Viral encephalitis

Viral encephalitis - Acute

Definition  

An acute viral infection of the brain parenchyma causing an inflammatory process in association with clinical evidence of neurologic dysfunction

 

Medical History  

* Adult, Geriatric (>65 years)

* Pediatric (0-18 years)

* Neonate (<30 days and 37 weeks of gestation or more)

* Mosquito bite

* Tick bite

* Occupational Exposure

* Outdoor Recreational Activities

* Animal Contact

* Travel

* Past medical history of Inadequate immune status

* Infection after transfusion, Transfusion of blood product

* Patient immunocompromised and Immunodeficiency disorder

* Disorder related to transplantation, Transplantation

 

Findings  

* Fever

* Headache

* Altered mental status

* Nuchal rigidity

* Viral exanthem

* Lymphadenopathy - Acute

* Disturbance in speech

* Seizure

* Nausea and vomiting - Acute

* Myalgia

* Mosquito bite

* Pharyngeal erythema

* Respiratory finding

* Fatigue

* Diarrhea

* Muscle weakness

* Tick bite

* Focal neurological signs

* Impaired cognition

* Personality change

* Amnesia

* Abnormal movement

* Backache

* Dizziness

* Abdominal pain - Acute

* Splenomegaly

* Radicular pain

* Muscle rigidity

* Altered behavior

* Hallucinations

* Cranial nerve disorder

* Facial palsy

* Hemiparesis

* Hemiplegia

* Neurological muscular paralysis

* Pyramidal sign

* Retinitis

* Diplopia

* Photophobia

* Nystagmus

* Ophthalmoplegia

* Optic disc swelling

* Impairment level of vision

* Parotid swelling

* Sensorineural hearing loss

* Dysuria

* Urgent desire to urinate

* Urinary incontinence

 

Tests  

Evaluation for bacterial and fungal etiologies of encephalitis  

* Blood culture

 

Suspected viral encephalitis  

* MRI of head: MRI is a valuable procedure for the early detection of viral encephalitis and in some cases may help to differentiate specific etiologies .

 

Suspected viral encephalitis  

* Cerebrospinal fluid examination: Cerebrospinal fluid analysis in patients with viral encephalitis typically shows lymphocytic pleocytosis, normal or mildly elevated protein, normal glucose, and negative Gram staining .

 

Viral encephalitis  

* Polymerase chain reaction analysis, Cerebrospinal fluid

 

Suspected bacterial meningitis  

* Cerebrospinal fluid culture: Bacterial culture of the cerebrospinal fluid is critical in making the diagnosis of bacterial meningitis, identifying the causative organism, and selecting the appropriate antibiotic treatment regimen .

 

Suspected viral encephalitis  

* Electroencephalogram: EEG may show cerebral involvement early in the course of encephalitis and is important in detecting nonconvulsive seizures in patients with mental status changes .

 

Suspected herpes simplex encephalitis  

* Herpes simplex virus DNA assay: A positive polymerase chain reaction test for herpes simplex virus (HSV) in cerebrospinal fluid is generally diagnostic of HSV encephalitis .

 

Suspected herpes simplex encephalitis  

* Herpes simplex virus 1 AND 2 antibody assay: Tests of cerebrospinal fluid for herpes simplex virus (HSV) antibodies may be useful after a week of therapy for HSV encephalitis, but HSV polymerase chain reaction (PCR) is recommended for diagnosis .

 

Suspected and known herpes simplex encephalitis  

* Magnetic resonance imaging of brain and brain stem: A cranial MRI showing a hemorrhagic encephalitis affecting the temporal and inferior frontal lobes strongly suggests herpes simplex virus encephalitis .

 

Suspected or known herpes simplex encephalitis  

* Computerized axial tomography of brain: Although the brain CT may be normal early in the course of herpes simplex encephalitis, typical findings include lesions in one or both temporal lobes .

 

Suspected herpes simplex virus encephalitis  

* Electroencephalogram: An EEG done early in the course of herpes simplex encephalitis may reveal periodic lateralized epileptiform discharges localized to the temporal lobes .

