Exam 4 Flashcards
C. Diff Treatment Severe inital
Fidaxomicin
Vanco
IAI Empiric T/X Mild/Moderate
Mild/Moderate:
Ceftriaxone+Metro
Cefazolin +Metro
Cipro+Metro
Levo+Metro
Cefoxitin
Erapenem
Tigecyclin
Hep B Pathogen
Hepadnavirus
IE: Enterococci Native or Prosthetic
No B-lactam
Vanco plus Gentamycin
IE: Staphy Prosthetic MRSA
Vancomycin PLUS Rifampin PLUS Gentamicin 6/6/2
Hep C Drugs Called DAAs:
NS5A
Inhibits protein needed for HCV RNA replication and assembly
ASVIR
Ledipasvir
Elbasvir
Velpatasvir
Pibrentasvir
IAI Empiric Considerations
Look at Antibiogram
Consider enterococci
Consider Antifunal if Candida
Hep B cytokine drug
Peginterferon alfa 2a
Letermovir
Inhibits the terminase complex by binding to pUL56
CMV.
No cross resistance.
IE (Infective endocarditis) - Classifications
Location
Native Valve vs Prostehetic Valve
Early PVE: within 1 year of surgergy
Late PVE; >1 year
HEP C NS5B Drugs
SofoBUVIR- s288T Mutation
DasBUVIR
Chain Termination
C.diff Recurrent General Approach Saying…
Insanity to do same thing and expect different results
Change drug or dose
IE Strepto Prosthetic Valve:
Penicillin Susceptible
Penicillin 24 +/- Gentamicin 6/2 * Combo not superior
Ceftriaxone +/- Gentamicin 6/2 *avoid gent crcl<30
Vanco 6 weeks
Valacyclovir MOA,SOA, MOR
L-valyl ester. Prodrug.
Competitve inhibitor of viral dna polymerase. Chain terminator
HSV1, HSV2, VZV
Clincal Pearls for Trichomoniasis
Retest all sexually active women <3 months of tx
Avoid alc with Metronidazole and Tinidazole
In Breast Milk
Treat sexual Partner
Genital Herpes Resistant to Acyclovir TX
Foscarnet 40-80 mg/kg/dose
Cidofovir 5mg/kg IV
Bactermia caused by Streptococci TX/Duration
14 days IV to Oral
S. pyogenes: Penicillin IV to high dose Amoxicillin PO
S. Pneumoniae: Ceftriaxone or penicillin (if susceptible)
NNRTI Drugs
NeVIRAPINE
EfaVIRenz
Hep C Pathogen
Flavivirus
7 majors genotypes
Chlamydia TX for Pregnancy
Azithromycin 500 mg PO x 1 day
Alternative: Amoxicillin 500 mg PO TID x 7days
Hep B What number is the HBV DNA and ALT
> 2000 IU/mL is increased risk of cirrhosis
ALT is 35 for Males and 25 for women
If ALT IS >2x must treat
IE (Infective endocarditis) - Common Patogens
Staphylococci
Strepto
HACEK group
Fungi- WORSE
Syphilis TX Early Latent
Benzathine Penicillin IM One Dose
If Allergy: Doxy 14 days BID, Tetracyclin 500 mg QID 14 days,
Yes
yes
Hep B Monitoring
ALT q 3-6 months, eAG q6-12 months
HBV DNA q3 months
SAB (Staphylococcus Aureus Bactermia)- Empiric Treatment
Then what if its MRSA and what if MSSA
Cover MSSA And MRSA
Vanco or Dapto IV
MRSA; Vanco or Dapto (DO NOT ADD anything else)
MSSA: Nafcillin or Oxacillin or Cefazolin*
C. Diff Testing/Diagnosis
NAAT Test
Antigen (GDH) + Toxin Test
NAAT + Toxin
Repeat testing within 7 days of same episode
IAI Oral..Once stable
Augmentin
Cefopod+Metro
Cephale+Metro
Cefadroxil+Metro
Cipro+metro
Levo+Metro
TMP+Metro
Valganciclovir MOA, SOA, MOR
CMV retinitis in AIDS
Better oral Ganciclovir
IE: Culture Negative Prosthetic Late >1 year
Vanco + Ceftriazone
NNRTI MOA
Directly minds to RT side
Does not need to be phosphorylated
IE: Enterococci Native or Prosthetic
If AG Resistant
Amp plus Ceftriaxone
IE (Infective endocarditis) - Risk Factors
Presence of Prosthetic Valve (Biggest RIsk)
Previous IE (Infective endocarditis)
Heart diease
Other heart things
Gential Herpes Recurrent Treatment
Acyclovir 800 mg PO BID x 5
or
Famciclovir 125 mg PO BID x 5
or
Valacyclovir 500 mg PO BID x 3
Transplant Fecal Drugs
Reboyota - Expensive for recurrence following AB
Vowst-Oral- expensive bacterial spore suspension
Bezlotoxumab- MAB- Caution in CHF. expensive
INI Drugs
-GRAVIR
Syphillis HIV+ TX
Same as normal.
