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NAPLEX > ID Illness + Drug Regimen > Flashcards

ID Illness + Drug Regimen Flashcards

1
Q

Non-Colorectal Surgery Prophylaxis

A
  • Cefazolin
  • B-lactam allergy? Clindamycin or Vanco
  • Infuse 60 minutes before cut
  • If using vanco or quinolone: infuse 120 mins before surgery
  • D/C w/in 24 hours of surgery ending
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2
Q

Colorectal/Abdominal Space Surgery Prophylaxis

A
  • Cefotetan
  • Cefoxitin
  • Unasyn
  • Ertapenem

OR

  • Metronidazole + Cefazolin OR Ceftriaxone
  • *Note: no pseudomonas coverage; isn’t needed**
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3
Q

Meningitis Treat Durations

A
  • N. meningitidis and H. influenzae - 7 days
  • S. pneumoniae - 10-14 days
  • Listeria Monocytogenes - at least 21 days
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4
Q

Meningitis Treatments

A
  • Dexamethasone can be given prior/with first abx dose
  • Patient < 1 mo: Ampicillin (Listeria) + Cefotaxime or Gentamicin (CI: Ceftriaxone, biliary sludging)
  • Age 1 mo - 50 years: Ceftriaxone or Cefotaxime + Vanco
  • > 50 years or immunocompromised - Ampicillin (Listeria) + Ceftriaxone or Cefotaxime + Vanco
  • *Ampicillin covers Listeria; add for neonates, immunocompromised, and adults >50 yo**
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5
Q

Acute Otitis Media Treatments

A
  • High-dose amoxicillin (80-90 mg/kg/day) or Augmentin (90 mg/kg/day)
  • Non-severe penicillin allergy? Cephalosporin (IM or IV)
  • Observation: 48-72 hours with mild sxs (most are viral inf.); 6-23 months: one ear; 24+ months: one/both ears
  • *Use lowest dose of clavulanate to reduce diarrhea risk**
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6
Q

Acute Otitis Media Durations

A
  • 10 days for kids <2 year old
  • 7 days for kids 2-5 yo
  • 5-7 days for kids >= 6 yo
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7
Q

Pharyngitis Treatment

A
  • Strep throat: white patches on throat, sore throat
  • Need positive rapid antigen test
  • Penicillin or amoxicillin first line
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8
Q

Sinusitis Treatment

A
  • Drainage, pain/pressure on face
  • Augmentin - 1st line
  • 2nd line - cephalosporin (2nd or 3rd gen) + clinda/doxy OR resp. quinolone
  • Need to wait 10 days of sxs for abx unless severe sxs (face pain, purulent discharge x3 days)
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9
Q

Bronchitis

A
  • Rule out pneumonia: chest x-ray doesn’t show infiltrates
  • COPD Exacerbation IF mech. ventilation or purulent discharge + additional sxs: Augmentin (Alt: Azithromycin or doxycycline)
  • Whooping Cough cause: azithromycin or clarithromycin or Bactrim
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10
Q

Outpatient CAP

A
  • Treat 5-7 days
  • Category 1 (no comorbidities) - Amoxicillin high-dose (1g TID) OR Doxy OR Macrolide (if resistance < 25%)
  • Category 2 (Comorbidities) - Beta-lactam (Augmentin or cephalosporin) + Macrolide/Doxy OR resp. quinolone alone
  • Comorbidities: chronic heart/lung/kidney disease, DM, alcoholism, cancer, asplenia
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11
Q

Non-Severe Inpatient CAP

A
  • Non-ICU
  • Beta-lactam + Macrolide or Doxy OR resp. quinolone alone
  • Beta-lactam: usually ceftriaxone or cefotaxime (3rd gen)
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12
Q

Severe Inpatient CAP

A
  • ICU

- Beta-lactam + Macrolide or resp. quinolone (not Monotherapy)

