https://www.wikidoc.org/api.php?action=feedcontributions&user=Aravind+Kuchkuntla&feedformat=atomwikidoc - User contributions [en]2024-03-28T08:58:09ZUser contributionsMediaWiki 1.40.0https://www.wikidoc.org/index.php?title=User:Aravind_Kuchkuntla&diff=1323786User:Aravind Kuchkuntla2017-07-07T02:21:41Z<p>Aravind Kuchkuntla: /* Pages Authored */</p>
<hr />
<div>__NOTOC__<br />
==[[Aravind Reddy Kuchkuntla, M.B.B.S]]==<br />
Contact: 404-539-7985 <br /><br />
Email: [mailto:aravind.kuchkuntla@bidmc.harvard.edu akuchkun@bidmc.harvard.edu]<br /><br />
<br />
==Current Position==<br />
Associate Editor-in-Chief, WikiDoc.org<br><br />
Postdoctoral Research Fellow, PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School<br><br />
==Professional Background==<br />
Dr. Aravind kuchkuntla is a postdoctoral research fellow of cardiovascular medicine at the PERFUSE Study Group at Beth Israel Deaconess Medical Center. He received his M.B.B.S degree from Pondicherry University in India. Dr. Kuchkuntla is currently an Associate editor-in-chief at ''Wikidoc.org''. <br />
==Education==<br />
2013-Medical Degree, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry University, India.<br />
==Pages Authored==<br />
{{Columns-list|3|<br />
*[[Hypolipoproteinemia]]<br />
*[[Abetalipoproteinemia]]<br />
*[[Tangier disease]]<br />
*[[LCAT deficiency]]<br />
*[[Hypobetalipoproteinemia]]<br />
*[[Apolipoprotein A deficiency]]<br />
*[[Vaginitis]]<br />
*[[Atrophic vaginitis]]<br />
*[[Candida vulvovaginitis]]<br />
*[[Congenital infections]]<br />
*[[Neonatal herpes simplex]]<br />
*[[Congenital varicella syndrome]]<br />
*[[Congenital Toxoplasmosis]]<br />
*[[Congenital syphilis]]<br />
*[[Pulmonary valve stenosis]]<br />
*[[Pulmonic regurgitation]]<br />
*[[Anorectal abscess]]<br />
*[[Pott's disease]]<br />
*[[Trench mouth]]<br />
*[[HFMD]]<br />
*[[Tzanck smear]]<br />
*[[Rubella]]<br />
*[[Tropical sprue]]<br />
*[[Histoplasmosis]]<br />
*[[CMV infection]]<br />
*[[Cryptococcosis]]<br />
*[[Endometriosis]]<br />
}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322144Sandbox:Reddy2017-06-29T20:27:16Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
'<nowiki/>'''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'<nowiki/>'''''Acute Bronchitis''''''<br />
| ''Viral''<br />
|No drug therapy required <br />
|<br />
|-<br />
|'''Acute bacterial exacerbation of chronic bronchitis (COPD)'''<br />
|''S. pneumoniae''<br />
''H. influenzae'' <br />
<br />
''Moraxellacatarrhalis''<br />
|'''Doxycycline''' 100 mg PO BID X 10 days<br />
|'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
|-<br />
|'''Community-acquired Pneumonia (CAP)''' <br />
|''S. pneumoniae''<br />
''M. pneumoniae''<br />
<br />
''C. pneumoniae''<br />
<br />
Respiratory viruses<br />
<br />
''Legionella'' spp.<br />
<br />
C. psittaci<br />
<br />
'<nowiki/>'''H. influenzae'' (if patient has co-morbidity)'''''<br />
|No recent antibiotic therapy:<br />
'''Doxycycline''' 100 mg PO BID X 7 days<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
<br />
Recent antibiotic therapy or patients with co-morbidities:<br />
<br />
'''Levofloxacin''' 750 mg PO daily X 5 days<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily X 7 days<br />
|'''Previous antibiotic therapy within last 3 month''' should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa.<br />
Careful follow-up highly recommended.<br />
|-<br />
|Anerobic infection<br />
|<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
OR<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
|<br />
|-<br />
|'''Acute otitis media'''<br />
OR<br />
<br />
'<nowiki/>'''''Otitis media with effusion'<nowiki/>'' '''(OME)''' with signs or symptoms of acute infection''' <br />
|''S. pneumoniae''<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
''Group A Strep.''<br />
|'''Amoxicillin'''<br />
1 g PO BID x 5-7 days<br />
<br />
OR<br />
<br />
500 mg PO TID x 5-7 days<br />
|For severe PCN allergy:<br />
'''Azithromycin''' 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days<br />
<br />
OR<br />
<br />
'''Doxycycline''' 100 mg PO BID for 5-7 days<br />
* Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.<br />
<br />
* High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant ''S. pneumoniae''.<br />
<br />
* OME in the absence of acute signs and symptom of infection does not require antibiotics.<br />
<br />
* For recurrent prolonged otitis consider ENT referral.<br />
|-<br />
|'''Pharyngitis'''<br />
|Viral (EBV, rhinovirus, coronavirus, adenovirus etc)<br />
''Group A Streptococcus''<br />
<br />
(5-20%)<br />
|'''Penicillin VK''' 250 mg PO TID-QID x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin'''300 mg PO TID x 7-10 days<br />
* Most pharyngitis is viral thus antibiotics should not be used.<br />
<br />
* Treatment with PCN prevents rheumatic fever.<br />
<br />
* Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present.<br />
<br />
* Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.<br />
|-<br />
|'''Acute Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
|'''Amoxicillin''' 500 mg PO TID X 5-7 days<br />
|For severe PCN allergy:<br />
'''Doxycycline''' 100 mg PO BID X 5-7 days<br />
<br />
Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.<br />
|-<br />
|'''Chronic Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
Anaerobes<br />
<br />
''Staph. aureus''<br />
<br />
''Enterobacteriacae'' <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID X 10-14 days<br />
<br />
OR<br />
<br />
'''Amoxicillin/clavulanate''' CR 2 g BID X 10-14 days if drug-resistant ''Streptococcus pneumonia'' <br />
|For severe PCN allergy:<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 10-14 days<br />
<br />
EITHER OF ABOVE WITH OR WITHOUT*:<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
* Consider otolaryngology consult to rule out anatomic abnormality.<br />
<br />
* If acute exacerbation, treat as acute sinusitis.<br />
<br />
* HIV positive patients may need a 2-3 week course.<br />
|-<br />
|'''Treatment of active tuberculosis'''<br />
|<br />
|'''Isoniazid''' 300 mg PO daily x 6 months<br />
PLUS<br />
<br />
'''Rifampin''' 600 mg PO daily x 6 months<br />
<br />
PLUS<br />
<br />
'''Pyrazinamide''' 25 mg/kg PO daily x 2 months<br />
<br />
PLUS<br />
<br />
'''Ethambutol''' 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established<br />
<br />
PLUS:<br />
<br />
'''Pyridoxine''' (Vitamin B-6) 50 mg PO daily for 6 months<br />
|<br />
|-<br />
|'''Latent TB'''<br />
|<br />
|'<nowiki/>'''''Isoniazid'''''' 300 mg PO daily x 9 months<br />
|'''Rifampin''' 600 mg PO daily x 4 months <br />
|}<br />
{| class="wikitable"<br />
|'''Abscess'''<br />
|'<nowiki/>'''S. aureus''''<br />
|<br />
* Uncomplicated: Incision and drainage, no antibiotics needed<br />
* Complicated: Incision and drainage PLUS '''TMP/SMX''' 1-2 DS tablets PO BID OR '''Doxycycline''' 100 mg PO BID<br />
|Give antibiotics for complicated abscess<br />
* Abscess is large (> 5 cm) or incompletely drained<br />
* There is significant surrounding cellulitis<br />
* Systemic signs and symptoms of infection are present<br />
* Patient is immunocompromised<br />
7-10 days of therapy is generally adequate<br />
|-<br />
|'''Bites'''<br />
Dog and Cat<br />
|Streptococci<br />
''Pasteurella'' spp.*<br />
<br />
Staphylococci<br />
<br />
Oral anaerobes <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID<br />
<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days <br />
|For severe PCN allergy<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily<br />
* Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected.<br />
<br />
* '''Prophylaxis''' in high risk patients or in high risk bite only:<br />
<br />
* ''High risk patient'' = post splenectomy, immunocompromised<br />
<br />
* ''High risk bite'' = hand or foot<br />
* ''P.multocida'' is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin<br />
|-<br />
|'''Bites'''<br />
<br />
Human<br />
|Viridans streptococci<br />
''Eikenella''*<br />
<br />
Oral anaerobes<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''500 mg PO daily<br />
<br />
OR<br />
<br />
'''TMP/SMX''' One DS tablet PO BID<br />
|}<br />
{| class="wikitable"<br />
|'''Cellulitis'''<br />
|β-hemolytic streptococci (most common)<br />
''S. aureus'' (less common)<br />
|'''Cephalexin'''500 mg PO QID<br />
OR<br />
<br />
'''Amoxicillin'''500 mg PO TID<br />
<br />
OR<br />
<br />
'''Clindamycin'''300 mg PO TID<br />
|<br />
* If the patient does not respond to beta-lactam-based therapy consider adding TMP/SMX or doxycycline for MRSA coverage.<br />
<br />
* Clindamycin monotherapy provides reasonable coverage for both Group A strep and community-acquired MRSA however some isolates may be resistant. Please refer to hospital-specific antibiogram.<br />
<br />
* For cellulitis associated with an abscess treat for complicated abscess (see below).<br />
<br />
* 7-10 days of therapy is generally adequate<br />
|-<br />
|'''Diabetic Foot Ulcer'''<br />
Localized cellulitis without systemic signs or symptoms, no osteomyelitis<br />
|''S. aureus''<br />
''Streptococci''<br />
<br />
''Enterobacteriaceae''<br />
|'''Clindamycin''' 300 mg PO TID<br />
If patient has been treated with antibiotics within the past month ADD:<br />
<br />
'''Levofloxacin'''ID-R: VASF 750 mg PO daily<br />
<br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID <br />
|<br />
* While infections may be polymicrobial, they frequently respond to Gram-positive coverage alone.<br />
<br />
* Increasing rates of MRSA in the community may be a cause for failure to respond to initial therapy.<br />
<br />
* Consider osteomyelitis especially if there is a failure to respond to therapy.<br />
<br />
* 7-14 days of treatment is generally sufficient, duration should be based on clinical response.<br />
|-<br />
|Herpes Zoster<br />
|'''Immunocompetent'''<br />
(Shingles/Zoster)<br />
<br />
'''Immunocompromised'''<br />
<br />
(Lymphoma, HIV infection, etc) and not severe (one dermatome)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 7-10 days<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO TID x 7 days<br />
|<br />
* Treatment effective only if initiated within 48-72 hours of onset of lesions. May shorten duration of illness in immunocompetent patients.<br />
<br />
* In patients > 65 years old administration of concomitant corticosteroids may improve quality of life.<br />
|-<br />
|'''Primary Infection in Adults''' (Chicken Pox)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 5 days<br />
OR<br />
<br />
'<nowiki/>'''''Valacyclovir'''''' 1 g PO TID x 5 days<br />
|<br />
|<br />
* Initiate therapy within 24 hours of onset of rash.<br />
<br />
* Vaccination of non-immune close contacts recommended. Acyclovir treatment may also be effective for prophylaxis of at-risk individuals.<br />
|-<br />
|'''Mastitis'''<br />
Postpartum<br />
|''S. aureus''<br />
''Including MRSA becoming more frequent''<br />
|'''Dicloxacillin''' 500 mg PO QID x 10-14 days<br />
OR<br />
<br />
'''Cephalexin''' 500 mg PO QID x 10 -14 days<br />
<br />
If patient with risk factors for MRSA:<br />
<br />
'''TMP/SMX''' One DS tablet PO BID x 10-14 days<br />
<br />
OR<br />
<br />
'''Clindamycin''' 300mg PO TID x 10-14 days<br />
|For mild PCN allergy:<br />
