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Infectious Disease > Final > Flashcards

Final Flashcards

1
Q

Uncomplicated Cystitis

A

Non pregnant, young female
Bactrim x 3 days (avoid if resistance is known or if used in previous 3 months)
Cipro/levo x 3 days
Nitrofurantoin x 5 days (avoid if early pyelonephritis is suspected)
Beta-lactams x 3-7 days
Fosfomycin

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2
Q

Complicated cystitis

A

DM, > 65, Pregers
Bactrim x 7-10 days
Cipro/levo x 7-10 days
Augmentin x 7-10 days

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3
Q

Acute pyelonephritis

A

Cipro IV x 24-48 hours, then PO > 14 days

+/- doxycycline/azithromycin (chlamydia)

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4
Q

Acute prostatitis

A

Bactrim x 21 days

Cipro/levo x 21 days

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5
Q

< 3 UTIs / year

A

Treat as a separate infxn

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6
Q

> /= 3 UTI’s per year or UTI in the past 6 months

A

Bactrim
TMP
Nitrofurantoin
Cipro/levo

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7
Q

UTI Post-Coital Prophylaxis

A

Bactrim
Nitrofurantoin
Cephalexin
FQs (except moxi)

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8
Q

UTIs in pregnancy

A

1st gen Ceph x 7-10 days
Augmentin
Nitrofurantoin
Bactrim (except for 3rd trimester)

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9
Q

UTIs in children

A

Amoxil
Augmentin
Ceph 1st and 2nd generation

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10
Q

Impetigo

A

Superficial
Children/poor hygiene
S. aureus including MRSA and Group A strep

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11
Q

Impetigo treatment

A 
Wash gently with soap and water
Localized = Topical mupirocin or retapmulin x 5 days
Extensive = oral x 7 days
Keflex
Augmentin
Dicloxacillin
MRSA suspected = Bactrim, clinda, doxycycline
If streptococci alone = PCN G PO
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12
Q

Small furuncles

A

Moist heat to promote drainage

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13
Q

Large furuncles and Carbuncles

A

Incision and drainage required

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14
Q

Mild furuncles/carbuncles

A

Abx usually not needed

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15
Q

Moderate furuncles/carbuncles

A

PO x 5-10 days
Empiric: Bactrim, doxycycline
Defined: MRSA: Bactrim
MSSA: Dicloxacillin/cephalexin

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16
Q

Severe furuncles/carbuncles

A 
IV 5-10 days
Empiric: Vanc, telovancin, dalbavancin, oritovancin
Linezolid
Dapto
Ceftaroline
Defined: MRSA: Same as above
MSSA: nafcillin, oxacillin, clinda
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17
Q

Erysipelas

A

Very young/old
Group A strep
“Orange peel”
PCN G (IM, PO, IV) or amoxil x 7-10 days

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18
Q

Cellulitis (MSSA)

A 
Group A strep and staph aureus
x 5 days
IV agents: Nafcillin/oxacillin
PO agents: Dicloxacillin
IV if PCN-allergic: Cefazolin
PO if PCN allergic: Keflex
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19
Q

Cellulitis (MRSA)

A

7-10 days

IV agent: Vanc

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20
Q

Necrotizing Fasciitis (Type 1)

A

Mixed anaerobes, GNR, enterococci
Vanc/Linezolid + pip/tazo/carbapenems
OR
Vanc/Linezolid + ceftriaxone + metronidazole

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21
Q

Necrotizing Fasciitis (Type 2)

A

Group A strep (S. pyogenes)

Clinda + PCN G

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22
Q

Diabetic foot infection (mild)

A

MSSA, streptococcus spp.
Cephalexin
Augmentin
MRSA: Doxycycline, Bactrim

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23
Q

Diabetic Foot Infections (moderate to Severe)

