Infection |
Bugs |
Drugs |
Meningitis* |
S. pneumoniae N. Meningitidis, H. influenzae Listeria |
Ceftriaxone + vancomycin +/- ampicillin |
If post-op |
Staphylococcus sp. Gram negative rods (GNR) |
Ceftazidime + vancomycin |
Ventriculitis due to an infected VP shunt |
S. epidermidis S. aureus Coliforms$ Diphtheroids P. acnes |
Vancomycin + rifampin |
Encephalitis (viral) |
Herpes simplex virus Varicella zoster virus West Nile virus |
Acyclovir |
Sinusitis |
S. pneumoniae |
Amoxicillin or Augmentin (if prior antibiotic exposure) |
Mastoiditis |
M. catarrhalis Staphylococcus sp. |
Ceftriaxone +/- vancomycin |
Pharyngitis |
Group A, C, G streptococcus |
Penicillin |
N. gonorrhoea |
Ceftriaxone (IM) + treat for Chlamydia with azithromycin OR doxycycline |
|
Retropharyngeal/neck abscess |
Streptococcus sp. Oral anaerobes |
Clindamycin |
Pneumonia |
||
Community-acquired |
S. pneumoniae H. influenzae Chlamydia Mycoplasma Legionella |
Levaquin OR Ceftriaxone + azithromycin |
Hospital-acquired (48 hours) |
S. pneumoniae S. aureus Enteric GNR (i.e. klebsiella) |
Levaquin + Zosyn OR Ceftriaxone/ceftazidime + vancomycin +/- gentamicin |
Ventilator-associated (48-72 hours) |
P. aeruginosa MRSA Acinetobacter Multidrug resistant GNR Stenotrophomonas |
Imipenem + levofloxacin +/- (vancomycin OR linezolid if suspect MRSA) |
Pneumonitis |
PCP Cytomegalovirus |
High-dose Bactrim OR High-dose Ganciclovir |
Endocarditis |
S. aureus (MRSA) Viridans streptococcus Enterococcus Coagulase-negative staph Enteric GNR |
Blood cultures first! Vancomycin + gentamicin + rifampin (if valve) |
Candida |
Caspofungin |
|
Line Infections |
Coagulase-negative staph S. aureus |
Vancomycin |
Neutropenic Fever |
Enteric GNR P. aeruginosa Staphylococcus sp. Viridans streptococcus |
(Ceftazidime +/- gentamicin) OR Imipenem/Zosyn/Cefepime +/- vancomycin (if possible line infection) |
Sepsis |
Enteric GNR P. aeruginosa Staphylococcus sp. Viridans streptococcus |
Ceftriaxone + gentamicin + metronidazole |
Diarrhea |
Campylobacter E. coli Salmonella Shigella Giardia C. difficile |
Mild to moderate diarrhea®no antibiotics! Severe diarrhea use ciprofloxacin and/or metronidazole (if C. difficile suspected) |
Diverticulitis |
Enteric GNR Anaerobes Enterococcus sp. |
Ciprofloxacin + metronidazole (outpatient) Zosyn OR imipenem (inpatient) |
Biliary Sepsis |
Enteric GNR Anaerobes Enterococcus sp. |
(Ceftriaxone + metronidazole) OR Zosyn |
Spontaneous Bacterial Peritonitis (SBP) |
Enteric GNR Streptococcus sp. Enterococcus sp. |
Ceftriaxone (Prevention of SBP with Bactrim 5 days per week or weekly ciprofloxacin) |
Cystitis |
Enteric GNR Enterococcus sp. S. saprophyticus |
Ciprofloxacin Cephalexin Cefpodoxime |
Pyelonephritis |
Enteric GNR Enterococcus sp. S. saprophyticus |
(Ceftriaxone + gentamicin) OR (ampicillin + gentamicin) |
STD |
N. gonorrhoea C. trachomatis |
Ceftriaxone (IM) Azithromycin OR doxycycline |
Cellulitis |
S. aureus Streptococcus sp. |
Cefazolin (IV), cephalexin (PO) |
Boils, Furuncles, Spider bites |
MRSA |
Vancomycin Bactrim Doxycycline Rifampin Linezolid |
Diabetic Foot |
Mixed flora: MSSA/MRSA Enteric GNR Anaerobes |
Augmentin Ceftriaxone + metronidazole +/- vancomycin |
Necrotizing Fasciitis |
Streptococcus sp. S. aureus Clostridium Anaerobes |
Imipenem OR Penicillin + clindamycin + (fluoroquinolone OR 3rd generation cephalosporin OR aminoglycoside) Consider IVIG & Xigris |
Osteomyelitis |
MSSA/MRSA |
Oxacillin OR vancomycin |
with diabetic foot |
Enteric GNR Anaerobes P. aeruginosa |
(Oxacillin OR vancomycin) + metronidazole and ceftriaxone |
with hardware |
Enteric GNR Anaerobes P. aeruginosa Coagulase-negative staph |
Vancomycin + cefotaxime |
*Dexamethasone (N Engl J Med 2002;347:1549) $Coliforms include Escherichia, Enterobacter, Klebsiella, Citrobacter |
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