Infectious diseases Flashcards
what color do gram + orgs stain?
purple, blue
what color do gram - orgs stain?
pink from safranin
what is the MIC?
the lowest drug concentration to stop growth w/in 24 hours. MIC90: mic needed to inhibit growth of 90% of isolate
what is the breakpoint?
the level of MIC at which the bacterium is considered susceptible or resistant
whats the MBC
minimum bactericidal concentration : lowest drug [ ] that kills 99.99% of bacteria in 24 hours
which antibiotics typically do not have good concentration in the urine (generally)
those that are hepatically cleared
what are the top 5 most common Gram + bacteria?
staphylococcus streptococcus enterococcus clostridium listeria
Gram + cocci
streptococcus
staphylococcus
gram + rods
propionipacterium bacillus clorstirdum corynebacterium listeria nocardia actinomyces
gram - cocci
neisseria
spirochetes
borrelia
leptosipra
treponema pallidum
atypicals
chlamydia
mycoplasma
ureaplasma
which are the hydrophillic antibiotics
ABCDG aminoglycosides Beta lactams Colistin Daptomycin Glycopeptides (vancomycin)
which are the lipophillic antibiotics?
FQ Macrolides rifampin tetracyclines linezolid chloramphenicol
how are the hydorphillic compounds typically cleared
renally
how are the lipophillic compounds cleared?
hepatically
which drug classes have nearly 100% oral bioavailability
fluroquinolones doxycycline metronidazole fluconazole, voriconazole SMX/TMP RIfampin Linezolid
FLM DiVRS = Flame Divers
which FQ does not penetrate into urine?
moxifloxacin
which antibiotics have good bone penetration?
tetracyclines & fluroquinolones & rifampin
which of the penicillins is not renally cleared?
nafcillin
which of the AMGs is not renally cleared?
none
which of the cephalosporins is not renally cleared?
ceftriaxone! :)
cefotaxime some renal but more heaptic
which of the FQ is not renally cleared?
moxifloxacin
cipro R= H
which of the macrolides is not renally cleared?
ALL, clarithry H>R
how is doxycycline cleared?
H>R
is vancomycin renanally cleared?
YES
is linezolid renally cleared
NO, hepatic
is clindamycin renally cleared?
no, hepatic
is rifampin renally cleared?
no hepatic
is daptomycin renally cleared?
R>H
is metronidazole reanally cleared?
H>R
is SMX/TMP renally cleared
S = hepatically
T = Renally
so R= H
B lactams, time dependent or concentration dependent?
time dependent
Aminoglycosides, time dependent or concentration dependent?
concentration dependent
define time dependent?
killing depends on how much time is spent above the MIC so more frequent dosing is desireable
define concentration dependent?
killing depends on achieving higher peaks to maximize concentration of drug
Vancomycin, time dependent or concentration dependent?
concentration
macrolides, time dependent or concentration dependent?
concentration
tetracyclines, time dependent or concentration dependent?
concentration
which antibiotics are bacteriocidal vs bacteriostatic?
all are bacteriocidal except: Macrolides, Clindamycin, Linezolid, quinaprisitin/dalforisint, tetracyclines
what is so special about how AMGs kill bacteria?
they have a post-antibiotic effect
spectrum of activity for AMGs?
most all gram negatives
used for syndergy in treating gram + cocci (staph and enterococcus endocarditis)
of all the AMG’s which has the broadest spectrum?
Amikacin
which weight do you used to does AMGs
Ideal body weight
unless their actual weight is less
OR they are > 30% IBW, then use adjusted body weight
what is the BBW in AMGs?
can cause neurotoxicity and nephrotoxcity
what are the main SE os AMGS?
nephrotoxicity : acute tubular necrosis, Avoid other nephrotoxins
ototoxicity
when should you take a peak for an AMG?
1/2 hour after the end of the infusion
when should you take a trough level for a AMG?
right before the 4th dose (steady state)
what is the goal peak an trought for gent/tobra?
peak 5-10, trough < 2
what is the traditional dosing for gent/tobra?
