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SHPCPJEN2 > ABX TX > Flashcards

ABX TX Flashcards

1
Q

Anti pseudomonas PCN’s

A

1) ( Timentin ): ticarcillin + clavulanate
2) ( Zosyn ): piperacillin + tazobactam

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2
Q

Antipseudomonas cephalosporins

A

1) ceftazidime ( Fortaz, Tazicef )
2) cefipime ( maxipime)
3) cefiderocol ( fertoja) -new

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3
Q

Pseudomans aeruginosa abx

A

1) anti pseudo PCNS
2) anti pseudo cephs

3) carbapenems
4) fluroquinolones

5) aminoglycosides ( adjunct only )
6 ) monobactam : aztreonam

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4
Q

Neisseria gonorrheae

A

Ceftriaxone 500 mg single IM -( 1 G if >= 150 kg)

-If also chlamydia - doxycycline 100 mg po bid x 7days

If ceph allergy —> azithromycin 2 G + gentamicin 240 mg IM

Neonatal occcular prophylaxis —> erythromycin op ointment

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5
Q

GBS + to prevent neonatal meningitis

A

Intrapartum IV tx : PCN G or ampicillin prior to delivery

Mild PCN allergy : IV cefazolin
Severe PCN allergy: IV clindamycin

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6
Q

Impetigo from staph aureus

A

Mupirocin

2) retapamulin ( altabax)

If severe: systemic abx

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7
Q

MRSA Colonization eradication

A

Bactroban nasal single use tubes
+
Hibiclens ( 4% chlorhexidine)

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8
Q

IV ABX for MRSA

A

1st line: vanco

Clindamycin ( iv po )
Linezolid ( zyvox) IV PO

Tedizolid - iv po ( skin only )
Delafloxacin -iv po ( skin only )
Daptomycin ( baxdela) -not for pneumonia

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9
Q

MSSA

A

Tx with betalactamase resistant PCNs

-dicloxacillin: po

Nafcillin iv
Oxacillin iv

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10
Q

MRSA common abx

A

Vanco

Bactrim

Doxycycline

Linezolid ( zyvox)

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11
Q

PO outpatient ABX

A

Bactrim
Doxycycline
Clindamycin

Linezolid ( zyvox )
Tedizolid ( sicextro)
Delafloxacin ( baxdela )
Omadacycline ( nuzyra)

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12
Q

E faecalis / e faecium

A

Traditional : amp + gent
Newer tx: amp + ceftriaxone
- amp allergy: vanco + genta

VRE: daptomycin , Linezolid …

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13
Q

Corynebacterium diphtheria

A

Anti toxin + abx

PCN or erythromycin x 7d

Close contact prophylaxis: vax & abx
Erythromycin or pcn g

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14
Q

Listeria monocytogenes

A

Ampicillin + gent

PCN allergy : bactrim +/- gentamicin

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15
Q

Bacillus antracis

A

Tx depends on location
Cipro
Clindamycin
Doxycylin
Linezolid
Meropenum

Or a
Combo of ( for CNS)

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16
Q

Neisseria meningitidis

A

Non neonatal meningitis empiric: ceftriazxone + vanco
- once culture shows meningococcus continue with CEFTRIAXONE
- add ampicillin for listeria coverage in > 50 y/o
———If severe PCN allergy: moxifloxacin + vanco ( for listeria coverage only )

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17
Q

Close contact meningitis tx

A

Vax and abx prophylaxis:

Rifampin
Cipro
Ceftriaxone

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18
Q

Helicobacter pylori

A

Guidelines: Tx depends on macrolide resistance

1) triple therapy : clarithromycin + amox ( or metronidazole ) + PPI
2) bismuth quadruple tx : (1st line mostly): metronidazole + tetracycline + bismuth + PPI
3) concomitant therapy : triple therapy + metronidazole

Eradication confirm: - UBT

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19
Q

Haemophilus influenzae

A

H influ om/sinusitis tx: amoxicillin or augmentin

H influ meningitis or severe ifx: ceftriaxone or cefotaxime

Meningitis close contacts post exposure prophylaxis:
Rifampin/ ceftriaxone / cefotaxime
Prevention: Hib vax

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20
Q

Legionella pneumophila

A

Macrolides or resp quinolones:
-azithromycin
- resp quinolones in adults :

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21
Q

Bordetella Pertussis

A

Macrolides ( started within first 3 weeks

Prophylaxis: vax dtap/tdap

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22
Q

Clostridium difficile

A

Oral vanco -125 mg QID 10 days or Dificid ( fidaxomicin) 200 mg bid x 10 days

  • if these 2 unavailable-metronidazole

Fulminant cases( shock, ileus, megacolon) —> vanco 500 mg Qid add IV metronidazole if ileus. Consider rectal vanco

Bezlotoxumab ( zinplava ) : monoclonal ab. Conjunction with abx

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23
Q

Clostridium tetani

A

Tetanus immune globulin -neutralize unbound toxin.

