Empiric Abx Therapy Flashcards
True Drug Allergy
Raised hives, angioedema, anaphylaxis, quick onset (within minutes), with repeated exposure
Drug Intolerance
- GI distress
- REd Man Syndrome ( Vancomycin Infusion Reaction)
- Photosensitivity
- Benign Rash
- slow onset (hours, days)
Bugs Associated with Bacterial Meningitis
Bugs Associated with Otitis Media
Strep pneumonia, Moraxella, HIB
Bugs Associated with Pneumonia
Induced Resistance
M-SPA/ICE
- Morganella, Serratia, Pseudomonas, Acinetobacter, Indole (+), Citrobater, Enterobacter
Breakpoint
The MIC over which a specific bug is no longer considered susceptible to a drug
Monitoring peak vs trough
- peak = efficacy
- trough = safety
- mentioned in lecture: aminoglycosides and vancomycin
Key Bugs for Community Acquired Pneumonia
- Strep Pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Atypical bacteria
tx of CAP: non severe/outpatient vs moderate severity/low severity + comorbidities
- non-severe/outpatient:
- azythromycin (covers atypicals + strep)
- moderate severity/ low severity + comorbidities:
- beta-lactam + doxycycline
- OR fluoroquinolones: moxifloxacin, levofloxacin
respiratory fluoroqinoloes
- moxifloxacin
- levofloxacin
When to tx UTIs
- MUST have clinical symptoms
- only asymptomatic tx of UTIs in:
- pregnant
- immunocompromised
- with urological abnormalities
UTIs are considered complicated if they have one or more of the following:
- Male
- Elderly
- Hospital-acquired
- Pregnancy
- Indwelling Urinary Catheter
- Function/anatomical abnormality of the urinary tract
- recent abx use
- sxs > 7 days by presentation
- diabetes
- immunosuppression
Most common UTI bugs
- Proteus, E.coli, Klebsiella
- Staph saphrophyticus
- Enterococcus
- Pseudomonas
Abx for Cystitis
- Nitrofurantoin x 5 days
- TMP/SMX x 3 days (Bactrim)
- Fluoroquinolones (not moxi) x 3 days
Abx for Pyelonephritis
- Fluoroquinolones x 7days
- TMP/SMX x 7-10days
- Ceftriaxone 1gx1 dose followed by fluoroquinolones x 5 days
Mild, Moderate, Severe SSTIs
- Skin and Soft Tissue Infection
- Mild:
- erythema, pain, swelling
- Moderate:
- leukocytosis, fever
- Severe:
- immunocompromised
- systemic/sepsis
Nonpurulent SSTIs: Bugs and Drugs
- Strep (Beta hemolytic) and staph
- Drgs:
- PO: PenVK, cephalexin, clindamycin
- IV: PenG, cefazolin, ceftriaxone
Purulent SSTIs: Bugs and Drugs
- Skin and soft tissue infections:
- Bugs:
- staph aureus
- MSSA
- Drugs:
- MSSA:
- PO: cephalexin
- IV: cefazolin
- MRSA:
- PO: TMP/SMX, clindamycin, doxycycline
- IV: vancomycin, daptomycin, linezolid
- MSSA:
- Bugs:
- Duration: 5-14 days
