Package Insert SEARCH
Medical calc categories
New Drug Approvals
Google Site SEARCH
Arterial Blood Gas (ABG) Analysis
Anion Gap / Serum Osmolality
Common Laboratory (LAB) Values
Conventional- S.I. Units
Cerebrospinal fluid analysis
Adult Treatment Panel III
Opioids - Equianalgesic Dosages
Clinical concerns - Geriatric Pts
Renal Dosing Protocols
Important equations (four)
Continuing Education Links
Guest book (old)
Consumer Links (old section)
About this site
Gram Positive Bacteria
(includes pathogenic and saprophytic species)
(36 known strains). Most common strains associated with Lyme disease:
1] Borrelia burgdorferi
2] Borrelia afzelii
3] Borrelia garinii
Spirochaete bacterium with subspecies that cause treponemal diseases such as syphilis, bejel, pinta and yaws.
Treponemes have a cytoplasmic and outer membrane.
Using light microscopy treponemes are only visible using Dark field illumination.
T. pallidum causes syphilis and is a motile spirochaete that is generally acquired by close sexual contact, entering the host via breaches in squamous or columnar epithelium.
The helical structure of T. pallidum pallidum allows it to move in a corkscrew motion through a viscous medium such as mucus. It gains access to host's blood and lymph systems through tissue and mucous membranes.
: 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.
Syphilis (primary, early latent): Less than one year.
Primary: ulcer or chancre at site of infection.
Secondary: rash, mucocutaneous lesions, adenopathy
Benzathine Penicillin G (Bicillin L-A) 2.4 million units IM as a single dose
PCN-allergic patients / alternatives: Ceftriaxone 1 gram IV/IM q24h x 10 - 14 days OR Doxycycline 100mg twice daily for 2 weeks OR Azithromycin 2000mg x 1 OR
Tetracycline 500mg four times daily for 2 weeks. Note: pregnant women should be treated with pcn (desensitize patient if necessary).
Syphilis (late, or greater than one year duration):
Benzathine Penicillin G 2.4 million units IM weekly x 3 doses
PCN-allergic patients / alternatives: Doxycycline 100mg twice daily for 28 days OR tetracycline 500mg orally four times daily for 28 days. Note: pregnant women should be treated with pcn (desensitize patient if necessary).
Neurosyphilis: (Desensitize penicillin allergic patients)
Penicillin G 3 to 4 million units q4h IV for 10-14 days
Alternative(s): Procaine penicillin 2.4 million units IM once daily PLUS probenecid 500 mg orally four times daily for 10-14 days.
Infectious Disease Section References
Anand N, Kollef MH. The alphabet soup of pneumonia: CAP, HAP, HCAP, NHAP, and VAP. Semin Respir Crit Care Med. Feb 2009;30(1):3-9.
Arnold FW, LaJoie AS, Brock GN, Peyrani P, Rello J, Menéndez R, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Arch Intern Med. Sep 14 2009;169(16):1515-24.
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.
Ewig S et al. Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med. 1999;159:1835-42.
Fang WF, Yang KY, Wu CL, Yu CJ, Chen CW, Tu CY, et al. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia. Crit Care. Jan 19 2011;15(1):R32.
File TM Jr. Community-acquired pneumonia: recent guidelines for therapy. J Respir Dis. 1999;20:534-41.
Gilbert DN, Moellering Jr RC, Eliopoulos GM, et al ed. The Sanford Guide to Antimicrobial Therapy, 40th ed. Sperryville, VA: Antimicrobial Therapy; 2010.
Gold HS, Moellering RC. Antimicrobial-drug resistance. N Engl J Med. 1996;335:1445-1453.
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
Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am 1997;11:551-581.
Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook. 20th ed. Hudson, OH: Lexi-Comp, Inc; 2011.
Lipsky BA, Berendt AR.Principles and practice of antibiotic therapy of diabetic foot infections. Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6.
Mandell LA , Wunderink RG , Anzueto A , et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults . Clin Infect Dis . 2007;44(suppl 2):S27–S72.
Mufson MA.Pneumococcal Pneumonia. Curr Infect Dis Rep. 1999 Apr;1(1):57-64.
Nabel EG, Federman DD. Infectious Diseases: The Clinician's Guide to Diagnosis, Treatment, and Prevention. Jackson, WY: Teton Data Systems, 2010.
Phua J, See KC, Chan YH, Widjaja LS, Aung NW, Ngerng WJ, et al. Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Thorax. Jul 2009;64(7):598-603.
Pirracchio R, Mateo J, Raskine L, Rigon MR, Lukaszewicz AC, Mebazaa A, et al. Can bacteriological upper airway samples obtained at intensive care unit admission guide empiric antibiotherapy for ventilator-associated pneumonia?. Crit Care Med. Sep 2009;37(9):2559-63.
Reese RE, Betts RF: A Practical Approach to Infectious Diseases. 4th ed. Boston: Little, Brown, and Company; 1996: 251
Runyon B. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Vol 2. 8th ed. Philadelphia, Pa: Saunders; 2006:1935-64.
Rybak MJ, Lomaestro BM, Rotschafer JC, et al: Therapeutic monitoring of vancomycin in adults: summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2009; 29:1275-1279.
Stefani SD, Cadore LP, Villaroel RU, Azevedo S, Machado AL. Antibiotic Selection in the Treatment of Febrile Neutropenia: Current Approach and New Directions.
Braz J Infect Dis. 1998 Jun;2(3):109-117.
Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med 1993;329:1328-1334.
Tan J, et al. Expert Guide to Infectious Diseases 2nd ed. Philadelphia: ACP Press/American College of Physicians, 2008.
van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet. Oct 31 2009;374(9700):1543-56.
Wiggins KJ, Craig JC, Johnson DW, Strippoli GF. Treatment for peritoneal dialysis-associated peritonitis. Cochrane Database Syst Rev. Jan 23 2008;CD005284.
Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. Dec 17 2010;59:1-110.
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
Read the disclaimer
Medical Calculators - A thru Z
Lab Values - A thru Z
This site complies with the
HONcode standard for trustworthy health