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TT Step 3 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

PCP

  • dx
  • tx
A

Dx: CXR (ground glass, interstitial/alveolar infiltrates), LDH >500, Flourescence sputum stain or bronchoalveolar lavage

Tx: TMP-SMX x 21 days
or IV pentamidine
+ Prednisone if PaO2 <70mmHg

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2
Q 
Impetigo tx (infxn of epidermis)
- GBS
A

Limited infxn: topical mupirocin
Extensive infxn:
- Staph/strep: Cephalexin or dicloxacillin
- if MRSA concern: TMP-SMX or doxycycline

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3
Q

Erysipelas tx (infxn of upper dermis)

A

GBS - PCN
S. aureus - cephalexin
MRSA - TMP-SMX or doxycycline

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4
Q

Cellulitis tx (infxn of entire dermis and subQ fat)

A

Cephalexin
If MRSA - TMP-SMX or doxycycline or clindamycin or Vanc (if inpt)

If human/animal bite: amox/clav (for anaerobes).

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5
Q

Nec Fasc tx

A

1 cause GAS: PCN, or Pip/taz

Clindamycin - stop toxin production

Vancomycin - MRSA coverage

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6
Q

Pre-septal cellulitis tx

Orbital cellulitis tx

A

Pre-septal cellulitis (S. aureus, Strep) - cephalexin, dicloxacillin

Orbital cellulitis

  • GRNs: CTX, amp/sulbactam
  • Skin flora/MRSA: Vancomycin
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7
Q

Osteomyelitis:

  • Dx
  • Tx
A

Dx: plain films of area. If nl -> MRI
- If plain films or MRI is abnl -> bone bx w/ culture

Tx: Immediate broad coverage 
Staph - Nafcillin, oxacillin, cefazolin
MRSA - Vanc, Clindamycin
GN (salmonella) - CTX
Pseudomonas (IVDU, DM, LE ulcers) - Pip/Taz
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8
Q

Septic Arthritis tx

A 
Commonly caused by skin flora
- Empiric abx: 
Vanc ( S. aureus) >
Pip/taz, 
cetazidine or CTX (Unusual pathogens, Kingella, H. influ, N gonorrhea)
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9
Q

DIverticulitis

  • dx?
  • Tx?
A

Dx: CT (Do NOT Scope until acute process resolves! Risk of perf)

Tx: Bowel rest + Ciprofloxacin and Metronidazole

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10
Q

Encephalitis
Dx?
Tx

A

Lumbar puncture -> CSF (HSV PCR and HSV culture)

IV acyclovir

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11
Q

West Nile Encephalitis

  • Sx?
  • Dx?
A

Fever + AMS
and Extrapyramidal sx or flaccid paralysis suggestive of transverse myelitis

Serum or CSF IGM antibody to WNV

Supportive tx

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12
Q

Bacterial meningitis tx

A

Dexamethasone b4 abx if S. pneumo is suspected (lowers mortality)

Neonate: GBS, E. coli, Listeria

  • Ampicillin + Aminoglycoside (gentamycin)
  • Ceftriaxone can displace albumin-bound bilirubin in neonates, thereby increasing the amount of free bilirubin. The resultant hyperbilirubinemia can cross the blood-brain barrier and increase the risk of KERNICTERUS.

Child/Adult: Strep pneumo, N. meningitidis: CTX + Vanc

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13
Q

Acute sinusitis (Fever, h/a, facial pain/swelling) tx

A

7-10 d of amox/clav or doxycycline

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14
Q

Otitis media (fever + unilateral ear pain, bulging TM)

A

<2 y.o: amox/clav for 10 d
2-5 y.o: amox/clav for 7 d
>6 y.o: amox clav 7 d

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15
Q

Otitis externa (foul smelling drainage, tenderness upon pulling pinna) tx

A

remove foreign material

Minimal sx - topical acidifiers (acetic acid, domeboro)

Moderate sx - topical abx (ofloxacin, neomycin) + steroids

Severe sx (malignant otitis externa): IV Ciprofloxacin
- classically caused by pseudomonas
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16
Q

Pharyngitis tx

A

GAS: PCN (or macrolide if PCN allergy)

17
Q

Meningococcal prophylaxis for close contacts
( >8 hours of exposure in close proximity (<3 feet) to the affected patient or as direct exposure to respiratory secretions)

A

Recommended regimens include rifampin (600 mg orally twice daily for 2 days), ciprofloxacin (500 mg single oral dose), and ceftriaxone (250 mg single dose)

*Rifampin would generally be preferred, but it interacts with oral contraceptive pills (OCPs) to decrease their efficacy. Rifampin increases hepatic clearance of OCPs

18
Q

A pt with a + treponemal antibody absorption test, who has neurologic symptoms (eg, headache, blurred vision) requires _________ to evaluate for neurosyphilis.

