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NAPLEX 2022 > Infectious Diseases II: Bacterial Infections > Flashcards

Infectious Diseases II: Bacterial Infections Flashcards

1
Q

Perioperative Antibiotic Prophylaxis

Bug and Drug of Choice, Alternatives

A

Bug: Staphylococci and Streptococci

——Drugs——–
DOC: Cefazolin*** or Cefuroxime
Alt: Vancomycin or Clindamycin
- used when a beta-lactam allergy or risk of MRSA

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2
Q

Time of Perioperative Antibiotics

pg. 376

A

—-Pre-operative (prior to surgery)—-
DOC: 60 min before Alt: 120 min before

—-Intra-operative (during surgery)—-
Additional doses may be administered if surgery is >3-4
hours or there is major blood loss

—-Post-operative (after surgery)—-
ABX not usually needed; if used, discontinue within 24 hours

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3
Q

Surgery prophylaxis DOC & bug coverage

A

DOC: Cefazolin (1st gen ceph) - MRSA and Streptococci

Alt: Clindamycin if pt has a beta-lactam allergy or Vancomycin (MRSA colonization or risk instead of Clindamycin)

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4
Q

Colorectal surgery prophylaxis DOC vs alternatives & bug coverage

A

DOC: Cefotetan, cefoxitin, ampicillin/sulbactam (Unasyn), ertapenem, OR metronidazole PLUS cefazolin or ceftriaxone

Alt: Clindamycin PLUS (aminoglycoside, quinolone or aztreonam), OR metronidazole PLUS (aminoglycoside or quinolone)

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5
Q

Classic symptoms of meningitis

A

Fever
Headache
Stiff neck
Altered mental status

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6
Q

Meningitis Diagnosis & Bugs

A

Dx: Lumbar puncture

Bugs: S. pneumoniae, N. meningitidis, H. influenzae, Listeria

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7
Q

Acute Bacterial Meningitis Treatment (Community-Acquired)

ABX durations are pathogen-dependent

A

7 days for N. meningitidis and H. influenzae
10-14 days for S. pneumoniae
<21 days for Listeria monocytogenes

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8
Q

Meningitis: Empiric Treatment

A

Empiric antibiotic selection depends of age & RFs
Aggressive (high) doses are used to penetrate the CNS

——–Age < 1 month (neonates)——–
Ampicillin (Listeria) PLUS cefotaxime (no ceftriaxone) OR gentamicin

  • ——-Age 1 month to 50 years———
  • Ceftriaxone or cefotaxime PLUS vancomycin

——–Age > 50 years or immunocompromised———–
Ampicillin (Listeria) PLUS Ceftriaxone or Cefotaxime PLUS Vancomycin

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9
Q

Meningitis: Empiric Treatment but the adult has a severe penicillin allergy

A

Treat with a Quinolone (moxifloxacin) PLUS vancomycin +/- Bactrim (listeria coverage)

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10
Q

S/SX of AOM

A

Bulging tympanic (eardrum) membranes
Otorrhea (middle ear effusion/fluid)
Otalgia (ear pain)
Tugging/rubbing of ears

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11
Q

AOM Treatment in Kids: When to consider observation

A

Systemic drugs: Pain (APAP or Ibu)

Observation for 48-72 hours - non-severe AOM
-mild otalgia < 48 hours or temp <102.2F (39)

AND

Age 6-23 months: sx in one ear only
Age > 2 years: sx in one or both ears

**if sx do not improve, or worsen, use ABX

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12
Q

AOM Antibiotic Treatment

A

High-dose amoxicillin or amoxicillin/clavulanate (Augmentin)

**least amount of clavulanate - decrease risk of diarrhea

H-D covers S. pneumoniae

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13
Q

What is the ratio of amoxicillin to clavulanate? What’s the brand?

A

14:1 - Augmentin ES 600

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14
Q

American Academy of Pediatrics (AAP) guidelines recommended what drug class for non-severe penicillin allergy?

A

Cephalosporin

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15
Q

Treatment duration with oral medications

A

10 days for children < 2 years
7 days for age 2-5 years
5-7 days for age > 6 years

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16
Q

AOM: Antibiotic Treatment

A

——-First-Line Treatment———
Amoxicillin 80-90 mg/kg/day in 2 divided doses
OR
Amoxicillin/clavulanate 90 mg/kg/day
OR
Ceftriaxone IM (if vomiting or unable to tolerate PO)

——-Alternative Treatment———-
Cefdinir 14 mg/kg/d in 1-2 divided doses
Cefuroxime 30mg/kd/d in 2 divided doses

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17
Q

Compare and Contrast - Clinical Presentation

Common cold
Influenza
Pharyngitis
Sinusitis

pg. 379

A

———Clinical Presentation———–
C: sneezing, runny nose, cough
I: sudden onset fever, chills, fatigue, body aches
P: sore throat, swollen lymph nodes, white patches on tonsils
S: nasal congestion, facial/ear/dental pain, headache

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18
Q

Compare and Contrast - Criteria for Anti-Infective Treatment

Common cold
Influenza
Pharyngitis
Sinusitis

pg. 379

A

———Criteria for Anti-Infective Treatment—–

C: none
I: < 48 hours since sx onset
P: rapid antigen diagnostic test
S: > 10 days of sx OR > 3 days of severe sx (temp >102*F)

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19
Q

Compare and Contrast - Treatment Options

Common cold
Influenza
Pharyngitis
Sinusitis

pg. 379

A

C: OTC products
I: Oseltamivir x 5 days | Baloxavir x 1 dose | Zanamivir inhalation
P: Penicillin, amoxicillin
Sinusitis:
1st line - Augmentin
2nd line - PO 2nd/3rd gen ceph PLUS clindamycin, doxycycline or resp. FQ

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20
Q

Lower Respiratory Tract Infections - Bronchitis

Symptoms
Cause
Diagnosis
Treatment of Choice

A

Bronchitis

Symptoms: cough
Cause: RSV or bacteria (Bordetella pertussis ‘whooping cough’)
Diagnosis: chest x-ray
Treatment of Choice: supportive care (fluids, otc meds. abx not recommended “exception is Bordetella - macrolide or bactrim) “

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21
Q

COPD patient with Acute Bacterial Exacerbation of Chronic Bronchitis

A
  1. Supportive treatment (O2, short-acting inhaled
    bronchodilators, IV/PO steroids)
  2. ABX for 5-7 days if any one of the following are met:
    - increase dyspnea, incr. sputum volume and incr. sputum purulence
    - mechanically ventilated
  3. Preferred ABX
    - Augmentin**
    - Azithromycin
    - Doxycycline
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22
Q

Community-Acquired Pneumonia

Symptoms
Diagnosis
Common pathogens
Treatment of Choice & Duration

A

Community-Acquired Pneumonia

Sx: cough, purulent sputum, rales, tachypnea (incr. RR)
Dx: Chest X-ray
Bugs: S. pneumonia, H. influenzae, M. pneumoniae “walking pneumonia”
DOC: Respiratory FQs x 5-7 days

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23
Q

Outpatient CAP Treatment Stepwise Approach

A

Step 1: look for comorbidities (chronic heart, lung, liver, kidney disease, DM, alcoholism, malignancy or asplenia)

Step 2: check for MRSA or Pseudomonas

Step 3: Category 1 vs Category 2

Step 4: Choose DOC within category (look for allergies/DDIs)

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24
Q

Outpatient CAP Treatment Stepwise Approach

Category 1

A

No comorbidities

Amoxicillin H-D 1g TID 
OR 
Doxycycline 
OR 
Macrolide (Azithromycin or clarithromycin)
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25
Q

Outpatient CAP Treatment Stepwise Approach

Category 2

A

Beta-lactam PLUS macrolide OR doxycycline

  - augmentin OR cephalosporin (cefpodoxime, cefuroxime) PLUS
  - macrolide OR doxycycline

Respiratory quinolone monotherapy - moxifloxacin, gemifloxacin, levofloxacin

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26
Q

Inpatient CAP treatment for nonsevere (non-ICU care)

