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A - NAPLEX > Chapter 23: ID II - Bacterial Infections > Flashcards

Chapter 23: ID II - Bacterial Infections Flashcards

1
Q

If antibiotics are needed post-op, when should they be d/c

A

within 24 hrs

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2
Q

Which antibiotic is preferred for perioperative cardiac or vascular surgeries to prevent MSSA and streptococci infections. What is the alternative if the patient has an allergy

Include timing

A

Cefazolin - infuse 60 min before incision

Clindamycin or vanco if BL allergy - infuse 120 min before incision

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3
Q

The prophylactic antibiotic regimen in colorectal surgeries needs to cover skin flora plus broad gram-____ and ____ organisms found in the gut

Which drugs are used

A

Broad gram-negative
Anaerobic

Cefotetan, cefoxitin, ampicillin/sulbactam, ertapenem
OR
metronidazole + (cefazolin or ceftriaxone)

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4
Q

Which antibiotic is preferred for perioperative hip fracture repairs or total joint replacement surgeries to prevent MSSA and streptococci infections. What is the alternative if the patient has an allergy

A

Cefazolin

Clindamycin or vanco if BL allergy

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5
Q

Classic symptoms of meningitis

How is it diagnosed

A

fever, HA, nuchal rigidity (stiff neck), and altered mental status

lumbar puncture

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6
Q

The risk of meningitis is caused by which bacteria

A

Streptococcus pneumoniae, Neisseria meningitidis and H. infuenzae

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7
Q

Which pathogen is prevalent in select patient groups that puts them at risk for meningitis and what additional treatment is required for it

A

Listeria monocytogenes

ampicillin

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8
Q

Which drug can be given 15-20 minutes prior to or with the first antibiotic dose for meningitis to prevent neurological complications

A

Dexamethasone

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9
Q

Which groups should receive ampicillin for Listeria monocytogenes in meningitis

A

neonates
Age > 50 years
Immunocompromised

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10
Q

Meningitis treatment for neonates (< 1 month old)

A

Ampicillin (for Listeria coverage)
+
CefoTAXime or Gentamicin
(no ceftriaxone) - can cause biliary sludging & kernicterus

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11
Q

Meningitis treatment age 1 month to 50 years

A

Ceftriaxone or cefotaxime
+
Vanco

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12
Q

Meningitis treatment for age > 50 years or immunocompromised

A 
Ampicillin (for Listeria coverage)
\+
Ceftriaxone or cefotaxime
\+ 
Vanco
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13
Q

Observation of non-severe acute otitis media without antibiotics for __-__ hours (mild otalgia < 48 hours or temp < 102.2F) and what other factors can be considered

A

48-72 hrs and

  • Age 6-23 months: symptoms in one ear only
  • Age >/= 2 years: symptoms in one or both ears
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14
Q

After 48-72 hours of observation, what is the first line treatment option for acute otitis media, including the dose

ALTERNATIVE if patient has a non-severe PCN allergy

A

-High-dose amoxicillin (80-90 mg/kg/day) in 2 divided doses
OR
-Augmentin 90 mg/kg/day of amoxicillin in 2 divided doses (can be considered in pts who have received amoxicillin in the past 30 days)
-Remember to use the formulation with the LEAST amount of clavulanate to decrease the risk of diarrhea (Augmentin ES-600 is a common formulation)
OR
-Ceftriaxone IM for 1-3 days (if vomiting or unable to tolerate oral)

NON-SEVERE PCN ALLERGY: Cephalosporin (first or second generation; Cefdinir, Cefuroxime, Cefpodoxime, Ceftriaxone)

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15
Q

Which bug causes pharyngitis

A

S. pyogenes

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16
Q

Criteria for anti-infective treatment of influenza

Treatment options and duration

A

< 48 hours since symptom onset

  • Oseltamivir x 5 days
  • Baloxavir x 1 dose
  • Zanamivir inhalation x 5 days
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17
Q

Criteria for anti-infective treatment of pharyngitis

A

Positive rapid antigen diagnostic test

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18
Q

Criteria for anti-infective treatment of sinusitis

A

> 10 days of symptoms
OR
/= 3 days of severe symptoms

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19
Q

Which bug is responsible for causing whooping cough

A

Bordetella Pertussis

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20
Q

Bronchitis caused by bordatella pertussis is treated with

A

A macrolide

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21
Q

Antibiotics for 5-7 days should be used in COPD exacerbations if which criteria are met & what is the preferred antibiotic

