Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  PLUS Ceftazidime 2 grams IV every 8 hours  or Cefepime 2 grams q 12h

Methicillin-sensitive Staph aureus (MSSA)

Nafcillin or Oxacillin 2 grams IVPB q4h or

Cefazolin 2 grams IVPB q8h  or

MRSA

Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  +/- rifampin OR Linezolid 600 mg orally or IV q 12h

Gram negative rods are suspected:

3rd generation cephalosporin such as:  [Ceftriaxone 2g IV qd or Cefotaxime 2g IV q6-8h or Ceftazidime 2g IV q8h or Cefepime 2g IV q12h] PLUS Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)

Ciprofloxacin 400mg IV q12h then may switch to Cipro 750mg PO q12h  OR Levofloxacin 750mg IV (then PO) qd

Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  + Ciprofloxacin 400mg IVPB q12h.

MSSA: Nafcillin 2 grams IVPB q4h plus Ciprofloxacin 400mg  IVPB q12h.

Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  + Ciprofloxacin 400mg IVPB q12h or 750mg po q12h. (continue until cultures are available).

Alternatively: Ciprofloxacin 750mg po q12h + Rifampin 900mg po x 1 dose.

Ceftazidime 1-2 grams IVPB q8h OR Cefepime 2 grams IVPB q12h OR Ciprofloxacin 750mg po q12h.

Mild disease:

Ciprofloxacin 750mg PO q12h  (+/- rifampin 600mg PO qd) OR

Levofloxacin 750 mg PO qd (+/- rifampin 600mg PO qd for S. aureus if present) OR

Augmentin 500mg three times daily.

Severe disease:

Piperacillin-tazobactam 3.375 grams IVPB q4-6h  OR

Ticarcillin-clavulanic acid 3.1 grams IVPB q4-6h  OR

Ampicillin-sulbactam 1.5 to 3 grams IVPB q6h or

(Ciprofloxacin 400mg IVPB q12h + Clindamycin 600 to 900mg IVPB q6-8 hours)  OR

(Cefepime 1-2 grams IVPB q12h + Metronidazole 500mg IVPB q6-8 hours).