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Infectious Disease > Therapeutic Regimens > Flashcards

Therapeutic Regimens Flashcards

1
Q

Latent Tb in pregnancy, young children, HIV+

A

Isoniazid 300mg daily x 9 months

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2
Q

Latent Tb in isoniazid resistant or intolerant

A

Rifampin 600mg daily x 4 months

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3
Q

Latent Tb

Not used in HIV+, pregnancy, <2yo, presumed INH resistance or rifampin resistance

A

Rifapentine + isoniazid (Priftin)

Once weekly x 12 weeks

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4
Q

Active Tb

Preferred regimen

A

Intensive phase: 2 months
Rifampin, Isoniazid, Pyrazinamide, Ethambutol

Continuation phase: 4 months
Isoniazid, rifampin

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5
Q

Infective endocarditis - strep viridans

A

Penicillin, ampicillin or ceftriaxone +/- gentamicin for synergy

If beta lactam allergy then vancomycin monotherapy

4-6 weeks. Upper end if prosthetic valve or resistant organism

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6
Q

Infective endocarditis - staphylococcus MSSA

A

Nafcillin or cefazolin

Add gentamicin if prosthetic valve

If beta lactam allergy then vancomycin

4-6 weeks. Upper end if prosthetic valve or resistant organism

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7
Q

Infective endocarditis - staphylococcus MRSA

A

Vancomycin
Add gentamicin if prosthetic valve

4-6 weeks. Upper end if prosthetic valve or resistant organism

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8
Q

Infective endocarditis - Enterococcus

A

Penicillin or ampicillin + gentamicin for synergy

If beta lactam allergy then vancomycin

4-6 weeks. Upper end if prosthetic valve or resistant organism

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9
Q

Infective endocarditis dental prophylaxis

A

Amoxicillin 2g

If beta lactam allergy:
Clindamycin 600mg
Azithromycin or clarithromycin 500mg

One time dose given 30-60 minutes before procedure

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10
Q

Primary peritonitis (SBP) treatment

A

Ceftriaxone x 5-7 days

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11
Q 
Primary peritonitis (SBP)
Primary or secondary prophylaxis
A

SMX/TMP

Ciprofloxacin

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12
Q

SSTI impetigo

A

Cephalexin if multiple lesions

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13
Q

SSTI folliculitus/furuncles/carbuncles

A

Cephalexin

If doesn’t work- doxycycline or SMX/TMP

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14
Q

SSTI cellulitis nonpurulent

A

Cephalexin

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15
Q

SSTI abscesses purulent

A

SMX/TMP or doxycycline

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16
Q

Acute uncomplicated cystitis

A

Nitrofurantoin 100mg PO BID with foods 5 days

Or

SMX/TMP 1 DS tablet PO BID x 3 days

Or

Fosfomycin 3g x 1 time in 4oz of water

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17
Q

Acute uncomplicated pyelonephritis

A

Ciprofloxacin
Levofloxacin x 7 days

IV ceftriaxone if inpatient

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18
Q

pregnant patients with bacteriuria even with negative urinalysis and asymptomatic

A

3-7 days

Augmentin or oral cephalosporins

SMX/TMP and nitrofurantoin last line in 1st trimester and try to avoid last weeks before delivery

Fosfomycin can be used if drug allergies present

Avoid quinolones and tetracyclines

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19
Q

Urinary analgesic

A

Phenazopyridine (Azo, Uristat, Pyridium)

With food to minimize stomach upsets

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20
Q

Cdiff
Mild to moderate
1st infection

A

Metronidazole 500mg PO TID x 10-14 days

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21
Q

Cdiff
Mild to moderate
2nd infection (1st recurrence)

A

Metronidazole 500mg PO TID x 10-14 days

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22
Q

Cdiff
Mild to moderate
3rd infection(2nd recurrence)

A

Vancomycin taper/pulse

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23
Q

Cdiff
Severe
1st infection

A

WBC >= 15,000 OR SCr >= 1.5x baseline

Vancomycin 125mg PO QID x 10-14 days

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24
Q

Cdiff
Severe
2nd infection (1st recurrence)

A

Vancomycin 125mg PO QID x 10-14 days

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25
Q

Cdiff
Severe
3rd infection(2nd recurrence)

A

Vancomycin taper/pulse

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26
Q

Cdiff
Severe complicated
1st infection

A

Ileus, toxic megacolon, hypotension, shock

PO vanc + IV metronidazole

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27
Q

Cdiff
Severe complicated
2nd infection (1st recurrence)

A

PO vanc + IV metronidazole

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28
Q

Cdiff
Severe complicated
3rd infection (2nd recurrence)

A

Vancomycin taper/pulse

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29
Q

Travelers diarrhea

Bloody stools, fever, pregnant, pediatric

A

1-3 day course of azithromycin

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30
Q

Travelers diarrhea

NOT bloody, fever, pregnant or pediatric

A

1-3 day course of cipro, Levi, ofloxacin, rifaximin

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31
Q

Loperamide should be avoided in what type of travelers diarrhea?