'''Cephalexin''' 500 mg PO QID x 10-14 days<br />
<br />
For severe PCN allergy:<br />
<br />
'''Clindamycin''' 300 mg PO TID x 10-14 days<br />
* If no abscess, increased frequency of nursing may hasten response.<br />
<br />
* If abscess, I & D required; discontinue nursing.<br />
<br />
* Doxycycline is active against MRSA but should not be used if patient is breastfeeding.<br />
|}<br />
{| class="wikitable"<br />
|'''Uncomplicated Cystitis'''<br />
Women<br />
|Enterobacteriaceae ''(E. coli)''<br />
''S. saprophyticus'' (Coagulase negative staphylococcus) (4%)<br />
|'''Nitrofurantoin''' 100 mg PO BID x 5-7 days – contraindicated in renal insufficiency (CrCl < 60 ml/min)<br />
OR<br />
<br />
'''TMP/SMX''' 1 DS tablet PO BID x 3 days (if no previous antibiotic therapy)<br />
<br />
OR<br />
<br />
'''Fosfomycin''' 3 g PO x1 dose<br />
|Reserve for patients at highest risk of failure (selection for resistant isolates):<br />
'''Ciprofloxacin''' 500 mg PO BID x 3 days<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 3 days<br />
<br />
Reserve for patients with history of resistant organisms or therapeutic failure (less effective):<br />
<br />
'''Cephalexin''' 500 mg PO QID x 7 days<br />
<br />
OR<br />
<br />
'''Cefpodoxime''' 200 mg PO BID x 7 days<br />
* IDSA guidelines state Trimethoprim/ Sulfamethoxazole is appropriate if resistance rates do not exceed 20%.<br />
* Nitrofurantoin is contraindicated in renal insufficiency (CrCl <60 ml/min).<br />
|-<br />
|'''Recurrent Cystitis'''<br />
|Enterobacteriaceae (''E. coli'')<br />
''S. saprophyticus''(Coagulase negative staphylococcus) (4%)<br />
|Prophylaxis:<br />
Either self administration if symptoms occur or prophylactic post-coital antibiotics<br />
<br />
Post menopausal: topical estrogen<br />
|<br />
|-<br />
|'''Asymptomatic bacteriuria'''<br />
|''E.coli''<br />
''Klebsiella''<br />
<br />
''Enterococcus''<br />
|No treatment required<br />
|<br />
|-<br />
|'''Pyelonephritis'''<br />
|Enterobacteriaceae ''(E. coli)''<br />
Enterococci<br />
|'''Ciprofloxacin''' 500 mg PO BID X 7-14 days<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily X 7-14 days<br />
<br />
OR<br />
<br />
'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID X 14 days<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
|'''Cephalexin''' 500 mg PO QID X 10-14 days<br />
OR<br />
<br />
'''Cefpodoxime'''200 mg PO BID X 10-14 days<br />
<br />
EITHER OF ABOVE PLUS:<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
* Urine analysis and urine culture should be performed and therapy adjusted based on culture and sensitivity.<br />
<br />
* Trimethoprim-sulfamethoxazole is preferred if organism is susceptible.<br />
<br />
* Consider a single intravenous dose of ceftriaxone prior to fluoroquinolone therapy if patient is at high risk for fluoroquinolone-resistant organisms.<br />
|-<br />
|'''Prostatitis'''<br />
Acute<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Cephalexin''' 500 mg PO QID x 21 days <br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BIDX 2-4 weeks*<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily x 2-4 weeks*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Antibiotic penetration in the acute inflammatory state is adequate for most antibiotics.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
<br />
* Cultures should be obtained and definitive therapy should be based on sensitivities.<br />
|-<br />
|'''Prostatitis'''<br />
Chronic<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Ciprofloxacin''' x 2 months*<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF x 2 months*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Few drugs penetrate non-inflamed prostate. Fluoroquinolones and trimethoprim/sulfamethoxazole adequately penetrate in non-inflamed state.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
|}<br />
{| class="wikitable"<br />
|'''Chlamydia''' <br />
'''Genital/Rectal'''<br />
<br />
'<nowiki/>'''''Pharyngeal'''''' <br />
|'<nowiki/>'''Chlamydia trachomatis''''<br />
|'''Azithromycin''' 1 g PO once<br />
OR<br />
<br />
'<nowiki/>'''''Doxycycline'''''' 100 mg PO BID X 7 days<br />
|<br />
|-<br />
|'''First Clinical Episode or Anogenital Herpes'''<br />
|HSV 2 = 70-90%<br />
HSV 1 = 10-30% <br />
|'''Acyclovir''' 400 mg PO TID x 7-10 days<br />
|'''Valacyclovir''' 1 g PO BID x 7-10 days<br />
In HIV patients with documented acyclovir resistance, use foscarnet.<br />
|-<br />
|'''Episodic Therapy for Recurrent Episodes'''<br />
|<br />
|'''Acyclovir''' 400 mg PO TID x 5 days<br />
OR<br />
<br />
'''Acyclovir''' 800 mg PO BID x 5 days<br />
<br />
OR<br />
<br />
'''Acyclovir''' 800 mg PO TID x 2 days<br />
|'''Valacyclovir''' 1 g PO daily x 5 days <br />
* HIV patients:<br />
'''Acyclovir''' 400 mg PO TID x 5-10 days<br />
<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO BID x 5-10 days<br />
|-<br />
|'''Suppression for Frequent Recurrence'''<br />
|HSV 2 = 70-90%<br />
HSV 1 = 10-30%<br />
|'''Acyclovir''' 400 mg PO BID<br />
HIV patients:<br />
<br />
'''Acyclovir''' 400-800 mg BID or TID<br />
<br />
OR<br />
<br />
'''Valacyclovir''' 500 mg PO BID<br />
|'''Valacyclovir''' 500-1000 mg PO daily<br />
Consider suppressive therapy for patients experiencing greater than 3-4 episodes in 12 months. <br />
|}<br />
{| class="wikitable"<br />
|'''Pelvic inflammatory diseases (PID'''<br />
|''N.gonorrhoeae'' <br />
''C.trachomatis'' anaerobes<br />
<br />
Gram-negative facultative bacteria streptococci<br />
|'''Ceftriaxone''' 250 mg IM X 1<br />
PLUS<br />
<br />
'''Doxycycline''' 100 mg PO BID X 14 days<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO BID x 14 days if BV is present or cannot be ruled out<br />
|<br />
* Follow-up examination should be performed within 72 hours when PID is treated with these regimens.<br />
<br />
* Fluoroquinolones should not be used due to increasing resistance and treatment failures.<br />
|-<br />
|'''Syphilis'''<br />
'''Primary, Secondary, Early Latent'''<br />
|'<nowiki/>'''T. pallidum'''' <br />
|'''Benzathine penicillin G'''2.4 MU IM X 1 dose<br />
|'''Doxycycline'''100 mg PO BID X 2 weeks<br />
|-<br />
|'''Syphilis'''<br />
'''Late Latent and Latent of Unknown Duration'''<br />
|'<nowiki/>'''T. pallidum'''' <br />
|'''Benzathine penicillin G'''2.4 MU IM Q week X 3 doses <br />
|'''Doxycycline'''100 mg PO BID X 4 weeks <br />
Sexual partners must be treated.<br />
* Alternatives should only be used for penicillin-allergic patients because efficacy of these therapies has not been established. Compliance with some of these regimens is difficult, and close follow-up is essential.<br />
|}<br />
{| class="wikitable"<br />
|'''Candidal Vaginitis'''<br />
|''''''Fluconazole'''''' 150 mg PO x 1 dose<br />
|'''Miconazole''' 2% cream 5 g intravaginally x 3 days<br />
OR<br />
<br />
'''Miconazole''' 100 mg suppository, one suppository daily x 7 days<br />
<br />
OR<br />
<br />
'''Clotrimazole''' 1% cream 5 g intravaginally x 7-14 days<br />
|-<br />
|'''Protazoan Vaginitis'''<br />
|'''Metronidazole''' 2 g PO x 1 dose <br />
|'''Metronidazole''' 500 mg PO BID x 7 days <br />
In treatment failures to metronidazole, retreat with metronidazole 500 mg PO BID x 7 days.<br />
|-<br />
|'''Bacterial Vaginitis'''<br />
|'''Metronidazole''' 500 mg BID PO x 7 days<br />
OR<br />
<br />
'''Metronidazole''' vaginal gel 0.75%, 5 g intravaginally daily x 5 days<br />
<br />
OR<br />
<br />
'''Clindamycin''' vaginal cream 2%, 5 g intravaginally daily x 7 days<br />
|'''Clindamycin''' 300 mg PO BID X 7 days<br />
OR<br />
<br />
'''Clindamycin''' ovules 100 mg intravaginally daily x 3 days<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322142Sandbox:Reddy2017-06-29T20:24:29Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
'<nowiki/>'''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'<nowiki/>'''''Acute Bronchitis''''''<br />
| ''Viral''<br />
|No drug therapy required <br />
|<br />
|-<br />
|'''Acute bacterial exacerbation of chronic bronchitis (COPD)'''<br />
|''S. pneumoniae''<br />
''H. influenzae'' <br />
<br />
''Moraxellacatarrhalis''<br />
|'''Doxycycline''' 100 mg PO BID X 10 days<br />
|'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
|-<br />
|'''Community-acquired Pneumonia (CAP)''' <br />
|''S. pneumoniae''<br />
''M. pneumoniae''<br />
<br />
''C. pneumoniae''<br />
<br />
Respiratory viruses<br />
<br />
''Legionella'' spp.<br />
<br />
C. psittaci<br />
<br />
'<nowiki/>'''H. influenzae'' (if patient has co-morbidity)'''''<br />
|No recent antibiotic therapy:<br />
'''Doxycycline''' 100 mg PO BID X 7 days<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
<br />
Recent antibiotic therapy or patients with co-morbidities:<br />
<br />
'''Levofloxacin''' 750 mg PO daily X 5 days<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily X 7 days<br />
|'''Previous antibiotic therapy within last 3 month''' should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa.<br />
Careful follow-up highly recommended.<br />
|-<br />
|Anerobic infection<br />
|<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
OR<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
|<br />
|-<br />
|'''Acute otitis media'''<br />
OR<br />
<br />
'<nowiki/>'''''Otitis media with effusion'<nowiki/>'' '''(OME)''' with signs or symptoms of acute infection''' <br />
|''S. pneumoniae''<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
''Group A Strep.''<br />
|'''Amoxicillin'''<br />
1 g PO BID x 5-7 days<br />
<br />
OR<br />
<br />
500 mg PO TID x 5-7 days<br />
|For severe PCN allergy:<br />
'''Azithromycin''' 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days<br />
<br />
OR<br />
<br />
'''Doxycycline''' 100 mg PO BID for 5-7 days<br />
* Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.<br />
<br />
* High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant ''S. pneumoniae''.<br />
<br />
* OME in the absence of acute signs and symptom of infection does not require antibiotics.<br />
<br />
* For recurrent prolonged otitis consider ENT referral.<br />
|-<br />
|'''Pharyngitis'''<br />
|Viral (EBV, rhinovirus, coronavirus, adenovirus etc)<br />
''Group A Streptococcus''<br />
<br />
(5-20%)<br />
|'''Penicillin VK''' 250 mg PO TID-QID x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin'''300 mg PO TID x 7-10 days<br />
* Most pharyngitis is viral thus antibiotics should not be used.<br />
<br />
* Treatment with PCN prevents rheumatic fever.<br />
<br />
* Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present.<br />
<br />
* Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.<br />
|-<br />
|'''Acute Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
|'''Amoxicillin''' 500 mg PO TID X 5-7 days<br />
|For severe PCN allergy:<br />
'''Doxycycline''' 100 mg PO BID X 5-7 days<br />
<br />
Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.<br />
|-<br />
|'''Chronic Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
Anaerobes<br />
<br />
''Staph. aureus''<br />
<br />
''Enterobacteriacae'' <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID X 10-14 days<br />
<br />
OR<br />
<br />
'''Amoxicillin/clavulanate''' CR 2 g BID X 10-14 days if drug-resistant ''Streptococcus pneumonia'' <br />
|For severe PCN allergy:<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 10-14 days<br />
