RxPrep: Ch 16 - ID

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kerioppi
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RxPrep: Ch 16 - ID
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2012-07-02 23:57:53
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ID Infectious diseases NAPLEX antibiotics RxPrep
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Chapter 16 in RxPrep
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  1. What color do G+ organisms stain?
    Purplish, bluish
  2. What color do G- organisms stain?
    Reddish, pink
  3. What is the MOA of aminoglycosides?
    Bind to 30S ribosomal subunit, interfering with bacterial protein synthesis and resulting in defective bacterial cell membrane
  4. Which ABXs are concentration dependent?
    • *Aminoglycosides
    • *Quinolones
    • *Bactrim
    • *Flagyl
    • *Telavancin
    • *Colistin

    Q - looks like a concentrated FaBulous CAT
  5. Which ABXs are time dependent?
    • *Beta lactams
    • *Macrolides
    • *Tygacil
    • *Vancomycin

    I take my time doing a BM while watching TV
  6. What class of ABXs has PAE?
    Aminoglycosides
  7. What is the PAE?
    Continued suppression of bacterial growth when ABX levels are below MIC
  8. Aminoglycosides are active against what organisms?
    G- organisms
  9. What is the name of tobramycin inhaled?
    TOBI
  10. In what disease state is TOBI used for?
    CF
  11. What type of nebulizer do you use with TOBI?
    PARI-LC PLUS
  12. Which aminoglycoside has the broadest activity?
    Amikacin
  13. How do you dose aminoglycosides?
    • With IBW
    • But if TBW<IBW, use TBW
    • And use AdjBW when TBW>130% of IBW (morbidly obese)
  14. What are the BBW of aminoglycosides?
    Neurotoxicity (ataxia, vertigo) and nephrotoxocity
  15. What are two side effects of aminoglycosides?
    Nephrotoxicty and ototoxicity
  16. When you are using traditional dosing with aminoglycosides, what levels do you need to monitor?
    Peaks and troughs
  17. When you are using extended interval dosing with aminoglycosides, what level do you need to monitor?
    Random level
  18. What ABXs are in pregnancy category B?
    • *Beta lactams (exc. imipenem)
    • *Azithromycin, erythromycin
    • *Clindamycin
    • *Flagyl (but CI in 1st sem)
    • *Fosfomycin
    • *Nitrofurantoin
    • *Dificid 
  19. What ABXs are in pregnancy category C?
    • *Imipenem
    • *Bactrim
    • *FQs (cartilage damage in immature animals)
    • *Clarithromycin
    • *Telavancin
    • *Telithromycin 
  20. What ABXs are in pregnancy category D?
    • *Aminoglycosides
    • *Bactrim (near term)
    • *TCNs (retards bone growth and skeletal development)
    • *Tigecycline
    • *Nitrofurantoin (at term) 
  21. In traditional dosing, what is the dose of gent and tobra?
    1-2 mg/kg/dose
  22. In traditional dosing, what is the dose of amikacin?
    5-7.5 mg/kg/dose
  23. In extended interval dosing, what is the dose of gent and tobra?
    4-7 mg/kg
  24. In extended interval dosing, what is the dose of amikacin?
    15-20 mg/kg
  25. In traditional dosing of aminoglycosides, what is the dosing frequency when CrCl >60? CrCl 40-60? CrCl 20-40? And CrCl <20?
    • *Q8hrs
    • *Q12hrs
    • *Q24hrs
    • *Give LDs, monitor levels
  26. In traditional dosing of aminoglycosides, when do you take trough and peak levels?
    For trough levels, take right before the next dose, and for peak levels, take 1/2 hr right after end of drug infusion
  27. For extended interval dosing of aminoglycosides, when do you draw a random level? How do you determine dosing frequency with this level?
    Within 6-16 hrs post dose; then, plot result on a nomogram to determine the dosing frequency
  28. What peak levels do you want with gent/tobra?
    5-10 mcg/mL
  29. What trough levels do you want with gent/tobra?
    <2 mcg/mL
  30. What peak levels do you want with amikacin?
    20-30 mcg/mL
  31. What trough levels do you want with amikacin?
    <5 mcg/mL
  32. What is the MOA of beta lactams?
    Inhibit cell wall synthesis by binding to PBP, which prevents the final transpeptidation step of peptidoglycan synthesis
  33. What organisms do natural PCNS (PenG, PenVK, benzathine penicillin) cover?
    • *G+: Strep sp.
    • *G-: Neiserria meningitidis
    • *Other: Treponema pallidum (syphillis)
  34. What organisms do the antistaph PCNs (aka CONDoM, or cloxacillin, oxacillin, nafcillin, dicloxacillin, methicillin) cover?
    G+: MSSA, Strep sp (inclu. Strep Pneumo)
  35. What organisms do the aminoPCNs (amoxacillin, ampicillin) cover?
    • *G+: Strep sp (inclu. Strep pneumo), Enterococcus sp, Listeria sp.
    • *G-: Neiserria meningitidis, Proteus mirabilis
  36. What organisms do the antipseudomonal PCNs (ticarcillin and piperacillin) cover?
    • Ticarcillin:
    • *G+: Lancefield group Strep
    • *G-:
    • -Neiserria meningitidis
    • -Proteus mirabilis
    • -Salmonella
    • -B-lactamase (-) H. flu
    • -E. coli
    • -Enterobacter sp
    • -Pseudomonas
    • -Shigella

