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134 Cards in this Set
- Front
- Back
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MSSA abx: IV |
oxacillin/nafcillin |
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MSSA abx: Oral |
dicloxacillin |
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MRSA abx: Severe infx
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Vanco
Linezolin (TCP) Daptomycin (Myopathy) Ceftaroline (1st MRSA cephalo) Telavancin Tigecycline (MRSA & GNR; "Ceft + Vanco" [no Pseudomonas coverage]) |
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MRSA abx: Minor infx |
bactrim doxycycline |
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Staph abx: Penicillins cause rash |
cephalosporins
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Staph abx: Penicillins cause anaphylaxis |
macrolides (azithromycin, clarithromycin) or clindamycin
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Staph abx: Severe infx and PCN allergy |
Vanco Dapto Telavancin (derivative of and similar to Vanco) |
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Staph abx: Minor infx and PCN allergy |
macrolides (azithromycin, clarithromycin), clindamycin, bactrim |
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Strep antibiotics |
All of the above cover Staph and Strep Strep specific: Penicillin Ampicillin Amoxicillin |
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Gram-negative rods: E coli, Enterobacter, Citrobacter, Morganella, Pseudomonas, Serratia |
Cephalosporins (Cefepine, Ceftazidime) Penicillins (Pipera- & Ticarcillin) Monobactam (Aztreonam) Quinolones (Cipro-, Levo-, Moxi-, Gemifloxacin) Aminoglycosides (Gentamycin, Tobramycin, Amikacin) Carbapenems (Imi-, Mero-, Erta- and Doripenem) |
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what is the only carabapenem that doesn't cover pseudomonas |
ertapenem |
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Pseudomonas Abx |
aminoglycosides (genta, amikacin, tobramycin, but not kanamycin) |
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which 2 abx cover strep and anaerobes in addition to GNRs |
piperacillin and ticarcillin |
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which abx works synergistically with other drugs to treat staph and strep
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aminoglycosides
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name a GI anaerobe
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bacteroides
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what is the best abx for abdominal anaerobes |
metro |
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what three meds are almost equal to metro in their coverage of abdominal anaerobes
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These all also cover GNR, strep and MSSA too. carbepenems |
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name the only two cephalosporins that cover anaerobes |
cefoxitin
cefotetan |
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name a resp anaerobe
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anaerobic strep
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what is the best abx for anaerobic strep and lung abscess |
clindamycin
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what should you do if someone gets red man syndrome from vanco |
slow the infusion
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herpes simplex and varicella zoster antiviral agents |
acyclovir
valacyclovir famciclovir |
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CMV, HSV, and zoster antivirals |
ganciclovir Valganciclovir (best long therapy for CMV retinitis) |
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adverse effect of valgan and ganciclovir |
neutropenia and BM suppression
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adverse effect of foscarnet
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renal toxicity
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Antivirals for influenza A and B |
oseltamivir (neuraminidase inhibitors) |
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Hep C and RSV antivirals |
Ribavirin (plus IFN for HCV) |
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Chronic Hep B |
lamivudine telbivudine All oral except IFN. Generally no toxicity. No combos for HBV (combos for HCV) |
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Antifungal for candida and cryptococcus |
fluconazole (also for oral and vaginal candidiasis as an alternative to topicals) Itraconazole: as effective but more difficult to use. |
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coveral all candida; best agent for Aspergillus |
voriconazole AE: visual disturbances |
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fungal treatment for neutropenic patients
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echinocandins (caspofungin, micafungin, anidulafungin) Good for yeasts and aspergillus Better than ampho (less mortality) No significant human toxicity (1,3 glucan synthesis) Do not cover cryptococcus |
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adverse effect of echinocandins
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none |
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Amphotericin |
Effective against all Candida, Crypto and Aspergillus - Aspergillus: Voriconazole superior - Neutropenic fever: Echinocandins superior - Candida: Fluconazole equal efficacy and far fewer AEs Two remaining indications for ampho: 1. Cryptococcus (with fluconazole, lifelong) 2. Mucormycosis (Rhizopus) |
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adverse effects of amphotericin |
renal toxicity - distal renal tubular acidosis (↑CRT & ↓Bicarb) |
