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Chapter 23: Infectious Diseases II Flashcards

1
Q

Perioperative Abx Selection

A
  • Cefazolin (is preferred to prevent MSSA and streptococci infections)
  • Clindamycin is alt if beta-lactam allergy
  • Vanco if MRSA colonization risk is present
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2
Q

Perioperative Abx Selection: cardiac or vascular surgeries

A
  • Cefazolin or cefuroxime

- Vanco or clinda if beta-lactam allergy

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3
Q

Perioperative Abx Selection: hip fracture repairs / total joint replacments

A
  • Cefazolin

- Vanco or clinda if beta-lactam allergy

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4
Q

Perioperative Abx Selection: Colon (colorectal) or other surgeries involving the abdominal space

A

Cefotetan, cefoxitin, amp/sulbactam, ertapenem
or
Metronidazole + (cefazolin or ceftriaxone)

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5
Q

Perioperative Abx Selection: Colon (colorectal) or other surgeries involving the abdominal space
Beta-lactam allergy

A

Clinda + (aminoglycosides, quinolones, or aztreonam)
or
Metronidazole + (aminoglycoside or quinolones)

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6
Q

Meningitis empiric tx: neonate (<1month)

A 
Ampicillin (for listeria coverage)
\+
Cefotaxime (NO ceftriaxone)
or 
Gentamicin
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7
Q

Meningitis empiric tx: age 1 month to 50 years

A

Ceftriaxone or cefotaxime
+
Vanco

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8
Q

Meningitis empiric tx: >50 years or immunocompromised

A 
Ampicillin (for listeria coverage) 
\+
ceftriaxone or cefotaxime
\+
vanco
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9
Q

Acute Otitis Media (AOM) Abx therapy first-line

A

Amox 80-90mg/kg/day in 2 divided doses
or
Amox/clav 90mg/kg/day (6.4mg/kg/day clav) in 2 divided doses
or
Ceftriaxone 50mg/kg IM or IV for 1 or 3 days (if vomiting and unable to tolerate po)

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10
Q

Acute Otitis Media (AOM) Abx alternative therapy (beta-lactam allergy)

A

Cefdinir 14mg/kg/day in 1 or 2 doses
Cefuroxime 30mg/kg/day in 2 divided doses
Cefpodoxime 10mg/kg/day in 2 divided doses
Ceftriaxone 50mg/kg IM/IV qd for 1 or 3 days

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11
Q

Common Cold etiology, symptoms, criteria for anti-infective, and tx options

A

Etiology: respiratory viruses (rhinovirus, seasonal coronavirus)
Symptoms: sneezing, runny nose, cough
Anti-infective: none
Tx: OTC cold medications

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12
Q

Influenza etiology, symptoms, criteria for anti-infective, and tx options

A

Etiology: influenza virus
Symptoms: sudden onset fever, chills, fatigue, body aches
Criteria for anti-infective: <48 hours since symptom onset
Tx: oseltamivir x 5 days, baloxavir marboxil x 1 dose, zanamivir inh x 5 days

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13
Q

Pharyngitis etiology, symptoms, criteria for anti-infective, and tx options

A

Etiology: respiratory viruses, S. pyogenes
Symptoms: “strep throat,” sore throat, swollen lymph nodes, white patches on tonsils
Criteria for anti-infective: + rapid antigen diagnostic test
Tx: penicillin or amox or 1st or 2nd gen cephalosporin

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14
Q

Sinusitis etiology, symptoms, criteria for anti-infective, and tx options

A

S. pneumoniae, H. influenzae, and M. catarrhalis; Staphylococci, anaerobes, gram-neg rods
Symptoms: nasal congestion, purulent nasal discharge, facial/ear/dental pain, headache
Criteria for tx: >=10 days w/symptoms; >=3 days of severe symptoms
Tx: amox/clav

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15
Q

Bronchitis

A

Causes can include bordetella pertussis (whooping cough), S. pneumoniae, Mycoplasma pneumoniae, H. influenzae
Abx only indicated if whooping cough then treat with azith, clarith, or SMX/TMP

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16
Q

Acute Bacterial Exacerbation of Chronic Bronchitis

A 
ABECB
Supportive measures (O2, short-acting bronchodilators, IV or PO steroids)
Then abx for 5-7 days if one of the following are met: increased dyspnea, increased sputum volume, increased sputum purulence; mechanically ventilated
Preferred abx: amox/clav, azith, doxy
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17
Q

CAP symptoms and diagnostics

A
  • Fever
  • Cough with purulent sputum
  • Rales (crackling noises in lungs)
  • Tachypnea (increased resp rate)

Chest x-ray is gold standard for diagnostics and will have inflitrates, opacities, or consolidation

