Editors
January 2016
SANFORD GUIDE®
The Sanford Guide
To Antimicrobial Therapy
2016
th
46 Edition

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The Sanford Guide to Antimicrobial Therapy 2016
th
46 Edition
Editors
David N. Gilbert, M.D. Henry F. Chambers, M.D.
Chief of Infectious Diseases Professor of Medicine
Providence Portland Medical Center, Oregon Director, Clinical Research Services
Professor of Medicine, Oregon Health UCSF Clinical and 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 Center for AIDS Research,
Beth Israel Deaconess Hospital, Professor of Medicine and Director,
Professor of Medicine, Division of Infectious Diseases,
Harvard Medical School, University of Alabama, 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 of Washington, University of California University of Alabama,
Seattle at San Francisco Birmingham
Kami Kim, M.D.
Professor of Medicine, Microbiology & Immunology, Pathology
Albert Einstein College of Medicine
New York, 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.
The Sanford Guides are updated annually and published by:
ANTIMICROBIAL THERAPY, INC.
RO. Box 276, 11771 Lee Highway
Sperryville, VA 22740-0276 USA
Tel [phone] Fax [phone]
Email:
QUICK PAGE GUIDE TO THE SANFORD GUIDE
RECOMMENDED TREATMENT—DIFFERENT SITES/MICROBES:
BY ORGAN SYSTEM: 4-68
CAPD Peritonitis 231
BY ORGANISM:
Bacteria 69-71
Highly Resistant Bacteria 81
CA-MRSA 82
Fungi 121-133
Mycobacteria 137-147
Parasites 151-161
Non-HIV Viruses 166-176
HIV/AIDS 181 - 191
Influenza 173
DURATION OF TREATMENT: 72
ANTIMICROBIAL PROPHYLAXIS:
Pregnancy/Delivery 199
Post-Splenectomy 199
Sexual Exposure 200
Sickle Cell Disease 200
Surgical 200
Endocarditis 204
Exposure to HIV/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 Daily Dosing 118
Continuous/Prolonged Infusion 119
Desensitization (Pen, TMP-SMX, ceftriaxone) 83
Inhalation Antibiotics 120
Pregnancy Risk Categories 85
Antifungals 79 134-136
Antimycobacterials 148-150
Antiparasitics 162-165
Antivirals (Non-HIV) 177-180
Antiretrovirals 192-195
Pediatric Dosinq 211
DOSE ADJUSTMENTS:
Renal 214-228
Hepatic 230
Obesity 229
DRUG INFORMATION:
Pharmacologic Features 88
Pharmacodynamics 99
Drug-Drug Interactions 235 - 242 (243 ARV Drugs)
Generic/Trade Names 244
MISCELLANEOUS:
Abbreviations 2
Parasites Causing Eosinophilia 165
Parasitic Drugs: Sources 165
Directory of Resources 234
91
—TABLE OF CONTENTS—
ABBREVIATIONS 2
TABLE 1 Clinical Approach to Initial Choice of Antimicrobial Therapy 4
TABLE 2 Recommended Antimicrobial Agents Against Selected Bacteria 69
TABLE 3 Suggested Duration of Antibiotic Therapy in Immunocompetent Patients 72
TABLE 4A Antibacterial Activity Spectra 73
4B Antifungal Activity Spectra 79
4C Antiviral Activity Spectra 79
TABLE 5A Treatment Options For Systemic Infection Due To Multi-Drug Resistant Gram-Positive
Bacteria 81
5B Treatment Options for Systemic Infection Due to Selected Multi-Drug Resistant
Gram-Negative Bacilli 81
TABLE 6 Suggested Management of Suspected or Culture-Positive Community-Associated
Methicillin-Resistant S. aureus Infections 82
TABLE 7 Antibiotic Hypersensitivity Reactions & Drug Desensitization methods 83
TABLE 8 Pregnancy Risk and Safety in Lactation 85
TABLE 9A Selected Pharmacologic Features of Antimicrobial Agents 88
