Exam 3 Flashcards
How to treat sinusitis (viral)?
- Viral = Decongestants, irrigation, mucolytic
When to use antibiotics for sinusitis?
- Persistent symptoms > 10 days without improvement
- Severe symptoms > 3-4 days at beginning of illness (fever > 102 F, purulent nasal discharge, facial pain)
- Worsening symptoms after typical viral upper respiratory infection (new onset of symptoms after 5 days of recovering from URI)
What antibiotic is used for sinusitis?
Amoxicillin/clavulanate
- Alternatives = fluoroquinolones, clindamycin + cefpodoxime or cefuroxime, doxycycline, TMP/SMX
How long should antibiotics be used for sinusitis?
- Adults = 5-7 days
- Kids = 10-14 days
Drug of choice for pharyngitis (and duration)
Penicillin VK or Amoxicillin for 10 days
What drugs can be used for penicillin allergic patients for pharyngitis?
- Mild allergy (rash) = cephalexin for 10 days
- Severe allergy (anaphylaxis) = clindamycin for 10 days or azithromycin for 5 days
What drugs can be used for patients who are unlikely to be adherent for pharyngitis?
Benzathine penicillin IM 1 shot
Pain management for otitis media
PO acetaminophen or ibuprofen PRN (typically needed for up to 1 week
Who should get antibiotic for otitis media?
- 6 months - 12 years with mod-severe pain or temp > 102.2
- 6-23 months with non severe bilateral acute otitis media
What antibiotics should be used for otitis media?
Amoxicillin or amoxicillin/clavulanate
CAP outpatient treatment for previously healthy and no risk factors for drug resistance
- PO amoxicillin
- PO doxycycline (alternative)
- PO macrolide (azithro, clarithro)
CAP outpatient treatment for comorbidities
- PO amoxicillin/clavulanate or cephalosporin (cefpodox, cefdinir, cefurox) + macrolide
- PO respiratory quinolone
Inpatient CAP treatment non-severe
- IV beta lactam (ampicillin/sulbactam, ceftriaxone) + macrolide
- Respiratory fluoroquinolone
Inpatient CAP treatment severe
- IV beta lactam + macrolide
- IV beta lactam + respiratory fluoroquinolone
Duration of antibiotics for CAP
Minimum 5 days (generally 7 days)
- To stop, the patient should be afebrile for 48-72 hours
When should we consider antibiotic use for otitis media?
When symptoms are worsening for:
- 6-23 months with non severe unilateral otitis media
- 2-12 years with acute non severe acute otitis media
Empiric Antibiotics for HAP
- Ceftriaxone
- Levofloxacin, moxifloxacin
- Ampicillin/sulbactam
- Ertapenem
When to cover pseudomonas empirically for VAP/HAP?
- Prior IV antibiotic use within last 90 days
- Severe presentation (septic shock, need for ventilator support)
- Previous infection/colonization
- Immunosuppression
Antibiotics for covering pseudomonas in VAP/HAP
- Piperacillin/tazobactam
- Cefepime
- Ceftazidime
- Imipenem, meropenem
- Aztreonam
- Ciprofloxacin
- Levofloxacin
- Aminoglycosides
- Colistin, polymixin B
Duration of antibiotic therapy for VAP/HAP
7 days regardless of pathogen
Cystitis Symptoms
- Dysuria
- Frequency/urgency
- Hematuria
Pyelonephritis Symptoms
- Dysuria
- Frequency/urgency
- Hematuria
- Costovertebral angle tenderness
- Fever
- Chills
- N/V
Therapy for women with acute, uncomplicated cystitis
- Nitrofurantoin monohydrate/macrocrystals 100 mg PO BID for 5 days
- Bactrim PO BID for 3 days
- Also = fosfomycin trometamol, quinolones, beta-lactams (not amoxicillin or ampicillin empirically)
Outpatient treatment of acute pyelonephritis in women
- Bactrim BID for 14 days
- Also = ciprofloxacin for 7 days (with or without initial IV dose), quinolone (ciprofloxacin 1000 mg, levofloxacin), oral beta-lactams with an initial IV dose for 10-14 days
Inpatient treatment of acute pyelonephritis in women
- Extended spectrum cephalosporin or penicillin +/- aminoglycoside (IV)
- Also = quinolone IV, aminoglycoside +/- ampicillin, carbapenem
All for 10-14 days
When do you treat asymptomatic bacteriuria?
- Pregnancy
- Prior to invasive urinary tract procedures
- Prior to renal transplantation
Treatment of Asymptomatic Bacteriuria in Pregnancy
- Amoxicillin/clavulanate for 7 days
- Cephalexin for 3-7 days
- Also = Nitrofurantoin for 7 days (not for close to delivery), amoxicillin for 7 days, Bactrim for 3 days (avoid in last trimester)
- Quinolones and tetracyclines are contraindicated
Presentation of cystitis in men
- Elderly male with dysuria, frequency, fever, lower abdominal pain
- Rare = dysuria and frequency in younger men
Acute bacterial therapy of prostatitis in men
Duration = 2-4 weeks
- Bactrim PO BID
- Also = quinolones, gentamicin/ampicillin if enterococcus
How to treat traveler’s diarrhea?
Loperamide 2 mg PO PRN for loose bowel movement for 2 days
Mild Water Loss Classification
< 5% body weight lost
- Alert, restless
- Increased thirst
- Moist to slightly dry mucus membranes
- Normal/slightly decreased urinary output
Moderate Water Loss Classification
6 - 9% body weight loss
- Lethargic, restless
- Low volume (low BP, high HR)
- Dry mucus membranes
- Delayed cap refill
- Dark urine
Severe Water Loss Classification
> 10% body weight loss
- Drowsy, limp, LOC
- Bradycardia
- Cyanotic
- Skin tenting
- No urine production
Non-severe CDI Classification
Leukocytosis (WBC < 15k) and SCr < 1.5
Severe CDI Classification
Leukocytosis (WBC > 15k) or SCr > 1.5
Fulminant CDI Classification
- Hypotension or shock
- Ileus
- Megacolon
CDI diagnosis
> 3 unformed stools in 24 hours
AND either
- Stool test positive for c. diff or toxins
- Pseudomembranous colitis diagnosed by colonoscopy
Initial non-severe CDI treatment
- Vancomycin 125 mg x 10 days
- Fidaxomicin 200 mg x 10 days
- Metronidazole 500 mg x 10 days
Initial severe CDI treatment
- Vancomycin 125 mg x 10 days
- Fidaxomicin 200 mg x 10 days
Initial severe complicated CDI treatment
- Vancomycin 500 mg
Add metronidazole IV if ileus present
