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Infectious Disease > Surgery, Meningitis, lower respirtory tract, Bronchitis > Flashcards

Surgery, Meningitis, lower respirtory tract, Bronchitis Flashcards

1
Q

When should surgical prophylaxis start and end?

A

30 minutes to 1 hours before the first incision

Continued for 24 hours.

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2
Q

What are the drugs of choice for non-bowel surgery prophylaxis?

A

cefazolin (Kefzol)

cefuroxime (Ceftin, Zinacef)

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3
Q

A patient is having colon surgery (bowel), what can I use for surgery prophylaxis?

A

ceftriaxone(Rocephin) + metronidazole (Flagyl)
cefotetan
ertapenem(Invanz)

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4
Q

If a patient has a Beta-lactam allergy, what is the second line agent for surgical prophylaxis and when should it be used?

A

Vancomycin at least 2 hours prior to incision

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5
Q

What medications are used based on susceptibility results to treat Meningitis?

A

ceftriaxone (Rocephin) 2g IV q4-6

ampicillin 2g IV q4h

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6
Q

What is the typical duration of treatment for meningitis?

A

7-14 days

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7
Q

What is the treatment regimen in PCN/Rocephin intermediate or resistant patients with meningitis?

A

Vancomycin + Rocephin+/- Rifampin

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8
Q

what is emepric therapy for meningitis?

A

Rocephin 2g q12H or cefotaxime 2g q4-6H or Merum 2g q8H
+
Vancomycin 30-45mg/kg/day +/- dexamethasone 0.15mg/kg/dq6H x2-4 days

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9
Q

What medication is added to emperic therapy for meningitis if Listeria is the possible cause

A

ampicillin 2g q4H

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10
Q

What is emerpic therapy for immunocompromised patients or those >50 or <1 with meningitis

A

Vancomycin + ampicillin + Rocephin or cefotaxime

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11
Q

What is emperic meningitis therapy for a 16 yo patient with a severe PCN allergy?

A

Chloramphenicol 4-6g/day x4days + Vancomycin 30-45mg/kg/day

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12
Q

What is emperic meningitis therapy for a 16 yo patient with a severe PCN allergy and suspected cause as listeria ?

A

Chloramphenicol 4-6g/day x4days + Vancomycin 30-45mg/kg/day + SMX/TMP 5mg/kg IV q6h

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13
Q

How is pain treated in </= 5?

A

Tylenol: 10-15mg/kg q4-6h
Motrin: 5-15mg/kg q6-8h

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14
Q

What topical agents can be used ONLY in children >5 for otiis media pain

A

topical benzocaine, procaine or lidocaine

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15
Q

What criteria must be present for an observational period to be considered

A
  1. patient >/= 2yo
  2. No otorrhea (unilateral or bilateral)
  3. No severe symptoms (unilateral or bilateral)
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16
Q

What symptoms indicate sever otitis media?

A

otalgia >48h

temprature >/= 39C or 102.2F in past 48 hours

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17
Q

What are the recommended drugs of choice for otitis media?

A

Amoxicillin 80-90mg/kg/d or

Augmentin 90mg/kg/d

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18
Q

What is the recommended drug of choice for otitis media if patient has failed therapy with Amox?

A

Augmentin 90mg/kg/d

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19
Q

What is the recommended drug of choice for otitis media if patient has failed therapy with Augmentin?

A

Rocephin 80mg IV/IM x3 days

20
Q

What are the recommended alternative therapies for otitis media (2nd line)

A

Cefdinir 14mg/kg 1-2 doses
Ceftin 30mg/kg/d in 2 doses
cefpodoxime 10mg/kg in 2 doses
Rocephin 50mg IV/IM x1 or 3 days

21
Q

What is the duration of therapy for a child <2 with otitis media

A

10 days

22
Q

What is the duration of therapy for a child 2-5 yo with otitis media?

A

7 days

23
Q

What is the duration of therapy for a child >/= 6yo with otitis media?

