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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
How to treat COPD exacerbation
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
26
Common pathogens in CAP
S. pneumo H. influ M. pneumoniae C. pneumoniae
27
Outpatient CAP treatment
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
28
Inpatient CAP treatment
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
29
HAP/VAP onset
HAP: >48 hours after admission VAP: >48 hours after start of mechanical ventilation
30
Common pathogens in HAP and VAP
Nosocomial pathogens | Increased risk of MRSA, MDR GNR, pseudomonas, acinetobacter, enterobacter, e.coli, and klebsiella
31
HAP/VAP empiric therapy
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
32
What are risk factors for MRSA and MDR pathogens in HAP/VAP?
Positive MRSA nasal swab (indicates MRSA colonization) High prevalence of resistant pathogen noted in hospital unit IV antibiotic use within 90 days
33
What antibiotics are used for pseudomonas coverage in HAP/VAP?
``` Pip/tazo Cefepime, ceftazidime, ceftolozaine/tazobactam Levofloxacin or ciprofloxacin Imipenem/cilastatin or meropenem Tobra, gentamicin, or amikacin Colistimethate or polymixin B ```
34
What antibiotics are used for MRSA coverage in HAP/VAP?
Vanco and linezolid
35
What pathogen causes tuberculosis (TB)
mycobacterium tuberculosis
36
What vaccine can cause a false positive tuberculin skin test?
Bacille calmette-guerin (BCG) vaccine
37
Latent TB diagnosis - size of bump on arm after TB skin test
>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
38
How to treat latent TB
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
How to treat active TB
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
How to treat multidrug resistant TB
Respiratory FQ or streptomycin, amikcin, or kanamycin | Up to 24 months
41
Rifampin CI and SE
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
Isoniazid (INH) BBW, CI, warnings, and SE
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
What can be given with isoniazid to decrease risk of peripherial neuropathy?
Pyridoxine 25-50mg PO daily
44
Pyrazinamide CI and SE
CI: acute gout, hepatic damage | Side effects: increased LFTs, hyperuricemia/gout, GI upset
45
Ethambutol CI and SE
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
Rifampin drug interactions
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
Most common pathogens for infective endocarditis
Staphylococci, streptococci, and enterococci
48
Infective endocarditis duration of therapy
4-6 weeks IV abx for native valves | Longer for artificial valve or more resistant organisms
49
Infective endocarditis treatment when caused by | Viridans group strep
PCN or ceftriaxone +/- gent | If beta lactam allergy, use vanc monotherapy
50
Infective endocarditis treatment when caused by | Staphlococci (MSSA)
Nafcillin or cefazolin (+gent and rifampin if prosthetic valve) If beta lactam allergy, use vanc (+gent and rifampin if prosthetic valve)
51
Infective endocarditis treatment when caused by | Staphlococci (MRSA)
Vanc (+gent and rifampin if prosthetic valve)
52
Infective endocarditis treatment when caused by | Enterocci
PCN or ampicillin + gentamicin (both native and prosthetic valve) Beta lactam allergy - use vanc + gentamicin If VRE, use daptomycin or linezolid
53
Infective endocarditis dental prophylaxis | What makes a patient high risk?
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
Common pathogens in spontaneous bacterial peritonitis (SBP) and DOC
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
What medications are used as primary or secondary prophylaxis of spontaneous bacterial peritonitis?
Bactrim, ofloxacin, and/or ciprofloxacin
56
Impetigo pathogens, presentation, and treatment
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
Folliculitis/furuncles/carbuncles pathogens, presentation, and treatment
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
Cellulitis (non-purulent) pathogens, presentation, and treatment
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
Cellulitis (purulent/abscess) pathogens, presentation, and treatment
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
Severe purulent skin and soft tissue infection treatment
7-14 days | Use abx with MRSA activity: Vanc, dapto, linezolid, ceftaroline
61
Necrotizing fasciitis organisms and treatment
Organisms: strep pyogenes, clostridium spp. | Empiric therapy: vanc + beta-lactam (pip/tazo, imipenem/cilastatin or meorpenem)
62
Pathogens in diabetic foot infections
staph and strep - can be polymicrobial
63
Treatment of moderate-severe diabetic foot infection
``` 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
Uncomplicated UTI pathogen, criteria, and DOC
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
When is nitrofurantoin contrindicated?