1-2.5mg/kg/dose
how do you determine how frequently to give the get/ tobra?
clcr <20: give loading dose, mx levels
Clcr 20-40 : q24h
40-60 : q12h
Clcr: q8H
what is the Adjusted body weight equation?
IBW + 0.4 x (ACtual minus ideal)
amoxil
amoxicillin
amoxicillin brand
amoxil
augmentin
amox/clave
amox/clav brand
aumentin
unasyn
amp/sulbactam
amp/sulbactam brand
Unasyn
Pen VK
penicillin
penicillin brand
Pen VK
piperacillin/tazo brand
Zosyn
zosyn
pip/tazo
which of the penicillins has enhanced activity against MSSA?
nafcillin
which of the penicillins has activity against pseudomonas?
piperacillin/tazo
ticarcillin
which penicillins do not need to be renal dose adjusted?
nafcillin
oxacillin
dicloxacillin
which penicillin is DOC in pregnancy ?
amoxicillin
pregnancy category for penicillins
category B
for how long must augmentin be refrigerated?
always
for how long should amoxil be refrigerated?
can be stable for 14 days, but can be refrigerated to improve taste
how should you take the Pen VK tablets
on an empty stomach
how long should your refrigerate the pen VK suspension?
always
with what is Ampicllin IV compatible w/ for diluents?
normal saline only and it is stables only for 8 hours at room temperature
what do you do if you have extravasation of nafcillin?
use cold packs and hyaluronidase injections
what are the side effects of penicillins:
Diarrhea, Gi upset
allergic reactions: rash, anaphylaxis, pruritis
-if accumulation: seizures
-Acute interstitial nephritis
-bone marrow suppression w/ long term use
main DDis w/ penicillins?
May decrease effectiveness of oral contraceptives ; check package insert for each agent
-probenecid/allopurinol can increase levels of PCNs by interfering w/ renal excretion
first generation cephalosporins:
cefazolin
cephalexin
brand cephalexin
keflex
brand cefazolin
kefzol
kefzol
cefazolin
keflex
cephalexin
typical cephalexin doseing
250-500 q 6 h
typical cefazolin dose
250-2000 q 8 hours
what do the 1st generation cephalosporins cover?
staph> strept
PEK
2nd genration cephalosporins
cefprozil
cefuroxime
cefactor
cefotetan
cefoxitin (mefoxin)
spectrum of activity 2nd gen ceph
HNPEK
cefotetan , cefuroxime,cefoxitin also cover Bfrag
typical cefurxime dose
250-1500 q 8 h
typical cefprozil dose
250-500 q 12-24h
3rd generation cephalosporin
ceftriaxone
cefdinir
ceftazidime
ceftoaxime
brand ceftriaxone
rocephin
brand ceftazidime
Fortaz
Tazicef
typical ceftriaxone dose
1-2 rams q12 h-24h
typical ceftazidime dose
1-2 g q 8 / 12h
what is the advantage of ceftazidime over other 3rd gen cephalosporins?
it covers pseudomonas
what is the spectrum of activity of 3rd gen ceph?
HNPEKS
spectrum of cefepime?
HNPEKS
+ CAPES
typical dose of cefepime
1-2 grams q8-12h
brand cefepime
maxipime
maxipime
cefepime
what is special about cetaroline?
covers MRSA and has gram - coverage like ceftriaxone (HNPEK)
typical dose of ceftaroline
600mg q 12h
what is the cross reactivity in allergic reactions w/ cephalosprins and PCN?
< 10%
which pts that have a PCN allergic reaction should avoid cepalosporins?
if they have a type 1 sensivity: swelling, angioedema, anaphylaxis
cephalosporins pregnancy category
B
special side effects of cefotetan
cotnains NMTT side chain that can lead to bleeding and a disulfiram like reaction w/ alcohol ingestion
which three cephalosporins must be taken w/ food
cefaclor, cefpodoxime, cefurxoime
DDIs cephalosporins
probeneicid/allopurinol increase levels through renal secretion inhibitions
-decrease effectiveness of OCs
brand name imipenem
primaxin
typical dose of imipeneme
250-100mg VI q 6-8h
brand meropenem
Merrem
Primaxin
imipenem
Merrem
meropenem
brand ertapenem
Invanz
invanz
ertapenem
doribax
doripenem
typical meropenem dose
500-100mg iv q 6-8h
tipical ertapenem dose
1000mg IV/ IM q d
typical dose of doripenem
500 iv q 8h
which is the only carbapenem that does not have activity against pseudomonas or acenitobacter?
