Just Treatments for Infection

Question 1

Oseltamivir and Zanamivir

Answer 1

Antivirals which prevent removal of host sialic acid by neuraminidase, causing virions to fuse to one another and inhibiting their ability to affect new cells.

Question 2

Azidothymidine

Answer 2

NTRI that mimicks Adenosine

Question 3

Treatment of Mycobacterium tuberculosis infection

Answer 3

In any population of tubercle bacilli, mutations associated with resistance to any individual drug are present. Fortunately, the odds that any single oragnism is resistant to two drugs simultaneously are low.

Directly observed therapy for TB has become the standard of care, as regimens are often complicated.

Treatment of latent TB requires only a single drug, as numbers are much lower and less resistant.

Question 4

Treatment and prevention of norovirus

Answer 4

• No specific treatment options exist
• Hydrating, electrolyte replacement, IV fluids in extreme cases
• No proven vaccines

Question 5

Treatment of Lyme disease

Answer 5

Doxycycline for adults, amoxicillin for kids.2-4 week courseforstage I, stage II,andstage III manifesting as arthritis.

Stage III manifesting as neurological symptoms requires intravenous 3rd generation cephalosporine (ceftriaxone).

Question 6

Maraviroc

Answer 6

blocks association of the CD4-bound virion with the CCR5 co-receptor required to trigger membrane fusion and virion entry.

A “last resort” antiretroviral used when extensive resistance to other antiretrovirals leaves options limited.

Question 7

Prevention of Streptococcus aureus infection

Answer 7

Currently, there is no S. aureus vaccine, and attempts to develop vaccines are ongoing

Question 8

Treatment of N. meningitidis infection

Answer 8

Vaccines are the primary means of prevention.

Antibiotic prophylaxis is recommended for people with close contact with people who have N. meningitidis infection.

Treatment should be guided by susceptibility testing results. Third generation cephalosporins or penicillin are usually used

Question 9

Testing for Lyme: What is actually done?

Answer 9

First, a B. burgdorferi antigen ELISA (Sensitive, non-specific, low cost)

If this gives a positive, proceed to:

B. burgdorferi antigen Western blot (Sensitive, Specific, Expensive)

Question 10

Prevention of S. pyogenes infection

Answer 10

As of yet, there is no vaccine.

Question 11

MRSA

Answer 11

Methicillin-resistant Streptococcus Aureus

Increasingly common. Require treatment with vancomycin.

Question 12

Measles prevention

Answer 12

Live, attenuated measles vaccine has greatly diminished the incidence of measles in every country in which it has been used.

A single dose, given at 12 to 15 months of age, induces measles-specific immunity in about 95% of healthy children. The recommended second dose at 4 to 6 years of age serves principally to seroconvert children who missed or did not respond to the first dose. After the second dose, about 99% of healthy children gain immunity to measles

Question 13

Baloxavir marboxil

Answer 13

Antiviral which blocks the cap-dependent endonuclease activity of the influenza RNA-dependent RNA polymerase

Question 14

Adamantanes are only effective against. . .

Answer 14

Type A Influenza

Question 15

Treatment and prevention of West Nile Virus

Answer 15

There are no antivirals effective against WNV.

There are no vaccines for WNV.

Question 16

Prevention of Mycobacterium tuberculosis infection

Answer 16

Improving the standard of living decreases rates of disease. Currently there is no effective vaccine, mostly because antibodies do not provide protection against tuberculosis.

bacille Calmette-Guérin (BCG) vaccine is an attenuated strain of Mycobacterium bovis.

Not used in the US because it does not provide much protection and decreases the effectiveness of TB screening.

Question 17

Rotavirus treatment and prevention

Answer 17

• No specific threatments for active infection
• Oral immunization with live, attenuated strain is recommended. Given between 6 and 14 weeks of age.

Question 18

Enfurvirtide

Answer 18

Analog of the gp120 fusion peptide which binds to gp41 and blocks a conformational change required for fusion of the HIV and host cell membranes.

Question 19

Treatment of N. gonorrhoeae infection

Answer 19

Abstinence or condoms as a preventative measure. Notification of, and follow up with sexual partners of those known to have an STI can be preventative of future cases. Treatment recommendations change frequently as N. gonorrhoeae develops antibiotic resistance, so it is important to follow appropriate recommendations.

Current CDC recommendations:

• Single dose of a third-generation cephalosporin (ceftriaxone) and a single dose of azithromycin
• Opthalmia neonatorum can be prevented w/ erythromycin placed in each eye at birth

Question 20

Treatment of Mycobacterium tuberculosis infection

Answer 20

In any population of tubercle bacilli, mutations associated with resistance to any individual drug are present. Fortunately, the odds that any single oragnism is resistant to two drugs simultaneously are low.

Directly observed therapy for TB has become the standard of care, as regimens are often complicated.

Treatment of latent TB requires only a single drug, as numbers are much lower and less resistant.

Question 21

Adamantanes are only effective against. . .

Answer 21

Type A Influenza

Question 22

Rotavirus treatment and prevention

Answer 22

• No specific threatments for active infection
• Oral immunization with live, attenuated strain is recommended. Given between 6 and 14 weeks of age.

