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NAPLEX Review > Infectious Diseases II > Flashcards

Infectious Diseases II Flashcards

1
Q

What are organisms that live on the surface of the skin?

A

Staphylococci and Streptococci

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2
Q

What is given prior to surgery to reduce the risk of infection from the skin?

A

Intravenous antibiotics

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3
Q

Describe the timing of perioperative antibiotics

A
  • Pre-operative: infuse antibiotic (e.g. cefazolin or cefuroxime) 60 min before incision (start of surgery) or if a quinolone or vancomycin are used, start the infusion 120 min before incision
  • Intra-operative: additional doses may be administered if surgery is > 3-4 hours or there is a major blood loss
  • Post-operative: antibiotics are not usually needed; if used, discontinue within 24 hours
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4
Q

What is the preferred antibiotic for most surgeries to prevent methicillin-susceptible S. aureus (MSSA) and Streptococci infections?

A

Cefazolin

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5
Q

What is the alternative antibiotic for most surgeries to prevent methicillin-susceptible S. aureus (MSSA) and Streptococci infections?

A

Clindamycin is an alternative if the patient has a documented beta-lactam allergy

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6
Q

What coverage needs to be considered when selecting perioperative antibiotic selection for colorectal surgeries?

A

In colorectal surgeries, the prophylactic antibiotic regimen needs to cover skin flora plus broad gram-negative and anaerobic organisms found in the gut

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7
Q

When should Vancomycin be considered for perioperative antibiotic selection?

A

Vancomycin should be included in the regimen if MRSA colonization or risk is present. Vancomycin is also an alternative (instead of clindamycin) if the patient has a beta-lactam allergy

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8
Q

What is the recommended antibiotics for cardiac or vascular surgeries?

A

Cefazolin or cefuroxime

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9
Q

What is the recommended antibiotics for hip fracture repairs/total joint replacements?

A

Cefazolin

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10
Q

What is the recommended antibiotics cardiac or vascular surgeries and hip fracture repairs/total joint replacements with beta-lactam allergy?

A

Vancomycin or Clindamycin

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11
Q

What is the recommended antibiotics for colon (colorectal) or other surgeries involving the abdominal space?

A

Cefotetan, cefoxitin, ampicillin/sulbactam, ertapenem or Metronidazole + (cefazolin or ceftriaxone)

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12
Q

What is the recommended antibiotics for colon (colorectal) or other surgeries involving the abdominal space with beta-lactam allergy?

A

Clindamycin + (aminoglycoside, quinolone or aztreonam), or Metronidazole + (aminoglycoside or quinolone)

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13
Q

What is meningitis?

A

Meningitis is an inflammation of the meninges (membranes that cover the brain and spinal cord

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14
Q

What are symptoms of meningitis?

A

The meninges swell, causing classic symptoms of fever, headache, nuchal rigidity (stiff neck) and altered mental status. Other symptoms include chills, vomiting, seizures, rash and photophobia

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15
Q

How is meningitis diagnosed?

A

Diagnosis is made via a lumbar puncture (LP) to obtain a sample of cerebrospinal fluid (CSF), which is then analyzed to help guide drug selection before the culture and susceptibility results are available. Some patients will need a CT scan prior to the LP

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16
Q

What is the most common bacterial causes of meningitis?

A

Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae

*Listeria monocytogenes is prevalent in select patient groups and requires additional treatment with ampicillin

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17
Q

What is the antibiotic duration for the treatment of acute bacterial meningitis treatment?

A
  • 7 days for N. meningitidis and H. influenzae
  • 10-14 days for S. pneumoniae
  • At least 21 days for Listeria monocytogenes
18
Q

Describe the steroid treatment given along with antibiotics for acute bacterial meningitis treatment

A

Dexamethasone can be given 15-20 minutes prior to or with the first antibiotic dose to prevent neurological complications. The adult dose is 0.15 mg/kg (rounded to the nearest 10 mg) IV Q6H. Steroid treatment should be continued for 4 days

19
Q

What is the recommended empiric treatment for acute bacterial meningitis treatment of neonates (age < 1 month)?

A

Ampicillin (for Listeria coverage) + Cefotaxime (no Ceftriaxone) or Gentamicin

20
Q

What is the recommended empiric treatment for acute bacterial meningitis treatment of persons age 1 month to 50 years?

