Antibiotic guide Update: 22/03/2006

Antibiotic guide
Update: 22/03/2006
Category
ABCDE-
III III -
Definition
Strength of recommendation
Good evidence to support a recommendation for use
Moderate evidence to support a recommendation for use
Poor evidence to support a recommendation for or against use
Moderate evidence to support a recommendation against use
Good evidence to support a recommendation against use
Quality of evidence
Evidence from at least one properly randomized, controlled trial
Evidence from at least one well-designed clinical trial without randomization, from cohort or casecontrolled analytic studies (preferably from more than one center), from multiple time-series studies,
or from dramatic results in uncontrolled experiments
Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or
reports of expert committees
Reference: Clin Infect Dis 1994 ;18 :421
o
o
o
o
o
1.1. Meningitis, meningo-encephalitis, brain abscess
 1.1.1. Community acquired purulent meningitis (non HIV)
 1.1.2. Community acquired non purulent meningitis (non HIV)
 1.1.3. Méningo-encephalitis
 1.1.4. Brain abscess
1.2. Urinary tract infections
 1.2.1. Acute urethritis
 1.2.2. Acute prostatitis
 1.2.3. Chronic bacterial prostatitis
 1.2.4. Pyelonephritis
1.3. Digestive infections
 1.3.1. Acute infectious diarrhea
 1.3.2. Mild community acquired peritonitis
 1.3.3. Severe community acquired peritonitis
 1.3.4. Cholecystitis, cholangitis
 1.3.5. Liver abscess
1.4. Skin and soft tissue infections
 1.4.1. Gangrene, necrotizing fasciitis, severe cellulitis in diabetes mellitus patients
 1.4.2. Superficial cellulitis, non complicated erysipelas (facial excluded)
 1.4.3. Facial cellulitis
1.5. Various infections
1.5.1. Community acquired septic shock (unknown origin, non neutropenic)
 1.5.2. Septic arthritis
 1.5.3. Bites (cat, dog, human)
 1.5.4. Venous catheter associated lymphangitis without bacteremia
 1.5.5. Peripheral and central venous catheter associated bacteremia
1.6. HEENT
 1.6.1. Pharyngitis
 1.6.2. Acute otitis media: first episode
 1.6.3. Acute otitis media: treatment failure at day-3
 1.6.4. Acute sinusitis
1.7. Respiratory infections
 1.7.1. Community acquired pneumonia: PORT severity index
 1.7.2. Community acquired pneumonia (Class I and II, non associated pleural effusion)
 1.7.3. Community acquired pneumonia (Class III to V, and any class with associated
pleural effusion)
 1.7.4. acute bacterial exacerbation of chronic bronchitis

o
o
o
o
1.8. Gynecologic infections
 1.8.1. Non suppurated primitive salpingitis
 1.8.2. Suppurated primitive salpingitis
1.9. Endocarditis
 1.9.1. Enterococcus spp., Streptococcus spp., HACEK and blood culture negative
endocarditis
1.9.2. Endocarditis: other
 1.9.3. Methicillin susceptible Staphylococcus aureus endocarditis
1.10. Vascular infections
 1.10.1. Vascular graft infections (vascular graft removed)
 1.10.2. Vascular graft infections (vascular graft not removed)
1.11. Diabetic foot infections
 1.11.1. Without associated osteomyelitis
 1.11.2. With associated polymicrobial osteomyelitis and no sepsis
 1.11.3. With associated polymicrobial osteomyelitis and sepsis
 1.11.4. With associated monomicrobial osteomyelitis

o
o
1.1. Meningitis, meningo-encephalitis, brain abscess
•
•
•
•
Community acquired purulent meningitis (non HIV)
Community acquired non purulent meningitis (non HIV)
Méningo-encephalitis
Brain abscess
1.1.1. Community acquired purulent meningitis
Etiologic agents: Streptococcus pneumoniae, Neisseria meningitidis, Listeria, Haemophilus influenzae
Empiric treatment for all Community acquired purulent meningitis (non HIV)
Treatment
Route and dosage
Ceftriaxone
Amoxicillin
2g X2/d IV
2g X6/d IV
15 mg/Kg, then 60 mg/Kg/d IV continuous.