ertapenem
what is the spectrum of the carbopenemems
cover almost everything except : MRSA, VRE, C. diff, stenotorphomonas or naocardia
DDIs carbapenems
same as PCN/cephalosporins
why does imipenem come w/ cilastin?
because cilastin inhibits a renal dehydropeptidase from degrading imimpenem
main SEs carbapenems?
Diarrhea
rash
seisures at higher doses (esp. imipenem)
what is the MOA of fluroquinolones?
they inhibit bacterial cell DNA toposiomerase IV and inhibit DNA gyrase: leads to breaking of the double stranded DNA
fluroquinolones bacterisstatic or bacteriocidal?
bacteriocidal
what is the typical cipro PO dose/
250-750 po
what si the typical cipro dose IV
200-400 IV
how do you dose frequency for cipro based on clcd?
> 50 q8-12
30-50: q12
<30: q18-24
typical moxifloxacin dose?
400mg po q 24
typical levofloxacin dose
250-750mg po IV q 24 h if crcl > 50
what is the spectrum of activity of FQs
great gram +
great gram -
excellent atypical coverage
which of the FQs have pseudomonal coverage?
cipro
levo
what is the BBW of FQs
tendon inflammation and/ or rupture esp w/ concurrent corticosteroid use , if > 60 or organ transplant patient
comon SEs FQs
photosensisitivity and hyperglycemia
QT prolongation
GI- NVD
HA, rash
can u use FQs in pregnancy
do not use due to cartilage damage in immature animals : preg C
DDIs of FQs
Antacids , divalent ations: Ca, Fe, ZN, Al, MG, MVIs Bile acid bindingg resins - Warfarin -QT prolonging rugs (esp moxi) -SUs, Warfarin, NSAIDs
how much should you separate your FQs from other meds
Cipro: if you take the cipro first, you have to wait 6 hours to give the other meds. If you take the other meds first, you have to wait 2 hours to take your cipro
Levo: if you take the cipro first, you have to wait 2 hours to give the other meds. If you take the other meds first, you have to wait 2 hours to take your Levo
Moxi: if you take the cipro first, you have to wait 8 hours to give the other meds. If you take the other meds first, you have to wait 4 hours to take your Moxi
what is the MOA of macrolides?
bind to 50S ribosome leading to inhibition of protein synthesis
brand azithromycin
zithromax
z-pack
macrolides spectrum of activity
streptococus
Heamophilus, neisseria, moraxella
Atypicals
SEs of macrolides
GI upset: D, abd pain/cramping esp erythro,
liver dysfucntion,
QT prolongation
brand of clarithromycin
biaxin
biaxin XL
dosing of aztithro
500 x 1 , then 250mg x 4 days
or 500mg qd x 3 days
refrigerate aztithromycinn oral suspension?
NO
referiatgerate biaxin oral suspension?
NO
how should you take biaxin XL
w/ food!
typical clarithromycin dose
250-500mg po BID to 1 g daily
erythormycin brand
erythorcin
ery-tab
eryped
EES
typical erythomycin dose
EES 400mg QID
others 250-500mg po QID
refrigerated erythromycin ?
must ref E.E.Es : erythromycin ethylsuccinate and use w/ 10 days
the powder suspension is table at room temp x 35 days
renal dose adjustment for azithro/erythro
NONE!
bioequivalency of zithromax & azithromycin ER suspention (ZMAX)
none and should not be interchanged
how to take the Zmax oral suspension:
w/in 12 hours of reconstitution on an empty stomach
which macrolides are QT polongers
E
C
which macrocodes are mod-strogn cup 3a4 inhibitors
E
C
macrolides bacteriostatic or cidal?
static
tetracyclines static or cidal?
