- Usually an encapsulated organism such as pneumococcus due to loss of IgG with nephrotic syndrome. This is in contrast to Secondary peritonitis that is usually a gram - or anaerobe due to perforated bowel.
*Bonus: Dialysis = Staph Epidermidis!!! Not aureus
Treatment of septicemia in infants > 3 months
Ceftriaxone and Vancomycin
Household contacts of patients with meningococcemia? (3 options)
1. Rifampin Q12H x 2 days 2. Ceftriaxone 1 time dose 3. Ciprofloxacin 500 mg x1 (If > 18 and not preggers)
Treatment of Meningococcemia with sepsis?
Vancomycin & Ceftriaxone
Immunocompromised patient with fever and/or neutropenia
Ceftazadime monotherapy OR Zosyn & and aminoglycoside together
Nitazoxanide (anti-protozoal - good for giardia too) oral.... or drinking immune globulin or bovine colostrum!
Ascaris Lumbricoides (3)
Albendazole in a single dose Mebendazole x 3 days Ivermectin in a songle dose
Chlamydia Pneumonia with afebrile staccato cough and tachypnea w/wo eye discharge in a newborn within 2 months of life
Erythromycin IV or Oral ---NOT EYE DROPS Azithromycin alternative if unable to tolerate macrolides
- Remember eosinophilial common!
Rocky Mountain Spotted Fever
Doxycycline - even if less than 8 years old, may start treatment ASAP and wait for test results later due to mortality risk
Doxycycline - even if less than 8 years old. However this is a self-limited disease. Pneumonia but no rash, flu like symptoms followed in 5 days by respiratory distress. From coxiella burnetti (cattle, etc)
Amebiasis from entamoeba histolytica & Above with liver abscess
Metronidazole ("Flagyl") Liver abscess = Metronidazole & a luminal amebicide (Iodquinol or paromomycin).
Toxocariasis aka "visceral larva migrnas" from toxocara canis?
Mebendazole or thiabendazole Round worm Migrating worms from cats or dogs or eating dirt. Often present with abdominal pain (hepatomegaly) and wheezing with eosinophilia. *Diagnosis with ELISA
Furazolidone and albendazole are also effective
Schistosomal/Liver Fluke/ Tapeworm
Cat Scratch Fever with Bartonella Henselae
Supportive Treatment! Except if immunocompromised, hepatosplenomegaly or hepatosplenomegaly - then you can treat with: Azithromycin, erythromycin, ciprofloxacin, bactrim, or rifampin.
If one < 4 and not fully immunized or any are immunocompromised then treat the entire house with rifampin.
If non-typeable H Influenzae then nobody needs treatment!
Erythromycin or azithromycin or clarithromycin. This can shorten the catarrhal URI stage but not the prolonged paroxysmal coughing phase. It is given to decrease ability to infect others. Treat household with azithromycin or erythromycin too!
Supportive Care! Treating can induce a carrier state
If < 3 months or immunocompromised: amoxicillin, TMP-SMX, cefotaxime (cipro if > 18 years old)
Tetracycline or TMP-SMX AND Rifampin Combo therapy works best, long term treatment needed, MC cause of relapse is premature discontinuation.
Vancomycin PO is an alternative if repeat failure
Botulism in an infant
Supportive Care - can use antitoxin if an option
Antibiotics can result in lysis of spores and release of additional neurotoxins. Aminoglycosides even potentiate botulism!
PCN - If a mother is treated > 1 month prior to delivery of an infant and the infants titers are less than the mothers - you do not need to treat the infant. However, if the mom was treated with eryhtromcyin you do because that doesn't cross the placenta.
FYI: FTA-ABS are positive for life but VDRL goes down
Listeria Monocytogenes Sepsis in Newborn
AMP & GENT - In contrast, for GBS amp/cefotaxime is preferred
Gentamicin - Yersinia Pestis Alternames: streptomycin, tetracycline, and chloramphenicol
Community Acquired MRSA?
TMP-SMX, gentamicin, or doxycycline. (obv vancomycin - but save for hospital MRSA)
Amphotericin B combined with oral flucytosine or fluxonazole for serious infections. Note: there is a liposomoal formulation of Amphotericin B you should use in patients with renal impairment.
Amphotericin B, Fluconazole, or ketoconazole. "CAT-City- oidomycosis" California, Arizona, Texas.
Voriconazole or Amphotericin B in high doses ABPA
Supportive Care if immunocompetent and uncomplicated If immunocompromised (disseminated disease) treat with Amphoterecin B. Hisoplasmosis = Hepatosplenomegaly w/flu symptoms
Itraconazole (brand name "sporanox")
Ganciclovir - Main SE: Bone marrow suppression Dx in neonate with a urine culture for CMV within 3-4 weeks of life. Remember calcifications are periventricular
Exposure of an unimmunized infant, immunocompromised individual, or pegnant woman to Rubeola.
