Treatments, exam 1 Flashcards
more than skin
Coag negative staph infection
vancomycin
Reasoning: occurs on postop patients, on like in a hip replacement. Most states have aureus is MRSA so its a dire situation, might as well use the big gun.
impetigo
topical mupirocin/bactroban
Keflex, dicloxacillin, omicef/cefdinir
If MRSA- bactrim, clinda, doxy
Keflex = kleenex like they wiped their nose too many times and now they have impetigo.
Dicloxacillin because its a skin condition similar to staph skin infections, and its not MRSA.
MRSA always gets the big guys like doxy, clinda
erysipelas
OP w/o systemic:
■ Pick either, PCN VK, amoxicillin, dicloxacillin, Keflex, Clinda/Erythromycin
IP w/ systemic: vanc, cefazolin, ceftriaxone, clindamycin
PACK + D; v x 3
strep agalactiae
○ Prophylactic PCN G or cefazolin, vancomycin, ampicillin, clindamycin Q4h until delivery
Clap + VC (vacation)
ampicillin because giving birth is a positive feedback cycle.
Cl- a- p + V C
You could also do Clap + v-ancef like for example we are about to give birth, get ready, clap, we are going in the van.. ??
OM
○ Analgesics/antipyretics
○ 1st Amoxicillin for ten days
○ 2nd augmentin or cephalosporin
○ 3rd cephalosporin or augmentin
○ 4th Rocephin injection 1x a day for three days
○ 5th Ear tubes
- first line is ammo. when you shoot a gun, it hurts your ears. OM. pain. i hate shooting guns.
- C August Race Tubes - cephalosporin, Augmentin, Roce-ephin, Ear tubes
acute sinusitis
○ Augmentin for 14 to 21 days since it’s a cavity. Alternative is doxycycline or clindamycin.
Claud (ia) Cl- au- d
Think Claudia has a clogged up nose
Pneumococcal pneumonia
○ Outpatient –
■ First Line: amoxicillin, doxycycline, Z pack if less than 25% resistance in area
■ If COPD/comorbidities/recent abx treatment/inpatient:
● Levofloxacin
● combo of (Augmentin or cephalosporin) + Z max or doxycycline)
○ Inpatient –
■ Levofloxacin
■ combo macrolide + (amox or ceftriaxone)
OP- D’ ammo’ z (mon) - a coughing troll
If copd/IP: Levofloxacin
if copdinpatient only: Aug/ceph + Z/doxy
if IP only: macrolide + ammo/axe
Strep pneumo meningitis
○ Ceftriaxone or Rifampin QID dosing for two days.
associate the brain as the castle, and 3 warriors with axes, RIPping Rifampin throug the invaders
Endocarditis (enterococcus)
● Ampicillin + gentamicin
picture a gentlemen looking up at a window to sing to a lady. uses a music amp. it warms her heart.
Bacillus anthracis
& duration of treatment
○ Cipro PO or IV ASAP, alternative is Doxy
■ Cutaneous: 7-10 days
■ Inhalation: 60 days
○ Prophylactic cipro if exposed
Listeriosis
○ IP Ampicillin + gentamicin
○ OP amoxicillin for 2-3 weeks
Same as endocarditis ~ then gun
Think… lovers quarrel. She gets mad after he sings to her. She goes on a hunt for 2 to 3 weeks
You use mouthwash before a date.
P. Aeruginosa
o OP
Cipro (oral), Levofloxacin (oral)
Tobramycin (inhaled 9 mo)
o IP
All meds IV
Pip/taz
Ceftazidime
Cefepime
Meropenem
Aztreonam
o OP Inhaled
tobramycin
OP: Lift (the cup or your spirits) & Sip T - Levofloxacin Cipro Tobramycin
IP: Pip/Taz pine & dime Mr. Penem, as three. own em! aka pip/taz cefepime meropenem aztreonam
Corynebacterium diplitherae
○ Diphtheria equine antitoxin (from CDC)
○ PCN or erythromycin
○ Contacts: erythromycin
Purple and red corn - VIOLET! corn.
Purple = penicillin
Red = erythromycin
corn = coryne
CDC must be notified so they can provide the antitoxin.
