Infectious disease Flashcards
What is the 1st line treatment for CAP for outpatients?
Amoxicillin 1gm TID OR doxycycline 100mg BID OR azithro 500 then 250mg
What is the treatment for CAP as outpatient for patients with co-morbidities?
Augmentin or cefpodoxime AND azithromycin OR monotherapy with levaquin
What is the standard regimen for non-severe inpatient CAP?
beta-lactam + macrolide, like CTX + azithromycin OR Levaquin
What is the difference between severe vs non-severe inpatient CAP in terms of treatment?
In severe CAP, start with MRSA and PsA coverage and get cultures to DE-escalate (vanc + cefepime or zosyn)
What are 4 MRSA risk factors?
hemodialysis; hospitalization/abx in last 90 days; prior MRSA; IVDU/prisoners/recent influenza
When should you get sputum and blood culture in CAP?
In severe CAP or patients being treated empirically for PsA and MRSA
Who should get a single dose of PPSV-23 vaccine? Name 2 groups
Single dose > 65 years; Single dose age 2-64 yo IF DM2, cardiac disease, COPD/asthma/cigs, cirrhosis, cochlear implants, chronic care institutions
Who should get 2 doses of PPSV-23 atleast 5 years apart between 2-64 yo?
asplenic/sickle cell, immunocompromised, chronic renal disease
Who should get PCV-13? Two groups
Only high risk elderly > 65 AND 19-64 if cochlear implants, CSF leak, sickle cell/asplenia, immunocompromised (get 1 dose)
IF you want to give both PCV-13 and PPSV-23?
Give PCV-13 first and then PPSV-23 8 weeks later
Most CAP is viral or bacterial?
viral! though pathogen not identified 2/3 of the time.
what are main bacteria for PNA?
strep pneuo, staph, mycoplasma/h flu/chlamydia
What are two factors that should drive urgency of abx treatment>?
certainty of infection AND possible septic shock
what is the role of procal in diagnosing bacterial PNA?
BEST to help with duration of antibiotics; procal arm treated for a few less days
one piece of data in the diagnosis, but not predictive
What are the diagnostics you can use for PNA?
viral swab NAAT testing
MRSA swab if RF; get sputum cx if PsA RF
procal
XR
when to get sputum culture?
- severe PNA
- MRSA or PsA risk factors, including prior hx
- pt has been hospitalized in past 90 days
HMS doc Klompas - recommends getting sputum gram stain and culture + viral studies in ALL inpatients - RF ill defined, neg cultures can facilitate stopping abx early; viral diagnosis has infection control implications; positive cultures can tailor treatment - and data critial to generating hospital antibiograms to inform future empiric treatment choices
Treatment of PNA
B lactam (amox, ceftriaxone, etc) + macrolide (azithro)
- cover MRSA or PsA if prior hx
- if RF, then get testing
MRSA swab has really good negative predictive value? True or false.
True!
sensitivity 85%
PPV 57%
NPV 98%
Length of treatment?
One week of treatment for all HAP (vs 15 days), even for PsA
5 days of CAP (vs 10)…could even be 3 days! Since so many CAP dx not really CAP…..
Why do you not transition IV vanc to PO vanc even if PO vanc is used (for c diff)?
Because IV vanc and PO vanc absorbed into differetn compartments
PO vanc - absorbed by gut
IV - into blood
What is a problem with nafcillin or oxacillin?
high salt/water load, also q4hr dosing
What is major adverse effect of linezolid?
serotonergic syndrome
What are MRSA options?
vanc
linezolid (good for resp, but not blood infections)
daptomycin (not used for PNA - inactivated by surfactant)
new ones: tigecycline, ceftraoline, oirtvancin/dalbavancin/telavancin)
What do you need to monitor in blood for daptomycin?
CPK - myopathy is adverse effect!
