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1852
Appendix
JAntibiotics
TABL
E J.
1 A
min
op
eni
cill
ins
Dru
gD
rug
cla
ssU
sua
l do
se
in a
dul
tsA
ctio
ns, i
nte
rac
tions
, a
nd o
the
rsSp
ec
trum
of a
ctiv
ity, i
ndic
atio
ns, a
nd
ac
tive
ag
ain
st m
ost
stra
ins
of
Rout
e, r
ed
uce
do
se, a
nd
co
ntra
ind
ica
tions
Am
pic
illin
Am
ino
pe
nic
illin
IV: 2
.0 g
IV q
4 h
PO: 5
00 m
g q
6 h
Allo
pu
rino
l (in
cre
ase
d fr
e-
qu
en
cy
of r
ash
)W
arfa
rin (
inc
rea
sed
IN
R)
Stre
pto
co
cc
us
pn
eu
mo
nia
e; S
tap
hylo
co
cc
us
au
reu
s (p
en
icilli
na
se a
nd
no
np
en
icilli
na
se
pro
du
cin
g);
Ha
em
op
hilu
s in
flue
nza
e, a
nd
g
rou
p A
β-h
em
oly
tic S
tre
pto
co
cc
iBa
cte
rial m
en
ing
itis
ca
use
d b
y Es
ch
eric
hia
c
oli,
gro
up
B S
tre
pto
co
cc
i, a
nd
oth
er
gra
m-n
eg
ativ
e b
ac
teria
(Li
ste
ria m
on
oc
y-to
ge
ne
s, N
eiss
eria
me
nin
giti
dis)
End
oc
ard
itis
ca
use
d b
y su
sce
ptib
le g
ram
-p
osit
ive
org
an
isms
inc
lud
ing
Str
ep
toc
oc
cu
s sp
., p
en
icilli
n G
–su
sce
ptib
le S
tap
hylo
co
cc
i, a
nd
En
tero
co
cc
i. En
do
ca
rditi
s d
ue
to
e
nte
roc
oc
ca
l str
ain
s u
sua
lly re
spo
nd
to
in
tra
ven
ou
s th
era
py
Gra
m-n
eg
ativ
e s
ep
sis c
au
sed
by
E. c
oli,
Pr
ote
us
mira
bilis
, an
d S
alm
on
ella
sp
.G
ast
roin
test
ina
l in
fec
tion
s c
au
sed
by
Salm
o-
ne
lla t
yph
osa
(ty
ph
oid
feve
r), o
the
r Sa
lmo
-n
ella
sp
., a
nd
Sh
ige
lla s
p.
Urin
ary
tra
ct
infe
ctio
ns
ca
use
d b
y E.
co
li a
nd
Pr
ote
us
mira
bilis
•Pr
ima
ry m
od
e o
f elim
ina
-tio
n: R
en
al
•R
ed
uc
e d
ose
in m
od
era
te
to s
eve
re re
na
l im
pa
irme
nt
Am
oxi
cilli
nA
min
op
en
icilli
nIV
: 500
mg
–1 g
td
s (h
igh
er d
ose
s:
2 g
4 h
ou
rly in
e
nd
oc
ard
itis
PO: 1
g q
8 h
Bac
teric
ide
Som
e g
ram
- n
eg
ativ
e a
ctiv
ity
•St
rep
toc
oc
cu
s p
ne
um
on
iae
•H
ae
mo
ph
ilus
influ
en
zae
(e
xce
pt
CO
PD
pa
tien
ts)
•β-
He
mo
lytic
Str
ep
toc
oc
ci
•St
rep
toc
oc
cu
s p
yog
en
es
do
no
t p
rod
uc
e
β-la
cta
ma
se•
Ente
roc
oc
cu
s fa
ec
alis
•Pr
ima
ry m
od
e o
f elim
ina
-tio
n: R
en
al
•R
ea
son
ab
le o
ral a
bso
rp-
tion
(o
ral p
rep
ara
tion
)•
Re
du
ce
do
se in
mo
de
rate
to
se
vere
ren
al i
mp
airm
en
t
Am
oxi
cilli
n/
cla
vula
na
teA
min
op
en
icilli
n/β
-la
cta
m in
hib
itor
co
mb
ina
tion
PO: 5
00/1
25 m
g
q8
h o
r 875
/125
m
g q
12 h
for
seve
re in
fec
-tio
ns
or r
esp
i-ra
tory
tra
ct
infe
ctio
ns
Ae
rob
ic g
ram
-po
sitiv
e m
icro
-org
ani
sms
Stre
pto
co
cc
us
pn
eu
mo
nia
e (
inc
lud
ing
iso
late
s w
ith p
en
icilli
n M
ICs
≤2 μ
g/m
L)A
ero
bic
gra
m-n
eg
ativ
e m
icro
-org
ani
sms
Ha
em
op
hilu
s in
flue
nza
e (
inc
lud
ing
β-
lac
tam
ase
—p
rod
uc
ing
iso
late
s)M
ora
xella
ca
tarrh
alis
(in
clu
din
g
β-la
cta
ma
se—
pro
du
cin
g is
ola
tes)
The
follo
win
g in
vitr
o d
ata
are
ava
ilab
le, b
ut
the
ir c
linic
al s
ign
ific
an
ce
is u
nkn
ow
n.
Ae
rob
ic g
ram
-po
sitiv
e m
icro
-org
ani
sms
Sta
phy
loc
oc
cu
s a
ure
us
(inc
lud
ing
β-
lac
tam
ase
—p
rod
uc
ing
iso
late
s)N
OTE
: Sta
phy
loc
oc
ci t
ha
t a
re re
sista
nt
to
me
thic
illin
/oxa
cilli
n m
ust
be
co
nsid
ere
d
resis
tan
t to
am
oxi
cilli
n/c
lavu
lan
ic a
cid
S. p
yog
en
es
•Pr
ima
ry m
od
e o
f elim
ina
tion:
R
en
al
•R
ed
uc
e d
ose
in m
od
era
te
to s
eve
re re
na
l im
pa
irme
nt
•87
5/12
5 m
g fo
rmul
atio
n
sho
uld
no
t be
use
d in
p
atie
nts
with
CrC
l <30
mL/
min
LWBK1580-App-J_p1852-1874.indd 1852 29/07/17 7:30 AM
Dru
gD
rug
cla
ssU
sua
l do
se
in a
dul
tsA
ctio
ns, i
nte
rac
tions
, a
nd o
the
rsSp
ec
trum
of a
ctiv
ity, i
ndic
atio
ns, a
nd
ac
tive
ag
ain
st m
ost
stra
ins
of
Rout
e, r
ed
uce
do
se, a
nd
co
ntra
ind
ica
tions
Am
pic
illin
/su
lba
cta
mA
min
op
en
icilli
n/β
-la
cta
m in
hib
itor
co
mb
ina
tion
IV: 1
.5–3
.0 g
q6
hR
em
em
be
r: N
a+
co
nte
nt
= 4.
2 m
Eq/g
Tota
l do
se o
f su
l-b
ac
tam
sh
ou
ld
no
t e
xce
ed
4
g/d
Bac
teric
ide
Bro
ad
-sp
ec
tru
m
an
tibio
tic a
nd
a
β-la
cta
ma
se
inh
ibito
rFo
r mild
or m
od
era
te
infe
ctio
n,
1.5
g IV
q6
hPs
eu
do
resis
tan
ce
w
ith E
. co
li/Kl
eb
siella
(in
vitr
o)
Gra
m-n
eg
ativ
e b
ac
teria
Ha
em
op
hilu
s in
flue
nza
e (
β-la
cta
ma
se a
nd
n
on
–β-la
cta
ma
se p
rod
uc
ing
); M
ora
xella
(B
ran
ha
me
lla)
ca
tarrh
alis
(β-
lac
tam
ase
a
nd
no
n–β
-lac
tam
ase
pro
du
cin
g);
Esc
h-
eric
hia
co
li (β
-lac
tam
ase
an
d n
on
–β-
lac
tam
ase
pro
du
cin
g);
Kle
bsie
lla s
pp
. (a
ll kn
ow
n s
tra
ins
are
β-la
cta
ma
se p
rod
uc
-in
g);
Pro
teu
s m
irab
ilis (
β-la
cta
ma
se a
nd
n
on
–β-la
cta
ma
se p
rod
uc
ing
); P
rote
us
vulg
aris
; Pro
vid
en
cia
rett
ge
ri; P
rovi
de
nc
ia
stu
art
ii; M
org
an
ella
mo
rga
nii;
Ne
isse
ria
go
no
rrho
ea
e (
β-la
cta
ma
se a
nd
no
n–β
-la
cta
ma
se p
rod
uc
ing
).A
nae
rob
es
Clo
strid
ium
sp
.; Pe
pto
co
cc
us
sp.;
Pep
tost
rep
-to
co
cc
us
sp.;
Bac
tero
ide
s sp
., in
clu
din
g B
. fra
gilis
•Pr
ima
ry m
od
e o
f elim
ina
-tio
n: R
en
al a
nd
he
pa
tic•
Am
pic
illin
an
d s
ulb
ac
-ta
m fo
r in
jec
tion
ma
y b
e
ad
min
iste
red
by
eith
er t
he
IV
or t
he
IM ro
ute
s•
In p
atie
nts
with
imp
air-
me
nt
of r
en
al f
un
ctio
n,
the
elim
ina
tion
kin
etic
s o
f a
mp
icilli
n a
nd
su
lba
cta
m
are
sim
ilarly
affe
cte
d
INR
, in
tern
atio
na
l no
rma
lize
d ra
tio; C
OPD
, ch
ron
ic o
bst
ruc
tive
pu
lmo
na
ry d
isea
se; M
IC, m
inim
um
inh
ibito
ry c
on
ce
ntr
atio
n; C
rCl,
cre
atin
ine
cle
ara
nc
e.
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
TABL
E J.
1 A
min
op
eni
cill
ins
(Co
ntin
ued
)
1853
LWBK1580-App-J_p1852-1874.indd 1853 29/07/17 7:30 AM
TABL
E J.
2 A
ntip
seud
om
ona
l Pe
nic
illin
s
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
ag
ain
st m
ost
stra
ins
of
Rout
e, r
ed
uce
do
se,
and
co
ntra
ind
ica
tions
Pip
era
cilli
nA
ntip
seu
do
mo
na
l p
en
icilli
nIV
: 34
g q
48 h
Dru
g in
tera
ctio
n w
ith
am
ino
gly
co
side
s in
re
na
l fa
ilure
Pro
phy
laxi
s: P
ipe
rac
illin
is in
dic
ate
d fo
r pro
phy
lac
tic u
se in
su
rge
ry in
clu
din
g
intr
a-a
bd
om
ina
l (g
ast
roin
test
ina
l an
d b
iliary
) p
roc
ed
ure
s, va
gin
al h
yste
rec
-to
my,
ab
do
min
al h
yste
rec
tom
y, a
nd
ce
sare
an
se
ctio
n. P
ipe
rac
illin
sh
ou
ld
on
ly b
e u
sed
to
tre
at
or p
reve
nt
infe
ctio
ns
tha
t a
re p
rove
n o
r str
on
gly
su
s-p
ec
ted
to
be
ca
use
d b
y su
sce
ptib
le b
ac
teria
.In
dic
atio
ns a
nd u
seIn
tra
-ab
do
min
al i
nfe
ctio
ns
inc
lud
ing
he
pa
tob
iliary
an
d s
urg
ica
l in
fec
tion
s c
au
sed
by
E. c
oli,
Pse
ud
om
on
as
ae
rug
ino
sa, E
nte
roc
oc
ci,
Clo
strid
ium
sp
p.,
an
ae
rob
ic c
oc
ci,
or B
ac
tero
ide
s sp
p.,
inc
lud
ing
B. f
rag
ilis.
Urin
ary
tra
ct
infe
ctio
ns
ca
use
d b
y E.
co
li, Kl
eb
siella
sp
p.,
P. a
eru
gin
osa
, Pro
teu
s sp
p. i
nc
lud
ing
P. m
irab
ilis, o
r En
tero
co
cc
iG
yne
co
log
ic in
fec
tion
s in
clu
din
g e
nd
om
etr
itis,
pe
lvic
infla
mm
ato
ry d
isea
se,
pe
lvic
ce
llulit
is c
au
sed
by
Bac
tero
ide
s sp
p. i
nc
lud
ing
B. f
rag
ilis, a
na
ero
bic
c
oc
ci,
Ne
isse
ria g
on
orrh
oe
ae
, or E
nte
roc
oc
ci (
E. fa
ec
alis
)Se
ptic
em
ia in
clu
din
g b
ac
tere
mia
ca
use
d b
y E.
co
li, Kl
eb
siella
sp
p.,
Ente
ro-
ba
cte
r sp
p.,
Serra
tia s
pp
., P.
mira
bilis
, S. p
ne
um
on
iae
, En
tero
co
cc
i, P.
ae
rug
i-n
osa
, Ba
cte
roid
es
spp
., o
r an
ae
rob
ic c
oc
ci.
Low
er r
esp
irato
ry t
rac
t in
fec
tion
s c
au
sed
by
E. c
oli,
Kle
bsie
lla s
pp
., En
tero
-b
ac
ter s
pp
., P.
ae
rug
ino
sa, S
erra
tia s
pp
., H
. in
flue
nza
e, B
ac
tero
ide
s sp
p.,
or
an
ae
rob
ic c
oc
ci.
Skin
an
d s
kin
str
uc
ture
infe
ctio
ns
ca
use
d b
y E.
co
li, Kl
eb
siella
sp
p.,
Serra
tia
spp
., A
cin
eto
ba
cte
r sp
p.,
Ente
rob
ac
ter s
pp
., P.
ae
rug
ino
sa, M
org
an
ella
m
org
an
ii, Pr
ovi
de
nc
ia re
ttg
eri,
Pro
teu
s vu
lga
ris, P
. mira
bilis
, Ba
cte
roid
es
spp
. in
clu
din
g B
. fra
gilis
, an
ae
rob
ic c
oc
ci,
or E
nte
roc
oc
ci
Bon
e a
nd
join
t in
fec
tion
s c
au
sed
by
P. a
eru
gin
osa
, En
tero
co
cc
i, Ba
cte
roid
es
spp
., o
r an
ae
rob
ic c
oc
ci
•Pr
ima
ry m
od
e o
f e
limin
atio
n: R
en
al
•R
ed
uc
e d
ose
in
mo
de
rate
to
se
vere
re
na
l im
pa
irme
nt
Pip
era
cilli
n/
tazo
ba
cta
mA
ntip
seu
do
mo
na
l p
en
icilli
nIV
: 4.5
g q
8 h
Pne
um
on
ia
no
soc
om
ial,
use
4.
5 g
(IV
) q
6 h
Dru
g in
tera
ctio
n w
ith
am
ino
gly
co
side
s a
nd
ve
cu
ron
ium
Ind
ica
ted
for n
oso
co
mia
l pn
eu
mo
nia
(m
od
era
te t
o s
eve
re)
ca
use
d b
y p
ipe
r-a
cilli
n-r
esis
tan
t, β-
lac
tam
ase
–pro
du
cin
g s
tra
ins
of S
tap
hylo
co
cc
us
au
reu
s a
nd
by
pip
era
cilli
n/t
azo
ba
cta
m-s
usc
ep
tible
Ac
ine
tob
ac
ter b
au
ma
nn
ii,
Ha
em
op
hilu
s in
flue
nza
e, K
leb
siella
pn
eu
mo
nia
e, a
nd
Pse
ud
om
on
as
ae
ru-
gin
osa
(n
oso
co
mia
l pn
eu
mo
nia
ca
use
d b
y P.
ae
rug
ino
sa s
ho
uld
be
tre
ate
d
in c
om
bin
atio
n w
ith a
n a
min
og
lyc
osid
e)
Co
mm
un
ity-a
cq
uire
d p
ne
um
on
ia (
mo
de
rate
se
verit
y o
nly
) c
au
sed
by
pip
er-
ac
illin
-re
sista
nt,
β-la
cta
ma
se–p
rod
uc
ing
str
ain
s o
f H. i
nflu
en
zae
Ap
pe
nd
iciti
s (c
om
plic
ate
d b
y ru
ptu
re o
r ab
sce
ss)
an
d p
erit
on
itis
ca
use
d b
y p
ipe
rac
illin
-re
sista
nt,
β-la
cta
ma
se–p
rod
uc
ing
str
ain
s o
f Esc
he
rich
ia c
oli
or
the
follo
win
g m
em
be
rs o
f th
e B
ac
tero
ide
s fra
gilis
gro
up
: B. f
rag
ilis, B
. ova
tus,
B. t
he
taio
tao
mic
ron
, or B
. vu
lga
tus
Un
co
mp
lica
ted
an
d c
om
plic
ate
d s
kin
an
d s
kin
str
uc
ture
infe
ctio
ns,
inc
lud
-in
g c
ellu
litis
, cu
tan
eo
us
ab
sce
sse
s, a
nd
isc
he
mic
/dia
be
tic fo
ot
infe
ctio
ns
ca
use
d b
y p
ipe
rac
illin
-re
sista
nt,
β-la
cta
ma
se–p
rod
uc
ing
str
ain
s o
f S. a
ure
us
Infe
ctio
ns
ca
use
d b
y p
ipe
rac
illin
-su
sce
ptib
le o
rga
nism
s fo
r wh
ich
pip
era
cilli
n
ha
s b
ee
n s
ho
wn
to
be
effe
ctiv
e a
re a
lso a
me
na
ble
to
pip
era
cilli
n t
azo
ba
c-
tam
co
nte
nt.