 

Suspected arboviral encephalitis  

* Encephalitis viral serology test: A 4-fold or greater change in virus-specific antibody levels between acute and convalescent sera in the appropriate clinical setting is confirmatory for arboviral encephalitis .

 

Suspected or known West Nile virus disease, including encephalitis  

* West Nile virus antibody assay: A 4-fold or greater change in virus-specific serum antibody levels is confirmatory for West Nile virus infection .

 

Suspected viral encephalitis  

* Electromyography: Electromyography may show significant abnormalities in viral encephalitis .

 

Differential Diagnosis  

* Bacterial meningitis - Acute

* Bacterial encephalitis

* Viral meningitis - Acute

* Fungal infection of central nervous system

* Parasitic encephalitis

* Intracranial abscess

* Subdural hematoma - Acute

* Vascular disorder

* Encephalopathy

* Disseminated encephalomyelitis, acute

* Disease due to JC polyomavirus

* Rabies - Acute

* Encephalitis due to human herpes simplex virus - Acute

* West Nile encephalitis

* Enterovirus infection of the central nervous system

* Encephalitis due to Herpesviridae

* Arbovirus encephalitis

* Measles of the central nervous system

* Mumps encephalitis

* Rubella encephalitis

* Adenoviral encephalitis

* Encephalitis due to influenza

 

Treatment  

 

Drug Therapy  

 

All cases of suspected viral encephalitis while awaiting diagnostic lab results  

 

ACYCLOVIR

Adults: 10 mg/kg IV every 8 hours

Neonates: 20 mg/kg IV every 8 hours

Pediatrics: 10 mg/kg IV every 8 hours

 

Herpes simplex encephalitis  

 

ACYCLOVIR

Adults: 10 mg/kg IV every 8 hours for 14 to 21 days

Neonates: 20 mg/kg IV every 8 hours for 21 days

Pediatrics: 10 mg/kg IV every 8 hours for 14 to 21 days

 

Cytomegalovirus (CMV) encephalitis  

 

GANCICLOVIR SODIUM - FOSCARNET SODIUM  

Adults: Ganciclovir 5 mg/kg IV every 12 hours AND foscarnet [60 mg/kg IV every 8 hours OR foscarnet 90 mg/kg IV every 12 hours] for 3 weeks, followed by maintenance therapy

 

Varicella zoster virus (VZV) encephalitis  

 

ACYCLOVIR

Adults: 10 to 15 mg/kg IV every 8 hours for 10 to 14 days

 

Possible treatment option in immunocompromised patients with human herpesvirus 6  

 

GANCICLOVIR SODIUM - FOSCARNET SODIUM  

Adults: Ganciclovir 5 mg/kg IV every 12 hours AND foscarnet [60 mg/kg IV every 8 hours OR foscarnet 90 mg/kg IV every 12 hours]

 

Procedural Therapy  

 

Refractory cerebral edema or impending uncal herniation  

* Decompression of brain

 

Increased intracranial pressure  

* Introduction of intracranial pressure measuring device

 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .

Multiple myeloma

Multiple myeloma - Chronic
Rahul Soman, M. Pharm

 

Definition  

A clonal B lymphocyte malignancy

 

Medical History  

* Family history of Multiple myeloma

* Black or African American

* Aging

* Past medical history of Monoclonal gammopathy of uncertain significance

 

Findings  

* Asthenia

* Bleeding

* Bone pain

* Bone tenderness

* Fever

* Hyperviscosity syndrome

* Increased susceptibility to infections

* Pathological fracture

* Ataxia

* Confusion

* Depression - Chronic

* Headache

* Increased frequency of urination

* Increased thirst

* Nausea

* Paresthesia

* Plasmacytoma

* Retinal hemorrhage

* Visual disturbance

* Anemia - Chronic

* Carpal tunnel syndrome - Chronic

* Cryoglobulinemia

* Enlargement of tongue

* Fatigue

* Lethargy

* Pallor

* Purpuric disorder

* Weight loss

* Optic disc edema

 

Tests  

 

Multiple myeloma  

* Creatinine measurement, serum

* Serum protein electrophoresis

 

Suspected or known monoclonal proteinemia  

* Immunofixation electrophoresis, Urine: Immunofixation is useful for confirming the presence of a monoclonal protein and for identifying the specific type in monoclonal paraproteinemias .

