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3151 - nat > empiric regimen only > Flashcards

empiric regimen only Flashcards

1
Q

Likely pathogen for Impetigo or Ecthyma

Hence what is the treatment for limited / multiple lesions?

Culture directed?

A

MSSA, Grp A-D strep

Limited: No treatment needed, self limiting

Multiple lesions:
Empiric therapy
PO Cephalexin or Cloxacillin

Penicillin allergy
Mild allergy
Cefuroxime (replace Cephalexin)

Severe allergy
PO Clindamycin

Culture directed (Strep A, Pyogenes)
Penicillin V
Amoxicillin

Culture directed (MSSA)
PO Cephalexin or Cloxacillin

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2
Q

Common pathogens for purulent SSTI (Furuncles, Carbuncles, Skin abscesses, Purulent cellulitis) (4 points)

What is the treatment for mild, moderate severe purulent SSTI

Empiric MRSA, gram (-) and anaerobe?

A

MSSA, Grp A-D Strep
Gram (-), Anaerobes (at the perioral, perirectal, vulvovaginal areas)

Mild infection
I&D + Warm compress to promote drainage

Moderate infection + Systemic symptoms
I&D + Oral antibiotics
Cloxacillin
Cephalexin
Penicillin allergy: Clindamycin

Severe infection
I&D + IV antibiotics
IV Cloxacillin
IV Cefazolin
Clindamycin (for allergy)
Vancomycin (for MRSA)

Gram (-) and Anaerobe
Amox-Clav

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3
Q

Coverage for mild VS moderate nonpurulent SSTI?

Hence what is the treatment?

A

Mild: Grp A strep
Cover: Use oral antibiotic
Penicillin V
Cephalexin
Amoxicillin
Allergy: Clindamycin

Moderate: May use IV
similar to moderate purulent SSTI
Cover: Grp A strep + MSSA
Cefazolin
Cloxacillin
(penicillin allergy) Clindamycin

If water exposure
Add Ciprofloxacin
Cover Aeromonas, Vibrio and Pseudomonas

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4
Q

Treatment for severe nonpurulent SSTI

A

IV antibiotics
Pip-Tazo
Cefepime
Meropenem

MRSA risk factor
Add IV Vancomycin, Daptomycin, Linezolid

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5
Q

Criteria for Mild DFI?

Cover which bugs?

Drug of choice

A

< 2cm erythema around ulcer
Cover (+) only (Grp A-D strep + MSSA)

Use oral drugs for Mild DFI
Use Cephalexin, Cloxacillin, Clindamycin
MRSA: Clindamycin, Doxycycline

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6
Q

Moderate DFI requirement?

Need cover what?

Hence treatment?

A

> 2cm erythema around ulcer
(+), (-), Anaerobes

Use IV for Moderate DFI
Cefazolin + Metronidazole
Ceftriaxone + Metronidazole
Amox-Clav
MRSA: IV Vanco, Dapto, Linezolid

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7
Q

Requirement for Severe DFI

Need cover what?

Hence treatment?

A

> 2cm erythema around ulcer
Signs of systemic infection

(+), (-), Anaerobes, Pseudomonas

Treatment
Pip-Tazo

Meropenem

Cefepime + Metronidazole
Metronidazole → Anaerobes

Ciprofloxacin + Clindamycin
Ciprofloxacin → (-), Pseudomonas
Clindamycin → (+), anaerobes

Add IV MRSA if have risk factors

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8
Q

First line treatment for S.pyogenes pharyngitis?

Treatment for S.pyogenes with Penicillin allergy

A

Penicillin V 250mg Q6
Amoxicillin 500mg Q12

(only for Penicillin V allergy) Cephalexin 500mg Q12
(For Amoxicillin allergy) Cefuroxime 250mg Q12
Clindamycin 300mg Q8

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9
Q

Second line for S.pyogenes pharyngitis

Why is this second line?

