ANTIBIOTIC ESSENTIALS

Fourteenth Edition

Edited by

Burke A. Cunha, MD, MACP

Chief, Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

Professor of Medicine

State University of New York

School of Medicine

Stony Brook, New York

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Antibiotic Essentials

Fourteenth Edition:  2015

ISBN  978-93-5152-850-0

Printed at

ABOUT THE EDITOR

Burke A. Cunha, MD, MACP, is Chief, Infectious Disease Division at Winthrop-University Hospital, Mineola, New York; Professor of Medicine, State University of New York School of Medicine, Stony Brook, New York; and is one of the world’s leading authorities on infectious diseases. During his career, he has written/edited over 1250 articles, 200 book chapters, and 30 books on infectious diseases. He has received numerous teaching awards, including the Aesculapius Award for teaching excellence and the Spatz Award for clinical excellence and teaching excellence. Dr. Cunha is a Fellow of the Infectious Disease Society of America, American Academy of Microbiology,­ American­ College of Clinical Pharmacology, Surgical Infection Society, American College of Chest Physicians and Society of Hospital Epidemiologists of America. He has had a long interest in clinical syndromic diagnosis, diagnostic reasoning, antimicrobial therapy and resistance, atypical pneumonias, surgical infections, infections in compromised hosts, zoonoses, FUOs, meningitis and encephalitis, endocarditis, and nosocomial infections. Dr. Cunha is a Master of the American College of Physicians, awarded for lifetime achievement as a Master Clinician and Master Teacher of Infectious Diseases.

DEDICATION

for Marie

“Grace in her steps, Heaven in her eye,

In every gesture, dignity and love”

Milton

iv	A n t i b i o t i c E s s e n t i a l s

TABLE OF CONTENTS

1. OVERVIEW OF ANTIMICROBIAL
THERAPY	1
Factors in Antibiotic Selection....................................	2
Spectrum............................................................................	2
Tissue Penetration.........................................................	2
Antibiotic Resistance...................................................	2
Safety Profile.....................................................................	4
Cost........................................................................................	4
Factors in Antibiotic Dosing........................................	4
Dosing in Renal/Hepatic Insufficiency.............	5
Routes of Elimination (Renal and Hepatic)....	5
Microbiology and Susceptibility Testing..............	6
In Vitro vs. In Vivo Susceptibility...........................	7
PK/PD and Other Considerations in
Antimicrobial Therapy....................................................	9
Bactericidal vs. Bacteriostatic Therapy..............	9
Monotherapy vs. Combination Therapy.........	9
Intravenous vs. Oral Switch Therapy...............	10
Bioavailability of Oral Antibiotics......................	11
OPAT....................................................................................	11
Duration of Therapy..................................................	11
Empiric vs. Specific Antibiotic Therapy .............	12
Positive Blood Cultures vs. Bacteremia
(MSSA, MRSA, CoNS)................................................	13
Drug Fever...........................................................................	13
Relative Bradycardia.......................................................	14
Antibiotic Failure..............................................................	14
Pitfalls in Antibiotic Prescribing..............................	15
2. EMPIRIC THERAPY BASED ON CLINICAL
SYNDROME	17
CNS Infections
Acute Bacterial Meningitis.........................................	18
Acute Nonbacterial/Chronic Meningitis...........	21
Encephalitis.........................................................................	25
Brain Abscess/Subdural Empyema/
Cavernous Vein Thrombosis/Intracranial
Suppurative Thrombophlebitis.........................	27
HEENT Infections
Facial/Periorbital Cellulitis..........................................	29
Bacterial Sinusitis.............................................................	30
Keratitis..................................................................................	31
Conjunctivitis.....................................................................	32
Chorioretinitis....................................................................	34
Endophthalmitis...............................................................	35
External Otitis.....................................................................	37

