Infectious Diseases II: Bacterial Infections Flashcards
(38 cards)
What is the recommended perioperative antibiotic prophylaxis for
Cardiac/vascular or orthopedic surgical procedure
Common pathognes: MSSA & streptococci (skin flora)
Cefazolin
Beta-lactam allergy: clindamycin or vancomycin
Common pathognes: MSSA, streptococci
What is the recommended perioperative antibiotic prophylaxis for
Gastrointestinal surgical procedure
Common pathognes: skin flora, gram-negative and anaerobic organisms
Cefazolin + metronidazole
Alternatives: cefotetan, cefoxitin, or ampicillin/sulbactam
Common pathognes: skin flora, gram-negative and anaerobic organisms
What is the recommended antibiotic for
Meningitis
Common pathogens: S. pneumoniae, N. meningitidis, Listeria monocytogenes
Ceftriaxone or cefotaxime +/-
Ampicillin +/-
Vancomycin
- Use cefotaxime in neonates (ceftriaxone can caise biliary sludging and kernicterus in neonates)
- Ampicillin covers Listeria monocytogenes in neonates, age > 50 years and immunocompromised patients
- Vancomycin provides double coverage for S. pneumoniae in patients ≥ 1-month-old
What is the recommended antibiotic for
Acute otitis media
Common pathogens: S. pneumoniae, H. influenzae, Moraxella catarrhalis
Amoxiciilin
or
Amoxicillin/Clavulanate
90 mg amoxicillin/kg/day in 2 divided doses
What is the recommended antibiotic for
Pharyngitis
“strep throat”
Common pathogen: S. pyogenes
Penicillin or amoxicillin
What is the recommended antibiotic for
- Acute sinusitis
- Acute bacterial exacerbation of COPD
Common pathogens: S. pneumoniae, H. influenzae, Moraxella catarrhalis
Amoxicillin/Clavulanate
What is the recommended antibiotic for
Pertussis
“whooping cough”
Causative pathogen: Bordetella pertussis
Macrolides (azithromycin, clarithromycin)
What is the recommended antibiotic for
Outpatient CAP for “healthy” patients
Common pathogens: S. pneumoniae, H. influenzae, Mycoplasma pneumoniae
Healthy = no comorbidities
Comorbidities: chronic heart, lung, liver or renal disease, diabetes, alcohol use disorder, malignancy, or asplenia
Amoxicillin high-dose (1g TID)
or
Doxycycline
or
Macrolide (azithro, clarithro) if local pneumococcal resistant is < 25%
What is the recommended antibiotic for
Outpatient CAP for “high-risk” patients
Common pathogens: S. pneumoniae, H. influenzae, Mycoplasma pneumoniae
High risk = with comorbidities
Comorbidities: chronic heart, lung, liver or renal disease, diabetes, alcohol use disorder, malignancy, or asplenia
Beta-lactam plus macrolide or doxycycline
* Amoxicillin/clavulanate or cephalosporin (e.g., cefpodoxime, cefuroxime) plus
* Macrolide or doxycycline
or
Respiratory quinolone monotherapy (levofloxacin or moxifloxacin)
What is the recommended antibiotic for
Inpatient CAP for “non-severe” patients
Common pathogens: S. pneumoniae, H. influenzae, Mycoplasma pneumoniae
Non-severe = admission to a general medicine unit
Beta-lactam plus macrolide or doxycycline
* Preferred beta-lactams: ceftriaxone, cefotaxime, ceftaroline or ampicillin/sulbactam
or
Respiratory quinolone monotherapy (levofloxacin or moxifloxacin)
MRSA: add vancomycin or linezolid
Pseudomonas: use a beta-lactam with acitivity against Pseudomonas
Hospitalization and use of parenteral antibiotics in the past 90 days: use a regimen with antibiotics active against both MRSA and Pseudomonas
What is the recommended antibiotic for
Inpatient CAP for “severe” patients
Common pathogens: S. pneumoniae, H. influenzae
Severe = admission to the ICU
Beta-lactam + macrolide
or
Beta-lactam + respiratory quinolone monotherapy
Preferred beta-lactams: ceftriaxone, cefotaxime, ceftaroline or ampicillin/sulbactam
Do not use respiratory quinolone monotherapy
MRSA: add vancomycin or linezolid
Pseudomonas: use a beta-lactam with acitivity against Pseudomonas
Hospitalization and use of parenteral antibiotics in the past 90 days: use a regimen with antibiotics active against both MRSA and Pseudomonas
What is the recommended antibiotic for
HAP/VAP
Common pathogens: nosocomial pathogens
- All patients need an antibiotic for Pseudomonas and MSSA
- Add vancomycin or linezolid if risk for MRSA
- Use two antibiotics for Pseudomonas if risk for MDR gram-negative pathogens (do not use two beta-lactams together)
MDR gram-negative pathogens: Klebsiella spp., E. coli, Acinetobacter spp., Enterobacter spp.
