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NAPLEX > Bacterial Infections > Flashcards

Bacterial Infections Flashcards

1
Q

Cardiac, Orthopedic, Vascular Surgery Prophylaxis

A

Organism:
Staphylococci, Streptococci

Treatment:
Cefazolin or Cefuroxime

PCN allergy:
Vancomycin or Clindamycin

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2
Q

GI Surgery Prophylaxis

A

Organism:
Staphylococci, Streptococci, GI Flora (gram negative, anaerobe)

Treatment:
Ampicillin/Sulbactam (Unasyn)
Cefotetan
Cefoxitin
Cefazolin + Metronidazole

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3
Q

Meningitis in neonates

A

Organism:
Group B. Strep (14-21 days)
E. Coli, Listeria (>21 days)

Signs + Symptoms:
Fever, Headache
Stiff neck
Altered mental status

Diagnosis:
Lumbar puncture to get sample of CSF

Treatment:
Ampicillin + Cefotaxime or Gentamicin

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4
Q

Meningitis in 1-23 months old

A

Organism:
N. meningitis, H. influenzae (7 days)
S. pneumoniae (10-14 days)
Group B. Strep (14-21 days)
E. Coli (>21 days)

Signs + Symptoms:
Fever, Headache
Stiff neck
Altered mental status

Diagnosis:
Lumbar puncture to get sample of CSF

Treatment:
IV dexamethasone for 4 days. (D/C if organism isn’t S. pneumoniae)
+
Ceftriaxone or Cefotaxime + Vancomycin

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5
Q

Meningitis in 2-50 years old

A

Organism:
N. meningitis (7 days)
S. pneumoniae (10-14 days)

Signs + Symptoms:
Fever, Headache
Stiff neck
Altered mental status

Diagnosis:
Lumbar puncture to get sample of CSF

Treatment:
IV dexamethasone for 4 days. (D/C if organism isn’t S. pneumoniae)
+
Ceftriaxone or Cefotaxime + Vancomycin

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6
Q

Meningitis in >50 years old or immunocompromised

A

Organism:
N. meningitis (7 days)
S. pneumoniae (10-14 days)
Listeria (>21 days)

Signs + Symptoms:
Fever, Headache
Stiff neck
Altered mental status

Diagnosis:
Lumbar puncture to get sample of CSF

Treatment:
IV dexamethasone for 4 days. (D/C if organism isn’t S. pneumoniae)
+
Ampicillin + Ceftriaxone or Cefotaxime + Vancomycin

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7
Q

Acute Otitis Media

A

Organism:
S. pneumoniae
H. influenzae
M. catarrhalis

Signs + Symptoms:
Bulging tympanic membranes
Otorrhea
Otalgia
Ear tugging/rubbing

Treatment:
Amoxicillin 90mg/kg/day
Augmentin 14:1 ratio

PCN allergy:
2nd or 3rd gen. Cephalosporin

Treatment failure:
Augmentin if Amoxicillin initially used or Ceftriaxone IM x 3 days

Duration: 5-10 days

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8
Q

Common Cold

A

Organism:
Respiratory virus

Signs + Symptoms:
Sneezing
Runny nose
Mild sore throat
NO FEVER

Treatment:
Symptom-specific OTCs

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9
Q

Influenza (Flu)

A

Organism:
influenza virus

Signs + Symptoms:
Sudden onset fever
Chills
Fatigue
Myalgia

Diagnosis:
Confirm infection with PCR test

Treatment:
Symptom-specific OTCs

Oseltamivir (Tamiflu) if: symptom onset <48 hours and severe illness or high risk patient

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10
Q

Pharyngitis (Strep Throat)

A

Organism:
S. pyogenes
Respiratory virus

Signs + Symptoms:
Severe sore throat
Fever
Swollen lymph nodes
Tonsilar exudates

Diagnosis:
PCR or throat culture positive for S. pyogenes

Treatment:
Penicillin VK
Amoxicillin

PCN allergy:
Macrolide
Clindamycin

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11
Q

Acute Sinusitis

A

Organism:
Respiratory virus
S. pneumoniae
H. influenzae
M. catarrhalis

Signs + Symptoms:
Nasal congestion
Purulent nasal discharge
Facial/ear pain
Headache

Treatment:
Symptom-specific OTCs
Augmentin if: symptoms persist >10 days, severe symptoms >3 days, or worsening symptoms

