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