Condition

MAINMXi(S)

EMPIRIC ANTIBIOTIC(S)

Urinary tract infection

Escherichia coli

Trimethoprim-sulfamethoxazole, nitrofurantion, amoxicillin, qumolones

Bronchitis

Viral, Mycoplasma sp.;, Hoemophilus influenzae

Amoxicillin, erythromycin

Pneumonia--classic type

Streptococcus pneumoniae, H. influenzae .

Penicillin (for boards), cephalosporin, erythromycin

Pneumonia--.-atypical

" Mycoplasma■ sp.,-Chlamydia sp,.

Erythromycin, third-generation--cephalosporin

Osteomyelitis

Swpliylocoicif-s <iurats, Stlmondfo sp.

AiiUstapliyiocoixal penicillin,* vancomycin

Cellulitis

Streptococci, staphylococci

Antistaphylococcal penicillin* (covers both bugs)

Meningitis—neonate

Streptococci B, E.-roll,---listeria sp, -.

. - : Ampicillm +■-aminoglycoside, third-generation cephalosporin

Meningitis—child/adult

S. pmumomoe, Neisseria-meningitidis*'

Penicillin/amoxicillin + chloramphenicol, third-generation cephalosporin

Sepsis

Gram-negative, Streptococci,: staphylococci

. Third-generation: penicillin/cephalosporin + aminoglycoside, imipenem

Tuberculosis

Mycobacterium tubercufosis

. Isomazide + rifampin for 6-T 2 months-, add ethamburol/ •-. .-pyrazmamide in immunocompromised-patient

Septic arthritis*

S. aureus Gonococci

. Antistaphylococcal penicillin, vancomycin Ceftriaxone,.penicillin, spectinomycin ••

Hndocaithtis

Staphylococci, streptococci

Antistaphyk>coccal pemcillm (or vancomycin) + aminoglycoside

* Examples: dicloxaeiliio, methidilin, i Haemophilus influenzae type b is no longer a common' cause of.meningitis in children because of widespread vaccination. If-there is no his-

* rory of vaccination. H. influenzae is tbe most likely cause of meningitis in a child.

* Think of staphylococci if the patient is not sexually acti ve or is monogamous. Think of gonorrhea for younger adults who are sexually ac tive and/or promiscuous.

Empiric: antibiotics of choice for differen t bugs (always use culture sensiti vi ties to g uid e ther apy if available.) (See figure, top of next page.)

Staining hints:

^ Gram-positive organisms are blue/purple; gram-negative organisms are red. & Gram -posi tive cocci in chains — .streptococci « (.¡ram positive cocci in clusters staphylococci a Gram-positive cocci in pairs (diplococci) = Streptococcus pjuTtmomat: ® Gram negative coccobacilli (small rods) --- Haemophilus sp.

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