specific infections Flashcards
Pharingitis, Tonsillitis
– Potential pathogen: Viral, S. pyogenes, (other Streptococcis, C. diphteriae, Gonococci etc.)
– Therapy: Penicillin V, Aminopenicillins, I. gen Cephalosporins, Macrolids, Clindamycin
Sinusitis, Otitis media:
– Potential pathogen: Pneumococci, H. influenzae, Moraxella catarrhalis, Staphylococci aureus, Anaerobes, Streptococci species
– Therapy: Amoxicilline-Clavulanic acid, Cefuroxime, Cefprozil, Macrolide, III. gen. Fluoroquinolones, Doxycycline
Bronchitis
• Acute:
– Potential pathogen: Viral, M. pneumoniae, C. pneumoniae, B. pertussis
– Therapy (if it is necessary): Macrolides
• Chronic with acute exacerbation:
– Potential pathogen: H. influenzae, Moraxella, and Streptococcus pneumoniae
– Therapy: Macrolides, Amoxicilline-Clavulanic acid, II. gen Cephalosporine,
III. gen Fluoroquinolones
Risk of Pseudomonas (Bronchitis)
Fluoroquinolons+ Amoxycilline, Piperacilline-Tazobactam, Ceftazidime, Meropenem
Community acquired pneumonia, Without comorbidity, <65 :
– Potential pathogen : Pneumococci, H. influenzae, M. pneumoniae, C. pneumoniae, viruses (sometimes: Legionella, S. aureus, aerob Gr- rods, TBC)
– Therapy: Amoxicillin-Clavulanic acid (Amox-Clav), Macrolids, Cefuroxim-axetil,
Community acquired pneumonia, Middle severe comorbidities or >65 :
– Potential pathogen : Pneumococci, H. influenzae, aerob Gr- rods, S. aureus, C. pneumoniae (M. catarhalis, Legionella, TBC)
– Therapy: po.: Amox-Clav or Cefuroxim-axetil ± Macrolid, 3. gen. Fluoroquinolones (FQ); iv: Ceftriaxone/ Cefuroxim ± Macrolid
Community acquired pneumonia, Hospitalisation is required:
– Potential pathogen: Pneumococci, H. influenzae, aerob Gr- rods, Legionella, S. aureus, C. pneumoniae, polymicrobal inf. with anaerobs, viral (M. pneumoniae, M. catarhalis, TBC)
– Therapy: iv: Amox-Clav, Amp-Sulb, cefuroxime, ceftriaxone/cefotaxime + macrolid, 3 gen. FQ. If suspected anaerob infection: cephalosporins + clindamycin / metronidazol, moxifloxacin
Community acquired pneumonia, Very severe (ICU treatment)
– Potential pathogen: Pneumococci, Legionella, S. aureus, Gr- rods, M. pneumoniae, Viral (H. influenzae, TBC)
– Therapy:
• If Pseudomonas is not suspected: Ceftriaxone/cefotaxime/ertapenem + Macrolid or 3 gen. FQ
• If Pseudomonas is suspected: Ceftazidime, Cefepime, Carbapenems, Piperacillin-Tazobactam + Macrolids or Fluoroquinolones ± Aminoglycozides
Urinary tract infections
Women - uncomplicated cystitis
– Potential pathogen: E. coli, Staphylococci Saprophyticus, Proteus, Klebsiella, E. faecalis
– Therapy: Nitrofurantoin, Fosfomycin-trometamol, Cotrimoxazol (Res!), Fluoroquinolons (Res!!), oral 3. gen cephalosporins
Urinary tract infections
Women - uncomplicated acute pyelonephritis
– Potential pathogen: E. coli (Proteus, Klebsiella, S. saprophyticus)
– Therapy: 2-3 gen. parent. cephalosporinok, 3. gen. oral cephalosporins, Amox-Clav (iv. Amp-Sul), aminoglycosid, 2. gen. Fluoroquinolones (Res!)
Urinary tract infections
Complicated urinary tract infections (in case of men is always complicated)
– Potential pathogen: E. Coli, Klebsiella, Pseudomonas, Enterobacter, other Enterobacteriaceae, Enterococci, S. epidermidis (Microbiol. diagnosis is important)
– Therapy: 2-3-4 gen Cephalosporins, Aminoglycosids, Carbapenems (ESBL), Fluoroquinolons (Res!!)
Intraabdominal infections
Colecystitis
– Potential pathogen: Enterobacteriaceae (most common. E. coli), Klebsiella, Enterobacter), Enterococci, Anaerobs, Clostridium strains
– Therapy: 3-4 gen. Cephalosporins + metronidazole/clindamycin, Piperacillin-Tazo (pip- tazo), carbapenems
– The resistancy is very changeable; the ESBL is very common (Klebsiella)
Intraabdominal infections
Spontaneous bacterial peritonitis
– Potential pathogen: Enterobacteriaceae, Enterococci
– Therapy: 3 gen cephalosporins, Pip-Tazo, carbapenems, ofloxacin/ciprofloxacin
Intraabdominal infections
Secondary surgical peritonitis (non nosocomial)
– Potential pathogen: E. coli , K. pneumoniae + anaerobs (B. fragilis)
– Therapy: Ceftriaxone+Metronidazol, Pip-Tazo, Carbapenems
Intraabdominal infections
Secondary surgical peritonitis (nosocomial)
– Potential pathogen: Multiresistant GI bacterias (E. coli, Klebsiella, Enterobacter), Pseudomonas, Acinetobacter, Enterococci
– Therapy: Carbapenems±aminogylcosides, 3-4. gen Cephalosporins+Metronidazole ± Vancomycin. VRE: tigecyclin, linezolid, MACI: colistin
Intraabdominal infections
Pseudomembranosus colitis
– Pathogen: C. difficile
– Therapy: oral metronidazole (for 10 days)
– severe case: iv. metronidazol (if orally is not possible) + oral vancomycin.