9B Pharmacodynamics of Antibacterials 99
9C Enzyme -and Transporter- Mediated Interactions of Antimicrobials 99
TABLE 1 0A Antibiotic Dosage and Side-Effects 1 02
1 0B Selected Antibacterial Agents—Adverse Reactions—Overview 115
1 0C Antimicrobial Agents Associated with Photosensitivity 117
10D Aminoglycoside Once-Daily and Multiple Daily Dosing Regimens 118
1 0E Prolonged or Continuous Infusion Dosing of Selected Beta Lactams 1 1
10F Inhalation Antibiotics 120
TABLE 1 1 A Treatment of Fungal Infections—Antimicrobial Agents of Choice 121
1 1 B Antifungal Drugs: Dosage, Adverse Effects, Comments 1 34
TABLE 12A Treatment o' Mycobacterial Infections 137
12B Dosage and Adverse Effects of Antimycobacterial Drugs 148
TABLE 13A Treatment o' Parasitic Infections 151
1 3B Dosage and Selected Adverse Effects of Antiparasitic Drugs 162
13C Parasites that Cause Eosinophilia (Eosinophilia In Travelers) 165
1 3D Sources for Hard-to-Find Antiparasitic Drugs 165
TABLE 14A Antiviral Therapy 166
14B Antiviral Drugs (Non-HIV) 177
14C Antiretroviral Therapy (ART) in Treatment-Naive Adults (HIV/AIDS) 181
14D Antiretroviral Drugs and Adverse Effects 192
14E Hepatitis A & HBV Treatment 196
1 4F HCV Treatment Regimens and Response a 1 97
TABLE 15A Antimicrobial Prophylaxis for Selected Bacterial Infections 199
15B Antibiotic Prophylaxis to Prevent Surgical Infections in Adults 200
15C Antimicrobial Prophylaxis for the Prevention of Bacterial Endocarditis in Patients with
Underlying Cardiac Conditions 204
15D Management of Exposure to HIV-1 and Hepatitis B and C 205
15E Prevention of Selected Opportunistic Infections in Human Hematopoietic Cell
Transplantation (HCT) or Solid Organ Transplantation (SOT) in Adults With Normal
Renal Function 209
TABLE 1 6 Pediatric dosing (AGE > 28 DAYS) 21
TABLE 17A Dosages of Antimicrobial Drugs in Adult Patients with Renal Impairment 214
17B No Dosage Adjustment with Renal Insufficiency by Category 229
17C Antimicrobial Dosing in Obesity 229
TABLE 1 8 Antimicrobials and Hepatic Disease: Dosage Adjustment 230
TABLE 19 Treatment of CAPD Peritonitis in Adults 231
TABLE 20A Anti-Tetanus Prophylaxis, Wound Classification, Immunization 232
20B Rabies Postexposure Prophylaxis 233
TABLE 21 Selected Directory of Resources 234
TABLE 22A Anti-Infective Drug-Drug Interactions 235
22B Drug-Drug Interactions Between Non-Nucleoside Reverse Transcriptase Inhibitors
(NNRTIS) and Protease Inhibitors 243
TABLE 23 List of Generic and Common Trade Names 244
INDEX OF MAJOR ENTITIES 246
ABBREVIATIONS
3TC = lamivudine CSF = cerebrospinal fluid IM= intramuscular
AB,% = percent absorbed CXR = chest x-ray IMP = imipenem-cilastatin
ABC = abacavir d4T = stavudine INH =
isoniazid
ABCD = amphotericin B colloidal dispersion Dapto = daptomycin Inv =
investigational
ABLC = ampho B lipid complex DBPCT = double-blind placebo-controlled trial IP = intraperitoneal
AD = after dialysis dc = discontinue IT = intrathecal
ADF = adefovir ddC = zalcitabine Itra = itraconazole
AG = aminoglycoside ddl = didanosine IV = intravenous
AIDS = Acquired Immune Deficiency Syndrome DIC = disseminated intravascular coagulation IVDU =
intravenous drug user
AM-CL = amoxicillin-clavulanate div = divided IVIG = intravenous immune
globulin
