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NAPLEX Prep > ID II: Bacterial Infections > Flashcards

ID II: Bacterial Infections Flashcards

periop ppx, meningitis, URTI, LRTI, infective endocarditis, intra-abdominal infections, SSTIs, diabetic foot infections, UTIs, c. diff, STIs, tickborne diseases

1
Q

drug of choice for perioperative orthopedic ABX ppx

A

cefazolin (covers skin flora staph and strep, MSSA)
start within 60 min prior to procedure

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2
Q

drug of choice for perioperative cardiac or vascular ABX ppx

A

cefazolin start 60 min pre op
or
cefuroxime (more G- coverage)

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3
Q

drug of choice for perioperative GI ABX ppx

A

cefazolin + metronidazole
or
cefotetan, cefoxitin
or
amp/sul

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4
Q

meningitis in <1 month old
likely pathogens
treatment

A

listeria = #1
neisseria meningitidis
h inf
s pneumo
ampicillin + cefotaxime or gentamicin

NO CTX IN NEONATES 2/2 biliary sludging

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5
Q

meningitis in 1 month to 50 yo
likely pathogens
treatment

A

s pneumo
n meningitidis
h inf
need double strep coverage!!

CTX or cefotaxime
+
vanco

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6
Q

meningitis in >50 yo
likely pathogens
treatment

A

listeria = #1
n menin
h inf
s pneumo

need to cover listeria and double strep coverage

amp
+
CTX or cefotaxime
+
vanco

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7
Q

AOM
what classifies as non severe?
what classifies as severe?
treatment for each?
duration of treatment?

A

non-severe = otalgia <48h, no otorrhea, T <102.2 (39C) –> observe for 2-3d, supportive care
severe = otorrhea, T >102.2, LESS THAN 6 MONTHS OLD, otalgia x >48h, ill appearance –> antibiotics

<6 months or > 6 months with severe OM treat with high dose amoxicillin 90mg/kg/day DIV BID or amox/clav 90mg/kg/day if had amoxicillin in last 30 days

<2 yo treat for 10 days
2-5 yo treat for 7 days
>6 yo treat for 5-7d

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8
Q

Case scenario
patient OT 1 yo male, reports to hospital with a 3 day history of otorrhea, fever 102, decreased appetite and irritability. Provider suspects AOM and wants an ABX regimen recommendation. Patient has not received ABX recently
NKDA
what if patient had an amoxicillin allergy (rash and hives)?

A

patient classifies as severe AOM due to otorrhea and symptoms lasting over 48 hours.

recommend amoxicillin 90mg/kg/d DIV BID for 10 days

if amox allergy do 2nd or 3rd gen cephalo

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9
Q

first line for pharyngitis
pathogen(s)?
what if mild PCN allergy? severe PCN allergy?

A

amoxicillin or penicillin
if mild allergy do 2nd or 3rd gen cephalo
if severe allergy do clarithro or azithro or clinda

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10
Q

when do we treat acute sinusitis
tx of choice?

A

sx >10d
T >102 >3d
sx worsen after improvement
amox/clav

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11
Q

pertussis
what kind of bacteria is bordatella pertussis
tx?

A

G- coccobacilli
azithromycin or clarithromycin

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12
Q

Patient 61 yo male admitted to ED with suspicion of COPD exacerbation.
What qualifies as COPD exacerbation? How do we treat it?
QTc 510

A

patient must have inc SOB, inc sputum volume and increased sputum purlence. If purulence is present, only need one other sx.
treat with azithromycin 500mg PO QD x3d or z pak
however, patient’s QTc is prolonged (normal is 350-450 in males) so alternative is doxycycline 100mg po QD-BID x5-7 days

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13
Q

other than antibiotics, what else do we use to treat a COPD exacerbation

A

prednisone 40mg po QD x5 days
MDI
supp oxygen

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14
Q

patient is prescribed prednisone 40mg po QD for 5 days for copd exacerbation. hospital pharmacy only has methylprednisolone. What is the equivalent dose

A

4mg MEPN = 5mg prednisone

4mg MEPN/5mg pred = x mg MEPN/40mg pred

32mg MEPN po once daily or in divided doses

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15
Q

what is the goal O2 saturation in a COPD patient

A

88-92%

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16
Q

CAP
common pathogens
treatment for a healthy individual (no comorbidities)

A

s pneumo, h inf, m pneumo

high dose amoxicillin 1g TID
or
doxycycline
or
macrolide if local PNA resistance <20

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17
Q

severe CAP is classified as a patient with ______________________
treatment?

