Immunocompromised antibiotics

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

Cryptococcosis

Pulmonary (not AIDS associated)

• Fluconazole 400mg PO IV q24hrs x 6-12 months OR
• Itraconazole 200mg PO q12hrs daily x 6-12 months OR
• Voriconazole 200mg PO q12hrs x 6-12 months

Pulmonary (with AIDS)

• Fluconazole 400mg PO q24hrs x 6-12 months

Meningitis (not AIDs associated)

• Amphotericin B 0.7-1mg/kg IV q24hrs AND Flucytosine 25mg/kg PO q6hrs x 4 weeks
  • Followed by Fluconazole 400mg PO q24hrs x 8 weeks

Meningitis (with AIDS)

• Amphotericin B 0.7-1mg/kg IV q24hrs AND Flucytosine 25mg/kg PO q6hrs x 2 weeks
  • Followed by Fluconazole 400mg PO q24hrs x 8 weeks
• Initiation of HAART is delayed by 2 to 10 weeks to minimize the risk of immune reconstitution syndrome

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
  • 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:
  • 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
• 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)