Treatment Guidelines - Exam 3 Flashcards
Osteomyelitis PO
- Streptococci: Amox, Cephalexin, Clindamycin (+/- Rifampin)
- MSSA: Dicloxacillin, Cephalexin, Cefadroxil, Bactrim, Linezolid (+/- Rifampin)
- MRSA: Linezolid, Bactrim, Clinda (+/- Rifampin)
- G(-): Bactrim, FQ’s
Acute Otitis Externa
Antibiotic ear drops with/without hydrocortisone
PJI: Amputation w/ complete removal
Targeted Tx x 24-48 days
Animal/Human Bites
- Augmentin (DOC)
- Alternative: 2nd/3rd Gen Cepha + Anaerobic coverage
- B-Lactam Ax: Cipro/Levo + Anaerobic coverage OR Moxiflox
- established Infxn: 7-14 days
- Preemptive Tx: 3-5 days
Outpt CAP - WITH comorbidities (chronic heart, lung, or renal disease, DM, alcoholism, malignancy, asplenia, immunocomped)
- MonoTx: Levo or Moxiflox
- ComboTx (DOC): Augmentin, Cefpodixime, or Cefuroxime AND Macrolide or Doxycycline
Minimum 5 days and clinically stable
Inpt CAP - Severe
- Unasyn or Ceftriaxone AND Macrolide (DOC)
- Unasyn or Ceftriaxone AND Levo/Moxiflox
Minimum 5 days and clinically stable
Acute Bronchitis
Sx management (OTCs)
- NO antibiotics!! (viral infxn)
Acute Pharyngitis
- Penicillin VK or Amoxicillin PO (DOC)
- IF PCN Ax: Cephalexin, Cefadroxil, Cefuroxime, or Cefpodoxime
- If PCN anaphylaxis: Azithro or Clindamycin
10 days
HAP - high risk for mortality and MRSA risk
- PICK 2 diff classes: Zosyn, Cefepime, Imipenem, Meropenem OR Levoflox OR Troba, Amikacin (cover MDR Pseudomonas)
- AND Vanc or Linezolid (cover MRSA)
7 days if clinically stable
VAP
- Pick 2 diff classes IF RF for Pseudo Resistance: Zosyn, Cefepime, Imipenem, Meropenem OR Levoflox OR Tobra, Amikacin (cover Pseudo)
- AND Vanc or Linezolid (cover MRSA)
7 days if clinically stable
Impetigo
- Few Lesions: Mupirocin topical
- Many Lesions/Outbreak: Dicloxacillin or Cephalexin
- Strep ONLY: PCN
- Allergies/MRSA: Doxy, Clinda, or Bactrim
Inpt UTI (IV or PO)
- Ceftriaxone (DOC)
- Ampicillin + Gent
- Cefazolin +/- Gent
- Cefepime
- Gent
cUTI: 7-14 days
PJI: 1 Stage Exchange
- Targeted Tx + Rifampin x 2-6 weeks
- Oral Antibiotics + Rifampin x 3 months
MILD Diabetic Foot Infxn
- 1st Line: Dicloxacillin, Cephalexin, Clindamycin
- Recent Antibiotics? Switch to Augmentin, Levo, or Moxiflox
- MRSA RF? switch to Bactrim or Doxycycline
1-2 weeks
MODERATE Diabetic Foot Infxn
- 1st LIne: Moxiflox, Augmentin, or Cipro/Levo + Clindamycin/Metronidazole
- Pseudomonas RF? switch to Cipro/Levo + Clinda/Metronidazole
- MRSA RF? ADD Vanc, Linezolid, Doxy, or Bactrim
2-3 weeks
SEVERE Purulent SSTI
- I&D and C&S
- Empiric: Vanc, Dapto, or Linezolid
- Targeted: MRSA (Vanc, Dapto, Linezolid) or MSSA (Nafcillin, Cefazolin, or Clindamycin)
5 days
Outpt UTI (PO)
- Nitrofurantoin (uncomplicated only)
- Bactrim
- Ciproflox, Levoflox
- Fosfomycin (uncomplicated only)
- B-lactam (cephalexin, Cefadroxil, Cefpodoxime, Augmentin, Amoxicillin)
cUTI&Pyelo: 7-14 days
UTI: 3-7 days
Inpt CAP - w/ MRSA RF
ADD Vanc or Linezolid
Acute Otitis Media
- DOC: Amoxicillin 80-90mg/kg/day Q12H
- 2nd Line: Augmentin (same dose)
- Alt: Cefpodoxime, Ceftriaxone
- If pt has tubes: quinolone ear drops
Prosthetic Joint Infxn (options)
