ID and ABX


See abxCosts.pdf document attached for abs costs.

Nitrofurantoin SE - hemolysis in G6PD def pts (2% of AAF), interstitial fibrosis when used long term.
TMP/SMX SE - kernicterus
Doxy SE - turns deciduous teeth of newborns grey.
Doxy, TMP/SMX, Cipro and Cephalexin don't cover anaerobes.
Clinda & Amox/Clav do cover anaerobes - what's the difference and why ?




1/6000 fluoroquinolone rxs will cause tendon rupture. REF

Comcomitant macrolides with simvastatin increases risk of myopathy. p. 2671 St. Louis 2013

Treat erythrasma with erythromycin. REF

Health care-associated pneumonia is more likely to involve severe pathogens such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter species.  Methicillin-resistant Staphylococcus aureus also is a consideration, depending on local prevalence.  Of the antibiotic regimens listed, ceftazidime and gentamicin is the only choice that covers these organisms. REF

First-line treatment for gonorrhea includes intramuscular ceftriaxone, oral cefixime, ciprofloxacin, ofloxacin, and levofloxacin.  REF

Rifampin, in the absence of major contraindications, is the drug of choice for preventing the spread of meningococcal disease when the susceptibility of the organism is not known. REF

With widespread immunization against Haemophilus influenzae infection, Streptococcus pneumoniae has become the predominant cause of serious bacterial infection in infants and young children. REF

Which fluoroquinolone should not be used in UTI ? REF

Studies show that patients who present for treatment of herpes zoster within 72 hours will benefit from antiviral therapy such as famciclovir to reduce the pain and decrease the risk of postherpetic neuralgia. REF  - This could be the basis for an ad page.

The most common cause of pneumonia in children age 4 months to 4 years is respiratory syncytial virus. REF

The quadrivalent A, C, Y, W-135 meningococcal vaccine does not provide immunity against type B Meningococcus, which is responsible for 30%–50% of cases of invasive meningococcal disease. Therefore, antibiotic prophylaxis with rifampin, ciprofloxacin, or ceftriaxone is indicated for all exposed persons. REF

Whereas many antibiotics temporarily suppress nasopharyngeal colonization by Haemophilus influenzae type b, only rifampin is effective in eradicating the organism. REF

In a young adult with community-acquired pneumonia who is not sick enough to be hospitalized, the current recommendation is to empirically treat with a macrolide antibiotic such as azithromycin. This covers the atypical organism Mycoplasma pneumoniae, which is one of the most common causes of community-acquired pneumonia. Certain fluoroquinolones such as levofloxacin also cover atypical causes, but ciprofloxacin does not. The other antibiotics listed are also ineffective against Mycoplasma. REF


OP tx of diverticulitis is amoxicillin/clavulanate, 875 mg every 12 hours. REF

Look up differences between Ceftriaxone + doxy vs. Levo for epididymitis. REF

Tx should not be started for CDiff unless stool toxins for A & B are positive. REF

Empiric tx for endocarditis by G+cc. REF

The best predictor of vancomycin efficacy is the trough serum concentration, which should be over 10 mg/L to prevent development of bacterial resistance. REF


What year were clotting factors cleared of Hep C ? Think TaB FaG (1987). REF
- While on this Q - name a lab dyscrasia that should always result in a Hep C screen.

PNA ABX consensus recommendations See the attached PDF below.

.msccipro
- G- rods of urinary and GI tracts (including pseudomonas), Neisseria, some G+ (w) A.B. Bayer
- GI upset, rash, HA, dizziness, cartilage damage.
- Bacteriocidal, Inhibits DNA gyrase (topoisomerase II), don't take with ant-acids.
- Use levofloxacin in CAP because cipro has little activity against Strep pneumo.

.msczosyn
- Piperacillin/Tazobactam (inhibits B-lactamases) (Wyeth)
- G+ & G- including anaerobes (incl pseudomonas).
- Preferred for P. aeruginosa CAP
- Good for SBP prophylaxis, PNA, peritonitis, diabetic foot infections.
- Bacteriocidal, bind PBPs, Blocks X-linking of cell wall, activate autolytic enzymes.

