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79 Cards in this Set
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Streptococcus pyogenes (Group A) strep throat, cellulitis, erysipelas, impetigo, scarlet fever, TSS, necrotizing fascilitis, acute rheumatic fever, glomerulonephritis, pneumonia
Streptococcus agalactiae (Group B) sepsis 60%/pneumonia 30%/meningitis 10% in newborn, diabetc foot infection |
penicillin (or other beta lactams) allergy: erythromycin (macrolide) or clindamycin increasingly resistant to macrolides |
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Enterococci - UTI, endocarditis |
Ampicillin or vancomycin can add Gentamicin (toxicity- renal tubule, oto) |
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Staph ayreus - cellulitis |
Dicloxacillin (stable to penicillinase) |
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MRSA |
Vancomycin (Red man syndrom if too fast) linezolid (toxicity- low platelets, neuropathy) daptomycin (binds lung surfactant, check CK) ceftaroline (new cephalosporine) |
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Staph epidermidis |
Vancomycin |
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Bacillus anthracis (Gram pos rod) Escherichia coli (Gram neg rod) - UTI |
Ciprofloxacin |
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Neisseria gonorrhoeae (Gram - diplococci) Neisseria meningitidis (Gram - coccus) |
Ceftriaxone |
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exposed to someone with Neisseria meningitidis |
Rifampin (orange body fluids, rapid resistance) |
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used to be used for E coli (Gram - rod) |
Trimethoprim Sulfamethoxazole |
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Haemophilus influenza (Gram - coccobacillus) - otits media |
amoxicillin |
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Mycoplasma pneumonia - atypical pneumonia (also Legionella pneumophila, chlamydophila pneumoniae, chlamydia psittaci, Coxiella burnetii) |
Erythromycin; variants - clarithromycin, Axithromycin or Doxycycline (a Tetracycline) (can-->esophagitis) variant - Tigecycline |
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Clostridium difficile |
vancomycin metronidazole (no EtOH! disulfiram-like reaction) fidaxomicin |
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Treponema pallidum - syphilis |
penicillin |
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mycobacterium tuberculosis |
rifampin isoniazid (impairs synthesis of mycolic acid) pyrazinamide (hyperuricemia, gout) ethambutol (optic neuritis, color blind) |
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Borrelia burgdorgeri (spirochete) - Lyme |
Doxycycline or Amoxacillin |
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empiric Staph aureus (or coagulase neg staph) - TSS |
clindamycin + vancomycin + carbapenem |
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severe MSSA Toxic Shock Syndrome |
clindamycin + nafcillin |
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MRSA Toxic Shock Syndrome |
clindamycin + vancomycin/linezolid |
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Group A Strep./C. sordellii - Toxic Shock Syndrome |
clindamycin + penicillin G |
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SCC mecIV CA-MRSA |
clindamycin Tetracycline trimethaprim/sulfamethoxazole |
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coagulase negative Staph |
vancomycin |
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Streptococcus pneumoniae - meningits |
vancomycin until penicillin susceptibility proven or cephalosporins
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Streptococcus pneumoniae - pneumonia, sepsis, otitis media, sinusitis |
if penicillin-resistant clindamycin 65% macrolides 25-50% fluoroquinolones - levofloxacin, moxifloxacin 95% |
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Streptococcus viridans (anginosus, mitis, mutans, salivarus)- subacute bacterial endocarditis, TSLS
Streptococcus mutans - Dental caries |
beta lactams Gentamicin (synergistic killing) Vancomycin or quinolones if penicillin resistant (mitis) |
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Nutritionally variant "Strep" (variable Gram, pleomorphic) Granulitcatella Abiotrophia |
penicillin + Gentamicin Vancomycin + rifampin |