A

Ceftriaxone or cefotaxime + Vancomycin

21
Q

What is the recommended empiric treatment for acute bacterial meningitis treatment of persons age > 50 years or immunocompromised?

A

Ampicillin (for Listeria coverage) + Ceftriaxone or cefotaxime + Vancomycin

22
Q

What can’t Ceftriaxone be used in neonates?

A

Ceftriaxone can cause biliary sludging (solids that precipitate from bile) and kernicterus (brain damage from high bilirubin) in neonates

23
Q

What is the recommended empiric treatment for acute bacterial meningitis treatment for patients with severe penicillin allergy (adults)?

A

Treat with a quinolone (e.g. moxifloxacin) + vancomycin +/- Bactrim (for Listeria coverage)

24
Q

What are signs and symptoms of acute otitis media?

A

Bulging tympanic (eardrum) membranes, otorrhea (middle ear effusion/fluid), otalgia (ear pain), fever, crying and tugging or rubbing the ears

25
Q

What is recommended to treat pain for acute otitis media?

A

Systemic drugs are preferred for pain (acetaminophen or ibuprofen), rather than topical anesthetic drops

26
Q

When is observation for acute otitis media without antibiotics for 48-72 hours considered an option?

A

Try observation for 2-3 days if symptoms are non-severe ([mild otalgia < 48 hours or temperature < 102.2 degrees farenheit) and age 6-23 months: symptoms in one early only OR age > 2 years: symptoms in one or both ears

*If symptoms do not improve, or worsen, use antibiotics

27
Q

What is considered severe symptoms of acute otitis media?

A

Severe symptoms include moderate-severe otalgia > 48 hours or temperature > 102.2 degrees 102.2 F (39 degrees celsius)

28
Q

Why is a high dose of amoxicillin needed for acute otitis media?

A

A high dose of amoxicillin is needed to cover most strains of S. pneumoniae

29
Q

Why should the least amount of clavulanate be used in the treatment of acute otitis media?

A

The formulation with the least amount of clavulanate should be used to decrease the risk of diarrhea

30
Q

What is recommended in children with a non-severe penicillin allergy for the treatment of acute otitis media?

A

The AAP recommends a cephalosporin. Although there is some risk of cross-reactivity, it is low with second- and third-generation cephalosporins

31
Q

What is the treatment duration with oral medications for acute otitis media?

A
  • 10 days for children < 2 years
  • 7 days for ages 2-5 years
  • 5-7 days for age > 6 years
32
Q

What is considered first-line treatment for acute otitis media?

A
  • Amoxicillin: 80-90 mg/kg/day in 2 divided doses or
  • Amoxicillin/clavulanate: 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses (may be considered in patients who have received amoxicillin in the past 30 days)
  • Ceftriaxone 50 mg/kg IM or IV for 1 or 3 days (if vomiting or unable to tolerate oral medications)
33
Q

What are alternative treatments considered for acute otitis media?

A

Cefdinir 14 mg/kg/day in 1 or 2 doses, Cefuroxime 30 mg/kg/day in 2 divided doses, Cefpodoxime 10 mg/kg/ day in 2 divided doses, Ceftriaxone 50 mg/kg IM/IV daily for 1 or 3 days

34
Q

What is considered treatment failure for acute otitis media?

A

Not improved after 48-72 hours of initial treatment

35
Q

What is given after treatment failure of acute otitis media?

A
  • Amoxicillin/clavulanate: 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses or
  • Ceftriaxone 50 mg/kg IM/IV daily for 3 days
36
Q

What are some examples of upper respiratory tract infections?

A

Common cold, influenza, pharyngitis, sinusitis

37
Q

What is the typical etiology of the common cold?

A

Respiratory viruses (rhinovirus, seasonal coronavirus)

38
Q

What is the clinical presentation of the common cold?

A

Sneezing, runny nose, cough, mucus production, sore throat and mild (low-grade) fever

*Generally clears up in a few days

39
Q

What is the criteria for anti-infective treatment for the common cold?

A

None

40
Q

What are treatment options for the common cold?

A

Symptomatic treatment with OTC products (e.g. analgesics, decongestants, cough suppressants, antihistamines)

NAPLEX Review (45 decks)

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