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naplex id > Infectious Diseases II: Bacterial Infections > Flashcards

Infectious Diseases II: Bacterial Infections Flashcards

1
Q

What is the recommended perioperative antibiotic prophylaxis for

Cardiac/vascular or orthopedic surgical procedure

Common pathognes: MSSA & streptococci (skin flora)

A

Cefazolin

Beta-lactam allergy: clindamycin or vancomycin

Common pathognes: MSSA, streptococci

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2
Q

What is the recommended perioperative antibiotic prophylaxis for

Gastrointestinal surgical procedure

Common pathognes: skin flora, gram-negative and anaerobic organisms

A

Cefazolin + metronidazole

Alternatives: cefotetan, cefoxitin, or ampicillin/sulbactam

Common pathognes: skin flora, gram-negative and anaerobic organisms

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3
Q

What is the recommended antibiotic for

Meningitis

Common pathogens: S. pneumoniae, N. meningitidis, Listeria monocytogenes

A

Ceftriaxone or cefotaxime +/-
Ampicillin +/-
Vancomycin

  • Use cefotaxime in neonates (ceftriaxone can caise biliary sludging and kernicterus in neonates)
  • Ampicillin covers Listeria monocytogenes in neonates, age > 50 years and immunocompromised patients
  • Vancomycin provides double coverage for S. pneumoniae in patients ≥ 1-month-old
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4
Q

What is the recommended antibiotic for

Acute otitis media

Common pathogens: S. pneumoniae, H. influenzae, Moraxella catarrhalis

A

Amoxiciilin
or
Amoxicillin/Clavulanate

90 mg amoxicillin/kg/day in 2 divided doses

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5
Q

What is the recommended antibiotic for

Pharyngitis
“strep throat”

Common pathogen: S. pyogenes

A

Penicillin or amoxicillin

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6
Q

What is the recommended antibiotic for

  • Acute sinusitis
  • Acute bacterial exacerbation of COPD

Common pathogens: S. pneumoniae, H. influenzae, Moraxella catarrhalis

A

Amoxicillin/Clavulanate

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7
Q

What is the recommended antibiotic for

Pertussis
“whooping cough”

Causative pathogen: Bordetella pertussis

A

Macrolides (azithromycin, clarithromycin)

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8
Q

What is the recommended antibiotic for

Outpatient CAP for “healthy” patients

Common pathogens: S. pneumoniae, H. influenzae, Mycoplasma pneumoniae

Healthy = no comorbidities
Comorbidities: chronic heart, lung, liver or renal disease, diabetes, alcohol use disorder, malignancy, or asplenia

A

Amoxicillin high-dose (1g TID)
or
Doxycycline
or
Macrolide (azithro, clarithro) if local pneumococcal resistant is < 25%

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9
Q

What is the recommended antibiotic for

Outpatient CAP for “high-risk” patients

Common pathogens: S. pneumoniae, H. influenzae, Mycoplasma pneumoniae

High risk = with comorbidities
Comorbidities: chronic heart, lung, liver or renal disease, diabetes, alcohol use disorder, malignancy, or asplenia

A

Beta-lactam plus macrolide or doxycycline
* Amoxicillin/clavulanate or cephalosporin (e.g., cefpodoxime, cefuroxime) plus
* Macrolide or doxycycline

or

Respiratory quinolone monotherapy (levofloxacin or moxifloxacin)

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10
Q

What is the recommended antibiotic for

Inpatient CAP for “non-severe” patients

Common pathogens: S. pneumoniae, H. influenzae, Mycoplasma pneumoniae

Non-severe = admission to a general medicine unit

A

Beta-lactam plus macrolide or doxycycline
* Preferred beta-lactams: ceftriaxone, cefotaxime, ceftaroline or ampicillin/sulbactam

or

Respiratory quinolone monotherapy (levofloxacin or moxifloxacin)

MRSA: add vancomycin or linezolid
Pseudomonas: use a beta-lactam with acitivity against Pseudomonas
Hospitalization and use of parenteral antibiotics in the past 90 days: use a regimen with antibiotics active against both MRSA and Pseudomonas

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11
Q

What is the recommended antibiotic for

Inpatient CAP for “severe” patients

Common pathogens: S. pneumoniae, H. influenzae

Severe = admission to the ICU

A

Beta-lactam + macrolide
or
Beta-lactam + respiratory quinolone monotherapy

Preferred beta-lactams: ceftriaxone, cefotaxime, ceftaroline or ampicillin/sulbactam

