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Infectious Diseases (tx options) Flashcards

1
Q

Otitis media common pathogens

A

Strep Pneumo. > H.Influenzae. M. Catarhallis

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2
Q

Otitis media first line therapy. (2)

A

Watchful waiting OR Amoxicillin (high/low dose- 40, 75-90) split BID-TID

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3
Q

Otitis media 2nd line therapy. (6) (+ when to use)

A

Symptoms not improve after 3 days : Hi dose amox, amox-clav, cefuroxime, cefprozil, ceftriaxone injection, clindamycine.

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4
Q

Streptococcal sore throat common pathogens.

A

Group A strep. (beta hemolytic)

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5
Q

Streptococcal sore throat first line therapy

A

Pen VK

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6
Q

Streptococcal sore throat second line therapy. (6)

A

Cephalexin, cefuroxime, cefprozil, cefixime, amoxicillin, cefadroxil.

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7
Q

Streptococcal sore throat - pen LRG (4)

A

Clinda, azithro, erythro, clarithro.

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8
Q

Acute sinusitis common pathogens.

A

Strep Pneumo, H.Flu, (M. Catarrhalis: children) (in adults catarrhalis less common than flu.)

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9
Q

Acute sinusitis first line therapy children. Duration.

A

Amoxicillin HD, or Amox-clav. If Pen allergic: SMP-TMX. X 10 days

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10
Q

Acute sinusitis first line therapy adults. Duration.

A

Amoxicillin. If pen LRG: Doxycycline or SMX-TMP. X 10 days.

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11
Q

CHRONIC sinusitis pathogens.

A

Anaerobes (mostly). Someimes gram (+), (-)

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12
Q

CHRONIC sinusitis treatment. Duration.

A

Amoxi-clav. Beta lactam LRG - Clindamycin. 3 wks

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13
Q

Acute bronchitis common pathogens.

A

90% viral

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14
Q

Acute bronchitis first line therapy.

A

Nothing

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15
Q

Community acquired pneumonia common pathogens.
Ambulatory
Treated in Hospital
Treated in ICU

A

Ambulatory: Strep. Pneumo > Mycoplasma Pneumo > H.flu
Treated in Hospital: Strep. Pneumo, Chlamydia Pneum (atyp), H. Influenzae, legionella.
Treated in ICU: Strep pneumo, staph aureus, legionella.

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16
Q

Community acquired pneumonia first line therapy:

Outpatient - previously healthy.

A

Outpatient - previously healthy - Macrolide (any) OR Doxycycline

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17
Q

Community acquired pneumonia first line therapy:

Outpatient - w/ risk factors.

A

Outpatient - w/ risk factors - (Macrolide (not erythro) + HD amox OR amox-clav) or R. FQ

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18
Q

Community acquired pneumonia first line therapy:

Inpatient - ward.

A

Inpatient - ward - Betalactam (IV/PO) + Macrolide (IV/PO) OR R. FQ

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19
Q

Community acquired pneumonia first line therapy:

Inpatient - ICU.

A

Inpatient - ICU - Betalactam IV + one of: Macrolide IV OR R.FQ IV

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20
Q

Community acquired pneumonia first line therapy:

Inpatient - suspected pseudomonas -

A

Antipseudomonal B-lactam + Cipro OR AG + Macrolide OR AG + Cipro

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21
Q

Latent TB therapy first line.

Second line.

A

INH daily, or 2x/wk for 9 months

Rifampin daily x 4 months. (if cannot tolerate INH)

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22
Q

Active TB drug therapy (4)

A

RIP(+/-)E x 2 months. RI x 4 months.

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23
Q

INH resistant TB therapy (5)

A

RPE +/- FQ or streptomycin

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24
Q

RIF resistant TB therapy (5)

