lựa chọn kháng sinh tiêm theo tác nhân gây bệnh

mầm bệnh	thuốc đầu tay			thay thế
Acanthamoeba
viêm não	không hiệu quả			Pentamidine Trimethoprimsulfamethoxazole + rifampin
viêm giác mạc	0.1% propamidine (bôi) + neomycin/ gramicidin/polymyxin (bôi)			Polyhexamethylene biguanide 0.02% (bôi) Chlorhexidine 0.02% (bôi)
Acinetobacter calcoaceticus— baumanni complex	Imipenem or Meropenem or Tobramycin + ciprofloxacin			Tobramycin + piperacillin Colistin Tigecycline Ampicillin-sulbactam
Actinomyces israeli and others	Penicillin G or Ampicillin			Clindamycin Doxycycline Erythromycin Ceftriaxone
Adenovirus	None			Cidofovir
Aeromonas hydrophila nhiễm khuẩn huyết	Ciprofloxacin			Trimethoprim sulfamethoxazole
tiêu chảy	Trimethoprim sulfamethoxazole			Imipenem or Meropenem Cefepime Doxycycline Ciprofloxacin
Alcaligenes xylosoxidans	Imipenem or Meropenem or Piperacillin-tazobactam			Trimethoprim sulfamethoxazole
Ameba	See Entameba histolytica or Naegleria
Anaplasma	Doxycycline			Ciprofloxacin
Aspergillus species	Voriconazole			Liposomal amphotericin B (AmBisome) or ABLC Amphotericin B Itraconazole Caspofungin Micafungin
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 Levofloxacin
Bacillus subtilis	Vancomycin or Clindamycin			Imipenem or Meropenem Levofloxacin
Bacteroides fragilis	Metronidazole			Imipenem or Meropenem Piperacillin-tazobactam
Bacteroides	Metronidazole			Piperacillin-tazobactam
melaninogenicus				Imipenem or Meropenem
Bartonella species (Cat scratch fever)	Erythromycin or Azithromycin			Clarithromycin Doxycycline Ciprofloxacin
Blastomyces dermatitidis	Liposomal amphotericin B (AmBisome) or ABLC			Itraconazole Fluconazole Amphotericin B
Bordetella pertussis	Azithromycin			Trimethoprim sulfamethoxazole
				Erythromycin Clarithromycin
Borrelia burgdorferi sớm liệt thần kinh mặt viêm khớp viêm tim viêm não/màng não	Doxycycline Doxycycline Doxycycline Ceftriaxone Ceftriaxone			Amoxicillin Amoxicillin Ceftriaxone Doxycycline Penicillin G
Burkholderia cepacia	Imipenem or Meropenem			Trimethoprim sulfamethoxazole
Campylobacter thai nhi	Imipenem or Meropenem			Gentamicin Erythromycin
Campylobacter jejuni	Erythromycin or Azithromycin			Doxycycline Ciprofloxacin
Candida species (mucosal—not life-threatening)	Fluconazole (IV/PO) or Caspofungin			Itraconazole (IV/PO) Amphotericin B Liposomal amphotericin B (AmBisome) or ABLC Micafungin
Candida species (xâm lấn)	Liposomal amphotericin B (AmBisome) or ABLC or Caspofungin			Fluconazole Amphotericin B Micafungin
Capnocytophaga ochracea (DF-1)	Clindamycin			Imipenem or Meropenem Ceftriaxone Ciprofloxacin Doxycycline
Capnocytophaga canimorsus (DF-2)	Ampicillin-sulbactam			Ciprofloxacin Ceftriaxone
				Imipenem or Meropenem
Cardiobacterium	Ceftriaxone			Ampicillin + gentamicin
Chlamydia pneumoniae	Doxycycline or Azithromycin			Clarithromycin Erythromycin Levofloxacin or Gatifloxacin
Chlamydia psittaci	Doxycycline			Erythromycin Azithromycin
Chlamydia trachomatis
viêm vùng châu (PID)	Doxycycline			Azithromycin Ofloxacin
Citrobacter diversus	Imipenem or Meropenem			Ciprofloxacin Gentamicin
Citrobacter freundii	Imipenem or Meropenem			Ceftriaxone Ciprofloxacin
Clostridium botulinum	Trivalent equine antitoxin			Metronidazole + antitoxin
