Info

' Exceptions can be considered wticn tlieie lias boon prolonged, high-volume contact See page 2 tor abbreviations St*p 3 Determine Post-E poauro Prophylaxis (PEP) Recommendation 1 1 Consider basic logtmen' 1 2 Recommend basic legmen' 2 I Recommend basic teamen 2 2 Recommend expanded legmen' 3 I or 2 Recommend expanded legimen' 1 2. 3 Unknown II exposure selling suggests nsks ol HIV exposure, consider basic legimen' * * Based on eslimales ol i nsk ol inleclion altei mucous membrane exposuie in...

Alternative

PROTOZOA EXTRAINTESTINAL .00niwxl) Toxoplasma gondii ilWerence Ln 3b3 1965. 2004) Immunologically normal patients r* podn iK doses see'efetcnce) Ao o_itncss with l,rnpfttderxj MlhyJNo sgicctfic, rx unless 9MXapervsicrtf syrnpti < '- .-.xk > ( > .' .-'.al ayan d.ynotf) Acqu> cclyui VantfuSM i(lab aaidonll Jfreal asfcx PROTOZOA EXTRAINTESTINAL .00niwxl) Toxoplasma gondii ilWerence Ln 3b3 1965. 2004) Immunologically normal patients r* podn iK doses see'efetcnce) Ao o_itncss with...

Bm

(Suramin' 100 mg ft' (tost dose), llam 1 gm Won il V i.3 7 14.4 21 Etlornithine tv rum kg tjG> > IV limi-. 14days Late EncophaijUs Melaraoprol* 2 2 rrig pot kg per day IV Itirnos 10dgys 'yjM kg IM < 6 mos East African aleeplng sickness (T hiijcei rhodesnmso) Early & oot Vr.ph.tt c Suramin' 100 mg IV (lest dose) tf ii I grti Molufsoprol Inal data JID 191 1793 4 1922. 2IXK 1 Sulonamdos tot tuxo Scitocia me no cnnmotaaAy avaaat*r StXhsorazolo much loss cfloctrvo 1 AvaJabie Iron CDC Drug...

Pza

Times 4 months (total 6 mos I May ttoat up to 9 mos m pis with r Tyiid response (Authors a< 1< I pyrldoxine 25-50 my po*q24h t i im ini.> ris'lhat include INHI Concomitant protease Inhibitor (PI) therapy (Modified torn MKMR 49. 185. 2000. AJRCCM 1627. 200II Initial 4 cont. therapy Alternative regimen INH 300 nig i RFB (seebelow for d* m.-i PZA 25 mg kg INH SM PZA - ETB '5mg pel kgq24htimos2 mos then INH RFB limes 4 mos tup to 7 mos ' Neltinavii I200ingql2hoi indnavlt 1000 mg g8hor...

Initial Therapy

CONTINUATION PHASE OF THERAPY (in vitro susceptibility known) oxino 25-50 mg po q24h to regimens that include INH 6-month regimens ptobably dlnctive. M sl experience with 9-12 mo regimens Am Acad Pod (1994) recommends 6 mos rx tor isolated cervical adenilis lenal and 12mos lor meningitis miliary, bone ioirit DOT useful hoio as wt*ll as 1 pulmonary tuberculosis IDSA tecommends 6 mos. Ich lymph nodo. pleural, pericarditis, disseminated disease genitourinary & peiitonea TBc. 6-9 mos loi bono...

Primary

Praziquantel 20 nig pa kg po 1*1 tirmw I day (2 doses) Somo doso I dmdrvn Alternative metnlanaln 10 njl. kg 1 dosopo< J iksJr.* 3dqws Prsziqusr M n por kg po t tunos l dfiy (2 dosos Saira dom In dskksn Praziquantel 20 mg per kg po tld limir, 1 day (3 dosss) Same doso m ct k on Cues 0 90*. pts Oxamniquine > . ,- ' Ii rig per kd po once, 1 Math and Emt A rta 20 mg per kg po darfy tmes 3 days Oo not use dung 20 mq per kg to Md unes 1 day i3 doses. Same doso 1er cltfiim Cues 60 90 pts Report ci...

Tmpsmx

An orythro-resislanl strain reported In Arizona M 43.807. 1994) Borrelia burgdorferi, B. afzelil, B. garlnll Ceftriaxone, celuroxime axetil. doxy, amox (See Comments) Clarithro Choice depends on stage ot disease. Table t. page 42 Doxy * either gentamicin or streptomycin (IDCP 7. 2004) (Doxy + RIF) ot (TMP-SMX + Gentamicin) FO + RIF (AAC 41 80. 1997. EID 3 213, 1997. CID 21 283. 1995) Minocycline + RIF (J Cbemothei 15 248. 2003) (Usually resistant to APAG. AG polymyxins) (AAC 37 123. 1993 &...

Ss

Enterotoxigenic (tiavelar s dianhoa) 13 Ethambutol 58, 62, 87-93, 137. 147 Ethionamide 88.87. 88.90. 92.84.137.147 Extendod-spectiurn lactamases (ESBL) 30 34. 50. 57 Eyeworm (Onchocerca votattNHHHHMBHBllH Famciclovir 58 62, 109-111 114. 138 Fansrdar (pyrimethamine suttadoxine) 58,105 Fever blisters (cold sores) 110 Fluconazole 58. 62.75-81. 83. 4.98. 131.136.

Comments

Eyelids Petroleum lolly ,ipi I I ynl 10 days OR yellow oxldo ol mercury I Umjf 111 IS) No drugs lor pi. Ileal lh.> c I. ii'img Oryarimm lv.-y, & OMpOiftl eggs in sear itkilhion ikrAxief or 10 DDT powder_ Permelhrin success m 78 Extia combeig ot no it Resistor .' ncroa ng No ai Vantage In 5 permettxiTi Malathion Ropc t trial t-2 20 ni - jnprcaittxis 98 eltuctrve Pod Dam 21 C70, 2004) In alccini potentially Costs Pmmetliiiri 1 lo irxVci im S8 9 Malathion 0.5 lotion S119 Ivermectin 20...