Post
pa
rtu
m e
nd
om
etr
itis
or p
elv
ic in
flam
ma
tory
dise
ase
ca
use
d b
y p
ipe
rac
il-lin
-re
sista
nt,
β-la
cta
ma
se–p
rod
uc
ing
str
ain
s o
f E. c
oli
•M
od
e o
f elim
ina
-tio
n: 2
0% in
bile
, 80%
u
nc
ha
ng
ed
in u
rine
•R
ed
uc
e d
ose
in
mo
de
rate
to
se
vere
re
na
l im
pa
irme
nt
1854
LWBK1580-App-J_p1852-1874.indd 1854 29/07/17 7:30 AM
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
ag
ain
st m
ost
stra
ins
of
Rout
e, r
ed
uce
do
se,
and
co
ntra
ind
ica
tions
Tic
arc
illin
d
isod
ium
An
tipse
ud
om
on
al
pe
nic
illin
IV: 3
g q
6 h
Dru
g in
tera
ctio
n w
ith
am
ino
gly
co
side
s in
re
na
l fa
ilure
Tic
arc
illin
is a
se
misy
nth
etic
an
tibio
tic w
ith a
bro
ad
sp
ec
tru
m o
f ba
cte
ricid
al
ac
tivity
ag
ain
st m
any
gra
m-p
osit
ive
an
d g
ram
-ne
ga
tive
ae
rob
ic a
nd
a
na
ero
bic
ba
cte
ria.
Tic
arc
illin
is, h
ow
eve
r, su
sce
ptib
le t
o d
eg
rad
atio
n b
y β-
lac
tam
ase
s, a
nd
th
ere
-fo
re, t
he
sp
ec
tru
m o
f ac
tivity
do
es
no
t n
orm
ally
inc
lud
e o
rga
nism
s th
at
pro
du
ce
th
ese
en
zym
es.
•Pr
ima
ry m
od
e o
f e
limin
atio
n: R
en
al
•R
ed
uc
e d
ose
in
mo
de
rate
to
se
vere
re
na
l im
pa
irme
nt
Tic
arc
illin
/c
lavu
lan
ate
Tic
arc
illin
diso
diu
m
(An
tipse
ud
o-
mo
na
l pe
nic
illin
)+ β-
lac
tam
ase
in
hib
itor c
lavu
la-
na
te p
ota
ssiu
m
(th
e p
ota
ssiu
m
salt
of c
lavu
-la
nic
ac
id),
for
intr
ave
no
us
ad
min
istra
tion
IV: 3
.1 g
q4–
6 h
(3.
1 g
via
l co
nta
inin
g
3-g
tic
arc
illin
an
d
100-
mg
cla
vula
nic
a
cid
)M
od
era
te in
fec
-tio
ns
200
mg
/kg
/d
in d
ivid
ed
do
ses
eve
ry 6
hSe
vere
infe
ctio
ns
30
0 m
g/k
g/d
in
div
ide
d d
ose
s e
very
4 h
For p
atie
nts
we
igh
ing
<6
0 kg
, th
e re
co
m-
me
nd
ed
do
sag
e is
20
0–30
0 m
g/k
g/d
, b
ase
d o
n t
ica
rcil-
lin c
on
ten
t, g
ive
n
in d
ivid
ed
do
ses
eve
ry 4
–6 h
ou
rs.
Dru
g in
tera
ctio
n w
ith
am
ino
gly
co
side
s in
re
na
l fa
ilure
Tic
arc
illin
is a
se
misy
nth
etic
an
tibio
tic w
ith a
bro
ad
sp
ec
tru
m o
f ba
cte
ricid
al
ac
tivity
ag
ain
st m
any
gra
m-p
osit
ive
an
d g
ram
-ne
ga
tive
ae
rob
ic a
nd
a
na
ero
bic
ba
cte
ria.
Tic
arc
illin
is, h
ow
eve
r, su
sce
ptib
le t
o d
eg
rad
atio
n b
y β-
lac
tam
ase
s, a
nd
th
ere
-fo
re, t
he
sp
ec
tru
m o
f ac
tivity
do
es
no
t n
orm
ally
inc
lud
e o
rga
nism
s th
at
pro
du
ce
th
ese
en
zym
es.
Gra
m-p
osi
tive
ae
rob
es
Sta
phy
loc
oc
cu
s a
ure
us;
Sta
phy
loc
oc
cu
s e
pid
erm
idis
Gra
m-n
eg
ativ
e a
ero
be
sC
itro
ba
cte
r sp
.; En
tero
ba
cte
r sp
., in
clu
din
g E
. clo
ac
ae
; Esc
he
rich
ia c
oli;
Ha
e-
mo
ph
ilus
influ
en
zae
; Kle
bsie
lla s
p. i
nc
lud
ing
K. p
ne
um
on
iae
; Pse
ud
om
on
as
sp. i
nc
lud
ing
P. a
eru
gin
osa
; Se
rratia
ma
rce
sce
ns
Ana
ero
bic
ba
cte
riaBa
cte
roid
es
frag
ilis g
rou
p; P
revo
tella
(fo
rme
rly B
ac
tero
ide
s) m
ela
nin
og
en
icu
sG
ram
-po
sitiv
e a
ero
be
sSt
ap
hylo
co
cc
us
sap
rop
hytic
us;
Str
ep
toc
oc
cu
s a
ga
lac
tiae
(g
rou
p B
); S
tre
p-
toc
oc
cu
s b
ovi
s; S
tre
pto
co
cc
us
pn
eu
mo
nia
e (
pe
nic
illin
-su
sce
ptib
le s
tra
ins
on
ly);
Str
ep
toc
oc
cu
s p
yog
en
es;
Viri
da
ns
gro
up
str
ep
toc
oc
ci
Gra
m-n
eg
ativ
e a
ero
be
sA
cin
eto
ba
cte
r ba
um
an
nii;
Ac
ine
tob
ac
ter c
alc
oa
ce
ticu
s; A
cin
eto
ba
cte
r h
ae
mo
lytic
us;
Ac
ine
tob
ac
ter l
wo
ffi; M
ora
xella
ca
tarrh
alis
; Mo
rga
ne
lla
mo
rga
nii;
Ne
isse
ria g
on
orrh
oe
ae
; Pa
ste
ure
lla m
ulto
cid
a; P
rote
us
mira
bilis
; Pr
ote
us
pe
nn
eri;
Pro
teu
s vu
lga
ris; P
rovi
de
nc
ia re
ttg
eri;
Pro
vid
en
cia
stu
art
ii;
Ste
no
tro
ph
om
on
as
ma
ltop
hilia
Ana
ero
bic
ba
cte
riaC
lost
ridiu
m s
p. in
clu
din
g C
. pe
rfrin
ge
ns, C
. diffi
cile
, C. s
po
rog
ene
s, C
. ra
mo
sum
, a
nd
C. b
iferm
en
tan
s; E
ub
ac
teriu
m s
p.;
Fuso
ba
cte
rium
sp
. in
clu
din
g F.
n
uc
lea
tum
an
d F.
ne
cro
ph
oru
m; P
ep
tost
rep
toc
oc
cu
s sp
.; Ve
illon
ella
sp
.
•Pr
ima
ry m
od
e o
f e
limin
atio
n: R
en
al
•R
ed
uc
e d
ose
in
mo
de
rate
to
se
vere
re
na
l im
pa
irme
nt
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
TABL
E J.
2 A
ntip
seud
om
ona
l Pe
nic
illin
s (C
ont
inue
d)
1855
LWBK1580-App-J_p1852-1874.indd 1855 29/07/17 7:30 AM
TABL
E J.
3 C
arb
ap
ene
ms
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
ag
ain
st
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Ae
rob
ic a
nd fa
cul
tativ
e g
ram
-po
sitiv
e m
icro
-org
ani
sms
Sta
phy
loc
oc
cu
s a
ure
us
(me
thic
illin
-su
sce
ptib
le is
ola
tes
on
ly);
St
rep
toc
oc
cu
s a
ga
lac
tiae
; Str
ep
toc
oc
cu
s p
ne
um
on
iae
( p
en
icilli
n s
usc
ep
tible
iso
late
s o
nly
); S
tre
pto
co
cc
us
pyo
ge
ne
sN
ote
: Me
thic
illin
-re
sista
nt
Sta
phy
loc
oc
ci a
nd
En
tero
co
cc
us
spp
. a
re re
sista
nt
to e
rta
pe
ne
m.
No
t a
su
bst
rate
/in
hib
itor o
f c
yto
ch
rom
e P
450
en
zym
es
Ae
rob
ic a
nd fa
cul
tativ
e g
ram
-po
sitiv
e m
icro
-org
ani
sms
Erta
pe
ne
mC
arb
ap
en
em
IV/I
M: 1
g q
24 h
Pro
be
ne
cid
(d
ec
rea
se
cle
ara
nc
e o
f ert
ap
en
em
)Es
ch
eric
hia
co
li; H
ae
mo
ph
ilus
influ
en
zae
(β-
lac
tam
ase
ne
ga
tive
iso
late
s o
nly
); K
leb
siella
pn
eu
mo
nia
e; M
ora
xella
ca
tarrh
alis
; Pr
ote
us
mira
bilis
Ana
ero
bic
mic
ro-o
rga
nism
sBa
cte
roid
es
frag
ilis; B
ac
tero
ide
s d
ista
son
is; B
ac
tero
ide
s o
va-
tus;
Ba
cte
roid
es
the
taio
tao
mic
ron
; Ba
cte
roid
es
un
iform
is;
Clo
strid
ium
clo
strid
iifo
rme
; Eu
ba
cte
rium
len
tum
; Pe
pto
stre
pto
-c
oc
cu
s sp
.; Po
rphy
rom
on
as
asa
cc
ha
roly
tica
; Pre
vote
lla b
ivia
Prim
ary
mo
de
of
elim
ina
tion
: Re
na
lRe
duc
e d
ose
in m
od
era
te
to s
eve
re re
na
l im
pa
irme
nt.
Imip
en
em
/c
ilast
atin
Ca
rba
pe
ne
mIV
: 1,0
00 m
g q
6 h
(4
g)
on
ly in
se
vere
life
-th
rea
ten
ing
infe
c-
tion
s (m
ain
ly in
so
me
Pse
ud
o-
mo
na
s sp
ec
ies)
no
mo
re t
ha
n
50 m
g/k
g/2
4 h
IV: 2
50 m
g q
6 h
in m
ild in
fec
tion
sIV
: 500
mg
q8
h (
1.5
g)
or q
6 h
(2
.0 g
) in
mo
de
rate
infe
ctio
ns
Tota
l do
se o
f so
diu
m 3
7.5
mg
(1
.6 m
Eq)
by
500-
mg
imip
en
em
The
ba
cte
ricid
al a
ctiv
ity
of i
mip
en
em
resu
lts fr
om
th
e in
hib
itio
n o
f ce
ll w
all
syn
the
sis
Co
nditi
ons
:Ba
cte
rial s
ep
tice
mia
. Lo
we
r re
spira
tory
tra
ct
infe
ctio
ns.
Urin
ary
tr
ac
t in
fec
tion
s (c
om
plic
ate
d a
nd
un
co
mp
lica
ted
). N
oso
co
-m
ial p
ne
um
on
ia, p
erit
on
itis,
sep
sis. G
yne
co
log
ic in
fec
tion
s. Bo
ne
an
d jo
int
infe
ctio
ns.
Skin
an
d s
kin
str
uc
ture
infe
ctio
ns.
End
oc
ard
itis.
Poly
mic
rob
ic in
fec
tion
s.G
ram
-po
sitiv
e a
ero
be
sEn
tero
co
cc
us
fae
ca
lis (
form
erly
S. f
ae
ca
lis)
(NO
TE: I
mip
en
em
is
ina
ctiv
e in
vitr
o a
ga
inst
En
tero
co
cc
us
fae
ciu
m [
form
erly
S.
fae
ciu
m])
; Sta
phy
loc
oc
cu
s a
ure
us
inc
lud
ing
pe
nic
illin
ase
-p
rod
uc
ing
str
ain
s; S
tap
hylo
co
cc
us
ep
ide
rmid
is in
clu
din
g p
en
-ic
illin
ase
-pro
du
cin
g s
tra
ins;
Str
ep
toc
oc
cu
s a
ga
lac
tiae
(g
rou
p
B st
rep
toc
oc
ci);
Str
ep
toc
oc
cu
s p
ne
um
on
iae
; Str
ep
toc
oc
cu
s p
yog
en
es
Gra
m-n
eg
ativ
e a
ero
be
sA
cin
eto
ba
cte
r sp
p.;
Citr
ob
ac
ter s
pp
.; En
tero
ba
cte
r sp
p.;
Esc
he
rich
ia c
oli;
Ga
rdn
ere
lla v
ag
ina
lis; H
ae
mo
ph
ilus
influ
en
zae
; Ha
em
op
hilu
s p
ara
influ
en
zae
Kle
bsie
lla s
pp
.; M
org
an
ella
mo
rga
nii;
Pro
teu
s vu
lga
ris;
Pro
vid
en
cia
rett
ge
ri; P
seu
do
mo
na
s a
eru
gin
osa
(N
OTE
: Im
ipe
-n
em
is in
ac
tive
in v
itro
ag
ain
st X
an
tho
mo
na
s [P
seu
do
mo
na
s]
ma
ltop
hilia
an
d s
om
e s
tra
ins
of P
. ce
pa
cia
); S
erra
tia s
pp
., in
clu
din
g S
. ma
rce
sce
ns
Gra
m-p
osi
tive
ana
ero
be
sBi
fido
ba
cte
rium
sp
p.;
Clo
strid
ium
sp
p.;
Eub
ac
teriu
m s
pp
.; Pe
pto
co
cc
us
spp
.; Pe
pto
stre
pto
co
cc
us
spp
.; Pr
op
ion
iba
cte
-riu
m s
pp
.G
ram
-ne
ga
tive
ana
ero
be
sBa
cte
roid
es
spp
., in
clu
din
g B
. fra
gilis
; Fu
sob
ac
teriu
m s
pp
.G
ram
-po
sitiv
e a
ero
be
sBa
cillu
s sp
p.;
List
eria
mo
no
cyt
og
en
es;
No
ca
rdia
sp
p.;
Sta
phy
loc
oc
cu
s sa
pro
phy
ticu
s; g
rou
p C
str
ep
toc
oc
ci;
g
rou
p G
str
ep
toc
oc
ci;
Viri
da
ns
gro
up
str
ep
toc
oc
ci
Ce
ntr
al n
erv
ou
s sy
ste
m
ad
vers
e e
xpe
rien
ce
s su
ch
as
co
nfu
sion
al
sta
tes,
myo
clo
nic
a
ctiv
ity, a
nd
se
izu
res
ha
ve b
ee
n re
po
rte
d
du
ring
tre
atm
en
t w
ith
imip
en
em
.R
ed
uc
e d
ose
in m
od
er-
ate
to
se
vere
ren
al
imp
airm
en
t.Fo
r pa
tien
ts o
n h
em
od
i-a
lysis
, im
ipe
ne
m is
rec
-o
mm
en
de
d o
nly
wh
en
th
e b
en
efit
ou
twe
igh
s th
e p
ote
ntia
l risk
of
seiz
ure
s.
1856
LWBK1580-App-J_p1852-1874.indd 1856 29/07/17 7:30 AM
TABL
E J.
3 C
arb
ap
ene
ms
(Co
ntin
ued
)
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
ag
ain
st
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Gra
m-n
eg
ativ
e a
ero
be
sA
ero
mo
na
s hy
dro
ph
ila; A
lca
lige
ne
s sp
p.;
Ca
pn
oc
yto
ph
ag
a
spp
.; H
ae
mo
ph
ilus
du
cre
yi; N
eiss
eria
go
no
rrho
ea
e in
clu
din
g
pe
nic
illin
ase
-pro
du
cin
g s
tra
ins
Past
eu
rella
sp
p.;
Pro
vid
en
cia
stu
art
ii.G
ram
-ne
ga
tive
ana
ero
be
sPr
evo
tella
biv
ia; P
revo
tella
disi
en
s; P
revo
tella
me
lan
ino
ge
nic
a;
Veillo
ne
lla s
pp
.In
vitr
o t
est
s sh
ow
imip
en
em
to
ac
t sy
ne
rgist
ica
lly w
ith a
min
o-
gly
co
side
an
tibio
tics
ag
ain
st s
om
e is
ola
tes
of P
seu
do
mo
na
s a
eru
gin
osa
.
