Infections Flashcards
What are the typical and atypical bacteria causing CAP?
Typical: streptococcus pneumoniae, haemophilus influenzae, moraxalla catarrhalis
Atypical: legionalla pneumophila, mycoplasma pneumoniae, chlamydophila pneumoniae
What are the common and uncommon viruses causing CAP?
Common: influenza viruses (A,B,C)
RSV
Uncommon
Measles virus
Avain influenza
MERS
In the initial dx of CAP what needs to be assessed?
local endemicity of pulmonary tuberculosis
host factors like immunocompromised status
risk factors for atypical or emerging pathogens (FTOCC, i.e. fever, travel, occupation, cluster and contact)
Early isolation of patients with suspected or confirmed air-borne pathogens if indicated
What is empirical treatment for outpatient CAP?
PO Amoxicillin-clavulanate (beta-lactam with beta-lactamase inhibitor) ± macrolide OR doxycycline
What is empirical treatment for outpatient CAP?
PO/IV Amoxicillin-clavulanate ± macrolide OR doxycycline
Alternatives: IV ceftriaxone, cefotaxime ± macrolide OR doxycycline
Anti-pseudomonal antibiotics (e.g. IV piperacillin-tazobactam, cefepime) ± macrolide OR doxycycline for those with chronic lung condition like bronchiectasis
Consider oseltamivir (especially during influenza season)
What is the major and minor criteria for admitting severe pneumonia patients into hospital?
What is the treatment?
1 in 3 major criteria OR 2 in 6 minor criteria:
Major criteria: need of mechanical ventilation, septic shock, acute renal failure;
Minor criteria: multi-lobar involvement, mental confusion, respiratory rate >30 bpm, PaO2/FiO2 <250, SBP <90 mmHg/ DBP <60 mmHg, serum urea level >7 mmol/L)
IV piperacillin-tazobactam or ceftriaxone or cefepime ± macrolide OR doxycycline
Consider oseltamivir (especially during influenza season)
What the organisms causing HAP with onset <4 days after admission with no previous antibiotics?
What is the empirical antibiotics?
S. pneumoniae, H.influenzae, M. catarrhalis, S. aureus
Empirical antibiotics: IV/PO amoxicillin-clavualante or IV ceftriaxone
What the organisms causing HAP with onset <4 days after admission + recieved antibiotics?
What is the empirical antibiotics?
MRSA, P. aeruginosa, Acinetobacter spp, klebsiella spp, enterobacter spp
IV piperacillin-tazobactam/IV cefipime/IV meropenem/imipneme +vancomycin if at risk of MRSA infection
Who is notified in TB case:
Notified to DH, particularly once the case is put on treatment
If patient happens to be a health care worker or working in other relevant occupations with increased risk of exposure to TB, notification to the Labor department is required under the occupational safety and health ordinance.
What is the treatment for uncomplicated TB cases?
– 6 months in total
2 HRZ + (E or S)7 / 4HR7 (When Rx started in hospital or when 3x/week regimen not tolerated)
2 HRZ + (E or S)7 / 4 HR3
2 HRZ + (E or S)3 / 4HR3 (Government Chest Clinic regimen)
What is the treatment for retreatment cases of TB?
9 months in total
3 (or 4) HRZES7 / 6 (or 5) HR E7
What are the drug dosages for TB treatment?
What are adverse reactions to 1st line anti TB treatment?
If suspicious of CNS infection what Ix should be done?
- Watch out for signs of ↑ ICP and do urgent CT brain before LP. If LP is contraindicated, likely to be delayed or fails, empirical antibiotics
can be started after taking blood cultures - CSF analysis: cell count, protein, glucose (simultaneous blood
sugar), gram stain, culture, AFB (smear and C/ST), Cryptococcus (India ink smear, Ag and culture), viral studies. Do not wait for C/ST results before starting Rx - Other Ix: CBP, RFT, LFT, CXR, EEG, XR skull, sinuses and mastoid
- Look for any predisposing factors: sinusitis, endocarditis, otitis
media, skull fracture, immunocompromised state, etc
What is the CSF findings in meningitis for viral, bacterial TB/cryptococcal?
What is initial impericial antimicobial regimens for bacterial, brain abscess, tb, crypotoccal meningitis and viral encephalitis?
What is dexamethasone given for CNS infections?
Consider dexamethasone in patients with TB meningitis (0.3 to 0.4 mg/kg/day for two weeks, then 0.2 mg/kg/day week 3, then 0.1 mg/kg/day week 4, then taper 1 mg off the daily dose each week) or brain abscess with significant cerebral oedema.
Dexamethasone (0.15 mg/kg q6h for 2-4 days with the first dose administered 10-20 min before, or at least concomitant with, the first dose of antimicrobial therapy) in adults with suspected or proven pneumococcal meningitis
Prophylactic anti-convulsant may be considered in cerebral abscess & subdural empyema
How long is treatment for brain abscess and meningitis?
Duration of Rx for brain abscess 6–8 weeks
Duration of Rx for meningitis: 7 days for H. influenzae, 10–14 days for S. pneumoniae, 14–21 days for L. monocytogenes and S. agalactiae, and 21 days for Gram negative bacilli.
DO NOT change to oral therapy.