Infectious Disease: Bacterial Infection Treatments Flashcards
How would you treat a staphylococcus skin infection outpatient with low risk of MRSA?
Cephalexin, dicloxacillin
How would you treat a staphylococcus skin infection outpatient with a high risk of MRSA?
Clindamycin, tetracyclines (doxycycline, minocycline), or sulfamethoxazole/trimethoprim
How would you treat a staphylococcus skin infection inpatient?
Vancomycin
How would you treat an inpatient staphylococcal skin infection if allergy to vancomycin?
Clindamycin, cefazolin, Nafcillin or oxacillin, linezolid
How would you empirically treat staphylococcal osteomyelitis?
Vancomycin + 3rd or 4th generation cephalosporin
How would you treat staphylococcal osteomyelitis with MSSA on culture?
Nafcillin, oxacillin, or cefazolin
How would you treat staphylococcal osteomyelitis with MRSA on culture?
Vancomycin IV
How would you treat toxic shock syndrome empirically?
Vancomycin plus clindamycin plus pip/taz or cefepime or carbapenem (meropenem, doripenem, imepenem)
How would you treat scalded skin syndrome with MSSA?
Supportive measures: fluid management, skin care, Nafcillin or oxacillin
How would you treat scalded skin syndrome with a high risk of MRSA?
Vancomycin
How would you treat staphylococcal food poisoning?
No treatment, self limiting and typically resolves within 12 hours
How would you treat a coagulase negative staphylococcal infection (s. Epidermidis, s. Saprophyticus, s. Lugdunensis)
Vancomycin and prosthetic device removal if infected
How would you treat strep pyogenes pharyngitis?
Benzathine PCN G, Penicillin VK or amoxicillin
How would you treat strep pyogenes pharyngitis with a allergy to penicillin?
Cephalosporin such as cephalexin
How would you treat scarlet fever?
Benzathine PCN G, penicillin VK or amoxicillin
How would you treat impetigo without suspected MRSA?
Topical mupirocin, cephalexin, dicloxacillin
How would you treat impetigo with suspected MRSA?
Sulfamethoxazole/trimethoprim, doxycycline, clindamycin
How would you treat outpatient erysipelas?
penicillin, amoxicillin
What are alternatives to penicillin, amoxicillin in treatment of outpatient erysipelas?
Dicloxacillin, cephalexin, clindamycin/erythromycin
How do you treat erysipelas inpatient?
Vancomycin if severe and s. Aureus suspected, cefazolin, ceftriaxone, clindamycin
How would you treat cellulitis outpatient?
Empiric treatment directed at both organisms depending on severity
Dicloxacillin, cephalexin, penicillin
How would you treat cellulitis with MRSA outpatient?
Clindamycin, doxycycline/minocycline, bactrim
How would you treat cellulitis inpatient?
Vancomycin
How do you treat other GABHS infections: necrotizing fasciitis, streptococcal toxic shock syndrome, arthritis?
Penicillin or ampicillin and clindamycin
How do you treat strep agalactiae prophylactively?
PCN G or ampicillin, cefazolin
What is alternative treatment for strep agalactiae?
Clindamycin or vancomycin
How would you treat otitis media?
Amoxicillin
How would you treat otitis media if allergy to penicillin?
Omnicef (cefdinir)
If otitis media is still present after 2 weeks of treatment, how would you treat?
Augmentin or omnicef
If otitis media is still not better after 4 weeks, how would you treat?
Referral to ENT and rocephin
How would you treat acute sinusitis?
Augmentin
What are alternatives to augmentin for treatment of acute sinusitis?
Doxycycline or clindamycin
What are treatments for outpatient pneumococcal pneumoniae?
Amoxicillin, doxycycline, azithromycin (only in areas <25% resistance)
How would you treat pneumococcal pneumoniae outpatient in patients who have COPD/comorbidities?
Levofloxacin, (amoxicillin/clavulanate (augmentin) or cephalosporin) + (zmax or doxycycline)
How would you treat pneumococcal pneumoniae inpatient?
Levofloxacin or macrolide + beta-lactam
How would you treat endocarditis?
Ampicillin + gentamicin
How would you treat mild or complicated skin/wound/UTI infection due to enterococcus?
Ampicillin or vancomycin
How would you treat complicated skin/wound/UTI infections due to enterococcus?
Ampicillin or vancomycin
How would you treat vancomycin resistant skin/wound/UTI enterococcus infection?
