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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 |
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DOC for enterococcus?
2nd line? 3RD |
1st- ampicillin
2nd-Vanco 3rd- if VRE, use daptomycin or linezolid |
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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 |
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Aerobic Gram + bacilli
3 |
listeria
corynebacterium bacillus |
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DOC for listeria
DOC for bacillus anthracis |
L- ampicillin
anthrax-doxy + tetra |
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describe gram negative bacteria
|
2 cell walls
perisplasmic space btwn walls Pspace-where B lactamses are |
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gram negative cocci
examples |
M. Cat
Neisseria gonorrhoea(diplococci) H. Influenzae |
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tx C.A.P with?
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macrolides
azithromycin |
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what are 2 ESBL gram neg bacilli
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E. coli
Klebsiella pneumoniae, oxytoca |
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which gram neg. bacilli causes cystic fibrosis
|
burkholderia cepacia
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non fermenting gram neg bacilli
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Psuedomonas aetuginosa
acinetobacter baumanii S. maltophillia Burk. cepacia must tx for 14 days, fermenting=7-10 days |
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Anaerobic positive org
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C.diff
C. perfingens-gan greene P acnes-acne |
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Anaerobic negative organisms
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B.frag
prevotella species |
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examples of atypicals
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mycoplams pneumoniae
chlamydia pneumoniae legionella pneumophillia |
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drugs to tx atypicals
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azithromycin(macrolidies)
levofloxacin moxiflox (FQs) |
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Mycobacterium fast growers
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M foruitum
M. abscessus M. chelonae fast->FAC |
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how do you calc the MBC
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x2 the MIC
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interpretation of MICS
S I R |
S-suseptible at regular doses
I-suseptible at high doses R-resistent-not suspt. at any dose |
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how to determine the % of MRSA
|
look at the % of oxicillin suseptible for staph areus
100-x= 100-38%=62% of MRSA for jackson |
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colonization vs infection
|
c-supp pathogentic bacteria
stim cross protective antibodies i-cause damage to hose |
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Indicators of infection
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>38C or 98.5F
BANDS>Segs bands norm <5%, but higher in ifxn |
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how to calc ANC
|
ANC= (B + S) x (WBC X 1000)
or =(Neut %) x (WBCx1000) |
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normal ANC range
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1500 to 8000
neutropenia <500 cells/mcl |
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colonization issues
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org. present but no disease/immune response=false positive culture
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antacids and cations interfere with which abx?
when to take? |
quinolones + tetracyclines
take abx 2 hrs before or 4h after |
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which drugs cause QT prolongation
|
quinolones, macrolides, and azoles
|
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synergistic drugs
example? |
beta=lactam opends drug cell wall and aminoglycoside works to dec protein synthesis
for enterococcos |
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example of resistance
binding site change |
MSSA to MRSA via MecA gene
PBP2->PBP2A |
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vanco is static or cidal?
linezolid is static or cidal? |
vanco is cidal
linezolid is static |
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when would you never use linezolid?
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never for MRSA in blood
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what is good at penetrating prostate, eyes, brain, lungs
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FQs
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what is a combo drug given to old ppl for meningitis
|
ceftriaxone and ampricillin
wierd cause 2 beta lactams-usually not together |
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4 mechs of resistence?
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beta-lactamase
change binding site efflux pumps porin channels |
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which is more agressive: wild type or resistant bacteria?
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wild type- even though resistant is hard to kill, its slow and not too agressive
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what drugs are affected by porin channels?
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CLEAN
clind, clarith, erythromy, azithromycin dalfopristin |
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what drugs are affected by efflux pumps
|
macrolides-CLEAN
FQ's tetraclycines clindamycin |
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what is DOC for ESBL
e.coli, kleb, proteus |
carbapenems
|
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if pt with penicillin allergy needs beta lactam drug..which is least likely to react
|
monobactams-aztreonam
|
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how do beta-lactams work?