Abx: metronidazole IV. Alt: PCN G IV

Benzo: prevent spasm.
Resp support
Alpha/ beta blockade: if needed. Labetalol dual blocker.

Prevention: immunization with td

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24
Q

Bacteroides
B fragilis

A

DOC: metronidazole

Other abx: carbapenums & betalactams + betalactamase inhibitor

Due to increase resistance to clindamycin & moxifloxacin no longer recommended

Dental ifx: 50% anaerobic but NOT bacteroides
Outpatient : augmentin or clindamycin
Inpatient: ampicillin + sulbactam ( unasyn IV)

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25
Q

Chlamydiae trachomatis / genital chlamydia

A

Doxycycline 100mg bid x7d

Alternatives: 1 G x 1 ( preferred in pregnancy) or Levofloxacin 500mg daily x 7 days

Expedited partner tx: abstain 7 days
Retest 3 months for re infection

26
Q

Mycoplasma Pneumoniae

A

Macrolides or doxycycline

If resistant : 3rd /4th gen quinolones

27
Q

Treponema pallidum: syphilis

A

PCN G benzathine ( Bicilin-LA) IM x 1 - early syphilis

Late latent or tertiary syphilis: PCN G benzathine IM weekly x 3 wks

NeuroSyphilis: aqueous PCN G IV Q4h 10-14 d

28
Q

Borrelia burgdorferi: Lyme disease

A

Early localized disease: doxycycline 10-14d or
Amox or cefuroxime

Lyme carditis: doxycycline , amoxicillin, or CEFTIN ( cefuroxime ) 14-21 days, if severe IV ceftriaxone 14-21 days
Lmk arthritis : doxy, amoxicillin, ceftin ( cefuroxime) 14-21 days , if severe IV ceftriaxone 28 days

Neurologic Lyme disease : facial palsy : doxy 14-21 days
•meningitis : oral doxy or IV ceftriaxone 14-21 days

29
Q

Candida Albicans

A

Yeast

Oropharyngeal -esophageal thrush : nystatin swish and swallow or fluconazole

Vaginal thrush : azole vaginal creams or diflucan

Systemic candidemia : IV echinocandin with po fluconazole as oral step down therapy

30
Q

Candida diaper rash

A

Vusion: Rx ointment : 0.25% michonazole + zinc oxide

Next 2 are strong topical corticosteroids ( not recommended but commonly used. Not recommended bc they have steroid and steroids can cause candida )
• mycologist-II : nystatin + triamcinolone
• Lotrisone: betamethasone + clotrimazole

31
Q

Cryptococcosis

A

yeast

Meningitis tx: indication with ampho B + flucytosine x2weeks; consolidation with fluconazole

Pneumonia tx: fluconazole or itraconazole

32
Q

Aspergillus fumigatus

A

MOLD - found everywhere

DOC : voriconazole ( VFEND)
In severe cases add echinocandin

33
Q

Coccidioides immitis

A

Can cause pnemonia ( valley fever ) and meningitis

Tx: fluconazole or itraconazole

34
Q

Coccidioides immitis

A

Coccidiodomycosis: Dimorphic funcgus - yeast and mold

Pneumonia ( valley fever) and meningitis

Tx : fluconazole or itraconazole

35
Q

Other dimorphics
• histoplasma
• blastomyces

A
36
Q
A

Tx :
Mild- itraconazole po
Severe: amphotericin B IV and step down to azole

37
Q
A

Antifungals and different types of fungi.

Ampho B really reserved for severe cases bc it has lots of side

38
Q

Dermatophytes/ trichophytions

A
39
Q

Tineas by Trichophytons ( dermatophytosis)

A

Capitis ( scalp) and Onychomycosis ( nails) : both treated with systemic Rx ( TERBINAFINE ( lamisil or itraconazole ( sopranox))
-scalp: 4- 6 weeks
- toe nails : 12 weeks, finger nails 6 weeks
- LFT at baseline and Q month
* must check LFTs before we start oral systemic antifungal. Then check once a month

For
Versicolor ( thorax), Corporis ( ringworm), cruris ( jock itch) , Pedis ( athletes foot) : all topical OTC anitfungal ( anoles )

topical Rx:
Ciclopirox: 8% lacquer ( penlac )
Efinaconazole ( jublia)
Tavaborole ( kerydin)
* very low success rate for these topicals and they’re expensive

40
Q

Seasonal influenza

A

Class is called Neuroaminidase inhibitors:
•oseltamivir ( tamiflu)
Adults: 75 mg po bid x5d
•Plx for adults: 75 mg po 7d ( CDC ) or 10d
Can be used in neonates

Zanamivir ( relenza) : diskhaler ( AVOID In asthma patients )

• Peramivir ( rapivab) : IV 600 mg IV as a single dose.

