ID Flashcards
What is the treatment for candidiasis?
Candidal esophagitis requires systemic therapy (as opposed to thrush which can be treated with topical swish and spit antifungal preparations).
What is the treatment for malignant otitis externa?
Malignant otitis externa as evidenced by the discharge, granulation tissue within the ear canal, fever, and pain on pulling the tragus.
Associated with an immunocompromised state, such as diabetes.
Otitis externa is often pseudomonal–> oral ciprofloxacin.
What is the treatment for herpes virus?
Acyclovir
If resistant to that then.. foscarnet
What is a positive PPD test for immunocompromised patient?
cutoff for patients with HIV/AIDS, transplant patients, chronic steroid use, and close contacts to patients with TB is >/= 5 mm. The next step after a positive PPD is the chest X-ray.
What should you do with pyelonephritis that does not improve with antibiotics?
If a patient with pyelonephritis does not show any signs of improvement at 48 hours (such as decrease in leukocytosis or resolution of fevers), imaging should be undertakne to evaluate for the presence of an abscess.
What is the treatment for mild community acquired pneumonia?
Mild community-acquired pneumonia can be treated with oral antibiotics - macrolide (clarithromycin, azithromycin), beta-lactam with inhibitor, or a fluroquinolone (levofloxaci)
What is the best test for diagnosing endocarditis?
Best test is transesophageal echocardiogram (TEE)
but do Transthoracic echocardiogram (TTE) if you have low pretest probability and want to rule out endocarditis.
How does (Haemophilus ducreyi) present?
A single painful ulcer with inguinal lymphadenopathy is chancroid
What is the treatment for pneumocystitis jiroveci pneumonia?
TMP/SMX. If there is profound hypoxia, steroids should also be given.
indications for endocarditis prophylaxis
surgery (mouth and throat) and a bad valve (prosthetic, congenital heart, or history of endocarditis).
Amoxicillin is the antibiotic you’d like to use
Allergic to penicillins, you can use cephalexin
If anaphylactic reaction (no penicillins or cephalosporins)
then use clindamycin and macrolides
How is osteomyelitis treated?
XRay–> MRI–> bone biopsy
Treating osteomyelitis without a biopsy is the right answer only when they are toxic.
What is the empiric therapy for bacterial meningitis?
Empiric therapy for bacterial meningitis includes ceftriaxone, vancomycin, and dexamethasone. Ampicillin should be added if immunocompromised.
Ring-enhancing brain lesions with a positive HIV should prompt suspicion for
toxoplasmosis- treat with Sulfadiazine, pyrimethamine, and folinic acid
Male UTIs treatment
Male UTIs are complicated UTIs by definition. They require 7 days of antimicrobial therapy.
Most commmon bug causing pneumonia in a COPD patient?
Pneumonia in a patient with COPD and smoking history should prompt suspicion for Haemophilus influenzae.
K.pneumoniae is associated with alcoholics and currant-jelly sputum.
S.aureus is associated with pneumonias following viral illnesses.
The most common organism is Streptococcus pneumoniae (regardless of risk factors).
M.catarrhalis is a common organism for sinusitis and pulmonary infections.
PCP prophylaxis?
CD4 Count <200 needs PCP prophylaxis TMP/SMX > dapsone > atovaquone.
What is the treatment for bronchitis?
Low fever, sputum production, and cough but no findings on chest xray–> bronchitis
Tx w/ tetracycline (doxy) or macrolide (azithromycin)
What is the outpatient management for pyelonephritis?
if not bad pyelo the no need to admit
treat w/ fluoroquinolone (ciprofloxacin)
How do you treat asymptomatic UTI in pregnant woman?
oral amoxicillin
Recheck culture in 2 weeks to confirm eradication
What is acute prostatitis?
Sounds like a UTI but w/ tender prostate/
Treat w/ TMP/SMX or fluoroquinolone
How to treat severe pyelonephritis?
Get cultures first AND THEN start pt on IV ceftriaxone
What antibiotics should be used for ascending cholangitis?
Intra abdominal infections require gram negative and anaerobic coverage.
Examples:
Ciprofloxacin for gram (-) coverage
Metronidazole for anaerobic coverage
What is the treatment for syphilis?
Treatment of choice is penicillin
if minor allergy or pregnant–> desensitize to pen and then give it
If anaphylaxis to pen–> Doxycycline (unless pregnant)
- can’t give doxy to pregnant *
How do you know when antibiotic is not effective (ie bacteria is resistant to it)?
If mean inhibitor concentration MIC >2
ex: if MIC for vanco is 2.5 then switch it to daptomycin to tx endocarditis
What is the treatment for endocarditis?
Acute endocarditis w/ staph–> empriric Vancomycin only
Vancomycin+ gentamycin+ Cefepime for new valve <60 days old
Vancomycin+gentamycin+ceftriaxone for old valve > 365 days old
Subacute endocarditis- No empiric antibiotics until (+) culture and then start specific antibiotic
meningitis empiric antibiotics
Neonates < 1month of age: ampicillin and cefotaxime
Children to Adults < 50 years of age: ceftriaxone and vancomycin
Adults >50 years of age: ceftriaxone, vancomycin, and ampicillin
Drug of choice for endocarditis prophylaxis for dental procedures
Amoxicillin
Treatment for Hepatitis C
Direct-acting antivirals (DAAs)
Patient should be tested for NS5A resistance-associated substitutions
Organophosphate toxicity treatment
Organophosphate toxicity leads to the inhibition of acetylcholinesterase and overstimulation of the parasympathetic nervous system. The treatment for organophosphate toxicity is the combination of atropine and pralidoxime.