Infectious Diseases: Bacterial Treatments Flashcards
Perioperative Abx: cardiac, vascular, fracture / joint surgeries
1st) Cefazolin
BL-Allergy:
- Vanco or Clindamycin
Perioperative Abx: colorectal
- cefotetan or cefoxitin
- amp-sulbactam
- [cefazolin or CTX] + Metronidazole
BL-Allergy:
[FQ or AMG or Aztreonam] + Clinda
[FQ or AMG] + Metronidazole
Beta-Lactam Allergy
For exam, never choose:
1) PCN
2) Cephalosporins
3) Carbapenems
OK for BL-Allergy:
AZTREONAM
Exception: AOM
*can use cephalosporin!
Meningitis: Sx & Diagnosis
Sx:
Fever, Headache, Stiff Neck, AMS
Diagnosis:
Lumbar puncture
Meningitis Treatment Groups:
1) Neonate < 1 month
2) 1 month - 50 years
3) > 50 years or Immunocompromised
Meningitis: cover Listeria in which Age Groups?
Use: Ampicillin to cover Listeria
1) Neonate < 1 month
2) > 50 years
3) Immunocompromised
Meningitis: Neonate < 1 month Treatment
Ampicillin + [cefotaxime or gentamicin]
*CI: Ceftriaxone in neonates
Meningitis: > 50 years or Immunocompromised
Ampicillin + Vanco + [Ceftriaxone or Cefotaxime]
Meningitis: 1 month to 50 years
Vanco + [CTX or Cefotaxime]
Acute Otitis Media: Non-Severe Sx
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
AOM: Tx
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
Pharyngitis: Sx / Tx
Strep throat (strep pyogenes)
Sx: white patches on tonsils
Tx:
1) PCN or Amox
2) Cephalosporin
Sinusitis: Treatment Consideration
Only treat if:
1) Sx ≥ 10 days
2) Fever > 102F, Face pain, purulent nasal discharge ≥ 3 days
Tx:
1) Amox-clav
Acute Bronchitis Tx
For Bordetella pertussis (whooping cough):
azithromycin or clarithromycin
Acute Bacterial Exacerbation of Chronic Bronchitis (COPD Exacerbation) Treatment Requirements:
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
Pneumonia CXR Diagnosis:
1) “Infiltrates”
2) “Opacities”
3) “Consolidation”
CAP Pathogens
1) Strep. pneumoniae
2) atypicals (mycoplasma pneumoniae, chlamydophila pneumoniae)
3) H. influenzae
CAP Treatment: Outpatient
WITHOUT Comorbidities vs WITH Comorbidities
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]
CAP Treatment: Inpatient
Non-ICU vs ICU
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
HAP / VAP: Risk Factors for MDR
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
HAP / VAP Treatment:
PSA + MSSA: 1 drug (PSA)
PSA + MRSA: 2 drugs (PSA + MRSA)
MDR PSA + MRSA: 3 drugs (2 PSA + MRSA)
Latent TB Treatment
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 (+)
Active TB Treatment
RIPE x 2 months –> RI x 4 months
RIPE Monitoring
LFTs
Rifampin ADRs
Orange secretions
Strong CYP inducer
Isoniazid ADRs
DILE Peripheral neuropathy (supplement with Vit B6 pyridoxine)
Rifampin & Isoniazid considerations
Take on EMPTY STOMACH
Hemolytic anemia
Pyrazinamide ADRs
Increased uric acid (CI @ gout)
Ethambutol ADRs
Visual damage (optic neuritis) Confusion / hallucinations
Endocarditis Treatment
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
Endocarditis Dental Prophylaxis
1st) Amox 2g
Allergy:
1) clindamycin 600mg
2) azithromycin / clarithromycin 500mg
Primary Peritonitis (SBP) / Cholecystitis (gallbladder)
Liver Disease / cirrhosis
Tx: Ceftriaxone
Ppx: Primary or Secondary Peritonitis
1) SMX/TMP
2) Ciprofloxacin
Secondary Peritonitis (traumatic event) / Cholangitis (common bile duct)
Polymicrobial = also cover anaerobes
Impetigo Sx / Tx
Sx: honey-colored crusts
Tx: MSSA
1) mupirocin
2) cephalexin
Folliculitis, furuncles, carbuncles Sx / Tx
Tx:
1) MSSA = cephalexin
2) MRSA = SMX/TMP or doxycycline
Non-purulent Cellulitis Tx
1) Cephalexin
Allergy = clindamycin
Purulent abcess
1) Incision & draining
2) MRSA = SMX/TMP or doxycycline
Necrotizing faciitis
Cover MRSA / PSA / anaerobes:
vanco + [pip-tazo or meropenem]
Uncomplicated cystitis
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
Uncomplicated pyelonephritis / Complicated cystitis
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
C. difficile: Severe & Fulminant
1) WBC ≥ 15k
2) SCr > 1.5
3) Fulminant = Shock, Ileus, Megacolon
C. difficile: Treatment
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
Syphilis
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
Neurosyphilis / Congenital Syphilis
PCN G aqueous crystalline
Gonorrhea
CTX 500mg IM
*ONLY add Azithromycin if positive for chlamydia or NOT ruled out
Chlamydia
1st) Azithromycin 1g
2nd) Doxycycline 100mg BID x 7 days
Bacterial Vaginosis
Sx: fishy odor, pH > 4.5
1) Metronidazole 500mg BID x 7 days
2) Metronidazole 0.75% cream x 5 days
Trichomoniasis
Sx: yellow/green discharge
1) Metronidazole 2g x 1 dose
Genital warts (HPV)
Imiquimod cream
Rocky Mountain Spotted Fever, Typhus, Lyme Disease
Doxycycline 100mg BID
Traveler’s Diarrhea
1) Azithromycin 500mg QD x 3 days
2) Cipro
3) Levo
4) Rifaximin
