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Infectious Diseases Module > EXAM FOUR COVERAGE > Flashcards

EXAM FOUR COVERAGE Flashcards

1
Q

Otitis Media

A

Inflammation of the middle ear
Most Common Pathogens:
1. Strep pneumo
2. Haemophilus influ
3. Moraxella catarr
MILD: <39C and Otalgia
SEVERE: >39C and severe Otalgia

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2
Q

Otitis Media Diagnosis

A
  1. New onset Otorrhea (ear drainage TM ruptured)
  2. Mod-Severe bulging of TM
  3. Mild bulging of TM + new onset otalgia/erythema
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3
Q

Pain Management of Otitis Media

A

Should be given to ALL patients with otalgia
PO: IBU and APAP

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4
Q

When is treatment indicated for Otitis Media?

A
  1. ALL with SEVERE illness or otorrhea
  2. <24 months with BILATERAL Mild illness
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5
Q

When is observation rather than treatment an option for Otitis Media?

A
  1. ALL with UNILATERAL Mild illness
  2. > 24 months with BILATERAL Mild illness
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6
Q

What are the major resistance mechanisms of organisms that cause Otitis Media?

A
  1. H. flu = beta lactamase
  2. M. cat = beta lactamase
  3. S. pneumo = PBP alterations
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7
Q

What is FIRST line therapy for Otitis Media?

A
  1. HIGH dose Amoxicillin (dose alone overcomes PBP modifications)
  2. HIGH dose Augmentin
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8
Q

What is the DOSE of First Line Therapy for Otitis Media?

A

45 mg/kg PO BID

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9
Q

When should Augmentin be used over Amoxicillin for first line therapy?

A
  1. Amoxicillin was given in a previous month
  2. Concomitant conjunctivitis
  3. Always recommend ES formulation
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10
Q

What are the therapy options for Otitis Media if the patient has a PCN allergy?

A

Cefdinir

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11
Q

What is the duration of antibiotics in Otitis Media for <2 yrs?

A

MILD = 10 days
SEVERE = 10 days

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12
Q

What is the duration of antibiotics in Otitis Media for 2-5 yrs?

A

MILD = 7 days
SEVERE = 10 days

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13
Q

What is the duration of antibiotics in Otitis Media for >6 yrs?

A

MILD = 5 days
SEVERE = 10 days

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14
Q

When dosing medication in Otitis Media for overweight children, ensure what?

A

The maximum or adult dose is NOT exceeded when prescribing

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15
Q

Treatment Failure Algorithm for Otitis Media

A
  1. Amoxicillin fails = Start Augmentin
  2. Augmentin daily = start Ceftriaxone IM +/- Clindamycin PO
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16
Q

Otitis Externa

A

Cellulitis of external canal
Swimmer’s Ear
Most Common Pathogens:
1. Staphylococcus aureus = most common
2. Pseudomonas aeruginosa = 2nd

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17
Q

S/S of Otitis Externa

A
  1. Rapid onset
  2. Otalgia
  3. Pruritus
  4. Otorrhea
  5. White Mucus = acute bacteria
  6. Fluffy Color Changing Mucus = fungal
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18
Q

Is fever seen in Otitis Externa?

A

NO, indicative of additional infection

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19
Q

Treatment Options for Otitis Externa

A

Treatment of Choice = Antibiotic DROPS
Symptom Relief Add On = Steroid DROPS

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20
Q

If a Perforated TM is present in Otitis Externa you must AVOID what?

A

AVOID
1. Neomycin = ototoxic
2. Acetic Acid = ototoxic
3. Cipro HC = NOT sterile

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21
Q

What is used for pain relief in Otitis Externa?

A
  1. NSAIDs
    AVOID topical pain relievers, it will coat the area where the antibiotics will be working
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22
Q

When should PO antibiotics be used in Otitis Externa?

A
  1. Persistant OE
  2. Temp >38.3
  3. Immunocompromised patients
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23
Q

What is the duration of treatment for Otitis Externa?

A

3 DAYS PAST symptom resolution

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24
Q

Sinusitis

A

Inflammation of the sinuses
Most often viral
Bacterial Causes (less common):
1. S. pneumo
2. H. flu
3. M. catarr

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25
Q

What are the THREE Cardinal Symptoms of Sinusitis?

