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Adult medicine > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What is the 1st line treatment for CAP for outpatients?

A

Amoxicillin 1gm TID OR doxycycline 100mg BID OR azithro 500 then 250mg

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2
Q

What is the treatment for CAP as outpatient for patients with co-morbidities?

A

Augmentin or cefpodoxime AND azithromycin OR monotherapy with levaquin

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3
Q

What is the standard regimen for non-severe inpatient CAP?

A

beta-lactam + macrolide, like CTX + azithromycin OR Levaquin

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4
Q

What is the difference between severe vs non-severe inpatient CAP in terms of treatment?

A

In severe CAP, start with MRSA and PsA coverage and get cultures to DE-escalate (vanc + cefepime or zosyn)

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5
Q

What are 4 MRSA risk factors?

A

hemodialysis; hospitalization/abx in last 90 days; prior MRSA; IVDU/prisoners/recent influenza

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6
Q

When should you get sputum and blood culture in CAP?

A

In severe CAP or patients being treated empirically for PsA and MRSA

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7
Q

Who should get a single dose of PPSV-23 vaccine? Name 2 groups

A

Single dose > 65 years; Single dose age 2-64 yo IF DM2, cardiac disease, COPD/asthma/cigs, cirrhosis, cochlear implants, chronic care institutions

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8
Q

Who should get 2 doses of PPSV-23 atleast 5 years apart between 2-64 yo?

A

asplenic/sickle cell, immunocompromised, chronic renal disease

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9
Q

Who should get PCV-13? Two groups

A

Only high risk elderly > 65 AND 19-64 if cochlear implants, CSF leak, sickle cell/asplenia, immunocompromised (get 1 dose)

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10
Q

IF you want to give both PCV-13 and PPSV-23?

A

Give PCV-13 first and then PPSV-23 8 weeks later

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11
Q

Most CAP is viral or bacterial?

A

viral! though pathogen not identified 2/3 of the time.

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12
Q

what are main bacteria for PNA?

A

strep pneuo, staph, mycoplasma/h flu/chlamydia

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13
Q

What are two factors that should drive urgency of abx treatment>?

A

certainty of infection AND possible septic shock

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14
Q

what is the role of procal in diagnosing bacterial PNA?

A

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

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15
Q

What are the diagnostics you can use for PNA?

A

viral swab NAAT testing
MRSA swab if RF; get sputum cx if PsA RF
procal
XR

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16
Q

when to get sputum culture?

A
  • 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

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17
Q

Treatment of PNA

A

B lactam (amox, ceftriaxone, etc) + macrolide (azithro)
- cover MRSA or PsA if prior hx
- if RF, then get testing

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18
Q

MRSA swab has really good negative predictive value? True or false.

A

True!
sensitivity 85%
PPV 57%
NPV 98%

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19
Q

Length of treatment?

A

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…..

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20
Q

Why do you not transition IV vanc to PO vanc even if PO vanc is used (for c diff)?

A

Because IV vanc and PO vanc absorbed into differetn compartments

PO vanc - absorbed by gut
IV - into blood

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21
Q

What is a problem with nafcillin or oxacillin?

A

high salt/water load, also q4hr dosing

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22
Q

What is major adverse effect of linezolid?

A

serotonergic syndrome

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23
Q

What are MRSA options?

A

vanc
linezolid (good for resp, but not blood infections)
daptomycin (not used for PNA - inactivated by surfactant)
new ones: tigecycline, ceftraoline, oirtvancin/dalbavancin/telavancin)

24
Q

What do you need to monitor in blood for daptomycin?

A

CPK - myopathy is adverse effect!

25
Q

what clinical sign is most sensitive for cellulitis? what make cellulitis more unlikely?

A

tenderness

rarely bilateral; rarely pruritic; rarely geometric shape - consider alternative

26
Q

common pathogens for skin infections

A

group a.strep
MSSSA
CA-MRSA

27
Q

What is a derm diagnosis with a net-like mesh of red/blue/purple with jagged edges?