 

Suspected or known plasma cell dyscrasia  

* Complete blood count with white cell differential, manual: Anemia is a common finding in plasma cell dyscrasias. Neutropenia and thrombocytopenia may be seen in advanced disease.

 

Suspected or known plasma cell dyscrasia  

* Bone marrow biopsy, needle or trocar: Bone marrow biopsy may be useful to confirm the diagnosis of and assess prognosis and treatment response in plasma cell dyscrasias .

 

Suspected plasma cell dyscrasia  

* Peripheral blood smear examination, light microscopy: The presence of red cell rouleaux formation should raise the suspicion of dysproteinemia.

 

Suspected and known monoclonal gammopathies  

* Immunofixation electrophoresis, Urine: In the appropriate clinical context, the presence of monoclonal globulin in the urine or serum suggests pathology .

 

Suspected and known multiple myeloma  

* Urine protein electrophoresis: Most patients with multiple myeloma have serum monoclonal bands with or without urinary monoclonal bands. Twenty percent of patients will have urinary monoclonal proteins only .

 

Suspected multiple myeloma  

* Erythrocyte sedimentation rate measurement: An elevated erythrocyte sedimentation rate may raise the suspicion of, but is not diagnostic for multiple myeloma. More specific studies are required .

 

Suspected or known monoclonal paraproteinemia  

* Immunofixation electrophoresis, Serum: Immunofixation electrophoresis identifies the specific monoclonal protein that is elevated in a plasma cell dyscrasia.

 

Differential Diagnosis  

* Monoclonal gammopathy of uncertain significance

* Multiple myeloma - Chronic

* Waldenström macroglobulinemia

* Plasmacytoma

* Non-secretory myeloma

* Smoldering myeloma

* Indolent multiple myeloma

* Plasma cell leukemia

* Heavy chain disease

* AL amyloidosis

* Osteosclerotic myeloma

* Low grade B-cell lymphoma

 

Treatment  

 

Drug Therapy  

 

Multiple myeloma  

 

MELPHALAN - PREDNISONE  

Adults: Melphalan 8-10 mg orally on days 1-7 AND prednisone 60 mg per day orally on days 1-7, regimen repeated every 6 weeks

 

VINCRISTINE SULFATE - CARMUSTINE - MELPHALAN - CYCLOPHOSPHAMIDE - PREDNISONE  

Adults: Vincristine 0.03 mg/kg (maximum 2 mg) IV on day 1 AND carmustine 0.5 mg/kg IV on day 1 AND melphalan 0.25 mg/kg orally on days 1-7 AND cyclophosphamide 10 mg/kg IV on day 1 AND prednisone 1 mg/kg orally on days 1-7; regimen repeated every 5 weeks

 

DEXAMETHASONE  

Adults: 40 mg orally on days 1-4, 9-12, and 17-20; regimen repeated every 4-5 weeks

 

VINCRISTINE SULFATE - DOXORUBICIN HYDROCHLORIDE - DEXAMETHASONE  

Adults: Vincristine 0.4 mg per day IV continuous infusion on days 1-4 AND doxorubicin 9 mg/m2 IV continuous infusion on days 1-4 AND dexamethasone 40 mg orally on days 1-4, 9-12, and 17-20; regimen repeated every 4 weeks

 

THALIDOMIDE

Adults: 200-400 mg orally on days 1-28; regimen repeated every 4 weeks

 

THALIDOMIDE - DEXAMETHASONE  

Adults: Thalidomide 200 mg orally on days 1-28 AND dexamethasone 40 mg orally on days 1-4, 9-12, and 17-20; regimen repeated every 4 weeks

 

MELPHALAN - PREDNISONE - THALIDOMIDE

Adults: Melphalan 4 mg/m2 orally on days 1-7 AND prednisone 40 mg/m2 on days 1-7 AND thalidomide 100 mg orally on days 1-28; regimen repeated every 4 weeks

