Immunocompromised antibiotics

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

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
  • 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:
  • 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
• 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)