ABX TX Flashcards

Question

Chlamydiae trachomatis / genital chlamydia

Answer 1

Doxycycline 100mg bid x7d Alternatives: 1 G x 1 ( preferred in pregnancy) or Levofloxacin 500mg daily x 7 days Expedited partner tx: abstain 7 days Retest 3 months for re infection

Answer 2

Macrolides or doxycycline If resistant : 3rd /4th gen quinolones

Answer 3

PCN G benzathine ( Bicilin-LA) IM x 1 - early syphilis Late latent or tertiary syphilis: PCN G benzathine IM weekly x 3 wks NeuroSyphilis: aqueous PCN G IV Q4h 10-14 d

Answer 4

Early localized disease: doxycycline 10-14d or Amox or cefuroxime Lyme carditis: doxycycline , amoxicillin, or CEFTIN ( cefuroxime ) 14-21 days, if severe IV ceftriaxone 14-21 days Lmk arthritis : doxy, amoxicillin, ceftin ( cefuroxime) 14-21 days , if severe IV ceftriaxone 28 days Neurologic Lyme disease : facial palsy : doxy 14-21 days • meningitis : oral doxy or IV ceftriaxone 14-21 days

Answer 5

Yeast Oropharyngeal -esophageal thrush : nystatin swish and swallow or fluconazole Vaginal thrush : azole vaginal creams or diflucan Systemic candidemia : IV echinocandin with po fluconazole as oral step down therapy

Answer 6

Vusion: Rx ointment : 0.25% michonazole + zinc oxide Next 2 are strong topical corticosteroids ( not recommended but commonly used. Not recommended bc they have steroid and steroids can cause candida ) • mycologist-II : nystatin + triamcinolone • Lotrisone: betamethasone + clotrimazole

Answer 7

yeast Meningitis tx: indication with ampho B + flucytosine x2weeks; consolidation with fluconazole Pneumonia tx: fluconazole or itraconazole

Answer 8

MOLD - found everywhere DOC : voriconazole ( VFEND) In severe cases add echinocandin

Answer 9

Can cause pnemonia ( valley fever ) and meningitis Tx: fluconazole or itraconazole

Answer 10

Coccidiodomycosis: Dimorphic funcgus - yeast and mold Pneumonia ( valley fever) and meningitis Tx : fluconazole or itraconazole

Answer 11

Tx : Mild- itraconazole po Severe: amphotericin B IV and step down to azole

Answer 12

Antifungals and different types of fungi. Ampho B really reserved for severe cases bc it has lots of side

Answer 13

Capitis ( scalp) and Onychomycosis ( nails) : both treated with systemic Rx ( TERBINAFINE ( lamisil or itraconazole ( sopranox)) -scalp: 4- 6 weeks - toe nails : 12 weeks, finger nails 6 weeks - LFT at baseline and Q month * must check LFTs before we start oral systemic antifungal. Then check once a month For Versicolor ( thorax), Corporis ( ringworm), cruris ( jock itch) , Pedis ( athletes foot) : all topical OTC anitfungal ( anoles ) topical Rx: Ciclopirox: 8% lacquer ( penlac ) Efinaconazole ( jublia) Tavaborole ( kerydin) * very low success rate for these topicals and they’re expensive

Answer 14

Class is called Neuroaminidase inhibitors: •oseltamivir ( tamiflu) Adults: 75 mg po bid x5d • Plx for adults: 75 mg po 7d ( CDC ) or 10d Can be used in neonates Zanamivir ( relenza) : diskhaler ( AVOID In asthma patients ) • Peramivir ( rapivab) : IV 600 mg IV as a single dose.

