Bacteremia

(Outpatient)

Strep pneumo

GAS

N. meningitidis

E. coli

Salmonella

Bacteremia (Outpatient)

Tx and Tx Length

Ceftriaxone x 7-10d

(Can do Amoxicillin if susceptible Strep pneumo if afebrile, well-appearing, and no focal complications)

Strep

Staph aureus

Staph epidermidis

Oral anaerobes

Eikinella corrodens

Human bite pathogens (Strep, S. aureus, S. epidermidis, oral anaerobes, Eikenella corrodens)

Pasteurella multocida

Human Bite/Dog Bite

ABX and Tx Length

PO: Augmentin

IV: Ampicilin/sulbactam

x5-7d

Most important aspect of tx is cleaning, irrigation and debridement

GAS

S. aureus (MSSA or MRSA)

Cellulitis

ABX and Length of Tx

PO Cephalexin

(or Clindamycin if MRSA common in population) or

IV Oxacillin

x 3d after acute inflammation resolves (7-10d)

Conjunctivitis

Neonatal

Suppurative

Dacrocystitis

• Neonatal
• Onset 2-4d: N. gonorrhoeae
• Onset 3-10d: C. trachomatis
• Suppurative
• S. pneumo, H. flu, Moraxella (AOM pathogens)
• Dacrocystitis
• S. pneumo, H. flu, S. aureus, S. pyogenes, P. aeruginosa

Conjunctivitis

(Neonatal, Suppurative, Dacrocystitis)

ABX and Length of Tx

• Neonatal
• CT: PO erythromycin (or other macrolides) x 14d (topically is ineffective in preventing pna)
• GC: IV/IM Ceftriaxone or Cefoxatime (one dose if localized to eye; if disseminated, then 7d of parenteral tx)
• Suppurative
• Erythromycin optho ointment, Polycin B (bacitracin/polymixinB) or Polytrim (polymyxinB+TMP) x 5d
• Ointment for infants/young kids and eyedrops for older kids/adolescents
• Dacrocystitis
• Initial mgmt: warm compresses
• PO cephalexin with optho referral

Dental Abscesses

ABX and Tx Length

Gastroenteritis

Nosocomial

Gastroenteritis

Nosocomial

ABX and Tx Length

Viruses

GAS

Mycobacterium tuberculosis

S. aureus

Anaerobes

Atypical mycobacteria

Actinomyces

Bartonella henselae

Lymphadenitis

ABX and Length of tx

PO Augmentin (or Cephalexin if MRSA present)

or IV Oxacillin

If M. tuberculosis-Surgical excision

If B. henselae-Needle aspiration

S. pneumo

Streptococcus pyogenes

S. aureus

H. flu

Mastoiditis

ABX and LoT

Clindamycin or Ampicillin/sulbactam x 10d

Surgical mgmt required

Meningitis

Neonate <1mo

Neonate 1-3mo

Children >3mo

• Neonate <1mo
• GBS, Enterbacteria (esp E. coli), listeria monocytogenes
• Neonate 1-3mo
• GBS, S. pneumo, H. flu, N. meningitidis, Enterbacteria
• Children >3mo
• S. pneumo, N. meningitidis, H. flu, neonatal pathogens (GBS, enterobacteria)

Meningitis

Neonate <1mo

Neonate 1-3 mo

Children >3mo

ABX and LoT

Neonate <1mo: Ampicillin and cefoxatime x 14-21d for GBS and Listeria; Cefoxatime x 21d for Enterbacter

Neonate 1-3 mo: Ampicillin and cefoxatime x 10-14d for S. pneumo, x7d for N. meningitidis, x 7-10d for H. flu

Children >3mo: Cefoxatime or Ceftriaxone (with addition of empiric vanco for PCN-resistant S. pneumo until susceptibilities known) with dexamethasone (unless H. flu uncertain)

S. pneumo

H. flu

Moraxella

S. aureus

GAS

Orbital cellulitis

ABX and LoT

Ampicillin/sulbactam or

(Cefoxatime or Ceftriaxone) + Clindamycin x 10d

S. aureus

GAS

If foot puncture, add pseudomonas

If sickle cell disease, add Salmonella

Osteomyelitis

ABX and LoT

Oxacillin or Nafcillin x 4-6wk

If foot puncture, add Ceftazidime

If sickle cell, add Cefoxatime

Pseudomonas

Enterbacteria

Proteus

Otitis Externa

ABX and LoT

GAS

GCS, GGS

Virus

Mono

Pna

Neonatal & 3 wk-4mo

• Neonatal: E. coli, GBS, S. aureus, Listeria, CT
• 3wk-4mo: CT, Strep pneumo, viruses

Pna

Lobar

6wk-4 yr

>4yr

• 6wk-4yr: S. pneumo
• >4yr: S. pneumo

Pna

Atypical

6wk-4 yr

>4 yr

• 6wk-4yr: Bordatella pertusis, RSV, influenza
• >4yr: Mycoplasma pneumo, Chlamydia pneumo, Influenza

Septic Arthritis

<5yr

>5yr

Adolescent

• <5 yr: S. aureus, GAS, Hib, Strep pneumo, Kingella, gram-negative bacteria
• >5 yr: S. aureus, GAS, Strep
• Adolescent: S. aureus, GAS, N. gonorrhoeae

Sinusitis

Acute

Chronic

• Acute: S. pneumo, H. flu, Moraxella cat (AOM organisms)
• Chronic: S. aureus, anaerobes, S. pneumo, H. flu, Moraxella

Gastroenteritis

Community Acquired

Gastroenteritis

Community Acquired

Abx and LoT

• E. coli-no tx recommended, as increased risk of HUS with tx
• Salmonella-Ceftriaxone
• Shigella-Ceftriaxone, Zithromax, or FQs
• Yersinia-Bactrim, FQs, or tetracycline (>8y/o)
• Campylobacter-Zithromax or erythromycin

S. aureus most common.

Oral flora, gram-negative rods, viruses (mumps, HIV, EBV) or noninfectious causes

Parotitis

ABx and LoT

Clindamycin or Augmentin

Local heat, massage of gland from posterior to anterior and hydration for symptomatic relief.  Surgical drainage may be indicated

Periorbital cellulitis

ABx and LoT

Augmentin or Clindamycin+Ceftriaxone x 10-14 days

If 2/2 local trauma and not associated sinusitis, tx as staph/strep

Chlamydia

Manifestation

Chlamydia

ABx and LoT

Azithromycin (single dose)

or

Doxycycline (7 days)

Always tx for GC concomitant infection (Ceftriaxone)

Syphilis

Abx and LoT

Sinusitis

Acute and Chronic

ABx and LoT

Acute: high dose amoxicillin x 10-14 days

Chronic: Augmentin or Cefdinir x 21 days or 7 days after resolution of sxs

Cystitis

ABx and LoT

PO: Cefixime (preferred syrup) or Bactrim

IV: Ceftriaxone OR Amp&Gent

x 7-14 days

Pyelonephritis

ABx and LoT