 

CYCLOPHOSPHAMIDE - THALIDOMIDE - DEXAMETHASONE  

Adults: Cyclophosphamide 50 mg orally on days 1-21 AND thalidomide 200-800 mg orally on days 1-21 AND dexamethasone 40 mg orally on days 1-4; repeat regimen every 3 weeks

 

BORTEZOMIB

Adults: 1.3 mg/m2 on days 1, 4, 8, and 11 followed by a 10-day resting period every 21 days

 

Prevention of influenza in patients with multiple myeloma  

 

INFLUENZA VIRUS VACCINE (SUBVIRION)  

 

Prevention of streptococcal pneumonia in patients with multiple myeloma  

 

PNEUMOCOCCAL VACCINE POLYVALENT  

Adults: 0.5 ml IM or subQ every 5 years

 

Procedural Therapy  

 

Impending spinal cord compression, impending pathologic fracture, or palliative treatment of uncontrolled pain in patients with multiple myeloma  

* Radiation therapy

Muscular dystrophy

Muscular dystrophy - Chronic
Rahul Soman, M. Pharm

 

Definition  

A group of hereditary disorders involving muscle protein dysfunction (deficient or abnormally formed protein), caused by mutations involving many different genes that are located on different chromosomes, resulting in different patterns of progressive muscle weakness, along with specific comorbid disorders .

 

Respiratory failure  

* Spirometry: A peak expiratory flow of 20% to 30% and an FEV1 of 20% to 30% of predicted normal values suggest significant airflow limitation and ventilatory effect.

 

Respiratory insufficiency  

* Pulse oximetry

 

Suspected obstructive sleep apnea  

* Polysomnography: More than 5 apneic episodes per hour of sleep, or 15 episodes without other findings, is important if sleepiness or other cardiovascular comorbidities exist

 

Evaluation for Sleep-Disordered Breathing and Alveolar Hypoventilation  

 

Suspected obstructive sleep apnea  

* Polysomnography: More than 5 apneic episodes per hour of sleep, or 15 episodes without other findings, is important if sleepiness or other cardiovascular comorbidities exist

 

Suspected alveolar hypoventilation in muscular dystrophy  

* Overnight pulse oximetry

 

Routine Evaluation of Cardiac Function  

 

Suspected or known muscular dystrophy  

* 12 lead ECG: Electrocardiography plays a key role in early detection of cardiomyopathy and cardiac conduction defects in muscular dystrophy .

 

Suspected and known dilated cardiomyopathy .  

* Transthoracic echocardiography

 

Findings  

* Difficulty running

* Difficulty walking up stairs

* Feeding problems in newborn

* Not yet walking

* Muscle atrophy

* Muscle weakness

* Mental retardation

* Coughing ineffective

* Hypoventilation

* Decreased cardiac function

* Dyspnea - Chronic

* Poor muscle tone

* Pseudohypertrophy of muscle

* Contracture of joint

* Myotonia

* Dysphagia - Chronic

* Ptosis of eyelid

* Hearing loss

* Nasal voice

* Abnormal vision

* Disorder of extraocular muscle

 

Tests  

 

Suspected muscular dystrophy  

* Serum creatine kinase measurement: Serum creatine kinase levels may be markedly elevated in some forms of muscular dystrophy; levels are high from birth in Duchenne muscular dystrophy .

 

Suspected muscular dystrophy .  

* Electromyography

 

Suspected muscular dystrophy  

* Biopsy of muscle: Typical muscle histological findings are variation in fiber sizes, fiber necrosis, presence of macrophages, and replacement by connective tissue and fat .

* Gene mutation analysis

 

Suspected muscular dystrophy  

* Immunohistochemistry procedure

* Western blot assay

 

Suspected or known muscular dystrophy  

* 12 lead ECG: Electrocardiography plays a key role in early detection of cardiomyopathy and cardiac conduction defects in muscular dystrophy .

