CNS & Blood Infectious Disease Flashcards
Empiric Therapy for Bacterial Meningitis
age under 1 month
Ampicillin + Cefotaxime or
Ampicillin + aminoglycoside
Pathogens common in bacterial meningitis
age under 1 month
Group B Strep, E. coli, Listeria monocytogenes, Klebsiella
Pathogens common in bacterial meningitis
age 1-23 months
S. pneumo, N. meningitides, Group B Strep, H. flu, E. coli
Empiric Therapy for Bacterial Meningitis
age 1-23 months
Vancomycin + Ceftriaxone/Cefotaxime
Pathogens common in bacterial meningitis
age 2-50 yrs
N. meningitides, S. pneumo
Empiric Therapy for Bacterial Meningitis
age 2-50 yrs
Vancomycin + Ceftriaxone/Cefotaxime
Pathogens common in bacterial meningitis
age >50 yrs
S. pneumo, N. meningitides, L. monocytogenes, aerobic gram neg bacilli
Empiric Therapy for Bacterial Meningitis
age >50 yrs
Vancomycin + Ampicillin + Ceftriaxone/Cefotaxime
Basilar Skull Fracture Empiric Therapy
Vancomycin + Ceftriaxone/Cefotaxime
Penetrating Trauma Empiric Therapy
Vancomycin + Cefepime/Ceftazidime/
Meropenem
Postneurosurgery Empiric Therapy
Vancomycin + Cefepime/Ceftazidime/
Meropenem
CSF Shunt Empiric Therapy
Vancomycin + Cefepime/Ceftazidime/
Meropenem
Empiric Abx for Sepsis in Urinary Tract (Community Acquired)
Ceftriaxone or Ciprofloxacin/Levofloxacin
Empiric Abx for Sepsis in Urinary Tract (Healthcare Acquired)
Ciprofloxacin/Levofloxacin or Ceftriaxone/Ceftazidime
Empiric Abx for Sepsis in Respiratory Tract (CA)
Levofloxacin/moxifloxacin or Ceftriaxone + Azithromycin
Empiric Abx for Sepsis in Respiratory Tract (HA)
Piperacillin/Tazobactam or
Ceftazidime/Cefepime + Levofloxacin/Ciprofloxacin or
Aminoglycoside
Empiric Abx for Sepsis in Intraabdominal (CA)
Ertapenem/Tigecycline/Cipro/Levo + Metronidazole
Empiric Abx for Sepsis in Intraabdominal (HA)
Piperacillin/Tazobactam or
Carbapenem
Empiric Abx for Sepsis in Skin/Soft Tissue (CA)
Vancomycin or Linezolid or Daptomycin
Empiric Abx for Sepsis in Skin/Soft Tissue (HA)
Vancomycin + Pip-Taz
Empiric Abx for Sepsis in Catheter-related
Vancomycin
Empiric Abx for Sepsis in Unknown
Pip-Taz or Ceftazidime/Cefepime or Imipenem/Meropenem with or without Vancomycin
Beta lactams
AE: hypersensitivity rxn, Type I IgE mediated reaction, rash, hemolysis
Carbapenems
AE: seizures (especially imipenem)
Vancomycin
AE: nephrotoxic, ototoxic, red man syndrome
Aminoglycosides
AE: nephrotoxic, neuromuscular blockade, ototoxic, teratogenic
Fluoroquinolones
AE: photosensitivity, chelation, QT prolongation, tendinitis
Ceftriaxone Contraindications (FDA MedWatch Program)
Hypersensitivity
Neonates: ceftriaxone can displace bilirubin from binding to serum albumin, leading to risk of bilirubin encephalopathy
Neonates requiring calcium IV solutions: risk of precipitation of ceftriaxone-calcium
Community acquired meningitis empiric abx
Ceftriaxone, cefotaxime, vancomycin
Listeria monocytogenes
Common in elderly & infants
Ampicillin with or without gentamicin should be added empirically
Start therapy ASAP when suspicion for meningitis exists
DO NOT withold abx for delay in lumbar puncture
Fluconazole
For suspected nosocomial blood stream fungal infx
Caution: recent exposure to abx & fluconazole can cause resistance!
Caspofungin
Potent against all Candida species as well as Aspergillus
Acute Complicated UTI organisms
Pseudomonas, Serratia, Providencia