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PDAT6 ID > Cumulative Study > Flashcards

Cumulative Study Flashcards

1
Q

WHICH ORGANISMS
cause
AOM

A

1 = STREPTOCOCCUS PNEUMONIAE

  • *VIRUS = MOST COMMON**
  • advocate to VACCINATE –> Influenze & Pneumococcal*

Moraxella Catarrhalis + HaemoPhilus Influenza

  • Staphylococcus Aureus*
  • rare but need for CLINDA for this*
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2
Q

When to consider:
OBSERVATION

A

Based on:
Age & Severity

Healthy Children:
6mo - 2y/o w/ non-severe illness & unilateral involvement
or
> 2 y/o** w/ **non-severe** illness & **no otorrhea (ear discharge)

Observation is:
Defer AB therapy for 48-72 hours
Schedule an RE-Evalulation // Communication
SNAP –> don’t fill RX until DR. conformation

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3
Q

2nd Line Treatment
For
SEVERE AOM

BILATERAL infection / OTORRHEA
Fever > 39*C (102.2*F)

A
  • *CEFTRIAXONE**
  • *IM QD x 3 days**

or

Cefdinir
QD - BID

Cefuroxime
BID

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4
Q

1st Line Treatment
For
NON-SEVERE AOM

Mild Symptoms / Unilateral Infxn / No Otorrhea
Fever < 39* (102.2F)

A

AMOXICILLIN** @ **80-90 mg/kg/day BID
HIGH DOSE –> needs to reach MIDDLE EAR

OR

OBSERVATION
defer AB for 48-72 hours
if observed & failed after 48-72 hours –> AMOX 80-90

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5
Q

Treatment if PCN allergy
For
NON-SEVERE AOM

Mild Symptoms / Unilateral Infxn / No Otorrhea
Fever < 39* (102.2F)

A

Cefuroxime - BID

or

Cefdinir - QD or BID

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6
Q

3rd Line Treatment
For
NON-SEVERE AOM

Mild Symptoms / Unilateral Infxn / No Otorrhea
Fever < 39* (102.2F)

A

After Failing AMOXICILLIN +/- Observation:
&
Failing AUGMENTIN:

CEFTRIAXONE - IM QD F3D

  • *CLINDAMYCIN**
  • may need ADDITIONALLY to cover* H.Influenzae

TYMPANOCENTESIS
TUBE to withdraw fluid or pus from middle ear

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7
Q

1st Line Treatment
For
SEVERE AOM

BILATERAL infection / OTORRHEA
Fever > 39*C (102.2*F)

A

AUGMENTIN** @ **80-90 mg/kg/day BID

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8
Q

When to Suggest < 10 day therapy
for
AOM

A

7 DAY THERAPY for:
2-5 y/ow/mild-Moderate AOM

  • *5-7 Day Therapy** for:
  • *>** 6y/o
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9
Q

Outpatient CAP Treatment

No recent AB therapy
<90 days

A

MACROLIDE** or **DOXYCYCLINE

  • ZPAK (500mg x1day -> 250mg x4days)
    • 5 days, stays INSIDE cellls
  • Azithromycin XR Suspension 2gm
    • one dose
  • ​Clarithromycin 250-500mg BID or XR 1gm daily
    • no renal adjustment
    • GI upset / Ototoxicity / 3A4 inhibitor
  • DOXYCYCLINE 100mg q12h
    • 7-14 days
    • no renal adjustment
    • Teeth discoloration / GI Upset
    • antacids / magnesium / iron / calcium
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10
Q

INPATIENT CAP Treatment

NON-ICU

A

B-LACTAM
cefuroxime / ceftriaxone / ertepenem / amp-sulbactam
+
MACROLIDE** or **DOXYCYLINE** or **RESPIRATORY FLUOROQUINOLONE
levofloxacin / moxifloxacin

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11
Q

INPATIENT CAP Treatment

ICU + PCN ALLERGY

A

RESPIRATORY FLUOROQUINOLONE
Levofloxacin + Moxifloxacin
+
AZTREONAM
1-2gm IVPB q8
instead of B-Lactam (ceftriaxone etc.)