    Think of adding "SHEEPS"

    • Piperacillin:
    • *G+:
    • -Lancefield group Strep
    • -Strep viridans
    • -Enterococcus

    • *G-:
    • -Ticarcillin plus
    • -Some Klebsiella
  37. What two new organisms do Unasyn and Augmentin now cover?
    Staph aureus (MSSA) and bacteroides (anaerobes)
  38. What new organisms do Zosyn and Timentin cover?
    Both: MSSA and Bacteroides; but for Zosyn, add SPACE-M
  39. Amoxacillin is the DOC for what conditions?
    AOM, H. pylori regimens, pregnancy, endocarditis prophylaxis
  40. Do you need to renally adjust beta lactams?
    Yes, except for CONDoM drugs and cefoperazone and Rocephin.
  41. What are the side effects of PCNs and other beta lactams?
    GI upset, diarrhea, allergic rxns, rash, pruritis, increased LFTs

    Seizures w/accumulation (e.g. imipenem), interstitial nephritis, colitis, agranulocytosis
  42. What are 2 test interactions with PCNs?
    False (+) urinary glu test and false (+) galactomannan test for aspergillosis
  43. Does Augmentin oral susp need to be refrigerated?
    Yes
  44. Does Amoxil oral susp need to be refrigerated?
    No - it may to improve taste, but it's stable at room temp for 14 d
  45. When do you take Moxatag?
    Within 1 hr of finishing a meal
  46. In regards to meals, how is PenVK taken?
    On an empty stomach
  47. Does PenVK susp need to be refrigerated?
    Yes
  48. How do uricosuric agents (i.e., probenecid, allopurinol) interact with beta lactams?
    Increase beta lactam levels by interfering with renal excretion
  49. Amoxicillin (+clavulanic acid)
    • *Amoxil, Moxatag (Augmentin)
    • *500 mg TID or 875 mg BID
  50. Ampicillin (+sulbactam)
    *Principen (Unasyn)

    • Principen:
    • *Oral: 250-500 mg QID (1-2 hrs before food)
    • *IV: up to 14 g daily divided in Q4-6 hr doses

