Infectious Diseases

Question 1

uncomplicated UTI

Answer 1

TMP/SMX 3 days
Not 1st line: Fluoroquinolones (cipro, levo) 3 days
Nitrofurantoin (5-7 days)
Fosfomycin (single dose)
B-Lactams when other regimens can’t be used

Question 2

uncomplicated acute pyelonephritis

Answer 2

fluoroquinolones OR TMP/SMX for 10-14 days

Question 3

recurrent UTI prophylaxis

Answer 3

nitrofurantoin 50mg/day for 6 months

trimethoprim/sulfa 1/2 single strength daily for 6 months

Question 4

UTI in pregnancy

Answer 4

7 days of therapy

best: amoxicillin, cephalexin
avoid: tetracyclines, fluroquins, sulfonamides (3rd trimester)

Question 5

bacterial prostatitis

Answer 5

2-4 weeks
TMP/SMX
Cipro, levo
cephalosporins

Question 6

CAP

Answer 6

1st line: macrolide, doxy
Alternatives for comorbidities or use of antimicrobial in past 3 months: resp fluoroquin (levo, moxi, gem); B-lactam plus a macrolide

Question 7

CAP with suspected aspiration

Answer 7

amox/clav

clindamycin

Question 8

CAP with suspected MRSA

Answer 8

add vancomycin or linezolid

Question 9

adamantanes

Answer 9

amantadine, rimantadine (preferred)
for influenza A virus
initiate w/in 48 hours of onset

Question 10

oseltamivir (Tamiflu)

Answer 10

for influenza A and B
initiate w/in 48 hours of onset
FDA approved age 1 and older for tx and prophylaxis

Question 11

zanamivir

Answer 11

for influenza A and B
initiate w/in 48 hours
50% have bronchospasm if not used with B2 agonist
FDA approved as tx at age 7 and prophylaxis at age 5

Question 12

upper respiratory tract infections

Answer 12

antimicrobial if symptoms > 7 days or worsening; or purulent and discolored sinus discharge
1st line: amoxicillin/clavulanate
penicillin allergic: doxy, levofox, moxiflox
tx failure: high dose amox/clav, doxy, resp fluoro
Treat for 7-10 days

Question 13

pharyngitis

Answer 13

Penicillin is first line for group A streptococcus

Question 14

acute otitis media

Answer 14

use abx: < 6 months old; less than 24 months with bilateral; or if certain of diagnosis and moderate otalgia
amoxicillin 80-90 mg/kg/day
amox/clav 90mg/mg/kg/day and 6.4 mg/kg/day
cephalosporins
clindamycin
treat 5-10 days

Question 15

impetigo

Answer 15

mupirocin ointment tid 7-10 days for mild

Question 16

furuncles and carbuncles

Answer 16

dicloxacillin
cephalexin
clindamycin (covers MRSA & CA-MRSA)
TMP/SMX (covers CA-MRSA)

Question 17

erysipelas

Answer 17

infection of upper dermis and superficial lymphatics
treat for 7-10 days
penicillin is TOC
clindamycin or erythromycin are alternatives

Question 18

diabetic foot infection

Answer 18

amoxicillin/clav 875mg BID (no gram neg)
clindamycin (no gram neg)
fluoroquinolones (good gram-neg)
for anaerobic coverage add: metronidazole or clindamycin
treat for 1-2 weeks or longer

Question 19

gonorrhea

Answer 19

cefriaxone 250mg once

cefixime 400mg once

Question 20

chlamydia

Answer 20

azithromycin 1g once

doxycycline 100mg BID 7 days

Question 21

syphilis

Answer 21

penicillin

Question 22

genital herpes

Answer 22

acyclovir, valacyclovir, famciclovir

diff dose regimens for first, recurrent, and suppressive therapy

Question 23

Syphillis follow-up

Answer 23

quantitative nontreponemal tests at 6 & 12 months (additionally at 24 months for latent dx).

Adequate tx response is 4-fold reduction in antibody titer, usually measured by the VDRL or RPR

Question 24

Bacterial vaginosis treatment in non-pregnant

Answer 24

Tx recommended for women with sxs.

Regimens:
metronidazole 500mg orally BID x 7d OR
metronidazole gel 0.75%, on full applicator (5g) intravaginally, once daily x 5 days OR
Clindamycin cream 2%, on full applicator (5g) intravaginally at bedtime x 7d

Question 25

Bacterial vaginosis tx in pregnant

Answer 25

metronidazole 500mg orally BID x 7d OR
Metronidazole 250mg TID x y days OR
Clindamycin 300mg BID x 7 days