Bacterial Infections Flashcards
Perioperative Antibiotic Prophylaxis
-Administer IV antibiotics prior to a procedure
-Beta-lactams should be given 1 hour before surgery
-Vancomycin and Fluoroquinolones given 2 hours before surgery
-Redosing may be necessary if the surgery is > 4 hours or major blood loss.
Preferred Antibiotics: Cefazolin or Cefuroxime
Alternatives (Beta Lactam Allergy): Vancomycin or Clindamycin
GI Surgery:
Preferred: Amp/Sul or Cefoxitin or Cefotetan or Cephalosporin+Flagyl
Meningitis
This is the inflammation of the Meninges (Dura mater, Arachnoid mater, Pia mater). Diagnosed by lumbar puncture
SYMPTOMS (hallmark symptoms)
-Severe Headache
-Confusion
-Stiff neck
-Fever
EMPIRIC TREATMENT:
1) IV Dexamethasone x 4 days
2) IV Antibiotics ASAP
-Avoid Cefazolin, Pip/tazo, Clinda due to low penetration into BBB
Neonates (< 1mth): Ampicillin + Cefotaxime or Gentamicin
Age 1 mth - 50 years: Ceftriaxone or Cefotaxime + Vancomycin
Age >50 years or immunocompromised: Ampicillin + Ceftriaxone or Cefotaxime + Vancomycin
Acute Otitis Media
Antibiotics required if
1) Patients < 6 months
2) Patients 2-23 months + Bilateral infection
2) Severe infection
*All other patients, we either treat antibiotics or observe
FIRST LINE: 5-10 days treatment
1) Amoxcillin or Augmetin(Amox+Clav) 90 mg/kg/day divided BID
*Use 2nd or 3rd Generation Ceph if the patient has mild penicillin allergy.
-Cefuroxime
-Cefdinir
-Cefpodoxime
-Ceftriaxone
Upper Respiratory Tract Infections
TYPES:
1) Common Cold - No antibiotics for this
-Symptom management with OTC
2) Influenza
-Oseltamivir (Tamiflu)
-Baloxavir (Xofluza)
*Outpatient: Use if symptom onset is <= 48 hours
*Severe: No time limit. Start antivirals ASAP
3) Pharyngitis aka StrepThroat
-Oral PenVK or Amoxicillin (Once bacterial infection is confirmed)
-Alternative (Macrolide or Clindamycin)
4) Acute Sinusitis
-Symptom management with OTC
-Antibiotics is indicated if:
Symptoms > 10 days
Symptoms are severe for > 3 days
Worsening Symptoms
Bronchitis & COPD Exacerbations
1) Acute Bronchitis
-Symptomatic management with OTC
2) Acute Bacterial exacerbation of COPD
-Triggered by respiratory viruses and bacteria, pollution
-Supportive Treatment: Oxygen, SABA, PO/IV Steriods
-Antibiotics: Augmentin, Azithromycin, Doxycycline, Respiratory Fluoroquinolone (Levofloxacin and Moxifloxicin) for 5-7 days
Community Acquired Pneumonia (CAP)
OUTPATIENT
1) No Comorbidities
-Amoxcillin 1g TID
-Doxycycline
-Macrolide (Azithromycin or Clarithromycin)
2) Comorbidities Present
-Beta-lactam + Macrolide or Doxycycline
-Respiratory Fluoroquinolone monotherapy (Levo and Moxi only)
INPATIENT
1) Non-ICU
-Beta-lactam + Macrolide or Doxycycline
-Respiratory Fluoroquinolone monotherapy
2) ICU
-Beta-lactam + Macrolide
-Beta-lactam + Respiratory Fluoroquinolone
When to avoid certain antibiotics:
1) Macrolides: QT Prolongation
2) Doxycycline: Pregnancy and Breastfeeding
3) Fluoroquinolone: Seizures, QT Prolongation, Tendonitis, CV disease, Peripheral Neuropathy, Pregnancy
Hospital (HAP) and Ventilator associated Pneumonia (VAP)
-Requires Pseudomonas coverage
EMPIRIC TREATMENT:
1) Need 1 antibiotic that covers Pseudomonas and MSSA
-Cefepime
-Pipercillin/Tazobactam
-Meropenem
-Levofloxacin
2) MRSA Coverage needed if: [Vancomycin/Linezolid]
-IV antibiotics in past 90 days
-MRSA prevelence > 20 %
-Prior or current infection
3) MRSA & MDR Coverage needed if: [Add 2nd antipseudomonal + Vancomycin/Linzolid]
-IV antibiotics in past 90 days
-Gram(-) resistance > 10 %
-Hospitalization >=5 days prior to VAP onset
Antibiotics with Pseudomonas Coverage
1) Beta Lactams
-Pipercillin/Tazobactam
-Cefepime, Ceftazidime
-Meropenem, Imipenem/Cilastatin
-Aztreonam
-Ceftolozane/Tazobactam
-Ceftazidime/Avibactam
2) Fluoroquinolones
-Ciprofloxacin
-Levofloxacin
3) Aminoglycosides
-Gentamicin
-Tobramycin
-Amikacin
Stages of Tuberculosis
1) Latent
-Immune system is able to contain the disease
-Asymptomatic and not contagious
-Reactivation can occur
-Treatment with 1-2 drugs
2) Active
-Leads to Disseminated Disease where it can spread to other organs
-Requires Antibiotics
-Treatment with 4 drugs
Latent TB Treatment
1) Isoniazid + Rifapentine weekly [12 weeks]
2) Isoniazid + Rifampin daily [3 months]
3) Rifampin daily [4 months]
4) Isoniazid daily [6 or 9 months]
*Add VitaminB6 to any regimen containing Isoniazid
*All can be used in pregnancy except the regimen with Rifapentine
Active TB Treatment
Initial Phase (RIPE) x 2 months
1) Rifampin
2) Isoniazid
3) Pyrazinamide
4) Ethambutol
Continuation Phase (RI) x >= 4months
1) Rifampin
2) Isoniazid
Rifampin
-10 mg/kg PO daily
-Do not use with Protease Inhibitors
-Increased LFT
-Orange/Red Discoloration
-Potent INDUCER of CYP enzymes and P-glycoprotein
Notable Interactions
-Oral Contraceptives
-Warfarin & DOACs
-Protease Inhibitors
Isoniazid (INH)
-5 mg/kg PO daily
-Boxed Warning: Severe and fatal Hepatitis
-Give Vitamin B6 (Pyridoxine) with this to avoid Peripheral Neuropathy
-Causes DILE (Drug Induced Lupus Erythromatosis)
Pyrazinamide & Ethambutol
PYRAZINAMIDE:
-20-25 mg/kg daily
-Contraindication: Acute Gout
-Increased LFTs
-Hyperuricemia/gout
ETHAMBUTOL: (‘E for Eyes’)
-15-20 mg/kg daily
-Eye damage and hallucinations
Infective Endocarditis
Endocarditis occurs when there is damage to one of the heart valves, and bacteria starts to grow on it. An emboli can form and cause infarction on many organs.
TREATMENT: (4-6 weeks)
*Add Rifampin & Gentamicin if Prosthetic Valve infection
1) Viridans Streptococci
-IV Penicillin G or Ceftriaxone (+- Gentamicin)
2) Staphylococci
-Nafcillin or Cefazolin
-Vancomycin or Daptomycin (if MRSA)
Prophylaxis is given prior to dental procedure.
1) Amoxcillin 2g [PO]
2) Ampicillin 2g or Cefazolin 1g [IV/IM]
