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ID Tx 2
Infectious Disease
| Question | Answer |
|---|---|
| Primaquine efficacy | Prevents relapse in P vivax & P ovale. Eradicates dormant liver forms of all malaria |
| Malaria tx | Non-falciparum & nonresistant falciparum: chloroquine. Quinine & quinidine effective but poorly tolerated. Resistant dz: combos with artemisinin, artesunate, amodiaquine, mefloquine |
| Malaria secondline tx | Malarone (atovaquone-proguanil). Doxycycline, clinda, azithromycin, halofantrine, lumefantrine. |
| Malaria prophylaxis | Chloroquine |
| Cryptococcus tx | HIV: PO fluconazole x10 wks, OR Ampho B x 2ks & fluconazole lifelong; non-HIV: ampho B (higher mortality) |
| Pneumocystis (PCJ) tx | TMP-SMX (alt: dapsone, pentamidine); steroids if PaO2 <70 mmHg |
| Ppx for Pneumocystis is recommended for: | pts with CD4 <200; TMP-SMX |
| Histoplasmosis tx | Itraconazole (wks to mos); ampho B if cannot tolerate or meningitis |
| RMSF tx | doxycycline or chloramphenicol hastens recovery; poorer outcomes in older pts (usu 2/2 pneumonitis or resp failure) |
| Aspergillosis / Blastomycosis mgmt. | Allergic bronchopulmonary: steroids, postural drainage, chest physiotherapy. Infxs: antifungals, debridement / resection. Disseminated dz: itraconazole vs Amphotericin B |
| Coccidiomycosis mgmt. | Most cases are self-limited. Ampho B vs itraconazole vs fluconazole vs ketoconazole, depending on dz severity |
| Cryptococcus mgmt. | Amph B followed by fluconazole (fluconazole not firstline due to resistance). Flucytosine (monitor for toxicity) |
| Histoplasmosis mgmt. | PO itraconazole. Ampho B if severe |
| Amebiasis tx | Combination therapy among: metronidazole, tinidazole, diloxanide furoate, iodoquinol, paromomycin. |
| Giardiasis tx | Adult: tinidazole or metronidazole; retreat with albendazole or paromomycin. Peds: furazolidone or ntazoxanide. F/U stool studies at 2 weeks |
| Toxoplasmosis tx in immunocompetent host | Mild dz is self limiting. Severe dz: pyrimethamine + sulfadiazine (or clinda). Add folate to prevent bone marrow suppression; increase UOP to prevent nephrotoxicity. |
| Toxoplasmosis tx in PG | Pyrimethamine is CI in first trimester (teratogenic). Tx with spiramycin. |
| Toxoplasmosis tx in immunocompromised pt | Prophylaxis if serology positive. Tx acute as in immunocompetent patients. |
| Tetanus tx | Tetanus IG (per IM) neutralizes circulating toxin. IV PCN. Supportive care: nonstimulating environment, sedation & vent PRN |
| Ehrlichiosis tx | Doxy |
| Ascariasis mgmt. | Mebendazole, albendazole, pyrantel pamoate are TOC. Delay until after first trimester in PG. Test of cure at 2 weeks |
| Glanders mgmt. | Drain abscesses. Streptomycin AND (tetracycline OR chloramphenicol) |
| Glanders post-exposure prophylaxis | TMP-SMX, ceftazidime, and doxy |
| Plague mgmt. | Strict resp isolation x48h after starting Abx. Streptomycin or gentamicin is TOC; alternative is doxy |
| Plague post-exposure prophylaxis | Doxy or tetracycline |
| Q fever mgmt. | Acute: Doxy or tetracycline (may not eradicate disease). Alternate: azithro, Cipro, Levaquin. If bioterror related: doxy or tetracycline for prophylaxis |
| Smallpox mgmt. | Supportive. Tx as international health emergency. Vax. Limited supply of vaccinia IG to tx severe cutaneous rxn to vax. |
| Tularemia tx | Streptomycin (alt: doxy or gentamicin) |
| Mgmt of Lassa virus and hemorrhagic fever with renal failure | Early IV ribavirin |
Created by:
Abarnard
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