RxPrep Infectious Diseases II - Bacterial Infections

skin flora:

staphylococci, streptococci

What 2 organisms commonly cause infection at surgical incision sites?

IV

What antibiotic route of administration is commonly used for surgical prophylaxis?

60 minutes

Pre-operative antibiotics, such as cefazolin or cefuroxime, should be infused within ________ before first incision.

120 minutes

If a quinolone or vancomycin is used for pre-operative prophylaxis, the infusion should start ________ before first incision.

major blood loss, surgery >4 hours

In what 2 situations would a patient receive intra-operative antibiotics?

24 hours

Post-operative antibiotics are not usually needed but should be discontinued within ________ if used.

cefazolin

What antibiotic is preferred for most types of surgery prophylaxis to prevent MSSA and streptococcal infections?

clindamycin, vancomycin

What 2 antibiotics are alternatives to cefazolin for most types of surgery prophylaxis in patients with a beta-lactam allergy?

GI

In ________ surgeries, the prophylactic antibiotic regimen needs to cover skin flora plus broad gram-negative and anaerobic organisms.

vancomycin

What antibiotic should be included in the surgery prophylaxis regimen if MRSA colonization or risk is present?

cefazolin

What antibiotic is recommended for cardiac or vascular surgery prophylaxis?

cefazolin

What antibiotic is recommended for orthopedic surgery prophylaxis?

- cefazolin + metronidazole, cefotetan, cefoxitin

- ampicillin/sulbactam

What are options for GI surgery prophylaxis?

meningitis

Fever, headache, nuchal rigidity (stiff neck), and altered mental status are symptoms of ________.

lumbar puncture

What procedure is used to diagnose meningitis?

CSF

What is analyzed to diagnose meningitis?

high

A (high/low) CSF pressure detected during the lumbar puncture is a sign of possible infection.

Neisseria meningitidis,

Streptococcus pneumoniae

h. influenzae

What are 3 common bacterial causes of meningitis?

>50 YO, immunocompromised, neonates

In what 3 patient populations is meningitis caused by Listeria monocytogenes most common?

dexamethasone

________, administered 15-20 minutes prior to or with the first antibiotic dose, can prevent neurological complications and death from pneumococcal meningitis.

IV

What route of administration is used for dexamethasone in acute bacterial meningitis?

- cover for strep pneumo or n. menigitidis (most will have this)

- add listeria coverage for neonate, >50yo, immuno

- add vanc for ≥1mo for double s.pneumo coverage

what is general treatment algorithm for meningitis empiric coverage

ampicillin (listeria coverage)

+ cefotaxime (not ceftriaxone!) - covers HNPEK and strep

or gentamicin (if beta lactam allergy)

What is the empiric therapy regimen for meningitis in neonates (<1 month old)?

cefotaxime or ceftriaxone

+ vancomycin

What is the empiric therapy regimen for meningitis in patients:

1 month-50 years old?

ampicillin

+ cefotaxime or ceftriaxone

+ vancomycin

What is the empiric therapy regimen for meningitis in patients:

>50 years old or those immunocompromised?

ceftriaxone

What drug commonly used in meningitis empiric therapy regimens should not be used in neonates due to risk of biliary sludging and kernicterus?

ampicillin

Which of the following is used for Listeria coverage in meningitis empiric therapy regimens?

a) ampicillin

b) cefotaxime

c) ceftriaxone

d) gentamicin

e) vancomycin

Bactrim

What drug is an alternative to ampicillin for Listeria coverage in meningitis empiric therapy for an adult when a patient has a beta-lactam allergy?

quinolone (moxi) + vancomycin

What is the meningitis empiric therapy regimen used in adult patients with a beta-lactam allergy?

acute otitis media

Bulging tympanic membranes, otorrhea, otalgia, and tugging or rubbing the ears are signs/symptoms of ________.

H.influenzae, Moraxella catarrhalis, S. pneumoniae

kids "pic" their ears when it is they have ear infection

What 3 bacteria are the most common causes of acute otitis media?

48-72 hours

Observation for ________ is an option for select patients age ≥6 months with non-severe acute otitis media.