Vancomycin
Target levels: 30 µg/ml
Strength of
recommendation
A
A
Quality of
evidence
III
III
A
III
Duration
Streptococcus pneumoniae
Treatment
Stop amoxicillin
Route and dosage
Strength of
recommendation
Quality of
evidence
Duration
AND CARRY ON
Ceftriaxone
Vancomycin. (stop if
susceptible to ceftriaxone))
2g X2/d
A
III
60 mg/Kg/d continuous..
Target levels: 30 µg/ml
A
III
10 to 14
days
Neisseria meningitidis
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Stop Amoxicillin
AND CARRY ON
Ceftriaxon
2g X2/d IV
A
II
7 days
Listeria
Treatment
Stop ceftriaxone
vancomycin
AND START
Amoxicillin
Gentamicin
Route and dosage
Strength of
recommendation
Quality of
evidence
2g X6/d IV
4,5mg/Kg/d IV
A
A
II
II
Duration
and
21 days
References:
1. Sanford guide to antimicrobial therapy 2004
2. Johns Hopkins University Division of Infectious Diseases antibiotic guide
1.1.2. Community acquired non purulent meningitis (non HIV)
Etiologic agents: Entérovirus, Listeria, leptospira
Treatment
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Amoxicilline (Clamoxyl®)
2g X6/j IV
B
III
7 days
Alternative treatment : (proven penicillin allergy)
Treatment
Route and dosage
Strength of
recommendation
Quality of
evidence
Duration
Triméthoprim/sulfaméthoxazole
15 à 20 mg/Kg/d IV
(triméthoprim) in 3 or 4
injection/d
B
III
7 days
Enterovirus
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Stop antibiotics
Human herpes virus
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Stop antibiotics and start
Acyclovir
10 mg/KgX3/d IV
14 à 21 days
1.1.3. Meningo-encephalitis
Etiologic agents: Herpes simplex, Listeria monocytogenes, Mycobacterium tuberculosis, Varicella zoster virus
Treatment
Treatment
Amoxicillin
Acyclovir
Rifampin
Isoniazid
Ethambutol
Route and dosage Strength of recommendation Quality of evidence
2gX6/d IV
10 mg/KgX3/d IV
10 mg/Kg/d oral or IV
B*
III*
5 mg/Kg/d oral or IV
20 mg/Kg/d oral or IV
Duration
21 days
21 days
1 year
1 year
2 months
Pyrazinamide (Pirilène®)
30 mg/Kg/j per os
2 months
* our recommandation
1.1.4. Brain abscess
Etiologic agents: Steptocoques, Bacteroides, enterobacteria
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence
Duration
Ceftriaxone
2gX2/d IV
B
II
6 to 12 weeks*
Metronidazole 7,5 mg/KgX4/d IV
B
II
6 to 12 weeks*
* Duration of Treatment not codified. Depend on CT Scan and/or MRI
References:
