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Gram Positive Bacteria
1] Bacillus anthracis
2] Bacillus cereus
3] Bacillus subtilis
Ubiquitous gram-positive, rod-shaped bacteria that can be obligate aerobes or facultative anaerobes, and test positive for the enzyme catalase.
Bacillus are known to form intracellular inclusions of polyhydroxyalkanoates under certain environmental conditions.
Two Bacillus species are considered medically significant: B. anthracis, which causes anthrax, and B. cereus, which causes a foodborne illness similar to that of Staphylococcus.
B. subtilis: notable food spoiler, causing ropiness in bread and related food.
Microscopic examination: Bacillus cells appear as rods, and a substantial portion usually contain an oval endospore at one end, making it bulge.
: The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions. Generally, the most common agents/regimens are listed first. Listed dosages may need to be adjusted for renal dysfunction.
Bacillus cereus and Bacillus subtilis
600mg IV every 6 or 8 hours or 300mg orally four times daily
500mg - 750 mg IV/PO once daily
Moxifloxacin 400mg orally/IV qd
250-500 mg orally or 200-400mg IV q12h.
500mg po q12h
Chloramphenicol 50-100 mg/kg/day in divided doses every 6 hours (Maximum daily dose is 4 grams e.g. 1 gram q6h)
Linezolid 600 mg orally or IV q12h
4 - 6 mg/kg IV once daily. NOT FOR PNEUMONIA
Tigecycline 100 mg IV x 1, then 50 mg q12h
500mg IV every 6 hours.
Infectious Disease Section References
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Baden LR, Eisenstein BI.Impact of Antibiotic Resistance on the Treatment of Gram-negative Sepsis. Curr Infect Dis Rep. 2000 Oct;2(5):409-416.
Bartlett JG et al. Community-acquired pneumonia in adults: guidelines for management. Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 1998;26:811-38.
Bartlett JG: Empirical therapy of community-acquired pneumonia: macrolides are not ideal choices. Semin Respir Infect 1997 Dec; 12(4): 329-33
Bartlett JG.1998 Pocket Book of Infectious Disease Therapy., Ninth Edition. Baltimore,MD: Williams&Wikins,1998.
Bernstein JM: Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America. Chest 1999 Mar; 115(3 Suppl): 9S-13S
Brown SM, Jones BE, Jephson AR, Dean NC. Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med. Dec 2009;37(12):3010-6.
CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2006. fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6.
CDC. Centers for Disease Control and Prevention. 2010 STD Treatment Guidelines.
Cunha BA. Antibiotic Essentials 8th.ed. Jones & Bartlett Learning, 2009.
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Gilbert DN, Moellering Jr RC, Eliopoulos GM, et al ed. The Sanford Guide to Antimicrobial Therapy, 40th ed. Sperryville, VA: Antimicrobial Therapy; 2010.
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Gonzales R, Sande M: What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet 1995 Mar 18; 345(8951): 665-6
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