.msccefepime 
- HEN PEcKs + 4th generation ceph w/ increased activity against ps and G+
- Bacteriocidal, inhibit cell wall synthesis
- Hypersensitivity reactions, x-hypersensitivity with penicillins 5-10%

.mscdoxycycline
- URIs, PNAs, STD, strep (pts allergic to pen), mycoplasma, legionella, chlamydia, neisseria
- prolonged QT (esp ery), GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rash.
- increases serum theophyllines, oral anticoagulants
- binds 30s r subunit

azithromycin
- does not cover aspiration PNA.  Add Zosyn if G- coverage needed.

Best emperic tx for nursing home-acquire PNA ? REF

Which infection should be treated with an oral anitfungal ? REF

Azithromycin and Gatifloxacin cover Strep pneumo, M pna & C pna.
- But can't give a fluorquinolone to anyone < 18. (see .png below (MStdy).

Whipple disease (Tropheryma whipplei) - IV ceftriaxone, then TMP/SMX x 1 year.

Dermatitis herpetiformis - Dapsone.

Enterococcus is uniformly resistant to cephalosporins. For UTI in a 3 yo use amp and gent. Could use Vanc if the child is pen sensitive. TMP-SMX is also insufficient coverage.

Amoxicillin 80–90 mg/kg/day is first-line in children with AOM and no pen allergy. (SOR B).
REF

Rifaximin, a nonabsorbable antibiotic, reduces the risk for traveler’s diarrhea by 77%.  REF

Empirc ABX therapy for nursing home acquired PNA ?  REF

DOC for Chlamydia in pregnant patients ? REF

Zanamivir should not be used in patients with COPD, asthma, or respiratory distress. REF

What's the 4 drug tx for TB ? REF

https://nf.aafp.org/Assessment/Take/848/c/25c35d10-aba9-4c8a-a8ff-66f4a1884edc?summary=1

Avelox - good for lungs, poor penetration into renal system.
Ciipro - good for  lungs, but no G+ coverage, great renal penetration, enterococcus
Levofloxacin - good for lungs, covers G+ in urine.

Outpatient tx for diverticulitis ? REF

CAP in young people - what's the emperic tx and most common bug ? REF

Best drug for nursing home CAP ? REF

Never ever use what antibiotic in children ? REF

MC soft tissue infection presenting in ERs ? REF
What are you going to give to an 8 yo with Traveler's Diarrhea coming home from Mexico ? REF
 
Regimens appropriate for tx of infectious endocarditis from pen-sus viridans Strep? REF

Note this important side effect of trimethoprim.

First line for uncomplicated cystitis ? REF

What are you going to use for lice ? REF

Vaginosis Amsel > 4.5, whiff, mik, clue.  Oral and topical clinda and met equally efficacious. REF
Trichomonas > 5.4, whiff. Metronidazole oral single dose, tx partners.
Candidiasis pH 4-5 (nl). Topical or oral antifungals.

Treatment for pyelonephritis in pregnancy ? REF

Nurse gets needle stick from HepBsAg+ patient. What to do ? REF

All anaerobes are killed by 
- chloamphenicol, imipenem, metronidazole
Other abx used against anaerobes include
- cefoxitin (Mefoxin), Clindamycin (Cleocin) REF

Swimming pool folliculitis - which bug comes to mind ? REF

Chlamydial mom's kids have a 30-50% of developing what ? REF

Dental infection is best treated with what ? REF

Which bugs would cause a suppurative sialadenitis ? REF

Treatment for TSS caused by group A streptococcus ? Clindamycin + Pen G (MedStudy)

Stevens-Johnson syndrome - caused by azithromycin + acetaminophen. 

Retropharyngeal abscess - Ceftriaxone+Clindamycin or Ampicillin-Sulbactam (GAS, anaerobes, Staph Aureus).

Antibiotics cause chronic carriage state in Salmonella, but reduce carriage state in Campylobacter.

Gentamycin for tularemia.

CMV is the leading cause of congenital hearing loss. REF

How to treat acute necrotizing ulcerative gingivitis. REF

ABX tx for dental infections complicated by cellulitis ? REF

Board Qs to format after getting through all Qs:

An accepted regimen for OP tx of diverticulitis ? Anaerobes is the key. REF

.msccipro
- G- rods of urinary and GI tracts (including pseudomonas), Neisseria, some G+ (w) A.B. Bayer
- GI upset, rash, HA, dizziness, cartilage damage.
- Bacteriocidal, Inhibits DNA gyrase (topoisomerase II), don't take with ant-acids.
- Use levofloxacin in CAP because cipro has little activity against Strep pneumo.


