(These recommendations for empiric therapy should be modified based on local susceptibility patterns. The susceptibility of clinically important pathogens must be substantiated by laboratory testing for most pathogens.) Pathogen First Choices Alternatives Acanthamoeba Encephalitis None definitely effective Pentamidine Keratitis 0.1% propamidine (topical) + neomycin/gramicidin/polymyxin (topical) Polyhexamethylene biguanide 0.02% (topical) Acinetobacter calcoaceticus— baumanni complex Imipenem or Meropenem or Tobramycin + ciprofloxacin Tobramycin + piperacillin Actinomyces israeli and others Penicillin G or Ampicillin Clindamycin Adenovirus None Cidofovir Aeromonas hydrophila Bacteremia Ciprofloxacin Trimethoprim- sulfamethoxazole Diarrhea Trimethoprim- sulfamethoxazole Doxycycline Alcaligenes xylosoxidans Imipenem or Meropenem or Piperacillin-tazobactam Trimethoprim- sulfamethoxazole Ameba See Entameba histolytica Naegleria Anaplasma Doxycycline Ciprofloxacin Aspergillus species Voriconazole Liposomal amphotericin B Babesia microti Atovaquone + azithromycin Clindamycin + quinine Bacillus anthracis Inhalational or gastrointestinal Ciprofloxacin + clindamycin + rifampin ± penicillin G Doxycycline + clindamycin + rifampin Bacillus anthracis cutaneous Ciprofloxacin Doxycycline Bacillus cereus (invasive) Vancomycin or Clindamycin Imipenem or Meropenem Bacillus subtilis Vancomycin or Clindamycin Imipenem or Meropenem Bacteroides fragilis Metronidazole Imipenem or Meropenem Bacteroides melaninogenicus Metronidazole Piperacillin-tazobactam Bartonella species (Cat scratch fever) Erythromycin or Azithromycin Clarithromycin Blastomyces dermatitidis Liposomal amphotericin B Itraconazole Bordetella pertussis Azithromycin Trimethoprim-sulfamethoxazole Borrelia burgdorferi Early Doxycycline Amoxicillin Burkholderia cepacia Imipenem or Meropenem Trimethoprim-sulfamethoxazole Campylobacter fetus Imipenem or Meropenem Gentamicin Campylobacter jejuni Erythromycin or Azithromycin Doxycycline Candida species (mucosal—not life-threatening) Fluconazole (IV/PO) or Caspofungin Itraconazole (IV/PO) Candida species (invasive) Liposomal amphotericin B Fluconazole Capnocytophaga ochracea (DF-1) Clindamycin Imipenem or Meropenem Capnocytophaga canimorsus (DF-2) Ampicillin-sulbactam Ciprofloxacin Cardiobacterium Ceftriaxone Ampicillin + gentamicin Chlamydia pneumoniae Doxycycline or Azithromycin Clarithromycin Chlamydia psittaci Doxycycline Erythromycin Chlamydia trachomatis Pelvic inflammatory disease (PID) Doxycycline Azithromycin Citrobacter diversus Imipenem or Meropenem Ciprofloxacin Citrobacter freundii Imipenem or Meropenem Ceftriaxone Clostridium botulinum (botulism) Trivalent equine antitoxin (CDC)a Metronidazole + antitoxin Clostridium difficile (diarrhea) Metronidazole (PO) Vancomycin (PO) Clostridium species (non-tetanus) (non-botulinum) Penicillin G ± Clindamycin Piperacillin-tazobactam Clostridium tetani (tetanus) Penicillin G + human tetanus immune globulin (CDC)a Metronidazole Coccidioides immitis Liposomal amphotericin B Itraconazole (IV/PO) Corynebacterium diphtheriae Penicillin + antitoxin (CDC)a Erythromycin + antitoxin Corynebacterium JK strain Vancomycin Penicillin G + gentamicin Coxiella burnetii Doxycycline Ciprofloxacin Cryptococcus neoformans Liposomal amphotericin B Fluconazole Cysticercosis