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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
Acute Pharyngitis Alternative Treatment
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...
26
ABRS Symptoms
- 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
27
Common Pathogens ABRS
Most Common: - Streptococcus pneumoniae - Haemophilus influenzae - Moraxella catarrhalis Pathogens in Patients with Frequent Abx Use: - Staphylococcus aureus - Pseudomonas aeruginosa
28
Treatment OVerview ABRS
1. initiate antibiotic therapy as soon as bacterial infection established 2. watchful waiting up to 7 days to observe improvement
29
Med Treatment ABRS First Line
- 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
30
Med Treatment ABRS Second Line
- 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
31
ABRS Concern for MRSA
- add agent with MRSA coverage (doxy/TMP/SMX, linezolid, clindamycin) - maintain coverage for common organisms unless cultures suggest monomicrobial infection with MRSA
32
ABRS Concern for Pseudomonas
- levofloxacin 750 mg PO daily - maintain coverage for common organisms unless suggest monomicrobial infection with pseudomas aeruginosa
33
Duration of ABRS Treatment
5-7 days
34
Duration of Acute Pharyngitis treatment
10 days (cefpodoxime 5-10 days)
35
Characteristics of Uncomplicated UTIs
- patient not meeting criteria for complicated UTI - pre-menopausal women - normal anatomy
36
36
Characteristics of Complicated UTIs
- anatomical abnormality of urinary tract - recent urologic procedure or instrumentation - immunocompromised patients - recurrent infections despite appropriate treatment - male sex - UTI in pregnancy
37
Diagnosis of UTI
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
Treatment of Asymptomatic Bacteriuria
- No treatment - only in pregnancy
39
Outpatient Approach Oral Agents
- Nitrofurantoin (uncomplicated only) - Bactrim - ciprofloxacin/levofloxacin - Fosfomycin (uncomplicated only) - Cephalexin - Cefadroxil - Cefpodoxime - Amoxicillin/clavulanate - Amoxicillin (only after susceptiblity is confirmed)
40
Duration of Treatment UTI Nitrofurantoin
5 days uncomplicated
41
Duration of Treatment UT Bactrim
- 3 days (uncomplicated) - 7-14 days (complicated)
42
Duration of Tx UTI Bactrim
- 3 days (uncomplicated) - 7-14 days (complicated)
43
Duration of Tx UTI Cipro
- 3 days (uncomplicated) - 7 days (complicated)
44
Duration of Tx UTI Cephalexin or Cefadroxil
- 3-7 days (uncomplicated) - 7-14 days (complicated)
45
Duration of Tx UTI Cefpodoxime
- 3-7 days (uncomplicated) - 7-14 days (complicated)
46
Duration of Tx UTI Augmentin
- 3-7 days (uncomplicated) - 7-14 days (complicated)
47
Inpatient Approach to UTI Tx
- 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
Duration of Inpatient treatment
7-14 days
49
Can oral be used in patient for UTI
yes as long as they have good bioavailabithy
50
Prostatitis Treatment
- FQs, Bactrim, cephalexin, augmentin
51
Treatment for Prostatitis duration
2-4 weeks
52
SSTI classification
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
Mild Non Purulent SSTI TX
Oral Antibiotics - Penicillin VK - Cephalosporin - Dicloxacillin - Clindamycin
54
Moderate Nonpurulent SSTI Tx
Parenteral Treatment - Penicillin - Ceftriaxone - Cefazolin - Clindamycin
55
Severe Non purulent SSTI treatment
Surgical - emergent surgical inspection/debridement Empiric Antibiotics - vancomycin (MRSA) + zosyn (anaerobes+pseudomonas) After Culture and Susceptibilities - narrow therapy based on culture and sensitivity
56
Treatment duration SSTI non purulent
5 days
57
Purulent Mild SSTI Treatment
incision and drainage
58
Purulent moderate SSTI treatment
- incision and drainage - culture and susceptibilities Empiric Antibiotics - TMP/SMX - Doxycycline
59
Target antibiotics for MRSA in Moderate Purulent SSTI
- TMP/SMX - Doxycycline
60
Target antibiotics for MSSA in Moderate Purulent SSTI
- dicloxacillin - cephalexin
61
Severe Purulent SSTI Severe Treatment
- incision and drainage - culture and susceptibilities Empiric Antibiotics - Vancomycin - Daptomycin - Linezolid
62
Target Antibiotics for Severe Purulent Treatment SSTI
Target Antibiotics - MRSA - see empiric - MSSA - Nafcillin - cefazolin - clindamycin
63
Duration of Treatment Purulent SSTI
5 days
64
NF Treatment
- SURGICAL INTERVENTION AND BROAD SPECTRUM ANTIBIOTICS Empiric Antibiotics - vancomycin plus zosyn Targeted Antibiotics - GAS --> PCN + clindamycin - Polymicrobial --> Vancomycin + Zosyn
65
Duration NF
- further debridement is no longer necessary - patient has improved clinically - fever has been absent for 48-72 hours
66
Treatment of Bites
- DOC --> augmentin - Alternative --> 2nd/3rd generation cephalosporin + anaerobic coverage - beta lactam allergy --> cipro/levo +anaerobic coverage or moxifloxacin
67
Duration of treatment of bites
7-14 days
68
Risk Factor MRSA of DFI
- previous MRS A infection within past year - local MRSA prevelance > 30-50% - recent hospitalization - failed on non-MRSA antibiotics
69
Risk Factor Pseudomonas of DFI
- history of pseudomonas infection - soaking feet in water - warm climate - severe infection - failed non-pseudomonal antibiotics
70
Mild DFI Treatment
First Line - dicloxacillin, cephalexin, clindamycin Recent Antibiotics? Switch to... - Augmentin or Levo/Moxi MRSA Risk Factors? Switch to... - SMZ/TMP or Doxycycline
71
Duration of Mild DFI
1-2 weeks
72
Moderate DFI Treatment
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
Duration of Moderate DFI
2-3 weeks
74
Severe DFI
First Line - Zosyn, carbapenem, cefepim +clinda/metro Duration - 2-3 weeks MRSA Risk Factors? Add... - vancomycin - linezolid - daptomycin

PHRM 865 (14 decks)

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