IDSA Guidlines - USC Arcadia Flashcards
Initial treatment
CAP
OUTPT; no comorbidities OR RF for pseudomonas
PO
B-lactam
+
Macrolide or doxy
Macrolide = azithromycin
B-lactam = amoxicillin
Initial treatment
CAP
OUTPT; with comorbidities
PO
Comination therapy
a)** Augementin** OR Ceph
+
Macrolide
b) **Resp FQ **monotherapy
Resp FQ = lexofloxacin, moxifloxacin
Cephs = cepfodoxime, cefuroxime
Regimen
CAP
Non-ICU
**Ceftriaxone ** 1-2g q24h
+
azithromycin 500mg QD OR doxycycline 100mg BID
Regimen
CAP
Non-ICU (with Pseudomonas risk)
Zosyn 4.5g q6h
+
azithromycin 500mg QD
+
tobramycin 5-7mg/kg QD
Regimen
CAP
ICU
ceftriaxone 1-2 q24h OR Zosyn 4.5 q6h
+
azithromycin 500mg QD
+/-
vancomycin 15mg/kg q8-12h (if MRSA risk)
Empiric therapy
HAP
NO high risk of mortality; NO RF for MRSA
Zosyn 4.5g q6h
(or cefepime, FQ, carbapenem)
Empiric therapy
HAP
NO high risk of mortality; INC RF for MRSA
Zosyn 4.5g q6h
(or cefepime, FQ, carbapenem)
+
vancomycin 15mg/kg q8-12h
Empiric therapy
HAP
HIGH risk mortality; INC RF (abx w/in prior 90 days)
Zosyn 4.5g q6h
(or cefepime, FQ, carbapenem)
+
tobramycin 5-7mg/kg
(or another AG)
+
vancomycin 15mg/kg q8-12h
Allergy: aztreonam (instead of Zosyn)
Empiric therapy
VAP
Gram (+) with MRSA activ
(vancomycin, linezolide)
+
Gram (-) with Pseudomonas activ (B-lactam)
(Zosyn, cephs - cefepime, ceftazidine, carbapenems)
+
Double Pseudomonas activ (non-B-lactam)
(FQ - cipro, levo, AG - amikacin, gentamicin, tobramycin, polymyxins)
Suggested regimen
HAP/VAP
Zosyn 4.5g q6h
+
tobramycin 5-7mg/kg QD
+
vancomycin 15mg/kg q8-12h
Common pathogens
UTI
(acute uncomplicated cystitis, pyelonephritis)
- E. coli
- Proteus mirabilis
- Klebs pneumoniae
- Staph saprophyticus
Treatment options
UTI
Acute uncomplicated cysitis
- Macrobid x7d
- Bactrim x3d
- Fosfomycin x1 dose
Treatment options
UTI
Acute pyelonephritis
- Ciprofloxacin (QD or BID) x7d OR levofloxacin QD x5d
- Bactrim DS BID x14d
Treatment options
UTI
Acute pyelonephritis req. hospitlization
IV ABX
1. FQ
2. carbapenems
2. AG
3. ES cephs, PCNs
Treatment options
UTI
Asymtomatic Bacteriuria in pregnant women
>= 10^5 CFU/ml, NO sx
- Macrobid
- B-lactam (ampicillin, cephalexin)
Treatment options
UTI
Asymtomatic Bacteriuria in endoscopic urologic proced
>= 10^5 CFU/ml, NO sx
- urine culture
- targeted abx
- abx should be initaited 30-60min before procedure
Common pathogens
Cellulitis
SSTI
- Group A strep (Strep pyogenes)
- S. aureus
- S. pneumoniae
Duration tx: 5-7d
Treatment options
Cellulitis
SEVERE
Clostridial sp.
Penicillin
+
Clindamycin
Treatment options
Cellulitis
SEVERE
Strep pyogenes
Pencillin
+
Clindamycin
Treatment options
Cellulitis
SEVERE
Aeromonas hydrophila
Doxycycline
+
Ciprofloxacin
Treatment options
Cellulitis
SEVERE
Vibrio vulmificus
Doxycycline
+
Ceftazidime
Treatment options
Cellulitis
SEVERE
Vibrio vulmificus
Doxycycline
+
Ceftazidime
Treatment options
Cellulitis
SEVERE
Polymicrobial
Vancomycin
+
Zosyn
Treatment options
Cellulitis
MODERATE
Systemic sx of infection
IV ABX
Cefazolin
(or PCN, ceftraixone, clindaymycin)
Treatment options
Cellulitis
MILD
No systemic sx of infection
PO ABX
1. PCN VK
2. cephs
3. dicloxacillin
4. clindamycin
Empiric treatment
Purluent SSTI
SEVERE
furnucle, carbuncle, abscess
IV ABX
1. vancomycin
2. daptomycin
3. linezolid
4. televancin
5. ceftaroline
Empiric tx - cover MRSA
Defined tx
Purluent SSTI
SEVERE
furnucle, carbuncle, abscess
IV ABX
MRSA - see empiric tx
MSSA
1. naficillin/oxacillin (DOC for MSSA)
2. cefazolin
3. clindamycin
Defined tx
Empiric treatment
Purluent SSTI
MODERATE
furnucle, carbuncle, abscess
PO ABX
1. Bactrim
2. Doxycycline
Empiric tx - cover MRSA
Defined tx
Purluent SSTI
MODERATE
furnucle, carbuncle, abscess
MRSA - see empiric tx
MSSA
1. dicloxacillin (DOC for MSSA)
2. cephalexin
Suggested treatment
Severe SSTI
Zosyn
+
vancomycin
Covers MRSA, E. coli, B frag
Suggested treatment
Mild/moderate SSTI
Cefazolin