Aerobic Gram Negative Bacteria

COCCI

Neisseria

• meningitides: vaccination, penicillin G or ceftriaxone, rifampicin (prophylaxis)
• gonorrhoea: piperacillin-tazobactam 4.5g Q8hrly, ceftriaxone

Moraxella

• azithromycin
• clarithromycin
• amoxicillin + clavulanate
• second or third generation cephalosporin
• co-trimoxazole 10mg/kg of sulphamethoxazole

RODS/BACILLI

-> aminoglycosides are good agents (gentamicin, tobramycin, amikacin, streptomycin)

Campylobacter

• fluoroquinolones
• erythromycin

Citrobacter

E. coli (from blood)

• cefuroxime 1.5g Q8 hrly
• ceftriaxone 1-4g Q24hrs
• ciprofloxacin 300mg Q12 hourly
• meropenem 2g Q8hrly
• gentamicin 3-5mg/kg LD -> titrate to trough
• tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
• piperacillin-tazobactam 4.5g Q8hrly
• nitrofurantoin 100mg QID PO (5-7mg/kg/day)

-> amoxicillin and penicillin = waste of time

E. coli (from urine)

• cefuroxime 1.5g Q8 hrly
• ceftriaxone 1-4g Q24hrs
• ciprofloxacin 300mg Q12 hourly
• meropenem 2g Q8hrly
• gentamicin 3-5mg/kg LD -> titrate to trough
• tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
• piperacillin-tazobactam 4.5g Q8hrly
• nitrofurantoin 100mg QID PO (5-7mg/kg/day)

-> not as much cover with amoxicillin-clavulnate, trimethoprim and co-trimoxazole

Enterobacter species

• ceftriaxone
• ciprofloxacin 300mg Q12 hourly
• imipenem 500mg Q6 hrly
• meropenem 2g Q8hrly
• gentamicin 3-5mg/kg LD -> titrate to trough
• tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
• co-trimoxazole 10mg/kg of sulphamethoxazole

Helicobacter

• clarithromycin + omeprazole

Klebsiella

• piperacillin-tazobactam 4.5g Q8hrly
• ceftriaxone
• ciprofloxacin

Morganella morganii

• piperacillin-tazobactam 4.5g Q8hrly
• meropenem 2g Q8hrly
• imipenem 500mg Q6 hrly
• tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
• gentamicin 3-5mg/kg LD -> titrate to trough

Proteus mirabilis

• cefuroxime 1.5g Q8 hrly
• ceftriaxone 1-4g Q24hrs
• amoxicillin-clavulate 1.2g Q6 hrly
• meropenem 2g Q8hrly
• imipenem 500mg Q6 hrly
• gentamicin 3-5mg/kg LD -> titrate to trough
• tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
• piperacillin-tazobactam 4.5g Q8hrly
• ciprofloxacin 300mg Q12 hourly
• co-trimoxazole 10mg/kg of sulphamethoxazole

-> only 90% coverage with penicillin & amoxicillin

Salmonella

• fluroquinolones: ciprofloxacin, moxifloxacin
• ceftriaxone
• co-trimoxazole 10mg/kg of sulphamethoxazole
• azithromycin

Serratia species

• ciprofloxacin 300mg Q12 hourly
• meropenem 2g Q8hrly
• imipenem 500mg Q6 hrly
• gentamicin 3-5mg/kg LD -> titrate to trough
• tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
• co-trimoxazole 10mg/kg of sulphamethoxazole

Shigella

• fluroquinolones: ciprofloxacin, moxifloxacin
• co-trimoxazole 10mg/kg of sulphamethoxazole

Vibrio

• doxycycline
• fluoroquinolone

Yersinia

• pestis: streptomycin, gentamycin, doxycycline
• enterocolitica: fluoroquinolone, co-trimoxazole 10mg/kg of sulphamethoxazole

PSEUDOMONAS + RELATIONS

Acinetobacter

• fluroquinolones: ciprofloxacin, moxifloxacin

Burkholderia cepacea

• co-trimoxazole 10mg/kg of sulphamethoxazole, ciprofloxacin

Burkholderia pseudomallei

• mild/ moderate: ceftazidine + co-trimoxazole
• severe: meropenem + co-trimoxazole

Flavobacterium

• -> resistant to imipenem

Pseudomonas aeruginosa:

(1) piperacillin-tazobactam + gentamicin
(2) imipenem or meropenem
(3) ceftazidime + gentamicin
(4) cefepime + gentamicin
(5) tobramycin
(5) fluroquinolones: ciprofloxacin, moxifloxacin

-> resistance to imipenem can develop during treatment

Stenotrophomonas maltophilia:

• co-trimoxazole

-> resistant to imipenem

COLLOBACILLI

Brucella

• doxycycline + gentamycin

Bartonella

• doxycycline
• chloramphenicol

Bordetella

• erythromycin, DPT vaccine

Haemophilus

• influenzae:
  piperacillin-tazobactam 4.5g Q8hrly, second or third generation cephalosporins, fluroquinolones (ciprofloxacin, moxifloxacin)
  Hib vaccination
• ducreyi:
  azithromycin or erythromycin, ceftriaxone, ciprofloxacin

Legionella

• erythromycin
• rifampicin
• fluroquinolones: ciprofloxacin, moxifloxacin

Pasturella

• penicillin G
• doxycycline
• third generation cephalosporin