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12
Q

INPATIENT CAP Treatment

ICU

A

B-LACTAM
cefuroxime / ceftriaxone / ertepenem / amp-sulbactam
ceftriaxone could be dosed 1gm IVPB q12
+
MACROLIDE** or **RESPIRATORY FLUOROQUINOLONE
levofloxacin / moxifloxacin, same doses

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13
Q

Common Organisms (6)
CAP

A

“SMH - MILC”
SMH = Same as AOM

STREPtococcus PNEUMoniae

M. Catarrhalis

H. Influenzae

Legionella + Influenza

Mycoplasma + Chlamydophilia

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14
Q

Outpatient CAP Treatment

Recent AB therapy (90days) or Comorbid Conditions

Chronic: Liver / Heart / Renal / Lung Disease

Diabetes / Malignancy

Diabetes / Asplenia / IMS disease-drugs

A

RESPIRATORY FLUOROQUINOLONE
Levofloxacin / Moxifloxacin / Gemifloxacin
OR
MACROLIDE + B-LACTAM
Zpak or Clarithromycin
Augmentin / Amoxicillin / Cefuroxime / Cefpodoxime

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15
Q
  • *CURB-65**
  • *PNEUMONIA TREATMENT**

Score:
0-1 = Outpatient
2 = Inpatient
> 3 = ICU

A

20 - 30/60/90

Confusion

Uremia = BUN > 20mg/dl

Respiratory Rate > 30

Blood Pressure < 90/60 mmHg

Age > 65

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16
Q

CAP Treatment

Length of Therapy

A

7-14 Days total
except for zpak (5days) / levofloxacin (750mg 5days)

Legionella = 7-10 days

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17
Q

When to COVER MRSA?

HAP

A

Risk factor for MDR
ABx <90 days / >5day hospitalization
VAP - Septic Shock / ARDS / Acute renal replacement therapy

Unit where patient is residing has:
>10% incidence of MRSA

Prevelence of MRSA NOT KNOWN
and/or
patient is INTUBATED
and/or
SEPTIC SHOCK

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18
Q

HAP Treatment if

MSSA ISOLATED

A

2-N-O-C

Nafcillin
2gm IVPB q4h

Oxacillin
2gm IVPB q4h

Cefazolin
2gm q8h

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19
Q

What HAP drug has DRUG INTERACTIONS?

& What drugs?

A

LINEZOLID
600mg q12h for MRSA Coverage

SSRI’s - Fluoxetine

TCA’s / Venlafaxine

Mirtazapine

TRAZADONE

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20
Q

HAP TREATMENT

2 DRUGS
for
Pseudomonas or Resistant Gram-NEG-

SECOND DRUG

A

“CCBM + FAP”

Antipseudomonal Fluoroquinolone

  • *Levofloxacin** - 750mg IVPB qd
  • *Ciprofloxacin** - 400mg IVPB q8h
  • *AminoGlycoside**
  • *Gentamicin / Tobramycin / Amikacin**
  • *Polymixin**
  • *Colistin** - 5mg/kg x1dose -> 2.5mg/kg IVPB q12h
  • *Polymixin B -** 2.5-3mg/kg/day IVPB in TDD
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21
Q

HAP TREATMENT if

NO MRSA RISK FACTORS / No factors for Resistance

A

Empirically Cover with MONOTHERAPY“CLIP-M”

Cefepime

Levofloxacin

Imipenem

Piperacillin-Tazobactam

Meropenem

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22
Q

When to use
2 DRUGS
for
Pseudomonas or Resistant Gram-NEG-

A

Risk Factor for MDR
ABx <90 days / >5day hospitalization
VAP - Septic Shock / ARDS / Acute renal replacement therapy

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS**or**BRONCHIECTASIS

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23
Q

Risk Factors for
MULTI DRUG RESISTANT PATHOGENS
HAP

A

<90 day Antimicrobial Therapy

> 5 days of Hospitalization

Septic Shock @ time of VAP

ARDS preceding VAP

Acute Renal Replacement Therapy prior to VAP

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24
Q

HAP TREATMENT

2 DRUGS
for
Pseudomonas or Resistant Gram-NEG-

FIRST DRUG

A

“CCBM + FAP”

Antipseudomonal Cephalosporin

  • *CEFtazadime** - 2gm IVPB q8h
  • *CEFipime** - 2gm IVPB q8h

Antipseudomonal Carbapenem

  • *Imipenem** - 500mg IVPB q6h
  • *Meropenem** - 1gm IVPB q8h
  • *B-Lactam_/_B-lactamase inhibitor**
  • *Piperacillin / Tazobactam** - 4.5gm IVPB q6h
  • *Monobactam**
  • *Aztreonam** - 2gm IVPB q8h
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25
Q

Which TB Drug based on Target?