Comment

Resistant to FQs Resistance both FQs & macrolidos reportod (CID 22 868. 7996. EID 7 24. 2002. AAC 47 2358. 2003) Klebsiella pneumoniae (producing ESBL Resistant to Ceftazidime & otfier 31 generation cephalosporins (see Table IOC), azlroonam IMP. MER. ERTA (CID 39 31. 2004) (See Comment) P Ceph 4 TC-CL PIP-TZ show in vitro activity but not proven entuoty etloctrve in animal models (UAA 8 37, 1997) some strains which hyperproduco ESBLs are pnmanly resistant to TC-CL and...

Ma

7 days per wk times 217 doses (31 wk) or 5 days per wk times 155 Second-line anli-TB agents can be dosed as loliows In laolitale DOT Cydnsetine 500-750 mg po q24h (5 times pei wk) Ethionamide 500-750 mg po q24h (5 limes pet wk) Knnamycin or capreomycin 15 mg per kg IM IV < 24h 13-5 limes per wk) Ciixolloxacin 750 mg po q24h (5 times per wk) Ofloxacin 600-800 mg po q24h (5 limes pis wkl Lovotloxacin 750 mg po q24h (5 limes pel wk) (CID 21 1245. 1995) Risk taclois lor drug-resistant TB Recent...

Recommended Alternative

IMP (Resistant o clindamycin cephalexin, erythromycin, nd metronidazole) Recommended aqents vary wth clinical setting See Tables 1 & 4 Enterococcus faecium -lactamase +, hioh-level arrurioqlvcoside resist vancomycin resist See Table 5. pacje 56 Penicillin G or AMP P Ceph 3, FQ llMP, AP Pen (van.- < van APAG TMP ISMX resistant) Recommended agents vary with clinical setting See Tables 1 & 4 Francisella tularensia (tularemia) Sog Table 18. page 48 Gentamicin,...

Hi

Itydrocodone, tramadol Codeine, hydtomorphone. morphine, mothadone AnB-arrhythmlca Antlconvulsanta carbarn ueplne, clonazepam, phonytoin, Antidepressants, all other Loraladine Beta blockers Metoprolol pindolol propranolol, timolol Calcium channel blockers (aH) Clanthro. erythro Contraceptives, oral Corticosteroids prednisone, dexamethaaotw Cyclosporin Eigol derivatives Erythromycin, clarithromycin Giapeliuit juico ( -200 ml day) H2 recoplot antagonists HMG-CoA reductase...

Adverse Reactions Comments

Antiprotozoan Drugs Intestinal Paraailos Albendazole (Albenza) Doses vary with cation 200 400 mg bkl po 200 mi) tali 1 58 Teralogorac Plogruncy Cot C. give aft regain progriancy tost Alxkxiuv.il pan. nauy.vYvominnj alopecia. 1 serum transaminase Roto leukopersa 1 5 mg per kg day to max ol 90 mg IM Local (Kin ECG iji-ingi-s rardiac aiiliyilmius ixecrxdi.il pain, (xresiiiesiar. wvokixiss. penplieial nouri > atl'y Gt nause. rvnniiting. diarrhea Avoid strenuous exercise la 4 wkr. ailiir rx Adults...

Ipidj23 12320041

Culture abscess & maybe bood l& D Hof packs If lecuirent & nost-rx decolonization desnod. see page 39 Close followup. Fever shouki lesolve quickly post DC inactive drug wtien suscept data available Need quam ciituies for diagnosis ed specimen Unozolid superior lo vaneo m leliospective subset analysis, prospodive study m progress compassionate use trial IJAC 50 1017. 2002) No strong data Itat addm i rifampin helps Addng gonta-micin to vaneo * risk ol neplxoloxicity with little evidence...

Antimicrobial Agents Of Choice

Candidiasis 'o v ,,.,, AIDS patient HAART tvis resulted in dramatic i in pevalence ot oropharyngeal & esopfiagoal candidiasis & 1 in rotractory disease MMVW 53(RR-15) 97. 2004 Oral candidiasis is a strono clinical marker ol immune tailute in pis tncotvirg HAART (AIDS Pi CaroSTDs 19 70. 2005) Oropharyngeal initial epsodes (7- Fluconazol -refractory 14 any rx) Fluconazole IX mg oropharyngeal Itra oral solution > 200 mg po q24li, or ampho B suspension 100 mg pet mL t mLpoqSv or ampho B 0 3...

Suggested Regimens

CONTINUATION PHASE OF THERAPY' (In vitro susceptibility known) III. Mycobacterium tuberculosis A. Pulmonary TB IGeoera reference on rx in adults 4 child on Ln 362 88 003. MMWR 52(RR-11) 1. 2003. CID JOtSuppl I) St. 2005 isolation essential1 Pts with active TB should be isolated in single is, not coharted Older observations on ffileclMty ol susceptible & -esistam M tbc bet re and alter rx (ARRD 85 5111. 1902) may mil be applicable loMDRM tbc or to Ihe HIV indrviduai Extended isolation may be...

