
4a639aac99226187448d7f45a5473089.ppt
- Количество слайдов: 18
e, like m l ers, r oth a menta ngs Fo ve hi ho ha ainst all t cs w g ti lock a to antibio b d relate Antibiotics 101 A review of common inf ections and their treatment
Antibiotic BINGO!! 0 Rules: 0 I will read a question for each “bingo ball, ” if you have the corresponding phrase on your sheet, answer the question in the box 0 Complete a row, column or diagonal 0 All answers must be correct to win the game 0 Winner will receive a prize! Woohoo!!
Brief Micro Refresher 0 Gram positive cocci: 0 Catalase positive: 0 Coag positive: staph aureus 0 Coag negative: staph epi 0 Catalase negative: 0 Enterococcus 0 Streptococcus 0 Atypicals: 0 C. pneumo: intracellular gram neg 0 Mycoplasma: no cell wall 0 Legionella: intracellular gram neg 0 Gram negatives: 0 Lactase positive: 0 E. coli 0 Klebsiella 0 Enterobacter 0 Others: 0 Proteus 0 Acinetobacter 0 Morganella 0 Serratia 0 Pseudomonas aeruginosa 0 Moraxella 0 H. flu
Basic Antibiotic Coverage Strep Staph MRSA Entero Gram - Pseudo Anaerobes (except bacteroides) Atypicals Penicillin + - - - - Ampicillin + +* - + +/- - + - Amox/clav + + - + - Vancomycin + +/- - - + - 1 st ceph + + - - - 2 nd ceph + + - - - 3 rd ceph + + - - + -* + - 4 th ceph + + - - + + + - Mero/imi + + - +/- + + + - Pip/tazo + + - +* + + + - Quinilones +* + - +/- + + +/- + Azithromycin +/- + - - +/- - + + Doxycyline +/- +/- * - +/- - + + TMP-SMX +/- + + - - -
Community Acquired Pneumonia 0 Common pathogens: 0 S. pneumo, H. flu, moraxella, chlamydia, legionella, mycoplasma, viruses 0 Empiric treatment: 0 Outpatient: 0 Azithromycin 500 mg x 1 d then 250 mg x 4 d 0 Doxycycline 100 mg BID x 7 -10 d 0 Moxifloxacin 400 mg (or levo) x 7 d for pts with co-morbidities 0 Inpatient: 0 Ceftriaxone 1 g IV Q 24 hrs + azithromycin 500 mg IV Q 24 hrs 0 Moxifloxacin 400 mg or levofloxacin 750 mg IV Q 24 hrs 0 Duration: 7 -10 d http: //www. acutemed. co. uk/diseases/Pneumonia
Healthcare Associated Pneumonia 0 Criteria: 0 Hospitalization for two or more days within the past 90 days 0 Current hospitalization > 48 hrs (*HAP) 0 Residence in skilled nursing facility or long term care facility within the last 30 days 0 Receiving outpatient IV therapy within the past 30 days 0 Attending a dialysis center in the last 30 days 0 Home wound care 0 Family member with known MDRP
HCAP Cont’d 0 Pathogens: 0 Pseudomonas 0 MRSA 0 Klebsiella, enterobacter, acinetobacter, serratia, E. Coli 0 Anaerobes (aspiration) 0 Empiric treatment: 0 Vitamin P and V 0 Piperacillin/tazo OR cefepime OR meropenem + vancomycin 0 Can also consider addition of gentamicin Pic 1: http: //www. qvision. es/blogs/almudena-valero/2013/04/21/trasplante-de-membrana-amniotica-en-queratitis-aguda-por-pseudomona/ Pic 2: http: //www. gasdetection. com/Interscan_News/health_news_digest 181. html
COPD Exacerbation 0 Most common pathogens: 0 H. flu 0 Moraxella 0 Strep pneumo 0 Viruses: parainfluenza, flu, rhinovirus, RSV 0 Otherapies: 0 Prednisone 0 Duonebs 0 Antibiotics: 0 Azithromycin (Z-pack) 0 Doxycycline 100 mg BID x 10 d 0 Amoxicillin 500 -875 mg TID x 10 d http: //meded. ucsd. edu/clinicalimg/thorax_tripod. htm