Cidofovir MOA, SOA, MOR
Viral DNA polymerase inhibitor. Chain Terminator.
Phosphorylated
Broad: CMV, HSV1/2, VZV, Adenovirus, Poxvirus, Polyomavirus, HPV
Hep C Virus inhibitors Black box warning
BBW for reactivation of HBV.
Ribavirin
IE (Infective endocarditis) - Surgical intervention facts
Vegetation leaflet >10mm
Early PVE
Valve Rupture
Valvular Dysfunction
IE Strepto Native Valve Treatment:
Resistant
Penicillin 24 million Plus Gentamicin 4/2 weeks (can also do ampicllin)*
Ceftriaxone plus Gentamicin 4/2 weeks
Vanco 4 weeks * allergy
Bactermia caused by Enterococci TX/Duration
7 days
E.Faecalis: Ampicillin
E. Faecium: VanA/B negative = Vancomycin
Dapto if VanA or B Positive
Syphilis TX Late Latent
>1 year or unknown duration
Benzathine Penicillin IM once weekly x 3
If Allergy: Doxy 28 days BID, Tetracyclin 500 mg QID 28 days,
IE: Enterococci Native or Prosthetic
If Gentamicin Resistant
Amp/Penicilli plus streptomycin
Chlamydia TX
Doxycycline 100 mg PO BID x7 days
Alternative:
Azithromycin 1 gram PO dose
Levo 500 mg po q24h
NRTI MOA
Nucleoside reverse transcriptase inhibitors
Lack the 3’ OH
Must be activated by cellular kinases
Interferes with DNA synthesis. RNA and DNA.
Abacavir BBW for HLAB5701
Hep A Pathogen
Picornavirus
Liver
NRTI Drugs
Abacavir
Emtricitabine
Tenofovir Alafenamide
Lamivudine
Trichomoniasis TX for Men
Metronidazole 2 g PO x 1 dose
Alternative: Tinidazole 2 g po
Syphilis TX Tertiary
Benzathine Penicillin IM once weekly x 3
If Allergy: Doxy 28 days BID, Tetracyclin 500 mg QID 28 days,
IE Fungal TX and Duration
Amphotericin B plus Flucytosine
Fluconazole >6 weeks might be life long supressive
PI- Protease inhibitors of HIV Drugs
NAVIR
IE (Infective endocarditis) - Diagnosis/Labs
Hematologic
Increased ESR and CRP
Proteniuria
BLOOD CULTURES MOST IMPORTANT
Draw 3 sets from different sites then 2 sets every 2-3 days
Must DO ECHO/CT or PET
HEP C: Ribavirin Dosing and CIs
1000mg <75; 1200 >75kg / 2
CI In CrCl <50. Not in pregnancy
Monitor Hgb <8.5 CI
SBP Clincal Presentation/Diagnosis
& Most common pathogen
Absolute Neutrophil Count >250
Low Ascitic Fluid <2.5g
Abdominal Pain
Ecoli- Monomicrobial
SARS-CoV2 Drugs
Remdisivir- inhibit RNA polymerase (adenoside)
Nirmatrelvir- SARS CoV 3C like- 5 day of onset
Molnupiravir - Polymerase inhibtor
IE Strepto Prosthetic Valve:
Penicillin Resistant
Penicillin 24 PLUS Gentamicin 6/6
Ceftriaxone + Gentamicin 6/6
Vancomycin 6 weeks
C. Diff Severity Criteria
Non Severe: <15,000 WBC
SCr <1.5
Severe >15000 WBC
>1.5 SCr
Fulminant
Hypotension or shock
Hep A Diagnosis
IgM and IgG
IE: Culture Negative Native:
Vanco plus Cefepime Acute
Unasyn plus Vnaco Subacute
Famciclovir MOA, SOA, MOR
Prodrug of Penciclovir.
Competitive inhibitor of DNA polymerase
Short-chain terminator
Oral: HSV2, VZV
C.Diff Antibiotic with highest risk
Fluroquinolones
Clindamycin
3/4th gen cephalosporins
Carbapenems
Hep B what is HBsAg
Marker of ongoing infection
IAI Empiric Considerations- Candida Albican
Fluconazole
Other Candida: Micafungim
SAB (Staphylococcus Aureus Bactermia)- Symptoms
Osler’s Nodes- papules on fingers/toes
Janeway Lesion- Plaques on palms of hand or feet
Splinter Hemorrhages- Thin line under nails
Roth Spots- Lesion on eye
Syphilis TX Primary and Secondary
Benzathine Penicillin IM One Dose
If Allergy: Doxy 14 days BID, Tetracyclin 500 mg QID 14 days,
IE: Culture Negative Prosthetic Early
Vanco + Genta + Rifampine + Cefepime
Penciclovir MOA, SOA, MOR
3’ hydroxyl
Competive inhibtor of viral DNA polymerase
Short chain terminator
Topical for cold sores.