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18
Q

CAP pathogens

A

S. pneumoniae, H. influenzae, M. pneumoniae and possibly C. pneumoniae

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19
Q

Outpatient CAP Tx: Category 1

A 
(no comorbidities)
Amox high dose (1gm tid)
or 
Doxy
or
Macrolide (azith or clarith) if local pneumococcal resistance is <25%
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20
Q

Outpatient CAP Tx: Category 2

A

Comorbidities present (chronic heart, liver, lung, or renal disease; diabetes, alcoholism, malignancy or asplenia)

  • Beta-lactam + macrolide or doxy
    e. g amox/clav or cephalosporin + macrolide or doxy
  • Respiratory quinolone monotherapy (levoflox, gemiflox, mociflox)
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21
Q

Inpatient CAP Tx: Non-severe (non-icu)

A

-Beta-lactam + macrolide or doxy
(preferred beta-lactams: ceftriaxone, cefotaxime, ceftaroline, or amp/sulb)
-Respiratory quinolone monotherapy

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22
Q

Inpatient CAP Tx: Severe (ICU typically required)

A
  • Beta-lactam + macrolide

- Beta-lactam + respiratory quinolone (do not use quinolone monotherapy)

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23
Q

Inpatient CAP Tx: if risk factors for Pseudomonas and/or MRSA add on

A

MRSA: add coverage with vanco or linezolid
Pseudomonas: add coverage with pip/tazo, cefepime, ceftazidime, imipenem/cilastatin, meropenem or aztreonam

