POGUE TREATMENT!! Flashcards
How should AB be administered for bacterial meningits?
IV at MAX dosing due to difficult penetration
Bactericidal (b-lactams)
Empirical Therapy for bacterial meningitis <1 month?
Ampicillin + Gentamycin
Ampicillin + cefotaxime
What antibiotics should be avoided for CNS infections?
Tetracyclines, aminoglycosides, polymixins
Empirical Therapy for bacterial meningitis 1-23 months?
Vancomycin + 3rd gen celphalosporin
Why add vancomycin for empirical therapy?
due to variable penetration of BBB for 3rd gens. Vanco added for strep isolates with slightly higher MICs
Empirical Therapy for bacterial meningitis 2-50 years?
3rd generation ceph + vanco
+ steriods!!! Dexamethasone
Why give steroids for meningitis??
Decrease inflammation in subarachnoid space– decrease the neurological sequelae.
In what order should you give therapy for bacterial meningitis 2-50?
Steroids given first!! Decrease the bad outcomes from antibiotics lysing bacteria? Definitely does not do anything BAD. help or do nothing…
Empirical Therapy for bacterial meningitis >50?
Vancomycin + 3rd gen Ceph + Ampicillin
listeria is back!
What is the major prophylaxis given for meningitis? what bug?
Ciprofloxacin given to those exposed to Neisseria meningitidis!
What is the most frequent type of infection in CSF shunt patients?
Coag negative staph (skin bugs)
Wide range empirically: vancomycin + cefepime
remove the shunt if you can
interventricular therapy as adjunct
Therapy of choice for Cryptococcal meningitis
Lipid Amphotericin B + flucytosine x 2 weeks
then:
fluconazole x 8 wks
Therapy of choice for blastomycosis and histoplasmosis
lipid amphotericin B x 4-6 weeks THEN
oral AZOLE 12 months (“maintenance”)
Therapy of choice for coccidiomycosis
GUIDELINES say fluconazole
Pogue says ampho B…
Acute bronchitis
VAST MAJORITY ARE VIRAL!! AB will not work!!
Treatment for acute bronchitis from pertussis
1st line Macrolides - azithromycin
Who gets antibiotics for COPD exacerbation?
Increased dyspnea, increased sputum volume, increased sputum purulence
What are the common bugs in COPD exacerbation?
S. pneumo, H influ, M. cattarhalis, C pneumo, M. Pneumo
Treatment for mild-moderate COPD exacerbation
Oral: Amoxicillin, amox/clavulanic
Doxycyclin, TMP/SMX (pen allergy)
Macrolides, FQ
Treatment for AT RISK COPD exacerbation (comorbidities, severe COPD, frequent exacerbations, recent AB use)
IV Therapy: Amp/sulbactam, 2/3rd gen cephs, FQ
When should we treat sinusitis with antibiotics?
Persistence of signs/symptoms for >10 days with no evidence of clinical improvement
Severe symptoms (fever>39, purulent nasal discharge, facial pain >3-4 days)
What AB should we use for sinusitis? (if any)
amoxicillin/clavulanic acid
Doxycycline, FQ
What are the common CAP bacterial pathogens?
Big 6
S pneumo, H influenzae, M cattarhalis
Myc, legionella, chlamydia (atypic)
To what populations do you empirically treat for Staph aureus CAP?
Post Viral
cases of severe, nectrotizing CAP (straight to the ICU)
CAP outpatient therapy for healthy patients?
Macrolides (usually azithro) or doxycycline
HIGH RISK- add B lactam
CAP inpatient therapy?
Non ICU- 3rd gen ceph + macrolide OR FQ
ICU- IV therapy, above + vanc maybe
Outpatient treatment of aspiration pneumonia
Clindamycin or amoxy/clav or moxifloxacin
In general, what should the duration of therapy be for CAP?
minimum of 5 days
afebrile x 48-72
No more than 1 CAP related sign of instability (fever, leukocytosis, HR, resp rate)
at least 5. assess DAILY
What the two MAIN bugs do we need to cover for HCAP/HAP/VAP?
MRSA and pseudomonas
What is the empiric therapy for HCAP/HAP/VAP?
Three drug regimen upfront
Anti psuedomonal B lactam AND antipseudomonal FQ or AG AND Vancomycin or linezolid
Whats the duration of therapy for HAP/HCAP/VAP?
historically 14-21 days
NOW: 8 days UNLESS psuedo or acinobacter then 2+ weeks
what populations are MAYBE susceptible for Stenotrophomonas maltophilia? how do we treat
People who have been in the hospital for LONG TIME! been on multiple courses of AB.
treat with TMP/SMX
When do we see AB doses that exceed the maximum? why?
CF patients! they have an extremely high metabolism rate for antimicrobials!!
also give aerosolized antibiotics- treat to suppress!