Viral kinase mutation cross resistance to acyclovir
What if S. Aureus is in the urine?
That menas it is Bactermia. It is not common in UTIs
HCV Ns5A Drugs
ASVIR
DaclastASVIR
LedipASVIR
VelpatASVIR
ElbASVIR
Hep B Inital Evaluation
History
- LIVER PANEL, HBeAg, HBV DNA PRC
IAI Uncomplicated Infection
Confined within Space/organ
Hep C Drugs Called DAAs:
NS3/4A
Serine Protease cleaves the HCV RNA; Protease inhibtor
PREVIR
Grazoprevir
Glecaprevir
Voxilaprevir
IE Staphy: Native Valve
Oxacillin Resistance (MRSA)
Vancomycin 6 weeks
Dapto 6 weeks * right sided only
Genital Herpes Suppressive TX
Life Long:
Acyclovir 400 mg PO BID
or
Famciclovir 250 mg PO BID
or
Valacyclovir 1 g PO Daily
Genital Herpes HIV+ TX
Acyclovir 400 mg PO TID
or
Famciclovir 550 mg PO BID
or
Valacyclovir 1 g PO BID
SAB (Staphylococcus Aureus Bactermia)-
Random facts
high mortality
Leading cause of CA and HA Bactermia
MUST Consolute ID!!!!!
IE Strepto Native Valve Treatment:
Highly penicillin Susceptible
Penicillin 12 million or Ceftriaxone 4 weeks* Preferred >65
Penicillin Plus Gentamicin 2 weeks each* Not for CLCr <20
Ceftriaxone plus gentamicin 2 weeks
Vanco 4 weeks * allergy
Baloxavir. MOA, what used for, SOR
Used for influenza.
Inhibits “Cap-snatching” by binding to PB2 subunit of RNA
C. Diff Treatment First Recurrence
Fidaxomicin
Vanco Oral
Fidaxomicin x 5 then every other day for 20 days
Vanco taper and pulse
IAI Duration
General- 4-7 days
Diverticulitis- Severe=5-10 uncomplicated=no tx
All else 24 hours
PI MOA
Amide bond replaced
SBP T/X Duration
5-7 days in cirrhosis and ascites
Secondary prophylaxis recommened- Bactrim or Cipro
Peritonitis CADP Dialysis removal
14-21 days
Gonocollal TX
<150 kg: Ceftriaxone 500 mg IM
>150 kg: Ceftriaxone 1 g IM
If Chlamydia not excluded: Doxycycline BID 7 days
If Prego: Azithro 1 g PO
AMIVIR Drugs. What are they used for? How do they work?
Influenza
Oseltamivir, Zanamivir, Peramivir
Neuraminidase inhibitor- blocks
Pelvic Inflammatory Disease TX
Ceftriazone 1g IV + Doxycycline + Metronidazole
alternative: Unasyn + Doxy
Severe alergy: Clinda+ Gentamicin
IM/Oral: Ceftriaxone + Doxycycline + Metronidazole
HBV Drugs
Lamivudine
Tenofovir
Entecavir
Foscarnet MOA, SOR, MOR
Inorganic pyrophospahte.
Inhibits viral DNA and RNA polymerase, and HIV RT
Blocks binding site of viral dna polymerase via gamma. Trapping polymerase in closed formation.
No Phosphorlation needed.
CMV Retinitis IV ONLY
Hep B Acute vs Chronic Infection
Acute- No TX, supportive care
Chronic- Remission of liver disease, Prevent Cirrhosis
Hep B what is IgM anti HBc
Recent to exposed virus
SAB (Staphylococcus Aureus Bactermia)- Catheter managment
remove all!
replace when negative for 2-3 days
Gential Herpes Initial Treatment
Treat for 7-10 days
Acyclovir 400 mg PO TID
or
Famciclovir 250 mg PO TID
or
Valacyclovir 1 g PO BID
Viral Hepatitis- Which are Blood transmission and curative?
HBV and HCV is chronic and blood transmission
HCV is curative B is not.