T lovois ot a 3MMMMM

1 levels ol B. do not use pimozide t levels otB T levels ol B it renal rmpairmenl I levels ol B-3MHMMM t levels ol B. monitor lovols T lovols ol B do no uaa t levels dA& B i indinavir & T saqiitnavii levels I levels ol A' MMMNHBH t levels of B do not uaa Poss tisUfiram reaction, alcohol T levels Ol B do not uaa 4 levels ol A - levels ol A. T levels ol B (avoid) Varios. some T & some a levels of B i lav ela ol A do not uaa i levels ol B add ritonavir

Tmpsmx Amsb

Pieomorptw Gm-nog bacfi f resistance to TMP-SMX Anaerctxc strep. Strep mfloi actcrordes sp. Entero-bacteriaceae. M tuberaJosis Clinda 450 900 mg IV il8ti - ceftriaxone PIP-TZ AM-SB Dosage see footnote 1 page 26) It organisms not seen, treat as subacute Drairioge R 0 tuboraiosis or lixnor Ploixal txopsy witfi oitixe for mycobacteria and histology it TBc suspected CO 22 747 1996) Human immunodeficiency virus C04 T-lymphocytes < 200 por mm'or clinical AIDS Dry courtv fxogiossivo dysp neti, &...

Drug

Amikacin, genlamicin, isepamicin11' netilmicin , streptomycin & tobramycin Beta Lactams Penicillins, pens + BLI cephalosporins, azlieonam Imipenem cilastatin Meropenem. ertapenem Chloramphenicol Ciprofloxacin, oflox, levotlox, gatiflox. gemiflox, moxiflox Erythromycins azithromycin Clarithromycin Metronidazole Nitrofurantoin Rifaximin Sulfonamides trimethoprim Telilhromyc'in Tetracyclines, tigecycline Tirudazole Vancomycin Antifungal Agents (CID 27 1151, 1998) Amphotericin B preparations...

Drugrelated

G generic I investigational IA injectable agent NB name bland NFDA-I nol FDA-approved indication NUS not available in lite U S ASA aspirin NSAIDs non-steroidal anli-intlammatory drugs DISEASE-ASSOCIATED ARDS acule respiiatoiy distress syndrome ARF acute rheumalic lev CAPD continuous ambulaloty pentomial dialysis CAVH continuous arteriovenous hemoffltration CSD cal-scratch disease DIC disseminated intravasculai coagulation ESRD endslaqe lenal disease HEMO hemodialysis PEP - post-exposure...

Empy

Regimens tor raHd disease see Comment). then Clinda 600 mg IV q8h primaquine 3D mg xi q24h Ol pentamidine isethionate 4 mg pet kg pet day IV) times 21 days Oagrwstic ptocotkce ot choice is sfxilum induction, it negative txonchoscopy Pts witti PCP rx 200 CD4 cots pet mm' stioird be on anti PCP ixoptrylfous lor lile Prednisone 40 mg bid po times 5 days then 40 mg q24h po times 5 days thon 20 mg q24h po times 11 days is indicated with PCP (pO. < 70 mmHg), should be given at initiation ol...

Adjunct Diagnostic Or Therapeutic Measures And Comments

LUNG Other (conttnuod) Cystic fibrosis Acute exacerbation of pulmonary aymplonis Rets Ui 36f 681. 2003. A fiCCV (68 918. 2003 S aureus or H influenzae oarty m cfcsease P aeruc -nosa tatet m dsease 3 3 mg pet kg ()8h or 10 mg pe kglVq24h Comtxne otxawtii -PIP or ticardllln lOOmgp kgq6h) or coftaz 50 mg xt kg IV q8h to max ol 6 am per day Seo footnote' q4h (Pods dose. Tabie 16) 2) MRSA vaneo 1 gm q 2h & chock serum lewis See Comment Ofhor options Clartthro synergistic with tobra vs P aoruonosa...

Organisms

B Ihetaiolaomicion LCM - lymphocytic chorlomenirigills virus MSSA MRSA - methicillin-sensitive iesistanl S aureus VISA - vancomycin intermediately resistant S aureus CtS culture & sensitivity CXR chest x-ray ESBLs extended spectrum ( -lactamases TEE transesopliageal echocaidlogiaphy ICAAC International Conterence on Antimicrobial Agents & Chemotherapy tDSA Inleclious Diseases Society ot America WHO World Health Organization DBPCT double-blind...

Side Effects Comments

Adenovirus Caus> -ni RTis itKkxfcng Intni (xtiHimriri-a No proven rx. Cldolovlrmy poi kq rj v.* times 2 wks liter q2 M probenecid 125 gm ' luldien & young adults Findings includo level. T Inter Ipet M given 3 his Ix'loto cirlofovir and 3 4 9 his alter each ilusi n (CID 38 45. 2004) sucosslul enzymes lot opon a, tluombocylopenia, darihoa. in 3 8 immmauppic& sed ctuklren Inliavesical ddofCMi (5 myper kg iri 100 ml salmo inslillod pnoumonia. or hemorrhagic cystitis lintu blatkletl...

Ajm 90t29 1901

IV lin* Infection Prevention (CID 35 1281. 2002. NEJM 348 1123. 2003) Tunneled hemodialysis catheters Small study, I intection tale when cathetei locked IV lin* Infection Prevention (CID 35 1281. 2002. NEJM 348 1123. 2003) Tunneled hemodialysis catheters Small study, I intection tale when cathetei locked To minimi e risk ol infection 1 Maximal slenle barriei precautions duting catheter inseilion Willi qontarriiiui 5rng imi mL) f hetwriti SOOOumts ixir inLi p- 002 (Knirn.y lull 66801 20041 2....

Initial Therapy Alternative

TST positive (or-gsnlsms likely to be INH-suscepti-bla) Age no longer considered modilying factor (see NH (5 mg pet kg per day. max 300 mg pet day lot adults. 10 ma per kg per day not to exceed 300 mg pei day tor cfuldten) Rosults Mill 6 mos tx nol qule as effective as 12 mos (65 vs 75 teduc-lon in ctsoaso) 9 mos is cuironl recommendation See IIA above for details and alternate rx Reanalysis ol eatlier studies lavors INH prophylaxis (it INH lolatod hopalitis case fatality late < 1 and TB...