static
MOA of tetracyclines
inhibiitonof 30s ribosomal subunit
brand doxycycline
Vibramycin
Oracea
doryx
typical dose of doxy
100mg po q 12h
brand minocylcine
minocin
dynacin
soldyn
ximino
typical dose of minocycline
50-100mg qd -bid
Spectrum of activity of doxy
mild skin infix w/ mesa
VRE UTIS
staph strep, enterococcus, nocardi, propio, bacillus
atypicals, HI, moraxella
how should you take your tetracyclines?
w/ 8 oz better to minimize go irritation
best on empty stomach (avoid DDIs)
SE of tetracyclines:
GI upset photosensitivity tooth discoloration in children DRESS lupus like syndrome inc in LFTs
renal adjustment in tetracylines?
not for doxy or mino yes for tetra
Tetracycline DDs
divalent cations sucralfate bile acid b resins -warfrain -OCs
who should you separate your tetracyclines
take your tetra, then wait 1-2 hours for your other meds
or take your other meds and wait 4 hours to take your doxy
what is the MOA of SMX /TMP
interfferes w/ folic acid synthesis via inhibition of dihydroflic acid formation
SMX/TMP dosing for most common indications
adult UTI: 1 ds tab bid x 3 days
PCP ppx: 1 ds or ss tab daily
and other doses: depends
what is the SS strength of smx/tmp
400 smx/ 80tmp 5:1 ratio
what is the DS strength of Smx/tmp
800 smx/ 160 tmp 5:1 ratio
contraindications for SMx/TMP
pregnancy (at term) breastfeeding anemia due to folate deficinecy marked hepatic/renal disease sulfa allergy
SE smx/ tmp
hyperkalemia go upset skin reactions photosensitivity false inc in scr
bactrim susp refrigerate?
no, keep at room temp and protect from light
DDIs SMX/tmp
warfarin
any cup 2c9 inducers
what is the MRSA dose for vancomycin
15-20mg/kg q8-12h
concetration or time dependent killing?
time dependent killin
side effects vancomycin
nephrotoxicity
ototoxicity
redman syndrome if infused too quickly (500mg 30 min each
what are the sx of redman syndrome
maculopapular rash
hypotensio
flushing
neutropenia
when should you target trough 15-20
pneumonia endocarditis osteomyelitis meningitis bactermia
when should you target 10-15
all other infections or decreased renal funciton
brand vancomycin
vancocin
how do you determine the dosing interval for vancomycin
Clcr 50 or > q 8-12
20-49: q 24
<20 give losing dose then mx levels
how do you determine the dosing interval for vancomycin
Clcr 50 or > q 8-12
20-49: q 24
<20 give losing dose then mx levels
max perifpher iv vancomcing concentration
5mg/kg
max perifpher iv vancomcing concentration
5mg/kg
whats the dose for C diff infections for vancomycin
125-250mg po QID
brand name of linezolid
Zyvox
MOA of lniezolid
binding the 23 s risomaal ran of the 50s subunit inhibition bacterial translation and protein synthesis
linezolid bacteriostatic or cidal
static
what to avoid to avoid serotonin syndrome w/ linezolid?
tyramine containing foods: wine and feremtend foods
ssris, maox, tcas, pusparione
contraindication of linezolid
concurrent use or w/in 2 weeks of MAOIs
uncontrolled HTN
sympathomimetics
what to avoid to avoid serotonin syndrome w/ linezolid?
tyramine containing foods: wine and feremtend foods
ssris, maox, tcas, pusparione
main side effects of linezolid
myelosuppression (> 14 days ) , thrombocytopenia
diarrrhea
incease pancreatic ezymes
renal dose adj linezolid
none
refrigerate linezolid?
keep oral suspension at room temp
quinuprisitin/dalfopristin brand
synercid
diluent for synercid
d5w
renal dose adj for syndercid
none
diluent for synercid
d5w
brand daptomycin
cubicin
why use dap to?
mrsa, vre, faecium and faecalis
gram + coverage
what to monitor for dapto
CPK esp if w/ statin
what diluent to use w/ dapto
normal sailine
what to monitor for dapto
cpk esp if w/ statin
what is the MOA of aztreonam?
nhibits cell wall synthesis by binding to PBPs
spectrum of activity of aztreonam
gram - inc pseudomonas
SE aztreonam
NVD
inc LFTs
rash
dose adjust renal imp? Afternoon
yes
why use tigecycline?
