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BCPS > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What are the most common organisms for pneumonia community acquired?

A

S.Pnuemoniae, M. Pneumoniae, H. Influenzae.

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2
Q

How do you treat outpatient community acquired pneumonia?

A

If no comorbidities or risk factors for MRSA or Pseudomonas- Amoxicillin, Doxycycline, Macrolide (Clarith or Azith) - IF local resistance < 25%.

IF comorbidities (COPD,DM,EtOH,CKD,CLD,HF,Malignancy,immunosuppresion).- Respiratory Fluroquinolone (levo 750, moxi, gemi) 
- Macrolide or doxycycline with amoxicillin/clavulanate or cefpodoxime or cefuroxime.
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3
Q

How do you treat community acquired (severe) pneumonia in ICU?

A

Amp/Sulbactam + a respiratory fluroquinolone or a macrolide

Ceftriaxone or ceftaroline + a respiratory fluoroquinolone or a macrolide

May need MRSA empirical therapy (ICU admission, necrotizing or cavitary infiltrates, empyema).

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4
Q

How do you treat community acquired non severe pneumonia (inpatient therapy)?

A

Respiratory fluoroquinolone or Macrolide(or doxycycline) + ampicillin/sulbactam, ceftriaxone or ceftaroline

CAP treatment at least 5 days and guided by clinical resolution

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5
Q

When do you add antibiotics for CAP for MRSA?

A

Prior respiratory isolation of MRSA, Validated risk factors for MRSA (hospitalization and IV abx in past 90 days)

Can use Vancomycin or Linezolid here

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6
Q

When do you add antibiotics for CAP for Pseudomonas?

A

Prior respiratory isolation of pseudomonas, validated risk factors for pseudomonas (hospitalization and IV abx in past 90 days)

Can use Pip/Tazo, cefepime, ceftazidime, imipenem, meropenem, aztreonam.

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7
Q

How do you treat VAP or HAP?

A

Requires abx against S.aureus, P.aeruginosa, and other GNR. Duration is 7 days. Options for single drug therapy include Pip/Tazo, Cefepime, Imipenem or meropenem, levofloxacin.

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8
Q

What are risk factors for MDR?

A

IV antibiotics in last 90 days (HAP or VAP)

Hospitilization for more than 5 days, septic shock at time of VAP, ARDS preceding VAP, acute renal replacement therapy prior to VAP (VAP)

Also 2nd antipseudomonal needed if resistance >10% or patient has structural lung disease and MRSA agent if resistance >20%

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9
Q

What is the therapy for VAP or HAP?

A

Antipseudomonal 1st agent (Beta-lactam (ceftazidime)), cefepime, imipenem or meropenem, zosyn or aztreonam.

Antipseudomnal 2nd agent- Aminoglycoside or fluoroquinolone (cipro,levo), can use colisitin or aztreonam

MRSA agent - Vancomycin or linezolid

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10
Q

What are the differences between bacterial and viral infections?

A

Nasal discharge is clear to purulent to clear for viral. Bacterial is generally longer than 10 days of infection.

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11
Q

What is the treatment for sinusitis?

A

1st line - Amox/clavulanate.

2nd line - Respiratory fluoroquinolone (FDA-avoid if possible), Doxycycline, Cefeixime or cefpodoxime proxetil with clindamycin.

Duration of therapy is 5-7 days for adults, for children it’s 10-14 days.

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12
Q

What are the differences in cystitis vs pyelonephritis?

A

Dysuria, frequency and urgency only vs these symptoms + N/V, flank pain, fever, increased WBC, casts.

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13
Q

What are the factors associated with a complicated UTI?

A

Male, hospital acquired, pregnant, anatomical abnormality of urinary tract, recent antibiotic, catheters, immunosuppression, poorly controlled diabetes.

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14
Q

What to know about asymptomatic bacteriuria?

A

Only screen for and treat in pregnant women and patients undergoing endoscopic urologic procedures. Pregnant women (treat 4-7 days), patients undergoing urologic procedures (treat with 1-2 doses). MUST have other symptoms if a patient has fallen recently or only mental status changes/confusion.

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15
Q

How to treat uncomplicated cystitis?

A

Bactrim for 3 days, Nitro for 5 days, fosfomycin for 1 dose. Can use Fluoroquinolones (3 days) or beta lactams (5 to 7 days).

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16
Q

How to treat uncomplicated pyelonephritis?

A

Bactrim (7-14 days), Fluoroquinolone (levo, cipro, 5-7 days), Beta lacatam (10-14 days, less effective).

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17
Q

How to treat complicated outpatient UTIs?

A

Bactrim, Fluoroquinolone (levo,cipro), beta lactam (5-14 days).

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18
Q

How to treat complicated inpatient UTIs?

A

Fluoroquinolone (levo,cipro), aminoglycoside, ceftriaxone (5-14 days).

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19
Q

How to treat UTI’s in pregnancy?

A

Amoxicillin or Amox/Clavulanate (3-5 days), Nitrofurantoin (5 days), Cephalexin or cefpodoxime (3-5 days), fosfomycin (1 dose).

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20
Q

What is CURB 65 scoring?

A

Confusion 1, BUN >19 1, RR >30 1, SBP <90 and DBP <50 1, AGE 65 and older 1.

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21
Q

What are mechanisms of antibiotic resistance?

A

Innate resistance, mutations, horizonal gene transfer, decreased uptake (b-lactams, fq’s, aminoglycosides (especially pseudomonas)), Enzyme modification and degradation (b-lactamases, aminoglycoside hydrolitic enzymes), Altered target site (b-lactams, glycopeptides, FQs, ribosomal mutations, sulfonamides, trimethoprim, Efflux pumps (macrolides, fqs, tetracyclines).

