Medications for Immunology

maraviroc (Selzentry)

blocks HIV from binding to host cells secondary CCR5 coreceptor- CCR5 Antagonist

fostemsavir (Rukobia)

binds to viral gp120 protein to block initial connection/attachment- Attachment Inhibitor

ibalizumab-uiyk (Trogarzo)

binds to CD4 cell surface receptors to block structural changes needed for viral entry- Post Attachment Inhibitor

enfuvirtide (Fuzeon)

NO LONGER GIVEN IN USA- binds to HIV viral envelope protein (gp41) to stop the viral and human cell membranes from joining)

emtricitabine/tenofovir alafenamide (Descovy)

functions as faulty genetic building blocks that halt viral DNA chain formation (NRTI- Nucleoside/Nucleotide Reverse Transcriptase Inhibitor)

also used as PrEP

emtricitabine (Emtriva)

functions as faulty genetic building blocks that halt viral DNA chain formation (NRTI- Nucleoside/Nucleotide Reverse Transcriptase Inhibitor)

doravirine (Pifeltro)

attaches directly to reverse transcriptase enzyme to disable it- NNRTI (Non Nucleoside Reverse Transcriptase Inhibitor)

rilpivirine (Edurant)

attaches directly to reverse transcriptase enzyme to disable it- NNRTI (Non Nucleoside Reverse Transcriptase Inhibitor)

dolutegravir (Tivicay)

disable integrase enzyme to prevent viral DNA from inserting into human DNA (INSTIs- Integrase Strand Transfer Inhibitors)

cabotegravir (Vocabria tb/Apretude long lasting inj.)

disable integrase enzyme to prevent viral DNA from inserting into human DNA (INSTIs- Integrase Strand Transfer Inhibitors)

Also used as PrEP

raltegravir (Isentress)

disable integrase enzyme to prevent viral DNA from inserting into human DNA (INSTIs- Integrase Strand Transfer Inhibitors)

lenacapivir (Sunleca/Yeztugo)

disrupts protective protein shell (aka capsid) during assembly, transport, and final core formation (Capsid Inhibitor)

Also used as PrEP

Atanavir (ATV)

blocks protease enzyme from cutting long protein chains, leaving newly budded viruses immature and noninfectious (Protease Inhibitors)

darunavir (DRV)

blocks protease enzyme from cutting long protein chains, leaving newly budded viruses immature and noninfectious (Protease Inhibitors)

Post Exposure Prophylaxis (PEP) Medications

must have 3 or more antiretroviral drugs

tenofovir disoproxil fumarate (TDF)+ emtricitibine (FTC) plus raltegravir (RAL) or dolutegravir (DTG)

should last for 4 weeks

should be started within 72 hours

when should HIV patients go on daily trimethoprim/sulfamethoxazole (TMP-SMX/Bactrim) and why

less than 200 to prevent P.Jirovecii prophylaxis

less than 100 for Toxoplasmosis prophylaxis

less than 50 for M. avium (MAC) infection indicated

gold standard ART therapy

3 drug INSTI regimen (Integrase Strand Transfer Inhibitor)

Bictegravir/Emtricitabine/Tenofovir Alafenamide= Biktarvy due to high barrier to resistance, works regardless of baseline viral load

ART if pregnant or have complex drug interactions

3 drug INSTI still

Dolutegravir+Emtricitabine (or Lamivudine) + TAF (or TDF)

aka Tivicay+Descovy (or Truvada)

ART if also have Hep B

2 drug INSTI

Dolutegravir/Lamivudine aka Dovato

cutaneous Anthrax

oral fluroquinalones or doxycycline

if systemic Anthrax

IV Ciprofloxacin or Levofloxacin + doxycycline, clindamycin, or linesolid + antitoxin of anthrax immunoglobulin, raxibacumab

Botulism treatment

Equine serum heptavalen botulism antitoxin

Medications for Diptheria

antitoxin + erythromycin or azithromycin

Medications for Clostridium tetani (Tetanus)

Human tetanus immune globulin (500 units)

With active immunization with tetanus toxoid

Metronidazole IV or Penicillin IV

Debridement of wounds should be undertaken if implicated as source (remove dead, damaged, or infected tissue)

Medications for Methicillin Resistant Staphylococcus aureus (MRSA)

Drain abscess

Give oral antibiotics:

TMP/SMX (Bactrim)

Doxycycline

Clindamycin

IV antibiotics:

Vancomycin- 1st line for serious infections

Medications for Group A Streptococcus/ Streptococcus pyogenes (Rheumatic fever)

Diagnosed using:

Rapid strep antigen test or positive throat culture

High or increasing titers of antistreptococcal antibodies (antistreptolysin O and anti-DNase B)

Medications:

