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PHRM 865 ID > EXAM 3 treatment guide > Flashcards

EXAM 3 treatment guide Flashcards

(69 cards)

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1
Q

CAP – outpatient therapy in healthy patients

A
  • amoxicillin 1 g PO q8h
  • doxycycline 100 mg PO BID
  • azithromycin 500 mg (if macrolide resistance < 25%)
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2
Q

CAP – outpatient therapy – DURATION

A

Abx for clinical stability for minimum of 5 days

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3
Q

CAP – common bacterial pathogens

A
  • Streptococcus pneumonia
  • H flu
  • atypicals
  • S aureus
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4
Q

CAP – outpatient therapy in adults with comorbidities

A
  • Combo therapy (preferred): B-lactam + macrolide or doxycycline
    (amox/clav 875/125, cefpodoxime 200, cefuroxime 500)
  • Monotherapy: Respiratory FQ
    (levo 750 qd, moxi 400 qd)
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5
Q

CAP – in-patient – non-severe

A
  • Combo therapy: B-lactam + macrolide
    —- (amp/sulbac (unasyn) IV 1.5-3 q6h, or ceftriaxone 1-2g q24h)
  • Monotherapy: respiratory FQ
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6
Q

CAP – in-patient – severe

A
  • B-lactam + Macrolide (preferred)
  • respiratory FQ + B-lactam
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7
Q

CAP - in-patient – severe – MRSA risk

A
  • ADD vancomycin or linezolid 600mg IV/PO q12h
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8
Q

CAP – in-patient – severe – Pseudomonas Risk

A

ADD one of the following:
- pip/tazo (zosyn) 4.5 g IV q6h
- cefepime 2g IV q8h
- meropenem 1g IV q8h

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9
Q

HAP – DURATION of therapy

A
  • 7 days if clinically stable
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10
Q

HAP – for MRSA coverage

A
  • vancomycin (AUC 400-600)
  • linezolid 600 mg PO/IV Q12H
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11
Q

HAP – Pseudomonas coverage

A
  • Pip/tazo
  • cefepime
  • imipenem
  • meropenem
  • levofloxacin
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12
Q

HAP – if not high mortality risk (cover MSSA & Pseudomonas

A
  • pip/tazo
  • cefepime
  • imipenem
  • meropenem
  • levofloxacin
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13
Q

HAP – if not high mortality risk but MRSA risk

A
  • Combo therapy
  • MRSA covg: vancomycin or linezolid
  • Pseudomonas coverage: Zosyn, cefepime, imipenem, meropenem, levofloxacin
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14
Q

HAP – high risk for mortality &MRSA risk

A
  • 2 drug classes (B-lactam &non) + MRSA covg
  • Pip/tazo, cefepime, imipenem, meropenem
  • levofloxacin, tobramycin, amikacin
  • vancomycin or linezolid
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15
Q

VAP – DURATION of therapy

A

7 days if clinically stable

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16
Q

VAP – empiric therapy

A
  • Pseudomonas and MRSA coverage
  • if risk factors for resistance, choose 2 anti-pseudomonals + MRSA covg (if not, choose 1 for pseudomonas and 1 for MRSA)
  • pip/tazo, cefepime, imipenem, meropenem, levofloxacin, tobramycin, amikacin
  • vancomycin or linezolid
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17
Q

LRTIs random pearls

A
  • never use daptomycin for LRTIs
  • polymixin reserved for MDR and nephrotoxicity
  • aminoglycosides never monotherapy
  • tigecycline increases motrality
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18
Q

Acute Bronchitis – therapy

A

no antibiotic therapy

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19
Q

Acute Exacerbation of chronic bronchitis – DURATION of therapy

A

5-7 days

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20
Q

Acute Exacerbation of chronic bronchitis – preferred treatment

A
  • amox/clav 875/125 PO q12h ***
  • cefuroxime 500mg PO q12h
  • cefpodoxime 200mg PO q12h
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21
Q

Acute Exacerbation of chronic bronchitis – alternative treatment

A

(less coverage for strep pneumo with these)
- doxycycline
- Bactrim
- azithromycin

