Indefinite antimicrobial therapy

From IDWiki
  • 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

RifaximinClarithromycin + rifabutin + clofazimine

Clofazimine

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