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CCFP 3 > Antibiotics + Infections > Flashcards

Antibiotics + Infections Flashcards

1
Q

What abx cover mycoplasma and chlamydia?

A

Macrolides (clarithromycin, azithromycin, erythromycin)
Tetracyclines (tetracycline, doxycycline, minocycline)

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2
Q

Which abx prolong QT?

A

QT MF - QT Makes u Flutter

Macrolides (clarithromycin, azithromycin, erythromycin)
Fluoroquinolones (ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin)

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3
Q

Rx pinworms

A

Mebendazole
Albendazole
Pyrantel

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4
Q

Folliculitis, Carbuncles, complicated carbuncles, impetigo Rx

A

Folliculitis = mupirocin 2%
Carbuncles or cellulitis = cephalexin 500mg BID x 7 days
Complicated = septra 1-2DS tabs
Impetigo = mupirocin 2%

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5
Q

Common pathogens UTI

A

E coli + enterobacteriaceae, Klebsiella, proteus mirabilis

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6
Q

UTI abx - simple

A

Nitrofurantoin 1st line
2nd line: septra, ciprofloxacin, cephalexin

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7
Q

rx of UTI in pregnancy

A

avoid quinolones (no cipro), repeat UC monthly during pregnancy

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8
Q

Out vs inpt rx for pyelonephritis

A

Outpatient: 1 dose ceftriaxone or gentamycin, 10 days amox-clav, Septra or cefixime, or 7 days cipro
Inpatient: 10 days ceftriaxone or gentamycin

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9
Q

cellulitis abx

A

cephalexin 5 days or cefazolin IV 5 days (can be done as outpatient with probenecid to increase half life and make it last 24 hrs)

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10
Q

difference between erysipelas + cellulitis + rx for erysipelas

A

difference is clear demarcation and raised edge - caused by group A strep, treat with penicillin V or amoxicillin

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11
Q

abscess management - when to give abx vs not

A

<2cm w/ no systemic sx + no surrounding cellulitis in otherwise healthy pt = drained, no need for abx
All other abscesses = antibiotics
>2cm or multiple
Immunocompromised
Systemic sx = fever
Surrounding cellulitis
Risk of endocarditis
Indwelling medical device
Risk of community transmission

Abx - cephalexin

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12
Q

Common pathogens for abscesses

A

group A strep, staph aureus, group B, C, G strep

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13
Q

types of impetigo + what bacteria causes them + what sx

A

Bullous impetigo - common in kids, vesicles enlarge to form flaccid bullae with clear yellow fluid that turns darker and turbid over time, commonly over thorax. Staph aureus
Non bullous impetigo - evolves over a week w/ lesions turning into papules into vesicles with surrounding erythema, form blisters that burst with honey crusted lesions, commonly face + extremities. Group A strep
Ecthyma - deeper punch lesions into dermis with surrounding erythema + yellow crust

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14
Q

rx impetigo

A

Tx - mupirocin 2% TID topically, if unresponsive to topical or if extensive involvement or if ecthyma = flucloxacillin 500mg PO QID treat until resolved (max 7 days). If MRSA suspected = Septra, clindamycin or doxycycline

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15
Q

What test to do if adult presents with impetigo?

A

HIV

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16
Q

When may CXR be falsely negative for PNA?

A

Immunocompromised pts
Need CT

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17
Q

common CAP pathogens

A

strep pneumonia, mycoplasma pneumonia, chlamydophyllia pneumonia, Hemophilus influenza

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18
Q

Rx for CAP

A

amoxicillin 1g PO TID x 5 days or doxycycline
If pt smokes, has comorbidities or recent abx use - amox-clav + azithromycin

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19
Q

Sx of bacterial sinusitis vs viral

A

nasal discharge, facial pain, fever, viral sx

Bacterial if fever >39, discharge/ facial pain for >3 days, or if URTI sx >10 days worsening around day 5. Unilateral facial pain, cacosmia, pain in teeth

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20
Q

common sinusitis pathogens

A

strep pneumonia, H influenza, moraxella catarrhalis

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21
Q

rx sinusitis (+ what is it if there is black necrotic discharge - who is more at risk and what should you do?)

A

Tx: amoxicillin 500-1g TID x5-7 days, nasal saline rinses
If black necrotic discharge, and diabetes or immunosuppression = mucormycosis (fungal infection). Needs ENT consult urgently

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22
Q

Sx UTI

A

dysuria, suprapubic discomfort, frequency
fever or flank pain = pyelo

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23
Q

cellulitis sx

A

redness, warmth, swelling, pain and unilateral involvement. Redness must not disappear with elevation of area