A

comorbidities (heart, lung, liver, renal disease, DM, AUD, malignancy, asplenia)
treatment is a beta lactam PLUS macrolide
amox/clav or CTX + azithro or clarithro

OR

levofloxacin/ciprofloxacin monotherapy

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18
Q

when do we add MRSA or pseud coverage in CAP

A

hospitalized and received IV ABX in last 90d

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19
Q

HAP/VAP
what are MRSA risk factors
how does this change therapy

A

IV ABX last 90 days
resistance >20%
hx MRSA
+ MRSA swab

need to add MRSA coverage with vanco or linezolid

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20
Q

HAP/VAP
what are pseud risk factors
how does this change therapy

A

IV ABX last 90d
G- resistance >10%
hospitalized >5d prior to HAP/VAP onset (has been in hospital for a while prior to HAP/VAP)

need double pseud coverage

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21
Q

Patient Case
Patient admitted 10 days ago for severe COPD exacerbation and has developed a fever, cough and lethargy in the last 48 hours. CXR showed new bilateral infiltrates. What would you recommend for treatment and why
Last hospitalization was 2 months ago for cellulitis (received IV SMX/TMP).
local MRSA resistance 18%
local G- resistance 12%

A

recommend MSSA, double pseud and vanco coverage since
1. hospitalized in last 90d w IV ABX (MRSA and double pseud cov needed)
2. has been in hospital for >5 days prior to HAP onset (need double pseud)
3. local pseud resistance is >10%

options for pseud include
pip/tazo, cefepime, levoflox, meropenem

options for MRSA coverage include vanco, linezo

examples:
pip/tazo + cefepime + vanco
pip/tazo + cipro + vanco
cefepime + cipro + linezo

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22
Q

latent TB treatment options

A

rifampin 600mg po qd x4 mo
or
isoniazid (INH) 300mg QD x6-9mo
or
rifampin and INH daily x 3mo

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23
Q

active TB treatment

A

RIPE
rifampin 10mg/kg po qd
isoniazid 5mg/kg
pyrazinamide 20-25mg/kg po qd
ethambutol 15-20mg/kg po qd

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24
Q

_________ is added in RIPE treatment of active TB to reduce the risk of INH-induced peripheral neuropathy

A

vitamin B6 (pyridoxime)

25
Q

rifampin is a CYP______ inducer/inhibitor and will inc/dec plasma concentrations of _____________________
_____________________
_____________________
and should not be used with

A

rifampin is a CYP1A2, 2C8, 2C19, 3A4 inducer and will decrease Cp of
protease inhibitors
warfarin
po contraceptives
and should NOT be used with warfarin or dabigatran

26
Q

infective endocarditis treatment if virdans group strep

A

penicillin or CTX
+/-
gentamicin

27
Q

infective endocarditis treatment if MSSA

A

nafcillin or cefazolin
+ gentamicin
+ rifampin if prosthetic valve

28
Q

infective endocarditis treatment if MRSA

A

vanco
+ gentamicin and rifampin if prosthetic valve

29
Q

infective endocarditis treatment if enterococci? What if its VRE?

A

ampicillin
+
gent
+
high dose CTX

if VRE –> dapto or linezolid

30
Q

patient with a prosthetic valve and a history of infective endocarditis from a root canal is getting another root canal (crazy right) next week. What should he take for ppx?

A

amoxicillin 2g PO 30-60 minutes before the procedure

31
Q

first line for SBP treatment

A

CTX x5-7d due to concern for strep, proteus, e coli, kleb)

32
Q

systemic s/sx of SSTI

A

T> 100.4
HR >90
WBC >12,000 or <4,000

33
Q

impetigo
appearance
treatment

A

honey-colored crusts, non-purulent
local lesions - mupirocin topical
many lesions - cephalexin 250-500mg PO QID
or
dicloxacillin 150-500mg PO QID

34
Q

folliculitis/fuurnicle/carbuncle
treatment

A

1 = I + D

#2 = SMX/TMP DS 1-2t PO BID
or
doxy 100mg po BID

35
Q

cellulitis
pathogens
treatment with duration

A

strep (pyogenes or GAS), staph (MSSA)
cephalexin 500mg PO QID x5d
dicloxacillin 500mg PO QID x5d
beta lac allergy –> clinda

36
Q

purulent abscess
likely pathogens
treatment

A

1 = source control

staph (CA MRSA, MSSA)

#2 = I + D
#3 = SMX/TMP DS PO BID
or
doxy 100mg PO BID
or
minocycline or clinda

37
Q

necrotizing fascitis
pathogens
treatment

A

s pyogenes, s aureus (MRSA), e coli (G-), anaerobes
vanco or linezo + B lac + clinda