MRSA
VRE (both f’s)
gram -s, anaerobes, atyicals but no pseu, prote, or providencia
max chloramphenicol per day
4g
why use tigecycline?
MRSA
VRE (both f’s)
gram -s, anaerobes, atyicals but no pseu, prote, or providencia
brand clindamycin
cleocin
bbw of clinda
can cause sever and possible fatal colitis
activity of clinda
most gram + aerobes but not enterococcus
anaerobic gram - and gram +
contraindications of flgayl
pregnancy in 1st trimester
metronidazole brand
flagyl
contraindications of flgayl
pregnancy in 1st trimester
how to take ur metronidazole
IR: w/ or w/o food
ER; on an empty stomach
macrobid dose vs macrodantin dose
macrobid 100 po bid
macrodanti 50-100mg po QID
how to take ur metronidazole
IR: w/ or w/o food
ER; on an empty stomach
macrobid dose vs macrodantin dose
macrobid 100 po bid
macrodanti 50-100mg po QID
Suspensions that must be refrigerated
Augemntin cefprozil cefuroxime cephalexin erythormycin ethylsuccinate penicillin VK Amoxil recommneded
agets for CA-MRSA skin infectiosn
SMX tmp ds 1-2 ds tab q 12
what are the organisms commonly found in the upper respiratory tract?
streptococccus
H. Influenzae
M. catarrhalis
what are common organisms found in Lungs for infections
strept. pneumoniae
H. influenza
Atypicals: legionella, mycoplasma
Enteric Grame Negative Rods
what are the common organism found in lungs esp if patient has been in the hospital?
Enteric gram - rods (PEK) Strep penumo Pseudomonas Enterobacter S. A (inc MRSA)
what are common CNS/Mengingitis pathogens?
Strep Pneumo Neisseria gonnorhea H. I Strept/ ecoli (young) listeria (young/old)
what organisms are found in the mouth and ENT?
peptostreptoccous actinomycines anaerobic GNRs Aerobic GNRS H.I
what organisms are found in the skin?
strep. pyogennes S.A S. Epi Pasturellea aerobi/anaerobic GNR if diabetics
what organisms are found in the bone/joints?
S. A S. Epi Streptococcus Nesseria Gonnorrhe \+/- GNRs
what organisms are found in the intrabdominal tract
PEK
Enterococcus
streptococcus
bacteroides
what organisms are found in the urnitary tract?
PEK
S. Saprophyticus
enteroccocs/
streptococus
which patients in the hospital should undergo contact precautions?
those w/ mrsa and VRE
when do you give antibiotics before surgery?
1 hour before
what are the DOC for surgical PPX?
cefazolin
cefuroxime
Vanc w/ 2 hours before surgery if PCN allergic
or Clinda if PCN allergic
what do you use if patient is undergoing surgery that involves the bowel?
broader coverage fro anaerobes: cefotetan, ertapenem, CTX + Metronidazole
what is the classic triad of meningitis?
fever
nuchal rigidity
altered mental status
most common meningitis pathogesn
S. pneumo
N. menigiditis
H. Influezae
L. Monocytogenes
What is a common cause of otitis media? should you just observe?
can be viral
appropriate to observe 48-72 hours if not < 6months, not severe, certain diagnosis is viral
which age group must get abx for otitis media no matter what?
< 6 months
if > 6months, should children get abx?
only if severe illness or you are certain they have bacteria otherwise observe
what do you treat the pain in otitis media?
APAP or ibuprofen
If > 5 yo, topical benzocaine: auraglan, americaine otic OK
DOC otitis media and dose
amox 90mg/kg/day divided q12 or q 8h
2nd choic otitis media if severe or failure?
