Infectious Disease Flashcards
How does the tetanus vaccine work?
- inactivated toxin
The tetanus toxoid is an FDA-approved vaccination given alone or in conjunction with other vaccines. It is protective against effects from a gram-positive bacillus, Clostridium tetani.
This bacteria produces a neurotoxin called tetanospasmin, which blocks the release of an inhibitory neurotransmitter and leads to unopposed muscle contractions and spasms.
Vaccinations exert their effect on the human body via priming the active immune system. Following the administration of the tetanus toxoid, the immune system is stimulated and responds to the antigens present in the vaccine.
Preparation of the tetanus toxoid is via inactivation of the toxigenic strains of Clostridium tetani. The toxic strains are grown in liquid media, purified, and then treated with formaldehyde to take away the pathogenic properties.
AOM Diagnostic criteria CPS
DIAGNOSTIC CRITERIA:
1.Acute onset symptoms (otalgia or suspected otalgia)
2.Middle ear fluid (loss of mvmt, loss of bony landmarks, air fluid level) and significant inflammation of middle ear
- decrease in TM mobility (as visualized with a pneumatic otoscope) has good sensitivity and specificity for MEE
*Bulging TM esp if yellow or hemorrhagic has high sensitivity for bacterial origin
*Perforation with purulent discharge also indicates bacterial cause
AOM antibiotics
AMOXICILLIN
<2y = 10d (or perforated TM)
>2y = 5d
TID: 45-60mg/kg/day
BID:75-100mg/kg/day required
*consider other antibiotics first line:
-Otitis-conjunctivitis syndrome: Hflu/Moraxella more common -> amox clav or second gen cephalosporin
-Recent tx w/ amox in 30d or relapse of current infx -> amox clav
Varicella complications
- varicella pneumonia
- varicella encephalitis
Lice Management and counselling
KIDS WITH LICE CAN GO TO SCHOOL
TREAT LICE WITH PERMETHRIN
Head lice infestations are not associated with disease spread or poor hygiene
Head lice infestations can be asymptomatic for weeks.
Diagnosis requires detection of live head lice. Nits do not indicate active infestation.
Environmental cleaning/ disinfection not warranted. Head lice or nits do not survive for long away from the scalp.
Treatment with topical head lice insecticide (two applications 7 to 10 days apart) is recommended for active infestation
When there is evidence of treatment failure—detection of live lice—using a full course of topical treatment from a different class of medication is recommended.
The scalp may be itchy after applying a topical insecticide but itching does not indicate treatment resistance or a reinfestation.
Topical insecticides can be toxic. Take care to avoid unnecessary exposure and, when indicated, minimize skin contact beyond the scalp.
Excluding children with nits or live lice from school or child care has no rational medical basis and is not recommended.
For children ≥2 months of age, permethrin and pyethrins are acceptable treatments for confirmed cases of head lice. Dimethicone can be used in children ≥2 years of age.
Myristate/ST-cyclomethicone (Resultz) can be used in children ≥4 years of age. Benzoyl alcohol lotion is comparatively expensive but can be used in children ≥6 months of age.
6yoF returned from to to Nova Scotia with family. Has erythematous rash with red centre and concentric ring around it. Also with fever, malaise, arthralgias. What is your management?
Start doxy for lyme disease now
Early, cutaneous disease is a clinical diagnosis. Treatment = doxycycline 10d
Dog bite bugs
Pasturella, Staph aureus, Strep, Anaerobes
Dog bite management
- tetanus
- maybe rabies
- amox clav if:
- Puncture wound
- Hands, genitalia, face, joints
- Wounds requiring closure
Up to how many weeks after birth is a neonate at risk of becoming ill with a perinatally acquired HSV infection?
6 weeks
Duration of treatment for neonatal HSV
SEM disease 14 days
Disseminated or CNS disease 21 days
–> For infants with CNS disease, CSF should be sampled near the end of a 21-day course of therapy. If the PCR remains positive, treatment should be extended with weekly CSF sampling and ACV stopped when a negative result is obtained.
