Antibiotics of choice

Antibiotics of Choice

Infecting Organism	Medication of Choice	Alternative Medications
I. AEROBIC BACTERIA
A. Gram Positive
1. Staphylococci
a. Non-penicillinase producing	PRP	Parenteral Cephaloporins, Vancomycin, Clindamycin
b. Penicillinase producing	Vancomycin	TMP/SMX
2. Streptococci
a. Pyogenic groups A, B, C	Penicillin G *–or–* Penicillin V± Gentamicin	Beta Lactams (Penicillins, Cephalosporins), Erythromicin, Azithromycin
b. Viridans	Amoxicillin/Clavulanate *–or–*Penicillin ± Streptomicin	Clindamycin + Ciprofloxacin, TMP/SMX
c. Enterococci (Group D)	Amoxicillin/Clavulanate *–or–*Penicillin ± Streptomicin	Clindamycin + Ciprofloxacin, TMP/SMX
3. Pseudomonas (Strep. Pneumoniae)	Penicillin G *–or–* Vancomycin ± Rifampin	Amoxicillin
B. Gram-negative cocci
1. Neisseria catarralis	Penicillin G	Ceftriaxone, Cefuroxime, Cefotaxime
2. Neisseria gonorrhoeae	Ceftriaxone *–or–* Cefixime *–or–* Cefpodoxime	Oxfloxacin, other FQs
C. Gram-negative bacilli
1. Escherichia coli	Cephalosporin *–or–* FQ *–or–* TMP/SMX *–or–* APA *–or–* Imipenem/Cilastatin	Cephalosporin, FQ, TMP/SMX, APA, Imipenem/Cilastatin
2. Enterobacter aerogenes	Imipenem/Cilastatin *–or–* Meropenem *–or–* APP + APA
3. Klebsiella species	Parenteral 3^rd Gen Cephalosporin *–or–* FQ	APA, Ticarcillin/Clavulanate, Ampicillin/Sulbactam, Piperacillin/Tazobactam
4. Pseudomonas aeruginosa	APP *–or–* Anti-pseudomonal Cephalosporin
5. Proteus
a. P. mirabilis	Ampicillin	TMP/SMX
b. other Proteus species	Parenteral 3^rd Gen Cephalosporin *–or–* FQ	APA
6. Serratia species	Parenteral 3^rd Gen Cephalosporin *–or–* Imipenem/Cilastatin *–or–* Meropenem *–or–* FQ	Aztreonam, Gentamicin
7. Salmonella typhi	FQ *–or–* Ceftriaxone	Chloramphenicol, Amoxicillin, TMP/SMX, Azithromycin
8. Hemophilus species
a. H influenzae	Cefotaxime *–or–* Ceftriaxone	TMP/SMX, Imipenem/Cilastatin, Meropenem, FQ
b. H. ducreyi	Azithromycin *–or–* Ceftriaxone	Erythromycin, Ciprofloxacin
9. Brucella species	Doxycycline	Doxycycline
10. Pasteurella species
a. Francisella tularensis (tularemia)	Streptomycin *–or–* Gentamicin	Doxycycline
b. Yersinia pestis	Streptomycin *–or–* Gentamicin	Doxycycline
D. Gram-positive bacteria
1. Bacillus anthracis	Penicillin G *–or–* Ciprofloxacin *–or–* Doxycycline	Erythromycin, Chloramphenicol
2. Corynebacterium species	Vancomycin	Penicillin G + APA
3. Diphtheroid species	Antitoxin + Erythromycin	Benzyl Penicillin G, followed by Penicillin VK
4. Mycobacterium tuberculosis	Isoniazid + Rifampin + Pyrazinamide	Add Ethambutol + FQ + Amikacin
5. Listeria monocytogenes	Ampicillin	TMP/SMX
II. ANAEROBIC BACTERIA
A. Gram-positive cocci
1. Streptococcus species	Penicillin G	Clindamycin
B. Gram-positive bacilli
1. Clostridium species
a. C. perfringens	Penicillin G ± Clindamycin	Doxycycline
b. C. novyi	Penicillin G ± Clindamycin	Doxycycline
c. C. histolyticum	Penicillin G ± Clindamycin	Doxycycline
d. C. septicum	Penicillin G ± Clindamycin	Doxycycline
e. C. sordellii	Penicillin G ± Clindamycin	Doxycycline
f. C. sporogenes	Penicillin G ± Clindamycin	Doxycycline
g. C. tetani	Metronidazole *–or–* Penicillin G	Doxycycline
C. Bacteroides species	Metronidazole	Clindamycin, Trovafloxacin
III. MISCELLANEOUS
A. Nocardia species	TMP/SMX *–or–* Sulfonamide	Minocycline, Amoxicillin/Clavulanate
B. Fusobacterium fusiforme	Penicillin G	Clindamycin
C. Calymmatobacterium granulomatis	Doxycycline *–or–* TMP/SMX	Erythromycin, Ciprofloxacin
IV. ACID FAST BACILLI
A. Mycobacterium species
1. M. tuberculosis	Isoniazid + Rifampin + Pyrazinamide
2. M. kansasii	Isoniazid + Rifampin + Ethambutol	Isoniazid + Pyridoxine + Ethambutol + Sulfamethoxazole
3. M. avium intracellulare complex	Clarithromycin + Ethambutol + Streptomycin + Clofazimine	Clarithromycin + Rifabutin + Ethambutol
4. M. fortuitum	Surgical excision	Amikacin + Cefoxitin + Probenecid, followd by Doxycycline or TMP/SMX
5. M. marinum (balnei)	Clarithromycin
6. M. leprae (leprosy)	Dapsone + Rifampin
V. ACTINOMYCETES
A. Actinomyces israelii (actinomycosis)	Ampicillin *–or–* Penicillin G	Doxycycline
B. Nocardia	TMP/SMX *–or–* Sulfonamide (in high doses)	Minocycline
VI. CHLAMYDIA
A. Chlamydia psittaci (psittacosis, ornithosis)	Azithromycin *–or–* Clarithromycin	Parenteral 3^rd Gen Cephalosporin + Azithromycin
B. Chlamydia trachomatis	Doxycycline–or– Azithromycin	Erythromycin, Ofloxacin
1. (trachoma)	Azithromycin	Doxycycline, Tetracycline
2. (inclusion conjunctivitis)	Doxycycline	Erythromycin
3. (pneumonia)	Doxycycline	Erythromycin, FQ
4. (urethritis)	Doxycycline	Azithromycin
C. Lymphogranuloma venereum	Doxycycline	Erythromycin
VII. FUNGI
A. Aspergillus	Amphotericin B *–or–* Itraconazole
B. Blastomyces dermatitidis	Amphotericin B *–or–* Itraconazole	Fluconazole
C. Candida species	Amphotericin B *–or–* Fluconazole	Increase dosages of first line agents
D. Chromomycosis	Surgical excision, then Itraconazole	Itraconazole
E. Coccidioides immitis	Amphotericin B *–or–* Itraconazole Fluconazole
F. Cryptococcus neoformans	Amphotericin B *–or–* Fluconazole	Amphotericin B + Flucytosine
G. Dermatophytes (tinea)
1. Tinea infections	Erythromycin *–or–* Terbinifine *–or–* Itraconazole *–or–* Fluconazole	Clindamycin 2% topical
2. Tinea versicolor	Ketoconazole
H. Histoplasma capulatum
1. Minor infections	Itraconazole
2. Severe infections	Amphotericin B
I. Mucor	Amphotericin B
J. Paracoccidioides brasiliensis	Itraconazole *–or–* Ketoconazole	Amphotericin B, Sulfonamide
K. Sporothrix schenckii	Itraconazole	Cutaneous: SSKI Extracutaneous: Amphotericin B
VIII. MYCOPLASMA
Mycoplasma pneumoniae	Erythromycin *–or–* Azithromycin *–or–* Clarithromycin *–or–* FQ	Doxycycline
IX. RICKETTSIA Rocky Mtn spotted fever; endemic typhus (murine); tick bite fever; typhus, scrub typhus; Q fever	Doxycycline	Chloramphenicol
X. PNEUMOCYSTIS CARINII	TMP/SMX *–or–* Dapsone	Clindamycin + Primaquine, Pentamidine
XI. SPIROCHETES
A. Borrelia recurrentis (relapsing fever)	Doxycycline	Erythromycin, Penicillin G
B. Leptospira	Penicillin G	Doxycycline
C. Treponema pallidum (syphilis)	Benzathine Penicillin G	Doxycycline, Tetracycline, Ceftriaxone
D. Treponema pertenue (Yaws)	Benzathine Penicillin G	Tetracycline
XII. VIRUSES
A. Herpes simplex	Acyclovir	Famciclovir, Valacyclovir
B. Herpes zoster	Acyclovir	Famciclovir, Valacyclovir
C. Influenza A	Zanamivir	Rimantidine, Amantadine
D. Hepatitis B	Interferon Alfa	Lamivudine
E. Hepatitis C	Ribaviran	Interferon Alfa-2B

