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3151 > General > Flashcards

General Flashcards

1
Q

pathogen to cover for impetigo/ecthyma + treatment duration

A

s. aureus + some grp A strep

*just impetigo: give topical mupirocin BD x5d
impetigo/ecthyma: 7d

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2
Q

what penicillin abx to give for GAS vs s. aureus

A

GAS: amoxicillin/ pen V

S. aureus: cloxacillin, cephalexin

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3
Q

what penicillin abx to give for GAS vs strep pneumo

A

GAS: amoxicillin/ pen v

Strep pneumo: pen v, amox, amoxi-clav, piptazo (penicillins: only cloxacillin does not cover strep pneumo); cephalexin, cefuroxime, ceftriaxone, cefepime, ceftaroline (ceftazidime is the only ceph that does not cover strep pneumo)

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4
Q

pathogen to cover for nonpurulent cellulitis + treatment duration

A

cellulitis: deeper tissue involvement -> beta-haemolytic strep (GAS)
*if severe (failed therapy/ immunocompromised) consider MRSA risk factors (IV vanco, dapto, linezolid), consider IV (piptazo, cefepime, meropenem)

IF water exposure -> cover for pseudomonas, vibrio, aeromonas -> cipro 500mg BD

5-10d therapy duration (up: 14d if immunocompromised)

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5
Q

pathogen to cover for purulent cellulitis + treatment duration

A

*purulent: incision & drainage as first-line therapy
-> also indicates s. aureus coverage needed

s. aureus & beta haemolytic strep (GAS) -> start giving abx when moderate (systemic symptoms)

*if skin abscess: cover for pseudomonas + anaerobe -> amoxi-clav (piptazo for long-term stay, carbapenem if more severe)

5-10d treatment duration

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6
Q

DFI pathogen to cover + treatment duration

A

*clinical presentation: purulent discharge

mild (erythema <2cm around ulcer, NO signs of systemic infection): staph aureus + strep
duration: 1-2 weeks

moderate (erythema >2cm around ulcer, NO signs of systemic infection - deeper tissue infection)
ADD ON gram -ve (+/- pseudomonas) + anaerobes
[amoxi-clav | cefazolin/ceftriaxone + metronidazole]
^these do not cover P. aeruginosa
*consider MRSA risk
duration: 1-3 weeks

severe (erythema >2cm around ulcer WITH signs of systemic infection)
COVER P. aeruginosa -> piptazo| cefepime + metronidazole
*consider MRSA risk
duration: 2-4 weeks

*consider surgery with bone involvement:
- if infected bone + surrounding tissues removed COMPLETELY -> 2-5d abx
- if residual infected tissue -> 1-3 weeks
- if residual viable bone -> 4-6weeks
- if residual dead bone -> >3months

**DO NOT CONTINUE ABX UNTIL WOUND HEALING

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7
Q

pathogen to cover for pharyngitis + treatment duration

A

GAS -> pen V, amoxicillin

duration: 10d

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8
Q

pathogen to cover for acute rhinosinusitis + treatment duration

A

Strep pneumo + haemophilus influenzae -> amoxi-clav / amox (if no H. influenzae)
(cloxacillin does not cover for strep penumo)

*some: s. pyogenes, moraxella caterrhalis, anaerobic bacteria

duration: 5-7d

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9
Q

pathogen to cover for outpt CAP w no comorbidities

A

strep pneumo -> amox/ respi FQ (levo/moxi)
duration: minimum 5d

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10
Q

pathogen to cover for outpt CAP WITH comorbidities

A

strep pneumo
Haemophilus influenzae
atypicals
-> beta lactam (amoxi-clav, cefuroxime) + macrolide/doxycycline (azithro/ clarithro) OR respi FQs (levo/moxi)

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11
Q

pathogen to cover for inpt NONSEVERE CAP

A

strep pneumo + H. influenzae + atypical
*consider MRSA, P. aeruginosa risk factors

beta-lactam(amoxi-clav/ cefuroxime) + macrolide/doxycycline/ respi FQs

if MRSA: add IV vanco OR PO/IV linezolid
if P.aeruginosa: modify to include [piptazo, cefepime, ceftazidime, meropenem/ levo]

*ceftazidime does not cover strep pneumo, need beta lactam to ensure coverage

duration: minimum 5d

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12
Q

pathogen to cover for inpt SEVERE CAP

A

strep pneumo+ H. influenzae + atypicals
PLUS
S. aureus + BURKHOLDERIA PSEUDOMALLEI + Klebsiella pneumonia

beta lactam + CEFTAZIDIME + macrolide
OR
respi FQ + CEFTAZIDIME

*if MRSA/ P. aeruginosa risk factors -> add on vanco/linezolid // ensure ceftazidime/levo in regimen

