Therapy Exam II UTI STD

Chamidia presentation

Asymptomatic infection common

Women

Mucopurluent discharge from cervis, hypertrophic cervical ectopy, abnormal vaginal bleeding

Men

Mucopurluent discharge from urethrra, dysuria, uretharal pruritus

Chladmida diagnosis

Urine, swabs of site of infection,

culture

Nucelia Acid Amplififcation Test NAATs

Gram stained smears

Nonamplified DNA probe tests

Treatment principles of clamidia

coinfection with N. gonorrhea common (empirically treat for both unless proven otherweise)

Treatment of Cladmida

Recommended

1. Doxycycline 100mg PO BID 7 days

Alternative

1. Azithromycin 1gm PO 1 dose

2. Levofloxacin 500mg PO q24h 7 days

3. Tetracyclien 500mg PO QID 7 days

Treatment off Clamidia in Pregnancy

Azithromycin 1gm PO 1 dose preferred

Amoxicillin 500mg PO TID 7 days

PEP therapy for Chamydia and SYphiss

Doxycycline 200mg with 72 hours of a sexual encoutner

Uncomplicated Gonorrhea presentation

women

1. 10 day incubation

2. asymptomatic

3. increase vaginal discharge

4. increase dysuria without urgency or frequency

5. Increase intermenstrual blleding

6. abdominal or pelvic pain

7. purulent cervical exudate

Men

1. 2 to 5 day incubation

2. Acuete urethritis

3. urethral discharge

4. acute epididymitis localized complicaiton

Disseminated Gonoccocall Infection DGI presentation

septic arthritis, diagnosed by culture of synovial fluid

dermatitis

periphepatitis

endocardiatins, menigitis, osteomyltis, septic shock, ards

Diagnosis of gonorrhea

culture

Nuclec acid amplication tests NAATS

gram stain smears

nonamplified DNA probe tests

Treatment of uncomplicated Gonorrhea

Primary

1. Ceftriaxone 500mg im 1 dose

Alternative

1. Gentamicin 240mg im plus Azithromycin 2mg PO 1 dose

2. Cefixime 899mg PO 1 dose

For patients greater than 150KG ceftriaxone 1g

If chamydia not excluded, patient should recieve doxycycline or azithromycin in combo with gonnorhea theraphy.

Treatment of complicated gonohhea or DGI

Primary

1. Ceftriaxone or IV q24h

Alternative

1. Cefotaxime 1g IV q 8 H

2. Cirpofloxain 400mg IV q12 H

3. levofloaxin 750 IV q 24 hours

Duration of therapy at least 7 days

ceftriaxone step down to oral cefixime may used in some scenarios

FQs should not be used without known susceptibility tests

Clinical presentation of Primary Syphillis

chacre 1-6 weeks

Clinical presentation of Secondary Syphillis

2-8 weeks following apearance of chacre

skin lesions

rash,

lymphadenophty

fever, malaise, anorexia, pharynitis,

Clinical presentation of Latent syphillis

positive seroligc test without other evidence of disease

Early latent acquired in previous year

Late latent o latent greater than aa year

non infectoius

Can be transferred in preganacy

Slowly progress to nurosypllis or tertiary syphllyis

menigitis, siezure, paresis, motor defects, vision problems

dianosis of syphillis

microscopic examinations, such as darkfield and direct flourescent antibody test

seroloifc tests

1. nontreponel testes such as Rapid plasma reagin RPR and Veneral Diesease resarach laborary VDRL

2. Treponemal tests such as Flourescent treponemal antivody absorb FTA avs, t pallidum passive particle agglution (TPPA assay, Various EIAs, Chemiluminescenc immunoassys CIA, CLAI

Treatment of Primary, Secondary, and Early Latent syphillis

Primary, secondary, and early latent

1. Benzathine Penicillin G 2.4 million unit IM dose

Late Latent or latent syphillis of unknown duration

1. Benzathine penicillin G 2.4 milllion units IM 3 dosees at 1 week interavals (7.2 million uints)

Treatment non penicclin options for Primary, secondary, and early latent syphillis

1. Doxycylcine 100mg PO BID 14 days, altt tetracycline 500mg PO 14 days

2. Ceftriaxone 1-2g IV/I 10-14 days

3. Azithromycin 2mg PO 1

Treatment non penicclin options for late latent or latent unknownt syphillis

1. doxycyline 100mg BID 28 days, Tetracycline 500mg QID 28 days

2. Ceftriaxone 1-2 IV/IM

3. 
   