Measles - Immune globulin IM within 6 days! MMR given within 3 days of expsoure may prevent the onset of the disease.
CMV retinitis inimmunocompromised patients
Foscarnet - also for severe mucocutaneous disease or Zoster caused by acyclovir resistant HSV or varicella.
Congenital Adrenal Hyperplasia
Hydrocortisone hemisuccinate - if given in high enough doses it will have a mineralocorticoid and glucocorticoid effect.
Hypercalcemia due to immobilization in a child with no specific signs like vomiting or irritability
High volume fluid, lasix, and EKG monitoring. In rare cases calcitonin is used.
Vitamin D Deficient Rickets (Nutritional) - remember this is the only type with low 25 hydroxy vitamin D levels.
Vitamin D and calcium supplementation
Vitamin D dependent Rickets Type 1
Due to renal disease resulting in inadeuate renal production of 1,25 dihydroxy vitamin D3 Treat with Vitamin D2 (1,25 dihydroxy vitamin D).
Note: they will not get better with Vitamin D replacement therapy alone - needs to be D2.
x-linked hypophosphatemic rickets
Phosphate supplementation and 1,25 dihydroxy Vitamin D (aka calcitriol)
Prophylaxis against travelers diarrhea
Bismuth sbsalicylate or an antiobiotic such as bactrim
Typhoid Fever (invasive salmonella diarrhea)
Ceftriaxone and cefotaxime (bactrim resistance common) You do not treat salmonella gastroenteritis - butwhen it invades epithelial cells, the mesenteric nodes, and eventually invades the blood stream it needs antibiotics.
Erythromycin or azithromycin
H. Pylori PUD
PPI & 2 antibiotics: - amoxicillin and metronidazole OR - amoxicillin and Clarithromycin
Acute CF exacerbation
Aminoglycoside and a penicillin derivative such as piperacillin that attacks pseudomonas
Treatment of a positive PPD with a negative CXR
isoniazid for 9 months rifampin for 9 months if it is INH resistant
2 months of RIP: Rifampin, INH, Pyrazinamide Then 4 months of Rifampin and INH or just straight up due 9 months of isoniazide and rifampin
What is the treatment of TB meningitis?
RIP (rifampin, INH, Pyriazinamide) for 2 months along with streptomycin then just RI for 10 months. You stop the streptomycin after you isolate the strain and cofirm INH sensitivity. STEROIDS are used.
Tet Spell in a patient with TOF
Knee to chest or squatting position Morphine, phenylephrine, IV propranolol, and volume expansion. Usually due to anemia and an increased R to L shunting.
vagal manuvers, cold ice Adenosine Atrial override pacing if unstable or med not available Digoxin therapy longterm
Folic acid. May need transusions w/illness and ultimately a splenectomy is some.
Sickle Cell Anemia with concern for stroke
Transfusion - then go to MRI (treat first)
Penicillamine for chelation - occasionally acute hepatic insufficiency will need a liver transplant
Acetazolamide (carbonic anhydrase inhibitors)
Spinal Cord trauma with compression
Methylprednisone 30 mg/kg over one hour
Infantile Spasms (West Syndrome)
Permethrin 5% - treatall family members
Crabs - Pubic Lice
Permethrin 1% Pyrethrin with piperonyl butoxide Permethrin 5% Malathion - $$$ Lindane - toxic if swallowed or applied wrong, don't use if pregnant or a neonate. For eyelashes you can apply petroleum jelly TID x 10 day
High Dose steroids, often with methotrexate or other immunosuppressive or cytotoxic agents and IVIG. Antimalarials are also used. Avoid sunlight! Note: Will have HIGH CPK levels
Kawasaki's disease - dose and time length.
IVIG 2 g/kg - may be repeated Aspirin 80 mg/kg for 1-2 days followed by maintenance of 5 mg/kg for 2 months. Repeat echo then.
Cyclophosphamide and steroids
topical antibiotics - no longer patch. Must do fluorescein staining first to make the diagnosis.
H flu treatment with an IV third generation cephalosporin such as ceftriaxone or cefotaxime
1 time dose of 2 grams of metronidazole Metronidazole is also the treatment for gardnerella vaginalis
PID (medication and dose)
Ceftriaxone 250 mg IM and 1 gram of azithromycin
Adenosine, bigger adenosine dose, diltiazem. Ice bags help too.
What is the best initial IV therapy for an infant in heart failure?
Furosemide - acts within minutes. Ace Inhibitors are more appropriate for long term treatment.