– In case of relapse: vancomycin or teicoplanin orally for 3 weeks (lower dose) or fidaxomycin (high price!)
Meningitis
Newbornes
– Pathogen: H. influenzae (vaccine!), S. agalatiae, E. coli, Listeria, Staphylococci
– Therapy: cefotaxime + ampicillin
Meningitis
1-3 months old
– Pathogen: S. agalatiae, Listeria, Gr- rods, Pneumococci, Meningococci, Haemophylus i.
– Therapy: cefotaxim + ampicillin ± vancomycicn
Meningitis!!!
3 months – 60 year
– Pathogen: Pneumococci, Meningococci
– Therapy: cefotaxime/ceftriaxone ± vancomycin
Meningitis
Meningitis >60 year
– Pathogen: Pneumococci, Meningococci, Listeria, Enterobacteriacae
– Therapy: cefotaxim/ceftriaxon + ampicillin, meropenem
Meningitis
• Meningitis >60 year
in case of beta lactam allergy:
– Pathogen: Pneumococci, Meningococci, Listeria, Enterobacteriacae
– Therapy: Vancomycin + moxifloxacin ± cotrimoxazol (Listeria) , Gr-: chloramphenicol or meropenem (!)
Meningococci contact profilaxis:
– Ciprofloxacin, Rifampicin
Skin and soft tissue infections
• Erysipelas
– Pathogen: S. pyogenes (S. aureus)
– Therapy: penicillin G, penicillin V, Clindamycin (oxacillin, cefazolin, ceftriaxon, linezolid)
Skin and soft tissue infections
• Cellulitis
– Pathogen: S. pyogenes, S. aureus (Gr- Bact., Clostridiums)
– Therapy: cefazolin, flucloxacillin, amox-clav, clindamycin, vancomycin
Skin and soft tissue infections
• Stapylococci TSS
– Therapys: vancomycin + clindamycin + carbapenem/pip-tazo
– MRSA: glycopeptids, ceftarolin-fosamil, ceftobiprol, oxazolidinons, daptomycin, tigecyclin
Skin and soft tissue infections
• Streptococci TSS
– Pathogen: S. pyogenes
– Therapy: penicillin G (24ME) + aminoglycosid + clindamycin
Skin and soft tissue infections
• Gas gangrene
– Pathogen: Clostridium perfringens
– Therapy: Pip-Tazo + clindamycin
Skin and soft tissue infections
• Diabetic leg:
– Pathogen: commonly polymicrobal: S. aureus, Streptococci, Gr- rods
– Therapy: 1-2 gen cephalosporins, amox-clav, clindamycin
Skin and soft tissue infections
• Osteomyelitis
– Pathogen: S. aureus, Gr- bacterias (Pseudomonas!)
– Therapy:
• MSSA: oxacillin, cefazolin, clindamycin
• MRSA: vancomycin ± rifampicin, Gr- : ceftazidime, cefepim, fluoroquinolones.
Skin and soft tissue infections
• Odontogenic infections:
– Pathogen: Streptococci, anaerob bacterias (Actinomyces, Spirochaetes and so)
– Therapy: amox-clav, clindamycin
Sexually transmitted diseases(STD)
• Syphilis:
treponema pallidum
– Early (1. 2. stage): benzathin-penicillin im.(high dose). Alternative: amox (3g!) + probenecid, doxycylin, ceftriaxone
– Late without neurosyiphilis: benzathin-penicillin. Alternative: ceftriaxone, doxycyclin
– Neurosyphilis: penicillin G, procain-penicillin + probenecid , ceftriaxone
Sexually transmitted diseases(STD)
• Gonorrhea:
Neisseria gonorrhea
– Ceftriaxone + azithromycin . Spectimomycin
Sexually transmitted diseases(STD)
• NGU -> nongonococcal urethritis
(C. trachomatis, M. hominis, Ureaplasma)
Azithromycin 1*1g orally or doxycyclin
Zoonotic infections
• Lyme disease
(Borellia burgdorferi)
– Early stage (local or disseminated): amoxicillin (+ probenecid), doxycyclin, cefuroxim-axetil, Ceftriaxone, (macrolids?) (+tinidazol?)
– Late stage: Ceftriaxone iv.
Zoonotic infections
• Plague
(Yersinia pestis)
– Streptomycin (gentamicin) + doxycyclin
– (Chloramphenicol)
– Ciprofloxacin, levofloxacin, moxifloxacin
Zoonotic infections
• Tularemia
Francisella tularensis?
– Streptomycin (gentamicin) / doxycyclin / ciprofloxacin
Zoonotic infections
• Brucellosis
Brucella ..?
– Streptomycin + doxycyclin or doxycylin+rifampicin (ciprofloxacin)
Zoonotic infections
• Rickettsiosis:
rocky mountain spotted fever?
rickettsia…?
– Doxycyclin, chloramphenicol (in case of pregnancy or children below the age of 9)