INHIBIT:
Mycolic Acid Synthesis - C60-90 alpha alkyl
&
target inhA = long chain NAD-dependent enoyl-ACP reductase
INH covalently attaches to nicotinamide ring of NADH@ side of hydride exhange

A
  • *ISONIAZID** = INH
  • *ETHIONAMIDE = ETH**

Hepatotoxicity** & **PERIPHERAL NEURITIS –> give B6

Both are:
Bacterial-Activated Prodrugs

Isoniazid is activated by Catalase Peroxidase = katG

Ethionamide is activated by Monooxygenase = etA

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26
Q

Which TB Drug based on Target?

binds to:
beta-subunit rpoB of RNA polymerase
changes conformation -> prevents binding of nucleotides & inhibits initiation of transcription

A

RIFAMYCINS

HEPATITIS + RED URINE
INDUCTION OF CYP450 ENZYMES –> ↓Half-Life of:
steroids / anticoagulants / macrolides / imidazoles
Protease inhibitors / NNRTIs

Rifampin

  • *Rifabutin**
  • less p450 activation –> recommended for HIV/TB co-infection*
  • *Rifapentine**
  • LONG HALF LIFE –> can be dosed WEEKLY in continuation phase*
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27
Q

Which TB Drug based on Target?

only active in vitro at low pH <6

Requires:
pncA
to generate the active agent = pyrazinoic acid

Sterilizing Activity
treatment 9mo –> 6mo

A

PYRAZINAMIDE

Significant HEPATOTOXICITY
↑ALT ↑AST

MOA IS UNCERTAIN

TB-SPECIFIC DRUG:
TB has deficient efflux compared to some naturally resistant mycobacteria

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28
Q

Which TB Drug based on Target?

inhibits:
ARABINOSYL TRANSFERASE
affecting the synthesis of:
arabinogalactan & lipoarabinomannan in cell wall

A

ETHAMBUTOL

OPTIC NEURITIS
visual acuity –> red-green differentiation

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29
Q

Isoniazid Resistance

PERIPHERAL NEURITIS –> GIVE B6

HEPATOTOXICITY

A

65% in

  • *katG** = activating enzyme
  • *Missense** or Large deletions in catalase peroxidase

20% in

  • *inhA** = final target
  • *mutations in NADH binding site**
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30
Q

Rifamycin Resistance

HEPATITIS + RED URINE

P450 INDUCER

A

Single AA substitutions in hotspot in:
rpoB
RNA polymerase subunit

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31
Q

Ethambutol Resistance

OPTIC NEURITIS

A

very low resistance

OVERexpression of:
embA**+**embB**+**embC

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32
Q
  • *Rifabutin Uses**
  • in comparison to RIFAMPIN*
A
  • LESS ACTIVATION OF P450*
  • rifampin –> strong p450 INDUCER*

Rifamycin of choice for:
HIV/TB Co-infection when using protease inhibitors

Active vs some:
Rifampin-resistant strains of M. TB

use for:
M.AVIUM - intracellulare infection

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33
Q
  • *Rifapentine Uses**
  • in comparison to RIFAMPIN*
A
  • *LONGER HALF LIFE**
  • *intermittent dosing** –> 2x a week for initial phase

ONCE A WEEK in Continuation phase

not active against Rifampin-resistant strains of M. TB

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34
Q

DiarylQuinoline = Bedaquiline

Uses for TB

A

Targets: ATP-SYNTHASE
5 month half life –> single dose

highly potent vs:
NON-REPLICATING M.TB = LATENT TB

FDA approved for MDR-TB when no other options available

Adr:
Prolonged QT Interval + Hepatotoxicities

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35
Q

Treatment for:

STAPH Aureus
Coagulase-Negative Staphylococci

PVE
(Prosthetic)

No resistance / Susceptible Strains

A

PVE STAPH = 3 DRUGS + >6 week treatment

Nafcillin** or **Oxacillin
12g per 24h
> 6 WEEKS
++++
Rifampin
900mg per 24 hours
> 6 WEEKS
+++
Gentamicin
3mg/kg per 24 hours
2 WEEKS

