ID: diseases and treatments Flashcards
empiric ABX treatment for septic shock (harrisons table 15-5)
Vancomycin + a broad spectrum antipseudomonal B-lactam (piperacillin-tazobactam, imipenem, meropenem, or cefepime)
empiric ABX tx for Meningitis (harrisons table 15-5)
Vancomycin + ceftriaxone
Empiric ABX tx for CNS abscess (harrisons table 15-5)
Vancomycin + ceftriaxone + Metronidazole
Empiric ABX tx for acute endocarditis (harrisons table 15-5)
Vancomycin + Cefepime
Empiric tx for pneumoina–CAP, outpatient or inpatient NON ICU (harrisons table 15-5)
Azithromycin + respiratory fluoro (moxifloxacin, gemifloxacin or levofloxacin)
OR
B-lactam (cefotaxime, ceftriaxone or ampicillin-sulbactam) + azitrhomycin
Empiric tx for pneumonia for ICU inpatient (harrisons table 15-5)
B-lactam plus azitrhomycin or a respiratory fluoro
hosp aquired pneumonia empiric tx (harrisons table 15-5)
Antipseudomonal b-lactam (cefepime, ceftazidime, imipenem, meropenem, piperacillin-tazobactam) \+ antipesudomonal fluroro (levofloxacin or ciprofloxacin) OR an aminoglycodise (amikacin, gentamicin, or tobramycin)
complicated intraabdominal infection empiric tx thats mild-moderate (harrisons table 15-5)
Cefoxitin
or
combination of: metronidazole + one of the following: cefazolin, cefuroxime, ceftriaxone, cefotaxime
empirix tx for high risk patient or high degree of severity for intraabdonial infection (harrisons table 15-5)
Carbapenem or Piperacillin-tazobactam or combination of metronidazole + either an antipseudomonal cephalosprin (cefepime, ceftazidime_ OR an antipseudomonal fluoro (ciprofloxacin, levofloxacin)
empiric tx for skin anf soft tissue infection
with and without MRSA
Dicloxacillin PO or cephalexin PO or clindamycin PO or Nafcillin/oxacilin
If possible MRSA:
clindamycin
vancomycin
linezolid
MRSA po (4) iv (4) **HA-MRSA **CA-MRSA
PO: doxycycline (CA-MRSA), clindamycin** second DOC (CA-MRSA), trimeothprim-sulfamethoxazole*** DOC for boards (CA-MRSA) or linezolid
IV: vancomycin (DOC for HA-MRSA) , ceftaroline, daptomycin or linezolid
sepsis
ID and remove cause of infection
PT MC will need ICU admission
- fluid resuscitation is priority in early mng—IV crystalloid at 30mL per kg w/in first three hours
- empiric ABX within one hour—- Piperacillin-tazobactam + vancomycin for adults
- vasopressors: if hypotensive after fluid resuscitation—–norepinephrine is DOC
- send blood cultures (draw b4 ABX tx)
- remove all existing caths, IV lines and central lines
scarlet fever
TX:
- PCN first line (po or im)
* **Macrolide (azithromycin) or clindamycin if PCN allergic - Amoxicillin
**kids can return to school 24 hrs after start of ABX
Diphtheria
- tx
- prophylaxis for close contact
- prevention
TX:
1. Diphtheria antitoxin immunoglobulin (horse serum)—GIVEN PROMPTLY— most important***
DO NOT WAIT FOR CULTURES TO COME BACK—GIVE ANTITOXIN IMMEDIATELY
- Erythromycin IV or PCN IM x2 weeks–switched to PO when PT can tolerate
- PT needs to be placed in isolation room
- cardiac monitoring–serial EKGs
Prophylaxis:
1. erythromycin PO 7-10 days
OR
2. PCN G x1 dose
PREVENTION: 1. DTaP sched: 5 doses given at 2MO 4MO 6 MO b/w 15-18MO b/w 4-6 Yrs
Tdap booster:
11-12 YO
pregnant mothers and those around them
10 year intervals after 11-22 yrs of age OR after any major injury if the last booster was 5 yrs ago or longer
tetanus
- tx
- prevention
TX:
- entry wound should be ID, cleaned and debrided of necrotic material
- IM Human tetanus immune globulin (TIG) EARLY ON
- Metronidazole DOC—alterntive is PCN
- Benzos like Diazepam for spasms
- IV mag has been shown to improve muscle spasm
- airway protection
Prevention:
