Micro

Question 1

Malaria prophylaxis for travelers

Answer 1

Atovaquone-proguanil, mefloquine, doxycycline, primaquine, or chloroquine (for areas with sensitive species)

Question 2

Prevention of postsurgical infection due to S aureus

Answer 2

Cefazolin

Vancomycin if ⊕ for MRSA

Question 3

Prophylaxis in CD4 <200

Answer 3

TMP-SMX (in pregnancy use pentamidine during 1st trimester) –> Pneumocystis pneumonia

(in case of allergy can use pentamidine, dapsone or atovaquone)

In endemic areas
Itraconazole –> Histoplasma

Question 4

Prophylaxis in CD4 <100

Answer 4

TMP-SMX –> Pneumocystis pneumonia and toxoplasmosis

In case of allergy can use pentamidine + dapsone + leucovorin

Question 5

Prophylaxis in CD4 <50

Answer 5

Azithromycin or clarithromycin or rifabutin (if can tolerate macrolide) –> MAC

Question 6

MRSA Treatment

Answer 6

Vancomycin
Daptomycin
Linezolid
Tigecycline
Ceftaroline
Doxycycline

Question 7

VRE Treatment

Answer 7

Daptomycin
Linezolid
Tigecycline
Streptogramins (quinupristin, dalfopristin)

Question 8

Multidrug-resistant P aeruginosa

Answer 8

Polymyxins B and E (colistin)

Question 9

Multidrug-resistant Acinetobacter baumannii

Answer 9

Polymyxins B and E (colistin)

Question 10

Hepatitis B Treatment

Answer 10

Pegylated interferon-α and interferon-α
Tenofovir
Adefovir
Entecavir
Lamivudine
Telbivudine

Question 11

Hepatitis C Treatment

Answer 11

Pegylated interferon-α and interferon-α
Ribavirin
Glecaprevir
Grazoprevir
Paritaprevir
Simeprevir
Voxilaprevir
Daclatasvir
Elbasvir
Ledipasvir
Ombitasvir
Pibrentasvir
Velpatasvir
Dasabuvir
Sofosbuvir

Question 12

Recommended HIV Regimens

Answer 12

3 NRTI (e.g., zidovudine, lamivudine, abacavir) OR
2 NRTI (e.g., lamivudine PLUS abacavir) PLUS
1 NNRTI (e.g., efavirenz) OR
1 PI (e.g., lopinavir) OR
1 INI (e.g., raltegravir)

Combinations that should be avoided 
Tenofovir + abacavir
Lamivudine + emcitrabine
Stavudine + didanosine
Tenofovir + didanosine
Stavudine + zidovudine

Question 13

HIV pre-exposure prophylaxis

Answer 13

Eligibility

• Negative HIV test result and no signs or symptoms of acute HIV infection
• Normal renal function test
• Fulfillment at least one indication criteria

Indications:
-Men who have sex with men
Any anal sex without condoms in the past 6 months
A bacterial STI (syphilis, chlamydia, or gonorrhea) diagnosed or reported in the past 6 months
-Heterosexual men and women
Sexually active with an HIV positive partner
Inconsistent or no condom use during sexual activity with one or more sexual partners of unknown HIV status
A bacterial STI in the past 6 months
-Intravenous drug users with high-risk needle behavior (e.g., sharing needles/equipment) or HIV positive injection partner

Timing:
Prior to the exposure to HIV and continued for a month after the exposure.

Drugs:
Emtricitabine + tenofovir disoproxil fumarate (TDF-FTC)
OR Emtricitabine + tenofovir alafenamide (TAF-FTC)

Follow-up:
HIV test every 3 months
Renal assessment at baseline and every 6 months
Counseling on adherence and risk reduction

Question 14

HIV post-exposure prophylaxis

Answer 14

Indications

• Injury with HIV-contaminated instruments or needles
• Contamination of open wounds or mucous membranes with HIV-contaminated fluids
• Unprotected sexual activity with a known or potentially HIV-infected person

Timing:
Initiate as soon as possible (ideally within one to two hours after exposure) (PEP is likely to be less effective if given after ∼ 72 hours. In patients with a very high-risk exposure it is given beyond that 72-hour window (as late as one week after exposure) if needed and, in this case, still offers a certain (albeit lower) level of protection)

Drugs:
A three-drug regimen is recommended (similar to cART treatment). Typically, this includes a nucleoside/nucleotide combination NRTI plus an integrase inhibitor:
-Tenofovir-emtricitabine + dolutegravir
-Tenofovir-emtricitabine + raltegravir