Hospital Health Plan

Adult Anti-Infective Therapy Guide

Infection Pathogens* P 1st Line

P P 2nd Line
P P 3rd Line
P P 4th line
P P

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P

Skin/Cellulitis Staph. a., Dicloxacillin Cephalexin 250- Amoxil/Clauv. Azithromycin

Strep A 500mg po QID 500mg QID acid 500mg X 1 day,
Or 500-875mg BID to then 250mg QD
Erythromycin TID X 4 days
500mg QID
Skin-Diabetic Staph. a., Clindamycin Amoxil/Clauv. For non-limb/life-
Strep A, 300mg QID X acid threatening,
GNR, 14 days 500-875mg BID to chronic, recurrent:
Anaer. Or TID levofloxacin
Cephalexin 750mg QD +
500mg QID X Clindamycin
14 days 300mg QID
Skin-Bite wound Staph. a, Amoxil/Clauv. Cefuroxime TMP/SMX DS Ciprofloxacin
Strep A, acid 500mg Q12h BID + 500-750mg BID
Past. mult., 500-875mg BID Or Clindamycin + Clindamycin
Anaer. to TID Doxycycline 300mg QID 300mg QID
100mg BID
Pharyngitis Strep A Pen VK Erythromycin Cephalexin Clarithromycin
250-500mg QID 250-500mg QID 250-500mg TID 500mg BID X
Or 10days
Clindamycin Or
300mg QID Azithromycin
500mg X 1 day,
then 250mg X 4
days
Rhinosinusitis- Strep. Reserve For mild/ moderate For mild/ moderate
Acute pneum., H. antibiotics for disease, no disease, antibiotics
flu patients given antibiotics taken in taken in the prior
decongestants/ the prior month month and/or
analgesics for 7 and/or DRSP** DRSP**
days who have prevalence <30%: prevalence >30%:
1) maxillary Amoxicillin Amoxil/Clauv.
/facial pain & 500mg TID acid
2) purulent, nasal Or 500-875mg BID to
discharge; if Amoxil/Clauv. TID
severe illness acid Or
(pain, fever), 500-875mg BID to Levofloxacin
TID 500mg QD
treat sooner
Sinusitis-Chronic Strep. No abx, treat Antibiotics usually
pneum., symptoms not effective
Staph. a., otolaryngology
H. flu, consultation is
Anaer. recommended.
For acute
exacerbations, Rx
as acute.
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(Dr. B. K. Iyer))
 Infection Pathogens* P 1st Line
P P 2nd Line
P P 3rd Line
P P 4th line
P P

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P

Bronchitis-Acute Myco. No abx; If pneumonia is

pneum., Treat symptoms. present, start
StrepA, H. antibiotics. (See
flu Pneumonia –
Community)
Bronchitis- Myco. For mild/ For severe disease
Chronic pneum., moderate (accompanied with
Strep. disease, no increased dyspnea,
pneum., H. antibiotics increased sputum
flu, Chlam. needed purulence, febrile),
pneum., Amoxil/Clauv.
Mor. cat. acid 500-875mg
BID to TID

Or
Azithromycin
500mg X 1 day,
then 250mg QD X
4 days
Pneumonia- Strep. Previously
Community pneum.(5- healthy with no
55%), H. recent antibiotic:
flu(9%), Erythromycin Previously healthy
Staph. 500mg QID Or with recent
a.(2%) , Doxycycline antibiotic therapy:
GNR 100mg BID
Azithromycin
With recent 500mg x 1d; then
antibiotic 250mg x 4d
therapy: Or
Levofloxacin Clarithromycin
500mgQD alone 500mg BID
+
Amoxicillin 1g
TID
Or
Amoxil/Clauv.
acid 500-875mg
BID to TID

Comorbidities Comorbidities
with no recent with no recent
antibiotic: antibiotic:
Azithromycin Levofloxacin
500mg x 1d; 500mg QD
then 250mg x 4d
Or
Clarithromycin
500mg BID
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(Dr. B. K. Iyer)
 Infection Pathogens* P 1st Line
P P 2nd Line
P P 3rd Line
P P 4th line
P P

