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Flashcards in 28 Microbial Prophylaxis Goad Deck (40):
1

Who should have infective endocarditis phrophylaxis?

High risk patients going in for dental procedures

2

Which dental procedures need prophylaxis for high risk individuals?

Extractions. Cleaning. Root canal surgery. Periodontal surgery. Intraligamentary injections

3

Which patients are considered "high risk" for infective endocarditis?

Highest-Risk Cardiac Conditions (Prosthetic heart valves, Previous IE, Congenital heart defects, Cardiac transplant with valvular regurgitation). Intravenous drug abuse

4

When is prophylaxis for IE NOT recommended?

Shedding of primary teeth. Adjustment of orthodontic appliances. X-rays, fluoride treatments, oral impressions. Restorative dentistry

5

What medications are used for High Risk patients going in for Dental Procedures?

Amoxicillin 2g 30-60min prior to dental procedure. Cephalexin as an alternative

6

What medications are used for High Risk patients going in for Dental Procedures who are unable to take oral medications?

Cefazolin 1g or Ampicillin 2g IM/IV 30-60min prior to the dental procedure

7

What medications are used for High Risk patients going in for Dental Procedures who are allergic to Penicillin?

Clindamycin 600mg PO/IV or Azithromycin 500mg 30-60min prior to procedure

8

What does the Spleen do?

Helps with immunity. Removes old RBCs

9

How can Asplenia occur?

Surgical or congenital. Functional (e.g. sickle cell anemia)

10

What is the Overwhelming Post-Splenectomy Infection (OPSI) caused by?

Encapsulated bacteria (S. pneumoniae, H. influenza, N. meningitidis). S. aureus. Gram Negative (E. coli, K. pneumoniae, Salmonella, Capnotcytophagia (from dog bite)). Babesia (east coast, from ticks). Malaria (not in US)

11

What is Asplenic Prophylaxis for < 5 yo?

PCN 125mg PO BID

12

What is Asplenic Prophylaxis for 5+ yo?

PCN 250mg PO BID

13

What is Asplenic Prophylaxis thats an alternative to PCN?

Amoxicililn (20mg/kg/d)

14

What is Asplenic Prophylaxis for Sickle Cell Anemia (+ other causes of functional asplenia)?

Stop at 5 years of age of daily prophylaxis unless: h/o severe pneumococcal disease, surgical splenectomy

15

What is Asplenic Prophylaxis for > 5 yo and h/o IPD or surgical splenectomy?

At least 2 years after surgery. Chronic Abx proph is controversial. Provide stand-by Abx treatment

16

What are the immunizations recommended for Asplenic Prophylaxis?

Hib (4 doses (2, 4, 5, 12-15 months of age). 1 dose for adults). Pneumococcal (PCV13 (2, 4, 6, 12-15 months of age) + PPSV23 (> 2 years of age + 5 years later). Meningococcal (MCV4 (2 doses: > 2 years of age + 2 months later). MCV4 Q5 years thereafter)

17

What is the summary for recommendations of 23-Valent Pneumococcal Vaccine?

Adults 65 years of age or older OR 2-64 year olds with: 1) A normal immune system who have chronic illness (heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of CSF). 2) Immune dysfunction and altered resistance to infection (HIV/AIDS, oncologic, steroids, asplenia, kidney disease, transplant)

18

What is the PCV13 and PPSV23 recommendation for persons with functional or anatomic asplenia (sickle cell disease/other hemaglobinopathy, congenital or acquired asplenia) with NO previous PPSV doses?

PCV13 --> 8 weeks --> PPSV23 --> 5 years --> PPSV23

19

What is the PCV13 and PPSV23 recommendation for persons with functional or anatomic asplenia (sickle cell disease/other hemaglobinopathy, congenital or acquired asplenia) with 1 previous dose of PPSV?

> 1 year --> PCV13 --> 5 years --> PPSV23

20

Why may some patients get 3 doses of PPSV23?

If their final dose of PPSV23 was before age 65 and its been at least 5 years

21

What is Chemoprophylaxis for Meningitis?

