ID II: Bacterial Treatments Flashcards
1
Q
Recommended ABX for cardiac or vascular surgery
A
cefazolin, cefuroxime
2
Q
Recommended ABX for orthopedic surgery
A
cefazolin
3
Q
Alternative ABX for cardiac, vascular, and orthopedic surgery if the patient has a beta-lactam allergy
A
clindamycin, vanco
4
Q
Recommended ABX for GI surgery
A
cefazolin PLUS metronidazole, cefotetan, cefoxitin, or amp/sulbactam
5
Q
Alternative ABX for GI surgery if the patient has a beta-lactam allergy
A
clindamycin or metronidazole + AG or quinolone
6
Q
Bacterial culprits in meningitis
A
N. meningitidis
S. pneumo
H. influenzae
Listeria (in the elderly, immunocompromised, and neonates)
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
8
Q
Meningitis treatment for neonates
A
Ampicillin + cefotaxime OR gentamicin
9
Q
Meningitis treatment for ages 1 month-50 years
A
ceftriaxone OR cefotaxime PLUS vanco
10
Q
Meningitis treatment for ages >50 years or immunocompromised
A
ampicillin PLUS ceftriaxone OR cefotaxime, PLUS vanco
11
Q
Bacterial culprits for AOM
A
H. influenzae
Moraxella
S. pneumo
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
13
Q
First-line treatment for AOM
A
Amoxicillin or amoxicillin/clav: 90mg/kg/day in 2 divided doses
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!
15
Q
Alternative AOM treatment for a mild PCN allergy
A
cefdinir
cefuroxime
cefpodoxime
CTX IM
16
Q
AOM treatment if there’s treatment failure
A
Try Augmentin if amoxicillin was used first, if not, use IM CTX x3 days
17
Q
Treatment for the common cold
A
there is none lol
18
Q
Treatment for influenza
A
there is none lol
19
Q
Causes of pharyngitis
A
S. pyogenes
20
Q
Criteria for pharyngitis treatment
A
Rapid antigen test
21
Q
Pharyngitis treatment
A
PCN, amoxicillin
22
Q
Pharyngitis treatment for a mild PCN allergy
A
1st or 2nd generation cephalosporin
23
Q
Pharyngitis treatment for a severe PCN allergy
A
clarithromycin, azithromycin, clindamycin
24
Q
Causes of acute sinusitis
A
S. pneumo, H. influenzae, Moraxella (aka the same pathogens as AOM)
25
Criteria for acute sinusitis treatment
≥10 days of persistent symptoms, ≥3 days of severe symptoms, OR worsening symptoms after initial improvement
26
Treatment options for acute sinusitis
Augmentin or self-care for up to 7 days
27
Treatment option for acute sinusitis for a mild PCN allergy
Doxycycline
28
Treatment options for acute sinusitis for severe PCN allergy
azithromycin (poor activity against S. pneumoniae though)
29
Potential bacterial causes of acute bronchitis
S. pneumo
H. influenzae
Mycoplasma pneumoniae
30
Treatment for acute bronchitis
there is none lol
31
Cause of pertussis
B. pertussis (duh lol)
32
Treatment for pertussis
Azithromycin, clarithromycin
33
Potential bacterial causes for COPD exacerbation
H. influenzae, S. pneumo, Moraxella (aka the same pathogens as AOM and acute sinusitis)
34
Treatment for COPD exacerbation: not ABX related
supportive care (oxygen, systemic steroids, bronchodilators)
35
ABX treatment for COPD exacerbation
Augmentin!!!
