Clindamycin vs metronidazole for cat bite

Regardless of treatment regimen used, relapse or recurrence is common; 188. For information on treatment of CAP, consult current IDSA clinical practice guidelines available at [Web]. 512. X. What Is the Appropriate Approach to the Evaluation and Treatment of Clostridial Gas Gangrene or Myonecrosis? Oral therapy for ecthyma or impetigo should be a 7-day regimen with an agent active against S. aureus unless cultures yield streptococci alone (when oral penicillin is the recommended agent) (strong, high). Because S. aureus isolates from impetigo and ecthyma are usually methicillin susceptible, dicloxacillin or cephalexin is recommended. When MRSA is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) is recommended (strong, moderate). Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Co-trimoxazole is drug of choice for primary and secondary prophylaxis of PCP in HIV-infected adults, adolescents, and TEENren. 440. Evaluation and Treatment of Clostridial Gas Gangrene and Myonecrosis. Systemic antimicrobials should be used for infections during outbreaks of poststreptococcal glomerulonephritis to help eliminate nephritogenic strains of S. pyogenes from the community (strong, moderate). Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Sheldon L. Kaplan, Jose G. Montoya, James C. Wade. XVI. What Is the Appropriate Approach for the Evaluation and Treatment of Bacillary Angiomatosis and Cat Scratch Disease? Gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma are recommended to help identify whether Staphylococcus aureus and/or a β-hemolytic Streptococcus is the cause (strong, moderate), but treatment without these studies is reasonable in typical cases (strong, moderate). Regimen of primaquine and clindamycin is an alternative for treatment of mild, moderate, or severe PCP in HIV-infected adults and adolescents who have had an inadequate response to co-trimoxazole or when co-trimoxazole is contraindicated or not tolerated. 440. Patients >45 kg: 500 mg on day 1 followed by 250 mg for 4 additional days (strong, moderate). Tetanus toxoid should be administered to patients without toxoid vaccination within 10 years. Tetanus, diptheria, and tetanus (Tdap) is preferred over Tetanus and diptheria (Td) if the former has not been previously given (strong, low). Purulent bite wounds usually are polymicrobial and broad-spectrum anti-infective coverage recommended. 292. Initiate treatment with IV ciprofloxacin or doxycycline and 1 or 2 other anti-infective agents predicted to be effective (e.g., chloramphenicol, clindamycin, rifampin, vancomycin, clarithromycin, imipenem, penicillin, ampicillin); 117. retreatment with the same or an alternative regimen (e.g., oral therapy when topical was used initially) may be used in such situations. 344. Component of multiple-drug parenteral regimens recommended for treatment of inhalational anthrax that occurs as the result of exposure to B. anthracis spores in the context of biologic warfare or bioterrorism. 117. Alternative for long-term suppressive or chronic maintenance therapy (secondary prophylaxis) to prevent relapse of toxoplasmosis† in HIV-infected adults, adolescents, and TEENren who have completed treatment for the disease; 440. XII. What Is the Treatment for Infected Animal Bite–Related Wounds? Penicillin plus clindamycin is recommended for treatment of documented group A streptococcal necrotizing fasciitis (strong, low). See Figures 1, 2, and Table 4. [ASKDEEIPSNPPET-21-23] 20 mg/kg/dose IV every 8 hours. In a study of 200 neonates and infants younger than 91 days of age with suspected or confirmed intra-abdominal infections, this dose was used in those patients younger than 32 weeks gestational age and at least 14 days post-natal age (n = 103). Treatment success was attained in 84% of this patient group. The predefined pharmacodynamic target exposure was meropenem concentrations more than 4 mcg/mL for 50% of the dosing interval and more than 2 mcg/mL for at least 75% of the dosing interval. 1 gram IV every 8 hours has been studied for febrile neutropenia. Limited data are available; 40 mg/kg/dose IV every 8 or 12 hours is the most commonly reported dosage. Some experts recommend 40 mg/kg/dose IV every 8 hours for all neonates with meningitis; others recommend a dosing interval of every 12 hours for premature neonates. A dosing interval of every 12 hours for the first week of life then increase to every 8 hours has also been used. Pharmacokinetic data in neonates (including premature neonates) have suggested the need for higher doses (40 mg/kg/dose IV every 8 hours), particularly for infections due to more resistant organisms, to achieve optimal pharmacodynamic targets. The recommended duration of therapy is 7 days for Neisseria meningitidis and Haemophilus influenzae, 10 to 14 days for Streptococcus pneumoniae, and at least 3 weeks for gram-negative bacilli. Based on Monte Carlo simulations, 1 g IV administered over 3 hours every 8 hours may increase the likelihood of pharmacodynamic target achievement in difficult to treat infections. Neonates 32 weeks gestational age and older and 0 to 13 days. 20 mg/kg/dose IV every 12 hours is recommended by the American Academy of Pediatrics (AAP). However, data are limited in neonates for this indication; dosing recommendations are based on pharmacokinetic data and use of meropenem for other indications in small studies. Guidelines recommend an antipseudomonal beta-lactam, such as meropenem, as a first line therapy option with or without an aminoglycoside and/or vancomycin as a treatment option for febrile neutropenia. Alternatively, 500 mg IV every 6 hours has shown similar clinical efficacy in hospitalized patients with a variety of infections (including febrile neutropenia) and based on Monte Carlo simulations, achieves pharmacodynamic endpoints equivalent to the manufacturer's recommended dose. 20 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP). However, data are limited in neonates for this indication; dosing recommendations are based on pharmacokinetic data and use of meropenem for other indications in small studies. 