Infections

Updated: March 12, 2023

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Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

cefoxitin 

Indicated for Moderate to Severe Infections :


2g intravenous two to three times a day. Maximum dose:6-8 g/day



cefoxitin 

Indicated for Uncomplicated Infections:


1 g intravenous two to three times a day



Dose Adjustments

Renal impairment
CrCl<5ml/min: 500mg to 1g once a day
CrCl 5 to 9 ml/min: 0.5 to 1g once or twice a day
CrCl 10 to 29 ml/min: 1 to 2g once or twice a day
CrCl 30 to 50 ml/min: 1 to 2g once or twice a day

albendazole 


Indicated for Neurocysticercosis by Taenia Solium
Body weight >60 kilograms: 400 mg orally two times a day for nearly 8-30 days
Body weight <60 kilograms: 15 mg/kg/day in divided doses two times a day orally for nearly 8-30 days. Should not exceed 800 mg in a day
Hydatid by Echinococcus Tapeworm
Body weight >60 kilograms: 400 mg orally two times a day for 1 month, after that, 14 days drug-free period for the 3 cycles
Body weight <60 kilograms: 15 mg/kg/day in divided doses two times a day orally for 1 month. Should not exceed 800 mg in a day; after that, 14 days drug-free period for the 3 cycles
Capillariasis
400 mg orally every day for 10 days
Ascariasis, Ancylostoma, Trichostrongylus, Hookworm
400 mg orally one time a day
Larva Migrans, Cutaneous, and Trichuriasis
400 mg orally every day for 3 days
Larva Migrans, Visceral
400 mg orally two times a day for 5 days
Fluke by Clonorchis Sinensis
10 mg/kg orally every day for seven days
Enterobius by Pinworm
400 mg orally one time a day, repeat in for two weeks
Gnathostomiasis, Microsporidiosis
400 mg orally two times a day for 21 days



erythromycin stearate 


Indicated for General Dosing for infection
250 mg orally four times in a day or 500 mg orally two times a day (should not exceed 1 gm in a day); may enhance upto 4 gm in a day depending upon the infection severity
Legionnaires Disease
1-4 gm in a day orally in divided doses for 3 weeks
Amebiasis
500 mg orally four times in a day for 10-14 days
Urethritis
500 mg orally four times in a day for 7 days
Or
333 mg orally three times in a day for 7 days
Urethritis is caused by U urealyticum or C trachomatis
Syphilis
30-40 gm orally in divided doses for the 10-15 days
Note:
For renal impairment, adjustment of dose is not necessary. For hepatic impairment, use it with caution



boric acid/alcohol otic 

Indicated for Swimmer's ear infection:


Administer 3 to 8 drops into each ear



oxiconazole 


Indicated for Fungal Infections
One-two time a day, topically apply near the affected area
Tinea cruris and corporis: Apply for two weeks
Tinea pedis: Apply for four weeks



ceftolozane/​tazobactam 

Complicated Intra-abdominal Infections
Administer 1.5g intravenous thrice a day for 4 to 14 days

Complicated Urinary Tract Infections
Administer 1.5g intravenous thrice a day for 7 days

Bacterial Pneumonia
Administer 3g intravenous thrice a day for 8 to 14 days



Dose Adjustments

Hepatic impairment
No dosage adjustment needed

Renal impairment
cIAI or cUTI
CrCl 30 to 50 mL/min: Administer 750 mg (500 mg/250 mg) intravenous thrice a day
CrCl 15 to29 mL/min: Administer 375 mg (250 mg/125 mg) intravenous thrice a day
End-stage renal disease on hemolysis:
Initial dose- Administer 750 mg (500 mg/250 mg) intravenous
Maintenance dose- Administer 150 mg (100 mg/50 mg) thrice a day for the whole treatment period

HAP/VABP
CrCl 30 to 50 mL/min: Administer 1.5 g (1 g/0.5 g) intravenous thrice a day
CrCl 15-29 mL/min: Administer 750 mg (500 mg/250 mg) intravenous thrice a day

End-stage renal disease on hemolysis:
Initial dose- Administer 2.25 g (1.5 g/0.75 g)
Maintenance dose- Administer 450 mg (300 mg/150 mg) thrice a day for the whole treatment period

ceftazidime/avibactam 

Intra-abdominal infections
Administer 2.5 g (2 g/0.5 g) intravenously every 8 hours infused for over 2 hours for 5 to 14 days.

Urinary tract infections
Administer 2.5 g (2 g/0.5 g) intravenously every 8 hours and infused for over 2 hours for 7 to 14 days.

