ORGANISM

FIRST CHOICE

ALTERNATIVES

Gram-Positive Cocci

*Staphylococcus aureus
(see 1III.C)


Methicillin resistant (MRSA)

antistaphylococcal penicillin or first generation cephalosporin


vancomycin with or without rifampin
linezolid (zyvox)

amox/clav^a or ampi/sulbac
clindamycin
vancomycin

TMP/SMX^b (some resistant) and/or rifampin

Staphylococcus epidermidis (coag. neg.)

vancomycin with or without rifampin

antistaph. penicillin or cephalosporin if sensitive (75 percent are resistant)

Streptococcus pyogenes and Streptococcus Groups B, C, G, F, S. viridans

penicillin or amoxicillin or 1st/2nd gen. cephalosporin (add gentamicin for serious infection)

amox/clav^a or ampi/sulbac
clindamycin or vancomycin
erythro-clarithro-azithro^c

*Streptococcus Group D (Enterococcus)

ampicillin or penicillin G with gentamicin^e

vancomycin with gentamicin^e amox/clav^a or ampi/sulbac

*Streptococcus pneumoniae (pneumococcus)

see 1III.A

Streptococcus anaerobic (peptostreptococcus)

clindamycin

amox/clav^a or ampi/sulbac
penicillin plus metronidazole
vancomycin

Gram-Negative Cocci

Moraxella catarrhalis (Branhamella catarrhalis)

see

*Neisseria gonorrhoeae (see)

ceftriaxone or cefixime or cefpodoxime

any quinolone^g

Neisseria meningitidis

penicillin G

ceftriaxone, cefotaxime, cefuroxime
TMP-SMX^b
chloramphenicol

Gram-Positive Bacilli

*Actinomyces israeli

penicillin or aminopenicillin

doxycycline, ceftriaxone
clindamycin

Bacillus anthracis

ciprofloxacin or doxycycline

penicillin or erythromycin

Clostridium difficile

metronidazole or vancomycin

bacitracin

Clostridium perfringens

penicillin plus clindamycin

doxycycline
cefoxitin
chloramphenicol

Clostridium tetani

penicillin with metronidazole

doxycycline
imipenem

Corynebacterium diphtheriae

erythromycin or clindamycin

rifampin, penicillin

Listeria monocytogenes

ampicillin with or without gentamicin^e

TMP-SMX^b

*Nocardia

TMP-SMX^b

minocycline
amikacin plus ceftriaxone

Enteric Gram-Negative Bacilli

*Bacteroides, intestinal and oropharyngeal anaerobes, see

clindamycin

amox/clav^a or ampi/sulbac
metronidazole
cefoxitin or cefotetan
imipenem or meropenem

*Enterobacter

imipenem or meropenem
OR piperacillin plus gentamicin^e

gentamicin, etc.^e
ticar/clav or pipr/tax^d

*Proteus mirabilis

ampicillin or TMP/SMX

most agents

*E. coli
*Klebsiella pneumoniae
Other *Proteus
*Providencia
*Serratia

cefotaxime or ceftizoxime or ceftriaxone or cetazidime

ampicillin with gentamicin^e
aztreonam
ticar/clav, pipr/taz^d
ciprofloxacin et al. quinolones^g
TMP-SMX^b

Other Gram-Negative Bacilli

Acinetobacter

imipenem or meropenem OR amikacin with quinolone^g

amikacin plus ceftazidime
amox/clav or ampi-sulbac^a

Bordetella pertussis (Whooping cough)

erythromycin or clarithromycin

TMP-SMX^b

*Brucella

doxycycline with gentamicin^e, streptomycin, or rifampin

quinolone^g plus rifampin plus
gentamicin
TMP/SMX^b plus gentamicin

Eikenella corrodens

amipicillin or amox/clav^a or ampi/sulbac

TMP/SMX, quinolone^g, doxycycline, cefotaxime

F. tularensis

streptomycin or gentamicin^e

doxycycline or chloramphenicol
ciprofloxacin, rifampin

*Hemophilus influenzae
Meningitis/epiglottitis

ceftriaxone or cefotaxime

trovafloxacin, meropenem
ampicillin/sulbactam

*Hemophilus influenzae
Otitis, sinusitis, etc. See

Amox/clav^a or ampi/sulbac
erythromycin with sulfonamide

TMP-SMX^b
ampicillin/amoxicillin
clarithromycin or azithromycin
2nd/3rd gen. cephalosporins
quinolones^g

Legionella pneumophila

erythromycin (with or without rifampin) or quinolones^g

azithromycin or clarithromycin
TMP-SMX^b, doxycycline

*Pseudomonas aeruginosa)

gentamicin^e
ticarcillin or piperacillin

orally: ciprofloxacin or ofloxacin

ceftazidime, cefepime, ticar/clav^d
imipenem or aztreonam plus
gentamicin^e or rifampin

Miscellaneous Organisims

Bartonella (formerly Rochalimaea) (cat scratch)

doxycycline or erythromycin or clarithromycin or azithromycin

ciprofloxacin
TMP-SMX^b

Chlamydia species

erythro-clarithro-azithro^c

doxycycline, quinolones^g

Mycoplasma pneumoniae

erythro-clarithro-azithro^c

doxycycline
quinolones^g

Rickettsia

doxycycline

chloramphenicol
quinolones^g

Spirochetes
Borrelia burgdorferi (Lyme).

Treponema pallidum (syphilis)

T. pertenue (yaws)

ceftriaxone or cefuroxime or doxycycline or amoxicillin

penicillin

penicillin

cefotaxime
erythro-clarithro-azithro^c

doxycycline
ceftriaxone

tetracycline

Fungi: Systemic and topicals, etc., information)

Aspergillus species

amphotericin B

itraconazole

Blastomyces dermatitidis

amphotericin B or itraconazole

fluconazole

Candida species

fluconazole

amphotericin B

Chromomycosis

itraconazole

Coccidioides immitis

itraconazole

fluconazole
amphotericin B

Cryptococcus neoformans

amphotericin B

fluconazole

Histoplasma capsulatum

amphotericin B

itraconazole

Mucor species

amphotericin B

none

Paracoccidioides brasiliensis

itraconazole or ketoconazole

amphotericin B
sulfonamide

Pseudallescheria boydii

itraconazole

miconazole

Sporothrix schenckii

cutaneous: potassium iodide
systemic: itraconazole

amphotericin B