ID 2

Question 1

Pathogens that can cause meningitis 6

Answer 1

1. Strep pneumo
2. Neisseria menintidis
3. Haemophilus Influenzae
4. Group B Streptococcus/E. Coli (Young patients)
5. Listeria (young and old)

Question 2

Common pathogens in the mouth 3

Answer 2

1. Mouth flora (peptostreptococcus, actinomyces)
2. Anaerobe GNR (provetella, others)
3. Viridans group streptococcus

Question 3

Upper respiratory pathogens 4

Answer 3

1. Streptococcus pyrogenes
2. Strep pneumo
3. H. Influenzae
4. Moraxella Catarrhalis

Question 4

Lower respiratory pathogens (community)

Answer 4

1. Strep pneumo
2. H. Influ
3. Atypicals: legionella, Mycoplasma
4. Enteric GNR: Alcoholics, IC

Question 5

Lower respiratory hospital 4

Answer 5

1. Staph aureus, including MRSA
2. Pseudomonas
3. enteric GNR
4. Strep pneumo

Question 6

Heart/Endocarditis pathogens

4

Answer 6

1. Staph aureus (MRSA)
2. Staph epidermidis
3. Streptococci
4. Enterococci

Question 7

Intraabdominal pathogens 4

Answer 7

1. Enteric GNR
2. Enterococci
3. Streptococci
4. Bacteroides specis

Question 8

Skin and Soft Tissue Pathogens

Answer 8

1. Staph aureus
2. Strep pyrogenes
3. Staph epidermidis
4. Pateurella multocida
5. +- aerobic/anaerobic GNR (diabetes)

Question 9

Bone and Joint Pathogens 5

Answer 9

1. Staph aureus
2. Staph epidermidids
3. Streptococci
4. Neisseria gonorrhoe
5. GNR only in specific situations

Question 10

Urinary tract pathogens

Answer 10

1. E.coli
2. Klebsiella
3. Staph sapro
4. Streptococci
5. Enterococci

Question 11

Surgical prophylaxis

Cardiac or vascular surgeries

Answer 11

• Cefazolin or cefuroxime
• If allergic to beta lactams, vanc or clinda

Question 12

Hip fracture repair or total joint replacement

Answer 12

• Cefazolin
• Allergy vanc or clinda

Question 13

Colon (colorectal)

Answer 13

• Cefotetan
• Cefoxitin
• Amp/sul
• ertapenem
• or Metronidazole + cefazolin or ceftriaxone
• Allergy: Clinda+(AMG or quinolone or aztreonam)
• Or metronidazole + (AG or quinolone)

Question 14

Hysterectomy

Answer 14

• Cefotetan, cefoxitin, cefazolin or amp/sul
• Allergy clinda/vanc + (AMG or quinolone or aztreonam)
• Mettro+ (AMG or quinolone)

Question 15

Classic Meningitis Symptoms, diagnosis, and commone pathogens

Answer 15

• HA, nuchal rigidity (stiff neck), and altered mental status
• Diagnosed with a lumbar puncture
• Strep pneumo, Neisseria meningtigis, H. Influenzae
• Listeria monocytogenes (neonates and patients > 50, and immunocompromised patients)

Question 16

What can be given to patients with meningitis to prevent neurologic symptoms

Answer 16

• Dexamethasone 15-20 minutes prior to abx admin
• 0.15 mg/kg rounded to 10 mg IV q6h

Question 17

What is meningitis treatment duration dependent on and what is it?

Answer 17

• 7 days for N. Meningit and H. FLu
• 10-14 for S. pneumo
• 21 days for listeria

Question 18

Empiric treatment recommendations for meningitis

<1mo

1-23 months

age 2-50 years

>50 or immunocompromised

Answer 18

< 1 mo

• Ampicillin for listeria coverage
• • cefotaxime (not ceftriaxone due to risk of biliary sludging in neonates)
• or Gentamicin

1-23 months

• Ceftriaxone or cefotaxime
• • Vanc

2-50 years

• Adult dose
• Ceftriaxone 2 g IV q12 or Cefotaxime 2 g q4-6h
• • vanc 30-45 mg/kg/day in divided doses

>50

• Ceftriaxone or cefotaxime
• • Vanc
• • Ampicllin for listeria coverage

Question 19

What Abx is added for neonates or people > 50 or immunocompromised to cover listeria

Answer 19

Ampicillin

Question 20

If pt has a serious PCN allergy what is the treatment regimen for meningitis?

Answer 20

• Quinolones (moxi or levo) + vanc +- Bactrim for listeria

Question 21

First line treatment and alternatives for Acute Otitis Media

Answer 21

• First:
  
  • Amox 80-90 mg/kg/day in 2 divided doses
  • or Augmentin 90 mg/kg/day, 6.4 mg/kg/day of clav
  • 14:1 amox clav ration
• Alt if PCN allergy
  
  • Cefdinir
  • Cefuroxime
  • Cefpodoxime
  • Ceftriaxone
• Treatment failure
  
  • Augmentin
  • or Ceftriaxone