Page 921 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 51 Clinical Use of Antimicrobial Agents 907

TABLE 51–1 Empiric antimicrobial therapy based on microbiologic etiology.

Suspected or Proven Disease or Pathogen Drugs of First Choice Alternative Drugs
Gram-negative cocci (aerobic)
3
1
Moraxella (Branhamella) catarrhalis TMP-SMZ, cephalosporin (second- Quinolone, macrolide 4
or third-generation) 2
Neisseria gonorrhoeae Ceftriaxone, cefixime Spectinomycin, azithromycin
Neisseria meningitidis Penicillin G Chloramphenicol, ceftriaxone, cefotaxime
Gram-negative rods (aerobic)
3
E coli, Klebsiella, Proteus Cephalosporin (first- or second- Quinolone, aminoglycoside 5
2
generation), TMP-SMZ 1
7
5
1
3
Enterobacter, Citrobacter, Serratia TMP-SMZ, quinolone, carbapenem 6 Antipseudomonal penicillin, aminoglycoside, cefepime
1
Shigella Quinolone 3 TMP-SMZ, ampicillin, azithromycin, ceftriaxone
3
Salmonella Quinolone, ceftriaxone Chloramphenicol, ampicillin, TMP-SMZ 1
Campylobacter jejuni Erythromycin or azithromycin Tetracycline, quinolone 3
5
Brucella species Doxycycline + rifampin or Chloramphenicol + aminoglycoside or TMP-SMZ 1
aminoglycoside 5
Helicobacter pylori Proton pump inhibitor + amoxicillin Bismuth + metronidazole + tetracycline + proton pump
+ clarithromycin inhibitor
3
Vibrio species Tetracycline Quinolone, TMP-SMZ 1
3
Pseudomonas aeruginosa Antipseudomonal penicillin + Antipseudomonal penicillin ± quinolone, cefepime,
6
aminoglycoside 5 ceftazidime, antipseudomonal carbapenem, or aztreonam ±
aminoglycoside 5
Burkholderia cepacia (formerly TMP-SMZ 1 Ceftazidime, chloramphenicol
Pseudomonas cepacia)
Stenotrophomonas maltophilia (formerly TMP-SMZ 1 Minocycline, ticarcillin-clavulanate, tigecycline, ceftazidime,
Xanthomonas maltophilia) quinolone 3
Legionella species Azithromycin or quinolone 3 Clarithromycin, erythromycin
Gram-positive cocci (aerobic)
3
Streptococcus pneumoniae Penicillin 8 Doxycycline, ceftriaxone, antipneumococcal quinolone,
4
macrolide, linezolid
Streptococcus pyogenes (group A) Penicillin, clindamycin Erythromycin, cephalosporin (first-generation) 2
5
Streptococcus agalactiae (group B) Penicillin (± aminoglycoside ) Vancomycin
2
Viridans streptococci Penicillin Cephalosporin (first- or third-generation), vancomycin
Staphylococcus aureus
2
β-Lactamase negative Penicillin Cephalosporin (first-generation), vancomycin
β-Lactamase positive Penicillinase-resistant penicillin 9 As above
1
Methicillin-resistant Vancomycin TMP-SMZ, minocycline, linezolid, daptomycin, tigecycline
Enterococcus species 10 Penicillin + aminoglycoside 5 Vancomycin + aminoglycoside 5
Gram-positive rods (aerobic)
3
Bacillus species (non-anthracis) Vancomycin Imipenem, quinolone, clindamycin
5
Listeria species Ampicillin (± aminoglycoside ) TMP-SMZ 1
Nocardia species Sulfadiazine, TMP-SMZ 1 Minocycline, imipenem, amikacin, linezolid
Anaerobic bacteria
6
Gram-positive (clostridia, Peptococcus, Penicillin, clindamycin Vancomycin, carbapenem, chloramphenicol
Actinomyces, Peptostreptococcus)
Clostridium difficile Metronidazole Vancomycin, bacitracin
6
Bacteroides fragilis Metronidazole Chloramphenicol, carbapenem, β-lactam—β-lactamase-
inhibitor combinations, clindamycin
Fusobacterium, Prevotella, Metronidazole, clindamycin, As for B fragilis
Porphyromonas penicillin
(Continued)