Infectious Dz Treatment Flashcards
Streptococcus sp.
Group A B-hemolytic streptococci:
Penicillin
Cephalosporins
Macrolides (for pt allergic to Penicillin)
Supportive care (i.e., fluids, analgesics, antipyretics)
Botulism
Antitoxin from CDC
If Respiratory failure: intubation, mechanical ventilation
If dysphagia: IV nutrition and hyperalimentation
Anthrax
Combo therapy for inhalation of, disseminated dz, or cutaneous infxn involving head or neck; Ciprofloxacin (1) Other Fluoroquinolone (1) Doxycycline (2) Vaccine available for exposure likelihood; Cutaneous exposure = good prognosis; Inhalation = 85% mortality; Tx early
Cholera
Fluid and electrolyte therapy;
Mild-moderate: 1 tsp salt or 4 tsp sugar and 1 cup H2O
Severe: IV replacement
Abx to shorten duration, reduce severity of sx, reserve for severely ill or comorbidities;
Tetracycline
Ampicillin
Chloroamphenicol
TMP-SMX
Fluoroquinolones
Prevent: clean H2O and food, proper waste disposal; vaccine for temporary uses
Tetanus
Immune globulin via IM; once recovered, full course of toxoid;
Bed rest, sedation, and mechanical ventilation for tetanic spasms
Penicillin
Active immunization recommended starting in children;
3-4 initial doses, then boosters q10 yrs; q5yrs if major injury occurs
Mortality is high
Salmonellosis
Ampicillin (1)
Chloramphenicol (1)
TMP-SMX (1)
Ceftriaxone (2)
Fluoroquinolones (2)
Tx for 2 wks; Tx of carries/close-contacts not effective
Prevent: clean H2O, food, and proper waster removal
Typhoid Fever: Ceftriaxone, fluoroquinolones (contra: pregnancy, children)
Gastroenteritis: self-limited; tx is symptomatic; Ampicillin/Ciprofloxacin
Bacteremia: same as typhoid; drain abscesses
Shigellosis
Abx: TMP-SMX (1) Ciprofloxacin Fluoroquinolone Amoxicillin - NOT EFFECTIVE Fluid Replacement essential
Diptheria
Penicillin Erythromycin Azithromycin (2) Clarithromycin (2 Horse serum antitoxin from CDC; If airway obstruction, removal of membrane if necessary; Isolate pt until 3 Neg. pharyngeal cultures; Tx close contacts w/ Erythromycin; Toxoid avail. as a vaccine (DTaP)
Pertussis
Erythromycin (1) Azithromycin (2) Clarithromycin (2) TMP-SMX (2) Tx aims to stop transmission; Supportive therapy; Tx close contacts w/ Erythromycin; Prevent: acellular vaccine; TDaP
Epstein-Barr Virus
Tx is symptomatic; Non-aspirin and anti-inflammatories; Antivirals only decrease viral shedding; Avoid contact sports (splenomegaly); Steroids for thrombocytopenia, hemolytic anemia, or airway obstruction caused by lymphedema
Human Papillomavirus
Salicylic acid
Liquid Nitrogen
Podophyllum
Topical interferon (imiquimod [Aldara]);
Spontaneous remission for most skin warts;
Tx goal: reduce number and frequency of lesions;
Surgery: blunt dissection, electrocautery, CO2 laser;
Recurrence is common
Herpes Simplex Virus
Acyclovir
Valacyclovir
Trifluridine - keratitis
Supportive and suppressive therapy
Influenza
Relenza (1)
Tamiflu (1) (both within 48 hrs)
Amantadine/Rimantadine (2) (resistance increasing)
Rest, analgesics, cough suppressants
Varicella-zoster
Tx is supportive;
Prevent: good hygiene, vaccine (1-2 y/o), Zostavax (>60 y/o) reduces shingles possibility;
Zostavax contra: pregnancy, TB, allergy to gelatin/neomycin, immunocompromised
Rabies
No specific tx;
Ventilation and O2; Vaccine immunoglobulin with monoclonal antibodies, ribavirin, interferon-a, ketamine;
Prevention is key;
Cleanse, debride, and flush a bite; do not suture;
Post-exposure: immunoglobulin and human diploid cell vaccine
HIV and AIDS
Prevention;
Antiretrovirals and chemoprophylaxis (2nd prevention);
Postexposure:
Prophylaxis (PEP) within 72 hrs;
Antiretroviral therapy (incl. pregnancy) (based on CD4 count, viral load, pt status)
Cytomegalovirus
Ganciclovir Valganciclovir Foscarnet Cidofovir Prevention: Limit blood transfusions; remove leukocytes from transfusions; restrict organ donor pool to seronegative donors
Candidiasis (Cutaneous)
Topical antifungal creams
Candidiasis (Mouth and Esophagus)
Fluconazole
Itraconazole
Amphotericin B (if recalcitrant)
Candidiasis (Vulvovaginal)
Topical azoles
Fluconazole
Candidiasis (Fungemia)
Amphotericin (IV)
Flucytosine (if + blood culture, retinal lesions, infxn of dermis, brain, meninges, myocardium)
Fluconazole (2)
Can be life threatening
Candidiasis (Hepatosplenic)
Amphotericin B (1) Fluconazole (2)
Candidiasis (Endocarditis)
Amphotericin B (1) Fluconazole (typically lifelong after recovery) Infected valves need surgical replacement
Histoplasmosis
Itraconazole (1) Amphotericin B (intolerance to (1) or pt w/ meningitis/severe dz) Itraconazole (lifelong for immunocompromised)
Cryptococcus sp.