- MSSA Coverage: Cefazolin, Ceftriaxone, Cefepime, Zosyn, Unasyn, Meropenem, Ciproflox, Levoflox* (*=add Metronid if anaerobic coverage needed)
- PLUS MRSA Coverage: Vanc, Dapto, Linezolid
HAP - not at high risk for mortality (no vent support or septic shock), but MRSA risk
- Zosyn, Cefepime, Imipenem, Meropenem, or Levofloxacin (cover Pseudomonas)
- AND Vanc or Linezolid (cover MRSA)
7 days if clinically stable
Acute Exacerbation of Chronic Bronchitis
- Augmentin (DOC), Cefuroxime, Cefpodoxime
- Alternatives: Doxy, Bactrim, azithromycin
- If Pseudo risk: Levofloxacin
5-7 days
Septic Arthritis
- MSSA Coverage: Cefazolin, Ceftriaxone, Cefepime, Zosyn, Unasyn, Meropenem, Ciproflox, Levoflox* (*=add Metronid if anaerobic coverage needed)
- PLUS MRSA Coverage: Vanc, Dapto, Linezolid
Necrotizing Fasciitis
- Emergent Surgical Inspection/Debridement
- Empiric: Vanc AND Zosyn
- Targeted: Strep Pyogenes (PCN AND Clindamycin) Polymicrobial (Vanc AND Zosyn)
Tx until fever has been absent for 48 hours
MILD Non-Purulent SSTI
PO Penicillin VK, Cephalosporin, Dicloxacillin, or Clindamycin
5 days
PJI: Debridement and Retention of Prosthesis
- Targeted Tx + Rifampin x 2-6 weeks
- Oral Antibiotics + Rifampin x 3 months (HIP) - 6 months (KNEE, or other joint)
Inpt CAP - Non-Severe
- MonoTx: Levo or Moxiflox
- ComboTx (DOC): Unasyn or Ceftriaxone AND Macrolide
(Doxy can be swapped if FQ or MAC can’t be used)
Minimum 5 days and clinically stable
Prostatitis
- FQ’s
- Bactrim
- Cephalexin
- Augmentin
2-4 weeks
MILD Purulent SSTI
incision & drainage (I&D)
PEDs UTI
- Cephalexin (DOC)
- Amoxicillin, Augmentin, Bactrim
- Nitrofurantoin (Cystitis only)
Broncholitis
Supportive Therapy (Oxygen, hydration, Mechanical Ventilation, ECMO)
SEVERE Non-Purulent SSTI
- Empiric Tx: Vanc or Zosyn
- Swith to narrow Tx after C&S
5 days
MODERATE Purulent SSTI
- I&D and C&S
- Empiric: Bactrim or Doxycycline
- Targeted: MRSA (Bactrim or Doxycycline) or MSSA (Dicloxacillin or Cephalexin)
5 days
HAP - not at high risk for mortality (no vent support or septic shock)
Zosyn, Cefepime, Imipenem, Meropenem, or Levofloxacin (cover MSSA + Pseudomonas)
7 days if clinically stable
PJI: 2 Stage Exchange
Targeted Tx x 4-6 weeks
Osteomyelitis IV
- MSSA Coverage: Cefazolin, Ceftriaxone, Cefepime, Zosyn, Unasyn, Meropenem, Ciproflox, Levoflox* (*=add Metronid if anaerobic coverage needed)
- PLUS MRSA Coverage: Vanc, Dapto, Linezolid
Outpt CAP - Healthy Adult, NO comorbidities
- Amoxicillin (DOC)
- Doxycycline
- Azithromycin
Minimum 5 days and clinically stable
Inpt CAP - w/ Pseudomonas RF
SWAP B-lactam choice for either Zosyn, Cefepime, or Meropenem
MODERATE Non-Purulent SSTI
IV Penicillin, Ceftriaxone, Cefazolin, or Clindamycin
5 days
SEVERE Diabetic Foot Infxn
- 1st Line: Zosyn, Carbapenem, or Cefepime + Clinda/Metronidazole
- MRSA RF? ADD Vanc, Linezolid, or Dapto
2-3 weeks
Acute Bacterial Rhinosinusitis
- Augmentin (DOC)
- 2nd Line: Doxy, Levo, or Moxiflox
- MRSA concern: ADD Doxy, Bactrim, Linezolid
- Pseudo Concern: ADD Levo 750mg QD
Recurrent UTI Management
Drink more water!
- May consider PTx antibiotics (nitrofurantoin or bactrim commonly used)
