PNN- Antibiotics

Define bacteriostatic

inhibits growth of the organism

example: macrolides, tetracyclines, clindamycin, chloramphenicol and linezolid

define bacteriocidal

drug that kills the organism

example: aminoglycosides, vanco, quinolones, and synercid

what is the bacterial class of Streptococcus

Gram + Cocci

what is the bacterial class of Staphylococcus

Gram + cocci in clusters

what is the bacterial class of Enterococcus

Gram + cocci

what is the bacterial class of Diphtheriae

Gram + Rods

what is the bacterial class of Listeria

Gram + Rods

what is the bacterial class of Anthrax

Gram + Rods

what is the bacterial class of Clostridium

Gram + Anaerobic Rods

what is the bacterial class of Neisseriae

Gram - Cocci

what is the bacterial class of Moraxella

Gram - cocci

what is the bacterial class of E. coli

Gram - Rod

what is the bacterial class of Pseudomonas

Gram - Rod

what is the bacterial class of Klebsiella

Gram - Rod

what is the bacterial class of Haemophilus

Gram - Rod

what is the bacterial class of Influenzae

Gram - Rod

what is the bacterial class of Helicobacter pylori

Gram - Rod

what is the bacterial class of Shigella, Salmonella

Gram - Rod

what is the bacterial class of Campylobacter

Gram - Rod

what is the bacterial class of Bacteroides (B. fragilis)

Gram - Anaerobic Rods

what is strep. pyogenes and what are two common infections

strep pyogenes is a Group A Strep that causes Pharyngitis (strep throat) and Cellulitis (deep skin infections)

what is strep. agalactiae

strep agalactiae is Group B Strep which is normal flora in females. if the female tests GBS+ in the 35-37th week of pregnancy then intrapartum IV with PCN G or Ampicillin prior to delivery to prevent neonatal meningitis/ sepsis.

mild PCN allergy: IV cefazolin

severe PCN allergy: IV clindamycin

what is the number one choice for treating streptococcus

1st Tx choice is PCN Family

what does strep pneumoniae cause

#1 cause of many infections including: otitis media, sinusitis, pneumonia, and meningitis

what does strep viridans cause

normal flora of oral mucosa and GI with low pathogenic potential but can cause endocarditis/ sepsis

what separates staph aureus from other staph species

MSSA and MRSA are usually Coagulase Positive

tx for staph aureus Imetigo, a superficial skin infxn with honey colored crust

Mupirocin (bactroban cream/ oint) tid for 3-5 days

Retapamulin (altabax crm/ oint) for MSSA only

MRSA colonization eradication:

Bactroban -Mupirocin- Nasally: 1/2 tube in each nostril BID for 5 days

Hibiclens soap solution: 4% Chlorhexidine

MRSA PO outpatient Abx

Bacrtim, Doxycycline, Clindamycin, Linezolid [zyvox], tedizolid [sivextro], or delafloxacin [baxdela]

common organisms causing adult meningitis

PNH

Pneumococcus - strep pneumo

Neisseria meningitidis - adolescents

Haemophilus influenza

common organisms causing meningitis in neonates

GEL

Group B Strep

E. coli

Listeria

most common organism for CAP

strep pneumo

mycoplasma- atypical also called walking pneumo

most common cause of CAP for Cystic Fibrosis pts

pseudomona and haemophillus influenza

most common cause of CAP for alcoholics

klebsiella

most common organisms for nosocomial [hospital] pneumonia

gram negatives

which hepatitis can be transmitted by fecal- oral

hep A

hep E

which hepatitis are transmitted by blood

hep B

hep C

hep D

which HEP's have vaccines

Hep A

Hep B

which Hep's can cause cirrhosis and liver cancer

Hep B

Hep C

what are the common organisms that cause gastroenteritis

mostly viral- stomach flu

bacterial causes include shigella, salmonella, e. coli, campylobacter, and c. diff

what are the common causes of otitis media and sinusitis

PHM

strep Pneumococcus

Haemophillus influenza

Moraxella

common causes in endocarditis

mostly in IVDA

MSSA/MRSA is #1 cause

strep viridans- dental procedures

enterococcus

staph epidermidis

what classification does Corynebacterium diphtheriae belongs to

Aerobic Gram + Rods [bacilli]

also called Diphtheriae

what class does Listeria monocytogenes belong to

Aerobic Gram + Rods [bacilli]

what does class Bacillus anthracis belong to

Aerobic Gram + Rods [bacilli]

Diphtheriae treatment and prophylaxis

tx: antitoxin and PCN or erythromycin x14 days

Pro: erythromycin for 7 days and vacine

Listeria treatment of choice

Ampicillin and gentamycin

Anthrax tx

cipro or doxy IV/PO for 60 days PLUS antitoxin PLUS 3 doses of anthrax vacine

C.diff initial tx and fulminate cases

initial tx: vanc 125 PO QID x 10 days or fidaxomicin 200 BID x 10 days

fulminate [HoTN, shock, ileus, or megacolon]: vanc 500 QID and IV metronidazole.

