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13 Cards in this Set

  • Front
  • Back
Skin and soft tissue infections

uncomplicated vs complicated
uncomplicated
- immunocompetent pts

complicated occur in pts w/:
- burns
- DM
- infected decubitus ulcers
- traumatic or surgical wounds

complicated usually polymicrobial
skin and soft tissue infections

predominant cause of suppurative skin infection in the US
MRSA
Skin and soft tissue infections - treatment

doc
alternatives
severe, less severe
what not to use due to resistance
CA-MRSA
doc - vancomycin

alternatives - linezolid or daptomycin
tigecycline (very broad) best reserved for pts unable to take other drugs

less severe - usually CA-MRSA
- clindamycin
- trimethoprim/sulfamethoxazole
- doxycycline

don't use fluoroquinolones for either CA-MRSA or MRSA
skin and soft tissue unlikely to be MRSA

uncomplicated
treatment
antistaphalococcal penicillin
- dicloxacillin
- first generation cephalosporin
- eg cephalexin
- if pt requires hospitalization
- same classes but IV instead of PO
- nafcillin, cefazolin
- clindamycin good choice for pts
allergic to b-lactams
skin and soft tissue unlikely to be MRSA

complicated
treatment
one of following as empirc monoTX
pip/taz
ticarcillin/clavulanate
imipenem
meropenem

in severely ill pts
- add vanc or linezolid until MRSA is
ruled out
Bone and joint

osteomyelitis (bone infection)
- common bug
- common dz

septic arthritis (joint infection)
bug - S. aureus most common

DM pts commonly get foot infections that involve both bone and soft tissue and are usually polymicrobial w/both anerobic and anaerobic bacteria
osteomyelitis
- empiric treatment

joint infection
osteomyelitis
IV antistaphylococcal penicillin (oxacillin) or first get ceph (cefazolin)

joint
ceftriaxone

both-if MRSA
- vanc or linezolid (if pt cant have vanc)
chronic osteomyelitis (as common in DM)
requires surgical debridement of bone followed by 4-8 w of abx tx

well absorbed oral abx used
- Bactim
- metronidazole
- flurorquinolones
- linezolid
- reversible bone marrow suppression
especially w/tx > 2w
Upper respiratory tract infections
- Acute sinsitis (often viral)
- AECB (often viral)
- acute pharyngitis
acute sinusitis, when bacterial is caused by which organisms

and treatment
pneumococci
H influenzae
Moraxella catarrhalis

amoxicillin or amox/clavulanate
-------------OR--------------------
cfuroxime axetil or defpodoxime
-------------OR--------------------
flurooquinolone w/good antipneumococcal act'y like
levofloxacin or moxifloxacin
acute bacterial sinusitis ABS
when pt allergic to pen and ceph
One of the following:
doxycycline
tmp/smx
axithromycin
clarithromycin

moderate ABS or risk factors for infection w/drug resistant s pneumoniae
(eg recent abx use)
- high dose amox/clav
---------OR------------
- antipneumococcal fluoroquinolone
AECB treatment
same as w/ABS
acute pharyngitis
penicillin or macrolide if allergic to pen