Albendazole ± prednisone Praziquantel ± prednisone Cytomegalovirus Ganciclovir ± IV immune globulin (IVIG) Foscarnet ± IV immune globulin (IVIG) DF-1 (Capnocytophaga) Clindamycin Imipenem or Meropenem DF-2 (Capnocytophaga) Ampicillin-sulbactam Ciprofloxacin Ehrlichia chaffeensis, phagocytophila, and other Ehrlichia Doxycycline Ciprofloxacin Eikenella corrodens Ampicillin or Penicillin G Cefotaxime Entameba histolytica Severe intestinal Metronidazole (IV) or Tinidazole (PO) followed by Paromomycin (PO) Dehydroemetine followed by Iodoquinol (PO) Mild Metronidazole (IV/PO) or Tinidazole (PO) followed by Iodoquinol (PO) Paromomycin Asymptomatic Paromomycin (PO) Iodoquinol (PO) Enterobacter species Ciprofloxacin Aztreonam Enterococcus (sensitive) Ampicillin ± gentamicin Vancomycin ± gentamicin Enterococcus (Vancomycin-resistant) Linezolid Synercid Escherichia coli Ceftriaxone Gentamicin Flavobacterium meningosepticum Vancomycin Trimethoprim-sulfamethoxazole Francisella tularensis Streptomycin or Gentamicin Ciprofloxacin Fusobacterium Penicillin G or Metronidazole Cefoxitin or Gardnerella vaginalis Metronidazole Clindamycin (topical or PO) Helicobacter pylori Amoxicillin + omeprazole (or rabeprazole) + clarithromycin Bismuth subsalicylate (PO) + metronidazole + tetracycline + omeprazole Hemophilus influenzae Cefotaxime or Ceftriaxone Piperacillin-tazobactam Herpes simplex Keratoconjunctivitis Trifluridine (topical) + acyclovir Idoxuridine (topical) Local Mucocutaneous Acyclovir Foscarnet Disseminated Acyclovir (high dose) Foscarnet Encephalitis Acyclovir (high dose) Foscarnet Herpes zoster Local Famciclovir (PO) ± prednisone Foscarnet Disseminated Acyclovir (high dose) Foscarnet Influenza A (H3N2) Oseltamivir Zanamivir (Inhal) Influenza A Avian (H5N1) Oseltamivir Zanamivir (Inhal) Influenza B Oseltamivir Zanamivir (Inhal) Hantavirus None (No documented benefit from ribavirin) Histoplasma capsulatum Liposomal amphotericin B Itraconazole (IV/PO) Klebsiella species Ceftriaxone Gentamicin Legionella species Ciprofloxacin or Trimethoprim-sulfamethoxazole + rifampin Leptospira Penicillin G or Ampicillin Doxycycline Lice see Pediculosis Listeria monocytogenes Ampicillin ± gentamicin or Penicillin ± gentamicin Trimethoprim-sulfamethoxazole Lyme disease See Borrelia burgdorferi Malaria See Plasmodia Moraxella catarrhalis (Branhamella catarrhalis) Ceftriaxone Levofloxacin, Gatifloxacin, Moxifloxacin Morganella species Imipenem or Meropenem or Ceftriaxone Gentamicin Mucormycosis Liposomal amphotericin B Amphotericin B Mycobacterium avium intracellulare (Non-AIDS) Clarithromycin + ethambutol ± rifabutin Rifabutin (PO) + ciprofloxacin (or moxifloxacin) + amikacin Mycobacterium avium-intracellulare (AIDS) Clarithromycin (PO) or Azithromycin (PO/IV) + ethambutol (PO) Rifabutin (PO) + moxifloxacin (or ciprofloxacin) + amikacin Mycobacterium chelonae Clarithromycin or Azithromycin + amikacin Amikacin + cefoxitin Mycobacterium fortuitum Amikacin + cefoxitin + probenecid Clarithromycin (PO) Mycobacterium kansasii Isoniazid (PO/IV) + rifampin (PO/IV) + ethambutol (PO) Trimethoprim-sulfamethoxazole Mycobacterium tuberculosis Isoniazid (PO/IM/IV) + rifampin (PO/IV) + pyrazinamide (PO) + ethambutol (PO) Cycloserine (PO) Mycoplasma pneumoniae Clarithromycin Levofloxacin Naegleria fowleri Amphotericin B