Exam 4 Flashcards
Truvada
- emtricitabine with TDF
- taken once daily
- recommended to prevent HIV among all people with sex or IVDU
Descovy
- emtricitaabine with TAF
- recommended to prevent HIV through sexual transmission (not receptive vaginal sex)
Apretude
- Cabotegravir IM
- first injection followed by a second injection 1 month after the first and q2 months after
- prevent HIV among all people
What is PrEP
FDA approved med to prevent HIV in adults and adolescents weighing ≥77 lb
Substantial risk for HIV and ≤72 hours since exposure AND source is known to have HIV
- nPEP vis recommended
Substantial risk for HIV and ≤72 hours since exposure AND source is unknown to have HIV
case-by-case determination
Substantial risk for HIV and ≥73 hours since exposure
nPEP not recommended
nPEP regimens
- TDF/Emtricitabine once daily + raltegravir BID or dolutegravir daily
- TDF/Emtricitabine + Darunavir/ritonavir daily
- 28 days
HPV Vaccine
- recommended for routine vaccination at age 11 or 12
- does not treat existing HPV infections or diseases
Uncomplicated Gonorrhea
- endocervix
- asymptomatic or mildly symptomatic
- disseminated infection may occur (in women mostly)
Gonorrhea in men
- acute urethritis
- purulent discharge and dysuria
- spontaneous resolution after several weeks
Anorectal gonorrhea infection
- most patients are asymptomatic
- acute proctitus
pharyngeal gonorrhea infection
- orogenital sexual exposure!
- asymptomatic
- screened less frequently
Gonorrhea in newborns
- may be transmitted in utero, birth canal
- opthalmia neonatorum
Treatment of Uncomplicated Gonoccoal Infections of Cervix/Urethra/Rectum
- <150 kg ceftriaxone 500 mg IM x 1
- > 150 kg ceftriaxone 1 gm IM x 1
- if w/ chlamydia, give doxycycline 100 mg PO BID x 7 days (pregnant azithro 1 gm PO once)
Treatment of Uncomplicated Gonoccoal Infections of Cervix/Urethra/Rectum and Ceftriaxone is NOT availabile
- gent 240 mg IM x 1 + azithro 2 g PO x 1
- cefixime 800 mg PO x1
Expedited partner therapy
- cefixime 800 mg PO x 1 + chlamydia treatment if not excluded
Primary Syphilis
- painless lesion (chancre)
- disappear spontaneously without treatment (3-6 weeks)
Secondary Syphilis
- lesions anywhere on body including hands and soles of feet
- malaise, fever, pharyngitis, headache, anorexia
Latent Syphilis
- positive serologic tests but no other evidence of disease
- early latent patient is potentially infectious
- late latent, noninfectious except in pregnancy
Tertiary (Late) Syphilis
- slowly progressing, inflammatory phase of the disease
- can affect any organ in the body
Primary and Secondary Syphilis Treatment
Benzathine PenG 2.4 million units IM x 1 dose
Primary and Secondary Syphilis Treatment PCN Allergy
- doxy 100 mg BID x 14 days
- tetracycline 500 mg QID x 14 days
- azithromycin 2 g x 1 dose (resistance)
Early Latent Syphilis Treatment
Benzathine PenG 2.4 million units IM x 1 dose
if PCN allergy
- doxy 100 mg BID x 14 days
- tetracycline 500 mg QID x 14 days
Late Latent Syphilis Treatment
Benzathine PenG 2.4 million units IM once weekly x 3 weeks
if PCN allergy
- doxy 100 mg BID x 28 days
- tetracycline 500 mg QID x 28 days
Tertiary Syphilis Treatment
Benzathine PenG 2.4 million units IM once weekly x 3 weeks
if PCN allergy
- doxy 100 mg BID x 28 days
- tetracycline 500 mg QID x 28 days
Neurosyphilis Treatment
- aqueous crystalline PenG 3-4 million units IV q4h x 10-14 days (or 18-24 million units/day as CI)
- Procaine Pen 2.4 million units IM daily + probenecid 500 mg PO QID x 10-14 days
if PCN allergy
- ceftriaxone 2 g IM or IV daily x 10-14 days
HIV + and Primary/SEcondary syphillus
same as non HIV patient
HIV and early latent syphilis
Benzathine PenG 2.4 million units IM x 1 dose