<br />
EITHER OF ABOVE WITH OR WITHOUT*:<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
* Consider otolaryngology consult to rule out anatomic abnormality.<br />
<br />
* If acute exacerbation, treat as acute sinusitis.<br />
<br />
* HIV positive patients may need a 2-3 week course.<br />
|-<br />
|'''Treatment of active tuberculosis'''<br />
|<br />
|'''Isoniazid''' 300 mg PO daily x 6 months<br />
PLUS<br />
<br />
'''Rifampin''' 600 mg PO daily x 6 months<br />
<br />
PLUS<br />
<br />
'''Pyrazinamide''' 25 mg/kg PO daily x 2 months<br />
<br />
PLUS<br />
<br />
'''Ethambutol''' 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established<br />
<br />
PLUS:<br />
<br />
'''Pyridoxine''' (Vitamin B-6) 50 mg PO daily for 6 months<br />
|<br />
|-<br />
|'''Latent TB'''<br />
|<br />
|'<nowiki/>'''''Isoniazid'''''' 300 mg PO daily x 9 months<br />
|'''Rifampin''' 600 mg PO daily x 4 months <br />
|}<br />
{| class="wikitable"<br />
|'''Abscess'''<br />
|'<nowiki/>'''S. aureus''''<br />
|<br />
* Uncomplicated: Incision and drainage, no antibiotics needed<br />
* Complicated: Incision and drainage PLUS '''TMP/SMX''' 1-2 DS tablets PO BID OR '''Doxycycline''' 100 mg PO BID<br />
|Give antibiotics for complicated abscess<br />
* Abscess is large (> 5 cm) or incompletely drained<br />
* There is significant surrounding cellulitis<br />
* Systemic signs and symptoms of infection are present<br />
* Patient is immunocompromised<br />
7-10 days of therapy is generally adequate<br />
|-<br />
|'''Bites'''<br />
Dog and Cat<br />
|Streptococci<br />
''Pasteurella'' spp.*<br />
<br />
Staphylococci<br />
<br />
Oral anaerobes <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID<br />
<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days <br />
|For severe PCN allergy<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily<br />
* Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected.<br />
<br />
* '''Prophylaxis''' in high risk patients or in high risk bite only:<br />
<br />
* ''High risk patient'' = post splenectomy, immunocompromised<br />
<br />
* ''High risk bite'' = hand or foot<br />
* ''P.multocida'' is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin<br />
|-<br />
|'''Bites'''<br />
<br />
Human<br />
|Viridans streptococci<br />
''Eikenella''*<br />
<br />
Oral anaerobes<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''500 mg PO daily<br />
<br />
OR<br />
<br />
'''TMP/SMX''' One DS tablet PO BID<br />
|}<br />
{| class="wikitable"<br />
|'''Cellulitis'''<br />
|β-hemolytic streptococci (most common)<br />
''S. aureus'' (less common)<br />
|'''Cephalexin'''500 mg PO QID<br />
OR<br />
<br />
'''Amoxicillin'''500 mg PO TID<br />
<br />
OR<br />
<br />
'''Clindamycin'''300 mg PO TID<br />
|<br />
* If the patient does not respond to beta-lactam-based therapy consider adding TMP/SMX or doxycycline for MRSA coverage.<br />
<br />
* Clindamycin monotherapy provides reasonable coverage for both Group A strep and community-acquired MRSA however some isolates may be resistant. Please refer to hospital-specific antibiogram.<br />
<br />
* For cellulitis associated with an abscess treat for complicated abscess (see below).<br />
<br />
* 7-10 days of therapy is generally adequate<br />
|-<br />
|'''Diabetic Foot Ulcer'''<br />
Localized cellulitis without systemic signs or symptoms, no osteomyelitis<br />
|''S. aureus''<br />
''Streptococci''<br />
<br />
''Enterobacteriaceae''<br />
|'''Clindamycin''' 300 mg PO TID<br />
If patient has been treated with antibiotics within the past month ADD:<br />
<br />
'''Levofloxacin'''ID-R: VASF 750 mg PO daily<br />
<br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID <br />
|<br />
* While infections may be polymicrobial, they frequently respond to Gram-positive coverage alone.<br />
<br />
* Increasing rates of MRSA in the community may be a cause for failure to respond to initial therapy.<br />
<br />
* Consider osteomyelitis especially if there is a failure to respond to therapy.<br />
<br />
* 7-14 days of treatment is generally sufficient, duration should be based on clinical response.<br />
|-<br />
|Herpes Zoster<br />
|'''Immunocompetent'''<br />
(Shingles/Zoster)<br />
<br />
'''Immunocompromised'''<br />
<br />
(Lymphoma, HIV infection, etc) and not severe (one dermatome)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 7-10 days<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO TID x 7 days<br />
|<br />
* Treatment effective only if initiated within 48-72 hours of onset of lesions. May shorten duration of illness in immunocompetent patients.<br />
<br />
* In patients > 65 years old administration of concomitant corticosteroids may improve quality of life.<br />
|-<br />
|'''Primary Infection in Adults''' (Chicken Pox)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 5 days<br />
OR<br />
<br />
'<nowiki/>'''''Valacyclovir'''''' 1 g PO TID x 5 days<br />
|<br />
|<br />
* Initiate therapy within 24 hours of onset of rash.<br />
<br />
* Vaccination of non-immune close contacts recommended. Acyclovir treatment may also be effective for prophylaxis of at-risk individuals.<br />
|-<br />
|'''Mastitis'''<br />
Postpartum<br />
|''S. aureus''<br />
''Including MRSA becoming more frequent''<br />
|'''Dicloxacillin''' 500 mg PO QID x 10-14 days<br />
OR<br />
<br />
'''Cephalexin''' 500 mg PO QID x 10 -14 days<br />
<br />
If patient with risk factors for MRSA:<br />
<br />
'''TMP/SMX''' One DS tablet PO BID x 10-14 days<br />
<br />
OR<br />
<br />
'''Clindamycin''' 300mg PO TID x 10-14 days<br />
|For mild PCN allergy:<br />
'''Cephalexin''' 500 mg PO QID x 10-14 days<br />
<br />
For severe PCN allergy:<br />
<br />
'''Clindamycin''' 300 mg PO TID x 10-14 days<br />
* If no abscess, increased frequency of nursing may hasten response.<br />
<br />
* If abscess, I & D required; discontinue nursing.<br />
<br />
* Doxycycline is active against MRSA but should not be used if patient is breastfeeding.<br />
|}<br />
{| class="wikitable"<br />
|'''Uncomplicated Cystitis'''<br />
Women<br />
|Enterobacteriaceae ''(E. coli)''<br />
''S. saprophyticus'' (Coagulase negative staphylococcus) (4%)<br />
|'''Nitrofurantoin''' 100 mg PO BID x 5-7 days – contraindicated in renal insufficiency (CrCl < 60 ml/min)<br />
OR<br />
<br />
'''TMP/SMX''' 1 DS tablet PO BID x 3 days (if no previous antibiotic therapy)<br />
<br />
OR<br />
<br />
'''Fosfomycin''' 3 g PO x1 dose<br />
|Reserve for patients at highest risk of failure (selection for resistant isolates):<br />
'''Ciprofloxacin''' 500 mg PO BID x 3 days<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 3 days<br />
<br />
Reserve for patients with history of resistant organisms or therapeutic failure (less effective):<br />
<br />
'''Cephalexin''' 500 mg PO QID x 7 days<br />
<br />
OR<br />
<br />
'''Cefpodoxime''' 200 mg PO BID x 7 days<br />
* IDSA guidelines state Trimethoprim/ Sulfamethoxazole is appropriate if resistance rates do not exceed 20%.<br />
* Nitrofurantoin is contraindicated in renal insufficiency (CrCl <60 ml/min).<br />
|-<br />
|'''Recurrent Cystitis'''<br />
|Enterobacteriaceae (''E. coli'')<br />
''S. saprophyticus''(Coagulase negative staphylococcus) (4%)<br />
|Prophylaxis:<br />
Either self administration if symptoms occur or prophylactic post-coital antibiotics<br />
<br />
Post menopausal: topical estrogen<br />
|<br />
|-<br />
|'''Asymptomatic bacteriuria'''<br />
|''E.coli''<br />
''Klebsiella''<br />
<br />
''Enterococcus''<br />
|No treatment required<br />
|<br />
|-<br />
|'''Pyelonephritis'''<br />
|Enterobacteriaceae ''(E. coli)''<br />
Enterococci<br />
|'''Ciprofloxacin''' 500 mg PO BID X 7-14 days<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily X 7-14 days<br />
<br />
OR<br />
<br />
'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID X 14 days<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
|'''Cephalexin''' 500 mg PO QID X 10-14 days<br />
OR<br />
<br />
'''Cefpodoxime'''200 mg PO BID X 10-14 days<br />
<br />
EITHER OF ABOVE PLUS:<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
* Urine analysis and urine culture should be performed and therapy adjusted based on culture and sensitivity.<br />
<br />
* Trimethoprim-sulfamethoxazole is preferred if organism is susceptible.<br />
<br />
* Consider a single intravenous dose of ceftriaxone prior to fluoroquinolone therapy if patient is at high risk for fluoroquinolone-resistant organisms.<br />
|-<br />
|'''Prostatitis'''<br />
Acute<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Cephalexin''' 500 mg PO QID x 21 days <br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BIDX 2-4 weeks*<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily x 2-4 weeks*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Antibiotic penetration in the acute inflammatory state is adequate for most antibiotics.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
<br />
* Cultures should be obtained and definitive therapy should be based on sensitivities.<br />
|-<br />
|'''Prostatitis'''<br />
Chronic<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Ciprofloxacin''' x 2 months*<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF x 2 months*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Few drugs penetrate non-inflamed prostate. Fluoroquinolones and trimethoprim/sulfamethoxazole adequately penetrate in non-inflamed state.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
|}<br />
{| class="wikitable"<br />
|'''Chlamydia''' <br />
'''Genital/Rectal'''<br />
<br />
'<nowiki/>'''''Pharyngeal'''''' <br />
|'<nowiki/>'''Chlamydia trachomatis''''<br />
|'''Azithromycin''' 1 g PO once<br />
OR<br />
<br />
'<nowiki/>'''''Doxycycline'''''' 100 mg PO BID X 7 days<br />
|<br />
|-<br />
|'''First Clinical Episode or Anogenital Herpes'''<br />
|HSV 2 = 70-90%<br />
HSV 1 = 10-30% <br />
|'''Acyclovir''' 400 mg PO TID x 7-10 days<br />
|'''Valacyclovir''' 1 g PO BID x 7-10 days<br />
In HIV patients with documented acyclovir resistance, use foscarnet.<br />
|-<br />
|'''Episodic Therapy for Recurrent Episodes'''<br />
|<br />
|'''Acyclovir''' 400 mg PO TID x 5 days<br />
OR<br />
<br />
'''Acyclovir''' 800 mg PO BID x 5 days<br />
<br />
OR<br />
<br />
'''Acyclovir''' 800 mg PO TID x 2 days<br />
|'''Valacyclovir''' 1 g PO daily x 5 days <br />
* HIV patients:<br />
'''Acyclovir''' 400 mg PO TID x 5-10 days<br />
<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO BID x 5-10 days<br />
|-<br />
|'''Suppression for Frequent Recurrence'''<br />
|HSV 2 = 70-90%<br />
HSV 1 = 10-30%<br />
|'''Acyclovir''' 400 mg PO BID<br />
HIV patients:<br />
<br />
'''Acyclovir''' 400-800 mg BID or TID<br />
<br />
OR<br />
<br />
'''Valacyclovir''' 500 mg PO BID<br />
|'''Valacyclovir''' 500-1000 mg PO daily<br />
Consider suppressive therapy for patients experiencing greater than 3-4 episodes in 12 months. <br />
|}<br />
{| class="wikitable"<br />
|'''Pelvic inflammatory diseases (PID'''<br />
|''N.gonorrhoeae'' <br />
''C.trachomatis'' anaerobes<br />
<br />
Gram-negative facultative bacteria streptococci<br />
|'''Ceftriaxone''' 250 mg IM X 1<br />
PLUS<br />
<br />
'''Doxycycline''' 100 mg PO BID X 14 days<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO BID x 14 days if BV is present or cannot be ruled out<br />
