415 Exam 4 Drugs Flashcards
What is the DOC for uncomplicated gonorrhea infections of the cervix, urethra, and rectum
Ceftriaxone 250mg IM once
Plus
Azithromycin 1g PO once OR
Doxycycline 100mg PO BID for 7 days
DOC for chlamydia
Azithromycin 1g PO once OR
Doxycycline 100mg PO BID for 7 days
DOC for patient who has chlamydia AND gonorrhea
Azithromycin 2g PO once
DOC for treatment of chlamydia in pregnant patients
Erythromycin base 500mg QID for 7 days OR
Amoxicillin 500mg TID for 7 days
DOC for trichomoniasis treatment
Metronidazole (Flagyl)
- short course: 2g PO once
- extended course: 500mg PO BID for 7 days
DOC for outpatient PID patients
Ceftriaxone 250mg IM once
plus
Doxycycline 100mg BID for 14 days
+/- Metronidazole 500mg BID for 14 day
DOC for inpatient PID patients
Cefoxitin 2g IV q6h
plus
Doxycycline 100mg IV q12h
Continue for 24 hours after improvement then follow with:
Doxycycline 100mg PO BID to complete 14 days of treatment
DOC for primary, secondary, and early latent (<1 year duration with neg CSF) syphilis
Benzathine Penicillin G 2.4 MU IM once
DOC for latent (neg CSF >1 year or unknown duration) syphilis
Benzathine Penicillin G 2.4 MU IM weekly for 3 weeks
DOC for neuro/cardiovascular syphilis
Aqueous Penicillin G 3-4 MU IV q4h for 10-14 days
DOC for first episode of genital herpes
Acyclovir (Zovirax) 400mg TID or 200mg 5x/day OR
Valacyclovir (Valtrex) 1g BID OR
Famiciclovir (Famvir) 250mg TID
For 7-10 days
DOC for recurrent/episodic genital herpes
Acyclovir (Zovirax) 400mg TID or 200mg 5x/d or 800mg BID for 5 days (or 800mg TID for 2 days) OR
Valacyclovir (Valtrex) 500mg BID for 3 days or 1g QD for 5 days OR
Famiciclovir (Famvir) 125mg BID for 5 days or 1000mg BID for 1 day or 500mg once followed by 250mg BID for 2 days
DOC for suppressive therapy for genital herpes
Acyclovir (Zovirax) 400mg BID OR
Valacyclovir (Valtrex) 500mg QD or 1g QD OR
Famiciclovir (Famvir) 250mg BID daily
DOC for severe disseminated herpes simplex
Acyclovir (Zovirax) 5-10 mg/kg IV q8h until clinical improvement followed by oral for a total of at least 10 days
DOC for mild to moderate CDAD
Metronidazole 500mg TID for 10-14 days
OR
Vancomycin PO 125-500mg QID
DOC for severe CDAD
Vancomycin PO 125-500mg QID
plus
Metronidazole 500mg QID-TID for 10-14 days
DOC for patients who have toxic megacolon
Metronidazole 500mg IV QID for 10-14 days
OR
Vancomycin retention enema 500-1000mg in 1-2L of isotonic saline q4-12h
DOC for the first recurrent episode of CDAD
Vancomycin PO 125-500mg QID
plus
Metronidazole 500mg QID-TID for 10-14 days
DOC for the second recurrent episode of CDAD
Tapering dose of oral Vancomycin
DOC for the third recurrent episode of CDAD
Vancomycin 125mg QID for 14 days
following by
Rifixamin 400mg BID for 14 days
alternative (expensive) options for treating CDAD
Fidaxomicin (Dificid) 200mg BID
Bezlotoxumab (Zinplava)
DOC for folliculitis (if antibiotics needed)
Topical antibiotics: clindamycin, erythromycin, or mupirocin 2% ointment applied 3 times daily for 3-5 days
antibiotics recommended for persistent carbuncle treatment
Cephalexin 250-500mg q6h
Dicloxacillin 250-500mg q6h
DOC for erysipelas
Penicillin VK 250-500 PO q6h OR
Procaine Penicillin G 600,000 units IM q12h (or 1MU q4h)
Clindamycin 150-300 q6-8h
Erythromycin 250-500mg q6h
DOC topical treatment for impetigo
Mupirocin 2% (Bactroban) BID for 5 days
If MRSA: Retapamulin (Altabax) BID for 5 days
systemic treatment is given for MSSA or Strep impetigo
Dicloxacillin
Cephalexin
Erythromycin
Clindamycin (ONLY for PCN allergy)
systemic treatment is given for MRSA impetigo
Clindamycin
TMP/SMX
