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NAPLEX - 2021 > Infectious Diseases: Bacterial Treatments > Flashcards

Infectious Diseases: Bacterial Treatments Flashcards

1
Q

Perioperative Abx: cardiac, vascular, fracture / joint surgeries

A

1st) Cefazolin

BL-Allergy:
- Vanco or Clindamycin

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2
Q

Perioperative Abx: colorectal

A
  • cefotetan or cefoxitin
  • amp-sulbactam
  • [cefazolin or CTX] + Metronidazole

BL-Allergy:
[FQ or AMG or Aztreonam] + Clinda
[FQ or AMG] + Metronidazole

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3
Q

Beta-Lactam Allergy

A

For exam, never choose:

1) PCN
2) Cephalosporins
3) Carbapenems

OK for BL-Allergy:
AZTREONAM

Exception: AOM
*can use cephalosporin!

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4
Q

Meningitis: Sx & Diagnosis

A

Sx:
Fever, Headache, Stiff Neck, AMS

Diagnosis:
Lumbar puncture

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5
Q

Meningitis Treatment Groups:

A

1) Neonate < 1 month
2) 1 month - 50 years
3) > 50 years or Immunocompromised

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6
Q

Meningitis: cover Listeria in which Age Groups?

A

Use: Ampicillin to cover Listeria

1) Neonate < 1 month
2) > 50 years
3) Immunocompromised

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7
Q

Meningitis: Neonate < 1 month Treatment

A

Ampicillin + [cefotaxime or gentamicin]

*CI: Ceftriaxone in neonates

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8
Q

Meningitis: > 50 years or Immunocompromised

A

Ampicillin + Vanco + [Ceftriaxone or Cefotaxime]

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9
Q

Meningitis: 1 month to 50 years

A

Vanco + [CTX or Cefotaxime]

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10
Q

Acute Otitis Media: Non-Severe Sx

A

Observation:

1) < 48 hr
2) Temp < 102.2 F
3) Age 6 to 23 months: One ear (if BOTH ears then severe)
4) Age ≥ 2 years: one or both ears

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11
Q

AOM: Tx

A

1) High-dose Amox 90 mg/kg/day
2) Amox-clav 90 mg/kg/day

Exception to Non-Severe PCN Allergy on exam:
*Can use cephalosporin

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12
Q

Pharyngitis: Sx / Tx

A

Strep throat (strep pyogenes)

Sx: white patches on tonsils

Tx:

1) PCN or Amox
2) Cephalosporin

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13
Q

Sinusitis: Treatment Consideration

A

Only treat if:

1) Sx ≥ 10 days
2) Fever > 102F, Face pain, purulent nasal discharge ≥ 3 days

Tx:
1) Amox-clav

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14
Q

Acute Bronchitis Tx

A

For Bordetella pertussis (whooping cough):

azithromycin or clarithromycin

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15
Q

Acute Bacterial Exacerbation of Chronic Bronchitis (COPD Exacerbation) Treatment Requirements:

A

Use Abx if:

1) Mechanical ventilation
2) All 3 Sx: Dyspnea, Sputum volume, Sputum purulence
2) Sputum purulence + 1 other Sx

Tx:

1st) Amox-clav
2) Azithromycin
3) Doxycycline

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16
Q

Pneumonia CXR Diagnosis:

A

1) “Infiltrates”
2) “Opacities”
3) “Consolidation”

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17
Q

CAP Pathogens

A

1) Strep. pneumoniae
2) atypicals (mycoplasma pneumoniae, chlamydophila pneumoniae)
3) H. influenzae

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18
Q

CAP Treatment: Outpatient

WITHOUT Comorbidities vs WITH Comorbidities

A

WITHOUT Comorbidities:

1) Amox 1g TID
2) Macrolide (azithromycin or clarithromycin)
3) Doxycycline

WITH Comorbidities (chronic heart / lung / liver / kidney disease, DM, alcoholism, cancer, asplenia):

1) Amox-clav OR Cephalosporin [cefpodoxime / cefuroxime / cefdinir] + [macrolide OR doxycycline]
2) Respiratory FQ MONOTHERAPY [moxi / gemi / levo]

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19
Q

CAP Treatment: Inpatient

Non-ICU vs ICU

A

Non-ICU (Non-Severe):

1) BL [CTX or Cefotaxime or Amp-sulb] + [Macrolide or Doxycycline]
2) Respiratory FQ MONOTHERAPY

ICU (Severe):

1) BL [CTX or Cefotaxime or Amp-sulb] + [Macrolide ONLY]
2) BL [CTX or Cefotaxime or Amp-sulb] + Respiratory FQ

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20
Q

HAP / VAP: Risk Factors for MDR

A

1) IV Abx within 90 days
2) High MRSA prevalence or nasal swab colonization

  • Additional Risk Factors @ VAP:
    1) Hospitalization ≥ 5 days
    2) Septic shock
    3) ARDS
    4) Hemodialysis
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21
Q

HAP / VAP Treatment:

A

PSA + MSSA: 1 drug (PSA)

PSA + MRSA: 2 drugs (PSA + MRSA)

MDR PSA + MRSA: 3 drugs (2 PSA + MRSA)

22
Q

Latent TB Treatment

A

1st) Isoniazid + Rifapentine Q week x 12 weeks
* preferred children, HIV (+)

