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155 Cards in this Set
- Front
- Back
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C albicans treatment
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fluconazole
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Candidemia/acute systemic candidiasis
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Echinocandin - caspofungin, anidulofungin
OR AmB (both are IV drugs) If after initial treatment, want to switch to oral, use voriconazole |
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C glabrata, krusei
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Echinocandins (-fungin)
if resistant: voriconazole |
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Cryptococcus neoformans (not meningitis)
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fluconazole
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cryptococcal meningitis
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AmB, then fluconazole
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Pneumocystis jirovecii (PCP)
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TMP-SMX
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Aspergillus
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Voriconazole
candins? |
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Mucormycosis
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Amphotericin B IV, OR oral Posaconazole
(1. correct underlying 2. debridement) |
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Sporothrix schenckii
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Itraconazole
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Histoplasmosis
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AmB --> severe illness
Itraconazole --> less severe, follow up Prolonged therapy! |
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Blastomycosis
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Itraconazole
AmB if severe or in CNS (fluconazole if can't tolerate AmB) |
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Cocciodomycosis
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Itraconazole --> choice
AmB initially for severe or CNS Prolonged therapy |
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Penicilliosis
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AmB then itraconazole
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Syphilis
(T. pallidum) |
Penicillin
allergy: tetracycline |
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HSV1/HSV2
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Acyclovir
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Chancroid (H ducreyi)
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Ceftriaxone
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Gonorrhea
(N. gonorrheae) |
Ceftriaxone IM
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Chlamydia
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Macrolide
(or fluroquinolone --> longer regimen) |
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Bacterial vaginosis
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metronidazole
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Trichomoniasis
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Metronidazole
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Vulvovaginal Candidiasis
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Azole (oral or vaginal)
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NRTI (nucleoside reverse transcriptase inhibitor)
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compete with nucleosides for RT --> chain termination
AZT, abacavir |
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NNRTI (non-nucleoside reverse transcriptase inhibitor)
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bind to reverse transcriptase --> cause structural changes at the nucleotide binding site
Efavirenz |
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PI (protease inhibitor)
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competitively bind HIV protease --> lock enzyme --> prevent cleavage --> prevent release from cell
Ritonavir |
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FI (fusion inhibitor)
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Inhibit cell entry
1. Enfuvirtide - inhibit p41 and prevents fusion 2. Maraviroc - inhibit gp121 and CCR5 interaction |
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Integrase inhibitors
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Inhibit HIV DNA transfer to host genome
Raltegravir |
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Endocarditis - empiric therapy
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vancomycin + gentimicin + ceftriaxone
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IE - strep viridans
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Penicillin + gentimicin
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IE - MSSA
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oxacillin + gentimicin
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IE - gram positives (MRSA, coagulase negative staph)
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vancomycin + gentimicin
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IE prophylaxis
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amoxicillin PO
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IE - enterococcus
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gentimicin + ampicillin
(Linezolid for VRE?) |
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Erysipelas - Group A, C, G strep
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penicillin, erythromycin, or narrow spectrum cephalosporin (1st or 3rd)
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Cellulitis
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Oxacillin/Nafcillin or cefazolin
Allergy: vancomycin |
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Necrotizing fasciitis - type 1
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anaerobe + mixed aerobes
broad spectrum with anaerobic coverage |
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Necrotizing fasciitis - type 2
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GAS
penicillin + clindamycin |
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Vibrio vulnificus
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doxycycline
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Erysipelothrix rhusipathiae
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Vancomycin
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Mycobacterium marinum
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Clarithromycin, doxycycline, or TMP-SMX
OR rifampin + ethambutol |
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CAP - strep pneumo
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ceftriaxone or fluoroquinolone
(PCN resistance!) |
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CAP - H influenza
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Ceftriaxone/cefotoxime, cefoxitin
ampicillin + clavulanate |
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CAP- Moraxella catarrhalis
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Higher level beta lactams
cefoxitin, ceftriaxone, augmentin |
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CAP - MRSA
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Vancomycin
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Pneumonia - mycoplasma
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Macrolides, tetracycline, or fluoroquinolone
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Pneumonia - chlamydia
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macrolide (erithromycin), tetracycline, or fluoroquinolone
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Pneumonia - legionella
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azithromycin/erythromycin or fluoroquinolones
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GI - campylobacter
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fluoroquinolone, erythromycin
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GI - ETEC
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antibiotics
fluoroquinolone (cipro) |
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GI - Salmonella
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No antibiotics in otherwise healthy pts
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GI - Salmonella typhi
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Antibiotics
Cipro or ceftriaxone |
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GI - Yersinia