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pregnant mom positive for Streptococcus agalactiae (group B) at 35-37 weeks ---> give treatment at least 4 hours before delivery to prevent bacteremia/meningitis in baby |
chemoprophylaxis with intrapartum IV penicillin or ampicillin |
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Streptococcus agalactiae (group B) - neonatal septicemia/pneumonia/meningitis, endocarditis, soft tissue infection, UTI |
penicillin, ampicillin, cephalosporins, vancomycin, Clindamycin (15-40% R) Erythromycin (25-50% R)
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Streptococcus C, F, G - bacteremia, wound infections, septic arthritis, pharyngitis, endocarditis, osteomyelitis |
penicillin |
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Streptococcus bovis (gallolyticus) - endocarditis, bacteremia (>50% assoc with colon malignancy), wound infections, UTI |
hmm.. |
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Enterococcus faecalis and Enterococcus faecium - UTI, bacteremia, endocarditis, wound infections, infections associated with medical hardware
*faecilis can (rarely) produce beta lactamase |
inhibited, NOT KILLED by penicillin Ampicillin + ureidopenicillins (piperacillin) Ampicillin + aminoglycoside for bacteremia Ampicillin alone (or nitrofurnatoin) for UTI Ampicillin/aminoglycoside resistant, vancomycin
alt - quinolones, tetracycline, imipenem, linezolid R - clindamycin, macrolides, cephalosporin, monobactam, semisynthetic penicillins |
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Group A Streptococcus - pharyngitis (Strep throat) - throat culture and direct antigen to diagnose - ASO titer is Gold Std but not practical |
kids under 60 lb - IM Benzathine Penicillin G adults over 12 yo - Penicillin V 500 mg -10 days children under 12 yo - penicillin V 250 mg - 10 d other macrolides, clindamycin, cephalosporins |
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suppurative complications of Group A Strep |
peritonsillar abscess otitis media sinutis lymphadenitis meningitis arthritis endocarditis osteomyelitis liver abscess pneumonia |
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non-suppurative complications of Group A Strep |
scarlet fever acute rheumatic fever post-strep glomerulonephritis toxic shock syndrome pediatric neuro-psych disorder (PANDAS) |
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Corynebacterium diptheriae |
horse serum product anti-toxin Erythromycin or penicillin |
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Bacillus anthracis |
IV high dose penicillin if natural cause Doxycycline or ciprofloxacin if terrorist |
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Lysteria monocytogenes - preg assoc bacteremia, granulomatosis infantiseptica, bacteremia, meningoencephalitis - Internalin mediates engulfment - Listeriolysin O mediates escape from vacuole - actin tail to propel into other cells |
IV ampicillin + Gentamicin trimethoprim/sulfa if penicillin allergy 3-6 week therapy for meningitis |
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Clostridium botulinum - food-borne kind - flaccid paralysis (CN --> descending) anaerobe |
antitoxin + supportive care |
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Clostridium tetani - spastic paralysis anaerobe |
antitoxin + Penicillin G + wound care/support |
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Clostridium perfringens anaerobe |
extensive surgery + Penicillin G |
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Clostridium difficile - diarrhea anaerobe |
metronidazole if no work, metronidazole + vancomycin (can also add rifampin) or vancomycin retention enema or vancomycin via pigtail catheter into caecum Fidaxomicin - expensive |
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anaerobic cocci |
penicillins metronidazole clindamicin (penicillin + beta lactamase inhibitor) |
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Bacteroides fragilis - intra-abdominal, pelvic infection, decubitus ulcer, diabetc foot ulcer anaerobe, periotonitis |
metronidazole beta lactam/beta lactamase inhibitor combo
cabapenem increasing resistance to Clindamycin
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Actinomyces - head/neck, chest/abdomen, draining sinuses - sulfur granules anaerobe |
high dose Penicillin G for long time |