Doxycycline
DOC for cellulitis WITHOUT systemic manifestations (MRSA not suspected)
Cephalexin 500mg QID
Dicloxacillin 500mg QID
Clindamycin 300-450mg QID (last choice)
5-10 days
DOC for cellulitis WITHOUT systemic manifestations (MRSA suspected)
Doxycycline 100mg BID
Clindamycin 300-450mg QID
TMP/SMX DS 1 tab BID
5-10 days
DOC for cellulitis WITH moderate to severe infection (MRSA not suspected)
Cefazolin 1g IV q8h
Nafcillin or Oxacillin 1-2g IV q4h
Clindamycin 600mg IV q8h
DOC for cellulitis WITH moderate to severe infection (MRSA suspected)
Vancomycin 15-20mg/kg q12-8h (max dose 2g, goal trough 10-15)
Add Zosyn for anaerobes
DOC for cellulitis with moderate to severe infection and possible polymicrobial (including anaerobes)
Zosyn 3.375g q6h
Meropenem 1-2g q8h
Ceftazidime 1g q8h or Cefepime 2g q12h plus Metronidazole
DOC for type 1 necrotizing faciitis
Zosyn 3.375 IV q6h OR Meropenem 1-2g q8h *plus* Clindamycin 600-900mg IV q8h *plus* Vancomycin (daptomycin or linezolid)
DOC for type 2 necrotizing faciitis
Clindamycin and Penicillin G
DOC for mild diabetic foot ulcers
- Amoxicillin/clavulanate
- Clindamycin + cephalexin
- Levofloxacin + Clindamycin
DOC for moderate to severe diabetic foot ulcers
Zosyn 3.375g q6h
Meropenem 1-2g q8h
Ceftazidime 1g q8h or Cefepime 2g q12h
plus Metronidazole
DOC for mild human/dog/cat bite treatment
- Amoxicillin/clavulanate
- TMP/SMX + Clindamycin or Metronidazole
Empiric therapy for primary SBP
Ceftriaxone
Ceftazadime
Cafotaxime
Cefepime
anaerobic agent can be added to primary SBP therapy if absence of response
Clindamycin
Metronidazole
treatment recommendations of secondary bacterial peritonitis (combinations)
Clindamycin or Metronidazole
plus
Antipseudomonal quinolone (Cipro) or Aminoglycoside
treatments of secondary bacterial peritonitis that do not require a combination
*Zosyn* Unasyn Imipenem/cilastin Meropenem Ertapenem
treatment recommendations for continuous ambulatory peritoneal dialysis-associated peritonitis
-Vancomycin (if G+) 30mg/L
-Aminoglycoside (8mg/L) or Cipro (if G-)
IV or intraperitoneal
treatment recommendations for acute cholecystitis and cholangitis
Zosyn or Aminoglycoside plus Clindamycin or Metronidazole
Ceftazadime or cefepime plus Metronidazole or Clindamycin
Carbapenem
single-dose therapy for UTIs
Fosfomycin tromethamine (Monurol) -single dose 3g powder packet dissolved in water (take on empty stomach)
three day therapy for uncomplicated simple UTI
TMP/SMX DS (Bactrim DS) BID for 3 days
seven day DOC therapy for UTI
- TMP/SMX DS BID
- Amoxicillin/clavulanate 875mg BID
- Amoxicillin 500mg TID
- Nitrofurantoin 100mg BID
outpatient treatment recommendations for acute pyelonephritis (nonpregnant women)
-TMP/SMX BID for 14 days
-Cirpro 500mg BID for 7 days
-Ceftriaxone 1g IV/IM once plus TMP/SMX or beta lactam
Follow up with culture at completion of therapy
empiric therapy for inpatient pyelonephritis
- ceftriaxone 1g q24h
- Zosyn 4.75g q8h
- Ertapenem or Meropenem
- Cipro IF local resistance <10%
prophylaxis treatment should be given if recurrent UTI is related to intercourse
TMP/SMX 1 tab or
Nitrofurantoin 50-100mg or
Cephalexin 250mg
after intercourse
prophylaxis treatment should be given if recurrent UTI is unrelated to intercourse
TMP/SMX 1/2 tab at bedtime or 1 tab 3x/week or
Nitrofurantoin 50-100mg at bedtime or
Cephalexin 250mg at bedtime
DOC for bacterial prostatitis (when N. gonorrhea is NOT suspected)
TMP/SMX 10-14 days
do not give quinalones empirically
DOC for athlete’s foot, ringworm, jock itch
OTC therapy—Antifungals
- Clotrimazole
- Miconazole
- Butenafine
- Terbinafine