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Antibiotics questionable effectiveness
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GI - C difficile
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Vancomycin
Metronidazole |
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GI- E histolytica
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Metronidazole
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GI- Giardia lamblia
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Metronidazole
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GI- EHEC
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NO antibiotics
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GI - Shigella
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Fluoroquinolone, TMP-SMX (some resistance)
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GI - cholera
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Antibiotics
Doxycycline? |
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Lower UTI
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TMP-SMX
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Acute pyelonephritis - outpatient
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Fluoroquinolone (cipro)
TMP-SMX |
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Acute pyelonephritis - hospital
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Fluoroquinolones, aminoglycosides, beta lactams
If suspect Gram positive: add ampicillin or vancomycin Modify tx when know organism |
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Asymptomatic bacteriuria
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No treatment usually
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Chronic prostatitis
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TMP-SMX or fluoroquinolone
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Peptostreptococcus
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ANAEROBE
Penicillin Then: clindamycin, chloramphenicol, cephalosporins |
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Clostridium (not difficile)
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ANAEROBE
Penicillin Then: clindamycin, chloramphenicol, cefoxitin |
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Clostridium difficile
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ANAEROBE
Vancomycin Then: metronidazole, bacitracin |
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Gram negative bacilli - beta lactamase negative - ANAEROBE
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Penicillin
Then: metronidazole, clindamycin, chloramphenicol |
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Gram negative bacilli - beta lactamase positive - ANAEROBE
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Metronidazole, clindamycin, penicillin + BL inhibitor, carbapenem
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Anaerobic - head and neck
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ampicillin + clavulanate, or clindamycin
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Anaerobic - CNS
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metronidazole + ceftriaxone (or penicillin)
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Anaerobic - pulmonary
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Clindamycin
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Anaerobic - intraabdominal infection
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Use combinations
Cefepime Cipro + metronidazole Cefoxitin Pipercillin + tazobactam Imipenem |
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Abdominal perforation
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Cover gram negatives and anaerobes
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Anaerobes - pelvic infection
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Cefoxitin + doxycycline
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Anaerobes - skin/soft tissue
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Polymicrobial - think gram positive anaerobes
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Bacteroides fragilis
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produces beta lactamase
- use anaerobic antibiotics (i.e., metronidazole, BL inhibitors, cefoxitin?) |
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Fusobacterium
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Clindamycin
Produces beta lactamase |
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C difficile
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Metronidazole or oral vancomycin
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C perfringens
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Penicillin + clindamycin
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Clostridium botulinum
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anti-toxin
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Actinomycosis
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Penicillin, doxycycline, clindamycin
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Ascaris lumbricoides
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Mebendazole
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Enterobius vermicularis
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Mebendazole
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Hookworm
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Mebendazole/albendazole
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Strongyloidiasis
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Ivermectin
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Trichinosis (Trichenella)
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Albendazole
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Lymphatic filariasis - W. bancrofti
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Albendazole + diethylcar
Albendazole + ivermectin |
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Onchocerciasis (O volvulus)
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Doxycycline - kills parasite
Ivermectin - temporary solution |
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Schistosomiasis
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Praziquantel
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Cerebral cysticercosis (T solium)
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Difficult to treat!
Albendazole or praziquantel? |
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Echinococcus granulosis
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Albendazole
OR surgery |
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Diphyllobothrium latum (fish tapeworm)
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Niclosamide
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P falciparum
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Quinine/quinidine with doxycycline or clindamycin
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P ovale, P vivax, P malariae
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Chloroquinolone or Malarone
hypnozoites --> Primaquine |
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Trypanosomiasis
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Acute: Nifurtimox or Benznidazole
Chronic: no treatment |
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Leishmaniasis
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Visceral - Milefosine
Cutaneous - paramomysin or itraconazole Otherwise: Pentavalent antimony or AmB |
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Toxoplasma gondii
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Pyramethamine + sulfadiazine
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Amebiasis
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Metronidazole or Nitazoxanide
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Giardia lamblia
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Metronidazole or nitazoxanide
(metronidazole resistance rising) |
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Cryptosporidium parvum
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Immunocompetent - self limited
Immunocompromised - no good therapy |
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Malaria prophylaxis
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Chloroquine
If resistant: Malarone, tetracycline, Mefloquine |
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Anthrax
(Bacillus anthracis) |
Ciprofloxacin/Doxycycline + ____
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Smallpox
(Variola virus) |
No good treatment
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Yersinia pestis