    • Unasyn:
    • *1.5-3 g IV QID
  51. PenVK
    *250-500 mg TID-QID (1 hr before or 2 hrs after meals)
  52. Piperacillin + tazobactam
    • *Zosyn
    • *3.375-4.5 g IV Q6hrs
  53. Cefazolin
    • *Ancef, Kefzol
    • *1st gen
    • *250-2000 mg IV Q8hr
  54. Cephalexin
    • *Keflex
    • *1st gen
    • *250-500 mg PO Q6hr
  55. What organisms do 1st-generation cephalosporins cover?
    • Good G+
    • G-: PEcK (P. mirabilis, E. coli, K. pneumoniae)
  56. Cefprozil
    • Cefzil
    • 2nd gen
    • 250-500 mg PO Q12hr-Q24hr
  57. Cefuroxime
    • *Ceftin, Zinacef
    • *2nd gen
    • *250-1500 mg PO/IV Q8hr
  58. What 2nd generation cephalosporins cover anaerobes?
    • Cefotetan (Cefotan)
    • Cefoxitin (Mefoxin) 
  59. What organisms do 2nd generation cephalosporins cover?
    • G+ maintained
    • G-: HeNPeCK (H. flu, Moraxella sp., Neisseria sp. added)
  60. Cefdinir
    • Omnicef 
    • 3rd gen
    • 300 mg PO Q12hr or 600 mg PO daily 
  61. Ceftazidime
    • Fortaz, Tazicef
    • 3rd gen
    • 1-2 g IV Q8-12hr 
  62. Ceftriaxone
    • Rocephin
    • 3rd gen
    • 1-2 g IV/IM Q12-24 hr 
  63. What organisms do 3rd generation cephalosporins cover?
    • G+: no MSSA, but resistant Strep
    • G-: Add SPPACE-M:
    • *Serratia
    • *Pseudomonas (ceftazidime only)
    • *Providencia 
    • *Acinetobacter
    • *Citrobacter
    • *Enterobacter
    • *Morganella
  64. Cefepime
    • Maxipime
    • 4th gen
    • 1-2 g IV Q8-12hr 
  65. What organisms do 4th generation cephalosporins cover?
    • G+: good, MSSA is back
    • G-: SPACE-M (no worry for AmpC ind.) 
  66. What is the difference between cefepime and pip/tazo?
    Cefepime lacks coverage of anaerobes and Enterococcus sp. 
  67. Ceftaroline fosamil
    • Teflaro
    • 5th gen
    • 600 mg IV Q12hr 
  68. What organisms does the 5th generation cephalosporin cover?
    MRSA
  69. What are two test interactions of cephalosporins?
    False (+) urinary glu test and (+) direct Coomb's test
  70. What cephalosporins contain the NMTT side chain? What are the consequences of this side chain?
    • Cefmetazole
    • Cefotetan
    • Cefamandole
    • Cefoperazone 
    • *I met a tan man at the opera*
    • Disulfiram-like rxn w/EtOH and hypoprothrombinemia (bleeding) 
  71. Why is imipenem combined with cilastatin?
    To prevent degradation by renal tubular dehydropeptidase
  72. Describe the coverage of carbapenems.
    • ESBLs, but:
    • Ertapenem: no APE (Acinetobacter, Pseudomonas, Enterococcus)
    • Merrem and Doribax: no E. faecium
  73. Imipenem/cilastatin
    • Primaxin
    • 250-1000 mg IV Q6H
  74. Meropenem 
    • Merrem
    • 500-2000 mg IV/IM Q8H 
  75. Ertapenem 
    • Invanz
    • 1 g IV/IM daily 
  76. Doripenem
    • Doribax
    • 500 mg IV Q8H 
  77. What is the MOA of quinolones?
    Inhibits DNA topoisomerase IV and DNA gyrase (topoisomerase II)
  78. Ciprofloxacin
    Cipro, Cipro XR

    • Dosing:
    • 250-750 mg PO or 200-400 mg IV

    • CrCl >50: Q8-12H
    • CrCl 30-50: Q12H
    • CrCl <30: Q18-24H 
  79. Levofloxacin
    Levaquin