A

Azithromycin 500mg OD
Clarithromycin 250mg Q12

Macrolides are 2nd line due to increasing resistance

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10
Q

Most common pathogens for Acute Rhinosinusitis (2 points)

First line for Acute Rhinosinusitis

with non-severe / severe penicillin allergy

A

Strep Pneumo
Haem Influenzae

Higher dose than Pharyngitis
Amoxicillin 500mg Q8
Amoxicillin Clav 625mg Q8

Non severe
Cefuroxime 500mg Q12

Severe
Levofloxacin 500mg OD
Moxifloxacin 400mg OD

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11
Q

What to cover for Outpatient CAP with no comorbidities?

Hence what is the treatment?

A

Strep Pneumo only

All oral
Amoxicillin 1g q8
Levofloxacin or Moxifloxacin

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12
Q

What to cover for Outpatient CAP with comorbidities

Hence what is the treatment?

A

Strep Pneumo
Haem Influenzae
Atypicals

All oral drugs

Strep Pneumo, Haem Influenzae coverage
Beta lactams
Amoxicillin Clavulanate
Cefuroxime

Atypical Coverage
Macrolides (Azithromycin, Clarithromycin)
Doxycycline

Have all 3 coverage
Respiratory quinolones
Moxifloxacin
Levofloxacin

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13
Q

What to cover for Inpatient, non-severe

Hence what is the treatment?

A

Big 3

MRSA (if have resp isolation in past 1 year or hospitalisation or parenteral antibiotic in past 90 days + MRSA PCR Screen positive)

Pseudomonas (if have resp isolation in past 1 year)

Treatment - all IV

Cover Big 3
Same as Outpatient w comorbidities
Ceftriaxone now an option

MRSA
IV Vancomycin OR IV/PO Linezolid

Pseudomonas
Add on Ceftazidime
Does not cover Strep Pneumo
OR
Replace beta lactam (amox-clav, cefuroxime, ceftriaxone) with:
Pip-Tazo
Cefepime
Meropenem
Levofloxacin (Can even cover atypicals)

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14
Q

Need to cover what for Inpatient severe CAP?

Hence what is the treatment?

A

Big 3 + MSSA, Burkholderia
MRSA and Pseudomonas based on risk factors
MRSA and Pseudomonas risk factor: Resp isolation in past 1 year OR Parenteral antibiotic use in last 90 days

Treatment
Beta lactam (Strep, Haem, MSSA)
Amoxicillin Clavulanic
Penicillin G

Burkholderia
Ceftazidime

Macrolides (atypicals)
Azithromycin
Clarithromycin

Respiratory Fluoroquinolones (Strep, Haem, Atypicals, MSSA)
Levofloxacin
Moxifloxacin

MRSA
IV Vancomycin OR IV/PO Linezolid

Pseudomonas
Add on Ceftazidime
Does not cover Strep Pneumo
OR
Replace beta lactam (amox-clav, cefuroxime, ceftriaxone) with:
Pip-Tazo
Cefepime
Meropenem
Levofloxacin (Can even cover atypicals)

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15
Q

What to cover for HAP / VAP?

Empiric therapy for HAP / VAP? (3 classes and their drugs)

Which should only be used with MRSA coverage? and why?

A

PME (Pseudomonas, MSSA, Enterobacterales)

Antipseudomonal Beta Lactam
Pip-Tazo
Cefepime
Meropenem
Imipenem

Antipseudomonal FQ
Levofloxacin

Aminoglycoside
Amikacin

Only with MRSA coverage (cos these do not cover MSSA)
Ceftazidime
Ciprofloxacin

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16
Q

First line treatment for Uncomplicated cystitis

A

Usually use Cotrimoxazole and nitrofurantoin
doses will be lower than pyelonephritis

PO Co-trimoxazole 800/160mg BD x 3d

PO Nitrofurantoin 50mg QD x 5d
CI in CrCl < 30 ml/min
Not in Pyelonephritis

PO Fosfomycin 3g single dose
Not used in hospitals
Reserved for ESBL producing E.coli
Not for pyelonephritis