|
block cell wall synthesis
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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 |
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beta-lactams
cidal or static? which organism is not affected |
cidal
except enterococci |
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what drug is cidal against enterococci
|
nothing, everything is static
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beta lactam
PK |
time dependect...T>MIC, longer time better killing
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which beta lactam can only be infused intermittant: 30mins
|
ampicillin
|
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allergy percentage:
penicillin to carbapenem penicillin to cephalosporin |
pen to carb is 30%
pen to ceph 3-5% |
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cephalosporin allergy
ceph to carb ceph to peni |
high
|
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SJS +TEN allergy
& skin lose? |
seen with beta lactam allergy
SJS-10% TEN->30% |
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natural penicillins coverage
|
staph-but not clinically
DOC for syphillis (T. Pallidum) |
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antistaphylococcal penicillin drugs
coverage? |
CONDM-clox, ox, naf, diclox, methacillin
cover MSSA-made for staph areus! |
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aminopenicillins
drugs? coverage? |
ampicillin, amoxicillin
cover enterococcus, but lost the Staph coverage |
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DOC for listeria
|
ampicillin
|
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antipsuedomonal penicillins
drugs? coverage? |
piperacillin, ticarcillin
cover psuedomonas, enterococcus |
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b-lactamase inhib
drugs? + ampicillin coverage? |
clavulanic acid
tazobactam sulbactam with ampicillins- get ampicill coverage + MSSA, gram neg except SPACEMs BACTEROIDES covered!!! |
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b-lactamase inhib+piperacillin
pipercillin + tazobactam coverage? |
staph areus
SPACEM!! Bacteroides |
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what are SPACEMs
|
S-erretia
P-suedomonas A-ceinobacter C-itrobacter E-nterobacter M-organella (indole proteus) |
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SPACEMs harbor what?
should avoid what? |
harbor AmpC blactamses in cytoplasm
avoid 1,2,3rd gen cephalosporins |
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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 |
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which gen of cephalosporins cover enterococcus
|
NONE of cephs cover enterococci
|
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1st gen ceph drugs?
coverage? |
cephalexin, cefazolin, cefadroxil
good gram posit. gram neg-PEcK P. miarbilis, Ecoli, Kleb pneumoniae no anerobes |
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2nd gen ceph drugs?
coverage |
cefuroxime, cefprozil, cefotetan, cefoxitin
HeNPEcK-more gram neg H.flu, morexella,Nisseria cefoxitin, cefotetan-anerobe coverage |
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3rd gen ceph drugs
coverage? |
ceftriaxone, ceftazaidime, cefdinir, cefpodoxime
more gram neg(SPACEM)-BUT TRY TO AVOID good gram positive-not staph |
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which 3rd gen ceph covers psuedomonas
|
ceftazidime
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4th gen ceph drug?
spectrum? |
cefepime
good gram + and neg SPACEMs!!! Psuedomonas!! |
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Pipercillin/tazo
vs cefepime coverage |
both cover SPACEMs
but piper/tazo covers anerobes add metro to cefepime for anero coverage |
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5th gen ceph
|
ceftaroline
extends coverage for MRSA |
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cephalosporin dosing
which is biliary excreted? |
all in grams
ceftriaxone-axes will make you ****! so good for renal dysfxn |
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carbapenems
drugs? |
imipenem-cilastatin
meropenem ertapenem doripenem |
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carbapenem
coverage |
MSSA, streptococcus
ESBLs, nocardia(imipenem) |
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carbapenems do not cover what?
|
stenotrophomonas or legionella
|
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meropenem
vs ertapenem |
meropenem is a gorilla
so it covers APE Aceinobacter Psuedomonas Enterococcus ertapenem is a lil monkey not ape |
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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 |
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monobactam
drug? activity? dosage? |
aztreonam
gram negatives ONLY-psuedomonas!!! good for pts with penicillin allergy dosed in grams inhalation product for cyst. fibrosis |
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FQ's
cause glycemic changes? cause QTc prolongation? |
gatifloxacin- gly+fat
grep+sparfloxacin |
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FQs
cause phototoxic cause liver tox |
photo-sparflox
liver-trovafloxacin |
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FQs
drugs(commonly uses ones) |
moxifloxicin
levofloxacin ciprofloxacin gemifloxacin |
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which antibiotic is first synthetic (man made)?
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FQs
|
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FQs coverage
|
great streptococci(except cipro)
enterobacteriaceae anaerobes(moxiflox) atypicals |
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FQs that have psuedomonas coverage?
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cipro and levo
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why cant cipro work for strep pneumoniae
|
it penetrates lungs well, but doesnt cover the organism
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when you hear wierd organisms, think why class of drugs?
