Flashcards in Treatment of CNS and Respiratory Infections Deck (32):
What antibiotics typically don't reach sufficient levels in the CSF?
the 30S inhibitors -> tetracyclines / aminoglycosides, + polymyxins
What is the empiric coverage we use for meningitis in patients <1 month?
Ampicillin + gentamicin or cefotaxime (3rd generation not ceftriaxone)
Gentamicin is okay because patient has no BBB
What is the empiric coverage for meningitis in patients 1-23 months of age and why?
Vancomycin + 3rd generation cephalosporin
Use vancomycin for possibility of mildly elevated MICs of Streptococcus pneumoniae which would not allow killing by cephalosporin in CSF
What is the only difference between treating adults under 50 and children for CNS infection?
Adults get Dexamethasone prior to first antibiotic dose
What is the purpose of giving dexamethasone?
It is a steroid to decrease inflammation in subarachnoid space and thus decrease neurological sequelae
What must be added onto the antibiotic regimen for adults >50 and why?
ampicillin, for listeria coverage
So regimen is:
ampicillin + vancomycin + ceftriaxone
What can be used against Listeria if patient is allergic to ampicillin?
Who gets prophylaxis for meningitis caused by N. meningitis and H. influenzae and what is it?
N. meningitis - anyone exposed to oral secretions and household contacts - Ciprofloxacin 500 mg or rifampin
H. influenzae - everyone in a household with unvaccinated children (might spread to them) - Rifampin
What is the most common causative pathogen in CSF shunt infections, and what is the recommended empiric treatment?
Usually coag-negative staph (from skin)
Recommended broad therapy: Vancomycin + cefepime or ceftazidime
What is the basic treatment for all fungal CNS infections minus Coccidio?
Lipid Amphotericin B + flucytosine for all
Blasto and Histo longer therapy, and longer oral therapy
Recommend switching to oral azole therapy after a few weeks
What is the recommended therapy for only Coccidio CNS infection?
High dose fluconazole
Typically acute bronchitis is not treated. What are the exceptions? What is used to treat?
Mycoplasmal, chlamydial, or B. pertussis
All use Macrolides with second line doxycycline
During a COPD exacerbation, who gets antibiotics?
Only those with increased sputum purulence
What are the most common bugs for COPD exacerbation?
S. pneumoniae, H. influenzae, M. catarrhalis (typical pathogens)
With some Chlamydia or mycoplasma
What is the first-line treatment for COPD exacerbation?
Doxycycline, with second-line amoxicillin/clavulanic acid
Who gets IV therapy for COPD exacerbations and what is it?
Those at high risk for poor outcome -> frequent exacerbations, comorbidities, and Abx use
It is ampicillin/sulbactum (basically IV augmentin)
How long are COPD exacerbations treated?
What are the only times you treat for sinusitis, since it is usually viral?
When signs / symptoms are persistent >10 days, with no improvement, or the symptoms are severe with purulent discharge / facial pain at least 3-4 days
What is the therapy for sinusitis?
Same as outpatient COPD: amox/clav or Doxycycline
What are "the big 6" of Community-Acquired pneumonia?
1. Streptococcus pneumoniae
2. Hemophilus influenzae
3. Moraxella cattarhalis
4. Mycoplasma pneumoniae
5. Chlamydia pneumoniae
6. Legionella pneumophilia
What is given to healthy CA-pneumonia and high risk CA-pneumonia in outpatient therapy?
Previously healthy: azithromycin or doxycycline
High risk: beta-lactam + azithromycin or doxycycline
For inpatient non-ICU CAP, what is the treatment?
Azithromycin or doxy + 3rd generation ceph, or respiratory fluoroquinolone
For inpatient ICU CAP, what is the treatment?
Same drugs, but IV is necessary. Can add Vancomycin if concern for MRSA
What is the treatment of choice for outpatient aspiration pneumonia?
Amoxicillin/clavulanic acid (good gram negative / anaerobe coverage)
What is the treatment of choice for inpatient aspiration pneumonia?
Ampicillin / sulbactam (IV version of augmentin)
What dictates the duration of therapy for community-acquired pneumonia?
Minimum of 5 days, must be afebrile for 48-72 hours, and no more than one "sign of instability"
1. Fever, leukocytosis, tachycardia, tachypnea
What is the empiric therapy for HAP/HCAP/VAP?
1. Antipseudomonal beta-lactam
2. Antipseudomonal FQ or aminoglycoside
3. MRSA coverage: Vancomycin or linezolid
What organism throws a wrench in your HAP/HCAP/VAP plans?
Acinetobacter baumanii -> resistant to many drugs
Typically you need tigecycline or polymyxins since it is gram negative
What is the duration of therapy recommended for HAP bugs?
7 days, assuming initial response to drugs and no pseudomonas
What should be done if the HAP is not MRSA? What should be done with pseudomonas?
Immediately discontinue vancomycin
Also de-escalate the anti-pseudomonal drugs to narrowest one possible
How should you treat Stenotrophomonas maltophilia pneumonia?
TMP/SMX is the drug of choice