(ngộ độc)	(CDCỵ3 (+ penicillin for wound botulism)
Clostridium difficile	Metronidazole (PO)			Vancomycin (PO)
(tiêu chảy)				Bacitracin (PO) Metronidazole (IV)
Clostridium species (non-tetanus) (non-botulinum)	Penicillin G ± Clindamycin			Piperacillin-tazobactam Imipenem or Meropenem Doxycycline
Clostridium tetani	Penicillin G + human tetanus			Metronidazole
(tetanus)	immune globulin (CDCf			Doxycycline Clindamycin Imipenem or Meropenem (all with antitoxin)
mầm bệnh	thuốc đầu tay			thuốc thay thế
Coccidioides immitis	Liposomal amphotericin B (AmBisome) or ABLC			Itraconazole (IV/PO) Amphotericin B
Corynebacterium	Penicillin + antitoxin			Erythromycin + antitoxin
diphtheriae	(CDC)ữ			Clindamycin + antitoxin
Corynebacterium JK strain	Vancomycin			Penicillin G + gentamicin Ciprofloxacin
Coxiella burnetii	Doxycycline			Ciprofloxacin
Cryptococcus	Liposomal amphotericin B			Fluconazole
neoformans	(AmBisome) or ABLC ± flucytosine			Amphotericin B
Cysticercosis	Albendazole ± prednisone			Praziquantel ± prednisone
Cytomegalovirus	Ganciclovir ± IV immune globulin (IVIG)			Foscarnet ± IV immune globulin (IVIG) Ganciclovir + foscarnet ± IVIG Cidofovir
DF-1 (Capnocytophaga)	Clindamycin			Imipenem or Meropenem Cefoxitin Ceftriaxone
DF-2 (Capnocytophaga)	Ampicillin-sulbactam			Ciprofloxacin Ceftriaxone Imipenem or Meropenem
Ehrlichia chaffeensis,	Doxycycline			Ciprofloxacin
phagocytophila, and other Ehrlichia
Eikenella corrodens	Ampicillin or Penicillin G		Cefotaxime Imipenem or Meropenem Ciprofloxacin
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) Diloxanide (PO)
Enterobacter species	Ciprofloxacin Imipenem or Meropenem		Aztreonam Cefepime Piperacillin-tazobactam
Enterococcus (sensitive)	Ampicillin ± gentamicin		Vancomycin ± gentamicin Daptomycin
Enterococcus (Vancomycin-	Linezolid Daptomycin		Synercid
resistant)
Escherichia coli	Ceftriaxone		Gentamicin Imipenem or Meropenem Ciprofloxacin Aztreonam Piperacillin-tazobactam Ampicillin (if sensitive)
Flavobacterium meningosepticum	Vancomycin		Trimethoprim-sulfamethoxazole Erythromycin Clindamycin Imipenem or Meropenem
Francisella tularensis	Streptomycin or Gentamicin		Ciprofloxacin Doxycycline
Fusobacterium	Penicillin G or Metronidazole		Cefoxitin or Imipenem Clindamycin
mầm bệnh	thuốc đầu tay		thuốc thay thế
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 Imipenem or Meropenem Levofloxacin, Gatifloxacin, or Moxifloxacin
Herpes simplex Keratoconjunctivitis Local Mucocutaneous	Trifluridine (topical) + acyclovir Acyclovir		Idoxuridine (topical) Vidarabine (topical) Foscarnet
Disseminated	Acyclovir (high dose)		Foscarnet
Encephalitis	Acyclovir (high dose)		Foscarnet
Herpes zoster Local	Famciclovir (PO) ±		Foscarnet
Disseminated	prednisone Valacyclovir (PO) ± prednisone Acyclovir ± prednisone Acyclovir (high dose)		Foscarnet
Influenza A (H3N2)	Oseltamivir		Zanamivir (Inhal)
Influenza A Avian	Oseltamivir		Zanamivir (Inhal)
(H5N1)
Influenza B	Oseltamivir		Zanamivir (Inhal)
Hantavirus	None		(No documented benefit from
			ribavirin)
Histoplasma capsulatum	Liposomal amphotericin B (AmBisome) or ABLC		Itraconazole (IV/PO) Amphotericin B
Klebsiella species	Ceftriaxone		Gentamicin Piperacillin Imipenem or Meropenem Piperacillin-tazobactam Aztreonam Ciprofloxacin or Levofloxacin
