Version June 2024
| Antibiotic | Adults | Children and infants >28 days old[1] |
| Preferred regimens include: | ||
| Monotherapy with a beta-lactam/beta-lactamase inhibitor, such as one of the following: | ||
| Ampicillin-sulbactam | 3 g every 6 hours | 50 mg/kg (based on ampicillin component; maximum 2 g per dose) every 6 hours |
| Piperacillin-tazobactam | 3.375 g every 6 to 8 hours | 100 mg/kg (based on piperacillin component; maximum 3 g per dose) every 8 hours |
| or | ||
| A third-generation cephalosporin, such as: | ||
| Ceftriaxone | 1 g every 12 hours or 2 g every 24 hours | 50 to 75 mg/kg every 24 hours or 50 mg/kg every 12 hours (maximum 1 g per dose) |
| plus | ||
| One of the following agents with anaerobic activity: | ||
| Metronidazole | 500 mg every 8 hours | 10 mg/kg every 8 hours (maximum 500 mg per dose) |
| Clindamycin*¶ | 600 mg every 6 to 8 hours | 10 to 13 mg/kg every 8 hours (maximum 900 mg per dose) |
| Alternative regimens include: | ||
| A fluoroquinolone, such as one of the following: | ||
| CiprofloxacinΔ | 400 mg every 12 hours | Use with caution in children <18 years of age:◊
|
| LevofloxacinΔ | 750 mg daily | Use with caution in children <18 years of age:◊
|
| plus | ||
| One of the following agents with anaerobic activity: | ||
| Metronidazole | 500 mg every 8 hours | 10 mg/kg every 8 hours (maximum 500 mg per dose) |
| Clindamycin*¶ | 600 mg every 6 to 8 hours | 10 to 13 mg/kg every 8 hours (maximum 900 mg per dose) |
| or | ||
| Monotherapy with a carbapenem, such as one of the following: | ||
| Imipenem-cilastatin | 500 mg every 6 hours | 15 to 25 mg/kg every 6 hours (maximum 500 mg per dose) |
| Meropenem | 1 g every 8 hours | 20 mg/kg every 8 hours (maximum 1 g per dose) |
| Ertapenem | 1 g daily | Children <13 years old: 15 mg/kg every 12 hours (maximum 500 mg per dose) Children ≥13 years old: 1 g daily |
| or | ||
| Monotherapy with a fluoroquinolone: | ||
| Moxifloxacinħ | 400 mg daily | Not recommended; insufficient experience |
MRSA: methicillin-resistant Staphylococcus aureus.
* We generally avoid clindamycin, if possible, due to risk for Clostridium difficile infection and the possibility of streptococcal and staphylococcal resistance (refer to UpToDate content for details).
¶ Clindamycin may also be active against MRSA; if it is used for MRSA, confirm susceptibility.
Δ In general, fluoroquinolones should be reserved for when other regimens are not options. If used, patients should be advised about the uncommon but potentially serious musculoskeletal, cardiac, and neurologic adverse effects associated with fluoroquinolones. Refer to UpToDate content for details.
◊ Use of fluoroquinolones in children should be limited to the treatment of infections for which no safe and effective alternative exists or in situations where oral therapy is a reasonable alternative to intravenous therapy with a different class of antibiotics.[1]
§ Moxifloxacin has good anaerobic activity and can be used as a monotherapy, but other options are preferable.[2]آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
