Antibiotics Flashcards
What is the treatment for bacterial vaginosis, along with the complications of the drug?
Bacterial Vaginosis tx Metronidazole (flagyl) 500mg BID x 7 days SE: 1)Gastrointestinal –> nausea, anorexia, vomiting, diarrhea… 2)CNS–> seizures, peripheral neuropathy, vertigo, ataxia 3)GU–> transient darkening of the urine
What is the treatment of vaginal candidiasis?
Fluconazole 150 mg PO single dose
What is the treatment for streptococcal toxic shock syndrome, and what are the criteria for it?
criteria: >/= 2 of coagulopathy, respiratory failure, soft tissue necrosis (necrotizing fasciitis, myositis, gangrene), liver or renal failure, erthematous macular rash High dose penicillin clindamycin IVIg
What are the side effects of rifampin ?
can cause menstrual abnormalities
Mupirocin
Bactroban (Mupirocin 2%) Use: Treatment of secondary infected traumatic skin lesions (up to 10 cm in length or 100 cm2 in area) due to susceptible strains of S. aureus and S. pyogenes Contraindications: allergy to anything in Bactroban Dosing: Apply TID for 3-5 days and reevaluate response Side Effects: localized irritation, skin rash, burning, headache
What is the treatment for adult community aquired pneumonia in the community?
No Comorbidities (asthma, smoking, hospitalization in last 3 months, diabetes, lung cancer, COPD, alcoholism, liver or renal failure, CHF, chronic steroid use, malnutrition, HIV)
Doxycycline 200mg PO first dose then 100mg PO BID 7-10days
or
Azithromycin 500mg PO first day then 150mg PO OD 4 days
if recent antibiotic use with no comorbid factors
Amoxicillin High Dose 1g PO tid 7-10d
WITH Comorbidities
Doxycycline 200mg PO first dose then 100mg PO BID 7-10days
or
Azithromycin 500mg PO first day then 150mg PO OD 4 days
if recent antibiotic use with no comorbid factors
Amoxicillin High Dose 1g PO tid 7-10d
or
Amox-Clav 875 PO BID 7-10 days
Failure of First LIne
Amox-Clav 875 PO BID 7-10days
plus
Azithromycin 500mg PO first day then 250mg PO daily x 5 days
THERE ARE OTHER ANTIBIOTICS IN THE TOP GUIDELINES, YOU SHOULD NOT PICK THE SAME ONE THEY FAILED FOR FAILURE OF FIRST LINE
What is the treatment for pediatric community aquired pneumonia?
3 months to 5 years- if no daycare or antibiotics last 3 months
-Amoxicillin 40mg/kg PO div TID 7-10 days
3 months to 5 years- if daycare or antibiotics last 3 months
-Amoxicillin 90mg/kg/d PO div TID 7-10 days
5-16 years-
azithromycin 10mg/kg/d PO 1st day (max 500mg/d) then 5mg/kg/d (max 250mg/d) for 4 days
What is the treatment for acute otitis media?
1st line
amoxicillin 40mg/kg/d po div TID for 5 days (standard)
90mg/kg/d po dv TID for 5 days ( High dose)
2nd line
amox-clav 90mg/kg/d PO div bid for 10 days
in case of beta-lactam allergy
azithromycin 10mg/kg/d 1st day then 5mg/kg/d for 4 days
Treatment of acute pharyngitis?
90% viral, 10% bacterial (Group A strep is most common cause)
-B-hemolytic strep (group C, G), neiseria gonorrhoeae, arcanobacterium haemolyticum
Suspected GAS must be confirmed by culture in patients with 2 or more symptoms
- pharyngeal or tonisllar exudate
- tonsillar enlargement
- swollen anterior cervical nodes
- history of fever >38C
- no cough
- up to 20% of patients may be asymptomatic
Tx
Penicillin VK 40mg/kg/d PO BD for kids and 300mg PO tid for 10 days
or
clindamycin 20mg/kg/d for kids or 300mg PO tid for 10 days for adults
Diagnosis and tx of acute bacterial sinusitis?
most viral, but of bacterial
10-14d of purulent nasal congestion and continued unwell state +/- fever, cough, irritability, lethargy
1st line
Amoxicillin 40mg/kg/d or 90mg/kg/d PO div tid x10d
depending on risk factors (daycare or abx last 3 months)
2nd line
amox-clav 45 mg/kg/d po div bid-tid for 10 days
(Strep pneumo, H.Influenza, M.Catarrhalis)
How do you diagnose acute bronchitis?
1) Acute onset of symptoms- cough, sputum production, chest discomfort but normal respiratory exam
2) Chest X-ray, sputum cultures only indicated for patients with evidence of consolodation
3) Green/yellow sputum production is indicative of inflammatory reaction, and does not necessarily imply bacterial infection
Antibiotics are not recomended in the management of acute bronchitis
What is the treatment of acute bronchitis?
Antibiotics are not recomended in management of acute bronchitis
-Management is symptomatic
- smoking cessation
- increased humidity
- good hydration
- analgesics/antipyretics
- antitussives might alleviate cough but will not reduce duration of illness
- bronchodilators offer modest improvement of protracted cough
What is the treatment of an acute exacerbation of COPD?
Home management of exacerbations of COPD?
- Salbutamol MDI 4-8 inhallations every 20 minutes for up to 4 hours
- Ipratroprium bromide 500 mcg neb q6-8h
- Dexamethasone
- Assessment of oxygen demands
- if at least 2 of: increased sputum production, increased sputum purulence, increased dyspnea–> ABX
What is appropriate antibiotic therapy for a AECOPD?
No Antibiotics in the last 6 weeks and < 4 episodes in past year:
Amoxicillin 50mg PO TID for 7-10 days
Doxycycline 200mg PO day 1 then 100mg PO daily for 7-10 days
Antibiotics in the last 6 weeks and/or >/= 4 episodes in past year
Cefuroxime 250-500mg PO BID 7-10 days
Amox-clav 500mg PO TID 7-10 days
Treatment failure or advanced lung disease with severe exacerbations
Levofloxacin 500mg PO daily 5-10 days
What is the dosing and conversion for corticosteroids?
Cortisone : pysiologic 25-35mg/d, 25-300mg/d 12-24 mg div q12-24
Hydrocortisone (solu cortef): dosing is dependant
Predisone: 40mg OD x5d for AECOPD
Betamethasone:
Dexamethasone:
The usual dosing is cortisone 25mg: hydrocortisone 20mg: methylprednisone 4mg: prednisone 5mg: Betamethasone: 0.6-0.75: Dexamethasone 0.75mg