W/in 24 hrs of exposure, limited after 14 days. Eradicates nasal carriage during an epidemic. Close contacts of infected person should get it (family, day car)

22

What is Immunization for Meningitis?

Quadrivalent conjugate vaccine (A, C!, Y, W135). Eradicates nasal carriage over time Indications (functional asplenia, travelers to Africa, outbreaks)

23

What is the usual drug used for Chemoprophylaxis for Meningococcal Disease?

Cirpofloxacin 500mg single dose

24

What are the two Meningococcal Vaccines?

Menomune (pure polysaccharide): 2+ yo, no upper age limit. Menactra or Menveo (conjugate): Menactra (9 months) & Menveo (2 years) up to 55 years, routine (11-12 yo + 16 years (2 doses), "boostable" & eradicate nasal carriage, Q5 years while at risk

25

What are the two main outer membrane structures of Influenza virus that are most important to look at?

NA (Neuraminidase) and HA (Hemagglutinin)

26

What is the PO influenza antiviral that is commonly used?

Oseltamivir (Tamiflu): 1+ yo, GI ADRs. Zanamivir (Relenza): 7+ yo (5+ yo for chemo-prophylaxis), not recommended for people w/ underlying respiratory disease (allergic reaction can cause oropharyngeal or facial edema)

27

What is the difference between Oseltamivir and Zanamivir?

Both dosed 1 QD. Oseltamivir can be used 1+ yo, while Zanamivir is 5+ yo. Oseltamivir is a 6 week treatment course while Zanamivir is 28 days. Oseltamivir is more efficacious

28

What is the DOC for postexposure prophylaxis for Pertusis?

Azithromycin. 10mg/kg/day x5 days for children. Adults: 500mg single dose day 1, 250mg single dose days 2-5

29

What is the recommendation for Tdap?

7+ yo, no upper age limit. For routine vaccination of adolescents 11-12 yo. Approved for one-time administration (except pregnancy). Two available products: Boostrix (10+ yo), Adacel (11+ yo)

30

What is the Tdap interval between Td and Tdap like?

No minimum interval (Td --> Tdap). Wound management (Tdap --> Td) 5 years. Routine (Tdap --> Td) 10 years

31

What is Tdap use like in pregnancy?

No evidence of teratogenicity. Give Tdadp during pregnancy (preferred > 20 weeks). May also give post-partum if not given during pregnancy. Give a dose for EVERY pregnancy!

32

What are the characteristics of Haemophilus Influenzae type b (Hib)?

Gram (-) coccobacilli. Polysaccharide capsule (invasive form): meningitis, epiglotitis. H. flu non-typable: common URIs. Recommended vaccination for children: 2, 4, 6, 12-18 months

33

What is given as Hib Prophylaxis?

Rifampin PO. Adults: 600mg QD x4 days

34

What are the characteristics of Hepatitis A?

Fecal-oral transmitted virus. Incubates 15-50 days. S/Sx: fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and jaundice. Self-limiting disease. No chronic disease

35

What is the pre-exposure Hepatitis A prophylaxis for Travelers?

> 4 weeks before travel: Hep A vaccine. < 4 weeks before travel: 1-40 yo: Hep A vaccine, < 1 or > 40: IgIM

36

For pre-exposure prophylaxis of Hepatitis A, how is Immune Globulin dosed?

0.02 ml/kg < 3 months protection. 0.06 ml/kg = 5 months protection

37

What is Post-Exposure prophylaxis for Hepatitis A?

Given w/in 2 weeks of exposure. > 85% effective. Hep A vaccine for 1-40 yo, IgIM for < 1 or > 40yo

38

What are the highest risk factors for Hepatitis B?

Multiple sex partners. IDU. MSM

39

What should be done after Hepatitis B Exposure?

Start PEP w/in 1 week of exposure. Up to 62% will seroconvert. Vaccine +/- HBIG

40

What are the "Quick Shots" available?

HPV4 (now recommended for boys 11-12 yrs and 13-21 yrs for catch-up). Hepatitis B (recommended for all people w/ DM < 60 yrs, permissive for those over 60 yrs)