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22
Q

Acute exacerbation of chronic bronchitis – risk for Pseudomonas

A
  • levofloxacin 750 mg PO QD
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23
Q

Acute Pharyngitis – DURATION of therapy

A
  • 10 days
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24
Q

Acute Pharyngitis – targeted for Strep pyogenes

A
  • Pen VK
  • Amoxicillin
  • (alts used if true penicillin allergy - cephs if no anaphylaxis, azithro or clinda if anaphylaxis)
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25
Acute Bacterial Rhinosinusitis -- DURATION of therapy
- 5-7 days
26
Acute Bacterial Rhinosinusitis -- approach to treatment
- can start immediately or do watchful waiting for 7 days then treat if symptoms worsen or don't resolve
27
Acute Bacterial Rhinosinusitis -- 1st line treatment
- amox/clav 500/125 po TID or 875/125 BID - amox/clav 2000/125 if concern for pen resistance
28
Acute Bacterial Rhinosinusitis -- 2nd line treatment
- doxycycline - levofloxacin (500) - moxifloxacin
29
Acute Bacterial Rhinosinusitis -- concern for MRSA
ADD one of the following: - doxycycline - Bactrim - linezolid - clindamycin
30
Acute Bacterial Rhinosinusitis -- concern for Pseudomonas
- levofloxacin 750 mg PO QD (High dose)
31
UTI -- most common pathogen
E. coli (for all kinds)
32
UTI -- pyelonephritis signs/symptoms
fever, chills, rigors, CVA tenderness, malaise, N/V, flank pain
33
UTI -- cystitis signs/symptoms
dysuria, increased urinary frequency and urgency, suprapubic heaviness or pain
34
UTI -- catheter-associated signs/symptoms
- classic UTI symptoms not present - pain over kidney and bladder - fever - lethargy and malaise
35
UTI -- treatment options
- nitrofurantion -- uncomplicated only - Bactrim (> 20% resistance) - cipro or levo (>20% resistance) - fosfomycin -- uncomplicated only - B-lactams (only cephalexin, cefadroxil, cefpodoxime, amox/clav) -- also used with caution - can maybe do amoxicillin after susceptibility confirmed
36
UTI -- in-patient -- empiric therapy
- ampicillin + gentamicin *** - pip/tazo - cefazolin + gentamicin - gentamicin alone - cefepime - ceftriaxone *
37
UTI -- DURATION of therapy
- uncomplicated: 5 days - complicated: 7-14 days
38
Prostatitis -- treatment DURATION
- 2-4 weeks
39
Prostatitis -- treatment options
- fluoroquinolones - bactrim - some B-lactams (cephalexin, amox/clav)
40
Recurrent UTI management
- may consider prophylactic antibiotic if no correctable cause identified - nitrofurantoin
41
SSTI -- risk factors
- history of SSTI - PAD - CKD - DM - IV drug use
42
SSTI -- common pathogens
staph and strep
43
Non-purulent SSTI -- DURATION of therapy
5 days
44
Non-purulent SSTI -- SEVERE treatment
- surgical inspection and debridement - vancomycin + Zosyn
45
Non-purulent SSTI -- MODERATE treatment
IV abx - ceftriaxone - cefazolin - clindamycin
46
Non-purulent SSTI -- MILD treatment
oral abx - penicillin VK - cephalosporin - dicloxacillin - clindamycin
47
Purulent SSTI -- SEVERE treatment
Empiric: vancomycin, daptomycin, linezolid - Targeted therapy: MRSA: vanco, dapto, linezolid MSSA: nafcillin, cefazolin, clindamycin
48
Purulent SSTI - MODERATE treatment
- Empiric: Bactrim or doxycycline - Targeted: MRSA: Bactrim or doxycycline MSSA: dicloxacillin or cephalexin
49
Purulent SSTI -- MILD treatment
- incision and drainage only
50
Necrotizing Fasciitis -- approach and treatment