**if ileus: rectal vanc

what classification goes with Neisseria and Moraxella catarrhalis

aerobic Gram - diplococci

Neisseria gonorrheae treatment

Ceftriaxone 250 IM once

PLUS co treatment for chlamydia with Azithromycin 1 g PO or doxy 100 x 7 days

Anti-pseudomonas PCN's

Zosyn- Piperacillin + Tazobactam

Anti- pseudomonas Cephalosporins

Fortaz, Tazicef = Ceftazidime

Cefepime = Maxipime

Avycaz = Ceftazidime- Avibactam for MDR

Zerbaxa = Ceftolozane- Tazobactam for MDR

H. pylori PUD triple play Tx

based on allergy, exposure, and local resistance

Triple tx is for pt's without risk factors for macrolide resistance

clarithromycin + amox [ or metronidazole for pcn allergy] + PPI

14 days

H. pylori Bismuth Quad tx

For patients with risk factors for Macrolide resistance-

10-14 days

Metronidazole + Tetracycline + Bismuth (combo brand is Pylera) + PPI

H. influenzae meningitis tx and prophylaxis

tx: ceftriaxone or cefotaxime

Post-exposure prophylaxis: Rifampin 600 for 4 days

Legionella tx and prevention

tx: macrolides or resp. quinolones

- azithro in children

- resp. quinolones in adults

Legionella typically produces b-lactamase so pcn and cephalosporins are less effective

Prev: hot-water supplies and hyper-chlorination

what does Bordetella Pertussis cause

whooping cough

Tx [macrolides] does not shorten duration just prevents spread

what are the main Gram + Anaerobic Rods

Clostridia organisms

what does C. perfringens cause

gas gangrene- G+ anaerobic rod

what is the main G- anaerobic rod

bacteroides- B.fragilis

C. tetani [Tetanus/lockjaw] treatment

1. immune globulin to neutralize the unbound toxin

2. Td or Tdap vaccine 3 doses 2 weeks apart

3. Metronidazole IV [PCN G as alt]

4. Benzo's to prevent spasms

5. alpha/beta blockade if needed- labetalol is both

B. fragilis is most common cause of what

DOC?

anaerobic infxn below diaphragm, although intra abdominal are usually poly microbia and should also tx for pseudomonas.

DOC: metronidazole

Chlamydia trachomatis tx

Azithromycin 1 gram po x 1 dose

Alt: doxy 100 bid x 7 days

should also co-tx for gonorrhea

Mycoplasma pneumoniae TX

has no cell wall so it cannot be gram stained

DOC- Macrolide or doxy --> if resistant then 3rd/4th gen quinolones

define primary syphilis

Characterized by a single, painless genital chancre that develops at the site of infection and disappears in 1-8 weeks without therapy

define secondary syphilis

rash develops on palms or soles

define Latent syphilis and testing

no symptoms: early [<1 year] or late [>1 year]

test: RPR or VDRL or Darkfield microscopy

define tertiary syphilis

affects the heart and can turn in to neuro-syphilis

Early, primary, and secondary syphilis tx

PCN G benzathine 2.4 million units IM x 1 dose

late latent or tertiary syphilis: treatment

PCN G benzathine 2.4 mil units IM weekly for 3 weeks

Neurosyphilis tx

PCN G 3-4 mil units **IV** q 4 h for 10-14 days

What does Borrelia burgdorferi cause?

Lyme disease and its a spirochete carried by deer ticks

Lyme Dz Tx

1) Early localized

2) Early disseminated

1. early: erythema migran [EM or bullseye Rash] with fever. ****TX- PO doxy or amox or cefuroxime for 10-21 days

2. Early disseminated: multiple EM's and/or neuro/cardiac findings ****TX- IV Abx = ceftriaxone, cefotaxime or PCN G for 14-28 days

Late Lyme Dz Tx [two parts]

Late: lyme arthritis +/- neurological symp months to a few years after.

Neuro- IV cetriaxone x 28 days

arthritis ONLY- PO doxy or amox for 28 days or IV ceftriaxone for 28 days

what is the fungal class of candida

yeast

what is the fungal class of Cryptococcus

yeast

what is the fungal class of Aspergillus

Mold

what is the fungal class of Histoplasma

dimorphic

what is the fungal class of blastomyces

dimorphic

what is the fungal class of coccidioides

dimorphic

what to Polyene antifungals do and name two

bind to erosterol

Ampho B and nystatin

what do Azole antifungals do

inhibit ergosterol synthesis

what do Echinocandin antifungals do and name three

inhibit glucan synthesis

- capsofungin, anidulafungin, and micafungin

thrush tx

mouth- nystatin swish/swallow or fluconazole

vaginal- azole vag cream or diflucan 150 mg PO x 1

candida diaper rash tx

miconazole + zinc oxide [brand- vusion] RX

Cryptococcus neoformans

-Meningitis tx

-Pneumo tx

M: Ampho B + Flucytosine

P: Fluconazole or Itraconazole

DOC of Aspergillus infections

Voriconazole [Vfend]

Tineas capitis location and tx

scalp

tx PO RX griseofulvin or terbinafine x 4-6 wks

tinea versicolor location

thorax

OTC antifungal

tinea corporis

ringworm

tinea cruris

jock itch

tinea pedis

athletes foot

Epstein-Barr virus (EBV)

infectious mononucleosis

Cytomegalovirus (CMV)

CD4 count <50 in HIV pts

tx: ganciclovir, valganciclovir, cidofovir, and foscarnet

Infective Endocarditis (IE) tests

3 sets of blood cultures + valve vegetation on ECHO

IE empiric tx

Pref: vanc IV +/- gram- culture

alt: oxacillin/nafcillin +gentamicin

Pathogen specific treatment IV for 4-6 weeks

IE dental prophylaxis

Amoxicillin 2 grams PO 30-60 minutes prior

PCN allergy:

- clinda 600

- azithro 500

- clarithro 500

animal/ human bite treatment

Augmentin

post- surgical intra-abdominal infection organisms

B.fragilis

E.coli

Enterococci

Pseudomonas