Infectious disease II: Bacterial Infections Flashcards
recommended antibiotic for procedure?
Cardiac or vascular
cefazolin or cefuroxime
beta-lactam allergy- clindamycin or vanco
recommended antibiotic for procedure?
Orthopedic
cefazolin
beta-lactam allergy- clindamycin or vanco
recommended antibiotic for procedure?
gastro
cefazolin + metronidazole, cefotetan, cefoxitin, or ampicillin/sulbactam
beta-lactam allergy- clinda or metronidazole + aminoglycosides or quinolones
Meningitis empiric tx
neonates <1months
ampicillin (for listeria coverage)
+
cefotaxime (no ceftriaxone)
or
gentamicin
Meningitis empiric tx
age 1 month- 50 years
Ceftriaxone or cefotaxime
+
vanco
Meningitis empiric tx
> 50 years or immunocompromised
ampicillin (for listeria coverage)
+
ceftriaxone or cefotaxime
+
vanco
Acute Otitis Media (AOM)
when to consider observing
try to observe 2-3 days, if symptoms are non-severe, <48hrs,
- age 6-23 months: symptoms in one ear only
- age >= 2 years and in one or both ears
if symptoms do not improve or worsen, use antibiotics
Acute Otitis Media (AOM)
first-line
amoxicillin 90 mg/kg/day in 2 divided doses
or
amoxicillin/clavulanate 90mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses
Acute Otitis Media (AOM)
alternative tx (mild penicillin allergy)
cefdinir 14mg/kg/day in 1 or 2 doses
cefuroxime 30mg/kg/day in 2 divided doses
cefpodoxime 10mg/kg/day in 2 divided doses
ceftriaxone 50mg/kg IM for 1 or 3 days
Acute Otitis Media (AOM)
tx failure, not improved after 2-3 days
if amoxicillin was the initial therapy:
amoxicillin/clavulanate 90mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses
or
ceftriaxone 50mg/kg IM daily for 3 days
CAP tx
healthy, no comorbidities
- amoxicillin (1gram TID or
- doxycycline or
- macrolide (azithromycin or clarithromycin if local pneumococcal resistance is <25%
CAP tx
high-risk with comorbidities
- beta-lactam (amox/cul or cephalosporins) + macrolide or doxycycline
- respiratory quinolone monotherapy (moxifloxacin, levofloxacin or gemifloxacin)
intensive phase TB treatment
four drugs: rifampin, isoniazid, pyrazinamide, and ethambutol
for two months
RIPE
Continuation phase TB treatment
two drugs: rifampin and isoniazid
for four months (can extend to 7 months in select cases)
`Rifampin
Rifadin
take on an empty stomach
- flu-like syndrome
- orange-red discoloration of the body secretions (sputum, urine, sweat, tears, teeth) can stain contact lense and clothing
Isoniazid
box warning hepatitis
drug-induced lupus
take with pyridoxine (B6) to decrease risk of INH-associated peripheral neuropathy
monitor for symptoms of dile
Pyrazinamide
contraindication, acute gout
CrCl <30 mL/min= extend interval
ethambutol
Myambutol, optic neuritis!
CrCl <50 mL/min= extend interval
Infective endocarditis tx
virdans group streptococci
penicillin or ceftriaxone (+/- genta)
if beta-lactam allergy use vanco mono therapy
Infective endocarditis tx
staphylococci MSSA
nafcillin or cefazolin (+ gent and rifampin if prosthetic valve)
if beta-lactam allergy, use vanco* (+ gent and rifampin if prosthetic valve)
Infective endocarditis tx
staphylococci MRSA
vanco (+ gent and rifampin if prosthetic valve)
Infective endocarditis tx
enterococci
for both native and prosthetic valve IE: penicillin or ampicillin + genta or ampicillin + high-dose ceftriaxone
if high dose beta-lactam allergy, use vanco + genta
If VRE, use daptomycin or linezolid
infective endocarditis dental prophylaxis
first line: amox 2gram PO
unable to take oral med: ampicillin 2 gram IM/IV or
cefazolin or ceftriaxone 1 gram IM/IV
able to take PO med but allergy to beta-lactam: azithro or clarithro 500mg or doxycycline 100mg
primary peritonitis, spontaneous bacterial peritonitis (SBP)
drug of choice: ceftriaxone for 5-7 days
alternative tx include: ampicillin, genta, or quinolone.