Symptomatic relief of arthritis

Give salicylates (aspirin) or NSAID

Eradication of GAS infection with antibiotic therapy

Penicillin G

If penicillin allergy, give cephalosporin or azithromycin

Medications for Gonococcal Infections (Neisseria)

Diag:

NAAT of discharge or urine

Must do Pelvic exam for women

Medications:

Ceftriaxone IM injection

500 mg if no conjunctivitis

1 g if conjuctivitis

If PID present:

"Ceftriaxone " 𝟓𝟎𝟎" mg IM (single dose)"

+

"Doxycycline " 𝟏𝟎𝟎" mg PO BID "×𝟏𝟒" days"

+

"Metronidazole " 𝟓𝟎𝟎" mg PO BID "×𝟏𝟒" days"

medications for Chancroid (Haemophilus ducrevi)

Treatment:

Azythromycin as 1st line

Ceftriaxone IM as alternative

Drain buboes (infected lymph node) with needle to prevent chronic sinus tract formation

medications for Bartonella (Bartonella henselae) aka Cat Scratch Disease

Diag:

Clinical

Exposure history

Compatible lymphadenopathy

May use Indirect Immunofluorescence Assa (IFA) or ELISA serology for elevated IgG/IgM against Bartonella

1st line: Azithromycin

Severe Disease: Azithromycin+Rifampin

If includes Bartonella heart, neurological, or ocular involvement: combined doxycycline+rifampin for extended duration

medications for Whooping cough (Bordetella pertussis)

Diag:

Nasopharyngeal culture

Elevated WBC count

Meds:

Azithromycin or other macrolides

Vaccines:

DTaP (infants)

Tdap (adults and pregnant women either between 27-36 weeks or postpartum)

medications for Campylobacter jejuni

Diag:

Stool culture (not typically done in clinical practice)

Management:

Self limiting

Fluid and electrolyte replacement

Azythromycin given for Travelers Diarrhea to shorten duration

May give ciprofloxacin as alternative

medications for Cholera (Vibrio cholerae)

Diagnostic:

Positive stool culture

Agglutination of vibrios with specific sera demonstrated via blood test

Treatment:

Replacement of fluids

Supportive management

Give tetracyclines (doxycyclines, tetracycline), Fluoroquinalones (ciprofloxacin), or macrolides (Azithromycin) to shorten duration

medications for Salmonella (non typhoidal)

Diag:

Stool culture

Blood culture

Mild Symptom treatment:

Supportive care

Rehydration

Self limiting

Severe Disease:

Cirpofloxacin

TMP/SMX

Cefixime

Azithromycin for children

Ceftriaxone

Shigella

Rehydration (oral or IV)

Self limiting in health persons

Antibiotics for severe cases:

Ciprofloxacin

Azithromycin

Ceftriaxone

TMP/SMX

Typhoid Fever (Salmonella Typhi)

Diag with blood cultures during weeks 1 and 2 of illness

Stool and urine cultures yield higher sensitivity in weeks 3 and 4

Meds:

1st line: Fluoroquinalones (Ciprofloxacin or levofloxacin) if susceptible

2nd line for fluoroquinalone resistant strains: Azithromycin or Ceftriaxone

If septic shock or delirium: IV dexamethasone with IV antibiotics

Chlamydia (Chlamydia trachomatis)

Diag:

NAAT testing (Nucleic Acid Amplification test) using urethral swab (men) or vaginal swab (women)

May also use first void urine

May use rectal and oropharyngeal swabs if necessary

Medications:

Doxycycline (unless pregnant)

If pregnant or adherence concerns use azithromycin

Alternative is levofloxacin

After done with medication, no sex for 1 week

REtest if pregnant

Rescreen after 3 months

Test and treat sexual partners within 60 days

Legionarres disease (Legionella)

Diag:

Legionella Urinary Antigen Test

Labs typically show hyponatremia, elevated transaminases, hypophosphatemia and elevated inflammatory markers

Medications:

1st line: oral or IV Fluoroquinalones (Levofloxacin or Moxifloxacin)

Alternative is Azithromycin (MAcrolide) for 7 to 14 day

Rocky Mountain Spotted Fever (Rickettsia rickettsii)

Lab:

Thrombocytopenia

Hyponatremia

Elevated aminotransferases

Hyperbilirubinemia

CSF with hypoglycorrhachia and/or mild pleocytosis

Disseminated intravascular coagulation in severe cases

DIag:

Immunohistologic or PCR of R. rickettsii from skin biopsy or swabs of eschars or skin lesions. Do not delay treatment while waiting for results\

Medications:

Doxycycline unless pregnant

If pregnant: chloramphenical

Sequelae:

Seizures

Encephalopathy

Peripheral neuropathy

Paraparesis

bowel/bladder incontinence

Cerebellar and vestibular dysfunction

Hearing loss

Motor deficits

Typhus (Rickettsia typhi)