- DtaP vaccine
* 2MO
* 4MO
* 6MO
* b/w 15-18 MO
* b/w 4-6 TO - Tdap booster
* 11-12 YO
* then every 10 yrs
Botulism
adult and infant
TX:
- Antitoxin first line tx
* if >1 YO: equine-derived heptavalent antitoxin
* if <1 YO: human-derived botulism immune globulin (BIG-IV) - NO ABX for foodborne or infantile ****
- YES ABX for wound botulism
Clostridial Myonecrosis
TX
- IV ABX– PCN + Clindamycin (metronidazole and tetracycline for PCN allergic OR just clindamycin alone)
- emergent surgical debridement
- possible amputation
- hyperbaric O2 can improve survival
cholera
tx:
1. prompt and adequate water and electrolyte replacement
2. ABX: tetracyclines, fluoroquinolones or macrolides not really necessary but shorten the duration of s/s
Lyme Disease
- early disease
- late or severe
- prophylaxis
- pregnancy
- early dz
*Doxycycline BID x 10-21 days for early localized
*Doxycycline BID x 14-28 days for early disseminated
Amoxicillin and Cefuroxime are alternative
PREGNANT: Amoxicillin x 14-21 days
can also use Azithromycin or Erythromycin - Late or severe (heart block, syncope, dyspnea, CP, CNS symps)
* IV Ceftriaxone - Prophylaxis—given w/in first 72 hours of tick removal if tick present for >36 hours and in endemic area
* Doxycycline 200mg X1 dose
* if allergic to doxy or cannot be used, no prophylaxis given
DOXY IS CONTRA IN PREGNANCY
RMSF
*pregnant and not pregnant
TX:
Doxycycline DOC (even if under 8***)
Chloramphenicol is 2nd line and for pregnancy
Gonorrhea
Disseminated Gonococcal
Gonorrhea:
- Ceftriaxone 250 mg IM**** and Azithromycin 1gram PO once
- if suspected PID: ceftriaxone + doxycycline x1 week
- Partner is tx as well
Disseminated gonococcal infection:
1. IV Ceftriaxone
**condoms MAY limit transmissino
GC/Chlamydia
Ceftriaxone IM x1 dose
and
Doxycycline 100 mg BID x7 days
Boards love the combo question*
syphilis
PCN is DOC for all stages
- primary, secondary or early latent
* **PCN G Benzathine IM one dose
* *PCN allergic: Doxycycline (PO) or ceftriaxone (IM/IV) - Late
* **PCN G Benzathine IM once weekly x3 weeks - neurosyphilis
* **IV PCN G potassium x10-14 days
Jarish-Herxheimer rxn
self limited
resolves w/o intervention in 12-24 hours
+NSAIDS or anti-pyretics if needed
Chlamydia
- Azithromycin 1gm PO—– on “outside”
OR
Doxycycline 100mg BID x10 days—- on “inside” (PID, salpingitis) - partner is tx too— no sex for 7 days after taking meds
- high risk PT–consider gonorrhea tx too
Lymphogranuloma Venereum (LGV)
Doxycycline 100mg BID x 21 days
Trichomoniasis
TX:
- Metronidazole 2g PO once OR 500mg BID x7 days (best this route if recurrent)
- partner needs to be tx
- condoms MAY limit transmission
prevention of congenital varicella syndrome
Prevention:
- Varicella Immune Globulin (VZIG) reduces severity of infection after exposure to VV in patients at high risk–which are:
- Pregnnt women who lack evidence of immunity to VZV
- newborns of mothers with varicella 5 days before to 2 days after delivery
- premature infants at or greater than 28 weeks who are exposed and whose moms has no evidence of immunity
congential syphilis
TX:
*IV PCN G X 10 days
congenital HSV
TX:
*infected moms: given meds prior to birth and during birth
OR infant is delivered c-section
- IV acyclovir x14 days followed by PO suppressive Acyclovir x6 MO
- Topical ophthalmic solution added if needed
zika virus prevention measures
- men with exposure should wait at least 3 MO to have unprotected sex
- women should wait at least 8 weeks after symptom onset or last possible exposure b4 unprotected sex
- pregnant women should avoid or consider postponing travel to areas below 6500 ft where mosquito transmission is ongoing
