Indefinite antimicrobial therapy
- Includes suppressive and prophylactic therapy, as well as use for treatment of non-infectious diseases (e.g. acne and reactive airways)
| Indication | Antimicrobial | Alternative |
|---|---|---|
| Prophylaxis | ||
| PJP prophylaxis following transplantation | TMP-SMX SS or DS daily or thrice weekly | Dapsone 50-100 mg p.o. daily
Atovaquone 1500 mg p.o. daily Pentamidine 300 mg inhaled every 3-4 weeks Clindamycin 300 mg p.o. daily plus pyrimethamine 15 mg p.o. daily |
| Post-splenectomy | Amoxicillin 250-500 mg p.o. daily | |
| Rheumatic fever | Benzathine penicillin 1.2 g IM every 3-4 weeks
Penicillin V 250 mg p.o. twice daily Sulphonamide 1 g p.o. daily Erythromycin 250 mg p.o. twice daily |
|
| Spontaneous bacterial peritonitis | Norfloxacin 400 mg p.o. daily | TMP-SMX DS p.o. daily
Ciprofloxacin 750 mg p.o. weekly |
| Urinary tract infection | TMP-SMX SS half tablet p.o. daily or thrice weekly
Trimethoprim 100-300 mg p.o. daily Ciprofloxacin 125 mg p.o. daily Cefalexin 125-250 mg p.o. daily Nitrofurantoin 50-100 mg p.o. daily Norfloxacin 200 mg p.o. daily |
|
| Suppressive Therapy | ||
| Prosthetic joint infection with MSSA | Cefalexin 500 mg p.o. three or four times daily
Cefadroxil 500 mg p.o. twice daily |
Dicloxacillin 500 mg p.o. three to four times daily
Clindamycin 300 mg p.o. four times daily Amoxicillin/clavulanic acid 500 mg p.o. three times daily |
| Prosthetic joint infection with MRSA | TMP-SMX DS 1 tab p.o. twice daily | Minocycline or doxycycline 100 mg p.o. twice daily
Fluoroquinolone +/- rifampin Fusidic acid + rifampin Cefalexin 500 mg p.o. three to four times daily |
| Prosthetic joint infection with beta-hemolytic streptococci and enterococci | Penicillin V 500 mg p.o. two to four times daily
Amoxicillin 500 mg p.o. three times daily |
|
| Prosthetic joint infection with Gram-negative bacilli | Ciprofloxacin 250-500 mg p.o. twice daily
TMP-SMX DS 1 tab p.o. twice daily |
|
| Non-Antimicrobial Properties | ||
| Acne | Minocycline 100 mg p.o. daily | Doxycycline, lymecycline, azithromycin, clindamycin, trimethoprim |
| Cystic fibrosis | Azithromycin 250-500 mg p.o. daily | |
| Inflammatory bowel disease | Metronidazole 10-20 mg/kg/day
Ciprofloxacin 500 mg p.o. twice daily plus metronidazole |
Rifaximin |
| Reactive airway disease | Azithromycin 250 mg p.o. daily
Azithromycin 500 mg p.o. thrice weekly |
Moxifloxacin 400 mg p.o. daily for 5 days followed by pulsed every 8 weeks |
Further Reading
- Life-long antimicrobial therapy: where is the evidence? J Antimicrob Chemother. 2018;73:2601-2612. doi: 10.1093/jac/dky174