A

5-7 days

24
Q

What vaccine should be given to all children 2-23 months to prevent/ decrease changes otitis media, prevent pneumococcal meningitis & pnumonia?

A

Prevnar 13

25
Q

should prophylactic antibiotics be given to prevent otitis media in children?

A

NO

26
Q

In most cases upper respiratory infections are viral in origin therefore antibiotics are not used. In which types of upper respiratory infections will antibiotics be used

A

Pharyngitis & sinusitis

27
Q

When will antibiotic therapy be used in pharyngitis?

A
  1. Fever
  2. Tonsil or lymph node swelling
  3. rapid antigen diagnosit test (RADT) is positive for strep
  4. NO cough
28
Q

What are the treatment options for pharyngitis?

A

Penicillin
Amoxicillin
1st/2nd generation cephlasporin
Macrolides

29
Q

what is the typical duration of therapy for pharyngitis

A

5-10 days

30
Q

When are antibiotics indicated in the treatment of sinusitis?

A
  1. Symptoms for >7-10 days
  2. Tooth/ face pain
  3. Nasal drainage/ discharge
  4. Congestion or severe worsening of symptoms
31
Q

What are the first line options for sinusitis

A

Amoxicillin
SXM/TMP
Doxycycline

32
Q

What are the second line agents for sinusitis ( failure of 1st line)

A

Azithromycin 10mg/kg/d x day1 , then 5mg/kg/d x day2-5
Augmentin
Oral 3rd gen cephlasporin
respiratory quinalones

33
Q

What OTC class of agents can be used for sinusitis

A

Nasal corticosteroids
decongestants
tylenol
NSAIDs

34
Q

What is the typical duration of therapy for acute sinusitis

A

7-14 days

35
Q

What is the duration of therapy for chronic sinusitis

A

> /= 21 days +/- surgery

36
Q

What medications are used for the management of acute bronchitis

A

antitussives +/- inhaled bronchodilators (albuterol, codiene, dexmethorphan) should be recommended. Antibiotics are not indicated as most cases of acute bronchitis are viral & self limiting.

37
Q

What is considered severe bronchitis

A
  1. symptoms & persistent cough >14 days or a whooping cough
38
Q

What medications can be used in the management of severe bronchitis?

A

Azithromycine (Z-pak)- 500mg x1, then 250mg xday 2-5
Erythromycin estolate(E.E.S)- 500mg QID x14
Clarithromycin (Biaxin)-500 mg BID or 1g ER qd x7 days
SMX/TMP DS(Bactrim, Septra)- 1 tab BID x14 days

39
Q

What symptoms of an Acute Exacerbation of Chronic Bronchitis must be present to start antibiotics?

A

2/more of: increased dyspnea, increased sputum production, increased sputum purulence.

40
Q

What are the symptoms of Acute Bronchitis

A

symptoms of sore throat, malaise, HA, low grade fever &/or purulent sputum production, coryza (inflammation of mucus membrane of nose)

41
Q

IF antibiotics were to be used in mild - moderate AECB, what can I choose from

A

Amoxicillin
Bactrim
cephlosporins
doxycycline

42
Q

What medications should be used in severe AECB

A

Inhaled anticholinergic bronchodilators + oral setroid, taper over 2 weeks

43
Q

IF antibiotics were to be used in severe AECB, what agents are beneficial?

A 
Augmentin
Antipneumococcal FQ
Bactrim
3rd generation cephalosporin
Doxycyclin
Macrolide
44
Q

Augmentin & Anti-pneumococcal FQ use should be reserved for which AECB patients

A

Patients at risk for drug resistiance S. pneumo

45
Q

What patients are at risk for drug resistant S. pneumo

A 
>65 
multiple comorbidities (HF, DM, cancer, renal/liver dysfunction, alcoholism, aplenia, immunosuppressed
46
Q

how long should antibiotic therapy for severe AECb be?

A

5-7 days, but longer may be needed.

Infectious Disease (7 decks)

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