A
  1. Purulent nasal discharge (green mucus)
  2. Nasal congestion
  3. Facial congestion
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26
Q

Bacterial Infection of Sinusitis

A
  1. FEVER the ENTIRE time
  2. Green mucus at the BEGINNING
  3. Feel gross for more than 10 days
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27
Q

Viral Infection of Sinusitis

A
  1. Fever for the first 48hrs ONLY
  2. Mucus ALL the time
  3. Peaks a day 6 and then better by day 10
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28
Q

What is Double Sickening in Sinusitis?

A

Starts viral but on day 6 gets worse = becomes a bacterial infection

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29
Q

What is first line treatment for Sinusitis?

A

Augmentin

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30
Q

What is the standard and high doses of Augmentin for Sinusitis?

A

Standard = 875/125 mg BID PREFERRED
High = 2000 mg BID

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31
Q

When should you use high dose Augmentin for Sinusitis?

A
  1. Recent antibiotics
  2. Age >65 yrs
  3. Recent hospitalizations
  4. Immunocompromised status
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32
Q

What are options for treatment in Sinusitis if the patient has a PCN allergy?

A
  1. LEVOFLOXACIN
  2. Maybe moxifloxacin
    NEVER doxycycline
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33
Q

What are the Black Listed Agents when treating Sinusitis?

A
  1. Macrolides
  2. Bactrim
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34
Q

What is the duration of treatment for Sinusitis?

A

5-7 days

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35
Q

Pharyngitis

A

Viral 80%
Bacterial = GROUP A Strep (no resistance mechanisms)
Antibiotic therapy should work within 48 hrs

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36
Q

What is the TRIAD of symptoms for Pharyngitis?

A
  1. Sore throat
  2. Pharyngeal edema
  3. Fever
    (sudden onset)
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37
Q

What is the diagnosis for Pharyngitis?

A

Throat Swab - Rapid Antigen Detection Test - Culture

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38
Q

When can you give antibiotics in Pharyngitis?

A

Antibiotics ONLY with +RADT or Culture

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39
Q

What is the first line therapy for Pharyngitis?

A

Penicillin or Amoxicillin
Amoxicillin preferred due to QD dosing

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40
Q

What is the therapy in a Type 1 Allergy for Pharyngitis?

A

Clindamycin or Azithromycin

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41
Q

What is a Type 1 Allergy?

A

HIVES or ANAPHYLAXIS

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42
Q

What is the therapy in a NON-Type 1 Allergy for Pharyngitis?

A

Cefdinir

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43
Q

What antibiotics should be avoided in Pharyngitis?

A
  1. Tetracyclines
  2. Bactrim
  3. Fluoroquinolones
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44
Q

Amoxicillin dosing for Otitis Media vs Sinusitis vs Pharyngitis

A

Otitis Media = BID
Sinusitis = BID
Pharyngitis = QD

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45
Q

Mycobacterim Tuberculosis

A

Doubles every 18 hrs, takes days to grow and get lab results
ACID FAST POSITIVE Rod Shaped Bacterium Bacilli
Large Lipid Content
NEEDS MORE THAN 1 DRUG TO TREAT

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46
Q

How does Tuberculosis spread?

A
  1. COUGH
  2. Sneezing
  3. Shouting
  4. Singing
    DROPLETS LAST UP TO 30 MINS IN THE AIR
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47
Q

Where does Tuberculosis infect?

A

LUNGS/Pulmonary

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48
Q

Macrophages surround the TB infection forming a Granuloma, are Granulomas effective in fighting an ACTIVE TB Infection?

A

NO, TB continues to spread
Caeseating (necrotic) granuloma is formed by the inflammatory response

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49
Q

Are Granulomas effective in fighting a LATENT TB Infection?

A

YES, granuloma contains TB successfully
NOT infectious or contagious

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50
Q

When can Latent TB Infections be reactivated?

A
  1. Infection
  2. Immunosuppression
  3. Immunocompromised
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51
Q

S/S of ACTIVE TB Infection

A
  1. Cough lasting more than 3 WEEKS
  2. Loss of appetite
  3. Night sweats
  4. Weight loss >30 LBS
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52
Q

What population of patients do NOT receive the Mantoux TB Skin Test?

A
  1. Infants
  2. Pregnant Women
  3. HIV
  4. TB Vaccinated
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53
Q

If the TB Skin Test is positive, what must be done next?

A

OFT-GIT or TSPOT TB BLOOD test and if positive, patient must go through additional testing of…
CHEST X RAY

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54
Q

Chest X-Rays determine what?

