What is the treatment for otitis media?
1- Most infections will resolve on their own
(watch and wait principle)
2- Most over treated infectious diseases; can lead to drug resistance
1- How would you treat a otitis media case caused these organisms:
2- What do you do if treatments fails after 3 days?
3- What are the alternatives?
4- What should you use if H. fluenzae
1- DOC: High dose amoxicillin
2- If treatment fails beyond 3 days:
- Amoxicillin- clavulanate
- 2nd or 3rd generation cephalosporin
3- Levofloxacin, macrolides, clindamycin
4- Use a Beta- lactamase agent
What is the DOC for acute sinusitis?
1- DOC: Amoxicillin
- 2nd or 3rd generation cephalosporins
Treat for 10 days for 2 weeks
1- What is the goal with treating chronic sinusitis?
2- What medications would you use to treat?
3- What should you use if you suspect a staph infection?
1- Goal is to control inflammation
2- Use nasal corticosteroids
3- Augmentin, Cleocin, Aveloz, Levaquin
1- What is the drug of choice for pharyngitis (strept throat caused by group A-strep)?
2- What do you use if their is a PCN allergy?
1- DOC: Penicillin
- Amoxicillin, cephalosporins
2- Use a Macrolid
1- What is the drug of choice for pertussis ("whooping cough") caused by bordetella
2- What do you use if you have a major allergic to a macrolide?
1- DOC: Azithromycin
- erythromycin, clarithromycin, azithromycin,
2- If allergic to macrolid use SMX/TMP (bactrim)
1- What is the DOC for acute bronchitis? (5)
***Note; acute bronchitis is usually caused by a viral agent, NOT a bacterial agent
1- Guaifensin (helps break up junk; found in cough suppressant)
2- Analgesic/ antipyretic therapy
3- Cough suppressant (helps PTs sleep)
5- Inhaled corticosteriods are sometimes used; but there is NO evidence to back this tx up
6- Only time you treat a bronchitis is when you suspect pertussis
If you HAD to administer a antimicrobial for acute bronchitis, what would you give?
***This really isn't recommended
1- What are the DOC of Community Acquired Pneumonia?
2- What should you use if their are co-morbidities with CAP?
1- DOC: Azithromycin (z pack), clarithromycin, or doxycycline
*Empiric therapy is usually sufficient
2- Treatment with comorbidity
- Levofloxacin or Moxifloxacin
- B-lactams + macrolide/doxy
What is the CURB-65 Criteria for CAP?
Uremia (BUM > 19)
Respiratory rate (>30)
Blood pressure (SBP < 90 or DBP < 60)
65 years or older
What is the empiric therapy for CAP inpatient for the general ward?
What is the Empiric therapy treatment for CAP inpatients in the ICU with NO risk of pseudomonas?
What is the Empiric therapy treatment for CAP inpatients in the ICU WITH risk of pseudomonas?
What is the DOC for hospital acquired pneumonia with NO MDR risks?
MDR= drug resistant pathogens
Any of these are good for Tx. Tx depends on the PTs need
What is the DOC for hospital acquired pneumonia with MDR risks?
MDR= drug resistant pathogens
- These patients need a combination therapy
- You need to pick something that covers psedomonas
The Plus: covers gram (+) and MRSA
When is a pneumococcal polysaccharide vaccine indicated? (2)
1- Age >65 if 5 years since you last dose
2- Need it once as an adult and then you don't need it again to until you are 65
What is the DOC for meningitis?
1- Empiric therapy
2- the age 2-50 drugs are the ones most used
What bacteria is associated with meningitis? (5)
1- If you have a low MIC what drugs can you use for meningitis?
2- What drug can you use if there is a high MIC?
1- Pen G or ampicillin
2- 3rd generation cephalosporins
- Cefotaxime/ ceftriaxone
1- What is the most common bacteria causing a UTI?
2- What is the DOC for uncomplicated urinary tract infection?
3- What do you use for young healthy females with sex related UTI's
1- E. coli
2- Sulfamethoxazole/ Trimethroprim (Bactrim, Septra)
3- Macrodantin or Macrobid
What are the complicated UTI cases? (6)
1- Everyone else is uncomplicated!
2- These cases may develop more resistant bacteria
1- How would you treat a complicated UTI?
2- How can a complicated PT prevent UTIs
1- Bactrium (in the real world use cipro)
- low amount of bactrim
What is the DOC for pylelonephritis?
1- DOC: Bactrium or Fluoroquinolones (end in - xacin)
How can you treat a UTI and pyelonephritis in a pregnant person?
Cephalosporins or B-lactams
What do use as prophylaxis for UTIs?
Bactrim or Nitrofurantoin
What are the normal G (+) bacteria on the skin?
What is the DOC for impetigo? (2)
- Cephalexin, erthryomycin, clindamycin, dicloxacillin
**systemic is rarely used
What is the cellulitis treatment with NO MRSA? (3)
3- Penicillin if there is a PCN or Ceph allergy: use Vancomycin
How do you treat cellulitis with MRSA involvement? (2)
1- Parenteral therapy
2- Penicillin if there is a PCN or Ceph allergy: use Vancomycin
How do you manage CA-MRSA abscess?
1- I & D alone can use
2- Most of the time these PTs are also on an antibiotic for empiric therapy: Vancomycin
Which oral agents work for CA-MRSA? (5)
What are the common pathogens in diabetic foot infection patients?
These infections are POLYMICROBIAL
What is the DOC of diabetic foot infection patients?
1- 2nd/3rd generation Cephalosporins + metonidazole (Flagly) for anaerobic coverage
2- Piperacillin/Tazobactan (Zosyn), Ampicillin/ Sulbactam (Unasyn)
3- Fluoroquinolones (Levaquin/Cipro) + metonizdazole (Flagyl) for anaerobic coverage