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NAPLEX Review > ID Bacterial > Flashcards

ID Bacterial Flashcards

1
Q

What organisms are found on the skin?

A

Staph (including MRSA) and strep

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2
Q

What medications should be given before/during/after surgery to prevent infection and how long before?

A

Cefazolin 1g or cefuroxime 60 minutes before
Quinolone or vanc 120 minutes before
Give same medication during surgery if >3-4 hours or if major blood loss
Abx not usually needed after - d/c within 24 hours if used

***cefazolin is DOC

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3
Q

What is abx of choice/second line for cardiac or vascular surgeries?

A

Cefazolin or cefuroxime

Vanc/clinda if beta-lactam allergy

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4
Q

What is abx of choice/second line for hip fracture repairs/total joint replacements?

A

Cefazolin

Vanc/clinda if beta-lactam allergy

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5
Q

What is abx of choice/second line for colorectal or other surgeries involving abdominal space

A

Cefotetan, cefoxitin, ampicillin/sulbactam, ertapenem
OR
Metronidazole + (cefazolin or ceftriaxone)

If beta-lactam allergy
Clinda + (AG, FQ or aztreonam)
OR
Metronidazole + (AG or FQ)

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6
Q

How to dx meningitis

A

LUMBAR PUNCTURE!

try to get before starting abx if possible

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7
Q

What bacteria cause bacterial meningitis?

A

Strep pneumo
N meningitidis
H. influ

Listeria in older (>50), younger (<1 month), and immunocompromised patients

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8
Q 
How long to treat meningitis caused by 
N. meningitidis
H. influ
S. pneumo
Listeria
A

7 days - N. menin and H. influ
10-14 days - S. pneumo
21 days - lysteria

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9
Q

Empiric treatment for meningitis in patients <1 month old

A

Ampicillin (listeria)
+
Cefotaxime (NOT CEFTRIAXONE) or gent

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10
Q

Why should ceftriaxone be avoided in neonates?

A

biliary sludging and kernicterus

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11
Q

Empiric treatment for meningitis in patients 1 month-50 years

A

Ceftriaxone or cefotaxime
+
Vancomycin

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12
Q

Empiric treatment for meningitis in patients >50 years or immunocompromised

A 
Ampicillin (listeria)
\+
Ceftriaxone or cefotaxime
\+
Vanc
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13
Q

What causes most ear infections in children?

A

Virus!

Most time abx won’t be effective

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14
Q

Acute otitis media treatment in children

A

Observe for 2-3 days if mild otalgia <48 hours or temp <102.2 F and 6-23 months sx in one ear or >2 in 2 ears

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15
Q

What is the ideal amoxicillin to clavulanate ratio to prevent diarrhea?

A

14:1

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16
Q

How long to treat acute otitis media in children?

A

<2 years - 10 days
2-5 years - 7 days
>/6 years - 5-7 days

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17
Q

First line treatment for acute otitis media

Alternative treatment if PCN allergy

A

Amoxicillin 80-90mg/kg/d in 2 doses OR
Amox/clav 90mg/kg/d of amox in 2 doses OR
Ceftriaxone 50mg/kg IM (if vomiting)

Cefdinir
Cefuroxime
Cefpodoxime
Ceftriaxone

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18
Q

Common cold:

Etiology
Clinical presentation
Criteria for anti-infective treatment
Treatment

A

Etiology: Rhinovirus
Presentation: sneezing, runny nose, cough
Criteria for treatment: none
Treatment: symptomatic treatment

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19
Q

Influenza:

Etiology
Clinical presentation
Criteria for anti-infective treatment
Treatment

A

Etiology: influ virus
Presentation: sudden onset fever, chills, fatigue, body aches
Criteria for treatment: <48 hours since symptom onset; prophylaxis if high risk for complications
Treatment: oseltamivir x 5 days; baloxavir x 1 dose; peramivir IV x 1 dose

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20
Q

Pharyngitis/strep throat

Etiology
Clinical presentation
Criteria for anti-infective treatment
Treatment

A

Etiology: S. pyogenes virus
Presentation: swollen lymph nodes, sore throat, white patches on tonsils
Criteria for treatment: positive rapid antigen test
Treatment: PCN, amoxicillin, 1st/2nd gen cephalosporin (or azithromycin, clarithormycin, or clinda if PCN allergy) –> treat for 10 days (5 days z-pak)