    • Dosing (IV/PO):
    • CrCl >50: 500 mg daily
    • CrCl 20-49: 500 mg, then 250 mg daily
    • CrCl <20: 500 mg, then 250 mg Q48H 
  80. Moxifloxacin
    • Avelox
    • 400 mg IV/PO Q24H
  81. What are the respiratory FQs (cover Strep pneumo)?
    GML (gemifloxacin, moxifloxacin, levofloxacin)
  82. Which FQs cover Pseudomonas?
    Cipro and Levaquin
  83. What FQ covers anaerobes?
    Avelox
  84. What ABXs cover atypicals?
    • Quinolones
    • Macrolides
    • TCNs 
  85. What is the BBW of FQs? What are the risk factors of this BBW? 
    • Tendon inflammation and/or rupture (Achilles tendon)
    • Risk factors: concurrent use of steroids, organ transplant pts, >60 y/o
  86. When does peri-operative ABX prophylaxis begin and how long does it last?
    Within 1 hr before surgical incision, and lasts no longer than 24 hrs post

    *Except: cardiac surgery (no longer than 48 hrs post)
  87. What is the DOC for most peri-operative procedures? And what if they have a PCN allergy?
    • 1st/2nd gen cephs (cefazolin/cefuroxime)
    • *PCN allergy: vancomycin (but give within 2 hrs before surgery)
  88. If surgery involves the bowel, or risk of anaerobe infection, what ABX would you use?
    Something with anaerobe coverage like cefotetan
  89. What are the recommended ABXs for CABG, cardiac surgeries, hip/knee arthroplasties?
    • Cefazolin, cefuroxime, vanco
    • *If PCN-allergy: vanco, clindamycin
  90. What are the recommended ABXs for colon surgeries and hysterectomies?
    Cefotetan, cefoxitin, Unasyn, cefazolin or cefuroxime (for both cephs, + Flagyl if colon)

    Ertapenem for colon

    • *If PCN allergy:
    • -Clindamycin/Flagyl + aminoglycoside/FQ/Aztreonam (only w/clinda)
  91. What are the empiric oral tx options for purulent cellulitis?
    • *Clindamycin 300-450 mg TID or
    • *Bactrim DS 1-2 tabs BID or
    • *Doxycycline 100 mg BID or
    • *Minocycline 200 mg x 1 dose, then 100 mg BID or
    • *Zyvox 600 mg BID

    Duration: 5-10 days
  92. What is the tx of non-purulent cellulitis?
    *Beta lactam (like Keflex)
  93. What is the primary treatment of cutaneous abscess?
    Incision and drainage
  94. What do you do when pt has recurrent SSTIs?
    • *Nasal decolonization w/mupirocin BID x 5-10 days and/or
    • *Topical body decolonization w/chlorhexidine x 5-14 days or
    • *Dilute bleach baths BIW x 3 mon
  95. What ABXs do you use for complicated SSTIs?
    • *Vanco or
    • *Zyvox 600 mg IV/PO BID or
    • *Cubicin 4 mg/kg/dose once daily or
    • *Vibativ 10 mg/kg/dose once daily or
    • *Clindamycin 600 mg IV/PO TID

    Duration: 7-14 days
  96. What pathogens are involved in acute uncomplicated cystitis in females?
    • *E. coli
    • *S. saprophyticus
    • *Enterococcus
  97. What is the DOC of acute uncomplicated cystitis in females?
    *Bactrim DS 1 tab BID x 3 days (if <20% E. coli resistant)

    • If >20% E. coli resistance:
    • *Cipro 250 mg BID, Cipro ER 500 mg daily, or Levaquin 250 mg daily or
    • *Macrobid 100 mg BID x 5 days or
    • *Fosfomycin x 1 dose (3 g in 4 oz H2O)
  98. What pathogens are involved in acute uncomplcated pyelonephritis?
    • *P. mirabilis
    • *P. aeruginosa
    • *E. coli
    • *Enterococci
    • *K. pneumoniae

    PPEEK!
  99. In acute uncomplicated pyelonephritis, what do you take if only moderately ill (outpt, PO)?
    FQ: Cipro 500 mg PO BID, Cipro ER 1000 mg daily, Levaquin 750 mg daily, or ofloxacin 400 mg BID x 5-7 days