Answer 15

Respiratory Syncytial Virus Just a cold virus Prevention: Monthly IM injection : synagis ( palivizumab: monoclonal ab) during RSV season

Answer 16

• Tx: Acyclovir, famciclovir, valacyclovir. Lessens duration of symptoms. Best if started early • a complication of zoster. This is after rash is gone. Neuralgia is nerve pain. We use medications that calm down the nerves. Post Herpetic Neuralgia: 10-15%. Gabapentin, Pregabalin ( lyrica), TCAs ( nortrityline), lidocaine 5% patch, capsaicin, prednisone

Answer 17

Other members of the herpesvirus family. Can cause Mono ( mononucleosis: pharyngitis, fever, lassitude, lymphadenopathy, lymphocytois, splenomegaly, anemia, thomobcytopenia in young. EPV: mono: Avoid contact sports: spleen gets big and if it hit it can rupture and cause spleen hemorrhage. No tx. CMV: Tx: ganciclovir, valganciclovir, cidofovir, foscarnet. Ifx, usually with immonocompromised. If healthy patient ifx, looks like mono. If immunocompromised, can be dangerous.

Answer 18

Empiric : vanco IV ± gram ( - ) coverage If MSSA or strep : Oxacillin/ Nafcillin + gentamicin are great. Pathogen specific therapy 4- 6 weeks IV Dental prophylaxis : are done in certain cardiac patients ( prosthetic heart valves, history of IE, cardiac transplant, valvulopathy) CHD ( mitral valve prolapse does NOT require prophylaxis ). - amoxicillin 2 grams PO 30 - 60 mins prior to procedure. If PCN allergy -Cephalexin ( mild allergy ) , ( severe allergy) : azithromycin or clarithromycin 500 mg PO or doxycycline 100 mg PO. If unable to take PO —> cefazolin or ceftriaxone 1G IM /IV * clindamycin no longer recommended.

Answer 19

All bacterial skin infections Augmentin ( alternative: doxycycline ) : 3- 5 days + Td/Tdap

Answer 20

Generally post surgical Empiric tx: single agent regimens : ertapenem ( Invanz ) or zosyn ( piperacillin-tazobactam ) Combo: Levaquin / cipro + metronidazole Prophylaxis : Cefazolin ( Ancef ) ± Metronidazole Alternatives: Cefotetan or Cefoxitin

Answer 21

Tx: •If norovirus/ rotavirus: supportive tx. •If bacterial ( febrile ) ABX: short course: quinolones, rifaximin( goes through GI and kills in GI but not absorbed) or azithromycin + supportive •Giardia( type of diarrhea: hiking, camping, drank from river or lake. Bloated mild diarrhea but doesn’t go away ) : Tx w/metronidazole •Clostridium difficile( not really acute gastroenteritis ) , colitis after recent abx use tx / w oral vanco or Dificid

Answer 22

Tx: abx to cover E. Coli and B. Fragilis Cipro/levo + Metronidazole Bactrim + Metronidazole Augmentin sometimes

Answer 23

Empiric Tx: Vancomycin + either Ceftriaxone or Ceftazidime Tx outpatient : IV abx via PICC line for at least 6 weeks • MSSA: Nafcillin, Oxacillin, Ceftriaxone • MRSA : vanco, daptomycin • gram (-) cipro, levo, cefepime, ceftazidime, ceftriaxone • enterococcus : ampicillin, vancomycin, daptomycin • Streptococus: PCN G, Ampicillin, Ceftriaxone

Answer 24

Tx: •Acute cystitis: bactrim( used for cys and pyelo avoid in first trimester and at end ( term ). Good for prostatitis and pyelo) , Nitrofurantoin( 1st line. Dont use if CrCl < 30. DONT USE FOR pregnant patients at term; macrobid good for first trimester). Dont give for prostatis ( ineffective ) ) , fosfomycin ( rarely used. Good if multi drug resistant bacteria). • Pyelonephritis: bactrim, urinary quinolones, ( cipro/levo) ( can you use cipro and levo for acute cystitis. You shouldn’t. You dont want resistance in these. •Acute cystitis in pregnancy: beta lactams ( Augmentin, keflex, Cefpodoxime, Cefdinir ) or fosfomycin. Macrobid is an option if not at term. •Pyelonephritis in pregnancy: IV ceftriaxone( most popular ) , cefipime, aztreonam Warfarin patient: cant use bactrim ( increase INR ) , quinolones ( INR monitor ) Urinary quinolones avoided in pregnancy.