1. Sanford guide to antimicrobial therapy 2004
2. Johns Hopkins University Division of Infectious Diseases antibiotic guide
3. Clin Infect Dis. 1993;17:857-63.
1.2. Urinary tract infections
•
•
•
•
Acute urethritis
Acute prostatitis
Chronic bacterial prostatitis
Pyelonephritis
1.2.1. Acute urethritis
Etiologic agents: Neisseria gonorhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas
vaginalis
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Ceftriaxone
500 mg IM
A
II
One injection
Azithromycin
1g oral
A
II
Single dose
Reference
1. CDC 1998 STD treatment Guidelines ( MMWR 1998 ; 47 : 49-52)
1.2.2. Acute prostatitis
Etiologic agents: E coli , Proteus spp, Klebsiella spp , Enterococcus spp, S aureus, N. gonorrhoeae , C
trachomatis
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Ofloxacin
200 mgx2/d oral
B
III
28 days
References:
1. Sanford guide for antimicrobial therapy 2004 Rev Med Int 2002 ;23 :999-1005
1.2.3. Chronic bacterial prostatitis
Etiologic agents : E coli , Proteus spp, Klebsiella spp , Enterococcus spp, S aureus
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Ofloxacin
200 mg x 2 / d oral
B
III
28 days
Alternative treatment
Route and
dosage
1 DS tabletX2/d
Triméthoprim/sulfaméthoxazole DS
oral
Treatment
Strength of
recommendation
Quality of
evidence
Duration
B
III
28 days
Reference:
1. Sanford guide for antimicrobial therapy 2004 Rev Med Int 2002 ;23 :999-1005
1.2.4. Pyelonephritis
Etiologic agents : Enterobacteria, enterococcus
Treatment
Must be adapted to antimicrobial susceptibility
Treatment
Route and dosage Strength of recommendationQuality of evidence Duration
Escherichia coli : ciprofloxacin 500 mgX2/d oral
14 days
Entérococcus : amoxicillin
1 grX3/d oral
14 days
Empiric treatment waiting antimicrobial susceptibility
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Ciprofloxacin
500 mgX2/d day
Alternative empiric treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Ceftriaxon
2 g/d IM or IV
1.3. Digestive infections
•
•
•
Acute infectious diarrhea
Mild community acquired peritonitis
Severe community acquired peritonitis
•
•
Cholecystis, cholangitis
Liver abscess
1.3.1. Acute infectious diarrhea
Etiologic agents: Viruses, Salmonella sp, Shigella, Campylobacter jejuni, E. coli, staphylococcus, amibiasis
Treatment
Treatment
Route and
dosage
Moderate diarrhoea (less than 6 episodes per
day and no fever) Symptomatic treatment
Severe diarrheoa (more than 6 episodes per
500 mgX2/d
day, fever) Ciprofloxacin
Alternative treatment
Strength of
recommendation
Quality of
evidence
A
I
A
II
Duration
3 to 5 days
Treatment
Triméthoprim/sulfaméthoxazole
Route and
dosage
1 DS tabletX2/d
Strength of
recommendation
B
Quality of
evidence
II
Duration
3 to 5 days
References:
1. J Infect Dis. 1993 Nov;168(5):1304-7. Arch Intern Med. 1990 Mar;150(3):541-6.
2. Sanford guide to antimicrobial therapy 2004
3. Johns Hopkins University Division of Infectious Diseases antibiotic guide
1.3.2. Mild community acquired peritonitis
Etiologic agents: Enterobacteria, pneumocoque, entérocoque, anaérobies
Treatment
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Amoxicillin/clavulanate 1 gX3/d oral or IV
B
III
10 days
Gentamicin
160 mg/d IV
B
III
3 days
1.3.3. Severe community acquired peritonitis
Etiologic agents: Entérobactéries, pneumocoque, entérocoque, anaérobies, P. aeruginosa, BGN
Treatment
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Piperacillin/tazobactam
4 gX3/d IV
B
III
10 days
Gentamicin
160 mg/d IV
B
III
3 days
1.3.4. Cholecystitis, cholangitis
Etiologic agents : Enterobacteria, entérocoques, bacteroides, clostridium
Treatment
Treatment
Ceftriaxone
Metronidazole
Route and
dosage
Strength of
recommendation
Quality of
evidence
Duration
2 g/d IV
B
III
Cholecystitis : 24 to 48 hours after surgery
or 3 to 5 days after surgery if delayed
surgery
500 mgX4/d
oral or IV
B
III
Cholangitis : 7 to 10 days
1.3.5. Liver abscess
Etiologic agents: Enterobacteria, Bacteroides, entérococcus, Entamoeba hystolytica
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
Ceftriaxone
2 g/d IV
B
III
1 to 4 months
Metronidazole
500 mgX4/d oral
B
III
1 to 4 months
*If confirmed amebiasis, then treat with Metronidazole alone for 10 days
Reference:
1. Sanford guide to antimicrobial therapy 2004
1.4. Skin and soft tissues infections
•
•
•
1.4.1. •
Gangrene, necrotizing fasciitis, severe cellulitis in diabetes mellitus patients
Superficial cellulitis, non complicated erysipelas (facial excluded)
Facial cellulitis
Gangrene, necrotizing fasciitis, severe cellulitis in diabetes mellitus patients
Etiologic agents: Clostridium perfringens, Clostridium sp., group A, C and G Streptococcus , gram negative
rods
Treatment
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Pipéracillin/tazobactam
4 gX3/d IV
B
III
10 to 28 days
If associated septic shock
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Pipéracillin/tazobactam
4 gX3/d IV
B
III
10 to 28 days
Gentamicin
160 mg/d IV
B
III
3 days
References:
1. Sanford guide to antimicrobial therapy 2004
2. Johns Hopkins University Division of Infectious Diseases antibiotic guide
1.4.2. •
Superficial cellulitis, non complicated erysipelas (facial excluded)
Etiologic agents: group A, B, C and G Streptococcus, Staphylococcus aureus
Treatment
Treatment
Route and
dosage
Strength of
recommendation
Quality of
evidence
Duration
Amoxicillin/clavulanat
1gX3/d oral
B
II
3 days after recovery. Not
more than 10 days
References:
