Page 67 - HPP ANTIMICROBIAL GUIDELINE 2018

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Spinal epidural abscess Ceftriaxone 2 gm IV q12h Cloxacillin 2gm IV q4-6h Source control is strongly
(after culture results are available) recommended

Viral encephalitis
Herpes simplex Acyclovir 500mg IV q8h for 14 days
Varicella zoster

Cytomegalovirus (CMV) Ganciclovir 5mg/kg IV q12h for Valganciclovir PO 900mg PO q12h Oral valganciclovir is only
Induction phase: 14-21 days. for 14-21 days recommended for CMV
polyradiculopathy or mononeuritis
Maintenance phase: Ganciclovir 5mg/kg IV q24h for 6 Valganciclovir PO 900mg PO q24h multiplex who has mild motor deficits
months depending on severity of for 6 months depending on severity
disease, time to response and end of disease, time to response and end
organ involvement. May switch to organ involvement.
oral valganciclovir if available

Cryptococcal meningitis
(non-HIV, non-transplant patient)
Induction therapy: Amphotericin B 0.7-1.0mg/kg/24h IV Amphotericin B 0.7-1.0mg/kg/24h IV Lipid formulations of amphotericin
PLUS PLUS may be used in cases of severe
Flucytosine 100mg/kg/24h PO in 4 Fluconazole 800-1200mg PO/IV nephrotoxicity
divided doses for 4-6 weeks q24h for 4-6 weeks

OR

Fluconazole 1200mg PO q24h
PLUS
Flucytosine 100mg/kg/24 h PO for 4
divided doses for 4-6 weeks

Consolidation therapy: Fluconazole 400-800mg PO q24h for
8 weeks

Maintenance therapy: Fluconazole 200mg PO q24h up to
12 months

HPP AMG Central Nervous Infections 28