Criteria staph toxic shock
Criteria (all 6 required):
Fever 38.9 or higher
Diffuse macular erythroderma
Desquamation 1-2 weeks after onset, particularly on palms/soles
Hypotension (systolic < 5%ile), orthostatic changes > 15 mmHg, or orthostatic syncope or dizziness
Involvement of 3 or more organ systems: GI, MSK, mucous membrane, renal, hepatic, hematologic, or neurologic
Negative blood, throat, or CSF cultures for alternate pathogens (blood cultures may be positive for staph aureus) and/or negative titres for rocky mountain spotted fever, leptospirosis or measles
Typhoid fever (presentation, w/u ,tx)
+/- diarrhea, fever in returning traveller
typically SEA/India
get a blood culture (but only~50% sensitive)
Tx: ceftriaxone (if from Pakistan, there is high ctx resistance so use meropenem)
malaria test
thick and thin smears
Severe malaria (clinical manifestations and laboratory measures)
Clinical:
- unable to walk
- impaired consciousness
- resp distress
- multiple convulsions
- shock
- DIC
- Jaundice
Labs
5% parasitemia typically
Hb <70
Acidosis
AKI
High lactate
malaria treatment
mild: malarone (Atovaquone-Proguanil)
Severe: artesunate
fever of unknown origin definition
duration > 2 weeks with uncertain diagnosis despite appropriate initial investigations
baratonella henselae
cat scatch disease
Q: unilateral swollen lymph nodes, impsilateral conjunctivitis, enlarged spleen. no atypical lymphocytes on smear
Treatment: azthromycin x 5d
cat scratch treatment
azithromycin
chronically draining cervical lymph node in 4year old - most likely pathogen
atypical mycobacterium
features
- young age, no fever, unilateral LN, no TB exposure, no cat exposure, chronic
ddx infections acute unilateral lymphadenopathy
Acute Bacterial Adenitis: staph aureus or strep pyogenes
Non-TB Mycobacterial Adenitis (Chronic)
chronic infection’s unilateral lymphadenopathy ddx
non tuberculous mycobacteria (MAC)
tuberculosis
bartonella
tularemia
chronic infections bilateral lymphadenopathy ddx
EBV, CMV, HIV, toxoplasmosis
perineud oculoglandular syndrome
bartonella with eye involvement
acute infection EBV lab tests
mono spot positive
VCA IgM +
EA IgG +
VCA IgG +
EBNA IgG + is remote past infxn
mono sports avoidance
risk splenic rupture
highest risk first 3 weeks for infection
return to sport once resolution of symptoms, normal labs and splenomegaly resolved
congenital infxn with rash on palms and soles
syphillis
congenital syphilis clues
persistent nasal discharge (esp bloody) - snuffles
rash on palms and soles
desquamating rash
pain with movement (pseudoparalysis) suggesting bony involvement
congenital syphilis precautions for health care workers
high risk of transmission through touching the skin!! contact precautions when handling baby
syphilis testing
treponemal tests (more sensitive and specific)
- CMIA, CLIA, TPPA, FTA ABS
- typically the screening test
Non treponemal tests
- RPR (serum), VDRL (CSF)
- quantitative titer
Syphilis RPR drop for adequate treatment
4 fold drop
divide the RPR number by 4
Ex. 1:64 –> 1:16
treatment for baby with congenital syphilis
IV penicillin x 10 days
full workup: Long bone XR, CSF, ab titers, labs (LFTs)
inadequate maternal treatment of syphilis
- non-penicillin regiment
- treated within 30 days of baby’s delivery
- less than 4 fold trop in titer
- no documentation of treatment
- mother had relapse or reinfection
Managment of baby born of mom with syphilis with adequate treatment
test the baby’s RPR and TT at 0,3,6 and 18mo and if negative, no further w/u needed. Baby should have drop in RPR by 3 mo and non reactive by 6 mo if they do not have syphilis.
If +RPR at 6 mo -> TREAT
CNS syphilis in neonate management
no change in abx (10 days IV penicillin)
rpt LP in 6 months
approach to possible zika virus exposure
mother with possible zika exposure in pgegnancy
- test maternal zika virus serology first
- if positive, chehck baby serology and PCR and head US
unexplained microcephaly + maternal history of travel or paternal history of travel
- zika serology mom then baby
Clinical features of congenital CMV
IUGR, microcephaly, rash (petechial), chorioretinitis, HSM, SNHL
10% of asymptomatic infants go onto have symptoms later (hearing loss)
Laboratory features of congenital CMV
Low platelets
Increased ALT
Conjugated hyperbili
Risk Factors for cCMV (who to test)
- Fetal US with findings suggestive of CMV (microcephaly, IUGR, periventricular calcifications)
- HIV exposure
- Primary immunodeficiency
- Babies who fail the newborn hearing screen
HUS finding in congenital CMV
periventricular calcifications
gold standard test for congenital CMV
urine PCR within 3 weeks of age
If CMV + newborn, what other investigations do you need to send?
