1.  Bacterial toxins

2.  Other infections (fungal or viral)

3.  Medications

4.  Trauma/surgery

5.  Other medical conditions

Neutrophils

1.  Normal Seg value

2.  Infection Bands value

3.  What can cause abnormal neutrophil values

1.  40-60%

2.  >10% is bandemia or left shift

3.  Corticosteroids 

1.  Elevated with infection

2.  Decrease with successful treatment

1.  Breakpoint

2.  If MIC < breakpoint

3.  If MIC > breakpoint

The concentration fo the antimicrobial that can be achieved in the serum after a normal or standard dose of that antimicrobial 

2.  The organism is considered suseptible

3.  Organism is resistant 

1.  Spectrum of activity and effects on non-targeted flora

2.  Single vs combo therapy

3.  Antimicrobial dose

1.  PK properties

2.  PD properties

3.  ADEs and DDIs

4.   Antimicrobial cost

PD properties

1.  Concentration-dependent pharmacodynamic activity

2.  Concentration independent/time-dependent pharmacodynamic activity

3.  Cidal

4.  Static

1.  Higher drug concentrations kill more so shooting for high peak (FQN, AG, Metronidazole)

2.  Maintain blood concentraiton for a given time (B-lactam and Vanc)

3.  Kill 99.9% (3 log) of bacterial population

4.  Do not reduce load by 3 log

1.  Anatomic locaiton of infection

2.  Antimicrobial hx

3.  Drug allergy hx

4.  Renal and hepatic function

5.  Concomitant medicaitons

6.  Pregnancy or lactation

7.  Compliance potential

Vanc Stats

1.  Peak in how many min

2.  Vd

3.  Protein binding

4.  Who has low skin penetration

5.  Excretion/metabolism

6.  t1/2

1.  30-60

2.  0.4-1 L/kg

3.  50-55%

4.  Diabetcs

5.  Urine IV and Feces Oral with no metabolism

6.  5-11 hrs

Vanc PD Parameters

1.  Static or Cidal

2.  Time or Concentration? (2 exceptions)

3.  Target AUC/MIC ratio

1.  Cidal

2.  Time; except S. aureus and S. epidermidis

3.  >400, not possible unless MIC 1 mg/L

MIC breakpoints (S. aureus):

1.  MIC < ? is suseptible

2.  Bacteria treated

1.  <2, but questionable when MIC > 1

2.  Staphy, Strep, Enterococcus (not VRE)

Vanc Toxicity

1.  Nephrotoxicity defined as

2.  What increases likelihood

3.  Typical infusion rate

1.  Scr inc of 0.5 mg/dL or 50% from baseline after multiple days of therapy

2.  Use with ototoxic agent (do not monitor routinely)

3.  1 g per hour...if does > 1 g infuse over 1.5-2 hours

Vanc Monitoring

1.  What do you need to monitor

1.  UTI

2.  Skin and skin structure

1.  Bacteremia 

2.  Endocarditis

3.  Osteomyelitis

4.  Meningitis

5.  Pneumonia

Vanc Dosing

1.  LD

2.  MD; Goal troubh 10-15 and 15-20

3.  Round dose to?

1.  25-30 mg/kg

2.  10-15:  15 mg/kg

15-20:  18 mg/kg

3.  Nearest 250 mg

Vanc Dosing Interval

CrCl

1.  >50

2.  30-49

3.  20-29

4.  <20 or HD

1.  8-12 hrs (8 hrs if pt <40)

