Infectious Diseases and Preferred Treatments (Status: Incomplete)

Table 29-5. Treatment of Tuberculosis
Disease stage	Treatment	Duration
Latent (probably isoniazid sensitive)	Isoniazid	9 months (6 months possible except for children and HIV-positive persons)
Latent (probably isoniazid resistant)	Rifampin + apyrazinamide	2 months
Active disease	Isoniazid + rifampin + pyrazinamide	2-4 months

 

Table 29-1. Empiric Treatment of Meningitis
Age of patient	Most likely organism	Empiric treatment
Newborn to 1 month	Gram-negative enterics (Escherichia coli), group B streptococci, or Listeria monocytogenes	Ampicillin and aminoglycoside, cefotaxime, or Ceftriaxone
1 month to 4 years	Haemophilus influenzae, Neisseria meningitidis, or Streptococcus pneumoniae	Cefotaxime or ceftriaxone, plus vancomycin
5-29 years	N. meningitidis, S. pneumoniae, or H. influenzae	Cefotaxime or ceftriaxone, plus vancomycin
30-60 years	S. pneumoniae or N. meningitidis	Cefotaxime or ceftriaxone, plus vancomycin
> 60 years	S. pneumoniae, Gram-negative enterics (E. coli), or L. monocytogenes	Cefotaxime, ceftriaxone, or ampicillin and aminoglycoside-vancomycin

 

NOTES:

ü  Empiric therapy hallmarkà coverage of the most common pathogen associated with the infection

ü  Most cellulitis infections are associated with Staphylococcus aureus and Streptococcus pyogenes.

ü  Cant be cultured in cell media

o   Rickettsia rickettsii.

o   Ehrlichia phagocytophila.

o   Francisella tularensis.

ü  Staphylococcus and Bacillus diarrheas are an intoxication not caused by a living organism. Both Salmonella and E. coli diarrheas should be treated only if severe or if signs of systemic infection are present. Vibrio cholerae causes a severe diarrhea requiring anti-infective treatment.

ü  P.carinii as many HIV patients (Oppurtunistic infections)

ü  Most common organisms associated with COMMUNITY ACQUIRED PNEUMONIA IN ADULTS

o   Chlamydia pneumoniae is not a pathogen associated with adult pneumonia.

o   Answer:  Mycoplasma pneumoniae, Streptococcus pneumoniae, and Haemophilus influenzae.

 

Gonorrhea Syphilis	Neisseria gonorrheae Treponema pallidum- cannot grown in culture, dark field fluorescent antibody exam  VDRL test Rapid plasma regain test (RPR Gonorrhea- Gram negative; gram stain)	Penicillin
Tick borne Systemic Febrile Syndromes
Lyme disease	Borrelia burgforfei	Doxycycline
Rocky mountain spotted fever	Rickettsia rickettsii
Ehrlichiosis	Erlichia phagocytophila
Tularemia	Francisella tularensis	Gentamicin  tobramycin
Hepatitis
Hepa B	Chronic	Interferon alfa 2b Lamivudine
Hepa C	Chronic	INF alfa 2b RIBAVIRIN
Hepa C	Acute	INF a2b
Influenza
Influenza A		Oseltamivir -mivir Rimantadine
Influenza B	Prohylaxis	Oseltamivir
Herpes Virus
Herpes Simplex	Initial		Acyclovir
	Recurrence		Famciclovir
	Chronic suppresion		Valacyclovir
	Immunocompromised		Acyclovir
	Resistance to Acyclovir		FOSCARNET
Varicella zoster		Acyclovir/ Foscarnet
UTI
Cystitis Pylonephritis Prostatitis		QUINOLONE TMP-SMX
Endocarditis		Penicillins allergic: vancomycin
Hospital acquired pneumonia		aminoglycoside and one other Gram-negative agent, such as cefepime. :MRSA vancomycin
Prostate infections	4-6 weeks	CIPROFLOXACIN: concentrate in prostate fluid TMP-SMX reasonable chice
Candida infections		Amphotericin and Fluconazole