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36
Q

Treatment for:

STREP
Veridans / Gallolyticus / Abiotrophia / Granulicatella

NVE
(native valve endocarditis)

  • *PCN - Intermediate Resistance**
  • *MIC > 0.12 , <0.5**
A
  • *Penicillin G Sodium**
  • *24 million** units per 24 hours
  • *4 WEEKS**

++PLUS++

  • *Gentamicin**
  • *3mg/kg** per 24 hours
  • *2 WEEKS**
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37
Q

Treatment for:

STREP
Veridans / Gallolyticus / Abiotrophia / Granulicatella

NVE
(native valve endocarditis)

PCN ALLERGY

A
  • *Vancomycin**
  • *30mg/kg** per 24 hours in 2divdoses
  • *4 WEEKS**

for
PVE –> 6 Week treatment

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38
Q

Treatment for:

STREP
Veridans / Gallolyticus / Abiotrophia / Granulicatella

NVE
(native valve endocarditis)

  • *PCN SENSITIVE**
  • *MIC < 0.12**
A
  • *Penicillin G sodium**
  • *12-18** million units / 24 hours
  • *4 WEEKS**

OR

Penicillin** + **Gentamicin
same + 3mg/kg / 24 hours
2 WEEKS

39
Q

Treatment for:

STREP
Veridans / Gallolyticus / Abiotrophia / Granulicatella

PVE
(Proshetic Valve Endocarditis)

  • *PCN SENSITIVE**
  • *MIC < 0.12**
A
  • *Penicillin G sodium**
  • *24 million** units for 24 hours
  • *6 WEEKS**

with or without

  • *Gentamicin**
  • *3mg/kg** per 24 hours in 1 dose
  • *2 WEEKS**
40
Q

Which patients should recieve
PROPHYLAXIS
for
Infective Endocarditis?

A

Prosthetic Valve** OR **Material

Previous IE
infective endocarditis

CONGENITAL HEART DISEASE
palliative shunts / conduits
repaired congenital heart defects
cardiac TRANSPLANTATIOn recipients

41
Q

Treatment for:

STREP
Veridans / Gallolyticus / Abiotrophia / Granulicatella

PVE
(Proshetic Valve Endocarditis)

  • *PCN Resistant**
  • *MIC > 0.12**
A

Same as PCN resistant, but PLUS gentamicin is 6 WEEKS (not 2)

  • *Penicillin G sodium**
  • *24 million** units for 24 hours
  • *6 WEEKS**

++PLUS++

  • *Gentamicin**
  • *3mg/kg** per 24 hours in 1 Dose
  • *6 WEEKS**
42
Q

Treatment for:

STAPH Aureus
Coagulase-Negative Staphylococci

NVE
(Native Valve Endocarditis)

PCN ALLERGY

A
  • *Vancomycin**
  • *30mg/kg** QD
  • *6 WEEKS**
43
Q

Treatment for:

STAPH Aureus
Coagulase-Negative Staphylococci

NVE
(Native Valve Endocarditis)

No Resistance = Susceptible Strains

A
  • *Oxacillin_ or _Nafcillin**
  • *12g / 24h** in 4-6 dd
  • *6 WEEKS**
44
Q

Treatment for:

STAPH Aureus
Coagulase-Negative Staphylococci

NVE
(Native Valve Endocarditis)

RESISTANT STRAINS

A
  • *Vancomycin**
  • *30mg/kg** per 24 hours in 2dd
  • *6 WEEKS**

same as PCN allergic

45
Q

Treatment for:

STAPH Aureus
Coagulase-Negative Staphylococci

PVE
(Prosthetic)

RESISTANT STRAINS

A
  • *PVE STAPH = 3 DRUGS** + >6 week treatment
  • Resistant –> vanco instead of oxacillin*

VANCOMYCIN
30mg/kg per 24hr in 2dd
> 6 WEEKS
++++
Rifampin
900mg per 24 hours
> 6 WEEKS
+++
Gentamicin
3mg/kg per 24 hours
2 WEEKS

46
Q

Treatment for:

Enterococcuus
Coagulase-Negative Staphylococci

PVE** or **NVE
(Prosthetic OR native)

