Antibiotics Flashcards
What is the treatment for bacterial meningitis in neonate ( < 28 days)
and what want to cover?
** “CVA”** for meningitis in first 28 days of life
Cefotaxime + Vancomycin + Ampicillin
Cefotaxime covers GBS/Strep pneumo/Neisseria
Vancomycin covers MRSA
Ampicillin covers Listeria
Why Ceftiraxone is C/I in neonates?
and what is the alternative?
causes biliary sludge
alternative: ampicillin + Gentamicin
Tx for meningitis in elderly pts ( > 50yo)?
** “CVA”** for meningitis in first 28 days of life + > 50 yrs
Cefotaxime + Vancomycin + Ampicillin
Cefotaxime covers GBS/Strep pneumo/Neisseria
Vancomycin covers MRSA
Ampicillin covers Listeria
Strep pneumo Meningitis, Tx?
Ceftriaxone + Vancomycin + Steroids (“CVS”)
MCC meningitis in adults 18-65 yo?
Strep.pneumo
Hospital-acquired or post-neurosurgical procedure bacterial meningitis
Pathogens and Tx?
Ceftazidime or cefepime + vancomycin
Psuadomoans + MRSA
Ceftazidime- the only 3rd generation the cover psuedomonas
Cefepime- 4th generation
Headache + nuchal rigidity + fever. LP shows gram-positive diplococci + neutrophil predominance
most likley pathogen?
Tx?
Strep. pneumo meningitis
Treatment- Ceftriaxone + Vancomycin + IV Steroids (“CVS”)
IV pt has severe headache + nuchal rigidity + papilledema.
Dx?
Tx?
Cryptococcal meningitis- Cryptococcus
Tx- Amphotericin B + flucytosine
Which pathogen ??
IV Pt present with meningtisis is charactirezid by ↑↑ significantly elevated opening pressure
WBC with lymphocyte predominance + ↓ glucose + ↑protein
and how do we the diagnosis?
Cryptococcus
Diagnosis test- CSF antigen test (highly sensitive and specific)»_space; Latex agglutination assay or India ink stain
MOA amphotericin B?
binds ergosterol → makes holes in fungal membrane
MOA flucytosine?
Inhibits thymidylate synthase
What is the maintanace therapy in croptoccocus meningitis?
Fluconazole until symptoms resolve + CD4 >100 for >1y
HIV + CD4 < 250 + lives in AZ
patohgen and PPx
Coccidioidomycosis
prophylaxis- Itraconazole
HIV + CD4 < 200
Pathogen and ppx
Pneumocystis jirovecii
TMP-SMX or pentamidine (HY alternative) or dapsone (HY alternative) or atovaquone
HIV + CD4 < 150 + lives in KY
pathogen and prophylaxis
Histoplasmosis
PPx- Itraconazole
HIV + CD4 < 50
pathogen and propylaxis
Mycobacterium avium complex (MAC)
PPx- none
Pt on chemotherapy develops fever + WBC count is 2000
Neutropenic fever
possible microbe and Tx
Pseudomonas + MRSA
Tx: Ceftazidime (or Cefepime) + Vancomycin
Tx for pt with seizures due to neurocysticercosis
Phenytoin
HIV + headache + nuchal rigidity. LP shows lymphocytic pleocytosis. Imaging shows enhancement at base of brain (or in basilar cisterns)
Dx?
Tuberculous meningitis
most common cause of cellulitis?
Tx?
Staph aureus
Tx- Clindamycin or TMP-SMX or Cephalexin
Most common cause o Erysipelas?
Strep pyogenes
(GAS)
well-circumscribed + elevated + face + abnormal vitals
Cellulitis or erysipelas?
Erysipelas