A

IPE +/- FQ or streptomycin

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25
Bacterial meningitis pathogens. | <6 wk
6 wk: E.coli, L.monocyogenes, group B strep.
26
Bacterial meningitis pathogens. | 6 wk- 3mo
< 3mo: E.coli, group B strep, Strep. Pneumo, H. Flu, N. Meningitidae
27
Bacterial meningitis pathogens. | 3mo - <50
> 3mo: Strep pneumo, N.meningitidae, (h.flu - most have vaccine)
28
Bacterial meningitis pathogens. | >50 years
>50 years: Strep. Pneumo, N. Meningiditis, L. monocytogenes, E.coli
29
Bacterial Meningitis first line therapy for <6 wk
Ampicillin + cefotaxime (ceftriaxone causes hyperbilirubinemia in neonates)
30
Bacterial Meningitis first line therapy for 6 - wk to 3mo
Ceftriaxone or Cefotaxime + Ampicillin + Vancomycin
31
Bacterial Meningitis first line therapy for 3mo - 50yr
Ceftriaxone or Cefotaxime + Vancomycin
32
Bacterial Meningitis first line therapy for > 50 yr old
Ceftriaxone or Cefotaxime + ampicillin + vancomycin
33
Hematogenous osteomyelits typical pathogens
Strep, Staph, enteric gram (-)
34
Contiguous osteomyelitis typical pathogens - head neck
Staph aureus, anaerobes, gram (-)
35
Contiguous osteomyelitis typical pathogens - Soft tissue spread
Staph/strep
36
Contiguous osteomyelitis typical pathogens - Genitourinary spread
Gram (-)
37
Contiguous osteomyelitis typical pathogens - Penetrating wound
Pseudomona or Staph Aureus (anti-pseudomonal agent + staph agent)
38
Hematogenous osteomyelits first line therapy.
Cloxacillin (or Vanco), +/- Cefotaxime (if suspected gram (-)
39
Contiguous osteomyelitis head neck first line therapy.
Clindamycin +/- gentamicin
40
Contiguous osteomyelitis Soft tissue spread first line therapy.
Cloxacillin or Cefazolin
41
Contiguous osteomyelitis Genitourinary spread first line therapy.
Fluoroquinolone OR extended spectrum B-lactam (recall only 3rd gen cephs = IV
42
Contiguous osteomyelitis Penetrating wound first line therapy.
Adult: Cipro
43
Osteomyelits route of therapy. Duration.
IV only. Higher dose than normal. 4-6 weeks.
44
Infective endocarditis - most common pathogens.
Staph (40%), Strep (20%, Enterococcus (10%)
45
First line therapy for IE -staph. | With Native Valve.
Native valve: Cefazolin or Cloxacillin (+/- AG for 3-5 days (time related toxicity)
46
First line therapy for IE -staph. | With replaced Valve.
Artificial valve: Cefazolin or Cloxacillin + Rifampin + AG
47
First line therapy for IE -staph. MRSA.
MRSA. Vancomycin alone, or Vancomycin + Rifampin + AG respectively.
48
Duration of treatment for Staph
6 weeks of therapy, unless uncomlicated, right sided only (2 weeks)
49
First line therapy for IE -strep | With Native Valve.
With Native Valve: PenG or Ceftriaxone (x 4wks) OR PenG/Ceftriaxone + AG (x2 wks)
50
First line therapy for IE -strep | With replaced Valve.
With replaced Valve: Peng or ceftriaxone (+/- AG depending on resistance) x 6 wks.
51
First line therapy for IE -strep - B-lactam resistance.
MRSA: Vancomycin x 4 wks (native valve) or Vanco x 6 wks (artificial valve)
52
Duration of Abic therapt for IE- Strep
Duration: 4 wks for native valve, 2 weeks for accelerated AG synergy, 6 wks for artificial valve.
53
First line therapy for IE -Enterococcus | No resistances
No resistances: Ampicillin or PenG + Aminoglycoside OR Vancomycin + AG x 4-6 wks.
54
First line therapy for IE -Enterococcus | Resistant to AG
Resistant to AG: Ampicillin or PenG + Streptomycin OR Vancomycin + AG
55
First line therapy for IE -Enterococcus | Resistant to penicillin
Resistant to penicillin: Vancomycin + Gentamicin.
56
Duration of therapy for IE - Enterococcus.
Duration: 2-6 weeks for NON-vanco regimens. 6 Weeks for vanco regimens.
57
Typical pathogens of uncomplicated UTI (1)
E.coli (90%)
58
Typical pathogens of pyelonephritis (1)
E.Coli (90%)
59
Typical pathogens of Complicated UTI (3)
E.coli (50%, Enterococcus (10%), Pseudomonas
60
Typical pathogens of bacterial prostatitis. (3)
E.coli, Pseudomonas, Staph aureaus
61
First line therapy of uncomplicated UTI (3)
Nitrofurantoin x 5 days, SMX-TMP, TMP. X 3days
62
second line therapy of uncomplicated UTI(2)
2nd line: Fluoroquinolone x 3 days. Cephalexin x 7 days.
63
First line therapy of MILD pyelonephritis (1)
First line therapy of MILD pyelonephritis- Fluoroquinolone .
64
Second line of MILD pyelonephritis (3)
Second line of MILD (3) - Amoxi/clav, SMX-TMP, TMP.
65
First line therapy for Severe pyelonephritis: (2)
First line therapy for Severe: (2) - AG +/- ampicillin
66
2nd line for severe pyelonephritis. (3)
2nd line for severe. (3) FQ or 3rd gen ceph +/- AG x 10-14 days
67
First line therapy for complicated UTI (mild)
FQ PO, TMP-SMX, TMP, Nitrofurantoin.
68
2nd line therapy for complicated UTI (mild)
2nd line: Amoxi/clav, cephalexin, cefixime. X 10 -14 days