    If FQ resistant: Augmentin, cefdinir, cefaclor, or cefpodoxime
  100. In acute uncomplicated pyelonephritis, what do you use in severe tx (inpt, IV)?
    FQ, Amp + Gent, Zosyn, or Rocephin x 10-14 days
  101. What pathogens are involved in complicated UTI?
    You can't "p" any more (lose a "P") PEEKSS! - add Serratia and Staph sp.
  102. What are the DOCs for complicated UTI?
    FQ +/- Amp+Gent or Zosyn or Timentin or Rocephin or cefotaxime

    Duration: 7 days if prompt sxt relief, and 10-14 days if delayed response

    If ESBL present, use Doribax, Merrem, or imipenem/cilastatin x 2 wks
  103. How long must you treat pregnant women w/UTI?
    7 days
  104. What ABXs should you avoid in pregnant women?
    FQ (cartilage toxicity, arthropathies), TCNs, Bactrim (hyperbilirubinemia, kernicterus in 3rd trimester)
  105. What is the Rx dose and OTC dose of Azo? Do you take it with food? How long should you take it? What's one major side effect?
    • *Rx: 200 mg TID
    • *OTC: 100 mg TID
    • *Take with food
    • *Take only up to 2 days
    • *May turn urine and bodily fluid red-orange: do not wear white clothes, do not wear contacts
  106. What is the treatment for Traveler's Diarrhea?
    • *Metronidazole 250-750 mg TID x 7-10 d or
    • *Rifaxamin 200 mg TID x 3 d
    • *Tinidazole 2 g PO x 1, may repeat daily for total of 3 d
    • *Azithromycin 1,000 mg x 1 or 500 mg daily x 1-3 d (DOC for pregnancy and children)
    • *Nitazoxanide 500 mg PO BID x 3 d
    • *Cipro 500 mg PO BID x 3 d
    • *Ofloxacin 300 mg BID x 3 d
    • *Levofloxacin 500 mg daily x 1-3 d
    • *TMP/SMX DS PO BID x 7-10 d

    MR. TAN COLT

    + Immodium 4 mg x 1, 2 mg after for each loose BM, max: 16 mg/d
  107. If the pt has bloody stool or fever, could you use Immodium?
    No
  108. What is the pathogens involved in Traveler's Diarrhea?
    E. coli, Shigella, Salmonella, Campylobacter
  109. If diarrhea lasts >7 d, what can you attribute the diarrhea to?
    Parasites (e.g., Giardia, Cryptosporidium)
  110. What do you use in mild-moderate C. diff infections?
    Flagyl 500 mg PO TID x 10-14 d
  111. What do you use in severe C. diff infections?
    Vancomycin 125 mg PO QID x 10-14 d
  112. What do you use in severe and complicated C. diff infections? What if the pt has ileus? What if the pt is receiving chemo or is immunocompromised?
    • *Vancomycin 500 mg PO QID +/- Flagyl 500 mg IV Q8hrs
    • *Use Vanco PR 500 mg in 100 mL NS QID
    • *Use Dificid
  113. How do you treat the first C. diff recurrence?
    Use the same agent
  114. How do you treat the 3rd episode of C. diff?
    Vanco taper therapy: 125 mg PO QID x 2 wks, BID x 1 wk, then TIW x 2-8 wks
  115. Can you use Immodium with C. diff infections?
    No - risk of toxic megacolon
  116. How do you prevent C. diff transmission?
    Wash hands - NO SANITIZERS!
  117. How long does a cough last in acute bronchitis?
    Up to 2 wks
  118. How do you treat acute bronchitis?
    Antitussives +/- inhaled bronchodilators (no ABXs!). Also, antipyretics, fluids, etc.
  119. What do you give if the adult has coughed >14 d?
    This means he has pertussis :(

