32 terms

BCPS-ID

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CAP - no abx in last 3 months
macrolide, doxy
CAP - COPD, DM, CKD, CHF, malignancy, asplenia, immunosuppression
resp. FQ (moxi, gem, levo)
Macrolide (or doxy) + amoxicillin 1g TID(high dose)/Augmentin 2g BID/ cephalosporin
CAP - inpatient
resp. FQ
amp, ceftriaxone, or cefotaxime plus macrolide
CAP - ICU
Amp/sulbactam + FQ/azithromycin
Ceftriaxone + FQ/azithromycin
Cefotaxime + FQ/azithromycin
CAP duration of treatment
5+ days with 48-72 hours afebrile
HAP early onset (2-4 days) bugs
S Pneumo
Hflu
MSSA
EColi
K. Pneumo
HAP early onset treatment
Ceftriaxone
FQ
Amp/sulbactam
Ertapenem
HAP late onset (5+days) bugs
pseudomonas
K pneumo (ESBL+)
acenetobacter
MRSA
legionella
HAP duration of therapy
7-8 days
14 days for P. aeruginosa or acinteobacter
Risk factors for MDR
Abx therapy in last 90 days
5+ days hospitalization
immunosuppressive disease
HCAP risk factors
2+ days hospitalization
NH resident
IV therapy within 30 days
Home wound care
Type A flu
changes through antigenic shift or drift
epidemic Q1-3 years
HN
Type B flu
antigenic drift only (minor mutations)
epidemic Q5 years
No difference in H and N between strains
Neuraminidase inhibitors
oseltamavir/zanamivir
1-1.5 day sooner resolution
oseltamivir AE
N/V
zanamivir
Relenza
two inhalations twice daily for 5 days
oseltamivir
Tamiflu
75mg PO BID x 5 days
75mg daily x 5 days in CrCl <30
zanamivir AE
Bronchospasm, cough
not for use in COPD or asthma
Pneumo vacc - People ≥65 years of age
Give PCV13 first followed by PPSV23 in 1 year
PCV13
13 capsular types
all but one also in PPSV23
GIVE FIRST - other 1 year later
PPSV23
85-90% of all pneumo covered
Who requires both PPSV and PCV
age 65+
2-64 yo with cochlear implants or CSF leaks
All immunocompromised
PPSV only people
2-64 with CVD
chronic pulm dx
DM
alcoholism
liver dx
smokers asthmatics (adults)
LTCF
Flu vaccine
2 type A and 1 type B
70-90% illness prevention <65 yo
flu vaccine efficacy >65 yo
53% illness
50% hospitalization
67% death
Who gets flu vaccine
everyone >6 months
2 doses 1+ month apart if first time and under 9 yo
Hives after egg exposure
recombinant inactivated flu vac only or by HCP
recombinant only if more serious than hives
bacterial sinusitis vs viral
10% bacterial
persistent purulent discharge > 10 days or double sickening
High temp first 3-4 days
persistent symptoms > 10 days
bacterial sinusitis tx
augmentin
high dose (2g BID) if non-susceptible S. Pneumo is prevalent or severe infection
Second line: FQ, doxy, cefixime/cefpodoxime + clinda
Duration of treatment for bacterial sinusitis
adults 5-7 days
children 10-14 days
UTI bugs - community
EColi
S saprophyticus
Klebsiella, proteus, enterococcus
UTI bugs - nosocomial
Ecoli
pseudomonas
other gram negatives
fungal