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22
Q

What are the differences between type A and B influenza?

A

Type A–> changes through antigenic drift or shift(less common dramatic change leading to a pandemic) causes epidemics every 1-3 years.

Type B–> antigenic drift changes, causes epidemics every 5 years.

23
Q

What is oseltamivir dosing for treatment vs prophylaxis?

A

Treatment - 75 mg twice daily for 5 days.

Prophylaxis - 75 mg once daily.

24
Q

Are adamantanes effective?

A

Never in B, not really in A.

25
Q

Do you always treat catheter related UTI’s?

A

No, if asymptomatic don’t. If symptomatic treat with 7 days of antibiotics if symptoms immediately improve and 10-14 days if they don’t. Levofloxacin for 5 days if patient is not severely ill, treat for 3 days in women 65 years of age and younger.

26
Q

How do you treat prostatitis?

A

Acute bacterial - 2-4 weeks duration, Bactrim or FQ’s.

Chronic bacterial- 1-4 months duration, Bactrim or FQ’s.

27
Q

How do you treat epidiymitis?

A

Older than 35 - 10 days to 4 weeks. Bactrim or FQs

Younger than 35 - 10 days. Ceftriaxone 250 mg IM once plus doxycycline 100 mg BID

28
Q

What to know about cellulitis?

A

Usually caused by S.Pyogenes and occasionally S.aureus. Treat for 5-10 days and treat with Penicillin G if definite strep, 1st gen cephalosporin (cefazolin, cephalexin), ceftriaxone, clindamycin, treat for MRSA if penetrating trauma, drug use, purulent drainage, nasal colonization with MRSA concurrent MRSA elsewhere, or SIRS (severe non purulent).

Outpatient- clinda, Bactrim (add b-lactam for strep), doxycycline (add b-lactam for strep).

Inpatient- vancomycin, linezolid, daptomycin, or telavancin

29
Q

What to know about erysipelas?

A

spreads through lymphatic symptoms. Treatment is 5 days, penicillin G, cefazolin, clindamycin

30
Q

What to know about necrotizing fasciitis?

A

Infection alters tissue, very painful. Mixed infection with facultative and anaerobic (type 1), strep pyogenes (type 2) Treated with surgical debridement, antibiotics are not curative, empiric (vancomycin or linezolid,+ Pip/tazo or a carbapenem or ceftriaxone with metronidazole.

If group A strep, s aureus or clost- clinda should be included in the empiric regimen to suppress toxin and cytokine production

If strep fasciitis- high dose IV penicillin + clindamycin.

31
Q

What is the preferred regimen in HIV infected women to prevent maternal fetal transmission?

A

Dual nucleoside reverse trancriptase inhibitor combo and either atazanavir/ritonavir or darunavir/ritonavir or raltegravir. Avoid dolutegravir in 1st 8 weeks, continue current regimen besides dolutegravir in 1st 8 weeks if on.

32
Q

What to give if women goes into labor with HIV?

A

Zidovidune (4 weeks if low), Zidovudine + nevirapine for 6 weeks or triple antiretroviral therapy with zidovudine,lamivudine, and nevirapine for 6 weeks if high.

33
Q

What to treat with post exposure prophylaxis?

A

Non occupational - begin in 72 hours, preferred is raltegravir 2x daily or dolutegravir once daily + tenofovir/emtricitabine

Occupational - begin within hours, raltegravir twice daily + tenofovir/emtricitabine.

34
Q

What is normal CD4 lab values?

A

500-1300 cells

35
Q

What is initial therapy for HIV?

A

2 NRTIs in combo with an INSTI.

36
Q

What drug has a potentially fatal hypersensitivity reaction and needs to be screened for HLA-B*5701?

A

Abacavir.

37
Q

How to manage statin therapy in HIV?

A

Avoid simvastatin and lovastatin. Prefer pravastatin. Often can use atorvastatin and rosuvastatin.

38
Q

Which drug do you need to avoid PPIs, H2 blockers, antacids?

A

Rilpivirine. Take with food.

39
Q

When do you start primary prophylaxis in PCP?

A

CD4 <200, treat with bactrim

40
Q

When do you start primary prophylaxis for cytomegalovirus retinitis?

A

CD4 <50 can treat with valganciclovir if sight threatening

41
Q

When do you start primary prophylaxis for MAC?

A

CD4 <50. Clarithro or azithromycin (drug of choice) +ethambutol

42
Q

When do you start primary prophylaxis for toxoplasmosis?

A

CD4 <100, Treat with Bactrim.

43
Q

Do you do prophylaxis for cryptococcal meningitis in HIV?

A

NO

44
Q

What is the treatment for cryptococcal?

A

Ampho B + Flucytosine followed by fluconazole

45
Q

How do you treat toxoplasmosis in HIV?

A

Pyrimethamine + sulfadiazine + leucovorine

46
Q

What is latent tb therapy?

A

INH for 6-9 months if HIV negative, RIF for 4 months.

INH for 9 months if HIV positive

47
Q

What is active TB therapy?

A

RIPE - treat for 2 months. Then RI for 4 months. Extend to 7 months if patient is HIV + and not receiving ART.

48
Q

How to treat candidemia?

A

Eichocandin or Fluconazole or Ampho B lipids for 14 days

49
Q

How to treat blastomycosis?

A

Itraconazole

50
Q

How to treat aspergillosis?

A

Voriconazole

51
Q

How to treat coccidiomycosis?

A

Fluconazole, severe is ampho b lipid then fluconazole or itraconazole

52
Q

How to treat histoplasmosis?

A

Ampho B followed by itraconazole if moderate to severe, Mild is itraconazole

53
Q

How to treat mucormycosis?

A

Ampho B and then isavuconazole or posaconazole

BCPS (21 decks)

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