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