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1
Q

Uncomplicated Cystitis

A

Non pregnant, young female
Bactrim x 3 days (avoid if resistance is known or if used in previous 3 months)
Cipro/levo x 3 days
Nitrofurantoin x 5 days (avoid if early pyelonephritis is suspected)
Beta-lactams x 3-7 days
Fosfomycin

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2
Q

Complicated cystitis

A

DM, > 65, Pregers
Bactrim x 7-10 days
Cipro/levo x 7-10 days
Augmentin x 7-10 days

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3
Q

Acute pyelonephritis

A

Cipro IV x 24-48 hours, then PO > 14 days

+/- doxycycline/azithromycin (chlamydia)

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4
Q

Acute prostatitis

A

Bactrim x 21 days

Cipro/levo x 21 days

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5
Q

< 3 UTIs / year

A

Treat as a separate infxn

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6
Q

> /= 3 UTI’s per year or UTI in the past 6 months

A

Bactrim
TMP
Nitrofurantoin
Cipro/levo

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7
Q

UTI Post-Coital Prophylaxis

A

Bactrim
Nitrofurantoin
Cephalexin
FQs (except moxi)

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8
Q

UTIs in pregnancy

A

1st gen Ceph x 7-10 days
Augmentin
Nitrofurantoin
Bactrim (except for 3rd trimester)

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9
Q

UTIs in children

A

Amoxil
Augmentin
Ceph 1st and 2nd generation

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10
Q

Impetigo

A

Superficial
Children/poor hygiene
S. aureus including MRSA and Group A strep

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11
Q

Impetigo treatment

A 
Wash gently with soap and water
Localized = Topical mupirocin or retapmulin x 5 days
Extensive = oral x 7 days
Keflex
Augmentin
Dicloxacillin
MRSA suspected = Bactrim, clinda, doxycycline
If streptococci alone = PCN G PO
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12
Q

Small furuncles

A

Moist heat to promote drainage

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13
Q

Large furuncles and Carbuncles

A

Incision and drainage required

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14
Q

Mild furuncles/carbuncles

A

Abx usually not needed

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15
Q

Moderate furuncles/carbuncles

A

PO x 5-10 days
Empiric: Bactrim, doxycycline
Defined: MRSA: Bactrim
MSSA: Dicloxacillin/cephalexin

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16
Q

Severe furuncles/carbuncles

A 
IV 5-10 days
Empiric: Vanc, telovancin, dalbavancin, oritovancin
Linezolid
Dapto
Ceftaroline
Defined: MRSA: Same as above
MSSA: nafcillin, oxacillin, clinda
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17
Q

Erysipelas

A

Very young/old
Group A strep
“Orange peel”
PCN G (IM, PO, IV) or amoxil x 7-10 days

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18
Q

Cellulitis (MSSA)

A 
Group A strep and staph aureus
x 5 days
IV agents: Nafcillin/oxacillin
PO agents: Dicloxacillin
IV if PCN-allergic: Cefazolin
PO if PCN allergic: Keflex
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19
Q

Cellulitis (MRSA)

A

7-10 days

IV agent: Vanc

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20
Q

Necrotizing Fasciitis (Type 1)

A

Mixed anaerobes, GNR, enterococci
Vanc/Linezolid + pip/tazo/carbapenems
OR
Vanc/Linezolid + ceftriaxone + metronidazole

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21
Q

Necrotizing Fasciitis (Type 2)

A

Group A strep (S. pyogenes)

Clinda + PCN G

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22
Q

Diabetic foot infection (mild)

A

MSSA, streptococcus spp.
Cephalexin
Augmentin
MRSA: Doxycycline, Bactrim

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23
Q

Diabetic Foot Infections (moderate to Severe)

A

1-2 weeks
MSSA, Streptococcus spp. Enterobacteriaceae, obligate anaerobes:
Amp/sulb
Ertapenem
Imipenem/cilstatin
MRSA: Dapto/vanco
Pseudomonas: Pip/tazo
MRSA, enterobacteriaceae, p. aeruginosa, obligate anaerobes:
Vanc + ceftaz/cefepime/piptazo or carbapenem
+/- anaerobic coverage if not using pip/tazo or carbapenem (metro, clinda)

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24
Q

Osteomyelitis (MSSA)