Me
rop
en
em
Ca
rba
pe
ne
mIV
: 500
mg
q8
hPn
eu
mo
nia
, urin
ary
tra
ct
infe
ctio
n, g
yne
co
log
ic
infe
ctio
ns,
skin
an
d s
kin
st
ruc
ture
infe
ctio
ns
Me
rop
en
em
is a
bro
ad
-sp
ec
tru
m c
arb
ap
en
em
an
tibio
tic. I
t is
ac
tive
ag
ain
st g
ram
-po
sitiv
e a
nd
gra
m-n
eg
ativ
e b
ac
teria
.M
ero
pe
ne
m h
as
sign
ific
an
t st
ab
ility
to h
ydro
lysis
by
β-la
cta
ma
ses
of m
ost
ca
teg
orie
s, b
oth
pe
nic
illin
ase
s a
nd
c
ep
ha
losp
orin
ase
s p
rod
uc
ed
by
gra
m-p
osit
ive
an
d g
ram
-n
eg
ativ
e b
ac
teria
.M
ero
pe
ne
m s
ho
uld
no
t b
e u
sed
to
tre
at
me
thic
illin
-re
sista
nt
Sta
phy
loc
oc
cu
s a
ure
us
(MR
SA).
In v
itro
te
sts
sho
w m
ero
pe
ne
m t
o a
ct
syn
erg
istic
ally
with
am
ino
-g
lyc
osid
e a
ntib
iotic
s a
ga
inst
so
me
iso
late
s o
f Pse
ud
om
on
as
ae
rug
ino
sa.
Re
du
ce
do
se in
mo
de
r-a
te t
o s
eve
re re
na
l im
pa
irme
nt.
IV: 1
g q
8 h
No
soc
om
ial p
ne
um
on
ia,
pe
rito
niti
s, n
eu
tro
pe
nic
p
atie
nts
, se
psis
IV: 2
g q
8 h
Me
nin
giti
s a
nd
cys
tic fi
bro
sis
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1857
LWBK1580-App-J_p1852-1874.indd 1857 29/07/17 7:30 AM
TABL
E J.
4 M
ono
ba
cta
ms
Dru
gD
rug
cla
ssU
sua
l do
se
in a
dul
tsA
ctio
ns, i
nte
rac
tions
, a
nd o
the
rsSp
ec
trum
of a
ctiv
ity, i
ndic
atio
ns, a
nd a
ctiv
e
ag
ain
st m
ost
stra
ins
of
Rout
e, r
ed
uce
do
se, a
nd
co
ntra
ind
ica
tions
Azt
reo
na
mM
on
ob
ac
tam
It w
as
orig
ina
lly
isola
ted
fro
m
Ch
rom
ob
ac
te-
rium
vio
lac
eu
m.
IV: 1
–2 g
q8
hIV
: 2 g
q6
h•
Syn
the
tic b
ac
teric
ida
l a
ntib
iotic
•Sy
nth
etic
ba
cte
ricid
al
an
tibio
tic•
Me
nin
ge
al d
ose
Ae
rob
ic g
ram
-ne
ga
tive
mic
ro-o
rga
nism
s: C
itro
ba
cte
r sp
p.,
inc
lud
ing
C
. fre
un
dii;
En
tero
ba
cte
r sp
p.,
inc
lud
ing
E. c
loa
ca
e; E
sch
eric
hia
c
oli;
Ha
em
op
hilu
s in
flue
nza
e (
inc
lud
ing
am
pic
illin
-re
sista
nt
an
d
oth
er p
en
icilli
na
se-p
rod
uc
ing
str
ain
s); K
leb
siella
, Pro
teu
s, a
nd
Se
rratia
sp
ec
ies.
Re
du
ce
do
se in
mo
de
rate
to
se
vere
re
na
l im
pa
irme
nt.
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1858
LWBK1580-App-J_p1852-1874.indd 1858 29/07/17 7:30 AM
TABL
E J.
5 C
ep
halo
spo
rins
(Pa
rent
era
l)
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Ce
fazo
linFi
rst-
ge
ne
ratio
n
ce
ph
alo
spo
rinIV
: 1 g
q8
hR
em
em
be
r: N
a+
co
nte
nt
= 46
mg
p
er g
ce
fazo
lin
In v
itro
te
sts
de
mo
n-
stra
te t
ha
t th
e b
ac
-te
ricid
al a
ctio
n o
f c
ep
ha
losp
orin
s re
sults
fro
m in
hib
itio
n o
f ce
ll w
all
syn
the
sisD
rug
inte
rac
tions
: No
ne
Sta
phy
loc
oc
cu
s a
ure
us
(inc
lud
ing
pe
nic
illin
ase
-pro
du
cin
g s
tra
ins)
; St
ap
hylo
co
cc
us
ep
ide
rmid
is; M
eth
icilli
n-r
esis
tan
t st
ap
hylo
co
cc
i a
re u
nifo
rmly
resis
tan
t to
ce
fazo
lin.
Gro
up
A β
-he
mo
lytic
Str
ep
toc
oc
ci a
nd
oth
er s
tra
ins
of s
tre
pto
-c
oc
ci (
ma
ny s
tra
ins
of e
nte
roc
oc
ci a
re re
sista
nt)
Stre
pto
co
cc
us
pn
eu
mo
nia
e; E
sch
eric
hia
co
li; P
rote
us
mira
bilis
; Kl
eb
siella
sp
.; En
tero
ba
cte
r ae
rog
en
es;
Ha
em
op
hilu
s in
flue
nza
e
Re
du
ce
do
se in
mo
de
rate
to
se
vere
ren
al i
mp
airm
en
t.
Ce
furo
xim
eSe
co
nd
-ge
ne
ratio
n IV
/o
ral c
ep
ha
losp
orin
IV: 1
.5 g
q8
hPO
: 500
mg
q12
hR
em
em
be
r: N
a+
co
nte
nt
= 2.
4 m
Eq/g
Ce
furo
xim
e h
as
in v
itro
a
ctiv
ity a
ga
inst
a
wid
e ra
ng
e o
f gra
m-
po
sitiv
e a
nd
gra
m-
ne
ga
tive
org
an
isms,
an
d it
is h
igh
ly s
tab
le
in t
he
pre
sen
ce
of
β-la
cta
ma
ses
of c
er-
tain
gra
m-n
eg
ativ
e
ba
cte
ria. T
he
ba
cte
-ric
ida
l ac
tion
of c
efu
-ro
xim
e re
sults
fro
m
inh
ibiti
on
of c
ell
wa
ll sy
nth
esis
.
Ae
rob
es,
gra
m-p
osi
tive
Sta
phy
loc
oc
cus
aur
eus
; Sta
phy
loc
oc
cus
ep
ide
rmid
is; S
tre
pto
co
cc
us
pne
umo
nia
e; S
tre
pto
co
cc
us p
yog
ene
s (a
nd o
the
r str
ep
toc
oc
ci)
NO
TE: M
ost
str
ain
s o
f en
tero
co
cc
i (e
.g.,
Ente
roc
oc
cu
s fa
ec
alis
[f
orm
erly
Str
ep
toc
oc
cu
s fa
ec
alis
]), a
re re
sista
nt
to c
efu
roxi
me
. M
eth
icilli
n-r
esis
tan
t st
ap
hylo
co
cc
i an
d L
iste
ria m
on
oc
yto
ge
ne
s a
re re
sista
nt
to c
efu
roxi
me
.A
ero
be
s, g
ram
-ne
ga
tive
Citr
ob
ac
ter s
pp
.; En
tero
ba
cte
r sp
p.;
Esc
he
rich
ia c
oli;
Ha
em
op
hilu
s in
flue
nza
e (
inc
lud
ing
am
pic
illin
-re
sista
nt
stra
ins)
; Ha
em
op
hilu
s p
ara
influ
en
zae
; Kle
bsie
lla s
pp
. (in
clu
din
g K
leb
siella
pn
eu
-m
on
iae
); M
ora
xella
(Br
an
ha
me
lla)
ca
tarrh
alis
(in
clu
din
g a
mp
i-c
illin
- a
nd
ce
ph
alo
thin
-re
sista
nt
stra
ins)
; Mo
rga
ne
lla m
org
an
ii (f
orm
erly
Pro
teu
s m
org
an
ii); N
eiss
eria
go
no
rrho
ea
e (
inc
lud
ing
p
en
icilli
na
se-
an
d n
on
–pe
nic
illin
ase
-pro
du
cin
g s
tra
ins)
; Ne
isse
ria
me
nin
giti
dis;
Pro
teu
s m
irab
ilis; P
rovi
de
nc
ia re
ttg
eri
(fo
rme
rly
Pro
teu
s re
ttg
eri)
; Sa
lmo
ne
lla s
pp
.; Sh
ige
lla s
pp
.
Re
du
ce
do
se in
mo
de
rate
to
se
vere
ren
al i
mp
airm
en
t.D
o n
ot
use
for m
en
ing
itis
pro
phy
laxi
s.
Ce
fota
xim
eTh
ird-g
en
era
tion
c
ep
ha
losp
orin
IV: 2
g q
6 h
Ad
min
iste
r by
IV in
jec
-tio
n o
r in
fusio
n o
r by
de
ep
IM in
jec
tion
.
Low
er re
spira
tory
tra
ct in
fect
ions
, inc
lud
ing
pne
umo
nia
, ca
use
d b
y St
rep
toc
oc
cus
pne
umo
nia
e (
form
erly
Dip
loc
oc
cus
pne
umo
nia
e),
Stre
pto
co
cc
us p
yog
ene
sa (
gro
up A
str
ep
toc
oc
ci)
and
oth
er
stre
pto
co
cc
i (e
xclu
din
g e
nte
roc
oc
ci,
e.g
., En
tero
co
cc
us fa
ec
alis
), St
ap
hylo
co
cc
us a
ure
us (
pe
nic
illina
se a
nd n
onp
eni
cilli
nase
pro
-d
ucin
g),
Esc
heric
hia
co
li, K
leb
siella
sp
., H
ae
mo
phi
lus
influ
enz
ae
(in
clu
din
g a
mp
icilli
n-re
sista
nt s
train
s), H
ae
mo
phi
lus
pa
rain
flue
nza
e,
Pro
teus
mira
bilis
, Se
rratia
ma
rce
sce
ns,a
Ent
ero
ba
cte
r sp
., in
do
le-
po
sitiv
e P
rote
us a
nd P
seud
om
ona
s sp
. (in
clu
din
g P.
ae
rug
ino
sa).
Ge
nito
urin
ary
infe
ctio
nsU
rina
ry tr
ac
t inf
ec
tions
ca
use
d b
y En
tero
co
cc
us s
p.,
Sta
phy
loc
oc
cus
e
pid
erm
idis,
Sta
phy
loc
oc
cus
aur
eus
a (
pe
nic
illina
se a
nd n
onp
eni
-c
illina
se p
rod
ucin
g),
Citr
ob
ac
ter s
p.,
Ente
rob
ac
ter s
p.,
Esc
heric
hia
c
oli,
Kle
bsie
lla s
p.,
Pro
teus
mira
bilis
, Pro
teus
vul
ga
ris,a
Pro
vid
enc
ia
stua
rtii,
Mo
rga
nella
mo
rga
nii,a
Pro
vid
enc
ia re
ttg
eri,
a S
erra
tia
ma
rce
sce
ns, a
nd P
seud
om
ona
s sp
. (in
clu
din
g P.
ae
rug
ino
sa).
Also
, un
co
mp
lica
ted
go
norrh
ea
(c
erv
ica
l/ur
eth
ral a
nd re
cta
l) c
aus
ed
b
y N
eiss
eria
go
norrh
oe
ae
, inc
lud
ing
pe
nic
illina
se-p
rod
ucin
g s
train
s.G
yne
co
log
ic in
fec
tions
, in
clu
din
g p
elv
ic in
flam
ma
tory
dise
ase
, e
nd
om
etr
itis,
an
d p
elv
ic c
ellu
litis
ca
use
d b
y St
ap
hylo
co
cc
us
ep
ide
rmid
is, S
tre
pto
co
cc
us
sp.,
Ente
roc
oc
cu
s sp
., En
tero
ba
cte
r sp
ec
ies,
a K
leb
siella
sp
.,a E
sch
eric
hia
co
li, P
rote
us
mira
bilis
, Ba
c-
tero
ide
s sp
. (in
clu
din
g B
ac
tero
ide
s fra
gilis
a),
Clo
strid
ium
sp
., a
nd
a
na
ero
bic
co
cc
i (in
clu
din
g P
ep
tost
rep
toc
oc
cu
s sp
. an
d P
ep
to-
co
cc
us
sp.)
an
d F
uso
ba
cte
rium
sp
. (in
clu
din
g F.
nu
cle
atu
ma)
Re
du
ce
do
se in
mo
de
rate
to
se
vere
ren
al i
mp
airm
en
t.
1859
(Co
ntin
ue
d)
LWBK1580-App-J_p1852-1874.indd 1859 29/07/17 7:30 AM
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Bac
tere
mia
/se
ptic
em
ia c
au
sed
by
Esc
he
rich
ia c
oli,
Kle
bsie
lla s
p.,
Serra
tia m
arc
esc
en
s, S
tap
hylo
co
cc
us
au
reu
s, a
nd
Str
ep
toc
oc
-c
us
sp. (
inc
lud
ing
S. p
ne
um
on
iae
)Sk
in a
nd s
kin
stru
ctu
re in
fec
tions
ca
use
d b
y St
ap
hylo
co
cc
us
au
reu
s (p
en
icilli
na
se a
nd
no
np
en
icilli
na
se p
rod
uc
ing
), St
ap
hylo
-c
oc
cu
s e
pid
erm
idis
, Str
ep
toc
oc
cu
s p
yog
en
es
(gro
up
A s
tre
pto
-c
oc
ci)
an
d o
the
r str
ep
toc
oc
ci,
Ente
roc
oc
cu
s sp
., A
cin
eto
ba
cte
r sp
ec
ies,
a E
sch
eric
hia
co
li, C
itro
ba
cte
r sp
ec
ies
(inc
lud
ing
C.
fre
un
diia
), En
tero
ba
cte
r sp
., Kl
eb
siella
sp
., Pr
ote
us
mira
bilis
, Pr
ote
us
vulg
aris
,a M
org
an
ella
mo
rga
nii,
Pro
vid
en
cia
rett
ge
ri,a
Pse
ud
om
on
as
sp.,
Serra
tia m
arc
esc
en
s, B
ac
tero
ide
s sp
., a
nd
a
na
ero
bic
co
cc
i (in
clu
din
g P
ep
tost
rep
toc
oc
cu
sa s
p. a
nd
Pe
pto
co
cc
us
sp.)
Intra
-ab
do
min
al i
nfe
ctio
ns in
clu
din
g p
erit
on
itis
ca
use
d b
y St
rep
to-
co
cc
us
sp.,a
Esc
he
rich
ia c
oli,
Kle
bsie
lla s
p.,
Bac
tero
ide
s sp
., a
nd
a
na
ero
bic
co
cc
i (in
clu
din
g P
ep
tost
rep
toc
oc
cu
sa s
p. a
nd
Pe
pto
-c
oc
cu
sa s
p.)
Pro
teu
s m
irab
ilis,a
an
d C
lost
ridiu
m s
pe
cie
sa
Bone
and
/or j
oin
t inf
ec
tions
ca
use
d b
y St
ap
hylo
co
cc
us
au
reu
s (p
en
icilli
na
se-
an
d n
on
–pe
nic
illin
ase
-pro
du
cin
g s
tra
ins)
, Str
ep
to-
co
cc
us
sp. (
inc
lud
ing
S. p
yog
en
esa
), Ps
eu
do
mo
na
s sp
. (in
clu
din
g
P. a
eru
gin
osa
a),
an
d P
rote
us
mira
bilis
a
Ce
ntra
l ne
rvo
us s
yste
m in
fec
tions
(e
.g.,
me
nin
giti
s a
nd
ve
ntr
icu
-lit
is), c
au
sed
by
Ne
isse
ria m
en
ing
itid
is, H
ae
mo
ph
ilus
influ
en
zae
, St
rep
toc
oc
cu
s p
ne
um
on
iae
, Kle
bsie
lla p
ne
um
on
iae
,a a
nd
Esc
h-
eric
hia
co
lia
Ce
fta
zid
ime
Third
-ge
ne
ratio
n
ce
ph
alo
spo
rinIV
: 2 g
q8
hC
eft
azi
dim
e is
ba
c-
teric
ida
l in
ac
tion
, e
xert
ing
its
effe
ct
by
inh
ibiti
on
of e
nzy
me
s re
spo
nsib
le fo
r ce
ll w
all
syn
the
sis.