- surgery and broad spectrum abx (vancomycin + Zosyn) - C&S: S pyogenes: penicillin + clindamycin polymicrobial: vancomycin + zosyn
51
DFI -- causative pathogens
- S. aureus, Streptococci, Pseudomonas
52
DFI -- MILD infections
- duration: 1-2 weeks - want to cover MSSA, strep dicloxacillin, cephalexin, clindamycin - Recent abx? switch to amox/clav or levo/moxi - MRSA risk? switch to Bactrim or doxycycline
53
DFI -- MODERATE infections
- duration 2-3 weeks - need to cover MSSA, strep, enterobac, anarobes moxi, amox/clav, cipro/levo + clinda/metronidazole - Pseudomonas risk? switch to cipro/levo + clinda/metrinidazole - MRSA risk? add doxycycline, vancomycin, Bactrim
54
DFI -- SEVERE infections
- duration: 2-3 weeks - need to cover MSSA, strep, enterobac, anaerobes, pseudomonas Zosyn, carbapenem, cefepime + clinda/metronidazole -MRSA risk? add vanc, linezolid, daptomycin (most hospitals meet criteria to be MRSA risk)
55
PEDs AOM -- treatment
(after deferred abx 48-72 hrs) 1st line- amoxicillin 80-90 mg/kg/day 2nd line- amox/clav 600/42.9/5ml -oral cephalosporins 2nd line but can be 1st if allergy (cefpodoxime, cefdinir, cefuroxime) - ceftriaxone for severe cases if oral not an option or initial oral treatment fails
56
PEDs UTIs -- treatment
- oral and IV = - cephalexin *** q6h or q8h - amox/clav - Bactrim (nitrofurantoin not really used, avoid FQs in kids)
57
PEDs -- bronchiolitis treatment
supportive therapy - RSV vaccine for prevention (pregnancy 32-36 weeks) - MAb for infants (Niserimab - 1 dose, 2 if high risk)
58
Bone & Joint infections -- most common pathogen
S. aureus
59
Osteomyelitis -- empiric therapy
- B-lactam (or cipro/levo +metronidazole) + MRSA coverage
60
Osteomyelitis -- DURATION of therapy
4-8 weeks
61
Osteomyelitis -- oral abx for specific pathogens
- Streptococci: amoxicillin, cephalexin, clindamycin - MSSA: dicloxacillin, cephalexin, cefadroxil, Bactrim, linezolid - MRSA: linezolid, Bactrim, clindamycin - GNRs: Bactrim, FQs Dalbavancin in 2 dose strategy provides 6-8 weeks of coverage
62
Septic Arthritis -- DURATION of therapy
- S. aureus -- 4 weeks - Streptococci -- 2 weeks - N. gonnorrhea -- 7-10 days - GNR -- 4 weeks
63
Septic Arthritis -- empiric therapy
- B-lactam or cipro/levo+metronidazole + MRSA coverage IV or highly bioavailable oral acceptable
64
Septic Arthritis -- targeted therapy
- Streptococci: amoxicillin, cephalexin, clindamycin - MSSA: dicloxacillin, cephalexin, cefadroxil, Bactrim, linezolid - MRSA: linezolid, Bactrim, clindamycin - GNRs: Bactrim, FQs - N gonorrhea: ceftriaxone alone
65
Prosthetic Joint Infection -- surgical intervention types
- debridement and retention of prosthesis (wash out) - 1 stage exchange - 2 stage exchange
66
Prosthetic Joint Infection -- debridement & retention of prosthesis
- pathogen-directed treatment + rifampin 2-6 weeks - oral abx treatment + rifampin x3months(hip) x6months(knee and other) (preferred oral agents are same as for osteomyelitis)
67
Prosthetic Joint Infection -- 1 stage exchange
- pathogen directed treatment + rifampin 2-6 weeks - oral abx treatment + rifampin x3 months (preferred oral agents are same as for osteomyelitis)
68
Prosthetic Joint Infection -- 2 stage exchange
- pathogen directed treatment x4-6 weeks
69
Prosthetic Joint Infection -- amputation with complete removal of infected bone/hardware
- pathogen-directed treatment 24-48 hours

PHRM 865 ID (5 decks)

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