38
Q

DFI
what do we need to cover
treatment options and duration

A

need to cover G+/- anaerobes, and (possibly) MRSA, pseud, GAS, enterobacter, proteus, klebsiella

amp/sul
pip/tazo
meropenem
moxifloxacin
CTX, cefotaxime, levoflox, cipro) + metronidazole
and can add vanco/dapto/linezo for MRSA if needed
x1-2 weeks non-severe
x2-4 weeks severe
x4-6 weeks if limb-threat or involved bone, joint

39
Q

acute uncompl cystitis treatment options and duration

A

macrobid (nitrof) 100mg PO BID x5 days
SMX/TMP 1 DS tab PO BID x3 days
fosfomycin 3g x1 dose

40
Q

acute pyelonephritis treatment options and duration

A

local FQ resistance-dependent
<10%: cipro 500mg PO BID x5-7d
levoflox 750mg PO QD x5-7d
>10%: CTX 1g IV/IM x1
ertapenem 1g IV/IM x1
AG extended int dosing

41
Q

when do we treat a pregnant patient with a UTI? treatment options?

A

always! especially if UA shows >10^5 CFU bacteria.
amoxicillin
cephalexin
fosfomycin

42
Q

c diff first episode treatment

A

vancomycin 125mg PO QID x10d
or
fidaxo 200mg PO QID x10d
or
metrondazole 500mg PO TID if above unavail

43
Q

c diff second episode treatment

A

vancomycin standard + pulse taper
or
vanco standard if metronidazole used 1st time
or
fidaxo 200mg PO BID x10d

44
Q

c diff third episode treatment

A

vanco standard + long pulse taper
or
vanco standard + rifaximin
or
fidaxo BID x10d
or
fecal microbiota transfer

45
Q

what warrants UTI ppx? what do we use?

A

> /= 3 episodes / year
SMX/TMP SS PO QD
or
nitrofurantoin 50mg PO QD
or
SMX/TMP 1 tablet after sexual intercourse

46
Q

chlamydia
s/sx
treatment

A

genital discharge or asx
non preg - doxy100mg PO BID x7d
preg - azithro 1g po x1

47
Q

gonorrhea
s/sx
treatment

A

genital discharge or asx
CTX (includes pregnant pts)
<150kg –> 500mg IM x1
>150kg –> 1g IM x1
+ doxy if cant rule out chlamydia

48
Q

b vag
s/sx
treatment

A

vaginal disch + fishy odor + pH >4.5 + little to no pain
metronidazole 500mg po BID x7d
or
metronidazole 0.75% gel appl QD x5d
or
clinda 2% crm appl qhs x7d
or
tinidazole 2g po qd x2d
or
clinda 300mg po bid x7d
or
secnidazole 2g po x1

49
Q

trich
s/sx
treatment

A

yellow/green frothy discharge + pH >4.5 + pain with intercourse
female: metronidazole 500mg PO BID x7d
male: 2g PO x1

50
Q

syphillis
s/sx
treatment

A

depends on stage of infection
primary, secondary or early latent
||
\/
Pen G 2.4 million units IM x1

latent or tertiary (>1year ago acquired)
||
\/
Pen G 2.4 million units IM qweek x3 weeks

51
Q

genital warts treatment

A

imiquimod cream

52
Q

patient presents to primary care office with urinary urgency, increased frequency and burning. female, 68 yo
CrCl 48 mL/min
treatment options?

A

macrobid CI 2/2 CrCl <60

SMX/TMP 1 DS tablet PO BID x3 days
would need to renally adjust if crcl <30!

53
Q

Patient admitted for uti. 72 yo female PMH insulin-dep DM, epilepsy, schizophrenia, failure to thrive, HTN, HLD, afib. pyelonephritis. treatment options?
QTc = 510

A

concern for psych, tendon rupture, BG changes, seizures, QTc prolongation

FQ (levo or cipro) not best option

can do SMX/TMP or B lac x7-10 days

54
Q

when is partner treatment warranted

A

gonorrhea
chlamydia
syphilis

55
Q

treatment for neurosyphilis

A

Pen G 3-4 million units IV q4h x10-14d

56
Q

rocky mountain fever treatment

A

doxy 100mg PO BID x5-7d

57
Q

lyme disease treatment

A

doxy 100mg po BID x10d

58
Q

Ehrlichosis treatment

A

tickborne disease
doxy 100mg PO BID x7-14 days

NAPLEX Prep (57 decks)

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