|<br />
* Follow-up examination should be performed within 72 hours when PID is treated with these regimens.<br />
<br />
* Fluoroquinolones should not be used due to increasing resistance and treatment failures.<br />
|-<br />
|'''Syphilis'''<br />
'''Primary, Secondary, Early Latent'''<br />
|''''T. pallidum'''' <br />
|'''Benzathine penicillin G'''2.4 MU IM X 1 dose<br />
|'''Doxycycline'''100 mg PO BID X 2 weeks<br />
|-<br />
|'''Syphilis'''<br />
'''Late Latent and Latent of Unknown Duration'''<br />
|''''T. pallidum'''' <br />
|'''Benzathine penicillin G'''2.4 MU IM Q week X 3 doses <br />
|'''Doxycycline'''100 mg PO BID X 4 weeks <br />
Sexual partners must be treated.<br />
* Alternatives should only be used for penicillin-allergic patients because efficacy of these therapies has not been established. Compliance with some of these regimens is difficult, and close follow-up is essential.<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322140Sandbox:Reddy2017-06-29T20:21:45Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
'<nowiki/>'''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'<nowiki/>'''''Acute Bronchitis''''''<br />
| ''Viral''<br />
|No drug therapy required <br />
|<br />
|-<br />
|'''Acute bacterial exacerbation of chronic bronchitis (COPD)'''<br />
|''S. pneumoniae''<br />
''H. influenzae'' <br />
<br />
''Moraxellacatarrhalis''<br />
|'''Doxycycline''' 100 mg PO BID X 10 days<br />
|'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
|-<br />
|'''Community-acquired Pneumonia (CAP)''' <br />
|''S. pneumoniae''<br />
''M. pneumoniae''<br />
<br />
''C. pneumoniae''<br />
<br />
Respiratory viruses<br />
<br />
''Legionella'' spp.<br />
<br />
C. psittaci<br />
<br />
'<nowiki/>'''H. influenzae'' (if patient has co-morbidity)'''''<br />
|No recent antibiotic therapy:<br />
'''Doxycycline''' 100 mg PO BID X 7 days<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
<br />
Recent antibiotic therapy or patients with co-morbidities:<br />
<br />
'''Levofloxacin''' 750 mg PO daily X 5 days<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily X 7 days<br />
|'''Previous antibiotic therapy within last 3 month''' should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa.<br />
Careful follow-up highly recommended.<br />
|-<br />
|Anerobic infection<br />
|<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
OR<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
|<br />
|-<br />
|'''Acute otitis media'''<br />
OR<br />
<br />
'<nowiki/>'''''Otitis media with effusion'<nowiki/>'' '''(OME)''' with signs or symptoms of acute infection''' <br />
|''S. pneumoniae''<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
''Group A Strep.''<br />
|'''Amoxicillin'''<br />
1 g PO BID x 5-7 days<br />
<br />
OR<br />
<br />
500 mg PO TID x 5-7 days<br />
|For severe PCN allergy:<br />
'''Azithromycin''' 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days<br />
<br />
OR<br />
<br />
'''Doxycycline''' 100 mg PO BID for 5-7 days<br />
* Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.<br />
<br />
* High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant ''S. pneumoniae''.<br />
<br />
* OME in the absence of acute signs and symptom of infection does not require antibiotics.<br />
<br />
* For recurrent prolonged otitis consider ENT referral.<br />
|-<br />
|'''Pharyngitis'''<br />
|Viral (EBV, rhinovirus, coronavirus, adenovirus etc)<br />
''Group A Streptococcus''<br />
<br />
(5-20%)<br />
|'''Penicillin VK''' 250 mg PO TID-QID x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin'''300 mg PO TID x 7-10 days<br />
* Most pharyngitis is viral thus antibiotics should not be used.<br />
<br />
* Treatment with PCN prevents rheumatic fever.<br />
<br />
* Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present.<br />
<br />
* Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.<br />
|-<br />
|'''Acute Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
|'''Amoxicillin''' 500 mg PO TID X 5-7 days<br />
|For severe PCN allergy:<br />
'''Doxycycline''' 100 mg PO BID X 5-7 days<br />
<br />
Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.<br />
|-<br />
|'''Chronic Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
Anaerobes<br />
<br />
''Staph. aureus''<br />
<br />
''Enterobacteriacae'' <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID X 10-14 days<br />
<br />
OR<br />
<br />
'''Amoxicillin/clavulanate''' CR 2 g BID X 10-14 days if drug-resistant ''Streptococcus pneumonia'' <br />
|For severe PCN allergy:<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 10-14 days<br />
<br />
EITHER OF ABOVE WITH OR WITHOUT*:<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
* Consider otolaryngology consult to rule out anatomic abnormality.<br />
<br />
* If acute exacerbation, treat as acute sinusitis.<br />
<br />
* HIV positive patients may need a 2-3 week course.<br />
|-<br />
|'''Treatment of active tuberculosis'''<br />
|<br />
|'''Isoniazid''' 300 mg PO daily x 6 months<br />
PLUS<br />
<br />
'''Rifampin''' 600 mg PO daily x 6 months<br />
<br />
PLUS<br />
<br />
'''Pyrazinamide''' 25 mg/kg PO daily x 2 months<br />
<br />
PLUS<br />
<br />
'''Ethambutol''' 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established<br />
<br />
PLUS:<br />
<br />
'''Pyridoxine''' (Vitamin B-6) 50 mg PO daily for 6 months<br />
|<br />
|-<br />
|'''Latent TB'''<br />
|<br />
|'<nowiki/>'''''Isoniazid'''''' 300 mg PO daily x 9 months<br />
|'''Rifampin''' 600 mg PO daily x 4 months <br />
|}<br />
{| class="wikitable"<br />
|'''Abscess'''<br />
|'<nowiki/>'''S. aureus''''<br />
|<br />
* Uncomplicated: Incision and drainage, no antibiotics needed<br />
* Complicated: Incision and drainage PLUS '''TMP/SMX''' 1-2 DS tablets PO BID OR '''Doxycycline''' 100 mg PO BID<br />
|Give antibiotics for complicated abscess<br />
* Abscess is large (> 5 cm) or incompletely drained<br />
* There is significant surrounding cellulitis<br />
* Systemic signs and symptoms of infection are present<br />
* Patient is immunocompromised<br />
7-10 days of therapy is generally adequate<br />
|-<br />
|'''Bites'''<br />
Dog and Cat<br />
|Streptococci<br />
''Pasteurella'' spp.*<br />
<br />
Staphylococci<br />
<br />
Oral anaerobes <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID<br />
<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days <br />
|For severe PCN allergy<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily<br />
* Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected.<br />
<br />
* '''Prophylaxis''' in high risk patients or in high risk bite only:<br />
<br />
* ''High risk patient'' = post splenectomy, immunocompromised<br />
<br />
* ''High risk bite'' = hand or foot<br />
* ''P.multocida'' is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin<br />
|-<br />
|'''Bites'''<br />
<br />
Human<br />
|Viridans streptococci<br />
''Eikenella''*<br />
<br />
Oral anaerobes<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''500 mg PO daily<br />
<br />
OR<br />
<br />
'''TMP/SMX''' One DS tablet PO BID<br />
|}<br />
{| class="wikitable"<br />
|'''Cellulitis'''<br />
|β-hemolytic streptococci (most common)<br />
''S. aureus'' (less common)<br />
|'''Cephalexin'''500 mg PO QID<br />
OR<br />
<br />
'''Amoxicillin'''500 mg PO TID<br />
<br />
OR<br />
<br />
'''Clindamycin'''300 mg PO TID<br />
|<br />
* If the patient does not respond to beta-lactam-based therapy consider adding TMP/SMX or doxycycline for MRSA coverage.<br />
<br />
* Clindamycin monotherapy provides reasonable coverage for both Group A strep and community-acquired MRSA however some isolates may be resistant. Please refer to hospital-specific antibiogram.<br />
<br />
* For cellulitis associated with an abscess treat for complicated abscess (see below).<br />
<br />
* 7-10 days of therapy is generally adequate<br />
|-<br />
|'''Diabetic Foot Ulcer'''<br />
Localized cellulitis without systemic signs or symptoms, no osteomyelitis<br />
|''S. aureus''<br />
''Streptococci''<br />
<br />
''Enterobacteriaceae''<br />
|'''Clindamycin''' 300 mg PO TID<br />
If patient has been treated with antibiotics within the past month ADD:<br />
<br />
'''Levofloxacin'''ID-R: VASF 750 mg PO daily<br />
<br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID <br />
|<br />
* While infections may be polymicrobial, they frequently respond to Gram-positive coverage alone.<br />
<br />
* Increasing rates of MRSA in the community may be a cause for failure to respond to initial therapy.<br />
<br />
* Consider osteomyelitis especially if there is a failure to respond to therapy.<br />
<br />
* 7-14 days of treatment is generally sufficient, duration should be based on clinical response.<br />
|-<br />
|Herpes Zoster<br />
|'''Immunocompetent'''<br />
(Shingles/Zoster)<br />
<br />
'''Immunocompromised'''<br />
<br />
(Lymphoma, HIV infection, etc) and not severe (one dermatome)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 7-10 days<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO TID x 7 days<br />
|<br />
* Treatment effective only if initiated within 48-72 hours of onset of lesions. May shorten duration of illness in immunocompetent patients.<br />
<br />
* In patients > 65 years old administration of concomitant corticosteroids may improve quality of life.<br />
|-<br />
|'''Primary Infection in Adults''' (Chicken Pox)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 5 days<br />
OR<br />
<br />
'<nowiki/>'''''Valacyclovir'''''' 1 g PO TID x 5 days<br />
|<br />
|<br />
* Initiate therapy within 24 hours of onset of rash.<br />
<br />
* Vaccination of non-immune close contacts recommended. Acyclovir treatment may also be effective for prophylaxis of at-risk individuals.<br />
|-<br />
|'''Mastitis'''<br />
Postpartum<br />
|''S. aureus''<br />
''Including MRSA becoming more frequent''<br />
|'''Dicloxacillin''' 500 mg PO QID x 10-14 days<br />
OR<br />
<br />
'''Cephalexin''' 500 mg PO QID x 10 -14 days<br />
<br />
If patient with risk factors for MRSA:<br />
<br />
'''TMP/SMX''' One DS tablet PO BID x 10-14 days<br />
<br />
OR<br />
<br />
'''Clindamycin''' 300mg PO TID x 10-14 days<br />
|For mild PCN allergy:<br />
'''Cephalexin''' 500 mg PO QID x 10-14 days<br />
<br />
For severe PCN allergy:<br />
<br />
'''Clindamycin''' 300 mg PO TID x 10-14 days<br />
* If no abscess, increased frequency of nursing may hasten response.<br />
<br />
* If abscess, I & D required; discontinue nursing.<br />
<br />
* Doxycycline is active against MRSA but should not be used if patient is breastfeeding.<br />
|}<br />
{| class="wikitable"<br />
|'''Uncomplicated Cystitis'''<br />
Women<br />
|Enterobacteriaceae ''(E. coli)''<br />
''S. saprophyticus'' (Coagulase negative staphylococcus) (4%)<br />
|'''Nitrofurantoin''' 100 mg PO BID x 5-7 days – contraindicated in renal insufficiency (CrCl < 60 ml/min)<br />
OR<br />
<br />
'''TMP/SMX''' 1 DS tablet PO BID x 3 days (if no previous antibiotic therapy)<br />
<br />
OR<br />
<br />
'''Fosfomycin''' 3 g PO x1 dose<br />
|Reserve for patients at highest risk of failure (selection for resistant isolates):<br />
'''Ciprofloxacin''' 500 mg PO BID x 3 days<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 3 days<br />
<br />