- CBC
- Bili
- Liver enzymes
- HUS if normal neuro exam (MR if abnormal neuro exam)
- Hearing eval
- Optho eval
** DO NOT NEED TO SEND CSF UNLESS SZ OR SEPTIC
treatment for CMV
valganciclovir for 6 mo
can use IV ganciclovir if very unwell child
indications for CMV treatment
- CNS disease
- chorioretinitis (Severe disease)
- severe single system
- multisystem 3+ systems
How frequently do children with cCMV need their hearing checked?
every 1 yr until school age
testing options for congenital toxoplasmosis
serum serology
PCR on CSF, blood or urine
placental pathology
findings of toxoplasmosis on CSF
lymphocytic pleocytosis
very high protein (can cause obstructive hydrocephalus)
toxoplasmosis triad
-hydrocephalus (may have macrocephaly)
-Cerebral calcifications (parenchymal)
-chorioretinitis
congenital varicella syndrome
hypoplastic limbs
scarred skin, dermatomal scars
micropthalmia
typically d/t varicella in 1st or 2nd trimester
pregnant woman exposed to chicken pox
if no definitive history of chickenpox, check mom’s serology
- if IgG postive, no further intervention (she has had infxn previously)
- if IgG NEGATIVE, given VZIG within 10 days of exposure and treat with acyclovir if rash revelops
congenital cataract most likely cause
rubella
classic rash in congenital rubella
blueberry muffin rash due to extramedullary hematopoeisis, often palpable
classic rubella triad
cataracts
cardiac (PDA)
SNHL
diagnosis congenital rubella
rubella specific IgM prior to 3 mo of age
can also do PCR in NP swab or urine
parvo B19 pearls
slapped cheeks
can cause aplastic anemia
can cause congenital infxn if pregnant woman resulting in hydrops - if exposed, the mom should get serology for parvo (IgM neg, IgG positive is protective)
adequate GBS abx prophylais
at least 1 dose 4 hour before delivery
amoxicillin or penicillin
cefazolin is used for penicillin allergy
gram positive cocci in clusters
staph aureus (or cons)
antibiotics for sepsis < 28 days
amp + gent
workup for HSV in neonate
any signs of HSV - do full wokrup including LP and start acyclovir
HSV PCR of vesicle, NP, eyes, urine, stool, blood and csf
do LP ieven if clinically well!
most common manifestation is skin/eyes/mouth with vesicular lesion
SEM = 14 days
CNS = 21 days
duration treatment for HSV in neonate
IV acyclovir only
- isolated SEM: 2 weeks
- disseminated or CNS: 3 weeks
must repeat the LP before stopping treatment
*suppressive oral acyclovir for 6 months if CNS disease
*consider suppressive oral acyclovir for other disease - should offer to parents for SEM disease
maternal recurrent HSV with lesion at pregnancy
surface swabs for baby at 24hr, no treatment pending results because you know this is recurrent disease for mom
management of well appearing, asymptomatic infant possibly exposed to HSV during delivery
moms first episode with membrane rupture (c/s or vaginal delivery)
- empiric acyclovir
- swabs at 24hr
- if negative: 10 days
- if positive: 14-21 days of acyclovir
moms first episode, no ROM, dry C/S
- no empiric acyclovir
- swab baby
- if swab positive, full work up and treat
recurrent episodes
- no empiric acyclovir
- 24 hr swab, if positive, full work up and treat
Treatment of mild C diff (<4 stools per day)
Stop precipitating abx and reassess in 48hr
Treatment of moderate C Diff (>4 stools per day, low grade temp)
PO metronidazole x 10-14d
Treatment of severe C Diff (systemic toxicity)
Vanco PO x 10-14d
If severe and complicated (pseudomembranous colitis) -> Vanco PO and metronidazole IV x 10-14 days
First reoccurrence of C diff, how to treat?
Initial regimen repeat, or PO vancox 10-14d
Second reoccurance of C diff, how to treat?
Vanco x 4-10 weeks (taper)
Initial screening test for C Diff
GDH EIA, if positive -> do toxin EIA
Child eats at a picnic and has vomiting and diarrhea 4 hrs later, most likely pathogen?
Staph Aureus
Bug associated with raw or undercooked shellfish?
Vibrio Spp
Tx of Gonorrhoea
Ceftriaxone 250mg
1g Azithromycin
Painless lump or ulcerating lesion to genitals, localized adenopathy, fever, fatigue, myalgia
Lymphogranuloma venereum (chlamydia)
Well infant, Mom has untreated gonorrhoea, what to do for baby?