 

Differential Diagnosis  

* Polymyositis

* Peripheral neuropathy - Chronic

* X-linked muscular dystrophy with abnormal dystrophin

* Congenital muscular dystrophy

* Limb-girdle muscular dystrophy

* Emery-Dreifuss muscular dystrophy

* Distal muscular dystrophy

* Facioscapulohumeral muscular dystrophy

* Oculopharyngeal muscular dystrophy

* Steinert myotonic dystrophy syndrome

 

Treatment  

 

Drug Therapy  

 

Duchenne muscular dystrophy  

 

PREDNISONE  

Pediatrics: 0.75 mg/kg/day orally; decrease as low as 0.3 mg/kg/day if necessary due to side effects

 

Procedural Therapy  

 

Ventilatory compromise in Duchenne muscular dystrophy  

* Respiratory therapy: Aggressive pulmonary care helps prevent respiratory complications and improves cardiac output by reducing afterload and left ventricular wall stress .

 

Respiratory failure  

* Noninvasive positive pressure ventilation: Most studies have shown favorable outcomes with the use of noninvasive positive pressure ventilation support for patients with respiratory failure ..

 

Respiratory failure  

* Mechanical ventilation: Early treatment of acute respiratory failure with mechanical ventilation may decrease morbidity, mortality, and length of hospitalization.

 

Non-Procedural Therapy  

 

Duchenne muscular dystrophy  

* Patient Education

 

 
 

Myasthenia gravis

Myasthenia gravis - Acute
Rahul Soman, M. Pharm

 

Definition  

An autoimmune disease of the neuromuscular junction marked by fatigable weakness of striated muscles .

 

Medical History  

* Neoplasm of thymus

* Penicillamine use

* Pregnancy

* Infectious disease

* Anesthetic, General use

 

Findings  

* Acute respiratory failure

* Diplopia

* Dyspnea - Acute

* Muscle weakness

* Ptosis of eyelid

* Weakness of face muscles

* Bulbar weakness

* Normal tendon reflex

* Pupil reactions normal

 

Tests  

 

Suspected myasthenia gravis  

* Edrophonium chloride test for myasthenia gravis: Edrophonium administration will transiently improve strength in patients with myasthenia gravis, but testing is subjective and not specific .

 

Differential Diagnosis  

* Myasthenic crisis

* Cholinergic crisis

* Guillain-Barré syndrome - Acute

* Brainstem stroke syndrome

* Botulism - Acute

* UNITED STATES SNAKES CROTALINAE

* SPIDERS, OTHER

* SCORPIONS

 

Treatment  

 

Drug Therapy  

 

Myasthenia gravis  

 

IMMUNE GLOBULIN  

Adults: 2 g/kg IV administered over 2 to 5 days

 

Procedural Therapy  

 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .

 

Myasthenia gravis  

* Therapeutic plasma exchange: Plasma exchange is used for short-term treatment of myasthenia gravis; it may be used for long-term treatment in patients refractory to other therapy .

Myxedema coma

Myxedema coma - Acute
Rahul Soman, M. Pharm

 

Definition  

A state of profound decompensated hypothyroidism that is a life-threatening endocrine emergency .

 

Medical History  

* Hypothyroidism

* Hypothermia [Hypothermia - Acute]

* Exposure to cold weather

* Infectious disease

* Surgical procedure

* Burn

* Traumatic injury

* Gastrointestinal hemorrhage

* Congestive heart failure

* Cerebrovascular accident

* Lithium Carbonate use

* Analgesic use

* Sedative use

* Amiodarone use

* Beta-Adrenergic Blocker use

* Phenytoin use

* Rifampin use

* Alcohol consumption

 

Findings  

* Altered mental status

* Hypothermia - Acute

* Lethargy

* Memory impairment

* Bradyarrhythmia - Acute

* Hypotension

* Somnolence

* Stupor

* Slow respiration

* Hypoxia

* Cool skin

* Dry skin

* Brittle hair

* Edema of lower extremity

* Constipation

* Abdominal distension

* Pharyngeal swelling

* Seizure

* Hallucinations

* Abnormal deep tendon reflex

* Heart sounds diminished

* Hypothyroid facies

* Goiter

* Thyroid eye disease

 

Tests  

Suspected or known hypothyroidism  

* Thyroid stimulating hormone measurement: Overt hypothyroidism is classified as a TSH above the upper limit of the reference range in the presence of a low serum free thyroxine (FT4) . Subclinical hypothyroidism is a laboratory diagnosis defined as a TSH above the upper limit of the reference range in the presence of a normal FT4.

