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241 Cards in this Set

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enterococcus
describe - or +
give species examples
its positive
E. Faecalis- can be VRE
E. Faecium-mainly VRE
E. Gallinarum
DOC for enterococcus?
2nd line?
3RD
1st- ampicillin
2nd-Vanco
3rd- if VRE, use daptomycin or linezolid
if you do hemolysis on blood agar- what does it mean
-alpha?
-beta?
alpha- strepococcus viridans, and strep pneumoniae

beta-group A-strep pyogenes,
group B-Strep Agalactiae
Aerobic Gram + bacilli
3
listeria

corynebacterium

bacillus
DOC for listeria

DOC for bacillus anthracis
L- ampicillin

anthrax-doxy + tetra
describe gram negative bacteria
2 cell walls
perisplasmic space btwn walls
Pspace-where B lactamses are
gram negative cocci
examples
M. Cat
Neisseria gonorrhoea(diplococci)
H. Influenzae
tx C.A.P with?
macrolides
azithromycin
what are 2 ESBL gram neg bacilli
E. coli
Klebsiella pneumoniae, oxytoca
which gram neg. bacilli causes cystic fibrosis
burkholderia cepacia
non fermenting gram neg bacilli
Psuedomonas aetuginosa
acinetobacter baumanii
S. maltophillia
Burk. cepacia

must tx for 14 days, fermenting=7-10 days
Anaerobic positive org
C.diff
C. perfingens-gan greene
P acnes-acne
Anaerobic negative organisms
B.frag
prevotella species
examples of atypicals
mycoplams pneumoniae

chlamydia pneumoniae

legionella pneumophillia
drugs to tx atypicals
azithromycin(macrolidies)

levofloxacin
moxiflox (FQs)
Mycobacterium fast growers
M foruitum
M. abscessus
M. chelonae

fast->FAC
how do you calc the MBC
x2 the MIC
interpretation of MICS
S
I
R
S-suseptible at regular doses

I-suseptible at high doses

R-resistent-not suspt. at any dose
how to determine the % of MRSA
look at the % of oxicillin suseptible for staph areus

100-x= 100-38%=62% of MRSA for jackson
colonization vs infection
c-supp pathogentic bacteria
stim cross protective antibodies

i-cause damage to hose
Indicators of infection
>38C or 98.5F
BANDS>Segs
bands norm <5%, but higher in ifxn
how to calc ANC
ANC= (B + S) x (WBC X 1000)

or =(Neut %) x (WBCx1000)
normal ANC range
1500 to 8000

neutropenia <500 cells/mcl
colonization issues
org. present but no disease/immune response=false positive culture
antacids and cations interfere with which abx?
when to take?
quinolones + tetracyclines

take abx 2 hrs before or 4h after
which drugs cause QT prolongation
quinolones, macrolides, and azoles
synergistic drugs
example?
beta=lactam opends drug cell wall and aminoglycoside works to dec protein synthesis
for enterococcos
example of resistance
binding site change
MSSA to MRSA via MecA gene
PBP2->PBP2A
vanco is static or cidal?

linezolid is static or cidal?
vanco is cidal

linezolid is static
when would you never use linezolid?
never for MRSA in blood
what is good at penetrating prostate, eyes, brain, lungs
FQs
what is a combo drug given to old ppl for meningitis
ceftriaxone and ampricillin

wierd cause 2 beta lactams-usually not together
4 mechs of resistence?
beta-lactamase
change binding site
efflux pumps
porin channels
which is more agressive: wild type or resistant bacteria?
wild type- even though resistant is hard to kill, its slow and not too agressive
what drugs are affected by porin channels?
CLEAN
clind, clarith, erythromy, azithromycin
dalfopristin
what drugs are affected by efflux pumps
macrolides-CLEAN
FQ's
tetraclycines
clindamycin
what is DOC for ESBL
e.coli, kleb, proteus
carbapenems
if pt with penicillin allergy needs beta lactam drug..which is least likely to react
monobactams-aztreonam
how do beta-lactams work?
block cell wall synthesis
b lactams-
BUGS mechs of resistance
1beta lactamases
OR
2 change in penicillin binding