A

Nafcillin/oxacillin
Allergy: cefazolin/ceftriaxone
IV x 4-6 weeks

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25
Osteomyeslitis (MRSA)
Vanc Dapto Linezolid IV x 4-6 weeks
26
Osteomyelitis (pseudomonas)
``` Pip/tazo Cefepime Cipro Imipenem/cilstatin IV x 4-6 weeks ```
27
Osteomyelitis (Enterobacteriaciae)
Pip/tazo Ceftriaxone Cipro IV x 4-6 weeks
28
Osteomyelitis (Streptococci)
PCN G (DOC) Clinda (if allergy) Ceftriaxone
29
Animal bite
Augmentin x 10-14 days
30
Human bite
10-14 days Augmentin ERtapenem Amp/sulb
31
HPV vaccine
not for preg women Females 11-26 yo x 3 doses Males 11-21 yo x 3 doses
32
N. gonorrhea
Gram - intracellular diplococci
33
Chlamydia
Will see nothing on gram stain
34
Uncomplicated urethritis (. gonorrhea)
Ceftriaxone 250mg IM x 1 dose + Azithromycin 1g PO x 1 dose
35
Complicated Urethritis (N. gonorrhea)
``` Ceftriaxone 1g IM or IV q24 + Azithro 1 g PO x 1 dose Then Cefixime 400mg PO BID > 1 week ```
36
N Gonorrhea Endocarditis
Ceftriaxone 1-2g IV q12 > 4 weeks PLUS Azithromycin 1g PO x 1
37
PID organisms
GNRs, anaerobes, H influenzae, S. agalactiae, chlamydia, n. gonorrhea, mycoplasma
38
PID (inpatient)
``` Cefotetan 2g IV q12 OR Cefoxitin 2g IV q6h + doxy 100mg q12 x 14 days OR Clinda 900mg IV q8 x 14 days + gent ```
39
PID (outpatient)
Ceftriaxone 250mg x 1 + doxy 100mg BID x 14 days | +/- metronidazole 500mg BID x 14 days
40
Syphilis
Treponema pallidum Spirocjete Test w/DFA
41
Syphilis (early)
Primary, secondary (RASH), Latent < 1 yr | Benzathine 2.4 MU IM x 1
42
Syphilis (late) (if no CNS findings)
> 1 year, or duration unknown | Benzathine 2.4 MU/week IM x 3 weeks
43
Syphilis (CNS findings)
Aqueous PCN G 18-24 MU IV daily x 10-14 days PLUS Benzathine 2.4MU/week IM x 3weeks
44
Jarsch-Herxheimer rxn
Rxn w/PCN injection Not allergy Support w/APAP and fluids
45
Syphilis (pregnancy)
Treat as if not pregnant
46
HSV
Acyclovir x 5 days Famciclovir 1500mg x 1 Valacyclovir 2g BID x 1
47
Bacterial Vaginosis
Fishy vaginal odor Metronidazole 500mg BID x 7 days Metro Gel 0.75% qhs x 5 days Clinda Cream 2% qhs x 7 days
48
Trichomoniasis
Yellow/green discharge with vulbular irritation Metronidazole 2g PO x 1 Tinidazole 2g PO x 1
49
VVC
Complicated = topical azole x 7 days or fluconazole 150mg q72h x 3 doses
50
Oropharyngeal Candidiasis
``` C. albicans White patches Mild: 7-14 days Clotrimazole troches 10mg 5 times daily Miconazole mucoadhesive buccal 50mg tab to upper gum Moderate-severe x 7-14 days Fluconazole 100-200mg daily ```
51
Esophageal Candidiasis
Ulcerations x 14-21 days Fluconazole 200-400 PO daily Echincandin Prophylaxis = not recommended
52
Invasive candidiasis (Non-Neutropenic)
Moderately-severely ill = capsofungin x 14 days after 1st (-) cx
53
Invasive Candidiasis (Neutropenic)
Echinocandin x 14 days after 1st (-) cx
54
Invasive candidiasis (pregs)
Systemic Ampho B only
55
Candiduria
``` Asymtomatic = only treat neonates and neutropenic adults Symptomatic = fluconazole 200mg x 14 days Pyelonephritis = fluconazole 200-400mg x 14 days ```
56
Aspergillus (BPA) - A. fumigatus
Corticosteroids + itraconazole
57
Aspergilloma
Sinuses/pulmonary | Chronic = Voriconazole
58
Aspergillus (invasive)
Voriconazole 6mg/kg IV x 1 day, then 4mg/kg IV q12h > 6-12 weeks
59
PCP Treatment Mild-moderate
Bactrim 5-20mg/kg/day PO in 3 divided doses | Bactrim DS 2 tabs TID
60
PCP Treatment Moderate-Severe