A

Beta-lactam PLUS macrolide OR doxycycline
- preferred beta-lactams (Ceftriaxone, cefotaxime, ceftaroline or Unasyn)

Respiratory quinolone monotherapy
- moxifloxacin, gemifloxacin, levofloxacin

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27
Q

Inpatient CAP treatment for severe (ICU care)

A

Beta-lactam PLUS macrolide

Beta-lactam PLUS respiratory quinolones (do NOT use FQ monotherapy)

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28
Q

Risk factors for Pseudomonas and/or MRSA in Inpatient CAP treatment:

A

MRSA: add coverage with Vancomycin or Linezolid

Pseudomonas: add coverage with zosyn, cefepime, meropenem or aztreonam

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29
Q

Hospital-acquired pneumonia (HAP) has an onset of

A

onset > 48 hours after hospital admission

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30
Q

Ventricular-associated pneumonia (VAP) occurs

A

> 48 hours after the start of mechanical ventilation

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31
Q

Common pathogens in HAP and VAP

A

Nosocomial pathogens

Risk for MRSA and MDR Gram-negative rods, including Pseudomonas

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32
Q

HAP/VAP: Selecting an Empiric Regimen

All patients need an antibiotic for Pseudomonas and MSSA regimen:

A

cefepime

piperacillin/tazobactam (Zosyn)

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33
Q

HAP/VAP: Selecting an Empiric Regimen

If patient is at risk for MRSA what drugs are added?

A

Vancomycin or Linezolid

  • cefepime PLUS vancomycin
  • meropenem PLUS linezolid
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34
Q

HAP/VAP: Selecting an Empiric Regimen

What 2 antibiotics are used in Pseudomonas if risk for MDR pathogens?

A

-piperacillin/tazobactam PLUS ciprofloxacin PLUS
vancomycin

-cefepime PLUS gentamicin PLUS linezolid

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35
Q

Identify the risks for MRSA or MDR pathogens

A
  1. Positive MRSA nasal swab (indicates MRSA colonization)
  2. High prevalence (>10%) of pathogen resistance to any single agent noted in hospital unit
  3. IV antibiotic use within the past 90 days
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36
Q

Antibiotics for Pseudomonas (do NOT use 2 beta-lactams together)

A 
piperacillin/tazobactam
cefepime, ceftazidime, or ceftolozane/tazobactam (Zerbaxa)
levofloxacin or ciprofloxacin
imipenem/cilastatin or meropenem
aztreonam
tobramycin, gentamicin or amikacin
colistimethate or polymyxin B
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37
Q

Antibiotics for MRSA

A

vancomycin

linezolid

38
Q

How is active pulmonary TB spread?

A

transmitted aerosolized droplets (i.e., sneezing, coughing & talking)

Highly contagious

39
Q

Clinical presentation of active pulmonary TB

A

cough/hemoptysis (coughing up blood)
fever
night sweats

Hospitalized patients require isolation in a single negative-pressure room

40
Q

Diagnosis of TB

A

Latent disease: TB skin test (PDD)

- intradermal injection, analyzed after 48-72 hours

41
Q

Diagnosis of Latent TB: Criteria for Positive TB Skin Test Results

A

≥ 5 mm induration = significant immunosuppression

≥ 10 mm induration = high-risk congregate settings (healthcare workers)

≥ 15 mm induration = patients with no risk factors

42
Q

Latent TB Treatment duration

A

Shorter regimens (3-4 mo) preferred** due to higher completion rates and less risk of hepatotoxicity

43
Q

Preferred Latent TB Regimens - Drugs/Duration

A
  1. INH and Rifapentine - weekly x 12 weeks via directly observed therapy (DOT) ‘adherence’

do not use this regimen in pregnancy

  1. Rifampin x 4 months (preferred in children of all ages & HIV-negative adults)
  2. Isoniazid w/ rifampin x 3 months (use in adults, children & HIV +)
44
Q

Alternate Latent TB Regimens - Drugs/Duration

A
  1. INH x 6-9 months (alternate for HIV -/+ adults/children)