C.Diff Risk Factors
Antibiotics
HC
Age>65
Proximity
Use of PPI or H2RA
Chemo
GI surgery
IE: HACEK Native or Prostehtic
Ceftriaxone
Unasyn
Ciprofloxin
HAV Vaccine
2 dose series given at 0 and 6 months
Safe in prego
C. Diff Fulminant Treatment
Vanco 500mg Oral
WITH
Metronidazole
if Ileus= Vanco rectal
Hep B First Line Nuceloside Drugs
TDF and TAF* Better
Entecavir
Mycoplasma Genitalium TX
Macrolide Susceptible: Doxy x 7, then azithro
Macrolide Resistant: Doxy x 7 then moxi x 7
Not tested: Doxy x 7 then moxi x 7
Hep B what is Total Anti-HBc
Marker of infection
Trichomoniasis TX for HIV+
Metronidazole 500 mg PO BID x 7 days
INI MOA
oxygen moleculres for each use metal ions.
Inserts of HIV Dna
IE: Staphy Prosthetic MSSA
Nafcillin/Oxacillin PLUS Rifampin PLUS Gentamicin 6/6/2
Hep C Drugs Called DAAs:
NS5B
Inhibits the RNA polymerase- replication inhibition. Nucleotide analog
BUVIR
Sofosbuvir
Ribavirin. Use? MOA, SOR, MOR?
Hep C drug.
Guanosine analog
Inhibits IMPDH
Influenza A and B, Hep A,B,C, Herpes
Syphilis TX Neurosyphilis
Aqueous Penicillin 3-4m units continous- May use benzathine after IV
Procaine Penicillin 2.4M + Probenecid
Allergy: Ceftriaxone 2g IM 10-14 days
C. Diff Treatment Second+ Recurrent TX
Fidaxomicin
Vanco Oral
Fidaxomicin x 5 then every other day for 20 days
Vanco taper and pulse
IE Staphy: Native Valve
Oxacillin Susceptible (MSSA)
Nafcillin or Oxacillin 6 weeks (right side only 2 weeks)
For Penicillin allergy: Cefazolin 6 weeks
IAI Empiric Severe or Healthcare aquired
Zosyn
Meropen
Cefepime+Metro
Cipro+Metro
Levo+metro
Treatment of uncomplicated gram-negative Bactermia
7 days
IV to PO: TMP/SMX
Longer not always better
Trichomoniasis TX for Women
Metronidazole 500 mg PO BID x 7 days
Alternative: Tinidazole 2 g po
Syphillis TX Pregnancy
Penicillin only- Use desensitization
IE: Enterococci Native or Prosthetic
If Gentamicin susceptible
Amp or Penicillin with Gent
If CRCL <50 use Amp plus Ceftriaxone
IAI Complicated Infection
Extends beyond single organ
Hep C NS3 Drugs
HCV Protease inhibitor
PREVIR
PrEP Medications
Prefered:
TDF+Emtricitabine (F) PLUS Raltegravir or Dolutegravor
Alternative:
TDF+ F PLUS Darunavir+ Ritonavir
28 days
SAB (Staphylococcus Aureus Bactermia)- Duration of Treatment
Uncomplicated- 14days of IV therapy from first negative BC
Complicated - 4 weeks
Complicated with metastatic- 6-8 weeks
SAB (Staphylococcus Aureus Bactermia)- Diagnosis
2 blood cultures repeating every 2-3 days until negative
Echocardiography for all patients with SAB
TTE, TEE
SBP Empiric T/X
Ceftriaxone
Cefepime
Zosyn
Meropenem
If MRSA: Vac, Linezolid, Dapto
Anerobic: Add Metronidazole
IE: Enterococci Native or Prosthetic
Super resistant to Pen, AG, Vanco
Dapto or Linezolid
Gonococcal TX If Ceftriaxone is not avaliable
Gentamicin + Azithromycin
or Cefixime
C. Diff Treatment Non-Severe inital
Fidaxomicin
Vanco ORAL
Metronidazole- last option
Genital Herpes during pregnancy TX
Suppressive at 36 weeks
Acyclovir 400 mg PO TID
Valacyclovir 500 mg PO BID
Hep B what is Anti-HBs
Marker of immunity. Previous vaccine or infection
Ganciclovir
Inhibitor of DNA polymerase. Short chain termination
CMV retinitis
Resistance UL97 and UL54
Fecal Microbiota Transplant Basics/Indications
Used as treatment and method to reduce recurrence
3+ Episodes of CDI
Poor response to inital AB
Requires colonscopy,endoscopy or tubes
Severe Genital Herpes TX
Acyclovir 5-10 mg/kg/dose IV
Acyclovir MOA, SOA, MOR
Acyclic guanosime triphosphorylation
Lacks 3’ hydroxyl
MOA: Competitive inhibitor of Polymerase. Chain terminator.
HSV1,HSV2, VZV