3/3 bind = susceptible
2/3 bind =low level resist
0/3 high level RESISTENCE
beta-lactams
cidal or static?
which organism is not affected
cidal
except enterococci
what drug is cidal against enterococci
nothing, everything is static
beta lactam
PK
time dependect...T>MIC, longer time better killing
which beta lactam can only be infused intermittant: 30mins
ampicillin
allergy percentage:
penicillin to carbapenem
penicillin to cephalosporin
pen to carb is 30%

pen to ceph 3-5%
cephalosporin allergy
ceph to carb
ceph to peni
high
SJS +TEN allergy
& skin lose?
seen with beta lactam allergy
SJS-10%
TEN->30%
natural penicillins coverage
staph-but not clinically
DOC for syphillis (T. Pallidum)
antistaphylococcal penicillin drugs

coverage?
CONDM-clox, ox, naf, diclox, methacillin

cover MSSA-made for staph areus!
aminopenicillins
drugs?
coverage?
ampicillin, amoxicillin
cover enterococcus, but lost the Staph coverage
DOC for listeria
ampicillin
antipsuedomonal penicillins
drugs?
coverage?
piperacillin, ticarcillin

cover psuedomonas, enterococcus
b-lactamase inhib
drugs?
+ ampicillin coverage?
clavulanic acid
tazobactam
sulbactam

with ampicillins- get ampicill coverage + MSSA, gram neg except SPACEMs
BACTEROIDES covered!!!
b-lactamase inhib+piperacillin
pipercillin + tazobactam
coverage?
staph areus
SPACEM!!
Bacteroides
what are SPACEMs
S-erretia
P-suedomonas
A-ceinobacter
C-itrobacter
E-nterobacter
M-organella (indole proteus)
SPACEMs harbor what?
should avoid what?
harbor AmpC blactamses in cytoplasm
avoid 1,2,3rd gen cephalosporins
Pen G dose?
Pen VK dose?
CONDM drugs?
Ampicillin/ Amox dose?
pipercillin?
PenG- GUNIT!!!!-million units
VK,ampicillin, amoxicillin-in mg

CONDM,pipercillins- in grams
which gen of cephalosporins cover enterococcus
NONE of cephs cover enterococci
1st gen ceph drugs?
coverage?
cephalexin, cefazolin, cefadroxil

good gram posit.
gram neg-PEcK
P. miarbilis, Ecoli, Kleb pneumoniae
no anerobes
2nd gen ceph drugs?
coverage
cefuroxime, cefprozil, cefotetan, cefoxitin

HeNPEcK-more gram neg
H.flu, morexella,Nisseria

cefoxitin, cefotetan-anerobe coverage
3rd gen ceph drugs
coverage?
ceftriaxone, ceftazaidime, cefdinir, cefpodoxime

more gram neg(SPACEM)-BUT TRY TO AVOID
good gram positive-not staph
which 3rd gen ceph covers psuedomonas
ceftazidime
4th gen ceph drug?
spectrum?
cefepime
good gram + and neg
SPACEMs!!!
Psuedomonas!!
Pipercillin/tazo
vs
cefepime
coverage
both cover SPACEMs
but piper/tazo covers anerobes
add metro to cefepime for anero coverage
5th gen ceph
ceftaroline
extends coverage for MRSA
cephalosporin dosing

which is biliary excreted?
all in grams

ceftriaxone-axes will make you shit! so good for renal dysfxn
carbapenems
drugs?
imipenem-cilastatin
meropenem
ertapenem
doripenem
carbapenem
coverage
MSSA, streptococcus

ESBLs, nocardia(imipenem)
carbapenems do not cover what?
stenotrophomonas or legionella
meropenem

vs

ertapenem
meropenem is a gorilla
so it covers APE
Aceinobacter
Psuedomonas
Enterococcus

ertapenem is a lil monkey not ape
carbapenem dosing
all need renal dosing

ertapenem-daily good for home d/c, in grams

mero in grams, q 6H

doripenem-in mg, Q 8 H
monobactam
drug?
activity?
dosage?
aztreonam
gram negatives ONLY-psuedomonas!!!
good for pts with penicillin allergy

