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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Empiric antibiotic selection in patients with impaired splenic function and fever and/or sepsis*

Empiric antibiotic selection in patients with impaired splenic function and fever and/or sepsis*
  Standard regimen Cephalosporin allergy or intoleranceΔ
Adults

Vancomycin: Administer an initial loading dose (25 to 30 mg/kg, rounded to the nearest 250 mg increment) then give 15 to 20 mg/kg IV every 8 to 12 hours (maximum 2 g per dose or a total daily dose of 60 mg/kg initially)◊

PLUS either:

Ceftriaxone: 2 g IV every 12 hours

OR

Cefotaxime: 2 g IV every 4 to 6 hours

Vancomycin: Administer an initial loading dose (25 to 30 mg/kg, rounded to the nearest 250 mg increment) then give 15 to 20 mg/kg IV every 8 to 12 hours (maximum 2 g per dose or a total daily dose of 60 mg/kg initially)◊

PLUS either:

Moxifloxacin: 400 mg IV every 24 hours§

OR

Meropenem: 2 g IV every 8 hours§
Children

Vancomycin: 15 mg/kg IV every 6 hours (maximum 2 g per dose, initially)

PLUS either:

Ceftriaxone: 50 mg/kg IV every 12 hours (maximum 2 g per dose)

OR

Cefotaxime: 75 mg/kg IV every 6 hours or 50 mg/kg IV every 4 hours (maximum 2 g per dose and 12 g per day)

Vancomycin: 15 mg/kg per IV every 6 hours (maximum 2 g per dose, initially)

PLUS either:

Levofloxacin§:

≥6 months old and <50 kg: 10 mg/kg IV every 12 hours (maximum 375 mg per dose)

≥50 kg: 750 mg IV every 24 hours (maximum 750 mg per day)

OR

Meropenem: 40 mg/kg IV every 8 hours (maximum 2 g per dose)§
This table should be used in conjunction with the UpToDate topic on clinical features, evaluation, and management of fever in patients with impaired splenic function. The doses in this table are intended for patients with normal renal function. The doses of many of these agents must be adjusted in the setting of renal insufficiency; refer to the Lexicomp drug-specific monographs for renal dose adjustments.
IV: intravenously.
* Modifications to these regimens may be needed based on suspected source of infection, exposure history, risk for multidrug-resistant pathogens, renal dysfunction, and other patient-specific factors.
¶ For most adults with suspected bacterial meningitis, we give adjunctive dexamethasone. The decision to use adjunctive dexamethasone in children is individualized. For selected patients, we also give adjunctive intravenous immunoglobulin.
Δ Following the first dose of antibiotics, we generally consult an allergist to determine whether the patient can be transitioned to a cephalosporin.
◊ The vancomycin dose should be adjusted to achieve a trough concentration of 15 to 20 mcg/mL for adults.
§ Meropenem is an alternative to fluoroquinolones for adults and children who have a history of mild, delayed reactions to cephalosporins or immunoglobulin E-mediated reactions to penicillin or cephalosporins. Meropenem is preferred by some experts, particularly for patients with meningitis and/or severe sepsis, because the likelihood of cross-reactivity is low.
References for pediatric dosing:
  1. American Academy of Pediatrics. Tables of antibacterial drug dosages. In: Red Book: 2018 report of the Committee on Infectious Diseases, 31st ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Itaska, IL 2018. p.914.
  2. American Academy of Pediatrics. Flouroquinolones. In: Red Book: 2018 report of the Committee on Infectious Diseases, 31st ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Itaska, IL 2018. p.904.
  3. Jackson MA, Schutze GE, Committee on Infectious Diseases. The use of systemic and topical fluoroquinolones. Pediatrics 2016; 138:e20162706.
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