Neisseria meningococcal meningitis
○ PCN G (if known susceptibility)
○ Rocephin (empiric) – covers atypicals, group B strep, S pneumo, and H flu, all the causative agents
■ Continue until afebrile for 5 days
○ Contacts: prophylactic rocephin
Assoicate neisseria with the lochness monster Nessie.
Nessie races (roce) towards penicillin G (the gate or finish line)
Neisseria gonorrhoeae
○ Rocephin + azithromycin
Roce ~ Race
Azithromycin ~ Z (for z pack)
Racy = sexual
which is fitting for a STI
Bordetella pertussis
○ Supportive care
○ 1st Azithromycin
○ 2nd alternative is Bactrim
Give them the A - B - C ‘s
They are a baby, so they are learning their alphabet!
Azithromycin, Bactrim, Care (supportive care)
Legionaires
& duration of treatment
○ Macrolide (Azithromycin, Clarithromycin) or Fluroquinolone (levofloxacin)
○ 10 to 14 days of abx
○ 21 d for IC
The Legion macroleads/macroguides through flowers (fluroquinolones)
Klebsiella pneumumoniae
○ Empiric: resp. fluoroquinolone (levo, moxi, gemi) or carbapenem
Mneumonic for Klebsiella is Sierra is at the club with her red jelly lipstick. She drinks alcohol and contracts HIV from the men at the club.
Extending this, she parties in Penem w/ flowers (a rose, like president snow)
UTI
1st line Bactrim – CI in 1st trimester but is 1st line in kids
1st line Nitrofurantoin (Macrobid) - (avoid in last trimester)
○ Ciprofloxacin – last line, like saving for pyelo
○ Fosfomycin (good for everyone)
○ Cephalexin or cefdinir (use in children and last trimester pregnancy)
○ Omnicef or Keflex (good for everyone)
Kids trim dinner, a reflex
Kids: (1st line)-Bactrim Cefdinir keflex
Will have to study pregnant UTIs in a seperate section
Adult UTIs-
Nitrofurantoin, Fosfo, Keflex, Dinner, Omnicef. Cipro is usually saved for last
Mneumonic kids trim dinner inflexibly
Adults: nights trimmed
Pregnant: nights ( use in first trimester) trimmed ( use in last trimester)
Yersinia Pestis
○ Gentamicin or doxycycline x 10 days
○ Streptomycin x 10 d
○ Fluoroquinolone (cipro, levo, moxi)
○ Prophylactic doxy AND cipro for contacts for 7 d
○ Strict isolation for pneumonia
10 gentlemen strip down + flowers
Gentamicin, streptomycin, Doxycycline 10 days each. + fluroquinolone (posies)
they are stripping down to quarantine. posies are a type of flower.
7 contacts sip drinks
Contacts get cipro and doxycycline for 7 days
Francisella Tularensis Tularemia
Treatment: identical to bubonic plague
○ Gentamicin or doxy, Streptomycin, fluroquinolones
10 gentlemen strip down + flowers
Mycoplasma pneumoniae
○ 1st Azithromycin (macrolides) – both kids and adults
○ Fluroquinolones – adults only. Bactericidal and MIC higher than macrolides.
○ Tetracyclines – older children and adults
This mneumonic is a bit rough
Rated - Z’ for Z’everyone (azithromycin)
Tetris is for teens and adults to play (Tetracyclines)
Fluroquinolones = fully grown - sounds phonetically similar if you say it out loud
Chlamydia psittaci
● Treatment:
○ Tetracycline or erythromycin
Red bird with four feathers
or, red teradactyl
Syphillis
○ PCN G IM (single dose) aka Bicillin
○ TREAT PARTNERS + REPORT
○ If we don’t have Bicillin in stock, then treat with amoxicillin or penicillin VK
Lyme
Duration of treatment
○ Pregnant - amoxicillin
○ Adults: doxycycline
○ Children: doxycycline as long as your treat under 21 days
○ Treat for 10-21 days
○ Refer to criteria if someone wants prophylaxis
Rocky mtn rickettsia rickettsii
doxy even for pregnancy
Staph skin infections
Low MRSA, high MRSA, IP, 2nd line after IP, and kids
○ DRAIN THE ABSCESS
○ Low MRSA risk: keflex or dicloxacillin
■ Know that most cases are going to be MRSA
○ High MRSA risk: clinda, or doxy/mino, Bactrim
○ Inpatient: 1st line vancomycin IV.