 

Suspected or known hypothyroidism  

* Serum free T4 measurement: Free thyroxine (FT4) is decreased in conjunction with an elevated TSH level in primary hypothyroidism and in conjunction with a low, normal, or slightly elevated TSH level in secondary hypothyroidism .

 

Diagnostic evaluation of myxedema coma  

* Complete blood count

* Metabolic function test

* Arterial blood gas analysis

* Plain chest X-ray

* Electrocardiographic monitoring

 

Differential Diagnosis  

* Acquired hypothyroidism

* Sepsis - Acute

* Heart failure

* Severe depression

* Sick-euthyroid syndrome

 

Treatment  

 

Drug Therapy  

 

Myxedema coma  

 

LEVOTHYROXINE SODIUM  

Adults: Initial dose 200 mcg to 500 mcg IV daily; reduce dose to 50 mcg to 100 mcg IV daily until patient is able to take medication orally

 

LIOTHYRONINE SODIUM  

Adults: Initial dose 10 mcg to 20 mcg IV every 4 hours; reduce dosage to 10 mcg every 6 hours after 24 hours and continue this regimen for an additional 24 to 48 hours until patient is able to take medication orally

 

LEVOTHYROXINE SODIUM / LIOTHYRONINE SODIUM  

Adults: Initial loading dose 200 mcg to 300 mcg levothyroxine IV AND 10 mcg liothyronine IV; follow with maintenance dose 50 mcg to 100 mcg levothyroxine IV AND 10 mcg liothyronine IV every 8 hours until the patient is able to take oral medication

 

Suspected adrenal insufficiency  

 

HYDROCORTISONE  

Adults: Initial dose 100 mg IV (or equivalent) every 6 to 8 hours

 

Procedural Therapy  

 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .

Nongonococcal urethritis or Nongonococcal cervicitis

Nongonococcal urethritis; Nongonococcal cervicitis - Acute
Rahul Soman, M. Pharm

 

Definition  

Inflammation of the urethra or cervix caused by a nongonococcal infection and characterized by a mucopurulent or purulent discharge that may produce dysuria or urethral pruritus, although in many cases, the infection is asymptomatic

 

Medical History  

* Sexual intercourse

 

Findings  

* Urethral discharge

* Cervical discharge

* Intermenstrual bleeding - irregular

* Blood at uterine os cervix

* Dysuria

* Finding of frequency of urination

* Increased body temperature

 

Tests  

 

Suspected nongonococcal urethritis  

* Gram stain microscopy, Urethral swab: Five or more WBCs per oil immersion field in the absence of Gram-negative intracellular diplococci indicates nongonococcal urethritis .

 

Suspected nongonococcal cervicitis  

* Gram stain microscopy, Vaginal secretions, Cervical secretion sample: A finding of 10 or more WBC in vaginal fluid, in the absence of trichomoniasis, might indicate endocervical inflammation caused specifically by Chlamydia trachomatis.

 

Suspected urethritis  

* Urine Microscopy: white cells: Microscopic examination of first-void urine sediment demonstrating ?10 WBC per high power field indicates urethritis and the need for further testing .

 

Suspected urethritis  

* Urine dipstick for leukocyte esterase: A positive leukocyte esterase test on first-void urine indicates the presence of urethritis and the need for further testing for gonorrhea and chlamydia .

 

Suspected urogenital Chlamydia trachomatis infection  

* Chlamydia trachomatis nucleic acid amplification test: Nucleic acid amplification testing provides a rapid and accurate diagnosis of Chlamydia trachomatis infections using either cervical or urine samples .