2nd) Rifampin x 4 months
* HIV negative

3rd) Isoniazid x 9 months
* Pregnant / HIV (+)

23
Q

Active TB Treatment

A

RIPE x 2 months –> RI x 4 months

24
Q

RIPE Monitoring

A

LFTs

25
Q

Rifampin ADRs

A

Orange secretions

Strong CYP inducer

26
Q

Isoniazid ADRs

A 
DILE
Peripheral neuropathy (supplement with Vit B6 pyridoxine)
27
Q

Rifampin & Isoniazid considerations

A

Take on EMPTY STOMACH

Hemolytic anemia

28
Q

Pyrazinamide ADRs

A

Increased uric acid (CI @ gout)

29
Q

Ethambutol ADRs

A 
Visual damage (optic neuritis)
Confusion / hallucinations
30
Q

Endocarditis Treatment

A

Strep viridans:
1) [PCN or CTX] (+/- gent)
Allergy = Vanco

MSSA:
1) [Nafcillin or Cefazolin]
*Prosthetic valve = + Gentamicin & Rifampin
Allergy = Vanco

MRSA:

1) Vanco
* Prosthetic valve = + Gentamicin & Rifampin

Enterococci:
1) [PCN or Ampicillin] + Gentamicin
Allergy = Vanco

@ MSSA/MRSA without prosthetic valve & BL-allergy = daptomycin MONOTHERAPY koi

31
Q

Endocarditis Dental Prophylaxis

A

1st) Amox 2g
Allergy:
1) clindamycin 600mg
2) azithromycin / clarithromycin 500mg

32
Q

Primary Peritonitis (SBP) / Cholecystitis (gallbladder)

A

Liver Disease / cirrhosis

Tx: Ceftriaxone

Ppx: Primary or Secondary Peritonitis

1) SMX/TMP
2) Ciprofloxacin

33
Q

Secondary Peritonitis (traumatic event) / Cholangitis (common bile duct)

A

Polymicrobial = also cover anaerobes

34
Q

Impetigo Sx / Tx

A

Sx: honey-colored crusts

Tx: MSSA

1) mupirocin
2) cephalexin

35
Q

Folliculitis, furuncles, carbuncles Sx / Tx

A

Tx:

1) MSSA = cephalexin
2) MRSA = SMX/TMP or doxycycline

36
Q

Non-purulent Cellulitis Tx

A

1) Cephalexin

Allergy = clindamycin

37
Q

Purulent abcess

A

1) Incision & draining

2) MRSA = SMX/TMP or doxycycline

38
Q

Necrotizing faciitis

A

Cover MRSA / PSA / anaerobes:

vanco + [pip-tazo or meropenem]

39
Q

Uncomplicated cystitis

A

1) Nitrofurantoin 100mg BID x 5 days
CI: CrCl < 60

2) SMX/TMP x 3 days
3) Fosfomycin x 1 dose

Alternative Tx:

1) Cipro 250mg BID x 3 days
2) Levo 250mg QD x 3 days

Pregnancy Tx:
1) Cephalexin
2) Amoxicillin
Allergy: Nitrofurantoin or SMX/TMP

40
Q

Uncomplicated pyelonephritis / Complicated cystitis

A

FQ Resistance ≤ 10%:

1) Cipro 500mg BID x 7 days
2) Levo 750mg QD x 5 days

FQ Resistance > 10%:

1) [CTX 1g or Gentamicin], then FQ
2) SMX/TMP x 14 days

If PSA:

1) pip-tazo
2) carbapenem

41
Q

C. difficile: Severe & Fulminant

A

1) WBC ≥ 15k
2) SCr > 1.5
3) Fulminant = Shock, Ileus, Megacolon

42
Q

C. difficile: Treatment

A

1) Vanco 125mg PO QID
2) Fidaxomicin 200mg BID
3) Metronidazole 500mg TID

Duration = 10 days

Subsequent:

1) Vanco Tapered & Pulsed
2) Vanco 125mg QID x 10 days, then Rifaximin
3) Fidaxomicin 200mg BID

43
Q

Syphilis

A

Labs: VDRL or RPR

1) PCN G benzathine [Bicillin-LA] 2.4mil Units IM
* Do NOT use Bicillin CR!
* Pregnant / HIV = desensitization

2) Doxycycline 100mg BID x 14 days

44
Q

Neurosyphilis / Congenital Syphilis

A

PCN G aqueous crystalline

45
Q

Gonorrhea

A

CTX 500mg IM

*ONLY add Azithromycin if positive for chlamydia or NOT ruled out

46
Q

Chlamydia

A

1st) Azithromycin 1g

2nd) Doxycycline 100mg BID x 7 days

47
Q

Bacterial Vaginosis

A

Sx: fishy odor, pH > 4.5

1) Metronidazole 500mg BID x 7 days
2) Metronidazole 0.75% cream x 5 days

48
Q

Trichomoniasis

A

Sx: yellow/green discharge

1) Metronidazole 2g x 1 dose

49
Q

Genital warts (HPV)

A

Imiquimod cream

50
Q

Rocky Mountain Spotted Fever, Typhus, Lyme Disease

A

Doxycycline 100mg BID

51
Q

Traveler’s Diarrhea

A

1) Azithromycin 500mg QD x 3 days
2) Cipro
3) Levo
4) Rifaximin

NAPLEX - 2021 (18 decks)

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