HIV and late latent or unknown duration
Benzathine PenG 2.4 million units IM x once weekly x 3 weeks
HIV and neurosyphilis
- aqueous crystalline PenG 3-4 million units IV q4h x 10-14 days (or 18-24 million units/day as CI)
- Procaine Pen 2.4 million units IM daily + probenecid 500 mg PO QID x 10-14 days
if PCN allergy
- ceftriaxone 2 g IM or IV daily x 10-14 days
Syphilis and Pregnancy
- penicillin is the only reliable agent to treat the fetus
Recommended treatment of chlamydia for adolescents and adults
doxycycline 100 mg PO BID x 7 days
Alternative treatment of chlamydia in adolescents and adults
- azithromycin 1 gm PO x 1 dose
- levofloxacin 500 mg PO q24h x 7 days
Treatment of chlamydia in pregnancy
- azithromycin 500 mg PO x 1 dose
- alternative is amox 500 mg PO TID x 7 days
Macrolide-susceptible mycoplasma gen
- doxy 100 mg PO bid x 7 days followed by azithromycin 1 g PO x 1 followed by 500 mg PO daily x 3 additional days
Macrolide-resistan mycoplasma gen
- doxy 100 mg PO BID x 7 days followed by moxi 400 mg PO daily x 7 days
Testing not available for mycoplasma gen
- doxy 100 mg PO BID x 7 days followed by moxi 400 mg PO daily x 7 days
First clinical episode of genital herpes
- acyclovir 400 mg PO TID
or - famciclovir 250 mg PO TID
or - valtrex 1 g PO BID
- 7-10 days
Recurrent treatment of genital herpes
- acyclovir 800 mg PO BID x 5 days (or TID x 2 days)
or - famciclovir 125 mg PO BID (or 1 g x1)
or - valtrex 500 mg PO BID x 3 days (1 g po daily x 5 days)
Severe HSV disease
acyclovir 5-10 mg/kg/dose IV q8h for 2-7 days until clincial improvement
Suppressive treatment of HSV
- acyclovir 400 mg PO BID
- famciclovir 250 mg po bid
- valacyclovir 500 mg/1g PO daily
Pregnancy suppressive therpay for HSV
- acyclovir 400 mg PO TID
- valacyclovir 500 mg PO BID
start at 36 weeks
Trich treatment in women
metronidazole 500 mg PO BID x 7 days
OR
tinidazole 2 g po x 1 dose
Trich treatment in men
metronidazole 2g mg PO x 1 dose
OR
tinidazole 2 g po x 1 dose
Trich treatment in HIV
metronidazole 500 mg PO BID x 7 days
PID Standard Tratment
- ceftriaxone.1 g IV
and - doxy 100 mg IV or PO BID
and - metronidazole 500 mg IV or PO BID x 14 days
PID Alternative PN Treatment
- unasyn 3 g q6
and - doxy 100 mg IV/PO q12
14 days
PCN allergy (clinda+gent)
PID IM/Oral treatment
- ceftriaxone 500 mg IM x 1 dose
and
doxy 100 mg BID
and
metronidazole 500 mg BID
14 days
Lab findings for endocarditis
- bacteremia is continuous and low grade (<100 CFU/mL blood)
- draw at least 3 sets from different sites initially, then 2 sets q2-3 days
Major Criteria for Endocarditis
- microbio
- imaging
- surgicaal
Viridans Group Strep and S. gallolyticus native valve endocarditis treatment
- pen G or ceftriaxone 4 weeks
- pen g + gent 2 weeks (not for patients with cardiac abscessess)
- ceftriaxone + gent 2 weeks
- vanc 4 weeks only for patients who cannot tolarate beta lactams
Viridans Group Strep and S. gallolyticus pen resistant native valve endocarditis treatment
- pen g (4 weeks) + gent (2 weeks)
- ceftriaxone (4 weeks) + gent (2 weeks
- vancomycin 4 weeks
Viridans Group Strep and S. gallolyticus prothestic valve endocarditis treatment
- pen g w or w/o gent
- ceftriaxone w or w/o gent
- vancomycin
- amp is reasonable alternative
- gent is 2 weeks, others are 6 weeks
Viridans Group Strep and S. gallolyticus prosthetic valve pen resistant endocarditis treatment
- pen g + gent
- ceftriaxone + gent
- vancomycin
- amp is reasonable alternative
- 6 weeks
staphylococci native valve endocarditis MSSA
- nafcillin or oxacillin x 6 weeks
- cefazolin for pcn allergy x 6 weesks
- if uncomplicated, then 2 weeks
staphylococci native valve endocarditis MRSA
- vanc or dapto x 6 weeks
What is daptomycin FDA approved for in endocarditis?