 

Suspected Chlamydia trachomatis infection  

* Chlamydia trachomatis nucleic acid hybridization test: A positive nucleic acid hybridization test provides presumptive evidence of Chlamydia trachomatis infection .

 

Differential Diagnosis  

* Chlamydial urethritis

* Chlamydial cervicitis

* Trichomoniasis

* Gonorrhea - Acute

* Syphilis - Acute

* Genital herpes simplex

* Urinary tract infectious disease - Acute

 

Treatment  

 

Drug Therapy  

 

Nongonococcal urethritis  

 

AZITHROMYCIN  

Adults: 1 g orally as a single dose

 

DOXYCYCLINE  

Adults: 100 mg orally twice daily for 7 days

 

ERYTHROMYCIN  

Adults (alternative): 500 mg orally 4 times daily for 7 days

 

ERYTHROMYCIN ETHYLSUCCINATE  

Adults (alternative): 800 mg orally 4 times daily for 7 days

 

OFLOXACIN  

Adults (alternative): 300 mg orally twice daily for 7 days

 

LEVOFLOXACIN  

Adults (alternative): 500 mg orally once daily for 7 days

 

Presumptive treatment for nongonococcal cervicitis  

 

AZITHROMYCIN  

Adults: 1 g orally as a single dose (consider concurrent treatment for gonococcal infection if prevalence of gonorrhea is high in the patient population under assessment)

 

DOXYCYCLINE  

Adults: 100 mg orally twice daily for 7 days (consider concurrent treatment for gonococcal infection if prevalence of gonorrhea is high in the patient population under assessment)

 

Chlamydial infection in men and women  

 

AZITHROMYCIN  

Adults: 1 g orally as a single dose

 

DOXYCYCLINE  

Adults: 100 mg orally twice daily for 7 days

 

ERYTHROMYCIN  

Adults: 500 mg orally 4 times daily for 7 days

 

ERYTHROMYCIN ETHYLSUCCINATE  

Adults (alternative): 800 mg orally 4 times daily for 7 days

 

OFLOXACIN  

Adults: 300 mg orally twice daily for 7 days

 

LEVOFLOXACIN  

Adults: 500 mg orally once daily for 7 days

 

Chlamydial infection in pregnant women  

 

AZITHROMYCIN  

Adults: 1 g orally as a single dose

 

AMOXICILLIN  

Adults: 500 mg orally 3 times daily for 7 days

 

ERYTHROMYCIN  

Adults (alternative): 500 mg orally 4 times daily for 7 days or 250 mg orally 4 times daily for 14 days

 

ERYTHROMYCIN ETHYLSUCCINATE  

Adults (alternative): 800 mg orally 4 times daily for 7 days

 

 

Recurrent and persistent nongonococcal urethritis  

 

METRONIDAZOLE - AZITHROMYCIN  

Adults: Metronidazole 2 g orally in a single dose AND azithromycin 1 g orally in a single dose (if not used for initial episode)

 

TINIDAZOLE - AZITHROMYCIN  

Adults: Tinidazole 2 g orally in a single dose AND azithromycin 1 g orally in a single dose (if not used for initial episode)

 

Chlamydial infection in preadolescent children  

 

ERYTHROMYCIN  

Pediatrics (<45 kg): 50 mg/kg/day orally in 4 divided doses for 14 days

 

ERYTHROMYCIN ETHYLSUCCINATE  

Pediatrics (<45 kg): 50 mg/kg/day orally in 4 divided doses for 14 days

 

AZITHROMYCIN  

Pediatrics (?45 kg): 1 g orally as a single dose

 

DOXYCYCLINE  

Pediatrics (>8 years): 100 mg orally twice daily for 7 days

 

Procedural Therapy  

 

Sexual contacts of patients with a sexually transmitted disease  

* Sexual partner notification: Patients with certain sexually transmitted diseases need to refer their partners for evaluation and treatment .

 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .

 

At risk for sexually transmitted disease  

* Infection prevention education: Patient education and counseling is one of the essential strategies for the prevention and control of sexually transmitted diseases (STDs) .

 

Non-Procedural Therapy  

 

Nongonococcal urethritis  

* Sexual abstinence