Infectious Dz Flashcards
Coverage of Penicillin (G, V, benzathine)
Viridans strep
Strep pyo
Oral anaerobes
Syphillis
leptospira
Coverage of ampicillin and amoxicillin
Same as penicillin +
E. coli
Lyme
Some G (-) coverage
HELPS
H. influenszae
E. coli
Leptospira
Proteus
Salmonella
Penicillins are the best initial therapy for
Otits media
Dental infection and endocarditis prophylaxis
Lyme disease
UTI in prego
Listeria
Enterococcal
What are the penicillinase resistant penicillins?
What are they used to Tx?
Skin infections (impitigo, cellulitis, erysipelas)
Endocarditis, meningitis, bacteremia from staph
Osteomyelitis and septic arthritis is bug sensititive
Oxacillin, cloxacillin, dicloxacillin, nafacillin
Best initial therapy for:
Cholecystitis, ascending cholangitis
Pyelonephritis
Bacteremia
VAP
Neutropenia with fever
Pipercillin
ticarcillin
azlocillin
mezlocillin
(cover G- bacilli as well as pseudomonas)
Reason we do not use methacillin
Causes renal failure from allergic interstitial nephritis
Best initial therapy for PID
Cefotan or cefoxitin (2nd gen)
+
Doxycycline
Ceftriaxone is this generation and covers…
3rd gen
CAP- pneumococcus with a macrolide
Meningitis
Gonorrhea
Lyme involving heart or brain
Which cefalosporin not to give noenates
Ceftriaxone
4th gen cephalosporin
Cefepime
Covers more staph– VAP
Adverse effect of cefoxitin and cefotan
deplete prothrombin and increase bleeding risk
Carbapenems cover…
Gram - bacilli
anaerobes
Step
Staph
Only monobactam abx
Good for…
Aztreonam
Exclusively for gram negative bacilli and pseudomonas
Best therapy for CAP
Levofloxacin and other Fluoroquinolones
Best treatment for cystitis and pyelonephritis
Ciprofloxacin
Only single agent treatment for diverticulitis
Moxifloxacin
Cautions with fluroquinolones
Bone growth abnormalities
Tendonitis and achillies tendon rupture
Side effects of aminoglycosides (gentamycin and tobramycine)
Ototoxic and nephrotoxic
god for gram negative bacilli in the bowel urine and bacteremia
Doxycycline works well for…
Chlamydia
Lyme disease (limited to joint, rash, bell palsy)
Rikettsia
Adverse effects of doxy
tooth discoloation
fanconi syndrome (Type II RTA proximal)
Photosensitivity
TMP-SMX works well for
cystitis
PCP pna tx and prophylaxis
Adverse effects of TMP-SMX
Rash
Hemolysis in G6PD deficiency
Bone marrow suppression (folate antag)
Best initial therapy for gram-positive organisms (staph and strep)
Oxacillin
Cloxacillin
Dicloxacillin
Nafcillin
Best initital treatments for MRSA
Vanc
Linezolid
Daptomycin- elevated CPK
Tigecycline
Ceftaroline
Best tharapies for gram-negative bacilli
(peritonitis, diverticulitis, pyelo, cholangitis, cholecystitis)
Quinolones
aminoglycosides
carbapenems
piparcillin
aztreonam
cephalosporins
Coverage for oral anaerobes
Penicillin (G, VK, ampicillin, amxicillin)
Clindamycin
Coverage for abdominal/GI anaerobes
Metronidazole
beta-lactamase/lactamase combo
When to answer head CT first when suspecting infection…
If there is the possibility of a space occupying lesion
- papilledema
- seizures
- focal neurological abnormalities
- Confusion
Best initial treatment for bacterial meningitis
Ceftriaxone
Vancomycin
steroids
If a patient presents with meningitis and has risk factors for listeria, what medication should be added/started…
Ampicillin
Risk factors:
Elderly, neonate, steroids, AIDS/HIV, pregnant, alcoholics
Close contacts to patients with Neisseria meningitidis should recieve…