dosed in grams
inhalation product for cyst. fibrosis
FQ's
cause glycemic changes?
cause QTc prolongation?
gatifloxacin- gly+fat

grep+sparfloxacin
FQs
cause phototoxic
cause liver tox
photo-sparflox

liver-trovafloxacin
FQs
drugs(commonly uses ones)
moxifloxicin
levofloxacin
ciprofloxacin
gemifloxacin
which antibiotic is first synthetic (man made)?
FQs
FQs coverage
great streptococci(except cipro)

enterobacteriaceae
anaerobes(moxiflox)

atypicals
FQs that have psuedomonas coverage?
cipro and levo
why cant cipro work for strep pneumoniae
it penetrates lungs well, but doesnt cover the organism
when you hear wierd organisms, think why class of drugs?
FQs
legionella
chlamydia
FQs MOA?
inhib. bacterial topoisomerase IV and DNA gyrase (topo II)
which drug as positive affinity(topo IV)

which drug is neutral

which drug has neg(topo II-DNA gyrase) affinity
moxi- +, so no psuedomonas

levo-neutral

ciprofloxacin-neg-so no strep pneumo
low to high conc needed to fight Strep penumon.
mox, cip, levo
low--> high
mox, levo, cipro(very large conc needed)
FQs adv vs disadv
levo is 100% bio (IV to PO)
cipro is 80% bio (IV to PO)
good penetration-eye,lung

create MDR, avoid if possible
FQs S.E.s
phototoxic-wear sunscreen

QTc interval
can rupture achiliestendons
FQs dosing
moxifloxacin doesnt need renal dose
all given in mg
Macrolides
drugs?
work wear?
CLEAN
clarithromycin, erythromycin, azithromycin

work at 50S protein synthesis
Macrolides
coverage
bacteriostatic

atypicals**

H.flu-azithro is DOC
strep pneumoniae
which macrolide is a motilin agent

which is commonly used for H. flu
erythromycin

clarithromycin
macrolide
SEs
QTC prolongation
interactions-mainly erythromycin
bactrim
gen name?
work by?
used for?
sulfa/trim
block folic acid synthesis

use-UTI(ecoli)
Nocardia
toxoplamosis
how is bactrim dosed by?
dosed by the trim portion-think rate limiting factor
Bactrim AE
sulfa allergy
cause bone marrow suppression**
-photo sensitivity
HYPER K**
bactrim dosing
requires renal adjustment
SS=400/80
DS=800/160

15MG/KG daily
tetracyclines
drugs

work where?
part of TAG
at 30S

tetracycline, doxycyclines, minocyclines
tetracyclines cover
atypicals
MSSA, MRSA
strep pneumo
BURGDORFERI-lymes disease
acnes
tetracyclines
avoid in?
cause?
take how?
in persons <8 yo or pregnancy
-cause brown/blue teeth

take on empty stomach
tigecycline
works where?
cover?
30S,tight binding so less efflux
like tetracyclines

VRE,MSSA,MRSA
ESBL
ANEROBES-B.FRAG**

MRS. A told the tiger he was VERY bad, so he must wear BELLS on his neck and go UNDERWATER
tigecycline
SE

not to use when?
N/V(30%)-give zofran

NOT FOR BACTEREMIA!!!
tigecycline dosing?
IV ONLY 100mg, then 50 q 12H
liver do half
no renal adjust.
metronidazole
static or cidal?
covers?
cidal-loss of helical dna
ANAEROBIC coverage-C.DIFF
metro
SE.
Intxn
dose adjustment?
metal taste, dark urine
alcohol-disulfuram rxn=nasuea

only adjust in severe renal impairment
clindamycin
MOA?
covers?
50s
anaerobes-NOT BFRAG
MSSA, MRSA-but check to see if D test is -

used with vanco + piperacillin for its anti-toxin efex with streptococcus
clindamycin
SE
C. diff colitits(avoid long term use)

no renal adjust necessary
aminoglycosides
drugs?
work where?
cover?
gentamicin, tobramycin, amikacin all are IV

part of TAG-work at 30s
mono only for UTI
cover mainly negatives
aminoglycosides
monitor?
throughs for ADE
nephrotoxic
goal is through of <.6mcg/ml
vanco coverage
works how?
NO gram neg
oral form for C.diff

binds d-ala d-ala inhibits cell wall synthesis

cidal-except for enterococcus
Vanco
distrib
SE.
large-use TBW

caues Redman syndrome(histamine release)-infuse slowly 1g/60-90mins - this is not an allergy

can cause thrombophlebitis
vanco monitoring

dosing
throughs for efficacy
want 15-20mg/L
linear kinetics

15mg/kg BID, LD 20 to 30mg/kg for seriously ill

use metro for mild c.diff
use po vanco for severe cdiff
linezolid
coverage?
dosed?
bacteriostatic for staph and enterococci