69
First line therapy for complicated UTI (Severe)
First: Aminoglycoside +/- ampicillin
70
Second line therapy for complicated UTI (Severe)
2nd: FQ or 3rd gen cephalosporin x 10-14 days
71
First line therapy for acute prostatitis
1st: AG +/- Ampicillin (enterococcus?) +/- Cloxacillin (MRSA)
72
Second line therapy for acute prostatitis
2nd: FQ or SMX-TMP x 4-6 wks
73
Grey copius frothy discharge.
Bacterial vaginosis
74
Fishy odor.
Bacterial vaginosis
75
Off-white frothy.
Trichomoniasis.
76
Vaginal infections which increase pH .
Trichomoniasis or Bacterial
77
Topical metronidazole is OK in which vaginal infection.
Baterial only - recall topical clinda + metro only OK for bacterial
78
First line therapy for bacterial vaginosis (3)
Metronidazole 500mg BID x 7 days (or 2g single dose)
79
Second line therapy for bacterial vaginosis (1)
Topical Metro once daily x 5 day
80
Bacterial Vaginosis: Preferred drug in pregnancy.
ORAL Metronidazole. (BV can cause pre term birth - Topicals less effective at preventing this)
81
Trichomoniasis first line therapy:
Metronidazole 500mg BID x 7 days (or 2g single dose)
82
VVC- first line therapy.
Azoles - fluconazole (oral), clotrimazole, miconazole, (others).
83
Best option in pregnancy for VVC
Nystatin x 14 days. Boric acid x 14 days.
84
Chlamydia - first line therapy.(2)
Azithromycin 1g single dose or Doxycycline 100mg BID x 7 days
85
Chlamydia - Second line:
2nd: Erythromyxin, levofloxacin, ofloxacin, AMOXIcillin. X 7 days.
86
Gonorhoea - first line therapy.
Ceftriaxone 125mg Im, or cefixime 400mg PO.
87
Gonorhoea - second line. (4)
Alt - cirpo, ofloxacin, cefotaximr, spectinomycin. ALL single doses.
88
Syphillis - first line therapy. Acute latent (1) Late latent Neurosyphillis
2.4million units PenG. X 1 dose late latent: 2.4 million units/dose x 1 dose/wk x 3 wks. Neurosyphillis: 3-4 million units q 4 hours x 10-14 days
89
Syphillis - 2nd line.
2nd: Doxy - but consider desensitizing patient.
90
Ano-genital warts - first line therapies. (5)
Imiquod, podophyliin, podophyllotoxin, trichloro acetic acid, dichloro acetic acid.
91
Ano-gential warts drug therapy safe in pregnancy. (2)
Dichloroacetic acids + liquid nitrogen.
92
Chicken pox - therapy must be started within how many hours.
<24 hours.
93
Drug of choice for chicken pox.
Acyclovir - but only use in those likely to experience complications (comrobidities or >12 years old)
94
Shingles - therapy must be started within how many hours.
<72 hours -
95
First line agents for shingles (3)
Famcyclovir - 500mg TID x 7 days Valacyclovir - 1000mg TID x 7 days Acyclovir - 800mg 5x/day x 7 days.
96
Herpetic Antiviral medications safe in pregnancy.
All are believed to be safe in pregnancy/lactations.
97
Oroloabial herpes first line agents: Topical agents available: Suppression (2)
Valacyclovir - 2g single oral dose Acyclovir 400mg 5x/day x 5 days Famcyclovir - 1.5g single oral dose. Topical acyclovir - start within 1 hour of sxs - apply 5x/day during waking hours x 4 days. Suppression: acyclovir 400mg BID or valacyclovir 500mg OD (x 4 months)
98
Genital herpes first line agents: (3) | Supression (3)
``` Acyclovir 200mg 5x/day x 7-10 days Famcyclovir 250mg tid x 7-20 days valacyclovir 1000 BID x 7-10 days Suppression= acyclovir 200mg 5x/day, valacyclovir 500mg OD, famcyclovir 250mgBID (x 3-6 mo) (LESS SEVERE SHINGLES) ```
99
TD prophylaxis (3)
Bismuth subsalicylate qid w/meals. FQ (better to use as tx. Dukoral (ETEC + cholera vaccine)
100
TD treatment Mild Moderate Severe
Mild (5 BM/day or blood or fever): antibioitcs + ORT +/- loperamide (if fever - never w/o Abics)
101
TD antibiotics first line: | First line in children:
Cipro 500mg BID x 5 days (Not ok in south east asia or india - resistance) Levo floxacin - 500mg OD SMX-TMP (only good in mexico in summer due to resistances) Azithromycin 500mg OD x 3 days (DoC in southeast asia/india.
102
``` Appropriateness of the following medications in children for TD: Bismuth salicylate Loperamide SMX-TMP Azithromycin FQ's ```
``` Reyes < 3 years not OK Resistance Drug of choice! Cartilage problems. ```
103
Malaria Prophylaxis algorithm. If 1st line not an option. If 2nd line not an option. If 2nd + pregnant or
Chloroquine. Mefloquine (seizure/psychiatric hx) --> doxycycline, primaquine, atovaquone-proguanil (pregnant/ NO for pregnancy. Atovaquone - proguanil for child. Chloroquine = central america Mefloquine = south east asia/india
104
Pregnancy drug of choice for malaria prophylaxis
Chloroquine.
105
When malaria prophylaxis started/stopped.
2 weeks before - continued for 4 weeks after.
106
Which anti-malarial kills hypnzooites.
Primaquine

PEBC (6 decks)

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