A

Dysentery or bloody diarrhea
Or
Patients with a fever

32
Q

Syphilis
Primary, secondary
Early latent <1year

A

Penicillin G benzathine (Bicillin LA) 2.4 million units IM x 1

33
Q

Syphilis
Tertiary
Late latent >1 year

A

Penicillin G benzathine 2.4 million units weekly x 2-3 weeks

34
Q

Gonorrhea

A

Ceftriaxone 250mg IM x 1 plus azithromycin(preferred) or doxycycline

35
Q

Chlamydia

A

Azithromycin 1g PO x 1

36
Q

Bacterial vaginosis
Symptom
Treatment

A

Fishy odor and pH>4.5

Metronidazole or metronidazole 0.75% gel

37
Q

Trichomoniasis
Symptoms
Treatment

A

Yellow-green discharge

Metronidazole 2g PO x 1

38
Q

Rocky Mountain spotted fever

A

Doxycycline

39
Q

Lyme disease

A

Doxycycline

40
Q

Outpatient CAP

Relatively healthy and no antibiotics the past 3 months

A

Macrolide (azithromycin, erythromycin, clarithromycin)

Or

Doxycycline

41
Q

Outpatient CAP

Antibiotics within the past 3 months, immunosuppressed, or medical comorbidities

A

Beta lactam (high dose amoxicillin, Augmentin, cefpodoxime, cefdinir, cefuroxime, ceftriaxone)

PLUS macrolide or doxycycline

OR

Respiratory fluoroquinolone monotherapy (gemifloxacin, moxifloxacin, levofloxacin)

42
Q

Inpatient CAP

No pseudomonas risk

A

Beta lactam (ceftriaxone, cefotaxime, IV ampicillin)

PLUS

Macrolide or doxycycline

Duration 5-6 days

43
Q

Inpatient CAP

Pseudomonas risk

A

Zosyn, cefepime, imipenem/cilastatin, meropenem, levofloxacin

PLUS

Aminoglycoside (gentamicin, tobramycin, amikacin)

PLUS

Azithromycin

Duration 5-7 days

44
Q

Inpatient CAP

Add which medications to regimen to cover MRSA?

A

Vancomycin

Linezolid

45
Q

HAP/VAP

MSSA and pseudomonas

A 
Cefepime
Zosyn
Imipenem/cilastatin
Meropenem
Levofloxacin

Duration 7 days

46
Q

HAP/VAP

Pseudomonas and MRSA

A 
Aztreonam
Meropenem
Imipenem/cilastatin
Zosyn
Cefepime
Ceftazidime
Levofloxacin
Ciprofloxacin

PLUS

Vancomycin
Linezolid

Duration 7 days

47
Q

HAP/VAP

MDR pseudomonas and MRSA

A 
Choose 2
Cefepime
Ceftazidime
Zosyn
Aztreonam
Meropenem
Imipenem/cilastatin
Levofloxacin
Ciprofloxacin
Colistin, polymixin B
Tobramycin, gentamicin

PLUS

Vancomycin
Linezolid

Duration 7 days

48
Q

Which amphotericin B formulation requires pre-medication for infusion-related reactions?

A

Conventional

Amphotericin B deoxycholate

49
Q

Flucytosine should always be used with which agent to prevent resistance?

A

Amphotericin B

50
Q

Fluconazole is active against which fungal species?

A

Candida albicans and tropicalis

51
Q

Which azoles capsule and oral suspension is not interchangeable?

A

Itraconazole (Sporanox)

Posaconazole (Noxafil)

52
Q

Which form of itraconazole should be taken without food?

A

Solution

53
Q

Which form is itraconazole should be taken with food?

A

Capsule

54
Q

Which azole is considered 1st line in treating c. Albicans?

A

Fluconazole (Diflucan)

55
Q

Which azole is drug of choice for aspergillosis?

A

Voriconazole

56
Q

Which azole has better coverage of c. Glabrata, c. Krusei, and aspergillosis?

A

Voriconazole

57
Q

Which azoles should be taken with food

A

Tablet, capsule itraconazole

All forms posaconazole

58
Q

Which azole requires a micron filter during administration because of particulates?

A

Isavuconazonium

59
Q

Candida albicans in HIV pt

A

PO fluconazole

60
Q

Moderate to severe Candida albicans

A

PO fluconazole

61
Q

Esophageal Candida albicans infection

A

PO fluconazole or echinocandin

62
Q

Candida glabrata or candida krusei

A

Echinocandins

Amphotericin B

63
Q

Aspergillus

A

Voriconazole
Amphotericin B
Isavuconazonium

64
Q

Nail bed infections

A

Terbinafine
Itraconazole
Fluconazole

65
Q

When should neuraminidase inhibitors be initiated?

A

Within 48h of symptom onset

66
Q

What is the benefit of a neuraminidase inhibitor?

A

Decrease flu by 1 day and avoid complications

67
Q

Oseltamivir treatment

A

75mg PO BID x 5 days

68
Q

Oseltamivir prophylaxis

A

75mg PO daily x 10 days

69
Q

Which neuraminidase is an inhaler?

A

Zanamivir (Relenza diskhaler)

70
Q

Which neuraminidase inhibitor is an injection?

A

Peramivir (Rapivab)

71
Q

How to dose acyclovir in obese patients?

A

IBW

72
Q

If HSV2 acyclovir-resistant, can you use Valtrex or Famvir?

A

No

73
Q

Ideally when should HSV2 (genital herpes) be treated?

A

At prodrome onset or within 1 day of symptom onset.

74
Q

HSV encephalitis

A

IV acyclovir

75
Q

When is initiating therapy most effective for shingles?

A

Within 72h of symptom onset

76
Q

Treatment of choice for CMV

A

Ganciclovir

Valganciclovir

Infectious Disease (14 decks)

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