Bactrim 15-20 mg/kg/d IV in 3-4 divided doses x 21 days | Switch to PO after clinical improvement
61
PCP prophylaxis
Bactrim 1 tab QD until CD4 > 200 > 3 months
62
Toxoplasma treatment
Sulfadiazine + pyrimethamin + leucovorin x >/= 6 weeks
63
Toxoplasma prophylaxis
Bactrim DS daily until CD4 > 200 > 3months
64
Toxoplasma chronic maintenance
Sulfadiazine + pyrimethamine + leucovorin until CD4 > 200 > 6 months
65
Cryptococcal Meningitis Treatment
CD4 < 150 Ampho B + 5-FC x at least 2 weeks Followed by fluconazole 400mg x weeks, then fluconazole 200mg QD for at least 1 year
66
Cryptococcal Meningitis Prophylaxis
Not recommended
67
Cryptococcal meningitis chronic suppression
Fluconazole 200mg QD until CD4 > 100 for at least 3 months
68
MAC treatment
Clarithromycin 500mg BID + EMB 15mg/kg/d (eye exam) Azithro 500-600mg QD + EMB 15mg/kg/d DDI or intolerance precludes the use of claritho 1 year of treatment and CD4 > 100 > 6 months
69
MAC primary prophylaxis
``` CD4 <50 Azithro 1200mg weekly Azithro 600mg twice weekly Clarithro 500mg BID Until CD4 > 100 > 3 months ```
70
CMV induction
Occurs at CD4 < 50
71
CMV retinitis
Sight threatening leasions Ganciclovir or foscarnet for 1-4 doses over 10 days PLUS Valganciclovir 90mg PO BID x 14-21 days then once daily
72
CMV retinitis for small peripheral lesions
Ganciclovir x 2142 days or until resolution of symptoms | PO valganciclovir if PO absorption adequate
73
CMV neurological disease
Ganciclovir IV PLUS Foscarnet IV until symptom improvement MD w/PO valganciclovir + IV foscarnet lifelong unless evidence of immune recovery
74
CMV suppression (secondary prophylaxis)
Valganciclovir 900mg QD until CD4 > 100 >3-6 months
75
Confirmation of TB
PPD, CXR, Sputum cx with AFB smear for 3 days
76
Latent TB
INH QD x 9 months (no DOT) | INH + Rifapentin once a week for 12 weeks (w/DOT)
77
Active TB
INH/EMB/RIF/PZA + pyridoxine x 8 weeks then INH + pyridoxine + RIF x 18 weeks Extrapulmonary/meningitis x 12 months
78
MDR-TB
Resistant to RIF and INH | do not use 12 week regimen
79
Otitis Media pathogens
Viral (most common) Strep pneumonia M. catarrhalis H. influenzae
80
Otitis media tx
Severe: Amox 875mg Q12 or 500mg Q8 x 10 days Mild-moderate: Amox 500mg Q12 or 250mg Q8 x 5-7 days PCN allergic: Azith/Clarithro/Bactrim
81
Pharyngitis pathogens
Viral | GABHS
82
Pharyngitis tx
``` PCN VK PCN G Amox Ceph PCN allergy: Azith/Clarith/Eryth ```
83
Recurrent Pharyngitis tx
Clinda Augmentin PCN G +/- RIF
84
Sinusitis organisms
``` Viral (7-10 days or less) Bacterial (> 10 days) Strep pneumoniae M. Catarrhalis H. influenziae ```
85
Acute sinusitis tx
``` Treat sx Analgesic/antipyretic Topical/systemic decongestants Saline and steam Topical nasal steroids ABX ```
86
Acute Sinusitis ABX
``` Amox Cefpodoxime Cefuroxime Cefdinir Beta lactam allergy: Bactrim SS, Doxy, Clarithro, Azithro, Erythro ```
87
Recurrent sinusitis tx
Augmentin Ceftriaxone Levo/Moxi Beta-lactam allergy: levo/moxi, clinda
88
Acute bronchitis pathogens
Viral Mycoplasma pneumoniae Chlamydia pneumoniae Bordatella pertussis
89
Acute bronchitis symptoms
``` Cough (hallmark) Ronchi Bilateral rales Fever HA Malaise ```
90
Acute bronchitis treatment
Supportive APAP, ibuprofen, DTM, codeine, nasal decongestants ABX - for pts w/persistent fever or respiratory sx longer than 4-6 days Macrolides/FQs
91
Chronic Bronchitis Tx
STOP SMOKING Long-acting beta2 agonists Long-acting anticholinergics Inhaled corticosteroids