Legionella species	Ciprofloxacin or Levofloxacin or Azithromycin or Erythromycin ± rifampin		Trimethoprim-sulfamethoxazole + rifampin Moxifloxacin
Leptospira	Penicillin G or Ampicillin		Doxycycline
Lice see Pediculosis
Listeria monocytogenes	Ampicillin ± gentamicin or Penicillin ± gentamicin	Trimethoprim-sulfamethoxazole Erythromycin
Lyme disease	See Borrelia burgdorferi
Malaria	See Plasmodia
Moraxella catarrhalis	Ceftriaxone	Levofloxacin, Gatifloxacin,
(Branhamella catarrhalis)		Moxifloxacin Telithromycin (PO) Azithromycin Trimethoprim-sulfamethoxazole
Morganella species	Imipenem or Meropenem or Ceftriaxone	Gentamicin Ciprofloxacin or Levofloxacin
Mucormycosis	Liposomal amphotericin B (AmBisome) or ABLC	Amphotericin B Posaconazole (investigational)
Mycobacterium avium intracellulare	Clarithromycin + ethambutol ± rifabutin	Rifabutin (PO) + ciprofloxacin (or moxifloxacin) + amikacin
(Non-AIDS)
mầm bệnh	thuốc đầu tay	thuốc thay thế
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) Doxycycline Imipenem
Mycobacterium kansasii	Isoniazid (PO/IV) + rifampin (PO/IV) + ethambutol (PO)	Trimethoprim sulfamethoxazole Amikacin (IV) Ciprofloxacin (PO/IV) Clarithromycin
Mycobacterium tuberculosis	Isoniazid (PO/IM/IV) + rifampin (PO/IV) + pyrazinamide (PO) + ethambutol (PO)	Cycloserine (PO) Ethionamide (PO) Streptomycin (IM/IV) Amikacin (IV) Linezolid (PO, IV) Moxifloxacin (PO, IV)
Mycoplasma pneumoniae	Clarithromycin Azithromycin	Levofloxacin Gatifloxacin Moxifloxacin Doxycycline
Naegleria fowleri	Amphotericin B intraventricular + liposomal amphotericin (AmBisome) or ABLC
Neisseria gonorrhea	Ceftriaxone (IM) or	Cefotaxime
(uncomplicated)	Ofloxacin (PO/IV) or Doxycycline (PO)	Ciprofloxacin
Neisseria gonorrhea Disseminated	Ceftriaxone or Cefotaxime	Ciprofloxacin Levofloxacin
Neisseria meningitidis	Penicillin G	Ampicillin Cefotaxime, or Ceftriaxone
Nocardia asteroides	Trimethoprimsulfamethoxazole ± amikacin	Imipenem + amikacin Ceftriaxone + amikacin
Nocardia brasiliensis	Trimethoprimsulfamethoxazole ± amikacin	Ampicillin-sulbactam Ceftriaxone + amikacin
Pasteurella multocida	Penicillin G	Cefazolin Piperacillin-tazobactam Doxycycline
Pediculosis (lice)
Body, Head	Permethrin 5% (topical) (Elimite) or Ivermectin (PO)	Malathion 0.5% (topical) Lindane 1% (Kwell) (topical) Pyrethrin (RID) (topical)
Peptostreptococcus	Penicillin G or Ampicillin	Clindamycin Metronidazole Imipenem or Meropenem Vancomycin
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) Quinidine (PO/IV)
Pneumocystis jiroveci	Trimethoprim-	Atovaquone (PO)
(mild)	sulfamethoxazole	Clindamycin + primaquine (PO) Pentamidine (IV) Trimetrexate (IV)
Pneumocystis jiroveci	Trimethoprim-	Pentamidine (IV) + prednisone
(severe)	sulfamethoxazole + prednisone	or Trimetrexate + prednisone
Propionibacterium	Penicillin	Clindamycin
acnes
Proteus	Ceftriaxone			Gentamicin Piperacillin-tazobactam Aztreonam Imipenem or Meropenem
Providencia species	Ceftriaxone or Ciprofloxacin			Piperacillin-tazobactam Imipenem or Meropenem Aztreonam
Pseudomonas	Imipenem ± Gentamicin or			Piperacillin-tazobactam
aeruginosa	Ciprofloxacin			Cefepime Levofloxacin Ceftazidime Aztreonam