Low
er r
esp
irato
ry tr
ac
t inf
ec
tions
, inc
lud
ing
pne
umo
nia
, ca
use
d b
y Ps
eu
do
mo
na
s a
eru
gin
osa
an
d o
the
r Pse
ud
om
on
as
spp
.; H
ae
-m
op
hilu
s in
flue
nza
e, i
nc
lud
ing
am
pic
illin
-re
sista
nt
stra
ins;
Kle
bsi-
ella
sp
p.;
Ente
rob
ac
ter s
pp
.; Pr
ote
us
mira
bilis
; Esc
he
rich
ia c
oli;
Se
rratia
sp
p.;
Citr
ob
ac
ter s
pp
.; St
rep
toc
oc
cu
s p
ne
um
on
iae
; an
d
Sta
phy
loc
oc
cu
s a
ure
us
(me
thic
illin
-su
sce
ptib
le s
tra
ins)
.Sk
in a
nd s
kin
stru
ctu
re in
fec
tions
ca
use
d b
y Ps
eu
do
mo
na
s a
eru
-g
ino
sa; K
leb
siella
sp
p.;
Esc
he
rich
ia c
oli;
Pro
teu
s sp
p.,
inc
lud
ing
Pr
ote
us
mira
bilis
an
d in
do
le-p
osit
ive
Pro
teu
s; E
nte
rob
ac
ter s
pp
.; Se
rratia
sp
p.;
Sta
phy
loc
oc
cu
s a
ure
us
(me
thic
illin
-su
sce
ptib
le
stra
ins)
; an
d S
tre
pto
co
cc
us
pyo
ge
ne
s (g
rou
p A
β-h
em
oly
tic
stre
pto
co
cc
i).U
rina
ry tr
ac
t inf
ec
tions
, bo
th c
om
plic
ate
d a
nd u
nco
mp
lica
ted
, c
aus
ed
by
Pse
ud
om
on
as
ae
rug
ino
sa; E
nte
rob
ac
ter s
pp
.; Pr
o-
teu
s sp
p.,
inc
lud
ing
Pro
teu
s m
irab
ilis a
nd
ind
ole
-po
sitiv
e P
rote
us;
Kl
eb
siella
sp
p.;
an
d E
sch
eric
hia
co
liBa
cte
rial s
ep
tice
mia
ca
use
d b
y Ps
eu
do
mo
na
s a
eru
gin
osa
, Kle
b-
siella
sp
p.,
Ha
em
op
hilu
s in
flue
nza
e, E
sch
eric
hia
co
li, Se
rratia
sp
p.,
Stre
pto
co
cc
us
pn
eu
mo
nia
e, a
nd
Sta
phy
loc
oc
cu
s a
ure
us
(me
thic
illin
-su
sce
ptib
le s
tra
ins)
Bone
and
join
t inf
ec
tions
ca
use
d b
y Ps
eu
do
mo
na
s a
eru
gin
osa
, Kl
eb
siella
sp
p.,
Ente
rob
ac
ter s
pp
., a
nd
Sta
phy
loc
oc
cu
s a
ure
us
(me
thic
illin
-su
sce
ptib
le s
tra
ins)
Re
du
ce
do
se in
mo
de
rate
to
se
vere
ren
al i
mp
airm
en
t.
TABL
E J.
5 C
ep
halo
spo
rins
(Pa
rent
era
l) (C
ont
inue
d)
1860
LWBK1580-App-J_p1852-1874.indd 1860 29/07/17 7:30 AM
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Gyn
ec
olo
gic
infe
ctio
ns, i
nc
lud
ing
en
do
me
triti
s, p
elv
ic c
ellu
litis
, a
nd
oth
er i
nfe
ctio
ns
of t
he
fem
ale
ge
nita
l tra
ct
ca
use
d b
y
Esc
he
rich
ia c
oli
Intra
-ab
do
min
al i
nfe
ctio
ns, i
nclu
din
g p
erit
oni
tis c
aus
ed
by
Esc
h-
eric
hia
co
li, Kl
eb
siella
sp
p.,
an
d S
tap
hylo
co
cc
us
au
reu
s (m
eth
i-c
illin
-su
sce
ptib
le s
tra
ins)
an
d p
oly
mic
rob
ial i
nfe
ctio
ns
ca
use
d b
y a
ero
bic
an
d a
na
ero
bic
org
an
isms
an
d B
ac
tero
ide
s sp
p. (
ma
ny
stra
ins
of B
ac
tero
ide
s fra
gilis
are
resis
tan
t)C
ent
ral n
erv
ous
sys
tem
infe
ctio
ns, i
nclu
din
g m
eni
ngiti
s, c
aus
ed
by
Ha
em
op
hilu
s in
flue
nza
e a
nd
Ne
isse
ria m
en
ing
itid
is. C
eft
azi
dim
e
ha
s a
lso b
ee
n u
sed
su
cc
ess
fully
in a
lim
ited
nu
mb
er o
f ca
ses
of
me
nin
giti
s d
ue
to
Pse
ud
om
on
as
ae
rug
ino
sa a
nd
Str
ep
toc
oc
cu
s p
ne
um
on
iae
.
Ce
fep
ime
Fou
rth
-ge
ne
ratio
n
ce
ph
alo
spo
rinIV
: 1–2
g q
12 h
For p
rove
n s
erio
us
sys-
tem
ic P.
ae
rug
ino
sa
infe
ctio
ns,
feb
rile
n
eu
tro
pe
nia
, or c
ys-
tic fi
bro
sis: 2
g (
IV)
q
8 h
(m
ax
do
se)
Me
nin
ge
al d
ose
: 2 g
(IV
) q
8 h
(m
ax
do
se)
Loc
al i
nto
lera
nc
es
to IV
o
r IM
ad
min
istra
tion
o
f ce
fep
ime
we
re n
ot
sta
tistic
ally
diff
ere
nt
from
th
ose
of c
eft
azi
-d
ime
ad
min
istra
tion
In v
itro
, ac
tivity
ag
ain
st g
ram
-po
sitiv
e o
rga
nism
s in
clu
din
g S
tre
pto
-c
oc
cu
s a
ga
lac
tiae
, Str
ep
toc
oc
cu
s p
ne
um
on
iae
, Str
ep
toc
oc
cu
s p
yog
en
es,
an
d p
en
icilli
n-s
usc
ep
tible
Sta
phy
loc
oc
cu
s a
ure
us
The
bro
ad
rang
e o
f gra
m-n
eg
ativ
e o
rga
nism
s se
nsiti
ve to
incl
ude
fa
mily
En
tero
ba
cte
riac
ea
e, K
leb
siella
pn
eu
mo
nia
e, H
ae
mo
ph
i-lu
s in
flue
nza
, Ne
isse
ria m
en
ing
itid
is, N
eiss
eria
go
no
rrho
ea
e, a
nd
Ps
eu
do
mo
na
s a
eru
gin
osa
Re
du
ce
do
se in
mo
de
rate
to
se
vere
ren
al i
mp
airm
en
t
aU
sua
l do
se, a
ssu
me
s n
orm
al r
en
al/
he
pa
tic fu
nc
tion
.D
ata
fro
m C
un
ha
BA
. An
tibio
tic E
sse
ntia
ls. 1
2th
ed
. Bu
rlin
gto
n, M
A: J
on
es
& B
art
lett
Le
arn
ing
, 201
3. A
vaila
ble
at
htt
p:/
/ww
w.d
rug
s.c
om
. Re
vise
d J
an
ua
ry 2
015.
TABL
E J.
5 C
ep
halo
spo
rins
(Pa
rent
era
l) (C
ont
inue
d)
1861
LWBK1580-App-J_p1852-1874.indd 1861 29/07/17 7:30 AM
TABL
E J.
6 G
lyc
op
ep
tide
s
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Van
co
myc
inG
lyc
op
ep
tide
The
initi
al d
ose
sh
ou
ld b
e n
o
<15
mg
/kg
, eve
n in
pa
tien
ts
with
mild
to
mo
de
rate
ren
al
insu
ffic
ien
cy
IV: 1
g q
12 h
The
ba
cte
ricid
al a
ctio
n o
f va
nc
o-
myc
in re
sults
prim
aril
y fro
m in
hib
i-tio
n o
f ce
ll w
all
bio
syn
the
sis. I
n
ad
diti
on
, va
nc
om
ycin
alte
rs b
ac
-te
rial c
ell
me
mb
ran
e p
erm
ea
bilit
y a
nd
RN
A s
ynth
esis
.C
on
co
mita
nt
ad
min
istra
tion
of v
an
-c
om
ycin
an
d a
ne
sth
etic
ag
en
ts
ha
s b
ee
n a
sso
cia
ted
with
ery
-th
em
a a
nd
hist
am
ine
like
flu
shin
g
an
d a
na
phy
lac
toid
rea
ctio
ns.
Ind
ica
ted
for t
he
tre
atm
en
t o
f se
riou
s o
r se
vere
infe
c-
tion
s c
au
sed
by
susc
ep
tible
str
ain
s o
f me
thic
illin
-re
sista
nt
(β-la
cta
m–r
esis
tan
t) s
tap
hylo
co
cc
i. It
is in
dic
ate
d fo
r pe
nic
illin
-alle
rgic
pa
tien
ts; f
or p
atie
nts
w
ho
ca
nn
ot
rec
eiv
e o
r wh
o h
ave
faile
d t
o re
spo
nd
to
oth
er d
rug
s, in
clu
din
g t
he
pe
nic
illin
s o
r ce
ph
alo
-sp
orin
s; a
nd
for i
nfe
ctio
ns
ca
use
d b
y va
nc
om
ycin
-su
sce
ptib
le o
rga
nism
s th
at
are
resis
tan
t to
oth
er
an
timic
rob
ial d
rug
s. A
lso in
dic
ate
d fo
r in
itia
l th
er-
ap
y w
he
n m
eth
icilli
n-r
esis
tan
t st
ap
hylo
co
cc
i are
su
spe
cte
d, b
ut
aft
er s
usc
ep
tibilit
y d
ata
are
ava
il-a
ble
, th
era
py
sho
uld
be
ad
just
ed
ac
co
rdin
gly
.Ef
fec
tive
in t
he
tre
atm
en
t o
f Sta
phy
loc
oc
ca
l en
do
-c
ard
itis.
Its
effe
ctiv
en
ess
ha
s b
ee
n d
oc
um
en
ted
in
oth
er i
nfe
ctio
ns
du
e t
o s
tap
hylo
co
cc
i, in
clu
din
g
sep
tice
mia
, bo
ne
infe
ctio
ns,
low
er r
esp
irato
ry t
rac
t in
fec
tion
s, a
nd
ski
n a
nd
ski
n s
tru
ctu
re in
fec
tion
s.Ef
fec
tive
alo
ne
or i
n c
om
bin
atio
n w
ith a
n a
min
og
ly-
co
side
for e
nd
oc
ard
itis
ca
use
d b
y S.
viri
da
ns
or
S. b
ovi
s. F
or e
nd
oc
ard
itis
ca
use
d b
y e
nte
roc
oc
ci
(e.g
., E.
fae
ca
lis),
van
co
myc
in h
ydro
ch
lorid
e h
as
be
en
rep
ort
ed
to
be
effe
ctiv
e o
nly
in c
om
bin
atio
n
with
an
am
ino
gly
co
side
.Ef
fec
tive
for t
he
tre
atm
en
t o
f dip
hth
ero
id
en
do
ca
rditi
sH
as
be
en
use
d s
uc
ce
ssfu
lly in
co
mb
ina
tion
with
rif
am
pin
, an
am
ino
gly
co
side
, or b
oth
, in
ea
rly-o
nse
t p
rost
he
tic v
alv
e e
nd
oc
ard
itis
ca
use
d b
y S.
ep
ide
r-m
idis
or d
iph
the
roid
sTh
e p
are
nte
ral f
orm
of v
an
co
myc
in m
ay
be
a
dm
inist
ere
d o
rally
for t
he
tre
atm
en
t o
f an
tibio
tic-
ass
oc
iate
d p
seu
do
me
mb
ran
ou
s c
olit
is p
rod
uc
ed
b
y C
. diffi
cile
an
d fo
r sta
phy
loc
oc
ca
l en
tero
co
litis
Do
sag
e a
dju
stm
en
t m
ust
b
e m
ad
e in
pa
tien
ts
with
imp
aire
d re
na
l fu
nc
tion
.Va
nc
om
ycin
do
sag
e
sch
ed
ule
s sh
ou
ld b
e
ad
just
ed
in e
lde
rly
pa
tien
tsD
osa
ge
ta
ble
for v
an
co
-m
ycin
(A
da
pte
d fr
om
M
oe
llerin
g e
t a
l.)b
Cre
atin
e C
lea
ran
ce
/Do
sem
L/m
in—
mg
/24
h10
0—1,
545
90—
1,39
080
—1,
235
70—
1,08
060
—92
550
—77
040
—62
030
—46
520
—31
010
—15
5
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1862
LWBK1580-App-J_p1852-1874.indd 1862 29/07/17 7:30 AM
TABL
E J.
7 C
hlo
ram
phe
nic
ol,
Clin
da
myc
in, E
ryth
rom
ycin
Gro
up, K
eto
lide
s
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
a
ctiv
e a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Ch
lora
mp
he
nic
ol
Ch
lora
mp
he
nic
ol
sod
ium
su
cc
ina
teC
hlo
ram
ph
en
ico
l so
diu
m
suc
cin
ate
is in
ten
de
d fo
r in
tra
ven
ou
s u
se o
nly
. It
ha
s b
ee
n d
em
on
stra
ted
to
b
e in
effe
ctiv
e w
he
n g
ive
n
intr
am
usc
ula
rly.
0.25
–1 g
IV q
6 h
(m
ax
of 4
g/d
)A
dm
inist
ratio
n o
f 50
mg
/kg
/d in
d
ivid
ed
do
ses
will
pro
du
ce
b
loo
d le
vels
of t
he
ma
gn
i-tu
de
to
wh
ich
th
e m
ajo
rity
of s
usc
ep
tible
mic
ro-o
rga
n-
isms
will
resp
on
d.
The
mo
st s
erio
us
ad
vers
e e
ffec
t o
f ch
lora
mp
he
nic
ol i
s b
on
e
ma
rrow
de
pre
ssio
n. S
erio
us
an
d fa
tal b
loo
d d
ysc
rasia
s (a
pla
stic
an
em
ia, h
ypo
pla
stic
a
ne
mia
, th
rom
bo
cyt
op
en
ia,
an
d g
ran
ulo
cyt
op
en
ia)
are
kn
ow
n t
o o
cc
ur a
fte
r th
e a
dm
inist
ratio
n o
f c
hlo
ram
ph
en
ico
l.
Ch
lora
mp
he
nic
ol m
ust
be
use
d o
nly
in t
ho
se
serio
us
infe
ctio
ns
for w
hic
h le
ss p
ote
n-
tially
da
ng
ero
us
dru
gs
are
ine
ffec
tive
or
co
ntr
ain
dic
ate
d:
1. A
cut
e in
fec
tions
ca
use
d b
y Sa
lmo
nella
typ
hi
2. S
erio
us
infe
ctio
ns
ca
use
d b
y su
sce
ptib
le
stra
ins:
•Sa
lmo
ne
lla s
p.
•H
. in
flue
nza
e, e
spe
cia
lly m
en
ing
ea
l in
fec
tion
s•
Ric
kett
sia•
Lym
ph
og
ran
ulo
ma
-psit
tac
osis
gro
up
•Va
riou
s g
ram
-ne
ga
tive
ba
cte
ria c
au
s-in
g b
ac
tere
mia
, me
nin
giti
s, o
r oth
er
serio
us
gra
m-n
eg
ativ
e in
fec
tion
s•
Oth
er s
usc
ep
tible
org
ani
sms
tha
t ha
ve
be
en
de
mo
nstr
ate
d to
be
resis
tant
to a
ll o
the
r ap
pro
pria
te a
ntim
icro
bia
l ag
ent
s3.
Cys
tic fi
bro
sis re
gim
en
s
Tota
l urin
ary
exc
retio
n o
f c
hlo
ram
ph
en
ico
l in
th
ese
st
ud
ies
ran
ge
d fr
om
a lo
w
of 6
8% t
o a
hig
h o
f 99%
o
ver a
3-d
ay
pe
riod
. Fro
m
8% t
o 1
2% o
f th
e a
ntib
iotic
e
xcre
ted
is in
th
e fo
rm o
f fr
ee
ch
lora
mp
he
nic
ol
Clin
da
myc
inC
lind
am
ycin
p
ho
sph
ate
IV o
r IM
: 600
–900
mg
q8
hPO
: 0.1
5–0.
45 g
q6
hPs
eu
do
me
mb
ran
ou
s c
olit
is h
as
be
en
rep
ort
ed
with
ne
arly
all
an
tiba
cte
rial a
ge
nts
, in
clu
d-
ing
clin
da
myc
in, a
nd
ma
y ra
ng
e in
se
verit
y fro
m m
ild t
o
life
th
rea
ten
ing
.
Ae
rob
ic g
ram
-po
sitiv
e c
oc
ci,
inc
lud
ing
:St
ap
hylo
co
cc
us
au
reu
s (p
en
icilli
na
se a
nd
n
on
–pe
nic
illin
ase
-pro
du
cin
g s
tra
ins)
; Sta
phy
-lo
co
cc
us
ep
ide
rmid
is (p
en
icilli
na
se-
an
d n
on
–p
en
icilli
na
se-p
rod
uc
ing
str
ain
s); S
tre
pto
co
cc
i (e
xce
pt
Ente
roc
oc
cu
s fa
ec
alis
); P
ne
um
oc
oc
ci
Ana
ero
bic
gra
m-n
eg
ativ
e b
ac
illi,
inc
lud
ing
Ba
cte
roid
es
sp. (
inc
lud
ing
Ba
cte
roid
es
frag
ilis
gro
up
an
d B
ac
tero
ide
s m
ela
nin
og
en
icu
s g
rou
p)
an
d F
uso
ba
cte
rium
sp
ec
ies
Ana
ero
bic
gra
m-p
osi
tive
no
n–sp
ore
-fo
rmin
g
ba
cill
i, in
clu
din
g P
rop
ion
iba
cte
rium
, Eu
ba
cte
-riu
m, a
nd
Ac
tino
myc
es
sp.
