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NAPLEX > ID II: Bacterial Infections > Flashcards

ID II: Bacterial Infections Flashcards

1
Q

Which 2 agents are commonly used for prophylaxis before cardiac/vascular surgeries?

A

cefazolin or cefuroxime

*vanco or clinda if allergy

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2
Q

Which agent is commonly used for prophylaxis before joint replacement surgeries?

A

cefazolin

*vanco or clinda if allergy

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3
Q

Which agents are commonly used for prophylaxis before colorectal surgeries?

A

cefoxitin, unasyn, ertapenem OR metronidazole + (cefazolin orceftriaxone)

*clinda + (AG or quinolone or aztreonam) OR metronidazole + (AG or quinolone) if allergy

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4
Q

Which agents are commonly used for prophylaxis before a hysterectomy?

A

cefazolin, cefoxitin or unasyn

*clinda or vanc + (AG or quinolone or aztreonam) OR metronidazole + (AG or quinolone) if allergy

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5
Q

What is meningitis?

A

Inflammation of the meninges that cover the brain and spinal cord

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6
Q

Name the 3 classic sx of meningitis

A

HA, nuchal rigidity, altered mental status

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7
Q

Name the most likely bacterial pathogens of meningitis

A

strep pneumo, Neisseria meningitidis, h. flu, listeria*

*Infants

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8
Q

Empiric therapy for acute bacterial meningitis in infants

A

amp 150-200mg/kg/day + (gent 5-7.5mg/kg/day or cefotaxime 100-200mg/kg/day)

*amp added for listeria coverage

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9
Q

Empiric therapy for acute bacterial meningitis in children and adults aged 1 mo-50 yrs

A

(ceftriaxone or cefotaxime) + vanco

*PCN allergy: quinolone + vanco

For Lindsey - pts aged 1mo -23mo dosing:
ceftriaxone 80-100mg/kg/day or cefotaxime 225-300mg/kg/day + vanco 60mg/kg/day divided q6h

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10
Q

Empiric therapy for acute bacterial meningitis in immunocompromised pts or aged >50 yrs

A

vanco + amp + (ceftriaxone or cefotaxime)

  • amp added for listeria coverage
  • PCN allergy: quinolone + vanco (+/- SMX/TMP for listeria coverage)
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11
Q

Name the common types of upper respiratory infections

A

acute otitis media (AOM), pharyngitis (s. pyogenes), sinusitis (s. pneumo, h. flu, moraxella, staph, anaerobes, some gm- rods), influenza, common cold (rhinovirus, coronavirus)

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12
Q

When do you treat AOM in children 6 mo-2 yrs?

A

Bilateral with or without drainage, unilateral w/drainage, or uni/bilateral w/severe sx (ear pain >48 hrs, T >102.2F)

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13
Q

When do you treat AOM in children >2 yrs?

A

any drainage, uni/bilateral w/severe sx, and possibly bilateral w/out drainage

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14
Q

Empiric therapy for AOM

A

High dose amoxicillin (80-90mg/kg/day divided q12h) or augmentin (90mg/kg/day divided q12h)

*PCN allergy: cefdinir 14mg/kg/day or ceftriaxone 50mg/kg IM/IV

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15
Q

Indications for antibiotic tx in pharyngitis

A

+ rapid antigen diagnostic test OR + s. pyogenes culture

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16
Q

Indications for antibiotic tx in sinusitis

A

> 7-10 days of sx, tooth/face pain, nasal drainage, congestion or severe sx

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17
Q

Tx options for pharyngitis

A

penicillin, amoxicillin, 1st/2nd gen cephalosporin x 10 days

*If beta-lactam allergy: clarithromycin, azithromycin, or clinda

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18
Q

Tx options for sinusitis

A

1st line: augmentin x 5-7 days (children) or 10-14 days (adults)

2nd line or failure of augmentin: oral 2nd/3rd gen cephalosporin + (clinda or doxy) OR respiratory quinolone

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19
Q

Name the common types of lower respiratory infections

A

bronchitis - including: whooping cough; acute COPD exacerbation; community-acquired PNA; hospital-acquired/ventilator-associated PNA; TB

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20
Q

Acute bronchitis typical pathogens

A

90% caused by RESPIRATORY viruses: RSV, adenovirus, rhinovirus, coronavirus, influenza, parainfluenza

Bacterial etiology for more severe cases: mycoplasma, h. flu, bordetella pertussis, chlamydophila pneumoniae

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21
Q

Tx for mild-to-moderate acute bronchitis

A

Supportive tx

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22
Q

Tx for confirmed or suspected bordetella pertussis (whooping cough)