2.  24 hrs

3.  48 hrs

4.  Dose based on random

Low trough Vanc adjustments

1.  < 10

2.  10-15

1.  Shorten interval or increase dose

2.  Increase dose and keep interval same

RATIO

High Vanc Troubh adjustment

1.  20-25

2.  >25

1.  Decrease dose using RATIO

2.  Increase interval

Rapid development of sx of middle ear infeciton with effusion

*effusion can remain up to 6 months

Fever about 39C or 102.2F also diagnostic 

Moderate to severe ear pain

*mild with fever < 39 or 102.2 = non severe

1.  S. pneumoniae (50%) Most common

2.  H flue (15-30%) nontypeable increasing

3.  Moraxella catchalls

4.  S. pyrogenses

5.  S. aureus

6.  P. aeruginosa

AOM Tx

1.  DOC and concentration

2.  Alternatives (6)

3.  When do you think about switching

4.  Duration of normal therapy

1.  Amoxicillin or Amox/Clav 80-90 mg/kg/d

2.  Ceftriaxone (single dose, but 3 days preferred), azithromycin; cefuroxime; cefpodoxime; cefdinir; macrolide; clinda; emycin; bactrim 

3.  Lack of improvement or worsening during 1st 48-72 hrs

4.  10- days for <2yo 

5-7 day older children

**Exception:  azithromycin and ceftriaxone

AOM algorithm

1.  < 6 months old

2.  6 months to 2yrs or 2 years +

1.  ABX therapy

2.  ABX if severe illness in both groups;

ABX if Dx confirmed in 6 mo to 2 yr; 

If disease not confirmed in 2 yo+, observe...or if Dx certain, but not severe, no ABX either

ABX Selection AOM

No PCN allergy:

1. No severe illness first line...second

2.  Severe illness first...second

PCN allergy Non-type I

3.  Severe illness

4.  Non-severe illness

Type 1

5.  Drugs used (4)

1.  Amoxicillin; cefuroxime, cefpodoxime, or cefdinir

2.  Amoxicillin/clavulanate; ceftiraxone

3.  Ceftriaxone

4.  Cefuroxime, cefpodosime, cefdinir

5.  Macrolide; Clinda; Emycin/slfisoxazole; Bactrim

1.  Acute:  <4 wks

2.  >90 days

Viral usually lasts less than 7 days

Bacterial greater or get better then worse again

1.  S. pneumonia

2.  H. flu

3.  Moraxella

4.  S. pyogenes

Anaerobes

5.  Bacteroides

6. Peptostreptococcus

7.  S. aureus 

Non-resolving sx after 10 d or worsening after initial improvement

*Sputum color is NOT diagnostic

1.  Age <2 or >65

2.  Prior ABX within past month

3.  Propr hospitalization past 5 days

4.  Comorbidities

5.  Immunocompromised 

Duration of therapy

1.  No risk for resistance

2.  Risk for resistance

1.  5-7 days

2.  7-10 days

High dose Augmentin ARBS

1.  What is dose?

2.  Risk factors that justify use of High dose (7)

1.  2 g BID or 90 mg/kg/d orally twice daily

2.  High endemic (>10%) pcn-nonsuscep S. pneumo

Severe inf (Fever >102)

Daycare

Age <2 or >65

Recent hospitalization

ABX use within past month

Immunocompromised

1.  High-dose amoxicillin-clavulanate (2g BID)

2.  Doxycycline

3. Respiratory FQN

1.  Adults:  5-7 days

2.  Children:  10-14 days

1.  Group A strep pyogenese (most common)

2.  Corynebacterium diphtheriae

3. Groups C and G strep

4.  Chlamydia pneumoniae

5.  Mycoplasma pneumoniae

6.  Neisseria gonorrheoeae 

Dx of Pharnygitis

1.  RADT means what?

2.  What 3 groups do you not do RADT on

1.  Rapid antigen detection test

2.  <3 yo b/c acute rheumatic fever rate in this age group...may consider if sibling infected, not rhinorrhea, not in people from same house