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Gentimicin/streptimicin or ciprofloxacin
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Tularemia
(Francisella tularensis) |
Streptomycin/gentimicin, doxycycline, or ciprofloxacin
NO cephalosporins! |
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Rabies
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5 IM injections
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Bartonellosis
(Bartonella henselae) |
Azithromycin
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Brucellosis
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doxycycline + (streptimicin/gentimicin or rifampin)
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Q fever
(Coxiella burnetii) |
Acute: doxycycline
Chronic: doxycycline + rifampin |
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Psittacosis
(Chlamydia psittaci) |
doxycycline
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Lyme disease
(B burgdorferi) |
Doxycycline or amoxicillin
Complications: Ceftriaxone |
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Rocky Mountain Spotted Fever
(Rickettsia) |
doxycycline
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Ehrlichiosis
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doxycycline
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Neutropenic pt with fever
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Worry about Staph aureus and Pseudomonas
- Pseudomonas coverage: ceftazidime, cefepime, imipenem, meropenem, pipercillin - Vancomycin - Anaerobic coverage if infection site likely to have anaerobes |
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Bone/joints - MRSA
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Vancomycin
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Bone/joints - MSSA
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Nafcillin/oxacillin
Alternative: cefazolin, vancomycin, clindamycin |
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Bone/joints - Strep pneumo
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Penicillin
Alternative: cefazolin, vancomycin, clindamycin |
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Bone/joints - GAS
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Penicillin
Alternative: Cefazolin, vancomycin, clindamycin |
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Bone/joints - Enterococci
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Ampicillin
Alternative: vancomycin |
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Bone/joints - H influenza
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Ampicillin
Alternative: Ceftriaxone, cipro, TMP-SMX |
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Bone/joints - Pseudomonas
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Cipro or ceftazidime
Alternative: pipercillin + aminoglycoside; aztreonam |
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Bone/joint - Bacteroides
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Clindamycin
Alternative: imipenem, metronidazole |
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Bone/joint - Klebsiella
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Ceftriaxone
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Bone/joints - E coli
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Cefazolin
Alternative: cipro, ceftriaxone, imipenem |
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HSV1/2
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acyclovir
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enteroviruses
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none
Pleconaril not yet approved |
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arboviruses
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none
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VZV - shingles
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acyclovir
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CMV- symptomatic
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Ganciclovir
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HHV6/7 - Roseola
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Ganciclovir - first line?
Foscarnet Cidofovir |
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EBV
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acyclovir
BUT not effective in clinical syndromes |
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HHV8 (Kaposi Sarcoma)
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Foscarnet
efficacy unknown |
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Influenza virus
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Zanamavir good for H1N1, H3N2, and influenza B
Rimantidine/amantidine - lots of resistance (H1N1 especially) Other neuraminidase - oseltamavir |
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RSV
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possibly Ribavarin
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GBS+ pregnant women
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Ampicillin
Allergy: Clindamycin |
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Neonatal E. coli - empiric therapy
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Ampicillin and cefatoxime
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Neonatal Hepatitis B
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HBIG and Hepatitis B vaccine within 12 hours of birth
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HBV - prophylactic therapy
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unvaccinated, positive source: HBIG, start HBV vaccine within 7 days
vaccinated but unknown response, positive source: test antibodies, if low --> HBIG + booster vaccinated, positive source: no therapy needed |
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HCV - prophylactic therapy
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follow-up, no PEP (interferon)
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HIV - prophylactic therapy
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Low risk: 2 drug therapy for 28 days
High risk: 3 drug therapy for 28 days Then follow-up for both |
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N meningitides - prophylaxis
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Cipro, rifampin, or ceftriaxone
initiate ideally within 24 hours |
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Latent TB infection
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9 months of INH
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Initial TB infection
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INH + rifampin + ethambutol + pyrazinamide
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Mycobacterium avium complex
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Combination drugs
Clarithromycin Amikacin Ethambutol Rifampin/rifabutin |
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M kansii
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INH + rifampin + ethambutol
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Rapid growers- mycobacteria
M fortiutum, chelonae, abscessus |
Clarithro
Cefatoxin Imepenem Amikacin TMP-SMX Linezolid - Not sensitive to traditional antibiotics! |
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M leprae
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Dapsone + rifampin
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Nocardia
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TMP-SMX
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Rhodococcus
|
Vancomycin, Carbapenem, Macrolide, Fluoroquinolone
often in combo with rifampin |
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Legionella micdadei
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azithromycin or fluoroquinolone
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GI - C diphtheriae
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Erythromycin, clindamycin
|
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Listeria monocytogenes
|
Ampicillin, TMP-SMX
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C jeikeium
|
vancomycin
|
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CAP- empiric outpatient
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macrolide
moxi/levofloxacin doxycycline |
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CAP- empiric general medical ward
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3rd gen ceph + macrolide
(urasyn or zosyn) + macrolide moxi/levo |
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CAP- empiric ICU
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(macrolide or levo/moxi) + (3rd gen or zosyn or urasyn)
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