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PHRM 865 Personal > AntiBiotics Exam 3 > Flashcards

AntiBiotics Exam 3 Flashcards

(119 cards)

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1
Q

When should Infants get second dose of RSV vaccine?

A

Increased risk of severe disease age 8-19 months:
Lung disease
Chronic corticosteriod use
On supplmenetal o2 within 6 months
Immuno compromised
American indian or Alaskan

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2
Q

Acute Pharyngitis- Treatment

A

Penicillin VK or Amoxicillin
Alternatives:
Cephlosporins
Azithromycin

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3
Q

Peds Follow UP Time frames

A

Days for young infant with severe episode or severe pain

2 weeks for infant or young child with history of frequent

1 month after inital exam with only a single episode

None for older children

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4
Q

Do Not over treat this UTI.

A

Asymptomatic bacteria from catheterized patients

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5
Q

Empiric Therapy- Inpatient Severe CAP
No MRSA

A

RFQs + B-Lactams
or B-Lactams + Macrolide

B: Ampicillin/Sulbactam

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6
Q

UTI Treatment duration in PEDS

A

Oral and IV
Oral more prefered
3~ 7-14 days

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7
Q

Acute Otitis Media (AOM)- Should you defer antibiotics?

A

Yes, 48-72 hours.
Watch for symptoms resolution

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8
Q

Acute Otitis Media (AOM)- Treatment Criteria

A

Discharge=Treat
Severe=Treat
Non-Severe: Only treat if <6 months

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9
Q

Most Common Bacterial Pathogens for CAP?

A

Strepto, H.Influenzae, Atypicals (Mycoplasma, Legionella, Chlamydia), Staphylococcus

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10
Q

Urinalysis- what is considered a “fresh” sample

A

<1 hour after voiding in room temp
<4 hours after if refrigerated

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11
Q

Necrotizing Fasciitis -Diagnosis

A

Blood cultures and Wound Cultures
CT/MR

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12
Q

Duration of CAP therapy

A

5 days clinical stable

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13
Q

CAP Most common pathogenic organism

A

Virus

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14
Q

Bronchiolitis in PEDS- Pathogensis

A

RSV.

can also be rhinovirus

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15
Q

Typical duration of treatment for UTI

A

3-7 days

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16
Q

Acute Bacterial Rhinosinusitis - Treatment options

A

Amoxicillin/clabulanate (Augmentin)
5-7 days. Higher dose if peniciiling concern resistance

Second option; Doxy, Levo, Moxi

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17
Q

Bronchiolitis in PEDS- Viral or bacterial?

A

Viral.

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18
Q

Acute Otitis Media (AOM)- Augmentin dosing/pearls

A

Dose clavulanate at <10mg/kg/day

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19
Q

What test must you get with Staphyoccus Aureus CAP?

A

Nasal PCR for MRSA.

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20
Q

Common Pathogens for HAP/VAP

A

Aerobic Gram-NEGATIVE-70%
(P.Auro, Acinetobacter)

Staphylococcus aureus-30%

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21
Q

Acute Otitis Media (AOM)- Oral Cephalosporins

A

Second line if allergy
Cefpodoxime 10mg/kg/day/ BID
Cefdinir- sucks
13/mg/kg/day q12h

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22
Q

MRSA and P.Aero Empiric for HAP/VAP

A

MRSA- Vanco/Linze
P.Aeru- Zosyn, Cefepime, imipenem, meropenem, Levofloxacin

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23
Q

Duration of Treatment Acute Otitis Media (AOM)

A

Under 2- 10 days
Over 2- 10 days

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24
Q

Acute Bacterial Rhinosinusitis- Treatment approaches

A

1) Initate antibiotic therapu as soon as bacterial infection is established

or 2) Watch for 7 days to observe if improvement occurs without ABs.

