Bugs & Drugs

Question 1

In a patient with NKDA, how do you treat them for an infection w/ Streptococci?

Answer 1

Beta-lactams

e.g., Pencillin, Oxicillin

Question 2

In a patient with a known allergy to β-lactam antibiotics, how do you treat them for an infection w/ Streptococci?

Answer 2

Macrolides

e.g., Azithromycin, Erythromycin

Question 3

In a patient with NKDA, how do you treat them for an infection w/ Streptococcal TSS?

Answer 3

Clindamycin, but it’s linked to C. diff so… (see weekly essay 9B)

Question 4

In a patient with NKDA, how do you treat them for an infection w/ MSSA?

Answer 4

Either:

**A semi-synthetic penicillin: Amoxicillin or Amoxicillin + Clavulunate **

OR

An antistaphylococcal penicillin: Nafcillin or oxocillin

Question 5

In a patient with a known allergy to β-lactam antibiotics, how do you treat them for an infection w/ MSSA?

Answer 5

IV Vancomycin

Question 6

In a patient with NKDA, how do you treat them for an infection w/ MRSA?

Answer 6

IV Vancomycin

Question 7

How do you treat a patient w/ Clostridium difficile colitis as a result of clindamycin use? (Why?)

Answer 7

Oral vancomycin

(Because it oral vancomycin does not get absorbed into systemic circulation in the gut, so it remains in the gut lumen where it can have its effect on the colon)

Question 8

In a patient with NKDA, how do you treat them for an infection w/ Neisseria meningitidis?

Answer 8

Ceftriaxone

Question 9

In a patient with NKDA, how do you treat them for an infection w/ Chlamydia trachomatis?

Answer 9

Oral azithromycin (favored b/c it’s a one-time tx)

Doxycycline

Question 10

In a patient with NKDA, how do you treat them for an infection w/ Neisseria gonorrheae?

Answer 10

Ceftriaxone + azithromycin (to cover potential coinfection w/ Chlamydia)

OR

Ceftriaxone + doxycycline

Question 11

In a patient with NKDA, how do you treat them for an infection w/ Pseudomonas aeruginosa?

Answer 11

• Beta-lactams:
  
  • Piperacillin-Tazobactam
  • 3rd Generation Cephalosporins (Ceftriaxone)
  • 4th Generation Cephalosporins (Cefepime)
  • **Carbapenems **(Meropenem)
  • Monobactems: **Aztreonam **(very strange properties)
• Aminoglycosides
• Fluoroquinolone (Ciprofloxacin)

Since Pseudomonas is so hard to treat you’ll typically treat with two different antibioitics of those listed above

Question 12

In a patient with NKDA, how do you treat them for an infection w/ anaerobic bacteria?

Answer 12

Metronidazole

2nd choice: Clindamycin

Question 13

In a patient with NKDA, how do you treat them for an infection w/ Listeria monocytogenes?

Answer 13

Ampicillin

Question 14

In a patient with NKDA, how do you treat them for an infection w/ Atypicals?

Answer 14

Macrolides

2nd choice: Doxycycline

3rd choice: Fluoroquinolones (Ciprofloxacin, Levofloxacin)

Question 15

In a patient with NKDA, how do you treat them for an infection w/ an Arthropod-borne pathogen?

(e.g., Borellia, Rickettsia)

Answer 15

Doxycycline (drug’s ability to accumulate intracellularly makes it very effective against Rickettsia and Chlamydia)

Question 16

In a patient with NKDA, how do you treat them for an infection w/ Treponema pallidum?

Answer 16

Penicillin

Question 17

In a patient with NKDA, how do you treat them for an infection w/ an uncomplicated UTI?

Answer 17

• Nitrofurantoin
• TMP-SMX
• Fosfomycin

Question 18

In a patient with NKDA, how do you treat them for an infection w/ complicated UTI?

(Give the class and an example)

Answer 18

**Fluroquinolone **(e.g., Ciproflaxacin)

Question 19

In a patient with NKDA, how do you treat them for an infection w/ uncomplicated pyelonephritis?

Answer 19

Fluoroquinolone (e.g., Ciprofloxacin) as an outpatient

Question 20

In a patient with NKDA, how do you treat them for an infection w/ complicated pyelonephritis?

Answer 20

Fluoroquinolone (Ciprofloxacin)** **or 3rd gen. cephalosporin (Ceftriaxone) as an inpatient

Question 21

In a patient with NKDA, how do you treat them for an infection w/ Blastomyces dermatidis?

Answer 21

Amphotercin B

Question 22

In a patient with NKDA, how do you treat them for an infection w/ Coccidioides immitis?

Answer 22

Amphotercin B

Question 23

In a patient with NKDA, how do you treat them for an infection w/ Paracoccidioides brasiliensis?

Answer 23

Amphotercin B

Question 24

In a patient with NKDA, how do you treat them for an infection w/ Histoplasma capsulatum?

Answer 24

Voriconazole

2nd choice: Amphotercin B

Question 25

In a patient with NKDA, how do you treat them for an infection w/ *Crpytococcus neoformans*?

Answer 25

**Amphotercin B + Flucytosine**

Question 26

In a patient with NKDA, how do you treat them for an infection w/ **Nematodes (roundworms)**?

Answer 26

**Albendazole**

Question 27

In a patient with NKDA, how do you treat them for an infection w/ **Trematodes (flatworms/flukes)**?

Answer 27

**Praziquantel**

Question 28

In a patient with NKDA, how do you treat them for an infection w/ **Cestodes**?

Answer 28

**Praziquantel**

Question 29

What drugs should **_not_** be used to treat pregnant women w/ infections? (Try to give the reason why if you can)

Answer 29

* Aminoglycosides → ototoxicity * Fluoroquinolones → cartilage damage * Metronidazole → mutagenesis * Ribavirin → Teratogenic * Sulfonamides → Kernicterus * Tetracyclines → Inhibition of bone growth (& discolored teeth)

Question 30

In a patient with NKDA, how do you treat them for an infection w/ *Cryptosporidium parvum*?

Answer 30

**Nitazoxanide**

Question 31

How do you treat RSV in a wheezing 3 yr old? What would you give for prophylaxis in high risk patients?

Answer 31

* Bronchodilator (**albuterol** or **epi**) **by inhalation** for wheezing * **Ribavirin by aerosol** * For prophylaxis: Palivizumab

Question 32

What tests would you order for watery, traveler's diarrhea?

Answer 32

**Stool culture** **CBC and electrolytes to check hydration status of patient**

Question 33

What tests would you order for bloody diarrhea?

Answer 33

**Stool culture** **Immunoassay for toxins (e.g., Shiga)** **CBC and electrolytes to check hydration status of patient** **Renal chemistries (BUN, Cr) and U/A to check for RBCs, RBC casts, and protein (concern for HUS)**

Question 34

How would you treat a patient w/ traveler's diarrhea?

Answer 34

* **Rehydration** * **Anti-peristaltic like loperamide** * **Macrolide**

Question 35

How would you treat a patient w/ bloody diarrhea?

Answer 35

* **Rehydration until the causative agent is defined** * **No antibiotics until then because these ⇡the level of Shiga toxin produced by E. coli** * **No antiperistaltics because this ⇡the _duration_ of E. coli contact w/ the gut**

Question 36

How do you treat *Toxoplasma gondii*? (alone)

Answer 36

**Pyrimethamine-Sulfadiazine**

Question 37

How do you treat *Pneumocystic jiroveci*?

Answer 37

**TMP-SMX**