It’s easier to remember antibiotics that don’t need renal adjustment than antibiotics that do. Certain antibiotics ROMANCCED the kidneys. Rifampin Oxacillin Moxifloxacin Azithromycin Nafcillin Clindamycin Ceftriaxone Erythromycin Doxycycline Antipseudomonals: IV :aminoglycodisdes pip/tazo (Zosyn) ticarcillin/clavulanic acid (Timentin) ceftazidime (Fortaz) cefepine (Maxipime) imipenem/cilastin (Primaxin) meropenem (Merem) doripenem (Dorax) ciprofloxacin (Cipro) colistin (Nebuliner) PO:norfloxacin ofloxinc ciprofloxacin (best) levofloxin Carbapenems […]
Infectious Disease
Influenza
Influenza mortality is greatest in those over 65 years of age. Flu onset is sudden: high fever, dry cough, headache, muscle aches, exhaustion Type A – causes epidemics every 1-3 years Type B – less likely to mutate than Type A. Epidemics seen every 5 years. Treatment: Mostly supportive care. Adamantanes: amantadine, rimantadine – no […]
Urinary Tract Infections
When presented with a urinary tract infection, you have to ask: Cystitis or pyelonephritis? Lower UTI – cystitis: dysuria, frequent urination, urgency, hematuria Upper UTI – pyelonephritis: frequency, dysuria, hematuria, suprapubic pain, flank pain, tenderness, elevated WBC, nausea/vomiting, casts in urine Complicated or Uncomplicated Complicated: males, hospital-acquired, pregnancy, anatomic abnormality of the urinary tract, history of […]
Acne
Topical retinoids: adapalene, tazarotene, tretinoin Topical antibiotics: clindamycin, erythromycin Oral antibiotics: doxycycline, erythromycin, minocycline, tetracycline, Bactrim Non-antibiotic treatments: azelaic acid, benzoyl peroxide, dapsone, salicylic acid Accutane REMS program: You can read the whole thing here. Highlights- The goals of the isotretinoin risk evaluation and mitigation strategy are: To prevent fetal exposure to isotretinoin To inform […]
Skin and Suture Infections
Cellulitis: Usually staph or strep Treat for 5-10 days PenG if confirmed Strep cefazolin, cephalexin ceftriaxone clindamycin Treat for MRSA if penetrating trauma, injectable drug use, purulent drainage, nasal colonization or other evidence of MRSA. clindamycin, Bactrim or doxycycline with Beta-lactam. Erysipelas: Superficial dermis infection, usually on legs and feet. Has a distinct raised border (look for that […]
Diabetic Foot Infection
Up to 25% of diabetics develop infections, sometimes limbs amputated. Usually S. aureus, can be group B strep, enterococcus, proteus, E. coli, klebsiella, enterobacter, P. aeruginosa, bacteroides, peptostreptococcus Prevention is best. Mild infections: No antibiotics in the past month, local only involving skin and subcutaneous tissue, no SIRs. No MRSA risk – dicloxacillin, clindamycin, cephalexin, […]
Abdominal Infections
Complicated – extend beyond the hollow of the viscous origin into the peritoneal space. Associated with abscesses or peritonitis. Must drain, remove abscess, surgery Fluid resuscitation if sepsis Mild to moderate: cefoxitin, cefazolin, cefuroxime, ceftriaxone and metronidazole, ertapenem, moxifloxacin, cipro or levo AND metronidazole, tigecycline High risk or severe: pip/tazo, ceftazidime or cefepime AND metronidazole, cipro or levo AND metronidazole […]
HIV Infection
They probably won’t ask you to manage an HIV patient’s antiretrovirals, but prophylaxis and medication side effects are fair game. Know that everyone with a diagnosis of HIV should get HAART, which is usually 2 NRTIs and an NNRT or a PI. It’s always at least 3 drugs. You should probably be able to identify […]
Basic Vaccines
Hep A: Travelers, primate workers, healthcare workers, people with clotting disorders, homosexuals, people with liver disease should all get. Killer virus. Given in 2 doses, 6 months apart. Heb B: 3 doses, first administered at birth. Meningococcal: People in close quarters like military barracks or college dorms should get. HPV: All females from age 9-26 hours, […]
Pharyngitis aka Strep Throat
Caused by strep pyogenes or group A B-hemolytic strep, or viruses (rhinovirus, coronavirus, adenovirus, HSV, parainfluenza) Mononucleosis differential: splenomegaly, cervical adenopathy. A diffuse rash 2-3 days after PCN dose is indicative of mono. If you have to guess a sub for PCN allergic patients in ANYTHING chose a macrolide. Treatment: PCN V or Amoxil for […]