Treatment of CNS and Respiratory Infections Flashcards

1
Q

What antibiotics typically don’t reach sufficient levels in the CSF?

A

the 30S inhibitors -> tetracyclines / aminoglycosides, + polymyxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the empiric coverage we use for meningitis in patients <1 month?

A

Ampicillin + gentamicin or cefotaxime (3rd generation not ceftriaxone)

Gentamicin is okay because patient has no BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the empiric coverage for meningitis in patients 1-23 months of age and why?

A

Vancomycin + 3rd generation cephalosporin

Use vancomycin for possibility of mildly elevated MICs of Streptococcus pneumoniae which would not allow killing by cephalosporin in CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the only difference between treating adults under 50 and children for CNS infection?

A

Adults get Dexamethasone prior to first antibiotic dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the purpose of giving dexamethasone?

A

It is a steroid to decrease inflammation in subarachnoid space and thus decrease neurological sequelae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What must be added onto the antibiotic regimen for adults >50 and why?

A

ampicillin, for listeria coverage

So regimen is:
ampicillin + vancomycin + ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can be used against Listeria if patient is allergic to ampicillin?

A

TMP/SMX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Who gets prophylaxis for meningitis caused by N. meningitis and H. influenzae and what is it?

A

N. meningitis - anyone exposed to oral secretions and household contacts - Ciprofloxacin 500 mg or rifampin

H. influenzae - everyone in a household with unvaccinated children (might spread to them) - Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common causative pathogen in CSF shunt infections, and what is the recommended empiric treatment?

A

Usually coag-negative staph (from skin)

Recommended broad therapy: Vancomycin + cefepime or ceftazidime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the basic treatment for all fungal CNS infections minus Coccidio?

A

Lipid Amphotericin B + flucytosine for all
Blasto and Histo longer therapy, and longer oral therapy

Recommend switching to oral azole therapy after a few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the recommended therapy for only Coccidio CNS infection?

A

High dose fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Typically acute bronchitis is not treated. What are the exceptions? What is used to treat?

A

Mycoplasmal, chlamydial, or B. pertussis

All use Macrolides with second line doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

During a COPD exacerbation, who gets antibiotics?

A

Only those with increased sputum purulence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the most common bugs for COPD exacerbation?

A

S. pneumoniae, H. influenzae, M. catarrhalis (typical pathogens)

With some Chlamydia or mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the first-line treatment for COPD exacerbation?

A

Doxycycline, with second-line amoxicillin/clavulanic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who gets IV therapy for COPD exacerbations and what is it?

A

Those at high risk for poor outcome -> frequent exacerbations, comorbidities, and Abx use

It is ampicillin/sulbactum (basically IV augmentin)

17
Q

How long are COPD exacerbations treated?

A

3-7 days

18
Q

What are the only times you treat for sinusitis, since it is usually viral?

A

When signs / symptoms are persistent >10 days, with no improvement, or the symptoms are severe with purulent discharge / facial pain at least 3-4 days

19
Q

What is the therapy for sinusitis?

A

Same as outpatient COPD: amox/clav or Doxycycline

20
Q

What are “the big 6” of Community-Acquired pneumonia?

A
  1. Streptococcus pneumoniae
  2. Hemophilus influenzae
  3. Moraxella cattarhalis
  4. Mycoplasma pneumoniae
  5. Chlamydia pneumoniae
  6. Legionella pneumophilia
21
Q

What is given to healthy CA-pneumonia and high risk CA-pneumonia in outpatient therapy?

A

Previously healthy: azithromycin or doxycycline

High risk: beta-lactam + azithromycin or doxycycline

22
Q

For inpatient non-ICU CAP, what is the treatment?

A

Azithromycin or doxy + 3rd generation ceph, or respiratory fluoroquinolone

23
Q

For inpatient ICU CAP, what is the treatment?

A

Same drugs, but IV is necessary. Can add Vancomycin if concern for MRSA

24
Q

What is the treatment of choice for outpatient aspiration pneumonia?

A

Amoxicillin/clavulanic acid (good gram negative / anaerobe coverage)

25
Q

What is the treatment of choice for inpatient aspiration pneumonia?

A

Ampicillin / sulbactam (IV version of augmentin)

26
Q

What dictates the duration of therapy for community-acquired pneumonia?

A

Minimum of 5 days, must be afebrile for 48-72 hours, and no more than one “sign of instability”

  1. Fever, leukocytosis, tachycardia, tachypnea
27
Q

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

A
1. Antipseudomonal beta-lactam
\+
2. Antipseudomonal FQ or aminoglycoside
\+
3. MRSA coverage: Vancomycin or linezolid
28
Q

What organism throws a wrench in your HAP/HCAP/VAP plans?

A

Acinetobacter baumanii -> resistant to many drugs

Typically you need tigecycline or polymyxins since it is gram negative

29
Q

What is the duration of therapy recommended for HAP bugs?

A

7 days, assuming initial response to drugs and no pseudomonas

30
Q

What should be done if the HAP is not MRSA? What should be done with pseudomonas?

A

Immediately discontinue vancomycin

Also de-escalate the anti-pseudomonal drugs to narrowest one possible

31
Q

How should you treat Stenotrophomonas maltophilia pneumonia?

A

TMP/SMX is the drug of choice

32
Q

Why do we give CF patients high dose antibiotics and often aerosolized antibiotics?

A

High dose - they metabolize the drugs super fast

Aerosolized - just want to suppress the infection, we aren’t gonna stop it entirely