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Antibiotic Review Inf Dis

Terms in this set (127)

P aeruginosa, negative (also common are S aureus, P mirabilis, enterobacter, aspergillus and candida)
most common causative organism for otitis externa? gram positive or negative?
topical fluoroquinolones (oxofloxacin and ciprofloxacin) 3-4 drops QID x10 days
first line treatment of otitis externa including dosing?
neomycin polymixin b (can't use in perf TM) 3-4 drops QID x10 days
second line treatment of otitis externa including dosing?
S pneumoniae, positive (also common are H flu and M catarrhalis)
most common causative organism for otitis media? gram positive or negative?
amoxicillin 90mg/kg/day BID
first line treatment of otitis media including dosing?
amoxicillin/clavulanic acid 90mg/kg/day
second line treatment of otitis media including dosing?
2nd or 3rd gen cephalosporins
what classes of abx can be used for otitis media if the pt has a type 1 penicillin allergy?
macrolide or clindamycin
what classes of abx can be used for otitis media if the pt has a type 4 penicillin allergy?
10 days, 5 days, 7 days, 5 days, 10 days
how long do you treat otitis media if pt <2yo?
2-5yo mild-moderate case?
2-5yo severe case?
>5yo mild-moderate case?
>5yo severe case?
S aureus, positive (also common are P aeruginosa and H flu)
most common causative organism in mastoiditis in children? gram positive or negative?
S pneumoniae, positive (also common are H flu and S aureus)
most common causative organism in mastoiditis in adults? gram positive or negative?
aspergillus
most common causative organism in fungal otitis externa?
IV vancomycin or linezolid, 7-10 days then oral abx 3 weeks
what is the first line treatment for mastoiditis in children without hx of OM or recent abx therapy? include duration
ceftazidime, cefepime, or piperacillin-tazobactam plus vanc or linezolid
what is the first line treatment for mastoiditis in children with hx of OM or recent abx therapy? include duration
IV 3rd gen cephalosporins 7-10 days then oral abx 3 weeks
what is the first line treatment for mastoiditis in adults? include duration
S aureus, positive (also common are S pneumonia, H flue, M catarrhalis, and P aeruginosa)
what is the most common causative agent of bacterial conjunctivitis? gram positive or negative?
erythromycin ophthalmic ointment, 1/2in QID 5-7 days
what is the first line treatment for bacterial conjunctivitis? include dosage and duration
trimethoprim polymixin b ophthalmic drops, 1-2 drops QID 5-7 days
what is the second line treatment for bacterial conjunctivitis? include dosing and duration
ofloxacin or ciprofloxacin ophthalmic drops, 1-2 drops QID 5-7 days
what is the preferred treatment for bacterial conjunctivitis in contact wearers? include dosing and duration
erythromycin ointment/drops 1/2in QID 3-5 days
what is the first line treatment for corneal abrasion not due to contact lenses? include dosing and duration
fluoroquinolones (ofloxacin or cipro drops/ointment) 1-2 drops QID 3-5 days
what is the first line treatment for corneal abrasion due to contact lenses? include dosing and duration
S aureus, positive
what is the most common causative organism for blepharitis? gram positive or negative?
warm compress, gentle washing, tear replacement
what are the first line conservative treatments for blepharitis?
topical erythromycin, bacitracin, or azithromycin
what are the first line pharm treatments for blepharitis?
1/2in QID 5-7 days
what is the dosing and duration of erythromycin ointment for blepharitis?
S aureus, positive ( also common are S pneumoniae, H flu, M catarrhalis)
what is the most common causative organism for orbital cellulitis? gram positive or negative?
sinus infection
orbital cellulitis is most often secondary to what condition?
vancomycin IV plus 3rd gen cephalosporin or penicillin
what is the first line treatment for orbital cellulitis during hospitalization?
clindamycin or TMPSMX (bactrim/trimethoprim sulfamethoxazole) plus penicillin or 3rd gen cephalosporin
what is the first line treatment for orbital cellulitis after hospitalization?
2-3 weeks
what is the total duration of treatment for orbital cellulitis?
vancomycin plus cipro or levofloxacin
what is the treatment for orbital cellulitis in pts allergic to penicillin?
H flu, negative (also common are S pyogenes, S pneumoniae, S aureus, and N gonorrhoeae)
what is the most common causative organism for epiglottitis in children? gram positive or negative?
