clin med ID treatments only

Cat Scratch Disease

Adults-> azithromycin 500mg day 1, then 250mg days 2-5

Children-> 10mg/kg day 1, then 5mg/kg days 2-5

Botulism

antitoxin-> administer ASAP

abx only in wound botulism

Tetanus

-Tetanus immune globulin(TIG) ASAP

-metronidazole 500mg IV Q6hr x 7-10 days

-valium 10-30mg IV Q1-4hr

Diphtheria respiratory and cutaneous

Respiratory: antitoxin ASAP(high risk of serum sickness) and antibiotics. Intubate prn

Cutaneous: antibiotics only

Chancroid

-azithromycin 1 gram PO once OR

-ceftriaxone 250mg IM once

Chlamydia normal and pregnancy

-doxy 100mg BID 7 days

-if pregnant, azithromycin 1g once

Gonorrhea

uncomplicated(not associated with bacteremia):

-ceftriaxone 500mg IM 1 dose if <150kg

-ceftriaxone 1g IM 1 dose if >150kg

Rocky Mountain Spotted Fever (RMSF)

Doxy 100mg BID 5-7 days

necrotizing skin MRSA

abx and surgical excision

scalded skin MRSA

IV abx and hospitalization

Bacteremic MRSA

IV vanco or daptomycin

General simple infection MRSA->

-bactrim 160/800mg BID 7 days

-doxy 100mg BID x 7 days

-clinda 450mg TID x 7 days

-zyvox 600mg BID 14 days (last resort)

Rheumatic Fever

Primary prevention-> Penicillin V, Nsaids

Secondary prevention-> penicillin G IM x 28 days for 5-10 years

Campylobacter jejuni

Only give azithromycin in sever disease (bloody stool, high fever, infection)

Salmonellosis

Fluids and electrolytes. Abx only in severe disease- cipro or levofloxacin

Shigellosis

Fluids

Fluoroquinolone

Cipro or levofloxacin

azithromycin

Common Cold

-prevention

-Nsaids, benadryl

-intranasal cromolyn/ipratropium bromide

Influenza

-vaccine with H1N1 and H3N2

-nsaids

-antiviral(tamiflu) 75mg BID x5 days for ALL immunocompromised, or those with symptoms <48hr

Coronavirus

-vaccine

-if symptoms <5 days, paxlovid

-if symptoms >5 days or otherwise healthy, supportive care only

Mono

Prevention, Nsaids, steroids in advanced disease

Herpes

-acyclovir 400mg TID or

-valacyclocir 1000mg BID (not when pregnant)

-pain meds!!

ocular herpes

topical ganciclovir gel plus oral abx

neonatal herpes simplex

IV acyclovir ASAP for all presentations

chicken pox

-supportive care (tylenol, antihistamines, etc.)-acyclovir/valacyclovir only if >12, pregnant, or immunocompromised

shingles

-valacyclovir 1000mg TID 7days or

-acyclovir 800mg 5 a day for 7-10 days

congenital varicella

Prophylaxis with varizig for preterm baby, none for healthy

IV acyclovir with active infection

HIV

-Antiretroviral therapy (ART) indefinitely

PEP HIV

within 72 hours- TDF-FTC + dolutegravir x 28 days

PrEP HIV

TDF-FTC

Poliomyelitis

Mainly supportive, respiratory care

vaccination

Rabies

-Vaccine- given IM (not in glute) pre or post exposure

-RIG in wound, rest in muscle given post exposure

oral candidiasis

oral nystatin

Esophagitis candidiasis

fluconazole for 14-21 days

yeast infection

-fluconazole 150mg 1 day only or repear day 3 OR

- OTC clotrimazole/miconazole

balanitis candidiasis

topical clotrimazole or miconazole

mammary candidiasis

opical miconazole or clotrimazole

Intertriginous dermatitis candidiasis

topical miconazole, clotrimazole, ketoconazole

onychomycosis candidiasis

oral terbinafine, symptom relief with petroleum

otomycosis candidiasis

ear lavage, clotrimazole, fluconazole, miconazole

UTI candidiasis

no treatment if asymptomatic, or fluconazole x 14 days or IV amphotericin B

Endophthalmitis candidiasis

systemic antifungals (fluconazole/voriconazole) or eye antifungals (amphotericin B) for 4-6 weeks

Osteoarticular candidiasis

Both with IV echinocandin daily for 2 weeks. Then if septic arthritis, fluconazole(400 mg) for 6 weeks, if osteomyelitis, fluconazole for 6-12 months.

Meningitis candidiasis

amphotericin B plus flucytosine

pericarditis/endocarditis candidiasis

pericardial window, amphotericin, echinocandin

peritonitis candidiasis

surgical management, echinocandin, fluconazole, amphotericin

pneumonia candidiasis

echinocandin, amphotericin, fluconazole for 2-4 weeks

Cryptococcus

Amphotericin B, flucytosine, fluconazole

Atypical Mycobacterial Disease

Macrolide + ethambutol + rifamycin

Tuberculosis

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) for 4 months

Blastomycosis

itraconazole for 6-12 mos plus or minus 1-2 weeks of amphotercin

Valley Fever

Mild- none

Moderate- fluconazole/itraconazole for 12 weeks

Severe- amphotericin plus fluconazole/itraconazole for up to 24 weeks

Valley Fever meningitis

fluconazole 400-1200 mg daily for life. Amphotericin in pregnancy

Histoplasmosis

Amphotericin B and itraconazole

Pneumocystis Pnemonia (PCP)

Bactrim or clinda with primaquine x 21 days

Amebiasis

Intraluminal agents-> Paromomycin or diloxanide

Helminth

Ivermectin, Albendazole

Pinworms

Pyrantel pamoate, mebendazole, albendazole

Giardiasis

<1 year- metronidazole

1-3 year- metronidazole or nitazoxanide

>3- single dose tinidazole

+oral rehydration

Malaria

ACTs

Toxoplasmosis

normal + pregnant

Pyrimethamine + sulfadiazine/clindamycin + leucovorin calcium

If pregnant-> spiramycin or sulfadiazine

Trichomoniasis

Metronidazole 500mg BID x 7days

you met tron and you were dazzled and then he gave u trich :/

early/secondary Syphilis

Penicillin G 2.4 mil IM once

**large change of jarisch-herxheimer rxn to treatment

tertiary syphilis

tertiary-> Penicillin G 2.4 mil IM once a week for 3 weeks

neurosyphilis-> IV penicillin G

**large change of jarisch-herxheimer rxn to treatment

Lyme disease early or disseminated disease

IV doxy 100mg BID x 10 days or amoxil 500mg TID x 14 days

Lyme disease late disease

amoxil or cefuroxime

Prion disease

None. Certain death. Give supportive care

congenital toxoplasmosis

Fetal infection->spiramycin

No fetal infection-> pyrimethamine, sulfadiazine, leucovorin

Congenital Syphilis

IV/IM penicillin maybe

Congenital ZIka

none

Congenital Rubella

none

Congenital Cytomegalovirus

IV ganciclovir or valganciclovir

Group B strep

early-> ampicillin + gentamicin

late-> vancomycin + gentamicin