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NAPLEX review 2024 RXPrep Book > Infectious Diseases II: Bacterial Infections > Flashcards

Infectious Diseases II: Bacterial Infections Flashcards

1
Q

Preferred ABX for surgery prophylaxis

A

Cefazolin - start 1hr before incision, used to prevent MSSA and strep infections

Clindamycin/Vanc used if beta-lactam allergy

Vanc preferred if MRSA colonization or risk present

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2
Q

ABX prophylaxis for GI surgery

A

gram - + anaerobe coverage

Cefazolin + metro/cefoteta/cefoxitin or amp/sulbactam

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3
Q

Classic meningitis symptoms

A

Stiff neck
Fever/Headache
altered mental status

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4
Q

How to Dx meningitis?

A

Lumbar puncture for CSF sample

high CSF pressure could also be a sign of infection

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5
Q

common bacterial causes of meningitis

A

Neisseria meningitides
streptococcus pneumoniae
Haemophilus influenzae

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6
Q

Risk of meningitis due to L.monocytogenes is higher in…

A

neonates
> 50 yrs old
immunocompromised patients

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7
Q

Meningitis treatments

A

abx course depends on bug, ranging from 7-21 days

dexamethasone given empirically before d/c or keep of s.penumo

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8
Q

Empiric Meningitis txm

A

< 1 month = Ampicillin + Cefotaxime/Gent
1 month - 50 yrs old = Ceftriaxone/Cefotaxime + Vanc
> 50 yrs old = Ampicillin + Ceftriaxone/Cefotaxime + Vanc

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9
Q

Acute otitis Media info

A

most infections are viral
observe for 48-72 hrs before starting abx

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10
Q

AOM 1st line TXM

A

High dose Amoxicillin or Amox/Clav

use formulation with least amount of Clav to decrease diarrhea risk (14:1 ratio)

Duration 10 days for < 2 yrs old, 7 days 2-5, 5-7 days 6yrs <

** 2nd/3rd gen ceps if non severe allergy to pen **

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11
Q

Pertussis treatment…

A

highly contagious

should use macrolides

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12
Q

COPD exacerbation defined as….

A

increase in symptoms that worsen in < 14 days

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13
Q

3 cardinal symptoms of COPD exacerbation

A

increased dyspnea
increased sputum volume
increased sputum purulence

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14
Q

who meets criteria for abx for COPD exacerbation

A

abx for 5-7 days if….

  1. meets all 3 symptoms
  2. inc sputum purulence + 1 additional symptoms
  3. mechanically ventilated

preferred abx: amox/clav, azith, doxy, resp quinolone

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15
Q

CAP gold standard for diagnosis

A

Chest x-ray

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16
Q

Usual duration for CAP treatment?

A

5-7 days of abx

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17
Q

CAP txm for healthy, no comorbidities

A

amox 1g TID
Doxy
Macrolide (azith/clarith)

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18
Q

CAP txm for high risk, comorbidities (DM, AUD, cancer, heart/lung/liver/renal disease)

A

amox/clav or cephalosporin + macrolide/ doxy

moxi/levo monotherapy

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19
Q

inpatient CAP txm

A

non-severe = Blactam (ceftriaxone/unasyn) + macrolide or doxy, resp quinolone therapy

severe = blactam + macrolide or resp quinolone

MRSA risk = add vanc/linezolid
Pseudomonas = Pip/tazo/cefepime/meropenem

if hospitalized last 90 days or used IV abx, treat as MRSA & pseudomonas risk

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20
Q

Hospital acquired pneumonias starts with….

A

> 48hrs after hospital admission

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21
Q

Ventilator associated pneumonias starts with….

A

> 48yrs after start of mechanical ventilation

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22
Q

HAP/VAP regimene

A

All req MSSA/Pseudomonas ABX = Cefepime, Zosyn, levo

Add Vanco/Linezolid if MRSA risk

Use two anti-pseudomonas if MDR risk, dont use 2 Blactam (Zosyn, Cefepime, meropenem) levo/cipro, aztreonam, AminoGlyc (usually tobra)

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23
Q

Who can get a false positive with TST test?

A

those who got Calmette-Guerin (BCG) vaccine

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24
Q

Latent TB treatment regimens

A
  1. Isoniazid + refapentine QW for 12 week = not used in preg
  2. INH + rifampin QD for 3 months
  3. Rifampin 600mg QD for 4 months
  4. INH 300mg QD for 6-9 months = pref HIV pt due to reduce DI
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25
Q

Active TB treatment 2 phases

A

intensive = RIPE (rifampin, isoniazid,pyrazinamide,ethambutol) 2 months
continuation = rifampin + isoniazid = 4 months, extend if needed

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26
Q

Rifampin SE

A

inc LFTs, hemolytic anemia, orange colored secretions (can stain skin-contact stuff), many drug-drug interactions, can replace with rifabutin if needed

27
Q

Isoniazid Boxed warning

A

Severe and fetal hepatitis

28
Q

Isoniazid CI

A

active liver disease, previous severe adverse reaction to isoniazid

29
Q

Isoniazid warnings & SE

A

warning: peripheral neuropathy, vit B6 supplementation recommended

SE: inc LFTs, DILE, hemolytic anemia

30
Q

Pyrazinamide CI & SE

A

CI: acute gout, severe hepatic damage

SE: increased LFTs, gout, GI upset

31
Q

Ethambutol CI & SE

A

CI: optic neuritis, dont use young patients, anyone who cant discern and report visual changes

