GI Infections
What is the first line treatment for shigellosis in adults? Children?
Adults- fluoroquinolone (cipro)
Children- azithromycin
What is the primary microbe responsible for UTIs?
E. coli
What is the treatment for gonorrhea? What should be co-treated for and what should you add to do so?
Ceftriaxone; cotreat for gonorrhea and add doxycycline
Antibiotics for skin and soft tissue infections must cover _____________, because the most common causative agents are ______ and _____
gram +, staph and strep
Which antihelminth therapy is safe to use in pregnancy? What is its MOA?
pyrantel pamoate- neuromuscular paralysis of worms allowing for expulsion
What is a major complication of EHEC and what can cause it?
Hemolytic uremic syndrome; can be caused by giving antibiotics in EHEC
What patients should be treated for asymptomatic bacteriuria?
Pregnant patients or patients who will have invasive urologic procedures
How is syphilis diagnosed? What if you suspect neurosyphilis?
nontreponemal exams and treponemal exams
CSF testing for neurosyphilis
How is impetigo described? What age group does it often affect? What is the treatment?
honey-crusted lesions; children aged 2-5; topical mupirocin (Bactroban)
What is a potential complication of amebiasis? What are first line treatment options?
Liver abscess; metronidazole and tinidazole
What is the treatment for cryptosporidiosis? How does treatment differ between immunocompetent and immunocompromised?
Nitazoxanide (Alinia)
Immunocompetent- generally do not require antimicrobials, but in severe disease only require 3 days tx
Immunocompromised- must be treated for 2-8 weeks
What are the first line agents for outpatient treatment of complicated UTI?
ciprofloxacin and levofloxacin
How does primary syphilis present? Secondary?
Primary- painless chancre at site of inoculation
Secondary- systemic symptoms including fever, rash, headache, malaise, anorexia, diffuse lymphadenopathy
What antibiotics can be used for empiric parenteral therapy of drainable abscesses?
vancomycin and daptomycin
_________ such as ______ and _______ are used to treat all 3 types of lice, but what should be counseled to each patient?
Pyrethoids; pyrethrine, permethrin. This will not take care of the nits so still must carefully comb through the hair to manually remove them
What is the pathognomonic finding of cholera? What three antibiotic classes can be used for treatment?
Rice-water stools; tetracyclines, macrocodes, fluoroquinolone
What three agents are first line for acute outpatient uncomplicated cystitis?
nitrofurantoin, Bactrim, and fosfomycin
What medication is first line for syphilis treatment and what is the reaction that can occur during treatment? Describe the reaction and management of the reaction
Jarisch-Herxheimer rxn- acute febrile reaction with headache, myalgias, rash, hypotension in the first 24 hours after receiving treatment. Manage with symptomatic treatment (antipyretics, IV fluids)
Bite wounds from animals are often infected with _____________ while __________ is most commonly cultured from humans. Preventatively, patients should be started on _________, but if the bite is already infected they should be started on _________.
pasturella multicoccida; strep viridans; Augmentin; Unasyn
What is the suspected mechanism of action of Albendazole (Albenza)? What are some side effects?
inhibits glucose uptake by helminths
Abdominal pain, nausea, vomiting, transient increase in hepatic transaminases
What are two complications associated with campylobacteriosis? What antibiotics can be used in severe disease?
post-infection arthritis and Guillan-Barre
Azithromycin or fluoroquinolone (levo or cipro)
What should be used to empirically treat UTIs in neonates?
broad coverage abx such as combo of ampicillin and gentamicin
PID is typically caused by which two organisms? Describe treatment for outpatient vs inpatient.
Chlamydia or gonorrhea
Outpatient: ceftriaxone plus doxycycline; add metronidazole to cover anaerobes if gyn instrumentation recently
Inpatient- 2nd gen IV cephalosporin plus doxycycline
For non-purulent cellulitis, what are the PO antibiotic options if MRSA is not suspected? If it is?
No MRSA- cephalexin
MRSA- Bactrim, Amox + doxy, linezolid, clindamycin
What is the treatment of choice for cestodiasis (tapeworms)? What are side effects of this medication?
Praziquantel (Biltricide)- headache, dizziness, drowsiness, abdominal discomfort
What antibiotics should be used for the following intrabdominal infections?
Acute cholecystitis
Acute diverticulitis outpatient
Acute diverticulitis inpatient
Spontaneous bacterial peritonitis
Acute cholecystitis- Zosyn OR combo of cephalosporin and metronidazole
Acute diverticulitis outpatient- none if uncomplicated, if complicated use cipro + metronidazole OR Bactrim + metronidazole OR high dose augmentin
Acute diverticulitis inpatient- Zosyn OR cephalosporin and metronidazole
Spontaneous bacterial peritonitis- third gen cephalosporin (IV cefotaxime or ceftriaxone)
What are the three first line agents for inpatient pyelonephritis treatment without MDR risk factors? What would you use if there were MDR risk factors? What if they were critically ill?
ceftriaxone, Zosyn, or fluoroquinolones
if MDR risk factors use antipseudomonal carbapenem
If critically ill add vancomycin
What are the three treatment options for genital herpes? What are important side effects of each?
Acyclovir, famciclovir, valacyclovir
Acyclovir + famciclovir- phlebitis, malaise, nausea, headache, encephalopathic changes and renal function impairment
Valacyclovir- TTP or HUS, renal function impairment
What is the difference between Type 1 and Type 2 necrotizing fasciitis? What treatments are needed?
Surgical intervention "cut to viable tissue"
Borad spectrum abx: carbapenem OR Zosyn PLUS clindamycin PLUS anti-MRSA agent (vanc, dap, linezolid) (always use 3 agents) (hit it with a bazooka)
Describe the treatment options for uncomplicated malaria including MoA, side effects, and when each is used.
Artemisinin-based combination therapy (ACT) MOA- bind iron to break down peroxide bridges leading to generation of free radicals that damage parasite proteins. Side effects include transient neurologic abnormalities, transient neutropenia, and hypersensitivity. Preferred treatment
Chloroquine: interferes with feeding mechanism of parasite. Side effects include headache, dizziness, vomiting, diarrhea, pruritic, rarely visual or neuromuscular side effects. Use if ACT not available (often impoverished countries because it is much cheaper)