Reserve for patients with history of resistant organisms or therapeutic failure (less effective):<br />
<br />
'''Cephalexin''' 500 mg PO QID x 7 days<br />
<br />
OR<br />
<br />
'''Cefpodoxime''' 200 mg PO BID x 7 days<br />
* IDSA guidelines state Trimethoprim/ Sulfamethoxazole is appropriate if resistance rates do not exceed 20%.<br />
* Nitrofurantoin is contraindicated in renal insufficiency (CrCl <60 ml/min).<br />
|-<br />
|'''Recurrent Cystitis'''<br />
|Enterobacteriaceae (''E. coli'')<br />
''S. saprophyticus''(Coagulase negative staphylococcus) (4%)<br />
|Prophylaxis:<br />
Either self administration if symptoms occur or prophylactic post-coital antibiotics<br />
<br />
Post menopausal: topical estrogen<br />
|<br />
|-<br />
|'''Asymptomatic bacteriuria'''<br />
|''E.coli''<br />
''Klebsiella''<br />
<br />
''Enterococcus''<br />
|No treatment required<br />
|<br />
|-<br />
|'''Pyelonephritis'''<br />
|Enterobacteriaceae ''(E. coli)''<br />
Enterococci<br />
|'''Ciprofloxacin''' 500 mg PO BID X 7-14 days<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily X 7-14 days<br />
<br />
OR<br />
<br />
'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID X 14 days<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
|'''Cephalexin''' 500 mg PO QID X 10-14 days<br />
OR<br />
<br />
'''Cefpodoxime'''200 mg PO BID X 10-14 days<br />
<br />
EITHER OF ABOVE PLUS:<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
* Urine analysis and urine culture should be performed and therapy adjusted based on culture and sensitivity.<br />
<br />
* Trimethoprim-sulfamethoxazole is preferred if organism is susceptible.<br />
<br />
* Consider a single intravenous dose of ceftriaxone prior to fluoroquinolone therapy if patient is at high risk for fluoroquinolone-resistant organisms.<br />
|-<br />
|'''Prostatitis'''<br />
Acute<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Cephalexin''' 500 mg PO QID x 21 days <br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BIDX 2-4 weeks*<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily x 2-4 weeks*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Antibiotic penetration in the acute inflammatory state is adequate for most antibiotics.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
<br />
* Cultures should be obtained and definitive therapy should be based on sensitivities.<br />
|-<br />
|'''Prostatitis'''<br />
Chronic<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Ciprofloxacin''' x 2 months*<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF x 2 months*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Few drugs penetrate non-inflamed prostate. Fluoroquinolones and trimethoprim/sulfamethoxazole adequately penetrate in non-inflamed state.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
|}<br />
{| class="wikitable"<br />
|'''Chlamydia''' <br />
'''Genital/Rectal'''<br />
<br />
''''''Pharyngeal'''''' <br />
|''''Chlamydia trachomatis''''<br />
|'''Azithromycin''' 1 g PO once<br />
OR<br />
<br />
''''''Doxycycline'''''' 100 mg PO BID X 7 days<br />
|<br />
|-<br />
|'''First Clinical Episode or Anogenital Herpes'''<br />
|HSV 2 = 70-90%<br />
HSV 1 = 10-30% <br />
|'''Acyclovir''' 400 mg PO TID x 7-10 days<br />
|'''Valacyclovir''' 1 g PO BID x 7-10 days<br />
In HIV patients with documented acyclovir resistance, use foscarnet.<br />
|-<br />
|'''Episodic Therapy for Recurrent Episodes'''<br />
|<br />
|'''Acyclovir''' 400 mg PO TID x 5 days<br />
OR<br />
<br />
'''Acyclovir''' 800 mg PO BID x 5 days<br />
<br />
OR<br />
<br />
'''Acyclovir''' 800 mg PO TID x 2 days<br />
|'''Valacyclovir''' 1 g PO daily x 5 days <br />
* HIV patients:<br />
'''Acyclovir''' 400 mg PO TID x 5-10 days<br />
<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO BID x 5-10 days<br />
|-<br />
|'''Suppression for Frequent Recurrence'''<br />
|HSV 2 = 70-90%<br />
HSV 1 = 10-30%<br />
|'''Acyclovir''' 400 mg PO BID<br />
HIV patients:<br />
<br />
'''Acyclovir''' 400-800 mg BID or TID<br />
<br />
OR<br />
<br />
'''Valacyclovir''' 500 mg PO BID<br />
|'''Valacyclovir''' 500-1000 mg PO daily<br />
Consider suppressive therapy for patients experiencing greater than 3-4 episodes in 12 months. <br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322138Sandbox:Reddy2017-06-29T20:17:57Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
'<nowiki/>'''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'<nowiki/>'''''Acute Bronchitis''''''<br />
| ''Viral''<br />
|No drug therapy required <br />
|<br />
|-<br />
|'''Acute bacterial exacerbation of chronic bronchitis (COPD)'''<br />
|''S. pneumoniae''<br />
''H. influenzae'' <br />
<br />
''Moraxellacatarrhalis''<br />
|'''Doxycycline''' 100 mg PO BID X 10 days<br />
|'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
|-<br />
|'''Community-acquired Pneumonia (CAP)''' <br />
|''S. pneumoniae''<br />
''M. pneumoniae''<br />
<br />
''C. pneumoniae''<br />
<br />
Respiratory viruses<br />
<br />
''Legionella'' spp.<br />
<br />
C. psittaci<br />
<br />
'<nowiki/>'''H. influenzae'' (if patient has co-morbidity)'''''<br />
|No recent antibiotic therapy:<br />
'''Doxycycline''' 100 mg PO BID X 7 days<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
<br />
Recent antibiotic therapy or patients with co-morbidities:<br />
<br />
'''Levofloxacin''' 750 mg PO daily X 5 days<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily X 7 days<br />
|'''Previous antibiotic therapy within last 3 month''' should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa.<br />
Careful follow-up highly recommended.<br />
|-<br />
|Anerobic infection<br />
|<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
OR<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
|<br />
|-<br />
|'''Acute otitis media'''<br />
OR<br />
<br />
'<nowiki/>'''''Otitis media with effusion'<nowiki/>'' '''(OME)''' with signs or symptoms of acute infection''' <br />
|''S. pneumoniae''<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
''Group A Strep.''<br />
|'''Amoxicillin'''<br />
1 g PO BID x 5-7 days<br />
<br />
OR<br />
<br />
500 mg PO TID x 5-7 days<br />
|For severe PCN allergy:<br />
'''Azithromycin''' 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days<br />
<br />
OR<br />
<br />
'''Doxycycline''' 100 mg PO BID for 5-7 days<br />
* Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.<br />
<br />
* High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant ''S. pneumoniae''.<br />
<br />
* OME in the absence of acute signs and symptom of infection does not require antibiotics.<br />
<br />
* For recurrent prolonged otitis consider ENT referral.<br />
|-<br />
|'''Pharyngitis'''<br />
|Viral (EBV, rhinovirus, coronavirus, adenovirus etc)<br />
''Group A Streptococcus''<br />
<br />
(5-20%)<br />
|'''Penicillin VK''' 250 mg PO TID-QID x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin'''300 mg PO TID x 7-10 days<br />
* Most pharyngitis is viral thus antibiotics should not be used.<br />
<br />
* Treatment with PCN prevents rheumatic fever.<br />
<br />
* Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present.<br />
<br />
* Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.<br />
|-<br />
|'''Acute Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
|'''Amoxicillin''' 500 mg PO TID X 5-7 days<br />
|For severe PCN allergy:<br />
'''Doxycycline''' 100 mg PO BID X 5-7 days<br />
<br />
Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.<br />
|-<br />
|'''Chronic Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
Anaerobes<br />
<br />
''Staph. aureus''<br />
<br />
''Enterobacteriacae'' <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID X 10-14 days<br />
<br />
OR<br />
<br />
'''Amoxicillin/clavulanate''' CR 2 g BID X 10-14 days if drug-resistant ''Streptococcus pneumonia'' <br />
|For severe PCN allergy:<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 10-14 days<br />
<br />
EITHER OF ABOVE WITH OR WITHOUT*:<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
* Consider otolaryngology consult to rule out anatomic abnormality.<br />
<br />
* If acute exacerbation, treat as acute sinusitis.<br />
<br />
* HIV positive patients may need a 2-3 week course.<br />
|-<br />
|'''Treatment of active tuberculosis'''<br />
|<br />
|'''Isoniazid''' 300 mg PO daily x 6 months<br />
PLUS<br />
<br />
'''Rifampin''' 600 mg PO daily x 6 months<br />
<br />
PLUS<br />
<br />
'''Pyrazinamide''' 25 mg/kg PO daily x 2 months<br />
<br />
PLUS<br />
<br />
'''Ethambutol''' 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established<br />
<br />
PLUS:<br />
<br />
'''Pyridoxine''' (Vitamin B-6) 50 mg PO daily for 6 months<br />
|<br />
|-<br />
|'''Latent TB'''<br />
|<br />
|'<nowiki/>'''''Isoniazid'''''' 300 mg PO daily x 9 months<br />
|'''Rifampin''' 600 mg PO daily x 4 months <br />
|}<br />
{| class="wikitable"<br />
|'''Abscess'''<br />
|'<nowiki/>'''S. aureus''''<br />
|<br />
* Uncomplicated: Incision and drainage, no antibiotics needed<br />
* Complicated: Incision and drainage PLUS '''TMP/SMX''' 1-2 DS tablets PO BID OR '''Doxycycline''' 100 mg PO BID<br />
|Give antibiotics for complicated abscess<br />
* Abscess is large (> 5 cm) or incompletely drained<br />
* There is significant surrounding cellulitis<br />
* Systemic signs and symptoms of infection are present<br />
* Patient is immunocompromised<br />
7-10 days of therapy is generally adequate<br />
|-<br />
|'''Bites'''<br />
Dog and Cat<br />
|Streptococci<br />
''Pasteurella'' spp.*<br />
<br />
Staphylococci<br />
<br />
Oral anaerobes <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID<br />
<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days <br />
|For severe PCN allergy<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily<br />
* Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected.<br />
<br />
* '''Prophylaxis''' in high risk patients or in high risk bite only:<br />
<br />
* ''High risk patient'' = post splenectomy, immunocompromised<br />
<br />
* ''High risk bite'' = hand or foot<br />
* ''P.multocida'' is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin<br />
|-<br />
|'''Bites'''<br />
<br />
Human<br />
|Viridans streptococci<br />
''Eikenella''*<br />
<br />
Oral anaerobes<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''500 mg PO daily<br />
<br />
OR<br />
<br />
'''TMP/SMX''' One DS tablet PO BID<br />
|}<br />
{| class="wikitable"<br />
|'''Cellulitis'''<br />
|β-hemolytic streptococci (most common)<br />
''S. aureus'' (less common)<br />
|'''Cephalexin'''500 mg PO QID<br />
OR<br />
<br />
'''Amoxicillin'''500 mg PO TID<br />
<br />
OR<br />
<br />
'''Clindamycin'''300 mg PO TID<br />
|<br />
* If the patient does not respond to beta-lactam-based therapy consider adding TMP/SMX or doxycycline for MRSA coverage.<br />
<br />
* Clindamycin monotherapy provides reasonable coverage for both Group A strep and community-acquired MRSA however some isolates may be resistant. Please refer to hospital-specific antibiogram.<br />
<br />
* For cellulitis associated with an abscess treat for complicated abscess (see below).<br />
<br />
* 7-10 days of therapy is generally adequate<br />
|-<br />
|'''Diabetic Foot Ulcer'''<br />
Localized cellulitis without systemic signs or symptoms, no osteomyelitis<br />
|''S. aureus''<br />