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25
Acute Otitis Media (AOM)- Pathogens
H. Influenza, Strepto, Moraxella 20-30% no pathogens
26
Necrotizing Fasciitis - Treatment Targetted
After culture.. S.Pyogenes: PCN plus Clindamycin Polymicrobial: Vanco plus Zosyn
27
Empiric CAP Therapy- Outpatient: Healthy no Comorbidities
Amoxicillin 1gm PO Q8H Doxycycline 100 mg PO BID
28
Empiric for HAP- Low Risk
MSSA+P.aero Zosyn, Cefepime, imipenem, meropenem, Levofloxacin
29
Pearls for Vaccination against RSV in Pregnancy
Abrysvo Admistered before and during RSV season (Sep to Jan) Weeks 32-36 weeks of Prego ***Must have 14 days before delivery to work****
30
UTI microbiology criteria
>10^5 of 1 bacterial speices froma clean void >10^3 with catheter
31
Impetigo- Treatment Few Leisons
Topical for 5 days Mupirocin
32
Purulent SSTIs Diagnosis
Tender, warm to touch Systemic signs of infection Wound culture recommended CT/MR
33
Acute Bacterial Rhinosinusitis- MRSA and P.Aeru considerations
MRSA- Add Doxy, TMP, Linezolid P.Aeru- Add Levo at 750 mg PO Daily
34
Diabetic Foot Infection Treatment- Moderate
Must Cover: MSSA, Streptocci, Entro, Anaerobes Drugs: Moxi, Amox/Clav, Cipro/Levo+Clinda or Metronidazole- 2-3 weeks P.Aero risk: Switch to Cipro/Levo+Clinda or Metronidazole MRSA Risk: ADD- Doxy, Linezo,Vanco, SMX/TMP
35
Severe CAP Criteria Major vs Minor
Major: 1 of the following. Septic Shock or Respiratory Failure Minor >3: 30bpm <36 temp WBC <4 BUN>20
36
Streptococcus Pneumoniae Resistance drugs
Macrolide 50% Penicillin 3%
37
Acute Exacerbation of Chronic Bronchitis - PATHOGENS
Streptococcus, H. Influenzae, Moraxella Frequent use: Enterobacterales, P. Aeru
38
Purulent SSTIs Classification
Mild- No systemic signs of infection Moderate- Signs of infection Severe SIRS criteria (2 of the following): Temp >38 or <36 HR>90 RR>24 WBC>12k or <4K
39
Acute Otitis Media (AOM)- Amoxicillin Dosing
80-90 mg/kg/day divided by q12H for 5-10 days
40
MRSA drugs for Inpatient
Vanco/Linezolid
41
Testing for HAP/VAP
Respiratory Culture and Blood Cultures
42
Acute Pharyngitis- Common Pathogens
Virus-rhino Bacteria STEPTO Group A
43
Acute Exacerbation of Chronic Bronchitis- TREATEMENT
Preferred: Augmentin, Cefpodoxime, Cefuroxime Alternatives: Doxy, TMP, Azithromycin P.Aeru: LEVO
44
Necrotizing Fasciitis - Treatment Empiric
Surgical intervention Empiric: Vanco plus ZOSYN
45
Prevention for Acute Otitis Media (AOM)
Vaccines Tympanostomy tubes
46
Which cepholsporins has the lower cross-reactivity with penicillins
2nd and 3rd gen are much lower cross reactivity 1st is the highest
47
Which two CAP bacteria are gradual onset?
Mycoplasma and Chlamydia
48
Non-Purulent SSTIs Treatment Moderate
IV Antibiotics Pencillin or Ceftriaxone or Cefazolin or Clindamycin
49
Alternative agent for Peds if repeated failures or anaphylaxis
Clindamycin (Not against H.influenzae) Levo or Linezolid
50
Necrotizing Fasciitis - Pathogens
Mono or Polymicrobial Strepto, Vibrio, Peptostrepto CA-MRSA, Aeromonas, Clostridium
51
Purulent SSTIs Characteristics
Pus!! Abscesses: Collection of Pus Furuncles (Boils): abscess of the hair follicle Carbuncles: Adjacent follicles infected
52
PSI and CURB-65- What infection is this used for?
CAP
53
Prevent RSV in Peds
Hand washing, Isolation Vacinations RSV vaccines
54
Purulent SSTIs Treatment -Moderate
Incision and Drainage and Culture Empiric: TMP/SMX or Doxycycline Targeted: MRSA: TMP/SMX or Doxycycline MSSA: Dicloxacillin or Cephalexin
55
Empiric CAP Therapy- Outpatient: Comorbidities
Respiratory FQs: Levo/Moxi Beta-Lactam + (Macrolide or Doxy) B-Lactam list: Amoxicillin/Clavulanate, Cefpodoxime, Cefuroxime)
56
