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SSTI
| Question | Answer |
|---|---|
| Patients who present within 8-12 hours with a dog bite usually need | stitches, rabies shot , tetanus shot |
| What is the organisms involved in a dog? | Pasturella multocida, staphylococcus, streptococcus, anaerobes |
| Is empiric therapy recommended in a dog bite? why? | Yes 20 % will become infected therefore empiric 3-5 day course of antibiotics is recommended |
| How long is empiric therapy for a dog bite? | 3-5 days |
| How long is full therapy for a dog bite? | 10-14 days |
| Amoxicillin/Clavulante 875mg/125mg po BID | Dog Bite Cat Bite Human Bite |
| Clindamycin + FQ | Dog Bite |
| Metronidazole + FQ | Dog Bite |
| Clindamycin + TMP/SMX | Dog Bite |
| Metronidazole + TMP/SMX | Dog Bite |
| What antibiotics are in the DO NOT USE in Dog Bite category? | Dicloxacillin, Cephalexin, Erythromycin, Clindamycin monotherapy |
| How long should a cat bite be treated? | 10-14 days |
| What organisms are in a cat bite? | Pasturella multocida, Staphylococcus aureus, Streptococcus, Anaerobes |
| Cefuroxime 0.5G BID | Cat Bite |
| Doxycycline 100mg BID | Cat Bite |
| Empirical treatment for a human bite? | Amoxicillin/Clavulante 875mg/125mg po BID |
| What organisms are found in human bite? | Strept. Viridans, Staph. Aureus, Eikenella, Bacteriodes, peptostreptococcus(+) |
| What should clentched fist bite be checked for? | Evaluate for penetration into synovium, joint capsule and bone |
| What kind of bite requires hospitalization? | clenched fist human bite to the |
| If there is no sign of infection upon examation of a human bite what is the early treatment regimen? | Amoxicillin/Clavulanate 875/125 po BID x 5 days |
| What vaccine should a person with a human bite get? | Tetanus if they have not had it in 10 years |
| Cefoxitin 1-2 G IV Q8H | Human Bite: Sign of infection (3-24 hrs) Same for clenched fist |
| Ampicillin-Sulbactam 1.5-3G IV Q6h | Human Bite: Sign of infection (3-24 hrs)Same for clenched fist |
| Ticarcillin/clavulanate 3.1G IV Q 6H | Human Bite: Sign of infection (3-24 hrs)Same for clenched fist |
| Ertapenem 1 G daily | Human Bite: Sign of infection (3-24 hrs)Same for clenched fist |
| Human Bite with sign of infection Patient has penicillin allergy? What can you use? | Clindamycin + Ciprofloxacin OR TMP/SMX |
| How long should a human bite with signs of infection be treated? clenched fist? | 7 - 14 days |
| Lamisil AT BID x 7 days (gel/solution) | Athletes Foot |
| When is the rabies immunization warranted in a bite? | Animal is from endemic area, Wild animal |
| TWhat is Tinea Pedis? | Athletes foot |
| What is Tinea cruris? | Jock Itch mostly males Fungal Infection of upper thighs & pubic area |
| Where does Jock itch usually occurs? | thighs and buttocks |
| What is Tinea unguium? | Nail fungal infection |
| What is Onychomycosis? | Tinea unguium nail fungal infection |
| What causes Tinea unguium? | dermatophytes- have the ability to penetrate keratinous structures |
| Sweaty clothes, Failure to bath, Skin folds, Sedentary, Bed confinement,these are risk factors for? | Risk factors for Fungal Infection |
| How long should a superficial Athletes Foot infection be treated? | 2-4 weeks |
| When is oral therapy warranted for Tinea Pedis? | If cracks or breaks in the skin or nail involvement- need oral therapy |
| Lotrimin Ultra BID x 1 week | Athlete’s foot |
| Lamisil AT BID x 1-4 weeks (cream ) | Athlete’s foot |
| Lotrimin AF BID x 7 days | Athlete’s foot |
| Micatin AF Miconazole 2% BID x 4 weeks | Athlete’s foot |
| Nizoral A-D Ketoconazole 1%QD x 6 weeks | Athlete’s foot |
| Active Ingredient in Lotrimin Ultra | Butenafine 1% |
| Active Ingredient in Lamisil AT | Terbinafine 1% |
| Active Ingredient in Lotrimin AF | Clotrimazole 1% |
| Active Ingredient in Micatin AF | Miconazole 2% |
| Active Ingredient in Nizoral A-D | Ketoconazole 1% |
| Lotrimin Ultra Daily x 4 weeks | Atlethes foot |
| What is the length of tx for Tinea Cruris be treated? How? | Treat with topical therapy for 1-2 weeks after resolution of symptoms |