A

-All 3 of the following: ↑ dyspnea, ↑ sputum volume and ↑ sputum purulence
-↑ sputum purulence + 1 additional symptom
-Mechanically ventilated
Preferred abx: Augmentin

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22
Q

Most bacterial cases of pneumonia are caused by which bugs

A

S. pneumoniae, H. influenzae, M. pneumoniae

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23
Q

Duration of treatment for CAP

A

5-7 days

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24
Q

If patient does NOT have comorbidities (chronic heart, lung, liver or renal disease; DM; alcoholism; malignancy or asplenia) & has no RF for MRSA or PsA (prior resp isolation of either pathogen or hospitalization with receipt of parenteral abx in the past 90 days), what is the empiric regimen for CAP

A 
-Amoxicillin 1 gram TID
OR
-Doxycycline
OR
-Macrolide (azithromycin or clarithromycin) if local pneumococcal resistance is < 25%
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25
Q

If patient DOES have comorbidities (chronic heart, lung, liver or renal disease; DM; alcoholism; malignancy or asplenia) & has no RF for MRSA or PsA (prior resp isolation of either pathogen or hospitalization with receipt of parenteral abx in the past 90 days), what is the empiric regimen for CAP

A

-BL + macrolide + doxy (Augmentin or cephalosporin (e.g., cefpodoxime, cefdinir, cefuroxime)
PLUS
-Macrolide or doxycycline

-respiratory quinolone monotherapy (moxi, levo, gemi)

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26
Q

Non-severe (typically non-ICU care required) treatment of inpatient CAP

A

BL (ceftriaxone or cefotaxime) + macrolide or Unasyn
OR
Respiratory quinolone monotherapy (moxi, levo, gemi)

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27
Q

Severe (typically ICU care required) treatment of inpatient CAP

A

BL + macrolide
OR
BL + resp quinolone (do NOT use quinolone monotherapy)

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28
Q

In CAP treatment, if there are RF for MRSA, add coverage with:

In CAP treatment, if there are RF for PsA, add coverage with:

A

vanco or linezolid

Zosyn, cefepime, meropenem or aztreonam

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29
Q

HAP has an onset > __ hours after hospital admission

VAP occurs > __ hours after the start of mechanical ventillation

A

48 hours

48 hours

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30
Q

Which pathogens are common in HAP & VAP

A

nosocomial

The risk for MRSA and MDR Gram-negative rods, including PsA is increased in select cases

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31
Q

How to select empiric regimen for HAP/VAP

A
  • Choose 1 abx to cover PsA and MSSA if low risk for MRSA or MDR pathogens (cefepime or Zosyn)
  • Choose 2 abx, one for MRSA and one for PsA if risk for MRSA but low risk for MDR pathogens (cefepime + vanco or meropenem + linezolid)
  • Choose 3 antibiotics, one for MRSA and 2 for PsA if risk for both MRSA and MDR pathogens (e.g., IV antibiotics within the past 90 days (Zosyn + cipro + vanco or cefepime + gentamycin + linezolid)
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32
Q

What is latent TB & how is it diagnosed

What is active pulmonary TB

A

The immune system contains the infection and the patient lacks symptoms
Diagnosed: tuberculin skin test (TST) aka PPD test

It is transmitted by aerosolized droplets and is highly contagious.
Presents with cough/hemoptysis, fever and night sweats
Hospitalized pts are isolated in a single negative-pressure room

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33
Q

A false positive TB test can occur in those who have received which vaccine

A

BCG vaccine

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34
Q

What is a positive TST result in patients with no risk factors

What is a positive TST result in patients who reside in “high-risk” congregate settings (e.g., prison inmates, healthcare workers)

What is a positive TST result in patients with significant immunosuppression

A

> /= 15 mm induration

> /= 10 mm induration

> /= 5 mm induration

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35
Q

How is latent TB treated

A
  • INH or rifapentine weekly x 12 weeks via directly observed therapy (DOT) - DO NOT USE THIS REGIMEN IN PREGNANT WOMEN
  • Rifampin x 4 months (children and HIV-neg adults)
  • Isoniazid with rifampin x 3 months (all ages and HIV+)
  • Alternative: INH x 6 mo or 9 mo - treatment of choice for pregnant women
36
Q