Group A strep (G+) and H flu (G-)
what are the 2 most common causative agents for epiglottitis in adults?
S. pyogenes (gram positive), S. aureus (gram pos)
Bacterial cellulitis organisms
Cephalexin, Dicloxacillin
Bacterial cellulitis first line oral
Clindamycin or Erythromycin
bacterial cellulitis first line if penicillin allergy
Cefazolin, Ampicillin
Bacterial cellulitis first line IV
TMP-SMX, Doxycycline, Clindamycin
First Line Oral for MRSA
Vancomycin or Linezolid
First Line IV for MRSA
5
Duration of therapy for bacterial cellulitis should be a minimum of ___ days
S. pyogenes (+),
Organism(s) that cause erysipelas
Erysipelas
Intensely erythematous, raised areas with sharply demarcated borders. Involves the lower extremities, face or skin with impaired lymphatic drainage. Often associated with systemic symptoms, such as fever.
S pneumoniae, positive (also common are H flu, M catarrhalis, and GAS)
what is the most common causative organism for bacterial sinusitis? gram positive or negative?
amoxicillin/clavulanic acid 875mg BID (or high dose 2g BID)
what is the first line treatment for bacterial sinusitis? include dose
5, 10
Duration of therapy for erysipelas should be a minimum of ___ days, but may extend to ___ days.
S. aureus (+)
S. pyogenes (GAS, +)
Impetigo organisms
Impetigo
Risk Factors:
· Poor personal hygiene
· Poverty/ Overcrowding
· Warm, humid weather
· Physical Exam
Papules, vesicles and pustules, later develop honey-colored, golden crusts
mupirocin
First line for Impetigo
Cephalexin or Dicloxacillin
treatment if extensive or systemic symptoms of impetigo
S. aureus (+)
S. pyogenes (GAS, +)
(Oral flora if associated with nail biting)
Candida spp.
Acute Paronychia organisms
Warm water or antiseptic soaks + Mupirocin
first line acute paronychia
Clindamycin or Amoxicillin-Clavulanic acid
First Line for paronychia with Nail Biting:
topical therapy is 5-7 days.
Cephalexin 500 mg TID/QID
Clindamycin 250 mg QID
Paronychia dosage and duration
S. aureus (+)
Strep spp.
Bacterial Superinfection of Diaper Dermatitis organisms
Bacterial Superinfection of Diaper Dermatitis
Erythematous, scaly, eroded painful lesions that spare the creases.
Mupirocin
First Line Pharm for bacterial superinfection of diaper dermatitis
7 to 14
Duration of topical therapy for BSDD is ___ to ___ days.
Typical Organisms
S. pneumonia (+, Most common community-acquired pneumonia)
H. flu (-)
Klebsiella pneumonia (+)
S. aureus (+)
Pneumonia typical organisms
Mycoplasma pneumonia (Most common cause of atypical (walking) pneumonia).
Legionella pneumoniphila
Chlamydophila pneumoniae
Pneumonia atypical organisms
S. pneumoniae, chlamydophila pneumonia
Pneumonia organisms in Infants 5 months - kids 5 years
· First Line: Amoxicillin 1 g TID x 5 days
· Alternative: Macrolide (if resistance < 25%)
CA Uncomplicated Pneumonia - Healthy Adult pharm
· Frist Line: Beta-lactam PLUS Macrolide x 5 days.
· Alternative: Fluoroquinolones (Moxi, Floxi, and Levo)
CA Uncomplicated Pneumonia - Adult c Comorbidities pharm
· First Line: Beta-Lactam + Macrolide
· Alternative: Fluoroquinolone (Moxi, Floxi, and Levo)
CAP Inpatient - No Risk of MRSA or Pseudomonas pharm
· First Line: Beta-lactam + Macrolide
· Alternative: Beta-lactam + Respiratory Fluoroquinolones
CAP Inpatient - Severe, No Risk of MRSA or Pseudomonas pharm
· MRSA: Vancomycin or Linezolid
· Pseudomonas: Piperacillin-Tazobactam, Ceftazidime or Cefepime, Aztreonam, Carbapenems
CAP Inpatient - Severe, Risk of MRSA or Pseudomonas pharm
· First Line: Ampicillin
· Alternative: Gentamicin
CAP in Neonates pharm
· First Line: Erythromycin
· Alternative: Azithromycin
CAP in Infants 1-4 months pharm
· First Line: High dose amoxicillin
· Special Populations:
· Type 1 Penicillin Allergy: Clindamycin or Macrolide
· Type 4 Penicillin Allergy: 2nd and 3rd-Gen Cephalosporin
Atypical Organisms: Macrolide or Respiratory Fluoroquinolone
CAP in Infants 4 months - kids 5 years pharm
10-14
Outpatient treatment for CAP is typically ____ to ____ days.