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Escherichia coli - UTI, neonatal meningitis (second to GBS), septicemia, peritonitis, septic arthritis, abscess, wound infection, pneumonia, osteomyelitis |
beta lactamases (extended spectrum beta lactamases, AmpC cephalosporinases, Klebsiella pneumoniae carbapenemases) |
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enterotoxigenic - infant/traveler's - watery enteroinvasive - children - dysentery like enteropathogenic - bottle fed infants - water/muc enteroaggregative - 3rd wrld infants - water/bld
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rehydrate and antibiotics |
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enterohemorrhagic E coli - hemorrhagic colitis - developed world - watery bloody diarrhea and cramps - undercooked beef, sprouts, spinach - Shiga toxins |
rehydration |
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Salmonella - gastroenteritis, enteric/typhoid fever, bacteremia |
gastroenteritis usually self limiting antibiotic enhances the carrier state antibiotics for severe/disseminated - variable susceptibility |
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shigella - shigellosis (bacillary dysentery) A. Shigella dysenteriae B. Shigella flexneri C. Shigella boydii D. Shigella sonnei 75-85% in US (mostly peds) |
susceptible to most penicillins, cephalosporins, aminoglycosides, sulfonamides, aztreonam, carbapenems, quinolones
increasing resistance to ampicillin, tetracycline, and trim/sulfa |
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Yersina pestis - Bubonic, Pneumonic plague, septicemic, meningeal bubonic - fever, chills, bubo pneumonic - dyspnea, cyanosis, hemoptysis, resp collapse, sepsis, 100% mortality * adhesin fibrolysin, protein capsule |
Gentamicin, streptomicin tetracycline or chloramphenicol |
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Yersina enterolitica - enterocolitis, terminal ileitis, diarrhea, mesenteric lymphadenitis septic shock with contaminated blood products *invasin, enterotoxin, yops |
quinolones trimethoprim/sulfamethoxazole |
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Enterobacteriaceae: Klebsiella Enterobacter Serratia Proteus Citrobacter Morganella UTI, sepsis, wound infections |
beta lactamases (extended spectrum beta lactamases AmpC cephalosporinases Klebsiella pneumoniae carbapenemases)
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Pseudomonas aeruginosa - tracheobronchitis, necrotizing bronchopneumonia, granulocytopenia, bacteremia, worsen CF, meningitis, endocarditis, osteomyelitis, UTI, burn/surgical wound infection, otitis externia, folliculitis, corneal ulcers, febrile neutropenia * G-, non-ferm (Klebsiella penumoniae and E coli can cause) *Pili, LPS, MEP, Elastase, Exotoxin A (adp ribosylates EF2, prevent protein synthesis) |
antipseudomonal beta lactam aminoglycosides fluoroquinolone serious infection - combine cefepine (4th gen cephalosporin) |
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Burkholderia cepacia - endocarditis, septicemia |
trimethoprim/sulfamethoxazole |
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Stentotrophomonas maltophilia |
trimethoprim/sulfamethoxazole |
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Haemophilus influenzae - sinusitis, otitis media type b = meningits, sepsis, cellulitis, septic arthritis, epiglottitis biogroup aegyptius = conjunctivitis, Brazilian purpuric fever **needs X factor hemin and V factor NAD |
lesser infections: Augmentin (Amoxacillin + clavulanate), 2nd gen cephalosporin - cefixime/cefuroxime, quinolones (ciprofloxacin), macrolides (azithromycin), trim/sulf life threatening: 3rd gen cephalosporin IV, ampicillin if beta lactamase negative |
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Haemophilus parainfluenza - endocarditis, otitis media, epiglottitis, conjunctivitis, pneumonia **needs V factor |
Augmentin, cefixime/cefuroxime, quinolone-ciprofloxacin, azythromycin, trim/sulf severe - 3rd gen cephalosporin, beta lactamase |
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Haemophilus ducreyi - chancroid - STD |
Erythromycin Azithromycin |
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Aggregatibacter aphrophilus - otitis media, conjunctivits, epiglottitis, pneumonia |
penicillin/ampicillin |
