Version June 2024
| Nonpregnant adults¶ | Children and adolescents (age ≥1 month through 17 years) |
| A bactericidal agent: | |
| Preferred for all strains, regardless of penicillin susceptibility or if susceptibility is unknown: | |
| Ciprofloxacin 400 mg every 8 hours | Ciprofloxacin 30 mg/kg per day divided every 8 hours, not to exceed 400 mg per dose |
| Alternatives if ciprofloxacin is unavailable or contraindicated, in order of preference: | |
| Levofloxacin 750 mg every 24 hours OR | Meropenem 60 mg/kg per day divided every 8 hours, not to exceed 2 g per dose OR |
| Moxifloxacin 400 mg every 24 hours OR | Levofloxacin
|
| Meropenem 2 g every 8 hours OR | |
| Imipenem 1 g every 6 hoursΔ OR | Imipenem 100 mg/kg per day divided every 6 hours, not to exceed 1 g per doseΔ OR |
| Vancomycin 60 mg/kg per day divided every 8 hours, not to exceed 2 g per dose; maintain serum trough concentration of 15 to 20 mcg/mL | Vancomycin 60 mg/kg per day divided every 8 hours, not to exceed 2 g per dose; maintain serum trough concentration of 15 to 20 mcg/mL |
| Alternatives for penicillin-susceptible or ampicillin-susceptible strains◊: | |
| Preferred: | |
| Penicillin G 4 million units every 4 hours | Penicillin G 400,000 units/kg per day divided every 4 hours, not to exceed 4 million units per dose |
| Alternative: | |
| Ampicillin 3 g every 6 hours | Ampicillin 200 mg/kg per day divided every 6 hours, not to exceed 3 g per dose |
| PLUS | |
| A protein synthesis inhibitor: | |
| Preferred: | |
| Clindamycin 900 mg every 8 hours OR | Clindamycin 40 mg/kg per day divided every 8 hours, not to exceed 900 mg/dose OR |
| Linezolid 600 mg every 12 hours§ | |
| Alternatives if clindamycin and linezolid (for adults) or clindamycin (for children) are unavailable or contraindicated, in order of preference: | |
| Doxycycline 200 mg loading dose, then 100 mg every 12 hours OR | Linezolid (non-CNS infection dose)§
|
| Rifampin 600 mg every 12 hours¥ | Doxycycline‡
|
| Rifampin 20 mg/kg per day divided every 12 hours, not to exceed 300 mg/dose¥ | |
CNS: central nervous system; IV: intravenous; PEP: postexposure prophylaxis.
* The doses recommended above are intended for patients with normal renal function; the doses of some of these agents must be adjusted in patients with renal insufficiency.
¶ The treatment of pregnant, postpartum, and lactating individuals is similar to that for nonpregnant adults, except that ciprofloxacin is strongly preferred as the bactericidal agent because it crosses the placenta. If ciprofloxacin cannot be used, the regimen should include at least one other agent with transplacental passage. In addition to ciprofloxacin, agents that cross the placenta include levofloxacin, moxifloxacin, ampicillin, penicillin, rifampin, and chloramphenicol (avoid use in third trimester). Imipenem crosses the placental barrier but safety for the fetus is not known. Doxycycline crosses the placental barrier but should be used with caution in pregnancy.
Pharmacokinetic data suggest that ciprofloxacin, penicillin, ampicillin, and carbapenems may require higher doses in pregnant and postpartum women than those recommended for nonpregnant adults. Consult a clinical pharmacist, if available, for guidance on dosing during pregnancy.
Δ Imipenem is associated with an increased risk of seizures.
◊ Penicillin-based antimicrobial drug use warrants a high index of suspicion for emergence of resistance.
§ Linezolid should be used with caution in patients with thrombocytopenia because it might exacerbate it. Linezolid use for >14 days has additional bone marrow toxicity.
¥ Rifampin is not a protein synthesis inhibitor. However, it may be used as an alternative agent based on its in vitro synergy for staphylococci in place of a protein synthesis inhibitor if linezolid and clindamycin cannot be given. Rifampin has not been evaluated for B. anthracis.
‡ A single 10- to 14-day course of doxycycline is not routinely associated with tooth staining.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