Augmentin (90mg/kg/day),

high-dose amoxicillin (90mg/kg/day)

in 2 divided doses

What are 2 first line treatment options for acute otitis media?

least; diarrhea

When treating acute otitis media with Augmentin, the formulation with the (least/most) amount of clavulanate should be used to decrease the risk of ________.

Augmentin ES-600

(amox 600mg/clav 42.9mg)

14:1 ratio of amox to clav

What is the preferred Augmentin strength for treating acute otitis media?

2nd or 3rd generation cephalosporin

(ex. cefdinir)

What is an alternative to amoxicillin when treating acute otitis media in a patient with a non-severe penicillin allergy?

no otorrhea, otalgia <48 hours, temp <102.2ºF

What 3 conditions must be met to consider observation in patients >6 months old with acute otitis media?

ceftriaxone IM

What drug and route of administration is used for acute otitis media if symptoms have not improved after treatment for 2-3 days?

Augmentin

What drug is preferred for acute otitis media when a patient has used amoxicillin in the previous 30 days?

<2yo = 10 days (next age group is 2-5: 2*5=10)

2-5yo = 7 days (2+5 = 7)

>6yo = 5-7 days (6 is between 5 & 7)

what is length of treatment for AOM?

S. pyogenes (GAS)

What organism most commonly causes pharyngitis?

H. influenzae, M. catarrhalis, S. pneumoniae

same as AOM - pic - people pic their nose with sinusitis

(pic meaning touch)

What 3 organisms most commonly cause acute sinusitis?

influenza

clue is sudden onset of fever and myalgia

Sudden onset fever, chills, fatigue, and myalgia are symptoms of ________.

common cold

Sneezing, runny nose, mild sore throat, and/or cough are symptoms of ________.

pharyngitis (strep throat - s.pyogenes)

Sore throat, fever, swollen lymph nodes, and white patches on the tonsils are symptoms of ________.

acute sinusitis

Nasal congestion, purulent nasal discharge, facial/ear/dental pain, and headache are symptoms of ________.

positive rapid antigen test

What is the criteria for anti-infective treatment of pharyngitis?

≥3 days of severe symptoms,

≥10 days of persistent symptoms

What are 2 criteria for anti-infective treatment of acute sinusitis?

amoxicillin, penicillin

(covers GAS)

What are 2 antibiotic treatment options for pharyngitis?

1. 1st gen or 2nd gen cephalosporin

2. macrolide or clinda

1. what can you use in place of mild pcn allergy for strep throat?

2. for severe pcn allergy?

Augmentin

(same bug as AOM so use the same thing)

What is an antibiotic treatment option for acute sinusitis?

1-3 weeks

A cough lasting ________ is a defining feature of bronchitis.

an upper respiratory tract virus.

bronchitis is usually preceded by _________.

true

True or False:

Chest x-rays are typically normal in patients with bronchitis.

supportive care

What is the preferred treatment for acute bronchitis?

whooping cough

Pertussis is commonly known as ________.

Bordetella pertussis

What organism causes whooping cough?

false (highly contagious)

True or False:

Pertussis is not contagious.

macrolide

What drug class is preferred when treating pertussis?

GOLD guidelines

What are the COPD guidelines called?

increased dyspnea,

increased sputum purulence,

increased sputum volume

What are the 3 cardinal symptoms of a COPD exacerbation?

H. influenzae, M. catarrhalis, S. pneumoniae

(pic - touching chest ("pic") when cough)

What 3 organisms commonly cause COPD exacerbations?

- all 3 cardinal sx are present (↑sputum vol, ↑purulence, ↑dyspnea),

- ↑ sputum purulence + 1 additional symptom,

- mechanical ventilation

In what 3 situations are antibiotics indicated to treat a COPD exacerbation?

Augmentin

(also azithro, doxy, respir fq)

What antibiotic is preferred to treat a COPD exacerbation?

pneumonia

Shortness of breath, fever, cough with purulent sputum, rales, and tachypnea (increased respiratory rate) are symptoms of ________.

chest x-ray

What is the gold stand diagnostic test for pneumonia?

consolidations, infiltrates, or opacities

What 3 things on a chest x-ray indicate pneumonia?

CAP

community-acquired pneumonia

a lung infection contracted outside of healthcare facilities and can be bacterial, viral, or fungal

walking pneumonia

When CAP symptoms are mild, it can be termed "________."