chicken pox
tx
prevention
TX:
1. health children <12 YO= supportive and sympto tx–tylenol and calamine lotion–NO NO NO NSAIDS it can cause superinfection
- Adults/adolescents >12, and immunocomp: Acylovir to help prevent complications— win 72 hrs of onset
PREVENTION:
- Varicella (VAR) vaccine: live attenuated
* 1st dose=12-15MO
* 2nd dose=4-6 YO
shingles
- tx
- prevention
TX
- Acyclovir, Valacyclovir, famicilovir
* **Valacyclovir used MC bc of the dosing - Analgesics for pain–narcotics for serious cases
- can be transmited until all the lesions crust over
PRevention: the following are both good for 5 years
- recombinant vaccine (RVZ): adults >50 YO, 2 doses
* **second dose is given 2-6 MO after first - Zostavax: live attenuated vaccine–no longer in US
infectious mononucleosis
TX:
- supportive measures–rest, analgesia
- increased risk of splenic rupture–>avoid contact sports*** for at least 3-4 weeks
CMV
TX:
- primary dz for immunocompetnet= supportive
- tx for reactivation
* Ganciclovir is first line and TOC
* others: Foscarnet, Cidofovir, Valacyclovir - HIV PT w/ CD4< 50 cell/uL–>Valganciclovir is given prophylactically
roseola infantum HHV-6
TX:
- supp
- self limitng
fifth’s dz or erythema infectiosum
TX:
- Symptomatic
- self limiting
Measles (rubeola)
tx
prevention
tx:
1. supportive care
2. superinfection preventions
* Vit A high doses
* ribavirin–in cases of pneumonia
* Mealses immune globulin (if high risk PT)
Prevention MMR vaccine-- live attenuated 2 doses 1st: 12-15 MO 2nd: 4-6YO
Rubella or german measles
- tx
- prev
TX:
- supportive
- Prognosis: not assoc with complications in children (compared to rubeola)
- BUT it is teratogenic in first trimester
Prevention: MMR
1st: 12-15MO
2nd: 4-6 YO
rabies post-exposure tx
EXPOSURE:
- first episode: Rabies vaccine AND rabies Immune Globulin (RIG)
* vaccine—if healthy: days 0, 3, 7, 14, (add 5th dose, day 28 if immunocomp*
* RIG—-half direclty into the wound and surrounding areas… other 1/2 IM distal frm wound - second exposure or more: vaccine alone on days 0 and 3–NO immunoglobulin
influenza
- tx
- prevention
TX: given w/in 48 hours of onset of s/s
**mostly supportive but can give antivirals
THREE DRUGS FDA APPROVED FOR A and B:
1. Oseltamivir (tamiflu) PO ** DOC for anyone even pregnant/elderly/hospitallized/complicated infections
2. Zanamivir–inhaled nose
3. Peramivir–IV
M2 inhibitors: given within 48 hours of onset of s/s
- Amantadine***
- Rimantadine
* **act only against influenza A
* *high resistance to these drugs—not recc for tx or prophylaxis
Prevention
1. chemoprophylaxis–>antivirals if contact with infected
2. Influenza vaccine–ANNUALLY for everyone >6MO who dont have contraindications
**contains both A and B strains
**two types avail in US:
A) inactivated vaccine–70% efficiacy
B) A live, attenuated vaccine–recc for kids with 90% efficacy, 85% in adults, given intranasally–NEVER GIVE TO PREGNANT OR IMMUNOCOMP
genital warts
TX:
- antivirals: Acyclovir, valacyclovir or famciclovir
- first episode: PO acyclovir (5x/day) or valacyclovir (BID)
- recurrent: PO acyclovir (TID) and valacyclovir (BID)
* *can also give the antivirals daily for suppression
HPV tx and prevention
TX:
1. wart removal–cryoablation with liquid nitrogen, topical Imiquimod and Podofilox are PT applied at home vs Podophyllin, Bichloroacetic acid and Trichloroacetic acid are clinical applied
- prevention:
*Gardasil 9–> first dose age 1–12 and 2nd dose 6-12 MO later
*if starting after age 15: then 3 doses is reccomended
DO NOT GIVE TO PREGNANT OR BF MOMS
TX HIV
- list the MC classes
- regimen for newly diganosed?