A

If TB Infection is Active or Latent

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55
Q

TB Infection Treatment Options

A

R: Rifampin
I: Isoniazid
P: Pyrazinamide
E: Ethambutol

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56
Q

Treatment goals of TB Infections

A

Active: treat to cure
Latent: treat to stop progression

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57
Q

Rifampin TB

A

Inducer of Everything
Take on an EMPTY stomach
AE:
1. Red/Orange discoloration
2. Can discolor contacts
3. Elevated AST/ALT
Monitor: LFTs

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58
Q

What are the alternatives to Rifampin in TB?

A

Rifapentine and Rifabutin
Rifapentine = less frequent dosing intervals

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59
Q

Isoniazid-Isonicotinic Hydralazine INH

A

Inhibits mycelia acid and nucleic acid synthesis
Take on an EMPTY stomach
AE: peripheral neuropathy
Monitor: LFTs, peripheral neuropathy, optic neuritis
MUST TAKE 25 MG OF PYRIDOXINE B6 QD with INH for prevention of peripheral neuropathy

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60
Q

What are the drug interaction concerns with INH?

A
  1. Slow Acetylators: higher INH concentration = white/jewish
  2. Fast Acetylators: low INH concentration (need higher dose) = Inuit and Japanese
  3. Strong CYP 2C10 and 2D6 inhibitors
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61
Q

Pyrazinamide PZA

A

Inhibits cell enzyme and cell membrane function leading to cell death
Take without regard to food
AE: HYPERURICEMIA, elevated LFTs
Monitor: LFTs, uric acid, renal function
Renally excreted AVOID in CrCl <30

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62
Q

Ethambutol EMB

A

Disrupts synthesis of arabinogalactan component of cell wall
Take without regard to food
AE: Optic neuritis
Renally excreted AVOID in CrCl <30

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63
Q

Latent TB Treatment Options

A

Adherence is the MOST IMPORTANT factor
1. INH + Rifapentine Once WEEKLY x 3 months
2. Rifampin QD x 4 months

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64
Q

INH + Rifapentine Once Weekly x 3 Months

A
  1. Safe for HIV patients
  2. Shorter
  3. MUST ADD B6
  4. High pull burden
  5. Syncope/Hypotension
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65
Q

Rifampin QD x 4 months

A
  1. Safe for ALL ages
  2. 2 caps QD
  3. No studies in HIV patients
  4. Lots of drug interactions
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66
Q

What is the checklist BEFORE treatment for ACTIVE TB infection?

A
  1. Culture and sensitivities
  2. Baseline labs
  3. Identify potential drug interactions
  4. HIV test
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67
Q

What is the checklist DURING treatment for ACTIVE TB infection?

A
  1. Monthly sputum culture
  2. Adherence
  3. Periodic CBC, CMP, and eye exam
  4. DDI
  5. Check for neuropathy
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68
Q

What is the Intensive Treatment in ACTIVE TB infection?

A

Empiric Treatment
START RIPE: QD for 8 WEEKS
Stop Ethambutol if M. tuberculosis is susceptible to other medications

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69
Q

What is the Continuation Phase Treatment in ACTIVE TB infection?

A

INH + Rifampin QD for 18 WEEKS
Can INCREASE continuation phase to 30 WEEKS if signs of relapse are present

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70
Q

If Optic Neuritis occurs, what must be done?

A
  1. DC EMB
  2. Consider DC INH
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71
Q

If a Rash occurs during TB infection, assess for involvement of mucous membranes and what must be done?

A

No mucous involvement = Antihistamine Treatment
YES to FEVER or MUCOUS Membrane Involvement = DC ALL THERAPY, INPATIETNT, Re-Introduce therapy with sequential order

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72
Q

Intensive Phase ACTIVE TB Interruption Protocol

A

Lapse < 14 days in duration = continue treatment, ALL doses MUST be completed within 3 months
Lapse >14 days in duration = RESTART treatment from beginning

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73
Q

Continuation Phase ACTIVE TB Interruption Protocol

A
  1. Received >80% & AFB NEG = further therapy not necessary
  2. Received >80% & AFB POS = continue treatment, ALL doses MUST be completed
  3. Received <80% & lapse <3 months = continue therapy until completed
  4. Received <80% and lapse >3 months = RESTART therapy from BEGINNING AKA INTENSIVE PHASE FIRST followed by continuation phase
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74
Q

