Common/Viral Infect, Immunizations Flashcards
common pathogens for sinusitis
s. pneumoniae, h. influenzae, m. catarrhalis
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
treatment duration for sinusitis
5-7 days adults
10-14 days children
drug of choice for sinusitis
amoxicillin/clavulanate
treatment duration for pharyngitis
10 days
drug of choice for pharyngitis
penicillin VK or amoxicillin
common pathogens for otitis media
s. pneumoniae, h. influenzae
When are antibiotics ABSOLUTELY GIVEN for otitis media
6mo-12yrs + moderate-severe pain or temperature 102.2.
6mo-23mo + non-severe bilateral acute OM.
when are antibiotics CONSIDERED for otitis media
6mo-23mo + non-severe unilateral.
2-12yrs + acute non-severe acute OM.
what is drug of choice for initial treatment of otitis media
amoxicillin (1st time)
amoxicillin/clavulanate (with hx)
drugs of choice for otitis media after treatment failure
amoxicillin/clavulanate, ceftriaxone
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.
drugs of choice for COPD exacerbation
azithromycin, doxycycline, amoxicillin/clavulanate
typical pathogens causing CAP
s. pneumoniae, h. influenzae, anaerobes
atypical pathogens causing CAP
M. pneumoniae, C. pneumoniae
which type of pneumonia has abrupt onset, unilateral infiltrate, significant fever, chills, sweats, dyspnea, purulent sputum, pleuritic chest pain
typical pneumonia
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
pathogens that cause HAP
s. pneumoniae, h. influenzae, m. pneumoniae (atypical), S. aureus
treatment duration for CAP
at least 5-7 days
outpatient treatments for CAP
healthy- amoxicillin
comorbidities- amox/clav or cephalosporin + macrolide
inpatient treatment for CAP
non-severe/severe- IV beta lactam (amp/sul, ceftriaxone) + macrolide, fluoroquinolone
add anti-MRSA or anti-pseudomonal if needed
treatment duration for HAP
7 days
empiric drug options for HAP
ceftriaxone, levofloxacin, moxifloxacin, amp/sul, ertapenem
drugs to cover MDR organisms in HAP
MRSA- vanco, linezolid
Pseudomonas- pop/tazo, cefepime, ceftazidime, imipenem, meropenem, etc.
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
