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ID**** Flashcards

1
Q

Gram + cluster species

A

-MSSA
-MRSA

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2
Q

Gram + Pairs & Chains

A

-strep. pneumoniae
-strep. pyogenes
-entroccus (VRE)

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3
Q

Gram + Rods

A
  • listeria
    -monocytogens
    -corynebacterium spp
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4
Q

Gram + Anaerobes

A

-peptostreptococcus
-propionibacterium acnes
-clostridioides difficile
-clostridium spp.

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5
Q

Gram - cocci

A

neisseria spp

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6
Q

Gram - rods, colonizing the gut

A

-proteus mirabilis
-E. coli
-Klebsiella
-serratia
-enterobacter cloacoe
-citrobacter

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7
Q

Gram - rods, that do not colonize gut

A

-pseudomonas aergunosa
-haemophilus influenzae
-providencia

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8
Q

Gram - Anaerobes

A

-bacteroides fragilis
-prevotella spp

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9
Q

Gram - Coccobacilli

A

-acinetobacter baumannil
-bordertella pertussis
-moraxella catarrhalis

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10
Q

Gram - curved or spiral shaped rods

A

-H. pylori
-Campylobacter
-treponema
-Barrelia
-Leptospira

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11
Q

Common Resistant Pathogens

A

Kill Each and Every Strong Pathogen
-klebsiella pneumoniae
-escherichia coli
-acinetobacter baumannii
-enterococcus faecalis/faecium
-staphylococcus aureus
-pseudomonas aerginosa

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12
Q

Natural Penicillins: Pen V, Pen G

A

-covers gram + cocci, gram + anaerobes (in mouth)
PO: pen V, IV/IM: pen G,

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13
Q

Aminopenicillins: amoxicillin, ampicillin

A

-covers gram + cocci, gram + anaerobes (in mouth)
-adds on gram - coverage (HNPEK)
-PO amoxicillin, IV ampicillin

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13
Q

Aminopenicillin + Beta-lactamase Inhibitors: amoxicillin/clavulanate, ampicilin/sulbactam

A

-covers gram + cocci, gram + anaerobes (in mouth)
- gram - coverage (HNPEK)
-adds MSSA, more resistant strains of HNPEK, gram - anaerobes (B. fragilis)
- PO augmentin, IV unasyn

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14
Q

Extended-spectrum + beta-lactamase inhibitor: piperacillin/tazobactam

A

-covers gram + cocci, gram + anaerobes (in mouth)
- gram - coverage (HNPEK)
-MSSA, more resistant strains of HNPEK, gram - anaerobes (B. fragilis)
-adds CAPES, + pseudomonas
-IV only

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15
Q

Anti-staphylococcal: nafcillin, oxacillin

A

-covers MSSA and streptococci only!
-both IV
PO: dicloxacillin

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16
Q

Penicillin class trends

A

-all cover enterococcus (except antistaphylococcal penicillins)
-do NOT cover atypicals (penicillin are cell wall active agents and atypical dont have cell walls) or MRSA

-do not use with beta lactam allergies or risk of seizures

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17
Q

outpt/PO penicillin usage: Penicillin VK

A

-strep throat
-mild skin infections

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18
Q

outpt/PO penicillin usage: Amoxicillin (Moxatag)

A

-acute otitis media (90 mg/kg/day)
-infective endocarditis ppx before dental procedures ( 2 g po x1 30-60 mins before)
-H. pylori tx

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19
Q

outpt/PO penicillin usage: Amoxicillin/Clavulanate (Augmentin)

A

-acute otitis media (90 mg/kg/day)
-bacterial sinusitis
–> use lowest dose of clavulanate to dec diarrhea

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20
Q

outpt/PO penicillin usage: Doxioxacillin

A

-covers MSSA and streptococci only
-does not need renal adjustment

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21
Q

Inpatient/parenteral use of Penicillins: Pen G (Bicillin-L-A)

A

-drug of choice for syphilis (2.4 mil units IM x1)
–>**never use IV = death

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22
Q

Inpatient/parenteral use of Penicillins: Piperacillin/Tazobactam (Zosyn)

A

-only one active against pseudomonas
-extended infusion (4 hrs) can be used to maximize T > MIC

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23
Q

Inpatient/parenteral use of Penicillins: Nafcillin and Oxacillin

A

-covers MSSA and streptococci only
-does not need renal adjustment

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24
Q

1st gen cephalosporins

A

-IV: cefazolin
-PO cephalexin (Keflex)
–> cover staphylococci, streptococci, PEK, mouth anaerobes

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25
Q

2nd generation cephalosporins

A

-IV/PO/IM: cefuroxime (Ceftin)
–> better gram - activity (HNPEK),
-Cefotetan and Cefoxitine have anaerobic activity (B. fragilis)