Pk Pd Measurement

Concentralion-dryiendenliPiolonged persistent eltect Aminoglycosides, daptornycav ketolidos. qunokmos Time-doperKkint No jxisistent eltect Time-depondcnt Moderato to long persistent eltect Clindamycin erythTQ azithro daiithto. knezoW letiacycknos. vancomycin Adapted Itom Ciaig WA IOC No Amer 17 479.2003 See pago 2 for abbreviations ' AUC - aiea under diug concentration cuve Adapted Itom Ciaig WA IOC No Amer 17 479.2003 See pago 2 for abbreviations ' AUC - aiea under diug concentration cuve

S

Bloodstrosm clinically stable with or without venous catheter ,'OSA Guidelines ClD 38 161, Fluconazole -6 mg (let kg pet day or 400 mg Ail positive blood cultures require therspyt Remove 4 teplace venous catheter ('not over a wile) (CID 36 1221. 2003. ScandJlnlDis 37 111. 2005. J Clin Micro 43 1829, 2005 . esp in non-neuliopenic moitalily21 vs 4 il catheter nol temoved Ophthalmologic exam recommendod lor all pts wilh candidemla Tteat tot 2 wks aller iasl pes blood culture 4 resolution ol signs...

Mrsa

Vanco 1 gm IVql2hor linezolid 600 mjj IV q_12h Linezolid 6 mg'lV ql2li Retrospective analysis of 2 prospective randomized double-blind studies ol hospital-acquired MRSA showed enhanced sutvival wilh lirwoitd, p 0 03 (Chest 124.1632. 2003) ellicacy perhaps related to superb linezolid lung concentrations Concern ol possible misinterpretation ot post hoc subgroup analysis (Chest 126 314. 20041 In vitro synergy reis AAC39 2220. 1995. CMR 11 57. 199B IMP 2 gm IV q6h amox 1 gm po lid macrolide'. pen...

Mouth

Odontogenic mledion. including Ludwig's angina Can lesutt in more sonous (latapharyn-geal space inlection (see page 36) Oral miaollora infection polymicrobial Clinda 300-450 nig po q6hoi 600mglVq6 8li AM-CL 875 125 mg po bid or 500 125 mg lid Ol 2000 125 mg Did) ol cetotetan 2 qm iVql2li Surgical dioinage and lemoval ol necrotic tissue essential )-laclamase producing otganlsmsaie in liequency Rel CwactDonlirlAssnJ64 S08. 1998 Othet patentoial alternatives AM-SB. PIP-T2. cu TC-CL Cefuroximo...

Table 10a

SELECTED ANTIBACTERIAL AGENTS ADVERSE REACTIONS OVERVIEW Adverso reactions *xjiv> duai patients topresent all-or-none occurrences. oven it rare After selection of an agent the phynaan vuxM mad tho manufacturers package insert statements m the product labeling (package msrtt) must bo approved by ttie FDA Number frequency of occurrence (N) + occurs. Incidence not available + + significant adverse reaction 0 - not reported R - rare, denned as < 1 . NOTE Important reactions In bold print. A...

Ap Ag

Amikacin or P Cepli 3 oi FO TMP-SMX AP Pen. AP Ceph 3. IMP, MER, toblamy-cin. ClP. azlreonam Foi serious int. use AP fl-lactam + tobramycin or ClP (LnID 4 519. 20041 Foi UTI. single diugs usually ettective AP Pen. AP Ceph 3 celepime. IMP, MER. APAG ClP aztreonarn Resistance to n-lactams (IMP catlap) may emerge dunng rx i-iaclant inhibitor adds nothing lo activity ul TC ot PIP aqainst P aeruginosa Clavulamc acid lias been shown lo antagonize TC in vitro (AAC 43 882. (999) (Soe a so Tahiti 5A)...

Asymptomatic postre carrier

Multiple lepeulixl cufiijre-positive episodes (CID 25 574. 1997) Pon V po times 10 0 Ceph 2 times 4 lays (CID days Of il compli- 38 (526 4 1535, 2004) or ctinda i ufice unlikely, azithro times 5 days Of darKhro benzathine pen times 10 days or dtrithro i nieslO IM times 1 dose days oi erythro limes 10 days Up to 35 ol isolates lesistant lo erytlno, izilliio, clanlhio clinda (AAC 48 473. 2004) See footnote for adult and pediatric tiosagos Acetaminophen effective tot pain leliet (Br J Gen Prac...

S pyogenes Groups C A G cause pharyngitis but not a risk for poststrep rheumatic fever

To prevent iheumatic level, eradicate Group A strop Roquuos todays otpenV po. 4-6 days ol po O Ceph 2 5 days ol po azittvo 10 days ol dainlvo In coritiollod tnal. better eradication late with 10 days dantlvo (91 ) than 5 days a itmo (82 I(CID 32 1798.2001) Ceftriaxone 125rrig M f(CIP 5 0 mg potimes I) Of Gsrti 40 mg Because ol risk ol concomitant genial C trachomatis, add eilli times 1 dose* (untre po limes 1) or (Levo 250 mg po tones 1) (azithro t gm no tonos t) or (doocy 100 mgpoq12h tones 7...

Mm 140346 2004

'EG IFN Eitlii.1 alta-2a iPogasys) 180 mcq subait onco Alla-2b (PEG-INTRON) 1 5 meg per kg subcul onco weekly Monitor response by qusntificallon 400 mq a m & 600 mg p m 600 nig am & 600ingpm Discontinue llieiapy Dlscontinuo theiapy Treat 48 wks PEG IFN alla-2a or 2b dose as for types 1 & 4 abovo + Ribavirin 100 mg po tiu.l For prevention of acute and chronic Infection, see Table 1SD. page 128 iri U S 90 duo to genolyixi 1 Sustained vital response (SVRl to 48-wk rx ol ( eiKilype 1 42...