| Lotrimin Ultra 1% QD x 2 weeks | Tinea Cruris |
| Lamisil AT BID x 1-4 weeks (cream) | Tinea Cruris |
| Lamisil AT 1% x 7 days (gel) | Tinea Cruris |
| Micatin 2% BID x 4 weeks | Tinea Cruris |
| Nizoral A-D 1 % QD x 2 weeks | Tinea Cruris |
| Ciclopirox 8% - Penlac for | treatment of mild-moderate disease Tinea Unguium |
| What is the directions for Ciclopirox 8%? | Apply and remove every 7 days with alcohol |
| Terbinafine 250mg QD x 4 weeks | ORAL TREATMENT FOR Tinea Pedis/ Tinea cruris |
| Ketoconazole 250mg po QD x 4 weeks | ORAL TREATMENT FOR Tinea Pedis/ Tinea cruris |
| Fluconazole (Diflucan) 150mg weekly x 2-4 weeks cruris | ORAL TREATMENT FOR Tinea Pedis/ Tinea |
| What is the lenght of time for oral treatment of atlethes foot or jock itch? | usually 4 weeks |
| Terbinafine 250mg QD x 6 weeks | Tinea Unguium (oral therapy)- fingernail |
| Itraconazole 200mg daily x 12 weeks | Tinea Unguium (oral Therapy)- fingernail |
| Fluconazole 150-300mg weekly x 3-6 months | Tinea Unguium (Oral Therapy)- fingernail |
| Terbinafine 250mg QD x 12 weeks | Tinea Unguium-toenail |
| Itraconazole 200mg daily x 12 weeks | Tinea Unguium-toenail |
| Fluconazole 150-300mg weekly x 6-12 months | Tinea Unguium-toenail |
| Fourniers Gangrene | Necrotizing soft tissue infection involving the scrotum |
| Age 50 years, Diabetics, Trauma, Perirectal/perianal infections, Surgery | Fournier’s Gangrene |
| Fournier’s Gangrene- what are the organisms? | Mixed aerobic and anaerobic, staphylococcus, pseudomonas |
| Fournier’s Gangrene, surgery what abx are used? | Meropenem, Imipenem, Piperacillin/tazobactam |
| Fournier’s Gangrene | Necrotizing Soft Tissue Infections |
| Necrotizing fasciitis | Necrotizing Soft Tissue Infections |
| Predisposing Factors for Necrotizing Soft Tissue Infections | Diabetes Metillus , Local trauma, Recent surgery |
| Locations of Necrotizing Soft Tissue Infections | Abdomen, perineum, lower extremities |
| “Flesh-eating bacteria” | Necrotizing Fasciitis type II |
| What organism causes “Flesh-eating bacteria” | Group a streptococcus |
| Bacteriodes causes | Type I :Necrotizing Fasciitis |
| Clostridium causes | Type I :Necrotizing Fasciitis |
| Gangrene | Type II :Necrotizing Fasciitis |
| Clinical Presentation of _____________Wooden- hard feel of the subcutaneous tissues | Necrotizing Fasciitis |
| CT/ MRI | Necrotizing Fasciitis |
| Symtpoms of Necrotizing Fasciitis | Edema beyond the area of erythemaSkin blistersPallor/discolorationGas in the subcutaneous tissue (crepitus) |
| For Necrotizing Faciitis what bacteria should the antibiotics cover? | streptococcus, enterobacteraciae, anaerobes |
| Imipenem 1G IV Q6H | Mixed Infection Necrotizing Faciitis |
| Meropenem 1G IV Q8H | Mixed Infection Necrotizing Faciitis |
| Hyperbaric Oxygen is associated with | Necrotizing Faciitis Tx |
| Clindamycin 600-900mg IV Q8H | Necrotizing Faciitis Tx : Clostridium Infection |
| Penicillin 2-4 Million Unit IV Q4-6 H | Necrotizing Faciitis Tx : Clostridium Infection |
| Nafcillin 1-2 G IV Q4H | Necrotizing Faciitis Tx S. Aureus infection |
| Cefazolin 1-2G IV Q8H | Necrotizing Faciitis Tx S. Aureus infection |
| Vanocmycin 30mg/kg/day IV in 2 divided doses | Necrotizing Faciitis Tx S. Aureus infection |
| Clindamycin 600-900mg IVQ8h(static) | Necrotizing Faciitis Tx S. Aureus infection |
| Duration of tx for Osteomylelitis Infection: Viable Bone | 4-6 weeks |
| Duration of tx for Osteomylelitis Infecttion: Dead Bone Postoperatively | 13 months |
| Most common pathogen in infection of hair follicles? | S. Aureus |
| What is Folliculitis? | superficial infection of hair follicle |
| What are Furuncles? | found on hairy skin subject to friction and perspiration but extends into the subcutaneous tissue |
| What are Carbuncles? | furuncles that involve several adjacent follicles. This produces a coalescent inflammatory mass . Often on the back of the neck and are likely to occur in DM |
| Organism in Folliculitis | S. aureus, P. aeruginosa ( inadequate chlorine levels) |
| What is a symtpom of Folliculitis? | Pruritic erythematous papules within 48 hours of exposure |