Bronchitis

A

Inflammation of large airways of the tracheobronchial tree

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75
Q

Acute Bronchitis

A
  1. Self Limiting
  2. Viral Infections
76
Q

Chronic Bronchitis

A

Defined by CHRONIC COUGH with SPUTUM production lasting > 3 CONSECUTIVE MONTHS for at least 2 YEARS
1. Associated with COPD
2. Bacterial Infections
-Mycoplasma pneumoniae (atypical)
-Strep pneumo
-H. flu
-M. catarr

77
Q

S/S of Bronchitis

A
  1. COUGH is the hallmark symptom of ACUTE bronchitis
  2. EARLY and persists for 3 weeks
78
Q

Treatment of Acute Bronchitis

A

Provide Comfort
Supportive Care
-Antitussives
-Analgesics/Antipyretics
-Antihistamines

79
Q

What is NOT indicated in Acute Bronchitis and can lead to harm?

A
  1. Bronchodilators
  2. Inhaled/Systemic Steroids
  3. Antibiotics
80
Q

Treatment of Chronic Bronchitis

A

Reduce Severity and Symptoms
Pharmacotherapy
-Vaccines
-Antibiotics
Nonpharmacotherapy
-Smoking cessation

81
Q

What antibiotics can be used for Strep. pneumo causation of chronic bronchitis?

A
  1. High Dose Amoxicillin
  2. Doxycycline
  3. Respiratory FQ
82
Q

What antibiotics can be used for H. flu and M. catarr causation of chronic bronchitis?

A
  1. Augmentin
  2. Respiratory FQ
83
Q

What antibiotics can be used for Mycoplasma pneumo and Chlamydophila pneumo causation of chronic bronchitis?

A
  1. Macrolides (Azithromycin)
  2. Tetracyclines (Doxycycline)
  3. Lefamulin
  4. Respiratory FQ
84
Q

Influenza

A

Cause: single-stranded RNA virus
Transmitted through inhalation of respiratory droplets or direct contact with virus contaminated surface

85
Q

Antigenic Drift

A

Point mutations resulting in small changes
EPIDEMICS

86
Q

Antigenic Shift

A

Novel virus created from reassortment of 2 previous strains
PANDEMIC

87
Q

Incubation and Infectious Periods of Influenza

A

Incubation = 1-7 days
Infectious = 1 day before to 7 days after symptom onset

88
Q

What are the HIGH RISK targeted groups that are TREATED for influenza regardless of time since symptom onset?

A
  1. Hospitalized with flu
  2. Outpatient with severe or progressive illness
  3. Immunocompromised
  4. Children <2 yrs
  5. Adults >65 yrs
  6. Pregnant Women (or within 2 wks postpartum)
89
Q

When do you treat other patients that do not fall into the high risk category for influenza?

A

Treat ONLY if symptom onset within 48 HOURS of presentation

90
Q

What are the 3 antiviral classes used for influenza?

A
  1. Neuraminidase inhibitors
  2. Endonuclease inhibitors
  3. Adamantanes
91
Q

List the drugs that are classified as Neuraminidase Inhibitors?

A
  1. Oseltamivir/Tamiflu
  2. Zanamirvir/Relenza
  3. Peramivir/Rapivab
92
Q

List the drugs that are classified as Endonuclease Inhibitors?

A
  1. Baloxavir/Xofluza
93
Q

List the drugs that are classed as Adamantanes?

A
  1. Amantadine/Rimantadine aka AVOID DO NOT USE
94
Q

Oseltamivir

A

Capsule/Suspension

95
Q

Zanamivir

A

Inhalation

96
Q

Zanamivir

A

Inhalation

97
Q

Peramivir

A

IV Solution

98
Q

Baloxavir

A

Tablet, WEIGHT BASED SINGLE ORAL DOSE

99
Q

Community Acquired Pneumonia CAP

A

Pneumonia developing in the outpatient setting or <48 hrs after hospital admission

100
Q

Hospital Acquired Pneumonia HAP

A

Pneumonia developing in hospitalized patients >48 hrs after admission

101
Q

Ventilator Associated Pneumonia VAP

A

Pneumonia developing >48 hrs after endotracheal intubation

102
Q

What are the COMMON Causative Organisms for CAPs?

A
  1. Viral
  2. Strep pneumo
  3. H. flu
  4. M. catarr
  5. Mycoplasma pneumo
  6. Chlamydophila pneumo
  7. Legionella species
103
Q

When should MRSA and Pseudomonas Coverage be considered for CAPs?

