EXAM 3 treatment guide Flashcards
CAP – outpatient therapy in healthy patients
- amoxicillin 1 g PO q8h
- doxycycline 100 mg PO BID
- azithromycin 500 mg (if macrolide resistance < 25%)
CAP – outpatient therapy – DURATION
Abx for clinical stability for minimum of 5 days
CAP – common bacterial pathogens
- Streptococcus pneumonia
- H flu
- atypicals
- S aureus
CAP – outpatient therapy in adults with comorbidities
- Combo therapy (preferred): B-lactam + macrolide or doxycycline
(amox/clav 875/125, cefpodoxime 200, cefuroxime 500) - Monotherapy: Respiratory FQ
(levo 750 qd, moxi 400 qd)
CAP – in-patient – non-severe
- Combo therapy: B-lactam + macrolide
—- (amp/sulbac (unasyn) IV 1.5-3 q6h, or ceftriaxone 1-2g q24h) - Monotherapy: respiratory FQ
CAP – in-patient – severe
- B-lactam + Macrolide (preferred)
- respiratory FQ + B-lactam
CAP - in-patient – severe – MRSA risk
- ADD vancomycin or linezolid 600mg IV/PO q12h
CAP – in-patient – severe – Pseudomonas Risk
ADD one of the following:
- pip/tazo (zosyn) 4.5 g IV q6h
- cefepime 2g IV q8h
- meropenem 1g IV q8h
HAP – DURATION of therapy
- 7 days if clinically stable
HAP – for MRSA coverage
- vancomycin (AUC 400-600)
- linezolid 600 mg PO/IV Q12H
HAP – Pseudomonas coverage
- Pip/tazo
- cefepime
- imipenem
- meropenem
- levofloxacin
HAP – if not high mortality risk (cover MSSA & Pseudomonas
- pip/tazo
- cefepime
- imipenem
- meropenem
- levofloxacin
HAP – if not high mortality risk but MRSA risk
- Combo therapy
- MRSA covg: vancomycin or linezolid
- Pseudomonas coverage: Zosyn, cefepime, imipenem, meropenem, levofloxacin
HAP – high risk for mortality &MRSA risk
- 2 drug classes (B-lactam &non) + MRSA covg
- Pip/tazo, cefepime, imipenem, meropenem
- levofloxacin, tobramycin, amikacin
- vancomycin or linezolid
VAP – DURATION of therapy
7 days if clinically stable
VAP – empiric therapy
- Pseudomonas and MRSA coverage
- if risk factors for resistance, choose 2 anti-pseudomonals + MRSA covg (if not, choose 1 for pseudomonas and 1 for MRSA)
- pip/tazo, cefepime, imipenem, meropenem, levofloxacin, tobramycin, amikacin
- vancomycin or linezolid
LRTIs random pearls
- never use daptomycin for LRTIs
- polymixin reserved for MDR and nephrotoxicity
- aminoglycosides never monotherapy
- tigecycline increases motrality
Acute Bronchitis – therapy
no antibiotic therapy
Acute Exacerbation of chronic bronchitis – DURATION of therapy
5-7 days
Acute Exacerbation of chronic bronchitis – preferred treatment
- amox/clav 875/125 PO q12h ***
- cefuroxime 500mg PO q12h
- cefpodoxime 200mg PO q12h
Acute Exacerbation of chronic bronchitis – alternative treatment
(less coverage for strep pneumo with these)
- doxycycline
- Bactrim
- azithromycin
Acute exacerbation of chronic bronchitis – risk for Pseudomonas
- levofloxacin 750 mg PO QD
Acute Pharyngitis – DURATION of therapy
- 10 days
Acute Pharyngitis – targeted for Strep pyogenes
- Pen VK
- Amoxicillin
- (alts used if true penicillin allergy - cephs if no anaphylaxis, azithro or clinda if anaphylaxis)
Acute Bacterial Rhinosinusitis – DURATION of therapy
- 5-7 days
Acute Bacterial Rhinosinusitis – approach to treatment
- can start immediately or do watchful waiting for 7 days then treat if symptoms worsen or don’t resolve
Acute Bacterial Rhinosinusitis – 1st line treatment
- amox/clav 500/125 po TID or 875/125 BID
- amox/clav 2000/125 if concern for pen resistance
Acute Bacterial Rhinosinusitis – 2nd line treatment
- doxycycline
- levofloxacin (500)
- moxifloxacin
Acute Bacterial Rhinosinusitis – concern for MRSA
ADD one of the following:
- doxycycline
- Bactrim
- linezolid
- clindamycin
Acute Bacterial Rhinosinusitis – concern for Pseudomonas
- levofloxacin 750 mg PO QD
(High dose)
UTI – most common pathogen
E. coli (for all kinds)
UTI – pyelonephritis signs/symptoms
fever, chills, rigors, CVA tenderness, malaise, N/V, flank pain
UTI – cystitis signs/symptoms
dysuria, increased urinary frequency and urgency, suprapubic heaviness or pain
UTI – catheter-associated signs/symptoms
- classic UTI symptoms not present
- pain over kidney and bladder
- fever
- lethargy and malaise
UTI – treatment options
- nitrofurantion – uncomplicated only
- Bactrim (> 20% resistance)
- cipro or levo (>20% resistance)
- fosfomycin – uncomplicated only
- B-lactams (only cephalexin, cefadroxil, cefpodoxime, amox/clav) – also used with caution
- can maybe do amoxicillin after susceptibility confirmed
UTI – in-patient – empiric therapy
- ampicillin + gentamicin ***
- pip/tazo
- cefazolin + gentamicin
- gentamicin alone
