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Infectious disease II: Bacterial Infections Flashcards

1
Q

recommended antibiotic for procedure?

Cardiac or vascular

A

cefazolin or cefuroxime

beta-lactam allergy- clindamycin or vanco

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2
Q

recommended antibiotic for procedure?

Orthopedic

A

cefazolin

beta-lactam allergy- clindamycin or vanco

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3
Q

recommended antibiotic for procedure?

gastro

A

cefazolin + metronidazole, cefotetan, cefoxitin, or ampicillin/sulbactam

beta-lactam allergy- clinda or metronidazole + aminoglycosides or quinolones

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4
Q

Meningitis empiric tx
neonates <1months

A

ampicillin (for listeria coverage)
+
cefotaxime (no ceftriaxone)
or
gentamicin

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5
Q

Meningitis empiric tx
age 1 month- 50 years

A

Ceftriaxone or cefotaxime
+
vanco

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6
Q

Meningitis empiric tx
> 50 years or immunocompromised

A

ampicillin (for listeria coverage)
+
ceftriaxone or cefotaxime
+
vanco

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7
Q

Acute Otitis Media (AOM)
when to consider observing

A

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

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8
Q

Acute Otitis Media (AOM)
first-line

A

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

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9
Q

Acute Otitis Media (AOM)
alternative tx (mild penicillin allergy)

A

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

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10
Q

Acute Otitis Media (AOM)
tx failure, not improved after 2-3 days

A

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

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11
Q

CAP tx
healthy, no comorbidities

A
  • amoxicillin (1gram TID or
  • doxycycline or
  • macrolide (azithromycin or clarithromycin if local pneumococcal resistance is <25%
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12
Q

CAP tx
high-risk with comorbidities

A
  • beta-lactam (amox/cul or cephalosporins) + macrolide or doxycycline
  • respiratory quinolone monotherapy (moxifloxacin, levofloxacin or gemifloxacin)
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13
Q

intensive phase TB treatment

A

four drugs: rifampin, isoniazid, pyrazinamide, and ethambutol
for two months
RIPE

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14
Q

Continuation phase TB treatment

A

two drugs: rifampin and isoniazid
for four months (can extend to 7 months in select cases)

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15
Q

`Rifampin

A

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

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16
Q

Isoniazid

A

box warning hepatitis
drug-induced lupus
take with pyridoxine (B6) to decrease risk of INH-associated peripheral neuropathy
monitor for symptoms of dile

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17
Q

Pyrazinamide

A

contraindication, acute gout
CrCl <30 mL/min= extend interval

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18
Q

ethambutol

A

Myambutol, optic neuritis!
CrCl <50 mL/min= extend interval

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19
Q

Infective endocarditis tx
virdans group streptococci

A

penicillin or ceftriaxone (+/- genta)
if beta-lactam allergy use vanco mono therapy

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20
Q

Infective endocarditis tx
staphylococci MSSA

A

nafcillin or cefazolin (+ gent and rifampin if prosthetic valve)
if beta-lactam allergy, use vanco* (+ gent and rifampin if prosthetic valve)

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21
Q

Infective endocarditis tx
staphylococci MRSA

A

vanco (+ gent and rifampin if prosthetic valve)

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22
Q

Infective endocarditis tx
enterococci

A

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

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23
Q

infective endocarditis dental prophylaxis

A

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

24
Q

primary peritonitis, spontaneous bacterial peritonitis (SBP)

A

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

25
secondary peritonitis and cholangitis mild to moderate
Cover PEK, anaerobes, streptococci =/- enterococci - cefoxitin - ertapenem - moxifloxacin - (cefazolin, cefuroxime or ceftriaxone) + metronidazole - (cipro or levo) + metronidazole
26
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
27
impetigo
topical- mupirocin if numerous lesions, use systematic antibiotics that covers MSSA: cephalexin 250 mg PO QID
28
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
29
Cellulitis (non-purulent infection)
oral must be active agents streptococci cephalexin 500mg PO QID clinda 300mg PO QID if beta-lactam allergy
30
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
31
severe purulent SSTI
vanco goal trough 10-15 daptomycin linezolid use antibiotics with MRSA activity qq
32
Necrotizing fasciitis
vanco + beta lactam (zoysn, primaxin or meropenem)
33
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
34
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
35
complicated UTI
carbapenem if ESBL-producing bacteria and same as pyelonephritis
36
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
37
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
38
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
39
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
40
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
41
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
42
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
43
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
44
syphilis
bicilin LA 2.4 million units IM x 1 if beta-lactam allergy, use doxycycline 100mg PO BID x 14 days
45
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
46
Neurosyphilis
penicillin G aqueous 3-4 million units IV Q4H x 10-14 days, if allergy to beta-lactam, desensitization
47
Gonorrhea
ceftriaxone and if chlamydia has not been ruled out use doxycycline <150kg use 500mg IM x 1 >150kg use 1gram IM x 1
48
chlamydia
doxycycline 100mg PO BID x 7 days if prego use azithro 1 gram PO x 1
49
bacterial vaginosis
metronidazole or clinda
50
trichomonas vaginalis
metronidazole
51
genital warts
imiquimod cream (aldara, zyclara)
52
doxy prego
AE on fetus, suppress bone growth and skeletal development
53
rocky mt spotted fever
doxy 100mg PO/IV BID 5-7 days, drug of choice in peds
54
typhus
doxy 100mg PO/IV BIDfor 7 days
55
lyme disease
doxy 100mg PO BID for 10 days or amox or cefuroxime
56
ehrlichiosis
doxy 100mg PO BID for 7-14 days
57
tularemia
gent or tobra 5mg/kg/day IV dived q8H for 7-14 days

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