Bacterial Pneumonia
Administer 2.5 g (2 g/0.5 g) intravenously every 8 hours infused for over 2 hours for 7 to 14 days



griseofulvin 


Indicated for Tinea Infection
Ultra micro size:
Tinea cruris, capitis, or corporis: 375 mg every day orally
Tinea unguium or pedis: 250 mg orally three times a day
Microsize:
Tinea cruris, capitis, or corporis: 500 mg every day orally
Tinea unguium or pedis: 1000 mg orally every day as a single dose or in divided dose two times a day
Treatment duration
The duration of treatment will be generally based on the infection site
Tinea capitis: four-six weeks or may be nearly 8-12 weeks
Tinea corporis: two-four weeks
Tinea pedis: four-eight weeks
Tinea unguium: four-six months



miconazole topical 


Indicated for Tinea infection
Tinea corporis, cruris, and cutaneous candidiasis:
Apply near the affected area two times a day for two weeks
Tinea versicolor: Apply near the affected area every day for two weeks
Tinea pedis: Apply near the affected area two times a day for four weeks
Otitis Externa as an orphan
It is used for the therapy of fungal otitis externa (i.e., otomycosis) as an orphan designation



benzylpenicillin 

0.6-3.6 gm each day in 4-6 divided doses through intramuscular or intravenous route
In case of severe infections, a higher dose may be required
A dose of 1.2 gm is given intravenously at a maximum rate of 300 mg/min



framycetin, dexamethasone, and gramicidin 

Indicated for Ophthalmic inflammation/ infection:

Acute conditions: Apply 1 to 2 drops to the affected eye for every 1 to 2 hours, typically for 2 to 3 days, and then repeat 1 to 2 drops 3 to 4 times daily.

Otic inflammation/ infection
Instill 2 to 3 drops in the affected ear(s) 3 to 4 times per day.



spiramycin 

Indicated for mild to moderate infections
4-6 capsules (6,000,000-9,000,000 units) of Rovamycine 500 orally daily (in two divided doses)



spiramycin 

Indicated for severe Infections
8-10 capsules (12,000,000-15,000,000 units) of Rovamycine 500 orally daily (in two divided doses)



flucloxacillin 


Indicated for Severe infections, endocarditis
250 mg to 500 mg orally, four times a day
Or
1 gm to 6 gm as intravenous/intramuscular in divided 3-6 times a day



noxytiolin 

(in vivo suggested dosing)
Indicated for irrigation of peritoneum
2 ml of the solution into the peritoneal cavity



streptomycin 


Indicated for Moderate to Severe type Infections
1 gm to 2 gm every day intramuscularly in divided two-four times a day
It should not exceed 2 gm in a day
Tuberculosis
Daily treatment: 15 mg/Kg intramuscularly every day
It should not exceed 1 gm in a day
Two times in a week treatment: 25 mg/kg to 30 mg/Kg intramuscularly two times in a week
It should not exceed 1.5 mg/Kg in a day
Plague
15 mg/kg intramuscularly two times a day for nearly 10 days
Tularemia
1 gm to 2 gm intramuscularly in divided doses for nearly 7 to 10 days or till the individual is afebrile for 5 to 7 days
Enterococcal Endocarditis
1 gm intramuscularly two times a day for nearly two weeks, after that 500 mg two times a day for nearly four weeks, concomitant with the penicillin
Streptococcal Endocarditis
1 gm intramuscularly two times a day for one week; after that, 500 mg two times a day for one week concomitant with the penicillin
Age >60 years: 500 mg two times a day for two weeks
Brucellosis
1 gm intramuscularly one-two times a day for nearly one week in conjunction with tetracycline or doxycycline
Note:
Renal impairment:
Load dose: 1 gm intramuscularly
Sr CrCl 50 to 80 ml/min: 7.5 mg/kg intramuscularly every day
Sr CrCl 10 to 50 ml/min: 7.5 mg/kg intramuscularly for every one to three days
Sr CrCl <10 ml/min: 7.5 mg/kg intramuscularly for every three to four days Hemodialysis dose: 50-75% of the initial loading dosage at the end of the dialysis period



cefsulodin 

Indicated to treat infections caused by Pseudomonas aeruginosa
6 gm intravenously daily in 4 divided doses as a usual dose
3-4 gm intravenously daily in 4 divided doses for less severe infections