A positive TST is likely with active TB, but the diagnosis must be confirmed with

A

sputum culture

37
Q

M. tuberculosis (MTB) is an acid-fast bacilli and can be detected using a(n)

A

AFB stain (note: MTB is a slow-growing organism)

38
Q

The preferred intensive phase treatment for active TB consists of which drugs and how long is therapy

In the continuation phase of active TB, what are the drugs used and how long is treatment

A 
RIPE:
-Rifampin
-Isoniazid
-Pyrazinamide
-Ethambutol
2 months

Rifampin and Isoniazid x 4 months

39
Q

Rifampin SE

A

↑ LFTs, hemolytic anemia (positive Coombs test), flu-like sx, Orange-red discoloration of sputum, urine, sweat, tears, teeth, can stain contact lenses and clothing
-Rifabutin can replace rifampin in some cases d/t DDI

40
Q

What can be used to decrease the risk of isoniazid-associated peripheral neuropathy (include dose)

A

Pyridoxine 25-50 mg

41
Q

Isoniazid BW

A

Hepatitis

42
Q

Isoniazid SE

A

↑ LFTs, hemolytic anemia (positive Coombs test), DILE

43
Q

Pyrazinamide CI

A

acute gout

44
Q

Pyrazinamide SE

A

↑ LFTs, hyperuricemia/gout

45
Q

Ethambutol SE

A

↑ LFTs, optic neuritis (dose-related), confusion, hallucinations

46
Q

Major drug interactions with rifampin

A

Potent PgP and 3A4 inducer
-Protease inhibitors
-Warfarin (very large ↓ in INR)
-Oral contraceptives (decreases efficacy)
DO NOT USE RIFAMPIN WITH apixaban and rivaroxaban

47
Q

What are the 3 most common bugs that can cause infective endocarditis

A

Staphylococci, Streptococci, and Enterococci

48
Q

Which drug is added to infective endocarditis treatment for synergy, when the infection is more difficult to eradicate

A

Gentamicin

49
Q

When gentamicin is used for synergy in infective endocarditis, traditional dosing is typically used to target peak levels of __-__ mcg/mL and trough levels of < __ mcg/mL

A

3-4

<1

50
Q

Adult ppx regimens for infective endocarditis after dental procedures if no PCN allergy and in PCN allergy (including dose)

A

No PCN allergy:
-Amoxicillin 2 grams 30-60 min before dental procedure

PCN allergy:
-Clindamycin 600 mg or azithromycin or clarithromycin 500 mg

51
Q

DOC for spontaneous bacterial peritonitis (SBP) and duration of treatment

A

Ceftriaxone for 5-7 days

52
Q

What are the most likely pathogens of secondary peritonitis

A

Streptococci, enteric Gram-negatives and anaerobes (B. fragilis)

53
Q

Purulent SSTIs include

Superficial SSTIs include

Subcutaneous tissue SSTIs include

A

abcesses

impetigo (honey-colored crusts), furuncles, and carbuncles

Cellulitis

54
Q

Treatment of impetigo

A 
Topical mupirocin (Bactroban)
If numerous lesions, use Keflex to cover MSSA
55
Q

Treatment of folliculitis/furuncles/carbuncles

A
  • Cephalexin

- If non-responsive, change to a drug with CA-MSSA coverage (Doxy or Bactrim)

56
Q

Mild cellulitis treatment

A

Keflex

57
Q

Mild to moderate purulent abscess treatment

Severe purulent SSTI treatment

A

Bactrim or doxy
(commonly caused by CA-MRSA)

Severe: Need MRSA coverage: vanco, linezolid or dapto

58
Q

Necrotizing fasciitis treatment

A

vanco + BL

59
Q

UTIs that occur in the lower urinary tract are called
Symptoms?

UTIs that occur in the kidneys are called
Symptoms?

A

cystitis

  • Urgency and frequency including nocturia
  • Dysuria
  • Suprapubic heaviness
  • Hematuria

pyelonephritis
-Flank pain

60
Q

Drugs of choice for acute uncomplicated cystitis with dose

A

Nitrofurantoin (Macrobid) 100 mg PO BID with food x 5 days (CI if CrCl < 60 mL/min)
OR
Bactrim DS 1 tab PO BID x 3 days

Can add phenazopyridine (Pyridium) to relieve dysuria for max 2 days

61
Q

Drugs of choice for acute uncomplicated cystitis for pregnant women

A

Keflex, Amoxicillin

Treat asymptomatic pregnant women!!!