NOT for MRSA bacteremia
NO gram neg coverage
100%BA, always dosed 600mg BID
linezolid
what kind of drug
SE
oxa zolid inone
thrombocytopenia > 28days

causes serotonin syndrome
daptomycin
type of drug?
lipoglycopeptide--vanco is just a glycopeptide
dapto
MOA?
rapid DEPOLARIZATION!
no gram -
+=enterococc,VRE, MSSA, MRSA, strep
dapto
never use when?
dosage?
for pneumonia-inactivated by surfactant in lung

ONLY IV, watch in renal dysfxn
telavancin
MOA
SE
vanco(d-ala,dala) + dapto(depol)

gram + only-MRSA
NOT VRE!
SE-foamy urine, QT prolong
dalfopristin/quinprisitn
synercid
covers VRE faecium(+)
causes inflam at injection site
fidaxomicin
treats
MOA?
C.diff
inhib RNA polym sigma subunit
nitrofurantoin
MOA?
covers?
SE
fucks with acetyl coA
covers-Ecoli,Kleb,Staph

but really only UTI tx

causes pulm fibrosis
not for preg or renal dysfxn
polymixin E
MOA
coverage
SE
cationic detergent-causes leaking of intracellular stuff
-cidal

broad gram + cov
-MDR pseudomonas, Aceinobacter

NEPHROTOXIC!!
fosfomycin
MOA
coverage
inactivvates pyruvyl tranferase-cell wall form
-cidal

MRSA, VRE cov
utility-KPCs & EBBL +UTIs
Rifampin
MOA
blocks RNA synthesis

penetrates biofilms on hardware
ABX NOT requiring renal adjustment
CONDMs
moxifloxacin
ceftriaxone
cefperizone
doxy
tigecycline
clindamycin
drugs active against psuedomonas
pipercillin/tazobactam
cefepime
levoflox
ciproflox
aminoglyc
ceftazidime
aztreonam
meropenem
imipenem
colistin
agents agaist MRSA
vanco
depto (not pnuemo)
linezo(not bactermia)
dalfo/quinu
clindamycin
bactrim
doxy
ceftobiprole
quinu/dalfo
what agents for taken oral for skin MRSA
bactrim, doxy, clindamycin
see nocardia
think?
bactrim
see stenotrophamonas
think?
bactrim
see atypicals
think
FQs
macrolides
see anaerobes
think
metro, clindamycin, pen w beta lactamase inhib
see C.diff think
metro, oral vanco, fidaxomicin
see ESBL think?
carbapenems
see KPC
think?
colistin
see VRE
think?
daptomycin, linezolid, dalfo/quinu, tigecycline
see corynebacterium
think?
vancomycin
ABX with inhal forms
tobramycin, atreonam, colistin
ABX that can be give intrathecally
tobramycin
gentamycin
vanco
colistin
main risk factors for AOM
<2 y.o.
day care
recent antibiotic use
male
winter season
smoke-even if person does outside
3 things needed to diagnose AOM
1-ACUTE onset-w/i 4 H
2-Middle ear effusion
3-middle ear inflamm.
T or F
middle ear effusion is not the same as Acute otitis media
true
MEE-can take 3 months to resolve
AOM
bacteria that cause it?
viral that cause it?
most common bacteria or viral
b-strep pneumoniae
H. flu
moraxella

v-not sure, but 40-75% cause
what are resistance % for these in AOM:
strep pneumoniae

H.flu

Moraxella
strep-50% reistant to penicillin, 50% intermedit to pen

H.flu-50% have b-lactamases
M-100% have b-lactamases
AOM tx
<6 months

6mo-2y.o.