''Streptococci''<br />
<br />
''Enterobacteriaceae''<br />
|'''Clindamycin''' 300 mg PO TID<br />
If patient has been treated with antibiotics within the past month ADD:<br />
<br />
'''Levofloxacin'''ID-R: VASF 750 mg PO daily<br />
<br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID <br />
|<br />
* While infections may be polymicrobial, they frequently respond to Gram-positive coverage alone.<br />
<br />
* Increasing rates of MRSA in the community may be a cause for failure to respond to initial therapy.<br />
<br />
* Consider osteomyelitis especially if there is a failure to respond to therapy.<br />
<br />
* 7-14 days of treatment is generally sufficient, duration should be based on clinical response.<br />
|-<br />
|Herpes Zoster<br />
|'''Immunocompetent'''<br />
(Shingles/Zoster)<br />
<br />
'''Immunocompromised'''<br />
<br />
(Lymphoma, HIV infection, etc) and not severe (one dermatome)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 7-10 days<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO TID x 7 days<br />
|<br />
* Treatment effective only if initiated within 48-72 hours of onset of lesions. May shorten duration of illness in immunocompetent patients.<br />
<br />
* In patients > 65 years old administration of concomitant corticosteroids may improve quality of life.<br />
|-<br />
|'''Primary Infection in Adults''' (Chicken Pox)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 5 days<br />
OR<br />
<br />
'<nowiki/>'''''Valacyclovir'''''' 1 g PO TID x 5 days<br />
|<br />
|<br />
* Initiate therapy within 24 hours of onset of rash.<br />
<br />
* Vaccination of non-immune close contacts recommended. Acyclovir treatment may also be effective for prophylaxis of at-risk individuals.<br />
|-<br />
|'''Mastitis'''<br />
Postpartum<br />
|''S. aureus''<br />
''Including MRSA becoming more frequent''<br />
|'''Dicloxacillin''' 500 mg PO QID x 10-14 days<br />
OR<br />
<br />
'''Cephalexin''' 500 mg PO QID x 10 -14 days<br />
<br />
If patient with risk factors for MRSA:<br />
<br />
'''TMP/SMX''' One DS tablet PO BID x 10-14 days<br />
<br />
OR<br />
<br />
'''Clindamycin''' 300mg PO TID x 10-14 days<br />
|For mild PCN allergy:<br />
'''Cephalexin''' 500 mg PO QID x 10-14 days<br />
<br />
For severe PCN allergy:<br />
<br />
'''Clindamycin''' 300 mg PO TID x 10-14 days<br />
* If no abscess, increased frequency of nursing may hasten response.<br />
<br />
* If abscess, I & D required; discontinue nursing.<br />
<br />
* Doxycycline is active against MRSA but should not be used if patient is breastfeeding.<br />
|}<br />
{| class="wikitable"<br />
|'''Uncomplicated Cystitis'''<br />
Women<br />
|Enterobacteriaceae ''(E. coli)''<br />
''S. saprophyticus'' (Coagulase negative staphylococcus) (4%)<br />
|'''Nitrofurantoin''' 100 mg PO BID x 5-7 days – contraindicated in renal insufficiency (CrCl < 60 ml/min)<br />
OR<br />
<br />
'''TMP/SMX''' 1 DS tablet PO BID x 3 days (if no previous antibiotic therapy)<br />
<br />
OR<br />
<br />
'''Fosfomycin''' 3 g PO x1 dose<br />
|Reserve for patients at highest risk of failure (selection for resistant isolates):<br />
'''Ciprofloxacin''' 500 mg PO BID x 3 days<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 3 days<br />
<br />
Reserve for patients with history of resistant organisms or therapeutic failure (less effective):<br />
<br />
'''Cephalexin''' 500 mg PO QID x 7 days<br />
<br />
OR<br />
<br />
'''Cefpodoxime''' 200 mg PO BID x 7 days<br />
* IDSA guidelines state Trimethoprim/ Sulfamethoxazole is appropriate if resistance rates do not exceed 20%.<br />
* Nitrofurantoin is contraindicated in renal insufficiency (CrCl <60 ml/min).<br />
|-<br />
|'''Recurrent Cystitis'''<br />
|Enterobacteriaceae (''E. coli'')<br />
''S. saprophyticus''(Coagulase negative staphylococcus) (4%)<br />
|Prophylaxis:<br />
Either self administration if symptoms occur or prophylactic post-coital antibiotics<br />
<br />
Post menopausal: topical estrogen<br />
|<br />
|-<br />
|'''Asymptomatic bacteriuria'''<br />
|''E.coli''<br />
''Klebsiella''<br />
<br />
''Enterococcus''<br />
|No treatment required<br />
|<br />
|-<br />
|'''Pyelonephritis'''<br />
|Enterobacteriaceae ''(E. coli)''<br />
Enterococci<br />
|'''Ciprofloxacin''' 500 mg PO BID X 7-14 days<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily X 7-14 days<br />
<br />
OR<br />
<br />
'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID X 14 days<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
|'''Cephalexin''' 500 mg PO QID X 10-14 days<br />
OR<br />
<br />
'''Cefpodoxime'''200 mg PO BID X 10-14 days<br />
<br />
EITHER OF ABOVE PLUS:<br />
<br />
'''Ceftriaxone''' 1 g IV X 1 dose<br />
* Urine analysis and urine culture should be performed and therapy adjusted based on culture and sensitivity.<br />
<br />
* Trimethoprim-sulfamethoxazole is preferred if organism is susceptible.<br />
<br />
* Consider a single intravenous dose of ceftriaxone prior to fluoroquinolone therapy if patient is at high risk for fluoroquinolone-resistant organisms.<br />
|-<br />
|'''Prostatitis'''<br />
Acute<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Cephalexin''' 500 mg PO QID x 21 days <br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BIDX 2-4 weeks*<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily x 2-4 weeks*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Antibiotic penetration in the acute inflammatory state is adequate for most antibiotics.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
<br />
* Cultures should be obtained and definitive therapy should be based on sensitivities.<br />
|-<br />
|'''Prostatitis'''<br />
Chronic<br />
|Enterobacteriaceae''(E. coli)''<br />
|'''Ciprofloxacin''' x 2 months*<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF x 2 months*<br />
|'''Trimethoprim/ Sulfamethoxazole''' 1 DS tablet PO BID<br />
* Few drugs penetrate non-inflamed prostate. Fluoroquinolones and trimethoprim/sulfamethoxazole adequately penetrate in non-inflamed state.<br />
<br />
* Consider sexually transmitted disease treatment (Gonococcus or ''C. trachomatis'') for appropriate patient populations.<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322134Sandbox:Reddy2017-06-29T20:11:56Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
'<nowiki/>'''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}<br />
{| class="wikitable"<br />
!<br />
!<br />
!<br />
!<br />
|-<br />
|'<nowiki/>'''''Acute Bronchitis''''''<br />
| ''Viral''<br />
|No drug therapy required <br />
|<br />
|-<br />
|'''Acute bacterial exacerbation of chronic bronchitis (COPD)'''<br />
|''S. pneumoniae''<br />
''H. influenzae'' <br />
<br />
''Moraxellacatarrhalis''<br />
|'''Doxycycline''' 100 mg PO BID X 10 days<br />
|'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
|-<br />
|'''Community-acquired Pneumonia (CAP)''' <br />
|''S. pneumoniae''<br />
''M. pneumoniae''<br />
<br />
''C. pneumoniae''<br />
<br />
Respiratory viruses<br />
<br />
''Legionella'' spp.<br />
<br />
C. psittaci<br />
<br />
'<nowiki/>'''H. influenzae'' (if patient has co-morbidity)'''''<br />
|No recent antibiotic therapy:<br />
'''Doxycycline''' 100 mg PO BID X 7 days<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
<br />
Recent antibiotic therapy or patients with co-morbidities:<br />
<br />
'''Levofloxacin''' 750 mg PO daily X 5 days<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily X 7 days<br />
|'''Previous antibiotic therapy within last 3 month''' should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa.<br />
Careful follow-up highly recommended.<br />
|-<br />
|Anerobic infection<br />
|<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
OR<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
|<br />
|-<br />
|'''Acute otitis media'''<br />
OR<br />
<br />
'<nowiki/>'''''Otitis media with effusion'<nowiki/>'' '''(OME)''' with signs or symptoms of acute infection''' <br />
|''S. pneumoniae''<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
''Group A Strep.''<br />
|'''Amoxicillin'''<br />
1 g PO BID x 5-7 days<br />
<br />
OR<br />
<br />
500 mg PO TID x 5-7 days<br />
|For severe PCN allergy:<br />
'''Azithromycin''' 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days<br />
<br />
OR<br />
<br />
'''Doxycycline''' 100 mg PO BID for 5-7 days<br />
* Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.<br />
<br />
* High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant ''S. pneumoniae''.<br />
<br />
* OME in the absence of acute signs and symptom of infection does not require antibiotics.<br />
<br />
* For recurrent prolonged otitis consider ENT referral.<br />
|-<br />
|'''Pharyngitis'''<br />
|Viral (EBV, rhinovirus, coronavirus, adenovirus etc)<br />
''Group A Streptococcus''<br />
<br />
(5-20%)<br />
|'''Penicillin VK''' 250 mg PO TID-QID x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin'''300 mg PO TID x 7-10 days<br />
* Most pharyngitis is viral thus antibiotics should not be used.<br />
<br />
* Treatment with PCN prevents rheumatic fever.<br />
<br />
* Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present.<br />
<br />
* Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.<br />
|-<br />
|'''Acute Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
|'''Amoxicillin''' 500 mg PO TID X 5-7 days<br />
|For severe PCN allergy:<br />
'''Doxycycline''' 100 mg PO BID X 5-7 days<br />
<br />
Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.<br />
|-<br />
|'''Chronic Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
Anaerobes<br />
<br />
''Staph. aureus''<br />
<br />
''Enterobacteriacae'' <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID X 10-14 days<br />
<br />
OR<br />
<br />
'''Amoxicillin/clavulanate''' CR 2 g BID X 10-14 days if drug-resistant ''Streptococcus pneumonia'' <br />
|For severe PCN allergy:<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 10-14 days<br />
<br />
EITHER OF ABOVE WITH OR WITHOUT*:<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
* Consider otolaryngology consult to rule out anatomic abnormality.<br />
<br />
* If acute exacerbation, treat as acute sinusitis.<br />
<br />
* HIV positive patients may need a 2-3 week course.<br />
|-<br />
|'''Treatment of active tuberculosis'''<br />
|<br />
|'''Isoniazid''' 300 mg PO daily x 6 months<br />
PLUS<br />
<br />
'''Rifampin''' 600 mg PO daily x 6 months<br />
<br />
PLUS<br />
<br />
'''Pyrazinamide''' 25 mg/kg PO daily x 2 months<br />
<br />
PLUS<br />
<br />
'''Ethambutol''' 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established<br />
<br />
PLUS:<br />
<br />
'''Pyridoxine''' (Vitamin B-6) 50 mg PO daily for 6 months<br />
|<br />
|-<br />
|'''Latent TB'''<br />
|<br />
|'<nowiki/>'''''Isoniazid'''''' 300 mg PO daily x 9 months<br />
|'''Rifampin''' 600 mg PO daily x 4 months <br />
|}<br />
{| class="wikitable"<br />
|'''Abscess'''<br />
|'<nowiki/>'''S. aureus''''<br />
|<br />
* Uncomplicated: Incision and drainage, no antibiotics needed<br />
* Complicated: Incision and drainage PLUS '''TMP/SMX''' 1-2 DS tablets PO BID OR '''Doxycycline''' 100 mg PO BID<br />
|Give antibiotics for complicated abscess<br />
* Abscess is large (> 5 cm) or incompletely drained<br />
* There is significant surrounding cellulitis<br />
* Systemic signs and symptoms of infection are present<br />
