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NAPLEX > ID II: Bacterial Treatments > Flashcards

ID II: Bacterial Treatments Flashcards

1
Q

Recommended ABX for cardiac or vascular surgery

A

cefazolin, cefuroxime

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2
Q

Recommended ABX for orthopedic surgery

A

cefazolin

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3
Q

Alternative ABX for cardiac, vascular, and orthopedic surgery if the patient has a beta-lactam allergy

A

clindamycin, vanco

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4
Q

Recommended ABX for GI surgery

A

cefazolin PLUS metronidazole, cefotetan, cefoxitin, or amp/sulbactam

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5
Q

Alternative ABX for GI surgery if the patient has a beta-lactam allergy

A

clindamycin or metronidazole + AG or quinolone

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6
Q

Bacterial culprits in meningitis

A

N. meningitidis
S. pneumo
H. influenzae
Listeria (in the elderly, immunocompromised, and neonates)

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7
Q

What can be given with ABX treatment for meningitis to prevent neurological complications and death?

A

dexamethasone IV x4 days, give prior to or with first dose of ABX

Only give if S. pneumonia is the cause of meningitis

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8
Q

Meningitis treatment for neonates

A

Ampicillin + cefotaxime OR gentamicin

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9
Q

Meningitis treatment for ages 1 month-50 years

A

ceftriaxone OR cefotaxime PLUS vanco

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10
Q

Meningitis treatment for ages >50 years or immunocompromised

A

ampicillin PLUS ceftriaxone OR cefotaxime, PLUS vanco

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11
Q

Bacterial culprits for AOM

A

H. influenzae
Moraxella
S. pneumo

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12
Q

When to consider observation in AOM

A

If Sx are non-severe (otalgia <48 hours, no otorrhea, temperature <102.2) AND

age 6-23 months: symptoms in one ear only
age ≥2 years: symptoms in one or both ears

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13
Q

First-line treatment for AOM

A

Amoxicillin or amoxicillin/clav: 90mg/kg/day in 2 divided doses

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14
Q

If using Augmenting for AOM, what should the dose of clav be?

A

6.4mg/kg/day; try to keep it as low as possible to decrease the chance of diarrhea!

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15
Q

Alternative AOM treatment for a mild PCN allergy

A

cefdinir
cefuroxime
cefpodoxime
CTX IM

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16
Q

AOM treatment if there’s treatment failure

A

Try Augmentin if amoxicillin was used first, if not, use IM CTX x3 days

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17
Q

Treatment for the common cold

A

there is none lol

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18
Q

Treatment for influenza

A

there is none lol

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19
Q

Causes of pharyngitis

A

S. pyogenes

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20
Q

Criteria for pharyngitis treatment

A

Rapid antigen test

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21
Q

Pharyngitis treatment

A

PCN, amoxicillin

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22
Q

Pharyngitis treatment for a mild PCN allergy

A

1st or 2nd generation cephalosporin

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23
Q

Pharyngitis treatment for a severe PCN allergy

A

clarithromycin, azithromycin, clindamycin

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24
Q

Causes of acute sinusitis

A

S. pneumo, H. influenzae, Moraxella (aka the same pathogens as AOM)

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25
Q

Criteria for acute sinusitis treatment

A

≥10 days of persistent symptoms, ≥3 days of severe symptoms, OR worsening symptoms after initial improvement

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26
Q

Treatment options for acute sinusitis

A

Augmentin or self-care for up to 7 days

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27
Q

Treatment option for acute sinusitis for a mild PCN allergy

A

Doxycycline

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28
Q

Treatment options for acute sinusitis for severe PCN allergy

A

azithromycin (poor activity against S. pneumoniae though)

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29
Q

Potential bacterial causes of acute bronchitis

A

S. pneumo
H. influenzae
Mycoplasma pneumoniae

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30
Q

Treatment for acute bronchitis

A

there is none lol

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31
Q

Cause of pertussis

A

B. pertussis (duh lol)

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32
Q

Treatment for pertussis

A

Azithromycin, clarithromycin

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33
Q

Potential bacterial causes for COPD exacerbation

A

H. influenzae, S. pneumo, Moraxella (aka the same pathogens as AOM and acute sinusitis)

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34
Q

Treatment for COPD exacerbation: not ABX related

A

supportive care (oxygen, systemic steroids, bronchodilators)

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35
Q

ABX treatment for COPD exacerbation

A

Augmentin!!!
Azithromycin
Doxycycline
Levo, moxifloxacin

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36
Q

Potential bacterial causes of CAP

A

S. pneumo
H. influenzae
M. pneumo
C. pneumo

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37
Q

Outpatient CAP treatment in healthy patients

A

High-dose amoxicillin (1gm TID) OR
Doxycycline OR
Azithromycin or clarithromycin if resistance rates <25%

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38
Q

Outpatient CAP treatment in high-risk patients with comorbidities

A

Beta-lactam PLUS macrolide or doxycycline (Augmentin or cephalosporin like Vantin or cefuroxime PLUS macrolide or doxycycline)

OR respiratory quinolone monotherapy (moxi, levo)