Dose Adjustment
In the case of renal impairment,
When CrCl is 20-50 ml/min, keep the loading dose at 1.5 gm and 1 gm after every 8 hours
When CrCl is < 5 ml/min, keep the loading dose at 1.5 gm and 1 gm after every 24 hours
When CrCl is 5-20 ml/min, keep the loading dose at 1.5 gm and 1 gm after every 12 hours



policresulen 


Indicated for Cervicitis, Vaginitis
Insert one suppository deep into the vagina for every other day at the bedtime



betamethasone/fusidic acid 


Indicated for Corticosteroid-responsive dermatoses with the secondary infection
Apply near the affected area two times a day
It should not exceed more than two weeks



midecamycin 


Indicated for Susceptible infections
0.9 gm to 1.8 gm orally every day in divided two-three times a day



ceforanide 

Take a dose of 250 mg to 500 mg orally two times a day



cefoperazone + sulbactam 

Indicated for Upper and lower respiratory and urinary tract infections:


Administer 1 to 2 g (cefoperazone) twice daily intramuscularly or intravenously. Do not exceed 4g.



cefpirome 

Indicated for susceptible infections
The suggested dose is 1 to 2 grams intravenously two times a day



reltecimod (pending FDA approval) 

Indicated for Organ Failure or Dysfunction
:

Pending FDA clearance for suspected organ failure/dysfunction in patients suffering with necrotizing soft tissue infection (NSTI) aged 12 years, in addition to surgical debridement, antibiotic treatment, and supportive care



eprinomectin 

Treatment and Long-Term Effectiveness of External and Internal Parasite Control in Pastured Cattle
:


Administer 1 mL/110 pounds of body weight
Each mL of longrange contains 50 mg of eprinomectin, which is enough to treat a person weighing 110 pounds. To prevent occasional pain or site response, divide dosages higher than 10 mL between two injection sites.



neracorvir 

An investigational drug used for the treatment of Hepatitis B virus.



upleganan (Investigational Drug) 

Pseudomonas aeruginosa infection and Enterobacteriaceae infection (off-label)
This intravenous (IV) drug (dose studied: 0.125 mg/kg) is undergoing phase I trial study where it is being investigated for the treatment of infections caused due to Pseudomonas aeruginosa and Enterobacteriaceae (gram -ve infections, bacteria) :



Dose Adjustments

Limited data is available

aminacrine undecylate 

Indicated for vaginal infections
14mg of aminacrine hydrochloride is used along with sulphanilamide twice a day in the form of vaginal suppositories



itraconazole 

Indicated for Life-threatening Infections
:

Sporanox
2 capsules orally 3 times a day total of 600 mg/day 3 days; then follow recommended dosing

Tolsura
130 mg orally 3 times a day total of 390 mg/day 3 days; then follow recommended dosing
Duration: Continue for 3 months and a short duration of treatment could cause the active infection to come back



bacitracin topical 

Indicated for dermal infections (Superficial)
Application of ointment thrice a day giving 8 hours gap between application



kitasamycin 

Indications: it is indicated for use in the treatment of Pneumonia, tonsilitis, gonorrhea, otitis media, pertussis, bronchitis, etc.



cloxacillin 

Indicated for kidney infection:

Oral Therapy: 250 to 500 mg every 6 hours. Maximum 6g per day. (Depends on the severity of infection)

IM, IV Therapy: 1 to 2 g every 4 to 6 hours, dose adjustment depends on serious infection



cloxacillin 

Indicated for hepatic infections:

Oral Therapy: 250 to 500 mg every 6 hours. Maximum 6g per day. (Depends on severity of infection)

IM, IV Therapy: 1 to 2 g every 4 to 6 hours, dose adjustment depends on serious infection



ampicillin 

Indicated for Respiratory tract:

875mg oral dose every 12hrs

500mg oral dose every 8hrs



ampicillin 

Indicated for gastrointestinal infections:

500mg orally every 12hrs

250mg orally every 8hrs



 

cefoxitin 

<3 months: Safety and efficacy not established
>3 months: 80-160mg/kg/day intravenous thrice a day



albendazole 


Indicated for Neurocysticercosis by Taenia Solium
Body weight >60 kilograms: 400 mg orally two times a day for nearly 8-30 days
Body weight <60 kilograms: 15 mg/kg/day in divided doses two times a day orally for nearly 8-30 days. Should not exceed 800 mg in a day
Hydatid by Echinococcus Tapeworm
Body weight >60 kilograms: 400 mg orally two times a day for 1 month, after that, 14 days drug-free period for the 3 cycles
Body weight <60 kilograms: 15 mg/kg/day in divided doses two times a day orally for 1 month. Should not exceed 800 mg in a day; after that, 14 days drug-free period for the 3 cycles
Capillariasis
400 mg orally every day for 10 days
Ascariasis, Ancylostoma, Trichostrongylus, Hookworm
400 mg orally one time a day
Larva Migrans, Cutaneous, and Trichuriasis
400 mg orally every day for 3 days
Larva Migrans, Visceral
400 mg orally two times a day for 5 days
Enterobius by Pinworm
400 mg orally one time a day, repeat in for two weeks



