Immunocompromised antibiotics: Difference between revisions
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==[[CMV Retinitis]]== | |||
{{CMV retinitis treatment}} | |||
==[[CMV esophagitis]]== | |||
{{CMV esophagitis treatment}} | |||
==[[CMV colitis]]== | |||
{{CMV colitis treatment}} | |||
==[[CMV neurologic disease]]== | |||
{{CMV neurologic disease treatment}} | |||
==[[CMV pneumonia]]== | |||
{{CMV pneumonia treatment}} | |||
==[[Neutropenic Fever]]== | |||
{{Neutropenic fever treatment}} | |||
==See Also== | |||
{{Antibiotics by diagnosis navigation}} | {{Antibiotics by diagnosis navigation}} | ||
Revision as of 23:30, 29 April 2015
CMV Retinitis
Severe Vision Threatening
- Ganciclovir intraocular implant for 8 months AND
- Valganciclovir 900mg PO q12hrs x 14 days FOLLOWED BY 900mg PO q24hrs x 7 days
Peripheral lesions
- Valganciclovir 900mg PO q12hrs x 21 days FOLLOWED BY 900mg PO q24hrs x 7 days
CMV esophagitis
- Ganciclovir 5mg/kg IV q12hrs daily x 21 days (or until symptom resolution)
- Foscarnet 90mg/kg IV q12 hrs daily x 21 days (or until symptom resolution)
CMV colitis
- Ganciclovir 5mg/kg IV q12hrs x 21 days (or until resolution of symptoms)
- Foscarnet 90mg/kg IV q12hrs daily x 21 days (or until resolution of symptoms)
CMV neurologic disease
- Ganciclovir 5mg/kg IV q12hrs daily x 21 days FOLLOWED BY 5mg/kg IV q24hrs +
- Foscarnet 90mg/kg IV q12hrs x 21 days THEN 90-120mg/kg IV q24hrs
CMV pneumonia
- Ganciclovir 5mg/kg IV q12hrs x 3 weeks
Neutropenic Fever
Therapy is aimed at treating multiple flora that include Gram Negatives, Gram Positive Bacteria, Pseudomonas and if there is an indwelling catheter or high risk, then MRSA.
Inpatient
- Monotherapy appears to be as good as dual-drug therapy[1]
- Cefepime 2g IV q8hr or Ceftazidime 2g IV q8hr OR
- Imipenem/Cilastin 1gm IV q8hr or Meropenem 1gm IV q8hr OR
- Piperacillin/Tazobactam 4.5gm IV q 6hr
- Consider adding Vancomycin to above regimen for:[2]
- Severe mucositis
- Signs of catheter site infection
- Fluoroquinolone prophylaxis was recently used against gram-negative bacteremia
- Hypotension is present
- Institutions with hospital-associated MRSA
- Patient has known colonization with resistant gram-positive organisms
Outpatient
- Ciprofloxacin 750mg PO q12hrs AND Amoxicillin/Clavulanate 875mg PO q12hrs x7d OR[1]
- Ciprofloxacin 750mg PO q12hrs AND Clindamycin 450mg PO q8hrs
See Also
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
References
- ↑ 1.0 1.1 Friefeld AG et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the IDSA. Clin Infect Dis. 2011; 52(4):e56-93 fulltext
- ↑ Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clinical Infectious Disease 2002; 34:730-751