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PHM 603 Infectious Disease > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

How to treat sinusitis (viral)?

A
  • Viral = Decongestants, irrigation, mucolytic
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2
Q

When to use antibiotics for sinusitis?

A
  • 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)
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3
Q

What antibiotic is used for sinusitis?

A

Amoxicillin/clavulanate
- Alternatives = fluoroquinolones, clindamycin + cefpodoxime or cefuroxime, doxycycline, TMP/SMX

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4
Q

How long should antibiotics be used for sinusitis?

A
  • Adults = 5-7 days
  • Kids = 10-14 days
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5
Q

Drug of choice for pharyngitis (and duration)

A

Penicillin VK or Amoxicillin for 10 days

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6
Q

What drugs can be used for penicillin allergic patients for pharyngitis?

A
  • Mild allergy (rash) = cephalexin for 10 days
  • Severe allergy (anaphylaxis) = clindamycin for 10 days or azithromycin for 5 days
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7
Q

What drugs can be used for patients who are unlikely to be adherent for pharyngitis?

A

Benzathine penicillin IM 1 shot

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8
Q

Pain management for otitis media

A

PO acetaminophen or ibuprofen PRN (typically needed for up to 1 week

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9
Q

Who should get antibiotic for otitis media?

A
  • 6 months - 12 years with mod-severe pain or temp > 102.2
  • 6-23 months with non severe bilateral acute otitis media
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10
Q

What antibiotics should be used for otitis media?

A

Amoxicillin or amoxicillin/clavulanate

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11
Q

CAP outpatient treatment for previously healthy and no risk factors for drug resistance

A
  • PO amoxicillin
  • PO doxycycline (alternative)
  • PO macrolide (azithro, clarithro)
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12
Q

CAP outpatient treatment for comorbidities

A
  • PO amoxicillin/clavulanate or cephalosporin (cefpodox, cefdinir, cefurox) + macrolide
  • PO respiratory quinolone
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13
Q

Inpatient CAP treatment non-severe

A
  • IV beta lactam (ampicillin/sulbactam, ceftriaxone) + macrolide
  • Respiratory fluoroquinolone
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14
Q

Inpatient CAP treatment severe

A
  • IV beta lactam + macrolide
  • IV beta lactam + respiratory fluoroquinolone
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15
Q

Duration of antibiotics for CAP

A

Minimum 5 days (generally 7 days)
- To stop, the patient should be afebrile for 48-72 hours

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16
Q

When should we consider antibiotic use for otitis media?

A

When symptoms are worsening for:
- 6-23 months with non severe unilateral otitis media
- 2-12 years with acute non severe acute otitis media

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17
Q

Empiric Antibiotics for HAP

A
  • Ceftriaxone
  • Levofloxacin, moxifloxacin
  • Ampicillin/sulbactam
  • Ertapenem
18
Q

When to cover pseudomonas empirically for VAP/HAP?

A
  • Prior IV antibiotic use within last 90 days
  • Severe presentation (septic shock, need for ventilator support)
  • Previous infection/colonization
  • Immunosuppression
19
Q

Antibiotics for covering pseudomonas in VAP/HAP

A
  • Piperacillin/tazobactam
  • Cefepime
  • Ceftazidime
  • Imipenem, meropenem
  • Aztreonam
  • Ciprofloxacin
  • Levofloxacin
  • Aminoglycosides
  • Colistin, polymixin B
20
Q

Duration of antibiotic therapy for VAP/HAP

A

7 days regardless of pathogen

21
Q

Cystitis Symptoms

A
  • Dysuria
  • Frequency/urgency
  • Hematuria
22
Q

Pyelonephritis Symptoms

A
  • Dysuria
  • Frequency/urgency
  • Hematuria
  • Costovertebral angle tenderness
  • Fever
  • Chills
  • N/V
23
Q

Therapy for women with acute, uncomplicated cystitis

A
  • 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)
24
Q

Outpatient treatment of acute pyelonephritis in women

A
  • 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
25
Q

Inpatient treatment of acute pyelonephritis in women

A
  • Extended spectrum cephalosporin or penicillin +/- aminoglycoside (IV)
  • Also = quinolone IV, aminoglycoside +/- ampicillin, carbapenem

All for 10-14 days

26
Q

When do you treat asymptomatic bacteriuria?

A
  • Pregnancy
  • Prior to invasive urinary tract procedures
  • Prior to renal transplantation
27
Q

Treatment of Asymptomatic Bacteriuria in Pregnancy

A
  • 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
28
Q

Presentation of cystitis in men

A
  • Elderly male with dysuria, frequency, fever, lower abdominal pain
  • Rare = dysuria and frequency in younger men
29
Q

Acute bacterial therapy of prostatitis in men

A

Duration = 2-4 weeks

  • Bactrim PO BID
  • Also = quinolones, gentamicin/ampicillin if enterococcus
30
Q

How to treat traveler’s diarrhea?

A

Loperamide 2 mg PO PRN for loose bowel movement for 2 days

31
Q

Mild Water Loss Classification

A

< 5% body weight lost

  • Alert, restless
  • Increased thirst
  • Moist to slightly dry mucus membranes
  • Normal/slightly decreased urinary output
32
Q

Moderate Water Loss Classification

A

6 - 9% body weight loss

  • Lethargic, restless
  • Low volume (low BP, high HR)
  • Dry mucus membranes
  • Delayed cap refill
  • Dark urine
33
Q

Severe Water Loss Classification

A

> 10% body weight loss

  • Drowsy, limp, LOC
  • Bradycardia
  • Cyanotic
  • Skin tenting
  • No urine production
34
Q

Non-severe CDI Classification

A

Leukocytosis (WBC < 15k) and SCr < 1.5

35
Q

Severe CDI Classification

A

Leukocytosis (WBC > 15k) or SCr > 1.5

36
Q

Fulminant CDI Classification

A
  • Hypotension or shock
  • Ileus
  • Megacolon
37
Q

CDI diagnosis

A

> 3 unformed stools in 24 hours

AND either

  • Stool test positive for c. diff or toxins
  • Pseudomembranous colitis diagnosed by colonoscopy
38
Q

Initial non-severe CDI treatment

A
  • Vancomycin 125 mg x 10 days
  • Fidaxomicin 200 mg x 10 days
  • Metronidazole 500 mg x 10 days
39
Q

Initial severe CDI treatment

A
  • Vancomycin 125 mg x 10 days
  • Fidaxomicin 200 mg x 10 days
40
Q

Initial severe complicated CDI treatment

A
  • Vancomycin 500 mg

Add metronidazole IV if ileus present

PHM 603 Infectious Disease (3 decks)

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