1. J Int Med Res. 1991;19(6):433-45.
2. Eur J Clin Microbiol Infect Dis. 1991;10(10):880-4.
Alternative treatment
Treatment
Route and dosage
Strength of recommendation Quality of evidence Duration
Azithromycin 500 mg on day-1, then 250 mg/d
B
II
5 days
References:
1. Cutis. 1984;34(6):567-70
2. Antimicrob Agents Chemother. 1983;24(6):856-9.
3. Antimicrob Agents Chemother. 1983;24(5):679-81.
1.4.3. Facial cellulitis
Etiologic agents: Staphylococcus aureus, group A Streptococcus
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence
Duration
Oxacillin
2gX6/d IV
B
III
3 days after recovery.
Alternative treatment
Treatment Route and dosage Strength of recommendation Quality of evidence
Duration
Vancomycin
2 g/d IV
B
III
3 days after recovery.
References:
1. Sanford guide to antimicrobial therapy 2004
2. Johns Hopkins University Division of Infectious Diseases antibiotic guide
1.5. Various infections
•
•
•
•
1.5.1. •
Community acquired septic shock (unknown origin, non neutropenic)
Septic arthritis
Bites (cat, dog, human)Venous catheter associated lymphangitis without bacteremia)
Peripheral and central venous catheter associated bacteremia
Community acquired septic shock (unknown origin, non neutropenic)
Etiologic agents: gram negative rods, gram positive, other (Klebsiella sp. and staphylococcus aureus)
Treatment
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Pipéracilline/tazobactam
4 gX3/d IV
B
III
Non codified
Vancomycin
2 g/j IV
B
III
Alternative treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Imipenem
1 gX3/d IV
B
III
Non codified
Vancomycin
2 g/d IV
B
III
References:
1. Sanford guide to antimicrobial therapy 2004
2. Johns Hopkins University Division of Infectious Diseases antibiotic guide
1.5.2. Septic arthritis
Etiologic agents: S. aureus, streptococcus, haemophilus sp., Neisseria gonorrheae, other
Treatment
Treatment
Adapted to
susceptibility
Route and
dosage
Strength of
recommendation
Quality of
evidence
antimicrobial
Empiric treatment waiting for antimicrobial susceptibility
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Vancomycin
2 g/d IV
B
III
1.5.3. Bites (cat, dog, human
Comment:
1. Role of antimicrobial treatment debated in case of small bite at early stage (< 9 hours)
Duration
14 to 28 days
2. Check tetanus vaccination
3. Evaluate HIV risk in case of human bite
4. Evaluate rabies risk
Etiologic agents: Pasteurella multocida, Bacteroides spp., Capnocytiphaga, S. aureus
Treatment
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Amoxicillin/clavulanate
1 gX3/d oral
B
II
10 days
References:
1. Sanford guide to antimicrobial therapy 2004
2. Pediatr Emerg Care. 1992;8:194-9
3. Am J Emerg Med. 2004;22:10-3
4. Arch Emerg Med. 1989;6:251-6
1.5.4. Venous catheter associated lymphangitis without bacteremia
Treatment
Remove catheter
• 3 blood culture
• No antibiotic if negative blood cultures
References:
1. Clin Infect Dis 2001 ;32 :1249-72
•
1.5.5. Peripheral and central venous catheter associated bacteremia
Treatment:
• Remove catheter
• 3 blood cultures
