Infectious Diseases II Flashcards
What is a Type I allergic reaction?
Immediate onset (< 1 hour)
IgE-mediated
Characterized by anaphylaxis, laryngeal edema, wheezing
Which generation of cephalosporins has the highest risk of cross-reactivity for patients with a PCN allergy?
First
Which patient population should receive treatment for asymptomatic bacteriuria?
Pregnant women
What are acceptable treatment regimens for uncomplicated cystitis?
-Nitrofurantoin (5-7 days)
-Fosfomycin (1 dose)
-Trimethoprim/sulfamethoxazole (3 days)
-FQs (levofloxacin or ciprofloxacin) (3 days)
Alternatives:
-Amoxicillin/clavulanate (5-7 days)
-Cefdinir, cefaclor, cefuroxime, cefpodoxime (5-7 days)
What are acceptable treatment regimens for uncomplicated pyelonephritis?
-Trimethoprim/sulfamethoxazole (7-14 days)
-FQs (levofloxacin or ciprofloxacin) (7-14 days)
What is the recommended duration of treatment for pregnant women with symptomatic UTIs?
7 days
What is the recommended duration of treatment for pregnant women with asymptomatic bacteriuria?
3-7 days
What are the preferred UTI antibiotics in pregnant women?
-PCNs and cephalosporins
*Amoxicillin/clavulanate
*Cefuroxime
*Cefpodoxime
*Amoxicillin
*Cephalexin
*Bactrim (avoid in 3rd trimester)
What are important co-morbidies to consider in patients with CAP?
-DM
-Chronic lung, heart, renal, or liver disease
-Alcohol abuse
-Active malignancy
-Asplenia
-Immunosuppressive conditions/medications
What are risk factors of MRSA and Pseudomonas as it pertains to CAP?
-Prior respiratory isolation of MRSA or Pseudomonas
-Recent hospitalization and receipt of IV antibiotics within previous 90 days
What are recommended treatment regimens for CAP patients without comorbidities?
-Amoxicillin 1 g TID
-Doxycycline 100 mg BID
-Azithromycin 500 mg on day 1 then 250 mg on days 2-5
What are recommended treatment regimens for CAP patients with comorbidities?
Combination:
-B-Lactam (amoxicillin/clavulanate BID, cefpodoxime BID, cefuroxime BID)
AND
-Macrolide (azithromycin 500 mg on day 1 then 250 mg on days 2-5) or doxycycline BID
Monotherapy:
-Respiratory FQ (levofloxacin 750 mg daily, moxifloxacin 400 mg daily)
What is the recommended treatment duration for CAP?
At least 5 days (afebrile for 48-72 hours and clinically stable)
What are recommended treatment recommendations for latent TB?
-Isoniazid (15 mg/kg - max of 900 mg) PLUS rifapentine 900 mg x 12 weeks
-Rifampin (10 mg/kg - max of 600 mg) x 4 months
-Isoniazid (5 mg/kg - max of 300 mg) PLUS rifampin (10 mg/kg - max of 600 mg) x 12 weeks
When are antibiotics indicated for acute bacterial rhinosinusitis?
-Signs/symptoms fail to improve or worsen after 10 days or more
-Severe symptoms for 3 days or more
-Worsening after initial improvement for 3 days or more
What antibiotics are preferred for treatment of acute bacterial rhinosinusitis?
Preference: Amoxicillin/clavulanate
Alternatives:
-Doxycycline
-Respiratory FQ
What is the recommended treatment duration for acute bacterial rhinosinusitis?
5-7 days
What antibiotics are preferred for treatment of group A strep?
Preferred:
-PCN VK 500 mg BID x 10 days
-Amoxicillin 500 mg BID x 10 days
PCN-Allergy:
-First-Generation Cephalosporin
-Clindamycin
-Macrolides
When are antibiotics indicated for AOM?
-Otorrhea w/ diagnosis of AOM
-AOM w/ severe symptoms (toxic appearing, fever, otalgia greater than 48 hours)
-Bilateral AOM in children 6 mo to 2 years
What antibiotics are preferred for AOM?
-Amoxicillin 80-90 mg/kg given in 2 divided doses (if no amoxicillin over past 30 days)
-Amoxicillin/clavulanate 90 mg/kg given in 2 divided doses (if amoxicillin in past 30 days)
If PCN-Allergy:
-Cefdinir
-Cefuroxime
-Cefpodoxime
What is the recommended treatment duration for AOM?
5-10 days
When is empiric coverage of MRSA indicated in treatment of SSTIs?
Purulent SSTIs (furuncles, carbuncles, abscesses)
What antibiotics may be used for SSTIs?
-Amoxicillin/clavulanate 875/125 mg BID
-Cephalexin 250-500 mg QID
-Clindamycin 300-450 mg TID-QID
-Doxycycline 100 mg BID
-Bactrim 1-2 DS BID
What is the recommended treatment duration for SSTIs?
7-10 days
Which patients qualify for IE prophylaxis?
Conditions:
-Prosthetic heart valves
-Previous IE
-Congenital heart disease
-Cardiac transplantation with cardiac valvulopathy
Procedures:
-Dental procedures involving gingival or periapical tissue of teeth
-Perforation of oral mucosa
What are recommended antibiotic prophylaxis regimens for IE?
-Amoxicillin 2 g one hour before procedure
PCN-Allergy:
-Clindamycin 600 mg one hour before procedure
-Cephalexin 2 g one hour before procedure
-Azithromycin 500 mg one hour before procedure
Which antibiotics are the biggest culprits for CDI?
-Beta-lactams
-Clindamycin
-FQs
How is severe CDI characterized?
WBC > 15 or SCr > 1.5
What antibiotics may be used for initial CDI?
-Vancomycin 125 mg QID x 10 days
-Fidaxomicin 200 mg BID x 10 days
What is the recommended treatment for the first recurrence of CDI?
-Fidaxomycin
-Standard vancomycin
-Tapered or pulsed vancomycin
What is the recommended treatment for the second recurrence of CDI?
-Fidaxomycin
-Tapered or pulsed vancomycin
*125 mg QID x 10-14 days
*125 BID x 7 days
*125 mg daily x 7 days
*125 mg every 2-3 days for 2-8 weeks