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26
Q

3rd generation cephalosporins

A

Group 1:
-IV Ceftriaxone
-PO Cefdinir
–> less staphylococci coverage but better streptococci coverage

Group 2:
-IV ceftazidime, ceftazidime/avibactam
–> pseudomonas

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27
Q

4th generation Cephalosporins

A

IV cefepime
–> broad spectrum: gram +, HNPEK, CAPES, pseudomonas

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28
Q

5th generation cephalosporins

A

IV ceftaroline (Teflaro)
-less staphylococci coverage but better streptococci coverage
HAS MRSA COVERAGE

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29
Q

Cephalosporin class trends

A

-no enterococcus coverage
-does not cover atypical
-do not use with beta-lactam allergy and risk of seizures

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30
Q

outpt/oral cephalosporins: 1st gen

A

–> Cephalexin (Keflex)
-strep throat, MSSA skin infections (Staph)

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31
Q

outpt/oral cephalosporins: 2nd generation

A

–> Cefuroxime
-acute otitis media, CAP, sinus infections

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32
Q

outpt/oral cephalosporins: 3rd generations

A

–> Cefdinir (Omnicef)
- CAP, sinus infections

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33
Q

Inpt/parenteral cephalosporin use: 1st gen

A

–> cefazolin
-surgical prophylaxis

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34
Q

Inpt/parenteral cephalosporin use: 2nd gen

A

–> Cefotetan, Cefoxitin
-anaerobic coverage (B. fragilis)
-surgical ppx (GI procedures)

–> Cefotetan
AE: can cause a disulfiram-like reaction w/ alcohol ingestion

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35
Q

Inpt/parenteral cephalosporin use: 3rd gen

A

–> Ceftriaxone and cefotaxime
-CAP, meningitis, SBP, pyelonephritix

–> ceftriaxone does not need renal adjustment
AE: do not use with neonates (0-28 do)

–> ceftazidime:
-pseudomonas

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36
Q

Inpt/parenteral cephalosporin use: 4th generation

A

–> Cefepime
-pseudomonas

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37
Q

Inpt/parenteral cephalosporin use: 5th generation

A

–> ceftaroline
-MRSA, CAP, skin and soft tissue infections

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38
Q

Carbapenems: Study tip

A

–> IV Meropenem
–> IV/IM Ertapenem (Invanz)

Class effects:
-cover ESBL orgs (e. coli, klebsiella)
-pseudomonas (exceot ertapenem)
-beta-lactam allergy and seizures (do not use)
–> All are IV (NS must be used for ertapenem)

DOES NOT COVER:
-atypical, VRE, MRSA
-Ertapenem does not cover PEA (pseudomonas, enterococcus, acinetobacter)

Common uses:
-polymicrobial infections (severe diabetic foot infection)
-empiric therapy when multi drug resistance are suspected

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39
Q

Exam Scenario: if you see a carbapenem as a choice (meropenem, ertapenem (Invanz)

A

-PCN allergy: do not choose carbs
-if culture is growing EBSL + (e. coli) - yes choose it!
-if the culture is growing pseudomonas: do not choose ertapenem
-PMH: seizures, epileptic drug- do not use

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40
Q

Monobactam: Aztreonam (Azactam)

A

-IV only
CAN BE USED IN PTS WITH BETA LACTAM/PEN ALLERGY
-covers gram -, including pseudomonas

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41
Q

Aminoglycosides facts

A

Gentamicin, tobramycin (trough < 2, draw 30 mins before 4th dose) , amikacin

Coverage:
-gram -, including Pseudomonas, synergy for gram + (staphylococci/Enterococci)

SEs:
-toxicities like nephroxicity, ototoxicity

-taking advantage of the concentration dependent killing –> give larger doses less frequently –> this gives the kidneys time to recover in between doses

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42
Q

Quinolones

A

–> ciprofloxicin, levofloxicin, moxifloxicin, ofloxacin
-concentration-dependent killing
BBW: tendon rupture, peripheral neuropathy, CNS effects (use last line)
Warnings: QT prolongation, hypo/hyprtglycemia, psychiatric disturbances, photosensitivity, avoid use in children
Interactions: chelation with divalent cations

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43
Q

Respiratory quinolones (My Good Lungs)

A

-active againse S. pneumoniae
Levofloxacin
Gemifloxicin
Moxifloxaxin (IV:PO = 1 to 1, not renally adjusted, do not use for UTIs)

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44
Q

Anti-pseudomonal quinolones

A

-levofloxacin ( IV:PO = 1 to 1)
-Ciprofloxacin
–> pseudomonas infections, UTI, intra-abdominal infections, travelers diarrhea