Answer 25

1) healthy patients( adult. Stable. Not short of breath. Osat> 95 96 or 97. Can take pills at home) w/o comorbidities: Amoxicillin high dose ( 1 G. PO TID) or doxycycline or a macro like ( only if local resistance rate < 25% ) 2) patients with comorbidities: Combo therapy: PO B lactam: Augmentin or Cefpodoxime or Cefuroxime + macrolide or doxycycline Monotherapy: a respiratory fluroquinolone ( levo, moxi, Gemi, dela ( these are respiratory quinolones)) Comorbidities include: Chronic Heart Disease, lung, liver, renal diseases, DM, alcoholism, malignancy, or asplenia

Answer 26

Outpatient: high dose amoxicillin 1st line Macrolide if mycoplasma ( atypicals) Inpatient: IV ampicillin, PCN G, Ceftriaxone, Cefotaxime, ± macrolide if mycoplasma

Answer 27

Empiric Tx: No risk MDR: 1 anti-pseudomonal agent : Zosyn, Cefepime, or levofloxacin Risk for MDR: 2 anti-pseudomonal agents + 1 anti-MRSA agent ( zosyn, cefepime, Ceftazidime, imipenem, meropenem, or aztreonam PLUS An Aminoglycoside agent ( amikacin or genta or tobra ) PLUS 1 anti mRSA ( Vanco, linezolid, or telavancin )

Answer 28

Empiric Tx: Ceftriaxone + vanco Add ampicillin > 50 y/o. Dexamethasone beneficial Neonatal Meningitis : Empiric amp+ gent ( or cefotaxime) Empiric if admitted from the community ( amp + gent + cefotaxime)

Answer 29

Chlamydia: Doxy 100 bid x7d Alt: levofloxacin 500 mg daily x7 days, Azithromycin 1 g x1 ( preferred if pregnant) Gonorrhea: •Ceftriaxone 500 mg single dose IM injection ( 1 gram if ≥ 150 kg ) If chlamydia too : doxy 100 bid x7d Syphilis: -Benzathine PCN G IM 2.4 MU IM x1 for 1° or 2° If PCN allergy doxy for 14 to 28 days If PCN allergy and pregnant, then best to desensitize patient for PCN bc we cant doxycycline. Genitalia herpes: tx : acyclovir, famciclovir , valacyclovir ( dont see Gancyclovir) Also may need for suppression: lower dosages of same meds but taken daily. Also helps reducing transmission to partner. Trichomonas: metronidazole or tinidazole HPV : vax, if warts ( imiquimod ( aldara) , podofilox, trichloracetic acid ) or freeze them ( cryotherapy)

Answer 30

Tx: Elimite Cream ( permethrin 5% ) Oral ivermectin ( stromectol ) off label Topical sulfur 6-33% is primarily tx of infants < 2 months Apply neck to toe, wash off in 8 to 14 hours, may repeat in 1 to 2 weeks. Night they put this on, this the night they do laundry of everything. Put cream on and sleep with it. Location of where you put it depends on itch. Usually everywhere neck to toe. If children then scalp to toe. For whatever reason it doesn’t like adult faces. For children it does affect them. Topical premethrin safe for most. Not fda approved for below 2 months so use for topical sulfur.

Answer 31

Anal itching. Intestinal nematode. Tiny white string. Treat whole family. Mebendazole ( emverm) single tab 100 mg po x1 Albendazole 400 mg x1

Answer 32

Tx: •Acute cystitis: bactrim, Nitrofurantoin, fosfomycin • Pyelonephritis: bactrim, urinary quinolones, ( cipro/levo) ( can you use cipro and levo for acute cystitis. You shouldn’t. You dont want resistance in these.