SMX/TMP, ofloxacin or cipro can be used for primary or secondary prophylaxis of SBP
secondary peritonitis and cholangitis
mild to moderate
Cover PEK, anaerobes, streptococci =/- enterococci
- cefoxitin
- ertapenem
- moxifloxacin
- (cefazolin, cefuroxime or ceftriaxone) + metronidazole
- (cipro or levo) + metronidazole
secondary peritonitis and cholangitis
high-severity
Cover PEK, CAPES, Pseudomonas, anaerobes, streptococci =/- enterococci
- carbapenem (except erthapenem)
- piperacillin/tazobactam
- (cefepime or ceftazidime) + metronidazole
- (cipro or levo) + metronidazole
- cefazolin + (aztreonam or aminoglycoside) + metronidazole
impetigo
topical- mupirocin
if numerous lesions, use systematic antibiotics that covers MSSA: cephalexin 250 mg PO QID
folliculitis/ furuncles/ carbuncles
if systematic signs use antibiotics that covers MSSA: cephalexin 500mg PO QID
if non-responsive to initial tx:
SMX/TMP DS 1-2 tab PO BID
doxycycline 100mg PO BID
Cellulitis (non-purulent infection)
oral must be active agents streptococci
cephalexin 500mg PO QID
clinda 300mg PO QID if beta-lactam allergy
Abscess (purulent infection)
if systemic signs or multiple site (moderate infection), perform I&D, culture fluid and use oral antibiotics that cover CA- MRSA
SMX/TMP DS 1-2 tabs PO BID
doxycycline 100mg PO BID
Minocycline 200mg PO x 1 then 100 BID
clinda 300mg PO QID
linezolid cover CA-MRSA, but more expensive
severe purulent SSTI
vanco goal trough 10-15
daptomycin
linezolid
use antibiotics with MRSA activity qq
Necrotizing fasciitis
vanco + beta lactam (zoysn, primaxin or meropenem)
acute uncomplicated cystitis
UTI
macrobid 100mg PO BID x 5 days (contraindicated if CrCL <60ml/min)
SMX/TMP DS 1 tab PO BID x 3 (avoid in sulfa allergy)
Fosfomycin 3gram x 1 dose (inferior efficacy)
prego: amoxicillin or cephalexin (beta-lactam allergy fosfomycin)
can use cipro or levo, or beta-lactam, but avoid in children, QT prolong risk, seizures, neuropathy, tendinitis/rupture
acute pyelonephritis
local quinolone resistance <10%
cipro (500mg BID for 7 days) or levo (750mg PO BID x 5 days)
local quinolone resistance >10%
ceftriaxone, SMX/TMP (14 days), beta-lactam
last-line is cefderocol, recarbrio, vabomere, zemdri
complicated UTI
carbapenem if ESBL-producing bacteria and same as pyelonephritis
phenazopyridine
OTC
pyridium, azo, urinary pain relief
some doc can use this as high dose prescription for tx seen at clarks
take with water, immediately following food or with food
can cause red-orange coloring of the urine and other body fluids, contact lense/clothes can be stained
Bacteriuria and prego
must be treated even if asymptomatic,
beta-lactam preferred
avoid quinolones
if beta-lactam allergy use nitrofurantoin, or SMX/TMP- avoid 1st trimester if possible,
SMX/TMP hyperbilirubinemia and kernicterus in newborn if used closed to deliver
Nitrofurantoin should get avoided in 3rd times due to risk of hemolytic anemia in infant
maybe consider fosfomycin
traveler’s diarrhea
loperamide for symptomatic relief but not preferred if bloody stool…
if fever, blood in stool, prego, or pediatrics: azitro 1,000mg PO x1 or 500mg PO BID for 1-3 days
otherwise choose:
cipro 750mg PO x1 or 500mg BID x 3
levo 500mg PO x 1 or 1-3 days
ofloxacin 400mg x1 or BID x 3
rifaximine 200mg PO TID or 3 days
bezlotoxumab
zinplava
binds to toxin B and neutralizes the AE and decreases the risk of CDI recurrence but does not treat the active infection must be used with antibacterial therapy
c.diff guidelines…
1st episode
FDX 200mg PO BID x 10 days or
VAN 125 PO QID x 10 days
MET 500mg PO TID x 10 days (option only if non-severe and treatment above are unavailable)
non-severe= WBC<15,000 and SCr< 1.5
c. diff guidelines
2nd episode (1st recurrence)
FDX 200mg PO BID x 10 days or
VAN 125 PO QID x 10 days followed by a prolonged pulse/tapered course
(the standard regimen w/o a prolonged taper is acceptable if MET was used for the initial episode)
pulse/tapper: 125mg PO QID x 10 days, BID x 1 week, then 125 mg every 2-3 days for 2-8 weeks
3rd or subsequent episodes
FDX 200mg PO BID x 10 days or
VAN 125 PO QID x 10 days followed by a prolonged pulse/tapered course
or VAN standard regimen followed by rifaximin 400mg TID x 20 days or fecal microbiota transplantation
c. diff fulminant/complicated disease
significant systemic toxic effects such as hypotension, shock, megacolon, etc.
vanco 500mg PO/NG/PR QID + metronidazole 500mg IV Q8H
syphilis
bicilin LA 2.4 million units IM x 1
if beta-lactam allergy, use doxycycline 100mg PO BID x 14 days
syphilis latent or tertiary
bicilin LA 2.4 million units IM x weekly for 3 weeks
beta-lactam allergy, doxy 100mg PO BID x 28 days
Neurosyphilis
penicillin G aqueous 3-4 million units IV Q4H x 10-14 days,
if allergy to beta-lactam, desensitization
Gonorrhea
ceftriaxone and if chlamydia has not been ruled out use doxycycline
<150kg use 500mg IM x 1
>150kg use 1gram IM x 1
chlamydia
doxycycline 100mg PO BID x 7 days
if prego use azithro 1 gram PO x 1
bacterial vaginosis
metronidazole or clinda
trichomonas vaginalis
metronidazole
genital warts
imiquimod cream (aldara, zyclara)
doxy prego
AE on fetus, suppress bone growth and skeletal development
rocky mt spotted fever
doxy 100mg PO/IV BID 5-7 days, drug of choice in peds
typhus
doxy 100mg PO/IV BIDfor 7 days
lyme disease
doxy 100mg PO BID for 10 days or amox or cefuroxime
ehrlichiosis
doxy 100mg PO BID for 7-14 days
tularemia
gent or tobra 5mg/kg/day IV dived q8H for 7-14 days