Acute Otitis Media..........................................................				38
Mastoiditis............................................................................				39
Suppurative Parotitis.....................................................				40
Pharyngitis...........................................................................				40
Thrush (Oropharyngeal Candidiasis)...................				43
Mouth Ulcers/Vesicles..................................................				44
Deep Neck Infections, Lemierre’s
Syndrome, Severe Dental Infections.............				46
Epiglottitis............................................................................				47
Lower Respiratory Tract Infections
Acute Bacterial Exacerbation of
Chronic Bronchitis.......................................................				48
Mediastinitis........................................................................				49
Community-Acquired Pneumonia.......................				49
Zoonotic Atypical Pneumonia................................				60
Lung Abscess/Empyema............................................				67
Nursing Home-Acquired Pneumonia.................				68
Nosocomial Pneumonia.............................................				68
Cardiovascular Infections
Subacute Bacterial Endocarditis............................				70
Acute Bacterial Endocarditis.....................................				74
Prosthetic Valve Endocarditis...................................				76
Pericarditis/Myocarditis...............................................				78
Central IV Line/Pacemaker Infections.................				79
Vascular Graft Infections.............................................				82
Gastrointestinal Tract Infections
Esophagitis	..........................................................................			84
Peptic Ulcer Disease......................................................				85
Gastric Perforation..........................................................				85
Diarrhea/Typhoid (Enteric) Fever..............................				86
Cholecystitis........................................................................				92
Cholangitis...........................................................................				93
Gallbladder Wall Abscess/Perforation................				93
Acute Pancreatitis............................................................				94
Pancreatic Abscess/Infected Pancreatic
Pseudocyst­ .....................................................................				95
Liver Abscess......................................................................				95
Hepatosplenic Candidiasis........................................				96
Granulomatous Hepatitis...........................................				96
Viral Hepatitis.....................................................................				97
Intraabdominal or Pelvic Peritonitis/­
Abscess (Colitis, Appendicitis,­
Diverticulitis,­			Septic Pelvic ­
Thrombophlebitis, Spontaneous
Bacterial­	Peritonitis, CAPD-Associated
Peritonitis,­		TB Peritonitis)....................................		100

Table of Contents

v

Genitourinary Tract Infections
Dysuria-Pyuria Syndrome........................................		103
Cystitis..................................................................................		103
Catheter-Associated Bacteriuria/Candiduria.......		104
Epididymitis.....................................................................		106
Acute Pyelonephritis..................................................		107
Chronic Pyelonephritis..............................................		108
Renal TB..............................................................................		108
Renal Abscess (Intrarenal/Perinephric)...........		109
Prostatitis/Prostatic Abscess..................................		110
Urosepsis............................................................................		111
Pelvic Inflammatory Disease, Salpingitis,
Tuboovarian­	Abscess, Endometritis/­
Endomyometritis, Septic Abortion..............		113
Sexually Transmitted Diseases
Urethritis/Cervicitis........................................................		114
Vaginitis/Balanitis...........................................................		115
Genital Vesicles................................................................		116
Genital Ulcers....................................................................		117
Suppurating Inguinal Adenopathy.....................		118
Genital/Perianal Warts.................................................		118
Syphilis..................................................................................		119
Bone and Joint Infections
Septic Arthritis/Bursitis...............................................		121
Lyme Disease/Lyme Arthritis..................................		127
Infected Joint Prosthesis............................................		128
Osteomyelitis....................................................................		129
Skin and Soft Tissue Infections
Cellulitis, Erysipelas, Mastitis....................................		132
Complicated Skin/Skin Structure
Infections (cSSSIs).....................................................		134
Skin Ulcers...........................................................................		137
Skin Abscesses/Infected Cysts (Skin
Pustules/Boils, Furunculosis)..............................		140
Skin Vesicles (Non-Genital).......................................		142
Wound Infections...........................................................		144
Superficial Fungal Infections Skin/Nail.............		147
Skin Infestations..............................................................		150
Ischiorectal/Perirectal Abscess...............................		151
Sepsis/Septic Shock		151
Febrile Neutropenia		158
Transplant Infections
Bacteremia..........................................................................		160
Candidemia........................................................................		161
CMV/HHV-6/BK Virus....................................................		162
EVB/PTLD.............................................................................		163
RSV...........................................................................................		163
Adenovirus.........................................................................		163
Encephalitis/Meningitis..............................................		164