Acute Bacterial Rhinosinusitis Pathogens
Streptococcus, H. Influenzae, Moraxella Frequent: Staphy, P.Aeru
57
Non-Purulent SSTIs Pathogens
Streptococcus A,B,C,F/G
58
Purulent SSTIs Pathogens
MRSA, MSSA, Streptococcus
59
Diabetic Foot Infection- Pathogens
S. Aureus and Streptococci
60
Necrotizing Fasciitis- Characteristics
Medical Emergency High morbidity/mortality DEEP *Change in color of skin to maroon/pruple/black and Severe pain, EDEMA
61
Acute Otitis Media (AOM)- Diagnosis
Tympanic Membrane (TM) Membrane looks concave *Acute onset, Middle ear effusion Symptoms of middle ear inflammation
62
Diabetic Foot Infection Treatment- Mild
Must Cover: MSSA and Strep Dicloxacillin, Cephalexin, Clindamycin- 1-2 weeks Recent ABs: Amox/Clav or Levo/Moxi MRSA Risk: SMX/TMP, or Doxycycline
63
Animal/Human Bites- Preemptive Criteria
Immunocompromised Moderate to severe bites Bites on face/hand Bites that penetrate joints Asplenia
64
Why Clindamycin for Necrotizing Fasciitis?
Inhibits Streptococcal toxin production. Inoculum effect
65
Acute Otitis Media (AOM)- pathogenesis
Middle ear space is inflamed. Trapped air creates vacuum reversing flow of secretions into middle ear. Bacteria grows
66
Diabetic Foot Infection Risk Factors for MRSA/Pseudomonas
MRSA: Previous infection 30-50 Prevalence Pseudomonas- History Soaking feet in water Warm climate Severe Infection
67
Impetigo - Characteristics/Diagnosis
Highly contagious- skin abrasions Common in kids and hot weather Small painless fluid filled vesicles= thick golden crust Cultures recommended but not required.
68
If you have Tympanostomy tubes what can you use for uncomplicated otorrhea?
Topical quinolone drops Oflaxacin, ciprofloxacin
69
Common UTI drugs for Treatment
Nitrofurantoin SMZ/TMP FQ Fosfomycin B-Lactams
70
Impetigo- Treatment Many Leisons
Oral 7 days Dicloxacillin or cephalexin Strepto: use PRN Allergies/MRSA: Doxycycline,Clinda, TMP/SMX
71
CAP Supportive Measures
Humidified O2, Bronchodilators, Fluids, Chest Physiotherapy
72
Purulent SSTIs Treatment -Severe
Incision and Drainage and Culture Empiric: Vanco, Dapto, Linezolid Targetted: MRSA: Vanco, Dapto, Linezolid MSSA: Nafcillin, cefazolin, clindamycin
73
Dense CXR vs Patchy CXR?
Dense= Bacterial Patchy= atypical/viral
74
MDR Factors for VAP
Prior IV AB use in 90 days Septic shock at diagnosis Acite Respiratory distress Acute REnal replacement therapy More than 5 days hospitalization prior diagnosis
75
Non-Purulent SSTIs Classifications
Mild- No systemic signs of infection Moderate- Signs of infection Severe SIRS criteria (2 of the following): Temp >38 or <36 HR>90 RR>24 WBC>12k or <4K
76
P. Aeru Inpatient Drugs
Zoysn, Cefepime, Meropenem
77
Procalcitonin use?
In guiding duration of treatment
78
Empiric CAP Therapy- Inpatient non-severe No MRSA or P.Aeru
Respiratory FQs: Levo/Moxi Beta-Lactam + Macrolide B-Lactam: Ampicillin/Sulbactam or Ceftriaxone
79
UTI Urinalysis
Urinalysis- Hours Bacteria must be present WBC >10 Leukocyte Nitrates may or may not be present Urine culture- 2-3 days
80
Which two drugs have high resistance to UTI/E.coli
SMZ/TMP and Ciprofloxacin
81
Animal/Human Bites- Treatment
DOC: Amoxicillin/Clavulanate Alternatives: 2nd/3rd gen cephalosporin + Anerobic coverage B-Lactam Allergy: Cipro/Levo + Anerobic coverage or Moxifloxacin Tdap if Tabies addition
82
Bronchiolitis in PEDS- How long to resolve?
up to 2 weeks. Symptoms peak around day 5.
83
Risk Factors for SSTI (Soft Skin Tissue Infections)
Hx of SSTI, IV Drug Use, PAD, DM, CKD
84
Prostatitis Treatment options
FQs SMZ/TMP Cephalexin, Amoxicillin/clavulanate
85
RSV Risk Factors In PEDS
<6 months old Pre-term birth CHD Chronic lung disease Weak immune system