Diag:

Serological confirmation with R typhi antigens

Labs:

Anemia, thrombocytopenia, leukopenia, hyponatremia, elevated liver enzymes

Medications:

Doxycycline

If pregnantL Ciprofoxacin and ampicillin successful

Lyme disease (Borrelia burgdorferi)

Diag:

Typically made clinically for localized stage

Late stage: screening immunoassay

If negative, no further testing needed

If positive, do immunoblot

Medication:

Doxycycline

Amoxicillin

Cefuroxime axetil

Syphilis (Treponema pallidum)

penicillin

medications for laten TB

Rifampin and isoniazid

gram negative diplococci (gonnorhea)

ceftriaxone

medication for MRSA

Septra (TMP/SMX)

meds for preventing neonatal herpes

acyclovir at 36 weeks

CMV medication if eye issues

ganciclovir

meds for chlamydia

doxycycline

meds for syphilis

penicillin

meds for trichmoniasis

metronidazole

MRSA skin absess meds

TMPSMX, doxyxycline, or clindamycin

serious/invasive MRSA

IV vancomycin

meds for diptheria

diptheria antitoxin + azithromycin/erythromycin

meds for tetanus

human tetanus immune globulin+ tetanus toxoid+ metronidazole+ wound debridement

cutaneous anthrax

Ciprofloxacin/other fluoroquinolone OR doxycycline

Systemic anthrax

IV ciprofloxacin/levofloxacin + protein-synthesis inhibitor (e.g., doxycycline, clindamycin, linezolid) + antitoxin

Acute rheumatic fever

Benzathine penicillin G to eradicate GAS + NSAID/salicylate for arthritis/inflammation

Recurrent rheumatic fever prevention

Benzathine penicillin G IM every 4 weeks

HSV-1 / HSV-2

Acyclovir or valacyclovir

Severe/neonatal HSV

High-dose IV acyclovir

HSV keratitis

Oral/topical antiviral + urgent ophthalmology

Herpes zoster (shingles)

Valacyclovir preferred or acyclovir, ideally within 72 hr

Postherpetic neuralgia

Gabapentin, lidocaine, TCA, or capsaicin

EBV infectious mononucleosis

Supportive care; steroids only for specific severe complications

CMV in immunocompromised patient / retinitis

IV ganciclovir or valganciclovir

Congenital/perinatal CMV

IV ganciclovir

Influenza

Oseltamivir or baloxavir

Influenza in pregnancy

Oseltamivir preferred

COVID-19, appropriate high-risk outpatient

Nirmatrelvir/ritonavir (Paxlovid); check drug interactions

Rabies exposure

HRIG infiltrated around wound + rabies vaccine

Measles

Supportive care + vitamin A

Mumps

Supportive care

Rubella

Supportive care

Active tuberculosis

RIPE: rifampin + isoniazid + pyrazinamide + ethambutol initially → then rifampin + isoniazid

Latent TB

Rifampin x4 mo, OR INH + rifampin x3 mo, OR INH x6–9 mo

INH therapy

Add pyridoxine (vitamin B6) to prevent neuropathy

Pulmonary MAC

Clarithromycin + ethambutol + rifampin

Disseminated MAC

Clarithromycin + ethambutol ± rifabutin

MAC lymphadenitis in young child

Complete surgical excision; antibiotics usually unnecessary

Mycobacterium marinum

Clarithromycin, doxycycline, minocycline, or TMP-SMX

Cryptococcal meningitis / severe cryptococcosis

Amphotericin B + flucytosine → fluconazole

Chronic pulmonary histoplasmosis

Itraconazole

Severe/disseminated histoplasmosis

Liposomal amphotericin B → itraconazole

Pneumocystis jirovecii pneumonia (PCP)

High-dose TMP-SMX x21 days

PCP with PaO₂ <70 or A–a gradient ≥35

TMP-SMX + corticosteroids

Pinworm – Enterobius vermicularis

Albendazole or mebendazole, single dose repeated in 2 weeks; treat household contacts

Fasciolopsis buski

Praziquantel

Intestinal tapeworms

Praziquantel

Ascariasis

Albendazole or mebendazole

Trichuriasis (whipworm)

Albendazole or mebendazole

Hookworm

Albendazole + iron when iron deficient

Trichinosis – Trichinella spiralis

Albendazole or mebendazole; corticosteroids for severe myositis

Lymphatic filariasis

Diethylcarbamazine (DEC)

Lymphatic filariasis + Onchocerca coinfection

Ivermectin + albendazole

Malaria

3-day artemisinin-based combination therapy (ACT)

P. vivax/P. ovale hypnozoites (sleeping parasites)

Primaquine after G6PD testing; contraindicated in pregnancy

Toxoplasmosis in AIDS

Pyrimethamine + sulfadiazine + leucovorin