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12
Q

Acute Bronchitis

A

Organism:
S. pneumoniae
H. influenzae
Atypicals

Signs + Symptoms:
Cough lasting 1-3 weeks
NO SYSTEMIC SYMPTOMS

Diagnosis:
Normal chest x-ray

Treatment:
Symptom-specific treatment only

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13
Q

Pertussis

A

Organism:
Bordetella pertussis

Signs + Symptoms:
Whooping cough

Diagnosis:
PCR or nasopharyngeal swab culture positive for B. pertussis

Treatment:
Macrolides

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14
Q

COPD Exacerbations

A

Organism:
H. influenzae, M. catarrhalis, S. pneumoniae

Signs + Symptoms:
Increased dyspnea
Increased sputum volume
Increase sputum purulence

Diagnosis:
Increase in symptoms that worsen over <14 days

Treatment:
Supportive treatment with O2, short-acting inhaled bronchodilators, IV/PO steroids
Antibiotics if: all 3 cardinal symptoms or mechanically ventilated
- Augmentin
- Azithromycin
- Doxycycline
- Levofloxacin or Moxifloxacin

Duration: 5-7 days

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15
Q

Community Acquired Pneumonia (CAP)

A

Organism:
S. pneumoniae
H. influenzae
Atypicals

Signs + Symptoms:
Shortness of breath
Fever
Cough with purulent sputum
Rales
Tachypnea

Diagnosis:
Chest x-ray with infiltrates, opacities, or consolidations
Elevated WBC

Treatment:
- Outpatient:
— Healthy:
—— Amoxicillin 1g TID
—— Doxycycline
—— Macrolide
— High Risk:
—— Beta-lactam + Macrolide or Doxycycline
—— Respiratory fluoroquinolone

  • Inpatient:
    — Non-severe:
    —— Beta-lactam + Macrolide or Doxycycline
    —— Respiratory fluoroquinolone
    — Severe:
    —— Beta-lactam + Macrolide
    —— Beta-lactam + Respiratory fluoroquinolone

Beta lactam options:
Ceftriaxone
Cefotaxime
Unasyn
Ceftaroline

MRSA or Pseudomonas risk:
Recent hospitalization with IV antibiotic use
Prior history of MRSA/Pseudomonas
- Add Vancomycin or Linezolid for MRSA
- Use beta-lactam with Pseudomonas coverage
— Cefepime, Meropenem, Zosyn, Aztreonam

Duration:
5-7 days

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16
Q

Hospital/Ventilator Acquired Pneumonia (HAP/VAP)

A

Organism:
Nosocomial pneumonia
MRSA, MSSA
Pseudomonas aeruginosa
E. Coli, Acinetobacter, Enterobacter, Klebsiella (MDR rods)

Signs + Symptoms:
Shortness of breath
Fever
Cough with purulent sputum
Rales
Tachypnea

Diagnosis:
HAP - onset >48 hours after hospital admission
VAP - onset >48 hours after mechanical ventilation

Treatment:
- Beta-lactam with Pseudomonas and MSSA coverage:
— Cefepime
— Zosyn
— Meropenem
— Levofloxacin for PCN allergy
- MRSA risk:
— Vancomycin
— Linezolid
- MDR risk:
— Add 2nd antipseudomonal (DO NOT COMBINE 2 BETA LACTAMS)
— Add Vancomycin or Linezolid as well

Duration:
7 days

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17
Q

Tuberculosis

A

Organism:
M. tuberculosis

Prevention:
N95 mask (transmitted by aerosolized droplets)
Quarantine patient

Signs + Symptoms:
Cough with blood
Fever
Night sweats

Diagnosis:
TST (PPD)
IGRA
Chest x-ray
Sputum culture

Treatment:
- Latent:
— Isoniazid (INH) + Rifampin QW for 12 weeks
— INH + Rifampin QD for 3 months
— Rifampin QD for 4 months
— INH QD for 6 or 9 months
— Add Vit. B6 for regimens with INH

  • Active:
    — Initial 2 month phase of RIPE:
    —— Rifampin
    —— INH
    —— Pyrazinamide
    —— Ethambutol
    — Continuation phase >4 months if no resistance + sputum culture (-)
    —— Rifampin
    —— INH