Augmentin 90mg/kg/day divided BID or TID
cefdinier, cefpodoxime, cefprozil, cefurxime
what if otitis media and PCN allergy?
azithro 10mg/kg/day x 1 then 5mg/kg/day x 4 days, clarithro, erythro sulfisoxazole
SMX/TMP
Clinda
duration of tx meningitis
7-14 days
duration tx for otitis media
= 2 5-7 days
what if otitis media and cannot take anything orally?
ctx IM/IV 50mg/kg x 3 days
rocephin
ceftriaxone
which people should get the Prevnar 13 pneumococcal vaccine?
people 2-23 months old
when can you give the antivirals for FLU?
< 48 hours after symptoms
- if severe
- outbreak scenario
what is the treatment duration for antivirals for flu?
5 days
when should you give ABX for pharyngitis
they have fever
they have a no cough
tonsil swelling or lymph node
+RADT, cx
what is the tx duration for abx for pharyngitis?
5-10days
tx agents of phryngitis
amox
pen
cephalexin
macrolides
common bacteria or pharyngitis?
s. pyogenes
common bacteria for sinusitis?
s. pneumo
H. I
moraxell
tx sinusitis
amox augmentin cephalosporins azithro FQ
when should you treat sinusitis w/ abx?
> 7 days sx
tooth face pain
discharge
worsening sx
tx for otitis media agents
same as sinusitis , except CTX instead of FQ
tx for acute bronchitis
symptomatic tx, NO ABX as its caused by viruses
sx of acute bronchitis
cough > 2 weeks sore throat coryza malaise HA low-grad fever \+/- purulent sputum
whooping cough
> 14 days cough w/ whoop
tx for whooping cough
azithromycin zpack
erythormycin 500 QID x 14 days
bactrim ds 1 BID x 14 days
clarithr 500 bid , or 1g ER daily x 7 days
when to treat w/ abx for AECB?
inc dyspnea
inc sputum production
inc purulence
tx for AECB
debated
mild/mod: amox, doxy, bactim, cephalo
sever: aug, azith, clari,cephalo
FQ
which FQ does not work in the lungs?
cipro
which FQ does not work in the bladder
moxi
CAP outpatient tx
ABx in last 3 mo/HF/DM/immussupression
Resp FQ: moxi/levo
B lactam + macrolide
Otherwise: macrolide or (can consider FQ instead) doxy
CAP inpatient Medical ward TX
Beta lactam + macrolide OR
just a resp FQ
CAP tx in ICU and no pseudomonas risk
B lactam +
( Azithromycin or resp FQ)
If allergic to to BL
Resp FQ + Aztreonam
CAP tx ICU ww pseudomonal risk
beta lactam (AP) + (cipro/levo) OR AMG+ azithro
Allergy BL
Aztreonam +
(cipro/levo) OR AZTh
cefpodoxime dose for cap
200mg po q12h
cefuroxime dose for cap
500mg q12h
ceftin
cefuroxime
azithromycin dose for cap
z pack dose
clarithrymicin dose for cap
250-500mg q 12
or 1000mg daily
erythromycin dose for CAP
250-500 q 6h
Levoloxacin dose for CAP
750mh po qd
moxifloxacin dose for CAP
400mg po qd
avelox
moxifloxacin
docy dose for cap
100mg po q12h
amoxicillin dose for cap
1 g q 8h
augmentid dose fro cap, which augmentin
Augmentin XR
2g q 12h
treatment duration for CAP
at leas 5 days and afebrile 48-72 hours and <= one sign of clinical instability
duration of treatment for HAP
7 days
unless pseudomonas/acenitobacter or bloodstream infix = 14 days
early onset HAP tx
CTX OR levo/mox OR Unysn OR ertapenem
what is early onset HAP
when it occurs and you have been in the hops for < = 5 days
treatment for late onset HAP tx
2 antipseudomonal agents + anti MRSA
for late onset HAP, AP agent 1 and AP agent 2
AP 1 :
cefepime/ ceftazidime
imip/mero
pip/tazo
AP2:
gent/ tobra/amikacin
Levo/cipro
what three tests can you do to test for TB
PPD skin test
sputum smear and culture
PCR for acid fast bacillus
what is the tx for latent TB?
