|
Infecting Organism
|
Medication of Choice
|
Alternative Medications
|
| I.
AEROBIC BACTERIA
|
|
A. Gram
Positive
|
|
1. Staphylococci
|
|
a.
Non-penicillinase producing
|
PRP
|
Parenteral Cephaloporins, Vancomycin, Clindamycin
|
|
b.
Penicillinase producing
|
Vancomycin
|
TMP/SMX
|
|
2. Streptococci
|
|
a.
Pyogenic groups A, B, C
|
Penicillin G –or–
Penicillin V±
Gentamicin |
Beta Lactams (Penicillins, Cephalosporins),
Erythromicin, Azithromycin
|
|
b.
Viridans
|
Amoxicillin/Clavulanate –or–Penicillin ±
Streptomicin
|
Clindamycin + Ciprofloxacin,
TMP/SMX
|
|
c.
Enterococci (Group D)
|
Amoxicillin/Clavulanate –or–Penicillin ±
Streptomicin
|
Clindamycin + Ciprofloxacin,
TMP/SMX
|
|
3. Pseudomonas (Strep. Pneumoniae)
|
Penicillin G –or–
Vancomycin ±
Rifampin
|
Amoxicillin
|
| B.
Gram-negative cocci |
|
1. Neisseria catarralis
|
Penicillin G
|
Ceftriaxone, Cefuroxime, Cefotaxime
|
|
2. Neisseria gonorrhoeae
|
Ceftriaxone –or–
Cefixime –or– Cefpodoxime
|
Oxfloxacin, other FQs
|
|
C.
Gram-negative bacilli
|
|
1. Escherichia
coli
|
Cephalosporin –or–
FQ –or– TMP/SMX –or–
APA –or– Imipenem/Cilastatin
|
Cephalosporin, FQ, TMP/SMX, APA, Imipenem/Cilastatin
|
|
2. Enterobacter aerogenes
|
Imipenem/Cilastatin –or–
Meropenem –or–
APP + APA
|
|
|
3. Klebsiella species
|
Parenteral 3rd Gen Cephalosporin –or–
FQ
|
APA, Ticarcillin/Clavulanate, Ampicillin/Sulbactam,
Piperacillin/Tazobactam
|
|
4. Pseudomonas aeruginosa
|
APP –or–
Anti-pseudomonal Cephalosporin
|
|
|
5. Proteus
|
|
a.
P. mirabilis
|
Ampicillin
|
TMP/SMX
|
|
b.
other Proteus species
|
Parenteral 3rd Gen Cephalosporin –or–
FQ
|
APA
|
|
6. Serratia species
|
Parenteral 3rd Gen Cephalosporin –or–
Imipenem/Cilastatin –or–
Meropenem –or–
FQ
|
Aztreonam, Gentamicin
|
|
7. Salmonella typhi
|
FQ –or–
Ceftriaxone
|
Chloramphenicol, Amoxicillin, TMP/SMX, Azithromycin
|
|
8. Hemophilus species
|
|
a.
H influenzae
|
Cefotaxime –or–
Ceftriaxone
|
TMP/SMX, Imipenem/Cilastatin, Meropenem, FQ
|
|
b.
H. ducreyi
|
Azithromycin –or–
Ceftriaxone
|
Erythromycin, Ciprofloxacin
|
|
9. Brucella species
|
Doxycycline
|
Doxycycline
|
|
10. Pasteurella species
|
|
a.
Francisella tularensis (tularemia)
|
Streptomycin –or–
Gentamicin
|
Doxycycline
|
|
b.
Yersinia pestis
|
Streptomycin –or–
Gentamicin
|
Doxycycline
|
|
D.
Gram-positive bacteria
|
|
1. Bacillus anthracis
|
Penicillin G –or–
Ciprofloxacin –or–
Doxycycline
|
Erythromycin, Chloramphenicol
|
|
2. Corynebacterium species
|
Vancomycin
|
Penicillin G + APA
|
|
3. Diphtheroid species
|
Antitoxin + Erythromycin
|
Benzyl Penicillin G, followed by Penicillin VK
|
|
4. Mycobacterium tuberculosis
|
Isoniazid + Rifampin + Pyrazinamide
|
Add Ethambutol + FQ + Amikacin
|
|
5. Listeria monocytogenes
|
Ampicillin
|
TMP/SMX
|
| II.
ANAEROBIC BACTERIA
|
|
A.
Gram-positive cocci
|
|
1. Streptococcus species
|
Penicillin G
|
Clindamycin
|
|
B.
Gram-positive bacilli
|
|
1. Clostridium species
|
|
a.
C. perfringens
|
Penicillin G ±
Clindamycin
|
Doxycycline
|
|
b.
C. novyi
|
Penicillin G ±
Clindamycin
|
Doxycycline
|
|
c.
C. histolyticum
|
Penicillin G ±
Clindamycin
|
Doxycycline
|
|
d.
C. septicum
|
Penicillin G ±
Clindamycin
|
Doxycycline
|
|
e.
C. sordellii
|
Penicillin G ±
Clindamycin
|
Doxycycline
|
|
f.
C. sporogenes
|
Penicillin G ±
Clindamycin
|
Doxycycline
|
|
g.
C. tetani
|
Metronidazole –or–
Penicillin G
|
Doxycycline
|
| C.
Bacteroides species |
Metronidazole
|
Clindamycin, Trovafloxacin
|
| III.
