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42 Cards in this Set

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Clinical Signs of Infection:
Respiratory
Cough
Purulence (Pus)
Sputum Production
Hyperventilation
Clinical Signs of Infection:
Urinary
Pyuria (WBC's)
Frequency
Clinical Signs of Infection:
Systemic
Fever / Chills
Hypotension
Hypothermia
Clinical Signs of Infection:
Neurologic
Mental Status Changes
Clinical Signs of Infection:
Skin
Erythemia (redness)
Pustulation
Lesions
ANC Calculation
ANC = WBC x [bands/100 + segs/100]
DEFN: Neutropenic Fever
ANC < 500 cells/mm3
Fever 38.3C / 101F
or
> 1hr 38C / 100.4F
Diagnosis and Workup
Physical exam
2 blood cultures
Chest Xray
Cultures (urine,stool,skin lesions, sputum)
Pathogens Gram +
MRSA = Meth resist. S. Aureus
MSSA = Meth suseptible
S. Epidermidis
Pathogens Gram -
E. coli
H. Influenzae
Klebsiella
Pseudomonas
Enterococcus Fecalis
Pathogens Yeast
Candida Albicans
Pathogens Fungi
Aspergillus
Crypto
Histo
Prevention of Infections:
isolaton
Gut decontamination
hand washing
avoid invasive procedures
avoid fruits, vegs, plants, flowers, smoking
Prevention of Infections:
Anti-microbial prophylaxis
Cipro 500-750mg po bid
decreases incidence of gram (-)
Prevention of Infections:
Antifungal Prophylaxis
Fluconazole 400mg po qd in BMT pts
Prevention of Infections:
Viral Infections
1) Varicella-Zoster seronegative should avoid others with primary or secondary infxn
2) CMV seronegative to receive seronegative blood
Treatment:
Penicillin + Aminoglycoside
Pipercillin 4g q6h

Gentamicin 2mg/kg loading followed by maintenance dose determined by serum conc.
Treatment:
Antiseudomonal Cephalosporine + Aminoglycoside
(Cefepime 1-2g q12h
or
Ceftazidime 1-2g q8h)
+

Gentamicin 2mg/kg loading followed by maintenance dose determined by serum conc.
Treatment:
Aminoglycoside + Quinolone
Ciprofloxacin 0.4g q 8-12h
+

Gentamicin 2mg/kg loading followed by maintenance dose determined by serum conc.
Treatment:
Monotherapy
Cefepime 1-2g q12h
Ceftazidime 1-2g q8h
Piperacillin/tazobactam 4.5g q6h
Imipenem/cilastatin 0.5g q6h
Meropenem 1g q8h
Antifungal Therapy
Vorconazole 400mg BID x 2 doses, then 200mg BID

IV: 6mg/kg q12h x 2 doses then 3mg/kg q12h
Vorconazole Concerns
Cyclodextran in formulation is toxic with CrCl < 50ml/min

Drug-Drug interactions

Visual Disturbances with IV dosing
Vorconazole Plus's
Decreased SE's
Superiority to emperic Amphotericin B
Amphotericin B therapy:
Esophageal Candidiasis
0.5 mg/kg/day
Amphotericin B therapy:
Disseminated Candidiasis
0.5 - 1 mg/kg/day
Amphotericin B therapy:
Aspergillosis
1.5 mg/kg/day
Amphotericin B therapy:
Lifetime dose
4 grams (regular product)
Amphotericin B therapy:
Infusion related / acute effects
Fever, Chills, Nausea, Vomiting
Amphotericin B therapy:
Chronic Effects
Nephrotoxicity
Amphotericin B therapy:
Infusion related / acute effects
TREATMENT
APAP 650-1000mg po/pr 30min prior
(Avoid NSAIDS b/c increased bleeding effects)

Hydrocortisone for rigors 25-50 mg iv 30 min prior (reasses q3-7 days)

Benadryl ....DOSE??.....

Meperidine 25mg IV q15 min prn rigors up to 100mg over 1 hr caution renal insufficiency
Amphotericin B therapy:
Nephrotoxicity TREATMENT
Limit cumulative dose

Hydration and high sodium diet

1L NS qd (NOT Dextrose)

Liposomal formulations with reduced nephrotoxicity
Amphotericin B therapy:
Electrolyte problems
Mg / K wasting
Oral Antifungal Agents:
Nystatin for Thrush
100,000U/ml 5ml swish and swallow QID x 7-10 days
Oral Antifungal Agents:
Clotrimazole for Thrush
10mg Troche 15 - 20 min for slow dissolution 4-5x/day x 7-14 days
Oral Antifungal Agents:
Fluconazole for Thrush
100 mg tab po qd x 7-14 days
Oral Antifungal Agents:
Fluconazole for Esophogeal Candidiasis
200 mg qd x 14 - 21 days
Fever & Neutropenia:
Route of Initial Therapy
High Risk IV AB's
Low Risk IV or PO
IV vs PO
Fever & Neutropenia:
Initial Therapy Drug Therapy
If pt. qualifies for vanco, begin 2-3 drug combo with vaco.

(cefepime, ceftrazidime etc. with aminoglycoside)
Fever & Neutropenia:
Persistent Fever 48-72 hrs
A) If no Change in pt condition consider stopping Vanco and continue with inital ab's

B) Progressive dx: Change ab's add vanco if required

C) Febrile days 5-7 but resolution of neutropenia iminent: use ANTIFUNGAL with/without AB change
Fever & Neutropenia:
Persistent Fever 48-72 hrs
OK wait 5 days to make changes unless clinical deterioration or culture results.
Fever & Neutropenia:
Persistent Fever 7 days
Contiunue Therapy with init. AB's

Change or add AB's

Add antifungal with/without changing antibiotics
Aminoglycoside Benefits
Concentration killing

Synergy with other antibiotics