• Antimicrobial treatment adapted to antimicrobial susceptibility (initial blood culture). Start treatment
after the third blood culture
• If 3 negative blood cultures, then stop antibiotics
• If ay least 1 positive blood culture, then carry on antimicrobial treatment for 14 days
• Search for metastatic localization (transoesop^hageal echocardiography, CT Scan of the thorax and
abdomen, vertebram MRI if pain). Then treatment duration is 6 weeks
* Duration du Treatment : 14 jour si bactériémie simple. 6 semaines en cas de localisation septique secondaire
References:
1. Clin Infect Dis 2001 ;32 :1249-72
1.6. HEENT
•
•
•
•
Pharyngitis
Acute otitis media: first episode
Acute otitis media: treatment failure at day-3
Acute sinusitis
1.6.1. Pharyngitis
Etiologic agents:
• Viruses ( Rhinovirus, coronavirus..) +++++
• Group A Streptococcus, Anaerobes, Neisseria gonorrhoeae, Corynebacterium diptheriae, other
Treat only confirmed group A Streptococcus pharyngitis
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Pénicillin V 1 million UI X 3 / d oral
A
II
10 days
Alternative treatment
Treatment
Route and dosage
Strength of recommendation Quality of evidence Duration
Azithromycin 500 mg/d oral (1 daily dose)
A
II
3 Days
References:
1. Clin Infect Dis 2002 ;35 :113-125
1.6.2. Acute otitis media
Etiologic agents : Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Viruses
Treatment
Treatment
Route and
dosage
Strength of
recommendation
Quality of
evidence
Duration
If no antimicrobial treatment in the
1gX3/d oral
previous month: Amoxicillin
If antimicrobial treatment in the previous
2gX3/d oral
month : Amoxicillin
B
II
10 days
B
II
10 days
Alternative treatment
Treatment
Azithromycin
Route and dosage
Strength of recommendation Quality of evidence Duration
500 mg at day-1, then 250 mg/d
B
II
5 days
oral
References:
1. Ann Otol Rhinol Laryngol Suppl. 2000;183:1-12.
2. Pediatr Infect Dis J. 2000;19(2):95-104
3. Pediatr Infect Dis J. 1996;15(Suppl 9):4-9.
1.6.3. Acute otitis media: treatment failure at day-3
Etiologic agents: Streptococcus pneumoniae
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Ceftriaxone
2g/d IM
B
III
3 days
References:
1. Pediatr Infect Dis J. 1998;17(10):963-8
2. Sanford guide to antimicrobial therapy 2004
3. Johns Hopkins University Division of Infectious Diseases antibiotic guide
1.6.4. Acute sinusitis
Etiologic agents:
• Bcteria: 0,2 to 10%
o H. influenzae, S. pneumoniae, group A streptococcus, M. catarrhalis, S. aureus, anaerobes
• allergy or viruses : 90 à 99%
o
Coronavirus, Parainfluenza virus, Rhinovirus
Treatment
Treatment
Route and
dosage
Symptomatic treatment
Persistent symptoms at day-7 or severe initial
presentation (major pain, fever > 38°C): Amoxicillin/ 1gX3/d oral
clavulanate
Strength of
recommendation
A
Quality of
evidence
I
B
III
Duration
7 days
10 days
Alternative treatment (proven penicillin allergy)
Treatment
Route and dosage
Strength of recommendation Quality of evidence Duration
Azithromycin 500 mg day-1, then 250 mg / d oral
B
I
5 days
References:
1.
2.
3.
4.
