antibiotics 101 a review of common infections and their treatment for others, like me, who have a...
TRANSCRIPT
Antibiotics 101Antibiotics 101A review of common infections and their treatment
For others, like
me, who have
a mental block
against all
things related
to antibiotics
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 diagonal0 All answers must be correct to win the game0 Winner will receive a prize! Woohoo!!
Brief Micro Refresher
Basic Antibiotic CoverageStrep Staph MRSA Entero Gram - Pseudo Anaerobes
(except bacteroides)
Atypicals
Penicillin + - - - - - - -
Ampicillin + +* - + +/- - + -
Amox/clav + + - + + - + -
Vancomycin + + + +/- - - + -
1st ceph + + - - - - - -
2nd ceph + + - - + - - -
3rd ceph + + - - + -* + -
4th 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 500mg x 1d then 250mg x 4d
0 Doxycycline 100mg BID x 7-10d0 Moxifloxacin 400mg (or levo) x 7d
for pts with co-morbidities 0 Inpatient:
0 Ceftriaxone 1g IV Q24hrs + azithromycin 500mg IV Q24hrs
0 Moxifloxacin 400mg or levofloxacin 750mg IV Q24hrs
0 Duration: 7-10dhttp://www.acutemed.co.uk/diseases/Pneumonia
Healthcare Associated Pneumonia
0 Criteria:0 Hospitalization for two or more
days within the past 90 days0 Current hospitalization > 48hrs
(*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 care0 Family member with known
MDRP
HCAP Cont’d0 Pathogens:
0 Pseudomonas0 MRSA0 Klebsiella, enterobacter,
acinetobacter, serratia, E.Coli0 Anaerobes (aspiration)
0 Empiric treatment:0 Vitamin P and V0 Piperacillin/tazo OR cefepime
OR meropenem + vancomycin0 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_digest181.html
COPD Exacerbation0 Most common pathogens:
0 H.flu0 Moraxella0 Strep pneumo0 Viruses: parainfluenza, flu,
rhinovirus, RSV
0 Antibiotics:0 Azithromycin (Z-pack)0 Doxycycline 100mg BID x 10d0 Amoxicillin 500-875mg TID x
10d
0 Other therapies:0 Prednisone0 Duonebs
http://meded.ucsd.edu/clinicalimg/thorax_tripod.htm
Sinusitis0 Common Pathogens:
0 Viruses: rhinovirus0 S.pneumo0 H.flu
0 Classification:0 Acute: < 4wks0 Subacute: 4-12 wks0 Chronic: > 12wks
http://www.cnn.com/2012/02/14/health/antibiotics-not-helpful-sinus-infections/
Sinusitis: Empiric Tx
0 When?0 Persistent symptoms
(>10d) or worsening symptoms at day 7
0 What?0 Augmentin 875/125mg
BID0 Amoxicillin 500mg TID 0 Duration: 10-14d
http://4.bp.blogspot.com/_3xJEG7fcX7w/SMS5ECJRwtI/AAAAAAAACBA/v126PDIjCZA/s1600/
Neti+Pot+2.JPG
Cellulitis0 Common pathogens:
0 Strepococcus0 Staphylcoccus
0 Empiric treatment:0 Outpatient:
0 Cephalexin 500mg QID or amoxicillin 500mg TID +/- doxycycline or TMP-SMX
0 Duration: 7-10d0 Inpatient:
0 Vancomycin0 Duration: 7-10d
0 Other therapies: elevation of affected area, +/- steroids
http://en.wikipedia.org/wiki/File:Cellulitis_Left_Leg.JPG
Cellulitis- Diabetics0 Common pathogens:
0 Staph and strep0 Enterobacter0 Enterococcus0 Pseudomonas0 Anaerobes
0 Empiric treatment:0 Augmentin 875mg BID0 Clindamycin 300mg TID0 Amp/sulbactam 3g IV Q6hrs0 +/- vancomycin0 Duration: 5-14d (resolution of
symptoms)
*Important note: bactrim and doxycycline have less strep activity so are not preferred agents
http://healthyliving.blog.ocregister.com/files/2008/10/cellulitis.jpg
Urinary Tract Infection0 Pathogens:
0 Pathogens: E.Coli, E.Coli, E.Coli, Staph saprophyticus, Proteus
0 Uncomplicated:0 Women, no systemic
symptoms (afebrile, no leukocytosis, etc)
0 Complicated:0 Men, indwelling foley,
systemic symptoms0 Pyelonephritis:
0 Flank pain, fever, leukocytosis, +/- WBC casts
http://hsl.uw.edu/files/antibiograms/uw-medicine-2012-antibiogram
UTIs Empiric Treatment0Uncomplicated:
0 Check antiobiograms for resistance patterns0 In Seattle: TMP-SMX = ciprofloxacin BUT nitrofurantoin is
better than all!0 Duration: 3-5d (5d for nitrofurantoin)
0Complicated:0 Cipro or TMP-SMX if mild to moderate illness0 Pip/tazo, cefepime, ceftazidime, carbapenem for severe
illness0 Duration: 7-14 days in general (3-5 days after
defervescence)
0Pyelonephritis:0 Ceftriaxone, ceftazidime, pip/tazo0 Duration: 48hrs IV or until afebrile, then complete total
14d course
Osteomyelitis0Acute vs chronic:
0 Acute: first presentation, symptoms < 2 weeks, absence of necrotic bone
0 Chronic: necrotic bone, > 3 weeks of symptoms
0Pathogens:0 S. Aureus, coag negative staph, strep, enterococcus,
pseudomonas, anaerobes
0Diagnosis:0 Blood culture, bone biopsy culture; wound culture
is generally not helpful
Osteomyelitis
0 Chronic treatment: based on culture results0 Empiric treatment for acute: need to cover anaerobes,
MRSA, pseudomonas0Ampicillin/sulbactam OR pip/tazo OR carbopenem OR
ceftriaxone0AND Vancomycin
0 Duration:0Acute: 4-6 weeks abx (usually minimum 2 weeks IV)0Chronic: 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 iPhone App
0 Cleveland Clinic Guidelines for Antimicrobial Usage 2011-2012