MSK Infection treatment Flashcards
Gram + bacterial organisms?
MRSA
Staph
Strep
Gram - bacterial organism?
Pseudomonas
E. coli
ESBL
Anaerobes?
Streptococci (+)
Clostridia (+)
Bacteroides (-)
Problematic resistant organisms?
MRSA (+)
VRE (+)
ESBL (-)
Beta-Lactams: Penicillin
Amoxicillin
Oxacillin
Penicillin G
Penicillin/Beta-Lactamase
Amoxicillin/clavulanate
Piperacillin/tazobactam
First gen cephalosporin
Cephalexin*
cefazolin
cefadroxil
Second gen cephalosporin
Cefaclor
Cefoxitin
Cefotetan
Third gen cephalosporin
Ceftriaxone*
cefotaxime
Fourth gen cephalosporin
Cefepime*
Carbapenems
Ertapenem*
Meropenem
Aminoglycosides
gentamicin
tobramycin
Amikacin
Quinolones
Ciprofloxacin*
Levofloxacin
Moxifloxacin
Macrolides
Erythromycin
Clarithromycin
Azithromycin*
Glycopeptides
Vancomycin*
Sulfonamides
Sulfamethoxazole/trimethoprim *
Inhibition of cell wall synthesis
PCN, Cephalosporins, Imipenem, Meropenem, Aztreonam, Vancomycin
Inhibition of bacterial protein synthesis
Aminoglycosides
Macrolides
Mechanisms of resistance
Enzymatic inactivation of target site or antimicrobial
Alteration of target site
Decreased permeability
Bacteriostatic
Clindamycin
Erythromycin
Sulfamethoxazole
Tetracycline
Trimethoprim
Bactericidal
Cephalosporin
Fluoroquinolones
Metronidazole
Penicillin
Vancomycin
Majority have what side effects
N/V/D
Rash
Thrush
ASE Penicillin
Hypersensitivity
Skin reactions
Cephalosporin ASE
C. diff
Macrolides ASE
QT interval prolongation
Quinolone ASE
QT prolongation
Aminoglycosides ASE
Nephrotoxicity
Ototoxicity
Vancomycin ASE
“Red man syndrome”
Clindamycin ASE
C. Diff
Sulfonamides ASE
SJS
Blood dyscrasias
Drugs that do not need renal adjustment
Oxacillin
Ceftriaxone
Clindamycin
Azithromycin
Doxycycline
Rifampin
What should be done prior to administering AB for SA
Synovial fluid
2 sets of blood cultures
Radiographs
What is an important part of SA treatment
Joint drainage
SA treatment is MSSA
Cefazolin 2g IV q8hrs
Oxacillin 2g IV q4hrs
If penicillin allergy, keep Vanco
SA treatment for MRSA
Vancomycin
Alternatives: Daptomycin or Linezolid
Gram + cocci SA
Empiric Vancomycin
Gram - Bacilli SA
Cephalosporin:
Ceftriaxone
Cefotaxime
Cefepime
Pseudomonas Aeruginosa (IVDU concern)
Initial therapy - 2 antipseudomonal drugs
Cephalosporin + Ciprofloxacin
Aztreonam is alternative to cephalosporin
Staph aureus infection with bacteremia but no endocariditis
IV ABx for 4 weeks
Staph aureus no bacteremia or endocarditis
IV 14 days the oral 7-14 days
Septic arthritis + osteomyelitis
4-6 week course of antibiotics
SA monitoring protocol
- Culture/sensitivity of synovial fluid and blood at initiation of treatment
- WBC weekly until within normal range
- Daily monitoring - evaluate clinical signs
- Reinforcement of compliance
OM empiric therapy
Vancomycin + agent with activity against gram negative organisms
OM MSSA
Oxacillin
Cefazolin
OM MRSA
Vancomycin
Linezolid with allergy
OM anaerobes
Clindamycin
OM Enterobacteriaceae (E. coli - quinolone resistant)
E. coli - quinolone resistant
Piperacillin/tazobactam (Zosyn)
OM Enterobacteriaceae (E. coli - quinolone sensitive)
Ciprofloxacin
OM Pseudomonas
Cefepime + Ciprofloxacin
Piperacillin/Tazobactam
OM Streptococcus
Penicillin G 2-4 million units IV every 4 hours
Chronic OM
Ciprofloxacin
Linezolid
Sulfamethoxazole/Trimethoprim
OM duration
generally 4-8 weeks
prosthetic joint replacement: 3-6 months or longer