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ISBP IIB2: Exam 3 Previous Material

Terms in this set (38)

Bacterial
o Syphilis - T. pallidum
o Bacterial vaginosis - G. vaginalis, Bacteroides sp.
Viral
o Herpes - HSV
Protozoal
o Trichomoniasis
Gonorrhea
o Treatment (First line)
- Ceftriaxone 500mg IM x 1 dose
Chlamydia
o Treatment (First line)
· Azithromycin 1g PO x 1 dose
· Doxycycline 100mg PO BID x 7 days

o Alternate
· Erythromycin 500mg PO QID x 7 days
· EES 800mg PO QID x 7 days
· Levofloxacin 500mg PO QD x 7 days
· Ofloxacin 300mg PO BID x 7 days
Syphilis
o Treatment (follow-up)
- 6, 12mo for primary/secondary
- 6, 12, 24mo for early latent

§ If allergic to penicillin (Primary/secondary/early latent)
o Doxycycline 100mg PO BID for 14 days
o Tetracycline 500mg PO QID for 14 days
o Ceftriaxone 1-2g IM or IV QD for 10-14 days

o Monitoring
- Jarisch-Herxheimer reaction - benign, self limiting
Bacterial Vaginosis
o Clinical criteria - at least 3
- Homogenous, thin, white vaginal discharge
- + clue cells on microscopic exam
- Vaginal fluid pH > 4.5
- Fishy odor

o Patient education
- Disulfiram like reactions - avoid alcohol 24h after metronidazole, 72h after tinidazole
- Avoid use of vaginal douches
Trichomoniasis
o Treatment
§ Treatment of partners recommended (including presumptive therapy)

o Monitoring
§ If first treatment fails, repeat with extended duration Metronidazole or single dose tinidazole
§ If breast-feeding, interrupt for 12-24h after metronidazole single dose
Herpes
o Treatment (First episode)
- Famciclovir 250mg PO TID x 7-10 days

o Recurrent (Episodic)
- Valacyclovir 1g PO QD x 5 days
Bronchiolitis
§ Aerosolized albuterol or nebulized epinephrine - not recommended
§ Nebulized hypertonic saline - hospitalized infants/children
§ NO corticosteroids
§ No antibiotic unless bacterial infection
§ Nasogastric or IV fluids for infants who can't maintain hydration orally
Acute Bronchitis
o Hallmark - cough
Influenza
o Antiviral treatment ASAP w/influenza
§ Hospitalized patients, outpatient w/severe illness or high risk of complications, <2yo or >=65yo, pregnant or w/in 2 weeks postpartum
§ PO oseltamivir - for everyone; preferred in pregnancy
§ Inhaled zanamivir - >7yo; avoid in geriatric - incorrect use
Animal and human bite wounds
o Be familiar with first-line empiric therapy for infected dog bites
§ Augmentin
UTI
o Preferred method for routine collection of urine
§ Midstream clean catch - after 20-30mL of urine is voided

o Diagnosing UTI
§ Cornerstone - urine collection
§ Symptoms alone are unreliable for diagnosis

o First-line agents and alternative agents
§ TMP-SMX x 4-6 weeks
§ Quinolone x 4-6 weeks

o Fluoroquinolone place in therapy for uncomplicated cystitis
§ FDA's drug safety communication issued in 2016 states that the serious adverse events outweigh the benefits in patients w/uncomplicated cystitis when other treatment options are available.

