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PHRM 865 > Exam Three > Flashcards

Exam Three Flashcards

1
Q

CAP Empiric Therapy Outpatient Healthy Outpatient Without Comorbidities

A
  • Amoxicillin 1 gm PO q8h
  • Doxycycline 100 mg PO BID
  • Azithromycin 500 mg PO on Day 1, followed by 250 mg PO on day 2-5
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2
Q

CAP Empiric Therapy Outpatient Healthy Outpatient With Comorbidities

A
  • Levofloxacin 750 mg PO daily OR
  • Moxifloxacin 400 mg PO daily OR

Combination Beta Lactam and Macrolide/Doxycycline
- Augmentin 875 PO q12
- Augmentin 500 mg PO q8
- Cefpodoxime 200 mg PO q12H
- Cefuroxime 500 mg PO q12H

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3
Q

CAP Empiric Therapy Inpatient Non-Severe

A

Monotherapy
- levofloxacin 750 mg PO daily OR
- Moxifloxacin 400 mg PO daily OR
Combination Beta Lactam and Macrolide/Doxycycline
- Unasyn 1.5-3 mg IV q6h
- Ceftriaxone 1 - g IV q24h
- combination B lactam and Macrolide
- if long QTC or allergy, can do doxycycline

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4
Q

Empiric Therapy Inpatient Severe No MRSA/PSEUDOMONAS for CAP

A
  • combination FQ + B lactam
    • Unasyn 1.5-3 mg IV q6h
    • ceftriaxone 1-2 g IV q24h
    • **doxycycline IV/PO may be used if FQ or
      macrolide contraindicated
  • combination B lactam and Macrolide
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5
Q

Empiric Therapy Inpatient Severe MRSA Risk Factors for CAP

A
  • 2-14 days post influenze
  • Previous MRSA infection/isolation
  • previous hospitalizaiton and use of IV antibiotics
    within 90 days
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6
Q

Empiric Therapy Inpatient Severe MRSA Coverage for CAP

A

vanc o linezolid

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7
Q

Pseudomonas aeruginosa Risk Factors for CAP

A
  • previous pseudomonas aeruginoasa respiratory infection
  • previous hospitalizatino and use of IV abx within last 90 days
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8
Q

Empiric Therapy Inpatient Severe Pseudomonas aeruginosa Coverage for CAP

A
  • Zosyn
  • Cefepime
  • Meropenem
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9
Q

Corticosteroids in CAP

A

not recommended

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10
Q

Duration in CAP

A
  • continue abx until clinical stability for at least 5 days
  • temperature ≤ 38º
  • HR ≤ 100 bpm
  • RR ≤24 bpm
  • SBP ≥ 90 mmHg
  • aterial O2 sat ≥ 90% or pO2 ≥ 60 mmHg on room air
  • baseline mental status
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11
Q

Empiric Therapy MRSA Coverage HAP Risk Factors for MRSA

A
  • typical risk factors for MRSA
  • ICUs where > 10-20% MRSA isolates
  • treatment where prevalence is unknown
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12
Q

Empiric Therapy MRSA Coverage in HAP

A
  • vanc
  • linezolid
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13
Q

Empiric Therapy Pseudomonas Coverage Risk Factors for Resistance in HAP

A
  • ICUs where >10% isolates resistant
  • treamtnet where resistance rates are unknown
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14
Q

Empiric Therapy Pseudomonas Coverage in HAP

A
  • Zosyn
  • Cefepime
  • Imipenem
  • Meropenem
  • Levofloxacin
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15
Q

Empiric Therapy HAP
Not at High Risk for Mortality (not on vent or shock)

A
  • provide coverage for MSSA and pseudomonas
  • Zosyn
  • Cefepime
  • Imipenem
  • Meropenem
  • Levofloxacin
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16
Q

Empiric Therapy HAP Not at High Risk for Mortality but MRSA risk

A
  • provide coverage for MRSA and pseudomonas
  • Zosyn
  • Cefepime
  • Imipenem
  • Meropenem
  • Levofloxacin
    PLUS
  • vanc or linezolid
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17
Q

Empiric Therapy HAP High Risk for Mortality and MRSA Risk/VAP

A
  • provide coverage for MRSA + MDR pseudomonas
  • Pick 2 different classes
  • Zosyn
  • Cefepime
  • Imipenem
  • Meropenem
  • Levofloxacin
  • tobramycin/amikacin IV
    PLUS
  • vanc or linezolid
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18
Q

Duration of HAP/VAP treatment

A

7 days if clinically stable

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19
Q

Chronic Bronchitis Preferred Treatment Options

A
  • Amoxicillin/clavulanaate 875/125 mg PO Q12
  • Cefuroxime 500 mg PO Q12H
  • Cefpodoxime 200 mg PO Q12H
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20
Q

Chronic Bronchitis Alternative Treatment Options

A
  • Doxycycline 100 mg PO Q12H
  • TMP/SMX 1 DS PO Q12H
  • Azithromycin 500 mg PO day 1, then 250 mg daily on days 2-5
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21
Q

