Flashcards in Infectious Disease Deck (97):
IV treatment for MSSA
Oxacillin, nafcillin, cefazolin
Oral treatment for MSSA
Severe MRSA infection tx
Vancomycin, Linezolid, Daptomycin, Tigecycline, Ceftaroline, Telavancin
Major SE of LInezolid
Major SE of daptomycin
Myopathy and rising CK
Minor MRSA infection tx
TMP/SMX, clindamycin, doxycyline
In patients with an anaphylactic penicillin allergy what antibxs can you use?
Macrolides (e.g. azithromycin, clarithromycin)
In patients with severe infection and a penicillin allergy what alternate antibiotics can be used?
Vancomycin, daptomycin, linezolid, telavancin
In patients with mild infection and penicillin allergy what alternate antibiotics can be used?
Macrolides (e.g. azithromcyin, clindamycin)
Which penicillin medications are specific for Streptococcus?
Amoxicillin, Ampicillin, Penicillin
What are options from each of the below classes for the treatment of gram negative bacilli?
Cephalosporins: cefepime, ceftazidime
Penicillins: piperacillin, ticarcillin
Quinolones: cipro, levo, moxi, gemifloxa
Aminoglycosides: gentamicin, tobramycin amikacin
Carbapenems: imipenem, meropenem, ertapenem, doripenem
In addition to gram negative bacilli what else do piperacillin and ticaricillin cover?
What is the only carbapenem which doesn't cover Pseudomonas?
What class of antibiotics generally offers great pneumococcal coverage?
Best med for gastrointestinal anaerobes
What are the only cephalosporins which cover anaerobes?
Major SE of imipenem
What is the best drug for anaerobic strep?
Tx options for CMV
Valganciclovir, ganciclovir, foscarnet
Major SE of valganciclovir and ganciclovir
Major SE of foscarnet
Agents for chronic HCV
Simeprevir, boceprevir, sofosbuvir, ledipasvir
Major SE of ribavirin
Treatment options for HBV
Lamividuine, interferon, adefovir, tenofovir, entecavir, telbivudine
What pathogens is fluconazole effective against?
Candida (most of them)
What is the best agent for Aspergillus?
What is its major SE?
What -conazole also covers mucormycosis or Mucorales?
What are examples of echinocandins?
Caspofungin, micafungin anidulafungin
In patients with neutropenic fever requiring antifungal coverage what class is a great option?
Because of toxicity there are fewer true uses for amphotericin even though it has great coverage. What are its remaining uses?
What are the adverse effects of amphotericin?
Fever, shakes, chills
In a patient with mucormycosis (who needs amphotericin) but has renal toxicity due to it what is an option moving forward?
What is the best initial test for osteomyelitis?
(Even though an MRI would be better you should get an X-ray first)
What is the earliest finding of osteomyelitis on Xray?
What can you use as a gauge to know how long to treat osteomyelitis?
*Many patients will become afebrile and have normal WBC so this is useful to use
Can you use oral antibiotics for Staph osteomyelitis?
What form can you use oral antibiotics for?
Can only use oral for Salmonella or Pseudomonas but even then these pathogens need to be bone biopsy/culture confirmed
For otitis externa what topical antibx are used?
What is used to decrease swelling and itching?
What is used to reacidify the ear?
Topicals: oxfloxacin, ciprofloxacin, polymyxin/neomycin
Decreased swelling/itching: topical hydrocortisone
Reacidify: acetic acid and water solution
How is malignant otitis externa treated?
Treat this like osteomyelitis of the skull
Surgical debridement and anti-Pseudomonal antibiotics
Best initial test in sinusitis?
Most accurate test?
Accurate: Sinus aspirate for culture
There is a live attenuated influenza vaccine and an injected inactivated virus. In what situations should both be used?
50 or with COPD, CHF, dialysis, steroid use, or health care workers should get inactivated virus
Treatment of impetigo
Mild/Mod: Topical mupirocin or retapamulin
Severe: Oral dicloxacillin or cephalexin
Best initial treatment of erysipelas
What if the organism is confirmed as group A beta hemolytic Strep?
Initial: oral dicloxacillin or cephalexin
If confirmed GAS: penicillin VK
Treatment of cellulitis (or folliculitis, furuncle, carbuncle, boil)
Mild: dicloxacillin or cephalexin orally
Severe: oxacillin, nafcillin, cefazolin IV
What is the best initial test of fungal infections in skin or nails?
What topical antifungals are used for fungal infections which don't involve the hair or nails?
Clotrimazole and many other -azoles
What oral antifungals are used for treatment of tinea capitis or onychomycosis?
Griseofulvin (more so for tinea capitis)
In patients with urethritis what two meds should you give?
Azithromycin or doxycycline
In patients with recurrent Gonorrhea infections what should they be tested for?
Terminal complement deficiency
What diagnostic tests should be done for urethritis?
