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DRUGS OF CHOICE ACCORDING TO INFECTING ORGANISM1,2

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/clava or ampi/sulbac
clindamycin
vancomycin

TMP/SMXb (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/clava or ampi/sulbac
clindamycin or vancomycin
erythro-clarithro-azithroc

*Streptococcus Group D (Enterococcus)

ampicillin or penicillin G with gentamicine

vancomycin with gentamicine amox/clava or ampi/sulbac

*Streptococcus pneumoniae (pneumococcus)

see 1III.A

 

Streptococcus anaerobic (peptostreptococcus)

clindamycin

amox/clava or ampi/sulbac
penicillin plus metronidazole
vancomycin

Gram-Negative Cocci

Moraxella catarrhalis (Branhamella catarrhalis)

see

 

*Neisseria gonorrhoeae (see)

ceftriaxone or cefixime or cefpodoxime

any quinoloneg

Neisseria meningitidis

penicillin G

ceftriaxone, cefotaxime, cefuroxime
TMP-SMXb
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 gentamicine

TMP-SMXb

*Nocardia

TMP-SMXb

minocycline
amikacin plus ceftriaxone

Enteric Gram-Negative Bacilli

*Bacteroides, intestinal and oropharyngeal anaerobes, see

clindamycin

amox/clava or ampi/sulbac
metronidazole
cefoxitin or cefotetan
imipenem or meropenem

*Enterobacter

imipenem or meropenem
OR piperacillin plus gentamicine

gentamicin, etc.e
ticar/clav or pipr/taxd

*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 gentamicine
aztreonam
ticar/clav, pipr/tazd
ciprofloxacin et al. quinolonesg
TMP-SMXb

Other Gram-Negative Bacilli

Acinetobacter

imipenem or meropenem OR amikacin with quinoloneg

amikacin plus ceftazidime
amox/clav or ampi-sulbaca

Bordetella pertussis (Whooping cough)

erythromycin or clarithromycin

TMP-SMXb

*Brucella

doxycycline with gentamicine, streptomycin, or rifampin

quinoloneg plus rifampin plus
gentamicin
TMP/SMXb plus gentamicin

Eikenella corrodens

amipicillin or amox/clava or ampi/sulbac

TMP/SMX, quinoloneg, doxycycline, cefotaxime

F. tularensis

streptomycin or gentamicine

doxycycline or chloramphenicol
ciprofloxacin, rifampin

*Hemophilus influenzae
Meningitis/epiglottitis

ceftriaxone or cefotaxime

trovafloxacin, meropenem
ampicillin/sulbactam

*Hemophilus influenzae
Otitis, sinusitis, etc. See

Amox/clava or ampi/sulbac
erythromycin with sulfonamide

TMP-SMXb
ampicillin/amoxicillin
clarithromycin or azithromycin
2nd/3rd gen. cephalosporins
quinolonesg

Legionella pneumophila

erythromycin (with or without rifampin) or quinolonesg

azithromycin or clarithromycin
TMP-SMXb, doxycycline

*Pseudomonas aeruginosa)

gentamicine
ticarcillin or piperacillin

orally: ciprofloxacin or ofloxacin

ceftazidime, cefepime, ticar/clavd
imipenem or aztreonam plus
gentamicine or rifampin

Miscellaneous Organisims

Bartonella (formerly Rochalimaea) (cat scratch)

doxycycline or erythromycin or clarithromycin or azithromycin

ciprofloxacin
TMP-SMXb

Chlamydia species

erythro-clarithro-azithroc

doxycycline, quinolonesg

Mycoplasma pneumoniae

erythro-clarithro-azithroc

doxycycline
quinolonesg

Rickettsia

doxycycline

chloramphenicol
quinolonesg

Spirochetes
Borrelia burgdorferi (Lyme).

Treponema pallidum (syphilis)

T. pertenue (yaws)


ceftriaxone or cefuroxime or doxycycline or amoxicillin


penicillin

penicillin


cefotaxime
erythro-clarithro-azithroc


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

  1. Medical Letter Handbook of Antimicrobial Therapy, current edition
  2. Gilbert, et al.: The Sanford Guide to Antimicrobial Therapy 2000, page 71 ff.

*Because drug resistance may be a problem, sensitivity studies are indicated. aAmox/clav: amoxicillin/potassium clavulanate (Augmentin). Ampi-sulbac: ampicillin/sulbactam (Unasyn).

bTMP-SMX: trimethoprim-sulfamethoxazole (Bactrim, etc.)

cErythro-clarithro-azithro: erythromycin or clarithromycin (Biaxin) or azithromycin (Zithromax).

dTicar/clav: ticarcillin/potassium clavulanate. Pipr/taz: piperacillin/tazobactam (Zosyn)

eGentamicin or tobramycin or amikacin.

fWhen history of anaphylaxis from penicillins.
gfluroquinolones: ciprofloxacin (Cipro), gatifloxacin (Tequin), gemifloxacin (Factive), moxifloxacin (Avelox)

 

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