Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

sepsis or severe systemic infection

1st line – intravenous antibiotic therapy

Back
ACUTE
|
sepsis or severe systemic infection
1st line – 

intravenous antibiotic therapy

No antibiotics are specifically approved for use in Vibrio infections, but the results of observation studies support the following treatment approaches.

One option is combination therapy with a third-generation cephalosporin (e.g., ceftazidime, ceftriaxone) plus a tetracycline (e.g., doxycycline, minocycline). A retrospective study of risk factors for fatality among patients with Vibrio vulnificus septicemia found that combination treatment with a third-generation cephalosporin plus a tetracycline was an independent predictor for lower mortality.[43] The combination of a third-generation cephalosporin plus a tetracycline is also supported by a standard antimicrobial therapy guide.[48]

Another option is treatment with a third-generation cephalosporin plus ciprofloxacin. This approach is supported by the results of a retrospective study of patients with V vulnificus septicemia, which reported lower mortality at 30 days in patients receiving a third-generation cephalosporin plus ciprofloxacin.[49]

Fluoroquinolones are associated with serious, disabling, and potentially irreversible adverse effects including tendonitis, tendon rupture, arthralgia, neuropathies, and other musculoskeletal or nervous system effects.[50][51] The Food and Drug Administration (FDA) has also issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[52][53]

The onset of septic shock and delay in initiating antibiotic therapy with Vibrio activity results in marked increases in fatality rates.[43] For further information on the management of sepsis, please see Sepsis in adults.

Antibiotic therapy should be reassessed with microbiology and clinical data to narrow coverage, when appropriate.[35]

Treatment course: should be individualized, but it is expected to be a minimum of 10-14 days.

Primary options

ceftazidime sodium: 2 g intravenously every 8 hours

or

ceftriaxone: 2 g intravenously every 12 hours

-- AND --

doxycycline: 100 mg intravenously every 12 hours

or

minocycline: 100 mg intravenously every 12 hours

or

ciprofloxacin: 400 mg intravenously every 8 hours

Plus – supportive care

Back
ACUTE
|
sepsis or severe systemic infection
Plus – 

supportive care

Treatment recommended for ALL patients in selected patient group

These patients are critically ill and should be managed in an emergency or intensive care unit setting under protocol by experienced intensivists.

Early goal-directed resuscitation is indicated in patients with sepsis and septic shock. Patients with septic shock require treatment with vasopressors. Intravenous corticosteroids may also be required if there is an ongoing need for vasopressor treatment.[35] For further information on the management of sepsis, please see Sepsis in adults.

Gastroenteritis may occur as a concomitant symptom with sepsis in a compromised host.[4][21][28] It should be managed as part of the intensive care.

Plus – early aggressive debridement of devitalized tissue

Back
ACUTE
|
sepsis or severe systemic infection
|
with necrotizing skin/soft-tissue infection
Plus – 

early aggressive debridement of devitalized tissue

Treatment recommended for ALL patients in selected patient group

Early surgical management of the necrotizing skin/soft-tissue infection (within the first 24 hours of admission) is essential to improve survival outcomes and shorten intensive care unit and hospital stay.[45][54][55][56][57]

localized skin/soft-tissue infection alone

1st line – intravenous antibiotic therapy

Back
ACUTE
|
localized skin/soft-tissue infection alone
|
necrotizing
1st line – 

intravenous antibiotic therapy

Necrotizing skin/soft-tissue infections should be managed in the hospital with intravenous antimicrobial therapy.

Recommended antibiotic therapy is with a third-generation cephalosporin (e.g., ceftazidime, ceftriaxone) plus a tetracycline (e.g., doxycycline).[38] Alternative regimens are a third-generation cephalosporin plus a fluoroquinolone, or monotherapy with a fluoroquinolone.[38]

This approach is supported by a retrospective study of patients with necrotizing fasciitis caused by Vibrio vulnificus. Survival was greater among patients treated with surgery and ceftazidime plus minocycline, or ciprofloxacin alone, than in patients treated with surgery and ceftazidime alone.[59]

Fluoroquinolones are associated with serious, disabling, and potentially irreversible adverse effects including tendonitis, tendon rupture, arthralgia, neuropathies, and other musculoskeletal or nervous system effects.[50][51] The Food and Drug Administration (FDA) has also issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[52][53]

Treatment course: should be individualized, but it is expected to be a minimum of 10-14 days.