INH x 9 months in pregnancy (Tx of choice)

45
Q

Active TB Diagnosis

A

A positive TST and confirmed with an acid-fast bacilli (AFB) statin

46
Q

Active TB Treatment

A

2 phases (intensive and continuation)

Intensive “RIPE x 2 months”

Continuation phase x 4 months (2 drugs: rifampin & isoniazid)

47
Q

RIPE Drugs

A

rifampin (RIF)
isoniazid (INH)
pyrazinamide (PZA)
ethambutol

Duration: 8 weeks (2 mo)

48
Q

Rifampin - Safety/SE/Monitoring

A

SE: increase LFTs, hemolytic anemia (detected with a positive Coombs test), flu-like syndrome, orange-red discoloration (sputum, urine, sweat, tears, teeth), stain contacts & clothes

DDI:
-RIF is a potent inducer of CYP450 and P-glycoprotein
- decrease concentration of PI, Warfarin (decr. INR),
OC (decr. efficacy)
- Do NOT use RIF w/ apixaban, rivaroxaban

Alternative to rifampin is rifabutin (less DDIs)

49
Q

Isoniazid - Safety/SE/Monitoring/Notes

A

Boxed Warning: hepatitis

Warnings: Peripheral neuropathy
Notes: Supplement with pyridoxine (Vit B6) 25-50 mg to decr. risk of peripheral neuropathy

SE: increase LFTs, drug-induced lupus erythematosus (DILE), hemolytic anemia (+ Coombs test)

50
Q

Pyrazinamide - Safety/SE/Monitoring/Notes

A

Contraindications: acute gout

SE: increase LFTs, hyperuricemia/gout

51
Q

Ethambutol - Safety/SE/Monitoring/Notes

A

SE: increase LFTs, optic neuritis (dose-related), confusion, hallucinations

52
Q

RIPE Therapy for TB (Drug-Specific Key Points)

A

Monitor infection: sputum samples, sx, and chest x-ray

All RIPE drugs: increase LFTs

———–Rifampin————
orange bodily secretions
strong CYP450 inducer (use rifabutin if CI)
flu-like symptoms
———–Isoniazid————
peripheral neuropathy; give w/ pyridoxine (Vit B6) 25-50 mg PO daily
monitor for sx of DILE
———–RIF & INH———–
risk of hemolytic anemia (+ Coombs test)
——–Pyrazinamide——–
increase uric acid - do not use with acute gout
——–Ethambutol———–
visual damage (requires baseline & monthly vision exams)
confusion/hallucinations

53
Q

Infective endocarditis - Diagnosis & Common Pathogens

A

Dx: ECG & positive cultures

Pathogens: Staphylococci, Streptococci & Enterococci

54
Q

What drug is added for synergy effect in Infective Endocarditis? Monitoring?

A

Gentamicin

Pathogens: active against Pseudomonas and enhances Gram-positive coverage with used as synergy

Monitoring: peak levels 3-4 mcg/mL & troughs <1 mcg/mL

55
Q

Preferred ABX Regimen in infective endocarditis treatment associated with which pathogen?

A

Viridans group Streptococci: PCN or ceftriaxone (+/- Gent)

Staphylococci (MSSA): NAF or cefazolin (+ Gent & RIF ‘if prosthetic valve’)
use Vanc if beta-lactam allergy

Staphylococci (MRSA): Vancomycin (+ Gent & RIF ‘if PV’)

Enterococci: Both native & prosthetic valve IE
- PCN or ampicillin + gent OR ampicillin + high-dose ceftriaxone
beta-lactam allergy: Vanc + Gent
^^ if VRE, use daptomycin or linezolid ^^

56
Q

Infective endocarditis dental prophylaxis

Adult Prophylaxis Regimen

A

PO: Amoxicillin 2 g 30-60 min b4 dental procedure
**if can’t do PO: Ampicillin 2g IM/IV OR Cefazolin 1 g IM/IV

^^ if allergic to PCN: Clindamycin 600 mg

OR
Azithromycin/Clarithromycin 500 mg
**if can’t do PO & PCN allergy: Clindamycin 600 mg IM/IV