RADT Positive GAS Pharngitis Treatment and Duration

1.  First line (1)

2.  Second line or PCN allergy (4)

1.  Penicilin or Amoxicillin X 10 days

2.  1st gen cephalosporin X 10 days

Clindamycin X 10 Days

Clarithromycin X 10 days

Azithromycin X 5 days

1.  Use for analgesic/antipyretics

2.  Avoid ASA in kids

3.  Corticosterioud adjunct NOT recommended

AG 

1.  Absorption

2.  Distribution

3.  Metabolism

4.  Excretion

1.  Rapid; IM 30-90 min to peak; IV 30 min after 30 min infusion

2.  Poor to CSF and epithelial lining; Vd 0.2-0.4 L/kg; No cross BBB

3.  Not metabolized in liver

4.  Half-life 2-4 hrs; ESRD = 36-70 hrs; Excreted in urine unchanged

AG PD

1.  Concentration or time dependent

AG Spectrum

1.  Gm -

2.  Synergy with

3.  Used in what infections

1.  Great Gm - esp pseudomonas; frequent double coverage

2.  B-lactams (ampicillin) or vanc (low dose AG)

3.  Bone infections; Respiratory tract infections; Skin and soft tissue infections; abdominal infections, UTI, septicemia; persistent febrile neutropenia; infective endocarditis

AG toxicity

3 types with any risk factors

1.  Nephrotoxicity:  older; preexisting renal disease; volume depletion; multiple daily doses; concomitant nephrotoxic drugs and length of tx

2.  Ototoxicity:  Cochlear = high frequency hearing loss; Vestibular; Dizziness, vertigo, loss of balance

3.  Neuromuscular blockage (rare unless also on NMBs)

AG dosing basics

1.  Round doses to nearest?

2.  IBW equations

3.  AdjBW equation

4.  Cockroft and Gault

1.  20 mg

2.  M:  50+2.3 (in over 5 ft)

F:  45.5+2.3(in over 5 ft)

3.  AdjBW = 0.4(TBW-IBW) + IBW

4.  [(140-age)XIBW] / [(72 X Scr)}    X 0.85 if female

Extended-Interval Dosing

1.  Good things (4)

2.  Exclusions (4)

1.  Lower nephro and ototoxicity

Adaptive resistance less

Efficacy enhanced d/t conc dep killing

Simpler less time consuming

2.  Renal impairment CrCl<30

Altered VD (burns, ascites, prego/post-partum; CF, cirrhosis, myasthenia gravis)