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Osteomyelitis diagnostic testing |
Best initial: x-ray Second-line (high suspicion and negative xray): MRI. (Bone scan has equal Sn abut MRI has far greater Sp) Most accurate: Bone biopsy & culture |
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earliest x-ray finding of osteo |
Periosteal elevation |
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follow response to osteo treatment |
ESR. 90% of pts will have no fever and a normal white cell count. If ESR still ↑ after 4-6 weeks need further treatment and possible I&D |
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Osteo treatment |
Staph is still the MCC MSSA: oxacillin or nafcillin IV for 4-6 weeks MRSA: Vanco, dapto, linezolid Cannot use oral therapy for staph osteo (for at least the first month) |
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GNR that can cause osteo |
salmonella This is the only form of osteo that can be treated with oral abx (quinolones). - Must confirm with bone bx - Must be sensitive - No urgency to tx on CCS |
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Diagnosis of otitis externa |
No specific tests necessary. Don't routinely culture the ear canal. |
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tx for otitis externa
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topical abx - ofloxacin or polymixin/neomycin Add acetic acid and water soln to reacidify |
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what is malignant otitis externa
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osteomyelitis of the skull from pseudomonas
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Diagnosis of malignant otitis externa |
Best initial: Skull x-ray or MRI Most accurate: bone biopsy |
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Malignant otitis externa treatment |
surgical debridement and abx against pseudomonas (cipro, piperacillin, cefepime, carbapenem, aztreonam) |
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most sensitive test for otitis media |
No specific tests. bulging membrane - if it moves, it's not OM. Other findings: redness, bulging, ↓ hearing, loss of light reflex |
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best initial therapy for otitis media |
amoxicillin for 7-10 days. Abx for bilateral or severe unilateral disease in all infants. Children > 24 mos w/ mild disease can be observed. |
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Recurrent or persistent otitis media |
tympanocentesis
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If OM fails to improve after 3 days |
Move clock forward and switch to: amoxicillin-clavulanate cefpodoxime |
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bugs that cause otitis media and sinusitus |
S pneumoniae (Most cases are viral) |
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Sinusitis diagnostic testing |
Best initial: X-ray Most accurate: Sinus aspirate for culture (more accurate than CT or MRI) |
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treatment for sinusitis
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Rest and ample water. same as OM but add inhaled steroids. Add amoxicillin (or augmentin or cephalos) for: - Fever and pain - Persistent sx despite 7 days of decongestants - Purulent nasal discharge Use fluoros, clarithro, or Doxy for severe PCN allergy |
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Pharyngitis diagnostic testing |
Best initial: Rapid strep test. Just as specific as a throat culture. In adults, sensitivity of the RST is enough; if negative no further testing required. Most accurate: Culture |
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tx for strep pharyngitis
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penicillin or amoxicillin PCN allergy: - Rash: cephalos - Anaphylaxis: azithromycin or clarithromycin |
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dx test for influenza?
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viral antigen detection from nasopharyngeal swab |
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when is the correct time to use oseltamivir or zanamivir on a Pt with influenza A or B
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within 48 hrs of symptom onset. These are neuraminidase inhibitors and effective against both A and B. (Amantadine and rimantadine only effective against A and are wrong answers; used in Parkinsons) |
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who should get vaccinated against influenza
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Acceptable in general population at any age. Strongest indications are: COPD Egg allergy no longer a CI. Live attenuated not for older or IC'd |
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weeping, oozing, honey-colored lesions... |
Impetigo Infecting the epidermal layer |
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tx for mild impetigo |
mupirocin (Bactroban) or retapamulin |
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tx for severe impetigo
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oral dicloxacillin or cephalexin
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tx for impetigo if CA-MRSA |
bactrim, sometimes clinda |
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very bright red skin and hot skin...often affecting the face
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erysipelas
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best initial treatment for erysipelas |
oral dicloxacillin or cephalexin (same as for severe impetigo). If organism confirmed as GAS - PCN VK |
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can skin infx cause rheumatic fever and glomerulonephritis like strep throat can?
