Infectious Flashcards
improvements cap 1 wk- 4wks-6wks-3mos-6mospoppy
1 week - FEVER should have resolved
4 weeks - CHEST PAIN and SPUTUM PRODUCTION should have substantially reduced
6 weeks - COUGH and BREATHLESSNESS should have substantially reduced
3 months - most SYMPTOMS should have resolved BUT FATIGUE may still be present
6 months - most people will feel back to NORMAL
repeat cxr cap when?
4-6wks
ptb tx for cat 1new? cat 1a-bone joint meninge? cat 2retreatment? cat 2a retreatment?
Category 1 - New Cases of all forms of TB (except Meninges, Bone, and Joints): 2HRZE/4HR - 6 months total
Category 1a - New Cases TB of the Meninges, Bone, and Joints): 2HRZE/10HR - 12 months total
Category 2 - Retreatment cases of all forms of TB (except Meninges, Bone, and Joints): 2HRZES/1HRZE/5HRE - 8 months total
Category 2a - Retreatment cases of of TB of Meninges, Bone, and Joints): 2HRZES/1HRZE/9HRE - 12 months total
- TB 2016, CPG, p94 -
tb tx regimen: renal? dm? pregnant? compensated cirrhosis? decompensated cirrhosis? sot low risk? sot high risk?
> What is the recommended treatment regimen for patients with CKD?
ANSWER: Same with the general population but with dose adjustment of Ethambutol and Pyrazinamide depending on the EGFR. For HD patients, give HRZE post HD.
DM - same with general population
Pregant - same with general population
Compensated Liver Cirrhosis - DO NOT GIVE PYRAZINAMIDE: 2HRSE/6HR or 2HSE/10HE or 9HRE
Decompensated Liver Cirrhosis: Refer to specialized center for 2nd Line Drugs
Post-SOT recipients without risk factor of drug resistance (mild, non-cavitary, non-miliary, not-extra-pulmonary, and clinically diagnosed): 2HEZ/12-18HE, avoid RIFAMPICIN due to interaction with immunosuppresive drugs
Post-SOT recipients, severe cases (disseminated, cavitary, bacteriologically positive): 2HRZE/4-9HR… Just monitor the drug level of the immunosuppresive drugs
- TB 2016, CPG, pp152-163 -
1st line tx uncomplicated uti
nictrofurantoin monohydrate/macrocrystals 100mg bid x 7 days; fosfomycin 3g single dose
treatment cryptococcal meningitis
- Induction: Ampho B (0.7-1.0 mg/kg) + Fluco 800 PO/IV ODx 2 weeks or until cultures are negative
- Consilidation: Fluco 400 PO/IV OD for at least 8 weeks
- Maintenance: Fluco 200 PO OD for at least 1 year until there is reconstitution of symptoms- Fungal Culture after 2 weeks to ensure clearance - CALAS and CSF India Ink SHOULD NOT BE USED to monitor response to treatment
- Monitor Ampho B’s dose dependent nephrotoxicity and electrolyte imbalance
- Monitor Fluco’s hepatotoxicity
urine ph indication for imaging in uti
7.0
duration of retreatment for uti with recurrence
- 2 weeks: absence of urologic abnormality
- 4-6 weeks: symptoms recus and whose Urine CS shows the same organism as the initial infecting organism
complicated uti definition
- Functional or anatomic ABNORMALITY of urinary tract or kidneys
OR
- Underlying disease that INTERFERES with host defense mechanisms
OR
- Condition that increases the RISK of persistent infection and/or treatment failure
significant bacteruria
complicated uti >100, 000 cfu clean catch urine;
What is the treatment regimen of choice for Toxoplasmosis Encephalitis in HIV?
ANSWER: S-P-F ( Sulfadiazine, Pyrimethamine, and Folinic Acid or Leucovorin)
Duration of treatment
CAP
In general
Low risk: 5-7 days
Moderate risk: 7-10 days
Duration of treatment
CAP
MSSA Comunity acquired
Non bacteremic - 7-14 days
Bacteremic - upto 21 days
Duration of treatment
CAP
MRSA Community acquired
Nonbacteremic - 7-21 days
Bacteremic - upto 28 days
Duration of treatment
CAP
Pseudomonas
Nonbacteremic - 14 - 21 days
Bacteremic - upto 28 days
Duration of treatment
CAP
Legionella
14- 21 days
10 days (azalides)
Duration of treatment
CAP
Mycoplasma and chlamydophila
10-14 days
To Remember - NRTI:
All NRTIs end with BINE, DINE except for tenofOVIR and abaCAVAR
NRTIs zidovuDINE lamiviDINE emcitraBINE tenofOVIR abacAVIR
To remember nnrti
All NNRTIs have VIR in the middle of their names
NNRTIs neVIRapine efaVIRenz etraVIRine rilpiVIRine
To Remember - PI:
All PIs end with NAVIR
PIs ritoNAVIR atazaNAVIR daruNAVIR lopiNAVIR
To Remember - InteGrase Inhibtor:
All inteGrase inhibitors end with GRAVIR
InteGrase Inhibitors
ralteGRAVIR
elviteGRAVIR
doluteGRAVIR
Entry inhibitors antiretrovirals
For Entry Inhibitors, no pattern:
Maraviroc
Enfuviritide
What is the typical ALTERNATIVE treatment for PCP (especially if TMP-SMX cannot be tolerated)?
ANSWER: Clindamycin + Primaquine
Test to monitor treatment response and to rule out pcp pneumonia
- Diagnosis
- Chest Xray - can be normal in the course but typically shows BILATERAL FLUFFY INFILTRATES
- Chest HRCT - can demonstrate typical ground glass opacities and a normal finding is sufficient for ruling out
- Specialized stain (Methenamine Silver Stain) when available ***but cant be used to rule out
- LDH - elevated level can provide supporting evidence of PCP and can be used to MONITOR TREATMENT RESPONSE