Rifampin:
- CI with protease inhibitors
- Hepatotoxicity
- Orange-red discoloration of bodily secretions

INH:
- Severe hepatitis
- Peripheral neuropathy
- DILE

Pyrazinamide:
- CI with acute gout, severe hepatic damage
- Increases uric acid

Ethambutol:
- CI with optic neuritis

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18
Q

Infective Endocarditis

A

Organism:
Staphylococci
Streptococci
Enterococci

Risk Factors:
Age
IV drug use
Poor dental
Valvular heart disease
Previous history
Dental procedures
Medical devices

Signs + Symptoms:
Fever
Elevated WBC
Signs of thromboembolism

Diagnosis:
Echocardiogram for vegetation
Positive bacteremia

Treatment:
- Viridans Streptococci:
— Penicillin or Ceftriaxone
— Add Gentamicin for difficult infection
— PCN allergy: Vancomycin

  • MSSA:
    — Nafcillin or Cefazolin
    — Add Gentamicin + Rifampin if prosthetic valve
    — PCN allergy: Vancomycin
  • MRSA:
    — Vancomycin or Daptomycin
    — Add Gentamicin + Rifampin if prosthetic valve
  • Enterococci:
    — Penicillin or Ampicillin + Gentamicin
    — Ampicillin + High-dose ceftriaxone
    — PCN allergy: Vancomycin + Gentamicin
    — VRE: Daptomycin or Linezolid

Duration:
4-6 weeks

19
Q

Antibiotic prophylaxis for Dental Procedure

A

For patients at high risk:

30-60 minutes before procedure

Amoxicillin 2 g PO

No PO:
Ampicillin 2g IM/IV
Cefazolin or Ceftriaxone 1g IM/IV

PCN allergy:
Azithromycin or Clarithromycin 500 mg
Doxycycline 100 mg

20
Q

Spontaneous Bacterial Peritonitis (SBP)

A

Organism:
Streptococci
Proteus
E. Coli
Klebsiella

Occurs in patients with cirrhosis and ascites

Diagnosis:
Ascites
Abdominal pain/tenderness
Paracentesis to collect fluid sample: PMN leukocyte >250 cells/mm3

Treatment:
Ceftriaxone or Cefotaxime
- Critically ill or MDR risk: use Meropenem or Zosyn

Duration:
5-7 days

Prophylaxis for those with history:
SMX/TMP or Ciprofloxacin
Indefinitely or until liver transplant

21
Q

Intra-abdominal Infections

A

Types:
Cholecystitis - gall bladder
Cholangitis - bile duct
Appendicitis
Secondary peritonitis
Diverticulitis

Signs + Symptoms:
Abdominal pain/tenderness

Diagnosis:
Drain abscess and send for culture
CT abdomen

Treatment:
- Low Risk CA-Infections: Streptococci, PEK, anaerobes
— Ertapenem
— 2nd or 3rd Gen. Cephalosporin + Metronidazole
— Ciprofloxacin or Levofloxacin + Metronidazole

  • Risk of Resistance or Nosocomial: PEK, Pseudomonas, Enterobacter, anaerobes, Streptococci, Enterococci
    — Zosyn
    — Meropenem or Doripenem
    — Cefepime or Ceftazidime + Metronidazole

Duration:
5-7 days

22
Q

Skin + Soft Tissue Infections (SSTI)

A

Types:

Superficial:
- Impetigo
- Folliculitis/Furuncle/Carbuncle
Cellulitis:
- Purulent
- Non-purulent
Necrotizing fascitis
Diabetic foot infection

Mild = local symptoms only
Moderate = local + systemic symptoms
Severe = Skin sloughing, hypotension, immunocompromised

Systemic symptoms = Fever, HR >90, WBC >12,000 or <4000 cells/mm3

23
Q

Impetigo

A

Organism:
S. pyogenes
S. aureus (MSSA)

Signs + Symptoms:
Honey-colored crusts

Treatment:
- Limited lesions:
— Mupirocin topical

  • Extensive lesions:
    — Cephalexin or Dicloxacillin PO

Duration:
5-7 days

24
Q

Folliculitis/Furuncles/Carbuncles

A

Organism:
S. aureus (CA-MRSA, MSSA)

Signs + Symptoms:
Folliculitis: inflammation of hair follicle
Furuncles: purulent infection of hair follicle
Carbuncles: group of furuncles