IM CTX + conjunctival swab
Well infant, Mom has untreated chlamydia, what to do for baby?
Nothing, swab only if symptomatic
Mom with IV drug use and recent incarceration presents in labor with undocumented HIV status, next steps?
Rapid HIV for mom
If rapid positive-> with intrapartum and infant postnatal prophylaxis (zidovudine) and send serology
If Ab test positive for Mom, send baby HIV PCR
If baby HIV PCR +-> start full treatment with 3 drug regimen x 6 weeks
Needle stick injury, child is not fully vaccinated for Hep B, next steps?
Test HBsAg and HBsAb
If both neg-> give HB vacc and HBIG
If HbSAb+ -> complete vaccine series at 1mo and 6 mo
If no results available within 48hr, give both HB vacc and HBIG
Child fully vaccinated against Hep B with needle stick, next steps?
Test HBsAb
If positive -> no further action
If negative -> send HBsAg
If HBsAg negative-> vaccine and HBIG
Baseline and follow up labs for needle stick injury
Baseline: HBV, HIV, HCV (Ab/status)
Follow up labs:
-1mo-> HIV
-3mo-> HIV and HCV
-6mo-> HIV, HCV, HBV
Hx of MIS-C, when can you give COVID vacc?
3 months post MIS-C
When TB is suspected CLINICALLY, what test should you do?
Sputum for culture - send for AFB stain and culture
- All patients with TB needs HIV testing
TST cut offs for positive test
> 5mm for contact cases + immunosuppressed
> 10mm for everyone else
TST is a better test for TB than IGRA/Quantiferon in patients <age ___?
TST better for <2yrs old
Management of close contacts for TB?
ALL GET TST +CXR
If <5yrs and TST <5 = WINDOW PROPHYLAXIS (one agent effective for index case +Vit B12)
- rpt TST 8-10 weeks after last contact with + case
If >5yrs and TST <5 = no treatment
- rpt TST 8-10 weeks after last contact with + case
If any age and TST >5 = TREAT: Isonazid and Rifampin x 12 weeks
Side effects of ethambutol?
Optic neuropathy (requires optho assessment if used in TB treatment regimen)
Live vaccines are contraindicated in immunocomprimised patients EXCEPT which conditions:
- IgA deficiency
- Complement deficiency
- Asplenia
- CGD can receive live VIRAL (not bacterial)
- HIV if not severely immune comprimised
When can you give live vaccines post high dose steroids?
1 month
When can you give live vaccines post chemo?
3 months
When can you give live vaccines post Ritux?
6mo
When can you give live vaccines post stem cell transplant?
2 years post
Inactive can be started 3-12 months post
When can you give live vaccines post solid organ transplant?
NEVER
Inactive 3-6mo post
Prophylaxis for close contacts of pt with invasive mennigococcal disease?
Contact within last 10days
Give to all household contacts within 24hrs
VACCINE + RIFAMPIN (2d)
Men-C-C vaccine, when to give for healthy children?
One dose at 12mo
HPV vaccine for 9-14 yrs, how many doses, how far apart?
2 doses, 6 mo apart
HPV vaccine >15 yrs, how many doses, how far apart?
3 doses at, 0, 1, 6 mo
When can you give Rotavirus to hospitalized prems?
On discharge (first dose between 6-15 weeks, all doses complete by 8mo)
Complication of rotavirus vacc?
Intuss (highest risk in 1 week after receiving)
At what age can you give live flu vaccine?
> 2yrs
When would you give two doses of the influenza vaccine?
If first time getting it and between 6mo-9yrs
Doses 4 weeks apart
When to give Tamiflu?
ALL HOSPITALIZED W/ INFLUENZA and basically any underlying comorbidity = start even if >48hrs since symptom onset
If <5yrs and mild, start if <48hrs from symptom onset, otherwise supportive care
Which vaccines are live?
MMR
VZV
Live influenza
Rotavirus
BCG
Yellowfever
Hep A post exposure prophylaxis
Give to close contacts within the past two weeks
If >6mo = Hep A vaccine
If <6mo = Hep A immunoglobulin
If immunocomprimised = Hep A vaccine + immuniglobulin
Mom HepB unknown at delivery, how to manage the baby?
HepBsAg STAT for Mom, if results available within 12 hrs can wait for results to treat baby
If Mom HBsAg - = no treatment
Mom HBsAg + = Hep B vaccine and immunoglobulin within 12hrs
If no results available in 12hrs, give HB vaccine within 12hrs, can wait up to 7d for HBIG
When to do Hep B serology in an infant born to Mom with Hep B?
