Anti Infective Guidelines Flashcards
First line agent for acute prostatitis
What are s/s
Duration: 10-14 days
-if no improvement r/a
S/s: acute onset chills, fever, perineal and low back pain, irritative and obstructive voiding. Prostate is tender, swollen, indurated and warm
Obtain urine specimen before empiric therapy
What should you avoid with prostatitis
Prostate massage because it’s painful and may cause bacteremia
Chronic prostatitis treatment ? What is it
Symptoms vary but include dysuria, other voiding complaints, ejaculatory or genital pain, some patients may be asymptomatic and prostate exam is usually normal
Antibiotics usually don’t have a role unless positive culture is present. When treating, cultures may be negative but clinical presentation significant; best to treat with syndrome approach
If there is no response in 4-6 weeks, refer to urologist
Epididymitis
What are the symptoms
Presents as inflammation of the epididymis manifested by acute onset of unilateral testicular pain and swelling, often with tenderness of the epididymis and vas deferans and occasionally with erythema and edema of the overlying skin
If there is discharge, presumed to be from STI
First line for Epididymitis for >35
The non sexually transmitted version occurs most in men >35
Can also present secondary to prostatitis and may require up to 6 weeks of therapy
Ciprofloxacin 500 mg BID x10-15 days
Epididymitis for <35 or with multiple sex partners first line
Usually caused by chlamydia or gonorrhea
Cefixime 400-800mg orally OR ceftriaxone IM 250mg single dose
+
Azithromycin 1g single dose
Or
Doxycycline 100mg BID
Urethritis - gonococcal first line treatment for penicillin allergy and non penicillin allergy
this is gonorrhea
Recommended to treat both chlamydia and gonorrhea as they often accompany each other. Where lab results are not available and there is no urethral discharge wait for results but if present treat.
Cefixime 400-800mg single dose OR ceftriaxone IM 250mg
+
Azithromycin 1g single dose OR
Doxycycline 100mg BID x 7 days
Penicillin allergy:
Azithromycin 2g PLUS gentamicin 240mg IM in two separate 3mL injections
Do you need test of cure for gonorrhea and do you report to public health
Yes report to PHU
All sexual partners from 60 days prior to symptom onset should be evaluated and treated
Test of cure: if alternate regimen then yes test for cure 1-2 weeks after completion of the therapy
Urethritis -nongonococcal
This is chlamydia
Azithromycin 1g single dose
Or
Doxycycline 100mg BID x 7 days
Pregnancy with chlamydia or gonorrhea
Chlamydia: azithro 1g single dose or erythromycin. Alternative is amoxicillin 500mg TID x 7 days
Gonorrhea: cefixime and ceftriaxone. Azithro can be given to treat concomitant chlamydia infection
Must culture 4-5 days post treatment
doxy is contraindicated in pregnancy
HSV- genital herpes what is the first line for first symptomatic episode
Acute recurrent episodes<6 / year for genital herpes
Initiate therapy within 72 hours of onset of signs and symptoms for most benefit
What treatment for chronic suppressive therapy for genital herpes ?
If you have >6 episodes per year ,
Usual duration is 3-6 months
Herpes simplex (mouth herpes) first line for first episode ?
No therapy needed
First line for recurrent herpes of mouth >3 per year ?
Famciclovir 500mg BID x 7 days
Or
Valacyclovir 2g BID x 1 day