A

azithromycin x 5 days or
clarithromycin x 7 days or
SMX/TMP x 14 days

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23
Q

Tx for acute bacterial COPD exacerbation

A

Tx w/ antibiotics for the following 3 sx: increase in dyspnea, sputum volume, and sputum purulence (or if MV is required)

supportive tx + augmentin or azithromycin, or doxycycline x 5-10 days

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24
Q

Common causes of CAP

A

Outpatient: STREP PNEUMO, h. flu, Moraxella catarrhalis, mycoplasma, chlamydophila pneumonia

Inpatient: + legionella, gm- bacilli, staph aureus, pseudomonas

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25
Q

Outpatient empiric tx of CAP

A

If previously healthy + no abx use in past 3 months:

  1. macrolide (azith, clarith, eryth) OR
  2. doxy

If comorbidities (chronic heart, lung, liver or renal dz, DM, alcoholism, malignancies, asplenia, use of abx w/in past 3 months, immunosuppressed) OR risk for drug-resistant strep pneumo:

  1. beta-lactam + macrolide (HD amox or augmentin preferred)
  2. Respiratory quinolone monotherapy
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26
Q

Inpatient empiric tx of CAP

A

Non-ICU

  1. beta-lactam + macrolide (ceftriaxone or cefotaxime preferred)
  2. Respiratory quinolone monotherapy (IV or PO)

ICU

  1. beta-lactam + (azith or respiratory quinolone) - (ceftriaxone, cefotaxime or unasyn preferred)
    * PCN allergy: aztreonam + respiratory quinolone

Suspected pseudomonas: use zosyn/cefepime/imipenim/or meropenem for beta-lactam + (cipro or levo)

Suspected MRSA: + vanco or linezolid

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27
Q

Common causes of early onset HAP or VAP

A

strep pneumo, MSSA, h. flu, e. coli, proteus, klebsiella, enterobacter, serratia

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28
Q

Empiric tx for early onset HAP or VAP

A

ceftriaxone or unasyn or ertapenem or levo/moxi/cipro

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29
Q

Common causes of late onset HAP, VAP, or HCAP

A

strep pneumo, MRSA, pseudomonas, CAPES

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30
Q

Empiric tx for late onset HAP/VAP/HCAP

A

antipseudomonal beta-lactam (cefepime, ceftazidime, zosyn, imipenem/cilastatin, meropenem) +

2nd antipseudomonal agent (gent, tobra, amikacin, levo, cipro) +

Anti-MRSA if pt has risk factors (vanco or linezolid)

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31
Q

Length of tx for HAP/VAP/HCAP

A

7-8 days*

*14 days if caused by pseudomonas or acinetobacter

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32
Q

Length of tx of CAP

A

5-7 days

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33
Q

What organism causes TB?

A

mycobacterium tuberculosis (aerobic, non-spore forming acid fast bacillus)

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34
Q

Describe the 2 phases of TB

A

Latent: no sx seen; NOT contagious; diagnosed via PPD intradermal test

Active: HIGHLY contagious (through aerosolized droplets) w/sx (cough, hemoptysis, purulent sputum, fever); diagnosed via sputum culture

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35
Q

Tx of latent TB

A
  1. isoniazid (INH) 300mg daily x 9 months
  2. rifampin 600mg daily x 4 months if INH resistant/INH-intolerant
  3. INH + rifapentine once weekly x 12 weeks*

*Cannot use in HIV+ pts, children

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36
Q

Tx of active TB

A 
Initial Phase (tx for 8 weeks): RIPE
rifampin + INH + pyrazinamide + ethambutol

Continuation Phase (tx depends on resistnance)

  1. susceptible to INH and rifampin: continue INH + rifampin daily x 18 wks
  2. resistant to INH: rifampin + pyrazinamide + ethambutol +/- moxifloxacin x 18 wks
  3. resistant to rifampin: INH + ethambutol + quinolone x 12-18 mo + pyrazinamide x 2 mo
  4. MDR-TB: quinolone (levo or moxi) + pyrazinamide + ethambutol + AMG (streptomycin or amikacin or kanamycin) +/- alt agent x 18-24 mo
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37
Q

Common SE from RIPE tx of TB

A

orange-red discoloration of body secretions, flu-like syndrome, GI upset, rash, increase in LFTs, HA, hyperuricemia, optic neuritis, drug-induced lupus erythematosus

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38
Q

CI to rifampin

A

concurrent use w/ protease inhibitors*

*Pts on protease inhibitors (e.g. HIV pts) may replace rifampin with RIFABUTIN to avoid DDI

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39
Q

BBW for INH

A

severe and fatal hepatitis

40
Q

CI to pyrazinamide

A

acute gout, severe hepatic damage

41
Q

CI to ethambutol

A

optic neuritis, use in young children, use in any pt who cannot discern and report any visual changes

42
Q

What are the 3 most common causative organisms of infective endocarditis (IE)?

A

staph (MRSA & MSSA), strep viridans, enterococcus

43
Q

What is infective endocarditis?

