Bacterial infections Flashcards
rank the highest to lowest hearing loss risk organisms for meningitis
S. pneumoniae, N. meningitidis, H. influenzae
what is the clinical presentation- 3 core sx of meningitis
stiff neck, fever, altered mental status
which meningitis bacteria require post exposure prophylaxis?
H. influenzae and N. meningiditis
when should dexamethasone be given in meningitis
before or with first dose of empiric abx
should empiric IV abx be given before or after lumbar puncture
after
in pts <1mth, what is the recommended empiric tx for meningitis
ampicillin + cefotaxime or AMG
in pts 1mth-50yrs, what is the preferred tx for meningitis
cefotaxime/ ceftriaxone + vancomycin
in pts >50yrs or with immunocomp, what is the preferred tx for meningitis
cefotaxime/ ceftriaxone + vancomycin + ampicillin
which cephalosporins are beta lactamase resistant
3rd gen
how long to tx H. influenzae and S. pneumoniae causing meningitis after obtaining culture results
targeted tx for 7-10d
how long to tx meningitis caused by N. meningitidis, with what?
5-7d with 3rd gen cephalosporin or pen G
what should be given as post exposure prophylaxis in H. influenza or S. pneumoniae meningitis
rifampin
ceftriaxone if pregnant
what is the most common cause of uncomplicated UTI
E. coli
what is the frequency considered recurrent or relapse UTI
2x/6mths or 3x/yr
what are the 3 most common pathogens in UTI
enterobacterales (-)
staphylococcus saprophyticus (+)
enterococcus (-)
what are some indications fro culture in UTI
pregnancy, pyelonephritis, complicated UTI, bacterial prostatitis, early recurrence <1mth, failure to response to empirical tx
what is 1st line tx for uncomplicated cystitis
nitrofurantoin x5d
TMP/SMX x3d
fosfomycin 3g x 1 dose
what is 1st line tx for complicated cystisis
TMP/SMX
amoxi/clav
cefixime
fluoroquinolones (levo/cipro)
which FQ should not be used in cystitis
moxifloxacin - doesn’t penetrate into urine
what is 1st line tx for uncomplicated pyelo
FQs (cipro/levo) x5-7d
what may be used for post coital UTI prophylaxis
TMP/SMX, macrobid, cephalexin, FQ 2hrs after sex
T or F: asymptomatic bacteremia should be treated in pregnancy
T- use amoxi/clav, cephalexin, or ceftriaxone
which of the following should be avoided in preg
1. macrobid
2. TMP/SMX
3. ceftriaxone
4. 1+2
4
how long is the treatment for adults vs children in sinusitis
adults = 5-10d
children = 10-14d
what is 1st line for adults and children for uncomplicated acute sinusitis
adults: amoxicillin SD (HD if RF)
children: amoxicillin HD div BID
what is tx duration for AOM =>2yrs or <2/ relapse/ perf TM
=>2yrs = 5d
<2yrs/ relapse/ perf TM= 10d
when is HD amoxicillin recommended for AOM
if <2yrs, daycare, abx i nlast 3mths
what are alt tx for lief threatening penicillin allergies in AOM
clarithomycin, azithromycin, clindamycin
what are alts for AOM for nonlife threatening penicillin allergy
ceftriaxone or cefuroxime
what is the common cause of AOM w/ purulent conjunctivitis
H. influenzae, M. catarrhalis
what is the key sx of tuberculosis
consumption
what is 1st and 2nd line tx for latent TB + duration
rifampin x4mths
isoniazid x9 mths
what are the durations for active TB tx
intensive phase = 2mths
continuous phase = 4 or 7 mths
what tx used in intensive TB tx
RIPE
RIE if risk hepatotoxicity for >75yrs
when to use RIE instead of RIPE
if risk hepatotoxicity or >75yrs
what is tx for continuation phase of TB tx
R + I
4mths if perfect RIPE + culture conversion
7 mths if imperfect or no PZA
_________ is given to prevent peripheral neuropathy in high risk pops in both latent and active TB- esp in those using INH
pyridoxine
how long to tx extrapulmonary TB? with what?
RIPE for 1-1.5yrs
how to modify RIPE tx if pt has HIV coinfxn
use rifabutin isntead of RMP to decrease DDI
at least 8 mths tx required if pt not on ARVs
delay ART if tx CNS TB
hwo to tx active TB in pregnancy
RIE
how to tx latent TB in pregnancy
low risk = wait till 3mths postpartum
otherwise rifampin x4mths (pref) or INH (monitor hepatotoxicity)
+ supplement w/ pyridoxine
rank the following on hepatotoxicity: RIPE
P > I > R >E
which tuberculosis drug is associated with peripheral neuropathy
INH
which TB drug is associated with discoloration of bodily fluids
rifamycins
which TB drug is associaed with red/green vision changes
EMB
refer if cough goes longer than
14d
what is the bacteria that causes strep
group A beta hemolytic streptococci
T or F: strep does not need to be tx in children
F- must be tx to decrease risk of rheumatic fever and glomerulonephritis
what are the criteria of the modified centor score
temp >38
no cough
lymph nodes swollen
tonsillar swelling
age 3-14
2-3 = do culture or RADT
4 = start abx then do culture
what is typical tx for strep
amoxicillin or pen VK or pen G
cephalexin x10d
what is empiric tx for CAP outpt
doxycycline, amoxicillin, macrolide (azithro or clarithro)
what is empiric tx for CAP outpatient with modifying factors
beta lactam (amoxi/clav or 2nd gen cephalosporin) + macrolide/ doxycycline
or respiratory FQ (levo/ moxi)
what are some abx for pseudomonas coverage for inpt/ ICU pneumonia
pip/taz or cefepime, or meropenem, or ceftazidine + cipro/ levofloxacin
what is inpatient non ICU tx for CAAP
respiratory FQ
beta lactam (ceftriaxone, cefotaxime, or amoxi/clav) + macrolide
which abx cover legionella in CAP
azithro/clarithro
what are some tx options for HAP w/out MRSA
PIP/TAZO, cefepime, levofloxacin, meropenem, imipenem
what are some tx options for HAP w/ possible MRSA
PIP/TAZO, cefepime, levofloxacin, ciprofloxacin, meropenem, imipenem, aztronam
+
vanco or linezolid
what abx target pseudomonas aeruginosa
ceftazidime, pip/tazo, cipro, meropenem/ imipenem
how long to tx CAP in adults vs children
adults: 5-7d
children; 7-10d
how long to tx HAP/VAP
7d
what should empiric tx always cover in diabetic foot infections
S. aureus and beta hemolytic streptococci
when should you add anaerobe coverage in diabetic foot infections
if deep tissue affected, ischemic wounds, foul smell, ischemic/ necrotized tissue
how long to tx mild diabetic foot infxn
1 wk
what abx to tx localized diabetic foot infxn
cloxacillin, amoxi/calv, cephalexin, doxycycline
what is considered severe C diff
WBC >15x10^9/L or SCr >133 mcmol/L
what is typical H pylori tx
PAMC x14d
PPI + amoxi + clarithro + metro