Ana
ero
bic
and
mic
roa
ero
phi
lic g
ram
-po
sitiv
e
co
cc
i, in
clu
din
g P
ep
toc
oc
cu
s sp
., Pe
pto
stre
p-
toc
oc
cu
s sp
., M
icro
ae
rop
hilic
str
ep
toc
oc
ci,
an
d C
lost
ridia
The
elim
ina
tion
ha
lf-lif
e o
f c
lind
am
ycin
is in
cre
ase
d
slig
htly
in p
atie
nts
with
m
ark
ed
ly re
du
ce
d re
na
l or
he
pa
tic fu
nc
tion
. He
mo
-d
ialy
sis a
nd
pe
rito
ne
al
dia
lysis
are
no
t e
ffec
tive
in
rem
ovi
ng
clin
da
myc
in
from
th
e s
eru
m.
1863
(Co
ntin
ue
d)
LWBK1580-App-J_p1852-1874.indd 1863 29/07/17 7:30 AM
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
a
ctiv
e a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Cla
rith
rom
ycin
Sem
i-syn
the
tic
ma
cro
lide
a
ntib
iotic
PO: 0
.5 g
q12
hD
rug
Inte
rac
tions
:Pa
tien
ts w
ho
are
rec
eiv
ing
sin
gle
do
ses
of c
larit
hro
myc
in
an
d t
he
op
hyllin
e o
r ca
rba
m-
aze
pin
e m
ay
be
ass
oc
iate
d
with
an
inc
rea
se o
f se
rum
th
eo
phy
lline
an
d c
arb
am
-a
zep
ine
co
nc
en
tra
tion
s.
Ae
rob
ic g
ram
-po
sitiv
e m
icro
-org
ani
sms
Sta
phy
loc
oc
cu
s a
ure
us;
Str
ep
toc
oc
cu
s p
ne
u-
mo
nia
e; S
tre
pto
co
cc
us
pyo
ge
ne
sA
ero
bic
gra
m-n
eg
ativ
e m
icro
-org
ani
sms
Ha
em
op
hilu
s in
flue
nza
e; H
ae
mo
ph
ilus
pa
rain
flu-
en
zae
; Mo
raxe
lla c
ata
rrha
lisO
the
r mic
ro-o
rga
nism
sM
yco
pla
sma
pn
eu
mo
nia
e; C
hla
myd
ia
pn
eu
mo
nia
eM
yco
ba
cte
riaM
yco
ba
cte
rium
avi
um
co
mp
lex
co
nsis
ting
of
Myc
ob
ac
teriu
m a
viu
m a
nd
Myc
ob
ac
teriu
m
intr
ac
ellu
lare
β-La
cta
ma
se p
rod
uc
tion
sh
ou
ld h
ave
no
effe
ct
on
cla
rith
rom
ycin
ac
tivity
.M
ost
str
ain
s o
f me
thic
illin
-re
sista
nt
an
d o
xac
illin
-re
sista
nt
sta
phy
loc
oc
ci a
re re
sista
nt
to
cla
rith
rom
ycin
.H
elic
ob
ac
ter
He
lico
ba
cte
r pyl
ori
Co
ntr
ain
dic
atio
ns:
Any
o
f th
e fo
llow
ing
dru
gs:
c
isap
ride
, pim
ozi
de
, a
ste
miz
ole
, te
rfen
ad
ine
, a
nd
erg
ota
min
e o
r d
ihyd
roe
rgo
tam
ine
.If
cla
rith
rom
ycin
is c
oa
d-
min
iste
red
with
cisa
prid
e,
pim
ozi
de
, ast
em
izo
le, o
r te
rfen
ad
ine
resu
ltin
g in
c
ard
iac
arrh
yth
mia
s (Q
T p
rolo
ng
atio
n, v
en
tric
ula
r ta
chy
ca
rdia
, ve
ntr
icu
lar
fibril
latio
n, a
nd
to
rsa
de
s d
e
po
inte
s), t
his
is m
ost
like
ly
du
e t
o in
hib
itio
n o
f me
tab
-o
lism
of t
he
se d
rug
s.
Lin
ezo
lidO
xazo
lidin
on
ePO
or I
V: 6
00 m
g q
12 h
all
ind
ica
tion
s e
xce
pt
400
mg
q
12 h
for u
nc
om
plic
ate
d
skin
infe
ctio
ns
Reve
rsib
le m
yelo
sup
pre
ssio
n in
clu
din
g a
ne
mia
, le
uko
-p
en
ia, p
an
cyt
op
en
ia, a
nd
th
rom
bo
cyt
op
en
ia h
as
be
en
re
po
rte
d in
pa
tien
ts. I
n c
ase
s w
he
re t
he
ou
tco
me
is k
no
wn
, w
he
n li
ne
zolid
wa
s d
isco
ntin
-u
ed
, th
e a
ffec
ted
he
ma
to-
log
ic p
ara
me
ters
ha
ve ri
sen
to
wa
rd p
retr
ea
tme
nt
leve
ls.
Lac
tic a
cid
osi
s h
as
be
en
re
po
rte
d w
ith t
he
use
of
line
zolid
.Sp
on
tan
eo
us
rep
ort
s o
f se
ro-
toni
n sy
ndro
me
ass
oc
iate
d
with
th
e c
oa
dm
inist
ratio
n
of l
ine
zolid
an
d s
ero
to-
ne
rgic
ag
en
ts, i
nc
lud
ing
a
ntid
ep
ress
an
tsPe
riphe
ral a
nd o
ptic
ne
uro
pa
-th
y h
ave
be
en
rep
ort
ed
in
pa
tien
ts t
rea
ted
with
Lin
ezo
lid
Ae
rob
ic a
nd fa
cul
tativ
e g
ram
-po
sitiv
e
mic
ro-o
rga
nism
sEn
tero
co
cc
us
fae
ciu
m (
van
co
myc
in-r
esis
tan
t st
rain
s o
nly
); S
tap
hylo
co
cc
us
au
reu
s (in
clu
d-
ing
me
thic
illin
-re
sista
nt
stra
ins)
; Str
ep
toc
oc
cu
s a
ga
lac
tiae
; Str
ep
toc
oc
cu
s p
ne
um
on
iae
(in
clu
din
g m
ulti
dru
g-r
esis
tan
t iso
late
s); S
tre
pto
-c
oc
cu
s p
yog
en
es
Ae
rob
ic a
nd fa
cul
tativ
e g
ram
-po
sitiv
e
mic
ro-o
rga
nism
sEn
tero
co
cc
us
fae
ca
lis (
inc
lud
ing
va
nc
om
ycin
-re
sista
nt
stra
ins)
; En
tero
co
cc
us
fae
ciu
m (
van
-c
om
ycin
-su
sce
ptib
le s
tra
ins)
; Sta
phy
loc
oc
cu
s e
pid
erm
idis
(inc
lud
ing
me
thic
illin
-re
sista
nt
stra
ins)
; Sta
phy
loc
oc
cu
s h
ae
mo
lytic
us;
V
irid
an
s g
rou
p s
tre
pto
co
cc
iA
ero
bic
and
fac
ulta
tive
gra
m-n
eg
ativ
e
mic
ro-o
rga
nism
sPa
ste
ure
lla m
ulto
cid
a
Lin
ezo
lid is
prim
aril
y m
eta
bo
-liz
ed
by
oxi
da
tion
of t
he
m
orp
ho
line
rin
g, w
hic
h
resu
lts in
tw
o in
ac
tive
rin
g-o
pe
ne
d c
arb
oxy
lic
ac
id m
eta
bo
lite
s: T
he
a
min
oe
tho
xya
ce
tic a
cid
m
eta
bo
lite
(A
) a
nd
th
e
hyd
roxy
eth
yl g
lyc
ine
m
eta
bo
lite
(B)
.N
on
ren
al c
lea
ran
ce
a
cc
ou
nts
for a
pp
roxi
-m
ate
ly 6
5% o
f th
e t
ota
l c
lea
ran
ce
of l
ine
zolid
. U
nd
er s
tea
dy-
sta
te c
on
di-
tion
s, a
pp
roxi
ma
tely
30%
o
f th
e d
ose
ap
pe
ars
in t
he
u
rine
as
line
zolid
, 40%
as
me
tab
olit
e B
, an
d 1
0% a
s m
eta
bo
lite
A.
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
TABL
E J.
7 C
hlo
ram
phe
nic
ol,
Clin
da
myc
in, E
ryth
rom
ycin
Gro
up, K
eto
lide
s (C
ont
inue
d)
1864
LWBK1580-App-J_p1852-1874.indd 1864 29/07/17 7:30 AM
TABL
E J.
8 Te
tracy
clin
es
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns, a
nd
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
ag
ain
st
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Do
xyc
yclin
eD
eriv
ed
fro
m
oxy
tetr
ac
yclin
ePO
: 0.1
g q
12 h
IV: 0
.1 g
q12
hTh
e t
etr
ac
yclin
es
are
prim
ar-
ily b
ac
terio
sta
tic a
nd
are
th
ou
gh
t to
exe
rt t
he
ir a
nti-
mic
rob
ial e
ffec
t b
y th
e in
hi-
biti
on
of p
rote
in s
ynth
esis
.
Wid
e ra
ng
e o
f gra
m-p
osit
ive
an
d g
ram
-ne
ga
tive
m
icro
-org
an
isms
Ae
rob
ic g
ram
-po
sitiv
e m
icro
-org
ani
sms
Bac
illus
an
thra
cis;
List
eria
mo
no
cyt
og
en
es;
Sta
phy
lo-
co
cc
us
au
reu
sA
ero
bic
gra
m-n
eg
ativ
e m
icro
-org
ani
sms
Bart
on
ella
ba
cilli
form
is; B
ruc
ella
sp
.; C
aly
mm
ato
ba
c-
teriu
m g
ran
ulo
ma
tis; C
am
pyl
ob
ac
ter f
etu
s; F
ran
-c
isella
tu
lare
nsis
; Ha
em
op
hilu
s d
uc
reyi
; Ha
em
op
hilu
s in
flue
nza
e; N
eiss
eria
go
no
rrho
ea
e; V
ibrio
ch
ole
rae
; Ye
rsin
ia p
est
is.
Ana
ero
bic
mic
ro-o
rga
nism
sA
ctin
om
yce
s isr
ae
lii; F
uso
ba
cte
rium
fusif
orm
e;
Clo
strid
ium
sp
.O
the
r mic
ro-o
rga
nism
sBo
rrelia
rec
urre
ntis
; Ch
lam
ydia
psit
tac
i; C
hla
myd
ia
tra
ch
om
atis
; Myc
op
lasm
a p
ne
um
on
iae
; Ric
kett
siae
; Tr
ep
on
em
a p
allid
um
; Tre
po
ne
ma
pe
rte
nu
e
Ca
n b
e u
sed
in p
atie
nts
with
ren
al
failu
reH
em
od
ialy
sis d
oe
s n
ot
alte
r se
rum
h
alf-
life
.
Oxy
tetr
ac
yclin
eTe
tra
cyc
line
PO: 0
.25–
0.5
g q
6 h
IV: 0
.5–1
.0 g
q12
hPr
ima
rily
ba
cte
riost
atic
Wid
e ra
ng
e o
f gra
m-p
osit
ive
an
d g
ram
-ne
ga
tive
m
icro
-org
an
isms,
simila
r to
oth
er t
etr
ac
yclin
es
Co
ntr
ain
dic
ate
d in
pre
gn
an
cy,
he
pa
-to
toxi
city
in m
oth
er,
tra
nsp
lac
en
tal
to fe
tus.
Intr
ave
no
us
do
sag
e o
ver
2.0
g/d
ma
y b
e a
sso
cia
ted
with
fa
tal h
ep
ato
toxi
city
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1865
LWBK1580-App-J_p1852-1874.indd 1865 29/07/17 7:30 AM
TABL
E J.
9 Fl
uoro
qui
nolo
nes
Dru
gD
rug
cla
ssU
sua
l do
se
in a
dul
tsA
ctio
ns, i
nte
rac
tions
, and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Cip
roflo
xac
inFl
uo
roq
uin
olo
ne
IV: 4
00 m
g q
8–12
h
( infu
sion
ove
r a
pe
riod
of 6
0 m
in)
PO: 5
00–7
50 m
g
q12
h
Inh
ibiti
on
of b
ac
teria
l to
po
isom
er-
ase
IV a
nd
DN
A g
yra
se (
bo
th o
f w
hic
h a
re t
ype
II t
op
oiso
me
rase
s),
en
zym
es
req
uire
d fo
r DN
A re
pli-
ca
tion
, tra
nsc
riptio
n, r
ep
air,
an
d
rec
om
bin
atio
nD
rug
inte
rac
tions
with
th
eo
phy
lline
, c
affe
ine
, wa
rfarin
ph
eny
toin
, su
lfo-
nylu
rea
gly
bu
ride
, me
tro
nid
azo
le,
pro
be
ne
cid
, pip
era
cilli
n s
od
ium
, a
nd
cyc
losp
orin
e
Ae
rob
ic g
ram
-po
sitiv
e m
icro
-org
ani
sms
Ente
roc
oc
cu
s fa
ec
alis
(m
any
str
ain
s a
re o
nly
mo
d-
era
tely
su
sce
ptib
le);
Sta
phy
loc
oc
cu
s a
ure
us
(me
thic
illin
-su
sce
ptib
le s
tra
ins
on
ly);
Sta
phy
loc
oc
-c
us
ep
ide
rmid
is (m
eth
icilli
n-s
usc
ep
tible
str
ain
s o
nly
);
Sta
phy
loc
oc
cu
s sa
pro
phy
ticu
s; S
tap
hylo
co
cc
us
pn
eu
mo
nia
e (
pe
nic
illin
-su
sce
ptib
le s
tra
ins)
; St
ap
hylo
co
cc
us
pyo
ge
ne
sA
ero
bic
gra
m-n
eg
ativ
e m
icro
-org
ani
smC
itro
ba
cte
r (d
ive
rsu
s, fr
eu
nd
ii); E
nte
rob
ac
ter c
loa
ca
e;
Esc
he
rich
ia c
oli;
Ha
em
op
hilu
s (in
flue
nza
e, p
ara
influ
-e
nza
e);
Kle
bsie
lla p
ne
um
on
iae
; Mo
raxe
lla c
ata
rrha
-lis
; Mo
rga
ne
lla m
org
an
ii; P
rote
us
(mira
bilis
, vu
lga
ris),
Pro
vid
en
cia
(re
ttg
eri,
stu
art
ii); P
seu
do
mo
na
s a
eru
gi-
no
sa; S
erra
tia m
arc
esc
en
s.A
lso c
ipro
floxa
cin
ha
s b
ee
n s
ho
wn
to
be
ac
tive
ag
ain
st
Bac
illus
an
thra
cis
bo
th in
vitr
o a
nd
by
use
of s
eru
m
leve
ls a
s a
su
rrog
ate
ma
rke
r.
Co
ntr
ain
dic
atio
ns:
Co
nc
om
itan
t a
dm
inist
ratio
n w
ith
tiza
nid
ine
Patie
nts
with
imp
aire
d re
na
l fu
nc
tion
:C
rea
tinin
e c
lea
ran
ce
(m
L/m
in):
•>3
0 (s
ee
usu
al d
ose
)•
5–29
(20
0–40
0 m
g q
18–2
4 h
)
Levo
floxa
cin
Flu
oro
qu
ino
lon
e25
0–75
0 m
g q
d
PO o
r IV
Inh
ibiti
on
of b
ac
teria
l to
po
isom
er-
ase
IV a
nd
DN
A g
yra
se (
bo
th o
f w
hic
h a
re t
ype
II t
op
oiso
me
rase
s),
en
zym
es
req
uire
d fo
r DN
A re
pli-
ca
tion
, tra
nsc
riptio
n, r
ep
air,
an
d
rec
om
bin
atio
nD
rug
inte
rac
tions
with
th
eo
phy
lline
, c
affe
ine
, wa
rfarin
, ph
eny
toin
, su
lfo-
nylu
rea
gly
bu
ride
, me
tro
nid
azo
le,
pro
be
ne
cid
, pip
era
cilli
n s
od
ium
, a
nd
cyc
losp
orin
e
Ac
ute
ba
cte
rial s
inus
itis
du
e t
o S
tre
pto
co
cc
us
pn
eu
-m
on
iae
, Ha
em
op
hilu
s in
flue
nza
e, o
r Mo
raxe
lla
ca
tarrh
alis
Ac
ute
ba
cte
rial e
xac
erb
atio
n o
f chr
oni
c b
ronc
hitis
d
ue
to
Sta
phy
loc
oc
cu
s a
ure
us,
Str
ep
toc
oc
cu
s p
ne
u-
mo
nia
e, H
ae
mo
ph
ilus
influ
en
zae
, Ha
em
op
hilu
s p
ara
-in
flue
nza
e, o
r Mo
raxe
lla c
ata
rrha
lis.
No
soc
om
ial p
neum
oni
a d
ue
to
me
thic
illin
-su
sce
ptib
le
Sta
phy
loc
oc
cu
s a
ure
us,
Pse
ud
om
on
as
ae
rug
ino
sa,
Serra
tia m
arc
esc
en
s, Es
ch
eric
hia
co
li, Kl
eb
siella
p
ne
um
on
iae
, Ha
em
op
hilu
s in
flue
nza
e, o
r Str
ep
to-
co
cc
us
pn
eu
mo
nia
e. A
dju
nc
tive
th
era
py
sho
uld
be
u
sed
as
clin
ica
lly in
dic
ate
d. W
he
re P
seu
do
mo
na
s a
eru
gin
osa
is a
do
cu
me
nte
d o
r pre
sum
ptiv
e p
ath
o-
ge
n, c
om
bin
atio
n t
he
rap
y w
ith a
n a
ntip
seu
do
mo
na
l β-
lac
tam
is re
co
mm
en
de
d.
