Infectious Diseases Flashcards
Scarlet Fever rash
Erysipelas
Impetigo
Jones Criteria: Major Criteria (5)
- Carditis
- Erythema marginatum
- Subcutaneous nodules
- Sydenham’s chorea
- Arthritis
Jones Criteria: Minor Criteria (7)
- Fever
- Polyarthralgias
- Reversible prolongation of the PR interval
- Rapid ESR
- Elevated CRP
- Leukocytosis
- History of rheumatic fever
Streptococcal pharyngitis: Management
Penicillin G or VK, Augmentin. Macrolides if PCN allergic. Clindamycin
Impetigo: Management
Topical Mupirocin (Bactroban) treatment of choice.
PO keflex, erythromycin, clindamycin
Cellulitis: Managment
- Cephalexin, dicloxacillin
- Clindamycin or erythromycin (if PCN allergic)
- MRSA: Bactrim 2nd best PO med for MRSA; clindamycin, doxycycline, vancomycin, daptomycin, linezolid
Erysipelas: Management
IV PCN. Vancomycin (if PCN allergic or MRSA suspected)
Cat bite: Management
- Augmentin
- If PCN allergic –> Clindamycin + (Moxifloxacin or Bactrim)
Necrotizing fasciitis (Flesh eating disease): Management
- Surgical debridement + broad spectrum abx (ex: Unasyn, Zozyn, imipenem)
Osteomyelitis: Management
Nafcillin or Oxacillin (+/- Unasyn, Zosyn, Imipenem)
FQs if sickle cell disease
Septic Arthritis: Management
- Arthrotomy + abx. If gram positive –> Nafcillin, Vanco, Clindamycin. If gram negative –>ceftriaxone
Diphtheria: Management
- Diphtheria antitoxin (horse serum) + erythromycin or penicillin x 2 weeks
- Erythromycin is given to close contacts
Erysipeloid
Erysipeloid: Management
- Penicillin G, cephalosporin, clindamycin (Good gram positive coverage)
Tetanus: Management
- Metronidazole or PCN G + Tetanus immune globulin (ex: 5,000 units)
- Diazepam (Benzos used to reduce spasms)
Gas Gangrene: Management
- Penicillin 2 million units q3h IV
- Tetracycline, clindamycin, metronidazole
Botulism: Management
- Antitoxins in all cases*. Respiratory support: intubation if respiratory failure
- Cathartics to remove toxins. No abx in foodbourne type (may worsen)
- Antibiotics ONLY used in wound botulism: PCN G, chloramphenicol, clindamycin
Listeriosis: Management
IV Ampicillin tx of choice* + gentamicin (synergistic). Bactrim
Chlamydia: Management
1 g Azithromycin (one time dose) or Doxycycline 100mg bid for 10 days. Re-test in 3 weeks to ensure clearance of the organism. Also tx for gonorrhea.
Gonorrhea: Management
Ceftriaxone 250mg IM, Cefixime. Tx for chlamydia
Meningiococcal meningitis: Management
Penicillin G tx of choice*. Chloramphenicol, 3rd generation cephalosporin
Meningococcal meningitis: Prophylaxis
Ciprofloxacin or Rifampin
Chancroid: Management
- Azithromycin 1 g x 1 dose
- Ceftriaxone 250mg IM
- Erythromycin
- Cipro
Cat Scratch Disease: Management
- Self-limiting usually requiring sxatic therapy (antipyretics, analgesics, warm compresses)
- If moderate disease: Azithromycin; amoxicillin or doxycycline
- Severe –> Rifampin, ciprofloxacin, gentamicin IM
Pertussis (Whooping Cough): Management
- Erythromycin drug of choice
- Bactrim 2nd line agent
- Treatment is generally ineffective @ changing clinical course but decreases contagiousness