    • *Azithromycin 500 mg x 1, 250 mg daily for 2-5 d or
    • *Clarithromycin 500 mg BID or 1 g ER daily x 7 d or
    • *Erythromycin estolate 500 mg QID x 14 d or
    • *Bactrim DS 1 tab BID x 14 d
  120. What ABX do you give in mild-mod Acute Bacterial Exacerbation of Chronic Bronchitis?
    None needed, but if used: amoxicillin, doxy, Bactrim, or ceph
  121. How do you treat severe ABECB?
    • *INH anticholinergic brochodilator + steroids; taper over 2 wks
    • *ABXs: maybe. If so, use FQ (GML!), azithromycin or clarithromycin, Augmentin, ceph; tx for 3-10 d
  122. What are the criteria for outpatient tx for CAP? What ABXs do you use?
    • *Healthy, no ABX use w/in last 3 months
    • ABXs:
    • *Macrolides or
    • *Doxycycline
  123. What are the risk factors for DRSP? What is the outpt tx of DRSP in CAP?
    • Risk factors:
    • *Age > 65 y/o
    • *Comorbidities (e.g., HF, cancer, DM, renal/liver dysfunction)
    • *ABX use w/in last 3 months

    • ABXs:
    • *Respiratory FQ (GML)
    • *Beta lactam (amox, Augmentin, cefpodoxime, cefuroxime) + macrolide
  124. What is the inpt, non-ICU tx of CAP?
    • *Resp FQ (GML) IV or PO or
    • *BL (Unasyn, Rocephin, cefotaxime) + macrolide
  125. What is the inpt, ICU tx of CAP? What do you do if Pseudomonas is suspected? CA-MRSA?
    Use IV

    • *Beta lactam (Unasyn, Rocephin, cefotaxime) + Azithromycin or resp FQ (moxi or levo)
    • *For Pseudomonas, use antipseudo BL + antipseudo FQ or AMG
    • *For CA-MRSA, add vanco or Zyvox
  126. Cefpodoxime (in CAP)
    • *Vantin
    • *200 mg BID
  127. Cefuroxime (in CAP)
    • Ceftin
    • 500 mg BID
  128. Azithromycin (in CAP)
    • Zithromax
    • 500 mg x 1 dose, then 250 mg daily (Day 2-5)
  129. Clarithromycin (in CAP)
    • Biaxin (XL)
    • 250-500 mg BID; XL: 1 g daily
  130. Erythromycin base (in CAP)
    • E-mycin
    • 250-500 mg Q6hrs
  131. Gemifloxacin (in CAP)
    • Factive
    • 320 mg daily
  132. Levofloxacin (in CAP)
    • Levaquin
    • 750 mg daily
  133. Moxifloxacin (in CAP)
    • Avelox
    • 400 mg daily
  134. Doxycycline (in CAP)
    • Vibramycin
    • 100 mg Q12hrs
  135. Amoxicillin (in CAP)
    • Amoxil
    • 1 g Q8hrs
  136. Amoxicillin/clavulanic acid (in CAP)
    • Augmentin
    • 2 g BID
  137. How do you prevent HAP?
    Ween off ventilator ASAP, d/c stress ulcer prophylaxis if unnecessary, remove NG tube, elevate head of bed by 30 degrees
  138. What is considered HAP?
    When it occurs 5 days or more after hospitalization
  139. How do you treat HAP/VAP?
    • *Zosyn 4.5 g IV Q6h or
    • *Rocephin 1-2 g IV Q24h or
    • *Unasyn 3 g IV Q6h or
    • *Ertapenem 1 g IV Q24h

    If suspect Legionella or bioterrorism, add/replace tx w/resp FQ (Avelox, Levaquin)