| What topical Antibiotic are used in the tx of folliculitis? | Topical antibacterials: Clindamycin, erythromycin, mupirocin |
| What are Furuncles commonly known as? | Boils |
| Furuncles causitive organism? | S. aureus |
| Clinical Presentation : Firm Tendered nodule,Painful fluctuant | Furuncles |
| What is the Duration of Treatment for Furnucles? | 7-10 days |
| What antibiotics are used for Furbuncles? | Dicloxacillin 250mg Q6H Clindamycin 150mg/300mg Q6HErythromycin 250/500mg Q6H |
| Causitive Organism for Carbuncles? | S. aureus |
| Duration of treatment for Carbuncles? | 7-10 days |
| Abx Tx for Carbuncles | Dicloxacillin 250mg QID Clindamycin 150mg/300mg QIDErythromycin 250/500mg QID |
| St. Anthony’s Fire aka | Erysipelas |
| Erysipelas causitive organisms | B- hemolytic streptococcus (Group A ) |
| Lesions are raised above the skin border. Clear line of demarcation. Usually in lower extremities | Erysipelas |
| Affects the upper dermis extensive lymphatic involvement | Erysipelas |
| What is the duration of treatment for Erysipelas | 7-10 days |
| Procaine PCN G 600,000 units IM Bid | Erysipelas Mild to moderate |
| Pen VK 250-500mg QID | Erysipelas Mild to moderate |
| Erythromycin 250-500mg QID- caution RESISTANCE | Erysipelas Mild to moderate |
| Penicillin G 2-8 million units IV/day in 4-6 divided doses | Erysipelas Severe ( hospitalized |
| Symptoms:Lesion: hot, edema, red, poorly defined marginsSystemic: fever, chills, leukocytosis | Cellulitis |
| Causitive Organism for Cellulitis | B- hemolytic streptococcus (common), S. aureus |
| Abx for Cellulitis | Treatment: PCN dicloxacillin erythromycin |
| Duration of treatment for Cellulitis is? | 5-10 days depending on severity |
| What is Impetigo? | superficial cellulitis |
| Impetigo Organism | Group A streptococcusS. aureus |
| Causes of Impetigo | Children, hot, humid weather, minor trauma, scratches, insect bites |
| Fluid/pus-filled blisters, that readily rupture and dry to yellow crust | Symptoms of Impetigo |
| Duration of topical impetigo treatment? | 7 days |
| Abx for topical impetigo treatment? | Mupirocin or Bacitracin Ointment TID |
| Dicloxacillin 12.5mg/kg/d divided into 4 doses | Treatment of Systemic Impetigo |
| Cephalexin 25-50mg/kg/d divided into 2 doses | Treatment of Systemic Impetigo |
| Cefadroxil 30mg/kg/d divided into 2 doses | Treatment of Systemic Impetigo |
| Benzathine Pen G IM x 1 dose 300,000-600,000 units | Pediatric dose for systemic impetigo |
| Benzathine Pen G IM x 1 dose 1.2 million units | Adult dose for systemic impetigo |
| Erythromycin 30-50mg/kg/d in 4 divided doses | Pediatric dose for systemic impetigo |
| Erythromycin 250-500mg QID | Adult dose for systemic impetigo |
| What is the duration of treatment for Treatment of Systemic Impetigo | 7-10 days |
| Lymphangitis | Group A streptococcus |
| Fever, chills, malaise, HA, leukocytosis, red linear streaks from initial site of infection toward involved lymph node | Lymphangitis |
| Duration of treatment for Lymphangitis? | 10 days |
| Penicillin G IV for 48-72 hours followed by oral Pen VK | Treatment for Lymphangitis |
| Treatment for Lymphangitis patient with PCN allergy? | erythromycin, clindamycin |
| Genes for Panton-Valentine leukocidin are found in? | CA MRSA gene |
| What is the DOC of CA- MRSA | Trimethoprim-Sulfamethoxazole |
| Doxycycline minocycline Clindamycin are all used in what infection? | CA- MRSA |
| Neuropathy is associated with what SSSI | Diabetic Foot Infections |
| Inflamation: (need 2) Redness Warmth swelling induration, pain tenderness Purulent drainage | Diabetic Foot Infections |
| Medically stabilize patient i.e. fluid, electrolytes, insulin with what infection? | Diabetic Foot Infections |
| What labs should be ordered for Diabetic Foot Infections | MRI, CT, Bone scan |
| When should antibiotic therapy be stopped in a diabetic patient undergoing amputation? | If all the area of infection is removed antibiotics are no longer necessary |
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PHARMER88
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