A

Infection of the inner tissue of the heart - most commonly the heart valves

44
Q

Empiric tx of IE

A

vanco + ceftriaxone +/- gentamicin for synergy x 4-6 wks

45
Q

Preferred tx for viridian group strep IE

A

PCN, amp, or ceftriaxone +/- gent for synergy

*bet-lactam allergy: vanco monotherapy

46
Q

Preferred tx for MSSA IE

A

nafcillin or cefazolin + gent if prosthetic valve

*bet-lactam allergy: vanco

47
Q

Preferred tx for MRSA IE

A

vanco + gent if prosthetic valve

48
Q

Preferred tx for enterococci IE

A

PCN or amp + gent

*beta-lactam allergy or resistance: vanco

49
Q

IE prophylaxis

A

Pt at risk of IE should use abx before dental procedures for IE prophylaxis

High risk pts: hx of endocarditis, heart transplant w/abnormal valve fxn, some congenital heart defects

Ex regimens: amoxicillin 2 g, clinda 600mg, azith 500mg, cefazolin 1 g IM/IV

50
Q

Common types of intra-abdominal infections

A

spontaneous bacterial peritonitis (SBP), secondary peritonitis (caused by trauma e.g. ulceration, ischemia, obstruction or surgery), cholecystitis (inflammation of gallbladder), cholangitis (inflammation of bile duct)

51
Q

Tx of SBP

A

DOC: ceftriaxone x 5-7 days

*SMX/TMP or cipro can be used for primary or secondary prophylaxis

52
Q

Tx of secondary peritonitis and cholangitis

A

mild-to-moderate infection: cover PEK, anaerobes, strep, enterococci

Ex. regimen: cefoxitin, ertapenem, moxi

high-severity infections/ICU pts: cover PEK, CAPES, anaerobes, strep, enterococcus

Ex. regimen: carbapenem or zosyn or (cefepime or ceftazidime) + metronidazole

53
Q

Common types of non-purulent SSTIs

A

Cellulitis, erysipelas, necrotizing infections

54
Q

Common types of purulent SSTIs

A

Furncle, carbuncle, absess*

Further categorized into mild, moderate and severe infections

55
Q

Common pathogens associated with cellulitis

A

strep pyogenes (group A strep), staph aureus (CA-MRSA)

56
Q

Empiric tx of mild non-purulent SSTIs

A

Target strep

PCN, cephalexin, clinda x 5 days

57
Q

Empiric tx of moderate non-purulent STTIs

A

OR penetrating mild non-purulent infections - target strep +/- MSSA

ceftriaxone, cefazolin, clinda x 5 days

58
Q

Empiric tx of severe or necrotizing non-purulent SSTIs

A

BROAD coverage

vanco + beta-lactam (zosyn, imipenem/cilastatin, meropenem)

*Tx of choice for group A strep necrotizing fasciitis = pen G + clinda

59
Q

Empiric tx of moderate purulent SSTIs

A

Target CA-MRSA

  1. I&D
  2. SMX/TMP or doxy/minocycline or clinda or linezolid

After C&S narrow to:

  • MSSA: cephalexin or dicloxacillin
  • MRSA: SMX/TMP
60
Q

Empiric tx of mild purulent SSTIs

A

I&D only

61
Q

Empiric tx of severe purulent SSTIs

A

Target MRSA

Start with IV abx and when pt is stable transition to PO

  1. I&D
  2. vanco or dapto or linezolid or telavancin or ceftaroline or tedizolid or dalbavancin x 7-14 days

*BITE infections require addition of aerobic gm- and anaereobes (e.g. unasyn or augmentin)

62
Q

Name the predominant gm+ pathogens associated with diabetic foot infections (DFI)

A

aerobic: staph (including MRSA), group A strep, viridans group strep, staph epidermidis
anaerobic: peptostreptococcus, clostridium perfringens

63
Q

Name the predominant gm- pathogens associated with diabetic foot infections (DFI)

A

aerobic: e. coli, klebsiella, proteus, enterobacter, pseudomonas
anaerobic: baceroides fragilis

64
Q

Empiric tx of moderate-to-severe DFI

A

Monotherapies: unasyn, zosyn, timentin, imipenem/cilastatin, meropenem, ertapenem, tigecycline, moxifloxacin

Combos: vanco + (ceftazidime, cefepime, zosyn, aztreonam or a carbapenem)

Tx length: 7-14 days; more severe = 2-4 wks; osteo = 4-6 wks

65
Q

Name the most common sx associated with lower UTI

A

dysuria, urgency, frequency, burning, nocturia, suprapubic burning, +/- hematuria

*fever is UNCOMMON

66
Q

Name the most common sx associated with upper UTI

A

flank pain, abdominal pain, FEVER, N/V, malaise

67
Q

What is a lower urinary tract infection?