A
  1. Previous respiratory isolation of either organism
    OR
  2. Recent <90 days hospitalization AND receipt of IV antibiotics
104
Q

Outpatient CAPs Treatment

A
  1. NO Comorbidities = AMOXICILLIN, if PCN allergy use Doxycycline
  2. Comorbidites = AUGMENTIN or CEPHALOSPORIN + Macrolide or Doxycycline
    -Cephalosporin: Cefpodoxime or Cefuroxime
    -AVOID Doxycycline if patient has QT problem
    -Allergy = use FQs LEVO or MOXI
105
Q

Inpatient CAPs Treatment

A
  1. Non-Severe = IV Beta Lactam + Macrolide or Resp FQ
  2. Severe = IV Beta Lactam + Macrolide or IV Beta Lactam + Resp FQ
    -Beta Lactase: Unasyn/Cefotaxime/Ceftriaxone/Ceftaroline

ADD ON if MRSA or Pseudomonas
MRSA = Vanc or Linezolid
Pseduo = Zosyn, Cefepime, Ceftazidime, Imipenem, Meropenem, or Aztreonam

106
Q

Duration of Therapy for CAPs

A

NO LESS than 5 DAYS
If treating MRSA/Pseudomonas add on duration >7 DAYS

107
Q

List 3 Prediction Rules in determine location of care for CAPs

A
  1. CURB-65
  2. Pneumonia Severity Index PSI
  3. IDSA/ATS Criteria for Severe CAP
108
Q

CURB65 and PSI

A

Both are utilized to determine Inpatient vs Outpatient preference
Guidelines prefer PSI

109
Q

IDSA/ATS

A

Determine if patient should be placed in ICU for Severe CAP

110
Q

Do you use Procalcitonin in CAPs?

A

NO, not to be used

111
Q

What are the Causative Organisms for HAP and VAP?

A
  1. Enteric Gram Neg: Klebsiella/E.coli
  2. Pseudomonas
  3. Acinetobacter, Stentrophomonas
  4. Staph Aureus
112
Q

Empiric Therapy for HAP/VAP, no matter what these have to be covered empirically

A
  1. Staph Aureus MSSA
  2. Pseudomonas
  3. Gram Neg Bacilli
113
Q

You should always cover MSSA in HAP, but when should you recommend MRSA Coverage?

A
  1. MDR Risk Factor
  2. High mortality risk
  3. Unit prevalence of MRSA >20%
114
Q

You should always cover MSSA in HAP, but when should you recommend PSA Coverage?

A
  1. MDR Risk Factor
  2. High mortality risk
  3. Structural lung disease
    DOUBLE COVER = 2 drugs from different classes
115
Q

Empiric Therapy for HAP/VAP

A

NO MRSA/MDR =
1. Zosyn or
2. Cefepime or
3. Levofloxacin or
4. Imipenem/Meropenem
MRSA but NO MDR =
1. Zosyn or
2. Cefepime/Ceftazidime or
3. Cipro/Levofloxacin or
4. Imipenem/Meropenem or
5. Aztreonam
PLUS VANC or LINEZOLID

DOUBLE COVERAGE NOT NEEDED

116
Q

Empiric Therapy for MDR HAP/VAP (PSA Double Cover)

A
  1. Zosyn or Cefepime/Ceftazidime or Imipenem/Meropenem or Aztreonam
  2. Ciprofloxacin/Levofloxacin or Amikacin/Gentamicin/Tobramycin or Colistin

One from option 1 and One from option 2 for DOUBLE PSA COVERAGE

IF MRSA present with MDR RISK FACOR ADD ON:
3. Vancomycin or Linezolid

117
Q

Duration of Therapy for HAP/VAP

A

Uncomplicated = 7 days

118
Q

What are the two major classes of UTIs?

A
  1. Cystitis = Lower UTI
  2. Pyelonephritis = Upper UTI
119
Q

What is the most common pathogen to cause UTIs?

120
Q

What are the S/S of Cystitis?

A
  1. Urgency
  2. Frequency
  3. Dysuria
  4. Suprapubic
  5. Heaviness
121
Q

What are the S/S of Pyelonephritis?

A
  1. FLANK PAIN
  2. FEVER
  3. Malaise
  4. HA
  5. Nausea
  6. Vomiting
  7. Lethargy
122
Q

Urinalysis Components

A

Leukocyte Esterase = BEST Predictor
Nitrates = appears with gram neg bacteria

123
Q

Urine Cultures are the GOLD Standard but what are the specific indications when it should be used?