RESISTANT STRAINS
to PCN / Vancomycin / Gentamicin

A
  • *LINEZOLID**
  • *600mg** IV or ORAL q12 hr
  • *>** 6 Weeks

OR

  • *DAPTOMYCIN**
  • *10-12 mg/kg per dose**
  • *>** 6 Weeks
47
Q

Treatment for:

Enterococcuus
Coagulase-Negative Staphylococci

PVE** or **NVE
(Prosthetic OR native)

NO RESISTANCE
to PCN / Vancomycin / Gentamicin

A
  • *AMPICILLIN**
  • *2g** every 4hrs
  • *4-6 WEEKS**

for PCN allergy:
Vancomycin + Gentamycin

48
Q

Treatment for:

FUNGI
Infective Endocarditis

A
  • *Amphotericin B** +/- Flucytosine
  • treatment duration is UNKNOWN*

REQUIRES VALVE REPLACEMENT

49
Q

Treatment for:

GRAM NEGATIVE BACILLI
Infective Endocarditis

A
  • *B-Lactam_ + _AminoGlycoside**
  • *6 WEEKS**

REQUIRES VALVE REPLACEMENT

50
Q

Treatment for:

HACEK
Haemophilus / Aggregatibacter / Cardiobacterium / Eikenella-Kingella

Responsible for 5-10% of community aquired NVE

A
  • *CEFTRIAXONE**
  • *2g** per 24hours IV or IM 1 dose

4 WEEKS

51
Q

Indications for
LONG-TERM CATHETERS

PICC

Port-a-cath

Groshong = CLosed end

Hickman = open end

A
  • Lack of short term peripheral venous access (e.g, IV drug users)
  • Infusion of hyperosmolar solutions (e.g., TPNs)
  • Infusion of vessicant/ irritant drugs (e.g., certain chemotherapy)
  • Long-term IV therapy (e.g., treatment of endocarditis)
  • Infusion of intermittent drug therapy (e.g., chemotherapy)
  • Use of continuous ambulatory drug pumps (e.g., TPN)
  • Patient, physician or nursing preference
  • Geographic location (e.g., lives out in the country)
52
Q

Bacterial ETIOLOGY
of
CR-BSI

A

Coagulase Negative STAPHylococcus

All Gram Negative Bacteria

Enterococci = STAPH.Areus

Candida

53
Q

CR-BSI TREATMENT:

STAPHYLOCOCCUS AUREUS

no resistance

A
  • *Nafcillin** or Oxacillin
  • *1-2 gm IVPB q4-6hr**

2-6 WEEKS

REMOVE LINE

54
Q

CR-BSI TREATMENT:

ENTEROCOCCI
&
VRE
(Vanco Resistant Enterococci)

A

same as Coagulase Negative STAPH
VANCOMYCIN
15mg/kg q12h
AB LOCK
10 - 14 day treatment

for isolated VRE - ​PULL LINE
Daptomycin - 6mg/kg/day
OR
Linezolid - 600mg q12h

55
Q

CR-BSI TREATMENT:

GRAM NEGATIVE BACILLI

A

Piperacillin/Tazobactam

Ceftazidime or Cefipime

Imipenem or Meropenem
+/- aminoglycoside

7-14 days

REMOVE THE CATHETER

56
Q

CR-BSI TREATMENT:

STAPHYLOCOCCUS AUREUS

RESISTANCE

A

Methicillin Resistant Strains

  • *Vancomycin**
  • *15mg/kg q12**

OR

  • *Daptomycin**
  • *6-8mg/kg**

2-6 WEEKS
REMOVE LINE

57
Q

TREATMENT FOR:

  • *SEVERE / MODERATE PURULENT ABSSSI**
  • *Cutaneous / Furuncle / Carbuncle**

SYSTEMICALLY ILL
Elevated HR / RR / TEMP / WBC

IMMUNOCOMPROMISED

Multiple Abscesses - Extreme Age

Lack of RESPONSE to I&D

A

INCISION & DRAINAGE
+
EMPIRIC ABx –> MRSA
Vancomycin / Daptomycin / Linezolid / Doxy / Bactrim
+
Check Cultures –> DEFINED Rx
MSSA Possible –> Nafcillin / Cefazolin / Clindamycin

58
Q
  • *Erysipelas & Cellulitis**
  • NON-purulent ABSSSI*

CAUSED BY WHAT ORGANISM(s)?