Arch Intern Med. 2003 Aug 11-25;163(15):1793-8 (non intérêt amoxicilline/clavulanate d emblée)
Antimicrob Agents Chemother. 2003;47(9):2770-4
Sanford guide to antimicrobial therapy 2004
Johns Hopkins University Division of Infectious Diseases antibiotic guide
1.7. Respiratory infections
•
•
•
•
1.7.1. •
Community acquired pneumonia: PORT severity index
Community acquired pneumonia (Class I and II, not associated with pleural effusion)
Community acquired pneumonia (Class III to V, and any class with associated pleural effusion)
Acute bacterial exacerbation of chronic bronchitis
Community acquired pneumonia: PORT severity index
PORT severity index
Patient characteristics
Demographic factor
male
Points assigned
No. Of years of age
Female
No. Of years of age - 10
Nursing home resident
+10
Comorbid illness
Neoplastic disease
+30
Liver disease
+20
Congestive heart failure
+10
Cerebrovascular disease
+10
Renal disease
+10
Physical examination findings
Altered mental status
+20
Respiratory rate > 30 breaths/min
+20
Systolic blood pressure < 90 mm Hg
+20
Temperature < 35°C or > 40°C
+15
Puls > 125 beats/min
+10
Laboratory or radiographic findings
Arterial PH < 7,35
+30
Blood urea nitrogen > 30 mg/dL
+20
Sodium < 130 mEq/l
+20
Glucose > 250 mg/dL
+10
Hematocrit < 30%
+10
Arterial partial pressure of oxygen < 60 mm Hg
+10
Pleural effusion
+10
Score
Class
Points
Class I
0,1%
Class II
> 70
Class III
71 à 90
Class IV
91 à 130
Class V
131
1.7.2. •
Mortality
note
age < 50 years, non of the 5 comorbid conditions (see table), normal or
only mild deranged vital signs, and normal mental status
0,6% à
0,7%
0,9% à
2,8%
8,2% à
9,3%
27% à 31%
Community acquired pneumonia (Class I and II, not associated with pleural effusion)
Etiologic agents: S pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Coxiella burnetii ( H
influenza, Moraxella catarrhalis)
Treatment
Treatment
Telithromycin
1.7.3. •
Route and dosage Strength of recommendation Quality of evidence
Duration
800 mg/d oral
B
II
3 to 5 days apyrexia
Community acquired pneumonia (Class III to V, and any class with associated pleural effusion)
Etiologic agents: S pneumoniae, Mycoplasma pneumloniae, Chlamydia pneumoniae, Coxiella burnetii ( H
influenza, Moraxella catarrhalis)
Treatment
Treatment
Azithromycin
Ceftriaxone
Change azithromycin to
erythromycin if oral route impossible
Route and dosage
500 mg/d at day-1, then
250 mg/d oral
2 g/d IV
1gX3/j IV
Strength of
recommendation
Quality of
evidence
B
II
B
II
Duration
If alcoholism, coma, psychotropic treatment, neurological conditions (suspected aspiration pneumonia),
ad to the previous treatment
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration
Metronidazole 500 mgX3/d oral or IV
B
III
*Duration: 3 to 5 days after apyrexia or 3 weeks if associated pleural effusion
References:
1. Clin Infect Dis 2003 ; 37 : 1405-33
1.7.4. •
Acute bacterial exacerbation of chronic bronchitis
Etiologic agents
Viruses, S pneumoniae, H influenza, Moraxella catharrhalis.