AM-CL-ER = amoxicillin-clavulanate extended release DLV = delavirdine Keto = ketoconazole
AMK = amikacin DORI = doripenem kg =
kilogram
Amox = amoxicillin DOT = directly observed therapy LAB = liposomal
ampho B
AMP = ampicillin Doxy = doxycycline LCM =
lymphocytic choriomeningitis virus
Ampho B = amphotericin B DR = delayed release LCR =
ligase chain reaction
AM-SB = ampicillin-sulbactam DRSP = drug-resistant S. pneumoniae Levo = levofloxacin
AP = atovaquone proguanil DS = double strength LP/R =
lopinavir/ ritonavir
APAG = antipseudomonal aminoglycoside EBV = Epstein-Barr virus meg (or
pg) = microgram
ARDS = acute respiratory distress syndrome EES = erythromycin ethyl succinate MDR =
multi-drug resistant
ARF = acute rheumatic fever EFZ = efavirenz MER = meropenem
ASA = aspirin ELV = elvitegravir Metro = metronidazole
ATS = American Thoracic Society EMB = ethambutol Mino =
minocycline
ATV = atazanavir ENT = entecavir mL = milliliter
AUC = area under the curve ER = extended release Moxi =
moxifloxacin
Azithro = azithromycin ERTA = ertapenem MQ =
mefloquine
bid = 2x per day Erythro = erythromycin MSM = men who
have sex with men
BL/BLI = beta-lactam/beta-lactamase inhibitor ESBLs = extended spectrum (Wactamases MSSA/MRSA =
methicillin-sensitive/resistant S. aureus
BSA = body surface area ESR = erythrocyte sedimentation rate MTB = Mycobacterium tuberculosis
BW = body weight ESRD = endstage renal disease NB = name brand
C&S = culture & sensitivity Flu = fluconazole NF = nitrofurantoin
CARB = carbapenems Flucyt - flucytosine NAI = not FDA-approved (indication
or dose)
CAPD = continuous ambulatory peritoneal dialysis FOS-APV = fosamprenavir NFR = nelfinavir
CDC = Centers for Disease Control FQ = fluoroquinolone NNRTI = non-nucleoside reverse
transcriptase inhibitor
Cefpodox = cefpodoxime proxetil FTC = emtricitabine NRTI = nucleoside reverse
transcriptase inhibitor
Ceftaz = ceftazidime G = generic NSAIDs = non-steroidal
Ceph= cephalosporin GAS = Group A Strep NUS = not available in the
U.S.
CFB = ceftobiprole Gati - gatifloxacin NVP = nevirapine
CFP = cefepime GC - gonorrhea O Ceph
1 , 2, 3 = oral cephalosporins
Chloro = chloramphenicol Gemi - gomifloxacin Oflox = ofloxacin
CIP = ciprofloxacin; CIP-ER = CIP extended release Gent gentamicin P Ceph
1, 2, 3, 4 = parenteral cephalosporins
Clarithro = clarithromycin; ER = extended release gm gram P
Ceph 3 AP = parenteral cephalosporins
Clav = clavulanate GNB gram-negative bacilli with antipseudomonal
activity
Clinda = clindamycin Griseo griseofulvin PCR = polymerase chain
reaction
CLO = clofazimine HEMO hemodialysis PEP = post-exposure prophylaxis
Clot = clotrimazole HHV human herpesvirus PI = protease inhibitor
CMV = cytomegalovirus HIV human immunodeficiency virus PIP-TZ
= piperacillin-tazobactam
CQ = chloroquine phosphate HLR high-level resistance o = oral dosing
Cobi = cobicistat H/O
history of Q = primaquine
CrCI = creatinine clearance
HSCT hematopoietic stem cell transplant PRCT = Prospective randomized controlled trials
CrCIn = CrCI normalized for BSA
HSV - herpes simplex virus PTLD = post-transplant lymphoproliferative disease
CRRT = continuous renal replacement therapy
IA - injectable agent/anti-inflammatory drugs Pts = patients
C/S = culture & sensitivity
IDV = indinavir Pyri = pyrimethamine