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FQs
legionella chlamydia |
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FQs MOA?
|
inhib. bacterial topoisomerase IV and DNA gyrase (topo II)
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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 |
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low to high conc needed to fight Strep penumon.
mox, cip, levo |
low--> high
mox, levo, cipro(very large conc needed) |
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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 |
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FQs S.E.s
|
phototoxic-wear sunscreen
QTc interval can rupture achiliestendons |
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FQs dosing
|
moxifloxacin doesnt need renal dose
all given in mg |
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Macrolides
drugs? work wear? |
CLEAN
clarithromycin, erythromycin, azithromycin work at 50S protein synthesis |
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Macrolides
coverage |
bacteriostatic
atypicals** H.flu-azithro is DOC strep pneumoniae |
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which macrolide is a motilin agent
which is commonly used for H. flu |
erythromycin
clarithromycin |
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macrolide
SEs |
QTC prolongation
interactions-mainly erythromycin |
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bactrim
gen name? work by? used for? |
sulfa/trim
block folic acid synthesis use-UTI(ecoli) Nocardia toxoplamosis |
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how is bactrim dosed by?
|
dosed by the trim portion-think rate limiting factor
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Bactrim AE
|
sulfa allergy
cause bone marrow suppression** -photo sensitivity HYPER K** |
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bactrim dosing
|
requires renal adjustment
SS=400/80 DS=800/160 15MG/KG daily |
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tetracyclines
drugs work where? |
part of TAG
at 30S tetracycline, doxycyclines, minocyclines |
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tetracyclines cover
|
atypicals
MSSA, MRSA strep pneumo BURGDORFERI-lymes disease acnes |
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tetracyclines
avoid in? cause? take how? |
in persons <8 yo or pregnancy
-cause brown/blue teeth take on empty stomach |
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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 |
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tigecycline
SE not to use when? |
N/V(30%)-give zofran
NOT FOR BACTEREMIA!!! |
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tigecycline dosing?
|
IV ONLY 100mg, then 50 q 12H
liver do half no renal adjust. |
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metronidazole
static or cidal? covers? |
cidal-loss of helical dna
ANAEROBIC coverage-C.DIFF |
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metro
SE. Intxn dose adjustment? |
metal taste, dark urine
alcohol-disulfuram rxn=nasuea only adjust in severe renal impairment |
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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 |
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clindamycin
SE |
C. diff colitits(avoid long term use)
no renal adjust necessary |
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aminoglycosides
drugs? work where? cover? |
gentamicin, tobramycin, amikacin all are IV
part of TAG-work at 30s mono only for UTI cover mainly negatives |
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aminoglycosides
monitor? |
throughs for ADE
nephrotoxic goal is through of <.6mcg/ml |
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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 |
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Vanco
distrib SE. |
large-use TBW
caues Redman syndrome(histamine release)-infuse slowly 1g/60-90mins - this is not an allergy can cause thrombophlebitis |
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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 |
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linezolid
coverage? dosed? |
bacteriostatic for staph and enterococci
NOT for MRSA bacteremia NO gram neg coverage 100%BA, always dosed 600mg BID |
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linezolid
what kind of drug SE |
oxa zolid inone
thrombocytopenia > 28days causes serotonin syndrome |
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daptomycin
type of drug? |
lipoglycopeptide--vanco is just a glycopeptide
|
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dapto
MOA? |
rapid DEPOLARIZATION!
no gram - +=enterococc,VRE, MSSA, MRSA, strep |
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dapto
never use when? dosage? |
for pneumonia-inactivated by surfactant in lung
ONLY IV, watch in renal dysfxn |
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telavancin
MOA SE |
vanco(d-ala,dala) + dapto(depol)
gram + only-MRSA NOT VRE! SE-foamy urine, QT prolong |
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dalfopristin/quinprisitn
|
synercid
covers VRE faecium(+) causes inflam at injection site |
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fidaxomicin
treats MOA? |
C.diff
inhib RNA polym sigma subunit |
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nitrofurantoin
MOA? covers? SE |
***** with acetyl coA
covers-Ecoli,Kleb,Staph but really only UTI tx causes pulm fibrosis not for preg or renal dysfxn |
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polymixin E
MOA coverage SE |
cationic detergent-causes leaking of intracellular stuff
-cidal broad gram + cov -MDR pseudomonas, Aceinobacter NEPHROTOXIC!! |
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fosfomycin
MOA coverage |
inactivvates pyruvyl tranferase-cell wall form
-cidal MRSA, VRE cov utility-KPCs & EBBL +UTIs |
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Rifampin
MOA |
blocks RNA synthesis
penetrates biofilms on hardware |
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ABX NOT requiring renal adjustment
|
CONDMs
moxifloxacin ceftriaxone cefperizone doxy tigecycline clindamycin |
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drugs active against psuedomonas
|
pipercillin/tazobactam
cefepime levoflox ciproflox aminoglyc ceftazidime aztreonam meropenem imipenem colistin |
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agents agaist MRSA
|
vanco
depto (not pnuemo) linezo(not bactermia) dalfo/quinu clindamycin bactrim doxy ceftobiprole quinu/dalfo |
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what agents for taken oral for skin MRSA
|
bactrim, doxy, clindamycin
|
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see nocardia
think? |
bactrim
|
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see stenotrophamonas
think? |
bactrim
|
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see atypicals
think |
FQs
macrolides |
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see anaerobes
think |
metro, clindamycin, pen w beta lactamase inhib
|
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see C.diff think
|
metro, oral vanco, fidaxomicin
|
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see ESBL think?