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Amoxicillin
1g X 3 / d oral
B
III
7 days
Alternative treatment
Treatment
Telithromycin
Route and dosage Strength of recommendation Quality of evidence Duration
800 mg/d oral
B
III
7days
Treatment recommandation:
• Bronchitis in patients with no underlying conditions: no antibiotics
• Acute bacterial exacerbation of chronic bronchitis without obstructive syndrome: no antibiotics
• Acute bacterial exacerbation of chronic bronchitis without obstructive syndrome in case of persistent
fever > 38°C after 3 days: start antibiotics
• Acute bacterial exacerbation of chronic bronchitis with obstructive syndrome: start antibiotics
1.8. Gynecologic infections
•
•
1.8.1. •
Non suppurated primitive salpingitis
Suppurated primitive salpingitis
Non suppurated primitive salpingitis
Etiologic agents: Neisseria gonohorroeae, Chlamydia, Bacteroides, enterobacteria, streptococcus
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
Ofloxacin
400 mgX2/d oral
B
III
14 days
Metronidazole
500 mgX2/d oral
B
III
14 days
Alternative treatment
Treatment Route and dosage Strength of recommendation
Ceftriaxone
Doxycycline
1 g IM
100 mgX2/d oral
B
B
Quality of
evidence
III
III
Duration
1 injection
14 days
References:
1. Sanford guide to antimicrobial therapy 2004
2. MMWR 1998;47:79-86
1.8.2. •
Suppurated primitive salpingitis
Etiologic agents : Neisseria gonohorroeae, Chlamydia, Bacteroides, enterobacteria, streptococcus
Treatment
Treatment
Clindamycin
Route and
dosage
Strength of
recommendation
Quality of
evidence
Duration
900 mgX3/d IV
B
III
24 hours after
apyrexia
4,5 mg/Kg/d IV
or IM
24 hours after apyrexia, change 100 mgX2/d
treatment to : Doxycycline
oral
Gentamicin
B
III
24 hours after
apyrexia
B
III
14 days
References:
1. Sanford guide to antimicrobial therapy 2004
2. MMWR 1998;47:79-86
1.9. Endocarditis
•
•
•
1.9.1. •
Enterococcus spp., Streptococcus spp., HACEK and blood culture negative endocarditis
Endocarditis: other
Methicillin susceptible Staphylococcus aureus endocarditis
Enterococcus spp., Streptococcus spp., HACEK and blood culture negative endocarditis
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
Amoxicillin
2 grX6/d IV
B
III
Gentamicin
3 mg/Kg/d IV
B
III
*Duration:
•
•
•
•
•
•
Pénicillin G susceptible Sterptococcus (CMI < 0.1) and non complicated native cardiac valves: 2
weeks of combination therapy
Streptococcus (Pénicillin G: 0.1 < CMI < 0.5): 2 weeks of combination therapy, then 2 weeks
amoxicillin IV alone.
Streptococcus (Penicillin G: CMI > 0.5, Enterococcus: 6 weeks of combination therapy
Complicated streptococcus endocarditis and/or prosthetic cardiac valves: 2 weeks of combination
therapy, then 4 weeks amoxicillin IV alone.
Blood culture negative endocarditis: 3 weeks of combination therapy, then 3 weeks amoxicillin IV
alone
HACEK: 4 weeks of combination therapy
1.9.2. Endocarditis: other
Coagulase negative Staphylococcus, methicillin resistant Staphylococcus aureus, enterococcus (Penicillin G CMI
> 16 µg/ml), blood culture negative pacemaker-related endocarditis, post-operative endocarditis (< 12 months),
right-sided endocarditis, nosocomial endocarditis
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
Vancomycin
30 mg/Kg/d
B
III
Gentamicin
3 mg/Kg/d IV
B
III
*Duration:
•
•
Staphylococcus and blood culture negative endocarditis: 7 days of combination therapy, then 5
weeks vancomycin IV for native valves; 2 weeks of combination therapy, then 4 weeks vancomycin
IV for prosthetic valves and pacemakers.
Enterococcus : 6 weeks of combination therapy.
1.9.3. Methicillin susceptible Staphylococcus aureus endocarditis
Treatment
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
cloxacillin
2 grX6/d IV
B
III
Gentamicin
3 mg/Kg/d IV
B
III
*Duration:
•
7 days of combination therapy, then 5 weeks cloxacillin alone for native valves; 2 weeks of
combination therapy, then 5 weeks cloxacillin alone for prosthetic valves.
1.10. Vascular infections
•
•
1.10.1. •
Vascular graft infections (vascular graft removed)
Vascular graft infections (vascular graft not removed)
Vascular graft infections (vascular graft removed)
Methicillin susceptible Staphylococcus aureus
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
oxacillin
2 grX6/d IV
B
III
Methicillin-resistant Staphylococcus aureus, coagulase-negative Staphylococcus, infection of lower limb
vascular graft (unknown etiologic agent)
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
Vancomycin
2 g/d IVSE
B
III
Enterococcus and Streptococcus
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
Amoxicillin
2 grX6/d IV
B
III
Gram-negative rods and intra abdominal vascular graft (unknown etiologic agent)
Treatment
Route and dosage Strength of recommendation Quality of evidence Duration*
Ticarcillin/clavulanate
5 grX3/d IV
B
III
Pseudomonas spp.