o Management of acute uncomplicated pyelonephritis
§ 1st line
· Quinolone x 7 days (Cipro, Levo)
§ Alt or after susceptibility confirmed
· TMP-SMX x 14 days
· Augmentin x 10-14 days
· Cefpodoxime x 10-14 days
OM is a 2-year-old female who presents to clinic with a fever of 102.5F (39.2C). Mom reports she has been tugging at her ear and has been fussy for the past couple of days. OM is diagnosed with acute otitis media during this visit. She has no significant past medical history and has no known drug allergies. Which of the following would be most appropriate antibiotic to recommend for the treatment of this patient?
amoxicillin 90mg/kg/day in 2 divided doses
The most common bacterial pathogens associated with acute otitis media are Streptococcus pneumoniae, Moraxella catarrhalis, and non-typeable Haemophilus influenzae
True
For a patient with a reported penicillin allergy (rash) who will be treated for acute otitis media, cefdinir could be an appropriate alternative
True
The majority of rhinosinusitis infections are bacterial in nature and will require appropriate antimicrobial therapy
False
· Which of the following statements regarding acute bacterial rhinosinusitis (ABRS) is correct?
Amoxicillin-clavulanate, rather than amoxicillin alone is recommended as empiric antimicrobial therapy for children and adults with ABRS
In a patient with severe acute bacterial rhinosinusitis (ABRS) requiring hospitalization, which of the following would provide the most appropriate empiric coverage?
ampicillin-sulbactam 1.5-3grams IV q6hrs
Which of the following are appropriate agents to use, either as first-line or alternative agents, in the management of patients with bacterial pharyngitis? [SELECT ALL THAT APPLY]
*a. Penicillin V
*b. Penicillin G benzathine
*c. cephalexin
*d. amoxicillin
The primary bacterial cause of pharyngitis is:
Group A beta-hemolytic streptococcus
Which option below would be the most appropriate to recommend for initial treatment in an adult male patient presenting to his local emergency department with a diagnosis of community acquired pneumonia (CAP) and past medical history significant for type 2 diabetes and hypertension?
Ceftriaxone 1gram IV q24hrs + azithromycin 500mg IV q24hrs
What does the usual treatment approach for acute bronchitis consist of?
Usually symptomatic/supportive in nature (aimed at treating fever/malaise and rehydration). It is almost always self-limiting.
RC is a 23-year-old, female with asthma who presents to clinic with history of 4-5 days of fever, myalgia, dry cough, and malaise. At clinic, she is diagnosed with influenza A infection. What would be the most appropriate recommendation for her at this time?
Oseltamivir 75 mg once daily for 5 days
Which of the following patients should not receive the live-attenuated influenza vaccine (LAIV)?
Diabetes
Pregnant
Younger than 2yo
The most common cause of folliculitis, furuncles, and carbuncles is
Staph aureus
Which of the following statements are true regarding impetigo? [select all that apply]
*a. Impetigo is highly communicable and can be spread through close contact.
*c. Exposed skin, especially on the face, is a common site for infection.
*d. Topical mupirocin ointment is an appropriate treatment choice in mild cases which do not involve the face.
KT is a 9-year-old female who presents to the ED after suffering from a dog bite. Her parents report that KT was playing with the neighbors dog when she accidentally stepped on its tail. She received the bight to the left side of her face. The bite involves multiple deep puncture wounds with some tearing around adjacent tissues. Immunization records for the dog are up to date, including rabies. What would be the most appropriate recommendation to make for the management of this patient?
The patient should begin oral antibiotic for at least 3-5 days and the dog should be quarantined and monitored for a period of 10 days
The most appropriate first-line, empiric therapy for an infected dog bite would:
amoxicillin-clavulanate
CP is a 31-year-old female who presents to her primary care physician complaining that her leg feels hot and painful. On physical exam, the lower leg shows an area of erythema, edema, and is warm to touch. The erythematous areas are non-elevated and have poorly defined margins. There is no drainage, exudates, or abscesses. Vital signs and CBC count are within normal limits. The patient has no significant past medical history and does not have allergies. The resident would like to treat this patient for cellulitis and would like your recommendations. What would be the most appropriate therapy to begin for this patient?
An oral beta-lactam (e.g., dicloxacillin, cephalexin)
TM is a 45-year-old male who presents to his primary care clinic with a clinical picture indicative of a moderate purulent cellulitis. The physician feels this patient can be safely managed in the outpatient setting. Based on the information provided, what would be the most appropriate therapy to recommend for this patient?
oral trimethoprim-sulfamethoxazole
Which of the following statements are incorrect regarding erysipelas? [SELECT ALL THAT APPLY]
*b. S. aureus is the most common cause
*d. It is important to ensure that empiric antibiotics have good coverage against MRSA.
Which of the following antibiotics can be considered for patients requiring therapy for carbuncles with systemic findings of infection (e.g., fever)?
trimethoprim-sulfamethoxazole
A 53-year old woman (ht 65in, wt 70kg) with well-controlled type 2 diabetes presents to the ED with burning during urination, costovertebral angle tenderness, and nausea. The urinalysis showed ≥105 CFU/L and was nitrite positive. The patient is allergic to trimethoprim/sulfamethoxazole. The ED medical resident would like your recommendation for the appropriate management of this patient. Which of the following recommendations would be most appropriate?
*a. perform urine culture and susceptibility testing
*c. start therapy with a quinolone or ceftriaxone
Which of the following would be categorized as a complicated urinary tract infection?
*b. an acute infection with involvement of the kidneys of a 27-year-old male.
*c. an acute recurrent infection involving the lower urinary tract of a 58-year-old female.
*d. an acute infection with involvement of the kidneys in a patient with an indwelling catheter
A 23-year-old woman presents to her PCP with dysuria and suprapubic discomfort. A urinalysis was performed and was indicative for urinary tract infection. The patient has no significant past medical history and no known drug allergies. Based on the 2010 IDSA Guidelines, which of the following regimens would be the most appropriate treatment for this patient?
nitrofurantoin 100 mg orally twice daily for 5 days
TM is A 32-year-old woman who is diagnosed with her 3rd incidence of uncomplicated cystitis in the last 18 months. Her last prescription filled was TMP/SMX and was completed 30 days ago. The trimethoprim-sulfamethoxazole resistance rate for E.coli is 8% in the community. Which of the following would be the most appropriate choice for treatment of an uncomplicated UTI for this patient?
trimethoprim-sulfamethoxazole double strength, one tablet orally twice daily for 3 days
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