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Aggregaticbacter actinomycetemcomitans - periodontitis, brain abscess |
cephalosporins or quinolones |
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Cardiobacterium hominis - bulbous ends, n.f.URT
Eikenella corrodens - oral normal flora, oral infections, human bite wound infections
Kingella kingae - URT n.f., osteomyeltits, septicemia |
penicillin for all 3 |
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Pasteurella multocida - animal bite wound infection esp. cat bite |
penicillin or tetracylcine |
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Francisella tularensis (tick, animal, food/wat, terr) fever, chills, HA, myalgia, arthralgia, ulceroglandular form - skin/oral lesions, painful lymphadenopathy pneumonic form - chest pain, pneumonia, hemptysis ocular, pharyngeal, sepsis, meningitis |
Streptomycin or Gentamicin alternatives - doxycycline, ciprofloxacine, chloramphenicol |
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Brucella melitensis - fever, malaise, night sweats, myalgia, anorexia, osteomyelitis, endocarditis, |
Doxycylcine + rifampin (or Gentamicin) |
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Legionella - multifocal acute fibrinopurulent pneumonitis ----survives in phagocytes |
Azithromycin, ciprofloxacin |
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Bordetella pertussis - catarrhal stage, paroxysmal, convalescent antibiotics not effective after catarrhal stage |
Erythromycin Azithromycin trimethoprim/sulfamethoxazole |
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Vibrio cholerae - acute profuse watery diarrhea, dehydration, acidosis, oliguria, hypotension, altered mentation, 25-50% mortality untreated |
rehydrate tetracycline, doxycycline, quinolones, or trimethoprim/sulfamethoxazole |
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Vibrio vulnificus - wound infections, septicemia Vibrio alginolyticus - wound infections Vibrio parahemolyticus - gastroenteritis, wound ***exposure to the sea |
chloramphenicol tetracycline gentamicin |
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Aeromonas hydrophila, Aeromonas caviae Aeromonas veronii *fresh or salt water, sewage, leeches |
beta lactams besides ampicillin (R to ampicillin) quinolones trimethoprim/sulfamethoxazole tetracycline |
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Plesiomonas shigelloides - watery diarrhea, wound infection, meningits |
quinolones, trimethoprim/sulfa, cephalosporin R to ampicillin |
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Campylobacter jejuni - diarrhea w blood and pus, abd pain, fever, Guillein-barre |
rehydrate Erythromycin, other macrolides, quinolones |
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Helobacter pylori - antric gastritis, peptic ulcers |
PPI + amoxicillin + clarithromicin PPI + bismuth salt + tetracycline + metronidazole
PPI = proton pump inhibitor |
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Acinetobacter baumanii- tracheobronchitis, pneumonia ----- after war in Iraq |
trim/sulfa amp/sulbactam colistin tigecycline imipenem-cilastatin (a carbapenem) - cilastatin inhibits renal dihydropeptidase |
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Moraxella catarrhalis symptoms |
sinusitis, otitis media, bronchitis, |
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Mycobacterium leprae - Hansen disease |
**Dapsone rifampin clofazimine minocycline |
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Mycobacterium avium-intracellulare (MAI, MAC) - lung infection |
clarithromycin, azithromycin TB drugs: rifampin, rigabutin, ethambutol, quinolones - ciprofloxacin, levofloxacin amikacin |
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Mycobacterium kansasii |
Isoniazid Rifampin Ethambutol - 18 months Resistant to Pyrazinomide |
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Rapidly growing mycobacterium Mycobacterium abscessus, Mycobacterium fortuitum, Mycobacterium chelonae |
amikacin, ciprofloxacin, sulfonamides, cefoxitin, imipenem, doxycycline, linezolid, clarithromycin, tigecycline |
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Mycobacterium marinum - skin infections after water-associated trauma |
excision or clarythromicin |
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Mycobacteriae gordonae |
tap water bacillus |
