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Micro > POGUE TREATMENT!! > Flashcards

POGUE TREATMENT!! Flashcards

1
Q

How should AB be administered for bacterial meningits?

A

IV at MAX dosing due to difficult penetration

Bactericidal (b-lactams)

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2
Q

Empirical Therapy for bacterial meningitis <1 month?

A

Ampicillin + Gentamycin

Ampicillin + cefotaxime

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3
Q

What antibiotics should be avoided for CNS infections?

A

Tetracyclines, aminoglycosides, polymixins

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4
Q

Empirical Therapy for bacterial meningitis 1-23 months?

A

Vancomycin + 3rd gen celphalosporin

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5
Q

Why add vancomycin for empirical therapy?

A

due to variable penetration of BBB for 3rd gens. Vanco added for strep isolates with slightly higher MICs

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6
Q

Empirical Therapy for bacterial meningitis 2-50 years?

A

3rd generation ceph + vanco

+ steriods!!! Dexamethasone

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7
Q

Why give steroids for meningitis??

A

Decrease inflammation in subarachnoid space– decrease the neurological sequelae.

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8
Q

In what order should you give therapy for bacterial meningitis 2-50?

A

Steroids given first!! Decrease the bad outcomes from antibiotics lysing bacteria? Definitely does not do anything BAD. help or do nothing…

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9
Q

Empirical Therapy for bacterial meningitis >50?

A

Vancomycin + 3rd gen Ceph + Ampicillin

listeria is back!

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10
Q

What is the major prophylaxis given for meningitis? what bug?

A

Ciprofloxacin given to those exposed to Neisseria meningitidis!

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11
Q

What is the most frequent type of infection in CSF shunt patients?

A

Coag negative staph (skin bugs)
Wide range empirically: vancomycin + cefepime
remove the shunt if you can
interventricular therapy as adjunct

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12
Q

Therapy of choice for Cryptococcal meningitis

A

Lipid Amphotericin B + flucytosine x 2 weeks
then:
fluconazole x 8 wks

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13
Q

Therapy of choice for blastomycosis and histoplasmosis

A

lipid amphotericin B x 4-6 weeks THEN

oral AZOLE 12 months (“maintenance”)

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14
Q

Therapy of choice for coccidiomycosis

A

GUIDELINES say fluconazole

Pogue says ampho B…

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15
Q

Acute bronchitis

A

VAST MAJORITY ARE VIRAL!! AB will not work!!

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16
Q

Treatment for acute bronchitis from pertussis

A

1st line Macrolides - azithromycin

17
Q

Who gets antibiotics for COPD exacerbation?

A

Increased dyspnea, increased sputum volume, increased sputum purulence

18
Q

What are the common bugs in COPD exacerbation?

A

S. pneumo, H influ, M. cattarhalis, C pneumo, M. Pneumo

19
Q

Treatment for mild-moderate COPD exacerbation

A

Oral: Amoxicillin, amox/clavulanic
Doxycyclin, TMP/SMX (pen allergy)
Macrolides, FQ

20
Q

Treatment for AT RISK COPD exacerbation (comorbidities, severe COPD, frequent exacerbations, recent AB use)

A

IV Therapy: Amp/sulbactam, 2/3rd gen cephs, FQ

21
Q

When should we treat sinusitis with antibiotics?

A

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)

22
Q

What AB should we use for sinusitis? (if any)

A

amoxicillin/clavulanic acid

Doxycycline, FQ

23
Q

What are the common CAP bacterial pathogens?

A

Big 6
S pneumo, H influenzae, M cattarhalis
Myc, legionella, chlamydia (atypic)

24
Q

To what populations do you empirically treat for Staph aureus CAP?

A

Post Viral

cases of severe, nectrotizing CAP (straight to the ICU)

25
Q

CAP outpatient therapy for healthy patients?

A

Macrolides (usually azithro) or doxycycline

HIGH RISK- add B lactam

26
Q

CAP inpatient therapy?

A

Non ICU- 3rd gen ceph + macrolide OR FQ

ICU- IV therapy, above + vanc maybe

27
Q

Outpatient treatment of aspiration pneumonia

A

Clindamycin or amoxy/clav or moxifloxacin

28
Q

In general, what should the duration of therapy be for CAP?

A

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

29
Q

What the two MAIN bugs do we need to cover for HCAP/HAP/VAP?

A

MRSA and pseudomonas

30
Q

What is the empiric therapy for HCAP/HAP/VAP?

A

Three drug regimen upfront

Anti psuedomonal B lactam AND antipseudomonal FQ or AG AND Vancomycin or linezolid

31
Q

Whats the duration of therapy for HAP/HCAP/VAP?

A

historically 14-21 days

NOW: 8 days UNLESS psuedo or acinobacter then 2+ weeks

32
Q

what populations are MAYBE susceptible for Stenotrophomonas maltophilia? how do we treat

A

People who have been in the hospital for LONG TIME! been on multiple courses of AB.
treat with TMP/SMX

33
Q

When do we see AB doses that exceed the maximum? why?

A

CF patients! they have an extremely high metabolism rate for antimicrobials!!

also give aerosolized antibiotics- treat to suppress!

Micro (10 decks)

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