>2
<6 MONTHS :tx no mater what

6-2yo: certain-tx, uncertain-tx if severe

>2YO: certain-tx if severe, uncertain-observe

severe=>102 fever or pain in middle ear
dose of amoxicillin in AOM
80-90mg/kg/day - give in 2 doses
severe-90mg/kg/day

if amox allergy-2ng gen cephs
if amox anaph-macrolides
unable to po-ceftriaxone
AOM drugs:Initial Tx

non severe( not >39C or pain in ear)
amox
if allergic nontype1:cefdinitr, cefuroxime, cepodoxime

type1-azithromycin, clarithro
AOM drugs: Initial tx
severe
augmentin
if allergy- non1-ceftriaxone 1 or 3 days

type1-clindamycin
AOM
after watching for 48-72H
start giving em something-see last chart
AOM
tx failed after 48-72H
nonsevere
augmentin
non1 allergy-ceftriaxone x3days
typ1-clindamycin
AOM tx failed 48-72H
severe
ceftriaxone x3days
allergy-tympanocentesis**
clindamycin
prevention of AOM
influ vaccine-6 to 23months old (dec reccurent AOM by 30%)

breast fed.mmmmmmm
signs of pharyngitis
fever, soare throat
positive throat culture-can be false neg
whats main causes of pharyngitis
mostly viral-rhino being most

bacterial-hemolytic strep
strep pyrogenes
tx for pharyngitis
OTC
DOC?
APAP-preferred
IBU-can cause toxic shock
analgesic

DOC-penV oral-250TIDx10days
if allergy give macros
bronchiolitis
risk factos
premature
heart prob
immunocompromised
signs of brionchiolitis

causes
wheezing-hallmark

RSV causes it-in so fl its year round causing
tx of brionchiolits
mainly manage o2 sat, but can use albuterol, ribavirin(doesnt dec mortality)
palivizumab
for who?
whats it do
its for prevention, for high risk pts with bronchio
its passive acquired-give every month, $$$$$
guidelines for palivizumab
who should get it?
high risk <2y.o
-premature (36wks or less)
cystic fibrosis
primary peritonitis
define
commonly in(etiology)
infxn in cavity without evidence of source

spontaneous bacterial peritonitis
10-30% in alcholoic cirrhois pts
bacteria for prim. peritonitis
E.Coli
Kleb
bacteroides

strep
staph
clinical presentation
primary peritonitis
absent bowel sounds!!
worsening enceph
cloudy dialysate
secondary peritonitis
define

etiology?
focal disease is in abdomen

-appendicitis**
tumors
surgery
secondary peritonitis
bacteria seen
E.coli
kleb
c. diff
bacteroides***must cover
strep
clinical presentation of secondary peritonitis
normal temp then inc to 100-102 in hours

hypotension->shock
dec. urine output
secondary peritonitis
labs
high BUN, dehydration

alkalosis->acidosis
abscess
define
collection of fluid encapsulized by inflam cells

result of peritonitis
what trives in abscess?

gold stand to diagnose it
anaerobic bacteria thrive

use CT
what are micro seen in pelvic inflam disease
neisseria gonorrhoeae

chlymadia
trac
micro seen in hepatic visceral abcess
amoeba
ecoli + anerobes
secondary peritonitis
how to tx?
has acidosis
so use 1 or 2 LD5W or lactated rings-->lactate=bicarb so helps with acids
agents for C.A. IntaAbdominal Infxns

mild to mod
b-lactamase inib (ticarcill + clav)
__________________
ertapenem
---------------------------------
(cefazolin, cefuroxime,ceftriax, cipro, levo) + metro
agents for C.A. IntaAbdominal Infxns

high-severity
piper/tazo
----------------------------------
meropen, imipenem/cilastain
-----------------------------------
(ceftaz, cefepime, cipro/levo, aztreonam) + metro
risk factors of high severity infxn

how u decide mod or high basically
tx not within/24 H
old ppl
malnourished
H.A. intra-abdomn infxns
use high severity + vanco