A
  1. Must be performed with pyelonephritis
  2. +/- with acute cystitis
  3. Reflex culture
124
Q

Phenazopyridine/AZO

A

Pain Relief ONLY
1. Limit use to 2 DAYS ONLY
2. Red/Orange discoloration of urine
3. Take with food

125
Q

Ibuprofen (UTI)

A

Can help with pain and fever
1. AVOID with kidney disease, increased risk of bleeding, and cardiac conditions
2. Take with food

126
Q

APAP (UTI)

A

Can help with pain and fever
1. AVOID or reduce dose with liver disease

127
Q

Nitrofurantoin/Macrobid

A

-Enterics, E. faecalis
AE: urine discoloration
High concentration in urine
CAUTION: CrCl <30
TAKE with FOOD

128
Q

Bactrim

A

-Enterics, staph
AE: Rash, SJS, Pancytopenia, Hyperkalemia
TAKE with 8oz of WATER

129
Q

Fosfomycin

A

-Enterics, Gram +
AE: HA/Diarrhea
High concentration in urine
Dose ADJUST CrCl <40
1 TIME DOSING

130
Q

Fluoroquinolone: Ciprofloxacin and Levofloxacin UTI

A

-QT Prolongation
-Chelation with cations
Moxifloxacin is NOT used UTIs, does not have good concentrations in the bladder

131
Q

Beta Lactam: Augmentin, Ceftriaxone, Cephalexin, Cefdinir, and Zosyn UTI

A

NOT FIRST LINE

132
Q

Management of Cystitis Uncomplicated

A

AVOID FQ is possible
FIRST LINE:
1. Nitrofurantoin BID x 5 days
2. Bactrim BID x 3 days
3. Fosfomycin PO SINGLE dose

133
Q

Management of Cystitis COMPLICATED

A

Empiric:
1. Cipro PO BID
2. Cipro IV
3. Levo PO QD
Duration 7-14 days

134
Q

What makes a patient deemed COMPLICATED in UTIs?

A
  1. Male
  2. Pregnant Women
  3. Structural Abnormalities
  4. Immunocompromised
  5. Catheters
  6. Uncontrolled Diabetes
135
Q

Management of Pyelonephritis Uncomplicated with LOCAL FQ resistance <10%

A
  1. Cipro BID x 7 days
  2. Levo QD x 5-7 days
136
Q

Management of Pyelonephritis with LOCAL FQ resistance >10% ADD ON THERAPY for uncomplicated or complicated

A
  1. Ceftriaxone 1 TIME DOSE
  2. Aminoglycoside 1 TIME DOSE
137
Q

Management of Pyelonephritis if Susceptible

A
  1. Bactrim BID x 14 days + Ceftriaxone x 1 time
  2. Beta Lactam x 10-14 days + Ceftriaxone x 1 time
138
Q

Management of Pyelonephritis COMPLICATED

A

Empiric:
1. Cipro BID
2. Cipro IV
3. Levo QD
Severe Illness: INPATIENT
1. IV FQ or AG +/- Ampicillin
2. Zosyn, Cefepime, or Ceftazidime
DURATION = 14 DAYS

139
Q

UTI Management in Pregnant Women

A

PREFERRED: Beta Lactams
1. Augmentin BID x 7 days
2. Cephalexin q6h x 7 days
3. Cefdinir BID
AVOID
-Nitrofurantoin in the last 30 days of pregnancy
-Bactrim overall

140
Q

What is the diagnosis of Recurrent UTIs?

A
  1. > 2 POS cultures and symptomatic acute cystitis episodes in 6 months
  2. > 3 episodes in 1 year
141
Q

Treatment of Fungal UTI

A
  1. Fluconazole – Preferred
  2. Amphotericin B DEOXYCHOLATE
142
Q

When are the TWO TIMES you ALWAYS treat Asymptomatic Bacteriuria?