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no, just glomerulonephritis but not rheumatic fever
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warm, tender, red, hot skin usually on leg or arm
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cellulitis
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what should you order if cellulitis presents on leg
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doppler (r/o DVT)
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2 organisms that cause cellulitis
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staph and strep (nearly equal) |
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tx for mild cellulitis |
oral dicloxacillin or cephalexin (same as for severe impetigo or erysipelas) |
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tx for severe cellulitis
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IV oxacillin, nafcillin, or cefazolin
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Tx for cellulitis with PCN allergy |
Rash: Cephalos (cefazolin) Anaphylaxis: Vanco, Linezolid, Dapto, Televancin - Minor infx: bactrim, clinda, macrolides |
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what skin infx is caused by staph epidermidis
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none. nml skin flora
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treatment for folliculits
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same as for cellulitis (minor: dicloxacillin or cephalexin oral; severe: oxacillin, nafcillin, or cefazolin IV). you can drain boils |
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best initial test for fungal infx of skin
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KOH prep:
scrape skin or nail put on slide with KOH and acid heat slide (epi's dissolve) |
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tx of fungal infx of skin if no hair or nail involvement
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clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin or ciclopirox
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tx of tinea capitis or onychomycosis
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terbinafine (hepatotoxic) Griseofulvin (tinea capitis): harder to use and less effective |
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someone with tinea capitis comes in with elevated LFT's. dx?
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terbinafine use
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Urethritis diagnostic tests |
Frequency, urgency, burning, dysuria Initial: urethral swab for gram stain, WBC, cx, DNA probe Most accurate: NAAT |
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tx of urethritis
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one drug against gonorrhea (ceftriaxone IM (pregnant)) and one against chlamydia (azithromycin x1 dose (prego) or doxy x1 wk) Fluoroquinolones no longer effective against gonorrhea |
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what should you test for in someone who gets recurrent urethritis
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terminal complement deficiency - thet get recurrent neisseria infx (genital or CNS)
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how do you tx cervicitis
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same as for urethritis: one drug against gonorrhea (ceftriaxone IM (pregnant)) and one against chlamydia (azithromycin x1 (prego) or doxy x1wk) |
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PID diagnostic tests |
Initial: Beta HCG, cervical cx, and DNA probe for chlamydia and gonorrhea Most accurate: Laparoscopy but rarely done (recurrent or persistent infx) |
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tx for PID as outpatient
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ceftriaxone IM and doxy oral
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tx for PID as inpatient
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cefoxitin IV (or cefotetan) and doxy, and maybe metro |
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abx safe in pregnancy |
All beta-lactams penicillins Nitrofurantoin |
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difference in presentation of epidydimo-orchitis vs testicular torsion
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in testicular torsion the testicle is elevated and in transverse position
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tx for epidydimo-orchitis
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<35: ceftriaxone and doxy
>35: fluoroquinolone |
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dz and organism associated with painful genital ulcer
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chancroid - haemophilus ducreyi |
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best initial tx for chancroid |
Soft painful ulcer swab for gram stain and cx |
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findings on swab stain of someone with painful genital ulcer |
(chancroid) cx: requires Nairobi medium or Mueller-Hinton agar |
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tx for chancroid |
ceftriaxone IM x1 or azithromycin oral x1
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genital ulcer + large tender lymph nodes (buboes - may develop draining sinus tract) |
lymphogranuloma venererum
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work-up and tx for LGV |
serology for chlamydia |
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dx and tx of man with vesicles on penis and lg inguinal lymph nodes |
HSV2 |
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organism responsible for painless, firm genital lesion and painless adenopathy |
(syphilis) |
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Primary syphilis diagnostic testing |
Initial: Darkfield microscopy, then VDRL/RPR (only 75% Sn) Most accurate: Darkfield |
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symptoms and tx for primary syphillis |
chancre (firm, painless genital lesion) and LAD
Jarish-Herxheimer rxn: fever, HA, myalgia 24 hours later. Benign, self-limited; tx w ASA |
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sx and secondary syphillis
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sx: rash, mucous patch, alopecia areata (spot baldness), condylomata lata (painless warty lesions) |
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initial dx test for secondary syph
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RPR and FTA |
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tx for secondary syph
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penecillin IM x1
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sx of tertiary syphillis |
