Infectious Diseases II: Bacterial Infections Flashcards
Preferred ABX for surgery prophylaxis
Cefazolin - start 1hr before incision, used to prevent MSSA and strep infections
Clindamycin/Vanc used if beta-lactam allergy
Vanc preferred if MRSA colonization or risk present
ABX prophylaxis for GI surgery
gram - + anaerobe coverage
Cefazolin + metro/cefoteta/cefoxitin or amp/sulbactam
Classic meningitis symptoms
Stiff neck
Fever/Headache
altered mental status
How to Dx meningitis?
Lumbar puncture for CSF sample
high CSF pressure could also be a sign of infection
common bacterial causes of meningitis
Neisseria meningitides
streptococcus pneumoniae
Haemophilus influenzae
Risk of meningitis due to L.monocytogenes is higher in…
neonates
> 50 yrs old
immunocompromised patients
Meningitis treatments
abx course depends on bug, ranging from 7-21 days
dexamethasone given empirically before d/c or keep of s.penumo
Empiric Meningitis txm
< 1 month = Ampicillin + Cefotaxime/Gent
1 month - 50 yrs old = Ceftriaxone/Cefotaxime + Vanc
> 50 yrs old = Ampicillin + Ceftriaxone/Cefotaxime + Vanc
Acute otitis Media info
most infections are viral
observe for 48-72 hrs before starting abx
AOM 1st line TXM
High dose Amoxicillin or Amox/Clav
use formulation with least amount of Clav to decrease diarrhea risk (14:1 ratio)
Duration 10 days for < 2 yrs old, 7 days 2-5, 5-7 days 6yrs <
** 2nd/3rd gen ceps if non severe allergy to pen **
Pertussis treatment…
highly contagious
should use macrolides
COPD exacerbation defined as….
increase in symptoms that worsen in < 14 days
3 cardinal symptoms of COPD exacerbation
increased dyspnea
increased sputum volume
increased sputum purulence
who meets criteria for abx for COPD exacerbation
abx for 5-7 days if….
- meets all 3 symptoms
- inc sputum purulence + 1 additional symptoms
- mechanically ventilated
preferred abx: amox/clav, azith, doxy, resp quinolone
CAP gold standard for diagnosis
Chest x-ray
Usual duration for CAP treatment?
5-7 days of abx
CAP txm for healthy, no comorbidities
amox 1g TID
Doxy
Macrolide (azith/clarith)
CAP txm for high risk, comorbidities (DM, AUD, cancer, heart/lung/liver/renal disease)
amox/clav or cephalosporin + macrolide/ doxy
moxi/levo monotherapy
inpatient CAP txm
non-severe = Blactam (ceftriaxone/unasyn) + macrolide or doxy, resp quinolone therapy
severe = blactam + macrolide or resp quinolone
MRSA risk = add vanc/linezolid
Pseudomonas = Pip/tazo/cefepime/meropenem
if hospitalized last 90 days or used IV abx, treat as MRSA & pseudomonas risk
Hospital acquired pneumonias starts with….
> 48hrs after hospital admission
Ventilator associated pneumonias starts with….
> 48yrs after start of mechanical ventilation
HAP/VAP regimen
All req MSSA/Pseudomonas ABX = Cefepime, Zosyn, levo
Add Vanco/Linezolid if MRSA risk
Use two anti-pseudomonas if MDR risk, dont use 2 Blactam (Zosyn, Cefepime, meropenem) levo/cipro, aztreonam, AminoGlyc (usually tobra)
Who can get a false positive with TST test?
those who got Calmette-Guerin (BCG) vaccine
Latent TB treatment regimens
- Isoniazid + refapentine QW for 12 week = not used in preg
- INH + rifampin QD for 3 months
- Rifampin 600mg QD for 4 months
- INH 300mg QD for 6-9 months = pref HIV pt due to reduce DI
Active TB treatment 2 phases
intensive = RIPE (rifampin, isoniazid,pyrazinamide,ethambutol) 2 months
continuation = rifampin + isoniazid = 4 months, extend if needed
Rifampin SE
inc LFTs, hemolytic anemia, orange colored secretions (can stain skin-contact stuff), many drug-drug interactions, can replace with rifabutin if needed
Isoniazid Boxed warning
Severe and fetal hepatitis
Isoniazid CI
active liver disease, previous severe adverse reaction to isoniazid
Isoniazid warnings & SE
warning: peripheral neuropathy, vit B6 supplementation recommended
SE: inc LFTs, DILE, hemolytic anemia
Pyrazinamide CI & SE
CI: acute gout, severe hepatic damage
SE: increased LFTs, gout, GI upset
Ethambutol CI & SE
CI: optic neuritis, dont use young patients, anyone who cant discern and report visual changes
SE: inc LFTs, dose related optic neuritis, confusion, hallucinations
Common Rifampin DI
warfarin, dec INR by a lot so inc dose
oral contraceptives, dec efficacy
dont use with apixaban/rivaroxaban/edoxaban/dabigatran
Infective Endocarditis info
Empiric txm = vanc + ceftriaxone, Gentamicin added for synergy
generally 4-6 wk txm IV abx
IE prophylaxis dental regimen
1 dose 30-60min before procedure
Amox 2g
Doxy 100mg or Azith/Clarith 500mg if cant do amox
Spontaneous Bacterial peritonitis (SBP) info
often occurs in patients with cirrhosis and ascites
fluid > 250 cells PMNs
SBP empiric treatment
Ceftriaxone 5-7 days
SMX/TMP or quinolone for secondary prophylaxis after getting SBP
Intra-abdominal infections txm duration….
