Nonpregnant adults | Pregnant, postpartum, and lactating women | Children and adolescent (age ≥1 month through 17 years) |
First bactericidal agent: | ||
Preferred: | ||
Ciprofloxacin 400 mg every 8 hours | Ciprofloxacin 400 mg every 8 hours NOTE: The treatment of pregnant, postpartum, and lactating women is similar to that for nonpregnant adults, except that ciprofloxacin is strongly preferred as the first bactericidal agent At least one agent with transplacental passage is recommended; agents with transplacental passage include ciprofloxacin, levofloxacin, meropenem, ampicillin, penicillin, clindamycin, rifampin | Ciprofloxacin 30 mg/kg per day divided every 8 hours, not to exceed 400 mg per dose |
Alternatives if ciprofloxacin is unavailable or contraindicated, in order of preference: | ||
Levofloxacin 750 mg every 24 hours OR | Levofloxacin 750 mg every 24 hours OR | Levofloxacin
|
Moxifloxacin 400 mg every 24 hours | Moxifloxacin 400 mg every 24 hours | Moxifloxacin
|
PLUS | ||
Second bactericidal agent: | ||
Preferred for all strains, regardless of penicillin susceptibility or if susceptibility is unknown: | ||
Meropenem 2 g every 8 hours | Meropenem 2 g every 8 hoursΔ | Meropenem 120 mg/kg per day divided every 8 hours, not to exceed 2 g per dose |
Alternatives if meropenem is unavailable or contraindicated, in order of preference: | ||
Imipenem 1 g every 6 hours◊ OR | Imipenem 1 g every 6 hoursΔ◊ OR | Imipenem 100 mg/kg per day divided every 6 hours, not to exceed 1 g per dose◊ OR |
Doripenem 500 mg every 8 hours | Doripenem 500 mg every 8 hoursΔ | Doripenem 120 mg/kg per day divided every 8 hours, not to exceed 1 g per dose OR |
Vancomycin 60 mg/kg per day divided every 8 hours, not to exceed 2 grams per dose; maintain serum trough concentration of 15 to 20 mcg/mL | ||
Alternatives for penicillin-susceptible strains (MIC ≤0.5 mcg/mL):§ | ||
Penicillin G 4 million units every 4 hours OR | Penicillin G 4 million units every 4 hoursΔ OR | Penicillin G 400,000 units/kg per day divided every 4 hours, not to exceed 4 million units per dose OR |
Ampicillin 3 g every 6 hours | Ampicillin 3 g every 6 hoursΔ | Ampicillin 400 mg/kg per day divided every 6 hours, not to exceed 3 g per dose |
PLUS | ||
Protein synthesis inhibitor (preferred): | ||
Linezolid 600 mg every 12 hours¥ | Linezolid 600 mg every 12 hours¥ | Linezolid¥
|
Alternatives if linezolid unavailable or contraindicated, in order of preference: | ||
Clindamycin 900 mg every 8 hours OR | Clindamycin 900 mg every 8 hours OR | Clindamycin 40 mg/kg per day divided every 8 hours, not to exceed 900 mg per dose OR |
Rifampin 600 mg every 12 hours‡ OR | Rifampin 600 mg every 12 hours‡ | Rifampin 20 mg/kg per day divided every 12 hours, not to exceed 300 mg per dose‡ OR |
Chloramphenicol 1 g every 6 to 8 hours† | Chloramphenicol 1 g every 6 to 8 hours† | Chloramphenicol 100 mg/kg per day divided every 6 hours, not to exceed 1 g per dose† |