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infections
Antal Gbor Kondsz Med.
Resident doctor of infectious diseases
Age
<1 month Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes Ampicillin plus cefotaxime; OR ampicillin plus an
aminoglycoside
1 to 23 months Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Vancomycin plus a third-generation cephalosporin
Haemophilus influenzae, E. coli
>50 years S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram- Vancomycin plus ampicillin plus a third-generation
negative bacilli cephalosporin
Head trauma
Basilar skull fracture S. pneumoniae, H. influenzae, group A beta-hemolytic streptococci Vancomycin plus a third-generation cephalosporin
Penetrating trauma Staphylococcus aureus, coagulase-negative staphylococci Vancomycin plus cefepime; OR vancomycin plus
(especially Staphylococcus epidermidis), aerobic gram-negative ceftazidime; OR vancomycin plus meropenem
bacilli (including Pseudomonas aeruginosa)
Postneurosurgery Aerobic gram-negative bacilli (including P. aeruginosa), S. aureus, Vancomycin plus cefepime; OR vancomycin plus
coagulase-negative staphylococci (especially S. epidermidis) ceftazidime; OR vancomycin plus meropenem
Immunocompromised S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram- Vancomycin plus ampicillin plus cefepime; OR
state negative bacilli (including P. aeruginosa) vancomycin plus ampicillin plus meropenem
Microorganism, susceptibility Standard therapy Alternative therapies
Streptococcus pneumoniae
Penicillin MIC
0.06 mcg/mL Penicillin G or ampicillin Third-generation cephalosporin,
chloramphenicol
Third-generation Third-generation cephalosporin Cefepime, meropenem
cephalosporin MIC <1
Third-generation cephalosporin Vancomycin plus a third-generation Fluoroquinolone
MIC 1 cephalosporin
Neisseria meningitidis
Penicillin MIC
<0.1 mcg/mL Penicillin G or ampicillin Third-generation cephalosporin,
chloramphenicol
0.1 to 1.0 mcg/mL Third-generation cephalosporin Fluoroquinolone, meropenem,
chlorampenicol
Listeria monocytogenes Ampicillin or penicillin G Trimethoprim-sulfamethoxazole
Streptococcus agalactiae (group B Ampicillin or penicillin G Third-generation cephalosporin
Streptococcus)
Microorganism, susceptibility Standard therapy Alternative therapies
Escherichia coli and other Third-generation cephalosporin Aztreonam, fluoroquinolone,
Enterobacteriaceae meropenem, trimethoprim-
sulfamethoxazole, ampicillin
Pseudomonas aeruginosa Cefepime or ceftazidime Aztreonam, ciprofloxacin, meropenem
Acinetobacter baumannii Meropenem Colistin or polymyxin B
Haemophilus influenzae
Beta-lactamase negative Ampicillin Third-generation cephalosporin,
cefepime, fluoroquinolone, aztreonam,
chloramphenicol
Beta-lactamase positive Third-generation cephalosporin Cefepime, fluoroquinolone, aztreonam,
chloramphenicol
Staphylococcus aureus
Methicillin susceptible Nafcillin or oxacillin Vancomycin, meropenem, linezolid,
daptomycin
Methicillin resistant Vancomycin Trimethoprim-sulfamethoxazole,
linezolid, daptomycin
Staphylococcus epidermidis Vancomycin Linezolid
Enterococcus species
Ampicillin susceptible Ampicillin plus gentamicin
Ampicillin resistant
Vancomycin plus gentamicin