Therapeutics UTI, IE, Into to ID, Pneumonia, Flu, PKPD, Osteomyelitis, Septic arthritis

etiology of UTI

e coli

ways to diagnose UTI

clinical presentation, dipstick test, urine culture and sensitivity, urinalysis

when is a urinalysis required

recurrent infection, complicated infection, pyelonephritis, infection not responding to therapy

can a presumptive diagnosis of UTI be made in a symptomatic female with no complicating factors

yes

what are indicators of UTI seen in a urinalysis

WBC, hematuria, proteinuria, nitrites, leukocyte esterase

are nitrites normally found in the urine

no gram negative bacteria reduces nitrates to nitrites

what is a leukocyte esterase

enzyme produced by WBCs

symptomatic abacteriura treatment for pt who is sexually active

1 g of azithromycin once

doxycycline 100mg BID x 7 days

pregnant females with asymptomatic bacteriuria treatmetn

cephalosporin or augmentin x 7 days

non pharm treatment for UTI

avoid avoidable factors, postcoital urination to flush out bacteria, do not ignore urge to void, increase fluid intake

what can methenamine hippurate do in a UTI

reduce recurrent infection in 12 and older

what can you use for pain relief of a UTI

phenazopyridine 200mg PO TID max 2 days after meals

when is phenazopyridine contraindicated

patients with renal disease or severe hepatitis

treatment options for uncomplicated cystitis

Nitrofurantoin

fosfomycin

TMP/SMX

FQ

Amox/clav, cefdinir, ceftriaxone, cefpodoxime

nitro uncomplicated cystitis dose

100mg PO BID x 5 days

fosfomycin dosing for uncomplicated cystitis

3g PO once

TMP/SMX dosing uncomplicated cystitis

160/800mg PO BID x 3 days (7-10 days for complicated)

how long do you use a FQ for uncomplicated cystitis and why should you not use them

3 days, ADRs and resistance

what antibiotics are safe to use in pregnancy for a UTI

amox, amox/clav, cephalextin, nitrofurantoin

complicated cystitis treatment

cipro, levo, ceftriaxone, (severely ill: cefepime, ceftazidime, pip/tazo, imipenem/cilistatin)

cipro dosing for complicated cystitis

250-500mg PO BID or 400mg IV Q12H

levo dosing for complicated cystitis

500-750mg PO or IV QD for 5 days

ceftriaxone doing for complicated cystitis

1g IV QD

cefepime dosing for complicated cystitis

2g IV Q12H

ceftazidime dosing for complicated cystitis

2g IV Q8H

pip tazo dosing uncomplicated cystitis

3.375-4.5g IV Q6H

how long is treatment for complicated cystitis

7-14 days

complicated pyelonephritis treatment

cipro, levo, ceftriaxone, TMP/SMX

second line agents for complicated pyelonephritis

amox/ clav, ceftazidime, cefepime

cipro dosing for complicated pyelonephritis

500mg PO or 400mg IV BID x 7 days

levo dosing for complicated pyelonephritis

750mg IV/PO QD x 5 days

ceftriaxone dosing for complicated pyelonephritis

1g IV QD

TMP/SMX dosing for pyelonephritis

160/800mg PO BID x 14 days

cefpodoxime dosing for uncomplicated pyelonephritis

200mg PO BID x 10 days

ceftibuten dosing for uncomplicated pyelonephritis

400mg PO QD x 10 days

prophylactic TMP/SMX dosing for UTI

1/2 - 1 PO QD or TIW

prophylactic trimethopirm dosing for UTI

100mg PO QD

prophylactic nitro dosing for UTI

50-100mg PO QD

prophylactic cephalexin dosing for UTI

125-250mg PO QD

prophylactic fosfomycin dosing for UTI

3 g x 10 days

ineffective endocarditis

infection of endocardial surface of the heart

etiology of ineffective endocarditis

staph, strep, enterococcus, HACEK

empiric treatment for NVE acute valve

vanco and cefepime

how long is empiric treatment for NVE

4 weeks

empiric treatment for NVE subacute valve

vanco and ampicillin sulbactam

empiric treatment for PVE within 1 year of replacement

vanco and cefepime

empiric treatment for PVE more than a year

vanco and ceftriaxone

targeted therapy for viridans/ strep NVE

penicillin or ceftriaxone 4 weeks

targeted therapy for viridans/ strep PVE

penicillin or ceftriaxone and gentamicin 6 weeks

targeted therapy for MSSA NVE

nafcillin or oxacillin and cefazolin

targeted therapy for MSSA PVE

nefcillin or oxacillin and cefazolin and rifampin 6 weeks and gentamicin for 14 days