HIV+:
Fluconazole (lifelong)
Amphotericin B (in severe) followed by Fluconazole
Flucytosine (may be added if severe)
HIV-:
Amphotericin B (immunocompromised; mortality higher)
Pneumocystis jiroveci pneumonia
TMP-SMX (1) (SE: fever, rash, malaise, neutropenia, hepatitis, nephritis, thrombocytopenia, hyperbilirubinemia) Dapsone (2a) Pentamidine (2b) Atovaquone (3) Prophylaxis post-tx
Amebiasis
Asymptomatic:
Diloxanide furoate
Iodoquinol
Paromomycin
Mild-Moderate:
Tinidazole/Metronidazole + above
Severe:
Fluids, electrolytes, opioids (ctrls bowel motility)
Hepatic abscess:
Tinidazole/Metronidazole + above + Chloroquine
Follow-up:
3 stool exams (2-3 day intervals after 2-4 wks)
Prevent:
clean water and H2O, good sanitation and hygiene
Hookworms
Mebendazole (1) Pyrantel (2) (> 5 y/o) Albendazole (2) Note: avoid all if pregnant Supportive: High-protein intake, vitamis, ferrous sulfate
Pinworms
Albendazole Mebendazole Pyrantel (> 5 y/o) Prevent: Wash hands; wash linens; tx close contacts
Malaria
Chloroquine (1)
Mefloquine (2) (in areas of (1) resistance)
Severe:
Quinine, Quinidine, Chloroquine + Doxycycline, Clindamycin, or Tetracycline
Alternatives:
Atovaquone, Proguanil, Mefloquine, Hydroxychloroquine, Atovaquone/Doxycycline
Prevention is key
Syphilis
Benzathine penicillin G (1)
Neurosyphilis:
Aqueous penicillin followed by (1)
Jarisch-Herxheimer rxn: fever, toxic state; destruction of spirochetes; antipyretics during initial 24 hrs of tx
Report syphilis cases to public health dept and sexual partners
Careful follow-ups
Gonorrhea
Ceftriaxone (1)
Oral Cefixime (1)
+ Doxycycline or Azithromycin
Tx all partners; report cases
RESISTS: Penicillin, Tetracyclines, and Fluoroquinolones
Chlamydia
Azithromycin
Doxycycline
Erythromycin (1 - pregnancy)
Tx all partners
Trichomonas
Metronidazole
Tx all partners
Lyme Disease
Doxycyline (1) Amoxicillin (2) Cefuroxime (2) Ceftriaxone (2) Cefotaxime (2)
Sx tx with analgesics (NSAIDs)
Prevention is key; Prophylactic abx NOT recommended
Rocky Mountain Spotted Fever
Doxycycline
Chloramphenicol
Note: both helps recovery
Poor outcomes in older pts; death caused by pneumonitis, respiratory or cardiac failure;
Sequelae: seizures, encephalopathy, peripheral neuropathy, paraparesis, bowel/bladder incontinence, cerebellar dysfunction, vestibular dysfunction, hearing loss, motor deficits
Prevention is key