Brain Abscess/Mass Lesions.....................................		164
Focal/Segmental Pulmonary
Infiltrates.........................................................................		165
Diffuse Pulmonary Infiltrates...................................		165
Viral Hepatitis....................................................................		166
Toxin-Mediated Infectious Diseases
Toxic Shock Syndrome................................................		169
Botulism...............................................................................		170
Tetanus..................................................................................		170
Diphtheria...........................................................................		170
Bioterrorist Agents
Anthrax.................................................................................		173
Tularemia Pneumonia.................................................		173
Pneumonic Plague........................................................		174
Botulism...............................................................................		174
Smallpox..............................................................................		174
Ebola.......................................................................................		174
3. ANTIBIOTIC SUSCEPTIBILITY PROFILES
AND INITIAL THERAPY­	OF ISOLATES
PENDING SUSCEPTIBILITYRESULTS		185
Antibiotic Susceptibility Profiles (Penicillins,
Macrolides, Tetracyclines, and Others).........		186
Antibiotic Susceptibility Profiles
(Cephalosporins).......................................................		191
Antibiotic Susceptibility Profiles
(Aminoglycosides, Fluoroquinolones,
Carbapenems, and Others).................................		198
Gram Stain Characteristics of Isolates (by
Morphology Arrangement,
Oxygen Requirements).........................................		203
Alphabetical Index of Isolates.................................		205
Key Factors in Antibiotic Selection (Isolate
Known)............................................................................		207
Antibiotic Resistance Potential..............................		207
Aerobic Isolates...............................................................		208
Capnophilic Isolates......................................................		235
Anaerobic Isolates..........................................................		236
Yeast/Fungi.........................................................................		242
Gram Stain/Giemsa Stain Technique..................		246
CSF Gram Stain................................................................		246
Sputum Gram Stain.......................................................		248
Urine Gram Stain.............................................................		248
Fecal Gram Stain.............................................................		249
4. PARASITES, FUNGI, UNUSUAL ­
ORGANISMS		253
Blood Pathogens
Microfilaria in Blood......................................................		254
Trypanosomes in Blood..............................................		255
Spirochetes in Blood....................................................		257
Intracellular Inclusion Bodies in Blood..............		258

vi	A n t i b i o t i c E s s e n t i a l s

CSF/Brain Pathogens
Cysts/Mass Lesions in CSF/Brain...........................	261
Lung Pathogens
Pulmonary Cystic Lesions/Masses.......................	265
Pulmonary Coin Lesions............................................	266
Pulmonary Infiltrates/Mass Lesions.....................	267
Heart Pathogens
Chagas’ Disease................................................................	273
Liver Pathogens
Liver Flukes.........................................................................	273
Cystic Masses in Liver...................................................	274
Hepatomegaly.................................................................	275
Stool/Intestines Pathogens
Intestinal Protozoa.........................................................	276
Intestinal Nematodes (Roundworms)...............	278
Intestinal Cestodes (Tapeworms).........................	281
Intestinal Trematodes
(Flukes/Flatworms)...................................................	282
Other Intestinal Infections........................................	282
Skin/Muscle Pathogens
Infiltrative Skin/Subcutaneous­ Lesions...........	283
Infiltrative Skin Lesions ± Ulcers/Sinus
Tracts/Abscesses......................................................	284
Skin Vesicles/Bullae......................................................	288
Subcutaneous Serpiginous Lesions..................	288
Skin Papules/Nodules/Abscesses.......................	289
Rickettsia (Fever/Petechial Skin Rash)..............	294
Other Skin Lesions.......................................................	297
Myositis...............................................................................	298
5. HIV INFECTION	301
Overview ..........................................................................	302
Stages of HIV Infection..............................................	303
Acute (Primary) HIV Infection................................	304
Approach to HIV Testing..........................................	305
Initial Assessment of HIV Patients...............................	308
Indications for Treatment of HIV
Infection........................................................................	312
Antiretroviral Treatment...........................................	313
Antiretroviral Treatment Failure...........................	316
Opportunistic Infections in HIV Disease.........	319
Treatment of Opportunistic Infections...........	323
Treatment of Other Opportunistic
Infections in HIV.......................................................	338
HIV Coinfections (HBV/HCV)..................................	344
6. PROPHYLAXIS AND
IMMUNIZATIONS	353
Surgical Prophylaxis....................................................	354
Post-Exposure Prophylaxis......................................	358