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13
Q

Pseudomonas/MRSA Add-ons for CAP

A
  • Vanco or Linezolid for MRSA risks

- Zosyn, meropenem, or aztreonam for pseudomonas risks

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14
Q

HAP/VAP Treatment

A
  • All need antibiotic for MSSA/Pseudomonas: Cefepime, Zosyn
  • Add Linezolid or Vanco if MRSA risk
  • Typically ends up being a 3-drug regimen if MDR risk (one of each above + Gentimicin or cipro for example)
  • MRSA/MDR risk factors: IV abx in last 90 days, IV drug use, positive nasal swab, >10% prevalence of pathogen resistant
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15
Q

Latent TB Regimens

A
  • Confirmed by TST (also PPD)
  • Preferred: Isoniazid + Rifampin daily for 3 months (okay in most pts, adults and kids)
  • Alt: INH daily for 6 or 9 months (preferred in preggos and any HIV pts -less DDI)
  • Alt: Rifampin daily for 4 months (INH resistant/intolerant)
  • INH + Rifapentine once weekly for 12 weeks via DOT (NOT recommended kids/preggo/HIV)
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16
Q

Active TB Regimen

A
  • RIPE x 2 months (intensive phase)
  • Continuation Phase: Rifampin and isoniazid usually for 4 months (extended to 7 mo if sputum culture still positive at 2 months)
  • P: pyrazinamide and E: ethambutol
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17
Q

Infective Endocarditis - Viridans Streptococci

A
  • Diagnosis: echocardiogram and blood cultures
  • Penicillin or Ceftriaxone +/- Gent
  • B-lactam allergy? Use Vanco monotherapy
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18
Q

Infective Endocarditis - MSSA

A
  • Nafcillin or Cefazolin
  • Replace with vanco if B-lactam allergy
  • Add gent and vanco if prosthetic valve
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19
Q

Infective Endocarditis - MRSA

A
  • Vanco (MIC < 2; don’t use if >=2)
  • Add gent and rifampin if prosthetic valve
  • *With gent synergy lower trough goals (<1 mcg/mL)**
20
Q

Infective Endocarditis - Enterococci

A
  • Penicillin or Ampicillin + gent or ampicillin + high-dose ceftriaxone
  • B-lactam allergy? Vanco + gentamicin
  • VRE? Use Daptomycin or Linezolid
21
Q

Infective Endocarditis Dental Prophylaxis

A
  • Amoxicillin 2g 30-60 minutes before dental procedure

- Penicillin allergy? Clindamycin (600 mg), Azithromycin or Clarithromycin 500 mg

22
Q

Intraabdominal Infections (SBP)

A
  • First-line: Ceftriaxone x 5-7 days
  • Bactrim or Cipro for secondary prophylaxis of SBP
  • Add metronidazole to cover anaerobes (secondary peritonitis, abscess, etc.)
23
Q

Impetigo

A
  • Honey-covered crusts
  • Mupirocin if mild
  • Cephalexin if numerous lesions
24
Q

Folliculitis/Carbuncles

A
  • Systemic signs? Cephalexin

- Alternatives: Bactrim or Doxycycline (cover CA-MRSA)

25
Q

Cellulitis

A
  • Cephalexin

- Beta-lactam allergy? Clindamycin (MSSA and anaerobes)

26
Q

Abscess

A
  • I&D
  • Systemic signs? Bactrim or Doxycycline (cover CA-MRSA)
  • Alt w/ systemic signs: Minocycline, Clindamycin
27
Q

Severe Purulent SSTI

A

Usually staph involvement:

  • Vancomycin
  • Linezolid
  • Daptomycin
28
Q

Necrotizing Faciitis

A

-Vanco + B-lactam (Zosyn, meropenem, etc.)

29
Q

Moderate-Severe Diabetic Foot Infections

A

Monotherapy

  • Unasyn
  • Zosyn
  • Carbapenem
  • Tigecycline

Combo Therapy
-Vanco + Ceftazidime, Cefepime, Zosyn, Aztreonam, or a carbapenem

Treat 7-14 days (usually polymicrobial, broad spectrum!)