Co
mm
unity
-ac
qui
red
pne
umo
nia
du
e t
o S
tap
hylo
co
c-
cu
s a
ure
us,
Stre
pto
co
cc
us
pn
eu
mo
nia
e (
inc
lud
ing
m
ulti
dru
g-r
esis
tan
t st
rain
s [M
DR
SP])
,a H
ae
mo
ph
ilus
influ
en
zae
, Ha
em
op
hilu
s p
ara
influ
en
zae
, Kle
bsie
lla
pn
eu
mo
nia
e, M
ora
xella
ca
tarrh
alis
, Ch
lam
ydia
pn
eu
-m
on
iae
, Le
gio
ne
lla p
ne
um
op
hila
, or M
yco
pla
sma
p
ne
um
on
iae
Cle
ara
nc
e o
f le
voflo
xac
in is
su
b-
sta
ntia
lly re
du
ce
d a
nd
pla
sma
e
limin
atio
n h
alf-
life
is s
ub
sta
n-
tially
pro
lon
ge
d in
pa
tien
ts w
ith
imp
aire
d re
na
l fu
nc
tion
(c
re-
atin
ine
cle
ara
nc
e <
50 m
L/m
in),
req
uiri
ng
do
sag
e a
dju
stm
en
t in
su
ch
pa
tien
ts t
o a
void
ac
cu
mu
-la
tion
. Ne
ithe
r he
mo
dia
lysis
no
r c
on
tinu
ou
s a
mb
ula
tory
pe
rito
-n
ea
l dia
lysis
(C
APD
) is
effe
ctiv
e
in re
mo
val o
f le
voflo
xac
in fr
om
th
e b
od
y, in
dic
atin
g t
ha
t su
pp
le-
me
nta
l do
ses
of l
evo
floxa
cin
are
n
ot
req
uire
d fo
llow
ing
he
mo
di-
aly
sis o
r CA
PD.
Ad
vers
e re
ac
tion
s:O
pia
te s
cre
en
false
po
sitiv
es;
ph
o-
tose
nsit
ivity
; QTc
inte
rva
l pro
lon
-g
atio
n a
nd
te
nd
ino
pa
thy
1866
LWBK1580-App-J_p1852-1874.indd 1866 29/07/17 7:30 AM
TABL
E J.
9 Fl
uoro
qui
nolo
nes
(Co
ntin
ued
)
Dru
gD
rug
cla
ssU
sua
l do
se
in a
dul
tsA
ctio
ns, i
nte
rac
tions
, and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
ac
tive
a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Co
mp
lica
ted
ski
n a
nd s
kin
stru
ctu
re in
fec
tions
du
e
to m
eth
icilli
n-s
usc
ep
tible
Sta
phy
loc
oc
cu
s a
ure
us,
Ente
roc
oc
cu
s fa
ec
alis
, Str
ep
toc
oc
cu
s p
yog
en
es,
or
Port
eu
s m
irab
ilis.
Unc
om
plic
ate
d s
kin
and
ski
n st
ruc
ture
infe
ctio
ns (
mild
to
mo
de
rate
) in
clu
din
g a
bsc
ess
es,
ce
llulit
es,
furu
n-
cle
s, im
pe
tigo
, pyo
de
rma
, an
d w
ou
nd
infe
ctio
ns,
du
e t
o S
tap
hylo
co
cc
us
au
reu
s o
r Str
ep
toc
oc
cu
s p
yog
en
es
Chr
oni
c b
ac
teria
l pro
sta
titis
du
e t
o E
sch
eric
hia
c
oli,
Ente
roc
oc
cu
s fa
ec
alis
, or S
tap
hylo
co
cc
us
ep
ide
rmid
is C
om
plic
ate
d u
rina
ry tr
ac
t inf
ec
tions
(m
ild t
o m
od
er-
ate
) d
ue
to
En
tero
co
cc
us
fae
ca
lis, E
nte
rob
ac
ter
clo
ac
ae
, Esc
he
rich
ia c
oli,
Kle
bsie
lla p
ne
um
on
iae
, Pr
ote
us
mira
bilis
, or P
seu
do
mo
na
s a
eru
gin
osa
Ac
ute
pye
lone
phr
itis
(mild
to
mo
de
rate
) c
au
sed
by
Esc
he
rich
ia c
oli
Unc
om
plic
ate
d u
rina
ry tr
ac
t inf
ec
tions
(m
ild t
o m
od
er-
ate
) d
ue
to
Esc
he
rich
ia c
oli,
Kle
bsie
lla p
ne
um
on
iae
, o
r Sta
phy
loc
oc
cu
s sa
pro
phy
ticu
s
Mo
xiflo
xac
inFl
uo
roq
uin
olo
ne
400
mg
PO
or I
V q
dTh
e b
ac
teric
ida
l ac
tion
of m
oxi
flox-
ac
in re
sults
fro
m t
he
inte
rfere
nc
e
with
to
po
isom
era
se II
an
d IV
Co
mm
un
ity-a
cq
uire
d p
ne
um
on
ia (
CA
P), i
nc
lud
ing
C
AP
ca
use
d b
y m
ulti
dru
g-r
esis
tan
t St
rep
toc
oc
cu
s p
ne
um
on
iae
b
Co
mp
lica
ted
ski
n a
nd
ski
n s
tru
ctu
re in
fec
tion
s, in
clu
d-
ing
dia
be
tic fo
ot
infe
ctio
ns
Co
mp
lica
ted
intr
a-a
bd
om
ina
l in
fec
tion
s, in
clu
din
g
po
lym
icro
bia
l in
fec
tion
s su
ch
as
ab
sce
sse
s
Sim
ilar t
o o
the
r flu
oro
qu
ino
lon
es
aM
DR
SP (
mu
ltid
rug
-re
sista
nt
Stre
pto
co
cc
us
pn
eu
mo
nia
e)
are
str
ain
s re
sista
nt
to t
wo
or m
ore
of t
he
follo
win
g a
ntib
iotic
s: p
en
icilli
n (
min
imu
m in
hib
itory
co
nc
en
tra
tion
[M
IC]
= 2
μg/m
L), s
ec
on
d-g
en
era
tion
ce
ph
alo
spo
rins
(e.g
., c
efu
roxi
me
, m
ac
rolid
es,
tetr
ac
yclin
es,
an
d t
rime
tho
prim
/su
lfam
eth
oxa
zole
).bM
ulti
dru
g-r
esis
tan
t S.
pn
eu
mo
nia
e in
clu
de
s iso
late
s p
revi
ou
sly k
no
wn
as
PRSP
(p
en
icilli
n-r
esis
tan
t S.
pn
eu
mo
nia
e),
an
d a
re s
tra
ins
resis
tan
t to
tw
o o
r mo
re o
f th
e fo
llow
ing
an
tibio
tics:
Pe
nic
illin
(M
IC ≥
2 m
g/m
L), s
ec
on
d-g
en
era
tion
ce
ph
a-
losp
orin
s (e
.g.,
ce
furo
xim
e),
ma
cro
lide
s, te
tra
cyc
line
s, a
nd
trim
eth
op
rim/s
ulfa
me
tho
xazo
le.
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1867
LWBK1580-App-J_p1852-1874.indd 1867 29/07/17 7:30 AM
TABL
E J.
10 P
oly
myx
ins
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns, a
nd o
the
rsSp
ec
trum
of a
ctiv
ity, i
ndic
atio
ns,
and
ac
tive
ag
ain
st m
ost
stra
ins
of
Rout
e, r
ed
uce
do
se, a
nd
co
ntra
ind
ica
tions
Poly
myx
in B
Pho
sph
olip
id c
ell
me
mb
ran
e-
alte
ring
an
tibio
tic0.
75–1
.25
mg
/kg
(IV
) q
12 h
(1
mg
= 1
0,00
0 u
nits
)C
olis
tin is
po
lyc
atio
nic
an
d h
as
bo
th
hyd
rop
hilic
an
d li
po
ph
ilic m
oie
ties.
The
se in
tera
ct
with
th
e b
ac
teria
l c
yto
pla
smic
me
mb
ran
e, c
ha
ng
ing
its
pe
rme
ab
ility.
This
effe
ct
is b
ac
teric
ida
l.Th
e m
ain
toxi
citi
es
de
scrib
ed
with
in
trave
nous
tre
atm
ent
are
ne
phr
oto
xic
ity
and
ne
uro
toxi
city
.A
t a
do
se o
f 160
mg
co
listim
eth
ate
IV
q8
h, v
ery
litt
le n
ep
hro
toxi
city
is s
ee
n.
Co
listin
is e
ffec
tive
ag
ain
st g
ram
- n
eg
ativ
e b
ac
illi, e
xce
pt
Pro
teu
s a
nd
Bu
rkh
old
eria
ce
pa
cia
, an
d is
u
sed
as
a p
oly
pe
ptid
e a
ntib
iotic
.M
ulti
dru
g-r
esis
tan
t A
cin
eto
ba
cte
r b
au
ma
nii,
eve
n in
Ac
ine
tob
ac
ter
me
nin
giti
s w
ith in
tra
the
ca
l po
ly-
myx
in E
Myc
ob
ac
teriu
m a
uru
m is
su
sce
ptib
le
to t
he
an
tibio
tic c
olis
tin (
po
lym
yxin
E)
, wh
ich
ha
s a
n M
IC o
f 5 μ
g/m
L a
nd
an
ap
pa
ren
t b
ac
teric
ida
l e
ffec
t a
t c
on
ce
ntr
atio
ns
>50
μg/m
L.
Usa
ge
in p
reg
na
nc
y: T
he
sa
fety
of t
his
dru
g in
h
um
an
pre
gn
an
cy
ha
s n
ot
be
en
est
ab
lish
ed
.
Poly
myx
in E
Co
listin
(p
oly
myx
in E
) is
a p
oly
-m
yxin
an
tibio
tic p
rod
uc
ed
b
y c
ert
ain
str
ain
s o
f Ba
cillu
s p
oly
myx
a v
ar.
co
listin
us.
Two
form
s o
f co
listin
ava
ilab
le
co
mm
erc
ially
: co
listin
su
lfate
a
nd
co
listim
eth
ate
so
diu
m
(co
listin
me
tha
ne
sulfo
na
te
sod
ium
, co
listin
su
lfom
eth
ate
so
diu
m)
Co
lom
ycin
1,0
00,0
00 u
nits
is
80-m
g c
olis
time
tha
teC
oly
-myc
in M
150
mg
“c
olis
tin b
ase
” is
360-
mg
c
olis
time
tha
te, o
r 4,
500,
000
un
its
Poly
myx
ins
bin
d t
o t
he
ce
ll m
em
bra
ne
a
nd
alte
r its
str
uc
ture
ma
kin
g it
mo
re
pe
rme
ab
le. T
he
resu
ltin
g w
ate
r up
take
le
ad
s to
ce
ll d
ea
th. T
he
y a
re c
atio
nic
, b
asic
pro
tein
s th
at
ac
t lik
e d
ete
rge
nts
. In
tera
ctio
ns:
Am
ph
ote
ricin
B, a
mik
ac
in,
ge
nta
mic
in, t
ob
ram
ycin
, va
nc
om
ycin
. A
dve
rse
effe
cts
: Re
na
l fa
ilure
(tu
bu
lar
ne
cro
sis).
Ne
uro
toxi
city
ass
oc
iate
d w
ith
very
pro
lon
ge
d o
r hig
h s
eru
m le
vels;
n
eu
rom
usc
ula
r blo
cka
de
with
ren
al
failu
re a
nd
or n
eu
rom
usc
ula
r diso
rde
rs
Bac
teric
ida
l fo
r gra
m-n
eg
ativ
e;
little
to
no
effe
ct
on
gra
m-p
osit
ive
sin
ce
ce
ll w
all
is to
o t
hic
k to
pe
rmit
ac
ce
ss t
o m
em
bra
ne
Co
listin
su
lfate
an
d
co
listim
eth
ate
so
diu
m
are
elim
ina
ted
fro
m
the
bo
dy
by
diff
ere
nt
rou
tes.
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1868
LWBK1580-App-J_p1852-1874.indd 1868 29/07/17 7:30 AM
TABL
E J.
11 A
min
og
lyc
osi
de
s
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
a
ctiv
e a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
co
ntra
ind
ica
tions
Ge
nta
mic
inA
min
og
lyc
osid
e
an
tibio
tic, d
eriv
ed
fro
m M
icro
mo
no
s-p
ora
pu
rpu
rea
, an
a
ctin
om
yce
te
Intr
ave
no
us
use
on
ly fo
r g
en
tam
icin
su
lfate
in
0.9%
so
diu
m c
hlo
ride
.G
en
tam
icin
su
lfate
IV:
3 m
g/k
g/d
q8
hIn
pa
tien
ts w
ith li
fe-
thre
ate
nin
g in
fec
tion
s:
5 m
g/k
g/d
q24
h
(pre
ferre
d o
ver q
8 h
d
osin
g)
Bac
teric
ida
l an
tibio
tic t
ha
t a
cts
by
inh
ibiti
ng
no
rma
l p
rote
in s
ynth
esis
in s
usc
ep
-tib
le m
icro
-org
an
isms
Dru
g in
tera
ctio
ns: A
mp
ho
-te
ricin
B, c
ep
ha
loth
in,
cyc
losp
orin
e, e
nflu
ran
e,
me
tho
xyflu
ran
e, p
oly
myx
in
B, ra
dio
gra
ph
ic c
on
tra
st,
van
co
myc
in (
inc
rea
se
ne
ph
roto
xic
ity),
cisp
lati-
nu
m, e
tc. (
see
sp
ec
ific
a-
tion
s o
f th
e p
rod
uc
t)
Esc
he
rich
ia c
oli;
Pro
teu
s sp
. (in
do
le-p
osit
ive
a
nd
ind
ole
-ne
ga
tive
); P
seu
do
mo
na
s a
eru
-g
ino
sa; s
pe
cie
s o
f Kle
bsie
lla-E
nte
rob
ac
ter-
Serra
tia g
rou
p; C
itro
ba
cte
r sp
.; a
nd
St
ap
hylo
co
cc
us
sp. (
inc
lud
ing
pe
nic
illin
a
nd
me
thic
illin
-re
sista
nt
stra
ins)
Ge
nta
mic
in is
also
ac
tive
in v
itro
ag
ain
st
spe
cie
s o
f Sa
lmo
ne
lla a
nd
Sh
ige
lla.
To a
dju
st t
he
do
ses
for p
atie
nts
with
ren
al
imp
airm
en
tA
dve
rse
rea
ctio
ns:
Ne
ph
roto
xic
ity: A
dve
rse
ren
al e
ffec
ts h
ave
b
ee
n re
po
rte
d. T
he
y o
cc
ur m
ore
fre
qu
en
tly
in p
atie
nts
with
a h
isto
ry o
f re
na
l im
pa
ir-m
en
t a
nd
in p
atie
nts
tre
ate
d fo
r lo
ng
er
pe
riod
s o
r with
larg
er d
osa
ge
s th
an
rec
om
-m
en
de
d. O
the
rs s
uc
h a
s n
eu
roto
xic
ity (
seri-
ou
s a
dve
rse
effe
cts
on
bo
th v
est
ibu
lar a
nd
a
ud
itory
bra
nc
he
s o
f th
e e
igh
th n
erv
e),
pe
riph
era
l ne
uro
pa
thy,
or e
nc
ep
ha
lop
ath
y, in
clu
din
g n
um
bn
ess
, ski
n t
ing
ling
, mu
scle
tw
itch
ing
, co
nvu
lsio
ns,
an
d a
mya
sth
en
ia
gra
vis-
like
syn
dro
me
, ha
ve b
ee
n re
po
rte
d
(se
e s
pe
cifi
ca
tion
s o
f th
e p
rod
uc
t).