Chronic Medical Prophylaxis/Suppression.........	364
HIV Pre-Exposure Prophylaxis (PrEP)........................	365
HIV Post-Exposure Prophylaxis (PEP).......................	366
HIV Opportunistic Infections.........................................	366
Transplant Prophylaxis........................................................	367
Endocarditis Prophylaxis..........................................	369
Travel Prophylaxis.........................................................	371
Malaria Prophylaxis......................................................	375
Tetanus Prophylaxis.....................................................	377
Immunizations...............................................................	378
7. PEDIATRIC INFECTIOUS DISEASES
AND PEDIATRIC DRUG
SUMMARIES	386
CNS Infections...............................................................	387
HEENT Infections.........................................................	391
Lower Respiratory Tract Infections...................	396
Vascular Infections......................................................	402
Gastrointestinal Infections.....................................	403
Bone and Joint Infections......................................	407
Skin and Soft Tissue Infections...........................	411
Common Pediatric Antimicrobial Drugs........	414
8. CHEST X-RAY ATLAS	425
Unilateral Focal Segmental/Lobar Infiltrate ­
Without Effusion.....................................................................	426
Unilateral Focal Segmental/Lobar
Infiltrate With Effusion........................................	431
Unilateral Ill-Defined Infiltrates Without
Effusion .......................................................................	436
Unilateral Ill-Defined Infiltrates With
Effusion .................................................................................	443
Bilateral Infiltrates Without Effusion ...............	448
Bilateral Infiltrates With Effusion .......................	458
Cavitary Infiltrates (Thick-Walled) ....................	463
Cavitary Infiltrates (Thin-Walled) ......................	470
9. INFECTIOUS DISEASE DIFFERENTIAL
DIAGNOSIS	474
10. ANTIBIOTIC PEARLS & PITFALLS	507
11. ANTIMICROBIAL DRUG SUMMARIES	521
APPENDIX	720
INDEX	731
COLOR ATLAS OF CSF, SPUTUM, AND
URINE GRAM STAINS & FUNGAL STAINS

vii

	EDITORS
Burke A. Cunha, MD, MACP	Cheston B. Cunha, MD
Editor	Associate Editor

CONTRIBUTORS

Burke A. Cunha, MD, MACP

Chief, Infectious Disease Division Winthrop-University Hospital Mineola, New York

Professor of Medicine

State University of New York School of Medicine

Stony Brook, New York

All chapters except HIV Infection & Pediatric ID

Jeffrey Baron, PharmD

Clinical Pharmacist

Winthrop-University Hospital

Mineola, New York

HBV, HCV, and HIV Guidelines

Antimicrobial Drug Summaries

Edward J. Bottone, PhD

Professor of Medicine

Professor of Microbiology

Professor of Pathology

Mount Sinai

School of Medicine

New York, New York

Medical Microbiology; Parasites,

Fungi, Unusual Organisms

John L. Brusch, MD

Associate Chief of Medicine

Cambridge Health Alliance

Infectious Disease Service

Cambridge Health Alliance

Medical Director, Somerville Hospital

Assistant Professor of Medicine

Harvard Medical School

Boston, Massachusetts

Endocarditis: Therapy & Prophylaxis

Cheston B. Cunha, MD

Director, Antibiotic Stewardship Program

Rhode Island Hospital and The Miriam Hospital

Infectious Disease Division

Assistant Professor of Medicine

Brown University Alpert School of Medicine

Providence, Rhode Island

Infectious Disease Differential Diagnosis

Overview of Antimicrobial Therapy

Empiric Therapy Based of Clinical Syndromes

Antimicrobial Drug Summaries

Daniel Caplivski, MD

Infectious Disease Division

Assistant Professor of Medicine

Mt. Sinai School of Medicine

New York, New York

Fungal Stain Atlas

Dennis J. Cleri, MD

St. Francis Medical Center

Professor of Medicine

Seton Hall University

School of Graduate Medical Education

Trenton, New Jersey

Bioterrorism

Staci A. Fischer, MD

Director, Transplant Infectious Diseases

Rhode Island Hospital

Infectious Disease Division

Associate Professor of Medicine

Brown University Alpert School of Medicine

Providence, Rhode Island

Transplant Infections: Therapy & Prophylaxis

viii	A n t i b i o t i c E s s e n t i a l s

Pierce Gardner, MD

Senior Advisor, Clinical Research and Training National Institutes of Health

John E. Fogarty International Center for Advanced Study in the Health Sciences Bethesda, Maryland