Cid 20 421 1995

Spiiillum minus & Strepto-ImiciIIiis moniliformis Con take weeks lo appear alter lute Iin 364 448. 2004) Pseudomonas sp , Enlerobacteriaceae, Staph epidot Primary Iherapy is antivenom Pemcilliri generally used but would nol be elfectve vs organisms isolated midis, Clostridium sp ICeltnaxone should I more elloctrvo Tetanus prophylaxis indicated Spider bite Most neciotic illcei Widow (Laltodeclusl attributed 10 spiders are pro Nol inloclious s. e.g., cutaneous anlhiax (Ln 364 549. 2004) oi...

Continuation Phase Of Therapy

Mycobacterium tuberculosis exposure but TST negative (liouse-hokl members 4 other dose contacts of poten-tialy mfodious cases) INH (10 mg pel kg pot day lor 3 months) Repeal luberculin skin lesl (TST) In 3 mos II mother's smear negative & infant's TST negative & chest x-ray (CXB) normal, stop INH In UK. BCG is then given (Ln 2 1 479. 1990). unless motlior HIV* II infants lepeat 1ST positive & ot CXR abnormal (Mm adenopathy & or mliltiale). INH RIF (10-20 mg xi kg pot day) (ot SM)...

Table 100

AMINOGLYCOSIDE ONCE-DAILY AND MULTIPLE DAILY DOSING REGIMENS (See Tab * 17. page 134, II estimated creatinine clearance < 90 mL per min.) General Dosage given as both once-daily (OD) and multiple dally dose (MDD) regimens. 111 Estimated creatinine clearance (CrCl) i40-agel(ideal body weight in kg) . (72)(setum creatinine)1 (2) Ideal body weight (IBW) Females 45 5 kg r 2,3 kg pet inch over 5' - weight ir Males 50 kg i 2 3 kg per inch over 5 - weight in kg CrCl lor men in ml pei mm, multiply...

Gastrointestinal

Gastroenteritis Empiric Therapy (laboratory studies not porformod or culture, microscopy, toxin results NOT Associated with intestinal Treolmcnt rind rationale as tor drverticulitis perttonitis Ikxs See Table 10. page 133 (or perfutnc Pneumatosis intestinalis on x-tay confirms dx Bactoromia-pentonitis m 30-S0 II Staph opKlcrniKis isolated, add vaneo (IV) Mild dlarrhoa IS3 unformed stools per day. minimal assocutf ed .SOTplwpalolpgy . unformed stools per day ancUoi systemic symptomsj Baclcri.il...

NOTE Cephalosporins ertsponem not activo vs

Rule out obstiuclion Walch ouilot enterococci and y aonjglnoso nol al listed drugs hovo predKlabie activity CIP-ER nal dose 1000mgpoq24h symptomatic bacteriurla. SA Gudeiines CID 40 643. 2006 Preschool children Beforo and after invasive Urologie Intervention, e.g., Foley cathetor Neurogenic bladdor Aerobic Gm-neg hac li & Staph hemolyticus Amobic Gm-nog b aili Base r opinen on C4S, nol emp ricaI Soman 1* trimester II positive, rx 3-7 days with niox. NF O Ceph TMP-SMX i TMP Obtain urine turo...

J

CLASS, AGENT, GENERIC NAME (TRADE NAME) ADVERSE REACTIONS, COMMENTS (Saa Table 10A (or Summary) NATURAL PENICILLINS Benzathine penicillin G 600,000-1.2 million units IM q2-4 wks Low 600,000-1.2 million units IM per day High > 20 million units IV q24h( 12 gm) 0.25-0.5 gm po bid, lid, qld before meals & Most common adverse reactiona are hypersensitivity Anapliyiaxis in up to 0 05 . 5-10 latal Commercially available skin lest anligec ipervcilloyl pofyfyryne) does not predict anaphylactic...

Anatomic Site Diagnosis Modifying Circumstances

1 SUGGESTED REGIMENS- ADJUNCT DIAGNOSTIC OR THERAPEUTIC MEASURES AND COMMENTS PRIMARY ALTERNATIVE' TMP-SMX OS 2 tabs po bid whtfe waiting lot cutute test ISee Taole 6 lot atetnet .re. Contad wth oral mucosa dentists, anosthosiologisls. wtesllets Famciclovir - > valacy-clovlr should work, see Comment Gram slain and routine culluro nogalive Famddovir Valacydovtr doses used lot ptimaty genital herpes shoukl work, see Table 14, page 110 Oishwash (prolonged watw immwsion) Candida sp

Rx Exchange transfusions successlul adjunct used early in severe disease

Bartonella Elections CID 35 684. 2002 Doxy tOO nig po IV times 5days Can load to endocarditis & ot trench fever found in homeless, esp illice leq pain Azithro or symptomatic only -see page 33 usually lymphadenitis, c-an involve CNS. liver in immunocompetent pts Bacillary angiomatosis Peliosis hepatis pts with AIDS iCIarithro 500 mg bid ot clarithro ER 1 gm po q24h j' azKhroiSOmg po q24h or CIP 500-7K) mg po bid) times 8 wks i Erythro 5C0 mg po qid ot doxy 100 mg po bid) limes 8 wks or II...

Vesicular ulcerstive

Membian s Oiphltir Vincent's angina Coxsackie A9. BI S, ECHO (m ltiplo tyjxis) Erterawrus VHorpossimplex 12 1,2 acyclovir- qO Vincent's angina (anaeiobes spirochetes) Antibacterial agents nol indicated, but lot HSV- -. 10 days Antitoxin erythro 24-25 rng pei kg IV q12h times 7 14 days WAC 35 717, (995)1 re benzyl per 50,000 units i kg pel day limes 5 days, then VK 50 mgpoi k pei day limes 5 days Pen G 4 irticflunitsIV' ICIinda 600nigiv'qSli q4h iphtherl ccurs*lmmmiiri d individu is Antibiotics...