Adults with Febrile neutorpenia and endocarditis

Children

Extended-Interval Dosing

1.  Dosing wt

2.  What do you use 5 mg/kg dosing for (3)

3.  What do you use 7 mg/kg for (3)

1.  TBW < 120% IBW use actual body weight

TBW > 120% IBW use AdjBW

2.  Open fracture prophylaxis

Surgery prophylaxis

OB/GYN infections

3.  Pseudomonas

Pneumonia

Sepsis

Extended-Interval Dosing

1.  Dosing interval CrCl:  >60, 40-59, 30-39

2.  Monitoring

3.  7 mg/kg nomogram baed from what time

5 mg/kg nomogram based from what time

1.  >60:  Q24H

40-59:  Q36H

30-39: Q48H

2.  Obtain random level 10 hr after start of infusion and adjust based on nomogram

Trough undetectable:  Chk 1-2 weekly; also Scr BUN 2X weekly

More frequent checks with renal dysfunciton

3.  7:  time from start of infusion

5:  5: based on time after infusion complete

*Infusion always over 30 min

Traditional AG Dosing

1.  When do you use?

Traditional AG Dosing

1.  Dose for the day

2.  Target peak 8-10 dose

3.  Target peak 6-8 dose

4.  Target peak 4-6 dose

5.  Dose interval?

1.  3-6 mg/kg/d

2.  2 mg/kg

3.  1.5 mg/kg

4.  1 mg/kg

5.  3 times the T1/2

1.  Peaks 30 mins after end of infusion after 3rd dose:  Efficacy

2.  0-30 mins prior to 3rd dose:  Toxicity

Indications and Peaks Traditional AG dosing

1.  Peak 8-10; Trough < 1 (3)

2.  Peak 6-8; Trough < 1 (5)

3.  Peak 4-6; Trough < 1 (2)

1.  Severe infection; Gm - sepsis; pneumonia

2.  Moderate infection; pyelonephritis; cellulitis; intraabdominal infection; bacteremia

3.  UTI; minor infection

Traditional AG dosing interval determination

1.  Ke =?

2.  T1/2 =?

3.  Dosing interval =?

4.  Dosing interval will ALWAYS be one of these 3

1.  Ke = (0.00293*CrCl) + 0.014

2.  T1/2 = 0.693/Ke

3.  Interval = 3 X T1/2

4.  8, 12, 24 hours

Synergy AG Dosing

1.  AG used for synergy and dose

2.  What do you use it with?

1.  Gentamicin = 1 mg/kg

2.  Cell active agent like ampicillin or vanc

Synergy AG Dosing Interval

CrCl

1. >60

2.  30-60

3.  <30

1.  Q8H

2.  Q12H

3.  Q24 or use random level to determine dosing

Synergy Dosing

1.  When do you check peaks and troughs

2.  What is goal peak for gent and goal trough

1.  Check with 3rd or 4th dose, after dose adjustmetn, or if renal function changes

2.  Peak:  3-5 mcg/mL

Trough < 1 mcg/mL

Dx of 

1.  CAP

2.  HAP

3.  VAP

4.  HCAP

1.  No exposure to healthcare facilities

2.  48 hours + after admission

3.  Endotracheal intubation 48-72 hours

4.  Hospitalized at least 2 days in last 90; LTCF; IV ABX therapy; wound care; chemo within last 30 days; Hemodialysis clinic

1.  ABX in prior 30 days

2.  Current hospitalization of 5 d or more

3.  High frequency of ABX resistance in community or hospital

4.  Immunosuppressive disease and/or therapy

1.  Hospitalizaiton for 2 d + in the preceding 90 d

2.  Residence in a nursing home or LTCF

3.  Home infusion therapy (including ABX)

4.  Chronic dialysis within 30 d

5.  Home wound care

6.  Family member with MDR pathogen

Empiric Tx HAP or VAP no risk MDR pathogens

1.  Pathogens (8)

2.  Recommended ABX

1.  Strep pneumo; H flu; MSSA

Gm -:  E. coli; K. pneumonia; Enterobacter; Proteus; Serratia

2.  Ceftriaxone OR

Levoflox/Moxiflox OR

Unasyn OR

Ertapenem

Initial Tx HAP, VAP, HCAP that is late onset and risk exists for MDR pathogens 

1.  Pathogens that need to be covered (4)

2.  Drugs (Triple at initiation, but many options)

1.  Pseudomonas; ESBL Klebsiella; Acinetobacter

MRSA

2.  Antipseudomonal Cephalosporin (Cefepime, Ceftazidime)

Antipseudomonal carbapenem (Dori, Imi, Meropenem)

Zosyn **All of first 3 replace with Aztreonam if PCN

+

Antipseudomonal FQN (Cipro or Levo)

AG (Amikacin, Gent, Tobra)

