Diferencia entre revisiones de «Immunocompromised antibiotics»
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==[[CMV pneumonia]]== | ==[[CMV pneumonia]]== | ||
{{CMV pneumonia treatment}} | {{CMV pneumonia treatment}} | ||
==[[Cryptococcus]]== | |||
{{Cryptococcus Pneumonia}} | |||
{{Cryptococcus Meningitis}} | |||
Revisión del 14:33 4 may 2015
CMV Retinitis
====Severe Vision Threatening==== *Ganciclovir intraocular implant for 8 months AND
- Valganciclovir 900mg PO q12hrs x 14 days then 900mg PO q24hrs x 7 days
====Peripheral lesions==== *Valganciclovir 900mg PO q12hrs x 21 days then 900mg PO q24hrs x 7 days
CMV esophagitis
- Ganciclovir 5mg/kg IV q12hrs x 21 days
- Foscarnet 90mg/kg IV q12hrs x 21 days
CMV colitis
- Ganciclovir 5mg/kg IV q12hrs x 21 days
- Foscarnet 90mg/kg IV q12hrs x 21 days
CMV neurologic disease
- Ganciclovir 5mg/kg IV q12hrs x 21 days then 5mg/kg IV q24hrs +
- Foscarnet 90mg/kg IV q12hrs x 21 days then 90-120mg/kg IV q24hrs
CMV pneumonia
- Ganciclovir 5mg/kg IV q12hrs x 3 weeks
Cryptococcus
Pulmonary (not AIDS associated)
- Fluconazole 400mg PO/IV q24hrs x 6-12 months OR
- Itraconazole 200mg PO q12hrs x 6-12 months OR
- Voriconazole 200mg PO q12hrs x 6-12 months
Pulmonary (with AIDS)
- Fluconazole 400mg PO q24hrs x 6-12 months
Meningitis (not AIDs associated)
- Amphotericin B 0.7-1mg/kg IV q24hrs AND Flucytosine 25mg/kg PO q6hrs x 4 weeks
- Followed by Fluconazole 400mg PO q24hrs x 8 weeks
Meningitis (with AIDS)
- Amphotericin B 0.7-1mg/kg IV q24hrs AND Flucytosine 25mg/kg PO q6hrs x 2 weeks
- Followed by Fluconazole 400mg PO q24hrs x 8 weeks
- Initiation of HAART is delayed by 2 to 10 weeks to minimize the risk of immune reconstitution syndrome
Pediatric Cryptococcal Meningitis
- Amphotericin B 0.7-1mg/kg IV daily x 2-4 weeks + Flucytosine 25mg/kg PO q6hrs
- Followed by Fluconazole 6-12mg/kg PO daily x 8 weeks (max 400mg)
Neutropenic Fever
Therapy is aimed at treating multiple flora that include Gram Negatives, Gram Positive Bacteria, Pseudomonas and if there is an indwelling catheter or high risk, then MRSA.
Inpatient
- Monotherapy appears to be as good as dual-drug therapy[1]
- Cefepime 2g IV q8hrs or Ceftazidime 2g IV q8hrs OR
- Imipenem/Cilastatin 1g IV q8hrs or Meropenem 1g IV q8hrs OR
- Piperacillin/Tazobactam 4.5g IV q6hrs
- Consider adding Vancomycin to above regimen for:[2]
- Severe mucositis
- Signs of catheter site infection
- Fluoroquinolone prophylaxis was recently used against gram-negative bacteremia
- Hypotension is present
- Institutions with hospital-associated MRSA
- Patient has known colonization with resistant gram-positive organisms
Outpatient
- Ciprofloxacin 750mg PO q12hrs AND Amoxicillin/Clavulanate 875mg PO q12hrs x 7 days OR[1]
- Ciprofloxacin 750mg PO q12hrs AND Clindamycin 450mg PO q8hrs
Pediatric Inpatient
- Cefepime 50mg/kg IV q8hrs (max 2g) OR
- Meropenem 20mg/kg IV q8hrs (max 1g) OR
- Piperacillin/Tazobactam 80-100mg/kg IV q6-8hrs (max 4.5g)
- Add Vancomycin 15mg/kg IV q6hrs for same indications as adults
See Also
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
References
- ↑ 1.0 1.1 Friefeld AG et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the IDSA. Clin Infect Dis. 2011; 52(4):e56-93 fulltext
- ↑ Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clinical Infectious Disease 2002; 34:730-751