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21
Q

Sinusitis

Etiology
Clinical presentation
Criteria for anti-infective treatment
Treatment

A

Etiology: S. pneumo, H. influ, M catarrhalis, staph, anaerobes
Presentation: nasal congestion, purulent nasal discharge, facial/ear/dental pain, HA, fever
Criteria for treatment: >10 days of symptom onset or >3 days of severe sympotms or “second sickening”
Treatment: Amox/clav (DOC) or 2nd/3rd gen cephalosporin + clinda, doxy, or respiratory FQ

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22
Q

What are the primary pathogens that cause acute bronchitis?

A

Respiratory viruses: RSV, adenovirus, rhinovirus, influ virus
Bacterial: S. pneumo, mycoplasma pneumo, H. influ, bordatella pertussis (whooping cough), Chlamydophilia pneumoniae

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23
Q

Bronchitis treatment

A

Usually supportive care
Abx not recommended unless pneumonia is present
If caused by bordetella pertussis treat with azithromycin, clarithormycin, or bactrim

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24
Q

What does ABECB stand for and what else is it known as?

A

acute bacterial exacerbation of chronic bronchitis

COPD exacerbation

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25
Q

How to treat COPD exacerbation

A

Supportive treatment (oxygen, short acting inhaled bronchodilators, IV/PO steroids
Abx for 5-7 days if:
- Pt has increased dyspnea, increased sputum volume and increased sputum purulence
- Increased sputum purulence + one additional symptom
- Patient is mechanically ventilated

Preferred abx: Amox/clav, Azithromycin, doxycycline

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26
Q

Common pathogens in CAP

A

S. pneumo
H. influ
M. pneumoniae
C. pneumoniae

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27
Q

Outpatient CAP treatment

A

5-7 days with abx
No comorbidities: Amox (1g TID), doxycycline, or macrolide if resistance is <25%
Comorbidities: Beta lactam + (macrolide or doxycycline) OR respiratory quinolone monotherapy

Preferred beta lactams: amox/clav or cephalosporin

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28
Q

Inpatient CAP treatment

A

Non-severe: Beta-lactam (ceftriaxone, cefotaxime, ceftaroline or ampicillin/sulbactam) + macrolide or doxycycline OR respiratory quinolone monotherapy
Severe: beta lactam + macrolide OR beta lactam + respiratory FQ

If pseudomonas risk - add pip/tazo, cefepime, ceftaz, imipenem/cilastatin, meropenem, or aztreonam

If MRSA risk - add vanc or linezolid

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29
Q

HAP/VAP onset

A

HAP: >48 hours after admission
VAP: >48 hours after start of mechanical ventilation

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30
Q

Common pathogens in HAP and VAP

A

Nosocomial pathogens

Increased risk of MRSA, MDR GNR, pseudomonas, acinetobacter, enterobacter, e.coli, and klebsiella

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31
Q

HAP/VAP empiric therapy

A

1 abx to cover MSSA and pseudomonas if low risk for MRSA or MDR pathogens

2 abx to cover MRSA and pseudomonas if risk for MRSA but low MDR risk

3 abx, 1 for MRSA 2 for pseudomonas if risk for MRSA and MDR

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32
Q

What are risk factors for MRSA and MDR pathogens in HAP/VAP?

A

Positive MRSA nasal swab (indicates MRSA colonization)
High prevalence of resistant pathogen noted in hospital unit
IV antibiotic use within 90 days

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33
Q

What antibiotics are used for pseudomonas coverage in HAP/VAP?

A 
Pip/tazo
Cefepime, ceftazidime, ceftolozaine/tazobactam
Levofloxacin or ciprofloxacin
Imipenem/cilastatin or meropenem
Tobra, gentamicin, or amikacin
Colistimethate or polymixin B
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34
Q

What antibiotics are used for MRSA coverage in HAP/VAP?

A

Vanco and linezolid

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35
Q

What pathogen causes tuberculosis (TB)

A

mycobacterium tuberculosis

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36
Q

What vaccine can cause a false positive tuberculin skin test?

