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ID Exam 3 Flashcards

1
Q

CAP definition

A

pneumonia that developed outside of hospital or within first 48 hours of hospital admission

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2
Q

Severe CAP major criteria

A

(need 1)
1. septic shock requiring vasopressors
2. respiratory failure requiring mechanical ventilation

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3
Q

Severe CAP minor criteria

A

(need ≥ 3)
1. resp rate ≥ 30
2. multilobar infiltrates
3. confusion
4. BUN ≥ 20 (uremia)
5. leukopenia (wbc < 4000)
6. temp < 36
7. thrombocytopenia ( < 100,000 plts)
8. hypotension requiring fluids

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4
Q

CURB-65

A

C = confusion
U = uremia (BUN > 19)
R = resp rate ≥ 30
B = BP <90/<60
Age ≥ 65

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5
Q

CAP outpatient empiric therapy:
healthy adults without comorbidities or risk factors

A
  1. amoxicillin 1g PO q8h
  2. doxycycline 100mg PO BID
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6
Q

CAP outpatient empiric therapy:
adults with comorbidities

A

monotherapy:
levofloxacin 750mg PO daily
moxifloxacin 400mg PO daily

combo therapy:
beta-lactam + macrolide or doxycycline
(beta lactams recommended: amoxicillin, cefpodoxime, cefuroxime)

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7
Q

Non-severe CAP inpatient empiric therapy (no MRSA/pseudomonas risk factors)

A

monotherapy:
levofloxacin 750mg PO daily
moxifloxacin 400mg PO daily

combo therapy:
beta-lactam + macrolide

*beta-lactams recommended
unasyn 1.5-3gm IV q6h
ceftriaxone 1-2gm IV q24h

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8
Q

Severe CAP inpatient empiric therapy (no MRSA/pseudomonas risk factors)

A

Combo therapy options:

  1. FQ + beta-lactam
  2. macrolide + beta-lactam

*beta-lactams recommended:
unasyn 1.5-3gm IV q6h
ceftriaxone 1-2gm IV q24h

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9
Q

MRSA risk factors

A
  1. 2-14 days post influenza
  2. previous MRSA respiratory infection
  3. previous hospitalization and use of IV antibiotics within last 90 days
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10
Q

MRSA coverage options

A
  1. Vancomycin target AUC 400-600
  2. Linezolid 600mg IV/PO q12h
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11
Q

Pseudomonas risk factors

A
  1. Previous p. aeruginosa respiratory infection
  2. previous hospitalization and use of IV antibiotics within last 90 days
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12
Q

Pseudomonas coverage options

A
  1. Zosyn 4.5 gm IV q6h
  2. Cefepime 2gm IV q8h
  3. Meropenem 1gm IV q8h
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13
Q

Acute pharyngitis common pathogens

A
  1. respiratory viruses - rhinovirus, coronavirus, adenovirus
  2. streptococcus pyogenes (group A)
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14
Q

Acute pharyngitis treatment (for streptococcus pyogenes)

A
  1. penicillin VK 250mg PO TID or 500 mg PO BID
  2. Amoxicillin 500mg PO TID or 875 mg BID

x10 days

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15
Q

Most common respiratory pathogens

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
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16
Q

Chronic bronchitis - acute exacerbation treatment options

A
  1. Amox/clav 875/125mg PO BID
  2. Cefuroxime 500mg PO BID
  3. Cefpodoxime 200mg PO BID

x 5-7 days

If risk for P. aeruginosa: Levofloxacin 750mg PO daily

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17
Q

Acute bacterial rhinosinusitis first-line treatment

A

Amox/clav 500/125mg PO TID or 875/125mg PO BID x 5-7 days

-MRSA risk: add doxycycline or TMP/SMX
-Pseudomonas risk: add levofloxacin

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18
Q

Genitourinary infections risk factors

A
  1. urologic instrumentation and catheterization
  2. anatomical abnormality of urinary tract (i.e. obstruction commonly due to calculi)
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19
Q

What is the most common causative pathogen of UTIs?

A

E. coli

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20
Q

Which Abx are only used for uncomplicated UTIs due to not reaching good systemic concentrations?

A

Nitrofurantoin and fosfomycin

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21
Q

Empiric inpatient UTI treatment

A
  1. ampicillin 2 g IV q6h + gentamicin 5mg/kg q24h
  2. cefazolin 1-2 g IV q8h + gentamicin 5mg/kg q24h
  3. Ceftriaxone 1-2 g IV q24h
  4. Cefepime 1g IV q8-12h
  5. Gentamicin 5mg/kg IV q24h

for gentamicin - use AdjBW

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22
Q

Treatment duration for complicated UTI

A

7-14 days

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23
Q

Definition of recurrent UTI

A

-3 or more infections in 1 year
-2 of more infections in 6 months

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24
Q

What pathogen causes “walking pneumonia”?