|
carbapenems
|
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see KPC
think? |
colistin
|
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see VRE
think? |
daptomycin, linezolid, dalfo/quinu, tigecycline
|
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see corynebacterium
think? |
vancomycin
|
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ABX with inhal forms
|
tobramycin, atreonam, colistin
|
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ABX that can be give intrathecally
|
tobramycin
gentamycin vanco colistin |
|
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main risk factors for AOM
|
<2 y.o.
day care recent antibiotic use male winter season smoke-even if person does outside |
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3 things needed to diagnose AOM
|
1-ACUTE onset-w/i 4 H
2-Middle ear effusion 3-middle ear inflamm. |
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T or F
middle ear effusion is not the same as Acute otitis media |
true
MEE-can take 3 months to resolve |
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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 |
|
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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 |
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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 |
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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 |
|
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AOM
after watching for 48-72H |
start giving em something-see last chart
|
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|
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 |
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prevention of AOM
|
influ vaccine-6 to 23months old (dec reccurent AOM by 30%)
breast fed.mmmmmmm |
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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 |
|
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tx of brionchiolits
|
mainly manage o2 sat, but can use albuterol, ribavirin(doesnt dec mortality)
|
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|
palivizumab
for who? whats it do |
its for prevention, for high risk pts with bronchio
its passive acquired-give every month, $$$$$ |
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|
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 |
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|
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 |
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|
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 |
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anaerobes in what surgery
enterococcus- |
inta abdominal
ENTERO-OBGYN |
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how do u dose vanco
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<80kg use 1g
>80kg use 2g |
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for cardiovascular surgery
use what agent? |
cefazolin
cefuroxime vanco all in grams |
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gastro-billiary surgery
|
cefazolin
cefoxitin cefotetan cefuroxime |
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colorectal appendectomy surgery agents
|
cefzolin + metro
cefoxitin cefotetan |
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neurosurgical surgery agents
|
cefazolin-clean?
clindamycin-contaminated? |
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OBGYN surgery agents
orthopedic urologic vascular |
cefazolin all 1-2g 30-60 mins before
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pts with penicillin allergies options-prophylaxis for surgeries
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cephs
clindamycin 600mg PO 1 hr before vanco 1 g IV 2 hours before incision |
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T or false
prophylactic regimens are NOT designed to prevent post-op infxns at other sites |
True
goal is to prevent nosocrmial SSI, MRSA |
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lapatoscopic surgery
agents |
usually NONE, unless they are old or immunocomped
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if DRSP use what
|
if recent abx use, day care, <2yo
use high dose amox or clindamycin |
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bacterial sinusitis vs viral?
days |
viral is 7-10days
bacterial >7 days |
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usual pathogens for sinusitis
|
usually viral,
step pneumonia H. flu M.cat |
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acute bacterial sinusistis tx
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symptoms tx
decong. saline guafensin 2ng gen antihistamines |
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sinusitis
moderate sympt >10 days or have worsend after 5 to 7 days tx |
Amoxicillin
if allergy-use clarithromycin or azithromycin |
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if DRSP (sinusitis) use what
|
if recent abx use, day car, <2yo
use high dose amox or clindamycin |
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if tx failure with amox for sinusitis, tx with?
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no imprvt in 72h, use high dose augment
bactrim cefurox, ceproz,cepodox |
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how long to use abx for sinusitis infxn
|
10-14days
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acute bronchitis tx
|
usually non, self resolving
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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 |
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clear sign of bronchitis
|
CXR-clear!
if not clear its prolly pneumonia |
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what are mod symp of AECB that must be present for abx tx
|
>2 of these
increased dyspnea, sputum volume, sputum purulence |
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if > or = 2 mod symptoms for AECB, tx with what?
|
cefdinir, cefprozil, cefuroxime
azithrom, clarithro bactrim doxy |
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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 |
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if >1 or = 1 R.F. for AECB tx with what?