CSD = cat-scratch disease
IFN = interferon PZA = pyrazinamide
ABBREVIATIONS (2)
qid = 4x per day SM = streptomycin
QS = quinine sulfate SQV = saquinavir TNF = tumor necrosis factor
Quinu-dalfo = Q-D = quinupristin-dalfopristin SS = steady state serum level Tobra = tobramycin
q[x]h = every [x] hours, e.g., q8h = every 8 hrs STD = sexually transmitted disease TPV = tipranavir
TST = tuberculin skin test
wk = dose weekly subcut = subcutaneous
= resistant Sulb = sulbactam UTI = urinary tract infection
Vanco = vancomycin
RFB = rifabutin Sx = symptoms
RFP = rifapentine Tazo = tazobactam VISA = vancomycin intermediately resistant S. aureus
Rick = Rickettsia TBc = tuberculosis VL = viral load
RIF = rifampin TDF = tenofovir Vori = voriconazole
RSV = respiratory syncytial virus TEE = transesophageal echocardiography VZV = varicella-zoster virus
RTI = respiratory tract infection Teico = teicoplanin ZDV = zidovudine
RTV = ritonavir Telithro = telithromycin
rx = treatment Tetra = tetracycline
SA = Staph, aureus sc = subcutaneous tid = 3x per day
SD = serum drug level after single dose TMP-SMX = trimethoprim-sulfamethoxa/olu
Sens = sensitive (susceptible)
ABBREVIATIONS OF JOURNAL TITLES
AAC: Antimicrobial Agents & Chemotherapy Curr Med Res Opin: Current Medical Research and Opinion JAIDS: JAIDS Journal of Acquired Immune Deficiency Syndromes
Adv PID: Advances in Pediatric Infectious Diseases Derm Ther: Dermatologic Therapy JAMA: Journal of the American Medical Association
AHJ: American Heart Journal Dermatol Clin: Dermatologic Clinics JAVMA: Journal of the Veterinary Medicine Association
AIDS Res Hum Retrovir: AIDS Research & Human Retroviruses Dig Dis Sci: Digestive Diseases and Sciences JCI: Journal of Clinical Investigation
AJG: American Journal of Gastroenterology DMID: Diagnostic Microbiology and Infectious Disease JCM: Journal of Clinical Microbiology
AJM: American Journal of Medicine EID: Emerging Infectious Diseases JIC: Journal of Infection and Chemotherapy
AJRCCM: American Journal of Respiratory Critical Care Medicine EJCMID: European Journal of Clin. Micro. & Infectious Diseases JID: Journal of Infectious Diseases
AJTMH: American Journal of Tropical Medicine & Hygiene Eur J Neurol: European Journal of Neurology JNS: Journal of Neurosurgery
Aliment Pharmacol Ther: Alimentary Pharmacology & Therapeutics Exp Mol Path: Experimental & Molecular Pathology JTMH: Journal of Tropical Medicine and Hygiene
Am J Hlth Pharm: American Journal of Health-System Pharmacy Exp Rev Anti Infect Ther: Expert Review of Anti-Infective Therapy Ln: Lancet
Amer J Transpl: American Journal of Transplantation Gastro: Gastroenterology LnID: Lancet Infectious Disease
Mayo Clin Proc: Mayo Clinic Proceedings
AnEM: Annals of Emergency Medicine Hpt: Hepatology
AnIM: Annals of Internal Medicine ICHE: Infection Control and Hospital Epidemiology Med Lett: Medical Letter
Ann Pharmacother: Annals of Pharmacotherapy I DC No. Amer: Infectious Disease Clinics of Norlh America Med Mycol: Medical Mycology
AnSurg: Annals of Surgery IDCP: Infectious Diseases in Clinical Practice MMWR: Morbidity & Mortality Weekly Report
Antivir Ther: Antiviral Therapy I JAA: International Journal of Antimicrobial Agents NEJM: New England Journal of Medicine