57
Q

Intra-abdominal infections

DOC in spontaneous bacterial peritonitis (SBP)

Pathogens for Primary & Secondary Peritonitis

A

DOC: Ceftriaxone x 5-7 days

Prophylaxis for SBP: Bactrim or Cipro

Primary Peritonitis: Streptococci, enteric Gram-negative (Proteus, E.coli, Kleb, or PEK)

Secondary Peritonitis: “same” PLUS anaerobes (B. fragilis) - DOC: Flagyl

58
Q

Intra-abdominal infections

Define Cholecystitis vs Cholangitis

A

Cholecystitis: inflammation of the gallbladder

Cholangitis: infection of the common bile duct

59
Q

Skin & Soft Tissue - Clinical Presentation & Classifications

A

Mild: Superficial (impetigo, furuncles, carbuncles)
Moderate: Non-purulent cellulitis
Severe: Purulent/Abscesses

Systemic Signs:

        - Temp > 100.4*F
        - HR > 90 BPM
        - WBC > 12000 < 4000 cells/mm^3
60
Q

Outpatient Treatment of MSSA/MRSA & Streptococci SSTIs

Impetigo

A

Honey-colored crusts

DOC: mupirocin (Bactroban)

**if numerous lesions, use PO abx for MSSA: Keflex

61
Q

Outpatient Treatment of MSSA/MRSA & Streptococci SSTIs

Folliculitis/furuncles/carbuncles

A

Follicles & Furuncles: warm compress

Carbuncles require incision & drainage ((&D)

  • *if systemic signs, PO for MSSA: Keflex
  • *if unresponsive to initial treatment, change to CA-MRSA: Bactrim or Doxy
62
Q

Mild Cellulitis (Non-purulent) SSTI

A

PO abx must be active againists Streptococci + MSSA

DOC: Keflex
Alt: Clindamycin

63
Q

Mild-Moderate purulent SSTI

A

Commonly caused by CA-MRSA

1st-line: I&D

**if systemic signs or multiple sites: I&D PLUS Bactrim or Doxy

64
Q

Severe purulent SSTI Treatment

A

Cover MRSA + CA-MRSA

Vancomycin (goal trough 10-15 mcg/mL)
Daptomycin**
Linezolid**

**VRE coverage

65
Q

Necrotizing fasciitis Treatment

A

Empiric therapy is broad: Vanc + beta-lactam

Beta-lactam: piperacillin/tazobactam (Zosyn), imipenem/cilastatin or meropenem)

66
Q

What are the aerobic Gram-positive pathogens?

A

S. aureus (MRSA)
Group A Streptococcus
Viridans group Streptococci
S. epidermidis

67
Q

What are the aerobic Gram-negative pathogens?

A 
E. coli
K. pneumoniae
P. mirabilis
Enterobacter cloacae
Pseudomonas
68
Q

What are the anaerobic Gram-positive pathogens?

A

Peptostreptococcus

Clostridium perfringens

69
Q

What are the anaerobic Gram-negative pathogens?

A

Bacteroides fragilis and faecium

70
Q

Urinary Tract Infection (UTI) Symptoms

A 
-------Cystitis (Lower UTI)-------
urgency and frequency (nocturia)
dysuria
suprapubic heaviness
hematuria
----Pyelonephritis (Upper UTI)----
flank pain
----Vaginal Candida albicans "fungal infection"----
itchy
71
Q

Uncomplicated UTIs occur in what population(s)?

A

non-pregnancy women

72
Q

Complicated UTIs occur in what population(s)?

A

Males
Patients with indwelling catheter
Children

73
Q

Does the presence of bacteria alone qualify to be diagnosis as a UTI?

A

No

Urinalysis must confirm pyuria & bacteriuria

Exception: asymptomatic bacteriuria in pregnancy

74
Q

Drugs of Choice in Acute Uncomplicated Cystitis

A

Macrobid 100 mg PO BID x 5 days (CI: CrCl < 60 mL/min)

OR

Bactrim DS 1 tab PO BID x 3 days

OR

Fosfomycin 3 g x 1 dose

75
Q

What are the drugs of choice in pregnancy with acute uncomplicated cystitis?