Azithromycin
Doxycycline
Levo, moxifloxacin
36
Potential bacterial causes of CAP
S. pneumo
H. influenzae
M. pneumo
C. pneumo
37
Outpatient CAP treatment in healthy patients
High-dose amoxicillin (1gm TID) OR
Doxycycline OR
Azithromycin or clarithromycin if resistance rates <25%
38
Outpatient CAP treatment in high-risk patients with comorbidities
Beta-lactam PLUS macrolide or doxycycline (Augmentin or cephalosporin like Vantin or cefuroxime PLUS macrolide or doxycycline)
OR respiratory quinolone monotherapy (moxi, levo)
39
Inpatient CAP treatment: patient's on the general med floor
Beta-lactam PLUS macrolide or doxy
OR respiratory quinolone monotherapy (moxi, levo)
40
Preferred beta-lactams in inpatient CAP treatment (4 drugs)
(patient is on the general med floor)
CTX, cefotaxime, ceftaroline, amp/sulbactam
41
Inpatient CAP treatment: patient's in the ICU
beta-lactam PLUS macrolide OR respiratory quinolone
42
Inpatient CAP treatment: MRSA risk
add on vanco or linezolid
43
Inpatient CAP treatment: pseudomonas risk (5 drugs)
use pip/tazo, cefepime, ceftazadime, imipenem/cilastin, or meropenem
44
Inpatient CAP treatment: hospitalization and parenteral ABX use in the last 90 days
use a regimen with ABX active against MRSA and Pseudomonas
45
Common pathogens in CAP, HAP
MRSA, P. aeruginosa, Acineobacter, Enterobacter, E. coli, Klebsiella
46
Empiric regimens for CAP/HAP
Cefepime
Pip/tazo
Levofloxacin
Meropenem
47
CAP/HAP: add on this if at risk for MRSA
vanco, Zyvox
Examples: cefepime and vanco, meropenem; linezolid, aztreonam and vanco
48
CAP/HAP: add on this if at risk for MDR gram-negative pathogens
use 2 ABX that have activity against Pseudomonas
Examples: pip/tazo, cipro, vanco; cefepime, gentamicin, linezolid
49
ABX for Pseudomonas: quinolones
levo, ciprofloxacin
50
ABX for Pseudomonas: other
aztreonam, tobramycin
51
Latent TB treatment options
INH and rifapentine QW x12 weeks
INH with rifampin QD x3 months
Rifampin QD x4 months
INH 300mg QD x6-9 months
52
Do not use latent TB treatment in what population?
Pregnant patients
53
Active TB treatment: intensive phase
Rifampin, isoniazid, pyrazinamide, ethambutol QD or 5 times a week x8 weeks
54
Active TB treatment: continuation phase
Rifampin and isoniazid QD, 5x a week, or TIW x18 weeks
55
What should be given with isoniazid and why?
Vitamin B6 to decrease peripheral neuropathy
56
Most common species of organisms to cause infective endocardiitis
Staph, strep, enterococci
57
What can be added to IE treatment for synergy?
Gentamicin
58
IE treatment: viridans group strep
PCN OR CTX, +/- gentamicin
59
IE treatment: viridans group strep but allergic to beta-lactams
vanco monotherapy
60
IE treatment: MSSA
nafcillin OR cefazolin
can add on rifampin and gentamicin if prosthetic valve
61
IE treatment: MSSA but allergic to beta-lactams
vanco plus rifampin and gentamicin if prosthetic valve
Can use dapto if the patient doesn't have a prosthetic valve
62
IE treatment: MRSA
vanco plus rifampin and gentamicin if prosthetic valve
can use dapto if the patient doesn't have a prosthetic valve
63
IE treatment: enterococci
PCN or ampicillin PLUS gentamicin
ampicillin PLUS high-dose CTX
64
IE treatment: enterococci but the patient has a beta-lactam allergy
vanco and gentamicin
65
IE treatment: enterococci (but VRE)
dapto or linezolid
66
Dental prophy treatment
2gm amoxicillin
67
Dental prophy treatment: PCN allergy but can take PO meds
azithromycin or clarithromycin 500mg, or doxycycline 100mg
68
Empiric treatment for SBP
CTX x5-7 days, can also use a carbapenem
69
Prophy treatment for SBP
Bactrim or a quinolone
70
Treatment options for community-acquired intra-abdominal infections
Ertapenem
Moxifloxacin
Cefuroxome, cefotaxime, or CTX PLUS Flagyl
cipro or levo PLUS Flagyl
71
Treatment options for resistant or nosocomial pathogens (intra-abdominal infections)
Carbapenem (not ertapenem)
Pip/tazo
cefepime or ceftazidime PLUS Flagyl
72
SIRS Criteria
Temp >100.4
HR >90 BPM