- cefepime
- ceftriaxone *
UTI – DURATION of therapy
- uncomplicated: 5 days
- complicated: 7-14 days
Prostatitis – treatment DURATION
- 2-4 weeks
Prostatitis – treatment options
- fluoroquinolones
- bactrim
- some B-lactams (cephalexin, amox/clav)
Recurrent UTI management
- may consider prophylactic antibiotic if no correctable cause identified
- nitrofurantoin
SSTI – risk factors
- history of SSTI
- PAD
- CKD
- DM
- IV drug use
SSTI – common pathogens
staph and strep
Non-purulent SSTI – DURATION of therapy
5 days
Non-purulent SSTI – SEVERE treatment
- surgical inspection and debridement
- vancomycin + Zosyn
Non-purulent SSTI – MODERATE treatment
IV abx
- ceftriaxone
- cefazolin
- clindamycin
Non-purulent SSTI – MILD treatment
oral abx
- penicillin VK
- cephalosporin
- dicloxacillin
- clindamycin
Purulent SSTI – SEVERE treatment
Empiric: vancomycin, daptomycin, linezolid
- Targeted therapy:
MRSA: vanco, dapto, linezolid
MSSA: nafcillin, cefazolin, clindamycin
Purulent SSTI - MODERATE treatment
- Empiric: Bactrim or doxycycline
- Targeted:
MRSA: Bactrim or doxycycline
MSSA: dicloxacillin or cephalexin
Purulent SSTI – MILD treatment
- incision and drainage only
Necrotizing Fasciitis – approach and treatment
- surgery and broad spectrum abx (vancomycin + Zosyn)
- C&S:
S pyogenes: penicillin + clindamycin
polymicrobial: vancomycin + zosyn
DFI – causative pathogens
- S. aureus, Streptococci, Pseudomonas
DFI – MILD infections
- duration: 1-2 weeks
- want to cover MSSA, strep
dicloxacillin, cephalexin, clindamycin - Recent abx? switch to amox/clav or levo/moxi
- MRSA risk? switch to Bactrim or doxycycline
DFI – MODERATE infections
- duration 2-3 weeks
- need to cover MSSA, strep, enterobac, anarobes
moxi, amox/clav, cipro/levo + clinda/metronidazole - Pseudomonas risk? switch to cipro/levo + clinda/metrinidazole
- MRSA risk? add doxycycline, vancomycin, Bactrim
DFI – SEVERE infections
- duration: 2-3 weeks
- need to cover MSSA, strep, enterobac, anaerobes, pseudomonas
Zosyn, carbapenem, cefepime + clinda/metronidazole
-MRSA risk? add vanc, linezolid, daptomycin (most hospitals meet criteria to be MRSA risk)
PEDs AOM – treatment
(after deferred abx 48-72 hrs)
1st line- amoxicillin 80-90 mg/kg/day
2nd line- amox/clav 600/42.9/5ml
-oral cephalosporins 2nd line but can be 1st if allergy (cefpodoxime, cefdinir, cefuroxime)
- ceftriaxone for severe cases if oral not an option or initial oral treatment fails
PEDs UTIs – treatment
- oral and IV =
- cephalexin *** q6h or q8h
- amox/clav
- Bactrim
(nitrofurantoin not really used, avoid FQs in kids)
PEDs – bronchiolitis treatment
supportive therapy
- RSV vaccine for prevention (pregnancy 32-36 weeks)
- MAb for infants (Niserimab - 1 dose, 2 if high risk)
Bone & Joint infections – most common pathogen
S. aureus
Osteomyelitis – empiric therapy
- B-lactam (or cipro/levo +metronidazole) + MRSA coverage
Osteomyelitis – DURATION of therapy
4-8 weeks
Osteomyelitis – oral abx for specific pathogens
- Streptococci: amoxicillin, cephalexin, clindamycin
- MSSA: dicloxacillin, cephalexin, cefadroxil, Bactrim, linezolid
- MRSA: linezolid, Bactrim, clindamycin
- GNRs: Bactrim, FQs
Dalbavancin in 2 dose strategy provides 6-8 weeks of coverage
Septic Arthritis – DURATION of therapy
- S. aureus – 4 weeks
- Streptococci – 2 weeks
- N. gonnorrhea – 7-10 days
- GNR – 4 weeks
Septic Arthritis – empiric therapy
- B-lactam or cipro/levo+metronidazole + MRSA coverage
IV or highly bioavailable oral acceptable
Septic Arthritis – targeted therapy
- Streptococci: amoxicillin, cephalexin, clindamycin
- MSSA: dicloxacillin, cephalexin, cefadroxil, Bactrim, linezolid
- MRSA: linezolid, Bactrim, clindamycin
- GNRs: Bactrim, FQs
- N gonorrhea: ceftriaxone alone
Prosthetic Joint Infection – surgical intervention types
- debridement and retention of prosthesis (wash out)
- 1 stage exchange
- 2 stage exchange
Prosthetic Joint Infection – debridement & retention of prosthesis
- pathogen-directed treatment + rifampin 2-6 weeks
- oral abx treatment + rifampin x3months(hip) x6months(knee and other)
(preferred oral agents are same as for osteomyelitis)
Prosthetic Joint Infection – 1 stage exchange
- pathogen directed treatment + rifampin 2-6 weeks
- oral abx treatment + rifampin x3 months
(preferred oral agents are same as for osteomyelitis)
Prosthetic Joint Infection – 2 stage exchange
- pathogen directed treatment x4-6 weeks
Prosthetic Joint Infection – amputation with complete removal of infected bone/hardware
- pathogen-directed treatment 24-48 hours