A

Keflex & Amoxicillin x 7 days

**PCN allergy: Fosfomycin

76
Q

Which quinolone is not used in UTIs?

A

Moxifloxacin

it’s only available in retail as antibiotic eye/ear drops

77
Q

What is the class of choice in Complicated UTI if ESBL-producing bacteria is present?

A

Carbapenems

78
Q

Phenazopyridine - Brand & Counseling Points

A

Brand: Pyridium or AZO

CP: max 2 days, take with 8 oz of water or food to decr. GI upset, may cause red-orange coloring of urine; contact lense/clothes staining

79
Q

Common pathogens of Travelers’ Diarrhea

A 
-----Bacterial------
E. coli
Campylobacter jejuni
Shigella
Salmonella

Viral: Rotavirus

80
Q

Travelers’ Diarrhea Treatment

A

Azithromycin preferred treatment if fever, blood in stools, pregnant or pediatric

Quinolones (1-3 days) or rifaximin (3 days) if bloody diarrhea is not present

Antimotility agents: Loperamide (for symptomatic relief only)

81
Q

Symptoms of C. difficile infection (CDI)

A 
Abdominal cramps
Profuse diarrhea (can be bloody)
Fever
82
Q

C. difficile guideline recommendations for treatment

A
  • ———1st episode (nonsevere or severe)——-
  • Vancomycin 125 mg PO QID x 10 days OR
  • Fidaxomicin 200 mg PO BID x 10 days
  • *if non-severe and above treatment not available
  • Metronidazole 500 mg PO TID x 10 days

——–Fulminant/Complicated 1st episode——-Vancomycin 500 mg PO/NG/PR QID + Flagyl 500 mg IV Q8H

  • ——2nd episode “Recurrence”————
  • If MET used initially: Vanc 125 mg PO QID x 10 days
  • If VANC used initially: FDX 200 mg PO BID x 10 days
  • If VANC or FDX used initially: Vanc tapered and pulsed regimen** (125 mg QID x 10 days, BID x 1 week, daily x 1 week, then 125 mg Q2-3 days x 2-8 weeks)

——-Subsequent Episodes———–
VANC taperer and pulsed regimen** OR

VANC 125 mg PO QID x 10 days,
then rifaximin 400 mg TID x 20 days OR

FDX 200 mg PO BID x 10 days OR

Fecal microbiota transplant

83
Q

Syphilis (primary, secondary or early latent)

Treatment of Choice, Dosing/Duration & Alternatives

A

DOC: Bicillin L-A

Dosing/Duration: 2.4 million units IM x 1

Alternatives: Doxycycline

If allergic to PCNs (desensitized and treat with Bicillin L-A)

  • HIV
  • Pregnancy
84
Q

Syphilis (late latent or tertiary)

Treatment of Choice & Dosing/Duration

A

DOC: Bicillin L-A

Dosing/Duration: 2.4 million units IM x 3 weeks

85
Q

Neurosyphilis and congenital syphilis DOC

A

Pen G

86
Q

Gonorrhea DOC

A

Ceftriaxone
< 150 kg: 500 mg IM x 1
> 150 kg: 1 g IM x 1

If Chlamydia has not been excluded: add Doxycycline

87
Q

Chlamydia DOC

A

Doxycycline 100 mg PO BID x 7 days

OR

Azithromycin 1 g PO x 1

88
Q

Bacterial Vaginosis DOC

A

Metronidazole PO or 0.75% gel

89
Q

Trichomoniasis DOC

A

Metronidazole 2 g PO x 1

CDC recommended Flagyl in all trimesters (even though MET is CI in 1st trimester)

90
Q

Genital Warts (HPV) DOC

A

Imiquimod cream

91
Q

What is the drug of choice in rickettsial diseases?

A

DOC: Doxycycline

DOC esp. pediatrics

NAPLEX 2022 (25 decks)

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