ID Tx Flashcards
What pphx should HIV pts be on w/ CD4 <200
TMP/SMZ, if allergic → dapsone, atovaquone
for PCP
What pphx should HIV pts be on w/ CD4 <50
Azithromycin 2 g qwk or clarithromycin
for MAC
What is the goal of HIV tx?
get viral load to undetectable (<20)
If pt has + HLA-b5601 what HIV medication should you AVOID?
Do NOT use Abacavir due to hypersensitivity response*
What medication should you avoid in the first 8 wks pregnancy?
efavirenz
Tx for HIV w/ + HBV
Must use Tenofovir AF or DF and Emtricitabine + fully suppressive ARV tx
Can use entecavir if tenofovir cannot be used
Post-exposure Prophylaxis
Raltegravir 400 mg twice daily + tenofovir DF/emtracitabine (Truvada) QD x 4 wks
Within 2 hrs best, MAX 72 hrs
Who gets Pre-exposure Prophylaxis (PrEP)?
Inj drug users, sex workers, hx unprotected intercourse esp MSM
What drug is used for Pre-exposure Prophylaxis (PrEP)?
Tenofovir DF 300 mg + emtricitabine 200 mg (Truvada) one PO daily
90 day supply
Test q3mo
What are the NRTIs?
Abacavir (Ziagen)
Emtricitabine (Emtriva)
Lamivudine (Epivir)
Tenofovir AF or DF
What are the integrase inhibitors?
Raltegravir (Isentress)
Elvitegravir (only in combo with cobisistat/tenofovir AF or DF/emtricitabine =
Genvoya/Stribild)
Dolutegravir
What are the protease inhibitors?
Darunavir
Ritonavir
Gram + Cocci
Staph
Strep
Enterococcus
Gram + Rods
Listeria
B. anthrax
Clostridium
B. cereus
G- diplococci
Gonorrhea
G- coccobacilli
H. flu
Morexilla
Enterobacter
G- rods
E. coli Salmonella Klebsiella Shigella Pseudomonas
Spirochetes
Treponema → Syphilus
Borrelia → Lyme
Molds
Dermatophytes → skin
Asperigillus
Yeast
Candida
Cryptococcus
GAS tx
penicillin x 10 d
UTI rx
nirtofuraintoin
complicated otitis media tx
amoxicillin + tylenol
CAP tx
azithromycin
G+ meningitis
ceftriazone + vancomycin
may want to add dexamethasone
if old/immunocompromised also add Ampicillin (to cover listeria)
Infected wound tx
Augmentin or IV vanc/linezolid
chlamydia tx
azithromycin
gonorrhea tx
ceftriazone + azithromycin
Hospital acquired pneumo tx
Pip/tazo + aminoglycoside or quinilone
c diff tx
metronidazole (or oral vanc) or await stool studies
Hospital acquired infection
IVF + meropenem + vancomycin
acute sinusitis sx > 10 d
augmentin + saline irrigation and decongestants
Bronchitis tx
Nsaids
if no improvement in 1 wk consider macrolides or doxy
Tx for RMSF
doxycycline
AE of Tenofovir DF (AF better)
Renal Disease
Bone loss
AE of NRTIs
Lipodystrophy
Lipoatrophy
AE of Protease inhibitors
Lipodystrophy
Lipid changes
Heart disease
AE of NNRTIs
Lipid changes
What should you avoid with PI or boosters (ritonavir/cobisistat)?
simvastatin, lovastatin or pitavastatin
What should you avoid with PI or NNRTIs?
St John’s wort
What should you avoid with PI AND boosters combined?
fluticasone
What meds should you avoid with PIs?
benzos
CCB
What is effect on viagra (PDE5 inhibitor) if taken with PI orNNRTIs?
levels of viagra are INC w/ PI and DEC w/ NNRTIs
PPhx for PJP w/ HIV
PPhx CD4 <200
Trimethoprim-sulfamethoxazole 160 mg/800 mg one PO daily
Alternatives: dapsone or atovaquone
PPhx for M. tuberculosis w/ HIV
PPhx for all pts w/ ⊕ PPD or close contacts of TB pts
Isoniazid
Pphx for Mycobacterium Avium Complex (MAC) w/ HIV
PPhx CD4 <50
Azithromycin 1200 mg weekly
TB treatment
Initial-
Daily INH, rifampin, PZA & ethambutol* X 8 wks (56 doses* may D/C ethambutol if sensitivities favorable)
Pyradoxine (vit B6) 25 mg PO daily
Continuation- INH and rifampin qd x 18 wk or 2x/wk x 18 wks
What is intermittent Preventive Treatment in Pregnancy (IPTp) for malaria?