Rifampin
Cipro
or Ceftriaxone
Most common neurological deficit of untreated bacterial meningitis
CN VIII deafness
Most common cause of encephalitis (acute onset confusion and fever)
Herpes simplex
Best initial therapy for herpes encephalitis
Acyclovir
Adverse effect of acyclovir…what is the treatment
Nephrotoxicity
decrease dose and add hydration
Treatment of choice for herpes encephalitis if acyclovir resistant
Foscarnet
A patient has recurrent otitis media that is reisitant to ABX, what is the best step in management
Typanocetesis
What is the most accurate diagnostic test for otitis media
tympanocentesis
Best initial therapy for otitis media
amoxicillin
amox-clavulinate if resistant
Patient with clearly described sinusitis..what is the next step OR action OR management
Amoxcillin/clavulinic acid and a decongestant
Dx clear so treat it
Tx for strep pharyngitis
Amoxicillin or penecillin
Tx for strep pharygitis if patient allergic to penicillion
Cephalexin if reaction is rash
clinda or macrolid is rxn is anaphylactic
Wheezing, flushing, rash following ingestion of fish
Scombroid– tx with antihistamines
Treatment for giardia
metronidazole or tinidazole
e-antigen in hepatitis is synonomys with
DNA polymerase
Tx of Hep C PCR-RNA is elevated
Interferon
+
Ribavirin and wither bocepavir or teleprevir
Treatment for gonorrhea and chlamydia
cefixime/ceftriaxone
and
Azithromycin or doxycycline
Most accurate test for PID
Laproscopy
Treatment for pyelonephritis
Ceftriaxone or ertipenem
Amp an gent until cultures are known
Cipro outpatient
Treatment for prostatitis
TMP/SMX for 6-8 weeks
Best initial empiric therapy for endocarditis
Vancomycin and gentamicin
Tx for Viridans endocarditis
ceftriaxone 4 weeks
Treatment for sensitive staph aureus
Nafacillin, oxacillin, or cefazolin
Enterococcus endocarditis
ampicillin and gentamicin
Add this drug for prosthetic valve endocarditis
rifampin
Most common cause of culture negative endocarditis….tx?
Coxiella
(HACEK organism)
Ceftriaxone
Treatment of lyme with cardiac manifestation
IV ceftriaxone
Best initial drug regimen for HIV
Emtricitrabine
Tenofovir
Efavirenz
Drug side effect associated with:
Zidovudine
Didanosine
Abacavir (HLA B5701)
Protease inhibitors
Zidovudine- anemia
Didanosine- pancratitis
Abacavir- SJS
Protease inhibs- Metabolic syndrome (HLD and hyperglycemia)
Indication for c-section in HIV+ mother
Viral load >1000/uL
Most common cause of CAP
S. pneumoniae
Most common causes of HCAP
GNR (E. coli, pseudomonas)
S. aureus
PNA in the upper lobe a nursing home pt…think of this bug
Pseudomonas
Uncomplicated CAP give this abx
Azithromycin or clarithromycin
CAP with comorbidities give this abx
fluoroquinolone
HCAP tx is taylored towards G(-) so give this abx
Ceftazidime or cefipime
Imipenem
Pipercillin/tazoctam (zosyn)
Toxicity common to all TB drugs
Hepatotoxicity
What is the common empiric treatment algorhythm for suspected bacterial meningitis in all age groups
- Cefotaxime (kids), or Ceftriaxone (adults), or Ceftazidime (immunocomp)
- Vancomycin
- Ampicillin
(add aminoglycoside in neonates)
A patient with head, fever mailaise, myalgias, changes in alertness and behavior. MRI shows increased signals in frontotemporal area
HSV encephalitis
Tx for uncomplicated pyelonephritis
TMP/SMX or a fluoroquinolone for G(-) Rods
Amoxicillin for G(+) Cocci
Prophylactic agents for MAC pna in AIDS cd4 <100
Clarithromycin and azithromycin