* Patient is immunocompromised<br />
7-10 days of therapy is generally adequate<br />
|-<br />
|'''Bites'''<br />
Dog and Cat<br />
|Streptococci<br />
''Pasteurella'' spp.*<br />
<br />
Staphylococci<br />
<br />
Oral anaerobes <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID<br />
<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days <br />
|For severe PCN allergy<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily<br />
* Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected.<br />
<br />
* '''Prophylaxis''' in high risk patients or in high risk bite only:<br />
<br />
* ''High risk patient'' = post splenectomy, immunocompromised<br />
<br />
* ''High risk bite'' = hand or foot<br />
* ''P.multocida'' is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin<br />
|-<br />
|'''Bites'''<br />
<br />
Human<br />
|Viridans streptococci<br />
''Eikenella''*<br />
<br />
Oral anaerobes<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''500 mg PO daily<br />
<br />
OR<br />
<br />
'''TMP/SMX''' One DS tablet PO BID<br />
|}<br />
{| class="wikitable"<br />
|'''Cellulitis'''<br />
|β-hemolytic streptococci (most common)<br />
''S. aureus'' (less common)<br />
|'''Cephalexin'''500 mg PO QID<br />
OR<br />
<br />
'''Amoxicillin'''500 mg PO TID<br />
<br />
OR<br />
<br />
'''Clindamycin'''300 mg PO TID<br />
|<br />
* If the patient does not respond to beta-lactam-based therapy consider adding TMP/SMX or doxycycline for MRSA coverage.<br />
<br />
* Clindamycin monotherapy provides reasonable coverage for both Group A strep and community-acquired MRSA however some isolates may be resistant. Please refer to hospital-specific antibiogram.<br />
<br />
* For cellulitis associated with an abscess treat for complicated abscess (see below).<br />
<br />
* 7-10 days of therapy is generally adequate<br />
|-<br />
|'''Diabetic Foot Ulcer'''<br />
Localized cellulitis without systemic signs or symptoms, no osteomyelitis<br />
|''S. aureus''<br />
''Streptococci''<br />
<br />
''Enterobacteriaceae''<br />
|'''Clindamycin''' 300 mg PO TID<br />
If patient has been treated with antibiotics within the past month ADD:<br />
<br />
'''Levofloxacin'''ID-R: VASF 750 mg PO daily<br />
<br />
OR<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID <br />
|<br />
* While infections may be polymicrobial, they frequently respond to Gram-positive coverage alone.<br />
<br />
* Increasing rates of MRSA in the community may be a cause for failure to respond to initial therapy.<br />
<br />
* Consider osteomyelitis especially if there is a failure to respond to therapy.<br />
<br />
* 7-14 days of treatment is generally sufficient, duration should be based on clinical response.<br />
|-<br />
|Herpes Zoster<br />
|'''Immunocompetent'''<br />
(Shingles/Zoster)<br />
<br />
'''Immunocompromised'''<br />
<br />
(Lymphoma, HIV infection, etc) and not severe (one dermatome)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 7-10 days<br />
OR<br />
<br />
'''Valacyclovir''' 1 g PO TID x 7 days<br />
|<br />
* Treatment effective only if initiated within 48-72 hours of onset of lesions. May shorten duration of illness in immunocompetent patients.<br />
<br />
* In patients > 65 years old administration of concomitant corticosteroids may improve quality of life.<br />
|-<br />
|'''Primary Infection in Adults''' (Chicken Pox)<br />
|'''Acyclovir''' 800 mg PO 5x/day x 5 days<br />
OR<br />
<br />
''''''Valacyclovir'''''' 1 g PO TID x 5 days<br />
|<br />
|<br />
* Initiate therapy within 24 hours of onset of rash.<br />
<br />
* Vaccination of non-immune close contacts recommended. Acyclovir treatment may also be effective for prophylaxis of at-risk individuals.<br />
|-<br />
|'''Mastitis'''<br />
Postpartum<br />
|''S. aureus''<br />
''Including MRSA becoming more frequent''<br />
|'''Dicloxacillin''' 500 mg PO QID x 10-14 days<br />
OR<br />
<br />
'''Cephalexin''' 500 mg PO QID x 10 -14 days<br />
<br />
If patient with risk factors for MRSA:<br />
<br />
'''TMP/SMX''' One DS tablet PO BID x 10-14 days<br />
<br />
OR<br />
<br />
'''Clindamycin''' 300mg PO TID x 10-14 days<br />
|For mild PCN allergy:<br />
'''Cephalexin''' 500 mg PO QID x 10-14 days<br />
<br />
For severe PCN allergy:<br />
<br />
'''Clindamycin''' 300 mg PO TID x 10-14 days<br />
* If no abscess, increased frequency of nursing may hasten response.<br />
<br />
* If abscess, I & D required; discontinue nursing.<br />
<br />
* Doxycycline is active against MRSA but should not be used if patient is breastfeeding.<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322123Sandbox:Reddy2017-06-29T20:06:40Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
'<nowiki/>'''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}<br />
{| class="wikitable"<br />
!<br />
!<br />
!<br />
!<br />
|-<br />
|'<nowiki/>'''''Acute Bronchitis''''''<br />
| ''Viral''<br />
|No drug therapy required <br />
|<br />
|-<br />
|'''Acute bacterial exacerbation of chronic bronchitis (COPD)'''<br />
|''S. pneumoniae''<br />
''H. influenzae'' <br />
<br />
''Moraxellacatarrhalis''<br />
|'''Doxycycline''' 100 mg PO BID X 10 days<br />
|'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
|-<br />
|'''Community-acquired Pneumonia (CAP)''' <br />
|''S. pneumoniae''<br />
''M. pneumoniae''<br />
<br />
''C. pneumoniae''<br />
<br />
Respiratory viruses<br />
<br />
''Legionella'' spp.<br />
<br />
C. psittaci<br />
<br />
'<nowiki/>'''H. influenzae'' (if patient has co-morbidity)'''''<br />
|No recent antibiotic therapy:<br />
'''Doxycycline''' 100 mg PO BID X 7 days<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
<br />
Recent antibiotic therapy or patients with co-morbidities:<br />
<br />
'''Levofloxacin''' 750 mg PO daily X 5 days<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily X 7 days<br />
|'''Previous antibiotic therapy within last 3 month''' should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa.<br />
Careful follow-up highly recommended.<br />
|-<br />
|Anerobic infection<br />
|<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
OR<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
|<br />
|-<br />
|'''Acute otitis media'''<br />
OR<br />
<br />
'<nowiki/>'''''Otitis media with effusion'<nowiki/>'' '''(OME)''' with signs or symptoms of acute infection''' <br />
|''S. pneumoniae''<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
''Group A Strep.''<br />
|'''Amoxicillin'''<br />
1 g PO BID x 5-7 days<br />
<br />
OR<br />
<br />
500 mg PO TID x 5-7 days<br />
|For severe PCN allergy:<br />
'''Azithromycin''' 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days<br />
<br />
OR<br />
<br />
'''Doxycycline''' 100 mg PO BID for 5-7 days<br />
* Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.<br />
<br />
* High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant ''S. pneumoniae''.<br />
<br />
* OME in the absence of acute signs and symptom of infection does not require antibiotics.<br />
<br />
* For recurrent prolonged otitis consider ENT referral.<br />
|-<br />
|'''Pharyngitis'''<br />
|Viral (EBV, rhinovirus, coronavirus, adenovirus etc)<br />
''Group A Streptococcus''<br />
<br />
(5-20%)<br />
|'''Penicillin VK''' 250 mg PO TID-QID x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin'''300 mg PO TID x 7-10 days<br />
* Most pharyngitis is viral thus antibiotics should not be used.<br />
<br />
* Treatment with PCN prevents rheumatic fever.<br />
<br />
* Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present.<br />
<br />
* Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.<br />
|-<br />
|'''Acute Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
|'''Amoxicillin''' 500 mg PO TID X 5-7 days<br />
|For severe PCN allergy:<br />
'''Doxycycline''' 100 mg PO BID X 5-7 days<br />
<br />
Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.<br />
|-<br />
|'''Chronic Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
Anaerobes<br />
<br />
''Staph. aureus''<br />
<br />
''Enterobacteriacae'' <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID X 10-14 days<br />
<br />
OR<br />
<br />
'''Amoxicillin/clavulanate''' CR 2 g BID X 10-14 days if drug-resistant ''Streptococcus pneumonia'' <br />
|For severe PCN allergy:<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 10-14 days<br />
<br />
EITHER OF ABOVE WITH OR WITHOUT*:<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
* Consider otolaryngology consult to rule out anatomic abnormality.<br />
<br />
* If acute exacerbation, treat as acute sinusitis.<br />
<br />
* HIV positive patients may need a 2-3 week course.<br />
|-<br />
|'''Treatment of active tuberculosis'''<br />
|<br />
|'''Isoniazid''' 300 mg PO daily x 6 months<br />
PLUS<br />
<br />
'''Rifampin''' 600 mg PO daily x 6 months<br />
<br />
PLUS<br />
<br />
'''Pyrazinamide''' 25 mg/kg PO daily x 2 months<br />
<br />
PLUS<br />
<br />
'''Ethambutol''' 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established<br />
<br />
PLUS:<br />
<br />
'''Pyridoxine''' (Vitamin B-6) 50 mg PO daily for 6 months<br />
|<br />
|-<br />
|'''Latent TB'''<br />
|<br />
|'<nowiki/>'''''Isoniazid'''''' 300 mg PO daily x 9 months<br />
|'''Rifampin''' 600 mg PO daily x 4 months <br />
|}<br />
{| class="wikitable"<br />
|'''Abscess'''<br />
|''''S. aureus''''<br />
|<br />
* Uncomplicated: Incision and drainage, no antibiotics needed<br />
* Complicated: Incision and drainage PLUS '''TMP/SMX''' 1-2 DS tablets PO BID OR '''Doxycycline''' 100 mg PO BID<br />
|Give antibiotics for complicated abscess<br />
* Abscess is large (> 5 cm) or incompletely drained<br />
* There is significant surrounding cellulitis<br />
* Systemic signs and symptoms of infection are present<br />
* Patient is immunocompromised<br />
7-10 days of therapy is generally adequate<br />
|-<br />
|'''Bites'''<br />
Dog and Cat<br />
|Streptococci<br />
''Pasteurella'' spp.*<br />
<br />
Staphylococci<br />
<br />
Oral anaerobes <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID<br />
<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days <br />
|For severe PCN allergy<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily<br />
* Only 5% of dog bites become infected, whereas 30-50% of cat bites become infected.<br />
<br />
* '''Prophylaxis''' in high risk patients or in high risk bite only:<br />
<br />
* ''High risk patient'' = post splenectomy, immunocompromised<br />
<br />
* ''High risk bite'' = hand or foot<br />
* ''P.multocida'' is resistant to cephalexin & clindamycin; many strains are resistant to erythromycin but sensitive to fluoroquinolones, doxycycline and penicillin<br />
|-<br />
|'''Bites'''<br />
<br />
Human<br />
|Viridans streptococci<br />
''Eikenella''*<br />
<br />
Oral anaerobes<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
Prophylaxis – x 5 days<br />
<br />
Treatment – x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin''' 300 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''500 mg PO daily<br />
<br />
OR<br />
<br />
'''TMP/SMX''' One DS tablet PO BID<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322117Sandbox:Reddy2017-06-29T20:02:44Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
'<nowiki/>'''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}<br />
{| class="wikitable"<br />
