Bacterial Infections

Question 1

Tx for neonatal profylaxis of gonorrhea and chlamydia

Answer 1

Erythromycin ointment

Question 2

Tx for bacterial conjunctivitis

Answer 2

Gentamycin, Tobramycin (Aminoglycosides)

or

Azithromycin (Macrolide)

or

Bactrim (sulfa)
ADR, corneal ulcer Interacts w SILVER

or

Ofloxacin, Ciprofloxacin, etc (Fluoro)
ADR, photophobia

Question 3

Tx for acute otitis externa

Answer 3

1. Acetic Acid (mild)

2. Polymyxin B / Neomycin Drops

Question 4

Tx chronic otitis externa

Answer 4

Polymyxin B / Neomycin drops

Question 5

Tx for “malignant “ otitis externa - usually caused by pseudomonas, DM patients more prone - infection has spread to surrounding tissue / bone

Answer 5

Medical emergency, IV antibiotics and debridement

Question 6

1st line Tx for Acute Otitis Media

Answer 6

Amoxacillin

Augmentin with resistance

Question 7

PCN allergic Tx for acute otitis media

Answer 7

Cefdinir or Ceftriaxone

If anaphylaxis Rx&raquo_space; Macrolide (Clarithro, Azithro)

Question 8

Gonorrhea and Chlamydia, treating togehter

Answer 8

Ceftriaxone IM + Azithromycin

Question 9

Nasal decolonization of MRSA

Answer 9

Mupirocin

Question 10

Tx for bacterial sinusitis, 1st line and PCN allergic

Answer 10

1. Augmentin (after 2 weeks of sinusitis)

PCN allergic: Cephalsporin (Cefdinir, Ceftriaxone)
if Analphylactic allergic: Macrolide (Clarithro, Azithro)

Question 11

1st line Tx Strep Pharyngitis

Answer 11

Augmentin
or
Amoxiicllin / Ampicillin 
or
Pen VK **black hairy tongue**

Question 12

Tx for PCN allergic, Strep Pharyngitis

Answer 12

Cephalosporins

1st gen: Ceph-alexin, Ceph-adroxil, Cef-azolin

2nd gen: Cef-prozil, Cef-otetan, Cef-uroxime

3rd gen: Ceftriaxone?

4th gen: Cefepime

5th gen: Ceftaroline (MRSA)

Question 13

1st line Tx for CAP, outpatient, no use of abx in the past 3 months

Answer 13

(Most like S. pneumonia)

1. Azithromycin, Clarithromycin, Erythromycin (Macrolides)

Question 14

1st line Tx for CAP, outpatient, WITH CHRONIC DZ or use of and in past 3 months

Answer 14

1. Respiratory Fluoroquinolone

Moxifloxacin, Gemifloxacin, Levofloxacin

Question 15

2nd line Tx for CAP, outpatient, WITH CHRONIC DZ or use of abx in past 3 months

Answer 15

Amoxicillin / Augmentin + Azithro or Clarithro

PCN allergic:

Ceftriaxone + Azithro or Clarithro

Question 16

1st line Tx for CAP INPATIENT, non-ICU

also good for PCN allergic

Answer 16

Moxi, Levo, Gemi (resp fluoroquinolone)

also good for PCN allergic

Question 17

2nd Line Tx for CAP INPATIENT, non-ICU

Answer 17

(same as 2nd line CAP outpatient w chronic dz)

Amoxicillin / Augmentin + Azithro or Clarithro

PCN allergic:

Cetriaxone + Azithro or Clarithro

Question 18

1st line Tx for CAP, INPATIENT ICU

Answer 18

Cefotaxime, Ceftriaxone, Ampicillin + Levo, Moxi, Gemi

PCN allergic: AZTREONAM + Levo, Moxi, gemi

Question 19

Notable ADR of Fluoroquinolones

Answer 19

Joint cartilage injury in kids <16 yrs

Question 20

Tx for known pseudomonas infection

Answer 20

Levofloxacin + B Lactam + Gentamycin (Aminoglycoside)

Question 21

Fluoroquinalones interact with what common OTC medication

Answer 21

Antacids! (Mg, Ca)

Separate dose by 2 hours

Question 22

Fluoroquinolone MOA

Answer 22

Inhibit DNA gyrase and Topoisomerase IV (X DNA)

Question 23

1st line HAP Tx, no MDR risks, not recent abc use

Answer 23

Levofloxacin

Question 24

1st line HAP Tx, MRSA or mortality risks

Answer 24

Levofloxacin + LINEZOLID or VANCOMYCIN

Question 25

Pertussis Tx, 1st line

Answer 25

Clarithromycin

Question 26

Pertussis Tx, 2nd line

Answer 26

Sulfa Trimethoprime

Question 27

Sulfonamide MOAs

Answer 27

Inhibits biosynthesis of bacterial nucleic acids and proteins (X DNA) Bacteriocidal

Question 28

Macrolide MOAs

Answer 28

Inhibit protein synthesis by binding 50 S ribosome (X DNA) Bacteriostatic

Question 29

Macrolides and P450

Answer 29

Azithromycin is NOT a P450 Erithro and Clarithro P450!! - show up in Breast Milk and Cross Placenta

Question 30

1st line for sepsis caused by Community Acquired Pneumonia, Skin and Soft Tissue Disease and Meningitis

Answer 30

Vancomycin 1. with Levo for CAP 2. with Ceftriaxone, Ampicillin, and Dexamethasone for Meningitis 3. Piperacillin or tazobactam for STD

Question 31

1st line for sepsis caused by Intra-abdominal infections, Pelvic or UTI

Answer 31

Piperacillin or Tazobactam with Gentamycin

Question 32

Gonorrhea Tx

Answer 32

1st line: Ceftriaxone with Azithromycin (presumptive tx of chlamydia too)

Question 33

Ceftriaxone IM - the shot MUST be given with what??

Answer 33

LIDOCAINE - very painful IM shot

Question 34

1st line Lyme Disease Tx

Answer 34

Doxycycline or Amoxicillin / Ampicillin

Question 35

Notable Doxycycline ADRs and warnings

Answer 35

Teeth discoloration Black tongue Preg D DON'T TAKE W DAIRY

Question 36

Perioperative Prophylaxis

Answer 36

CEFAZOLIN (1st gen cef)

Question 37

1st line Tx Uncomplicated UTI (Absence of fever, flank pain, or other suspicion for pyelonephritis Able to take oral medication)

Answer 37

``` Sulfa Trimethoprime (avoid if used recently for UTI or if known resistance) ``` or Nitrofurantoin or Fosfomycin

Question 38

Pyelonephritis or Complicated UTI

Answer 38

Ciprofloxacin | Levofloxacin unless there is known community resistance

Question 39

Black Box warning for Fluoroquinalones

Answer 39

Tendon issues, esp in adolescents

Question 40

1st line Tx ,Bacterial Vaginitis

Answer 40

Metronidazole

Question 41

Metronidazole ADRs and warnings

Answer 41

Metallic taste Alcohol toxicity, into with Disulfiram NO USE IN 1ST TRIMESTER PREGNANCY

Question 42

2nd line Tx, Bacterial vaginitis (if early preg or alcoholic)

Answer 42

Clindamycin

Question 43

1st line Tx Oncomycosis

Answer 43

Efinaconazole

Question 44

C diff Tx

Answer 44

Metronidazole Vancomycin PO Fidaxomycin