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Terms in this set (56)
Primary (Spontaneous) Peritonitis
3rd Generation Cephalosporin & Aminoglycoside
- 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
Zosyn & and aminoglycoside together
Cryptosporidium induced severe, non-bloody diarrhea?
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/o 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
& Entamoeba with liver abscess
Liver abscess = Metronidazole & a luminal amebicide (Iodquinol or paromomycin).
Toxocariasis aka "visceral larva migrnas" from toxocara canis
Mebendazole or thiabendazole
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
Cat Scratch Fever with Bartonella Henselae
Except if immunocompromised, hepatosplenomegaly or hepatosplenomegaly - then you can treat with: Azithromycin, erythromycin, ciprofloxacin, bactrim, or rifampin.
A Cat Bite
If PCN allergy - Clindamycin (staph coverage) & TMP-SMX (Pasteurella)
"gram negative pleomorphic organism"
Household contacts of patient with H. Influenza?
Nothing if all healthy!
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)
Alternates: gentamicin, tobramycin, cefepime (4th gen.)
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 "Rabbits are Gentle" - gram negative
Alternates: streptomycin, tetracycline, Ciprofloxacin
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
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 (immunocompromised patients)
- also for severe mucocutaneous disease or Zoster caused by acyclovir resistant HSV or varicella.
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
- 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.
Permethrin 5% - treat all family members
Crabs - Pubic Lice
Pyrethrin with piperonyl butoxide
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
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