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ID Tx 1

Infectious Disease

Lyme dz tx Adult: doxy or amox (ceftin if allergic). Kids: ceftriaxone
Empiric treatment for bacterial meningitis begin Abx immediately (ceftriaxone or cefotaxime 2 g IV and vanc; add ampicillin for pts <3months & >55 and/or immunocomp
Meningitis: add to empiric therapy if HSV is suspected: acyclovir
Bacterial meningitis: give concurrently with empiric Abx: dexamethasone, continue for 4 days
supportive care for bacterial meningitis hydration, pain meds, anticonv, antiemetics
meningitis bugs: >50 yo / EtOH SP, listeria; tx = amp + rocephin + vanc + dex
meningitis tx: 1 - 3 mos Amp + (rocephin or cefotaxime) + Dex
meningitis tx: 3 mos - 50 yo (rocephin or cefotaxime) + vanc (if >1 mo. old) + Dex (add Amp for listeria)
Meningitis: EtOH / impaired immune Amp
post exposure prophylaxis for meningitis PEP = rifampin for household contacts/droplet exp only; alts = cipro or rocephin
meningitis tx: hosp-acquired (or post-neurosurg) or immunocompromised: amp + ceftazidime + vanc
brain abscess tx PCN +/- chloramphenicol +/- flagyl; if SA suspected, add nafcillin
Furuncle/carbuncle tx mild: oral dicloxacillin or ceph; severe: IV ceph
Mastitis: No MRSA Dicloxacillin or Keflex
Mastitis: MRSA possible TMP-SMX or clinda
Otitis externa drops (polymyxin B + neomycin + hydrocortisone) + Se sulfide shampoo
Otitis media Amox; if Abx in past month: Aug or cefdinir/cefpodoxime
Internal hordeolum Dicloxacillin; TMP-SMX-DS if MRSA-CA
Orbital cellulitis nafcillin 2 gm IV; if MRSA: vanco 1 gm IV + Rocephin 2 gm IV + Flagyl 1 gm IV
Advanced generation macrolide azithromycin or clarithromycin
1st gen Ceph Duracef, Keflex, cephalothin, cephazolin
2nd gen Ceph cefuroxime
3rd gen Ceph Omnicef, Suprax, Rocephin, fortaz, cefotaxime, cefpodoxime
4th gen Ceph Cefclidine, Cefepime (Maxipime), Cefrom
1st gen Ceph efficacy: GP: MSSA/MSS strep; not vs MRSA/strep; GN: PEcK (Prot, e coli, Klebs)
Cefuroxime efficacy: No GP; GN: HEN (H flu, Enterobacter aerogenes, some Neisseria )+ PEcK; >Gen1
3rd gen Ceph efficacy: GN: Broad spectrum, esp hosp acquired; meningitis (pneumococci, meningococci, H flu, some E coli/Klebs); ceftriaxone / cefixime for NG
4th gen Ceph efficacy: GP: MSSA/MSS strep; not vs MRSA/strep; GN: exp beta-lactamase, meningitis, pseudomonas
5th gen Ceph (Ceftobiprole, Ceftaroline) efficacy: Antipseudomonal
tetanus tx IM IG; post recovery, full tetanus toxoid; PCN; DTaP/TDaP booster q 10 yrs (if clean wound; 5 yrs if dirty wound)
Tetanus IG: give if: pt has dirty wound & imms hx unknown, OR not fully immunized (ie, received <3 doses)
Tetanus toxoid: give if: 1) pt’s tetanus imms hx unknown or got <3 doses; 2) wound is >24 hrs old; 3) pt’s last booster was >5 yrs (if dirty wound) or >10 yrs (if clean wound)
Diphtheria tx serum antitoxin; airway (poss membrane removal via laryngoscopy); PCN or erythro/zithro; test of cure
HSV tx antivirals (acyclovir, valcyclovir); trifluridine for HSV keratitis; Foscarnet for immunocompromised pts
CMV tx ganciclovir, valganciclovir, foscarnet, cidofovir
Severe Rhinosinusitis tx Augmentin; macro or ceph
Monobactams w/antipseudomonal action = Imipenem & meropenem
PCNs MOA: inhibit peptidoglycan cross linking
