Version June 2024
| Nonpregnant adults¶ | Children and adolescent (age ≥1 month through 17 years) |
| First bactericidal agent: | |
| Preferred: | |
| 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 | Levofloxacin
|
| Moxifloxacin 400 mg every 24 hours | Moxifloxacin
|
| PLUS | |
| Second bactericidal agent: | |
| Preferred for all strains, regardless of penicillin susceptibility or if susceptibility is unknown: | |
| Meropenem 2 g every 8 hours | Meropenem 120 mg/kg per day divided every 8 hours, not to exceed 2 g per dose |
| Alternatives if meropenem is unavailable or contraindicated, in order of preference: | |
| Imipenem 1 g every 6 hoursΔ | 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 grams per dose; maintain serum trough concentration of 15 to 20 mcg/mL | |
| Alternatives for penicillin-susceptible or ampicillin-susceptible strains◊: | |
| Penicillin G 4 million units every 4 hours OR | Penicillin G 400,000 units/kg per day divided every 4 hours, not to exceed 4 million units per dose OR |
| Ampicillin 3 g every 6 hours | Ampicillin 400 mg/kg per day divided every 6 hours, not to exceed 3 g per dose |
| PLUS | |
| Protein synthesis inhibitor (preferred): | |
| Linezolid 600 mg every 12 hours§ | Linezolid§
|
| Alternatives if linezolid unavailable or contraindicated, in order of preference: | |
| Clindamycin 900 mg every 8 hours OR | Clindamycin 40 mg/kg per day divided every 8 hours, not to exceed 900 mg per dose OR |
| Rifampin 600 mg every 12 hours¥ OR | Rifampin 20 mg/kg per day divided every 12 hours, not to exceed 300 mg per dose¥ OR |
| Chloramphenicol 1 g every 6 to 8 hours‡ | Chloramphenicol 100 mg/kg per day divided every 6 hours, not to exceed 1 g per dose‡ |
MIC: minimum inhibitory concentration; 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 requires 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 they (linezolid, clindamycin) cannot be given. It has not been evaluated for B. anthracis.
‡ Because of toxicity concerns, chloramphenicol should only be used if other options are not available.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