Question 23

Amantadine and Rimantadine

Answer 23

Antivirals which inhibit the uncoating of infleunza proteins by blocking the M2 channel in the influenza capsid.

Question 24

Rubella prevention

Answer 24

Live, attenuated rubella vaccine.

Question 25

Prevention of S. pneumoniae infection

Answer 25

Occurence of S. pneumoniae-induced pneumonia and meningitis have both decreased due to the success of the S. pneumoniae vaccines.

Conjugate vaccine: protects against 13 of the most common childhood disease-associated capsular serotypes. Intended to prevent meningitis in children.

Polysaccharide vaccine: Capsule from 23 common disease causing capsular serotypes. Intended to prevent pneumonia and recommended for older adults at specific risk for infection.

Question 26

Oseltamivir and Zanamivir

Answer 26

Antivirals which prevent removal of host sialic acid by neuraminidase, causing virions to fuse to one another and inhibiting their ability to affect new cells.

Question 27

Treatment of S. pneomoniae infection

Answer 27

The first line is vaccination. If infection does occur:

Penicillin and 3rd generation cephalosporins are usually effective, but resistance is growing. This resistance is β-lactamase independent, so β-lactamase inhibitors are no good. All S. pneumoniae are sensitive to vancomycin

Question 28

Treatment and Prevention of Hepatitis A

Answer 28

There are no antivirals to treat Hepatitis A. However, those exposed may be treated with antiserum to reduce extent and severity (postexposure prophylaxis).

There is a vaccine against Hep A which is safe, highly immunogenic, and highly effective. Vaccination now recommended for all in the US.

Question 29

Treatment and Prevention of Influenza

Answer 29

• Antivirals may be used to treat symptoms. They are most effective when given early and may be given prophylactically to those in close proximity.
• Vaccines are made every year based on what subtypes are expected to circulate, however the coverage varries from year to year based on how good the prediction was
• 50-60% effective vaccines if predictions are good
  *

Question 30

Amantadine and Rimantadine

Answer 30

Antivirals which inhibit the uncoating of infleunza proteins by blocking the M2 channel in the influenza capsid.

Question 31

Testing for Lyme: What is actually done?

Answer 31

First, a B. burgdorferi antigen ELISA (Sensitive, non-specific, low cost)

If this gives a positive, proceed to:

B. burgdorferi antigen Western blot (Sensitive, Specific, Expensive)

Question 32

Treatment of Serotype D-K Chlamydia trachomatis

Answer 32

It is important to follow current CDC recommendations!!!

Current recommendations are for a single dose of azithromycin (a macrolide). Other protein synthesis inhibitors or fluoroquinolones are alternatives.

Neonatal infection requires two weeks of treatment with erythromycin.

Question 33

Treatment of staphylococcus infection

Answer 33

β-lactams, glycopeptides (vancomycin), antifolates, protein synthesis inhibitors (lincosamides, macrolides, aminoglycosides).

Usually responds well to smei-synthetic penicillins, like methicillin or the cephalosporines.

Question 34

Baloxavir marboxil

Answer 34

Antiviral which blocks the cap-dependent endonuclease activity of the influenza RNA-dependent RNA polymerase

Question 35

NRTIs

Answer 35

Nucleoside reverse transcriptase inhibitors

Mimick the enzyme’s natural nucleoside substrates, but lack the 3’ hydroxyl for continuation of the chain.

Question 36

Treatment of Lyme disease

Answer 36

Doxycycline for adults, amoxicillin for kids.2-4 week courseforstage I, stage II,andstage III manifesting as arthritis.

Stage III manifesting as neurological symptoms requires intravenous 3rd generation cephalosporine (ceftriaxone).

Question 37

Treatment and Prevention of Influenza

Answer 37

• Antivirals may be used to treat symptoms. They are most effective when given early and may be given prophylactically to those in close proximity.
• Vaccines are made every year based on what subtypes are expected to circulate, however the coverage varries from year to year based on how good the prediction was
• 50-60% effective vaccines if predictions are good
  *

Question 38

Prevention of Mycobacterium tuberculosis infection

Answer 38

Improving the standard of living decreases rates of disease. Currently there is no effective vaccine, mostly because antibodies do not provide protection against tuberculosis.

bacille Calmette-Guérin (BCG) vaccine is an attenuated strain of Mycobacterium bovis.

Not used in the US because it does not provide much protection and decreases the effectiveness of TB screening.

Question 39

ISTIs

Answer 39

Integrase strand-transfer-inhibitors

Highly potent and have favorable pharmacokinetics. Well tolerated because there is no overlap with native host biochemistry.

Question 40

Treatment and prevention of norovirus

Answer 40

• No specific treatment options exist
• Hydrating, electrolyte replacement, IV fluids in extreme cases
• No proven vaccines

Question 41

Ritonavir

Answer 41

HIV protease inhibitor

Requires “boosting” (administration with a secondary drug which acts ot increase serum levels of the primary drug by inhibiting hepatic drug metabolism of the primary drug)

Question 42

NNRTIs

Answer 42

Non-nucleoside reverse transcriptase inhibitors

Viral resistance to these drugs arises through mutations at or around this cleft, and are in general highly cross-resistant among members of this class