10 to 20 mg/kg/dose IV every 8 hours is the general dosing recommended for infants after the neonatal period by the American Academy of Pediatrics (AAP). However, data are limited in young infants specifically for this indication. One trial of 47 patients with a mean age of 2 years (range, 4 days to 20 years) examined meropenem 20 mg/kg/dose (or up to 40 mg/kg/dose for CNS or critical infections) IV every 8 hours for a variety of infections. Five of the 6 cases of skin and soft tissue infections were cured or improved with meropenem therapy. For the treatment of febrile neutropenia in pediatric patients. 20 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP). However, data are limited in neonates for this indication; dosing recommendations are based on pharmacokinetic data and use of meropenem for other indications in small studies. To maximize the likelihood of pharmacodynamic target achievement, several studies in a variety of patient populations have administered meropenem as a continuous intravenous infusion (CI). Premature Neonates younger than 32 weeks gestational age and 14 days and older. 20 mg/kg/dose IV every 12 hours. In a study of 200 neonates and infants younger than 91 days of age with suspected or confirmed intra-abdominal infections, this dose was used in those patients younger than 32 weeks gestational age and younger than 14 days post-natal age (n = 39). Treatment success was attained in 74% of this patient group, which was lower than the overall success rate of 84% in the study. The predefined pharmacodynamic target exposure was meropenem concentrations more than 4 mcg/mL for 50% of the dosing interval and more than 2 mcg/mL for at least 75% of the dosing interval. 1 g IV every 8 hours. Clinical practice guidelines recommend meropenem for 4 to 7 days for severe or high-risk community-acquired infections or complicated health-care associated infections. In one study, the 3-hour infusion achieved the pharmacodynamic target 99% of the time for bacteriostatic exposure and 93% of the time for bactericidal exposure. Additionally, this dose had a higher probability of achieving the pharmacodynamic target than traditionally infused meropenem for intermediately resistant pathogens with an MIC of 8 mcg/mL (62% vs less than 40%). Another study demonstrated that 2 g IV administered over 3 hours every 8 hours in combination with an aminoglycoside was able to suppress resistance and achieve the bacteriocidal pharmacodynamic parameter 79% of the time. 40 mg/kg/dose IV administered over 3 to 4 hours every 8 hours (Max: 2 g/dose). Extending the infusion duration to 3 to 4 hours has been shown to increase the likelihood of pharmacodynamic target achievement (%T above MIC), particularly for bacteria with higher MICs (2 mcg/mL or more), such as Pseudomonas. The IDSA recommends meropenem as a treatment option for documented meningitis and for empiric therapy in combination with vancomycin after a penetrating trauma or postneurosurgery; meropenem may also be used in combination with vancomycin as empiric therapy for CSF shunt infections when gram negative bacilli are present on gram stain. The recommended duration of therapy is 7 days for Neisseria meningitidis and Haemophilus influenzae, 10 to 14 days for Streptococcus pneumoniae, and at least 3 weeks for gram-negative bacilli. For the treatment of intraabdominal infections, including complicated appendicitis and peritonitis. We do not record any personal information entered above. For the treatment of complicated skin and skin structure infections. 2 g IV every 8 hours is recommended by clinical practice guidelines as a treatment option for empiric or documented meningitis. The IDSA recommends meropenem as a treatment option for documented meningitis and for empiric therapy in combination with vancomycin after a penetrating trauma or postneurosurgery; meropenem may also be used in combination with vancomycin as empiric therapy for CSF shunt infections when gram negative bacilli are present on gram stain. The recommended duration of therapy is 7 days for Neisseria meningitidis and Haemophilus influenzae, 10 to 14 days for Streptococcus pneumoniae, and at least 3 weeks for gram-negative bacilli. Based on Monte Carlo simulations and case reports, meropenem dosed at 2 g IV administered over 3 hours every 8 hours may increase the likelihood of pharmacodynamic target achievement in difficult to treat CNS infections. Monte Carlo simulation determined that there is an increased percentage of target attainment rates for a bactericidal response with a 3-hour infusion as compared to a traditional 30-minute infusion for Pseudomonas aeruginosa (84% vs. 79.9%, respectively) and Acinetobacter sp. (91.1% vs. 87.3%, respectively). In 3 case reports, patients had similar CSF and serum concentrations. Serum concentrations with the prolonged infusion demonstrated free drug concentrations were above the MIC for 100% of the dosing interval, thereby maximizing the pharmacodynamic target. Premature Neonates younger than 32 weeks gestational age and 0 to 13 days.