Infectious Disease Treatment

Question 1

CAP in pts <60 yrs?

Answer 1

1) Azithromycin or clarithromycin, doxycycline

2) Fluoroquinolones (2nd line)

Question 2

CAP in pts >60 yrs, with comorbidities?

Answer 2

1) Levofloxacin or moxifloxacin
2) 2nd or 3rd gen cephalosporin
All are first line agents

Question 3

Hospital acquired pneumonia?

Answer 3

Any of the following:

• Ceftazidime or cefepime
• Imipenem
• Piperacillin + tazobactam
• do NOT use macrolides (only in CAP)

Question 4

Lung abscess?

Answer 4

• Gram positive = ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, vanc for staph
• Anaerobes = clinda or metronidazole
• Gram negatives = quinolones or ceftazidime

Question 5

PPD positive without active dz?

Answer 5

9 mo INH

Question 6

Active TB?

Answer 6

4 drug regimen for 2 mo, then 4 mo of INH and rifampin

Question 7

Meningitis in infants <1 mo?

Answer 7

Ampicillin + gentamicin OR cefotaxime

Question 8

Meningitis in 3 mo - 50 yrs?

Answer 8

Vancomycin + ceftriaxone

Question 9

Meningitis in >50 yrs?

Answer 9

Vancomycin + ampicillin + ceftriaxone

Question 10

Meningitis in HIV?

Answer 10

Vancomycin + ampicillin + ceftazidime

Question 11

Viral encephalitis?

Answer 11

Support
HSV = acyclovir
CMV = ganciclovir or foscarnet

Question 12

Hep A and E?

Answer 12

Supportive

Question 13

HBV?

Answer 13

INF-a, tenofivir

Question 14

HCV?

Answer 14

IFN-a and ribavirin

Question 15

Botulism?

Answer 15

Support resp status, antitoxin (toxoid) ASAP

Question 16

Uncomplicated acute cystitis?

Answer 16

1) Oral TMP/SMX or nitrofurantoin first line

2) Fosfomycin or cipro

Question 17

Complicated acute cystitis?

Answer 17

Ampicillin, amoxicillin, or oral cephalosporins (avoid quinolones for fetal arthropathy)

Question 18

Uncomplicated pyelonephritis?

Answer 18

1) Gram negatives = TMP/SMX or fluoroquinolones
2) Gram positives = amoxicillin
A single dose of ceftriaxone or gentamicin is given intitially before starting oral tx

Question 19

Complicated pyelonephritis?

Answer 19

IV ampicillin + gentamicin or cipro

Question 20

Acute prostatitis?

Answer 20

TMP/SMX or fluoroquinolone and doxycycline

Question 21

Chronic prostatitis?

Answer 21

Fluoroquinolone

Question 22

Chlamydia?

Answer 22

1) Azithromycin (single oral dose)

2) Doxycycline (oral for 7 days)

Question 23

Gonorrhea?

Answer 23

1) Ceftriaxone (single IM dose)

2) Give azithromycin (one dose) or doxycycline (7 days) for coexistent chlamydia

Question 24

PCP?

Answer 24

TMP/SMX + prednisone

Question 25

PPD positive in HIV pt?

Answer 25

INH + pyridoxine (B6)

Question 26

MAC prophylaxis?

Answer 26

Clarithromycin + azithromycin (start at CD4 count <100)

Question 27

Toxoplasma prophylaxis?

Answer 27

TMP/SMX (start at CD4 count <100)

Question 28

Vaccinations in HIV?

Answer 28

REMEMBER--no live vaccines except MMR and VZV if CD4 >200 1) Pneumococcal every 5-6 yrs 2) Influenza 3) HBV

Question 29

Syphilis in pt allergic to penicillin?

Answer 29

Doxycyline, tetracycline

Question 30

Chancroid?

Answer 30

Azithromycin, ceftriaxone, or cipro

Question 31

Lymphogranuloma venereum?

Answer 31

Doxycycline

Question 32

Pubic lice?

Answer 32

Permethrin 1% shampoo

Question 33

Cellulitis?

Answer 33

Nafcillin, oxacillin or cefazolin

Question 34

Erysipelas?

Answer 34

Penicillin or erythromycin

Question 35

Necrotizing fasciitis?

Answer 35

Surgical debridement + broad spectrum antibx

Question 36

Lymphadenitis?

Answer 36

Penicllin, antistaph antibx, or cephalosporin + warm compresses

Question 37

Tetanus?

Answer 37

Resp support + passive immunization with single IM dose of TIG + active immunization with Td

Question 38

Osteomyelitis?

Answer 38

Antistaph antibx or cefazolin + possible surgical debridement

Question 39

Acute infectious arthritis?

Answer 39

Antistaph or anti-gonorrhea antibx + daily aspiration if effusion persists

Question 40

Lyme dz?

Answer 40

1) Doxycycline for 21 days 2) Amoxacillin and cefuroxime for pregnancy and kids 3) Erythromycin for pregnant pts with penicillin allergies

Question 41

RMSF?

Answer 41

1) Doxycyline | 2) CNS manifestation or pregnancy = chloramphenicol

Question 42

Rabies?

Answer 42

Clean wound with soap + passive immunization with human rabies IG in wound and gluteal region + active immunization with antirabies vaccine in 3 IM doses

Question 43

Oral candidiasis?

Answer 43

1) Clotrimazole troches (dissolve in mouth) = oral | 2) Nystatin mouthwash = oral

Question 44

Esophageal candidiasis?

Answer 44

Oral ketoconazole or fluconazole

Question 45

Vaginal candidiasis?

Answer 45

Miconazole or clotrimazole cream

Question 46

Cutaneous candidiasis?

Answer 46

Oral nystatin powder

Question 47

Systemic candidiasis?

Answer 47

Amphotericin B or fluconazole, voriconazole and caspofungin

Question 48

Allergic bronchopulmonary aspergillosis?

Answer 48

Corticosteroids

Question 49

Invasive aspergillosis?

Answer 49

IV amphotericin B, voriconazole, or caspofungin

Question 50

Crpytococcus?

Answer 50

Amphotericin B + flucytosine, followed by oral fluconazole

Question 51

Meningitis in 1 mo - 3 mo?

Answer 51

Vancomycin + ampicillin + cefotaxime

Question 52

Standard tx for malaria?

Answer 52

Chloroquine phosphate

Question 53

If chloroquine resistant malaria?

Answer 53

Quinine sulfate + tetracycline

Question 54

For P. falciparum?

Answer 54

IV quinidine + doxycycline

Question 55

For relapses of P. vivax and P. ovale?

Answer 55

Primaquine phosphate

Question 56

Malaria prophylaxis in travelers?

Answer 56

Mefloquine

Question 57

Disseminated Lyme dz?

Answer 57

IV ceftriaxone

Question 58

Leptospirosis?

Answer 58

Tetracycline or doxycycline; IV penicillin G if severe

Question 59

Ehrlichiosis?

Answer 59

Tetracycline or doxycycline

Question 60

Tularemia?

Answer 60

Streptomycin or gentamicin

Question 61

Q fever (Coxiella)?

Answer 61

Acute: doxycycline or fluoroquinolone Chronic: rifampin

Question 62

Cat scratch dz?

Answer 62

Doxycycline or ciprofloxacin (but usually self limited)

Question 63

Babesiosis?

Answer 63

Atovaquone + azithromycin

Question 64

Nocardia?

Answer 64

TMP-SMX

Question 65

Actinomyces?

Answer 65

Penicillin