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
ceftazidime
1 grX3/d IV
B
III
gentamicin
160 mg/d IV
B
III
ciprofloxacin
500 mgX3/d oral
B
III
Fungi
Treatment
amphotericin B
flucytosine
IN CASE OF RENAL FAILURE
Change amphotericin B to liposomal
amphotericin B
Route and dosage
Strength of
recommendation
Quality of
evidence
B
III
B
III
B
III
1 mg/Kg/d IV (in 12
hours)
100 mg/Kg/d IV
3 mg/Kg/j IV
*Duration: 1 week after vascular graft removal
1.10.2. •
Vascular graft infections (vascular graft not removed)
Susceptible Staphylococcus aureus and coagulase-negative staphylococcus
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
Rifampin
300 mgX3/d oral
B
III
ofloxacin
200 mgX2/d oral
Duration*
Resistant Staphylococcus aureus and coagulase-negative staphylococcus
Route and dosage
Strength of
recommendation
Quality of
evidence
IF POSSIBLE
Rifampin
Fusidic acid
IF NOT
300 mgX3/D oral
2 tabletsX2/d oral
B
B
III
III
triméthoprim/sulfaméthoxazole
2 DS tabletsX3/d
oral
B
III
600 mgX3/d oral
B
III
2 g/d IV
B
III
Treatment
OR
clindamycin
OR
Vancomycin
Pseudomonas aeruginosa
Duration*
Treatment Route and dosage Strength of recommendation Quality of evidence Duration
ceftazidime
1 grX3/d IV
B
III
ciprofloxacin
500 mgX3/d oral
B
III
3 weeks
gentamicin
160 mg/d IV
B
III
THEN
ciprofloxacin
500 mgX3/d oral
B
III
3 weeks
ceftazidime
1 grX3/d IV
B
III
THEN
ciprofloxacin
500 mgX3/d oral
B
III
4 months 1/2
Enterobacteria
Treatment
Route and dosage
Strength of
recommendation
Quality of
evidence
triméthoprim/sulfaméthoxazole
2 DS tablets X3/d
oral
B
III
Duration*
Enterococcus and Streptococcus
Treatment Route and dosage Strength of recommendation Quality of evidence Duration*
amoxicillin
2 grX3/d oral
B
III
Unknown etiologic agent
Treatment
triméthoprim/sulfaméthoxazole
clindamycin
Route and dosage
2 DS tabletsX3/d
oral
600 mgX3/d oral
*Duration: 6 months
1.11. Diabetic foot infections
Strength of
recommendation
Quality of
evidence
B
III
B
III
Duration*
Without associated osteomyelitis
With associated polymicrobial osteomyelitis and no sepsis
With associated polymicrobial osteomyelitis and sepsis
With associated monomicrobial osteomyelitis
•
•
•
•
1.11.1. •
Without associated osteomyelitis
Treatment
Treatment
triméthoprim/sulfaméthoxazole
clindamycin
1.11.2. •
Route and dosage
1 DS tabletX3/d
oral
600 mgX3/d oral
Strength of
recommendation
Quality of
evidence
Duration
B
III
3 weeks
B
III
3 weeks
With associated polymicrobial osteomyelitis and no sepsis
Treatment
Treatment
triméthoprim/sulfaméthoxazole
clindamycin
1.11.3. •
Route and dosage
1 DS tabletX3/d
oral
600 mgX3/d oral
Strength of
recommendation
Quality of
evidence
Duration
B
III
6 weeks
B
III
6 weeks
With associated polymicrobial osteomyelitis and sepsis
Treatment
Treatment
Ticarcillin/clavulanate
THEN
triméthoprim/sulfaméthoxazole
clindamycin
Route and dosage
5 gX3/d IV
1 DS tabletX3/d
oral
600 mgX3/d oral
Strength of
recommendation
B
Quality of
evidence
III
B
III
6 weeks
B
III
6 weeks
Duration
10 days
1.11.4. •
With associated monomicrobial osteomyelitis
Treatment
Treatment
Adapted to antimicrobial
susceptibility
Route and
dosage
Strength of
recommendation
Quality of
evidence
Duration
6 weeks
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