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q6h [caps: 250, 500 mg; extemporaneous
suspension].
-Patients infected with HIV who have completed initial
therapy for cryptococcus should receive lifelong
maintenance with low-dose fluconazole 3 mg/kg/day
PO/IV qd.
Genital Herpes
-Famciclovir (Famvir)
Adolescents
Treatment for genital herpes (not a cure!!) 250 mg
PO tid x 7-10 days
Daily suppressive therapy: 250-500 mg/day PO bid x
1 year then
reassess for recurrence
Episodic recurrence: 125 mg PO bid x 5 days
[tab: 125, 250, 500 mg]
-Valacyclovir (Valtrex)
First episode 1000 mg PO bid x 10 days; recurrent
episodes 500 mg PO bid x 3 days
Chronic suppressive therapy: 500-1000 mg PO qd
[tabs: 500, 1000 mg]
Herpes Simplex Infections in Immunocompromised
Host:
-Acyclovir (Zovirax) 15-30 mg/kg/day or 250-500
mg/m2/dose IV q8h for 7-14 days (infuse each dose
over 1 hr) or 500 mg/m2/dose PO 4-5 times daily.
Herpes Simplex Encephalitis:
-Acyclovir (Zovirax)
Birth-12 years: 60 mg/kg/day IV q8h
12 years: 30 mg/kg/day or 500 mg/m2/dose IV q8h
Infuse each dose over 1 hr.
Herpes Varicella Zoster:
-Acyclovir (Zovirax) 30 mg/kg/day or 500 mg/m2/dose
IV q8h for 10 days (infuse each dose over 1 hr).
-Famciclovir (Famvir)
Adolescents: 500 mg PO tid x 7 days
[tab: 125, 250, 500 mg]
Cytomegalovirus Infections:
-Ganciclovir (Cytovene) children 3 months-adults: 10
mg/kg/day IV q12h or 7.5 mg/kg/day IV q8h x 14-21
days, then maintenance 5 mg/kg/day IV qd or 6
mg/kg/day IV five days weekly
-May use oral maintenance therapy following IV
induction therapy
6 months-16 years: 30 mg/kg/dose PO q8h
16 years: 1000 mg PO q8h or 500 mg PO q3h while
awake given six times daily
[cap: 250, 500 mg; inj: 500 mg]
Toxoplasmosis gondii:
-Pyrimethamine (Daraprim) 2 mg/kg/day PO q12h x 3
days, then 1 mg/kg/day PO q12-24h x 4 weeks, max
25 mg/day [tab: 25 mg] and folinic acid 5-10 mg PO
q3 days [tabs: 5, 15, 25 mg] AND
-Sulfadiazine 100-200 mg/kg/day PO qid x 4 weeks,
max 8 gm/day [tab: 500 mg; extemporaneous
suspension]. Take with ample fluids.
Disseminated Histoplasmosis or Coccidiomycosis:
-Amphotericin B (Fungizone) 1 mg/kg/day IV qd over 2
4h for 6 weeks (see test dose and titration, page
50).
Mycobacterium Avium Complex (MAC):
-Azithromycin (Zithromax) 10-20 mg/kg/day PO qd,
max 500 mg [packet for oral soln: 1 gm; susp: 100
mg/5mL, 200 mg/5mL; tabs: 250, 500, 600 mg] AND
-Rifabutin (Mycobutin)
6-12 years: 5 mg/kg/day PO qd, max 300 mg/day
12 years: 300 mg/day PO qd
[cap: 150 mg] OR
-Ethambutol (Myambutol) 15-25 mg/kg/day PO qd, max
1 gm /day [tab: 100, 400 mg] OR
-Rifampin (Rifadin) 10-20 mg/kg/day PO q12-24h, max
600 mg/day [caps: 150, 300 mg; extemporaneous
suspension].
Single-drug therapy results in frequent development of
MAC antimicrobial resistance. Patients with HIV
should continue treatment at full therapeutic doses
for life.
Appendicitis
1. Admit to:
2. Diagnosis: Appendicitis.
3. Condition: Guarded.
4. Vital signs: Call MD if:
5. Activity:
6. Nursing: Inputs and outputs, daily weights; cooling
measures prn temp 38°C. Age appropriate pain
scale.
7. Diet:
8. IV fluids: Isotonic fluids at maintenance rate.
9. Special medications:
-Ampicillin 100 mg/kg/day IV/IM q6h, max 12 gm/day
AND
-Gentamicin (Garamycin):
30 days-5 years: 7.5 mg/kg/day IV/IM q8h.
5-10 years: 6.0 mg/kg/day IV/IM q8h.
10 years: 5.0 mg/kg/day IV/IM q8h AND
-Metronidazole (Flagyl) 30 mg/kg/day IV q6-8h, max 4
gm/day
OR (non-perforated)
-Cefotetan (Cefotan) 40-80 mg/kg/day IM/IV q12h,
max 6 gm/day OR
-Cefoxitin (Mefoxin) 100 mg/kg/day IM/IV q6-8h, max
12 gm/day
10. Symptomatic medications:
-Ibuprofen 5-10 mg/kg/dose PO q6-8h prn OR
-Acetaminophen 15 mg/kg PO/PR q4h prn temp
38°C or pain.
11. Extras and X-rays: Abdominal ultrasound,
abdominal X-ray series.
12. Labs: CBC, SMA 7, blood culture and sensitivity,
antibiotic levels.
Bite Wounds
1. Admit to:
2. Diagnosis: Bite Wound.
3. Condition: Guarded.
4. Vital signs: Call MD if:
5. Activity:
6. Nursing: Cooling measures prn temp 38°C, age
appropriate pain scale.
7. Diet:
8. IV fluids: D5 NS at maintenance rate.
9. Special medications:
-Initiate antimicrobial therapy for: moderate/severe bite
wounds, especially if edema or crush injury is
present; puncture wounds, especially if bone, tendon
sheath, or joint penetration may have occurred; facial
bites; hand and foot bites; genital area bites; wounds
in immunocompromised or asplenic patients.
Dog Bites and Cat Bites:
Most likely organisms: Pasteurella sp, Staph aureus,
Streptococci, anaerobes, Capnocytophaga, Moraxella,
Corynebacterium, Neisseria.
See antibiotic doses at the end of this section.
Oral: amoxicillin/clavulanate
Oral, penicillin allergic: extended-spectrum
cephalosporins or trimethoprim-sulfamethoxazole
plus clindamycin
IV: ampicillin-sulbactam
IV, penicillin allergic: extended-spectrum
cephalosporins or trimethoprim-sulfamethoxazole plus
clindamycin
Reptile Bites:
Most likely organisms: enteric gram negatives,
anaerobes.
Oral: amoxicillin-clavulanate
Oral, penicillin allergic: extended-spectrum
cephalosporins or trimethoprim-sulfamethoxazole plus
clindamycin
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