· Methicillin-resistant S. aureus
· P. aeruginosa
· Gram-negative bacilli
Hospital Acquired Pneumonia organisms
· First Line: Piperacillin-Tazobactam
· Alternative: Cefepime, Levofloxacin, Carbapenem (Imipenem or Meropenem)
HAP - No Risk of MRSA, Low Risk for Ventilator Support Pharm
· First Line: Piperacillin-Tazobactam PLUS Vancomycin or Linezolid
· Alternative: Cefepime, Levofloxacin, or Carbapenem PLUS Vancomycin or Linezolid
HAP - Risk of MRSA, Low Risk of Ventilator Support
· First Line: Piperacillin-Tazobactam PLUS Vancomycin or Linezolid
Alternative: Cefepime, Ceftazidime, Levofloxacin, Cipro, Carbapenem, Aminoglycoside, Aztreonam PLUS Vancomycin or Linezolid
HAP - High Risk for Ventilatory or has IV Abx < 90 days
7, 48-72
Duration of therapy for HAP is typically ___ days.
Patient should be clinically stable and afebrile for ____ to ____ hours before therapy discontinuation
cystic fibrosis (CF)
Mutation in the cystic fibrosis transmembrane conductance receptor (CFTR) gene leads to abnormal chloride and water transport across exocrine glands throughout the body, leading to thick, viscous secretions of the lungs, pancreas, sinuses, intestines, liver, and genitourinary tract.
cystic fibrosis
Meconium ileus as an infant. Bronchiectasis as a child/adult
Malabsorption of fat-soluble vitamins, steatorrhea, diarrhea, recurrent pancreatitis.
First Line: Macrolides (Azithromycin, Clarithromycin)
Alternative: Cephalosporins (Cefuroxime, Cefixime), Amoxicillin-clavulanate, Fluoroquinolones.
Cystic fibrosis pharm
· Viruses - Adenovirus, Parainfluenza, Influenza, Coronavirus, Coxsackie, Rhinovirus, Respiratory syncytial virus (most common)
Viral causes of bronchitis
· S. pneumoniae
· H. influenzae
· M. catarrhalis
Mycoplasma
Common organisms for bronchitis (no idea where this info came from)
· Respiratory syncytial virus (RSV)= most common
· Rhinovirus
· Adenovirus
· Influenza virus
Parainfluenza virus
Bronchiolitis causes
· First Line Conservative: Humidified oxygen, IV fluids, nebulized saline, cool mist humidifier, and antipyretics
Corticosteroids are NOT indicated unless history of underlying reactive airway disease.
Bronchiolitis treatment (no abx)
doxycycline or resp fluoroquinolones
what are the second line treatment options for bacterial sinusitis?
Cefazolin, Ceftriaxone, or Flucloxacillin
First Line IV for erysipelas
· Penicillin, Amoxicillin, Cephalexin
· Clindamycin, Trimethoprim-sulfamethoxazole, or Linezolid for penicillin allergy.
Erysipelas first line
ceftriaxone or cefotaxime plus vancomycin, clindamycin, oxacillin, nafcillin, or cefazolin
what are the first line pharm treatment options for epiglottitis?
S pyogenes, positive ( often common is staph)
what is the most common causative organism in peritonsillar abscesses? gram positive or negative?
IV penicillin
what is the first line treatment for peritonsillar abscesses?