Primary options

ceftazidime sodium: 2 g intravenously every 8 hours

or

ceftriaxone: 2 g intravenously every 12 hours

-- AND --

doxycycline: 100 mg intravenously every 12 hours

Secondary options

ciprofloxacin: 400 mg intravenously every 8 hours

OR

levofloxacin: 500-750 mg intravenously every 24 hours

OR

ceftazidime sodium: 2 g intravenously every 8 hours

or

ceftriaxone: 2 g intravenously every 12 hours

-- AND --

ciprofloxacin: 400 mg intravenously every 8 hours

or

levofloxacin: 500-750 mg intravenously every 24 hours

Plus – early aggressive debridement of devitalized tissue

Back
ACUTE
|
localized skin/soft-tissue infection alone
|
necrotizing
Plus – 

early aggressive debridement of devitalized tissue

Treatment recommended for ALL patients in selected patient group

Early aggressive surgical management of the necrotizing skin/soft-tissue infection is essential to improve patient outcome.[45]

1st line – oral antibiotic therapy

Back
ACUTE
|
localized skin/soft-tissue infection alone
|
non-necrotizing
1st line – 

oral antibiotic therapy

Treatment of mild cellulitis due to a local inoculation injury in an otherwise-normal host may be managed in the outpatient setting.

Oral doxycycline with or without an oral newer-generation fluoroquinolone (e.g., levofloxacin, moxifloxacin) is a recommended regimen.

Fluoroquinolones are associated with serious, disabling, and potentially irreversible adverse effects including tendonitis, tendon rupture, arthralgia, neuropathies, and other musculoskeletal or nervous system effects.[50][51] The Food and Drug Administration (FDA) has also issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[52][53]

Treatment course: 10-14 days.

Primary options

doxycycline: 100 mg orally twice daily

OR

doxycycline: 100 mg orally twice daily

-- AND --

levofloxacin: 500-750 mg orally once daily

or

moxifloxacin: 400 mg orally once daily

gastroenteritis

1st line – rehydration

Back
ACUTE
|
gastroenteritis
1st line – 

rehydration

Vibrio parahaemolyticus most commonly causes a self-limiting gastrointestinal illness, lasting 2-3 days.

On the rare occasions that therapeutic rehydration is required, as long as the patient is able to tolerate oral solutions, rehydration can be accomplished using the World Health Organization oral rehydration solution.

If the patient is unable to tolerate oral fluids, parenteral rehydration with lactated Ringer solution is indicated.

Plus – oral antibiotic therapy

Back
ACUTE
|
gastroenteritis
|
with diarrhea >5 days
Plus – 

oral antibiotic therapy

Treatment recommended for ALL patients in selected patient group

For more severe persistent diarrhea of >5 days' duration, it is suggested without published clinical data that a course of either oral doxycycline for 5-7 days or an oral fluoroquinolone for 3 days may be effective.[48]

Fluoroquinolones are associated with serious, disabling, and potentially irreversible adverse effects including tendonitis, tendon rupture, arthralgia, neuropathies, and other musculoskeletal or nervous system effects.[50][51] The Food and Drug Administration (FDA) has also issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[52][53]

Primary options

doxycycline: 100 mg orally twice daily

OR

ciprofloxacin: 500 mg orally twice daily

OR

levofloxacin: 500-750 mg orally once daily

OR

moxifloxacin: 400 mg orally once daily

superficial inoculation infections

1st line – targeted antibiotic therapy

Back
ACUTE
|
superficial inoculation infections
|
otitis externa
1st line – 

targeted antibiotic therapy

There are no standard recommendations for the management of otitis externa caused by Vibrio alginolyticus. Therapy should be based on the isolate's antimicrobial susceptibility.

1st line – ophthalmology referral

Back
ACUTE
|
superficial inoculation infections
|
ocular infections
1st line – 

ophthalmology referral

Data regarding the therapeutic management of Vibrio ocular infections are limited to remote anecdotal reports.[42] Referral to an ophthalmologist is recommended.

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer