Table 13.14-1. Recommended antimicrobial therapy for specific pathogens

Organism

Preferred antimicrobial(s)

Alternative antimicrobial(s)

Streptococcus pneumoniae

Penicillin nonresistant; MIC <2 microg/mL

Penicillin G, amoxicillin

Macrolide, cephalosporins (oral [cefpodoxime, cefprozil, cefuroxime, cefdinir, cefditoren] or parenteral [cefuroxime, ceftriaxone, cefotaxime]), clindamycin, doxycycline, respiratory fluoroquinolonea

Penicillin resistant; MIC ≥2 microg/mL

Agents chosen on the basis of susceptibility, including cefotaxime, ceftriaxone, fluoroquinolone

Vancomycin, linezolid, high-dose amoxicillin (3 g/d with penicillin MIC ≤4 microg/mL)

Haemophilus influenzae

Non–beta-lactamase producing

Amoxicillin

Fluoroquinolone, doxycycline, azithromycin, clarithromycinb

Beta-lactamase producing

Second- or third-generation cephalosporin, amoxicillin-clavulanate

Fluoroquinolone, doxycycline, azithromycin, clarithromycinb

Mycoplasma pneumoniae/Chlamydophila pneumoniae

Macrolide, a tetracycline

Fluoroquinolone

Legionella spp

Fluoroquinolone, azithromycin

Doxycycline

Chlamydophila psittaci

A tetracycline

Macrolide

Coxiella burnetii

A tetracycline

Macrolide

Francisella tularensis

Doxycycline

Gentamicin, streptomycin

Yersinia pestis

Streptomycin, gentamicin

Doxycycline, fluoroquinolone

Bacillus anthracis (inhalation)

Ciprofloxacin, levofloxacin, doxycycline (usually with a second agent)

Other fluoroquinolones; beta-lactam, if susceptible; rifampin; clindamycin; chloramphenicol

Enterobacteriaceae

Third-generation cephalosporin, carbapenemc (drug of choice if extended-spectrum beta-lactamase producer)

Beta-lactam/beta-lactamase inhibitor,d fluoroquinolone

Pseudomonas aeruginosa

Antipseudomonal beta-lactame plus (ciprofloxacin or levofloxacinf or aminoglycoside)

Aminoglycoside plus (ciprofloxacin or levofloxacinf)

Burkholderia pseudomallei

Carbapenem, ceftazidime

Fluoroquinolone, sulfamethoxazole/trimethoprim

Acinetobacter spp

Carbapenem

Cephalosporin-aminoglycoside, ampicillin/sulbactam, colistin

Staphylococcus aureus

Methicillin susceptible

Antistaphylococcal penicilling

Cefazolin, clindamycin

Methicillin resistant

Vancomycin or linezolid

Sulfamethoxazole/trimethoprim

Bordetella pertussis

Macrolide

Sulfamethoxazole/trimethoprim

Anaerobe (aspiration)

Beta-lactam/beta-lactamase inhibitor,d clindamycin

Carbapenem

Influenza virus

Oseltamivir or zanamivir

 

Mycobacterium tuberculosis

Isoniazid plus rifampin plus ethambutol plus pyrazinamide

 

Coccidioides spp

For uncomplicated infection in a normal host, no therapy generally recommended; for therapy, itraconazole, fluconazole

Amphotericin B

Histoplasmosis

Itraconazole

Amphotericin B

Blastomycosis

Itraconazole

Amphotericin B

Choices should be modified on the basis of susceptibility test results and advice from local specialists. Refer to local references for appropriate doses.

a Levofloxacin, moxifloxacin, gemifloxacin (not a first-line choice for penicillin susceptible strains); ciprofloxacin is appropriate for Legionella and most gram-negative bacilli (including Haemophilus influenzae).

b Azithromycin is more active in vitro than clarithromycin for H influenzae.

c Imipenem/cilastatin, meropenem, ertapenem.

d Piperacillin-tazobactam for gram-negative bacilli, ticarcillin/clavulanate, ampicillin/sulbactam or amoxicillin/clavulanate.

e Ticarcillin, piperacillin, ceftazidime, cefepime, aztreonam, imipenem, meropenem.

f 750 mg daily.

g Nafcillin, oxacillin flucloxacillin.

Source: Clin Infect Dis. 2007;44 Suppl 2:S27-72.

INN, international nonproprietary name; MIC, minimum inhibitory concentration.