HBsAg and HBsAb at 9-12 mo (at least one month after finishing vaccine series - 3 doses for most, 4 doses if <2kg at birth)
Interpret the serology: HBeAg+, HBcAg+, HBsAg+, HBeAb−, HBcAb+, HBsAb−
Acute infection
Interpret the serology: HBeAg−, HBcAg−, HBsAg− HBeAb−, HBcAb−, HBsAb+
Immunized
Interpret the serology: HBeAg−, HBcAg−, HBsAg− HBeAb+/−, HBcAb+, HBsAb+
Past infection
Testing of infant of HCV + mom?
Best method: serology at 12-18mo
If cannot ensure f/u: HCV PCR at >2mo, still need to rpt serology at 12-18 mo if neg to ensure Ab clearance
If serology negative at >6mo, NO REPEAT TESTING
If serology positive anytime earlier than 12-18mo, REPEAT AT 12-18 mo
If positive serology at 12-18mo, do HCV PCR to determine if spontaneously cleared or active infection
When to give VZIG to baby of Mom with varicella?
If moms rash was ONSET 5 days prior to delivery or 2 days after
Partially immunized child, has a clean cut, tetanus proph?
DTaP if <3 doses
Fully immunized child has a clean cut, tetanus proph?
Nothing! (even if dirty wound, no need to give vaccine unless it has been >5yrs since last dose)
Rabies prophylaxis
Vaccine (4-5 dose series within two weeks)
+ Immunoglobulin directly into wound
Give if: wild animal bite, bat bite or scratch, dog/cat/ferret if seems rabid
When can a kid with chickenpox go to school/daycare?
A child with mild illness should be allowed to return to school or child care as soon as she or he is well enough to participate normally in all activities, regardless of their state of rash
(contagious 2d before rash onset until all crusted over)
JK NOW ITS NOT UNTIL THE RASH IS IMPROVED
Who qualifies for RSV prophylaxis?
- <30wks and <6mo
- <36wks, <6mo, +rural
- CHD <1yr
- CLD on O2 <1yr (consider <2yrs if on O2)
Infectious contraindications to breastfeeding?
HIV
HTLV
Active HSV lesion on breast
Cracked and bleeding nipples with HCV
TB (until Mom has had 2 weeks of tx)
Treatment of pinworm?
Treat all family members with mebendazole now and again at 14days
Child with unilateral facial weakness, and vesicles in ear canal. Best management?
Ramsay Hunt
Treat with acyclovir and steroids
Previously healthy 6-year-old male with right sided parotitis and upper respiratory symptoms suggestive of viral illnesss. Two prior similar episodes. Salivary swab growing viridans group streptococci. Cause?
Juvenile recurrent parotitis (non-obstructive, most common in prepubertal males, conservative management)
Previously well 6-year-old boy with new onset flaccid paralysis of left leg 5 days after brief febrile illness associated with upper respiratory tract symptoms. Immunizations UTD. No travel. Reflexes intact. CSF normal. Likely diagnosis?
Acute Flaccid Myelitis
- Can be secondary to polio or enteroviruses (if immunized)
Endocarditis Prophylaxis Indications (who gets it?)
- Previous infectious endocarditis
- Unrepaired cyanotic CHD
- Completely repaired CHD with prosthetic material during first 6 months after procedure
- Repaired CHD with residual defects adjacent to prosthetic material
- Heart transplant with valvular defects
age cut off for watchful waiting for AOM
> 6 months old
treatment for chlamydia pneumonia
azithro or erythro
neonate with pneumonia and high eosinophilia - pathogen?