■ After 1st line, clindamycin, cefazolin, nafcillin/oxacillin, linezolid ($)
■ Also give them pip/taz empirically until the cx r/o pseudomonas
○ Children: 1st Bactrim (BID) or 2nd Clindamycin (TID)
kids = bad clean (bactrim clindamycin) or clean trim
Low MRSA risk = keflex or dicloxacillin
High MRSA = BCD (bactrim, clinda, doxy)
IP= vanco. 2nd- NO Ants Cl-imb
N (naf)/ O(oxa) Ants (Ancef) CL (clinda) -line (macrolide)
Note: very similar to impetigo tx
Staph osteomyelitis
○ Empiric first: vanc + Rocephin (cephtriaxone) IV (or other 3rd/4th gen cephalosporin)
○ Prolonged therapy required after culture 4-6 weeks
○ MSSA (with report): nafcillin IV or oxacillin or cefazolin
○ MRSA (with report): vanc IV
○ May require surgery and debride bone
Empiric: positive vampire races and win 3/4 (van + roce or 3/4 cephalosporin)
MSSA - NO Ants (Nacillin/oxacillin) Ancef
MRSA- vanco IV
Toxic shock
○ Hospitalize
○ Supportive: antipyretics, IV fluids, monitor liver and kidney function
○ Debride local infections
○ Empiric: Combo of vanc + clinda + (pip/taz or cefepime or imipenem or meropenem)
○ When we get the culture back, stop the empiric treatment and keep the one that is sensitive
Peter Piper Picked a clean vampire
(pime, penem, pip/taz, + clinda, + van)
scalded skin syndrome
○ Supportive: fluids, skin care (treat like burns)
○ MSSA: oxacillin or nafcillin
○ MRSA: vanc
“NO vampires”! the sun gives you blisters
Nafacillin/oxacillin – van if you mrsa
staph food poison
self limiting
Strep pyogenes pharyngitis
○ 1st PCN G (IM)
○ PCN VK (oral) or amoxicillin.
○ Kids prefer amoxicillin (available as a liquid)
○ If allergic to penicillin, cephalosporin- Cefalexin, Omnicef (once a day), Keflex
○ If they are positive, you treat. If they are negative you don’t treat.
PAC: Penicillin IM, Amoxicillin (or P VK), Cephalosporin
Kids: Amoxicillin
Impetigo
● Treatment:
○ If localized, topical mupirocin/bactroban
○ Systemic
■ Keflex, Dicloxacillin
○ If MRSA suspected (rare): Bactrim (TMP-SMZ), doxy, or clinda
○ Clears up in 24-48 hours
MRSA: BCD
Update version
Erysipelas
○ OP (no fever or sepsis)
■ PCN VK, amoxicillin, dicloxacillin, Clinda/Erythromycin
■ If allergic, Keflex
○ If severe/staph aureus suspected: vanc, cefazolin, ceftriaxone, clindamycin
PACK( K is alt) + D, V x 3
updated version
Strep agalactiae
○ Prophylactic PCN G IV infusion Q4h, ampicillin, cefazolin, Q4h until delivery
○ Alternative – Clinda, Vanco
○ If the mom wasn’t cultured before going to the hospital to deliver, then you treat the baby with penicillin.
○ Mom should be on antibiotics if culture comes back positive
○ Don’t do this for C section
P-amp ants 2 clean the van
Penicillin ampicillin ancef 2nd clinda vanco
updated
OM
○ Analgesics/antipyretics
○ 1st Amoxicillin for ten days (80-90 mg) x 10 d. 2 week f/u to check if the abx is working
○ 2nd augmentin or cephalosporin (like Omnicef)
○ 3rd cephalosporin or augmentin
○ 4th Rocephin injection 1x a day for three days
○ 5th Ear tubes
updated
Pneumococcal pneumonia
○ Determine pneumonia severity index, or curb score 65. Need for hospitalization based on this.