Am
ika
cin
Sem
i-syn
the
tic
am
ino
gly
co
side
a
ntib
iotic
, de
rive
d
from
ka
na
myc
in
Am
ika
cin
su
lfate
IV:
15 m
g/k
g o
r 1 g
q24
h
(pre
ferre
d t
o q
12 h
d
osin
g)
Dru
g in
tera
ctio
ns: A
mp
ho
-te
ricin
B, c
ep
ha
loth
in,
cyc
losp
orin
e, e
nflu
ran
e,
me
tho
xyflu
ran
e, p
oly
myx
in
B, ra
dio
gra
ph
ic c
on
tra
st,
van
co
myc
in (
inc
rea
se
ne
ph
roto
xic
ity),
cisp
lati-
nu
m, e
tc. (
see
sp
ec
ific
a-
tion
s o
f th
e p
rod
uc
t)
Gra
m n
eg
ativ
eA
mik
ac
in is
ac
tive
in v
itro
ag
ain
st P
seud
om
o-
na
s sp
., Es
ch
eric
hia
co
li, Pr
ote
us s
p. (
ind
ole
-p
osit
ive
an
d in
do
le-n
eg
ativ
e),
Pro
vid
en
cia
sp
., Kl
eb
siella
-En
tero
ba
cte
r-Se
rratia
sp
., A
cin
eto
ba
cte
r (fo
rme
rly M
ima
-He
relle
a)
sp.,
an
d C
itro
ba
cte
r fre
und
iiW
he
n s
tra
ins
of t
he
ab
ove
org
an
isms
are
fo
un
d t
o b
e re
sista
nt
to o
the
r am
ino
gly
co
-sid
es,
inc
lud
ing
ge
nta
mic
in, t
ob
ram
ycin
, a
nd
ka
na
myc
in, m
any
are
su
sce
ptib
le t
o
am
ika
cin
in v
itro
.G
ram
po
sitiv
eA
mik
ac
in is
ac
tive
in v
itro
ag
ain
st p
en
icil-
lina
se a
nd
no
n–p
en
icilli
na
se-p
rod
uc
ing
St
ap
hylo
co
cc
us
sp. i
nc
lud
ing
me
thic
illin
-re
sista
nt
stra
ins.
Ho
we
ver,
am
ino
gly
co
side
s in
ge
ne
ral h
ave
a lo
w o
rde
r of a
ctiv
ity
ag
ain
st o
the
r gra
m-p
osit
ive
org
an
isms.
See
ge
nta
mic
in s
ulfa
te.
Tob
ram
ycin
Am
ino
gly
co
side
a
ntib
iotic
, de
rive
d
from
th
e a
ctin
om
y-c
ete
Str
ep
tom
yce
s te
ne
bra
rius
Tob
ram
ycin
su
lfate
: IV
: 5 m
g/k
g q
24 h
o
r 240
mg
q24
h
(pre
ferre
d o
ver q
8 h
d
osin
g).
The
do
sag
e
sho
uld
be
red
uc
ed
to
3
mg
/kg
/d a
s so
on
as
clin
ica
lly in
dic
ate
d.
Tob
ram
ycin
ac
ts b
y in
hib
itin
g
syn
the
sis o
f pro
tein
in b
ac
-te
rial c
ells
.D
rug
inte
rac
tions
: Am
ph
o-
teric
in B
, ce
ph
alo
thin
, c
yclo
spo
rine
, en
flura
ne
, m
eth
oxy
flura
ne
, po
lym
yxin
B,
rad
iog
rap
hic
co
ntr
ast
, va
nc
om
ycin
(in
cre
ase
n
ep
hro
toxi
city
), c
ispla
ti-n
um
, etc
. (se
e s
pe
cifi
ca
-tio
ns
of t
he
pro
du
ct)
Gra
m-p
osi
tive
ae
rob
es
Sta
phy
loc
oc
cu
s a
ure
us
Gra
m-n
eg
ativ
e a
ero
be
sC
itro
ba
cte
r sp
., En
tero
ba
cte
r sp
., Es
che
richi
a
co
li, Kl
eb
siella
sp
., M
org
ane
lla m
org
ani
i, Ps
eud
om
ona
s a
eru
gin
osa
, Pro
teus
mira
bilis
, Pr
ote
us v
ulg
aris
, Pro
vid
enc
ia s
p.,
Serra
tia s
p.
Am
ino
gly
co
side
s h
ave
a lo
w o
rde
r of a
ctiv
-ity
ag
ain
st m
ost
gra
m-p
osit
ive
org
an
isms,
inc
lud
ing
Str
ep
toc
oc
cu
s p
yog
en
es,
Stre
p-
toc
oc
cu
s p
ne
um
on
iae
, an
d E
nte
roc
oc
ci
See
ge
nta
mic
in s
ulfa
te.
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1869
LWBK1580-App-J_p1852-1874.indd 1869 29/07/17 7:30 AM
TABL
E J.
12 M
isc
ella
neo
us
Dru
gD
rug
cla
ssU
sua
l do
se
in a
dul
tsA
ctio
ns, i
nte
rac
tions
, and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
a
ctiv
e a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Me
tro
nid
azo
leN
itro
imid
azo
le
an
tipa
rasit
ic/
an
tibio
tic
IV: 1
g q
/24
hPO
: 500
mg
q
12 h
Me
tro
nid
azo
le is
a s
ynth
etic
an
tiba
cte
rial
co
mp
ou
nd
.D
rug
inte
rac
tions
:W
arfa
rin a
nd
oth
er o
ral c
ou
ma
rin a
ntic
o-
ag
ula
nts
, ph
eny
toin
or p
he
no
ba
rbita
l, c
ime
tidin
e, a
nd
disu
lfira
m
Ana
erob
ic g
ram
-neg
ativ
e b
aci
lli, i
nclu
din
g
Bac
tero
ide
s sp
., in
clu
din
g th
e B
ac
tero
ide
s fra
gilis
g
roup
(B.
fra
gilis
, B. d
ista
soni
s, B.
ova
tus,
B. th
e-
taio
tao
mic
ron,
B. v
ulg
atu
s); F
uso
ba
cte
rium
sp
.A
nae
rob
ic g
ram
-po
sitiv
e b
ac
illi,
inc
lud
ing
C
lost
ridiu
m s
p. a
nd
su
sce
ptib
le s
tra
ins
of
Eub
ac
teriu
mA
nae
rob
ic g
ram
-po
sitiv
e c
oc
ci,
inc
lud
ing
Pe
pto
co
cc
us
sp.;
Pep
tost
rep
toc
oc
cu
s sp
.
Prim
ary
mo
de
of e
limin
atio
n:
He
pa
tic
Trim
eth
op
rim (
TMP)
/ su
lfam
eth
oxa
zole
(S
MX
) o
r co
trim
oxa
zole
Syn
the
tic fo
late
a
nta
go
nist
/su
lfon
am
ide
IV o
r PO
: 2.
5–5
mg
/kg
q
6 h
Sulfa
me
tho
xazo
le is
ba
cte
riost
atic
an
d
trim
eth
op
rim is
ba
cte
ricid
al
Dru
g in
tera
ctio
ns:
Wa
rfarin
(m
on
itorin
g c
are
fully
); p
he
nyto
in
(fo
late
de
ficie
nc
ies
wh
en
is u
sed
c
on
co
mita
ntly
); t
hia
zid
es
inc
rea
sed
in
cid
en
ce
of t
hro
mb
oc
yto
pe
nia
with
p
urp
ura
in e
lde
rly p
atie
nts
; cyc
losp
o-
rine
(n
ep
hro
toxi
city
reve
rsib
le);
dig
oxi
n;
ind
om
eth
ac
in; p
yrim
eth
am
ine
; tric
yclic
a
ntid
ep
ress
an
ts; a
ma
nta
din
e; m
eth
o-
tre
xate
; an
d o
ral h
ypo
gly
ce
mic
ag
en
ts
Prim
ary
ag
en
t in
th
e t
rea
tme
nt
of P
ne
um
oc
ystis
c
arin
ii p
ne
um
on
ia (
PCP)
, an
op
po
rtu
nist
ic
infe
ctio
n in
pa
tien
ts w
ith H
IV/A
IDS,
an
d a
s se
co
nd
ary
pro
phy
laxi
s o
f PC
P in
pa
tien
ts w
ho
h
ave
alre
ad
y h
ad
at
lea
st o
ne
ep
isod
e o
f PC
P.A
lso is
ind
ica
ted
for t
he
tre
atm
en
t o
f ch
ron
ic
bro
nc
hiti
s, e
nte
roc
olit
is c
au
sed
by
stra
ins
of S
hi-
ge
lla (
flexn
eri
an
d s
on
ne
i), a
cu
te o
titis
me
dia
in
ch
ildre
n, t
rave
ler’
s d
iarrh
ea
ca
use
d b
y e
nte
ro-
toxi
ge
nic
Esc
he
rich
ia c
oli
an
d S
hig
ella
sp
., a
nd
b
ac
teria
l urin
ary
tra
ct
infe
ctio
ns
SMX
-TM
P is
me
tab
oliz
ed
in t
he
liv
er.
Urin
ary
co
nc
en
tra
tion
s o
f bo
th
ac
tive
dru
gs
are
de
cre
ase
d
in p
atie
nts
with
imp
aire
d
ren
al f
un
ctio
n.
On
ly s
ma
ll a
mo
un
ts o
f trim
e-
tho
prim
are
exc
rete
d in
fec
es
via
bilia
ry e
limin
atio
n. T
rim-
eth
op
rim a
nd
ac
tive
su
lfa-
me
tho
xazo
le a
re m
od
era
tely
re
mo
ved
by
he
mo
dia
lysis
.
Da
ta fr
om
Cu
nh
a B
A. A
ntib
iotic
Ess
en
tials.
12t
h e
d. B
urli
ng
ton
, MA
: Jo
ne
s &
Ba
rtle
tt L
ea
rnin
g, 2
013.
Ava
ilab
le a
t h
ttp
://w
ww
.dru
gs.
co
m. R
evi
sed
Ja
nu
ary
201
5.
1870
LWBK1580-App-J_p1852-1874.indd 1870 29/07/17 7:30 AM
TABL
E J.
13 A
ntifu
nga
ls
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
a
ctiv
e a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Am
ph
ote
ricin
BA
ntif
un
ga
lPo
lye
ne
ma
cro
-lid
e a
ntib
iotic
p
rod
uc
ed
by
soil
ba
cte
ria
Stre
pto
myc
es
no
do
sus
IV: 0
.5–0
.8 m
g/k
g q
24 h
Am
ph
ote
ricin
B is
th
e g
old
st
an
da
rd fo
r th
e t
rea
tme
nt
of s
erio
us
an
d in
vasiv
e s
ys-
tem
ic m
yco
sis a
s w
ell
as
for
kala
aza
r.D
rug
inte
rac
tions
:A
void
co
nc
om
itan
t a
dm
in-
istra
tion
of n
ep
hro
toxi
c
dru
gs
an
d b
on
e m
arro
w
sup
pre
ssa
nts
.
Am
ph
ote
ricin
B h
as
use
ful a
ctiv
ity a
ga
inst
c
an
did
iasis
, cry
pto
co
cc
osis
, hist
op
lasm
osis
, b
last
om
yco
sis, p
ara
co
cc
idio
ido
myc
osis
, c
oc
cid
ioid
om
yco
sis, a
spe
rgillo
sis, e
xtra
-c
uta
ne
ou
s sp
oro
tric
ho
sis, z
ygo
myc
osis
(m
uc
orm
yco
sis),
pe
nic
illio
sis (
Pen
icilli
osis
m
arn
effe
i) p
seu
da
llesc
he
riasis
, hya
lohy
-p
ho
myc
osis
(in
clu
din
g in
fec
tion
du
e t
o
Ac
rem
on
ium
, Fu
sariu
m, P
en
icilli
um
, etc
.)
an
d p
ha
eo
hyp
ho
myc
osis
(in
clu
din
g in
fec
-tio
n d
ue
to
Alte
rna
ria, B
ipo
laris
, Cla
do
-sp
oriu
m, C
lad
op
hia
lop
ho
ra, C
urv
ula
ria,
Exo
ph
iala
, Exs
ero
hilu
m, F
on
sec
ae
a, P
hia
-lo
ph
ora
, Wa
ng
iella
, etc
.).
Emp
iric
al a
ntif
un
ga
l th
era
py
is u
sefu
l to
g
ran
ulo
cyt
op
en
ic p
atie
nts
with
pe
rsist
en
t o
r re
cu
rren
t fe
ver.a
Prim
ary
mo
de
of e
limin
atio
n:
Me
tab
oliz
ed
The
mo
st c
om
mo
n c
au
se fo
r with
-d
raw
al o
f or f
ailu
re t
o c
on
tinu
e
am
ph
ote
ricin
B t
he
rap
y is
its
seve
re re
na
l to
xic
ity in
ne
arly
h
alf
of a
ll th
e p
atie
nts
.Th
e s
ec
on
d p
rob
lem
, wh
ich
is a
m
ajo
r on
e, i
s th
e n
ep
hro
toxi
city
o
f am
ph
ote
ricin
B.
Lip
oso
ma
l a
mp
ho
teric
in B
An
tifu
ng
al
Poly
en
e
ma
cro
lide
a
ntib
iotic
Tru
e li
po
som
al
pre
pa
ratio
n
of a
mp
ho
-te
ricin
B in
w
hic
h li
pid
c
om
ple
x o
f lip
oso
me
s is
co
nst
i-tu
ted
of
lec
ithin
an
d
ch
ole
ste
rol
IV: 3
–6 m
g/k
g q
24 h
Is t
he
mo
st e
ffec
tive
an
d
affo
rda
ble
dru
g fo
r tre
at-
me
nt
of b
oth
sys
tem
ic
myc
osis
an
d k
ala
aza
r.D
rug
inte
rac
tions
:A
s w
ith c
onv
en
tion
al
am
ph
ote
ricin
B, a
void
co
n-
co
mita
nt
ad
min
istra
tion
o
f ne
ph
roto
xic
dru
gs
an
d
bo
ne
ma
rrow
su
pp
ress
an
ts,
on
ly a
nd
in p
atie
nts
with
hy
po
kale
mia
.
Am
ph
ote
ricin
B s
ho
ws
a h
igh
ord
er o
f in
vitr
o
ac
tivity
ag
ain
st m
any
sp
ec
ies
of f
un
gi
viz.
Hist
op
lasm
a c
ap
sula
tum
, Cry
pto
co
c-
cu
s im
miti
s, C
an
did
a s
p.,
Bla
sto
myc
es
de
rma
titid
is, R
ho
do
toru
la, C
ryp
toc
oc
cu
s n
eo
form
an
s, Sp
oro
thrix
sc
he
nc
kii,
Mu
co
r sp
., A
spe
rgillu
s fu
mig
atu
s, M
ala
sse
zia
furf
ur,
Tric
ho
spo
ron
be
ige
lii, S
ac
ch
aro
myc
es
ce
revi
siae
, Sc
ed
osp
oriu
m s
p.,
Pae
cilo
my-
ce
s sp
., Pe
nic
illiu
m s
p.,
Fusa
rium
sp
., Bi
po
-la
ris s
p.,
Exo
ph
iala
sp
., C
lad
op
hia
lop
ho
ra
sp.,
Ab
sidia
sp
., A
po
phy
som
yce
s sp
., C
un
-n
ing
ha
me
lla s
p.,
Rh
izo
mu
co
r sp
., R
hiz
op
us
sp.,
an
d S
aks
en
ae
a s
p. T
he
se fu
ng
i are
in
hib
ited
by
co
nc
en
tra
tion
s o
f am
ph
ote
ri-c
in B
ran
gin
g fr
om
0.0
3 to
1 μ
g/m
L in
vitr
o.
Am
ph
ote
ricin
B a
lso h
as
ac
tivity
ag
ain
st
spe
cie
s o
f Le
ishm
an
ia a
nd
is fo
un
d t
o b
e
effe
ctiv
e in
th
e t
rea
tme
nt
of K
ala
-Aza
r.
Prim
ary
mo
de
of e
limin
atio
n:
Me
tab
oliz
ed
1871
(Co
ntin
ue
d)
LWBK1580-App-J_p1852-1874.indd 1871 29/07/17 7:30 AM
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
a
ctiv
e a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Flu
co
na
zole
Tria
zole
a
ntif
un
ga
l a
ge
nt
IV o
r PO
: 400
mg
for 1
do
se, t
he
n
200
mg
q24
hFo
r ca
nd
ide
mia
, IV
or P
O: 4
00 m
g
q24
h a
fte
r lo
ad
ing
do
se o
f 800
mg
Me
nin
ge
al d
ose
, IV
or P
O: 4
00 m
g
q24
h
Flu
co
na
zole
is a
hig
hly
se
lec
-tiv
e in
hib
itor o
f fu
ng
al c
yto
-c
hro
me
P45
0 st
ero
l C-1
4 α-
de
me
thyl
atio
n.
Dru
g in
tera
ctio
ns:
Ora
l co
ntr
ac
ep
tive
s, c
ime
ti-d
ine
, an
tac
id, h
ydro
ch
loro
-th
iazi
de
, rifa
mp
in, w
arfa
rin,
ph
eny
toin
, cyc
losp
orin
e,
zid
ovu
din
e, t
he
op
hyllin
e,
terfe
na
din
e, o
ral h
ypo
gly
-c
em
ic a
ge
nts
, to
lbu
tam
ide
, g
lipiz
ide
, gly
bu
ride
, rifa
bu
-tin
, ta
cro
limu
s, c
isap
ride
, m
ida
zola
m, a
zith
rom
ycin
(n
ot
sign
ific
an
t)
Pro
phy
laxi
s:Fl
uc
on
azo
le is
ind
ica
ted
to
de
cre
ase
th
e
inc
ide
nc
e o
f ca
nd
idia
sis in
pa
tien
ts u
nd
er-
go
ing
bo
ne
ma
rrow
tra
nsp
lan
tatio
n w
ho
re
ce
ive
cyt
oto
xic
ch
em
oth
era
py
an
d/o
r ra
dia
tion
th
era
py.