17
Q

Alternative treatment for uncomplicated cystitis

A

PO Beta-lactams (5-7 days)
Cefuroxime 250mg BD
Amox-Clav 635mg BD

18
Q

Treatment for complicated cystitis in women

A

Same drugs as Uncomplicated Cystitis in women
Cotrimox, Nitrofurantoin

Treat for longer duration 7-14 days

19
Q

treatment for UTI in men, cystitis with no concern for prostatitis

A

Same as complicated cystitis
7-14 days

20
Q

Treatment for UTI in men, cystitis with concern for prostatitis, pyelonephritis

A

PO Ciprofloxacin 500mg BD
PO Co-trimoxazole 800/160mg BD
10-14 days

21
Q

First line treatment for Pyelonephritis (3 points)

A

principle: high dose, for long duration (14 days)

PO Fluoroquinolones
Ciprofloxacin 500mg BD x 7d
Levofloxacin 750mg OD x 5d

PO Co-trimoxazole
800/160mg BD X 14d

PO Beta lactam (10-14d)
Cefuroxime 250-500mg BD
Amox-Clav 625mg TDS

22
Q

Treatment for severely ill patient who require hospitalisation with pyelonephritis (cover what)

A

Use aminoglycosides to cover ESBL producing strains

IV Ciprofloxacin 400mg BD + IV Gentamicin 5mg/kg

others + gentamicin
IV Cefazolin 1g TD
IV Amox-Clav 1.2g TD

23
Q

Empiric treatment for HA-UTI (more sick, less sick, duration of therapy)

A

More sick = More broad spectrum
IV Cefepime 2g BD + IV Amikacin 15mg/kg/d
Cefepime cover pseudomonas, Amikacin cover ESBL, resistant pseudomonas
IV Imipenem 500mg QD
IV Meropenem 1g TD

Less sick = Narrow spectrum
PO Levofloxacin 750mg
PO Ciprofloxacin 500mg BD

7-14 days

24
Q

Empiric treatment for CA-UTI

Duration of treatment

A

similar to HA-UTI for serious patients on IV

7 days for prompt resolution and deferverse in 3 days, 10-14 days for those with delayed response

Pseudomonas, ESBL producing gram (-)

More sick = More broad spectrum
IV Cefepime 2g BD + IV Amikacin 15mg/kg/d
Cefepime cover pseudomonas, Amikacin cover ESBL, resistant pseudomonas
IV Imipenem 500mg QD
IV Meropenem 1g TD

Less sick = Narrow spectrum
PO Levofloxacin 750mg
PO Ciprofloxacin 500mg BD

7-14 days

25
Q

What to cover for Bacterial Meningitidis in Neonates?

Hence what is the empiric therapy?

A

Grp B Strep, E.coli, Listeria Monocytogenes

Ceftriaxone + Ampicillin

26
Q

What to cover for Bacterial Meningitidis in Infants?

Hence what is the empiric therapy?

A

Strep Pneumo, Neisseria meningitidis, Grp B strep, E.coli

Ceftriaxone + Vancomycin

27
Q

What to cover for Bacterial Meningitidis in children and adults?

Hence what is the empiric therapy?

A

Strep Pneumo, Neisseria meningitidis

Ceftriaxone + Vancomycin

28
Q

What to cover for Bacterial Meningitidis in adults > 50?

Hence what is the empiric therapy?

A

Strep Pneumo, Neisseria meningitidis, Listeria, E.coli

Ceftriaxone + Vancomycin + Ampicillin

29
Q

Treatment for non-severe C.diff

A

(WBC < 15 X 10^9 and SCr < 133umol/L)

First line
PO Vancomycin 125mg QDS
PO Fidaxomicin 200mg BD

2nd line
PO Metronidazole 400mg TDS

30
Q

Treatment for severe C.diff

A

Same as non-severe, just that no metronidazole

PO Vancomycin 125mg QDS
PO Fidaxomicin 200mg BD

31
Q

Treatment for fulminant C.diff

A

Must have either hypotension, ileus, or megacolon

IV Metronidazole 500mg TDS
+ PO Vancomycin 500mg QDS
+ Rectal Vancomycin 500mg QDS

3151 - nat (22 decks)

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