Treatment of Syphillis Pregnacny

1. Penicillin is the drug of choice, Desensitization to PCN is preferred in pregnant women

2. Do not use doxycyline

3. Primary, secondary, or latent treatment options

   1. Erythromycin 500mg QID 14 days

   2. Ceftriaxone 1-2 gm IM 14 days

   3. Azithromycin 2g PO

4. Late syphillis

   1. Erythomyicn 500mg QID 30 days

Treatment of Tertiary Syphillis

Benzathine peniccilin G 2.4 million units IM 3 doses 1 week interval 7.2 million units

Treatment of nuerosypllis including ocularo or otic syplhiilis

Aqueous crytalline penicilin G 18-24 millino unitns per day given as 3-4 miillionn units IV q4h or continous infusion 10-14 days

CLincal presenation of HSV

multiple painful pustularo or ulcer lesions

heal within 2-4 weeks

flu like symtoms

transmission can occur when asymptomatic

Manegement of HSV inital episode

Acyclovir 400 po TID 10 days or 200 mg PO 5 qd for 7-10 days

Famciclovir 250mg TID 7 10 days

Valacyclovir 1gm PO BID 7 10 days

treatment can be exteneded if healing is incomplete after 10 days

Management of Recurrence of HSV

Acyclobir 400mg PO RID 5 days or 800 mg PO BID 5 days or 800 mg PO TID 2 days

Famciclvor 125 mg VID 5 days or 1 g PO BID 1 days or 500mg PO 1 dose, 250 mg PO BID 2 days

Valacyclovir 1gm PO Q day 5 days

Suppressive therapy for HSV (May be less effective with greater than 10 episodes)

Acyclovir 400mg PO BID

Famicicloir 250 mg BID

Valacyclvoir 500mg PO QD or 1gm PO q Day

Sevire disease HSV such disseminated infection, pnemonitis, hepatitis, mengititis, enchphalitis

Acyclovir 5-10 mg/kg IBW IV q 8 h x 2-7 days or clinical improvement

IV may be followed by oral therpay to complete at least 10 days total duration

Gential Herpes treatment Pregnancy

Acyclovir believe to be safe in all three semesters

first episode oral acyclovbir

severe infection IV acyclovir

Bacterial Vaginosis treatment

Primary

1. Metronidazole 500mg PO BID for 7 days

Alternative

1. Metronidazole gel 0.75%

2. Clindamycin cream 2%

Oral alternative

1. Tiniddazole 2g daily 2 days or 1 gm daily 5 days

2. Clindamycin 300 mg BID 7 ddays or as ovules 100mg vaginally qhs 3 days

Treatment of trichomoniasis

yellow green grey discharge,

Primary

1. Metronidazole 500mg PO BID 7 days

Alternative

1. Metronidzole 2g

2. Tinidazole 2gm 1 dose

Compliacated UTI or infection beyound bladder

Phelonephrtis

Febrile or bacteriimc UTI

Catherer associated

Prostitius

fever

flank pain

UNCompliacated UTI or no infection beyound bladder

no fever

no sytemic symptoms

no flank pain

no agnle tenderness

Uncomplicated UTI treatment

1st line options

1. Nitrofuratoin 100mg PO BID if CrCL > 60 do not use phenlonrphritis

2. Bactrim DS tab PO BID for 3 days if resistance is less than 20

3. Fosfomycin 3gm PO 1 do not use in phyelonephritis

4. Pivemecillinam 200mg TID 3-7 days

2nd line options

1. FQs Levofolacin 750mg daily for 3 days or

2. Ciprofloacin 500mg BID for 3 days

3. Betat lacatmas

   1. Amoxicilln clavulnate

   2. cephalexin

   3. cefpodoxie for 8 days

4. other options

   1. cefdinir

   2. cefuroxime

Complicated UTI treatment with Sepsis or septic shock

Preferred

1. 3rd or 4th gen cephalspirns (ceftrixone, ceftotaxime, cefepime)

2. Pip tazo

3. FQs (levofloxcin or cipro) (avoid if received in last 12 months)

4. Carbapenems (imipenem/cilastatin, meropenem, doripenem, ertapenem)

Alternative

1. New novel bl blis (ceftazidime/avibactam, ceftolozane/tazobactam, meropenem/vaborbactam,

   imipenem/cilastatin/relebactam)

2. Cefiderocol

3. Plazomicn

4. older aminoglycosides (gentamycin, tobramycin , amikacin

Complicated UTI treatment without sepsis IV therapy

Preferred

1. 3rd or 4th gen cephalspirns (ceftrixone, ceftotaxime, cefepime)

2. Pip tazo

3. FQs (levofloxcin or cipro) (avoid if received in last 12 months)

Alternative

1. Carbapenems (imipenem/cilastatin, meropenem, doripenem, ertapenem)

2. New novel bl blis (ceftazidime/avibactam, ceftolozane/tazobactam, meropenem/vaborbactam,

imipenem/cilastatin/relebactam)

3. Cefiderocol

4. Plazomicn

5. older aminoglycosides (gentamycin, tobramycin , amikacin

CUTI treatment for Patients without sepsis oral Therapy

Primary

1. FQs (Levofloxacin and Cipro) (avoid if received in last 12 months)

2. TMP/SMP bactrim

Alternative

1. Augmentin

2. 1st or 2nd gen cephalosproins

Septic shock and sepis guidlines treatment

In spetic shock choose antibiotic wit 90%

in sepis choose antibioitc 80%

Duration CUTI therapy

5 days for FQs

7 days for non FQ

If they have bacteremia, 7 days if they are improving

Catheter associated UTI treatment

discontinuation of catherter

Use CUTI guidelines