UWorld Chapter 23: Infectious Disease II

60 minutes

Within what time frame should cefazolin or cefuroxime be infused before the first incision when used for perioperative prophylaxis?

120 minutes

Within what time frame should fluoroquinolones and vancomycin be infused before the first incision when used for perioperative prophylaxis?

24 hours

If used post operatively, within what time frame should antibiotics be discontinued?

Cefazolin

What antibiotic is preferred for most surgeries to prevent MSSA and streptococcal infections?

Gastrointestinal

In what type of procedure should metronidazole be added to cefazolin for surgical prophylaxis due to the need for broad gram negative and anaerobic coverage?

Vancomycin

What antibiotic should be used for surgical prophylaxis if MRSA colonization is confirmed or if risk is present?

Ceftriaxone and vancomycin

What *empiric* treatment regimen is recommended for *meningitis* in patients aged 1 month to 50 years old to cover for *s. pneumonia and n. meningitidis*?

ampicillin

What antibiotic should be added to *neonates, aged > 50 years, or immunocompromised patients* with meningitis in order to cover for *listeria*?

Dexamethasone

What medication can be administered 15 to 20 minutes *prior* to or *with* the first antibiotic dose to *prevent neurological complications* and death from pneumococcal meningitis and continued for *4 days* unless s. pneumoniae is not identified as a cause?

Ceftriaxone and macrolide or doxycycline, respiratory quinolone

What are the two treatment regimens recommended for empiric inpatient treatment of community acquired pneumonia?

Vancomycin or linezolid

What should be added to the inpatient treatment of CAP in patients with prior respiratory isolation of MRSA or positive nasal swab?

Piperacillin/tazobactam, cefepime, or meropenem

What should be added to the inpatient treatment of CAP in patients with a prior respiratory isolation of *pseudomonas*?

Hospitalization and use of parenteral antibiotics in the past 90 days

What *patient factor* indicates that the inpatient treatment of CAP should include coverage for *MRSA and Pseudomonas*?

Piperacillin/tazobactam, cefepime, or levofloxacin

What are *three* example antibiotics that should be considered in ALL patients with HAP or VAP in order to cover for *MSSA and Pseudomonas*?

Vancomycin or linezolid

What should be added to patients with HAP or VAP that have used IV antibiotics in the past 90 days, MRSA prevalence in the hospital unit is > 20% or unknown, the patient has had a prior MRSA infection or a positive MRSA nasal swab?

Multi Drug Resistant (MDR) organisms

What is a patient at risk for with use of IV antibiotics in the past 90 days, prevalence of gram-negative resistance in the hospital unit > 10%, hospitalized for ≥ 5 days prior to the onset of VAP and, therefore, should have *two antibiotics* for Pseudomonas coverage?

Intensive Phase

What *phase* of *active TB* treatment includes the following 4 drugs for 2 months?

*RIPE*

Rifampin (RIF)

Isoniazid (INH)

Pyrazinamide (PZA)

Ethambutol

Continuation Phase

What *phase* of *active TB* treatment includes the following 2 drugs for 4 months?

Isoniazid (INH)

Rifampin (RIF)

Infective Endocarditis

What infection may be caused by viridans group strep, stephylococci (MSSA or MRSA), and enterococci and should be treated for 4-6 weeks?

Amoxicillin 2g

What antibiotic is the first line choice for prophylaxis of infective endocarditis in high risk patients and should be given 30-60 minutes before a dental procedure as a single dose?

Ceftriaxone for 5-7 days

What is the *empiric* choice for treatment of spontaneous bacterial peritonitis (SBP) to target streptococci, proteus, E. coli, and klebsiella?

SMX/TMP or ciprofloxacin

What should patients who have received treatment for an initial SBP episode be prescribed for secondary prophylaxis to decrease the risk of subsequent infections?

ertapenem or moxifloxacin

What is the treatment of choice for community-acquired, low risk intra-abdominal infections for a duration of 4-5 days?

cefepime and metronidazole, piperacillin/tazobactam

What is the treatment of choice for intra-abdominal infections with a risk for resistant or nosocomial pathogens?

Severe Purulent

For what type of SSTI should antibiotics with MRSA activity including vancomycin, daptomycin, or linezolid be administered for 7-14 days?

Necrotizing fasciitis

For what type of SSTI should empiric antibiotic therapy include vancomycin or daptomycin + beta lactam (piperacillin/tazobactam, meropenem) + clindamycin in order to suppress streptococcal toxin production?

Acute cystitis

For what type of infection are nitrofurantoin, TMP/SMX, or fosfomycin considered the primary antibiotic choices?

Penicillin G

What is the primary antibiotic used to treat syphillis or neurosyphilis?

Ceftriaxone

What is the primary antibiotic used to treat gonorrhea?

Doxycycline

What is the primary antibiotic used to treat chlamydia in non-pregnant patients?

Azithromycin

What is the primary antibiotic used to treat chlamydia in pregnant patients?

Metronidazole

What is the primary antibiotic used to treat bacterial vaginosis or trichomoniasis?

Doxycycline

What is the primary antibiotic used to treat tickborne diseases including rocky mountain spotted fever, Lyme disease, and ehrlichiosis?

Moxifloxacin

What quinolone should NOT be used for the treatment of UTIs?

Purulent

What type of SSTIs are most associated with s. aureus and, therefore, are treated with TMP/SMX and doxycycline in mild, outpatient settings?

Non-purulent

What type of SSTIs are most associated with s. pyogenes and, therefore, are treated with cephalexin in mild, outpatient settings?

Penicillin or ceftriaxone

What is the preferred antibiotic regimen for infective endocarditis caused by viridans group streptococci?

Nafcillin or Cefazolin

What is the preferred antibiotic regimen for infective endocarditis caused by MSSA?

Rifampin

Which antibiotic may be used in cases of staphylococcal prosthetic valve endocarditis due to its ability to treat organisms with a biofilm?

Gentamicin

What antibiotic may be added for synergy in the treatment of infective endocarditis when the infections are more difficult to eradicate, such as with prosthetic valve infections or when treating more resistant organisms?

Amoxicillin/Clavulanate

What antibiotic should be administered for 5-7 days in patients with an acute COPD exacerbation and any of the following criteria:

1. All three cardinal symptoms (dyspnea, sputum volume, sputum purulence)

2. sputum purulence and 1 additional symptom

3. mechanically ventilated