INH 300mg po daily q 9mos
alt 15m/kg BIW
what does RIPE therapy consist of in terms of agents?
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
typical course for a typical active infection?
take 4 drugs x 8 weeks, then check cultures and susceptibilities. If fully susceptible then only take the INH/rifampin for the next 18 weeks
what do you do if the patient is resistant to INH?
continue RPE +/- a fluroquinolone for a total of 6 months now
what do you do if they are resistant to rifampin?
do IPE + FQ but only do the pyrazinamide for 2 months and the total duration is 1 year - 1.5 years
what can you add to INH to reduce neuropathy?
25-50mg vitamin b 6 (pyridoxine) po daily
what can you use instead of rifampin to avoid DDIs?
rifabutin
what is the MOA of rifampin
inhibits RNA synthesis
how should you take your rifampin?
on an empty stomach
1 hour before or 2 hours after a meal
dose for rifampin
10mg/kg per day max 600mg (or 2-3 x /week)
brand name rifampin
rifadin
when is rifampin contraindicated?
when used with Protease inhibitors, switch to rifabutin
SEs of rifampin
Flu like syndrome rash itchiness hepatotoxy ** stains secretions orange: tears, urine etc
INH for TB?
5mg/kg qd max 300mg
or 15m/kg 2-3x/ week max 900mg
contraindications for isoniazid therapy?
active liver disease or previous adverse rection to INH
SE of INH?
increased LFTs, Hepatitis
peripheral neuropathy
lupus-like sydnrome
pyrazinamide dosing
15-20mg/kg QD max 2 G
SE pyrazinamide
hepatoxicity
hyperuricemia, gout
NV
arthralgias, myagias
CI pyrazinamide
acute gout
severe hepatic damage
ethambutol brand
myambutol
ethambutol dose?
15-25 mg/kg QD max 1.5g
main SE of ethambutol?
optic neuritis therefore routine vision tests every month
who should get pox for endocarditis?
Prosthetic valve
previous IE
congenital heard disease
cardiac transplant who got valvulopathy
ppx for dental procedures?
axmo 2g 30-60 minutes before the procdure
ppx for dental procedures?
clindamycin 600mg 30-60min before procedure
azithro or clarithro 500mg before procedure
what are the most common bugs for primary peritonitis?
streptococcus
enteric gram - PEK
rare anaerobes
what is the the DOC is SBP?
ctx x 5-7 days
what is cholecytitis?
infection of the gallbladder
what is cholangitis?
infection of the biliary ductal system
what are the bugs in secondary peritonitis? MILDE to mdoerate
strept
enteric gram - PEK
anaerobes +/- enterococcus
what are the bugs in high severe secondary peritonitis?
strept
PEK
CAPES
+/- enterococcus
high-severity Secondary peritonitis tx?
imi/mero/dori
mild-mod severity secondary peritonitis tx?
Ticarcillin/clav erta cefoxitin tigecycline moxi
what its the dose fro the tx of ricketsial diseases?
dox 100 po/IV BID x ate least 7 days mostly. For ly at least 14 days
which are the rickettsial diseases?
lyme disease rocky mountain spotted fever typhus ehrlichiosis tularemia
what are the most common agents that cause cellulitis?
S. pyogenes
S. aureus
typicla treatmetn for non-purulent cellulitis?
beta lactam : cephalexi n
typical tx for purulent cellulitis?
clinda 300-450 TID bactim 1-2 ds BID doxy 100mg bid minocyline 200mg x1 then 100 id linezolid 600 bid
what duration of tx for purulent cellulitis?
5-10 days
inpatient SSTI
Vanco linezolid dapto telvancin clinda 600mg IV q 8h/ 300-450po q6h
duration of tx for inpatient cellutlis?
7-14 days
what is uncomplicated cystitis?
women of child bearing age 15-45 w/ a UTI
what are the common organisms in uncomplicated cystitis?
e. coli
s. saprophyticus
enterococcus
what is the DOC for uncomplicated cystitis?