A

a lumbar puncture
- (as the treatment for neurosyphilis is different from that for other stages of illness).

CSF analysis reveals an elevated leukocyte count (>5/mm3) and positive VDRL or fluorescent treponemal antibody absorption (FTA-ABS) testing.

19
Q

Tx of Syphilis
Primary
Secondary
Early latent (<12 months of infection)

A

IM Benzathine penicillin G,

  1. 4 million units
    - single dose
20
Q

Tx of Syphilis
Late latent (>12 months of infection)
Unknown duration
Gummatous/CV syphilis

A

IM Benzathine penicillin G,
2.4 million units
- weekly
for 3 weeks

21
Q

Tx of Syphilis

Neurosyphilis

A

IV Aqueous penicillin G,
3-4 million units
- every 4 hours for 10-14 days

22
Q

Tx of Congenital syphilis

A

IV Aqueous penicillin G,
50,000 units/kg/dose
- every 8-12 hours for 10 days

23
Q

Jarisch-Herxheimer reaction is an acute febrile response that often occurs after the initial treatment of spirochetal illnesses such as syphilis.
- How do you prevent/treat?

A

No effective prevention is available, but manifestations are generally self-limited and resolve within 48 hours.

24
Q

condylomata acuminata (anogenital warts),

  • due to human papilloma virus infection.
  • typically skin-colored or pink and vary in appearance from smooth, flattened papules to verrucous, papilliform growths.

First-line treatment ?

A

topical imiquimod, an immunomodulatory drug,

25
Q

Pediatric sepsis tx

A

ampicillin plus gentamicin or cefotaxime

Ceftriaxone and sulfonamides should be avoided due to risk of hyperbilirubinemia

26
Q

“swimmer’s ear”

pain, erythema, and otic discharge

A

Otitis externa

- topical acidifiers or topical abx

27
Q

tx for Symptomatic individuals found to be infected with Salmonella enteritidis

A

replacement fluid and electrolytes

  • Gastroenteritis is usually self-limited and antibiotic use has not been shown to hasten the resolution of symptoms
28
Q

How do PPI’s affect Cdiff infections?

A

increases risk

- C difficile spores are acid-resistant, but PPIs increases the risk of C difficile proliferation.

29
Q

varicella-zoster virus (VZV) vaccine is a live-attenuated vaccine that is administered typically in 2 doses: the first at age ____ and the second at age ____

A

12–15 months

4–6 years

  • should be monitored closely for a vaccine-associated VZV rash, which occurs in <10% of children
30
Q

UTI abx in pregnancy

A

amox-clav
Nitrofurantoin
cephalexin

31
Q

Tx of furuncles and carbuncles (subQ abscess of hair follicles)

A

most contain MRSA

  • Clindamycin
  • TMP-SMX
  • Doxycycline
32
Q

__________is a broad-spectrum regimen commonly used for chorioamnionitis, an intrapartum uterine infection.

A

Ampicillin plus gentamicin

*does not cover penicillin-resistant anaerobes

33
Q

Acute chest syndrome in sickle cell disease tx

A
  • tx w/ ceftriaxone and macrolide (eg, azithromycin), pain control, and intravenous fluids.
34
Q

Chronic bacterial prostatitis

A

6 weeks of a fluoroquinolone (eg, ciprofloxacin) or trimethoprim-sulfamethoxazole.

35
Q

Lyme arthritis

A

28-day course of oral doxycycline or amoxicillin.

Prognosis is favorable, and most patients recover completely.

36
Q

Why shouldnt you give CTX and sulfonamides to neonates with hyperbilirubinemia?

A

Ceftriaxone can displace albumin-bound bilirubin in neonates, thereby increasing the amount of free bilirubin. The resultant hyperbilirubinemia can cross the blood-brain barrier and increase the risk of kernicterus.

37
Q

______ helps prevent neurologic complications in adults with pneumococcal meningitis.
For viral meningoencephalitis, ________ is recommended

A

Dexamethasone

Acyclovir
*steroids are not recommended as they do not improve outcomes.

TT Step 3 (7 decks)

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