- post-exposure prophylaxis
- pre-exposure prohyplaxis
Antiretroviral therapy for ALL patients
- *highly active retroviral therapy (HAART) is mainstay in US
- *over 26 drugs
- *6 major classes
MC ones are:
- Nucleoside Reverse Transcriptase Inhibitor (NRTI)
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)
- Integrase strand transfer inhibitor (INSTI)
- Protease inhibitor
Regimens for newly diagnose PT:
*2 different NRTIs + INSTI
POST-EXP Prophylaxis:
1. within 72 hours of exposure–3 drug regimen x28 days
PRE-EXP Prophylaxis:
- reduce the risk in uninfected high-risk individuals
* 2 drug regimen
Pneumocytis (PCP) in HIV PT
-prophylaxis?
Bactrim DS
if CD4 <100 give fluconazole for prophylaxis
Histoplasmosis (if living in edemic area) in HIV PT
Itraconazole
Toxoplasmosis if HIV PT
Bactrim DS
Crptococcus in HIV PT
Fluconazole
Mycobacterium Avian Complex in HIV pT
Azithromycin or Clarithromycin
CMV retinitis in HIV PT
Valganciclovir
first line tx for uncomplicated P. falciparum malaria
- alternative?
- add on agent to kill latent species to prevent recurrence
Chloroquine
Hydroxychloroquine is alternative
Add on: Primaquine
TX for chloroquine-resistant P. Falciparum
1st and 2nd line
first line: Atovaquone/Proguanil or Artemisinin combination therapy
second: doxycycline, tetracycine, or clindamycin PLUS quinine sulfate
prophylaxis for malaria if traveling
Chloroquine or hydroxychloroquine for the chloroquine sensitive areas
chloroquine resistant areas: doxycycline, mefloquine or atovaquone-proguanil
chagas DZ
acute phase or PT without significant cardiac or GI disease:
*****benznidazole or Nifurtimox for 90-120 days
No treatment for chronic form with signiicant cardiac or GI dz
african sleeping sickness
Trypanosoma brucei gambiense
- early=Pentamidine
- late=Eflornithine and Nifurtimox
Trypanosoma brucei rhodesiense
- early= Suramin
- late=Melarsoprol +/- Nifurtimox
toxoplasmosis
- tx
- prophylaxis
tx:
1. Sulfadiazine or clindamycin PLUS Pyrimethamine
* *add folic acid/leucovorin to prevent depletion
- if pregnant: spiramycin
Prophylaxis: for PT with CD4 <100
- Trimethoprim-sulfamethoaxazole (Bactrim DS)
- Alternative: Dapson + Pyrimethamine & Leucovorin
Ascariasis
-preg and not preg
TX:
- albendazole or Mebendazole
- pregnant: pyrantel (only after 1st trimester)
hookworm
TX:
- ***Albendazole or Mebendazole or Pyranetel
- iron supplements and vitamins
tx for candida–DOC?
- oral thrush?
- vaginitis
- chronic mucocutaneous candidiasis
DOC=fluconazole
- oral thrush— nystatin swish and swallow
- vaginitis– azole drugs– po fluconazole or topical clotrimazole or minoconazole
- CMC: fluconazole or itraconazole
- disseminated candidiasis: fluconazole or capsofungin
Leprosy
-both kinds
tx:
* lepromatous: dapsone, rifampin, clofazimine x2-3 years
* tuberculoid: dapsone + rifampin 6-12MO and then dapsone for 2 years
MAC
TX:
- *very drug resistant and usually includes MANY (up to 6) drugs for tx
1. Clarithromycin + Ethambutol + a Rifamycin (rifampin or rifabutin)
2. add aminoglycoside to tx if it is a life threatening case
3. SECOND LINE: ethambutol + rifamycin + Aminoglycoside
Prophylaxis if CD4 <50
*Clarithromycin or Azithromycin
latent tb
HIV pt
non HIV
INH and Pyridoxine x 9 mo
HIV= same drugs but for 12 MO
Active TB
R I P E (S)