Haemophilus Influenzae: Management
- Amoxicillin, augmentin (if positive for beta lactamase), FQ, bactrim
- IV ceftriaxone for epiglottitis, pneumonia, and meningitis
Tularemia: Management
- Streptomycin drug of choice*
- Gentamicin
- Doxycycline
Brucellosis: Management
Doxycycline + Rifampin and/or streptomycin and/or gentamicin
Hot tub folliculitis: Management
- Usually resolves within 7-14 days without treatment
- Ciprofloxacin PO if persistent
Anthrax: Management
1. Ciprofloxacin for tx and exposure*.
- Doxycycline, Rifampin + Macrolide, clindamycin
Plague: Management
- Streptomycin or gentamicin*
- Doxycycline 2nd line
- Strict respiratory isolation for @ least 48 hours after initiating abx therapy
Plague: post exposure prophylaxis
Doxycycline or tetracycline
Syphilis: Management
Penicillin G tx of choice*
Tetracyclines, macrolides, ceftriaxone if PCN allergic
Lyme Disease: Management
- Doxycycline*; Amoxicillin (DOC in children <9y) x2-3 weeks, cefuroxime
- IV ceftriaxone if 2nd/3rd AVB, syncope, dyspnea, chest pain or CNS disease (other than Bell’s palsy)
Lyme Disease: Prophylaxis
- Doxycycline within 72 hours if Ixodes tick @ least 36 hours and >20% ticks infected in area
Rocky Mountain Spotted Fever: Management
Doxycycline (even in children*), chloramphenicol
Amebiasis: Management
Metronidazole; Tinidazole, Paromomycin (anti-parasitic aminoglycoside)
Acanthamoeba Keratitis: Management
Biguanides, chlorhexadine, propamidine, neomycin-polymyxin
Malaria: Management
Chlorquine*, quinidine; Atovaquone (with doxycycline or clindamycin) if multi drug resistant area*
Babesiosis: Management
Atovaquone + Azithromycin OR Clindamycin + Quinine
Taxoplasmosis: Management
- Sulfadiazene (or clindamycin) + Pyrimethamine (with folinic acid/leucovorin to prevent bone marrow suppression and reduce nephrotoxicity)
- Spiramycin if pregnant
Taxoplasmosis: Prophylaxis
Pyrimethamine, Sulfadiazene, Leucovorin. Bactrim
Enterobiasis (Pinworm): Management
Albendazole, mebendazole.
Pyrantel 2nd line (not used in children <2y)
Chagas Disease (American Trypanosomiasis): Management
Nifurtimox for 90-120 days depending on age. Benznidazole
African Trypanosomiasis (African Sleeping Sickness): Management
Infectious disease consult
Trichinosis (Trichenellosis): Management
- Mild cases: Most cases are mild and self-limiting and require only symptomatic treatment (analgesia and antipyretics)
- Severe cases: albendazole or mebendazole (antiparasitic with steroids)
Ascariasis (roundworm): Management
Mebendazole, Albendazole; Pyrantel if pregnant (given after 1st trimester)*
Leishmaniasis: Management
Infectious disease consult
Ehrlichiosis: Management
Doxycycline, Rifampin. Chloramphenicol
Mycobacterium Avium Complex (MAC): Management
Clarithromycin + Ethambutol* @ least 12 months (+/- rifampin)
Mycobacterium Kansaii: Management
Rifampin + Ethambutol
Mycobacterium Marinum: Management
Tetracyclines, FQ, Macrolides, Sulfonamides for 4-6 weeks
Leprosy (Hansen Disease): Management
- Lepromatous: Dapsone, Rifampin, clofazimine x 2-3 years
- Tuberculoid: Dapsone + Rifampin 6-12 months followed by Dapsone x 2 years
Herpes Keratitis: Management
Antiviral eye drops (ex: trifluridine, vidarabine, acyclovir) + PO acyclovir
Herpes Simplex Virus 1 and 2: Management
Acyclovir (IV for encephalitis), Valacyclovir, Famcyclovir
Cytomegalovirus: Management
Ganciclovir treatment of choice* or Foscarnet, Cidofovir
Chicken Pox: Management
Symptomatic Treatment
Shingles: Management
Acyclovir, Valacyclovir, Famciclovir (given within 72 hours to prevent PHN)
Herpes Zoster Ophthalmicus: Management
PO antivirals (may add trifluridine, acyclovir, vidarabine ophthalmic)
Ramsay Hunt syndrome: Management
Oral acyclovir and corticosteroids
Post-herpetic neuralgia: Management
Gabapentin or TCA. Topical (lidocaine gel, capsaicin)