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39
Q

Inpatient CAP treatment: patient’s on the general med floor

A

Beta-lactam PLUS macrolide or doxy

OR respiratory quinolone monotherapy (moxi, levo)

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40
Q

Preferred beta-lactams in inpatient CAP treatment (4 drugs)

(patient is on the general med floor)

A

CTX, cefotaxime, ceftaroline, amp/sulbactam

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41
Q

Inpatient CAP treatment: patient’s in the ICU

A

beta-lactam PLUS macrolide OR respiratory quinolone

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42
Q

Inpatient CAP treatment: MRSA risk

A

add on vanco or linezolid

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43
Q

Inpatient CAP treatment: pseudomonas risk (5 drugs)

A

use pip/tazo, cefepime, ceftazadime, imipenem/cilastin, or meropenem

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44
Q

Inpatient CAP treatment: hospitalization and parenteral ABX use in the last 90 days

A

use a regimen with ABX active against MRSA and Pseudomonas

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45
Q

Common pathogens in CAP, HAP

A

MRSA, P. aeruginosa, Acineobacter, Enterobacter, E. coli, Klebsiella

46
Q

Empiric regimens for CAP/HAP

A

Cefepime
Pip/tazo
Levofloxacin
Meropenem

47
Q

CAP/HAP: add on this if at risk for MRSA

A

vanco, Zyvox

Examples: cefepime and vanco, meropenem; linezolid, aztreonam and vanco

48
Q

CAP/HAP: add on this if at risk for MDR gram-negative pathogens

A

use 2 ABX that have activity against Pseudomonas

Examples: pip/tazo, cipro, vanco; cefepime, gentamicin, linezolid

49
Q

ABX for Pseudomonas: quinolones

A

levo, ciprofloxacin

50
Q

ABX for Pseudomonas: other

A

aztreonam, tobramycin

51
Q

Latent TB treatment options

A

INH and rifapentine QW x12 weeks
INH with rifampin QD x3 months
Rifampin QD x4 months
INH 300mg QD x6-9 months

52
Q

Do not use latent TB treatment in what population?

A

Pregnant patients

53
Q

Active TB treatment: intensive phase

A

Rifampin, isoniazid, pyrazinamide, ethambutol QD or 5 times a week x8 weeks

54
Q

Active TB treatment: continuation phase

A

Rifampin and isoniazid QD, 5x a week, or TIW x18 weeks

55
Q

What should be given with isoniazid and why?

A

Vitamin B6 to decrease peripheral neuropathy

56
Q

Most common species of organisms to cause infective endocardiitis

A

Staph, strep, enterococci

57
Q

What can be added to IE treatment for synergy?

A

Gentamicin

58
Q

IE treatment: viridans group strep

A

PCN OR CTX, +/- gentamicin

59
Q

IE treatment: viridans group strep but allergic to beta-lactams

A

vanco monotherapy

60
Q

IE treatment: MSSA

A

nafcillin OR cefazolin

can add on rifampin and gentamicin if prosthetic valve

61
Q

IE treatment: MSSA but allergic to beta-lactams

A

vanco plus rifampin and gentamicin if prosthetic valve

Can use dapto if the patient doesn’t have a prosthetic valve

62
Q

IE treatment: MRSA

A

vanco plus rifampin and gentamicin if prosthetic valve

can use dapto if the patient doesn’t have a prosthetic valve

63
Q

IE treatment: enterococci

A

PCN or ampicillin PLUS gentamicin
ampicillin PLUS high-dose CTX

64
Q

IE treatment: enterococci but the patient has a beta-lactam allergy

A

vanco and gentamicin

65
Q

IE treatment: enterococci (but VRE)

A

dapto or linezolid

66
Q

Dental prophy treatment

A

2gm amoxicillin

67
Q

Dental prophy treatment: PCN allergy but can take PO meds

A

azithromycin or clarithromycin 500mg, or doxycycline 100mg

68
Q

Empiric treatment for SBP

A

CTX x5-7 days, can also use a carbapenem

69
Q

Prophy treatment for SBP

A

Bactrim or a quinolone

70
Q

Treatment options for community-acquired intra-abdominal infections

A

Ertapenem
Moxifloxacin
Cefuroxome, cefotaxime, or CTX PLUS Flagyl
cipro or levo PLUS Flagyl

71
Q

Treatment options for resistant or nosocomial pathogens (intra-abdominal infections)

A

Carbapenem (not ertapenem)
Pip/tazo
cefepime or ceftazidime PLUS Flagyl

72
Q

SIRS Criteria

A

Temp >100.4
HR >90 BPM
WBC >12,000 or <4,000 cells

73
Q

Impetigo treatment: limited, localized lesions

A

topical ABX (mupirocin)

74
Q

Impetigo treatment: numerous, extensive lesions

A

Keflex PO QID
Dicloxacillin PO QID

75
Q

Folliculitis/furuncle/carbuncle treatment

A

Bactrim DS
Doxycycline

76
Q

Cellulitis treatment

A

Cephalexin QID
Dicloxacillin QID
Clindamycin QID (if beta-lactam allergy)