+

Linezolid or Vanc

1.  Do you ever reculture pneumonia patients?

2.  What 3 bugs always get 14 days of ABX

1.  No, will pick up a mess

2.  Pseudomonas

Acinetobacter

MRSA

1.  How long do you give empiric before adjusthing therapy

2.  What if you see improvement and cultures are negative at that time?

3.  What if cultures are positive at that time?

1.  2-3 days until cultures come back

2.  Stop ABX

3.  De-escalate if possible

Treat for 7-8 days and reassess

1.  Intubation and mechanical ventilation

2.  Aspiration

3.  Oropharangeal colonization

4.  Hyperglycemia (Inhibits phagocytosis and Provides nutrients for bacteria)

Pneumonia Dx

1.  What will CXR show?

2.  WBC may not be inc, but if they are what predominates

3.  What labs are critical to dosing?

4.  What does the Joint Commission mandate?

1.  Infiltrates

2.  Neutrophil

3.  BUN and Scr

4.  Blood cultures for bacteremia 

Sx differentiating mild and severe 

RR>30 in severe

Hypotension

Urine output less than 20 mL/hr

1.  Atelectasis

2.  ARDS

3.  Pulmonary embolism/hemorrhage

4. Cancer

5.  Empyema

6.  Lung abcess

Aspiration Pneumonia 

1.  Treatment (4)

2.  Likely causative bugs

3.  Risk factors (4)

1.  Pen G, Unasyn, Clinda...Hospital-->Zosyn

2.  Anaerobes and Strep

3.  Dysphagia; Change in oropharngeal colonization; GERD; Decreased host defences 

Outpatient CAP Treatment

1.  Etiology (5)

2.  Tx previously healthy w/o ABX last 3 months

3.  What are comorbidities that necessetate inc treatmetn (9)

4.  Treatment (Multidrug combo)

1.  S. pneumo; M. pneumo; H. flu; C. pneumo; Respiratory virus

2.  Macrolide (Emycin, Azithro, Clarithro) OR Doxycycline

3.  Chronic heart, lunch, liver, or renal disease; DM; alcoholism; malignancies; asplenia; immunosuppressing conditions or drugs; ABX within previous months

4.  Respiratory FQN (Only monotherapy FQN option for CAP)

B-lactam (Amox; Augmentin; Ceftriaxone; Cefotaxime) AND

Macrolide or doxycyclines 

Inpt Non-ICU CAP treamtent

1.  Bugs (7)

2.  Treatment options (2)

1.  S. pneumo; M. pneumo; C. pneumo; H. flu; Leigonella (Amp); Aspiration (Anaerobes and StreP); Respiratory viruses

2.  Respiratory FQN (Moxi, Levo, Gemi)

OR

B-lactam (Cefotaxime, ceftriaxone, Unasyn, ertapenem)

AND

Macrolide (Emycin, Clarithro, Azithro) or doxycycline

Inpatient ICU CAP

1.  Likely bugs (5)

2.  Treatmetn

1.  S. pneumo; MSSA; Legonella (Amp); Gm - bacilli; H. flu

2.  B-lactam (Cefotaxime, Ceftriaxone, Unasyn; Ertapenem)

AND

Azithromycin or respiratory FQN

CAP Pseudomonas Risk Factors

1.  What are pseudomonas risk factors (2)

2.  Treatment

1.  Structural lung disease

Recent, severe exacerbations of COPD requireing multiple courses ABX

2.  Antipneumococcal, antipseudomonal B-lactam (Unasyn; Pip/Ticar)

AND

Cipro/Levo 

OR

AG + Azithromycin 

MRSA CAP Risk Factors

1.  What are the risk factors (2)

2.  Treatment

1.  IV drug abuse; Post-influenza pneumonia

2.   Antipneumococcal, antipseudomonal B-lactam (Unasyn; Pip/Ticar)

AND

Cipro/Levo 

OR

AG + Azithromycin 

AND Vanc or Linezolid

Impetigo

1.  Most common age

2. Causative agents (2)

3.  Appearance

4.  Lesions resolve with time and what?

5.  S-aureus treatmetn (2)

6.  PCN allergy options (2)

7.  Only a few lesions option (1)

1.  2-5 yo

2.  GAS; S. aureus 

3.  Cornflakes

4.  Increased hygene 

5.  Penicillinase stable PCN (Diclox); 1st gen cephalosporin (Keflex)

6.  Clinda or Macrolide

7.  Mupriocin topical

Folliculitis

1.  How many hair follicles

2.  Causative agents (4)

3.  Depth in skin

4.  Presentation

5.  Nonpharm

6.  Pharm

1. 1

2.  S. aureus; pseudomonas; candida; chemically induced

3.  Superficial

4.  Small, pruritic, erythematous papules

5.  Warm compress

6.  Often resolve spontaneously...If staph or strep:

Mupirocin TID

Furuncles (boils)