30
Q

Uncomplicated UTIs

A
  • Nitrofurantoin 100 mg PO BID x 5 days (CI: CrCl <60)
  • Bactrim DS PO BID x 3 days (CI: sulfa allergy)
  • Fosfomycin 3g x 1
  • Phenazopyridine for urine discomfort sxs relief (red/orange discoloration)
31
Q

Pregnancy + UTI

A

Treat even if asymptomatic!!

  • Cephalexin
  • Amoxicillin
  • Treat 3-7 days asxs, 7 days with sxs
  • *Avoid quinolones**
32
Q

Acute Pyelonephritis

A

Local Quinolone Resistance < 10%

  • Levofloxacin
  • Ciprofloxacin

Local Quinolone Resistance > 10%

  • Ceftriaxone, ertapenem, or aminoglycoside then quinolone
  • Bactrim
  • B-lactam
33
Q

Complicated UTI

A
  • Carbapenem if ESBL-producing bacteria present

- Otherwise similar treatment plan to acute pyelonephritis

34
Q

Syphillis

A
  • Painless, smooth genital sore (chancre)
  • Primary/Early/Secondary: Bicillin-LA 2.4 million units once
  • Late/Tertiary: Bicillin-LA 2.4 million units Qweek x 3 weeks
  • Alt: Doxycycline
  • MUST desensitize preggo patients after confirming allergy skin test
35
Q

Gonorrhea

A
  • No sxs/discharge
  • Ceftriaxone 500 mg IM x 1 (<150 kg)
  • Include Doxycycline if chlamydia hasn’t been ruled out
36
Q

Chlamydia

A
  • No sxs/discharge
  • Doxycycline - 100 mg PO BID x 7 days
  • Azithromycin - 1g PO x 1 (pref. for preggo)
37
Q

Bacterial Vaginosis/Trichamonas

A
  • Vaginosis: discharge with fishy odor
  • Trichamonas: yellow-green “frothy” discharge, pain during intercourse (treat in any trimester)
  • Metronidazole (gel option for BV)
38
Q

Genital Warts

A
  • HPV; genital warts

- Imiquimod cream

39
Q

Tamiflu

A
  • Used for influenza tx if criteria met:
  • Sxs onset w/in 48 hours**
  • Complication risk
  • Severe illness
  • Prophylaxis (siblings, etc.)
40
Q

Meds to Cover Pseudomonas

A
  • Zosyn**
  • Cefepime**, ceftazidime, ceftolozane/tazobactam
  • Levo or ciprofloxacin
  • Imipenem/cilastatin or meropenem**
  • Aztreonam**
  • Tobramycin, gentamicin, or amikacin
  • Polymixin
41
Q

RIPE Key Notes

A
  • ALL can cause hepatotoxicity
  • Rifampin: discolors secretions orange
  • Rifampin: STRONG CYP P450 inducer, flu like sxs
  • INH: peripheral neuropathy (P used to reduce this risk, 25 mg)
  • RI: take on empty stomach, hemolytic anemia risks (Coombs!)
  • Ethambutol: vision damage, confusion/hallicination
  • Pyrazinamide: increases UA (gout attacks)
42
Q

SSTI Moderate Sxs

A

Systemic!

  • Fever > 100.4 F
  • HR > 90
  • WBC > 12000 or < 4000
43
Q

SSTI Severe Classification

A
  • Failed I&D
  • Purulent on oral abx
  • Deep infection
  • Immunocompromised
44
Q

Traveler’s Diarrhea

A
  • Loperamide for sxs relief
  • Preferred: azithromycin (good in preggo, kids, blood stool, fever)
  • Alt: rifaximin, levofloxacin, ciprofloxacin (inappropriate for above conditions)
45
Q

Rickettsial Disease

A
  • Doxycycline
  • Use even in peds patients (benefits > risk)
  • Ex: Lyme disease (bullseye rash), typhus
  • Lyme confirmed by ELISA

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