    If suspect Pseudomonas: antipseudo BL + antipseudo FQ (cipro, levo) or AMG

    If suspect MRSA, add vanco or Zyvox
  140. MRSA Tx
    • Vancomycin
    • Zyvox (but not MRSA bacteremia)
    • Cubicin (but not PNA)
    • Synercid
    • Vibativ
    • Tygacil
    • Teflaro
    • Bactrim (SSTI, CA)
    • Doxycycline, minocycline (SSTI, CA)
    • Clindamycin (D-test (-)) (SSTI, CA)
  141. VRE tx
    • Zyvox
    • Cubicin
    • Synercid (but not E. faecalis)
    • Tygacil
  142. Pseudomonas tx
    • Zosyn, Timentin
    • Fortaz, Maxipime
    • Merrem, Doribax, Primaxin
    • Azactam
    • Cipro, Levaquin
    • Aminoglycosides (all)
    • Colistin
  143. What causes syphyllis?
    Treponema pallidum (spirochete)
  144. How do you treat syphyllis (early: primary, secondary, latent: <1 yr duration)?
    • PenG benzathine 2.4 million units IM x 1 dose
    • Alternative: doxy 100 mg PO BID x 2 wks
  145. If pt is PCN allergic, and is pregnant, do we forgo PCN?
    No - must desensitize and tx w/PCN
  146. How do you tx late syphyllis (>1 yr duration, CV, gummas, late-latent, unknown duration)?
    • PenG benzathine 2.4 million units IM weekly x 3 wks
    • Alternative: doxy 100 mg PO BID x 4 wks
  147. How do you treat neurosyphyllis?
    • PenG aqueous 3-4 million units IV Q4hrs x 10-14 d
    • Alternative: PenG procaine 2.4 million units IM daily + probenecid 500 mg PO QID x 10-14 d
  148. How do you treat congenital syphillis?
    • PenG aqueous 50,000 units/kg IV Q12hrs x 7 d, then Q8hrs x 10 days total (3 more days)
    • Alternative: PenG procaine 50,000 units/kg IM daily x 10 d
  149. What causes gonorrhea?
    Neisseria gonorrhea, G-
  150. What is the tx for gonorrhea?
    • *Rocephin 250 mg IM x 1 or
    • *Cefixime (Suprax) 400 mg PO x 1 or
    • *Cefpodoxime (Vantin) 400 mg PO x 1
    • PLUS
    • *Chlamydia tx: azithromycin 1 g PO x 1
    • Alternative:
    • Azithromycin 2 g PO x 1 - tx both gonorr and chlam, but GI fx's & $$$ :(
    • Cefoxitin 2 g IM x 1 + probenecid or
    • Cefotaxime 500 mg x 1
  151. What is the pathogen of chlamydia?
    Chlamydia trachomatis
  152. How do you tx chlamydia?
    Azithromycin 1 g PO x 1

    • Alternative:
    • Doxycycline 100 mg BID x 7 d
    • Erythromycin 500 mg QID x 7 d
  153. What is the tx for bacterial vaginosis?
    • Flagyl 500 mg PO BID x 7 d or
    • Flagyl 0.75% gel 5 g PV daily x 5 d or
    • Clindamycin 2% cream 5 g PV QHS x 7 d

    • Alternative:
    • Tinidazole 2 g PO daily x 2 d or
    • Tinidazole 1 g PO daily x 5 d or
    • Clindamycin 300 mg PO BID x 7 d or
    • Clindamycin ovules 100 mg PV QHS x 3 d
  154. How do you tx trichomoniasis?
    • Flagyl 2 g PO x 1 or
    • Tinidazole 2 g PO x 1

    • Alternative:
    • Flagyl 500 mg PO BID x 7 d
  155. When must pts start herpes tx?
    During prodome or within 1 day of lesion onset
  156. When should pts take suppressive tx for herpes?
    When they get recurrences: >6 episodes/yr
  157. Prodrugs of herpes meds
    • Valacyclovir (Valtrex) --> acyclovir (Zovirax)
    • Famciclovir (Famvir) --> penciclovir
  158. How do you tx a primary (initial episode) of herpes?
    • Acyclovir (Zovirax) 400 mg PO TID x 7-10 d or
    • Valacyclovir (Valtrex) 1 g PO BID x 7-10 d or
    • Famciclovir (Famvir) 250 mg PO TID x 7-10 d
    • If severe: acyclovir 5-10 mg/kg IV Q8h x 2-7 d
    • In acyclovir-resistance: foscarnet 40 mg/kg IV Q8h until resolution (~7 d)
  159. How do you tx recurrent episode of herpes?
    • Acyclovir:
    • 800 mg TID x 2 d
    • 800 mg BID x 5 d
    • 400 mg TID x 5 d