WBC >12,000 or <4,000 cells
73
Impetigo treatment: limited, localized lesions
topical ABX (mupirocin)
74
Impetigo treatment: numerous, extensive lesions
Keflex PO QID
Dicloxacillin PO QID
75
Folliculitis/furuncle/carbuncle treatment
Bactrim DS
Doxycycline
76
Cellulitis treatment
Cephalexin QID
Dicloxacillin QID
Clindamycin QID (if beta-lactam allergy)
77
Abscess treatment
Bactrim DS BID
Doxycycline BID
Minocycline 200mg PO x1, then 100mg PO BID
Clindamycin 300mg PO QID
Use Keflex if MSSA is present
78
Severe, purulent SSTI treatment
vanco
dapto
linezolid
79
Necrotizing fasciitis treatment
vanco or dapto PLUS beta-lactam PLUS clindamycin
80
Diabetic foot infections: no MRSA coverage needed
amp/sulbac
pip/tazo
meropenem, ertapenem
moxifloxacin
CTX, cefepime, levofloxacin, or ciprofloxacin PLUS Flagyl
81
Diabetic foot infections: need MRSA coverage
Add vanco, dapto, or linezolid to any of the MSSA coverage regimens
82
UTI treatment: acute uncomplicated cystitis
Nitrofurantoin x5 days
Bactrim DS x3 days
Fosfomycin x1 dose
83
UTI treatment: acute uncomplicated cystitis alternative options
beta-lactam (Augmentin or cephalosporin) x5-7 days
cipro x3 days
levo x3 days
84
UTI treatment: acute uncomplicated cystitis options in pregnancy
amoxicillin
cephalexin
fosfomycin (for beta-lactam allergy)
85
Acute pyelonephritis treatment: moderately ill outpatient when the local quinolone resistance is <10%
cipro x5-7 days
levo x5-7 days
86
Acute pyelonephritis treatment: severely ill hospitalized patient
CTX or quinolone (cipro, levo)
87
Acute pyelonephritis treatment: moderately ill outpatient when the local quinolone resistance is >10%
CTX 1gm IM x1, ertapenem 1gm IM x1
88
Acute pyelonephritis treatment: severely ill hospitalized patient if there's concern for resistance
pip/tazo or a carbapenem
89
Acute pyelonephritis treatment: concern for Pseudomonas
consider pip/tazo, meropenem, dorpenem, imipenem/cilastatin
90
Bacteriuria and pregnancy
Augmentin or PO cephalosporin are preferred
Nitrofurantoin, Bactrim, and fosfomycin are alternatives in patients with a beta-lactam allergy
91
C. diff treatment options: first episode
fidaxomycin 200mg PO BID x10 days
vancomycin 125mg PO QID x10 days
metronidazole 500mg PO TID x10 days
92
C. diff treatment options: second episode
fidaxomycin 200mg PO BID x10 days
vanco standard regimen followed by prolonged pulse/tapered course
93
C. diff treatment options: third episode
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
Primary, secondary, or early latent syphilis treatment
Bicillin LA IM x1
pregnant patients who are severely allergic to PCN will have to be desensitized
95
Late latent or tertiary syphilis treatment
Bicilin LA IM weekly x3 weeks
96
Neurosyphilis treatment
Penicillin G aqueous crystalline IV q4h x10-14 days
97
Gonorrhea treatment
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
Chlamydia treatment: non-pregnant patients
Doxycycline 100mg PO BID x7 days
99
Chlamydia treatment: pregnant patients
Azithromycin 1gm PO x1
100
Syphilis treatment alternative
Doxycycline 100mg PO BID x14 days (early), x28 days (late latent)
101
Neurosyphilis treatment alternative
Penicillin G procaine
102
Gonorrhea treatment alternative
cefixime 800mg PO x1
103
Chlamydia treatment: pregnancy
amoxicillin 500mg PO TID x7 days
104
Chlamydia treatment alternative
erythromycin base 500mg PO x7 days
levofloxacin 500mg PO x7 days
105
Bacterial vaginosis treatment
metronidazole 500mg PO BID x7 days
metronidazole 0.75% gel intravaginally x7 days
clindamycin 2% cream
106
Bacterial vaginosis alternative treatment
clindamycin 300mg PO BID x7 days
tinidazole 2gm PO QD x2 days
secnidazole 2g PO x1 dose
107
Trichomoniasis treatment: females
metronidazole 500mg PO BID x7 days
108
Trich treatment: males
metronidazole 2gm PO x1 dose
109
Gential warts treatment
Imiquinod cream TIW until cleared, up to 16 weeks
110
Drug of choice in Rocky Mountain Spotted Fever, Lyme disease, and ehrlichiosis
DOXYCYCLINE