Do not use respiratory quinolone monotherapy

MRSA: add vancomycin or linezolid
Pseudomonas: use a beta-lactam with acitivity against Pseudomonas
Hospitalization and use of parenteral antibiotics in the past 90 days: use a regimen with antibiotics active against both MRSA and Pseudomonas

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12
Q

What is the recommended antibiotic for

HAP/VAP

Common pathogens: nosocomial pathogens

A
  1. All patients need an antibiotic for Pseudomonas and MSSA
  2. Add vancomycin or linezolid if risk for MRSA
  3. Use two antibiotics for Pseudomonas if risk for MDR gram-negative pathogens (do not use two beta-lactams together)

MDR gram-negative pathogens: Klebsiella spp., E. coli, Acinetobacter spp., Enterobacter spp.
Risk factors for MDR: IV antibiotic use in the past 90 days, prevelence of gram-negative resistance in hospital unit is > 10%, hospitalized ≥ 5 days prior to the onset of VAP

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13
Q

What is the recommended antibiotic for

Latent tuberculosis

Causative pathogen: Mycobacterium tuberculosis

A
  1. INH + rifapentine weekly for 12 weeks (do not use in pregnancy)
  2. INH + rifampin daily for 3 months
  3. Rifampin daily for 4 months
  4. Isoniazid daily for 6 or 9 months (preferred in HIV-positive patients)
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14
Q

What is the recommended antibiotic for

Active tuberculosis

Causative pathogen: Mycobacterium tuberculosis

A

Initial intensive phase (2 months) with RIPE:
Rifampin + Isoniazid + Pyrazinamide + Ethambutol

Continuation phase (≥ 4 months) with RI:
Rifampin + Isoniazid

All RIPE: ↑ LFTs, including total bilirubin
Rifampin: flu-like syndrome, orange bodily secretions, strong CYP3A4 inducer (can use rifabutin if unacceptable DDIs)
Isoniazid: peripheral neuropathy (give w/ pyridoxine/vitamin B6 25-50 mg daily), DILE
Rifampin and isoniazid: hemolytic anemia (identified w/ positive Coombs test)
Pyrazinamide: ↑ UA - do not use w/ acute gout
Ethambutol: visual damage (requires baseline and monthly vision exams), confusion/hallucinations

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15
Q

What are the common pathogens for

Infective endocarditis

A

Staphylococci, streptococci, enterococci

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16
Q

What is the recommended antibiotic for

Infective endocarditis

A

Beta-lactams

Beta-lactam allergy: vancomycin

Gentamicin is added to the antimicrobial regimen for synergy when the infection is more difficult to eradicate

Rifampin may be added in cases of staphylococcal prosthetic valve endocarditis

17
Q

Who are at risk for

Infective endocarditis

A

Dental work needed, such as a root canal
+
Select cardiac conditions, including:
* Artifical (prosthetic) heart valve or heart valve rapaired with artifical material
* History of endocarditis
* Heart transplant with abnormal heart valve function
* Certain congenital heart defects including heart/heart valve disease

18
Q

What is the recommended prophylaxis for

Infective Endocarditis

A

Amoxicillin 2 grams PO

Beta-lactam allergy: azithro or clarithro 500 mg, or doxycycline 100 mg

19
Q

What is the recommended antibiotic for

Spontaneous Bacterial Peritonitis

Common pathogens: streptococci, proteus, E. coli, Klebsiella

A

Ceftriaxone x5-7 days

20
Q

What are the secondary prophylaxis for

Spontaneous Bacterial Peritonitis

Common pathogens: streptococci, Proteus, E. coli, Klebsiella

A

Cipro or SMX/TMP

21
Q

What are the common pathogens for

Skin and Soft-Tissue Infections (SSTIs)

A

Staphylococci and streptococci

22
Q

What is the recommended antibiotic for

Impetigo

Common pathogens: S. pyogenes, S. aureus

Superficial infections

A
  • Use warm, wet compresses to help remove dried crusts
  • For limited, localized lesions: topical mupirocin
  • For numerous, extensive lesions: cephalexin, dicloxacillin
23
Q

What is the recommended antibiotic for

Folliculitis/Furuncle/Carbuncle

Common pathogens: S. aureus

Superficial infections

A
  • Folliculitis and small furuncles may require only warm compresses to ↓ inflammation and help with drainage
  • Incision & drainage (I&D) ± antibiotics is recommended for large furuncles and carbuncles
  • Use antibiotics that cover MSSA and MRSA: SMX/TMP, doxycycline
24
Q

What is the recommended antibiotic for

Cellulitis (non-purulent infections)