Or

Du'l' J' in lootncte 1. rvi.vxxis page For sovaety iH pis. antibiotic m is complementary lo adequate bdiary drainage 15-30 pts Mil lequire deconpression surgical, percutaneous or ERCP-placed stent Whether empirical rx should always oovor pseudomonas & anaerobes is uncertain (CID 19 279. 1994) Ceftriaxone associated with biliary sludge (by ultrasound 50 . symptomatic 9 . NEJM 3221821. 1990) clinical relevance still unclear Iml lias lixl In surgery (MM W 42 39. '9931_

Ccb

It no abscess, increased frequency ol mating may hasten tesponse. no risk to intant Corynebaclotium sp assoc with cFvomc granulomatous moslilis (CID 35 M3J, 20021 Botlonolla henselae inlection iepo< lod O0 4 Gyii 95 1027, 2000) With abscess, d c nursing l& D standard, noodle aspiration reportod successful (Am J Surg 182 117. 2001) Resume breast loodmg lioni altectvd breast as soon aspamatows S aweus loss olten Back*-okIos sp. peplosJicplococ-cus. & selected coagiiose-neq staphylococci...

Heart

IChlamycta pneumoniae INewnamo Chlomydoplula pneumoniae Re JAMA 290 1459 i ISIS, 2003 NOTE Diagnostic entena dude ewdonco ol continuous bacteremia (m ltiplo positive Mood allures), now miamui (wotsetvig (i old murmi ) ol valvular msutlioency. detmrtoemboli. and ochocnr< iogi )tilc (liansthotaoc01 liansosophagoall evKtoncoo( valvuiai vogotatioris Rets Circulation III 3167, 2005, Ln 363 139, 2004 Vatvliur or congenita fXKirt disease inducing mitral valve prolapse bul no modtytng orcumstances...

Orugdosage

Prevention of Influenza A & B give vaccine and it 213 yts age. consider osoltamMr 75 frig po q24h lot duration ol peak influenza m community ot 1 outbreak conttol in high-risk populations (CID 39 459. 2004) (Considor loi srinilar populations as immunization locommendations I Prevention of influenza A give vaccine followed by rimantadine or amantadine (dosages as above) for duration ot influenza A activity in community or lor outbreak conltol in high-risk populations (CIO 39 459, 2004)...

Cid 35 1191 2002

Postexposure prophylaxis Valacydnvit 1 gm p< i g8'i times 14 days i t acyclovii 800 mgpo 5 trmos pet day times 14 days Treatment ol disease ') CNS symptoms abser* Acydanr 12 5-15 mg pel kg IV q8h ol ganadovii 5 mg pet kg IV q12h (2) CNS symptoms present GanackMi 5 mg per kg IV q12h Fatal human coses ol myelitis and hemorthagic enceptialilis tiavo he n teporled lollowing txtes saatdies. in eye inoculation ol saliva liom monkeys initial fix include (ever. Iieadache. myalgias and ilittuse...

Systemic Febrile Syndromes

FLEA, or LICE (CID 29 888, < 999) Epidemiologic histow crucial Babesiosis, Lyme disease, & granulocytic Ehrlichiosis liave same Do not Ireat it asymptomatic, young, has spleen, and immunocompetent Bartonella Elections CID 35 684. 2002 Etiol. B microti et al Vector Usually Ixodes ticks Host Wlnte-looled mouse & others (Atovaquone 750 mg po q 2h) + azithro 500 mg po day 1. thon 250 mg per day) limos 7 days OR Clinda 1 2 gm IV bid or 600 mg po lid llmes 7 days '...

Primaryalternative

Pft6T620A SfTRAINTCSTlNAL < , el -- Malaria (Plasmodia spaciaa) NOTE CDC Malaria info-prophylaxis (877) 394-8747 treatment (770) 488-7788. Aftor hours 770-488-7100. Wobsites mrw.cdc.gov ncldoddpd, parasites, mslariadelault.htm www.who.inl health-topics malaria.htm. Prophylaxis Otugs plus personal protection screens, nets. 30 35 DEET skin repotenl (avoid 95 products in chkfton). permothnn spray on dottmg and nets (MM 128 931. 1996) For moas free ol ciilorotnane (CQ)-resistanl P lalo xvum...

Relapsing fever

Doxy 100 mg po bid Erythro 500 mg po qid ' In endemic area INew Yorkl high ut both adult licks and nymphs were oiritly inlecled wilh both HGE and B buigdorieri (NEJM 337 49. 1997) Abbreviations on page 2. NOTE All dosage recommendations are lor adults (unless otherwise indicated) and assume normal renal function SYSTEMIC FEBRILE SYNDROMES Spread by intectM TICK. FLEA or LICE (ccntmx.fl) Rickettsial diseases. Review Disease in travelers (CID 39 MM. 2004) IAJTMH 63.21. 2000 ArIM 163 769. 2003)...

Sppl Hi

Community-acqulred. not hoapltalized 1. FocusonS pneumo. ignore atypicals. & empha-si e hlgh doso amox or AM-CL 2. II no co-mort*kty, locus on alypeals & nmphasize macrolides ihat aro r> active vs ma oti1y ol S pneumo 3. Focus on bolh S pneumo & atypcals by combaxng hlgh doao amox + a macrolldo OR suqgeslmg a rospiratory FO OR tetlthromycin Community-acqulred. hos pitalizod NOT in the ICU Empiric therapy S. pneumo resistance data TRUST8-2003-2004) Penicillin high kivel 18...

