Infectious agent | Antibiotic regimen | Dosing |
Empiric therapy | ||
Vancomycin PLUS a third- or fourth-generation cephalosporin (such as ceftriaxone, ceftazidime, or cefepime) | As summarized below | |
Pathogen-specific therapy | ||
Staphylococci, methicillin susceptible* | Nafcillin | 2 g IV every 4 hours |
Oxacillin | 2 g IV every 4 hours | |
Cefazolin | 2 g IV every 8 hours | |
Flucloxacillin | 2 g IV every 6 hours | |
Ceftriaxone¶ | 2 g IV every 24 hours | |
Staphylococci, methicillin resistant* | Regimen of choice: | |
VancomycinΔ | Loading dose◊: 20 mg/kg Initial maintenance dose and interval determined by nomogram§: typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function Subsequent dose and interval adjustments based on AUC-guided or trough-guided serum concentration monitoring¥ | |
Alternative regimens:‡ | ||
Daptomycin† | 6 to 10 mg/kg IV once daily | |
Teicoplanin (where available)**,¶¶ | 12 mg/kg IV every 12 hours for 3 to 5 doses, followed by 12 mg/kg once daily | |
Staphylococci, adjunctive agents* | Rifampin | 300 to 450 mg orally twice daily |
Fusidic acid (where available)** | 500 mg orally 3 times daily | |
Gram-negative organisms | CiprofloxacinΔΔ,◊◊,§§ | 750 mg orally twice daily or 400 mg IV every 12 hours; if treating Pseudomonas, increase IV dose to 400 mg IV every 8 hours |
Levofloxacin◊◊,§§ | 750 mg orally or IV once daily | |
Ceftriaxone¥¥ | 2 g IV every 24 hours | |
Ceftazidime◊◊ | 2 g IV every 8 hours | |
Cefepime◊◊ | 2 g IV every 8 to 12 hours | |
Ertapenem¥¥ | 1 g IV every 24 hours | |
Meropenem◊◊ | 1 g IV every 8 hours | |
Enterococci‡‡ | Monotherapy regimens: | |
Ampicillin | 12 g IV every 24 hours, either continuously or in 6 equally divided doses | |
Aqueous crystalline penicillin G | 20 to 24 million units IV every 24 hours, either continuously or in 6 equally divided doses | |
VancomycinΔ | 20 mg/kg loading dose, then 15 mg/kg IV every 12 hours, not to exceed 2 g per dose | |
Daptomycin† | 6 to 10 mg/kg IV once daily | |
Teicoplanin (where available)**,¶¶ | 12 mg/kg IV every 12 hours for 3 to 5 doses, followed by 12 mg/kg once daily | |
Combination therapy regimen: | ||
Ampicillin | 12 g IV every 24 hours, given either continuously or in 6 equally divided doses | |
PLUS | ||
Ceftriaxone | 2 g IV every 12 to 24 hours | |
Streptococci, penicillin sensitive | One of the following: | |
Aqueous crystalline penicillin G | 20 to 24 million units IV every 24 hours, either continuously or in 6 equally divided doses | |
Ampicillin | 12 g IV every 24 hours, either continuously or in 6 equally divided doses | |
Ceftriaxone | 2 g IV every 24 hours | |
VancomycinΔ | 20 mg/kg loading dose, then 15 mg/kg/dose IV every 12 hours, not to exceed 2 g per dose, initially | |
Cutibacterium (formerly Propionibacterium) acnes†† | One of the following: | |
Aqueous crystalline penicillin G | 20 million units IV every 24 hours, either continuously or in 6 divided doses | |
Ceftriaxone | 2 g IV every 24 hours |
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