MISCELLANEOUS |
|
A. Nocardia
species
|
TMP/SMX –or– Sulfonamide
|
Minocycline, Amoxicillin/Clavulanate
|
|
B.
Fusobacterium fusiforme
|
Penicillin G
|
Clindamycin
|
|
C.
Calymmatobacterium granulomatis
|
Doxycycline –or–
TMP/SMX
|
Erythromycin, Ciprofloxacin
|
| IV.
ACID FAST BACILLI |
| A.
Mycobacterium species |
|
1. M. tuberculosis
|
Isoniazid + Rifampin + Pyrazinamide
|
|
|
2. M. kansasii
|
Isoniazid + Rifampin + Ethambutol
|
Isoniazid + Pyridoxine + Ethambutol +
Sulfamethoxazole
|
|
3. M. avium intracellulare complex
|
Clarithromycin + Ethambutol + Streptomycin +
Clofazimine
|
Clarithromycin + Rifabutin + Ethambutol
|
|
4. M. fortuitum
|
Surgical excision
|
Amikacin + Cefoxitin + Probenecid, followd by
Doxycycline or TMP/SMX
|
|
5. M. marinum (balnei)
|
Clarithromycin
|
|
|
6. M. leprae (leprosy)
|
Dapsone + Rifampin
|
|
|
V.
ACTINOMYCETES
|
|
A. Actinomyces
israelii (actinomycosis)
|
Ampicillin –or–
Penicillin G
|
Doxycycline
|
|
B. Nocardia
|
TMP/SMX –or–
Sulfonamide (in high doses)
|
Minocycline
|
|
VI.
CHLAMYDIA
|
|
A. Chlamydia
psittaci (psittacosis, ornithosis)
|
Azithromycin –or–
Clarithromycin
|
Parenteral 3rd Gen Cephalosporin +
Azithromycin
|
|
B. Chlamydia
trachomatis
|
Doxycycline–or–
Azithromycin
|
Erythromycin, Ofloxacin
|
|
1. (trachoma)
|
Azithromycin
|
Doxycycline, Tetracycline
|
|
2. (inclusion conjunctivitis)
|
Doxycycline
|
Erythromycin
|
|
3. (pneumonia)
|
Doxycycline
|
Erythromycin, FQ
|
|
4. (urethritis)
|
Doxycycline
|
Azithromycin
|
| C.
Lymphogranuloma venereum |
Doxycycline
|
Erythromycin
|
|
VII.
FUNGI
|
| A.
Aspergillus |
Amphotericin B –or–
Itraconazole
|
|
|
B. Blastomyces
dermatitidis
|
Amphotericin B –or–
Itraconazole
|
Fluconazole
|
|
C. Candida
species
|
Amphotericin B –or–
Fluconazole
|
Increase dosages of first line agents
|
|
D.
Chromomycosis
|
Surgical excision, then Itraconazole
|
Itraconazole
|
|
E. Coccidioides
immitis
|
Amphotericin B –or–
Itraconazole Fluconazole
|
|
|
F. Cryptococcus
neoformans
|
Amphotericin B –or–
Fluconazole
|
Amphotericin B + Flucytosine
|
|
G.
Dermatophytes (tinea)
|
|
1. Tinea infections
|
Erythromycin –or–
Terbinifine –or–
Itraconazole –or–
Fluconazole
|
Clindamycin 2% topical
|
|
2. Tinea versicolor
|
Ketoconazole
|
|
|
H. Histoplasma
capulatum
|
|
1. Minor infections
|
Itraconazole
|
|
|
2. Severe infections
|
Amphotericin B
|
|
|
I. Mucor
|
Amphotericin B
|
|
|
J.
Paracoccidioides brasiliensis
|
Itraconazole –or–
Ketoconazole
|
Amphotericin B, Sulfonamide
|
|
K. Sporothrix
schenckii
|
Itraconazole
|
Cutaneous: SSKI
Extracutaneous: Amphotericin B
|
| VIII.
MYCOPLASMA |
| Mycoplasma
pneumoniae |
Erythromycin –or–
Azithromycin –or–
Clarithromycin –or– FQ
|
Doxycycline
|
|
IX. RICKETTSIA
Rocky Mtn spotted fever; endemic typhus (murine);
tick bite fever; typhus, scrub typhus; Q fever
|
Doxycycline
|
Chloramphenicol
|
|
X.
PNEUMOCYSTIS CARINII
|
TMP/SMX –or–
Dapsone
|
Clindamycin + Primaquine, Pentamidine
|
| XI.
SPIROCHETES |
| A.
Borrelia recurrentis
(relapsing fever)
|
Doxycycline
|
Erythromycin, Penicillin G
|
|
B. Leptospira
|
Penicillin G
|
Doxycycline
|
|
C. Treponema
pallidum (syphilis)
|
Benzathine Penicillin G
|
Doxycycline, Tetracycline, Ceftriaxone
|
|
D. Treponema
pertenue (Yaws)
|
Benzathine Penicillin G
|
Tetracycline
|
| XII.
VIRUSES |
| A.
Herpes simplex |
Acyclovir
|
Famciclovir, Valacyclovir
|
|
B. Herpes
zoster
|
Acyclovir
|
Famciclovir, Valacyclovir
|
|
C. Influenza A
|
Zanamivir
|
Rimantidine, Amantadine
|
|
D. Hepatitis B
|
Interferon Alfa
|
Lamivudine
|
|
E. Hepatitis C
|
Ribaviran
|
Interferon Alfa-2B
|