A

Infection of the bladder (cystitis) and urethra

68
Q

What is an upper urinary tract infection?

A

Infection of the kidney (pyelonephritis) or upper urinary tract

69
Q

What is considered a complicated UTI?

A
  • Pregnancy
  • Infection resulting from neurogenic bladder (spinal cord injury, MS)
  • Infection resulting from an obstruction (kidney stone, enlarged prostate)
70
Q

Target and empiric tx of uncomplicated cystitis in females

A

Common pathogens: e. coli, klebsiella, proteus, enterococcus

nitrofurantoin 100mg BID x 5 days OR
SMX/TMP DS BID x 3 days OR
cipro 500mg daily x 3 days OR
levofloxacin 250mg daily x 3 days

71
Q

Target and tx of uncomplicated pyelonephritis

A

Common pathogens: e. coli, enterococcus, proteus, klebisella, pseudomonas

Moderate (PO): cipro 1,000mg daily x 7 days OR levofloxacin 750mg daily x 5 days

Severe (IV): ceftriaxone or amp/gent or cipro/levo or zosyn x 14 days total

72
Q

Target and tx of complicated UTI

A

Common pathogens: e. coli, klebsiella, enterobacter, serratia, pseudomonas, enterococcus, staph

ceftriaxone or amp/gent or cipro/levo or zosyn x 7-14 days

*If ESBL use a carbapenem

73
Q

Tx of UTI in pregnancy

A

Bacteriuria MUST BE TREATED even if pt is asymptomatic ( x 3-7 days)

1st line: beta-lactams (augmentin or cephalosporins)
2nd line: nitrofurantoin or SMX/TMP - contraindicated in last 2 weeks of pregnancy

*Quinolones are CI!

74
Q

What agent can you use to tx dysuria associated with UTI?

A

phenazopyridine (Azo, Pyridium, Uristat) x 2 days max

*may cause orange-red discoloring of urine and other body fluids

75
Q

Name the common sx of clostridium difficile infection

A

cramps, profuse diarrhea (+/- blood), fever

76
Q

Why should antimotility agents be avoided for c. difficile infections?

A

Increased risk of toxic megacolon from toxins released from c. difficile

77
Q

Tx of 1st c. difficile infection

A

Mild-moderate :metronidazole 500mg po TID x 10-14 days

Severe: vanco 125mg QID x 10-14 days

Severe, complicated (hypotension, shock, ileus, toxic megacolon): vanco 500mg QID + metronidazole 5000 mg IV q8h

78
Q

Tx of 2nd c. difficile infection (1st recurrence)

A

SAME as 1st tx if infection is of the same severity

79
Q

Tx of 3rd c. difficile infection (2nd recurrence)

A

vanco taper/pulse tx for all severities

*fidaxomicin or fecal stool transplants may be considered

80
Q

Common pathogens associated with travelers’ diarrhea (TD)

A

e. coli, campylobacter jejuni, shigella, salmonella

81
Q

Tx of TD

A

*MOST cases are benign and resolve in 3-5 days

cipro 500mg BID x 1-3 days OR
rifaximin (Xifaxan) 200mg TID x 3 days + loperamide

82
Q

DOC for tx of syphilis

A

pen G benzathine

83
Q

DOC for tx of neurosyphilis

A

pen G aqueous

84
Q

DOC for tx of congenital syphilis

A

pen G aqeous

85
Q

DOC for tx of gonorrhea

A

ceftriaxone 250mg IM + azithromycin 1 g (or doxy)

86
Q

DOC for tx of chlamydia

A

azithromycin 1 g

87
Q

DOC for tx of bacterial vaginosis

A

metronidazole or metrogel

88
Q

DOC for tx of trichomoniasis

A

Metronidazole 2 g (or tinidazole)

89
Q

Name the most common rickettsial diseases

A

Rocky mountain spotted fever, typhus, lyme disease, ehrlichiosis, tularemia

90
Q

What pathogen causes rocky mountain spotted fever?

A

rickettsia rickettsii

91
Q

Tx of rocky mountain spotted fever

A

doxycycline 100mg BID x 5-7 days

92
Q

What pathogen causes typhus?

A

rickettsia typhi

93
Q

Tx of typhus

A

doxycycline 100mg BID x 7 days

94
Q

What pathogen causes lyme disease?

A

borrelia burgdorferi

95
Q

Tx of lyme disease

A

doxycycline 100mg BID x 10-21 days OR
amoxicillin 500mg TID x 14-21 days OR
cefuroxime 500mg BID x 14-21 days

96
Q

How do humans contract rickettsial diseases?

A

Bites from ticks, fleas and lice

97
Q

Supplement to take to prevent peripheral neuropathy while on INH tx?

A

Pyridoxine

NAPLEX (8 decks)

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