*LUNG ABSCESS: ANAEROBE COVERAGE (IV/PO clindamycin OR metronidazole)

duration: minimum 5d

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13
Q

pathogen to cover for VAP/HAP + treatment duration

A

pathogen: S. aureus, P. aeruginosa, enterobacterales (e.coli/ kleb/ proteus)

*cover MRSA based on risk factor
*if p. aeruginosa risk factor -> DOUBLE antipseudomonal agents required
(beta-lactam AND/OR FQs)

*aminoglycosides should not be the sole antipseudomonal agent

Duration: 7d (regardless of pathogen)

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14
Q

pathogen to cover for uncomplicated/ community-acquired UTI + treatment duration

A

E. coli (>85%), S. saprophyticus (5-15%), gut enterobactericeae (enterococcus faecalis, klebsiella pneumoniae, proteus)
-> nitrofurantoin (5d)/ bactrim (3d)/ fosfomycin(1 dose)/ beta-lactam(5-7d)/ FQs (3d)

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15
Q

pathogen to cover for COMPLICATED /healthcare- associated UTI

A

E.coli (~50%), enterococci, proteus, klebsiella, enterobacter, p. aeruginosa

-> IV imi/mero, IV cefepime + amikacin, PO cipro/levo (less sick)

*CA-UTI: IV imi/mero/cefepime+amikacin, PO/IV levo x5d (mild), PO bactrim x3d (women <65 w/o upper UTI symptoms after catheter removed)

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16
Q

pathogen to cover for meningitis in neonates (<1mths) + treatment duration

A

Group B strep (covered by ampicillin) - treat for 14-21d
E. coli (covered by ceftriaxone/ampicillin)
listeria monocytogenes (covered by ampicillin) - treat for >/=21d

17
Q

pathogen to cover for meningitis in infants (1-23mths) + treatment duration

A

strep pneumo (covered by vanco) - 10-14d
Neisseria meningitidis (covered by ceftriaxone) - 5-7d

s. agalactiae (grp B strep)
E.coli

18
Q

pathogen to cover for meningitis in children & adult (2-50y/o) + treatment duration

A

Strep peneumo (covered by vanco) - 10-14d
Neisseria meningitidis (covered by ceftriaxone) - 5-7d

19
Q

pathogen to cover for meningitis in elderly (>50y/o) + treatment duration

A

strep pneumo (covered by vanco) - 10-14d
Neisseria meningitidis (covered by ceftriaxone) - 5-7d

Listeria monocytogenes (covered by ampicillin) - >/=21d
Aerobic gram -ve bacilli (ecoli, klebsiella)

20
Q

what is the sirs criteria

A

Systemic Inflammatory Response Syndrome criteria:

Temperature: >38 OR <36
Heart rate >90bpm
Respiratory rate >24 breaths/min
WBC > 12 x 10^9/L OR <4 x 10^9/L

21
Q

what antibiotics cover for enterobacterales

A

enterobacterales: E. coli, Klebsiella, Proteus

MACROLIDES do not cover; Pen G/V dont cover, amox/ampi only covers E. coli, metronidazole/ clindamycin doesnt cover

only amoxi-clav/piptazo covers,
all cephs cover, carbapenems cover, tetracycline (controversial), AGs cover, FQs cover
bactrim covers

22
Q

which abx provides MRSA coverage

A

oral: doxycycline, bactrim, clindamycin
IV: Vanco, linezolid

daptomycin (IV) only for SSTI; NOT for respi infxn

23
Q

which abx CANNOT cover strep pneumo

A

cloxacillin
cephalexin/cefazolin
ceftazidime
macrolides (controversial)
AG
CIPRO
bactrim (controversial)
metronidazole
clindamycin (controversial)

(all penicillins cover except clox, all cephs except cephalexin,cefazolin&ceftazidime)

24
Q

which abx covers haemophilus influenzae

A

pencillins: only amoxi-clav & piptazo;
all cephs cover
carbapenems cover
macrolides cover
AGS DO NOT COVER
tetracyclines cover
FQs cover
bactrim controversial
metronidazole, clindamycin DO NOT COVER

25
Q

General counseling points for doxycycline

A

take with/ without food
- WITH food if GI upset

take with a FULL GLASS OF WATER; sit upright for at least 30mins (prevent heartburn)

SEPARATE ADMINISTRATION from MILK/ Ca/ Fe – at least 2h APART

26
Q

Pointers to take note of for cipro

A

DDI WITH Ca/ divalent cations (Mg, Al) in ANTACIDS/ dietary supplements

27
Q

DDI for cefuroxime?

A

PPI (higher pH decreases absorption of cefuroxime)

3151 (7 decks)

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