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45
Q

Quinolones profile review tips

A

-caution in pts with CVD, dec mg/k, use of other QT prolonging drugs
-avoid if seizure hx or suing an antiepliptic drug
-avoid in children
-watch for tendon rupture, neuropathy, CNS/psychiatric SEs

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46
Q

Macrolides

A

-Azithromycin (Zithromax)
-Clarithromycin (Biaxin)
-Erythromycin (EES)

Coverage:
-atypical pathogens (Legionella, chlamydia, Mycoplasma, Mycobacterium avium)
-H. influenzae
-S. pneumoniae

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47
Q

Common uses of macrolides

A

-CAP, strep throat
–> Azithromycin: COPD exacerbation, pertussis, chlamydia (in prego pts), ppx for mycrobacterium avium complex, severe travelers diarrhea
- z pack: 500 mg (2 350 mg on day 1), then 250 mg x 4 days
–> Clarithromycin: H. pylori tx
–> Erythromycin: inc gastric motility, used in gasteroparesis

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48
Q

Macrolide safety issues

A

-QT prolongation: caution in CVD, dec Mg/K, use other QT prolonging drugs
-drug interactions: clarith/erthyo: CI with simvastatin and lovastatin

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49
Q

Tetracyclines agents & coverage

A

-Doxycycline (Vibramycin)
-Minocycline (minocin, Solodyn)
-Tetracycline

Coverage:
-S. aureus (including CA-MRSA)
-H. influenzae, Moxraella, atypicals +/- S. pneumo
-Rickettsiae
-H. pylori
-VRE

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50
Q

Common uses of tetracyclines

A

-CA-MRSA skin infections, acne (doxy and mino)
-Doxycycline: tick-borne illness (lymes, rocky mountain spotted fever), chlamydia, CAP, COPD exacerbation, bacterial sinusitis, VRE, UTI
-Tetracycline: H. pylori

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51
Q

Safety issues with tetracyclines

A

-avoid use in children < 8 y/o, pregnancy and breast feeding
-photosensitivity
-interactions w/ divalent cations
-IV:PO = 1 to 1 (doxy, mino)
-mino: DILE

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52
Q

Sulfonamides: sulfamethoxazole/trimethoprim (Bactrim)

A

-dosed based on TMP component
-treat uncomplicated UTI: 1 DS tab PO BID x 3 days

-do not use if sulfa allergy, pregnant or breastfeeding
Warnings: skin reactions (SJS/TEN), G6PD deficiency
SE: photosensitivity, in K, hemolytic anemia (positive Coombs test), crystalluria

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53
Q

SMX/TMP (bactrim) uses and SEs

A

Common uses:
-CA-MRSA infections
-UTI
-Pneumocystis pneumonia

5:1 Ration SMX/TMP: *dosing
-SS tab = 80 mg
-DS tab = 160 mg

Sulfa allergy:
-rash/hives are common
-can causes severe skin reactions

–> can inc INR when used with Warfarin (bactrim is 2C9 inhibitor

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54
Q

Abx for gram + infections: Vancomycin

A

Coverage:
-MRSA
-streptococci
-Enterococci
-C. diff (only time to use PO, 125 mg QID x10d)

Dosing:
-IV: 15-20 mg/kg q8-12 h using TBW (adjust in renal failure)
–>monitor SCr and avoid other nephrotoxic or ototoxic drugs (furosemide, aminoglycosides, cisplatin)

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55
Q

Key points about vancomycin

A

-1st line for MRSA infections (pneumonia, meningitis, bacteremia, some skin infections)
-target through for severe infections: 15-20 mcg/ml
-red man syndrome with rapid infusions
-PO only for c.diff infections (125 mg QID x 10d)
-ototoxicity, nephrotoxicity

**MIC > 2 = do not use

56
Q

Lipoglycopeptides: Telacancin, oritavancin, dalbavancin

A

Coverage:
-MRSA
-streptococci
-Enterococci

-approved fro skin infections (telavancin approved fro HAP/VAP)
-can all cause red man syndrome
–> orit and dalb are single dose regimens
BBW: fetal risk, nephrotoxicty, inc mortality
CI: concurrent use of IV UFH
Warnings: inc aPTT/PT/INR

57
Q

Abx for gram +: Daptomycin (Cubicin)

A

-coverage:
-MRSA
-streptococci
-Enterococc
-VRE

–> approved for SSTIs, bloodstream infections/endocarditis
Warnings: myopathy and rhabdomyolysis, falsely inc PT/INR
-compatible with NS and LR only
*do not use for pneumonia (surfactant in the lungs)
-monitor CPK weekly