SE: inc LFTs, dose related optic neuritis, confusion, hallucinations

32
Q

Common Rifampin DI

A

warfarin, dec INR by a lot so inc dose
oral contraceptives, dec efficacy

dont use with apixaban/rivaroxaban/edoxaban/dabigatran

33
Q

Infective Endocarditis info

A

Empiric txm = vanc + ceftriaxone, Gentamicin added for synergy
generally 4-6 wk txm IV abx

34
Q

IE prophylaxis dental regimen

A

1 dose 30-60min before procedure

Amox 2g
Doxy 100mg or Azith/Clarith 500mg if cant do amox

35
Q

Spontaneous Bacterial peritonitis (SBP) info

A

often occurs in patients with cirrhosis and ascites

fluid > 250 cells PMNs

36
Q

SBP empiric treatment

A

Ceftriaxone 5-7 days

SMX/TMP or quinolone for secondary prophylaxis after getting SBP

37
Q

Intra-abdominal infections txm duration….

A

4-5 days after source control

38
Q

Txm for Intra-abdominal infection, community acquired (low risk)

A

Ertapenem
Moxiflox
Cipro/Levo + metro
Cephalosporin + metro

39
Q

Txm for intra-abdominal infection, risk for resistant or nosocomial pathogens

A

Carbapenem (no ertapenem)
pip/tazo
Cefepime/ceftazidime + metro

40
Q

Impetigo info & txm

A

honey-colored crusts around nose/mouth/hands/arms

use mupirocin topical or cephalexin/dicloxacillin QID

41
Q

folliculitis txm

A

SMX/TMP DS 1-2 tabs BID or Doxy 100 BID

42
Q

Cellulitis txm

A

Cephalexin 500mg QID, Dicloxacillin 500mg QID, Glinda 300mg QID if allergic to B-lactam

txm duration = 5 days, longer if needed

43
Q

Abscess, purulent infection txm

A

SMX/TMP 1-2 BID
Doxy 100mg BID
Minocycline 200mg X 1, 100mg BID
Clinda 300mg QID
** Cephalexin if MSSA**

44
Q

Severe purulent SSTI txm

A

7-14 day txm duration

Vanco
Daptomycin
Linezolid

PO abx once stable

45
Q

Necrotizing fasciitis txm

A

vanc or daptomycin + zosyn/meropenem + clinda

46
Q

When is urinalysis considered positive?

A

WBC> 10 (pyuria)
bacteria
positive leukocyte esterase
nitrates

47
Q

Pyelonephritis (Upper UTI) vs cystitis (Lower UTI)

A

Pyelo = flank pain, fever/chills/nausea, ab pain

cystitis = burn/pain when peeing, inc in frequency, blood in urine

48
Q

Acute uncomplicated cystitis txm

A

Macrobid 100mg BID X 5 days (dont use CrCl < 60)
SMX/TMP DS 1 tab BID X 3 days
Fosfomycin 3g X 1 dose

49
Q

Options for pregnant women uncomplicated cystitis

A

Amox
Cephalexin

tx for 7 days

50
Q

acute pyelonephritis txm

A

Cipro 500mg BID X 5-7 days
Levo 750mg QD X 5-7 days

very ill hospitalized pt = IV ceftriaxone/cirpo/levo or carbapenem if think ESBL

51
Q

Urinary analgesic

A

phenazopyridine

can make urine red/orange

200mg TID for 2 days max

52
Q

Bacteriuria and pregnancy info

A

should be treated, even if asymptomatic

amox/clav or oral ceph preferred

avoid quinolones
Nitro or SMX/TMP can be used

53
Q

C.diff symptoms

A

3 or more watery stools in 1 day
abdominal cramps
fever
elevated WBC

54
Q

C.diff treatment

A

vancomycin or fidaxomicin preferred

bezlotoxumab reduces incidence of recurrence but doesn’t treat, has to be given with abx txm

55
Q

Syphillis txm

A

primary, secondary or early latent: Pen G 2.4mil unit X 1, Doxy 100mg BID X 14 days if allergy

late latent or tertiary: Pen G 2.4mil unit QW X 3 W, Doxy 100mg BID X 28 days if allergy

56
Q

Neurosyphillis txm

A

Pen G 3-4mil unit IV Q4H X 10-14 days, if allergy, then desensitization prior

57
Q

Gonorrhea txm

A

Ceftriaxone:
< 150kg = 500mg X 1
> 150kg = 1g X 1
add doxy if chlamydia not excluded

Cefixime 800mg if ceftriaxone no avail

58
Q

Chlamydia txm

A

nonpreg = doxy 100mg BID X 7 days
Preg = azith 1g X 1 dose

Erythromycin 500mg QID X 7 days, Levo 500mg QD X 7 days if allergy
preg + allergy = amox 500mg TID X 7 days

59
Q

Bacterial vaginosis treatment

A

Metronidazole 500mg BID X 7 days or metro gel X 5 days or Glinda 2% cream X 7 days

** Dont douche **

60
Q

Trichomoniasis txm

A

metronidazole, females 500mg BID X 7 days, males 2g X 1 dose

can still use in preg for trich

61
Q

Geneital wort txm

A

imiquimod cream, apply 3X per week until cleared or 16 weeks

62
Q

Go to drug for tick borne diseases?

A

Doxy 100mg BID from 5-14 day depending on what it is

63
Q
A

NAPLEX review 2024 RXPrep Book (71 decks)

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