Infectious Disease II

Question 1

Perioperative Surgical/Cardiac Prophylaxis Treatment

Answer 1

Cefazolin

Question 2

Perioperative Colorectal Surgery Prophylaxis Treatment

Answer 2

CeFOTetan (disulfiram rxn + bleeding risk)
CeFOXitin
Unasyn 
Ertapenem 
Metronidazole + Ceftriaxone or cefazolin

Question 3

Alternative Treatment for Beta-lactam allergy in surgical patient

Answer 3

Vancomycin or Clindamycin (cardiac/vascular)

Question 4

Meningitis signs and symptoms

Answer 4

• fever, stick neck, severe HA

Question 5

Meningitis Tx (0-28 days old)

Answer 5

Ampicllin (listeria)
PLUS
Gentamicin or CefoTAXime

Question 6

Meningitis Tx (1 month- 50 years old)

Answer 6

Vancomycin
PLUS
Ceftriaxone or CefoTAXime

Question 7

Meningitis Tx (>50 years or immunocompromised)

Answer 7

Ampicillin (listeria)
Vancomycin
PLUS
Ceftriaxone or CefoTAXime

Question 8

When are steroids indicated for Meningitis Tx?

Answer 8

Dexamethasone can be given with 1st dose of antibiotic or prior to antibiotic but NOT with antibiotic

Question 9

AOM Tx

AOM allergy

Answer 9

Augmentin or Amoxicillin
90 mg/kg/day

Ceftriaxone (IM)

Question 10

Influenza

Answer 10

Tamiflu (Olmesartan)

<48 hours symptoms

Question 11

Strep Throat Tx

Answer 11

S. pyogenes

- Pen VK, Amoxicillin, 1st or 2nd generation cephalosporin

Question 12

Sinusitis Tx

When to treat?

Answer 12

Augmentin
Severe symptoms for at least 3 days
Non-severe symptoms for at least 10 days

Question 13

Lower Respiratory Infection-Bronchitis
Whooping Cough (Bordetella pertusis) Tx- BAC

Answer 13

Bactrim
Azithromycin
Clarithromycin

Question 14

Lower Respiratory Infection- (Bronchitis)
COPD exacerbation Tx? ADD
When to treat?

Answer 14

Azithromcycin OR Augmentin OR Doxycycline

purulent sputum + 1 symptom OR
increase in purulent sputum, volume, SOB

Question 15

CAP common pathogens

Answer 15

S. Pneumoniae
H. Influenzae
M. Pneumoniae

Chlamyclophilia Pneumoniae

Question 16

CAP Tx in General

Answer 16

Beta-lactams~ Ceftriaxone or CefoTAXime (NEVER mono-therapy*)
Macrolides + Doxycycline
Respiratory Quinolones

*must include the other meds for atypical coverage

Question 17

What do we need to know before administering antibiotics for CAP treatment?

Answer 17

If the patient has had antibiotics in the past 90 days AND

Co-morbidities and immunocompromised

Question 18

Outpatient CAP- Healthy with NO antibiotics in the past 90 days- TX

Answer 18

Macrolides (Azithromax, Erythromycin, Clarithromycin)
OR
Doxycycline

Question 19

Outpatient CAP- Category 2 Tx

• Co-mordities
• Immunocompromised
• At risk for drug-resistance (abx in the last 90 days)

Answer 19

JUST ADD B-lactams
1st line- Beta-lactam PLUS Macrolide OR Doxycycline
(amoxil, augmentin, cefuroxime, cefdinir, ceftriaxone)

Option 2- Respiratory Quinolones (My Good Lungs)

Question 20

Inpatient CAP TX when Pseudomonas is suspected? MRSA?

Answer 20

Same general tx as outpatient: IV B-lactams (ceftriaxone, cefotaxime) + doxy or macrolide

Pseudomonas-Zosyn (pipercillin/tazobactam), Cefepime, Meropenem + levofloxacin or aminoglycoside

MRSA- Vancomycin (Vancocin) or Linezolid (Zyvox)~ best for renal failure

Question 21

What would be used to treat Pseudomonas in the event that the patient has a Penicillin allergy?

Answer 21

Aztreonam (Azacatam)

Question 22

HAP/VAP Coverage:

Pseudomonas + MSSA

Answer 22

• Zosyn
• Cefepime
• Levofloxacin
• Meropenem or imipenem/cilastatin

Question 23

HAP/VAP Coverage:

Pseudomonas + MRSA

Answer 23

• Zosyn
• Cefepime or ceftazidime
• Levofloxacin or ciprofloxacin
• meropenem or imipenem/cilastatin
• aztreonam

PLUS aminoglycosides, polymixin B, colistimethate

Vancomcyin or linezolid

Question 24

HAP/VAP Coverage:

MDR Pseudomonas + MRSA

Answer 24

• Zosyn
• Cefepime or ceftazidime
• Levofloxacin or ciprofloxacin
• meropenem or imipenem/cilastatin
• aztreonam

PLUS

Vancomcyin or linezolid

Question 25

When treating infective endocarditis what should be added to the regimen of patient’s with a PROSTHETIC VALVE?

Answer 25

gentamicin or rifampin

Question 26

Infective Endocarditis Treatment

Viridans group streptococci

Answer 26

Penicillin or Ceftriaxone +/- gentamicin

Pen allergy- vancomycin

Question 27

Infective Endocarditis Treatment

MSSA

Answer 27

Nafcillin or Cefazolin

Pen allergy- Vancomycin

Question 28

Infective Endocarditis Treatment

MRSA

Answer 28

Vancomycin

Question 29

Infective Endocarditis Treatment

Enterococci

Answer 29

Penicillin or Ampicillin + gentamicin
Pen allergy- vancomycin + gentamicin
VRE- daptomycin or linezolid

Question 30

IE Dental prophylaxis

Answer 30

Amoxicillin 2 grams 30-60 min prior to surgery

Pen allergy: Clindamycin 600 mg or Azithromycin/Clarithromycin 500 mg

Question 31

Impetigo (SSI)
Bug/Presentation?
Treatment?

Answer 31

MSSA~ honey-colored crusts

Mupirocin (Bactrim)
KEFLEX 250 mg QID

Question 32

Folliculitis/Furuncles/Carbuncles (SSI)
Bug/Presentation?
Treatment?

Answer 32

Boils~ CAP, MRSA
KEFLEX 500 mg QID
OR
Bactrim or Doxycycline

Question 33

Non-purulent infection-Cellulitis
Bug/Presentation?
Treatment?

Answer 33

Localized swelling, redness, warmth~ S. pyogenes, S. aureus, Group A Strep
KEFLEX 500 mg QID
or Clindamycin 300 mg QID (Pen allergy)

Question 34

Purulent infection-Abscess
Bug/Presentation?
Treatment?

Answer 34

Recurrent MRSA infections~ CA-MRSA
Bactrim DS
or
Doxycyline