Linezolid or Daptomycin
How would you treat bacillus anthracis?
Ciprofloxacin for 7-10 days if cutaneous, up to 60 days if inhalation, multiple antibiotics can be used
What can you use for bacillus anthracis instead of ciprofloxacin?
Doxycycline
How can you treat bacillus cereus?
Supportive treatment: fluids and rest
How would you treat listeriosis inpatient?
Ampicillin and gentamicin
How would you treat listeriosis outpatient?
Amoxicillin
How would you treat corynebacterium diphtheria?
Diphtheria equine antitoxin (obtained from CDC, for all suspected causes of diphtheria), PCN or erythromycin
How would you treat contacts of patients with corynebacterium diphtheria?
Erythromycin
How would you treat meningococcal meningitis?
PCN G (if susceptible to penicillin) or
Ceftriaxone for coverage of other agents
How would you treat close contacts of a patient with meningococcal meningitis?
PCN G or ceftriaxone
How would you treat a patient with OE/UTI/RESP infection due to pseudomonas outpatient?
Ciprofloxacin or levofloxacin (oral)
Tobramycin (inhaled)
How would you treat a patient with OE/UTI/Resp infection due to pseudomonas inpatient?
Pip/taz, ceftazidime, cefepime, meropenem, aztreonam
“You’re CCAMP(ing) indoors
How would you treat whooping cough (bordetella pertussis)?
Supportive care, azithromycin
How would you treat whooping cough if patient can’t take azithromycin?
Bactrim
How would you treat haemophilus influenzae?
Empiric antibiotic treatment depending on area of infection
How would you treat legionnaires?
Macrolide (azithromycin, clarithromycin), fluoroquinolone (levaquin) typically for 10-14 days/21 day course of therapy for immunocompromised patients
How would you treat klebsiella (klebsiella pneumoniae)?
Susceptibility testing required due to resistance, empiric treatment with respiratory fluoroquinolone, carbapenem
How would you treat traveler’s diarrhea (E Coli)?
Tends to resolve itself, but if does not improve: antimotility agents/antidiarrheals: loperamide, etc.
Bismuth subsalicylate
How would you treat severe traveler’s diarrhea (E Coli)?
Antimotility agents/antidiarrheals, bismuth subsalicylate, antibiotics for severe symptoms: ciprofloxacin for 3-5 day course
How would you treat campylobacter jejuni?
Ciprofloxacin empiric treatment, azithromycin
How would you treat shigellosis?
Rehydration to treat hypotension in severe cases, ciprofloxacin (single dose), bactrim
How would you treat cholera (vibrio cholerae)?
Tetracycline/doxycycline, bactrim, azithromycin, quinolones (cipro), susceptibility testing to decide
Note: this little girly is out drinking river water with cholera so you gotta tell her: get BACT over here!!! (B)actrim (A)zithromycin (C)ipromycin (T)etracyclines (doxycycline)”
How would you treat non-cholerae vibrio infections?
Doxycycline or ciprofloxacin
How would you treat typhoid fever (salmonella)?
Ciprofloxacin/levofloxacin, ceftriaxone, azithromycin
How would you treat enterocolitis?
Supportive care
How would you treat complicated enterocolitis with severe illness?
Supportive care, ciprofloxacin, ceftriaxone, azithromycin, bactrim
How would you treat UTI/uncomplicated cystitis?
Bactrim, nitrofurantoin (furadentin, macrodantin, macrobid), fosfomycin, cephalosporins, ciprofloxacin
Who could you not give bismuth subsalicylate for traveler’s diarrhea?
Children, pregnant women or ASA allergy
Who would you not give nitrofurantoin for uncomplicated cystitis?
Last trimester of pregnancy
How would you treat bubonic plague?
Streptomycin x 10 days or gentamicin x 10 days or doxycycline x 10 days or fluoroquinolone (cipro, levo, moxi), respiratory isolation
How would you prophylactically treat someone exposed to bubonic plague?
Doxycycline and ciprofloxacin x 7 days
How would you treat tularemia?
Streptomycin, gentamicin, doxycycline, fluoroquinolones
How would you treat a fever of unknown origin?
No empiric treatment, treatment towards etiology once determined, referral if etiology cannot be determined
How would you treat sepsis?
Antibiotic therapy initiated within 1 hr of suspected diagnosis, multiple empiric antibiotics used, IV fluids, vasopressors, central lines, other means of organ perfusion