A

Primarily caused by:
STREPtococcus SPP.
B-HEMOLYTIC GROUP A
(S. Pyogenes)
Groups: B-C-F-G

rarely Staph Aureus

59
Q
  • *CUTANEOUS ABSCESS**
  • *Purulent ABSSSI**

CAUSED BY WHAT ORGANISM(s)?

Painful - Tender - Fluctuant Red Nodules

Often surmounted by a:
Pustule & Circumscribed by a rim of Erythema + Swelling

Collection of
PUS within dermis & deeper skin tissue

A

Primarily caused by:
STAPH Aureus

Treatment:
Incision & Drainage
addition of Systemic ABx does NOT improve cure rates
even in MRSA

60
Q
  • *CARBUNCLE**
  • *Purulent ABSSSI**

1st LINE TREATMENT

A

1st Line Treatment:
Incision & Drainage

abx unnecessary unless SYSTEMIC S/Sx of infection

61
Q
  • *ERYSIPELAS & CELLULITIS**
  • NON-Purulent ABSSSI*

1st LINE TREATMENT

A

1st Line Treatment:
ABx Therapy to cover:
GROUP A STREP** = **B-HEMOLYTIC Group A
(S. Pyogenes)

PENICILLIN VK

CEPHALOSPORIN / Ceftriaxone IV / Cefalozin IV

CLINDAMYCIN

DICLOXACILLIN

62
Q
  • *NECROTIZING FASCIITIS**
  • NON-Purulent ABSSSI*

1st LINE TREATMENT

A

SURGICAL INSPECTION** + **DEBRIDEMENT

ABx therapy until –> no more debridement needed
clinically improved / afebrile for 48-72 hours / until they are better

EMPIRIC THERAPY

  • *Gram +POS+** = STREP** / **STAPH** (**MRSA)
  • *VANCOMYCIN** - Linezolid - Daptomycin
  • *Gram -Neg-**
  • *PIP/TAZO** - Carbapenem - Ceftriaxone
  • *PLUS METRONIDOZOLE**
  • If suspected GAS*
  • *Protein Synthesis Inhibitor**
63
Q
  • *PURULENT ABSSSI**
  • *Cutaneous / Furuncle / Carbuncle**

When would we use ANTIBIOTICS?

A
  • *SYSTEMICALLY ILL**
  • *Elevated HR / RR / TEMP / WBC**

IMMUNOCOMPROMISED

Multiple Abscesses** - **Extreme Age

Lack of RESPONSE to I&D

ABx targetting MRSA

In ADDITION to I&D

64
Q

Osteomylitis Treatment

DURATION

&

Special Considerations?

A

minimum of

  • *>** 6 Weeks
  • consider IV –> PO switch for NON-B-lactam ABs*

EXCEPTION:
> 8 Weeks
VERTEBRAL OSTEOMYELITIS
+
PARAvertebral ABSCESS** OR **MRSA Infection

65
Q

Osteomylitis Treatment

  • *Streptococcus spp.**
  • pcn sensitive*

PCN Allergy

A

PCN Allergy:
VANCOMYCIN

Normal:

CeftriaXone
or
Penicillin G

66
Q

Osteomylitis Treatment

  • *Streptococcus spp.**
  • *PCN RESISTANT**

1st Choice

A

base on susceptibilities:

CeftriaXone

or

Vancomycin

67
Q

Osteomylitis Treatment
Gram Negatives

  • *Enterobacteriaceae**
  • *E. Coli / K. Pneumoniae / Enterobacter / Citrobacter**

1st Choice

A

CefePIME

Ertapenem

Alternate for PCN allergy:
Ciprofloxacin

68
Q

Osteomylitis Treatment
Gram Negatives

P. Aeruginosa

1st Choice

A

CefePIME

MEROpenem

Alternate for PCN allergy:
Ciprofloxacin

69
Q

Osteomylitis Treatment
Gram Negatives

Salmonella Spp

1st Choice

A

CIPROFLOXACIN

Salmonella = typically with SICKLE CELL

Alternate:
CeftriaXone

70
Q

Diabetic Foot Infection Treatment

1st line Therapy

SEVERE
IV ONLY
VERY BROAD:
MRSA / Streptococcus / Enterobaceteriae
Anaerobes / P.aeruginosa