A

Bacille calmette-guerin (BCG) vaccine

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37
Q

Latent TB diagnosis - size of bump on arm after TB skin test

A

> 5mm: positive for patients in close contact of recent TB case, significant immunosuppression (HIV)
10mm: Residents/employees of high-risk congregate settings (healthcare workers/prison inmates), IV drug users
15mm: patients with no risk factors

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38
Q

How to treat latent TB

A

INH and rifapentine weekly for 12 weeks via directly observed therapy (do NOT use in pregnancy)
Rifampin 600mg daily for 4 months (drug interactions)
Isoniazid with rifampin daily for 3 months

Alternative regimen: INH 300mg PO daily for 6-9 months –> treatment of choice in pregnancy

39
Q

How to treat active TB

A

RIPE
Rifampin, isoniazid, pyrizinamide, and ethambutol 5-7 times weekly x 2 months THEN
rifampin and isoniazid 3-5 times weekly x 4 months

40
Q

How to treat multidrug resistant TB

A

Respiratory FQ or streptomycin, amikcin, or kanamycin

Up to 24 months

41
Q

Rifampin CI and SE

A

CI: do not use with protease inhibitors
SE: increased LFTs, hemolytic anemia, flu-like syndrome, orange-red discoloration of body secretions (sputum, urine, sweat, tears, teeth)

42
Q

Isoniazid (INH) BBW, CI, warnings, and SE

A

BBW: hepatitis
CI: acute liver disease
Warnings: peripheral neuropathy (give pyridoxine)
Side effects: increased LFTs, drug induced lupus erythematosus (DILE), hemolytic anemia, skin reactions, optic neuritis

43
Q

What can be given with isoniazid to decrease risk of peripherial neuropathy?

A

Pyridoxine 25-50mg PO daily

44
Q

Pyrazinamide CI and SE

A

CI: acute gout, hepatic damage

Side effects: increased LFTs, hyperuricemia/gout, GI upset

45
Q

Ethambutol CI and SE

A

CI: Optic neuritis, do not use in young children, unconscious patients, or any patient who cannot discern and report visual changes
SE: increased LFTs, optic neuritis (dose related), confusion, hallucinations, N/V

46
Q

Rifampin drug interactions

A

Inducer of CYP 1A2, 2C8, 2C9, 2C19, 3A4, and P-glycoprotein
Decreases serum concentration of protease inhibiotrs, warfarin (decrease INR), oral contraceptives
Do not sue with DOACs

47
Q

Most common pathogens for infective endocarditis

A

Staphylococci, streptococci, and enterococci

48
Q

Infective endocarditis duration of therapy

A

4-6 weeks IV abx for native valves

Longer for artificial valve or more resistant organisms

49
Q

Infective endocarditis treatment when caused by

Viridans group strep

A

PCN or ceftriaxone +/- gent

If beta lactam allergy, use vanc monotherapy

50
Q

Infective endocarditis treatment when caused by

Staphlococci (MSSA)

A

Nafcillin or cefazolin (+gent and rifampin if prosthetic valve)
If beta lactam allergy, use vanc (+gent and rifampin if prosthetic valve)

51
Q

Infective endocarditis treatment when caused by

Staphlococci (MRSA)

A

Vanc (+gent and rifampin if prosthetic valve)

52
Q

Infective endocarditis treatment when caused by

Enterocci

A

PCN or ampicillin + gentamicin (both native and prosthetic valve)
Beta lactam allergy - use vanc + gentamicin
If VRE, use daptomycin or linezolid

53
Q

Infective endocarditis dental prophylaxis

What makes a patient high risk?

A

High risk: Artificial heart valve, hx of endocarditis, heart transplant with abnormal valve function, certain congenital heart defects including heart/heart valve disease

Amoxicillin 2g 30-60 minutes before dental procedure
If PCN allergy: cephalexin 2g OR clinda 600mg OR azithromycin or clarithromycin 500mg

54
Q

Common pathogens in spontaneous bacterial peritonitis (SBP) and DOC

A

streptococci, enteric gram-negative organisms (Proteus, E. coli, and klebsiella) and (rarely) anaerobes

DOC: ceftriaxone x 5-7 days
Alternative treatments: ampicillin, gentamicin, FQ

55
Q

What medications are used as primary or secondary prophylaxis of spontaneous bacterial peritonitis?