Chronic Bronchitis Risk for Pseudomonas

A
  • Levofloxacin 750 mg PO daily
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22
Q

Chronic Bronchitis Treatment Duratin

A

5-7 days

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23
Q

Chronic Bronchitis Clinical Presentation

A
  • established diagnosis of chronic bronchitis
  • chronic cough with productive sputum on most days for ≥ 3 consecutive months for 2 consecutive years
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24
Q

Acute Pharyngitis Preferred Treatment

A
  • Penicillin VK 250 mg PO TID-QID x 10 days
  • Penicillin VK 500 mg PO BID x 10 days
  • Amoxicillin 500 mg PO TID x 10 days
  • Amoxicilin 875 mg PO BID x 10 days
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25
Q

Acute Pharyngitis Alternative Treatment

A

Non-anaphylactic reactions
- Cephalexin 500mg BID (increased cross reactivity
- Cefadroxil 500 mg BID (increased cross reactivity)
- Cefuroxime 500 mg BID
- Cefpodoxime 200 mg BID (5-10 days)
Anaphylactic reactions
- Azithromycin 500 mg PO on day 1, then 250 mg on
days 2-5
- Clindamycin 300 mg PO TID x 10 days
- These choices have higher rates of resistance…

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26
Q

ABRS Symptoms

A
  • acute rhinosinusitis thought to be due to bacterial
    pathogen
  • persistant symptoms ≥ 10 days with no improvment
  • severe symptoms such as fever, purulent nasal discharge, facial pain for 3-4 consecutive days at beginning of illness
  • worsening symptoms after initial improvement
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27
Q

Common Pathogens ABRS

A

Most Common:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Pathogens in Patients with Frequent Abx Use:
- Staphylococcus aureus
- Pseudomonas aeruginosa

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28
Q

Treatment OVerview ABRS

A
  1. initiate antibiotic therapy as soon as bacterial infection established
  2. watchful waiting up to 7 days to observe improvement
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29
Q

Med Treatment ABRS First Line

A
  • Augmentin 500/125 mg PO TID x 5-7 days
  • Augmentin 875/125 mg PO BID x 5-7 days
  • Augmentin 2000/125 mg PO BID x 5-7 days if concern for penicillin resistance
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30
Q

Med Treatment ABRS Second Line

A
  • Doxycycline 100 mg PO BID x 5-7 days
  • Levofloxacin 500 mg PO once daily x 5-7 days
  • Moxifloxacin 400 mg PO once daily x 5-7 days
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31
Q

ABRS Concern for MRSA

A
  • add agent with MRSA coverage (doxy/TMP/SMX, linezolid, clindamycin)
  • maintain coverage for common organisms unless cultures suggest monomicrobial infection with MRSA
32
Q

ABRS Concern for Pseudomonas

A
  • levofloxacin 750 mg PO daily
  • maintain coverage for common organisms unless suggest monomicrobial infection with pseudomas aeruginosa
33
Q

Duration of ABRS Treatment

34
Q

Duration of Acute Pharyngitis treatment

A

10 days
(cefpodoxime 5-10 days)

35
Q

Characteristics of Uncomplicated UTIs

A
  • patient not meeting criteria for complicated UTI
  • pre-menopausal women
  • normal anatomy
36
Q

Characteristics of Complicated UTIs

A
  • anatomical abnormality of urinary tract
  • recent urologic procedure or instrumentation
  • immunocompromised patients
  • recurrent infections despite appropriate treatment
  • male sex
  • UTI in pregnancy
37
Q

Diagnosis of UTI

A

Cystitis Symptoms
- dysuria
- increased urinary frequency
- increaased urinary urgency
- suprapubic heaviness/pain
Pyelonephritis Symptoms
- fever, chills, rigors
- CVA tenderness
- Malaise
AND
Microbiologic Criteria
- ≥10^5 of ≥ 1 bacterial species from a clean void
- ≥10^3 of ≥ 1 bacterial species from a catheter
(placed in last 48 hour)

38
Q

Treatment of Asymptomatic Bacteriuria

A
  • No treatment
  • only in pregnancy
39
Q

Outpatient Approach Oral Agents

A
  • Nitrofurantoin (uncomplicated only)
  • Bactrim
  • ciprofloxacin/levofloxacin
  • Fosfomycin (uncomplicated only)
  • Cephalexin
  • Cefadroxil
  • Cefpodoxime
  • Amoxicillin/clavulanate
  • Amoxicillin (only after susceptiblity is confirmed)
40
Q

Duration of Treatment UTI Nitrofurantoin

A

5 days uncomplicated

41
Q

Duration of Treatment UT Bactrim

A
  • 3 days (uncomplicated)
  • 7-14 days (complicated)
42
Q

Duration of Tx UTI Bactrim

A
  • 3 days (uncomplicated)
  • 7-14 days (complicated)
43
Q

Duration of Tx UTI Cipro

A
  • 3 days (uncomplicated)
  • 7 days (complicated)
44
Q

Duration of Tx UTI Cephalexin or Cefadroxil

A
  • 3-7 days (uncomplicated)
  • 7-14 days (complicated)
45
Q

Duration of Tx UTI Cefpodoxime

A
  • 3-7 days (uncomplicated)
  • 7-14 days (complicated)
46
Q

Duration of Tx UTI Augmentin

A
  • 3-7 days (uncomplicated)
  • 7-14 days (complicated)
47
Q

Inpatient Approach to UTI Tx

A
  • Ampicillin 2 g IV q6h + Gentamicin 5 mg/kg IV q24h
  • Cefazolin 1-2 g IV q8h ± Gentamicin 5 mg/kg IV q24
  • Ceftriaxone 1-2 g IV q24h
  • Cefepime 1 g IV q8-12h
  • Gentamicin 5 mg/kg IV q24h
48
Q