Treatment:
Incision + drainage
SMX/TMP or Doxycycline

25
Q

Non-purulent Cellulitis

A

Organism:
Streptococci, MSSA

Signs + Symptoms:
Localized pain, swelling, redness

Treatment:
Cephalexin or Dicloxacillin
PCN allergy: Clindamycin

Duration: 5 days

26
Q

Mild-Moderate Purulent Cellulitis

A

Organism:
MSSA, CA-MRSA

Signs + Symptoms:
Initially looks like abscess

Treatment:
Incision + drainage
SMX/TMP or Doxycycline

27
Q

Severe Purulent Cellulitis

A

Organism:
MRSA

Treatment:
Vancoymcin
Daptomycin
Linezolid

Transition to PO once clinically stable

Duration: 7-14 days

28
Q

Necrotizing Fasciitis

A

Organism:
S. pyogenes
MSSA
MRSA
Anaerobes
Gram negative

Signs + Symptoms:
Rapid onset and progression
Skin discoloration

Treatment:
Urgent surgical debridement
Vancomycin or Daptomycin + Zosyn or Meropenem + Clindamycin

29
Q

Diabetic Foot Infection

A

Organism:
Gram positive: S. aureus (MRSA), Streptococci, S. epidermis
Gram negative: PEK, Enterobacter, Pseudomonas
Anaerobes

Signs + Symptoms:
Often polymicrobial
Neuropathy -> foot ulcers -> infection

Treatment:
- No MRSA:
— Unasyn
— Zosyn
— Carbapenem
— Moxifloxacin
— Metronidazole + Ceftriaxone or Cefepime or Levofloxacin or Ciprofloxacin

  • MRSA Coverage:
    — Add Vancomycin or Daptomycin or Linezolid to regimen
30
Q

Urinary Tract Infections (UTI)

A

Types:
Lower - Cystitis
Upper - Pyelonephritis

Urinalysis Interpretation:
WBC -> Pyuria = UTI
RBC -> often present in UTI
Bacteria -> Infection, contamination or colonization
Leukocyte esterase -> Marker of WBC + pyuria
Nitrites -> Nitrate reductase producing bacteria
pH -> Urease producing bacteria

31
Q

Acute Cystitis

A

Organism:
E. Coli
Proteus
Klebsiella
Staphylococci

Signs + Symptoms:
Dysuria
Increased urinary frequency and urgency
Suprapubic tenderness
Hematuria

Treatment:
Nitrofurantoin 100 mg PO BID x 5 days
- CI if CrCl <60 ml/min
SMX/TMP DS 1 tablet PO BID x 3 days
Fosfomycin 3 grams x 1 dose

32
Q

Acute Pyelonephritis

A

Organism:
E. Coli
Proteus
Klebsiella

Signs + Symptoms:
Flank pain
Fever and chills

Treatment:
- Local quinolone resistance <10%
— Ciprofloxacin or Levofloxacin 5-7 days

  • Local quinolone resistance >10%
    — SMX/TMP 7-10 days
  • Inpatient
    — Ceftriaxone IV
    — PCN allergy: Ciprofloxacin or Levofloxacin
    — Resistance: Zosyn or Carbapenem
    — 5-10 days

Phenazopyridine:
OTC
For urinary pain
Max 2 days
Take with 8 oz H20
Can discolor red-orange

33
Q

Asymptomatic Bacteriuria in Pregnancy

A

Diagnosis:
Bacteriuria > 10^5 CFU/mL

Treatment:
Beta-lactam preferred: Cephalexin or Augmentin
PCN allergy: Fosfomycin
Nitrofurantoin and SMX/TMP reserved b/c fetal risk

NO QUINOLONES

34
Q

Clostridioides Difficile Infection (C. diff)

A

Organism:
C. diff

Signs + Symptoms:
>3 loose, watery stools in 24 hours
Fever
Abdominal pain
Elevated WBC
Impaired renal function

Diagnosis:
Positive stool test (NAAT or Enzyme Immuno Assay)

Types:
Non-severe: WBC <15,000, SCr <1.5 mg/dL
Severe: WBC >15,000, SCr >1.5 mg/dL
Fulminant: Hypotension, shock, ileus, toxic megacolon