ArDerm: Archives of Dermatology Inf Med: Infections in Medicine Neph Dial Transpl: Nephrology Dialysis Transplantation
OFID: Open Forum Infectious Diseases
ArIM: Archives of Internal Medicine J AIDS & HR: Journal of AIDS and Human Retrovirology
ARRD: American Review of Respiratory Disease J All Clin Immun: Journal of Allergy and Clinical Immunology Ped Ann: Pediatric Annals
Peds: Pediatrics
BMJ: British Medical Journal J Am Ger Soc: Journal of the American Geriatrics Society
Pharmacother: Pharmacotherapy
BMT: Bone Marrow Transplantation J Chemother: Journal of Chemotherapy
PIDJ: Pediatric Infectious Disease Journal
Brit J Derm: British Journal of Dermatology J Clin Micro: Journal of Clinical Microbiology
QJM: Quarterly Journal of Medicine
Can JID: Canadian Journal of Infectious Diseases J Clin Virol: Journal of Clinical Virology
Scand J Inf Dis: Scandinavian Journal of Infectious Diseases
Canad Med J: Canadian Medical Journal J Derm Treat: Journal of Dermatological Treatment
Sem Resp Inf: Seminars in Respiratory Infections
CCM: Critical Care Medicine J Hpt: Journal of Hepatology
CCTID: Current Clinical Topics in Infectious Disease J Inf: Journal of Infection SGO: Surgery Gynecology and Obstetrics
SMJ: Southern Medical Journal
CDBSR: Cochrane Database of Systematic Reviews J Med Micro: Journal of Medical Microbiology
Surg Neurol: Surgical Neurology
CID: Clinical Infectious Diseases J Micro Immunol Inf: Journal of Microbiology,
Transpl Inf Dis: Transplant Infectious Diseases
Clin Micro Inf: Clinical Microbiology and Infection Immunology, & Infection
Transpl: Transplantation
CMN: Clinical Microbiology Newsletter J Ped: Journal of Pediatrics
TRSM: Transactions of the Royal Society of Medicine
Clin Micro Rev: Clinical Microbiology Reviews J Viral Hep: Journal of Viral Hepatitis
CMAJ: Canadian Medical Association Journal JAC: Journal of Antimicrobial Chemotherapy
COID: Current Opinion in Infectious Disease JACC: Journal of American College of Cardiology
3
1
TABLE 1 - CLINICAL APPROACH TO INITIAL CHOICE OF ANTIMICROBIAL THERAPY*
Treatment based on presumed site or type of infection. In selected instances, treatment and prophylaxis based on identification of pathogens.
Regimens should be reevaluated based on pathogen isolated, antimicrobial susceptibility determination, and individual host characteristics.
(Abbreviations on page 2)
ANATOMIC SITE/DIAGNOSIS/ ETIOLOGIES SUGGESTED REGIMENS* ADJUNCT DIAGNOSTIC OR THERAPEUTIC
MEASURES
MODIFYING CIRCUMSTANCES (usual)
PRIMARY ALTERNATIVE5 AND COMMENTS
ABDOMEN: See Peritoneum, page 46; Gallbladder, page 17; and Pelvic Inflammatory Disease, page 26
BONE: Osteomyelitis. Microbiologic diagnosis is essential. If blood culture negative, need culture of bone (EurJ Clin Microbiol Infect Dis
33:371, 2014). Culture of sinus tract drainaqe not predictive
of bone culture.
For comprehensive review of antimicrobial penetration into bone, see Clinical Pharmacokinetics 48:89, 2009.
Hematogenous Osteomyelitis (see IDSA guidelines for vertebral osteo: CID July 29, 2015)
Empiric therapy—Collect bone and blood cultures before empiric therapy
Newborn (<4 mos.) S. aureus, Gm-neg. bacilli, MRSA possible: Vanco + MRSA unlikely: (Nafcillin or Severe allergy or toxicity: (LinezolidNA1
10 mg/kg IV/po q8h + aztreonam).
