ID - exam 3 Flashcards by Ryan Slade

SSTI

Skin and Soft Tissue Infection

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Mild purulent infection treatment

Incision and Drainage followed by a culture and sensitivity

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Moderate purulent infection
- MRSA treatment

Bactrim

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Moderate purulent infection
- MSSA treatment

Cephalexin OR Dicloxacillin

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Moderate purulent infection
- Empiric treatment

Bactrim OR Doxycycline

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Severe purulent infection
- Empiric treatment

Vancomycin OR
Daptomycin OR
Linezolid OR
Televancin OR
Ceftaroline

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Severe purulent infection
- MRSA treatment

Same as empiric treatment (Vanco / Dapto / Linezolid / Televancin / Ceftaroline)

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Severe purulent infection
- MSSA treatment

Nafcillin OR
Cefazolin OR
Clindamycin

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Mild non-purulent infection
treatment

Oral treatments:
Penicillin VK OR
Cephalosporin OR
Dicloxacillin OR
Clindamycin

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Moderate non-purulent infection treatment

Intravenous treatment:
Penicillin OR
Ceftriaxone OR
Cefazolin OR
Clindamycin

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Severe non-purulent infection
- Empiric treatment

Vancomycin + Piperacillin/Tazobactam

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Severe non-purulent infection
- S. Pyogenes / Clostridial treatment

Pencillin + Clindamycin

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Severe non-purulent infection
- Vibrio vulnificus treatment

Doxycycline + Ceftazidime

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Severe non-purulent infection
- Aeromonas hydro treatment

Doxycycline + Ciprofloxacin

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Severe non-purulent infection
- Polymicrobial

Vancomycin + Piperacillin/ Tazobactam

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Clinical presentations of SSTI

1 - Erythema
2 - Swelling
3 - Warmth
4 - Induration
5 - Pain / tenderness
6 - Draining wound

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Majority of purulent infections are caused by:

Staphylococcus Aureus

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Duration of therapy for a purulent based infection post I+D

5 to 10 days

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Mild purulent SSTI classification

No systemic signs of infection

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Moderate purulent SSTI classification

Signs of systemic infection but hemodynamically stable

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Severe purulent SSTI classification

Any 1 of the following:
1 - Failed I+D + PO ABX
2 - Immunocompromised
3 - Acute hypotension / organ disfunction
4 - Multiple systemic signs

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Systemic signs of infection (SIRS criteria)

1 - Temperature >38C / 100.4F
2 - HR >90
3 - RR > 24
4 - Abnormal WBC >12k or <400

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Majority of non-purulent infections are caused by:

Streptococcus species

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Duration for mild cellulitis

5 days as long as patient responds

Duration for moderate to severe cellulitis

10-14 days and possibly longer in difficult to treat cases

Antibiotic therapy is completed for Nec. Fasc. when:

Patient is afebrile for >48hrs and debridement is no longer necessary

First line therapy for dog bites

Augmentin q12

Empiric mild DFI therapy - MSSA

Cephalexin OR Augmentin OR Clindamycin

Empiric mild DFI therapy - MRSA

Bactrim OR Doxycycline

Empiric Moderate to severe DFI therapy - MRSA

Vancomycin is first line

Empiric moderate to severe DFI therapy - MSSA

Cefoxitin OR Ampicillin/sulbactam

Empiric moderate to severe DFI therapy - Pseudomonas

Pip/tazo

Duration for mild DFI

Oral ABX 1-2 weeks

Duration for moderate DFI

Oral or IV (transition to oral), 1-3 weeks

Duration for severe DFI

IV (transition to oral), 2-4 weeks

Female with acute uncomplicated cystitis

Macrobid 100mg bid x5 OR Bactrim DS bid x3

Macrobid Contraindications + ADRs

CrCL <60 - hepatotoxic, GI, neuropathy, pulmonary toxicity

Female with acute pyelonephritis (outpatient)

Cipro 500mg bid x7 OR Bactrim DS bid x14

Female with acute pyelonephritis (inpatient)

cephalo/penicillin +/- aminoglycoside x10/14

UTI and asymptomatic in pregnancy

Augmentin x7 OR Keflex x3-7

Contraindicated drugs in pregnancy

Quinolones (Ciprofloxacin) Tetracyclines (doxycycline)

If relapse due to same organism for UTI within 1-2 weeks of therapy

Extend therapy up to 6 weeks

If relapse for UTI due to different organism

Treat as if new UTI for 3-5 days

Acute bacterial prostatitis

Bactrim DS bid x14-28

Chronic bacterial prostatitis

Bactrim DS bid x4-6w

Candiduria due to Candida albicans

Fluconazole 200mg qd x2w

Candiduria due to C. glabrata

Ampho B... x1-7 OR Flucytosine x7-10

Candiduria due to C. krusei

Ampho B... x1-7

Sinusitis treatment

Augmentin If allergic - Cef...oxime + clindamycin

Sinusitis treatment duration

Adults - x5-7 Children - x10-14

Pharyngitis treatment

Amoxicillin or Penicillin VK Keflex if mild allergy (rash) Macrolides if severe (anaphylaxis)

Pharyngitis treatment duration

x10d

Symptom management for pharyngitis

Lidocaine for pain APAP for fever

Otitis Media treatment

1st line = Amoxicillin for <24hr notice 1st line = Augmentin for 48-72hr notice

Otitis Media treatment duration

30 days according to slides - not mentioned on the guidelines

COPD exacerbation treatment

Antibiotics if sputum production, color change and dyspnea - Z pak (first line) - Augmentin - Doxycycline

COPD exacerbation treatment duration