chlamydia
empiric treatment for meningitis over 1 mo old
ctx + vanco
+/- ampicillin (listeria coverage for if close to 1 mo old)
empiric meningitis treatment under 1 mo old
amp + cefotax
steroids for meningitis
dex 0.6 mg/kg/day start within 4 hr of antimicrobials
helps reduce hearing loss for h flu (gram neg coccobacilli) and strep pneumo (gram positive diplococci)
continue x 4 days
discontinue if organism not identified within 48 hr (culture negative)
repeat LP for meningitis
strep pneumo if resistant strain or if received dex
gram negative repeat 24-48hr
some people do rpt LP for GBS meningitis
prophylaxis for h. flu meningitis
-when to tx household contacts
- what to treat with
rifampin x4days preferred
treat the household members if:
- at least one child < 4 years old who is un/partially immunized
- child < 12 months not completed primary series
- any immunocomp child in the home
prophylaxis for neisseria meningitis
all household contacts get rifampin x 2d
+/- meningococcal vaccine depending on the strain
abscess management
I&D no antibiotics unless systemic features or young < 3mo
if cellulitis, cephalexin for MSSA and septra for MRSA
centor score for pharyngitis
one point each for:
-exudate or swollen tonsils
-tender or swollen anterior cervical LNs
-fever
-no cough
if score 3 or 4, swab
for age 3-14 years
rheumatic fever antibiotic prophylaxis
no carditis: 5 years or until 21, whichever is longer
carditis but no residual heart disease: 10 years or until 21, whichever is longer
residual carditis: 10 years or until 40 or lifelong
osteo/septic arthritis empiric treatment
IV cefazolin
kingella < 4yo
staph aureus most common
chicken pox leading to severe lesions, erythema with some blackened areas
chickpox leading to necrotizing fascitis
6 yo with varicella presents with progressive, localized erythema - red with blue hue and exquisitely painful with temperature 39. what is pathogen and abx?
most likely GAS post chicken pox
nec fasc
penicillin + clindamycin (need anti toxin)
antibiotics for UTI prophylaxis
Do not do it without talking to nephro/uro!!
Consider TMP SMX or nitrofurantoin if Grade 4-5 VUR
if resistant to both, then don’t prophylax
chemoprophylaxis for invasive GAS
For close contacts of confirmed severe disease
use keflex x 10d
close:
- household >4 hr/day or 20 hr total during the previous 7 days
- non-household: shared bed, sex, direct contact with mucousmembranes/secretions/open skin
severe:
- TSS
- nec fasc
- meningitis
- pna
- other life threatening GAS infxn
indications for UTI proph
grade IV - V VUR
strep toxic shock definition
hypotension or shock PLUS two or more of:
- renal impairment
- DIC
- hepatic abnormalities
- ARDS
- scarlet fever rash
- soft tissue necrosis
need to isolate strep pyogenes (GAS) from normally sterile body site
most common neurologic symptom of lyme disease
facial nerve palsy
purpura fulminans most likely pathogen
meningococcus
classic rash in lyme disease
erythema migrans (large target)
eczema flare with punched out lesions
eczema herpeticum
tx acyclovir
if near the eye, swab, call optho and start IV acyclovir
how to diagnose lyme in first mo since bite?
clinical
serology can be negative for first 2-4 weeks
antibiotic prophylaxis for asplenia
Amox 10mg/kg/day BID
2 yrs post splenectomy
SCD 2mo - 5 yr
antibiotics for lyme disease
doxycycline regardless of age
10 days if just skin
lyme disease prophylaxis
consider for exposed individual in known endemic region with:
- Tic attached for > 36, engorged Tic
- within 72 hr of tick removal
single dose doxy
deet percentages depending on age for mosquito prevention
> 12 yrs: 30%
</= 12 yrs: 10%
c diff mild vs. moderate vs severe definition and treatment
mild: watery diarrhea <4/day
- stop precipitating abx, supportive care
moderate: watery diarrhea 4+ stools/day, no or minimal systemic toxicity
- flagyl or vanco 10-14 days
severe: systemic toxicity (fevers, rigors, severe abdo pain)
- vanco
severe + complicated: colitis
- flagyl IV PLUS vanco po
recurrence: repeat first regimen or use vanco
rapid onset vomiting/diarrhea after soiled food ingestion
staph aeureus (30min-6hr)
giardia treatment
flagyl
painful vs. painless STI ulcers
painful = HSV
painless = syphilis
complication of macrolides in neonate
pyloric stenosis
hepatitis A post exposure prophylaxis
recommended for those 6+ mo old within 2 weeks exposure
hep B positive mom - management neonate
HBIG and HepB vaccine within 12 hr of birth
continue vaccine series
test HBsAg and HBsAb at 9-12 mo of age to check baby’s serology and response to vaccine
hep b unknown mom
stat HBsAg
If results within 12 hr, wait and give HBIG and vaccine within 12 hr
pinworm treatment
mebendazole or albendazole x 2 courses
if recurrent, treat full family
how do you treat strep throat in a patient with high risk medication non compliance (ex. couch surfing, no health card)
single dose benzathine penicillin IM
<27 kg: 600,000 units or ≥27 kg: 1,200,000 units
use in any patient you think won’t take 10 days po