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P

Comorbidities Comorbidities
with recent with recent
antibiotic: antibiotic:
Levofloxacin Azithromycin500
500mg QD mg X 1 day, then
250mg QD X 4
days
Or
* comorbidity Clarithromycin
include smoker, 500mg BID
COPD. (either one above)
+
Amoxicillin 1g
TID
Or
Amoxil/Clauv.
acid 500-875mg
BID to TID
Pneumonia- Myco. Clarithromycin Doxycycline
Atypical pneum., 500mg BID 100mg BID
Leg, Or Or
Chlam. Azithromycin50 Erythromycin
pneum. 0mg X 1 day, 500mg QID
then 250mg QD
X 4 days
UTI GNR, Ent. Ofloxacin
200mg BID X 3 Cefixime 400mg
days QD x 3 days
Or Or
Ciprofloxacin Doxycycline
250mg BID X 3 100mg BID x 3
days days
Or
Cephalexin
500mg QID x 7
days
Or
Nitrofurantoin
100mg BID x 3
days
Or
TMP/SMX DS
BID X 3 days
If TMP/SMX
resistant E-coli
are not prevalent
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(Dr. B. K. Iyer)
 Infection Pathogens* P 1st Line
P P 2nd Line
P P 3rd Line
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P P

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Pyelonephritis or GNR Ofloxacin TMP/SMX DS

Non-STD 400mg BID X 7 BID X 14 days
Prostatitis days
Or
Ciprofloxacin
500mg BID X 7
days
Diarrhea- Campy., Ciprofloxacin TMP/SMX DS Metronidazole
Inflammatory Shig., 500mg BID X 3- BID X 3-5 days 250-500mg TID X
Salm., 5 days 10 days
Ecoli
Cervical or N. Ceftriaxone Cefixime 400mg x
Urethral gonorrhea 125mg IM X 1 1 Or
Gonorrhea + + Doxycycline
(Doxycycline (Doxycycline 100mg BID X 7
100mg BID X 7 100mg BID X 7 days
days days
Or Azithromycin Or Azithromycin
1gm X 1) 1gm X 1)
Cervical or Chlam. Doxycycline Azithromycin Erythromycin
Urethral trach. 100mg 1000mg X 1 500mg QID X 7
Chlamydia BID X 7 days days
Or
Ofloxacin 300mg
BIDX 7 days
Vaginal Trich. vag. Metronidazole Tinidazole 2g po Metronidazole
Trichomoniasis 2g X 1 single dose 500mg
(Treat male BID X 7 days
sexual partners)
Bacterial Gard. vag., Metronidazole Metronidazole Clindamycin
Vaginosis Anaer. 500mg po BID X vaginal BID X 5 300mg BID X 7
7 days days days
Or
Clindamycin 2%
vaginal cream HS
X 7 days
Vaginal Cand. alb., Fluconazole Miconazole 2% Butoconazole vag Terconazole-3
Candidiasis Cand. gl. 150mg X 1 vag cream QHS X cream vag cream QHS
7 days QHS X 3 days X 3 days
Or
Miconazole-3 vag
supp
QHS X 3 days
PID-(Outpatient) Anaer., Ceftriaxone Metronidazole
Chlam. 250mg IM X 1 + 500mg BID +
trach., N. Doxycycline ofloxacin 400mg
gonorrhea 100mg BID X 14 BID X 14 days
days
With or without
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(Dr. B. K. Iyer)
 Infection Pathogens* P 1st Line
P P 2nd Line
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P

metronidazole
500mg BID x 14
days
Genital Herpes- Herpes Acyclovir Valacyclovir Famciclovir
Primary simp. 400mg TID or 1000mg BID X 7 250mg TID x 7-10
200mg 5X/day X days days
7-10 days
Genital Herpes- Herpes Acyclovir Famciclovir
Recurrent simp. 400mg TID or 1000mg BID X
800mg BID X 5 1day
days or 800mg Or
TID x 2 days Valacyclovir
500mg BID X 3
days
Herpes Zoster Herpes zos. Acyclovir Valacyclovir 1g Famciclovir
800mg 5x/day X TID X 7 days 500mg TID X 7
7-10 days days
* Anaer.=Anaerobes, Cand. alb.=Candida albicans, Campy.=Campylobacter sp., Cand. gl.=Candida glabrata, Chlam. pneum.=Chlamydia
pneumoniae, Chlam. trach.=Chlamydia trachomatis, Ent.=Enterococcus sp., GNR=Gram-negative rods, Gard. vag.=Gardnerlla
vaginalis, H. flu=Hemophilus inf., Herpes simp.=Herpes simplex, Herpes zos.=Herpes zoster, Leg=Legionella sp., Mor.
cat.=Moraxella catarrhalis, Myco. pneum.=Mycoplasma pneumoniae, N. gonorrhea=Neisseria gonorrhea, Past. mult.=Pasteurella
multocida, Strep. pneum.=Strep. Pneumoniae, Staph. a. =Staph. aureus, Salm.=Salmonella sp., Shig.=Shigella sp., StrepA=Group A
Strep., Trich. vag.=Trichomonas vaginalis

** DRSP = Drug Resistant Streptococcus pneumoniae

†
P Viruses included
P

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(Dr. B. K. Iyer)