A

SEVERE = VCM ALL 3

Vancomycin

Cefepime

Metronidazole

Moerate or Severe = 2-3 Weeks
until infection has cleared

71
Q

Diabetic Foot Infection Treatment

Moderate
MSSA + Streptococcus
Enterobacteriaceae + anaerobes
+
P. Aeruginosa Risk Factor
MACERATED would OR High Prevelence

A

MODERATE + P.Aeruginosa Risk Factor (MACERATED)

  • *PIP TAZO**
  • *2-3 Weeks**

Moderate Treatment:
Amoxicillin / Clavulanate

Ampicillin / Sulbactam

Piperacillin / Tazobactam

72
Q

Diabetic Foot Infection Treatment

1st line Therapy

MILD
+
P. Aeruginosa Risk Factor
MECERATED WOUND OR High Local P.Aeruginosa Prevelence

A

P. Aeruginosa Risk Factor = Macerated Wound
CEPHELEXIN** + **CIPROFLOXACIN
Mild = 1-2 Weeks
until the infection has cleared

Normal Mild Treatment:
Cephalexin** OR **Augmentin** OR **Clindamycin

73
Q

WHEN to treat EMPIRICALLY + What Abx?

for
Osteomyelitis?

A

typically NOT treating empirically –> want cultures first

only if:
HEMODYNAMICALLY UNSTABLE
cover for:
MRSA / Streptococci / Gram-NEG- bacilli

VANCOMYCIN** + **CEFEPIME

PCN ALLERGY:
instead of cefepime –> cipro or aztreonam

74
Q

Osteomyelitis Treatment

MSSA
Staphlococcus

ALTERNATE CHOICE

A

PCN Allergy:
VANCOMYCIN

Alt:
BACTRIM DS** + **RIFAMPIN

N-O-C
Nafcillin** or **Oxacillin
or
CefaZolin

75
Q

Osteomylitis Treatment

  • *MRSA**
  • *Coagulase Negative Staphylococcus**

ALTERNATE Choice

A

DAPTOMYCIN
or
Bactrim DS** + **RIFAMPIN

Normal:
VANCOMYCIN

76
Q

Osteomylitis Treatment

When to add RIFAMPIN?
to regular treatment of:

MSSA
or
MRSA** + **Coagulase NEG Staphylococci

A

RIFAMPIN in COMBO
has synergistic activity against BIOFILMS
for
PROSTHETIC JOINTS
or
Alternative PO THERAPY

77
Q

Osteomylitis Treatment

Streptococcus spp.

1st Choice

A

CeftriaXone

Penicillin G

PCN Allergy:
Vancomycin

78
Q

Osteomylitis Treatment
Gram Negatives

  • *Enterobacteriaceae**
  • *E. Coli / K. Pneumoniae / Enterobacter / Citrobacter**

PCN ALLERGY or PO Therapy

A

Alternate for PCN allergy or PO therapy:
CIPROFLOXACIN

Normal:
CefePIME or Ertapenem

79
Q

Osteomylitis Treatment
Gram Negatives

P. Aeruginosa

PCN ALLERGY

A

Alternate for PCN allergy:
CIPROFLOXACIN

Normal:
CefePIME or MEROpenem

80
Q

Osteomyelitis:

Which bacteria are considered

Enterobacteriaceae?

A

E. Coli

Kleb. Pneumoniae

Enterobacter

Citrobacter

Treat with:
CefePIME or Ertapenem

Alternate for PCN allergy:
Ciprofloxacin

81
Q

Diabetic Foot Infection Treatment

1st line Therapy

MILD
+
MRSA Risk Factor
H/O MRSA Infxn OR High Local MRSA prevelence

A

MRSA Risk Factor:
CEPHALEXIN** + **BACTRIM (sulfa+trimeth)
Mild = 1-2 Weeks
until the infection has cleared

Normal Mild Treatment:
Cephalexin** OR **Augmentin** OR **Clindamycin

82
Q

Diabetic Foot Infection Treatment

Moderate
MSSA + Streptococcus
Enterobacteriaceae + anaerobes
+
MRSA Risk Factor
H/O MRSA infxn OR High MRSA Prevelence

