POGUE TREATMENT!! Flashcards
(33 cards)
How should AB be administered for bacterial meningits?
IV at MAX dosing due to difficult penetration
Bactericidal (b-lactams)
Empirical Therapy for bacterial meningitis <1 month?
Ampicillin + Gentamycin
Ampicillin + cefotaxime
What antibiotics should be avoided for CNS infections?
Tetracyclines, aminoglycosides, polymixins
Empirical Therapy for bacterial meningitis 1-23 months?
Vancomycin + 3rd gen celphalosporin
Why add vancomycin for empirical therapy?
due to variable penetration of BBB for 3rd gens. Vanco added for strep isolates with slightly higher MICs
Empirical Therapy for bacterial meningitis 2-50 years?
3rd generation ceph + vanco
+ steriods!!! Dexamethasone
Why give steroids for meningitis??
Decrease inflammation in subarachnoid space– decrease the neurological sequelae.
In what order should you give therapy for bacterial meningitis 2-50?
Steroids given first!! Decrease the bad outcomes from antibiotics lysing bacteria? Definitely does not do anything BAD. help or do nothing…
Empirical Therapy for bacterial meningitis >50?
Vancomycin + 3rd gen Ceph + Ampicillin
listeria is back!
What is the major prophylaxis given for meningitis? what bug?
Ciprofloxacin given to those exposed to Neisseria meningitidis!
What is the most frequent type of infection in CSF shunt patients?
Coag negative staph (skin bugs)
Wide range empirically: vancomycin + cefepime
remove the shunt if you can
interventricular therapy as adjunct
Therapy of choice for Cryptococcal meningitis
Lipid Amphotericin B + flucytosine x 2 weeks
then:
fluconazole x 8 wks
Therapy of choice for blastomycosis and histoplasmosis
lipid amphotericin B x 4-6 weeks THEN
oral AZOLE 12 months (“maintenance”)
Therapy of choice for coccidiomycosis
GUIDELINES say fluconazole
Pogue says ampho B…
Acute bronchitis
VAST MAJORITY ARE VIRAL!! AB will not work!!
Treatment for acute bronchitis from pertussis
1st line Macrolides - azithromycin
Who gets antibiotics for COPD exacerbation?
Increased dyspnea, increased sputum volume, increased sputum purulence
What are the common bugs in COPD exacerbation?
S. pneumo, H influ, M. cattarhalis, C pneumo, M. Pneumo
Treatment for mild-moderate COPD exacerbation
Oral: Amoxicillin, amox/clavulanic
Doxycyclin, TMP/SMX (pen allergy)
Macrolides, FQ
Treatment for AT RISK COPD exacerbation (comorbidities, severe COPD, frequent exacerbations, recent AB use)
IV Therapy: Amp/sulbactam, 2/3rd gen cephs, FQ
When should we treat sinusitis with antibiotics?
Persistence of signs/symptoms for >10 days with no evidence of clinical improvement
Severe symptoms (fever>39, purulent nasal discharge, facial pain >3-4 days)
What AB should we use for sinusitis? (if any)
amoxicillin/clavulanic acid
Doxycycline, FQ
What are the common CAP bacterial pathogens?
Big 6
S pneumo, H influenzae, M cattarhalis
Myc, legionella, chlamydia (atypic)
To what populations do you empirically treat for Staph aureus CAP?
Post Viral
cases of severe, nectrotizing CAP (straight to the ICU)