Prophylaxis and Immunization

Arthur Gran, MD

Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

State University of New York

School of Medicine

Stony Brook, New York

Antimicrobial Drug Summaries

Jean E. Hage, MD

Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

State University of New York

School of Medicine

Stony Brook, New York

Empiric Therapy of Clinical Syndromes;

Prophylaxis & Immunization;

Parasitic & Fungi; Unusual Organisms;

Antimicrobial Drug Summaries

Mark H. Kaplan, MD

Professor of Medicine

Infectious Diseases

University of Michigan School of Medicine

Ann Arbor, Michigan

HIV Drug Summaries

Douglas S. Katz, MD

Vice Chairman, Clinical Research and Education

Director, Body CT

Winthrop-University Hospital

Mineola, New York

Professor of Clinical Radiology

State University of New York School of Medicine­

Stony Brook, New York

Chest X-ray Atlas

Raymond S. Koff, MD

Clinical Professor of Medicine

University of Connecticut School of Medicine

Farmington, Connecticut

Viral Hepatitis: Therapy & Prophylaxis

Leonard R. Krilov, MD

Chief, Pediatric Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

Professor of Pediatrics

State University of New York

School of Medicine

Stony Brook, New York

Pediatric Infectious Diseases

David W. Kubiak, PharmD

Infectious Disease Clinical Pharmacist

Brigham and Women’s Hospital

Boston, Massachusetts

Antiretroviral Drug Summaries

Brian R Malone, BS, MS, RPh

Director, Pharmaceutical Services

Winthrop-University Hospital

Mineola, New York

Adjunct Affiliate Professor

College of Pharmacy St. John’s University

Queens, New York

Pediatric Drug Summaries

George H. McCracken, Jr., MD

Distinguished Professor of Pediatric Infectious

Disease and the Sarah M. and Charles E. Seay

Chair in Pediatric Infectious Disease

University of Texas Southwestern Medical Center

Dallas, Texas

Pediatric Infectious Diseases

James H. McGuire, MD

Master Clinician

Division of Infectious Diseases

Brigham and Women’s Hospital

Professor of Medicine

Harvard Medical School

Boston, Massachusetts

Parasites, Fungi, Unusual Organisms

Nardeen Mickail, MD

Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

State University of New York

School of Medicine, Stony Brook, New York

Antimicrobial Drug Summaries

Contributors

ix

Maria D. Mileno, MD

Director, Travel Medicine

The Miriam Hospital

Infectious Disease Division

Associate Professor of Medicine

Brown University Alpert School of Medicine

Providence, Rhode Island

Prophylaxis and Immunizations

Robert Moore, MD

Chairman, Department of Radiology

Stony Brook University Hospital

Professor of Radiology

State University of New York School of Medicine

Stony Brook, New York

Chest X-ray Atlas

Sigridh Muñoz-Gomez, MD

Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

State University of New York

School of Medicine

Stony Brook, New York

Antimicrobial Drug Summaries

Ronald L. Nichols, MD

William Henderson Professor of Surgery

Professor of Microbiology and Immunology

Tulane University School of Medicine

New Orleans, Louisiana

Surgical Prophylaxis and Therapy

Genovefa Papanicolaou, MD

Attending Physician, Infectious Disease Service

Memorial Sloan Kettering Cancer Center

Associate Professor of Medicine

Weill Cornell Medical College

New York, New York

Transplant Infections: Therapy & Prophylaxis

Muhammed Raza, MBBS

Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

State University of New York

School of Medicine

Stony Brook, New York

Antimicrobial Drug Summaries

Michael F. Rein, MD

Professor of Medicine (Emeritus)