58
Q

Oxazolidonones: Linezolid (Zyvox), Tedizolid

A

Covers:
-MRSA
-streptococci
-Enterococc
-VRE

IV:PO = 1:1

CI: no MAOi within 14 days
Warnings: duration related myelosuppression - thrombocytopenia , optic neuropathy
–> Serotonin syndrome: caution! avoid tyramine- containing foods (ages, pickled)

59
Q

Quinupristin/Dalfopristin (synercid(

A

Covers: MRSA, VRE (E. faecium only)
Indications: skin/soft tissue infection
Poorly tolerated: arthralgias/myalgias, infusion reactions, hyperbilirubinrmia- only give via central line
*compatible with D5W only!

60
Q

Tigecycline (Tygacil)

A

Covers: MRSA, VRE, gram -, anerobes, atypical
–> approved fro complicated SSTIs, intra-abdominal infections and CAP

BBW: increased risk of death, do NOT use for blood stream infections
-no activity against: pseudomonas, proteus, providencia
-solution should be yellow-orange in color

61
Q

Polymyxins: Colistimethate sodium, polymyxin B

A

Covers: MDR gram - infections
Toxicities: nephrotoxicity, neurotoxicity

62
Q

Chloramphenicol

A

-broad spectrum abx
-serious blood dycrasias
-gray syndrome (high serum levels, coma and die)

63
Q

Clindamycin (Cleocin)

A

-covers: staphylococci, streptococci, and anaerobes
-no dose adjustment in renal impairment
BBW: C. diff
-positive induction test = resistance with clindamycin

64
Q

Metronidazole (Flagyl)

A

-anaerobic and protozoal infections
-IV:PO = 1 to 1
CI: pregnancy, alcohol (dissulfiram reaction)
-metallic taste
0inc INR with warfarin

65
Q

Fidaxomicin (Dificid)

A

-1st line tx or C. diff infections
PO only

66
Q

Rifaximin

A

-e. coli
PO only
Uses: travelers diarrhea, prevention of hepatic encephalopathy, IBS with diarrhea

67
Q

Urinary Agents: Fosfomycin

A

-single dose
covers: E. coli (include ESBL - producing organisms) E. faecalis (including VRE)

68
Q

Urinary agents: Nitrofurantoin

A

drug of choice for uncomplicated UTI
-do not use if Crcl < 60
–> common dosing = macrobid 100 mg BID x 5d
Warnings: avoid G6PD deficiency, can cause hemolytic anemia (positive coombs test)

Counseling: take with food, can discolor urine (brown)

69
Q

Mupirocin nasal (Bactroban)

A

-drug of choice when pt has MRSA colonization
-5 days of therapy, ointment

70
Q

abx for CA-MRSA skin & soft tissue infections

A

-SMX/TMP (bactrim)
-doxyctcline
-minocycline
-clindamycin (D- test)
-Linezolid

71
Q

abx for severe SSTI requiring IV tx or hospitalization

A

-vancomycin
-linezolid
-daptomycin
-ceftaroline
-telavancin

72
Q

ABX for VRE (E. faecium)

A

-daptomycin
-linezolid
-tiglecycline

–> cystitis only: nitrofurantoin, fosfomycin, doxycycline

73
Q

abx that cover psuedomonas aergoninosa

A

-pip/tazo
-cefepime
-ceftrazidime
-ceftozidime/avibactam
-ceftolozone/tazobactam
-ciprofloxicin
-levofloxacin
-aztreonam
-aminoglycosides
-colisitmethate
-polymixin B

74
Q

abx for carbapenem-resistant gram - rode (CRE)

A

-caftazidine/avibactam
-colistimethate
-polymyxin B

75
Q

abx for Bacteroides fragilis

A

-metronidazole
-cefotetan
-cefoxitin
-carbapenems

76
Q

abx for C. diff infections

A

-vancomycin (PO)
-fidaxomicin
-metronidazole

77
Q

abx for MRSA

A

-vancomycin
-linezolid
-daptomycin (not in pneumonia)
-ceftaroline

78
Q

what abx require refrigeration after reconstitution

A

-pen VK
-ampicillin
-amoxicillin/clavulanate (Augmentin)
-cephalexin (Keflex)

79
Q

which abx should NOT be refrigerated?

A

-cefdinir
-azithromycin
-doxycycline
-ciprofloxacin
-clindamycin

80
Q

abx that DO NOT require renal dose adjustments

A

-antistaphylococcal penicillins (nafcillin, dicloxacilin, oxicillin)
-ceftriaxone
-clindamycin
-doxycycline
-macrolides (azithromycin, erthrymycin)
-metronidazole
-moxifloxacin
-linezolid

81
Q

which abx needs light protection during admin?

