OMED Antibiotics and Infectious Diz Flashcards
Community acquired pneumonia-
hospital setting
non-hospital setting
beta-lactam allergy
hospital-ceftriaxone and azithromycin
non-hospital- azithromycin
CAP + beta lactam allergy- moxifloxacin
health care associated pneumonia (one main treatment and two allergy alternates)
vanc + Pip Tazo
if vanc allergy –> linezolid
if Pip Tazo allergy –> merzopenim
meningitis
ceftriaxone and vancomycin
+/- steroids (methylpred)
+/- ampicillin (if immunocomp)
UTI
amoxicillin overall
if beta-lac allergic–> nitrofurantoin
TMP-SMX as absolute alternative
cellulitis from strep
out patient–> amoxicillin
in-patient –> cetriaxone
cellulitis from staph
clindamycin (1st)
vancomycin (2nd)
2 + 1
DOMINANT HIV treatment: 1 NRTi + 2 NNRTi
NNRTi’s:
protease inhibitor- ritonavir
Entry inhibitor
fussion inhibitor
HIV: pre-exposure
PrEP
emtricitabine + tenofavir (both NTRi)
HIV: post-exposure
PEP
emtricitabine + tenofavir (both NTRi) +/- Raltegravir
HIV pregnancy
2 + 1 +AZT (vertical transmission prophylaxis)
Acute HIV flu: dx and tx
dx: PCR
tx: 2 + 1
ELISA will be negative
HIV opportunistic infection: dx and tx
dx:
1. Elisa (+)–>
2. Western blot (+) –>
3. HIV viral count –>
4. CD4 count —>
5. genotype
tx: 2 + 1
cd4 > 500
normal basically
cd4 > 350
no prophylaxis
cd4 < 200
PCP no sulfa allergies : TMP-SMX
PCP sulfa allergies: dapsone
PCP in G6PD pt: atovaquone
cd4 < 100
toxo: pyrimethamine + leucovorin
cd4 < 50
MAC: weekly azithromycin
lobar pneumonia, caseating granulomas
primary TB infection
hemoptysis, night sweats, weight loss, younger people or with RFs: initial steps
secondary TB (reactivation): CXR and AFB smear
- CXR: if positive for TB, isolate pt
- AFB smear
if both negative–> pt does not have TB
if positive: RIPE tx
PPD negative
no further work up
PPD positive
- get CXR
- negative CXR –> isoniazid + B6 for 9 months
- positive CXR –> AFB smear
- AFB positive –> active TB –> RIPE tx
- AFB negative –> INH + B6 9 months
PPD equal/above 10 mm: who
health care workers, prisoners, homelessness, travel
PPD equal/above 15 mm: who
soccer mom, no rf’s
PPD equal/above 5 mm: who
ppl with close contacts to others w/TB, immunocompromised, HIV, transplant, anargy
what will cause interferon beta to have a false positive?
pts with BCG vaccine
CXR is positive for TB but AFB smear is negative for TB: tx
latent TB: isoniazid + B6
CXR positive for TB and AFB smear (+) for TB: tx
active TB: RIPE
a. rifampin (red pee)
b. isoniazid (neuropathies, give B6)
c. pyrazinamide (hyperuricemia, gout)
d. ethambutol (red/green color blindness)
Fever + HA…+/- photophobia, phonophobia, N/V
brain inflammation: three things-
meningitis, abscess, encephalitis
Fever + HA…+stiff leg + leg raise positive: causes
Bacterial meningitis: TB, RMSF, Lyme, Crypto, Viral
Fever + HA + focal neurological deficit
abscess or cancer
Fever + HA + AMS
encephalitis: a million causes. tx for all of them is the same- supportive, except for HSV
FAILS mnemonic
the contraindications to lumbar puncture:
FND (focal neuro def) AMS (altered men stat) Immunosuppression Lesions Seizures
FAILS (+)
FAILS+: order is
- Blood cultures first
- IV abx + steroids
- CT scan
- LP
FAILS (-)
LP –> then ABX
FAILS (+), CT (-): now what
LP
LP: lots of PMNs, dx and tx
bacterial meningitis
ceftriaxone, vancomycin, steroids, +/- ampicillin
LP: no PMNs
consider something other than bacterial. c
Brain abscess: tx
drain and abx
LP: lymphocytes
encephalitis
Encephalitis, HSV suspected
dx: HSV PCR
tx: if HSV positive…acyclovir
dx: if HSV PCR negative…
tx: supportive
skin with well demarcated area that is red, hot and tender
cellulitis
skin with well demarcated area that is red, hot and tender with (+) abscess: toxic tx and non-toxic tx
Cellulitis, staph:
toxic: pip/tazo+augmentin
nontoxic: 1st gen cephalosporin
skin with well demarcated area that is red, hot and tender with, superficial and no abscess: toxic tx and non-toxic tx
Cellulitis, strep:
nontoxic: TMP-SMX (po), clindamycin
toxic: vanc, linezolid, clindamycin
wound with exposed bone, or recurrent/refractory cellulitis, or sinus tract: dx
suspect osteomyelitis:
dx:
1st: xray
2nd: MRI if xray is neg.