A

retiform purpura

28
Q

what three /triad of symptoms are highly sensitive for healthy non-pregnant woman for UTI? 96%

A

dysuria
frequency
urgency

29
Q

What test has poor sensitivity but good specificity (positive helpful, negative not) on UA

A

nitrite

30
Q

What test has good sensitivty but poorer specificity? on UA

A

pyuria

31
Q

what percent of women will have >100K colonies on urine cx with triad?

A

only 50% with positive urine culture that grows > 100K

32
Q

why is UTI more complicated for older women (>50 years)?

A

more variability in pathogens - more klebsiella and enteroccocus

33
Q

what is indication and dosing of fosfomycin for UTI?

A

E coli + E faecaslis uncomplicarted cystitis

3g single dose

34
Q

Indication and dosing of Nitrofuranotin for UTI?

A

afebrile cystitis

100mg PO BID for 5 days

don’t use in CKD (GFR < 60)

35
Q

Treatment for chronic prostatitis?

A

can do bactrim or cipro - with good penentration, need longer treatment 6-12 weeks

cant do nitrofuraintoin – not good coverage for tissue

can also do Ertapenem / fosfomycin

36
Q

acute prostatitis is akin to what condition in women?

A

pyelo!

37
Q

besides pregnant women, when do you treatment for asymptomatic bacteriuria?

A

TURP or other urologic procedures

38
Q

if you know pt has ESBL bacteriemia and susceptible to pip tazo – still give which abx?

A

meropenem!

39
Q

cefazolin vs nafcillin for MSSA bacteremia?

A

cefazolin lower all cause mortality!

40
Q

When do you need to get a TEE for endocarditis?

A

if community onset bacteremia; greater than 3 days of pos blood cultures; hemodialysis; or metastatic foci

41
Q

uncomplicated GNR bacteremia - length of treatment? Staph bacteremia

A

7 days? 4-6 weeks?

42
Q

Severe/complicated gram-positive infections (like MSSA) what is antibiotic of choice?

A

penicillin (!) or other beta-lactams are abx of choice

43
Q

what are the risks of nafcillin or oxacillin?

A

high salt/water load, risk of AIN (nafcilllin) or hepatitis (oxacillin)

44
Q

why is vanc + ctx an effective regimen?

A

vanc - covers MRSA (common in ecting drug use) and also strep

CTX - lots of gram negative, gram positive on staph

broad but not overly broad

not getting PsA coverage

45
Q

what are thae basic features of vancomycin?

A

inhibits cell well synthesis of gram positive bacteria ONLY

largest data for severe Blactam resistant gram positive infections

IV does not penetetrate intestinal lumen, because its a large hydrophilic molecule

46
Q

what are some toxicities of vanc?

A

local pain at injection sites

leukopenia, TCP, fever

nephrotoxicitiy, o

ototoxicity

47
Q

c diff treatment

A

ORAL vanc for intraluminal bowel infection like c diff

(or fidoximicin)

48
Q

what is basic of linezolid?

A

inhibits protein synthesis

49
Q

what are treatments for strep?

A

pcn, amoxicillin, augmentin, keflex (cephalexin), cefadroxil

50
Q

what is treatment for MSSA (if PN-resistant):

A

augmentin, keflex (cephalexin), cefadroxil, dixloxacillin

51
Q

What covers MRA?

A

bactrim, levofloxcacin, doxyclycine, clindamycin

52
Q

what is dosing for bactrim for most soft tissue infectinos?

A

1 DS tablet (800mg/160mg)
TWICE DAILY

renal effects, can be rash

53
Q

what antibiotics treat PsA?

A

cefepime, ceftazidime (both low toxicity), zosyn (broader – also treats some gram pos and anaerobes)

and then aztreonam, imipenem/meropenem

54
Q

ceftriaxone treats…

A

severe strep, some gram negative, also MSSA

55
Q
A

Adult medicine (14 decks)

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