targeted therapy for MRSA NVE

vanco or dapto 6 weeks

targeted therapy for MRSA PVE

vanco and rifampin 6 weeks and gentamicin for 14 days

targeted therapy for enterococcus NVE/ PVE

ampicillin or penicillin or vanco and gentamicing 6 weeks

targeted therapy for HACEK

ceftriaxone or ampicillin/ sulbactam or cipro

prophylatic antibiotics for ineffective endocarditis

amox before procedure

penicillin allergy: cephalexin or cefazolin

etiology of bacteremia

s aureus, staphylococcys, gram negative, entereococcus, candida

treatment of bacteremia

removal and or debridement

IV antibiotics for 7-14 days for up to 6 weeks

empiric therapy for bacteremia

vanco and cefepime, carbapenem, or pip/tazo

osteomyelitis

infection of bone

etiology of osteomyelitis

s aureus, s pyogenes, p aeruginosa, e coli, clostridium

signs and symptoms of osteomyelitis

tenderness, pain, swelling, chills, fever, increased WBC

empiric therapy of osteomyelitis

vanco and ceftriaxone or ceftazidime or cefepime or cipro

targeted therapy for MSSA osteomyelitis

nafcillin/ oxacillin or cefazolin

targeted therapy for MRSA osteomyelitis

vanco or linezolid or dapto

penicillin sensitive targeted therapy for osteomyelitis

penicillin g or ceftriaxone

pseudomonas targeted therapy for osteomyelitis

cefepime or meropenem

septic arthritis

infection of joint space

etiology of septic arthritis

s auerus, strep, e coli, p aeruginosa, neiseeseia goonorrhoeae

empiric treatment of septic arthritis

vanco and ceftriaxone or ceftazidime or cefepime

targeted MSSA therapy for septic arthritis

nafcillin/ oxacillin/ cefazolin

targeted MRSA therapy for septic arthritis

vanco, linezolid, clinda

targeted strep therapy for septic arthritis

ceftriaxone

targeted gram negative rod therapy for septic arthritis

ceftazidime or cefepime or pip/tazo

targeted pseudomonas therapy for septic arthritis

cipro or ceftazidime and tobramycin

targeted therapy for neisseria gonorrheae for septic arthritis

ceftriaxone

empiric therapy

organism not been isolated at the time of prescribing and starting therapy

definitive/ directed therapy

when you know the drug and pathogen

what are examples of gram positive bacteria in cocci clusters

staph

what are examples of gram positive bacteria in cocci pairs

strep

what are examples of gram positive bacteria in cocci chains

enterococcus

what are examples of gram positive bacteria in baccili

listeria, anaerobes

what are examples of gram negative bacteria in cocci

nessiria

what are examples of gram negative bacilli

e coli, klebsiella, pseudomonas aeruginosa

what are the organisms of concern for resistance

ESKAPE

enterococcus

staphylococcus aureus

klebsiella

acinetobacter

pseudomonas

e coli

staphylococcus aureus

colonizer of skin flora

rapidly developed resistance and requires MSSA therapy

what drugs are not broken down by penicillinase

nafcillin/ oxacillin

cefazolin

cephalexin

MSSA

express penicillinase want to chose drug that combats or avoids resistance mechanism

what drugs are not susceptible to enzyme degradation

nafcillin and cefazolin

what drugs cover MRSA

vanco, dapto, linezolid, ceftaroline

enterococcus faecium

bad bug hard to treat

what is enterococcus faecium resistant to

beta lactams

VRE

psuedomonas aeruginosa

gram negative concern for hospital acquired infections rapidly adapts and develops resistance

ESBL

more potent inactivate penicillins, cephalosporins, aztreonam, resistant to aminoglycosides, sulfonamides, and FQ

if it is a systemic infection with resistance of ESBL what drug do you use

carbapenem

what drugs are highly likely to induced AMPC

enterobacter cloacae complex

citrobacter

klebsiella

THINK CEFEPIME

what drugs are used to treat ampc beta lactamase

nitrofurantoin or fosfomycin for cystitis CEFEPIME

what increases the risk for carbapenem resistance

recent use of 3rd or 4th generation cephalosporins

what are reasons for antibiotic combinations

empiric coverage

multiple organisms

synergy

what are members of beta lactams

penicillins

cephalosporins

carbapenems