A

-doxycycline
-micrafungin

82
Q

which abx are only compatible with dextrose?

A

-quinupristine/dalfopristin
-bactrim
-amphotericon B

83
Q

which abx are only compatible with Saline?

A

-ampicillin
-ampicillin/sulbactam
-ertapnem
-daptomycin

84
Q

Preoperative ABX Prophylaxis: prior to surgery

A

-infused abx:
–> betalactams (cefazolin or cefuroxime) within 60 mins of first incision
–> quinolone or vancomycin are used, start infusion 120 mins before first incision

85
Q

Preoperative ABX Prophylaxis: intra-operative

A

additional doses may be administered for longer surgeries:
- > 4 hrs or major blood loss
-frequency is based on abx 1/2 life

86
Q

Preoperative ABX Prophylaxis: post operative

A

< 24 hr for most procedures
–> extending the duration does not have clinical benefit. can lead to:
-increased risk of AEs
-antimicrobial resistance
-C. diff infection

87
Q

ABX Prophylaxis: cardiac, orthopedic and vascular surgeries

A

Organisms: staphylococci & streptococci
Preferred abx: Cefazolin or Cefuroxime
Beta lactam allergy: vancomycin (can add on if MRSA risk) or clindamycin

88
Q

ABX Prophylaxis: Gastrointestinal Surgeries

A

Concerning orgs: staphlococci, streptococci, e. coli, Klebsiella, B. fregellias
Preferred abx:
-ampicillin/sulbactam
-cefoxitin
-cefotetan
-cephalosporin + metronidazole (adds on anaerobic activity)
Beta lactam allergy:
-metronidazole or clindamycin + fluoroquinolone or amino glycoside

89
Q

Common pathogens that cause bacterial meningitis: gram +

A

-cocci chains: group B streptococcus
-cocci pairs: streptococcus pneumoniae
-Bacilli rods: Listeria monocytogenes

90
Q

Common pathogens that cause bacterial meningitis: gram -

A

-cocci pairs: Neisseria meningitidis
-coccobacilli: Haemophilus influenzae
-bacilli rods: e. coli

91
Q

Empiric tx of Community - acquired Bacterial Meningitis: tx principles

A

–> IV dexamethasone (0.15 mg/kq q6) to reduce neurologic complications just before or with 1st dose of abx (x 4 days, d/c if org is NOT s. pneumonia)
–> IV abx duration
-N. menigitidis and H. influenzae: 7 days
-S. pneumoniae: 10-14 days
-Listeria monocytogenes: at least 21 days

92
Q

Empiric tx of Community - acquired Bacterial Meningitis: < 1 month (neonates)

A

–> e. coli, group B strep, listeria

-Ampicillin + ceftaximine or gentamicin
DO NOT USE ceftriaxone

93
Q

Empiric tx of Community - acquired Bacterial Meningitis: 1 month - 50 y/o

A

1-23 month: S. pneumoniae, N. meningitidis, H. influenzae, E. coli, group B strep
2- 50 y/o: S. pneumoniae, N. meningitidis

-Ceftriaxone or cefotaxime + vancomycin

94
Q

Empiric tx of Community - acquired Bacterial Meningitis: > 50 y/o or immunocompromised

A

-S. pneumoniae, N. meningitidis, listeria

-Ampicillin + ceftriaxone or cefotaxmine + vancomycin

95
Q

Acute Otitis. Media tx

A

Bacteria: S. pneumonia, H. influenzae, M. catarrhalis

1st line:
–> Amoxicillin or Amoxicillin/clavulanate ( 90 mg/kg/day D BID)

Alt (mild penicillin allergy)”
–> Cefuroxime
–> Cefdinir
–> Cefpodoxime
–> Ceftriaxone IM x 1-3 days

Tx failure:
–> Amoxicillin/clavulante (if used amoxicillin first)
–> ceftriaxone IM x 3 days

duration 5-10 days (younger pts get longer tx)

96
Q

Upper respiratory tract infections

A

-Common cold: OTC products
-Influenzae: Oseltamivir (Tamiflu), Baloxavir (Xofluza) if symptom onset < 48 hrs or inpatient/high risk
-Pharyngitis: + antigen test - Pen VK, amoxicillin (alts = macrolides, clindamycin)
-acute sinusitis: amoxicillin/clavulanate IF symptoms > 10 days, facial pain, purulent nasal drainage or temp > 102 for > 3 days, or worsening of symptoms