use antibiogram
new guidelines for C.A intra abdominal infxn
mod-mild
mm-avoid ampicill/aminogly,antifun
use-moxiflox or tigecycline
intra abdominal infxn-new guidelines
if bacteroides-which drug to avoid
avoid clindamycin, cefotetan
core measures of surgical infxn prevention
abx in 1 hr of incision

right drug for surgery

d/c abx in 24h of surgery

make sure t1/2 lasts surgery
superficial incisional infxn
characteristics?
</ =30days after operation
skin/subcutan infxn

one of following: drainage, +culture, sign of inflamm, wound opened by surgeon
deep incisional infxn
characteristics?
<30days after op or within 1 yr of prothesis implant

deep soft tissue

1 of following: drainage w/o organ involvement, fasical dehiscence, deep abscess
organ/space infxn
characteristics
<30 days of op or 1 yr of implant
involves structures not opened/manipulated

organism isolated from aseptic culture
cause of surgical infxns
pts skin
mucous
hollow organs
distant infxns
surgical ppl
staph is in what surgeries

strep in what surgeries
staph-most

strep-OBGYN, gastro
anaerobes in what surgery

enterococcus-
inta abdominal

ENTERO-OBGYN
how do u dose vanco
<80kg use 1g

>80kg use 2g
for cardiovascular surgery
use what agent?
cefazolin
cefuroxime
vanco
all in grams
gastro-billiary surgery
cefazolin
cefoxitin
cefotetan
cefuroxime
colorectal appendectomy surgery agents
cefzolin + metro
cefoxitin
cefotetan
neurosurgical surgery agents
cefazolin-clean?

clindamycin-contaminated?
OBGYN surgery agents
orthopedic
urologic
vascular
cefazolin all 1-2g 30-60 mins before
pts with penicillin allergies options-prophylaxis for surgeries
cephs
clindamycin 600mg PO 1 hr before
vanco 1 g IV 2 hours before incision
T or false
prophylactic regimens are NOT designed to prevent post-op infxns at other sites
True
goal is to prevent nosocrmial SSI, MRSA
lapatoscopic surgery
agents
usually NONE, unless they are old or immunocomped
if DRSP use what
if recent abx use, day care, <2yo

use high dose amox or clindamycin
bacterial sinusitis vs viral?
days
viral is 7-10days

bacterial >7 days
usual pathogens for sinusitis
usually viral,
step pneumonia
H. flu
M.cat
acute bacterial sinusistis tx
symptoms tx
decong.
saline
guafensin
2ng gen antihistamines
sinusitis
moderate sympt >10 days or have worsend after 5 to 7 days tx
Amoxicillin
if allergy-use clarithromycin or azithromycin
if DRSP (sinusitis) use what
if recent abx use, day car, <2yo

use high dose amox or clindamycin
if tx failure with amox for sinusitis, tx with?
no imprvt in 72h, use high dose augment
bactrim
cefurox, ceproz,cepodox
how long to use abx for sinusitis infxn
10-14days
acute bronchitis tx
usually non, self resolving
diff btwn acute and chronic bronchitis
a- <1month of sympt
sore throat, malaise
thin sputum
usually viral

c-COPD, excessive,thick sputum
can be viral or bacterial-H.flu, M.cat
wheezing
clear sign of bronchitis
CXR-clear!
if not clear its prolly pneumonia
what are mod symp of AECB that must be present for abx tx
>2 of these
increased dyspnea, sputum volume, sputum purulence
if > or = 2 mod symptoms for AECB, tx with what?
cefdinir, cefprozil, cefuroxime
azithrom, clarithro
bactrim
doxy
what are the severe risk factors needed for abx tx in AECB
>or = 65 yo
FEV <OR = 50%
4 episodes of AECB/year
1 or more comorbidities
if >1 or = 1 R.F. for AECB tx with what?
high dose augmentin
or resp FQ(moxi, levo)
if acute bronchitis and symp for >4-6 days do what?
if this or persistent fever tx with abx
diff btwn influenze A and B
A=A'S=all ages
B=usually kids
influenze A is broken into 2 categories based on

and what are the 2 names
surface antigens

Hemaglutinin(H)-helps virus attach- it Hooks

Neuraminidase(N)-helps virus penetrates- gets iN
antigenic shift vs drift
define
drift-change in antigenic surface

shift-major change in 1 or both of surface antigens
TIV-trivalent influenze
live or killed?
for who?
route?
killed
>or = 6months old
IM-shot
LAIV-attenuated influenze vaccine
live or killed?
for who?
route?
live
ages 2-49y.o.
intrasnal
LAIV
cold adapted, means?
if pt takin antiviral meds, LAIV should be admined when?