Common pathogens: Streptococci, S. aureus

Mild infections

A

Cephalexin

Beta-lactam allergy: clindamycin

25
Q

What is the recommended antibiotic for

Abscess (purulent infections)

Common pathogens: S. aureus

Mild-moderate infections

A

Use oral antibiotics that cover MSSA and MRSA:
* SMX/TMP
* Doxycycline

26
Q

What is the recommended antibiotic for

Severe purulent SSTI

Common pathogens: S. aureus (MRSA)

Mild-moderate infections

A

Use antibiotics with MRSA activity:
* Vancomycin
* Daptomycin
* Linezolid

27
Q

What is the recommended antibiotic for

Necrotizing fasciitis

Common pathogens: S.pyogenes, S. aureus, gram-negatives, anaerobes

Mild-moderate infections

A
  • Urgent surgical debridement
  • Empiric therapy is broad: vancomycin or daptomycin + beta-lactam (piperacillin/tazobactam, meropenem) + clindamycin

Clindamycin to suppress streptococcal toxin production

28
Q

What is the recommended antibiotic for

Acute uncomplicated cystitis

Common pathogens: E. coli, Proteus, Klebsiella, enterococci

A
  • Nitrofurantoin (Macrobid) 100 mg PO BID x5 days
  • SMX/TMP DS 1 tab PO BID x3 days
  • Fosfomycin 3g x1 dose

Pregnancy: amoxicillin, cephalexin, fosfomycin (if beta-lactam allergy)

29
Q

What is the recommended antibiotic for

Acute pyelonephritis

Common pathogens: E. coli, Proteus, Klebsiella

A

Moderately ill outpatient (PO)
* If local quinolone resistance ≤ 10%: cipro or levo (SMX/TMP or beta-lactam if concern for quinolone adverse effects)
* If local quinolone resistance > 10%: ceftriazone IV/IM, ertapenem IV/IM

Severely ill hospitalized patient (IV)
* Initial: ceftriaxone or a quinolone (cipro or levo)
* Concern for resistance: piperacillin/tazobactam or a carbapenem (if ESBL-producing organism suspected)

30
Q

What is the recommended antibiotic for

Bacteriuria in pregnancy

A
  • Beta-lactams are preferred (Augmentin or an oral cephalosporin)

Beta-lactam allergy: fosfomycin

31
Q

What is the recommended antibiotic for

C. difficile

A

1st episode:
* FDX
* Vanco (standard regimen)
* Metronidazole (only if non-severe and other treatments are unavailable)

2nd episode:
* FDX
* Vanco (standard followed by prolonged tapered course)

3rd episode:
* FDX
* Vanco (standard followed by prolonged tapered course)
* Vanco + rifaximin
* Fecal microbiota transplantation

Adjunct bezlotoxumab can be considered for high-risk patients: ≥ 65 years, immunocompromised status, severe presentation and/or expeienceing a 2nd episode of CDI within the past 6 months

Fulminant/complicated disease (can occur with any episode/recurrence) is diagnosed when significant systemic toxic effects are present, such as hypotension, shock, ileus or toxic megacolon: Van PO/NG/PR + metronidazole

32
Q

What is the recommended antibiotic for

Syphilis

Pathogen: treponema pallidum

A

Penicillin G benzathine (Bicillin L-A)

Beta-lactam allergy: doxycycline
Pregnancy: penicillin desensitization

33
Q

What is the recommended antibiotic for

Neurosyphilis

Pathogen: treponema pallidum

A

Penicillin G aqueous

Beta-lactam allergy: penicillin desensitization

34
Q

What is the recommended antibiotic for

Gonorrhea

Pathogen: neisseria gonorrhoeae

A

Ceftriazone
If chlamydia has not been excluded: add doxycycline

35
Q

What is the recommended antibiotic for

Chlamydia

Pathogen: chlamydia trachomatis

A
  • Non-pregnant: doxycycline
  • Pregnant: azithromycin
36
Q

What is the recommended antibiotic for

Bacterial vaginosis
Trichomoniasis

Bacterial vaginosis pathogen: gardnerella vaginalis
Trichomoniasis pathogen: trichomonas vaginalis

A

Metronidazole

37
Q

What is the recommended antibiotic for

Genital warts

Pathogen: HPV

A

Imiquimod cream

38
Q

What is the recommended antibiotic for

Common tickborne diseases:
* Rocky mountain spotted fever
* Lyme disease
* Ehrlichiosis

Rocky moyntain spotted fever pathogen: rickettsia rickettsii
Lyme disease pathogen: borrelia spp.
Ehrlichiosis pathogen: ehrlichia chaffeensis

A

Doxycycline

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