Specific Treatment of Select Bacterial Organisms at UCLA

Specific Treatment of Select Bacterial Organisms at UCLA

These guidelines are intended to provide assistance in selection of appropriate antimicrobial therapy for specific organisms. This is not intended to be a comprehensive list of all bacteria, only commonly-isolated ones. Some of the organisms listed, such as Proprionibacterium acnes and Bacillus spp, may represent contaminating organisms when isolated from blood culture.

Treatment should be guided by susceptibility testing, when available. The recommendations given below are meant to serve as guidelines. They should NOT supplant clinical judgment or Infectious Diseases consultation.

Note that antimicrobials may have differing pharmacokinetic profiles, such as CSF penetration or urinary concentration. Therefore depending on the clinical syndrome and site of infection, not all listed antimicrobials are appropriate for the listed organisms. Please feel free to contact the Antimicrobial Stewardship Program hotline at 310-267-7567 with questions.

Organisms	First-line treatment*	Alternate treatment*
Acinetobacter Multli-drug resistant	meropenem (not ertapenem) consult ID	pip/tazo, ampicillin-sulbactam, cefepime, fluoroquinolone, amikacin, doxycycline, TMP/SMX.
Bacillus spp (not B. anthracis)	vancomycin	clindamycin, ertapenem, fluoroquinolone
Bacteroides fragilis	metronidazole	ertapenem, piperacillin/tazobactam, clindamycin, cefoxitin, tigecycline
Bordatella pertussis	macrolide	TMP/SMX
Campylobacter jejuni	erythromycin, azithromycin	doxycycline, flouroquinolone, gentamicin
Chlamydophila pneumoniae	doxycycline, macrolide	fluoroquinolone, tigecycline
Citrobacter freundii	ertapenem	fluoroquinolone, aminoglycoside, TMP/SMX, piperacillin/tazobactam, cefepime, tigecycline, aztreonam
Clostridium difficile	metronidazole	vancomycin (oral)
Clostridium perfringens	penicillin	metronidazole, clindamycin, piperacillin/tazobactam, ertapenem
Corynebacterium Group JK	vancomycin	linezolid, daptomycin, dalfopristin/quinupristin
Enterobacter	ertapenem or meropenem	fluoroquinolone, TMP/SMX, cefepime, pip/tazo, aminoglycoside, tigecycline, aztreonam
Enterococcus Ampicillin-sensitive Ampicillin-resistant, vancomycin-sensitive VRE Add gentamicin or streptomycin when cidal activity is required (eg for endocarditis) and agents are susceptible for synergy	ampicillin, amoxicillin, penicillin vancomycin linezolid	vancomycin, linezolid, piperacillin/tazobactam, dalfopristin/quinupristin (E faecium only), daptomycin, tigecycline linezolid, daptomycin, dalfopristin/quinupristin (E faecium only) daptomycin, dalfopristin/quinupristin (E faecium only), tigecycline
Escherichia coli ESBL-producing strains	ceftriaxone, cefazolin, cefepime ertapenem	fluoroquinolone, aminoglycoside, pip/tazo, TMP/SMX, tigecycline, aztreonam
Fusobacterium sp	penicillin	metronidazole, clindamycin, ampicillin/sulbactam, carbapenem
Haemophilus influenzae (serious infections only)	ceftriaxone	fluoroquinolone, TMP/SMX, azithromycin, clarithromycin, pip/tazo, doxycycline, cephalosporins
Klebsiella pneumonia ESBL-producing strains carbapenem-resistant strains	ceftriaxone, cefepime ertapenem consult ID	fluoroquinlone, aminoglycoside, TMP/SMX, pip/tazo, carbapenem, tigecycline
Legionella	levofloxacin, azithromycin +/- rifampin	clarithromycin, doxycycline, TMP/SMX, any of these three +/- rifampin
Listeria monocytogenes	ampicillin or penicillin +/- gentamicin Never cephalosporins	TMP/SMX
Moraxella catarrhalis	2nd or 3rd-gen cephalosporin	fluoroquinolone, azithromycin, clarithromycin, TMP/SMX, cefepime, pip/tazo
Morganella morganii	cefepime, fluoroquinolone	ertapenem, pip/tazo, aminoglycoside, TMP/SMX, aztreonam
Mycoplasma pneumoniae	azithromycin	doxycycline, fluoroquinolone
N gonorrhoeae	Check with and report to LA County ceftriaxone + azithromycin	cefixime + azithromycin or doxycycline
N meningitidis (see section on CNS infections) Prophylaxis (with Hospital Epidmeology input)	penicillin, ceftriaxone	ampicillin, chloramphenicol ciprofloxacin, rifampin
Pasteurella multocida	penicillin, ampicillin, amoxicillin, amox/clav (if polymicrobial)	Doxycycline, ceftriaxone, TMP/SMX, amp/sulbactam, pip/tazo
Propionibacterium acnes	Penicillin	clindamycin, doxycycline, ertapenem
Proteus sp P mirabilis P vulgaris	ampicillin, amoxicillin, cephalosporin ertapenem	fluoroquinolone, aminoglycoside, TMP/SMX, pip/tazo, ertapenem fluoroquinolone, aminoglycoside, TMP/SMX, pip/tazo, ceftriaxone, cefepime, aztreonam
Providencia	ertapenem	fluoroquinolone, aminoglycoside, TMP/SMX, pip/tazo, ceftriaxone, cefepime, aztreonam
Pseudomonas aeruginosa See section on “double-coverage” of gram-negatives Multi-drug resistant	Cefepime or meropenem, plus gentamicin or ciprofloxacin until susceptibilities are known Consult ID	ciprofloxacin, levofloxacin, pip/tazo
Serratia sp	ertapenem	fluoroquinolone, aminoglycoside, cefepime, TMP/SMX, pip/tazo, aztreonam
Staphylococcus sp Methicillin-S Methicillin-R (MRSA) Vancomycin-intermediate or resistant (VISA, VRSA)	oxacillin, cefazolin, dicloxacillin vancomycin Consult ID	clindamycin (if S and no inducible resistance), TMP/SMX, doxycycline, cefepime, ceftriaxone, pip/tazo, ertapenem linezolid, daptomycin, for mild to moderate infections or step-down therapy: TMP/SMX, doxycycline
Stenotrophomonas maltophila	TMP/SMX Typically causes colonization (e.g. airways) and no treatment needed unless isolated from a sterile site,	levofloxacin, tigecycline, doxycycline
Streptococcus sp S pneumoniae Penicillin-susceptible Penicillin-resistant Beta Streptococci Viridans group	penicillin, amoxicillin Meningitis: vancomycin + ceftriaxone +/- rifampin Other infections: levofloxacin, vancomycin, ceftriaxone penicillin, cephalosporins penicillin, cephalosporin, for endocarditis base treatment on penicillin susceptibility testing	ceftriaxone, macrolide, clindamycin, doxycycline, fluoroquinolone linezolid, dalfopristin/quinupristin, macrolide, clindamycin, vancomycin vancomycin, levofloxacin
Ureaplasma	Macrolide, doxycycline

*Depending on susceptibility. Testing may or may not be performed for all of these, depending on the isolate and the source of infection.

Modified from Choice of Antibacterial Drugs. Treat Guidel Med Lett. 2007;5:33-50. Erratum in: Treat Guidel Med Lett. 2007;5:58.