GU antibiotics

• Clotrimazole 1 % cream applied vaginally for 7 days OR
• Clotrimazole 2% applied vaginally for 3 days
• Miconazole 2% cream applied vaginally for 7 days OR 4% cream x 3 days
• Butoconazole 2% applied vaginally x 3 days
• Tioconazole 6.5% applied vaginally x 1

• Fluconazole 150mg PO once
  • a second dose at 72hrs can be given if patient is still symptomatic

• Intravaginal Clotrimazole or Miconazole are the only recommended treatments
• Duration is 7 days
• PO fluconazole associated with congenital malformations and spontaneous abortions[1]

• Clotrimazole 1% applied topically to glans q12hrs until resolution
• Nystatin cream 100,000 units/gm if infection is recurrent after clotrimazole therapy

• Topical triple antibiotic ointment QID or mupirocin cream BID

• Ceftriaxone 250mg IM once PLUS
  • Azithromycin 1g PO once OR
  • Doxycycline 100mg PO BID x 14 days (7 days for gonorrhea, 14 days for chlamydia)[2]

• Azithromycin 2g PO once PLUS
  • Gentamicin 240mg IM once[3]
  • In theory this high dose macrolide will provide treatment for both GC and Chlamydia

• Cefixime 400mg PO once PLUS
  • Azithromycin 1g PO once OR
  • Doxycycline 100mg PO BID x 7 days

• Metronidazole 2g PO once OR 500mg PO BID for 7 days [4]
• Tinidazole 2g PO once

Only treat if the patient is symptomatic and avoid breast feeding until 24-hrs after last dose

• Metronidazole 2g PO once[5]

• Metronidazole 500mg PO BID x 7 days OR
• Tinidazole 2g PO once

• Metronidazole 500 mg PO BID x 7 days[6]

Women, Uncomplicated

• Nitrofurantoin ER 100mg BID x 5d, OR
• TMP/SMX DS (160/800mg) 1 tab BID x 3d, OR
• Cephalexin 250mg QID x 5d, OR
• Ciprofloxacin 250mg BID x3d
  • Avoid using fluoroquinolone for the first-line treatment of uncomplicated urinary tract infections (UTIs) in women.[7]
• Fosfomycin 3 g PO once
  • Lower clinical and microbiologic success compared to nitrofurantoin TID for 5 days [8]

Women, Complicated

• Ciprofloxacin 500mg BID x10-14d, OR
• Cefpodoxime 200 mg BID x10-14d

Women, Concern for Urethritis

• Ceftriaxone 250mg IM x1 AND azithromycin 1gm PO x1 AND nitrofurantoin ER 100mg BID x5d, OR
• Levofloxacin 500mg QD x 14d (covers urinary pathogens, GC, and chlamydia)
  • GC resistance to fluoroquinolones is increasing

Men

• Ciprofloxacin 500mg BID x10-14d, OR
• Cefpodoxime 200 mg BID x10-14d

• Ciprofloxacin 400mg IV q12hr, OR
• Ceftriaxone 1gm IV QD, OR
• Cefotaxime 1-2gm IV q8hr, OR
• Gentamicin 3mg/kg/day divided q8hr +/- ampicillin 1–2 gm q4hr, OR
• Piperacillin/Tazobactam 3.375 gm IV q6hr, OR
• Cefepime 2gm IV q8hr, OR
• Imipenem 500mg IV q8hr

• Metronidazole 500 mg PO BID for 7 days OR
• Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days OR
• Clindamycin cream 2%, one full applicator (5 g) intravaginally qHS for 7 days

• Tinidazole 2 g PO qd for 2 days OR
• Tinidazole 1 g PO qd for 5 days OR
• Clindamycin 300 mg PO BID for 7 days OR
• Clindamycin ovules 100 mg intravaginally qHS for 3 days (do not use if patient has used latex condom in last 72 hrs)

• Metronidazole 250mg PO q8h x 7 days[10]
• Metronidazole 2g PO x 1 dose is also acceptable[10]
• Multiple studies have not demonstrated teratogenicity from metronidazole use[10]

• Metronidazole 2 g PO x 1 OR
• Tinidazole 2 g PO x 1

Target organisms are E. coli, and STDs (GC)

• Doxycycline 100mg PO q12 hrs x14 days + Ceftriaxone 250mg IM x1
• Ciprofloxacin no longer recommended to treat gonorrhea in US

Aimed at Enterobacteriaceae, enterococci, Pseudomonas

• Ciprofloxacin 500mg PO q12hrs x 28 days OR
• Levofloxacin 500mg PO daily x 28 days OR
• TMP/SMX 1 DS tablet PO q12hrs x 28 days
• Consider extension to 6 wks of empiric therapy

