CNS infections
What are the three primary causative agents of community acquired meningitis?
strep pneumoniae, neisseria meningitidis, and listeria monocytogenes în patients over 50
What is the first lie treatment for otitis media in pediatric populations?
What is the greatest risk factor for antibiotic resistance in patients with pneumonia?
recent antibiotic therapy
A patient presents with five days of sinus pain, congestion, and 102 fever. He is requesting antibiotics. What do you say?
Sure :) (102 F is considered a severe symptom concerning for bacterial sinusitis)
What is the primary goal of using dexamethasone in meningitis? In which organism has it been proven to be most effective?
To diminish residual neurological complications; strep pneumoniae
____________ is the first line treatment for group A strep pharyngitis, but ____________ is typically used in children. Why?
Penicillin V; amoxicillin; it is more palatable
Which medications are first line for CAP in patients under 65 with no resistance risk factors?
High dose amoxicillin and either macrolide or doxycycline
Describe the three short course treatment options for latent TB
R4- rifampin daily for 4 months
3HR- isoniazid and rifampin daily x 3 mo
3HP- INH and rifapentine weekly x 3 mo
A patient who was treated for otitis media one week ago presents with recurrent symptoms. He was initially treated with augmentin. What two medications would you consider starting? Which is preferred in children?
ceftriaxone and levofloxacin; prefer ceftriaxone
What is the mechanism of action of acyclovir? What are two severe, if rare, side effects?
inhibits replication of herpes simplex virus types 1 and 2
Crystal induced acute renal failure and neurologic toxicity
What three organisms most commonly cause secondary bacterial infection in the sinuses?
S. pneumoniae, H. influenzae, and Moraxella catarrhalis
What should first line therapy be in aspiration pneumonia when anaerobes are the suspected pathogen?
Augmentin or Unasyn
Your patient is a 2 hour old baby with bacterial pneumonia. Which pathogen do you suspect is responsible? What is the treatment regiment?
Group B strep; ampicillin plus gentamicin
Describe the empiric therapy for meningitis in a patient with no known immune deficiency
Cefotaxime OR ceftriaxone, vancomycin, ampicillin, and dexamethasone
If a patient was treated for otitis media with augmentin, how many days would have to pass before you considered using augmentin again to treat recurrent symptoms?
15 days
What are the two antivirals used in influenza? Which one is a prodrug? How soon after symptom onset must they be started?
Zanamivir (Relenza) and Oseltamivir (Tamaflu). Tamaflu is a prodrug. Must be started within 2 days of symptom onset
Your 70 year old patient comes in with neck stiffness, fever, and altered mental status. The patient's daughter reports he has a history of anaphylactic reaction to penicillins. What medications would you like to start in this patient?
Vancomycin, moxifloxacin, and Bactrim, +/- dexamethasone
Describe the empiric antibiotic therapy for patients with an impaired immune response
Vancomycin, ampicillin, and cefepime OR meropenum
What would you prescribe a patient with 12 weeks of rhinosinusitis? What if they are allergic to penicillins? What if you suspect MRSA?
Augmentin; clindamycin; clindamycin
In a neonate with late-onset pneumonia, _____ is the most likely pathogen and the empiric coverage is ________ plus _________
staph; vancomycin, aminoglycoside
Your patient comes in with cough and fever, and CXR reveals left lower lobe consolidation. He is now admitted to the ICU. The patient mentions they recently had an influenza infection, but had fully recovered. What type of pneumonia are you suspicious for? What medications would you like to start?
CA-MRSA. Anti-pneumococcal beta lactam (ceftriaxone, cefotaxime, ceftaroline, or Unasyn) PLUS azithromycin or respiratory fluoroquinolone, PLUS Vancomycin or linezolid
What medications should a patient with significant joint pain 2/2 ARF be started on?
ASA and Penicillin G
For patients admitted to the hospital (non-ICU) what empiric treatment should be started?
anti-pneumococcal beta lactam (ceftriaxoe, cefotaxime, ertapenem, Unasyn) PLUS macrolide (azithromycin or clarithromycin) or doxycycline