S pyogenes, positive (also common are S pneumoniae, becteroides fusobacterium, N gonorrhoeae, Mycoplasma pneumoniae, S aureus)
what is the most common causative organism for pharyngitis? gram positive or negative?
penicillin VK 1g QID, amoxicillin 875mg BID 10 days
what are the first line treatment options for pharyngitis? include dosing and duration
1st gen cephalosporin
what is the treatment for pharyngitis in pts with type 4 penicillin allergy?
macrolide or clindamycin
what are the treatment options for pharyngitis in pts with type 1 penicillin allergy?
fluoroquinolones or beta lactams, 5-7 days
what are the second line treatment options for uncomplicated UTIs? include duration
fosfomycin or cephalexin
what are the treatment options for uncomplicated UTIs that can be used at any point during pregnancy?
fluoroquinolones
what is the first line outpatient treatment for pyelonephritis?
fluoroquinolones or TMP-SMX
what are the first line outpatient treatment options for acute prostatitis?
fluoroquinolones or TMP-SMX
what are the first line treatment options for chronic prostatitis?
IV fluoroquinolones +/- aminoglycosides or ampicillin +/- gentamicin
what are the first line treatment options for inpatient acute prostatitis?
ceftriaxone plus doxycycline
what is the first line treatment for acute prostatitis when an STI is likely?
2-6 weeks
what is the duration of treatment for prostatitis?
chlamydia trachomatis or N gonorrohea
what are the 2 most common causative organisms for epididymitis in males 14-35yo?
E coli (also common are klebsiella, pseudomonas, proteus)
what is the most common causative organism for epididymitis in men >35yo
E coli or Mycoplasma pneumoniae
what are the 2 most common causative organisms for epididymitis in prepubertal boys?
doxycline plus ceftriaxone
what is the first line treatment for epididymitis in men <35yo?
fluoroquinolones
what is the first line treatment for epididymitis in men >35yo?
cephalexin or amoxicillin
what are the treatment options for epididymitis in children?
E coli, negative (also common are proteus and enterococci)
what is the most common causative organism for prostatitis? gram positive or negative?
3rd or 4th gen cephalosporins, fluoroquinolones, aminoglycosides, or extended spectrum penicillins; 2 weeks total
what are the first line inpatient treatment options for pyelonephritis? include duration
E coli, negative (also common are proteus, enterobacter, klebsiella, pseudomonas)
what is the most common causative organism for pyelonephritis? gram positive or negative?
fluoroquinolones, 7-14 days
what is the first line treatment for complicated UTIs? include duration
E coli, negative (also common are enterobacteriaceae, enterococcus, staphylococcus, pseudomonas, GBS)
what is the most common causative organism in complicated UTIs? gram positive or negative?
nitrofurantoin 100mg BID x5 days, TMP-SMX BID x3 days, or fosfomycin 3g single dose
what are the first line treatment options for uncomplicated UTIs? include dosing and duration
IV clindamycin
what is the treatment for peritonsillar abscesses in pts allergic to penicillin?
E coli, negative (also common are S saprophyticus, klebsiella, proteus, enterobacter, and pseudomonas)
what is the most common causative organism for uncomplicated UTIs? gram positive or gram negative?
norovirus, rotavirus, E coli (other common causes of infectious diarrhea are S aureus and B cereus)
what is the most common cause of infectious diarrhea in adults in north america?
In unvaccinated children 6mo-2yo? Of traveler's diarrhea?
oral rehydration
what is the first line treatment for both viral and bacterial infectious diarrhea?
loperamide, bismuth subsalicylate
what are the second line treatment options for bacterial infectious diarrhea?
metronidazole plus cipro or levofloxacin
what are the first line treatment options for uncomplicated diverticulitis?
7-10 days
what is the duration of treatment for diverticulitis?
S aureus, positive (also common are strep and candida albicans)
what is the most common causative organism for mastitis? gram positive or negative?
warm/cool compress, breast pumping, NSAIDs
what are the first line conservative treatment options for mastitis?
dicloxacillin, nafcillin, cephalosporins
what are the first line pharm treatment options for mastitis?
10-14 days
what is the duration of treatment for mastitis?
S pneumoniae, positive (also common are N meningitidis, GBS, listeria monocytogenes, and H flu)
what is the most common causative organism for meningitis?
dexamethasone
the first line treatment for meningitis is an antibiotic plus ___________
vancomycin + ceftriaxone, vancomycin + ceftriaxone + ampicillin, ampicillin + gentamicin or cefotaxime
what is the first line antibiotic combo for meningitis in >1mo-5yo?
In >50yo?
In <1mo?
HSV (also common are varicella zoster, EBV, measles, mumps, rubella, HIV, St. Louis virus)
what is the most common causative organism for encephalitis?
IV acyclovir
what is the first line treatment for encephalitis?
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