A

Bactrim, ofloxacin, and/or ciprofloxacin

56
Q

Impetigo pathogens, presentation, and treatment

A

Pathogens: strep, staph (MSSA)
Presentation: children, honey-colored crusts over blister-like rash on nose, mouth, hands, and arms
Treatment: Topical abx (mupirocin); if numerous lesions, use systemic cephalexin 250 QID

57
Q

Folliculitis/furuncles/carbuncles pathogens, presentation, and treatment

A

Pathogens: S. aureus including CA-MRSA
Presentation: infected hair follicle, boil, or group of infected boils
Treatment: drainage, warm compress; if MSSA cephalexin 500 PO QID; if MRSA bactrim DS 1-2 BID or doxycycline 100mg BID

58
Q

Cellulitis (non-purulent) pathogens, presentation, and treatment

A

Pathogens: strep (including S. pyogenes), Staph
Presentation: pain, swelling, redness, one sided
Treatment: Cephalexin 500 PO QID or clindamycin 300 PO QID x 5 days

59
Q

Cellulitis (purulent/abscess) pathogens, presentation, and treatment

A

Pathogens: CA-MRSA
Presentation: fluid collection abscess
Treatment: systemic signs or multiple sites use bactrim DS 1-2 tablets BID, doxycycline 100 BID, minocycline 200 x 1 then 100 BID, clindamycin 300mg PO QID

60
Q

Severe purulent skin and soft tissue infection treatment

A

7-14 days

Use abx with MRSA activity: Vanc, dapto, linezolid, ceftaroline

61
Q

Necrotizing fasciitis organisms and treatment

A

Organisms: strep pyogenes, clostridium spp.

Empiric therapy: vanc + beta-lactam (pip/tazo, imipenem/cilastatin or meorpenem)

62
Q

Pathogens in diabetic foot infections

A

staph and strep - can be polymicrobial

63
Q

Treatment of moderate-severe diabetic foot infection

A 
Monotherapy (no MRSA coverage needed): ampicillin/sulbactam, pip/tazo, carbapenem, tigecycline, or moxifloxacin 
Combo therapy (MRSA/psudomonas coverage needed): Vancomycin + (Ceftazidime, defepime, pip/tazo, aztreonam or carbapenem)

Treat for 7-14 days (up to 6 weeks for bone/joint infection)

64
Q

Uncomplicated UTI pathogen, criteria, and DOC

A

Pathogen: E. coli
Criteria: females 15-45 years old
DOC: nitrofurantoin 100mg BID w/ food x 5 days OR bactrim DS 1 tab PO BID x 3 days OR fosfomycin 3g x 1
Alternative options: amox/clav, ciprofloxacin, levofloxacin

65
Q

When is nitrofurantoin contrindicated?

A

CrCl < 60

66
Q

What can be added to UTI treatment to help with dysuria?

A

phenazopyridine (pyridium) 200mg PO TID x 2 days

67
Q

How to treat UTI in pregnancy

A

Cephalexin, amoxicillin, fosfomycin

treat 3-7 days

68
Q

Acute uncomplicated pyelonephritis pathogen and DOC

A

Pathogens: E. coli, enterococci, proteus, klebsiella, pseudomonas
DOC: Ciprofloxacin BID x 7 days or Levofloxacin 750 x 5 days; if FQ resistance > 10% ceftriaxone, bactrim, beta-lactam
If pseudomonas risk use pip/tazo or meropenem +/- AG

69
Q

Complicated UTI pathogens and DOC

A

Pathogens: E. coli, klebsiella, enterobacter, serratia, pseudomonas, enterococci, staph
DOC: Carbapenem if ESBL; FQ; if FQ resistance > 10% ceftriaxone, bactrim, beta-lactam

70
Q

Phenazopyridine CI and SE

A

CI renal impairment or liver disease

SE: orange body secretions, HA, dizziness

71
Q

What UTI medications should be avoided in pregnancy?