• Gentamycin 7mg/kg IV daily + Ceftriaxone 1g IV q12hrs

Consider one dose of Ceftriaxone 1g IV or Gentamycin 7mg/kg IV if the regional susceptibility of TMP/SMX or Fluoroquinolones is <80%

• Ciprofloxacin 500mg PO BID x7 days OR
• Trimethoprim-Sulfamethoxazole DS 160/800mg PO BID x14 days OR[11]
• Cephalexin 500mg QID PO x 10-14 days (OR consider 1000mg BID if difficulty with QID regimen) OR
• Cefdinir 300mg BID PO x 10-14 days OR
• Cefpodoxime 200mg PO BID x 10 days OR[12]
• Cefixime 400mg PO daily x 10 days OR[13]
• Levofloxacin 750mg PO QD x7 days[14]

• Ciprofloxacin 400mg IV q12hr OR
• Ceftriaxone 1gm IV QD OR
• Cefotaxime 1-2gm IV q8hr OR
• Gentamicin 3mg/kg/day divided q8hr +/- ampicillin 1–2 gm q4hr OR
• Piperacillin/Tazobactam 3.375 gm IV q6hr OR
• Cefepime 2gm IV q8hr OR
• Imipenem 500mg IV q8hr

• Ceftriaxone 75mg/kg IV QD OR
• Cefotaxime 50mg/kg IV q8hrs OR
• Ampicillin 25mg/kg IV q6hrs + Gentamicin 2.5mg/kg IV q8hrs

• Acyclovir OR
  • 400mg PO q8hrs x 7-10 days
  • or 200mg PO 5x/day x 7-10 days
• Valacyclovir 1g PO q12hrs x 7-10 days OR
• Famciclovir 250mg PO q8hrs x 7-10 days

• Acyclovir OR
  • 400mg PO q8hrs x 5 days
  • or 800mg PO q12hrs x 5 days
  • or 800mg PO q8hrs x 2 days
• Valacyclovir OR
  • 500mg PO q12hrs x 3 days
  • or 1g PO qd x 5 days
• Famciclovir
  • 125mg PO q12hrs for 5 days
  • or 1g PO q12hrs for 1 day
  • or 500mg PO once, followed by 250mg PO q12hrs for 2 days

• Acyclovir 400mg PO q12hrs daily OR
• Famciclovir 250mg PO q12hrs daily OR
• Valacyclovir 500mg-1g PO daily (500mg may be less effective)

This is classified as primary, secondary, and early latent syphilis less than one year.

Treatment Options:

• Penicillin G Benzathine 2.4 million units IM x 1
  • Repeat dose after 7 days for pregnant patients and HIV infection
• Doxycycline 100mg oral twice daily for 14 days as alternative

Late stage is greater than one year duration, presence of gummas, or cardiovascular disease

Treatment Options:

• Penicillin G Benzathine 2.4 million units IM weekly x 3 weeks
• Doxycycline 100mg oral twice daily for 4 weeks as alternative

There are 3 Major options with none showing greater efficacy than others:

• Penicillin G 3-4 million units IV every 4 hours x 10-14 days
• Penicillin G 24 million units continuous IV infusion x 10-14 days
• Penicillin G Procaine2.4 million units IM daily + probenecid 500mg oral every 6 hours for 10-14 days.
• Alternative:
  • Ceftriaxone 2gm IV once daily for 10-14 days

• Desensitization to the penicillin allergy is still the preferred method of treatment for patients with early and late stage disease (especially during pregnancy)

• Penicillin, dosage depends on stage [16]

• Ceftriaxone 250mg IM once, PLUS
  • Azithromycin 1g PO once OR
  • Doxycycline 100mg PO BID x 7 days

• Azithromycin 2g PO once, PLUS
  • Gentamicin 240mg IM once[17]
  • In theory this high dose macrolide will provide treatment for both GC and Chlamydia

• Cefixime 400mg PO once, PLUS
  • Azithromycin 1g PO once, OR
  • Doxycycline 100mg PO BID x 7 days

Target M. genitalium

• Moxifloxacin 400 mg daily x 7 days

Consider coverage of trichomonas, among men who have sex with women

• Metronidazole 2 gm PO x 1, OR
• Tinidazole 2 gm PO x 1

• Bone and joint antibiotics
• Cardiovascular antibiotics
• ENT antibiotics
• Eye antibiotics
• GI antibiotics
• GU antibiotics
• Neuro antibiotics
• OB/GYN antibiotics
• Pulmonary antibiotics
• Skin and soft tissue antibiotics
• Bioterrorism antibiotics
• Environmental exposure antibiotics
• Immunocompromised antibiotics
• Post exposure prophylaxis antibiotics
• Pediatric antibiotics
• Sepsis antibiotics
• Arthropod and parasitic antibiotics

For antibiotics by organism see Microbiology (Main)