A

MODERATE + MRSA Risk Factor

  • *AMPICILLIN/SULBACTAM_ + _VANCOMYCIN**
  • *2-3 Weeks**

Moderate Treatment:
Amoxicillin / Clavulanate

Ampicillin / Sulbactam

Piperacillin / Tazobactam

83
Q

What SITES have ANAEROBES?
Bacteriodes / Clostridium / Peptostreptococcus

Intra-Abdominal Infections

A

Anaerobes
Bacteriodes / Clostridium / Peptostreptococcus

Proximal + Distal Small Intestine

COLON

no anaerobes in BILIARY TRACT or STOMACH

84
Q

Spontaneous Bacterial Peritonitis = SBP

TREATMENT

A
  • *Streptococcus** + Enterics (E.Coli + Kleb)
  • no anaerobes*

CEFTRIAXONE** or **Cefotaxime
for the ENTERICs, strep is covered by most
5 DAYS
should have improvement within 24-48 hours

PROPHYLAXIS
typically for MOST SBP (until no longer in LIVER FAILURE)
FQs or BACTRIM

85
Q

ABSCESSES

TREATMENT

A

SOURCE CONTROL
DRAIN via Percutaneous Catherer or Surgery
unable to FULLY DRAIN? –> duration could be WEEKS
based on the IMAGING

Treatment is the same as CIAI
CEFTRIAXONE or Cefotaxime​

Polymicrobial

  • *Enterics + Anaerobes**
  • *Pseudomonas - if HIGH-severity or Healthcare-associated**
86
Q

TREATMENT

Community-Acquired MILD-MODERATE
CIAI
Complicated ItraAbdominal Infection = Secondary Peritonitis

A
  • *CEFOXITIN**
  • *Enteric + Anaerobic** Activity
  • Ertapenem* –> only for pt w/ ho ESBL

or

METRONIDAZOLE** + **CEFTRIAXONE** or **Cefotaxime

87
Q

ORGANISMS

  • *CIAI**
  • *Complicated ItraAbdominal Infection = Secondary Peritonitis**
A

Often POLYmicrobial:

  • *ENTERICS**
  • *E. Coli + Kleb**
  • *GI ANAEROBES**
  • *Bacteroides / Clostridium / Peptostreptococcus**
  • PSEUDOMONAS*
  • *Mainly if HIGH-SEVERITY** or HEALTHCARE-ASSOCIATED
88
Q

TREATMENT

HIGH-RISK / SEVERE Community-Aquired
CIAI
Complicated ItraAbdominal Infection = Secondary Peritonitis

ICU PATIENT
Advanced Age / Comorbidities
Immunocomprimised / Malignancy
DELAY in initial intervention >24 hours

A

Treatment is the SAME with Healthcare-Associated CIAI

PIPERACILLIN / TAZOBACTAM
want to cover ALL
Enterics + Anaerobes + PSEUDOMONAS

Carbapenems –> reserved for ESBL

89
Q

TREATMENT

CHOLANGITIS + Biliary-Enteric Anastamosis
Infection/Inflammation of bile ducts

A

Enterics** + **Enterococcus
With additional coverage for:
ANAEROBES** + **PSEUDOMONAS

So treat with:
PIP/TAZO
or
CARBAPENEMS
except ERTAPENEM

ALSO:
SOURCE CONTROL –> REMOVE GALL BLADDER or ERCP

90
Q

TREATMENT

Community Acquired, Mild/Moderate
CHOLECYSTITIS
Infection/Inflammation of gallbladder

A
  • does NOT need anaerobic activity*
  • *Typically Sterile**
  • *Enterics_ + _Enterococcus**

CEFTRIAXONE

91
Q

TREATMENT

Healthcare-Associated or High Severity Community-Acquired
CHOLECYSTITIS
Infection/Inflammation of gallbladder

A

Enterics** + **Enterococcus
With additional coverage for:
ANAEROBES** + **PSEUDOMONAS

So treat with:
PIP/TAZO
or
CARBAPENEMS
except ERTAPENEM

ALSO:
SOURCE CONTROL –> REMOVE GALL BLADDER or ERCP

92
Q

Treatment / Bacteria

APPENDICITIS

A

Polymicrobial
Enterics + Anaerobes + Streptococci

ABx Choice is SAME as Community-Acquired CIAI

CEFOXITIN
Enterics + Anaerobic
OR
Ceftriaxone** + **Metronidazole

93
Q

Treatment DURATION

for
Short-Corse Antimicrobial Therapy
Intrabdominal Infections

A

after SOURCE CONTROL:

(fix leak / aspirating abscess)

4 DAYS

PDAT6 ID (31 decks)

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