Abbreviations Of Journal Titles

Dig Dis Set Digestive Diseases and Sciences DMID Diagnostic Microbiology and Inlectious Disease EID Emurutng Inlectious Diseases EJCMID European Jomnal ol Clin Micro & Inlectious Diseases Eur J Neurol European Journal ol Neurology Exp Mol Path Experimental & Molecular Pathology ICHE Inleclion Control and Hospllal Epidemiology IDC No. Am Inleclious Disease Clinics ol North America IDCP Inlectious Diseases in Clinical Practice IJAA international Journal ol Antimicrobial Agents Int Med...

Ear

'Swimmer's oai PIDJ 22 299. 2003 Psoudomonas sp. Entaro-bactenacoae. Ptoteus sp (Fungi hue) Acute inleclion usually S autuus Eardiopi Oftox 0.3 soln bid IX polymyxin B + neomycin hydrocortisone iid or CIP + hydrocortisone bid For oculn disease dicloxacillin 500 mg po 4 nines per day Rx should include gentle cleaning Recuironces prevented (or decreased) by drying with alcohol drops (1 3 white vinegar, 2 3 rubbing alcoliol) alter swimming then antibiotic drops ot 2 acetic add solution Ointments...

Sinuses Paranasal

Sinusitis, acute current terminology acute rhinosinusltls Obstruction of sinus oatia viral Infection, allergens Rols Ototaryn-HeiM 4 Neck Surgery 130 Sf. 2004 MM f 34 495 4 498. 200 For rtanovirus inlections (common cdd). soo Tank) 14 page > 13 Strep pneumotxae 3t . H mlkawae 21 . M catarrhal 2 . Group A strep 2 . anaerobes 6 . viruses 15 . Staph aixeus 4 By CT scans, sinus mucosa inflamed in 87 ot viral URIa only 2 develop bacterial rhlnosinusltis Reserve antibiotic rx for pts given...

Associated with chronic ambulatory poritonoal dialysis

(defined as > 100 WBC pot mcL. > 50 PMNs) Staph aiveus (most common) Staph epidermis P aeruanosa 7 . Gm-neg bacilli 11 . sterile 20 , M lortuitiffn (faro) II ol moderate seventy, can re by addng drug lo dulysis Itud soe TaWe 17 for dosage Reasonable empiric combinations vaneo ceftazidime) - vaneo APAG) It severely if, re with same drugs IV (.td usl iloso lor lenal lalure. Table 17) & via addition totkalysis (luid fxceHun.' tot Pent D< atysislnt 13 14. 1993_ For rfctgnons concentiale...

Therapeutic Options

Vaneo sltofVfjentamion IMIC > 500 mcdPerac.lim G or AMP (system* mlections) pet mL) amase neo (JAC 40 161, .1997 Pcn ciiiin ( -iaet m ) produc is) Nttrol *anion (oslomydn (UTI only) Usudly Non BL-r strains ot E taecaks resistant lo penicillin and AMP described m Spain, but unknown (excopt BL strains) in U S and elsewhere (AAC 40 2420. 1996) Linezolid eltect.ve m60 70* ol cases (AnIM 138135 20031 Daptomyon. tiyecydino activo in vitio JAC 52 123. 123. 2003 .Appear susceptible to AMP ar w citlin...

Cefotaxime Iamp

Subdural umpyoma In adult 60 90 aro extension ol sinusitis or otitis media R same as primary bran abscoss Surmcal omorgoncy must dram (CID 20 372. 1995) Horpes EOTipiox. arboviruses. tobies Wesl N< o v us Rarely listeria. cal-scratch cfcsoase Stan IV acyclovir while awaiting tesiits ol CSF PCR lor H sxnpta Newly tocogiwod strain ol bat rataes May not toquae a broak m tho skin Eastern equne encephalitis causes local MRI ciianges m basal ganglia and thalamus (IJEJM 336 1867. 1997) Cat saalch...

Plus

LAzithro i gm po times 1) or (doxy lOOmg poq 2h limes 7 days)J Treat lor both GC and C. trachomatis. Screen lot yplvlis Other allornalM's lot GC Spectmomycm 2 gm IM times 1 Oilier single-dose cephalosporins celtizoxime 500 mg IM. celotaxime 500 mg IM, cefoxitin 2 gm IM + probenecid I gm po Azilhro 1 gm po xl effective lor chlamydia but neod 2 gm po for GC nol recommended lor GC due to Gl slde-etlects and expense FO resistance rels MMWR 53 335, 2004. CID 38 643. 2004. BID 11 1009. 2005 NOTE Duo...

On Which Diseases Tryitra 200mg Used

(A israelii most common also A naeslundn. A viscosus. A odontolyticus, A meyeri, A geiencsenae) Cervicofacial, pulmonary, abdominal, cerebral. & rarely pericarditis (IDCP 12 233. 2004) Classically abdominal aclino presents as inloiabdominal or pubic mass abscess, fistula Itacl (Dis Catvi Rectum 48 575, 2005) years alter surgery & may mimic cancer (World J Gaslto 11 1722. 2005). Fino needle aspuale ot ceivicolacial actino established dx in 15 pts in Spain JMed Oral Pal ol Oral Ciro Bucal 9...

Tccl Piptz

TMP-SMX and AMP (resistance common in Middle East. Latin America) Azithro ref AnlM '26 697. 1997 P Ceph t vapcomycin. teicoplanin1'. Clindamycin. dalbavancin ERTA, IMP, MER, BL'BLI. FQ. erythro. clarithro dirithromycin, azithro, telithro. quinu-dallo linezblid, dapto Staph, aureus, methicillin-resistant (healthcare associated) Teicoplanin'- . TMP-SMX (some strains rosistant), quinu-dalfo. Iinezolid. daptornycin. dalbavancin Fusidic acidM-' > 60 ClP-resistanl in US (Foslomycln + RIF),...