- right sided endocarditis 6 mg/kg/day
- 14-28 days uncomplicated
- 28-42 days complicated
staphylococci prosthetic valve endocarditis oxacillin susceptible
- nafcillin/oxacillin (6 weeks)
+ - rifampin (6 weeks)
+ - gent (2 weeks)
staphylococci prosthetic valve endocarditis oxacillin resistant
- vanc (6 weeks)
+ - rifampin (6 weeks)
+ - gent (2 weeks)
Enterococi endocarditis pen and gent susceptible
- amp + gent
- pen + gent
- aamp + ceftriaxone for pts with clcl <50 mL/min
Enterococi endocarditis pen susceptible and gent resistanat
- amp + ceftriaxone
Enterococi endocarditis pen and gent resistant and streptomycin susceptible
- amp + streptomycin
- pen + streptomycin
Enterococi endocarditis unable to tolerate beta lactam
- vanc + gent
Enterococi endocarditis resistant to beta lactams or pcn
vanc+gent
Enterococi endocarditis pen, aminoglycoside, vanc resistant
daptomycin or linezolid
HACEK Endocarditis
- ceftriaxone
- unasyn
- cipro
culture negative native valve endo
- vanc + cefepime (acute)
- unasyn + vanc (subacute)
culture negative prosthetic valve endo eaarly
- vanc
+ - gent
+ - rifampin
+ - cefepime
culture negative prosthetic valve endo laate
vanc + ceftriaxone
SBP Empiric Treatment
- ceftriaxone
- cefepime
- zosyn
- meropenem
SBP risk for MRSA
add vanc/dapto/linezolid
Treatment duration for SBP
- 5-7 days for patient with cirrhosis and ascites
- 14-21 days for patients undergoing CAPB
Enterococci coverage for secondary peritonitis
- high seveirty IAI
- history of recent cephalosporin use
- immunocompromised
- biliary source of infection
- history of valvular heart disease
- prosthetic intravascular material
CA Mild-Moderate SP
- ceftriaxone + metro
- cefazolin + metro
- cefoxitin
- ertapenem
- tigecycline
CA Severe and HA SP
- zosyn
- meropenem
- cefepime
Oral therapy for SP
- augement q8
- cefpodoxime + metro
- cephalexin + metro
- cefadroxil + metro
- cipro + metro
- levo + metor
- TMP/SMX DS + metro
Treatment duration for SP
4-7 days after source control
Treatment of MRSA SAB
- vancomycin 15-20 mg/kg IV q8-12h
- daptomycin 6-10 mg/kg IV q24h (right sided endo)
Treatment of MSSA bactermia
- nafcillin 2g IV q4h
- oxacillin 2g IV q4h
- cefazolin 2g IV q8h inocculum effect?
Duration of uncomplicated SAB
- 14 days from first negative blood culture
Duration of complicated SAB
- 4 weeks IV
duration of complicated SAB with metastataic infection
6-8 weeks IV
Streptococci bacteremia
- penicillin for group strep
- ceftriaxone or penicillin for strep pneumo
- 14 days
enterococci bacteremia
- e faecalis is amp (vanc/dapto if allergy)
- e faecium vanc (VRE use dapto/linezolid)
- 7 days