○ Outpatient –
■ First Line: amoxicillin, doxycycline, Z pack if less than 25% resistance in area
■ If COPD/comorbidities/recent abx treatment in last 3 months:
● 1st - Levofloxacin (either for IP or this comorbid)
● 2nd - combo of (Augmentin or cephalosporin) + Z max or doxycycline)
● 3rd line Rocephin IM + Z pack
○ Inpatient (comorbidities) –
■ Levofloxacin
■ combo macrolide (z) + (amox or ceftriaxone)
Bacillus anthracis
Duration of treatment
○ Cipro PO or IV ASAP, alternative is Doxy
■ Cutaneous: 7-10 days
■ Inhalation: 60 days
■ Doxycycline is alternative
■ Don’t need to know dose/mg
Anthrax phoneticallly “an-thrax” “in-….” relax breathe and SIP tea (cipro)
P. Aeruginosa
o OP
1st Cipro (oral), Levofloxacin (oral)
Tobramycin (inhaled 9 mo), if CF, last line in children (CI’d normally)
o IP
All meds IV
1st Pip/taz
Ceftazidime
Cefepime
Meropenem
Aztreonam
o OP Inhaled
tobramycin
N. Meningococcal meningitis
○ PCN G (if known susceptibility)
○ Rocephin (empiric) – covers atypicals, group B strep, S pneumo, and H flu, all the causative agents
■ Continue until afebrile for 5 days
○ Contacts: prophylactic rocephin
○ Have to notify the health department
Whooping Bordatella pertussis
○ Supportive care
○ 1st Azithromycin (the only time you use in kids)
○ 2nd alternative is Bactrim
Legionaires
○ Macrolide (Azithromycin, Clarithromycin) or Fluroquinolone (levofloxacin)
○ 10 to 14 days of abx
○ 21 d for IC
updated
UTI
○ 1st Bactrim – CI in 1st trimester but is 1st line in kids
○ Nitrofurantoin (Macrobid) - (avoid in last trimester)
○ Ciprofloxacin – last line, like saving for pyelo
○ Fosfomycin (good for everyone)
○ Cephalexin or cefdinir (use in children and last trimester pregnancy)
○ Omnicef or Keflex (good for everyone)
Pyelonephritis
○ Treatment: Cipro or Levofloxacin,
○ Or combo of Ceftriaxone, X1 dose + (Bactrim, Augmentin or Omnicef)
Chlamydia pneumoniae
same as walking pneumonia
Syphillis
○ PCN G IM (single dose) aka Bicillin
○ TREAT PARTNERS + REPORT
○ If we don’t have Bicillin in stock, then treat with amoxicillin or penicillin VK
Lyme Disease
Doxycycline (under 21 days for kids), pregnant is amoxicillin
think *dog has ticks
Leptospirosis
Doxycycline
same as lyme
Rocky mtn spotted fever
○ DOXY FOR ANY AGE. Even for pregnancy. No amoxicillin use. 100 mg Twice a day, PO or IV 3 days after fever subsides. Minimum course of treatment is 5 to 7 days.
think *dog has ticks
Clostridial soft tissue infections
○ Drainage and debridement
○ Hyperbaric therapy
○ Pip/taz + clinda (covers strep and clostridium)
■ May switch to PCN + clinda if culture shows clostridium only
pip and taz (maids) clean first
If that doesn’t work, then we use purple cleaner
Tetanus
○ Hospitalization
○ Supportive care (respiratory, spasms)
○ Wound debridement
○ Tetanus immune globulin (HTIG) within 24 hours
○ Full tetanus vaccine series
○ PCN or metronidazole
purple metro
Botulism
○ Hospitalization
○ Supportive care (respiratory, NG tube)
○ Antitoxin (from CDC)
○ Wound botulism only: PCN G or metronidazole
(purple metro)
Pseudomembrane colitis
○ Mild
■ Both are 1st Vanc 125 mg PO QID (NOT IV) or Fidaxomicin 200 mg BID
○ Severe:
■ Both are 1st Vanco 125-500 PO QID or enema, (Fidaxomicin 200mg BID+- Metronidazole)
○ Refractory – fecal transplant
○ Recurrent – Fidaxomicin or vancomycin 500 mg PO q6hrs
BV (Gardnerella MC)
○ Metro or clinda (PO or vaginal)
○ Tinidazole (PO only)
vagina = subway station.
Clean the metro (as in, clean the infection out)
-+ Tinidazole
VRE skin/wound
short for vancomycin resistant enterococcus
Linezolid, Daptomycin
Staph. enterococcus skin wound
amp or vanc
Vampire + amp