University of Virginia Health System

Charlottesville, Virginia

Sexually Transmitted Diseases

John H. Rex, MD

Adjunct Professor of Medicine University of Texas Medical School Houston, Texas

Vice-President

Medical Director for Infection AstraZeneca Pharmaceuticals Macclesfield, UK

Antifungal Therapy

Paul E. Sax, MD

Clinical Director

Division of Infectious Diseases and HIV

Division of Infectious Diseases

Brigham and Women’s Hospital

Associate Professor of Medicine

Harvard Medical School

Boston, Massachusetts

HIV Infection

David Schlossberg, MD

Tuberculosis Control Program

Philadelphia Department of Health

Professor of Medicine

Temple University School of Medicine

Philadelphia, Pennsylvania

Tuberculosis

Paul E. Schoch, PhD

Director

Clinical Microbiology Laboratory

Winthrop-University Hospital

Mineola, New York

Medical Microbiology and Gram

Stains Atlas

Daniel S. Siegal, MD

Department of Radiology

Mount Auburn Hospital

Harvard Medical School

Boston, Massachusetts

Chest X-ray Atlas

x	A n t i b i o t i c E s s e n t i a l s

Stephanie Strollo, MD

Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

State University of New York

School of Medicine

Stony Brook, New York

Initial Therapy of Isolates Pending

Susceptibility Testing

Uzma Syed, DO

Infectious Disease Division

Winthrop-University Hospital

Mineola, New York

State University of New York

School of Medicine

Stony Brook, New York

Initial Therapy of Isolates Pending

Susceptibility Testing

Damary C. Torres, PharmD

Clinical Pharmacy Specialist

Winthrop-University Hospital

Mineola, New York

Associate Clinical Professor

College of Pharmacy St. John’s University

Queens, New York

Antimicrobial Drug Summaries

Kenneth F. Wagner, DO

Infectious Disease Consultant

National Naval Medical Center

Associate Professor of Medicine

Uniformed Services, University of

the Health Sciences

F. Edward Hebert School of Medicine

Bethesda, Maryland

Parasites, Fungi, Unusual Organisms

xi

ACKNOWLEDGMENTS

I would like to thank the many contributors who graciously contributed their time and energy; and especially Mark Freed, MD, past President and Editor-in-Chief of Physicians’Press, for his vision, commitment, and guidance.

Burke A. Cunha, MD

NOTICE

The clinical recommendations set forth in this book are those of the authors and are offered as general guidelines, not specific instructions for individual patients. Clinical judgement should always guide the physician in the selection, dosing, and duration of antimicrobial therapy for individual patients.

Not all recommendations in this book are approved indications by the U.S. Food and Drug Administration, and antimicrobial recommendations are not limited to indications in the package insert. The use of any drug should be preceded by careful review of the package insert, which provides indications and dosing approved by the U.S. Food and Drug Administration.

The information provided in this book is essential not exhaustive, and the reader is referred to other medical references and the manufacturer’s product literature for further information. Clinical use of the information provided and any consequences that may arise from its use is the responsibility of the prescribing physician. The authors, editors, and publisher do not warrant or guarantee the information herein contained and do not assume and expressly disclaim any liability for errors or omissions or any consequences that may occur from use of this information.

BASIS OF RECOMMENDATIONS

The therapeutic recommendations in Antibiotic Essentials are based on the contributors’ clinical expertise and experience as well as the literature and clinical guidelines.