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high dose augmentin
or resp FQ(moxi, levo) |
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if acute bronchitis and symp for >4-6 days do what?
|
if this or persistent fever tx with abx
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diff btwn influenze A and B
|
A=A'S=all ages
B=usually kids |
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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 |
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antigenic shift vs drift
define |
drift-change in antigenic surface
shift-major change in 1 or both of surface antigens |
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TIV-trivalent influenze
live or killed? for who? route? |
killed
>or = 6months old IM-shot |
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LAIV-attenuated influenze vaccine
live or killed? for who? route? |
live
ages 2-49y.o. intrasnal |
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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 |
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when vaccine is limited who get first dibbs?
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>or=50 y.o
immunocomped ppl kids geting aspirin reg(Reys) health care ppl BMI>40 FATTIES |
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drugs to tx influenze A + B
|
zanamivir
ostelamivir peramivir alt amantadine, rimantadine |
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tx must start within ? for influenza tx
|
within 48H for immuno comped, otherwise no good!
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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%) |
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pathogen most likely cause of CAP?
CAP usually seen in what season |
strep pneumo
winter |
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drug resist Step pneumo risk factors
|
<2 yo
>65 alcohol day care immuno supp BL, macro or FQ in 3 months |
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CAP
other pathogens likely cause |
M.Cat
H.flu atypicals -usually in summer Kleb pnuemo-alcoholics viral psuedomonas-rare |
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CAP-healthy OP(yes I used OP, **** off)
1st line tx |
macrolide (clarthi or azithro)
or doxy for kids >8 alt-respiratory FQs |
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CAP- comorbidity OP TX
|
Respiratory FQ
or macro(or doxy) + betalactam(high dose amox, augmentin cefpod,ceftriax,cefurox) |
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CAP IP nonICU tx
|
repiratory FQ(IV or PO)
OR IV B-lactam + macro(or doxy) same tx as CAP OP comorb. |
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CAP IP ICU/intubated
tx |
IV B-lactam + azithromycin IV or PO
or IV B-lactam + IV Resp FQ |
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CAP MRSA tx
|
clindamycin, vanco
linezolid( most likely)** |
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if aspiration of pneumo....tx with
|
add anaerobic cov...clindamycin
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HAP
early onset time? prognosis? caused by |
within first 4 days
better prognosis by antibiotic suseptible bugs |
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HAP
late onset time? prognosis? cause? |
after 5 or > days
increase in mortality multi-drug resist bugs |
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bugs seen in HAP
|
psuedomonas(1 cause)
Aceinetobacter (2 cause) E. Coli Kleb pneumo staph strep, H. flu legionella |
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diagnosis of HAP
|
new lung infiltrate
+ 2 of 3: fever, leukocytosis, purulent sectrions, low o2 |
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HAP, VAP, HCAP tx
if <5 days use what kind of tx if >5 days use... |
<5 days=narrow
>5 days broad spectrum tx |
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MDR risks for HAP
|
just had abx therapy
hosp for >2/=days in last 90days immuno therapy in nursing home |
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pathogens for tx in limited spectrum HAP
|
step pnuemo
H. flu MSSA E.coli Kleb pneumo enterobact |
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drugs for limited sprectrum HAP
|
ceftriaxone
or levo, moxiflox or ampicill/sulbactam or ertapenem |
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pathogens in broad spectrum HAP
|
all limited + psuedomon
kleb(ESBL) acinetobacter MRSA legionella |
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tx for broad spectrum HAP
|
antipsuedo ceph, or antipsudeo carbapenm, or antipsuedo blactam/b-lactam inhib
+ antipsudeoFQ or AG |
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if MRSA HAP use
|
linezolid or vanco
|
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if legionella HAP
USE |
macrolide or FQ
|
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|
pnuemococcal vaccine
who should get it? |
>65 yo
or <65 but with risk factors or current smoker |
|
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if <65 yo, who should get a pneumo vaccine
|
CV, pulm, renal, liver disease
DM Alcoholics immuno comped native americans long term care residents |
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|
pneumo vaccine
when should revaccination happen |
after age 65yo, must be >5 years before..so 60 or less
or immunocomped ppl |