41
Q

RSV

A

Respiratory Syncytial Virus
Just a cold virus

Prevention:
Monthly IM injection : synagis ( palivizumab: monoclonal ab) during RSV season

42
Q

Hepatitis

A
43
Q

Herpesvirus

A

• Tx: Acyclovir, famciclovir, valacyclovir. Lessens duration of symptoms. Best if started early

• a complication of zoster. This is after rash is gone. Neuralgia is nerve pain. We use medications that calm down the nerves. Post Herpetic Neuralgia: 10-15%. Gabapentin, Pregabalin ( lyrica), TCAs ( nortrityline), lidocaine 5% patch, capsaicin, prednisone

44
Q

Epstein Barr virus ( EBV ) and cytomegalovirus ( CMV )

A

Other members of the herpesvirus family. Can cause Mono ( mononucleosis: pharyngitis, fever, lassitude, lymphadenopathy, lymphocytois, splenomegaly, anemia, thomobcytopenia in young.

EPV: mono: Avoid contact sports: spleen gets big and if it hit it can rupture and cause spleen hemorrhage. No tx.

CMV:
Tx: ganciclovir, valganciclovir, cidofovir, foscarnet.
Ifx, usually with immonocompromised. If healthy patient ifx, looks like mono. If immunocompromised, can be dangerous.

45
Q

Infective endocarditis

Think empiric first
Once specified then choose?

A

Empiric : vanco IV ± gram ( - ) coverage

If MSSA or strep : Oxacillin/ Nafcillin + gentamicin are great.

Pathogen specific therapy 4- 6 weeks IV

Dental prophylaxis : are done in certain cardiac patients ( prosthetic heart valves, history of IE, cardiac transplant, valvulopathy) CHD ( mitral valve prolapse does NOT require prophylaxis ).
- amoxicillin 2 grams PO 30 - 60 mins prior to procedure.

If PCN allergy
-Cephalexin ( mild allergy ) , ( severe allergy) : azithromycin or clarithromycin 500 mg PO or doxycycline 100 mg PO. If unable to take PO —> cefazolin or ceftriaxone 1G IM /IV

  • clindamycin no longer recommended.
46
Q

Cellulitis / Erysipelas / Abscess

A

All bacterial skin infections

Augmentin ( alternative: doxycycline ) : 3- 5 days + Td/Tdap

47
Q

Intra abdominal infections

A

Generally post surgical
Empiric tx: single agent regimens : ertapenem ( Invanz ) or zosyn ( piperacillin-tazobactam )
Combo: Levaquin / cipro + metronidazole

Prophylaxis : Cefazolin ( Ancef ) ± Metronidazole
Alternatives: Cefotetan or Cefoxitin

48
Q

Acute Gastroenteritis

A

Tx:
•If norovirus/ rotavirus: supportive tx.
•If bacterial ( febrile )
ABX: short course: quinolones, rifaximin( goes through GI and kills in GI but not absorbed) or azithromycin + supportive

•Giardia( type of diarrhea: hiking, camping, drank from river or lake. Bloated mild diarrhea but doesn’t go away ) : Tx w/metronidazole

•Clostridium difficile( not really acute gastroenteritis ) , colitis after recent abx use tx / w oral vanco or Dificid

49
Q

Diverticulosis / diverticulitis

A

Tx: abx to cover E. Coli and B. Fragilis

Cipro/levo + Metronidazole
Bactrim + Metronidazole
Augmentin sometimes

50
Q

Osteomyelitis

Empiric tx?

Out pt tx:

A

Empiric Tx: Vancomycin + either Ceftriaxone or Ceftazidime

Tx outpatient : IV abx via PICC line for at least 6 weeks
• MSSA: Nafcillin, Oxacillin, Ceftriaxone
• MRSA : vanco, daptomycin
• gram (-) cipro, levo, cefepime, ceftazidime, ceftriaxone
• enterococcus : ampicillin, vancomycin, daptomycin
• Streptococus: PCN G, Ampicillin, Ceftriaxone

51
Q

UTI and Pyelonephritis

A

Tx:
•Acute cystitis: bactrim( used for cys and pyelo avoid in first trimester and at end ( term ). Good for prostatitis and pyelo) , Nitrofurantoin( 1st line. Dont use if CrCl < 30. DONT USE FOR pregnant patients at term; macrobid good for first trimester). Dont give for prostatis ( ineffective ) ) , fosfomycin ( rarely used. Good if multi drug resistant bacteria).
• Pyelonephritis: bactrim, urinary quinolones, ( cipro/levo)

( can you use cipro and levo for acute cystitis. You shouldn’t. You dont want resistance in these.

