Common/Viral Infect, Immunizations Flashcards by Sara Bojarski

common pathogens for sinusitis

s. pneumoniae, h. influenzae, m. catarrhalis

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when are antibiotics used for sinusitis

-persistent sx >= 10 days without evidence of improvement
-severe sx >=3-4 days at beginning of illness
-worsening sx after typical viral URTI, double sickening

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treatment duration for sinusitis

5-7 days adults
10-14 days children

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drug of choice for sinusitis

amoxicillin/clavulanate

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treatment duration for pharyngitis

10 days

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drug of choice for pharyngitis

penicillin VK or amoxicillin

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common pathogens for otitis media

s. pneumoniae, h. influenzae

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When are antibiotics ABSOLUTELY GIVEN for otitis media

 6mo-12yrs + moderate-severe pain or temperature 102.2.
 6mo-23mo + non-severe bilateral acute OM.

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when are antibiotics CONSIDERED for otitis media

 6mo-23mo + non-severe unilateral.
 2-12yrs + acute non-severe acute OM.

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what is drug of choice for initial treatment of otitis media

amoxicillin (1st time)
amoxicillin/clavulanate (with hx)

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drugs of choice for otitis media after treatment failure

amoxicillin/clavulanate, ceftriaxone

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when are antibiotics used for COPD exacerbation

o Patient has three cardinal symptoms- increase in dyspnea, sputum volume, sputum purulence.
o Has two cardinal symptoms if sputum purulence is one of them.
o Anyone who requires mechanical ventilation.

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drugs of choice for COPD exacerbation

azithromycin, doxycycline, amoxicillin/clavulanate

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typical pathogens causing CAP

s. pneumoniae, h. influenzae, anaerobes

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atypical pathogens causing CAP

M. pneumoniae, C. pneumoniae

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which type of pneumonia has abrupt onset, unilateral infiltrate, significant fever, chills, sweats, dyspnea, purulent sputum, pleuritic chest pain

typical pneumonia

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which type of pneumonia has gradual onset, gradual onset, diffuse infiltrates, ground-glass appearance, mild fever, mild dyspena, dry cough, myalgias, diarrhea, abdominal pain

Atypical pneumonia

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pathogens that cause HAP

s. pneumoniae, h. influenzae, m. pneumoniae (atypical), S. aureus

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treatment duration for CAP

at least 5-7 days

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outpatient treatments for CAP

healthy- amoxicillin
comorbidities- amox/clav or cephalosporin + macrolide

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inpatient treatment for CAP

non-severe/severe- IV beta lactam (amp/sul, ceftriaxone) + macrolide, fluoroquinolone

add anti-MRSA or anti-pseudomonal if needed

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treatment duration for HAP

7 days

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empiric drug options for HAP

ceftriaxone, levofloxacin, moxifloxacin, amp/sul, ertapenem

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drugs to cover MDR organisms in HAP

MRSA- vanco, linezolid
Pseudomonas- pop/tazo, cefepime, ceftazidime, imipenem, meropenem, etc.

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clinical UTI is defined by

significant bacteriuria + pyuria and signs/symptoms of infection

common pathogen causing UTIs

E. coli

infection in the lower UT

cystitis

infection in the upper UT

pyelonephritis

should you treat asymptomatic bacteriuria? if so when

NO unless pregnant, prior to invasive UT surgery, prior to renal transplant

drugs of choice for acute uncomplicated UTI

Nitrofurantoin monohydrate/macrocrystals 100 mg PO BID x 5 days. Bactrim DS 160/800 mg PO BID x 3 days.

treatment duration for acute moderate pyelonephritis

7-14 days

drug of choice for acute moderate pyelonephritis

Bactrim DS 160/800 mg PO BID x 14 days

treatment duration for acute severe pyelonephritis

10-14 days

drug of choice for for acute severe pyelonephritis

extended spectrum cephalosporin or penicillin +/- aminoglycoside

drugs for UTI/asymptomatic bacteriuria in pregnancy

amox/clav x 7 days, cephalexin x3-7 days alt: nitrofurantoin, amoxicillin, Bactrim

drugs for pyelonephritis in pregnancy

IV beta-lactams (ceftriaxone, cefazolin) and switch to oral when possible x 14 days.

antibiotics that are contraindicated in pregnancy

quinolones, tetracyclines

what do you do for recurrent UTI

relapse within 1-2 weeks --> extend treatment up to 6 weeks reinfection--> treatment duration per guidelines

drug of choice for prostatitis

Bactrim DS 160/800 mg PO BID

bacterial causes of infectious diarrhea

shigella, salmonella, e. coli, s. aureus, c. diff

which antibiotics are used for travelers diarrhea if necessary

Bactrim, fluoroquinolones, azithromycin

which OTC items can be used for travelers diarrhea

loperamide max 2 days pepto bismol

super toxin producing e. coli strain

O157:H7

antibiotics used for enterotoxic e.coli if necessary

cipro 750 mg QD x 3 days rifaximin azithromycin 1g x 1 or 500 mg QD x 3 days

what is contraindicated in enterotoxic e. coli

antimotility agents

signs of mild water loss

<5% body weight loss alert, restless, increased thirst, moist/slightly dry mucus membranes, normal/slightly decreased UOP.

signs of moderate water loss

6-9% body weight loss lethargic, restless, low volume (low BP, high HR), dry mucus membranes, delayed capillary refill, dark urine.

signs of severe water loss

>10% body weight loss drowsy, limp, LOC, bradycardia, cyanosis, skin “tenting”, no urine production.

when to use oral rehydration

mild or moderate water loss due to infectious diarrhea

when to use IV rehydration

severe water loss due to infectious diarrhea

non-severe c. diff

leukocytosis (WBC <15k cells/mL) AND SCr <1.5 mg/dL

drugs for initial treatment of NON-SEVERE c. diff

Vancomycin 125 mg PO QID x 10d Fidaxomicin 200 mg PO BID x10d (Metronidazole 500 mg PO TID x 10d)

severe c. diff

leukocytosis (WBC >15k cells/mL) OR SCr > 1.5 mg/dL

fulminant c. diff

hypotension or shock, ileus, megacolon

what do you avoid and/or discontinue when treating c. diff infection

avoid anti-peristaltic agents discontinue concurrent antibiotics if possible

drugs for initial treatment of SEVERE c. diff

Vancomycin 125 mg PO QID x 10d Fidaxomicin 200 mg PO BID x10d

drugs for initial treatment of FULMINANT c. diff

Vancomycin 500 mg PO or NG QID (PLUS Metronidazole 500 mg IV Q8H- if ileus is present)

what drug do you use for the FIRST episode of recurrence of C. diff

same regimen as initial

which drugs do you use for second or more recurrences of c. diff

vanco tapered, vanco pulsed, fidaxomicin 200 mg BID x 10d, vanco 125 mg QID x 10d then rifaximin 400 mg TID x 20d

most common candida species

candida albicans

risk factors for candida infection

chemotherapy exposure to immunosuppressives neutropenia

drug of choice for candida

fluconazole

most common aspergillus species

A. fumigates

drugs of choice for aspergillus infection

amphotericin B, voriconazole

which antifungal classes have cell membrane activity

azoles polyenes (amphotericin B)

side effects of voriconazole

visual disturbances, hallucinations, nightmares

which antifungals act against the cell wall of fungi

echinocandins (-fungin)

which antifungal has intracellular activity against fungi

pyrimidine analogues (flucytosine)

azoles have major interactions with

CYP3A4 substrates

major AE of amphotericin B

nephrotoxicity