I. Antimicrobial Agent Fundamentals • Spectrum of Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 • Pharmacokinetics of Antimicrobial Agents . . . . . . . . . . . . . . . . . . . . . . .14 Mayo Clinic • Antimicrobial Assays/Drug Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 • Laboratory and Clinical Toxicity Monitoring . . . . . . . . . . . . . . . . . . . . .23 Antimicrobial Therapy II. Antimicrobial Dosing—Adult and Pediatric • Adult Antimicrobial Dosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Wilson • Adult Dosing for Continuous Renal Replacement Therapy (CRRT). . . . .71 • Vancomycin Adult Dosing and Monitoring . . . . . . . . . . . . . . . . . . . . . .74 Estes QUICK GUIDE • Aminoglycoside Adult Dosing and Monitoring . . . . . . . . . . . . . . . . . . .79 • Pediatric Antimicrobial Dosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88 III. Treatment of Specific Organisms • Bacteria: Preferred and Alternate Treatment Options . . . . . . . . . . . . .121 M • Bacterial Drug Resistance Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 a • Fungi: Preferred and Alternate Treatment Options . . . . . . . . . . . . . . .133 y • Viruses: Preferred and Alternate Treatment Options . . . . . . . . . . . . .136 o C IV. Infectious Syndromes in Adults l i • Clinical Approach to Patients With Infection . . . . . . . . . . . . . . . . . . . .137 n • Respiratory Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 ic • Infective Endocarditis: Diagnosis and Treatment . . . . . . . . . . . . . . . . .144 Q A • Infective Endocarditis Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157 UI n • Central Nervous System Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . .161 C t • Urinary Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 K G im • Soft-Tissue Infections: Nontoxigenic . . . . . . . . . . . . . . . . . . . . . . . . . . .179 U i • Soft-Tissue Infections: Necrotizing or Toxigenic . . . . . . . . . . . . . . . . .184 I c D r • Surgical Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 E o • Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191 b • Acute Native Joint Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194 ia • Gastrointestinal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198 l • Intra-Abdominal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204 T • Neutropenic Fever Empiric Management . . . . . . . . . . . . . . . . . . . . . . .212 h • Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 e r • Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225 a • Nontuberculosis Mycobacterial Infections . . . . . . . . . . . . . . . . . . . . . .230 p y • Zoonotic (Animal-Associated) Infections . . . . . . . . . . . . . . . . . . . . . . .241 • Tick-Borne Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252 • Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261 John W. Wilson, MD •Antiretroviral Therapy for HIV Infection . . . . . . . . . . . . . . .274 Lynn L. Estes, PharmD •Select Opportunistic Infections in Adult HIV Patients . . . . . . . .296 •Occupational Postexposure Prophylaxis and Management. . 306 MAYO CLINIC SCIENTIFIC PRESS •Vaccination Schedules. . . . . . . . 313 •Travel Medicine/Prophylaxis. . 323 AntimicrobialTherapy.book Page i Monday, April 28, 2008 2:34 PM Mayo Clinic Antimicrobial Therapy Quick Guide AntimicrobialTherapy.book Page ii Monday, April 28, 2008 2:34 PM AntimicrobialTherapy.book Page iii Monday, April 28, 2008 2:34 PM Mayo Clinic Antimicrobial Therapy Quick Guide Editors John W. Wilson, MD Lynn L. Estes, PharmD MAYO CLINIC SCIENTIFIC PRESS and INFORMA HEALTHCARE USA, INC. AntimicrobialTherapy.book Page iv Monday, April 28, 2008 2:34 PM ISBN-13: 978-1-4200-8518-1 The triple-shield Mayo logo and the words MAYO, MAYO CLINIC, and MAYO CLINIC SCIENTIFIC PRESS are marks of Mayo Foundation for Medical Education and Research. ©2008 Mayo Foundation for Medical Education and Research. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form by any means— electronic, mechanical, photocopying, recording, or otherwise—without the prior written consent of the copyright holder, except for brief quotations embodied in critical articles and reviews. Inquiries should be addressed to Scientific Publications, Plummer 10, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. For order inquiries, contact: Informa Healthcare, Kentucky Distribution Center, 7625 Empire Drive, Florence, KY 41042 USA. E-mail: [email protected]; Web site: www.informahealthcare.com Library of Congress Cataloging-in-Publication Data Mayo Clinic antimicrobial therapy : quick guide/edited by John W. Wilson, Lynn L. Estes. p. ; cm. Includes bibliographical references. ISBN-13: 978-1-4200-8518-1 (pb : alk. paper) ISBN-10: 1-4200-8518-2 (pb : alk. paper) 1. Anti-infective agents-- Handbooks, manuals, etc. 2. Communicable diseases--Chemotherapy-- Handbooks, manuals, etc. I. Wilson, John W., 1967- II. Estes, Lynn L. III. Mayo Clinic. IV. Title: Antimicrobial therapy. [DNLM: 1. Anti-Infective Agents--therapeutic use--Handbooks. 2. Communicable Diseases--drug therapy--Handbooks. QV 39 M473 2007] RM262.M377 2007 615'.1--dc22 2007027808 Nothing in this publication implies that Mayo Foundation endorses any of the products mentioned in this book. Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the publication. This book should not be relied on apart from the advice of a qualified health care provider. The information contained in this book does not pertain to neonatal patient populations. The authors, editors, and publisher have exerted efforts to ensure that drug selections and dosages set forth in this text are in accordance with current recommendations and practices at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, readers are urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This precaution is particularly important when the recommended agent is a new or infrequently used drug. Data regarding efficacy and safety in pediatric populations is limited for many drugs. Some drugs and medical devices presented in this publication have U.S. Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of health care providers to ascertain the FDA status of each drug or device that they plan to use in their clinical practice. Some of the dosages and suggested uses of medications in this handbook are outside of FDA labeling. These suggestions are based on publications and clinical judgment and should be considered “off-label” use. Package inserts should be consulted for information on FDA-approved dosing and indications. The information provided herein is not intended to replace clinical judgment. The variable conditions of individual patients may mandate adjustments in therapy. An infectious diseases consultation should be considered to assist with patient care. AntimicrobialTherapy.book Page v Monday, April 28, 2008 2:34 PM Dedication We dedicate this book to the patients under our care and to our families, who continue to support us in our work. About the Cover The image on the cover illustrates the dichotomous impact of human intervention on infectious diseases and antimicrobial therapy worldwide. Landmark achievements of mankind against infectious diseases include vaccine and antimicrobial drug development, along with a growing international cooperative in disease awareness, surveillance, and containment. In contrast to such accomplishments, however, are human- driven problems of inappropriate antimicrobial prescribing with secondary development of drug-resistant microbes and the proliferation of the human immunodeficiency virus, tuberculosis, and sexually transmitted diseases through socioeconomic and educational inequalities and maladaptive behaviors. Finally, in the age of jet aviation and global tourism, infectious diseases that were once remote and geographically localized are emerging in new locations. In the 21st century, health care providers and scientists worldwide have the opportunity and the growing responsibility through antimicrobial stewardship to collectively work toward effective and responsible management of infectious diseases. v AntimicrobialTherapy.book Page vi Monday, April 28, 2008 2:34 PM AntimicrobialTherapy.book Page vii Monday, April 28, 2008 2:34 PM Preface The medical management of infectious diseases and antimicrobial therapy can be a daunting task for health care professionals. Although expansive textbooks and online resources are available, we believe that a more simplified, quick reference guide is needed for the day-to-day office and hospital clinical practice. This book is designed to provide information about infectious diseases and antimicrobial therapy in a format that is readily accessible and easily applicable to the clinical environment. Highlights of this book include simplified and thorough drug dosing recommendations for renal function and renal replacement therapies, drugs of choice for specific organisms (including bacteria, fungi, and viruses), and simplified antimicrobial and management recommendations for specific infectious syndromes. We hope that this book will assist health care providers in the management of infectious diseases and in the selection of appropriate antimicrobial therapy in a time-efficient manner. This book is not meant to serve as a comprehensive review of all infectious diseases topics. Instead, readers are encouraged to seek supplemental information from additional published resources and from the prescribing information provided by pharmaceutical manufacturers. vii AntimicrobialTherapy.book Page viii Monday, April 28, 2008 2:34 PM AntimicrobialTherapy.book Page ix Monday, April 28, 2008 2:34 PM Author Affiliations John W. Wilson, MD Consultant, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Medicine, College of Medicine, Mayo Clinic Lynn L. Estes, PharmD Infectious Diseases Pharmacy Specialist, Mayo Clinic, Rochester, Minnesota; Assistant Professor of Pharmacy, College of Medicine, Mayo Clinic Contributors Larry M. Baddour, MD Raymund R. Razonable, MD Elie F. Berbari, MD Ronald M. Sieve, PharmD Rachel M. Chambers, PharmD James M. Steckelberg, MD Lynn L. Estes, PharmD Rodney L. Thompson, MD W. Charles Huskins, MD Abinash Virk, MD William F. Marshall, MD Mark P. Wilhelm, MD Robert Orenstein, DO John W. Wilson, MD Douglas R. Osmon, MD ix