62
Q

Treatment for acute uncomplicated pyelonephritis

A
  • If local quinolone resistance is < / = 10%: cipro or levo

- If local quinolone resistance is > 10%: ceftriaxone, Bactrim, or BL

63
Q

Complicated UTI treatment

A

Use a carbapenem if ESBL-producing

64
Q

How should Pyridium be taken

A

with 8 oz of water with or immediately following food to minimize stomach upset

65
Q

Pyridium can cause

A

red-orange coloring of urine and other body fluids; contact lenses/clothes can be stained

66
Q

Which bugs can cause traveler’s diarrhea

A

Bacterial - E. coli, Campylobacter jejuni, Shigella spp, and Salmonella
Viral - rotavirus

67
Q

Treatment of choice in TD if dysentery is present

Treatment of choice in TD if dysentery is not present

A

Azithromycin - DO NOT USE LOPERAMIDE IN DYSENTERY

Quinolones or rifaximin

68
Q

How is the first episode of C. diff treated (non-severe or severe)

A

VAN 125 mg PO QID x 10 days
OR
FDX 200 mg PO BID x 10 days
if above tx are not available and episode is non-severe use Metronidazole 500 mg PO TID x 10 days

69
Q

How is fulminant/complicated C. diff treated

A

VAN 500 mg PO/NG/PR QID + metronidazole 500 mg IV Q8H

70
Q

How is the 1st recurrence (or 2nd episode) of C. diff treated if metronidazole was used for the initial episode

What about if vanco was used in the initial episode?

A

VAN 125 mg PO QID x 10 days

FDX 200 mg PO BID x 10 days

71
Q

How are subsequent episodes (more than 2) of C. diff treated

A 
VAN tapered and pulsed regimen 
OR
VAN 125 mg PO QID x 10 days then rifaximin 400 mg TID x 20 days
OR
FDX 200 mg PO BID x 10 days
OR
fecal microbiota transplant
72
Q

Symptoms of chlamydia & gonorrhea

A

genital discharge or no symptoms

73
Q

Syphilis symptoms & DOC for primary, secondary or early latent syphilis and dose & alternative

A

Painless, smooth genital sores (chancre)

Penicillin G benzathine (Bicillin L-A) 2.4 million units IM x 1
Alternative: doxy

74
Q

HPV symptoms

A

genital warts or no symptoms

75
Q

Pregnant patients with syphilis who are allergic to PCN should be treated with

A

Desensitize and treat with DOC (Bicillin L-A)

This is also recommended in HIV+ pts

76
Q

DOC for late latent syphilis and dose

A

Penicillin G benzathine (Bicillin L-A) 2.4 million units IM weekly x 3 weeks

77
Q

Gonorrhea treatment and dose

A

UPDATED PER CDC: Ceftriaxone (higher dose)
< 150 kg: 500 mg IM x 1
≥ 150 kg: 1 gram IM x 1

Old guideline (per book): Ceftriaxone 250 mg IM x 1 plus Azithromycin 1 g PO x 1 or doxy

Note: monotherapy is not recommended for treatment

78
Q

Chlamydia DOC and dose

A

Azithromycin 1 gram PO x 1 or doxy

79
Q

Bacterial vaginosis symptoms

Trichomoniasis symptoms

A

clear, white or gray vaginal discharge that has a fishy odor and pH > 4.5 with little to no pain

yellow/green frothy vaginal discharge, soreness, and pain with intercourse

80
Q

DOC for Bacterial vaginosis

DOC for Trichomoniasis & dose

A

Metronidazole or Metronidazole 0.75% gel

Metronidazole 2 g PO x 1

81
Q

Genital warts (HPV) DOC

A

Imiquimod cream (also approved for superficial basal cell carcinoma)

82
Q

Treatment for Rocky Mountain Spotted Fever

A

Doxycycline (also DOC for peds)

83
Q

Treatment for Lyme disease & how does disease present

Which bugs are responsible

A

Doxycycline

Bullseye rash (round, red), achy joints, fever

Borella burgdorferi and Borrelia mayonii, spread by ticks

84
Q

How to diagnose Lyme disease

A

EIA

85
Q

Which tests are done to diagnose syphilis

A

RPR and VDLR

A - NAPLEX (83 decks)

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