97
Q

Bronchitis, Pertussis and COPD exacerbation tx

A

B: dextromethorphan, guaifenesin - abx not indicated
P: azithromycin, clarithromycin
COPD: O2, SABA, IV/PO steroids
–> abx if: inc dyspnea, sputum volume, sputum purulence or mechanically ventilated: amox/clav, azithromycin, doxycycline, resp. flouroquinolones for 5-7 days

98
Q

TX of CAP: outpatient

A

Healthy w/ no comorbidities:
- Amoxicillin high dose ( 1 gram TID)
-Doxycycline
-Macrolide (azithro, clarithro if local resistance < 25%)

High - risk w/ comorbidities ( chronic heart, lung, liver or renal disease)
-Beta lactam (amox/clav or cephalosporin) + macrolide or doxycycline
-respiratory fluoroquinolone mono therapy (moxi or levo)

99
Q

CAP tx: Inpatient

A

Non severe/non-ICU:
-beta lactam (ceftriaxone, cefotaxime, ampicillin/sulbactam, ceftaroline) + macrolide or doxycycline
-respiratory fq monotherapy

Severe/ICU
-beta lactam + macrolide
-beta lactam + resp fq

100
Q

HAP & VAP Empiric tx regimen

A

-at least 1 abx with both pseudomonas and MSSA: cefepime, pip/tazo, meropenem, levofloxacin
-MRSA risk (IV abx in the past 90 days, MRSA prevalent > 20%, prior MRSA infection or + MRSA nares): add vancomycin or linezolid
-MDR gram - or MRSA risk (IV abx in past 90 days, gram - resistance > 10%, hosp. > 5 days prior to vental.): use 1 abx for pseudomonas (ex: pip/tazo + cipo + vancomycon)

101
Q

Treatment Regimens for Latent TB

A

-INH + rifapentine weekly x 12 weeks – observe pt, do not use with pregnancy (give B6)
-INH + rifampin daily x 3 months (give B6)
-Rifampin daily x 4 months
-Isoniazid daily x 6 or 9 months – for HIV pts, give B6

102
Q

Treatment of Active TB

A

–> Initial intensive phase (2 months) with RIPE:
-Rifampin
-Isoniazid
-Pyrazinamide
-Ethambutol

–> continuation phase (> 4 months) with RI: (no evidence of resistance & repeat sputum cultures are neg)
-Rifampin
-Isoniazid

103
Q

RIPE therapy for TB: key features

A

-monitor infection: sputum sample, symptoms and chest x-ray
-all RIPE drugs inc LFTs

–> Rifampin: orange bodily secretions, strong CYP450 inducer (can use rifabutin if DDIs), flu-like symptoms
–> Isoniazid: peripheral neuropathy: with with pyridoxine (vit B6) 25-50 mg PO daily, monitor for symptoms of DILE
–> Rifampin and Isoniazid: risk for hemolytic anemia
–> Pyrazinamide: inc uric acid - do not use with acute gout
–> Ethambutol: visual damage (requires baseline and monthly vision exams), confusion/hallucinations

104
Q

Pathogen-directed treatment of Infective Endocarditis: Viridans streptococci

A

-Penicillin or Ceftraixone ( +/- Gentamicin)

Beta lactam allergy: Vancomycin

105
Q

Pathogen-directed treatment of Infective Endocarditis: Staphylococci

A

-Methicillin-susceptible: Nafcillin or Cefazolin
-Methicillin-resistant: Vancomycin or daptomycin
-Prosthetic valve: add gentamicin & rifampin to above

Beta lactam allergy: Vancomycin

106
Q

Pathogen-directed treatment of Infective Endocarditis: Enterocci

A

-Native & prosthetic valve: Penicillin or Ampicillin + Gentamicin or high dose ceftriaxone
-Vancomycin resistant: Linezolid or daptomycin

Beta lactam allergy: Vancomycin + gentamicin

107
Q

Infective Endocarditis Prophylaxis

A

1st line: Amoxicillin 2 gram PO
If unable to take PO: Ampicillin 2 gram IV/IM or Cefazolin 1 gram IV/IM
Penicillin allergy: Azithromycin or Clarithromycin 500 mg PO or Doxycycline 100 mg PO

administer as a single dose 30-60 mins prior to the dental procedure

108
Q

Spontanesous Bacterial Peritonitis tx

A

PMN > 250 cells/mm3

-1st line: ceftriaxone or cefotaxime
- critically ill or risk of MDR: pipercillin/taxobactam, meropenem
–> 5-7 day duration

SBP Prevention: (prior SBO or ascitic fluid protein < 1.5 + impaired renal/hepatic function
–> SMX/TMP or flouroquinolone (cipro) indefinite or until post-liver transplant