tabes dorsalis (posterior column deficits), argyll-robertson pupil, general paresis, gumma, aortitis (very rare). |
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initial dx test for tertiary syph
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RPR and FTA (LP for neurosyph - test CSF for VDRL and FTA). Neurosyphilis is excluded with a negative CSF FTA |
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tx of tertiary syph
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penicllin IV. Desensitize if PCN allergic. |
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Pt is allergic to penicillin, desensitize if: |
neurosyphillis
pregnant |
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beefy red genital lesion that ulcerates
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granuloma inguinale
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initial dx test for beefy red genital lesion that ulcerates |
(granuloma inguinale) |
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tx for beefy red genital lesion that ulcerates
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(granuloma inguinale) |
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what's the difference between pediculosis and scabies
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scabies are smaller and burrow in the web spaces. pediculosis are in the hair (axilla and groin) and are visible to naked eye
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tx for scabies or pediculosis
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permethrin or lindane
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how are warts diagnosed
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visually
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5 options for treating warts
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surgically
imiquimod (immunostimulant) cryotherapy laser removal melting with podophylin |
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tx of uncomplicated cystitis
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bactrim PO x3 days. If E. coli resistance > 20%, use cipro or levoflox |
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tx of complicated UTI
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bactrim or cipro x7 days "complicated" means stone, stricture, tumor or obstruction |
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who should be treated for asymptomatic bacteriuria
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only pregnant women
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tx for pyelo |
outpatient: cipro Ceftriaxone (or any 4g ceph) Aztreonam Cipro/levo for 5d Amp & Gent for 7d Carbapenems Amp/sulbactam Fluoroquin resistance > 10% - add ceft, gentamicin, Tobramycin or Amikacin. 2nd line: bactrim |
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nitrites on UA indicate what |
gram neg bacteria
Leukocyte esterase means presence of bacteriuria; same as white cells |
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what should you do if pyelo is not responding to tx after 5-7 days |
CT or US to look for perinephric abscess |
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most accurate dx test for perinephric abscess |
bx. This is the only way to determine precise microbiologic dx and guide therapy. |
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tx of perinephric abscess
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quinolone AND staph coverage (oxacillin or nafcillin)
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prostatits |
Diagnosis - Initial: UA - Accurate: Urine WBCs after prostate massage
Treatment cipro or bactrim for a long time (it's like an abscess - use same drugs as cystitis and pyelo but extend length) |
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how many of the duke's criteria are necessary to diagnose endocarditis
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2 major, 1 major + 3 minor, or 5 minor |
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what are the 2 major risk factors for endocarditis |
+ blood cx
2 pos blood cx + pos echo = Endocarditis |
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what are the 5 minor criteria for endocarditis
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fever >38
lifestyle risk factors vascular findings immunologic findings + blood cx but not common organism |
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5 lifestyle risk factors for endocarditis
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IV drug use
structural heart dz prosthetic valve dental procedures w/ bleeding h/o endocarditis |
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5 vascular findings in endocarditis |
janeway lesion (flat, nontender on palms & soles) |
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3 immunologic findings in endocarditis
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roth spots (retina) |
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first step if fever and new heart murmer or change in murmer |
blood cx, if pos THEN echo Do TTE first and if neg do TEE |
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best empiric tx of endocarditis |
vanc and gent together x4-6 weeks If it's sensitive use the beta-lactam (oxa, naf, cefazolin) |
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next step if blood cx positive for strep bovis |
colonoscopy
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the only 4 cardiac defects that require endocarditis ppx
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prosthetic valve
unrepaired cyanotic heart dz previous endocarditis transplant Pt w/ valve dz |
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the only 3 procedures that need endocarditis ppx |
dental that causes bleeding (amoxicillin) |
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which abx should you use to ppx treat for endocarditis in someone getting surgery on their gums |
amoxicillin
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NRTIs |
AEs of class: lactic acidosis - stop meds Zidovudine: anemia Didanosine & stavudine: Pancreatitis and perif neuropathy Lamivudine Abacavir: rash - severe (SJS) Emtricitabine Tenofovir: RTA |
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Protease inhibitors |
AE of class: HyperGLC and HyperLipid anything "-navir" Indinatir: kidney stones |
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NNRTIs |
AE of class: drowsiness Efivarenz Nevirapine Etravirine Rilpivirine |
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Mechanisms Telavancin ceftaroline linezolid tmp-smx |
-Bactericidal inhibits cell wall synthesis by binding to D-Ala-D-Ala terminus of growing cell wall -inhibits cell wall growth by binding thr penicillin binding protein -inhibits protein synthesis -inhibits folate antagonist |