77
Q

Abscess treatment

A

Bactrim DS BID
Doxycycline BID
Minocycline 200mg PO x1, then 100mg PO BID
Clindamycin 300mg PO QID
Use Keflex if MSSA is present

78
Q

Severe, purulent SSTI treatment

A

vanco
dapto
linezolid

79
Q

Necrotizing fasciitis treatment

A

vanco or dapto PLUS beta-lactam PLUS clindamycin

80
Q

Diabetic foot infections: no MRSA coverage needed

A

amp/sulbac
pip/tazo
meropenem, ertapenem
moxifloxacin
CTX, cefepime, levofloxacin, or ciprofloxacin PLUS Flagyl

81
Q

Diabetic foot infections: need MRSA coverage

A

Add vanco, dapto, or linezolid to any of the MSSA coverage regimens

82
Q

UTI treatment: acute uncomplicated cystitis

A

Nitrofurantoin x5 days
Bactrim DS x3 days
Fosfomycin x1 dose

83
Q

UTI treatment: acute uncomplicated cystitis alternative options

A

beta-lactam (Augmentin or cephalosporin) x5-7 days
cipro x3 days
levo x3 days

84
Q

UTI treatment: acute uncomplicated cystitis options in pregnancy

A

amoxicillin
cephalexin
fosfomycin (for beta-lactam allergy)

85
Q

Acute pyelonephritis treatment: moderately ill outpatient when the local quinolone resistance is <10%

A

cipro x5-7 days
levo x5-7 days

86
Q

Acute pyelonephritis treatment: severely ill hospitalized patient

A

CTX or quinolone (cipro, levo)

87
Q

Acute pyelonephritis treatment: moderately ill outpatient when the local quinolone resistance is >10%

A

CTX 1gm IM x1, ertapenem 1gm IM x1

88
Q

Acute pyelonephritis treatment: severely ill hospitalized patient if there’s concern for resistance

A

pip/tazo or a carbapenem

89
Q

Acute pyelonephritis treatment: concern for Pseudomonas

A

consider pip/tazo, meropenem, dorpenem, imipenem/cilastatin

90
Q

Bacteriuria and pregnancy

A

Augmentin or PO cephalosporin are preferred

Nitrofurantoin, Bactrim, and fosfomycin are alternatives in patients with a beta-lactam allergy

91
Q

C. diff treatment options: first episode

A

fidaxomycin 200mg PO BID x10 days
vancomycin 125mg PO QID x10 days
metronidazole 500mg PO TID x10 days

92
Q

C. diff treatment options: second episode

A

fidaxomycin 200mg PO BID x10 days
vanco standard regimen followed by prolonged pulse/tapered course

93
Q

C. diff treatment options: third episode

A

fidaxomycin 200mg PO BID x10 days
vanco standard regimen followed by prolonged pulse/tapered course
vanco standard regimen followed by rifaximin 400mg TID x20 days
fecal microbiota transplant

94
Q

Primary, secondary, or early latent syphilis treatment

A

Bicillin LA IM x1

pregnant patients who are severely allergic to PCN will have to be desensitized

95
Q

Late latent or tertiary syphilis treatment

A

Bicilin LA IM weekly x3 weeks

96
Q

Neurosyphilis treatment

A

Penicillin G aqueous crystalline IV q4h x10-14 days

97
Q

Gonorrhea treatment

A

CTX 500mg IM x1 (if <150kg); CTX 1gm IM x1 (if ≥150kg)

Add doxycycline if chlamydia isn’t excluded

Treatment is the same for pregnancy

98
Q

Chlamydia treatment: non-pregnant patients

A

Doxycycline 100mg PO BID x7 days

99
Q

Chlamydia treatment: pregnant patients

A

Azithromycin 1gm PO x1

100
Q

Syphilis treatment alternative

A

Doxycycline 100mg PO BID x14 days (early), x28 days (late latent)

101
Q

Neurosyphilis treatment alternative

A

Penicillin G procaine

102
Q

Gonorrhea treatment alternative

A

cefixime 800mg PO x1

103
Q

Chlamydia treatment: pregnancy

A

amoxicillin 500mg PO TID x7 days

104
Q

Chlamydia treatment alternative

A

erythromycin base 500mg PO x7 days
levofloxacin 500mg PO x7 days

105
Q

Bacterial vaginosis treatment

A

metronidazole 500mg PO BID x7 days
metronidazole 0.75% gel intravaginally x7 days
clindamycin 2% cream

106
Q

Bacterial vaginosis alternative treatment

A

clindamycin 300mg PO BID x7 days
tinidazole 2gm PO QD x2 days
secnidazole 2g PO x1 dose

107
Q

Trichomoniasis treatment: females

A

metronidazole 500mg PO BID x7 days

108
Q

Trich treatment: males

A

metronidazole 2gm PO x1 dose

109
Q

Gential warts treatment

A

Imiquinod cream TIW until cleared, up to 16 weeks

110
Q

Drug of choice in Rocky Mountain Spotted Fever, Lyme disease, and ehrlichiosis

A

DOXYCYCLINE

NAPLEX (18 decks)

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