92
Chronic bronchitis exacerbation
``` Mild-moderate: Amox Doxy Bactrim 2nd/3rd generation ceph Severe: Augmentin Azith/Clarith 2/3rd gen ceph Levo/moxi ```
93
Outpatient CAP
Healthy + no abx w/in 3 months: Macrolides/doxy Comorbidities, immunocompromised, or abx w/in 3 months: Respiratory FQs Beta-lactams (high dose amoxil or augmentin) PLUS a macrolide
94
Inpatient CAP (non-ICU)
Respiratory FQs | Beta-lactams (cefotaxime/ceftriaxone/ampsulb/eratapenem) + Macrolide
95
Inpatient CAP (ICU)
Levo/Moxi | Beta-lactams (cefotaxime/ceftriaxone/ampsulb) + Azithro or Moxi/Levo
96
HAP risk factors for MDR
``` Hospitalizations 2 days or more within 90 days Residency in LTC or nursing home Home infusion therapues Chronic dialysis q/in 30 days Home wound care Family member with MDR pathogen ```
97
HAP treatment: No risk and no factors increasing MRSA
Pip/tazo Cefepime Levo Imipenem/Meropenem
98
HAP treatment: No risk but with factors increasing MRSA
``` Pip/tazo Cefepime/Ceftazidime Levo/Cipro Imipenem/Meropenem Aztreonam PLUS Vanc/linezolid ```
99
HAP treatment: High risk or recipeint of IV ABX during the prior 90 days
``` Pick 2 Pip/tazo Cefepime/Ceftazidime Levo/Cipro Imipenem/Meropenem Aztreonam AGs PLUS Vanc/linezolid ```
100
Meningitis age and organisms
< 1 month = S. agalactiae, E. coli, monocytogenes, klebsiella spp. 1-23 months = S. pneumo, H. flu, E. coli, N. meningitidis, S. agalactiae 2yr-50 years = N. meningitidis, S. pneumo > 50yr = S. pneumonia, N, meningitidis, L. monocytogenes, aerobic gram- bacilli
101
Meningitidis tx with age
< 1 month = Amp + cefotaxime OR AMP + AG 1-23 months = Vanc + cefotaxime (or ceftriaxone) 2yr-50yr = Vanc + cefotaxime (or ceftriaxone) > 50yr = can + cefotaxime (or ceftriaxone) + amp
102
Meningitidis tx duration based on organism
``` N. meningitidis 7d H. flu 7d S. pneumo 7-14 days S. agalactiae 14-21 days Gram - anaerobes 21d Listeria > 21d ```
103
Endocarditis Streptococcal: | Native MIC < 0.12
PCN G / Ceftriaxone x 4 weeks
104
Endocarditis Streptococcal: | Native MIC 0.12-0.5
PCN G / Ceftriaxone x 4 weeks + gent x 2 weeks | Vanc x 4 weeks
105
Endocarditis Streptococcal: | Native MIC > 0.5
Vanc + Gent x 6 weeks
106
Endocarditis Streptococcal: | Prosthetic MIC < 0.1
PCN G / Ceftriaxone x 6 weeks +/- gent x 2 weeks
107
Endocarditis Streptococcal: | Prosthetic MIC > 0.12
PCNG x 6 weeks + gent 6 weeks | Vanc x 6 weeks
108
Endocarditis Staphylococcal: | Native MSSA
Nafcillin/oxacillin x 6 weeks
109
Endocarditis Staphylococcal: | Native MRSA
Vancomycin x 6 weeks
110
Endocarditis Staphylococcal: | Prosthetic MSSA
Nafcillin/oxacillin + rifampin > 6 weeks + gent x 2 weeks
111
Endocarditis Staphylococcal: | Prosthetic MRSA
Vanc + rifampins > 6 weeks + gent x 2 weeks
112
Endocarditis Enterococcal: | PCN/GENT/Vanc susceptible
Amp + Gent x 4-6 weeks | Vanc + Gent x 6 weeks
113
Endocarditis Enterococcal: | PCN susceptible but gent resistant
Amp + ceftriaxone x 6 weeks
114
Endocarditis Enterococcal: | PCN resistant, but susceptible to vanc and AGs
Vanc + gent x 6 weeks
115
Endocarditis Enterococcal: | PCN/GENT/Vanc resistant
Linezolid/dapt > 6 weeks
116
Endocarditis (HACEK) tx
Ceftriaxone or Amp/sulb Native = 4 weeks Prosthetic = 8 weks
117
Endocarditis Dental prophylaxis
Amoxil 2g PO 30-60 min prior appt

Infectious Disease (19 decks)

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