give > 2 times during pregnancy
Protects against maternal anemia & low birth weight but less effective if HIV+
also recommended in infants
Tx for Plasmodium falciparum
Medical emergency*
IV quinidine or IV artesunate
ICU
IV fluids, ± blood transfusion
Anti-convulsants if seizure
Glucose if hypoglycemic
Tx for P vivax, P ovale and P malariae
Chloroquine
Primaquine x 14 days
Must treat liver hypnozoites to prevent
relapse (chloroquine doesn’t kill in liver) → screen for G6PD deficiency first
Babesiosis tx
Mostly self-limited
Treat severe and sx dz
Atovaquone + azithromycin (fewer side effects)
or Clindamycin + quinine
Tx for Giardia Intestinalis
Metronidazole
Tinidazole – single dose
Nitazoxanide
May need to treat multiple times before its gone due to relapse
Amoebiasis tx
If colitis or liver abscess→ Metronidazole (kills trophozoites) then luminal agent (to act on cysts)
If asymptomatic → luminal agent only
Cryptosporidiosis tx
If immunocompetent will recover in 1-2 wks
HIV (CD4 <200) → chronic diarrhea
↓ e immunosuppression (e.g., ARVs in HIV+)
Nitazoxanide (efficacy isn’t great)
Chagas Disease tx
Antiparasitic drugs not very effective
Long duration of treatment (months)
Cure in only ~50%
Pacemaker
Cardiac transplantation
Kala-azar
Visceral Leishmaniasis (VL) tx
Majority of infections self-resolving
Pentavalent Antimony (SbV) = 1st line
Liposomal amphotericin B= tx of choice in US
Mucocutaneous Leishmaniasis (ML) tx
Tx of cutaneous lesion may not prevent future mucosal lesion
Mild: topical paromycin, heat therapy, intralesional antimony
Moderate: pentavalent antimony, fluconazole/ketoconazole x4-6 wks, oral miltefosine
When is surgery indicated for infective endocarditis
CHF Recurrent systemic embolization Uncontrolled sepsis Conduction disturbances, myocardial abscess Fungal endocarditis Large vegetation size
What pphx would you give pt prior to dental procedure that involves perf of mucosa?
Amoxicillin 2 gm po
or
Cephalexin 2 gm po (if PCN allergic)
Pt w/ fever and neutropenia
Rapid initiation of empiric antimicrobial therapy is mandatory (treat even if fever is only sx in immunocomp pts)
Therapy goals for Infections in Neutropenic Host
Initial antimicrobial therapy is empiric
Gram negative coverage is mandatory
Recovery of the neutrophil count * major prognostic factor
What should you do if f patients remains febrile despite adequate antibacterial coverage?
consider beginning antifungal therapy
What preventive measures should you take for neutropenic pts to try to prevent infection?
Isolation
Consider prophylactic antimicrobials
Granulocyte colony stimulating factor (G‐
CSF)
PPhx for PJP w/ HIV +
Begin at CD4 <200
Trimethoprim‐sulfamethoxazole (Bactrim) which also protects against toxoplasma infections
Alt: dapsone, atovaquone
PPhx for MAI and TB w/ HIV +
Azithromycin for MAC at CD4 <50
PPhx for TB w/ isoniazid for all pts w/ + PPD or quantiferon (or close contacts of TB pt)
Sepsis tx
Medical emergency
Abx + supportive care
Delay in effective antibiotics → ↑ mortality
ARDS→ ventilate w/ low tidal vol (6mL/kg), control inflam and prevent vol overload that will ↑ lung congestion
Septic Shock tx
Stabilize resp and establish IV access
Empiric broad-spectrum abx (Vancomycin + carbapenem +/- fluoroquinolone or aminoglycoside)
IV bolus crystaloid (LR, 0.9% NS)→ want to maintain MAP ≥ 65 mmHg
Once euvolemic → add pressors (NE 1st line)
Stress steroids for shock refractory to vasopressor therapy
Admit to ICU
Drain spaces, surg control
If pt unable to clear lactate to <2 → poor prognosis*
Supportive meas: mech vent, renal replacement therapy, nutrition, blood glucose control, prevent DVT and stress ulcers
DIC management
Serial labs to monitor
If pt is bleeding → bleeding by giving coag support (FFP, cryo)
If pt clotting → give antigoagulation (heparin drip)
PRBC to replace lose blood vol
Support: vasopressors, O2, ventilator
