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ID Tx 2

Infectious Disease

QuestionAnswer
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: Adam Barnard Adam Barnard