1.  How many hair follicles?

2.  Level in skin

3.  Causitive agent

4.  Predisposing factors (3)

5.  Nonpharm

6.  When do you treat and with what?

1.  1

2.  Deeprer infection

3.  S. aureus

4.  Young male, DM, obesity

5.  Moist heat to drain...if that fails, I&D

6.  Surrounding cellulitis and fever or midline on face:  Diclox, keflex

CA-MRSA or PCN allergy:  Bactrim, doxycycline, clinda

*Treatment 5-10 days

Carbuncles

1.  Differentiate from furuncles

2.  nonpharm

3.  Pharm and when  you use it

1.  Multiple follicles and likely on back of neck

2.  I&D

3.  Surrounding cellulitis and fever or midline on face:  Diclox, keflex

CA-MRSA or PCN allergy:  Bactrim, doxycycline, clinda

*Treatment 5-10 days

Erysipelas

1.  Differentiate from cellulitis

2.  Likely pathogen (1)

3.  Mild-Moderate (oral) thearpy (4)

1.  Clearer boundaries and raised 

2.  B-hemolytic strep (GAS)

3.  Pen VK X 7-10D

Pen G benzanthine X 1 dose

Amoxicillin X 7-10 D

Cephalexin X 7-10 D

Differentiating staph and strep with erysipelas and cellulitis

1.  True dry

2.  Purulent

3.  Abcess

4.  Abcess and cellulitis

1.  Strep

2.  Staph

3.  Staph

4.  Staph and strep

Cellulitis (Non-purulent)

1.  Infection of what?

2.  Nonpharm

3.  Likely pathogens

4.  Mild-Mod Infection (Oral)

5.  Mod-Severe Infection IV

1.  Dermis and subQ tissue

2.  Elevate, sterile saline dressing, drainage

3.  B-hemolytic (GAS); MSSA

4.  Cephalexin X 7-10 D; Dicloxacillin X 7-10 D; Clinda X 7-10 D

5.  Cefazolin; Clinda; Vanc (if severe PCN allergy)

*Switch to appropriate PO therapy once clinical improvement seen

Abcess

1.  Pathogens?

2.  Mild-Mod Infection (oral) 4 

3.  Mod-severe infection (IV) 4

1.  MSSA; MRSA

2.  Bactrim X 7-14 days; Doxycycline X 7-14 Days; Clindamycin X 7-14 days; Linezolid X 7-14 days

3.  Vanc; Clinda; Linezolid; Dapto

*Switch to PO at earliest

Purulent celllulitis or celluitis with associated abcess

1.  Pathogens (3)

2.  Mild-Mod Infection monothearpy 

3.  Mild-mod infection combo therapy

4.  Mod-severe IV therapy

1.  B-hemolytic (GAS); MSSA; MRSA

2.  Clinda or linezolid X 7-14 days

3.  Cephalexin or dicloxacillin + Bactrim or doxycycline X 7-14 days

4.  Vanc; Clinda; Linezolid; Dapto 

*Switch to oral ASAP

Necrotizing Fasciitis

1.  Risk factors (4)

2.  Pathogens

3.  Nonpharm

4.  Pharm (3 gorups)

1.  Injection drug users; DM; immune suppression; obesity 

2.  Usually polymicrobial including anaerobes (bacteroides or pepto); facultative anaerobes (B-hemolytic strep); enterobacteriaceae; Pseudomonas 

3.  Prompt surgical intervention with debridment 

4.  1)  Zosyn or cabapenem (imi or dori)