Penicillinaseresistant Penicillins

Cosl 500 mg G 0 20 Blood levels - 2 limes greater lhan cloxacillin Acute hemorrhagic cystitis reported Acute abdominal pain wilh Gl bleeding wiinoul antibiotic-associated colitis also reported Flucloxacillin' (Floxaperi, Lutiopn, Slaphcil) In Australia, cholestatic hepatitis women predominate, age > 65, rx mean 2 weeks, onset 3 weeks Irom starting rx (Ln 1-2 gm IV 1M q4h. Cost 2 gm IV 20 11 Extravasation can result in tissue necrosis With dosages ol 200-300 mg per kg...

Comments Adverse Effects

Hepatitis (continued) Ribavirin (Rebetol) Use with pegylaled interterons (alta-2a 4 2ti) lor treatment ol hepatitis C Available as 200 mg capsules Dose ' 75 kg BW 2 caps in a m 4 3 caps In p m . > 75 kg BW 3 leaps mam 4 3capslnpm Cost 200mgS1060 S )o oftecls as above, esp hemolytic anemia (dunng 1 1-2 wfcsolix) with Iwmogtotm I of 3 4 gm Sliould not be used with CiQ < 50 mL per mm 4 cautiously with cardiac Idaease Influenza A Amantadins (Symmetrel) or Rimantadine (Flumadine) Influenza A...

Tig

1 Td Tetanus & diphtheria toxoids adsorbed (adult) TIG Tetanus immune globulin (human) 3 Yes il wound > 24 hours old For children < 7 years. DPT (DT if pertussis vaccine contraindicated) For persons 7 years, Td preferred to tetanus toxoid alone 3 Yes if > 5 years since last booster 4 Yes if > 10 years since last booster From MMWR 39 37. 1990 MMWR 46(SS-2) 15. 1997 TABLE 20D 2 RABIES POST-EXPOSURE PROPHYLAXIS'. All wounds should be cleaned Immediately and thoroughly with aoap and...

Drug Dosage

Hepatitis Viral Infoctions (i orHinuod) Hepatitla B Acute INo therapy recommended Most common cause of death lioni acute Impatilis in Uniy (Dig Lrvry Dis 35 404, 2003) Screon lor HIV Goal of rx I ft ) inflammation, slop pnxjtession ol cnthosis & ptevont hopato-cellular carcinoma For all drugs listed. ideal response I plasma I IB DMA to 20 000 copiestoil. N'oimal ALT AST HBsAg lo ami Has HBeAn to anti-HBc- Comblnation re e.u . PEG .ilta-2a + LAV lisappoiritinn (NEJM 352 26. 3005. ArllM...

Adverse Effects

Transcriptase Inhibitors (NNRTI) (boninued) Most common CNS Ids aWaula 62 symptoms include rfczanoss. insomnia, somnolence. enpoiod concwtmtion psyctulnc sx. and abnormal dflams, symptoms ate worse atla 1-or dose and anprrMi m 2 4 wiHSts. d-scortinuntKin ra1e2 6 Rash 26 . Snproves Willi rxnl isililaslamines. rkscontmurition tale 1 7 Can cause latse-positive in no tesl lesutts lor cannabirxxd with CcDlA DAU ttiulli-lovol THC assay Most significant Serious rnxxopsychtoinc symptoms, inducing...

Ftx On Sulbactam

TABLE 22C DRUG-DRUG INTERACTIONS BETWEEN NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS NNRTla AND PROTEASE INHIBITORS. TABLE 22C DRUG-DRUG INTERACTIONS BETWEEN NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS NNRTla AND PROTEASE INHIBITORS. IDV levels T 40 Dose IDV 600 mg q8h. DLV standard NFV levels T 2X. DLV levels i 50 Dose No dala Levels ol RTV T 70 Dose DLV standard. RTV no dala SOV levels T5X Dose SQV 800 mg lid. DLV standard ATV AUC i 74 Dose EFZ standard. ATA RTV 300 100 mg q24h with...

Si3

More stable vs staphylococcal Wactamaso than celazolin 3rd Generation, Parenteral Use ol P Ceph 3 drugs correlates with incidence ol C dillicile toxin diarrhea, perhaps due to cephalosporin resistance ol C dilticile ICID 38 646. 2004 3rd Generation, Parenteral Use ol P Ceph 3 drugs correlates with incidence ol C dillicile toxin diarrhea, perhaps due to cephalosporin resistance ol C dilticile ICID 38 646. 2004 Cefoperazone-sulbactam1 J Sutler azpn Celtizoxime jCeii ox Ceftriaxone Rocephin Usual...

Adverse Effects Comments

Consists pi vesicisaf Way. li gt isuriK- with ampiiri H mtoicalatod within the membrane Dosage 3-5 ma per kg per day iVas smijl d w .iitused ver a period crt approx 120mm II well tolerated. lnlu9ion time can bo reduced lo 60 min sou lootnoto 3. page BJ 1 mg por kg per day was as effective as 4 --------- ---- - transplant and or neutropenia imphotericin B colloidal dispersion, BCD, Amphotec j 4 mg gt ei kg pel day as single inlusion 100 mg 160 25.6 , i Mg 20 4 vs 25 6 Aculo...

Index

DRUG NAME ABBREVIATIONS Antibacterial amp Antimycobactorlal Drugs AM-CL-ER amoxiallln-clavulanate extended lelease AP Pen anlipseudomonal penicillins APAG anlipseudomonal aminoglycoside lobia genl, BUBLI bola-laclam tMlalactamaso inhibitor CIP ciprofloxacin, CIP-ER - CIP extended rnlenso Clartthro clarithromycin ER .'xterided release FO tluoroqulnolone CIP Otlox. Lome. Pellox. Lavo. Gati. IVIG - intravenous immune globulin Lovo levofloxacin Lome lomefloxacln Macrotides azilhro. clanthro....