Usual causative organisms | Initial parenteral antimicrobial regimens | Empiric oral step-down regimens |
Community-acquired infection in immunocompetent patients |
Staphylococcus aureus, viridans streptococci and other streptococci, Haemophilus influenzae, oral anaerobes (Peptostreptococci, Fusobacterium, etc) | - Ampicillin-sulbactam 3 g IV every 6 hours
If therapy against MRSA is indicated¶, add one of the following to the above regimens: - VancomycinΔ or
- Linezolid 600 mg IV or orally every 12 hours or
- Daptomycin 6 mg/kg IV every 24 hours
| - Amoxicillin-clavulanate 875/125 mg orally twice daily
- Cefuroxime 500 mg orally every 24 hours or
- Levofloxacin 500 mg orally every 24 hours*
PLUS - Metronidazole 500 mg orally every 8 hours
If therapy against MRSA is indicated◊, add one of the following to the above regimens: - Linezolid 600 mg orally every 12 hours OR
- Trimethoprim-sulfamethoxazole 1 double-strength tablet twice a day
|
Hospital-acquired infection or immunocompromised patients |
Staphylococcus aureus (including MRSA), viridans streptococci and other streptococci, Haemophilus influenzae, Pseudomonas aeruginosa, Enterobacterales, oral anaerobes (eg, Peptostreptococci, Fusobacterium) | PLUS one of the following regimens: - Cefepime 2 g IV every 12 hours PLUS metronidazole 500 mg IV or orally every 6 to 8 hours or
- Piperacillin-tazobactam 4.5 g IV every 6 hours or
- Imipenem 500 mg IV every 6 hours or
- Meropenem 1 g IV every 8 hours
| If therapy against MRSA is indicated◊ and clindamycin cannot be used§: - Linezolid 600 mg IV or orally every 12 hours or
- Trimethoprim-sulfamethoxazole 1 double-strength tablet twice a day
PLUS - Ciprofloxacin 750 mg orally twice daily or
- Levofloxacin 750 mg orally every 24 hours
PLUS - Metronidazole 500 mg orally every 8 hours
|