CrCl < 60
66
What can be added to UTI treatment to help with dysuria?
phenazopyridine (pyridium) 200mg PO TID x 2 days
67
How to treat UTI in pregnancy
Cephalexin, amoxicillin, fosfomycin | treat 3-7 days
68
Acute uncomplicated pyelonephritis pathogen and DOC
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
Complicated UTI pathogens and DOC
Pathogens: E. coli, klebsiella, enterobacter, serratia, pseudomonas, enterococci, staph DOC: Carbapenem if ESBL; FQ; if FQ resistance > 10% ceftriaxone, bactrim, beta-lactam
70
Phenazopyridine CI and SE
CI renal impairment or liver disease | SE: orange body secretions, HA, dizziness
71
What UTI medications should be avoided in pregnancy?
nitrofurantoin and bactrim in first trimester Bactrim in 3rd trimester Avoid FQ d/t cartilage toxicities and arthropathies
72
Travelers Diarrhea pathogen
E. coli, campylobacter jejuni, shigella, and salmonella
73
Travelers Diarrhea treatment
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
C. diff infection treatment 1st episode
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
C. diff infection treatment 1st recurrence
If used metronidazole, use vanc If used vanc, use fidaxamicin If used vanc or fidaxamicin, use vanc tapered and pulsed regimen
76
Symptoms of chlamydia and gonorrhea
genital discharge or no symptoms
77
Symptoms of syphilis
painless, smooth genital sores (chancre)
78
Symptoms of HPV
genital warts or no symptoms
79
Symptoms of bacterial vaginosis
vaginal discharge (clear, white or grey) that has a "fishy" odor and pH >4.5; little or no pain
80
Symptoms of trichomoniasis
yellow/green frothy vaginal discharge, soreness, pain with intercourse
81
DOC and alternative drugs to treat | syphilis (primary, secondary, or early latent (<1 year duration)
DOC: Pen G benzathine 2.4 million units IM x 1 Alternatives: doxycycline x 14 days
82
DOC and alternative drugs to treat | syphilis (>1 year or unknown duration)
DOC: Pen G benzathine 2.4 million units IM x 1 Alternatives: doxycycline x 28 days
83
DOC and alternative drugs to treat | Neurosyphilis and congenital cyphilis
DOC: Pen G aquesous 18-24 million units daily divided into 6 doses x 10-14 days Alternatives: Pen G procaine
84
DOC and alternative drugs to treat | Gonorrhea
DOC: Ceftriaxone x1+ (azithromycin x1 or doxycycline x7 days) Alternatives: Cefixime + (azithromycin or doxy) If cephalosporin allergy: azithromycin + (gemifloxacin or gentamicin)
85
DOC and alternative drugs to treat | Chlamydia
DOC: Azithromycin 1g x 1 or doxy x 7 days Alternatives: Erythromycin, levofloxacin, ofloxacin x 7 days Pregnancy: azithromycin (preferred) or amoxicillin
86
DOC and alternative drugs to treat | bacterial vaginosis
DOC: metronidazole oralx7d or gelx5d or clindamycin cream Alternatives: clindamycin oral, tinidazole oral, secnidazole oral
87
DOC and alternative drugs to treat | trichomoniasis
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
``` DOC and alternative drugs to treat genital warts (HPV) ```
DOC: imiquimod cream | Treatment not required if asymptomatic
89
Treatment for | Rocky mountain spotted fever
Doxycycline 100mg BID x 5-7 days
90
Treatment for | Typhus
Doxycycline 100mg BID x 5-7 days
91
Treatment for | Lyme disease
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
Treatment for | Ehrlichiosis
Doxycycline 100mg BID x 7-14 days
93
Treatment for | Tularemia
Gentamicin or tobramicin 5mg/kg/d IV divided q8h x 7-14 days

NAPLEX Review (79 decks)

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