-
Aztreonam
- Monobactam.
- For gram neg incl pseudo.
- No cross rxn with pen.
-
meningitis bugs
- Strep pneumo,
- group b strep,
- h flu,
- neisseria,
- listeria.
- Staph if recent surgery
-
Meningitis in cd4 <100
Cryptococcus
-
Csf cell count
- Bacterial 1000s neutrophils.
- Fungal and parasite, tb, and viral: 10-100s lymphocyte
-
Latex agglutination test of csf
- good specificity.
- Add if got Abx before LP
-
-
Meningitis initial tx
- Cedtriaxone, vancomycin, steroids.
- Steroids are effective in s pneumo.
- Add ampicillin for listeria if baby, old, steroids, hiv, immunocomp, etoh, pregnant.
- Add respiratory isolation if neisseria plus rifampin or ciprofloxacin to close contacts.
-
Herpes encephalitis tx
- Iv acyclovir.
- If resistant foscarnet.
- Foscarnet has more renal toxicity
-
Otitis media tx
- Amox.
- Amox/clav.
- Azithro or clarithromycin.
- Cefuroxime or loracef.
- Levofloxin.
- If recurrences, also cx
-
When to bx for sinusitis
- Recurrent, no response.
- Is the most accurate Dx test.
-
Sinusitis first line
- Amoxicillin, doxy, bactrim.
- Also decongestant.
-
Pharyngitis with membranous exudate
- Diphtheria,
- Vincent angina,
- ebv
-
Step pharyngitis tx
- Amoxicillin or pen.
- If all, cephalexin if rash and clindamycin or macrolide if anaphylaxis.
-
Flu management
- Within 48hrs: swab for antigen, oseltamivir or zanamivir.
- Longer: symptomatic
-
Aminoglycosides
- Gentamicin
- Tobramycin
- Amikacin
-
Aminoglycosides uses
- Gram neg bacilli - bowel, urine, bacteremia
- Synergy with beta lactam for enterococci and staph
- No effect against anaerobes
-
-
Doxycycline uses
- Chlamydia
- lyme
- Rickettsia
- prim and sec syphilis
- Borrelia, Ehrlichia, Mycoplasma
-
Doxy sides
- Tooth discoloration
- Fanconi syndrome/Type 2 RTA
- Photosens
- Esophagitits
-
Nitrofurantoin uses
Cystitis in pregnant
-
bactrim uses
- Cystitis
- PCP tx and ppx
- MRSA skin, cellulitis
-
bactrim sides
- rash
- G6PD def hemolysis
- bone marrow supprression (bc folate antagonist)
-
Beta lactamase
adds coverage of MSSA
-
MRSA tx
- Vanc
- Linezolid
- Daptomycin
- Tifecycline
- Minor on skin: bactrim, clinda, doxy
-
Linezolid side
bone marrow toxicity
-
Daptomycin sides
elevated CPK
-
Anaerobe tx
- Above diaphragm: Pen, amp, amox, clinda
- Below: metro
- Also piperacillin, carbapenems, 2nd gen ceph
-
Gram neg locals and tx
- Bowel, URI, Liver
- Quinolones
- Aminoglycosides
- Carbapenems
- Piperacillin, ticarcillin
- Aztreonam
- cephalosporins
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