A

Mycoplasma pneumoniae

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25
What might be used as prophylactic Abx for recurrent UTIs?
nitrofurantoin fosfomycin
26
Osteomyelitis empiric antibiotic options
C - ciprofloxacin C - cefepime C - cefazolin C - ceftriaxone L - levofloxacin A - ampicillin/sulbactam M - meropenem P - pip/tazo
27
Osteomyelitis general duration
4-8 weeks
28
Treatment duration: Vertebral osteomyelitis due to MRSA
8 weeks
29
Treatment duration: DFI osteomyelitis with complete resection of all infected bone/tissue
2-5 days
30
Treatment duration: DFI osteomyelitis with resection of all osteomyelitis, soft tissue infection remains
1-2 weeks
31
Treatment duration: DFI osteomyelitis with resection performed, but osteomyelitis still remains
3 weeks
32
Treatment duration: DFI osteomyelitis with no resection
6 weeks
33
Treatment duration: septic arthritis with S. aureus or GNRs
4 weeks
34
Treatment duration: septic arthritis with streptococci
2 weeks
35
Treatment duration: septic arthritis with N. gonorrhoeae
7-10 days
36
What is the most common causative pathogen of bone/joint infections
S. aureus
37
What is the most common CF mutation?
F508del
38
What is the sweat chloride test and how can it diagnose CF?
It tests the amount of chloride in someone's sweat, and a value of ≥ 60 mEq/L is indicative of CF
39
Which class of CF mutations are the hardest to treat and why?
Class I - nonsense mutations meaning no CFTR protein is made at all, also means more severe symptoms
40
Ivacaftor MOA
Binds to CFTR to stabilize it in the open state, so Cl- can flow through - it "opens the door"
41
Ivacaftor clinical pearls
1. Take with fatty foods 2. LFTs monitored every 3 months 3. Eye exam yearly 4. Dose adjustment for hepatic impairment 5. CYP 3A substrate
42
HAP empiric therapy
MSSA + Pseudomonas coverage: 1. Zosyn 2. Cefepime 3. Imipenem 4. Meropenem 5. Levofloxacin + MRSA coverage if needed: 1. Vancomycin 2. Linezolid *if at high risk for mortality, pick two agents from the first list
43
VAP empiric therapy
Need MRSA and Pseudomonas coverage 1. Zosyn 2. Cefepime 3. Imipenem 4. Meropenem 5. Levofloxacin 6. Tobramycin/Amikacin + Vancomycin or Linezolid
44
Osteomyelitis - dalbavancin 2-dose strategy
Dalbavancin 1500mg IV on days 1 and 8 - provides 6-8 weeks of coverage
45
When is rifampin added to treatment for prosthetic joint infection?
1. debridement and retention of prosthetic 2. 1-stage exchange
46
PJI treatment duration - debridement and retention of prosthesis
pathogen-directed treatment + rifampin = 2-6 weeks oral treatment + rifampin = 3-6 months
47
PJI treatment duration - 1 stage exchange
pathogen-directed treatment + rifampin = 2-6 weeks oral treatment + rifampin = 3 months
48
PJI treatment duration - 2 stage exchange
pathogen-directed treatment x 4-6 weeks
49
PJI treatment duration - amputation with complete removal of infected bone
pathogen-directed treatment x 24-48 hours
50
Non-purulent SSTIs
cellulitis erysipelas
51
SSTIs classifications (mild, moderate, severe)
mild - no systemic signs, only localized moderate - systemic signs of infection severe - meets SIRS criteria (≥ 2)
52
SIRS criteria
-Temp > 38 or < 36 -HR > 90 bpm -RR > 24 bpm -WBC > 12K or <4K
53
Non-purulent SSTIs - mild treatment options
oral -Penicillin VK -Cephalosporin -Clindamycin x 5 days
54
Non-purulent SSTIs - moderate treatment options
IV -penicillin -ceftriaxone -cefazolin -clindamycin x 5 days
55
Non-purulent SSTIs - severe treatment options
1. surgical inspection + debridement 2. empiric abx: -vancomycin + piperacillin/tazobactam 3. C/S
56
Purulent SSTIs
1. abscesses: collection of pus within dermis and deeper skin tissues 2. furuncles (boils): small abscess that forms around hair follicle 3. carbuncles: infection involving several adjacent follicles
57
Purulent SSTIs mild treatment
incision and drainage
58
Purulent SSTIs moderate treatment
first: I+D and C+S empiric therapy: TMP/SMX or doxycycline (MRSA) Dicloxacillin or cephalexin (MSSA)
59
Purulent SSTIs severe treatment
first: I+D and C+S empiric therapy: -Vancomycin, daptomycin, linezolid (MRSA) -Nafcillin, cefazolin, clindamycin (MSSA)
60
Necrotizing fasciitis treatment
in order: 1. surgical inspection + debridement 2. empiric therapy: vancomycin + zosyn 3. C/S: S. pyogenes: PCN + clindamycin polymicrobial: vancomycin + zosyn
61
Impetigo - few lesions treatment
topical - mupirocin x 5 days
62
Animal/human bites DOC
DOGmentin
63
When do we NOT use amoxicillin in pediatric acute otitis media?
-Known resistance -Treatment failure -Amoxicillin in last 30 days -Allergy -Concurrent conjunctivitis
64
Amoxicillin dose for acute otitis media
80-90 mg/kg/day divided q12h x 5-10 days
65
When are tympanostomy tubes indicated?
in recurrent AOM: -3 or more episodes in < 6mo -4 or more episodes in < 12 mo
66
Orkambi is approved for what type of mutation?
F508del homozygous
67
Trikafta is approved for what type of mutation?
at least one F508del mutation

P3 Therapeutics (21 decks)

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