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24
Q

CAP sx

A

cough, fever, tachypnea, dyspnea, tachycardia

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25
OM sx + signs on exam
commonly kids, unilateral otalgia, decreased hearing, fever bulging Tym Membrane, yellow or red membrane, perforation of Tym membrane with purulent discharge, impaired tympanic mobility
26
Rx OM - when to give abx + what to give
Tx: if fever >39, moderately to severe systemic sx, severe otalgia or if ill for >48 hrs. Otherwise, delayed script for abx. All adults with OM should be treated amoxicillin 90mg/kg/day divided BID x 10 days for kids under 2, older kids x 5 days
27
common OM pathogens
strep pneumonia, H influenza, moraxella catarrhalis
28
sx conjunctivitis
redness, purulent DC in one or both eyes, mild discomfort. Pain UNLIKELY Bacterial vs viral - bacterial has white milky purulent discharge that reappears when wiped away within few mins
29
common conjunctivitis pathogens
staph aureus, strep pneumonia, H influenza, moraxella catarrhalis
30
Rx conjunctivitis
Usually resolves spontaneously If given early, abx can resolve issue quicker Contact lens wearers always require abx bacitracin polymyxin, tobramicin, arithromycin
31
what is a hyperacute conjunctivitis?
develops within 12 hrs, copious discharge, redness, pain, conjunctival edema, lid swelling and tender pre-auricular lymphadenopathy Site threatening infection with neisseria gonorrhea or neisseria meningitidis
32
How do you manage a hyperacute conjunctivitis?
swab purulent dc for GC+S + PCR NAAT 2g ceftriaxone IV + 1 dose azithromycin or 7 days doxycycline Opthalmology consult Reportable to public health Partners to treat
33
H pylori management
CLAMET/PAMC: Amoxicillin 1000mg BID Clarithromycin 500mg BID Metronidazole 500mg BID PPI BID 14 days Quadruple (for penicillin allergy) Bismuth subsalicylate 2 tabs QID Metronidazole 500mg BID Tetracycline 500mg QID PPI BID 14 days
34
rx c diff in adults + kids
Vancomycin 125mg QID x 10 days Fidaxomicin 200mg BID x 10 days Peds: metronidazole + vanco
35
who gets IE prophylaxis + what do they get?
Pts needing prophylaxis: Prosthetic heart valve Prev bacterial IE During first 6mo of repair of congenital heart defect Dental procedures needing gingival manipulation Tonsillectomy, bronchoscopy Cystoscopy on pts with known enterococcal UTI Abx: Amoxicillin 2g or Cephalexin 2g
36
OE rx
Polysporin eye + ear drops 2 drops QID Ciprodex otic suspension 4 drops BID if perforated
37
What are common interactions with abx?
Oral contraceptives (rifampin can make OCP less effective) Alcohol use (avoid metronidazole) Methotrexate or allopurinol (avoid amoxicillin) Warfarin interacts with ciprofloxacin, metronidazole, clarithromycin, Septra, arithromycin Antifngals, ciclosporin, diuretics, muscle relaxants (avoid gentamicin and tobramicin d/t renal and hearing injury) Tetracyclines, fluoroquinolones, macrolides = interact with multiple meds Fluoroquinolones (achilles tendon rupture)
38
how to approach viral illness w/ pts
Explain likely viral nature of URTI + that abx will have no effect on duration of sx Explain that abx are potentially harmful, with increased colonization and infection with resistant pathogens in pts with prior abx therapy, increased antimicrobial resistance in community, unwanted allergic reactions and SE, cost of unnecessary treatment Empathise with pts about effect of sx on ADLs + provide educational materials and provide therapy for these sx. Offer FU if sx not improving
39
how to approach abx allergy w/ pts
R/O intolerance to side effects, viral exanthum, drug-drug interaction Allergy to penicillin can wane over time No cross-reactivity between sulfa abx and other sulfa drugs Consider referral to allergy testing if allergic reaction was a long time ago or if story not convincing
40
When to order cultures in: systemic illness UTI cellulitis abscess pharyngitis immunocompromised
Any systemic illness = culture UTIs if patient pregnant or other complicating factors (pyelo, structural abnormalities, stones), or if multiple recent infections Impetigo when dx is unclear Cellulitis with systemic illness Abscess if initial therapy failed Pharyngitis - swab needed to r/o group A strep Gonoccocal cultures for community resistance Immunocompromised pts or pts who have had abx in last 3 months
41
rx for meningitis (<3mo, 3mo-50y/o, >50y/o)
Meningitis 3 months - 50 y/o = ceftriaxone + vancomycin If >50 y/o or with comorbidities, add ampicillin If <3 months, ampicillin, cefataxime + call peds
42
rx for febrile neutropenia
Stable - Pip-tazo Unstable - pip-tazo, vancomycin + gentamicin then treat like sepsis
43
When to treat candida empirically (before results)?
Recent abx use
44
What ill-defined issues in pts could be caused by infection?
Elderly with confusion FTT Unexplained pain (necrotising fasciitis, abdo pain in kids w/ PNA)
45
Rx for shingles
72 Hour Window for Shingles Treatment Oral Antivirals (rash) Topical Steroids (keratitis/iritis) Analgesics
46
Complication of shingles + physical sign name
Post Herpetic Neuralgia Hutchinson's Sign - nose
47
Sensitivity calculation
true positive / true positive + false neg
48
Specificity calculation
true neg/ false positive + true neg TNFPTN
49
Positive predictive value calculation
true positive / true positive + false positive
50
Sensitivity calculation Positive predictive value calculation Specificity calculation Negative predictive value calculation
true neg/ false neg + true neg SENS - TPTPFN Positive predictive value - TPTPFP - switch N to P SPEC - TNFPTN Negative predictive value - TNFNTN - switch P to N
51
Tinea pedis rx
azoles, allylamines, terbinafine cream, keep feet cool + dry, wear sandals, air out shoes
52
Soft tissue infections requiring surgery
nec fas, pyomyositis
53
Sx of soft tissue infections
edema beyond erythema, hemorrhagic bullae, pain out of proportion to exam, cutaneous anesthesia
54
Types of nec fas (in terms of what bugs cause them)
polymicrobial (typically in people w/ chronic dz) monomicrobial (usually group A strep)
55
Rx for purulent cellulitis + what bug is most likely
clindamycin, usually staph, need to cover for MRSA
56
Rx for non-purulent cellulitis + what bug is most likely
keflex, septra, doxy, usually strep
57
Septra + ACEi + elderly = what?
AKI
58
Complications of cellulitis
recurrent cellulitis, nec fas
59
Complications of pyelo
renal abscess, obstructing stone, emphysematous pyelo
60
How to choose UTI abx
based on local guidelines, whichever abx does the local e coli have <10% resistance to

CCFP 3 (67 decks)

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