A

nitrofurantoin and bactrim in first trimester
Bactrim in 3rd trimester
Avoid FQ d/t cartilage toxicities and arthropathies

72
Q

Travelers Diarrhea pathogen

A

E. coli, campylobacter jejuni, shigella, and salmonella

73
Q

Travelers Diarrhea treatment

A

If fever, blood in stools, pregnant or pediatric:
Azithromycin 1000mg PO x1 or 500 PO daily x 1-3 days
Other options:
Ciprofloxacin, levofloxacin, ofloxacin, rifaximin

74
Q

C. diff infection treatment 1st episode

A

Non-severe or severe: vanc 125mg PO QID or fidaxomycin 200mg PO BID or metronidazole 500mg PO TID x 10 days

Fulminant/complicated: Vanc 500mg PO/NG/PR QID + metronidazole 500mg IV q8h

75
Q

C. diff infection treatment 1st recurrence

A

If used metronidazole, use vanc
If used vanc, use fidaxamicin
If used vanc or fidaxamicin, use vanc tapered and pulsed regimen

76
Q

Symptoms of chlamydia and gonorrhea

A

genital discharge or no symptoms

77
Q

Symptoms of syphilis

A

painless, smooth genital sores (chancre)

78
Q

Symptoms of HPV

A

genital warts or no symptoms

79
Q

Symptoms of bacterial vaginosis

A

vaginal discharge (clear, white or grey) that has a “fishy” odor and pH >4.5; little or no pain

80
Q

Symptoms of trichomoniasis

A

yellow/green frothy vaginal discharge, soreness, pain with intercourse

81
Q

DOC and alternative drugs to treat

syphilis (primary, secondary, or early latent (<1 year duration)

A

DOC: Pen G benzathine 2.4 million units IM x 1
Alternatives: doxycycline x 14 days

82
Q

DOC and alternative drugs to treat

syphilis (>1 year or unknown duration)

A

DOC: Pen G benzathine 2.4 million units IM x 1
Alternatives: doxycycline x 28 days

83
Q

DOC and alternative drugs to treat

Neurosyphilis and congenital cyphilis

A

DOC: Pen G aquesous 18-24 million units daily divided into 6 doses x 10-14 days
Alternatives: Pen G procaine

84
Q

DOC and alternative drugs to treat

Gonorrhea

A

DOC: Ceftriaxone x1+ (azithromycin x1 or doxycycline x7 days)
Alternatives: Cefixime + (azithromycin or doxy)
If cephalosporin allergy: azithromycin + (gemifloxacin or gentamicin)

85
Q

DOC and alternative drugs to treat

Chlamydia

A

DOC: Azithromycin 1g x 1 or doxy x 7 days
Alternatives: Erythromycin, levofloxacin, ofloxacin x 7 days
Pregnancy: azithromycin (preferred) or amoxicillin

86
Q

DOC and alternative drugs to treat

bacterial vaginosis

A

DOC: metronidazole oralx7d or gelx5d or clindamycin cream
Alternatives: clindamycin oral, tinidazole oral, secnidazole oral

87
Q

DOC and alternative drugs to treat

trichomoniasis

A

DOC: metronidazole 2gx 1 or tinidazole x 1
Alternatives: metronidazole 500mg PO BID x7d
Pregnancy: metronidazole regardless of the trimester (even tho it is CI in first trimester)

88
Q 
DOC and alternative drugs to treat
genital warts (HPV)
A

DOC: imiquimod cream

Treatment not required if asymptomatic

89
Q

Treatment for

Rocky mountain spotted fever

A

Doxycycline 100mg BID x 5-7 days

90
Q

Treatment for

Typhus

A

Doxycycline 100mg BID x 5-7 days

91
Q

Treatment for

Lyme disease

A

DOC: doxycycline 100mg BID x 10-21 days
Alternatives: Amox 500 TID x 14-21 days OR cefuroxime 500mg BID x 14-21 days

92
Q

Treatment for

Ehrlichiosis

A

Doxycycline 100mg BID x 7-14 days

93
Q

Treatment for

Tularemia

A

Gentamicin or tobramicin 5mg/kg/d IV divided q8h x 7-14 days

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