xii	A n t i b i o t i c E s s e n t i a l s

ABBREVIATIONS

ABE	acute bacterial endocarditis
ABM	acute bacterial meningitis
ADA	adenosine deaminase
AFB	acid fast bacilli
AIH	autoimmune lupoid hepatitis
AIHA	autoimmune hemolytic anemia
AML	acute myelogenous leukemia
ANA	antinuclear antibody
ARDS	adult respiratory distress syndrome
AG	Aspergillus galactomannan
A-V	atrio-ventricular
β-lactams	penicillins, cephalosporins,
	cephamycins (not monobactams or
	carbapenems)
BAL	bronchoalveolar lavage
BG	b 1, 3 D-glucan
BMT	bone marrow transplant
BPH	benign prostatic hypertrophy
CAB	catheter associated bacteriuria
CABG	coronary artery bypass grafting
CAC	catheter associated candiduria
CAH	chronic active hepatitis
CA-MRSA	community-acquired MRSA
CAP	community-acquired pneumonia
CD4	CD4 T-cell lymphocyte
CE	California encephalitis virus
CFS	chronic fatigue syndrome
CGD	chronic granulomatous disease
CIE	counter-immunoelectrophoresis
CLL	chronic lymphocytic leukemia
CML	chronic myelogenous leukemia
CMV	Cytomegalovirus
CNS	central nervous system
CO-MRSA	community onset MRSA
CoNS	coagulase negative staphylococci
CPH	chronic persistent hepatitis
CPK	creatine phosphokinase
CrCl	creatinine clearance
CRE	carbapenemase resistant
	Enterobacteriaceae
CSD	cat scratch disease
CSF	cerebrospinal fluid
CT	computerized tomography
CVA	costovertebral angle
CVC	central venous catheter
CVID	common variable immune deficiency
CVVH	continuous veno venous
	hemo filtration
CXR	chest x-ray
DFA	direct fluorescent antibody

DI	diabetes insipidus
DIC	disseminated intravascular coagulation
DM	diabetes mellitus
DOT	directly observed therapy
e.g.	for example
EBV	Ebstein-Barr virus
EEE	Eastern equine encephalitis
EEG	electroencephalogram
EIA	enzyme immunoassay
ELISA	enzyme-linked immunosorbent assay
EM	erythema migrans
EMB	ethambutol
Enterobacteriaceae: Citrobacter, Edwardsiella,
	Enterobacter, E. coli, Klebsiella,
	Proteus, Providencia, Shigella,
	Salmonella,­	Serratia, Hafnia,
	Morganella, Yersinia
ESBLs	extended spectrum β-lactamases
esp	especially
ESR	erythrocyte sedimentation rate
ESRD	end-stage renal disease
ET	endotracheal
EV	enterovirus
EVD	external ventricular drain
FTA-ABS	fluorescent treponemal
	antibody absorption test
FUO	fever of unknown origin
G6PD	glucose-6-phosphate dehydrogenase
GC	gonococcus/gonorrhea
GCA	giant cell arteritis
GI	gastrointestinal
gm	gram
GU	genitourinary
GVHD	graft versus host disease
HA-MRSA	hospital acquired MRSA
HAP	hospital acquired pneumonia
HAV	hepatitis A virus
HBcAb	hepatitis B core antibody
HBoV	human bocavirus
HBsAg	hepatitis B surface antigen
HBV	hepatitis B virus
HCV	hepatitis C virus
HD	hemodialysis
HDV	hepatitis D virus
HEV	hepatitis E virus
HFHD	high flux hemodialysis
HFV	hepatitis F virus
HFM	hand foot mouth disease

Abbreviations

xiii

HGA	human granulocytic anaplasmosis
HHV-6,7,8	human herpes virus 6,7,8
HME	human monocytic ehrlichiosis
hMPV	human metapneumovirus
HPS	Hanta virus pulmonary syndrome
HPV	human papilloma virus
HTLV-1	human T-cell leukemia virus
HRIG	human rabies immune globulin
HSV	herpes simplex virus
I & D	incision and drainage
IFA	immunofluorescent antibody
IgA	immunoglobulin A
IgG	immunoglobulin G
IgM	immunoglobulin M
IM	intramuscular
INH	isoniazid
IP	intraperitoneal
IT	intrathecal
ITP	idiopathic thrombocytopenic purpura
IV	intravenous
IV/PO	IV or PO
IVDA	intravenous drug abuser
IVIG	intravenous immunoglobulin
JE	Japanese encephalitis
kg	kilogram
L	liter
LCM	lymphocytic choriomeningitis
LDH	lactate dehydrogenase
LFTs	liver function tests
LGV	lymphogranuloma venereum
MAI	Mycobacterium avium-intracellulare
MCD	multicentric Castleman’s disease
mcg	microgram
mcL	microliter
MDR	multidrug resistant
MDRSP	multidrug resistant S. pneumoniae
MERS	middle east respiratory syndrome
mg	milligram
mL	milliliter
MIC	minimum inhibitory concentration
min	minute
MMR	measles, mumps, rubella
MPD	myeloprolifevative disorder
MRI	magnetic resonance imaging
MRSA	methicillin-resistant S. aureus
MRSE	methicillin-resistant S. epidermidis
MS	multiple sclerosis
MSSA	methicillin-sensitive S. aureus
MSSE	methicillin-sensitive S. epidermidis
MTT	methlytetrathiazole
MU	million units
MVP	mitral valve prolapse
NDM	New Delhi metallo-β-lactamase
NHAP	nursing home acquired pneumonia