intraventricular + liposomal amphotericin Neisseria gonorrhea (uncomplicated) Ceftriaxone (IM) or Ofloxacin (PO/IV) or Doxycycline (PO) Cefotaxime Neisseria gonorrhea Disseminated Ceftriaxone or Cefotaxime Ciprofloxacin Neisseria meningitidis Penicillin G Ampicillin Nocardia asteroides Trimethoprim-sulfamethoxazole ± amikacin Imipenem + amikacin Nocardia brasiliensis Trimethoprim-sulfamethoxazole ± amikacin Ampicillin-sulbactam Pasteurella multocida Penicillin G Cefazolin Pediculosis (lice) Body, Head Permethrin 5% (topical) (Elimite) or Ivermectin (PO) Malathion 0.5% (topical) Peptostreptococcus Penicillin G or Ampicillin Clindamycin Plasmodia species potentially resistant Falciparum Quinidine gluconate (PO/IV) or Quinine (PO) + either Doxycycline, Clindamycin, or Fansidar (PO) Artesunate (PO) + mefloquine (PO) Plasmodia species (not potentially resistant) Chloroquine (PO/IM) (followed by primaquine) Quinine (PO) Pneumocystis jiroveci (mild) Trimethoprim-sulfamethoxazole Atovaquone (PO) Pneumocystis jiroveci (severe) Trimethoprim-sulfamethoxazole + prednisone Pentamidine (IV) + prednisone or Propionibacterium acnes Penicillin Clindamycin Proteus Ceftriaxone Gentamicin Providencia species Ceftriaxone or Ciprofloxacin Piperacillin-tazobactam Pseudomonas aeruginosa Imipenem ± Gentamicin or Ciprofloxacin Piperacillin-tazobactam Respiratory Syncytial Virus (RSV) Ribavirin (aerosol) Palivizumab Rhizopus species Liposomal amphotericin B Amphotericin B Rhodococcus equi Vancomycin + ciprofloxacin Vancomycin + amikacin Rickettsia species Doxycycline Levofloxacin Salmonella typhi Ceftriaxone Trimethoprim-sulfamethoxazole Salmonella species (nontyphi )Cefotaxime Piperacillin-tazobactam Scabies Permethrin 5% cream (topical) Ivermectin (PO) Serratia marcescens Ceftriaxone ± gentamicin Either Gentamicin or Amikacin ± either Piperacillin- tazobactam or Ceftriaxone Shigella species Ciprofloxacin Trimethoprim-sulfamethoxazole Staphylococcus aureus (methicillin-sensitive) Oxacillin ± gentamicin Vancomycin Staphylococcus aureus (methicillin-resistant) Vancomycin ± either Rifampin or Gentamicin Linezolid Staphylococcus epidermidis Vancomycin ± rifampin Linezolid Staphylococcus haemolyticus Trimethoprim-sulfamethoxazole Ciprofloxacin Staphylococcus lugdunensis Oxacillin Daptomycin Staphylococcus saprophyticus Ampicillin-sulbactam Cefazolin Stenotrophomonas maltophilia Trimethoprim-sulfamethoxazole Ciprofloxacin Streptococcus groups A, B, C, G; bovis; milleri; viridans Penicillin G ± gentamicin Cephazolin Streptococcus pneumoniae (penicillin sens.) Penicillin G ± gentamicin Levofloxacin, Moxifloxacin Streptococcus pneumoniae (moderate penicillin resistance) Cefotaxime or Ceftriaxone Vancomycin Streptococcus pneumoniae (high level penicillin- resistant; MIC > 1.0 μg/ml) Levofloxacin Vancomycin ± rifampin Strongyloides stercoralis Ivermectin (PO) Albendazole (PO) Toxoplasma gondii Sulfadiazine (PO) + pyrimethamine (PO) + folinic acid (PO/IV) Clindamycin (IV) + pyrimethamine (PO) + folinic acid (PO/IV) Treponema pallidum Penicillin G Doxycycline Variola virus Cidofovir Vibrio cholerae Doxycycline Trimethoprim-sulfamethoxazole Vibrio vulnificus Doxycycline ± ceftazidime Cefotaxime Yersinia enterocolitica Trimethoprim-sulfamethoxazole Ceftriaxone Yersinia pestis
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