Respiratory Syncytial	Ribavirin (aerosol)			Palivizumab
Virus (RSV)
Rhizopus species	Liposomal amphotericin B (AmBisome) or ABLC			Amphotericin B Posaconazole (investigational)
Rhodococcus equi	Vancomycin + ciprofloxacin			Vancomycin + amikacin Imipenem or Meropenem Erythromycin or Azithromycin Ciprofloxacin
Rickettsia species	Doxycycline			Levofloxacin
Salmonella typhi	Ceftriaxone			Trimethoprim-sulfamethoxazole Ciprofloxacin Cefotaxime or Ceftizoxime
Salmonella species (non typhi)	Cefotaxime			Piperacillin-tazobactam Trimethoprim-sulfamethoxazole Cefotaxime Ciprofloxacin
Scabies	Permethrin 5% cream (topical)			Ivermectin (PO) Crotamiton 10% (topical)
Serratia marcescens	Ceftriaxone ± gentamicin			Either Gentamicin or Amikacin ± either Piperacillin- tazobactam or Ceftriaxone Cefepime Imipenem or Meropenem Ciprofloxacin Aztreonam
Shigella species	Ciprofloxacin			Trimethoprim-sulfamethoxazole
Staphylococcus aureus (methiciMin- sensitive)	Oxacillin ± gentamicin			Vancomycin Cefazolin Imipenem or Meropenem Daptomycin Linezolid
Staphylococcus	Vancomycin ± either			Linezolid
aureus	Rifampin or Gentamicin			Daptomycin
(methicillin-resistant)
Staphylococcus epidermidis	Vancomycin ± rifampin			Linezolid Daptomycin
mầm bệnh	thuốc đầu tay			thuốc thay thế
Staphylococcus	Trimethoprim-			Ciprofloxacin
haemolyticus	sulfamethoxazole
Staphylococcus	Oxacillin			Daptomycin
lugdunensis				Vancomycin Cefazolin
Staphylococcus	Ampicillin-sulbactam			Cefazolin
saprophyticus				Levofloxacin Trimethoprim-sulfamethoxazole
Stenotrophomonas	Trimethoprim-			Ciprofloxacin
maltophilia	sulfamethoxazole
Streptococcus groups	Penicillin G ± gentamicin			Cephazolin
A, B, C, G; bovis;				Vancomycin
milleri; viridans				Cefepime
Streptococcus	Penicillin G ± gentamicin			Levofloxacin, Moxifloxacin
pneumoniae				Imipenem or Meropenem
(penicillin sens.)				Ceftriaxone
Streptococcus	Cefotaxime or Ceftriaxone			Vancomycin
pneumoniae				Levofloxacin, Moxifloxacin
(moderate penicillin				Linezolid
resistance)
Streptococcus	Levofloxacin			Vancomycin ± rifampin
pneumoniae (high				Moxifloxacin
level penicillin-				Gatifloxacin
resistant; MIC >1.0 ^g/ml)				Linezolid
Strongyloides	Ivermectin (PO)			Albendazole (PO)
stercoralis
Toxoplasma gondii	Sulfadiazine (PO) + pyrimethamine (PO) +			Clindamycin (IV) + pyrimethamine (PO) + folinic
	folinic acid (PO/IV)			acid (PO/IV) Trimethoprim-sulfamethoxazole Atovaquone (PO) + pyrimethamine (PO) + folinic acid (PO/IV) Trimethoprim-sulfamethoxazole (IV) + pyrimethamine (PO) or Trimetrexate (IV) + folinic acid (PO/IV)
Treponema pallidum	Penicillin G			Doxycycline
	(Neuro: 12-24M U/d IV) (Late latent, cardiac, or other tertiary: Benzathine 2.4M U IM q7d x 3)			Ceftriaxone
Variola virus	Cidofovir
Vibrio cholerae	Doxycycline			Trimethoprim-sulfamethoxazole Ciprofloxacin
Vibrio vulnificus	Doxycycline ± ceftazidime			Cefotaxime Ciprofloxacin
Yersinia enterocolitica	Trimethoprim- sulfamethoxazole			Ceftriaxone Ciprofloxacin Tobramycin Amikacin
Yersinia pestis	Streptomycin or Gentamicin ± doxycycline			Doxycycline Ciprofloxacin
IM, intramuscular; IV, intravenous; PO, by mouth aCDC: obtain from Centers for Disease Control (404) 639–2206 (days) or (404) 639–2888 (nights, weekends, holidays)