Infectious Diseases and Antimicrobial Therapy Review

Flashcards covering Community-Acquired Pneumonia (CAP), UTIs, SSTIs, C.diff, HIV management, and general antimicrobial principles based on lecture notes.

Community-Acquired Pneumonia (CAP) Diagnosis Confirmation

Diagnosis is confirmed by a Chest X-ray.

CAP common pathogen

Strep. Pneumonaie

First-line Treatment for Healthy Outpatient CAP

Amoxicillin or Doxycycline.

First-line Treatment for CAP Outpatient with Comorbidities

Augmentin + azithromycin or doxycycline.

First-line Treatment for Inpatient CAP

Ceftriaxone + azithromycin.

CAP Treatment Duration

$5$ days.

Common Pathogen in UTI

E.coli.

Cystitis Symptoms

Dysuria, Frequency, and Urgency.

Pyelnephritis Identification

Fever, Flank pain, and CVA tenderness.

UTI Lab

Urine culture

Uncomplicated Cystitis Treatment Options

• Macrobid x $5$ days

• Bactrim x $3$ days

• Fosfomycin x $1$ dose.

Pyelonephritis Tx

• FQ

• IV ceftriaxone

Nonpurulent SSTI Classification

Cellulitis and Erysipelas.

Purulent SSTI Classification

Abscess, Furuncle, and Carbuncle.

Nonpurulent SSTI Pathogens

Strep pyogenes and MSAA.

Purulent SSTI Pathogen

MRSA.

Cellulitis (Nonpurulent) First-line Treatment

Cephalexin or Cephazolin.

Purulent SSTI pathogen

• MRSA

Purulent SSTI Treatment

• Doxycycline

• Clindamycin

Moderate purulent SSTI treatment

• Bactrim

• Doxy

• Clindamycin

Severe purulent SSTI treatment

Vancomycin.

SSTI Treatment duration

5 days

C.diff Risk Factors

Antibiotics, hospitilzation, and PPI use.

Non-severe C.diff Criteria

WBC $< 15,000$ cells and SCr $< 1.5$.

Severe C.diff Criteria

WBC $> 15,000$ and SCr $> ⅕$.

Fulminant C.diff Symptoms

HoTN or shock, Illeus, and Megacolon.

Non-severe C.diff First-line Treatment

• Fidaxomicin BID x $10$ days

• Vancomycin QID x $10$ days

• Metronidazole TID x $10$ days.

Severe C.diff

• Fidaxomicin BID

• Vancomycin QID

Fulminant C.diff treatment

Vancomycin PO QID + metronidazole IV Q8H x 10-14 days

Recurrent C.diff Tx

• Fidaxomicin PO BID x 10 days or taper/pulse x 20 days

• Vancomycin PO QID x 10 days or taper/pulse x 2-8 weeks

PJP Prophylaxis in HIV

Indicated when CD4  < 200;

Treatment is Bactrim.

Toxoplasmosis Prophylaxis in HIV

Indicated when CD4  < 100

Treatment is Bactrim.

MAC Prophylaxis in HIV

Indicated when CD4  < 50

Treatment is Azithromycin.

HIV tx no hx of cabotegravir

• Biktarvy

• Dovato

• DTG + tenofovir +FTC/3TC

HIV tx hx of cabotegravir

• Symtuza

• Darunavir/cobicstat

• Darunavir/ritonavir

HIV PEP (Post-Exposure Prophylaxis) Protocol

• Start within $72$ hours,

• continue for $28$ days,

• using a $3$ drug regimen

  • Biktarvy.

Preferred option for HIV PrEP (Pre-Exposure Prophylaxis) in high-risk patients

Truvada (TDF/FTC)

Influenza Treatment Timing

Oseltamivir should be started within $48$ hours of symptoms for a

Oseltamivir treatment duration

$5$ days.

Live Vaccines List

MMR, Varicella, Liver zoster (for patients $> 50$ YO), and Intranasal flue.

Inactivated Vaccines List

Flue, PCV20/23 (for patients $> 50$), Covid, Hepatitis, Tdap, and RSV.

MRSA Coverage Agents

• Vancomycin

• Linzeloid

• Bactrim

• Daptomycin

• Doxycycline

• Clindamycin

• Ceftaroline.

Pseudomonas Coverage Agents

• Zosyn

• cefepime

• meropenem

• aztreonam

• Ciproflaxocin

• Levofloxacin

• Ceftazidine.

Atypical Pathogen Coverage

Azithromycin, Doxycycline, and FQs ($$-floxacin).

Anaerobe Coverage Agents

• Metronidazole

• Zosyn

• Ampicillin-sulbactam

• Carbapenems

• Clindamycin.

Time Dependent

• Beta Lactams

  • penicillins

  • cephalosporins

  • carbapenems

Concentration dependent

• AGs

• FGs

AUC/MIC

Vancomycin

Vancomycin Trough AUC/MIC Target

$400-600$.

Bactericidal Agents

• Beta-lactams (Penicillins, Cephalosporins)

• Carbapenems

• Vancomycin

• FQs

• AGs

• Metronidazole.

Bacteriostatic Agents

• Macrolides ($$-mycins)

• Tetracyclines ($$-cyclones)

• Clindamyin

• Sufnonamides

• Linezolid.

Vancomycin Major Side Effects

Nephrotoxicity and Red man syndrome.

FQ Major Side Effects

Tendon rupture and QT prolong.

Bactrim Major Side Effects

Hyperkalemia, Rash, and BMS.

Macrobid Precautions

Avoid in poor renal function; may cause Pulmonary toxicity.

Metronidazole Specific Reaction

Disulfiram life rxn.

Tetracycline Side Effects

Photosensitivity and Tooth discoloration; avoid in pregnancy and young kids.

Clindamycin Major Side Effect

C.diff diarrhea.

Severe Nonpurulent SSTI treatment

Vancomycin + Zosyn

Complicated UTI treatment duration with FQs

7 days

Complicated UTI treatment duration

5 days