109
Q

Impetigo Treatment

A

Pathogens: staph aureus, Group A strep
Topical: Mupirocin, retapamulin
Oral: Cephalexin, dicloxacillin

110
Q

Folliculitis, fureneles + carbuncles tx

A

–> S aureus (MSSA, MRSA)
Oral: sulfazmethoxazile/trimethoprim, doxycycline

111
Q

Cellulitis tx

A

Purulent (MSSA, MRSA): I&D PLUS SMX/TMP or doxycycline

Non-purulent: Dicloxacillin or cephalexin
-beta latam allergy: clindamycin

Severe: vancomycin, daptomicin, linezolid

112
Q

Treatment of Necrotizing Fasciitis

A

urgent surgical debridement AND
-pip/tazo or meropenem + vancomycin or damptomycin + clindamycin

113
Q

Empiric tx of Diabetic Foot Infection

A

No concern for Pseudomonas or MRSA:
-Ampicillin/sulbactam
-Ertapenem
-Moxifloxacin
-Metronidazole + Ceftriaxone

Concern for Pseudomonas:
-Pip/tazo
-Meropenem
-Metronidazole + cefepime, cipro or levo

114
Q

Acute cystitis tx

A

-Nitrofurantoin 100 mg PO BID x 5 days (CI if crcl < 60)
-SMX/TMP DS 1 tab PO BID x3 days (CI in sulfa allergy)
-Fosfomycin 3 gram x 1 dose

115
Q

Acute pyelonephritis tx

A

-systemic symptoms

Outpatient:
-Ciprofloxacin or levofloxacin
-Sulfamethoxazole/trimethoprim

Inpatient:
-Ceftriaxone
-Ciprofloxacin or Levofloxacin

Concerns for resistance: pip/tazo, carbapenem

116
Q

Treatment of bacteremia in pregnancy

A

Preferred: (beta-lactams): cephalexin, amox/clavulanate
Alts (in cases of beta lactam allergy): Fosfomycin, nitrofurantoin, SMX/TMP

117
Q

Treatment options for C. diff: Initial episode

A

-Fidaxomicin 200 mg PO BID
-Vancomycin 125 mg PO QID

–> only if above unavailable:
-metronidazole 500 mg PO TID

Duration = 10 days

118
Q

Treatment options for C. difficile: recurrence & fulminant disease

A

-Fidaxomicin 200 mg PO BID
-Vancomycin PO + prolonged taper

–> 2+ recurrences
-Vancomycin PO + rifaximin x 20 days
-fecal microbiota transplant

Fulminant: (hypotension, shock)
-Vancomycin 500 mg PO/NG Q6h (or PR if ileus) PLUS IV metronidazole

119
Q

Symptoms of common STIs

A

-Chlamydia: genital discharge or no symptoms
-Gonorrhea: genital discharge or no symptoms
-Genital warts: single ot multiple pink/skin-toned lesions
-Latent syphillis: asymptomatic
-Primary syphills: painless, smooth genital sores

Females only:
-bacterial vaginosis: vaginal d/c (clear, white or gray) that has a fishy odor and pH > 4.5
-Trichomoniasis: yellow/green, frothy vaginal d/c with pH > 4.5, soreness, pain with intercourse

120
Q

Syphilis tx

A

-treponema pallidum
tests: VDRL, PRP test
–> Penicillin G benzathine (Bicillin LA) 2. 4 mill IM x1 (latent gets 3 doses)
-beta lactam allergy: doxycycline x 14 days

121
Q

Penicillin desensitization for syphilis

A

desensitization is required in: neurosphylis, pregnancy and expected suboptimal adherence to doxycycline

-confirm the allergy with a skin test, temp desensitize with an approved protocol, then treat with IM Pen G benzathine (Bicillin LA)

122
Q

Gonorrhea treatment

A

-N. gonorrhoeae
Males: urethral d/c, dysuria or asymptomatic
Females: commonly asymptomatic, vaginal prutitis & mucopurulent cervial d/c
–> vag swab or urine test

-Ceftriaxone 500 mg IM x1 (< 150 kg)
–> if chlamydia not excluded, add doxycycline

123
Q

Chlamydia treatment

A

-Chlamydia trachomatis
-commonly asymptomatic
-nucleic acid swab

-Doxycycline 100 mg PO BID x 7 days
Pregnancy: Azithromycin 1 gram PO x 1 dose

124
Q

Bacterial vaginosis treatment

A

-Gardnerella vaginalis
-off-white vag d/c, fishy odor, little or no pain

-Metronidazole 500 mg PO x 7 days
-Metronidazole 0.75% gel x 5 days
-Clindamycin 2% cream x 7 days

125
Q

Trichomoniasis treatment

A

-Trichomoniasis vaginalis
-yellow/green, frothy d/c, foul odor, soreness and pain