Flu
co
na
zole
exh
ibits
in v
itro
ac
tivity
ag
ain
st
Cry
pto
co
cc
us
ne
ofo
rma
ns
an
d C
an
did
a
spp
. Fu
ng
ista
tic a
ctiv
ity h
as
also
be
en
d
em
on
stra
ted
in n
orm
al a
nd
imm
un
oc
om
-p
rom
ised
an
ima
l mo
de
ls fo
r sys
tem
ic a
nd
in
tra
cra
nia
l fu
ng
al i
nfe
ctio
ns
du
e t
o C
ryp
-to
co
cc
us
ne
ofo
rma
ns
an
d fo
r sys
tem
ic
infe
ctio
ns
du
e t
o C
an
did
a a
lbic
an
s.Fl
uco
nazo
le is
ind
ica
ted
for t
he tr
ea
tme
nt o
f:1.
Va
gin
al c
an
did
iasis
(va
gin
al y
ea
st in
fec
-tio
ns
du
e t
o C
an
did
a)
2. O
rop
ha
ryn
ge
al a
nd
eso
ph
ag
ea
l ca
nd
i-d
iasis
. In
op
en
no
nc
om
pa
rativ
e s
tud
ies
of r
ela
tive
ly s
ma
ll n
um
be
rs o
f pa
tien
ts,
fluc
on
azo
le w
as
also
effe
ctiv
e fo
r th
e t
rea
t-m
en
t o
f Ca
nd
ida
urin
ary
tra
ct
infe
ctio
ns,
pe
rito
niti
s, a
nd
sys
tem
ic C
an
did
a in
fec
-tio
ns
inc
lud
ing
ca
nd
ide
mia
, diss
em
ina
ted
c
an
did
iasis
, an
d p
ne
um
on
ia.
3. C
ryp
toc
oc
ca
l me
nin
giti
s
Prim
ary
mo
de
of e
limin
atio
n:
Re
na
lC
on
tra
ind
ica
tion
s: T
erfe
na
din
e
an
d c
isap
ride
Flu
co
na
zole
ha
s b
ee
n a
sso
ci-
ate
d w
ith ra
re c
ase
s o
f se
riou
s h
ep
atic
to
xic
ity.
Voric
on
azo
leTr
iazo
le
an
tifu
ng
al
ag
en
t
IV: L
oa
din
g d
ose
of 6
mg
/kg
(IV
) q
12 h
× 1
da
y, th
en
ma
inte
na
nc
e
do
se o
f 4 m
g/k
g (
IV)
q12
h.
It is
po
ssib
le t
o s
witc
h t
o w
eig
ht-
ba
sed
PO
ma
inte
na
nc
e IV
do
se.
PO:
If w
eig
ht
≥40
kg: L
oa
din
g d
ose
of
400
mg
(PO
) q
12 h
× 1
da
y, th
en
m
ain
ten
an
ce
do
se o
f 200
mg
(P
O)
q12
h. I
f re
spo
nse
is in
ad
-e
qu
ate
, in
cre
ase
do
se t
o 3
00 m
g
(PO
) q
12 h
.If
we
igh
t <4
0 kg
: Lo
ad
ing
do
se o
f 20
0 m
g (
PO)
× 1
da
y, th
en
ma
in-
ten
an
ce
do
se o
f 100
mg
(PO
) q
12 h
. If r
esp
on
se is
ina
de
qu
ate
, in
cre
ase
do
se t
o 1
50 m
g (
PO)
q12
h.
In p
atie
nts
with
ch
ron
ic a
nd
/or n
on
–lif
e-t
hre
ate
nin
g in
fec
tion
s, lo
ad
ing
d
ose
ma
y b
e g
ive
n P
O.
Mo
de
of a
ctio
n o
f vo
rico
n-
azo
le is
th
e in
hib
itio
n o
f fu
ng
al c
yto
ch
rom
e P
450–
me
dia
ted
14
α-la
no
ste
rol
de
me
thyl
atio
n, a
n e
sse
ntia
l st
ep
in fu
ng
al e
rgo
ste
rol
bio
syn
the
sis.
Dru
g in
tera
ctio
ns:
Ben
zod
iaze
pin
es,
vin
ca
alk
a-
loid
s, c
arb
am
aze
pin
e, e
rgo
a
lka
loid
s, rif
am
pin
, rifa
bu
-tin
, siro
limu
s, lo
ng
-ac
ting
b
arb
itura
tes
(se
e c
on
tra
-in
dic
atio
ns)
, cyc
losp
orin
e,
om
ep
razo
le, t
ac
rolim
us,
ph
eny
toin
, wa
rfarin
, sta
tins,
dih
ydro
pyr
idin
e, c
alc
ium
c
ha
nn
el b
loc
kers
(lo
w a
rte
-ria
l pre
ssu
re),
sulfo
nylu
rea
s (h
ypo
gly
ce
mia
). Po
ten
tial
he
pa
toto
xic
ity ri
sk.
Inva
sive
asp
erg
illo
sis
Ind
ica
ted
for t
he
prim
ary
tre
atm
en
t o
f ac
ute
in
vasiv
e a
spe
rgillo
sis (
Asp
erg
illus
spp
.). A
lso
with
Fu
sariu
m s
pp
. an
d S
ce
do
spo
rium
sp
p.
Oth
er d
ise
ase
-ca
usin
g a
ge
nts
Voric
on
azo
le w
as
sho
wn
to
be
effe
ctiv
e
ag
ain
st b
oth
Sc
ed
osp
oriu
m a
pio
spe
rmu
m
an
d F
usa
rium
sp
p. F
or S
ce
do
spo
rium
a
pio
spe
rmu
m, a
su
cc
ess
ful r
esp
on
se t
o
Vfe
nd
wa
s re
po
rte
d in
15
of 2
4 su
bje
cts
(6
3%).
In t
ho
se w
ith F
usa
rium
sp
p.,
9 o
f 21
(43
%)
we
re s
uc
ce
ssfu
lly t
rea
ted
with
vo
rico
na
zole
.
Prim
ary
mo
de
of e
limin
atio
n:
He
pa
ticC
on
tra
ind
ica
tion
s:
Lon
g-a
ctin
g b
arb
itura
tes
TABL
E J.
13 A
ntifu
nga
ls (
Co
ntin
ued
)
1872
LWBK1580-App-J_p1852-1874.indd 1872 29/07/17 7:30 AM
Dru
gD
rug
cla
ssU
sua
l do
se in
ad
ults
Ac
tions
, int
era
ctio
ns,
and
oth
ers
Spe
ctr
um o
f ac
tivity
, ind
ica
tions
, and
a
ctiv
e a
ga
inst
mo
st s
train
s o
fRo
ute
, re
duc
e d
ose
, and
c
ont
rain
dic
atio
ns
Itra
co
na
zole
An
tifu
ng
al
ag
en
tIV
or P
O: 2
00 m
g q
24 h
200-
mg
ca
psu
le/s
olu
tion
(PO
) q
24 h
. Be
gin
itra
co
na
zole
for a
cu
te/
seve
re in
fec
tion
s w
ith a
loa
din
g
reg
ime
n o
f 200
mg
(IV
) q
12 h
×
2 d
ays
(4
do
ses)
, th
en
giv
e 2
00 m
g
(IV o
r PO
) q
24 h
ma
inte
na
nc
e
do
se. E
ac
h IV
do
se s
ho
uld
be
in
fuse
d o
ver 6
0 m
in.
Dru
g in
tera
ctio
ns: C
oa
d-
min
istra
tion
of c
isap
ride
, p
imo
zid
e, q
uin
idin
e, d
ofe
ti-lid
e, o
r le
vac
ety
lme
th-
ad
ol (
levo
me
tha
dyl
) w
ith
itra
co
na
zole
.
Itra
co
na
zole
exh
ibits
in v
itro
ac
tivity
ag
ain
st
Bla
sto
myc
es
de
rma
titid
is, H
isto
pla
sma
c
ap
sula
tum
, Hist
op
lasm
a d
ub
oisi
i, A
spe
rgil-
lus
flavu
s, A
spe
rgillu
s fu
mig
atu
s, C
an
did
a
alb
ica
ns,
an
d C
ryp
toc
oc
cu
s n
eo
form
an
s.
Itra
co
na
zole
also
exh
ibits
va
ryin
g in
vitr
o
ac
tivity
ag
ain
st S
po
roth
rix s
ch
en
cki
i, Tr
ich
o-
phy
ton
sp
ec
ies,
Ca
nd
ida
kru
sei,
an
d o
the
r C
an
did
a s
pe
cie
s.Fu
ng
ista
tic a
ctiv
ity h
as
be
en
de
mo
nst
rate
d
ag
ain
st d
isse
min
ate
d fu
ng
al i
nfe
ctio
ns
ca
use
d b
y Bl
ast
om
yce
s d
erm
atit
idis
, His-
top
lasm
a d
ub
oisi
i, A
spe
rgillu
s fu
mig
atu
s, C
oc
cid
ioid
es
imm
itis,
Cry
pto
co
cc
us
ne
o-
form
an
s, Pa
rac
oc
cid
ioid
es
bra
silie
nsis
, Sp
o-
roth
rix s
ch
en
cki
i, Tr
ich
op
hyto
n ru
bru
m, a
nd
Tr
ich
op
hyto
n m
en
tag
rop
hyte
s.
Prim
ary
mo
de
of e
limin
atio
n:
He
pa
tic; m
eta
bo
lize
d p
red
om
i-n
an
tly b
y th
e c
yto
ch
rom
e P
450
3A4
isoe
nzy
me
sys
tem
(C
YP3A
4)Pa
tient
s w
ith im
pa
ired
he
pa
tic
func
tion
sho
uld
be
ca
refu
lly m
on-
itore
d w
hen
taki
ng it
rac
ona
zole
.If
sign
s o
r sym
pto
ms
of c
on
ge
s-tiv
e h
ea
rt fa
ilure
ap
pe
ar d
urin
g
ad
min
istra
tion
of i
tra
co
na
zole
, m
on
itor c
are
fully
an
d c
on
side
r o
the
r tre
atm
en
t a
ltern
ativ
es.
Co
ntra
ind
ica
tions
:C
isap
ride
, ora
l mid
azo
lam
, pim
o-
zid
e, q
uin
idin
e, d
ofe
tilid
e, t
ri-a
zola
m, a
nd
leva
ce
tylm
eth
ad
ol
(levo
me
tha
dyl
) a
re c
on
tra
ind
i-c
ate
d w
ith it
rac
on
azo
le.
Ca
spo
fun
gin
Ech
ino
ca
nd
in
an
tifu
ng
al
70 m
g (
IV)
× 1
do
se, t
he
n 5
0 m
g
(IV)
q24
h. I
n p
atie
nts
>80
kg
, giv
e
70 m
g/d
rath
er t
ha
n 5
0 m
g/d
. Pa
tien
ts w
ith m
od
era
te li
ver i
nsu
f-fic
ien
cy
sho
uld
rec
eiv
e a
do
se o
f 35
mg
/d
Ca
spo
fun
gin
is n
ot
an
inh
ibi-
tor a
nd
is a
po
or s
ub
stra
te
for c
yto
ch
rom
e P
450
en
zym
es.
Dru
g in
tera
ctio
ns:
Cyc
losp
orin
e, t
ac
rolim
us,
ca
rba
ma
zep
ine
, rifa
mp
in,
de
xam
eth
aso
ne
, efa
vi-
ren
z, n
elfi
na
vir,
ne
vira
pin
e,
ph
eny
toin
Ca
spo
fun
gin
is a
ctiv
e a
ga
inst
all
spe
cie
s o
f C
an
did
a. I
t is
ext
rem
ely
ac
tive
ag
ain
st a
ll sp
ec
ies
exc
ep
t C
an
did
a p
ara
psil
osis
, Ca
n-
did
a g
uillie
rmo
nd
ii, a
nd
Ca
nd
ida
lusit
a-
nia
e, a
ga
inst
wh
ich
it is
mo
de
rate
ly a
ctiv
e.
Ca
spo
fun
gin
is a
lso v
ery
ac
tive
ag
ain
st a
ll A
spe
rgillu
s sp
. It
do
es
no
t ki
ll A
spe
rgillu
s c
om
ple
tely
in t
est
tub
es.
The
re is
a v
ery
lim
ited
am
oun
t o
f ac
tivity
ag
ain
st C
oc
cid
i-o
ide
s im
miti
s, Bl
ast
om
yce
s d
erm
atit
idis,
Sc
e-
do
spo
rium
sp
., Pa
ec
ilom
yce
s va
riotii
, an
d
Hist
op
lasm
a c
ap
sula
ta b
ut it
is li
kely
th
at
the
ac
tivity
is n
ot
suffi
cie
nt
for c
linic
al u
se.
Prim
ary
mo
de
of e
limin
atio
n:
He
pa
tic
An
idu
lafu
ng
inSe
misy
nth
etic
p
rod
uc
t o
f e
ch
ino
ca
n-
din
B
200
mg
(IV
) x
1 d
ose
, th
en
100
mg
IV
q24
h. N
o d
osa
ge
ad
just
me
nts
a
re re
qu
ired
for r
en
al o
r he
pa
tic
insu
ffic
ien
cy
Ad
min
iste
r IV
infu
sion
s a
t a
ra
te ≤
1.1
mg
/min
(1.
4 m
L/m
in)
Tre
atm
en
t sh
ou
ld b
e g
ive
n fo
r ≥14
d
ays
an
d t
he
n fo
r ≥7
da
ys fo
llow
-in
g re
solu
tion
of s
ymp
tom
s.
An
idu
lafu
ng
in is
no
t a
n in
hib
i-to
r an
d is
a p
oo
r su
bst
rate
fo
r cyt
oc
hro
me
P45
0 e
nzy
me
s.D
rug
inte
rac
tions
:C
yclo
spo
rine
An
idu
lafu
ng
in is
rec
om
me
nd
ed
in t
he
tre
at-
me
nt
of c
an
did
em
ia in
no
nn
eu
tro
pe
nic
p
atie
nts
or f
or e
mp
iric
tre
atm
en
t o
f su
s-p
ec
ted
inva
sive
ca
nd
idia
sis (
intr
a-a
bd
om
i-n
al a
bsc
ess
an
d p
erit
on
itis)
.A
nid
ula
fun
gin
b is
ac
tive
ag
ain
st a
ll sp
ec
ies
of C
an
did
a. I
t is
ext
rem
ely
ac
tive
an
d
usu
ally
rap
idly
fun
gic
ida
l ag
ain
st a
ll sp
e-
cie
s e
xce
pt
Ca
nd
ida
pa
rap
silo
sis, C
an
-d
ida
gu
illie
rmo
nd
ii a
nd
Ca
nd
ida
fam
ata
a
ga
inst
wh
ich
it is
mo
de
rate
ly a
ctiv
e.
An
idu
lafu
ng
in is
also
ac
tive
ag
ain
st a
ll A
spe
r-g
illus
spp
., b
ut
is n
ot
fun
gic
ida
l.A
nid
ula
fun
gin
ha
s lim
ited
ac
tivity
ag
ain
st
Co
cc
idio
ide
s sp
p.,
Bla
sto
myc
es
de
rma
-tit
idis
, Sc
ed
osp
oriu
m s
pp
., Pa
ec
ilom
yce
s va
rioti
an
d H
isto
pla
sma
sp
p.,
wh
ich
is n
ot
suffi
cie
nt
for c
linic
al u
se
He
pa
tic m
eta
bo
lism
of a
nid
ula
-fu
ng
in h
as
no
t b
ee
n o
bse
rve
d.
An
idu
lafu
ng
in is
no
t a
clin
ica
lly
rele
van
t su
bst
rate
, in
du
ce
r, o
r in
hib
itor o
f cyt
oc
hro
me
P45
0 iso
en
zym
es.
The
co
mm
one
st s
ide
effe
cts
(all
<1
in 4
0 p
atie
nts)
we
re fl
ushi
ng o
r a
hot fl
ush,
pru
ritus
, ra
sh a
nd/o
r urt
i-c
aria
. Ra
ised
live
r enz
yme
s o
cc
ur
in a
bo
ut 1
in 4
0 p
atie
nts.
Oth
er
side
effe
cts
ap
pe
ar t
o b
e ra
re.
Co
ntra
ind
ica
tions
: Hyp
ers
en
sitiv
ity
to t
he
ac
tive
su
bst
an
ce
. Hyp
er-
sen
sitiv
ity t
o o
the
r me
dic
ina
l p
rod
uc
ts o
f th
e e
ch
ino
ca
nd
in
cla
ss
aW
alsh
TJ,
Le
e J
, Le
cc
ion
es
J. E
mp
iric
th
era
py
with
am
ph
ote
ricin
B in
feb
rile
gra
nu
loc
yto
pe
nic
pa
tien
ts. R
ev
Infe
ct
Dis
. 199
1;13
:496
–503
.D
ata
fro
m C
un
ha
BA
. An
tibio
tic E
sse
ntia
ls. 1
2th
ed
. Bu
rlin
gto
n, M
A: J
on
es
& B
art
lett
Le
arn
ing
, 201
3. A
vaila
ble
at
htt
p:/
/ww
w.d
rug
s.c
om
. Re
vise
d J
an
ua
ry 2
015.
TABL
E J.
13 A
ntifu
nga
ls (
Co
ntin
ued
)
1873
LWBK1580-App-J_p1852-1874.indd 1873 29/07/17 7:30 AM
LWBK1580-App-J_p1852-1874.indd 1874 29/07/17 7:30 AM
