Infections Flashcards
how long can cough last in acute bronchitis, how long before other sx resolve?
8 weeks, 10-14 days. 90% viral
who is watch and wait appropriate in for AOM
six months and older if appropriate follow up will be done and it is not severe or complicated (fever less than 39, not immunocomp, etc)
what is watchful waiting
wait 48-72 hours- if gets worse start ABX
main pathogens in AOM
strep pneumo, haem, moraxilla
how to take penV
empty stomach. AE black tongue, GI
how to take cloxacillin
empty stomach, dosed at least QID, don’t need to adjust in renal failure
gram negative coverage with cephalosporins by generation
1- PEK (proteus, Ecoli, kleb), 2- HPEK (add haem), 3- HEN PEK (enterobacter, neisseria
name 1st gen cephalosporins
cephalexin (PO), cefazolin
name 2nd gen cephs
Fox is a Pro at Fur- cefoxitin, cefprozil (PO), cefuroxime (axetil makes it PO)
name 3rd gen cephs
cefotax, ceftriax, ceftazidime, cefixime (PO)
which 3rd gen ceph covers pseudomonas
ceftaz
name 4th gen cephs
cefepime (no oral)
purulent skin infections are more likely
staph
non purulent skin infections are more likely
strep
most likely to cause c diff
clinda, ampicillin, cephalosporins
what covers pseudomonas
piptaz, cipro, carbapenems (except erta), ceftaz, cefipime, aminoglycosides
which suspensions don’t go in fridge
clinda, azith, clarith, sulfatrim. get clumpy
which eyedrop goes in fridge
latanoprost
in meningitis, what drug regimen is given then stepped down? what changes in those over 50yo
under 50 worry about s pneumo, n mening, h influ. In over add listeria. Therefore if over 50, must have cefotaxime or ceftriaxone with ampicillin, and vanco (this si same for infants 6wks to 3 months) . If 50 and under,use cefotax or ceftriaxone with \ vanco
dose of amoxicillin (high) in kids for AOM
75-90mg/kg/day divided BID-TID (standard dose is 40mg/kg/day divided). If under 2, treat for 10 days. If 2 and over, treat for 5 days. Max 4g/day
post exposure prophylaxis in meningitis
rifampin x4d
adjunct therapy in meningitis
dexamethasone. if there are resistant pneumococcal organisms present, may be worried about decreased inflammation altering penetration of vanco, so consider adding rifampin
why can’t rifampin or fusidic acid be used alone in osteomyeltitis
role not known, but def can’t be used as mono as resistance develops rapidly
how to treat osteomyselitis empirically; hematogenous spread, or contiguous site, or penetrating trauma
hematogenous; most likely s aureus or gram neg enterics so use clox or cefaz, if from head use clinda and gent, tissue clox or cefaz, if puncture wound use FQ(to cover pseudomonas and staph)
how long do you treatAOM
5 days if 2 and older (high dose or normal dose amox), 10 if under 2
why would you use amoxclav vs amox in AOM
if thought it was h influ or m cat and there was resistance as their mechanism is beta lactamase production (ie amox clav is stable against beta lactamases)
how to treat CAP outpatient
outpatient no comorbidities/risk factors; macrolide or doxy. If risk, resp FQ or HD amox with macrolide.
how to treat CAP inpatient
ward; resp FQ or beta lactam with macrolide. ICU beta lactam plus either resp FQ or macrolide all IV. pseudomonas suspect; beta lactam with cirpo or AG+macrolide or AG+cipro
good choices for mrsa pneumonia-which are terrible
vanco linezolid. tigecycline had increased mortality, and dapto is inactivated by pulmonary surfactant
which macrolide shouldnt be used in the first 3 months of pregnancy, according to the product monograph
clarith-increased risk of spontaneous abortion possible
when do you give antivirals in shingles
those 50yo and older. If under 50, use analgesics and consider antivirals (but rarely get post herp neuralgia). Give f7d; vala 1000 TID, fam 500 TID, acycl 800 5xD
antiviral dosing for cold sores (Tx, supp and proh)- acyclovir
acyc; 400mg 5xD x5d, 400mg BID12 hrs prior to trigger exposure, suppression 200 QID or 400BID up to 4m
antiviral dosing for cold sores (Tx, supp and proh)- famacyclovir
fam;tx only; 750mg BID x1d or 1500mg as single dose
antiviral dosing for cold sores (Tx, supp and proh)- valacyclovir
val; tx 2g BID x1day, supp= 500mg OD x4m
which HIV drug requires that a patient is HLA-B negative?
abacavir
who is HIV antiretroviral therapy indicated in
qone except those with a cd4 over 500 and viral load less than 1000 that is maintained off of therapy
which HIV drugs have the most potential for interactions
nnrtis and PIs- metabolized by p450. generally nrtis have much lower potential for DI
what are the navirs
PI
what are the gravirs
instis (integrase strand transfer inhibitors) (integrase inhibitors)
which HIV drugs need a booster
elvitagravir and PI (ie the navirs)
what is the best studied HIB drug in preg
zidovudine (an NRTI)
can you breastfeed with HIV
no- CI. use formula
what is the target usually in HIV for viral load
less than 40copies/mL
how to treat MSSA and MRSA endocarditis (40% of cases)
MSSA- clox or cefaz, MRSA or pen allergy use vanco (all for 6 weeks from negative blood culture). If prosthetic valve, do clox +rifampin+gent subbing vanco for MRSA.