Abbreviations / Classifications:

APA (Anti-pseudomonal Aminoglycoside)

Amikacin, Gentamicin, Netilmicin, Tobramycin

APP (Anti-pseudomonal Penicillins)

Piperacillin, Mezlocillin, Ticarcillin, Pipercillin/Tazobactam, Ticarcillin/Clavulanate

FQ (Fluoroquinolones)

Ciprofloxacin, Gatifloxacin, Levofloxacin, Lomefloxacin, Moxifloxacin, Ofloxacin, Pefloxacin, Sparfloxacin, Trovafloxacin

PRP (Penicillinase-Resistant Penicillins)

Cloxacillin, Dicloxacillin, Methlocillin, Nafcillin, Oxacillin,

1^st Gen Cephalosporins:

Parenteral: Cefazolin
Oral: Cefadroxil, Cephalexin

2^nd Gen Cephalosporins:

Parenteral: Cefoxitin, Cefuroxime
Oral: Cefaclor, Cefprozil, Cefuroxime acetil, Loracarbef (carbacephem classified as a cephalosporin)

3^rd Gen Cephalosporins:

Parenteral: Cefepime (sometimes classified as a 4^th Generation), Cefoperazone, Cefotaxime, Ceftazadime, Ceftizoxime, Ceftriaxone
Oral: Cefdinir, Cefixime, Cefpodoxime proxetil, Ceftibuten

SSKI: Super saturated Potassium Iodide solution

TMP/SMX: Trimethoprim and Sulfamethoxazole

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The information contained here is an abbreviated summary. For more detailed and complete information, consult the manufacturer's product information sheets or standard textbooks.

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300.

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
January 1, 2001

United States Special Operations Command
7701 Tampa Point Blvd.
MacDill AFB, Florida
33621-5323

*This web version is provided by The Brookside Associates, LLC. It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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