    • Valacyclovir:
    • 500 mg PO BID x 3 d or
    • 1000 mg PO daily x 5 d

    • Famcyclovir:
    • 1 g BID x 1 d or
    • 125 mg PO BID x 5 d
  160. How do you give suppressive tx for herpes?
    • Acyclovir 400 mg PO BID or
    • Valacyclovir 500-1000 mg PO daily or
    • Famciclovir 250 mg PO BID
  161. Do you need to renally adjust antivirals for herpes?
    Yes
  162. If you're using acyclovir IV, and you begin to see clinical improvement, can you cut the IV short and start PO tx?
    Yes - start and give for duration of at least 10 d
  163. What is the pathogen that causes TB?
    Mycobacterium tuberculosis
  164. When do you look for induration after giving a PPD?
    Within 48-72 hrs after inj
  165. How do you treat latent TB?
    • INH 300 mg PO daily x 9 months
    • Alternative: rifampin 600 mg PO daily x 4 months
  166. How do you tx active TB?
    • INH + RIF + EMB + PZA x 2 mon, then
    • INH + RIF x 4 mon

    • If INH resistance:
    • RIF + PZA + EMB +/- FQ x 6 mon

    • If RIF resistance:
    • INH + EMB + FQ + (PZA x 2 mon) x 12-18 mon

    • If MDR-TB (resistant to at least 2 meds):
    • FQ + PZA + EMB + amg (strepto/amika/kanamy) +/- alternative agent x 18-24 mon

    Alternative agent: cycloserine, ethionamide, clarithromycin, Unasyn, Zyvox, streptomycin (replace EMB)
  167. Daily regimen or DOT regimen?
    DOT - 2-3 x's per wk
  168. Since INH increases risk of neuropathy, what should you supplement in TB tx?
    Pyridoxine (vitB6) 25-50 mg PO daily
  169. What can you substitute RIF with if there is concern of drug-drug intxts?
    Rifabutin (RFB)
  170. In regards to meals, how should INH and RIF be taken?
    On an empty stomach
  171. What are the major side effects of INH?
    Peripheral neuropathy, lupus-like syndrome, hepatitis, increased LFTs
  172. What are the major side effects of rifampin?
    Orange-red discoloration of body secretions (stains contact lens and white t-shirts), flu-like syndrome, rash, pruritis, hepatotoxicity
  173. What is one major side effect of ethambutol?
    Optic neuritis
  174. What is one major side effect of pyrazinamide?
    Hepatotoxicity
  175. How long is the observation period in AOM?
    48-72 hrs
  176. When the child is <6 mon old, do we still have the observation period as an option?
    No - give ABXs tx right away, even when uncertain dx
  177. What are the drug options for AOM?
    • Amoxicillin 90 mg/kg/d in 2 divided doses or
    • Augmentin 90 mg/kg/d of amox and 6.4 mg/kg/d of clav in 2 divided doses or
    • Zithromax 10 mg/kg/d on Day 1, then 5 mg/kg/d daily on Days 2-5 or 
    • Biaxin 15 mg/kg/d in 2 divided doses
    • Erythomycin sulfsoxazole (Pediazole) 40-50 mg/kg/d of erythromycin in 3-4 div doses (NTE 2 g erythromycin/6g sulfisoxazole per day)
    • Bactrim 6-10 mg/kg/d of TMP in 2 div doses
    • Rocephin 50 mg/kg IV/IM x 3 d (max 1 g/d)

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