A
  1. Pregnant Women
  2. Urologic Surgical Procedures
143
Q

Chlamydia

A
  1. Atypical Organism
  2. NAAT = most sensitive test
  3. Often Asymptomatic
  4. Most frequently reported STI
144
Q

Chalmydia Treatment

A
  1. Doxycycline x 7 days = first line
  2. Azithromycin SINGLE DOSE = alternative
  3. Levo x 7 days = alternative
145
Q

Chalmydia Mangement

A
  1. Refer sex partners 60 days of onset of symptoms or diagnosis
  2. RE-TEST 3 MONTHS after completion of treatment
146
Q

Gonorrhea

A
  1. Gram Neg Diplococci
  2. NAAT = most sensitive test
  3. Second most reported bacterial communicable disease
147
Q

Gonorrhea Treatment

A

First Line: Ceftriaxone, and if chlamydia has not been excluded add on Doxycycline x 7 days, if chlamydia was ruled out then do Ceftriaxone ALONE

Alternative: Gentamicin + Azithromycin (both as SINGLE doses)

148
Q

Gonorrhea Management

A
  1. Presumptively treat sex partners within the last 60 days
  2. RE-TEST at 3 months after treatment
149
Q

Syphilis

A
  1. Slow Growing Spirochete
  2. Titers
    Primary syphilis = Single Chancre
    Secondary syphilis = Skin Rash
    Tertiary syphilis = Gummatous Lesions
    Neurosyphilis = Altered Mental Status
150
Q

Syphilis Treatment

A

Primary/Secondary syphilis = Penicillin G IM SINGLE dose

Tertiary syphilis = Penicillin G IM once weekly for 3 DOSES

Neurosyphilis = Penicillin IV x 10-14 days

151
Q

Jarisch-Herxheimer Reaction

A
  1. Occurs within 24 hrs after initiation of ANY syphilis treatment
  2. NOT an allergic reaction to penicillin
  3. Manage with ANTIPYRETICS
152
Q

Penicillin Allergies in Syphilis

A

MUST USE PENICILLIN for Pregnant Women and Neurosphyilis even if there is a reported allergy
MUST desensitize patient and use penicillin treatment

PCN Allergy in Primary or Secondary Syphilis:
1. Doxycycline x 14 days
2. Tetracycline x 14 days
3. Ceftriaxone x 10 days

153
Q

Syphilis Management

A
  1. RE-TEST 6-12 months after treatment
  2. Titer expect a 4-FOLD DECLINE (2 dilutional)
154
Q

Genital HSV

A
  1. HSV 1 = Oral
  2. HSV 2 = Genital (highest among AA and lowest in asians)
    -More severe in women
    LIFE LONG INFECTION
    Herpes Simplex Virus
155
Q

Genital HSV Treatment

A

First Episode:
1. Acyclovir, Famciclovir, Valacyclovir
2. 7-10 days
3. NO topical therapy
Recurrent:
1. Foscarnet or Cidofovir
2. QD
Episodic:
1. Start therapy with 1 day of lesion onset
2. Acyclovir, Famciclovir, Valacyclovir

156
Q

Trichmoniasis

A
  1. Most prevalent NON Viral STI worldwide
  2. Anaerobic Flagellated Protozoan Parasite
  3. Wet mount microscopy
  4. WOMEN RE-TEST 3 months after initial treatment, no re-testing in men
157
Q

Trichmoniasis Treatment

A
  1. Metronidazole PO x 7 days = preferred
  2. Tinidazole PO SINGLE dose = alternative
158
Q

Bacterial Vaginosis

A
  1. NOT technically an STI
  2. Reducing normal vaginal flora of lactobacillus and increased concentrations of anaerobic bacteria
  3. Amsels Criteria
  4. NO Follow Up
159
Q

Amsels Diagnostic Criteria, requires at least 3 of the following:

A
  1. Thin milk like consistency
  2. Clue cells
  3. pH of vaginal fluid >4.5
  4. Fish odor of vaginal discharge before or after addition of 10% KOH
160
Q

Bacterial Vaginosis Treatment

A
  1. Metronidazole PO x 7 days
  2. Metronidazole GEL INTRAvaginally x 5 days
  3. Clinda CREAM INTRAvaginally x 7 days
161
Q

Meningitis

A

Inflammation of subarachnoid space of CSF
-Bacterial

162
Q

Encephalitis

A

Inflammation of the brain tissue
-Viral

163
Q

Meningoencephalitis

A

Inflammation of both

164
Q

Bacterial Meningitis

A
  1. S. pneumo is the MOST common pathogen
  2. Community Acquired: most common, infants, crowded conditions
  3. Hospital Acquired: invasive or neurological trauma
165
Q

Causative Organisms of Hospital Acquired Bacterial Meningitis

A
  1. S. aureus
  2. S. epidermis
  3. Gram neg bacilli
166
Q

What is the classic TRIAD of symptoms for bacterial meningitis?