Risk factors for MDR: IV antibiotic use in the past 90 days, prevelence of gram-negative resistance in hospital unit is > 10%, hospitalized ≥ 5 days prior to the onset of VAP
What is the recommended antibiotic for
Latent tuberculosis
Causative pathogen: Mycobacterium tuberculosis
- INH + rifapentine weekly for 12 weeks (do not use in pregnancy)
- INH + rifampin daily for 3 months
- Rifampin daily for 4 months
- Isoniazid daily for 6 or 9 months (preferred in HIV-positive patients)
What is the recommended antibiotic for
Active tuberculosis
Causative pathogen: Mycobacterium tuberculosis
Initial intensive phase (2 months) with RIPE:
Rifampin + Isoniazid + Pyrazinamide + Ethambutol
Continuation phase (≥ 4 months) with RI:
Rifampin + Isoniazid
All RIPE: ↑ LFTs, including total bilirubin
Rifampin: flu-like syndrome, orange bodily secretions, strong CYP3A4 inducer (can use rifabutin if unacceptable DDIs)
Isoniazid: peripheral neuropathy (give w/ pyridoxine/vitamin B6 25-50 mg daily), DILE
Rifampin and isoniazid: hemolytic anemia (identified w/ positive Coombs test)
Pyrazinamide: ↑ UA - do not use w/ acute gout
Ethambutol: visual damage (requires baseline and monthly vision exams), confusion/hallucinations
What are the common pathogens for
Infective endocarditis
Staphylococci, streptococci, enterococci
What is the recommended antibiotic for
Infective endocarditis
Beta-lactams
Beta-lactam allergy: vancomycin
Gentamicin is added to the antimicrobial regimen for synergy when the infection is more difficult to eradicate
Rifampin may be added in cases of staphylococcal prosthetic valve endocarditis
Who are at risk for
Infective endocarditis
Dental work needed, such as a root canal
+
Select cardiac conditions, including:
* Artifical (prosthetic) heart valve or heart valve rapaired with artifical material
* History of endocarditis
* Heart transplant with abnormal heart valve function
* Certain congenital heart defects including heart/heart valve disease
What is the recommended prophylaxis for
Infective Endocarditis
Amoxicillin 2 grams PO
Beta-lactam allergy: azithro or clarithro 500 mg, or doxycycline 100 mg
What is the recommended antibiotic for
Spontaneous Bacterial Peritonitis
Common pathogens: streptococci, proteus, E. coli, Klebsiella
Ceftriaxone x5-7 days
What are the secondary prophylaxis for
Spontaneous Bacterial Peritonitis
Common pathogens: streptococci, Proteus, E. coli, Klebsiella
Cipro or SMX/TMP
What are the common pathogens for
Skin and Soft-Tissue Infections (SSTIs)
Staphylococci and streptococci
What is the recommended antibiotic for
Impetigo
Common pathogens: S. pyogenes, S. aureus
Superficial infections
- Use warm, wet compresses to help remove dried crusts
- For limited, localized lesions: topical mupirocin
- For numerous, extensive lesions: cephalexin, dicloxacillin
What is the recommended antibiotic for
Folliculitis/Furuncle/Carbuncle
Common pathogens: S. aureus
Superficial infections
- Folliculitis and small furuncles may require only warm compresses to ↓ inflammation and help with drainage
- Incision & drainage (I&D) ± antibiotics is recommended for large furuncles and carbuncles
- Use antibiotics that cover MSSA and MRSA: SMX/TMP, doxycycline
What is the recommended antibiotic for
Cellulitis (non-purulent infections)
Common pathogens: Streptococci, S. aureus
Mild infections
Cephalexin
Beta-lactam allergy: clindamycin