how to treat strep endocarditis (20% of cases)
mono with pen G or ceftriaxone, may add gent to shorten duration (from 4 weeks down to 2-count from negative blood culture) . or vanco if can’t have beta lactam
how long should antivirals be used if they are given for influenza
5 days (adults or kids). Usual duration of influenza sx is 4-7 days, and this shortens sx by about 1 day. Try to start within 48 hours. Kids get adult dose (75mg oseltamivir BID) when over 40kg
how long is deet effective vs citronella
deet 4-6hours, citronella under 1
in general, prophylaxis for HIV infections includes
septra for PCP (ie same as tx) or toxoplasma, isoniazid and B6 for TB, fluconazole for reccurent thrush, macrolide for mycobacterium avium (azith once weekly or clarith twice daily)(with tx add on ethambtol and maybe rifampin or FQ). Generally, if cd4 over 200 for 3 months don’t need proph
who should you treat for trichomoniasis and what are the sx. Treat partner?
treat qone except asxatic pregnant women. treat partner always (regardless of sx or test) (no sex until both finished tx and asxatic). Discharge often off white or yellow and frothy. Can have all other sx too (odour, itch, inflam)
signs of bacterial vaginosis, and treatment. treat partner?
fishy odour and grey or milky thin copious discharge. Don’t need to treat asxatic unless iUD insertion, gyn surgery, abortion, or if she’s at high risk preterm delivery. Do not need to treat partner usually
how do you treat a partner with chlamydia or gonnorhea
all partners in last 60 days get treated empirically, and no sexual contact for either until 1 week after starting tx
how to treat trich and bacterial vaginosis
metronidazole po (2gx1 or 500mg BID x7d) (CANNOT USE PV FOR TRICH). bacterial vag can also use clinda pv, or metro pv.
treatment for sinusitis
amox, then amox clav, reserve macrolides due to resistance of strep pneumo and poor coverage of h influ, can use levo or moxi if tx failure or allergy to beta lactams. Treat 5-7days
doc for GAS sore throat
pen v- amox often used in kids due to suspensions poor palatability. cephalexin 2nd line if can, or clarith clinda or azith. treat x10d
treating travellors diarrhea
FQ only. If preg or kid really needs, use azith
when can’t you use loperamide
bloody diarrhea or fever ie over 38.5 as can prolong infection and lead to toxic megacolon etc. BUT can use these if taking an AB.
how to treat mild travellor’s diarrhea
ORT and antimotility agents- will usually resolve in 24 hours. If have fever, seek medical help if no improvement in 48 hours despite therapy
treatment for TB
isoniazid, rifampin, pyrazinamide, f2m then iso and rif f4m. If previous treatment or risk for resistance, add on 2 new drugs not used previously (FQ and/or ethambutol)
T/F- patients with latent TB are asxatic and non infectious
T
what do you treat latent TB with
may choose not to treat. If high risk can use isoniazid x9m- weight risk, ben, SE, etc. Rifampin x4m can be substituted
T/F- single drug therapy is okay for active TB and can be added on in tx failure
F- never
what is DOT and why is it recommended
direct observed therapy- for TB- due to high rates of resistance and relapse if doses missed
when are urine cultures indicated in UTI
pyelo, complicated UTI (before abx therapy). Not for uncomplicated cystitis unless don’t respond to empiric or recurs in less than 1 month or pregnant.
which types of UTI is psuedomonas more likely in
complicated or bacterial prostatitis
who is asxatic screening okay in for UTI
preg (12-16wk) (need 2 consecutive cultures to start treating) or those about to undergo invasive urologic procedure
what can be used for UTI proph post intercourse
(consider if 2 or more episodes in 6 months or 3 or more in 12);septra 1/2 DS tab, trimethoprim 100mg, nitro 100mg, cephalexin 125mg, cipro 250mg, norflox 200mg
what can be used for long term low dose proph of UTIs
septra (1/2 DS tab ie 200/40) HS or 3xw, trimethoprim 100 HS, nitro 100 HS, 2nd line norflox 200mg qod
T/F- nitrofurantoin can be used for UTI pyelo
false
treatment for uncomplicated UTI
septra or trimethoprim x3d, nitro x5d, fosfomycin one dose. 2nd line FQ x3d or cephalexin x7d
tx for pyelo (mild-mod and sev)
m-m; FQ 7-14d (2nd; amox clav, septra or trimethoprim all 10-14d). Severe; aminoglycoside and amp both IV f10-14d (2nd; FQ IV 10-14d)
tx for complicated UTI (mild-mod, sev)
m-m; FQ, septra, trimethoprim, nitrofurantoin all 7-10d. severe aminoglycoside and amp 10-14d
tx for acute and chronic bacterial prostatitis
acute; AG + clox + amp IV (2nd FQ IV/PO x4w), chronic FQ PO x4-6w
cranberry juice interaction with warfarin
raises INR (increases warf levels)
how to treat cystitis in preg
amox, amoxclav, cephalexin, nitrofurantoin (near term may induce hemolytic anemia with g6p def but rare). Pyelo in preg empric tx of choice cetriaxone
syphillis tx
pen G