A

1-2 weeks
MSSA, Streptococcus spp. Enterobacteriaceae, obligate anaerobes:
Amp/sulb
Ertapenem
Imipenem/cilstatin
MRSA: Dapto/vanco
Pseudomonas: Pip/tazo
MRSA, enterobacteriaceae, p. aeruginosa, obligate anaerobes:
Vanc + ceftaz/cefepime/piptazo or carbapenem
+/- anaerobic coverage if not using pip/tazo or carbapenem (metro, clinda)

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24
Q

Osteomyelitis (MSSA)

A

Nafcillin/oxacillin
Allergy: cefazolin/ceftriaxone
IV x 4-6 weeks

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25
Q

Osteomyeslitis (MRSA)

A

Vanc
Dapto
Linezolid
IV x 4-6 weeks

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26
Q

Osteomyelitis (pseudomonas)

A 
Pip/tazo
Cefepime
Cipro
Imipenem/cilstatin
IV x 4-6 weeks
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27
Q

Osteomyelitis (Enterobacteriaciae)

A

Pip/tazo
Ceftriaxone
Cipro
IV x 4-6 weeks

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28
Q

Osteomyelitis (Streptococci)

A

PCN G (DOC)
Clinda (if allergy)
Ceftriaxone

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29
Q

Animal bite

A

Augmentin x 10-14 days

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30
Q

Human bite

A

10-14 days
Augmentin
ERtapenem
Amp/sulb

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31
Q

HPV vaccine

A

not for preg women
Females 11-26 yo x 3 doses
Males 11-21 yo x 3 doses

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32
Q

N. gonorrhea

A

Gram - intracellular diplococci

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33
Q

Chlamydia

A

Will see nothing on gram stain

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34
Q

Uncomplicated urethritis (. gonorrhea)

A

Ceftriaxone 250mg IM x 1 dose
+
Azithromycin 1g PO x 1 dose

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35
Q

Complicated Urethritis (N. gonorrhea)

A 
Ceftriaxone 1g IM or IV q24 
\+
Azithro 1 g PO x 1 dose
Then
Cefixime 400mg PO BID > 1 week
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36
Q

N Gonorrhea Endocarditis

A

Ceftriaxone 1-2g IV q12 > 4 weeks
PLUS
Azithromycin 1g PO x 1

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37
Q

PID organisms

A

GNRs, anaerobes, H influenzae, S. agalactiae, chlamydia, n. gonorrhea, mycoplasma

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38
Q

PID (inpatient)

A 
Cefotetan 2g IV q12 
OR 
Cefoxitin 2g IV q6h + doxy 100mg q12 x 14 days
OR
Clinda 900mg IV q8 x 14 days + gent
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39
Q

PID (outpatient)

A

Ceftriaxone 250mg x 1 + doxy 100mg BID x 14 days

+/- metronidazole 500mg BID x 14 days

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40
Q

Syphilis

A

Treponema pallidum
Spirocjete
Test w/DFA

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41
Q

Syphilis (early)

A

Primary, secondary (RASH), Latent < 1 yr

Benzathine 2.4 MU IM x 1

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42
Q

Syphilis (late) (if no CNS findings)

A

> 1 year, or duration unknown

Benzathine 2.4 MU/week IM x 3 weeks

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43
Q

Syphilis (CNS findings)

A

Aqueous PCN G 18-24 MU IV daily x 10-14 days
PLUS
Benzathine 2.4MU/week IM x 3weeks

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44
Q

Jarsch-Herxheimer rxn

A

Rxn w/PCN injection
Not allergy
Support w/APAP and fluids

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45
Q

Syphilis (pregnancy)

A

Treat as if not pregnant

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46
Q

HSV

A

Acyclovir x 5 days
Famciclovir 1500mg x 1
Valacyclovir 2g BID x 1

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47
Q

Bacterial Vaginosis

A

Fishy vaginal odor
Metronidazole 500mg BID x 7 days
Metro Gel 0.75% qhs x 5 days
Clinda Cream 2% qhs x 7 days

48
Q

Trichomoniasis

A

Yellow/green discharge with vulbular irritation
Metronidazole 2g PO x 1
Tinidazole 2g PO x 1