Sinusitis 0 Common Pathogens: 0 Viruses: rhinovirus 0 S. pneumo 0 H. flu 0 Classification: 0 Acute: < 4 wks 0 Subacute: 4 -12 wks 0 Chronic: > 12 wks http: //www. cnn. com/2012/02/14/health/antibiotics-not-helpful-sinus-infections/
Sinusitis: Empiric Tx 0 When? 0 Persistent symptoms (>10 d) or worsening symptoms at day 7 0 What? 0 Augmentin 875/125 mg BID 0 Amoxicillin 500 mg TID 0 Duration: 10 -14 d http: //4. bp. blogspot. com/_3 x. JEG 7 fc. X 7 w/SMS 5 ECJRwt. I/AAAAC BA/v 126 PDIj. CZA/s 1600/Neti+Pot+2. JPG
Cellulitis 0 Common pathogens: 0 Strepococcus 0 Staphylcoccus 0 Empiric treatment: 0 Outpatient: 0 Cephalexin 500 mg QID or amoxicillin 500 mg TID +/doxycycline or TMP-SMX 0 Duration: 7 -10 d 0 Inpatient: http: //en. wikipedia. org/wiki/File: Cellulitis_Left_Leg. JPG 0 Vancomycin 0 Duration: 7 -10 d 0 Otherapies: elevation of affected area, +/- steroids
Cellulitis- Diabetics 0 Common pathogens: 0 0 0 Staph and strep Enterobacter Enterococcus Pseudomonas Anaerobes 0 Empiric treatment: 0 0 0 http: //healthyliving. blog. ocregister. com/files/2008/10/cellulitis. jpg Augmentin 875 mg BID Clindamycin 300 mg TID Amp/sulbactam 3 g IV Q 6 hrs +/- vancomycin Duration: 5 -14 d (resolution of symptoms) *Important note: bactrim and doxycycline have less strep activity so are not preferred agents
Urinary Tract Infection 0 Pathogens: E. Coli, Staph saprophyticus, Proteus 0 Uncomplicated: 0 Women, no systemic symptoms (afebrile, no leukocytosis, etc) 0 Complicated: 0 Men, indwelling foley, systemic symptoms 0 Pyelonephritis: 0 Flank pain, fever, leukocytosis, +/- WBC casts
http: //hsl. uw. edu/files/antibiograms/uw-medicine-2012 -antibiogram
UTIs Empiric Treatment 0 Uncomplicated: 0 0 0 Check antiobiograms for resistance patterns In Seattle: TMP-SMX = ciprofloxacin BUT nitrofurantoin is better than all! Duration: 3 -5 d (5 d for nitrofurantoin) 0 Complicated: 0 0 0 Cipro or TMP-SMX if mild to moderate illness Pip/tazo, cefepime, ceftazidime, carbapenem for severe illness Duration: 7 -14 days in general (3 -5 days after defervescence) 0 Pyelonephritis: 0 Ceftriaxone, ceftazidime, pip/tazo 0 Duration: 48 hrs IV or until afebrile, then complete total 14 d course
Osteomyelitis 0 Acute vs chronic: 0 Acute: first presentation, symptoms < 2 weeks, absence of necrotic bone 0 Chronic: necrotic bone, > 3 weeks of symptoms 0 Pathogens: 0 S. Aureus, coag negative staph, strep, enterococcus, pseudomonas, anaerobes 0 Diagnosis: 0 Blood culture, bone biopsy culture; wound culture is generally not helpful
Osteomyelitis 0 Chronic treatment: based on culture results 0 Empiric treatment for acute: need to cover anaerobes, MRSA, pseudomonas 0 Ampicillin/sulbactam OR pip/tazo OR carbopenem OR ceftriaxone 0 AND Vancomycin 0 Duration: 0 Acute: 4 -6 weeks abx (usually minimum 2 weeks IV) 0 Chronic: 2 -6 weeks IV abx then usually addition 6 weeks with oral therapy (until ESR and CPR normalize)
References 0 Sanford Guide to Antimicrobial Therapy: Sanford Guide Web Edition 2 0 Johns Hopkins Antibiotics Guide, Unbound Medicine i. Phone App 0 Cleveland Clinic Guidelines for Antimicrobial Usage 2011 -2012