A
  1. FEVER
  2. Nuchal Rigidity
  3. Altered Mental Status
167
Q

Petechial Rash is seen most common with?

A

Meningococcal meningitis – Neisseria Meningitidis

168
Q

What are the objective tests that should be performed prior to antimicrobial administration, for bacterial meningitis?

A
  1. Lumbar Puncture BP
  2. CT or MRI
  3. Blood Cultures
169
Q

What are the 5 FATORs that make an antimicrobial agent effective in penetrating in the CNS?

A
  1. Dose = higher doses best
  2. MW = lower molecular weight
  3. Lipid Solubility = lipid soluble > water soluble
  4. Protein Binding = free drug passes easier
  5. Ionization = non-ionized able to diffuse
170
Q

What 4 antibiotics require specific dosing alterations when used in the treatment of CNS infections?

A
  1. Ceftriaxone
  2. Meropenem
  3. Vancomycin
  4. Ampicillin
    Need higher doses for better penetration in the setting of CNS infections
171
Q

What is the empiric therapy of CNS infections for a patient less than 1 month old?

A

Ampicillin + Cefotaxime or Gentamicin
Continue 48-72 hrs until infectious process ruled out

172
Q

What is the empiric therapy of CNS infections for a patient age 1 month to 50 yrs?

A

Vancomycin + Cefotaxime or Ceftriaxone
Continue 48-72 hrs until infectious process ruled out

173
Q

What is the empiric therapy of CNS infections for a patient >50 yrs?

A

Vancomycin + Ampicillin + Cefotaxime or Ceftriaxone
Continue 48-72 hrs until infectious process ruled out

174
Q

What is the definitive therapy for S. pneumo causation of CNS infections?

A
  1. PCN Susceptible: PCN G or Ampicillin
  2. PCN Intermediate: Ceftriaxone, Cefotaxime, Meropenem
  3. PCN Resistant: Vanco + Cefotaxime or Ceftriaxone
175
Q

What is the definitive therapy for GBS causation of CNS infections?

A

Ampicillin or Penicillin

176
Q

What is the definitive therapy for Neisseria meningitis causation of CNS Infections?

A

PCN Susceptible: PCN G or Ampicillin
PCN Resistant: Cefotaxime or Ceftriaxone

177
Q

What is the prophylatic therapy for Nesisseria meningitides?

A

Infants and Children = Rifampin q12h x 4 DOSES or Ceftriaxone x 1
Adults = Rifampin q12h x 4 DOSES or Ceftriaxone x 1 or Cipro

178
Q

What is the defintive therapy for H. flu causation of CNS Infections?

A

B-Lactamase Neg: Ampicillin
B-Lactamase Pos: Cefotaxime or Ceftriaxone

179
Q

What is the prophlyatic therapy for H. flu?

A

Rifampin x 4 DAYS
NOT recommended if FULLY VACCINATED
If not vaccinated, then vaccine should not be initiated

180
Q

What is the defintiive therapy for Listeria monocytogenes causation of CNS infections?

A

Penicillin G or Ampicillin + Gentamicin

181
Q

What is the definitive therapy for Gram Neg Bacteria (klebsiella, e.coli, s. marcescens, p. aeruginosa, salmonella) causation of CNS infections?

A

Pseudomonas: Cefepime or Ceftazidime + Aminoglycoside
Other Gram Neg: 3rd or 4th gen cephalosporin

182
Q

When should Dexamethasone Q6h for 2-4 days be used to reduce inflammatory mediated sequelae in CNS Infections? Adjunct Therapy

A
  1. Children 6 weeks and older with either pneumococcal or meningococcal meningitis
  2. Adults with pneumococcal meningitis
183
Q

What is empiric therapy for hospital acquired CNS infections?

A

VANC + Cefepime or Meropenem
AVOID Zosyn due to poor CNS penetration

184
Q

What is definitive therapy for hospital acquired CNS Infections?

A
  1. MSSA: Nafcillin, NOT cefazolin
  2. MRSA: VANC, consider rifampin for biofilm penetration on hardware
  3. Pseudomonas: Antipseudomonal B-Lactam; can add AG for extracerebral infections
185
Q

What is definitive therapy for HSV Encephalitis?

A

IV Acyclovir
If resistant = Foscarnet

Infectious Diseases Module (5 decks)

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