49
Q

VVC

A

Complicated = topical azole x 7 days or fluconazole 150mg q72h x 3 doses

50
Q

Oropharyngeal Candidiasis

A 
C. albicans
White patches
Mild: 7-14 days
Clotrimazole troches 10mg 5 times daily
Miconazole mucoadhesive buccal 50mg tab to upper gum
Moderate-severe x 7-14 days
Fluconazole 100-200mg daily
51
Q

Esophageal Candidiasis

A

Ulcerations x 14-21 days
Fluconazole 200-400 PO daily
Echincandin
Prophylaxis = not recommended

52
Q

Invasive candidiasis (Non-Neutropenic)

A

Moderately-severely ill = capsofungin x 14 days after 1st (-) cx

53
Q

Invasive Candidiasis (Neutropenic)

A

Echinocandin x 14 days after 1st (-) cx

54
Q

Invasive candidiasis (pregs)

A

Systemic Ampho B only

55
Q

Candiduria

A 
Asymtomatic = only treat neonates and neutropenic adults
Symptomatic = fluconazole 200mg x 14 days
Pyelonephritis = fluconazole 200-400mg x 14 days
56
Q

Aspergillus (BPA) - A. fumigatus

A

Corticosteroids + itraconazole

57
Q

Aspergilloma

A

Sinuses/pulmonary

Chronic = Voriconazole

58
Q

Aspergillus (invasive)

A

Voriconazole 6mg/kg IV x 1 day, then 4mg/kg IV q12h > 6-12 weeks

59
Q

PCP Treatment Mild-moderate

A

Bactrim 5-20mg/kg/day PO in 3 divided doses

Bactrim DS 2 tabs TID

60
Q

PCP Treatment Moderate-Severe

A

Bactrim 15-20 mg/kg/d IV in 3-4 divided doses x 21 days

Switch to PO after clinical improvement

61
Q

PCP prophylaxis

A

Bactrim 1 tab QD until CD4 > 200 > 3 months

62
Q

Toxoplasma treatment

A

Sulfadiazine + pyrimethamin + leucovorin x >/= 6 weeks

63
Q

Toxoplasma prophylaxis

A

Bactrim DS daily until CD4 > 200 > 3months

64
Q

Toxoplasma chronic maintenance

A

Sulfadiazine + pyrimethamine + leucovorin until CD4 > 200 > 6 months

65
Q

Cryptococcal Meningitis Treatment

A

CD4 < 150
Ampho B + 5-FC x at least 2 weeks
Followed by fluconazole 400mg x weeks, then fluconazole 200mg QD for at least 1 year

66
Q

Cryptococcal Meningitis Prophylaxis

A

Not recommended

67
Q

Cryptococcal meningitis chronic suppression

A

Fluconazole 200mg QD until CD4 > 100 for at least 3 months

68
Q

MAC treatment

A

Clarithromycin 500mg BID + EMB 15mg/kg/d (eye exam)
Azithro 500-600mg QD + EMB 15mg/kg/d
DDI or intolerance precludes the use of claritho
1 year of treatment and CD4 > 100 > 6 months

69
Q

MAC primary prophylaxis

A 
CD4 <50
Azithro 1200mg weekly
Azithro 600mg twice weekly
Clarithro 500mg BID
Until CD4 > 100 > 3 months
70
Q

CMV induction

A

Occurs at CD4 < 50

71
Q

CMV retinitis

A

Sight threatening leasions
Ganciclovir or foscarnet for 1-4 doses over 10 days
PLUS
Valganciclovir 90mg PO BID x 14-21 days then once daily

72
Q

CMV retinitis for small peripheral lesions

A

Ganciclovir x 2142 days or until resolution of symptoms

PO valganciclovir if PO absorption adequate

73
Q

CMV neurological disease

A

Ganciclovir IV
PLUS Foscarnet IV until symptom improvement
MD w/PO valganciclovir + IV foscarnet lifelong unless evidence of immune recovery