Duration of Inpatient treatment

49
Q

Can oral be used in patient for UTI

A

yes as long as they have good bioavailabithy

50
Q

Prostatitis Treatment

A
  • FQs, Bactrim, cephalexin, augmentin
51
Q

Treatment for Prostatitis duration

52
Q

SSTI classification

A

Mild
- no systemic of infection

Moderate
- signs of systemic infection

Severe (2 of the following SIRS critiera met)
- Temperature >38ºC or <36ºC
- HR >90 bpm
- RR > 24 bpm
- WBC > 12k or <4k

53
Q

Mild Non Purulent SSTI TX

A

Oral Antibiotics
- Penicillin VK
- Cephalosporin
- Dicloxacillin
- Clindamycin

54
Q

Moderate Nonpurulent SSTI Tx

A

Parenteral Treatment
- Penicillin
- Ceftriaxone
- Cefazolin
- Clindamycin

55
Q

Severe Non purulent SSTI treatment

A

Surgical
- emergent surgical inspection/debridement

Empiric Antibiotics
- vancomycin (MRSA) + zosyn (anaerobes+pseudomonas)

After Culture and Susceptibilities
- narrow therapy based on culture and sensitivity

56
Q

Treatment duration SSTI non purulent

57
Q

Purulent Mild SSTI Treatment

A

incision and drainage

58
Q

Purulent moderate SSTI treatment

A
  • incision and drainage
  • culture and susceptibilities

Empiric Antibiotics
- TMP/SMX
- Doxycycline

59
Q

Target antibiotics for MRSA in Moderate Purulent SSTI

A
  • TMP/SMX
    • Doxycycline
60
Q

Target antibiotics for MSSA in Moderate Purulent SSTI

A
  • dicloxacillin
    • cephalexin
61
Q

Severe Purulent SSTI Severe Treatment

A
  • incision and drainage
  • culture and susceptibilities
    Empiric Antibiotics
  • Vancomycin
  • Daptomycin
  • Linezolid
62
Q

Target Antibiotics for Severe Purulent Treatment SSTI

A

Target Antibiotics
- MRSA
- see empiric
- MSSA
- Nafcillin
- cefazolin
- clindamycin

63
Q

Duration of Treatment Purulent SSTI

64
Q

NF Treatment

A
  • SURGICAL INTERVENTION AND
    BROAD SPECTRUM ANTIBIOTICS

Empiric Antibiotics
- vancomycin plus zosyn

Targeted Antibiotics
- GAS –> PCN + clindamycin

  • Polymicrobial –> Vancomycin + Zosyn
65
Q

Duration NF

A
  • further debridement is no longer necessary
  • patient has improved clinically
  • fever has been absent for 48-72 hours
66
Q

Treatment of Bites

A
  • DOC –> augmentin
  • Alternative –> 2nd/3rd generation cephalosporin +
    anaerobic coverage
  • beta lactam allergy –> cipro/levo +anaerobic coverage
    or moxifloxacin
67
Q

Duration of treatment of bites

68
Q

Risk Factor MRSA of DFI

A
  • previous MRS A infection within past year
  • local MRSA prevelance > 30-50%
  • recent hospitalization
  • failed on non-MRSA antibiotics
69
Q

Risk Factor Pseudomonas of DFI

A
  • history of pseudomonas infection
  • soaking feet in water
  • warm climate
  • severe infection
  • failed non-pseudomonal antibiotics
70
Q

Mild DFI Treatment

A

First Line
- dicloxacillin, cephalexin, clindamycin

Recent Antibiotics? Switch to…
- Augmentin or Levo/Moxi

MRSA Risk Factors? Switch to…
- SMZ/TMP or Doxycycline

71
Q

Duration of Mild DFI

72
Q

Moderate DFI Treatment

A

Need to Cover
- MSSA, streptococci, enterobacteriaceae, anaerobes

First Line
- Moxi, Augmentin, Cipro/Levo+ Clinda/Metro

Pseudomonas Risk Factors? Switch to…
- Cipro/Levo + clinda/metro

MRSA Risk Factors? Add…
- vancomycin
- linezolid
- doxycycline
- SMZ/TMP

73
Q

Duration of Moderate DFI

74
Q

Severe DFI

A

First Line
- Zosyn, carbapenem, cefepim +clinda/metro

Duration
- 2-3 weeks

MRSA Risk Factors? Add…
- vancomycin
- linezolid
- daptomycin

PHRM 865 (13 decks)

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