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24
Q

HAP and VAP onset

A

> 48 hours after hospital admission

>48 hours after start of mechanical ventilation

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25
Common Pathogens in HAP and VAP
- MRSA | - MDR gram-negative rods: P. aeruginosa, Acinetobacter spp. Enterobacter spp. E. coli, and Klebsiella spp.
26
HAP/VAP Empiric Regimen: Identifying Risk for MRSA and MDR
- Positive MRSA nasal swan - High prevalence (>10%) of pathogen resistance to any single agent noted in hospital unit - IV abx within the last 90 days
27
HAP/VAP Empiric Regimen: all patients need
Coverage for Pseudomonas and MSSA | E.g cefepime and pip/tazo
28
HAP/VAP Empiric Regimen: MRSA
- Vanco - Linezolid For example: cefepime + vanco Meropenem + linezolid
29
HAP/VAP Empiric Regimen: Pseudomonas if risk for MDR pathogens
If patient has risk for MDR pathogens then typically has risk for MRSA. Requires 3 drug regimen) E.G pip/tazo + cipro + vanco cefepime + linezolid + gentamicin
30
HAP/VAP Empiric Regimen: Abx for pseudomonas
- pip/tazo - cefepime, ceftazidime, or ceftolazone/tazobactam - levofloxacin or ciprofloxacin - imipenem/cilastatin or meropenem - aztreonam - tobramycin, gentamicin, amikacin (these are always used with another antipseudomonal drug) - colistimethate or polymixin b
31
HAP/VAP Empiric Regimen: Abx for MRSA
Vanco | Linezolid
32
Latent TB: Preferred Regimens
- Isoniazid (INH) and rifapentine qweek x12weeks (do not use on pregnant women) (for >2 children and adults) - Rifampin 600 qd x4 months (children of all ages and HIV pts) - INH and rifampin qd x3months (adults, children of all ages and HIV)
33
Latent TB: alternate regimens
INH 300mg qd for 6 months or 9 months (HIV positive and negative patients of all ages)
34
Active TB Tx
``` RIPE (Intensive therapy for 2 months) R- rifampin I- INH P- pyrazinamide E- ethambutol ``` Continuation with two drugs (usually rifampin and INH) for remaining 4 months
35
Rifampin SE, notes
SE: increased LFTs, hemolytic anemia, flu-like syndrome, orange-red discoloration of body secretions (sputum, urine, sweat, tears, teeth) can stain contact lenses, clothing Note: rifampin has many drug interactions, in some cases rifabutin can replace it
36
Isoniazid warnings, SE
Warnings: peripheral neuropathy (supplement with pyridoxine [b6] 25-50mg po qd to decrease risk) SE: increased LFTs, DILE, hemolytic anemia
37
Pyrazinamide CI, SE
CI: acute gout SE: increased LFTs, hyperuricemia/gout
38
Ethambutol SE
SE: increased LFTs, optic neuritis (dose-related), confusion, hallucinations
39
Rifampin Drug Interactions
- Protease inhibitors (substitute rifabutin) - Warfarin (very large decrease in INR) - Oral contraceptive (decrease efficacy) * Do not use with apixaban, rivaroxaban, edoxaban, or dabigatran
40
Infective Endocarditis Diagnosis
Modified Duke Criteria which includes an echocardiogram to visualize vegetation and positive blood cultures
41
Infective Endocarditis Most Common Pathogens
Streptococci, staphylococci, and enterococci
42
Infective Endocarditis Tx
- Generally Vanco and ceftriaxone. Sometime Gentamicin is added for synergy - Usually tx is is 4-6 weeks of IV abx
43
Infective Endocarditis Gentamycin dosing
Target peak levels of 3-4mcg/ml and trough levels of <1mcg/ml
44
Patients at high-risk for Infective Endocarditis after Dental Work
- artificial (prosthetic) heart valve or heart valve repaired with artificial material - Hx of endocarditis - Heart transplant with abnormal heart valve function - Certain congenital heart defects including heart/heart valve disease
45
Infective Endocarditis Dental Work Prophylaxis
PO: amoxicillin 2 grams 30-60 minutes before dental procedure *If unable allergic to PCN: clindamycin 600mg or azith or clarith 500mg
46
TX for SBP
Ceftriaxone for 5-7 days | SMX/TMP or cipro can be used for primary or secondary prophylaxis
47
Secondary peritonitis causes
Usually caused by a traumatic events and the most likely pathogens are streptococci, enteric gram-neg and anaerobes (b. frag)
48
Management of secondary peritonitis and cholangitis: mild to moderate infections
Coverage for PEK, anaerobes, streptococci and enterococci Examples: Cefoxitin, ertapenem, moxifloxacin, (cefazolin, cefuroxime, or ceftriaxone) + metronidazole, (cipro or levoflox) + metronidazole
49
Management of secondary peritonitis and cholangitis:: high-severity infections (ICU)
Coverage for PEK, CAPES, pseudomonas, anaerobes, streptococci+-enterococci Examples: Carbapenems (except ertapenem), pip/tazo,, (cefepime or ceftazidime) + metronidazole, (cipro or levo) + metronidazole, Cefazolin + (aztreonam or aminoglycoside) + metronidzolw
50
Superficial SSTI
- Impetigo - Furuncles - Carbuncles
51
Nonpurulent that penetrate the subq tissue
Cellulitis
52
Purulent
Abscess
53
Mild, Moderate, Severe SSTI
Mild- no systemic signs Moderate- systemic signs (fever >100/4, HR > 90bpm, WBC >12,000 or <4,000 Severe- failed oral abx + incision and drainage, systemic signs, signs of deeper infection, or immunocompromised
54
Impetigo tx
Topical mupirocin | If systemic needed use cephalexin 250mg po qid
55
Folliculitis/furuncles/carbuncles Tx
If systemic signs: cephalexin | If non-responsive change to drug with CA-MRSA coverage: SMP/TXM, doxycycline
56
Cellulitis (non-purulent)
Cephalexin
57
Abscess
Mild: I and D Moderate: SMX/TMP, Doxycycline
58
Severe purulent ssti
IV abx with MRSA - vanco (trough goal 10-15) - daptomycin - linezolid
59
Necrotizing Fascitis
Empiric therapy is broad | Vanco + beta lactam (pip/tazo, imipenem/cilastatin or meropenem)
60
Diabetic Foot Infections Monotherapy
When no MRSA coverage needed | -Amp/sulbactam, pip/tazo, carbapenems, tigecycline, or moxifloxacin
61
Diabetic Foot Infection Combo Therapy
When MRSA and Pseudomonas Vanco + ceftazidime, cefipime, pip/tazo, aztreonam, or a carbapenem (except ertapenem)
62
Acute Uncomplicated Cystitis Tx:
Nitrofurantoin (macrobid) 1 po bid f5d | SMX/TMP ds 1 po bid f3d
63
Acute Uncomplicated Cystitis in pregnancy
Cephalexin | Amoxicillin
64
Acute Pyelonephritis
- If local quinolone resistance is <10%: ciprofloxacin, levofloxacin - If local quinolone resistance is >10%: ceftriaxone, ertapenem, aminoglycoside
65
Complicated UTI
Carbapenem if ESBL are present
66
Traveler's Diarrhea Tx
In fever, bloody stool, pregnant or pediatric: Azithromycin 500mg qd f1-3 days If no bloody stool choose quinolone or rifaximin
67
Syphilis Tx
``` Pen G (Bicillin l-a) (desensitize for pregnancy or hiv positive) Alternative: doxycycline ```
68
Gonorrhea Tx
Cefrtriaxone 500mg im once; if chlamydia is not excluded and doxycyline
69
Chlamydia
Doxy (100mg po bid for 7 day) or azith (1 gram po once)
70
Bacterial Vaginosis
Metronidazole po or pv
71
Trichomonias
metronidazole 2gm po once
72
Genital warts
imiquimod
73
Rocky Mountain Spotted Fever
Doxycyline (also preferred in children)

NAPLEX (45 decks)

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