74
Q

CMV suppression (secondary prophylaxis)

A

Valganciclovir 900mg QD until CD4 > 100 >3-6 months

75
Q

Confirmation of TB

A

PPD, CXR, Sputum cx with AFB smear for 3 days

76
Q

Latent TB

A

INH QD x 9 months (no DOT)

INH + Rifapentin once a week for 12 weeks (w/DOT)

77
Q

Active TB

A

INH/EMB/RIF/PZA + pyridoxine x 8 weeks
then INH + pyridoxine + RIF x 18 weeks
Extrapulmonary/meningitis x 12 months

78
Q

MDR-TB

A

Resistant to RIF and INH

do not use 12 week regimen

79
Q

Otitis Media pathogens

A

Viral (most common)
Strep pneumonia
M. catarrhalis
H. influenzae

80
Q

Otitis media tx

A

Severe: Amox 875mg Q12 or 500mg Q8 x 10 days
Mild-moderate: Amox 500mg Q12 or 250mg Q8 x 5-7 days
PCN allergic: Azith/Clarithro/Bactrim

81
Q

Pharyngitis pathogens

A

Viral

GABHS

82
Q

Pharyngitis tx

A 
PCN VK
PCN G
Amox
Ceph
PCN allergy: Azith/Clarith/Eryth
83
Q

Recurrent Pharyngitis tx

A

Clinda
Augmentin
PCN G +/- RIF

84
Q

Sinusitis organisms

A 
Viral (7-10 days or less)
Bacterial (> 10 days)
Strep pneumoniae
M. Catarrhalis
H. influenziae
85
Q

Acute sinusitis tx

A 
Treat sx
Analgesic/antipyretic
Topical/systemic decongestants
Saline and steam
Topical nasal steroids
ABX
86
Q

Acute Sinusitis ABX

A 
Amox
Cefpodoxime
Cefuroxime
Cefdinir
Beta lactam allergy: Bactrim SS, Doxy, Clarithro, Azithro, Erythro
87
Q

Recurrent sinusitis tx

A

Augmentin
Ceftriaxone
Levo/Moxi
Beta-lactam allergy: levo/moxi, clinda

88
Q

Acute bronchitis pathogens

A

Viral
Mycoplasma pneumoniae
Chlamydia pneumoniae
Bordatella pertussis

89
Q

Acute bronchitis symptoms

A 
Cough (hallmark)
Ronchi
Bilateral rales
Fever
HA
Malaise
90
Q

Acute bronchitis treatment

A

Supportive
APAP, ibuprofen, DTM, codeine, nasal decongestants
ABX - for pts w/persistent fever or respiratory sx longer than 4-6 days
Macrolides/FQs

91
Q

Chronic Bronchitis Tx

A

STOP SMOKING
Long-acting beta2 agonists
Long-acting anticholinergics
Inhaled corticosteroids

92
Q

Chronic bronchitis exacerbation

A 
Mild-moderate:
Amox
Doxy
Bactrim
2nd/3rd generation ceph
Severe:
Augmentin
Azith/Clarith
2/3rd gen ceph
Levo/moxi
93
Q

Outpatient CAP

A

Healthy + no abx w/in 3 months:
Macrolides/doxy
Comorbidities, immunocompromised, or abx w/in 3 months:
Respiratory FQs
Beta-lactams (high dose amoxil or augmentin) PLUS a macrolide

94
Q

Inpatient CAP (non-ICU)

A

Respiratory FQs

Beta-lactams (cefotaxime/ceftriaxone/ampsulb/eratapenem) + Macrolide

95
Q

Inpatient CAP (ICU)

A

Levo/Moxi

Beta-lactams (cefotaxime/ceftriaxone/ampsulb) + Azithro or Moxi/Levo

96
Q

HAP risk factors for MDR

A 
Hospitalizations 2 days or more within 90 days
Residency in LTC or nursing home
Home infusion therapues
Chronic dialysis q/in 30 days
Home wound care
Family member with MDR pathogen
97
Q