86
Acute Otitis Media (AOM)- Severe vs non severe
Non-Severe <39 Severe >39 tem and severe pain
87
How to establish Chronic Bronchitis
Chronic cough with sputum on most days for >3 consecutibe months for 2 years
88
RSV Protection for infants
Vaccination of pregant woman or Monocolonal antibodies for infants (Palivizumab or Nirsevimab)
89
Non-Purulent SSTIs Diagnosis
Tender, swelling, warm to touch Orange peel-like skin Blood Culture Recommended CT/MR to rule out necrotizing
90
UTI in PEDS Treatment Option
Empiric: *Cephalexin *Amoxicillin *Amox/Clav SMX/TMP Nitrofurantoin only with cystitis
91
Purulent SSTIs Treatment -Mild
Incision and drainage
92
Acute Otitis Externa (Swimmer's Ear) Treatments
Organisms are different (P.Aero) Use: Polumyxin B, Neomycin, Hydrocortisone Ofloxacin Cipro with Hydrocortisone
93
Acute Otitis Media (AOM)- Resistance
Streptococcus-50% penicillin resistant H.Influenzae and Moraxella-50% b-lactam resistance Overcome both by high dose amox
94
UTI pathogen
E. Coli
95
UTI in PEDS common Pathogens
E.Coli Klebsiella
96
Diabetic Foot Infection Treatment- Severe
Need to Cover: MSSA, Streptocci, Entro, Anaerobes, P.Aero Drugs: Zosyn, Carbapenem, Cefepime+Clinda or Metro 2-3 weeks MRSA Risk? Add Vanco, Linezolid, Dapto
97
Acute Bacterial Rhinosinusitis Presentation
Symptoms >10 days with no improvement Severe symptoms Worsening symptoms
98
Uncomplicated UTI only drugs
Nitrofurantoin and Fosfomycin
99
Animal/Human Bites- Established and Preemptive Therapy Durations
Established= 7-14days Preemptive Therapy- 3-5 days
100
Non-Purulent SSTIs Treatment Mild
Oral Antibiotics Penicillin VK or Cepalosporin Or Dicloxacillin
101
Non-Purulent SSTIs Treatment Severe
Surgical Inspection Vanco plus Zoysn also Culture and Sensitivity
102
What is considered recurrent UTI
3 or more in 1 year 2 or more in 6 months
103
Acute Bacterial Rhinosinusitis - Pathogenesis
Body produces more mucus due to infection. This gets trapped and does not drain. This causes bacteria to proliferate.
104
CAP Three Pathogenesis
Aspiration, Aerosolization, Bloodborne
105
Tympanostomy tubes indications
3 or more episodes in 6 months 4 or more in 12 months
106
IV Cephlosporing for Peds
Ceftriaxone if oral not option. MUST WORRY ABOUT CA co-admin
107
Do you treat Acute bronchitis?
Not Necessary
108
Characteristics of Complicated UTI
Male, UTI in pregnancy, Recurrent infections despite treatment, Immunocompromised patients, obstructions, catheters
109
UTI in PEDS- S/S
Evaluate all febrile kids <24 momths Sepsis, failure to trive Strong urine smells
110
Empiric for HAP- Low Risk but MRSA
MRSA+P.aero Zosyn, Cefepime, imipenem, meropenem, Levofloxacin + Vanco/Linzeloid
111
Duration for HAP/VAP
7 days if clinically stable
112
Diabetic Foot Infection - Diagnosis
Typical local signs of infection Foul odor, discolored Wound cultures: NOT recommended for mild Bone and blood cultures
113
Non-Purulent SSTIs Characteristic
No Pus
114
Acute Bronchitis most common pathogens
Virus.
115
Empiric Therapy HAP- High Risk + MRSA
Pick 2 of different classes: Zosyn, Cefepime, imipenem, meropenem, Levofloxacin, Tobramycin/Amikacin IV + Vanco/Linezolid
116
Acute Bacterial Rhinosinusitis- Diagnostics
Sinus radiograph or CT
117
UTI Follow up for PEDS
All Boys All Girls <3 years old Girls 3-7 with a >38.5 fever
118
Empiric Therapy- VAP
Zosyn, Cefepime, imipenem, meropenem, Levofloxacin, Tobramycin/Amikacin IV + Vanco/Linezolid
119
Empiric UTI for Hospitalized patients
IV drug Ampicillin + Gentamicin - BEST Cefazolin+/- Gentamicin Ceftriaxone Cefepime Gentamicin

PHRM 865 Personal (7 decks)

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