.msczosyn
- Piperacillin/Tazobactam (inhibits B-lactamases) (Wyeth)
- G+ & G- including anaerobes (incl pseudomonas).
- Preferred for P. aeruginosa CAP
- Good for SBP prophylaxis, PNA, peritonitis, diabetic foot infections.
- Bacteriocidal, bind PBPs, Blocks X-linking of cell wall, activate autolytic enzymes.


.msccefepime 
- HEN PEcKs + 4th generation ceph w/ increased activity against ps and G+
- Bacteriocidal, inhibit cell wall synthesis
- Hypersensitivity reactions, x-hypersensitivity with penicillins 5-10%


.mscdoxycycline
- URIs, PNAs, STD, strep (pts allergic to pen), mycoplasma, legionella, chlamydia, neisseria
- prolonged QT (esp ery), GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rash.
- increases serum theophyllines, oral anticoagulants
- binds 30s r subunit


The patient was started on abx on an outpatient basis with Augmentin ( feb ), Keflex and Levaquin most recently, and these appear to have failed because his cellulitis is worsening. The patient does have a history of chronic venous stasis, and appears that have gotten infected. 

Empiric PNA: Avelox 400 mg QD (G+, atypicals, + oral anaerobes, no MRSA, no G-, )
Barnes says + oral anaerobes.
Empiric Sepsis: (Recall Cynthia Carmen 8/7/1960)
    1. Vancomycin (G+, MRSA)
  2. Zosyn (G-, Anaerobes, Atypicals, Pseudomonas, enterococcus)
                         - What if pt has penicillin allergy ? 
- Pharmacy suggested:  
 1. Vancomycin (G+, MRSA)
 2. Clindamycin (G+, MRSA, G-, Anaerobes)
 - But notice that we no longer have atypicals covered so:
                          1. Avelox(G+, atypicals, no MRSA, no G-, no anaerobes)
 2. Clindamycin (G+, MRSA, G-, Anaerobes)

(Recall Tonya Martin 7/2/73)
Enterococcus - Gentamycin (350 mg IVPB) IV, Oral Ampicillin 500 mg Q24H
Pseudomonas - Zosyn 3.375 Q6H IV, Oral Ciprofloxacin 500 mg Q12H
  Note: Zosyn also kills some enterococcus. 

Macrobid
Adult doses of nitrofurantoin for a urinary tract infections can be 100mg two times daily, or 50mg four times daily for seven days. For less severe cases of UTIs, the dosage may be prescribed as shortened to 3 days. The pediatric dose is 5–7 mg/kg/day in four divided doses.[9] or when in 25 mg/5ml oral suspension then pediatric dose is 3 mg/kg/day in four divided doses.[10] Nitrofurantoin should be taken with food, as this improves the absorption of the drug by 45%.
Nitrofurantoin is only clinically proven for use against E. coli or Staph. saprophyticus. It may also have in vitro activity against:
Coagulase negative staphylococci 
Enterococcus faecalis, 
Staphylococcus aureus, 
Streptococcus agalactiae, 
Citrobacter species, and 
Klebsiella species,
and is used in the treatment of infections caused by these organisms. Many or all strains of the following are resistant to nitrofurantoin:
Enterobacter species[5] 
Klebsiella species[5] 
Acinetobacter species, 
Morganella species, 
Proteus species,[5] 
Providentia species, 
Serratia species, 
Pseudomonas species.[5]
Nitrofurantoin must never be used to treat pyelonephritis,[11] prostatitis,[5] renal abscess, and pyeloempyema because of extremely poor tissue penetration and low blood levels, although the patient information leaflet states it is used to prevent and treat infections of the bladder, kidney and other parts of the urinary tract. Urinary catheter infections may be treated with nitrofurantoin if there are no systemic features; the catheter must be changed after 48 hours of antibiotics and treatment is ineffective if the catheter is not replaced or removed.


ą
Marc Curvin,
May 5, 2013, 1:41 PM
Ċ
Marc Curvin,
Jun 17, 2013, 7:10 AM
Ċ
Marc Curvin,
Aug 18, 2015, 3:51 PM
Comments