antiviral meds should not be given till how long after vaccine?
cold=cant replicate in lower airways

vaccine should not be given till 48h after meds stopped

meds can be started after 2 weeks of live vaccine
when vaccine is limited who get first dibbs?
>or=50 y.o
immunocomped ppl
kids geting aspirin reg(Reys)
health care ppl
BMI>40 FATTIES
drugs to tx influenze A + B
zanamivir
ostelamivir
peramivir

alt amantadine, rimantadine
tx must start within ? for influenza tx
within 48H for immuno comped, otherwise no good!
tx considerations for pneumonia

1st dose should be when?

general tx with what?
fluids

should be within 4H!
beralactams (50%pen in lung)
FQ's, macros, lenizolid(95%)
pathogen most likely cause of CAP?

CAP usually seen in what season
strep pneumo

winter
drug resist Step pneumo risk factors
<2 yo
>65
alcohol
day care
immuno supp
BL, macro or FQ in 3 months
CAP
other pathogens likely cause
M.Cat
H.flu
atypicals -usually in summer
Kleb pnuemo-alcoholics
viral
psuedomonas-rare
CAP-healthy OP(yes I used OP, fuck off)
1st line tx
macrolide (clarthi or azithro)
or doxy for kids >8

alt-respiratory FQs
CAP- comorbidity OP TX
Respiratory FQ
or
macro(or doxy) + betalactam(high dose amox, augmentin cefpod,ceftriax,cefurox)
CAP IP nonICU tx
repiratory FQ(IV or PO)

OR

IV B-lactam + macro(or doxy)

same tx as CAP OP comorb.
CAP IP ICU/intubated
tx
IV B-lactam + azithromycin IV or PO

or

IV B-lactam + IV Resp FQ
CAP MRSA tx
clindamycin, vanco
linezolid( most likely)**
if aspiration of pneumo....tx with
add anaerobic cov...clindamycin
HAP
early onset
time?
prognosis?
caused by
within first 4 days
better prognosis
by antibiotic suseptible bugs
HAP
late onset
time?
prognosis?
cause?
after 5 or > days
increase in mortality
multi-drug resist bugs
bugs seen in HAP
psuedomonas(1 cause)
Aceinetobacter (2 cause)
E. Coli
Kleb pneumo

staph
strep, H. flu
legionella
diagnosis of HAP
new lung infiltrate
+
2 of 3: fever, leukocytosis, purulent sectrions, low o2
HAP, VAP, HCAP tx
if <5 days use what kind of tx
if >5 days use...
<5 days=narrow
>5 days broad spectrum tx
MDR risks for HAP
just had abx therapy
hosp for >2/=days in last 90days
immuno therapy
in nursing home
pathogens for tx in limited spectrum HAP
step pnuemo
H. flu
MSSA
E.coli
Kleb pneumo
enterobact
drugs for limited sprectrum HAP
ceftriaxone
or
levo, moxiflox
or
ampicill/sulbactam
or
ertapenem
pathogens in broad spectrum HAP
all limited + psuedomon
kleb(ESBL)
acinetobacter

MRSA
legionella
tx for broad spectrum HAP
antipsuedo ceph, or antipsudeo carbapenm, or antipsuedo blactam/b-lactam inhib

+

antipsudeoFQ or AG
if MRSA HAP use
linezolid or vanco
if legionella HAP
USE
macrolide or FQ
pnuemococcal vaccine
who should get it?
>65 yo
or
<65 but with risk factors
or
current smoker
if <65 yo, who should get a pneumo vaccine
CV, pulm, renal, liver disease
DM
Alcoholics
immuno comped
native americans
long term care residents
pneumo vaccine
when should revaccination happen
after age 65yo, must be >5 years before..so 60 or less

or immunocomped ppl