•Acute cystitis in pregnancy: beta lactams ( Augmentin, keflex, Cefpodoxime, Cefdinir ) or fosfomycin. Macrobid is an option if not at term.
•Pyelonephritis in pregnancy: IV ceftriaxone( most popular ) , cefipime, aztreonam

Warfarin patient: cant use bactrim ( increase INR ) , quinolones ( INR monitor )
Urinary quinolones avoided in pregnancy.

52
Q

Outpatient adult Community -acquired Pneumonia ( CAP ) Empiric Therapy

A

1) healthy patients( adult. Stable. Not short of breath. Osat> 95 96 or 97. Can take pills at home) w/o comorbidities:
Amoxicillin high dose ( 1 G. PO TID) or doxycycline or a macro like ( only if local resistance rate < 25% )

2) patients with comorbidities:
Combo therapy: PO B lactam: Augmentin or Cefpodoxime or Cefuroxime + macrolide or doxycycline

Monotherapy: a respiratory fluroquinolone ( levo, moxi, Gemi, dela ( these are respiratory quinolones))

Comorbidities include: Chronic Heart Disease, lung, liver, renal diseases, DM, alcoholism, malignancy, or asplenia

53
Q

Inpatient adult Community acquired Pneumonia ( CAP )

A
54
Q

Pediatric CAP

A

Outpatient: high dose amoxicillin 1st line
Macrolide if mycoplasma ( atypicals)

Inpatient: IV ampicillin, PCN G, Ceftriaxone, Cefotaxime, ± macrolide if mycoplasma

55
Q

Hospital -acquired and ventilator associated Pneumonia ( HAP and VAP)

Empiric

Risk for MDR:

A

Empiric Tx:

No risk MDR: 1 anti-pseudomonal agent : Zosyn, Cefepime, or levofloxacin

Risk for MDR: 2 anti-pseudomonal agents + 1 anti-MRSA agent
( zosyn, cefepime, Ceftazidime, imipenem, meropenem, or aztreonam
PLUS
An Aminoglycoside agent ( amikacin or genta or tobra )
PLUS
1 anti mRSA ( Vanco, linezolid, or telavancin )

56
Q

Meningitis

A

Empiric Tx: Ceftriaxone + vanco
Add ampicillin > 50 y/o. Dexamethasone beneficial

Neonatal Meningitis :
Empiric amp+ gent ( or cefotaxime)
Empiric if admitted from the community ( amp + gent + cefotaxime)

57
Q

STI ( sexually transmitted Infections )

A

Chlamydia:
Doxy 100 bid x7d
Alt: levofloxacin 500 mg daily x7 days,
Azithromycin 1 g x1 ( preferred if pregnant)

Gonorrhea:
•Ceftriaxone 500 mg single dose IM injection ( 1 gram if ≥ 150 kg )
If chlamydia too : doxy 100 bid x7d

Syphilis:
-Benzathine PCN G IM 2.4 MU IM x1 for 1° or 2°
If PCN allergy doxy for 14 to 28 days
If PCN allergy and pregnant, then best to desensitize patient for PCN bc we cant doxycycline.

Genitalia herpes: tx : acyclovir, famciclovir , valacyclovir ( dont see Gancyclovir)
Also may need for suppression: lower dosages of same meds but taken daily. Also helps reducing transmission to partner.

Trichomonas: metronidazole or tinidazole

HPV : vax, if warts ( imiquimod ( aldara) , podofilox, trichloracetic acid ) or freeze them ( cryotherapy)

58
Q

Scabies

A

Tx:
Elimite Cream ( permethrin 5% )
Oral ivermectin ( stromectol ) off label
Topical sulfur 6-33% is primarily tx of infants < 2 months

Apply neck to toe, wash off in 8 to 14 hours, may repeat in 1 to 2 weeks. Night they put this on, this the night they do laundry of everything. Put cream on and sleep with it. Location of where you put it depends on itch. Usually everywhere neck to toe. If children then scalp to toe. For whatever reason it doesn’t like adult faces. For children it does affect them.

Topical premethrin safe for most. Not fda approved for below 2 months so use for topical sulfur.

59
Q

Pinworm

A

Anal itching. Intestinal nematode. Tiny white string.

Treat whole family.
Mebendazole ( emverm) single tab 100 mg po x1
Albendazole 400 mg x1

60
Q
A

Tx:
•Acute cystitis: bactrim, Nitrofurantoin, fosfomycin
• Pyelonephritis: bactrim, urinary quinolones, ( cipro/levo)

( can you use cipro and levo for acute cystitis. You shouldn’t. You dont want resistance in these.

61
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62
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SHPCPJEN2 (26 decks)

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