Females: metronidazole 500 mg PO x 7 days
Males: metronidazole 2 g PO x1

126
Q

Genital Wart treatment

A

-HPV strains 6 & 11
-lesions range from smooth, flattened papules to cauliflower-like growths

-Imiquimod cream (immune activator)
-Podofilox solution or gel (causes wart necrosis)
-prevention: Gardasil 9, barrier contraception

127
Q

Lyme Disease tx

A

-Borrelia burgdorferi
-erythema migraines flu-like symptoms, can lead to disseminated disease & organ dysfunction, chronic disorders

PO doxycycline, amoxicillin, or cefuroxime
Severe cases: IV ceftriaxone

128
Q

Rocky Mountain Spotted Fever treatment

A

-Rickettsia rickettsii
-fever, HA, muscle pain, erythematous petechial rash appears 3-5 days after initial symptoms

Adults and peds: Doxycycline 100 mg PO/IV BID x 5-7 days

129
Q

Erlichiosis treatment

A

-caused by Ehrlichia chaffeensis
-endemic to southeastern and south central US
-symptoms: flu-like illness, confusion
-PO doxycycline

130
Q

Amphotericin B

A

-conventional and lipid formulation
BBW: mixing dosing of diff formulations can result in cardiopulmonary arrest
SE: infusion related: fever, chills, HA, malaise, rigors, dec K, Mg, nephrotoxicity
–> premedicate with APAP/NSAIDs, diphenhydramine
use a filter

131
Q

Flucytosine

A

-used in combo with amphotericin B for tz of invasive Cryptococcal (meningitis) or Candida infections
SE: myelosuppression
-oral only

132
Q

Key issues with Azole antifungals

A

Class effects:
-inc LFTs, hypokalemia
-QT prolongation (except isavuconazonium)
-many drug interactions

Drug specific concerns:
-Fluconazole: requires renal dose adjustment
-Ketoconazole: hepatotoxicity (mainly used topically)
-Itraconazole: can cause HF - used for nail bed fungal infections
-Voriconazole: can cause visual changes and phototoxcity
-Posaconazole: take with food

IV Admin:
-IV to PO ratio is 1:1 for all azoles

133
Q

Antifungal agents: Echinocandins

A

-Caspofungin (Cancidas)
-Micafungin (Mycamine)
–> for Candida species C. glabrata and C. krusei
-IV only, no adjustments for renal failure
Warning: histamine mediated symptoms
SE: inc LFTs, HA, hypotension

134
Q

Treatment of Influenza

A

–> use within 48 hrs of symptoms or contact
Warning: neuropsychiatric symptoms
-Oseltamivir (Tamiflu):
tx: 75 mg PO BID x5 d
ppx: 75 mg PO qd x 10 d
GI SEs common- n/v
-Zanamivir (Relenza Dishkaler)
tx: 2 inhalations BID x 5d
ppx: 2 inhalations qd x 10d
CI: breathing problems, can cause bronchospasm

135
Q

Treatment for Herpes Simplex and Varicella Zoster Viruses

A

-Acyclovir (Zovirax) (IV, PO, buccal, topical)
-Valacyclovir (Valtrex) (PO)
-Famciclovir (PO)

HSV encephalitis: IV acyclovir 10 mg/kg

136
Q

Cytomalovirus treatment

A

-Granciclovir (IV)
-Valaganciclovir (Valcyte- PO)
BBW: myelosuppression, tx followed by maintenance/secondary ppx until immune system recovers

137
Q

Primary ppx in pts with HIV

A

-Pneumocystis (PCP) : CD4 <200 or oral candidiasis
–> SMX/TMP DS qd (alts: Dapsone or Dapsone + pyrimethamine + leucovorin)

-Toxoplasma gondii encephalitis: CD4 < 100 w/ + toxoplasma IgG
–> SMX/TMP DS qd ( alts: Dapsone + pyrimethamine + leucovorin)

-Mycobacterium avium complex: CD4 < 50
–> Azithromycin 1200 mg per week (alt: clarithrymocin) + bactrim

138
Q

Treatment of opportunistic infections (6 of them)

A

-Candidiasis: fluconazole
-Cryptococcal meningitis: Amphotericin B + flucytosine
-Cytomeglaovirus: Valganciclovir (PO) or Ganciclovir (IV)
-Mycobacterium avium: Clarithromycin/azithromycin + ethambutol
-Pneumocystis pneumonia: SMX/TMP +/- prednisone x 21 days
-Toxoplasma gondii encephalitis: Pyrimethamine + leucovorin + sulfadiazine

NAPLEX BABY (23 decks)

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