Treatment:
- Initial:
— Fidaxomicin 200 mg PO BID x 10 days
— Vancomycin 125 mg PO BID x 10 days
— Metronidazole ONLY if both unavailable

  • 1st Recurrence:
    — Fidaxomicin 200 mg PO BID x 10 days
    — Vancomycin 125 mg PO BID x 10 days with prolonged taper
  • 2nd Recurrence:
    — Vancomycin 125 mg PO BID x 10 days then Rifaximin 400 mg TID x 20 days
    — Fecal microbiota transplantation
  • Fulminant:
    — Vancomycin 500 mg PO QID + Metronidazole 500 mg IV Q8H
    — Surgical evaluation for colectomy

Adjunct Bezlotoxumab:
For recurrent C diff.
For high risk patients
No antimicrobial activity

Vancomycin taper:
Standard regimen -> BID x 1 week -> QD x 1 week -> Q2-3 days x 2-8 weeks

35
Q

Syphillis

A

Organism:
Treponema pallidum (corkscrew shape)

Signs + Symptoms:
- Primary: chancre sore
- Secondary: rash
- Latent: asymptomatic
- Tertiary: Cardiovascular, CNS manifestations
- Neuro: Altered mental status, meningitis, abnormal CSF

Diagnosis:
Nontreponemal test = VDRL, RPR
Treponemal test

Treatment:
- Primary to Early Latent:
— Bicillin L-A 2.4 million units IM x1
— PCN allergy: Doxcycline 100 mg PO BID x 14 days

  • Late Latent to Tertiary:
    — Bicillin L-A 2.4 million units IM QW x 3 weeks
    — PCN allergy: Doxycycline 100 mg PO BID x 28 days
  • Neurosyphilis:
    — Penicillin G Aqueous 3-4 million units IV Q4H x 10-14 days
    — PCN allergy: DESENSITIZATION
36
Q

Gonorrhea

A

Organism:
N. gonorrhoeae

Signs + Symptoms:
- Male: urethral discharge, dysuria
- Female: commonly asymptomatic

Diagnosis:
PCR swab for female
Urine specimen for male

Treatment:
Ceftriaxone 500 mg IM x 1 dose if <150 kg
If chlamydia hasn’t been ruled out: Doxycycline 100 mg PO BID x 7 days

37
Q

Chlamydia

A

Organism:
Chlamydia trachomatis

Signs + Symptoms:
Asymptomatic

Diagnosis:
PCR or swab

Treatment:
Doxycycline 100 mg PO BID x 7 days
Pregnancy: Azithromycin 1 g PO x 1 dose

38
Q

Bacterial Vaginosis

A

Organism:
Gardnerella vaginalis

Signs + Symptoms:
Off-white discharge
Fishy odor
pH >4.5
No pain

Treatment:
Metronidazole PO x 7 days
Metronidazole 0.75% Gel intravaginal x 5 days
Clindamycin 2% Cream intravaginal x 7 days

39
Q

Trichomoniasis

A

Organism:
Trichomonas vaginalis

Signs + Symptoms:
Yellow-green discharge
Foul odor
pH >4.5
Soreness/pain

Treatment:
Metronidazole PO
Recommended in all trimesters in pregnancy

40
Q

Genital Warts

A

Organism:
HPV 6
HPV 11

Signs + Symptoms:
Pink or skin colored legions
Cauliflower like growth

Treatment:
Imiquimod Cream (Aladara, Zyclara)

Prevention:
HPV-9 Vaccine (Gardasil)
Barrier contraceptives

41
Q

Lyme Disease

A

Organism:
Borrelia burgdorferi
Spirochetes

Signs + Symptoms:
- Early: bullseye rash (erythema migrans)
- Late: organ dysfunction

Diagnosis:
EIA specific for B. burgdorferi

Treatment:
Doxycycline 100 mg BID PO/IV x 10 days
Amoxicillin
Cefuroxime

42
Q

Rocky Mountain Spotted Fever

A

Organism:
Rickettsia rickettsii

Signs + Symptoms:
Erythematous petechial rash 3-5 days after infection

Treatment:
Doxycycline 100 mg BID PO/IV x 5-7 days
USE IN PEDIATRICS

43
Q

Ehrlichiosis

A

Organism:
Ehrlichia chaffeensis

Treatment:
Doxycycline 100 mg BID PO/IV x 7-14 days

NAPLEX (12 decks)

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