SMX/TMP ds tab BID x 3 days
if < 20% of local ecoli is resistant to bactrime and no sulfa allergy
alternative tx for acute uncomplicated cystitis?
cipro 250 bid x 3d cipro ER 500 daily x 3 d levo 250mg daily x 3 da nitrofurantoin 100mg bid x 5 days fosfomycin 3g x 1 (w/ 4oz)
when do you use for PPX for UTI (uncomplicated cystitis)?
> = 3 episodes in one year
What ppx to use for UTI (uncomplicated cystitis)?
1 SS daily bactrime
macrodanting 50mg po daily
or 1 DS post coitus
uncomplicated pyelonephritis organisms
PEK
Enterococus
PA
uncomplicated pyelonephritis moderate Out pt PO tx
cipro 500mg po bid
cipro ER, 1000 daily
Levo 750 daily all tx 5-7days
FQ-R: augmentin, cefaclor, cefpodosime, cefdinir and tx 14 days
uncomplicated pyelonephritis severe IV tx
FQ, Amp/gent, pip/tazo, ctx x 14 days
tx for complicated UTI?
Amp/gent
Pip/tazo
Ticar/clav
CTX/ ceftaxime +/- FQ
tx duration of complicated UTI?
7-14 days
what if you have a pregnant women w/ a UTI?
must treat x 7 days even if asymptomatic
brand phenazopyrdine
pyridium
Azo
Uristat
dose for phenazopyridine
200mg PO TID x 2 days
100mg po TID (OTC) x 2 days
How should patients take their phenazopyridine?
w/ food to dec stomach upset
no longer that 2 days cuz can mask sx of worsening n
can cause red-orange secretions= staining of lenses and clothes
mild-mod tx for c. diff
metronidazole 500mg po TID x 10-14days
tx for severe c.diff
vanco 125mg po QID x 10-14 days
what is Vanco pulse therapy? and when do you use it?
use it on the third Cdiff infection vanc 125mg po QID x 14 days BID x 1 week daily x 1 week then q 2-3 days for 2-8 weeks
tx for SEVERE (w/ shock, megacolon, ileus) cdiff
vanc 500 po QID + metro 500 IV Q8h
Syphilis TX primary, secondary or early latent (<1 year) tx dose
Penicillin Benzathine (Bicillin LA NOT CR) 2.4 Million Units IM x 1
Syphilis TX late latetnt > 1 year, tertiary, or unknown duration) tx dose
Bicillin LA
2.4 Million Units IM q Week x 3 doses
neurosyphillis tx
pen G aqueous 3-4 million units IV q 4h x 10-14 days
gonorrhea tx
CTX IM x 1
chlamydia tx
azithromycin 1g po X 1
bacterial vaginosis
metronidazole 500mg po bid x 7 days
metro gel 0.75% 5g intravaginall daily x 5 days
trichomoniais
metronidazole 2g po x 1
tinidazole 2g po x 1
which is the conventional amphotericin?
amphotericin desoxycholate
brands of liposomal amphotericin
Abelcet
AmBisome
Aphotec
main Side effects of ampho
hypokalemia
hypomagnesimea
nephrotoxicity
fluconazole brand
diflucan
coverage of fluconzole
candida
cryptococcus
why not use ketoconazole?
hepatoxiicity
can you interchange oral capsule and oral solution of itraconazole?
NO
how should you take your itracolzole capsule?
w/ food for acidity
brand name for voriconazole?
VFEND
spectrum of activity vori
Candida, Aspergillus but not nucor (zygomycosis)
how should you take your voriconazole?
1 hour before or 1 hour after meals (empty stomach)
contraindications for voriconazole
CYP3a4 inhibitors
SE vori
visual changes
must correct K/Ca/mg abnormalities before starting therapy
caution driving at night due to vision changes
avoid direct sunlight
DDIs for all azoles
CYP3A4 inhibitors
which two azoles require acidity for absorption?
itra/keto
DOC for aspergillus?
vori
brand caspofungin
cancidas
brand mycafungin
mycamine
main SE of caspo
increased LFTS
capo dose
IV lD 70mg x1 then 50mg daily
mycafungin candidemai dos
100mg Iv daily
mycafungin dose for esophageal candidiasis
150mg IV daily over 60 minutes