- Tolnaftate
DOC for Interdigital tinea pedis, tinea cruris, tinea corporis
Naftifine (Naftin 1 or 2% cream and gel)
Luliconazole (Luzu 1% cream)
DOC for onychomycosis
Terbinafine (Lamisil) 250mg/day 6-12 weeks
DOC for uncomplicated vulvovaginal candidiasis
Topical: Clotrimazole (1, 2, 10%), Micronazole (2%), Miconazole supp, Ticonazole (2,6%)
Oral: Fluconazole 150mg daily
Nystatin 100,000unit daily intravaginally 14 days
DOC for recurrent vulvovaginal candidiasis
Fluconazole 150mg qw x6 months
DOC for oropharyngeal candidiasis in healthy uncomplicated, HIV pts on HAART w/mild OPC and minimal esophageal likelihood
Nystatin topical
Clotrimazole troches
Miconazole buccal
DOC for oropharyngeal candidiasis in patients with refractory to topical OTC and cannot tolerate topical , moderate to severe disease and high risk for systemic disease
Systemic therapy
FLuconazole
Itraconazole solution
DOC for systemic Candida in immunocompetent adults
Echinocandins or
Fluconazole 800mg load then 400mg (IF C. albicans)
DOC for systemic Candida in Immunocompromised patients
Echinocandins
DOC for esophageal candidiasis
Fluconazole 200-400mg PO QD for 14-21 days
DOC symptomatic Candiduria
Fluconazole 200mg daily for 2 weeks
Alternative: AmB bladder irrigation
DOC for Aspergillosis
Azoles
DOC for invasive Aspergillosis
Voriconazole (start with IV, switch to PO) 6-12 weeks
DOC for allergic bronchopulmonary aspergillosis
Itraconazole or Voriconazole plus steroid
DOC for Aspergilloma
Surgery then Itraconazole or Voriconazole
DOC Non-HIV patients for cryptococcosis
Fluconazole 6-12 months
Induction: AmB + Flucytosine 4weeks
Consolidation: Fluconazole 400-800mg for 8 weeks
Maintenance: Fluconazole 200mg for 6-12 months
DOC for HIV patients with cryptococcosis
Fluconazole for life
Indication: AmB + Flucytosine for 4 weeks
Consolidation: Fluconazole 400mg for 8 weeks
Maintenance: Fluconazole 200mg for > 1year
DOC for acute pulmonary histoplasmosis
Ampho B with steroid then Itraconazole for 12 weeks
DOC for chronic pulmonary histoplasmosis
AmphoB then Itraconazole for 12-24 months
DOC for non-AIDS disseminated histoplasmosis
AmphoB then ITZ for at least 12 months
DOC AIDS disseminated histoplasmosis
AmphoB then Itraconazole for life
DOC for pulmonary life-threatening blastomycosis
Lipid AmphB then Itraconazole 6-12 months
DOC for pulmonary mild-moderate blastomycosis
Itraconazole 6-12 months
DOC for disseminated CNS blastomycosis
Lipid AmphoB for 4-6weeks then Itraconazole or Voriconazole for 12 months
DOC for Immunocompromised hosts with blastomycosis
Lipid AmphB then Itraconazole for life
DOC for initial coccidioidomycosis
Fluconazole 400-1200mg daily for life
DOC for influenza
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Peramavir (Rapivab)
DOC for Herpes simplex virus
*Acyclovir (Zovirax)* Valacyclovir (Valtrex) Famciclovir (Famvir) Penciclovir (Denavir) Foscarnet (Foscavir)
DOC for herpes labialis primary disease
Acyclovir
Famciclovir
Valacyclovir
DOC for Herpes labialis reactivation disease
Acyclovir
Famciclovir
Valacyclovir
Penciclovir 1% cream
DOC for Varicella-Zoster virus
Acyclovir (Zovirax)
Valacyclovir (Valtrex)
Famciclovir (Famvir)
Penciclovir (Denavir)
DOC for immunocompetent persons with herpes zoster
Acyclovir
Famciclovir
Valacyclovir
DOC for immunocompromised persons with herpes zoster
Acyclovir (severe: IV, non-severe: PO)
Famciclovir
Valacyclovir
Foscarnet (acyclovir resistant)
DOC for CMV antiviral therapy for treatment and prophylaxis
*Ganciclovir (Cytovene)* Valganciclovir (Valcyte) Foscarnet (Fascavir) Cidofovir (Vistide) CMV immune globulin (CytoGam)