H. influenzae, M. pneumoniae, S. pneumoniae

What 3 organisms most commonly cause CAP?

ciprofloxacin

what FQ is not considered a respiratory quinolone because it does not cover S. pneumoniae.

5-7 days

What is the typical duration of treatment for CAP?

alcohol use disorder,

asplenia,

cancer,

diabetes,

heart disease,

liver disease,

lung disease,

renal disease

What are 8 comorbidities that would put someone with CAP in the high-risk category for outpatient treatment?

doxycycline 100mg BID

high-dose amoxicillin (1g PO TID),

macrolide (azithro / clarithro)

X5-7 days

What are 3 outpatient treatment options for non-high-risk patients with CAP?

- beta-lactam + (doxycycline or macrolide),

- respiratory quinolone

What are 2 outpatient treatment options for high-risk patients with CAP?

Augmentin,

cephalosporin (cefuroxime or cefpodoxime)

What are 2 beta-lactam options for high-risk patients being treated outpatient for CAP?

levofloxacin, moxifloxacin

What are the 2 respiratory quinolones?

- beta-lactam + (doxycycline or macrolide),

- respiratory quinolone

(same as high risk outpatient)

What are 2 inpatient treatment options for non-severe CAP?

ampicillin/sulbactam,

3rd gen cephalo -> cefotaxime, ceftriaxone

What 3 beta-lactams are preferred for inpatient treatment of non-severe CAP?

true

True or False:

Quinolone monotherapy should not be used for inpatient treatment of severe CAP.

linezolid, vancomycin

What are 2 options when adding MRSA coverage to inpatient CAP treatment?

cefepime,

meropenem,

piperacillin/tazobactam

(or aminoglycos (tobi), FQ (CDL), or aztreonam, etc)

What are 3 options when adding Pseudomonas coverage to inpatient CAP treatment?

(hospitalization in last 90 days,)

parenteral antibiotic use in last 90 days

MRSA: - known prevalence in hospital >25% or if unknown or positive nasal swab

PsAr: - known prevalence is >10% or >5 days in hospital prior to HAP

In what situations should MRSA and Pseudomonas coverage be added to inpatient treatment of CAP?

>48 hours

HAP has an onset ________ after hospital admission.

>48 hours

VAP occurs ________ after the start of mechanical ventilation.

nosocomial

what are pathogens are common in HAP and VAP.

MRSA; MDR gram-negative rods;

PsAr

The risk for ________ and ________, including ________, is increased in select HAP and VAP cases.

MSSA, Pseudomonas

All patients being treated for HAP/VAP need an antibiotic that covers ________ and ________.

cefepime,

levofloxacin,

piperacillin/tazobactam

What are 3 examples of antibiotics used in HAP/VAP treatment that cover both MSSA and Pseudomonas?

linezolid, vancomycin

One of what 2 drugs should be added to HAP/VAP treatment if there's a risk of MRSA?

IV antibiotic use in last 90 days, MRSA prevalence >20% or unknown, positive MRSA nasal swab, prior MRSA infection

What are 4 risk factors to consider for MRSA when treating HAP/VAP?

MDR gram-negative

When treating HAP/VAP, use 2 antibiotics for Pseudomonas if there's a risk for ________ pathogens.

hospitalized ≥5 days prior to VAP, IV antibiotic use in last 90 days, prevalence of gram-negative resistance >10%

What are 3 MDR gram-negative risk factors to consider when treating HAP/VAP?

false

True or False: Two beta-lactams can be used together to cover Pseudomonas when treating HAP/VAP.

aminoglycosides, aztreonam, beta-lactams, ciprofloxacin, levofloxacin

What 5 drugs/classes are used to cover Pseudomonas when treating HAP/VAP?

cefepime, ceftazidime, imipenem/cilastatin, meropenem, piperacillin/tazobactm

What 5 beta-lactams are preferred for Pseudomonas coverage when treating HAP/VAP?

tobramycin

What aminoglycoside is typically preferred for Pseudomonas coverage when treating HAP/VAP?

Mycobacterium tuberculosis

What organism causes tuberculosis?

latent

With (active/latent) tuberculosis, the immune system is able to contain the infection and the patient lacks symptoms.

aerosolized droplets

Active pulmonary tuberculosis is transmitted by ________ and is highly contagious.