erythromycin stearate 


Indicated for General Dosing for Mild-moderate infection
30-50 mg/Kg in a day orally in divided doses three-four times in a day
Severe infection
60-100 mg/kg in a day orally in divided doses three-four times in a day
Should not exceed 4 gm in a day
Intestinal Amebiasis
30-50 mg/Kg in a day orally in divided doses for 10-14 days
Infancy Pneumonia
50 mg/kg in a day orally in divided doses four times in a day for nearly 3 weeks



oxiconazole 


Indicated for Fungal Infections
One-two time a day, topically apply near the affected area



ceftolozane/​tazobactam 

Complicated Intra-abdominal Infections
CrCl >50 mL/min/1.73 m2: Administer 30 mg/kg intravenous thrice a day for 5 to 14 days; Do not exceed 1.5 g/dose

Complicated Urinary Tract Infections
CrCl >50 mL/min/1.73 m2: Administer 30 mg/kg intravenous thrice a day for 7 to 14 days; Do not exceed 1.5 g/dose



griseofulvin 


Indicated for Tinea Infection
Ultra micro size:
7.3 mg/kg every day orally
Body weight 13.6 kg-22.7 kg (i.e.,30 lb-50 lb): 82.5 mg- 165 mg every day
Body weight >22.7 kg (i.e.,>50 lb): 165 mg-330 mg every day
As off-label: 5-15 mg/kg every day orally in divided two times a day. It should not exceed 750 mg in a day
Microsize:
11 mg/kg every day orally as a single dose or in divided two times a day
Body weight 13.6 kg-22.7 kg (i.e.,30 lb-50 lb): 125 mg- 250 mg every day
Body weight >22.7 kg (i.e.,>50 lb): 250 mg-500 mg every day
As off-label: 10-20 mg/kg every day orally in divided two times a day
Treatment duration
The duration of treatment will be generally based on the infection site
Tinea capitis: four-six weeks or may be nearly 8-12 weeks
Tinea corporis: two-four weeks
Tinea pedis: four-eight weeks
Tinea unguium: four-six months



miconazole topical 


Indicated for Tinea infection
Age >2 years
Apply powder or topical cream two times a day for nearly one month
Age <2 years
Safety and efficacy not established



benzylpenicillin 

In the neonates, 50 mg/kg each day in two divided doses
1–4-week-olds, 75 mg/kg each day in three divided doses
For more than 1-month to 12-year-olds, 100 mg/kg each day in four divided doses



flucloxacillin 


Indicated for Severe infections, endocarditis
25 mg/Kg to 50 mg/Kg as intravenous/intramuscular in divided 3-6 times a day
Or
Age >10 years
250 mg to 500 mg orally, four times a day
Age 2-10 years
125 mg to 250 mg orally four times a day
Age <2 years
62.5 mg to 125 mg orally four times a day



streptomycin 


Indicated for Moderate to Severe type Infections
20 mg/kg to 40 mg/Kg every day intramuscularly in divided two-four times a day
Tuberculosis
Daily treatment: 20 mg/Kg to 40 mg/Kg intramuscularly every day
It should not exceed 1 gm in a day
Two times in a week treatment: 20 mg/kg to 40 mg/Kg intramuscularly two times in a week
It should not exceed 1.5 mg/Kg in a day
Plague
15 mg/kg intramuscularly two times a day for nearly 10 days
It should not exceed 2 gm in a day
Brucellosis
Age >8 years
20 mg/Kg intramuscularly in divided two times a day for nearly one to two weeks in conjunction with tetracycline or co-trimoxazole
It should not exceed 1 gm in a day



cefsulodin 

Indicated to treat infections caused by Pseudomonas aeruginosa
100 mg/kg intravenously each day as usual dose
50 mg/kg each day for moderate infections



reltecimod (pending FDA approval) 

Indicated for Organ Failure or Dysfunction:

Pending FDA clearance for suspected organ failure/dysfunction in patients suffering with necrotizing soft tissue infection (NSTI) aged 12 years, in addition to surgical debridement, antibiotic treatment, and supportive care



bacitracin topical 

Indicated for dermal infections (Superficial)
Application of ointment thrice a day giving 8 hours gap between application



 

cefoxitin 

Indicated for Severe to Moderate Infections:


2g intravenous two to three times a day. Maximum dose:6-8 g/day
Uncomplicated Infections
1 g intravenous two to three times a day



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Infections

Updated : March 12, 2023

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