principles of infectious disease
Post on 25-May-2022
1 Views
Preview:
TRANSCRIPT
�Principles of Infectious Disease�
Dr. Ezra Levy
CSU+6 06PA Program
I. Microbiology
(1) morphology (e.g., cocci, bacilli)
(2) growth characteristics (e.g., aerobic vs anaerobic)
(3) other qualities (e.g., Gram’s stain positive or Gram’s stain negative)
Choice of Antimicrobial
Therapy
• based on the morphology and growth patterns of microorganisms
II. Empirical Therapy
• empirical therapy is often based on a working knowledge of the most likely pathogens expected to be found at the site of infection
• certain organisms are predictably associated with infection at certain tissue sites and not in others
• certain host factors such as age, immunosuppression, prior antibiotic usage, and environment help to predict the most likely organism
II. Empirical Therapy (cont.)
III. Selection of an Antimicrobial Agent
• selection of an antimicrobial agent for some infections can await the results of
appropriate culture and susceptibility (C & S) testing
III. Selection of an Antimicrobial Agent (cont.)
C & S Testing
III. Selection of an Antimicrobial Agent (cont.)
ANTIMICROBIAL MECHANISMS OF ACTION
Treatment of Uncomplicated UTI (Outpatient)
Pathogens E. Coli Proteus mirabilis Klebsiella pneumoniae Enterococcus faecalis Staph saprophyticus
Oral Antibiotic(s) of Choice Bactrim DS / Septra DS Sulfamethoxazole / Trimethoprim OR: 1st general CEPH e.g., cephalexin (Keflex) OR: Fluoroquinolone e.g., Ciprofloxacin (Cipro) or Levofloxacin (Levaquin)
Complicated UTI (ESBL pathogens) meropenem (Merrem) 500 mg IV Q6H ertepenem (Invanz) 1 gm IV/IM Q24H
FloroquinoloneAdverse Effectsa tendonitis myalgiab QT interval prolongation
Treatment of Pyelonephritis (Inpatient)
Pathogens E. Coli Klebsiella pneumoniae Enterobacter sp. Pseudomonas aeruginosa
Oral Antibiotic(s) of Choice Ceftriaxone (Rocephin) 1 GM IV Q24H OR: Ciprofloxacin 400 mg IV Q12H*
Levofloxacin 500 mg IV/PO Q24H OR: AGLY**: Gentamicin / Tobramycin
5 – 7 mg/kg/day IV once daily
* Ciprofloxacin 500 mg PO BID
** AGLY = aminoglycoside
Y
CAGLY AdverseEffects
1 nephrotoxicity2 ototoxicity
Tx of Community-Acquired Pneumonia (Inpatient)
Pathogens S. pneumoniae (12 - 68%)
H. influenza (2.5 - 45%)
Mycoplasma pneumoniae Chlamydia pneumoniae Legionella species
Antimicrobial Drug(s) of Choice Ceftriaxone 1 GM IVPB Q24H
PLUS Azithromycin 500 mg IVPB 24H
OR Levofloxacin 500-750 mg IVPB Q24H
a ae
can be switchedto Po outpatient Rx
AzithromycinAdverse Effectprolongs QT interval
Tx of Hospital (Nosocomial) Acquired Pneumonia (HAP)
Pathogens Staphylococcus aureus Klebsiella pneumoniae E. Coli Psuedomonas aeruginosa
Antibiotic(s) of Choice Vancomycin 15 mg/kg/dose IV Q12H
AND
Cefepime 2 GM IVPB Q8H OR Ceftazidime 2 GM IVPB Q8H OR Zosyn (Piperacillin-Tazobactam) 4.5 GM IVPB Q6H
OR Levofloxacin 500 MG IVPB Q24H
Ceftazidime (Fortaz), Cefepime (Maxipime), Levofloxacin (Levaquin), clindamycin (Cleocin)
Aspiration Pneumonia ! ! ! ADD: Clindamycin 600 mg IVPB Q8H
j
covers anaerobes G bugs
Treatment of Meningitis (Community-Acquired)
Pathogens Streptococcus pneumoniae (pneumococcus) Neisseria meningitidis (meningococcus)
Antibiotics of Choice Ceftriaxone 2 GM IV Q12H
PLUS Vancomycin 15 mg/kg IV Q8H
PLUS Acyclovir 10 mg/kg/dose IV Q8H
Ceftriaxone (Rocephin), Acyclovir (Zovirax)
higherdosesto penetratemeninges
Vancomycin AdverseEffects added to cover17nephrotoxicityca ototoxicity viral meningitis
pending Cx results
Treatment of Intra-Abdominal Sepsis (e.g., Peritonitis, Cholecystitis)
Pathogens Gram-negative bacteria Streptococci, anaerobic bacteria: Clostridium sp. Bacteroides sp.
Antibiotics of Choice Zosyn (Piperacillin-Tazobactram) 4.5 GM IV Q6H OR Ertapenem (Primaxin)
1 GM IV Q24H
G 0 enteric bugslAnaerobesrose
Treatment Helicobacter pylori (H. pylori)
PrevPac ! Lansoprazole (Prevacid) 30 mg PO BID x 10 days ! Amoxicillin (Amoxil) 1000 mg PO BID x 10 days ! Clarithromycin (Biaxin) 500 mg PO BID x 10 days
Treatment of Cellulitis / Osteomyelitis Cellulitis ! Cephalexin (Keflex) 500 mg PO QID, AND
! SMX-TMP (Bactrim DS) PO BID Osteomyelitis ! Vancomycin 15 mg/kg/dose IV Q12H, AND
! Clindamycin 600 mg IV Q8H
f Staphepidermitis
MRSA
MRSAanaerobes
top related