4-5 days after source control
Txm for Intra-abdominal infection, community acquired (low risk)
Ertapenem
Moxiflox
Cipro/Levo + metro
Cephalosporin + metro
Txm for intra-abdominal infection, risk for resistant or nosocomial pathogens
Carbapenem (no ertapenem)
pip/tazo
Cefepime/ceftazidime + metro
Impetigo info & txm
honey-colored crusts around nose/mouth/hands/arms
use mupirocin topical or cephalexin/dicloxacillin QID
folliculitis txm
SMX/TMP DS 1-2 tabs BID or Doxy 100 BID
Cellulitis txm
Cephalexin 500mg QID, Dicloxacillin 500mg QID, Clinda 300mg QID if allergic to B-lactam
txm duration = 5 days, longer if needed
Abscess, purulent infection txm
SMX/TMP 1-2 BID
Doxy 100mg BID
Minocycline 200mg X 1, 100mg BID
Clinda 300mg QID
** Cephalexin if MSSA**
Severe purulent SSTI txm
7-14 day txm duration
Vanco
Daptomycin
Linezolid
PO abx once stable
Necrotizing fasciitis txm
vanc or daptomycin + zosyn/meropenem + clinda
When is urinalysis considered positive?
WBC> 10 (pyuria)
bacteria
positive leukocyte esterase
nitrates
Pyelonephritis (Upper UTI) vs cystitis (Lower UTI)
Pyelo = flank pain, fever/chills/nausea, ab pain
cystitis = burn/pain when peeing, inc in frequency, blood in urine
Acute uncomplicated cystitis txm
Macrobid 100mg BID X 5 days (dont use CrCl < 60)
SMX/TMP DS 1 tab BID X 3 days
Fosfomycin 3g X 1 dose
Options for pregnant women uncomplicated cystitis
Amox
Cephalexin
tx for 7 days
acute pyelonephritis txm
Cipro 500mg BID X 5-7 days
Levo 750mg QD X 5-7 days
very ill hospitalized pt = IV ceftriaxone/cirpo/levo or carbapenem if think ESBL
Urinary analgesic
phenazopyridine
can make urine red/orange
200mg TID for 2 days max
Bacteriuria and pregnancy info
should be treated, even if asymptomatic
amox/clav or oral ceph preferred
avoid quinolones
Nitro or SMX/TMP can be used
C.diff symptoms
3 or more watery stools in 1 day
abdominal cramps
fever
elevated WBC
C.diff treatment
vancomycin or fidaxomicin preferred
bezlotoxumab reduces incidence of recurrence but doesn’t treat, has to be given with abx txm
Syphillis txm
primary, secondary or early latent: Pen G 2.4mil unit X 1, Doxy 100mg BID X 14 days if allergy
late latent or tertiary: Pen G 2.4mil unit QW X 3 W, Doxy 100mg BID X 28 days if allergy
Neurosyphillis txm
Pen G 3-4mil unit IV Q4H X 10-14 days, if allergy, then desensitization prior
Gonorrhea txm
Ceftriaxone:
< 150kg = 500mg X 1
> 150kg = 1g X 1
add doxy if chlamydia not excluded
Cefixime 800mg if ceftriaxone no avail
Chlamydia txm
nonpreg = doxy 100mg BID X 7 days
Preg = azith 1g X 1 dose
Erythromycin 500mg QID X 7 days, Levo 500mg QD X 7 days if allergy
preg + allergy = amox 500mg TID X 7 days
Bacterial vaginosis treatment
Metronidazole 500mg BID X 7 days or metro gel X 5 days or Glinda 2% cream X 7 days
** Dont douche **
Trichomoniasis txm
metronidazole, females 500mg BID X 7 days, males 2g X 1 dose
can still use in preg for trich
Geneital wort txm
imiquimod cream, apply 3X per week until cleared or 16 weeks
Go to drug for tick borne diseases?
Doxy 100mg BID from 5-14 day depending on what it is
