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STD Pharm

Gonorrhea Therapeutic principles ? * Be highly effective at all anatomic sites of infection --- Be well tolerated (particularly in patients with recurrent infections) --- Offer the feasibility of single-dose therapy at the point of care
Therapeutic regimens should ? * have efficacy rates of greater than 95 percent because treatment failure has significant public health implications related to ongoing transmission of infection
Why single dose therapy ? * B/c it ups the adherence rate of patients to stop their disease and stop its spread....... also see lower drug resistance and lower side effects.... * Drug = ceftriaxone (single dose and high efficacy)
The selection of antibiotics for the treatment of gonorrhea must also include the possibility of ? * Copathogens, such as Chlamydia
Antibiotic resistance and Gono. ? * recently strains are becoming more and more resistant to drugs and even multiple drugs
Happened due to antibiotic resistance ? * ceftriaxone as a single agent for gono is no longer recommended....... * ceftriaxone should be administered in combo w/ either azithromycin or doxycycline, regardless of chlamydial coinfection status
Current Tmt for Gono. = ? * For uncomplicated = Ceft. (IM) + Azithro. (Oral)...* Doxy can be used instead of Azithro.
Why no Azithro. mono-therapy ? * even though it could easily take care of both Gono and Chlamydia, its has high GI SEs and we are trying to not get Gono resistance to Azithro.
Disseminated gonococcal infection (DGI) is seen in who ? * under 40, DGI is a common cause of acute polyarthralgias, polyarthritis, or oligoarthritis in young
Patients with disseminated gonococcal infection (DGI) typically present with one of two syndromes ? * 1) A triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis.... * 2) Purulent arthritis without associated skin lesions.
DGI TmT = ? * Parenteral therapy w/ ceftriaxone is the preferred initial tmt .... * Pts should also receive a single oral dose of azithromycin, for dual coverage of Chlamydia co-infection.... * Can also use Doxy instead of Azithro.
Gonococcal urethritis tmt ? (men with Sx of urethritis with G- diplococci, must receive tmt as if co-infected) * a single intramuscular dose of ceftriaxone and a single oral dose of azithromycin..... * Doxy can be used instead of Azithro. again
Chlamydia trachomatis TmT = ? * most common bacterial STI.... * use Tetracyclines ( Doxy.) or Macrolides (Azithro.).... * Azithro - can be given once a day due to its t1/2..... * Doxy. - cheaper, but need a 7 day tmt with 2 a day dosing
Highly effective alternative agent, but can not be used in pregs., adolescence, and is more expensive ? * Levofloxacin
Trichomonas vaginalis Tmt = ? * most common non-viral STD ..... * TmT = The 5-nitroimidazole drugs --> Metronidazole orally
Metronidazole SEs ? * Metallic Taste (unique!)..... * disulfiram-like RxN, so don't drink with it
Metronidazole use ? * Metronidazole is the gold standard anti-anaerobic agent.... * It is a first line agent for giardiasis, trichomoniasis, and amebiasis..... *
Syphilis is a chronic infection caused by ? * the bacterium Treponema pallidum
Syphilis TmT = ? * long term tmt bc it divides slowly.... * For this reason, long-acting penicillin preparations are the preferred drugs for the treatment of all stages of syphilis..... * Only the long-acting benzathine preparation should be used (given IM)
Options for the treatment of early syphilis in penicillin allergic patients include ? * Doxy. = first to use if non-pregnant.... * Azithro. = given if you think they won't adhere to the Doxy double a day dosing
Bacterial vaginosis basics ? * most common vaginal discharge issue of women in child bearing age..... * BV resolves spontaneously in up to one-third of nonpregnant and one-half of pregnant women.
BV TmT = ? * Metronidazole or clindamycin administered either orally or intravaginally
Candida vulvovaginitis basics ? * 2nd most common, after BV..... * inflammation of vagina and vulva....* Not considered an STD like Tricg. Vag.
Candida Vulvovaginitis TmT = ? * relief of symptoms..... * tmt based on umcomplicated (tmt helps in days) vs. complicated (tmt is needed for longer course)... * Uncomp. = an antimycotic such as Monostat or fluconazoles..... *Comp. = flu or clot -azole
Created by: thamrick800