Group B strep, Kingella (Ceftaz or CFP) oxacillin) + (Ceftaz or CFP)
kingae in children
Children (>4 mos.) — Adult: S. aureus, Group A strep. MRSA possible: Vanco MRSA unlikely: (Nafcillin Severe allergy or toxicity: Clinda or TMP-SMX
or linezolid NAI .
Osteo of extremity Gm-neg. bacilli rare, Kingella 40 mg/kg/day div q6h or oxacillin) 150 mg/kg/day Adults: ceftaz
2 gm IV q8h, CFP 2 gm IV q12h.
(NEJM 370:352, 2014) kingae in children div q6h (max 12 gm) See Table 10B for adverse reactions to drugs.
Add Ceftaz or CFP if Gm-ne;g. bacilli on Gram stain
Adult doses below.
Adult (>21 yrs) S. aureus most common but MRSA possible: Vanco MRSA unlikely: Nafcillin Dx: MRI diagnostic
test of choice, indicated to rule out epidural abscess.
Vertebral osteo ± epidural variety other organisms. 15-20 mg/kg IV
q 8-1 2h for OR oxacillin 2 gm IV q4h + For comprehensive review of vertebral osteomyelitis see NEJM 362:11, 2010.
abscess In Turkey: Brucella & M.TBc trough of 15-20 ng/mL + (Ceftriaxone 2 gm q24h OR
Whenever possible empirical therapy should be administered after cultures
(see IDSA guidelines for vertebral common (Ceftriaxone 2 gm q24h CFP 2 gm q8h OR
are obtained.
osteo: CID 61:859, 2015) OR CFP 2 gm q8h OR Levo 750 mg q24h)
Levo 750 mg q24h)
Blood & bone cultures
essential.
Specific therapy -Culture and in \'itro susceptibility results knowri. See CID Jul 29, 2015 for IDiSA Guidelines
MSSA Nafcillin or oxacillin Vanco 1 5-30 mg/kg IV
q 8-1 2h Other options if susceptible in vitro and allergy/toxicity issues
2 gm IV q4h or cefazolin for trough of 15-20 ng/mL OR (see NEJM 362:1 1, 2010):
2 gm IV q8h Dapto 6-8 mg/kg IV q24h OR 1) TMP-SMX 8-10 mg/kg/d po/IV div q8h + RIF 300-450 mg bid: limited
Linezolid 600 mg IV/po data, particularly for MRSA (see AAC 53:2672, 2009); 2) Levo 750 mg po
q12h q24h) + RIF 600 mg po q24h; 3) Fusidic acidNUS 500 mg IV q8h + RIF
MRSA See Table 6, /»ge 82; Vanco 1 5-20 mg/kg IV q 8- Linezolid 600 mg q12h 300 mg po bid. (CID 42:394, 2006); 4) Ceftriaxone 2 gm IV q24h
IDSA Guidelines CID 52:e IB- 12h for trough of 15-20 jig/mL IV/po ± RIF 300 mg po/IV bid (CID 54:585, 2012)(MSSA only): Duration of therapy: 6 weeks, provided
55, 201 1; CID 52:285-92, 201 • RIF 300-450 mg bid. OR Dapto 6 mg/kg q24h IV that epidural or paravertebral abscesses can be drained; consider longer
i RIF 300-450 mg po/IV bid course in those with extensive infection or abscess particularly if not
amenable to drainage because of increased risk of treatment failure
(OFID Dec 5:1, 2014) (although data are lacking that this approach
improves efficacy versus a 6 wk course) and >8 weeks in patients
undergoing device implantation (CID 60:1330, 2015).
DOSAGES SUGGESTED are for adults (unless otherwise indicated) with clinically severe (often life-threatening) infections. Dosages also assume normal renal
function,
and not severe hepatic dysfunction.
ALTERNATIVE THERAPY INCLUDES these considerations: allergy, pharmacology/pharmacokinetics, compliance, costs, local resistance profiles.