+

2) Vanc; Dapto; linezolid until MRSA ruled out

+

3) Clinda or linezolid to dec toxin production

Necrotizing faciatis GAS or C. perfringens sole cause

1.  Treatmetn

Infected bites

1.  Human bites most common pathogen

2.  What 3 cases do you prophylax?

3.  Prophylaxis

1.  Viridans strep

2.  1)  Human; 2) Deep puncture; 3) Hand

3.  Augmenten or if PCN allergy, FQN or bactrim/clinda

PEDIS classificaitons

1

2

3

4

1.  No infection

2.  Mild foot ulcer

3.  Moderate foot ulcer

4.  Severe foot ulcer

PEDIS score 2 Foot Ulcer

1.  Likely pathogens (2)

2.  Thearpy (oral; 4)

3.  When do you suspect MRSA (4)

4.  Oral thearpies for MRSA (3)

1.  MSSA; Strep

2.  Diclox; Cephalexin; Clinda; Augmentin (if anaerobes)

3.  Previous Hx of infection or known MRSA colonization past yr

Local prevalence MRSA 50%+; Sereve infeciton; Previously long-term ABX

4.  Doxycycline; Bactrim; Clinda

PEDIS Score 3 Moderate Foot Ulcers

1.  Pathogens

2.  Oral thearpy (2)

3.  IV therapy (3)

1.  MSSA; Strep; Enterobacteriaceae; Obligate anaerobes

2.  Moxifloxacin (poor S. aureus); Levo or cipro (poor S. aureus) + clinda

3.  Ceftriaxone + Flagyl

Unasyn

Ertapenem

PEDIS 4 Foot Ulcer

1.  Pathogens that need to be covered

2.  Risk factors pseudomonas (4)

3.  Drugs to treat

1.  MRSA; P. aeruginosa; Anaerobes

2.  Warm climate

Feet soaker

Previously failed therapy without pseudomonas coverage

Severe infection

3.  Vanc; Linezolid; Dapto

+ 

Zosyn; Cefepime/Ceftaz + Flagyl (anaerobes); Carbapenem...not ertapen

Route of Infection Osteo

1.  Hematogenous

2.  Contiguous

3.  Two subclassifications of contiguous

1.  usually bloodstream and acute infections

2.  External penetraion (trauma/surgery)

Spread for adjacent tissue

3.  Vascular insufficiency

No vascular insufficiency

1.  Acute < 1wk

2.  Chronc > 1 month or relapse

Neonate Hematogenous Osteo

1.  Site of infection

2.  Pathogens (3)

3.  Tx

1.  Long bones

2.  S. aureus; E. coli; Group B strep

3.  Antistapy (naf or vanc)

3rd/4th gen cephalosporin except Rocephin (kernicturus)

Prepubertal Kids Hematogenous Osteo

1.  Infection site

2.  Risk factors

3.  Pathogens (1)

4.  Thearpy

1.  Long bones

2.  UTIs

3.  S. aureus

4.  Anti-staph agent

Clinda

Elderly hematogenous osteo

1.  Location of infection

2.  Pathogens (2)

3.  Treatment

1.  Vertebra

2.  S. aureus; E. coli

3.  Anti-staph agent

3/4 gen cephalosporin

Contiguous focus osteo vascular insufficiency

1.  Location

2.  Risk factors

3.  Bugs (5)

4.  Tx

1.  Feet; Fingers

2.  DM; PVD; Peripheral neuropathy

3.  MRSA; Enterobacteriaceae; P. aerubinosa; Enterococcus; Anerobes

4.  Vanc/linezolid/dapto

Penem (not erta)

Cefepime/ceftaz + clinda or flagyl

Cipro/Levo + Clinda or flagyl

Contiguous osteo w/o vacular insufficiency

1.  Risk factors

2.  Bugs

3.  Treatment

1.  Post op; soft tissue infection; implantable devices

2.  S. aureus...mixture of aerobic and anaerobics

3.  Anti-staph (MRSA)

1.  CPK wkly

2.  Consider d/c statin while on dapto

1.  Myelosuppression CBC at 1 wk

2.  Peripheral and optic neuropaty