Aminoglycoside MOA prevent mRNA translation into proteins
Glycopeptides (vancomycin, daptomycin) MOA inhibit peptidoglycan cross linking (Gram pos orgs only)
FQs MOA inhibit bacterial DNA gyrase
macrolides MOA bind to 50S ribosome (interfere w/protein synthesis)
Oxazolidinones MOA inhibit protein synthesis at 50S ribosomal subunit
macrolides: effective against: GPC, some anaerobes (NOT Bacteroides), mycoplasma, chlamydia
Flagyl MOA accepts electrons under anaerobic conditions => metabolite toxic to bac DNA
tetracyclines MOA locking tRNA to septal site of mRNA (thus interfere w/pro synthesis)
SMX-TMP MOA inhibit synthesis of tetrahydrofolate
MRSA (cellulitis) tx Vanco +/- rifampin, gentamicin, linezolid
Non-gono arthritis: gram neg: tx ceftazidime or genta; IV 2wks & po 4 wks
3 major types of HIV tx Nucleoside & nucleotide reverse transcriptase inhibitors (zidovudine, abacavir, tenofovir). Protease inhibitors (ritonavir). Nonnucleoside reverse transcriptase inhibitors (efavirenz). Entry inhibitors. Integrase inhibitors (raltegravir).
EBV / mono tx Supportive. No contact sports >1 month. Avoid amoxicillin for strep co-infection (increases rash from 15% to 90%)
Rabies mgmt. Rabies IG infiltrated around wound. Inactivated rabies vax on days 0, 3, 7, 14, 28 post exposure. Milwaukee protocol (coma).
RSV tx O2 support PRN. Corticosteroids, bronchodilators, ribavirin (poor evidence of benefit). High-risk infants (heart dz) get palivizumab.
West Nile virus tx Intensive supportive easures. IVIG or interferon alpha.
Anthrax tx Cipro or doxy. (second: amox, Pen G, clinda, clarithro, vanco, imipenem.
In anthrax outbreak, prophylaxis is: Cipro or doxy x 100 days (or vax w/investigational agent + 40 days of Abx)
Botulism mgmt. Admit to ICU => intubation. Antitoxin from CDC to neutralize unabsorbed toxin.
Brucellosis tx Doxy plus rifampin +/- streptomycin +/- gentamicin
Campylobacter mgmt. Tx may shorten dz course. Azithromycin or Cipro (FQ resistance rising). Fluid & lyte replacement
Role of vax in cholera Provides only short term protection; not useful in managing outbreaks
Cholera mgmt. PO or IV fluid replacement. Abx may shorten course, but there is often resistance
Diphteria mgmt. Diphtheria antitoxin (from CDC). Remove membrane. Erythromycin or PCN eliminate organism (secondline: other macrolides)
Hospitalization & isolation for diphtheria are needed until: 3 cultures document elimination of organism
MAC mgmt. TOC: clarithromycin and ethambutol +/- rifabutin. Possibly azithromycin.
Additional mgmt. for MAC in HIV+ patients with CD4 <50 cells/microliter Single-drug prophylaxis
Erysipeloid mgmt. Usually self limiting in 3-4 weeks. Pen G, imipenem, cephalosporins, clinda, cipro.
Hansen disease mgmt. Lepromatous: combo tx with dapsone rifampin, & clofazimine x2-3 years (due to single-drug resistance). Tuberculoid: dapsone & rifampin x6-12 months, then dapson x2 years
Salmonella tx Cipro, Bactrim, or ampicillin (if severe or HIV or SCD). Enteric fever: IV cipro, Levaquin, CTX, or per C&S.
Shigella tx Hydration / lyte repletion. Bactrim or FQ is TOC. Azithro in MDR.
Mgmt. of Lyme complications CNS/cardiac dz: IV Pen G, CTX, or cefotaxime x2-4 weeks. Arthritis: PO doxy or amox up to 60 days (vs Pen G or cefotaxime up to 4 weeks)
Created by: Abarnard