HAP treatment: No risk and no factors increasing MRSA

A

Pip/tazo
Cefepime
Levo
Imipenem/Meropenem

98
Q

HAP treatment: No risk but with factors increasing MRSA

A 
Pip/tazo
Cefepime/Ceftazidime
Levo/Cipro
Imipenem/Meropenem
Aztreonam
PLUS
Vanc/linezolid
99
Q

HAP treatment: High risk or recipeint of IV ABX during the prior 90 days

A 
Pick 2
Pip/tazo
Cefepime/Ceftazidime
Levo/Cipro
Imipenem/Meropenem
Aztreonam
AGs
PLUS
Vanc/linezolid
100
Q

Meningitis age and organisms

A

< 1 month = S. agalactiae, E. coli, monocytogenes, klebsiella spp.
1-23 months = S. pneumo, H. flu, E. coli, N. meningitidis, S. agalactiae
2yr-50 years = N. meningitidis, S. pneumo
> 50yr = S. pneumonia, N, meningitidis, L. monocytogenes, aerobic gram- bacilli

101
Q

Meningitidis tx with age

A

< 1 month = Amp + cefotaxime
OR
AMP + AG
1-23 months = Vanc + cefotaxime (or ceftriaxone)
2yr-50yr = Vanc + cefotaxime (or ceftriaxone)
> 50yr = can + cefotaxime (or ceftriaxone) + amp

102
Q

Meningitidis tx duration based on organism

A 
N. meningitidis 7d
H. flu 7d
S. pneumo 7-14 days
S. agalactiae 14-21 days
Gram - anaerobes 21d
Listeria > 21d
103
Q

Endocarditis Streptococcal:

Native MIC < 0.12

A

PCN G / Ceftriaxone x 4 weeks

104
Q

Endocarditis Streptococcal:

Native MIC 0.12-0.5

A

PCN G / Ceftriaxone x 4 weeks + gent x 2 weeks

Vanc x 4 weeks

105
Q

Endocarditis Streptococcal:

Native MIC > 0.5

A

Vanc + Gent x 6 weeks

106
Q

Endocarditis Streptococcal:

Prosthetic MIC < 0.1

A

PCN G / Ceftriaxone x 6 weeks +/- gent x 2 weeks

107
Q

Endocarditis Streptococcal:

Prosthetic MIC > 0.12

A

PCNG x 6 weeks + gent 6 weeks

Vanc x 6 weeks

108
Q

Endocarditis Staphylococcal:

Native MSSA

A

Nafcillin/oxacillin x 6 weeks

109
Q

Endocarditis Staphylococcal:

Native MRSA

A

Vancomycin x 6 weeks

110
Q

Endocarditis Staphylococcal:

Prosthetic MSSA

A

Nafcillin/oxacillin + rifampin > 6 weeks + gent x 2 weeks

111
Q

Endocarditis Staphylococcal:

Prosthetic MRSA

A

Vanc + rifampins > 6 weeks + gent x 2 weeks

112
Q

Endocarditis Enterococcal:

PCN/GENT/Vanc susceptible

A

Amp + Gent x 4-6 weeks

Vanc + Gent x 6 weeks

113
Q

Endocarditis Enterococcal:

PCN susceptible but gent resistant

A

Amp + ceftriaxone x 6 weeks

114
Q

Endocarditis Enterococcal:

PCN resistant, but susceptible to vanc and AGs

A

Vanc + gent x 6 weeks

115
Q

Endocarditis Enterococcal:

PCN/GENT/Vanc resistant

A

Linezolid/dapt > 6 weeks

116
Q

Endocarditis (HACEK) tx

A

Ceftriaxone or Amp/sulb
Native = 4 weeks
Prosthetic = 8 weks

117
Q

Endocarditis Dental prophylaxis

A

Amoxil 2g PO 30-60 min prior appt

Infectious Disease (19 decks)

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