NNRTI	non-nucleoside reverse
NP	transcriptase inhibitor
	nosocomial pneumonia
NRTI	nucleoside reverse
	transcriptase inhibitor
NSAIDs	nonsteroidal anti-inflammatory drugs
OI	opportunistic infection
OPAT	outpatient parenteral antibiotic therapy
PAN	polyarteritis nodosa
PBC	primary biliary cirrhosis
PBS	protected brush specimen
PCEC	purified chick embryo cells
PCN	penicillin
PCP	Pneumocystis (carinii) jiroveci
	pneumonia
PCR	polymerase chain reaction
PD	peritoneal dialysis
PDA	patent ductus arteriosus
PE	Powassan encephalitis
PEP	post-exposure prophylaxis
PI	protease inhibitor
PID	pelvic inflammatory disease
PML	progressive multifocal leukoencephalopathy
PMN	polymorphonuclear leucocytes
PO	oral
PPD	tuberculin skin test
PPIs	proton pump inhibitors
PPNG	penicillinase-producing N. gonorrhoeae
PTBM	partially treated bacterial meningitis
PVE	prosthetic valve endocarditis
PVL	Panton-Valentine leukocidin
PZA	pyrazinamide
q__d	every __ days
q__h	every __ hours
q month	once a month
q week	once a week
RA	rheumatoid arthritis
RBC	red blood cells
RE	regional ileitis (Crohn’s disease)
RMSF	rocky mountain spotted fever
RSV	respiratory syncytial virus
RUQ	right upper quadrant
RVA	rabies vaccine absorbed
SARS	severe acute respiratory syndrome
SBE	subacute bacterial endocarditis
SCID	severe combined immune deficiency
SGOT/SGPT	serum transaminases
SLE	systemic lupus erythematosus
St. LE	Saint Louis encephalitis
SOT	solid organ transplant
sp.	species
SPB	spontaneous bacterial peritonitis
SPEP	serum protein electrophoresis
SQ	subcutaneous
STD	sexually transmitted diseases
TA	temporal arteritis
TAA	teichoic acid antibody titers

xiv	A n t i b i o t i c E s s e n t i a l s

	TAH/BSO	total abdominal hysterectomy/bilateral	VA
		salpingoophorectomy	VAP
	TB	M. tuberculosis	VCA
	TDF	tenofovir disoproxil fumarate	VEE
	TEE	transesophageal echocardiogram
			VISA
	TEN	toxic epidermal necrolysis
			VLM
	TID	three times per day
			VP
	TMP	trimethoprim
			VRE
	TMP–SMX	trimethoprim-sulfamethoxazole
			VRSA
	TPN	total parenteral nutrition
			VSE
	TRNG	tetracycline-resistant N.gonorrhoeae
			VZV
	TSS	toxic shock syndrome
			WBC
	TTE	transthoracic echocardiogram
			WEE
	TTP	thrombotic thrombocytopenic purpura
	TURP	transurethral resection of prostate	WNE
	UC	ulcerative colitis	XMRV
			yrs
	UTI	urinary tract infection

ventriculoatrial

ventilator associated pneumonia viral capsid antigen

Venezuelan equine encephalitis virus vancomycin intermediate S. aureus visceral larval migrans ventriculoperitoneal

vancomycin resistant enterococci vancomycin resistant S. aureus vancomycin-sensitive enterococci varicella zoster virus

white blood cells

western equine encephalitis west nile encephalitis

xenotropic murine leukemia related virus years