Urethral swab and culture
Nucleic acid amplification tests
What is treatment for PID (outpatient and inpatient)?
OP: IM ceftriaxone and oral doxy
IP: IV cefoxitin and doxy
What is treatment of PIID in pregnant women?
Clindamycin and gentamicin
How does epididymo-orchitis differ from testicular torsion?
What is appropriate treatment (hint it depends on age)?
Both have exquisitely painful testicles but epididymo-orchitis has a normal testicular position
Haemophilus ducreyi causes _____. This ulcer is (painful/painless)
Treatment of chancroid
Single shot IM ceftriaxone or singe dose azithromycin
How does lymphogranuloma venerum present?
An ulcer with large tender nodes near it (often called "buboes" which may also have a draining sinus tract
What is the cause of lymphgranuloma venerum?
What is treatment of lymphgranuloma venerum?
Aspirate the buboes and treat with doxycycline or azithromycin
What is the most accurate test for syphilis?
What is treatment for primary syphilis?
What is the Jarisch-Herxheimer reaction?
What is it's treatment?
Fever, myalgia, headache which may begin after starting to treat primary symphilis
Self-limiting, can provide aspirin
What are the initial tests of choice in secondary syphilis?
RPR and FTA
What is treatment of tertiary syphilis?
IV penicillin (as opposed to IM penicillin for primary and secondary)
What is the best initial test for primary syphilis?
Then consider VDRL/RPR
How does granuloma inguinale present?
What causes it and what may be seen on diagnostics?
What is tx?
Red, beefy genital lesion that ulcerates
Klebsiella granulomatis; may see "Donovan bodies" on touch prep
Doxycycline, TMP/SMX, or azithromcyin
What is the difference in presentation of crabs (pediculosis) and scabies?
Crabs is larger and may be in hair-bearing areas like pubis and axilla
Scabies burrows in web spaces
How are all warts treated?
What is treatment for uncomplicated cystitis?
What if there is evidence of E. coli resistance?
Nitrofurantoin or fosfomycin orally
If E. coli resistance evident then ciprofloxacin or levofloxacin
How is complicated cystitis treated?
TMP/SMX or ciprofloxacin
What is OP treatment for pyelonephritis?
IP: Ceftriaxone, ertapenem, quinolones, ampicillin, or gentamicin
Patient with pyelonephritis fails to improve after 7 days. What do you suspect?
How should you treat?
Quinolone and add staphylococcal coverage
What is the most accurate test for prostatitis?
WBC in urine after prostate massage
Ciprofloxacin or TMP/SMX
If a patient is culture-negative for suspected infective endocarditis does that necessarily mean there aren't any bacteria causing it?
No; HACEK organisms commonly appear as culture negative
What are HACEK?
What are the most common organisms causing culture-negative infective endocarditis?
Coxiella and Bartonella
*It's actually not the HACEK organisms
What is the most common bacteria associated with colonic pathology-related infective endocarditis?
*It's actually not Strep bovis
What is best empiric therapy for infective endocarditis?
Vancomycin and gentamicin
What are the only types of procedures which need endocarditis prophylaxis? What is given as ppx?
Dental procedures which cause bleeding
Respiratory tract surgery
Surgery of infected skin
What are the only cardiac defects which require endocarditis prophylaxis?
Unrepaired cyanotic heart disease
Transplant recipients developing valve disease
In surgical procedures of infected skin what agent should be given for endocarditis ppx?
Is HIV therapy ever optional?
Yes actually, if CD4 count above 500
Adverse effect of nucleoside reverse transcriptase inhibitors (-dines/bines)
Adverse effect of Ziduvidine
Adverse effect of Didanosine
Adverse effect of Stavudine
Adverse effect of Abacavir
Adverse effect of Tenofovir
What are adverse effects of protease inhibitor class of HIV meds?
Adverse effect of Indinavir
Crystal-induced nephropathy (kidney stones)
What are adverse effects of non-nucleoside reverse transcriptase inhibitors?
Drowsiness (specifically efavirenz)
Blocks CCR5 receptor and inhibits entry of HIV into cells
What is tx of a needle-stick injury in an employee working with an HIV-positive patient?
HAART therapy for one month
What are HIV patients at risk for with CD4
Pneumocystis jiroveci (PCP PNA)
TMP/SMX is first-line
(If allergy then atovaquone or dapsone)
(Aerosolized pentamidine has poor efficacy)
In HIV patients with CD4 count
In HIV patients with PCP PNA which is severe (PaO2 35) what else should be given?
HIV pt presents with HA/N/V and ring-enhancing lesions on CTH. Dx? Tx?
Pyrimethanmine and sulfadiazine
HIV pt with CD4
Tx: ganciclovir or foscarnet; maintenance lifelong therapy with oral valganciclovir
HIV pt with CD4
Cryptococcal meningitis (Dx with India Ink stain and/or Cryptococcal antigen)
Tx: amphotericin and 5-FU followed by fluconazole