Drug/Bug Combos - Cases, PBL, + need to knows Flashcards
Staphylococcus aureus
cloxacillin
MRSA
vancomycin
Strep pyogenes
penicillin
Enteroccus faecalis
ampicillin +gentamicin (synergy)
Viridans group streptococci
penicillin or ceftriaxone
e.g. S. mitis
Haemophilus influenzae
cefuroxime or amoxicillin/clavulanate
Strep pneumoniae
amoxicillin (PO), penicillin or ceftriaxone (IV)
Enterobacteriaceae
gentamicin, ciprofloxacin, ceftriaxone
e.g. E. coli, Enterobacter spp. Salmonella spp. Proteus spp.
Anaerobes
metrinidazole
e.g. G+ : peptostreptococcus spp. clostridium spp. acintomyces spp. G- : bacteroides
Syphilis
organism: Treponema pallidum
Tx: IM benzathine penicillin
Giardia
metronidazole
4 TB medications
rifampin
isoniazid
pyrazinamide
ethambutol
Chlamydia tx
Doxycycline
MAC prophylaxis
Azithromycin
Toxoplasmosis prophylaxis
TMP/SMX
PJP tx
prophylaxis: TMP/SMX
treatment: TMP/SMX with prednisone
UTI tx
organism 90% of time E. coli
1st line: Nitrofurantoin
Other empiric options: fosfomycin or amoxicillin/clavulanate
High resistance levels: TMP/SMX, Cipro
If pregnant: Amoxicillin
Acute Bronchitis - cause and tx
most common cause: common cold viruses (e.g. rhinovirus)
invasive respiratory viruses cause more sever symptoms (e.g. influenza, adenovirus, parainfluenxa, RSV)
Tx: NO antibiotics. wash hands, stop smoking, fluids, cough suppressants, bronchodilator if coughing for significant amount of time
Is ear pain common with colds without it being AOM?
Yes! due to fluid building up in Eustachian tube. If normal movement of tympanic membrane, not AOM
Tx with analgesic
Tx of AOM
Children >2 yrs with unilateral AOM: acetaminophen and watchful waiting for 48 hrs
Antibiotics if: not better in 48 hr, eardrum perforated, unresponsive to analgesic, recurrent, < 6 mo old, bilateral, unlikely to return for follow up
Tx: amoxicillin to cover for S. pneumo
Otitis Media With Effusion - cause and when do you start to treat
fluid remaining post infection.
not an issue unless prolonged for >3-6 months
50% of children will have fluid in their ears for 1 month post AOM
Tx of severe cellulitis in diabetic pt
begin broad and narrow with improvement and C/S results
Piperacillin-Taxobactam, 4th gen cephalosporin (cefepime) or carbapenem
If at risk for MRSA (known colonization, Hx, pop prevalence 30-50%): IV vancomycin
Pseudomonas
Ciprofloxacin or Pipercillin-tazobactam
Asymptomatic bacteruria tx
No symptoms = no UTI = no antibiotics
very common in elderly pts (50% of nursing home pt)
2 situations to treat: pregnant, urologic procedure
VZV tx
acyclovir, famciclovir, and valacyclovir are effective at reducing severity and duration of symptoms and shedding if started withint 72 hours of rash onset
reduce risk of exposing susceptible individuals: neonates, pregnant women, immmunocompromised
What skin infection commonly complicates zoster? Organisms, tx
cellulitis common organisms: beta-hemolytic strep and staph aureus Tx: cephalexin or cloxacillin MRSA - vancomycin B-lactam allergy - clindamycin
What is the complication of zoster leading to long-term pain and paresthesias? Tx
Post-herpetic neuralgia
1st line: Amitriptyline (Tricyclic antidepressant; low dose for pain control) Gabapentin (anticonvulsant; useful for nerve pain)
2nd line: opiods b/c of abuse and addition potential
Treatment of mild and severe traveller’s diarrhea
often self-limited (~3 days) so no need for antibiotics
give support therapy (fluids, etc)
if prolonged, severe, or b/c of shigellosis, typhoid fever or cholera treat with abx
When are antibiotics contraindicated for diarrhea?
if its caused by enterohemorrhagic E. coli
TB treatment
Drug sensitive disease: 2 months of rifampin. pyrazinamide and isoniazid (INH) followed by 4 months of INH and rifampin
If not sensitive to all first line drugs, add ethambutol
HSV tx in children
acylovir
note: valacylovir not approved for children
Treatment of P. vivax (from PBL case)
Chloroquine followed by primaquine
choloroquine works on erythrocyte stage and primaquine eliminates liver forms