!<br />
!<br />
!<br />
!<br />
|-<br />
|''''''Acute Bronchitis''''''<br />
| ''Viral''<br />
|No drug therapy required <br />
|<br />
|-<br />
|'''Acute bacterial exacerbation of chronic bronchitis (COPD)'''<br />
|''S. pneumoniae''<br />
''H. influenzae'' <br />
<br />
''Moraxellacatarrhalis''<br />
|'''Doxycycline''' 100 mg PO BID X 10 days<br />
|'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
|-<br />
|'''Community-acquired Pneumonia (CAP)''' <br />
|''S. pneumoniae''<br />
''M. pneumoniae''<br />
<br />
''C. pneumoniae''<br />
<br />
Respiratory viruses<br />
<br />
''Legionella'' spp.<br />
<br />
C. psittaci<br />
<br />
''''H. influenzae'' (if patient has co-morbidity)''<br />
|No recent antibiotic therapy:<br />
'''Doxycycline''' 100 mg PO BID X 7 days<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg PO daily X 1 day; then 250 mg PO daily X 4 days<br />
<br />
Recent antibiotic therapy or patients with co-morbidities:<br />
<br />
'''Levofloxacin''' 750 mg PO daily X 5 days<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily X 7 days<br />
|'''Previous antibiotic therapy within last 3 month''' should be elicited from patient. A course of antibiotics is a risk factor for drug resistance. Recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa.<br />
Careful follow-up highly recommended.<br />
|-<br />
|Anerobic infection<br />
|<br />
|'''Amoxicillin/clavulanate''' 875 mg/125 mg PO BID<br />
OR<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
|<br />
|-<br />
|'''Acute otitis media'''<br />
OR<br />
<br />
''''''Otitis media with effusion''' '''(OME)''' with signs or symptoms of acute infection''' <br />
|''S. pneumoniae''<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
''Group A Strep.''<br />
|'''Amoxicillin'''<br />
1 g PO BID x 5-7 days<br />
<br />
OR<br />
<br />
500 mg PO TID x 5-7 days<br />
|For severe PCN allergy:<br />
'''Azithromycin''' 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days<br />
<br />
OR<br />
<br />
'''Doxycycline''' 100 mg PO BID for 5-7 days<br />
* Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.<br />
<br />
* High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant ''S. pneumoniae''.<br />
<br />
* OME in the absence of acute signs and symptom of infection does not require antibiotics.<br />
<br />
* For recurrent prolonged otitis consider ENT referral.<br />
|-<br />
|'''Pharyngitis'''<br />
|Viral (EBV, rhinovirus, coronavirus, adenovirus etc)<br />
''Group A Streptococcus''<br />
<br />
(5-20%)<br />
|'''Penicillin VK''' 250 mg PO TID-QID x 10 days<br />
|For severe PCN allergy:<br />
'''Clindamycin'''300 mg PO TID x 7-10 days<br />
* Most pharyngitis is viral thus antibiotics should not be used.<br />
<br />
* Treatment with PCN prevents rheumatic fever.<br />
<br />
* Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if 3 out 4 clinical criteria present.<br />
<br />
* Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.<br />
|-<br />
|'''Acute Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
|'''Amoxicillin''' 500 mg PO TID X 5-7 days<br />
|For severe PCN allergy:<br />
'''Doxycycline''' 100 mg PO BID X 5-7 days<br />
<br />
Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.<br />
|-<br />
|'''Chronic Sinusitis'''<br />
|Viruses<br />
''S. pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''M. catarrhalis''<br />
<br />
Anaerobes<br />
<br />
''Staph. aureus''<br />
<br />
''Enterobacteriacae'' <br />
|'''Amoxicillin/clavulanate'''<br />
875 mg/125 mg PO BID X 10-14 days<br />
<br />
OR<br />
<br />
'''Amoxicillin/clavulanate''' CR 2 g BID X 10-14 days if drug-resistant ''Streptococcus pneumonia'' <br />
|For severe PCN allergy:<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg PO daily x 10-14 days<br />
<br />
EITHER OF ABOVE WITH OR WITHOUT*:<br />
<br />
'''Clindamycin''' 300 mg PO TID<br />
* Consider otolaryngology consult to rule out anatomic abnormality.<br />
<br />
* If acute exacerbation, treat as acute sinusitis.<br />
<br />
* HIV positive patients may need a 2-3 week course.<br />
|-<br />
|'''Treatment of active tuberculosis'''<br />
|<br />
|'''Isoniazid''' 300 mg PO daily x 6 months<br />
PLUS<br />
<br />
'''Rifampin''' 600 mg PO daily x 6 months<br />
<br />
PLUS<br />
<br />
'''Pyrazinamide''' 25 mg/kg PO daily x 2 months<br />
<br />
PLUS<br />
<br />
'''Ethambutol''' 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established<br />
<br />
PLUS:<br />
<br />
'''Pyridoxine''' (Vitamin B-6) 50 mg PO daily for 6 months<br />
|<br />
|-<br />
|'''Latent TB'''<br />
|<br />
|''''''Isoniazid'''''' 300 mg PO daily x 9 months<br />
|'''Rifampin''' 600 mg PO daily x 4 months <br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322106Sandbox:Reddy2017-06-29T19:51:49Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
'<nowiki/>'''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}<br />
{| class="wikitable"<br />
|'''Diverticulitis'''<br />
|Enterobacteriaceae<br />
''Bacteroides fragilis''<br />
<br />
''''Enterococcus'''' <br />
|'''Amoxicillin/clavulanate''' <br />
875 mg/125 mg PO BID<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO daily<br />
<br />
OR the combination of:<br />
<br />
'''Metronidazole''' 500 mg PO TID<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 500 mg PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg PO daily<br />
|Duration of treatment should be until patient is afebrile for 3-5 days.<br />
Surgical evaluation and follow up is advised.<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322105Sandbox:Reddy2017-06-29T19:50:03Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>OUT Patient <br />
{| class="wikitable"<br />
|'''Dysenteric Diarrhea'''<br />
Frequent, sometimes bloody, small-volume diarrhea associated with abdominal pain and cramping.<br />
<br />
Patient may be febrile and toxic.<br />
|''Shigella''<br />
''Salmonella''<br />
<br />
''Campylobacter''<br />
<br />
''Yersinia''<br />
<br />
''E. coli'' 0157:H7<br />
<br />
''''C.difficile'''' <br />
|'''Ciprofloxacin''' 500 mg PO BID<br />
OR<br />
<br />
'''Ciprofloxacin''' 750 mg daily x 3 days<br />
<br />
(avoid in cases of ''E. coli'' O157:H7 as it may increase the risk of hemolytic-uremic syndrome)<br />
<br />
Recent antibiotic exposure: consider ''C. difficile''<br />
<br />
Antimotility drugs should not be used in ''C.difficile.''<br />
<br />
''C. difficile -'' '''Metronidazole''' 500 mg PO TID x 10-14 days. If no response at 5 days, switch to '''Vancomycin''' 125mg PO QID x10-14 days. See inpatient guidelines for severe or recurrent ''C. difficile'' infection and/or policy on ''C. difficile'' management.<br />
|<br />
* '''Empiric therapy''' is generally indicated if patient is toxic appearing, elderly or immunocompromised. If empiric therapy is given, obtain culture and give fluoroquinolone x 3 days while awaiting cultures<br />
* '''Azithromycin''' should be used for pregnancy and suspected quinolone resistant ''Campylobacter.''<br />
* Antimotility drugs improve symptoms and can be used if patient is not toxic. <br />
* Antimicrobial treatment may worsen outcomes in patients with ''E. coli''0157:H7<br />
* ''E. histolytica'' - '''Metronidazole''' 750 mg PO TID x 7-10 days then '''Iodoquinol''' 650 mg PO TID x 20 days or '''Paromomycin'''5 25-35 mg/kg/day in 3 divided doses x 7 days<br />
|-<br />
|'''Nondysenteric Diarrhea'''<br />
Large volume, nonbloody, watery diarrhea.<br />
<br />
Patient may have nausea, vomiting, and abdominal cramping but fever often absent.<br />
|Viruses<br />
''Giardia''<br />
<br />
Enterotoxigenic ''E. coli''<br />
<br />
''Enterotoxin-producing bacteria''<br />
|General Care: Observation<br />
Oral rehydration<br />
<br />
Antimotility agents<br />
<br />
''Giardia –'' especially if patient describes recent history of travel and/or ingestion of unfiltered water (e.g., camping), consider – '''Metronidazole''' 250 mg PO TID x 5 days.<br />
|<br />
* Generally, empiric therapy and stool cultures are '''not''' indicated. Most disease is self-limiting and can be treated with antimotility agents<br />
* If patient fails to improve, cultures (-), and symptoms persist, consider stool for O & P.<br />
* Metronidazole resistance seen in 20% giardia cases. Check ''C. difficile'' toxin if recent history of antibiotic use or hospitalization.<br />
|-<br />
|'''Traveler’s diarrhea'''<br />
Empiric treatment while abroad<br />
|Toxigenic ''E. coli''<br />
''Salmonella''<br />
<br />
''Shigella''<br />
<br />
''Campylobacter''<br />
<br />
Amebiasis<br />
|'''Ciprofloxacin''' 500 mg PO BID x 1-3 days<br />
Pregnancy or fluoroquinolone-resistant campylobacter:<br />
<br />
'''Azithromycin''' 1 g x 1 dose<br />
<br />
EITHER WITH or WITHOUT:<br />
<br />
'''Loperamide''' 4 mg PO x 1; then 2 mg after each loose stool,<br />
<br />
MAX 16 mg/day<br />
|Mild, self-limited cases can be treated with fluid and electrolyte repletion and bismuth subsalicylate.<br />
Prophylaxis generally not recommended.<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy&diff=1322103Sandbox:Reddy2017-06-29T19:46:29Z<p>Aravind Kuchkuntla: Blanked the page</p>
<hr />
<div></div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322102Sandbox:Reddy 22017-06-29T19:45:55Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|<br />
* If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
<br />
* Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|<br />
* Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
<br />
* Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
* Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Brain abscess'''<br />
|Streptococci (anaerobic or aerobic)<br />
''Bacteroides spp''<br />
<br />
''Prevotella'' spp<br />
<br />
Enterobacteriacea<br />
|'''Ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|'''Aztreonam'''<br />
2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
|Consider expanded Gram-positive coverage if patient at risk for drug-resistant streptococci or MRSA<br />
|-<br />
|'''Meningitis'''<br />
Community-onset<br />
|''S. pneumoniae''<br />
<br />
''Neisseria meningitidis''<br />
<br />
''Listeria'' (especially in immuno-compromised, elderly patients, and alcoholics)<br />
|'''ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''TMP/SMX''' 15 mg/kg/day (in divided doses)<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ampicillin'''''' 2 g IV q4h<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''2 g IV q6h-q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''TMP/SMX''' (if ''Listeria'') 15 mg/kg/day (in divided doses)<br />
|<br />
* Therapy should be guided by Gram stain.<br />
<br />
* If bacterial meningitis suspected'','' dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics. <br />
<br />
* Coverage for ''Listeria'' with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.<br />
|-<br />
|'''Meningitis'''<br />
Post-neurosurgical or device associated<br />
|''S. aureus''<br />
Coagulase negative<br />
<br />
Staphylococci<br />
<br />
Gram negative rods<br />
|'''Cefepime'''<br />
PLUS<br />
<br />
'<nowiki/>'''''Vancomycin'''''' <br />
|For '''severe''' PCN allergy:<br />
'''Aztreonam''' 2 g IV q6h-q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
|<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Native Valve'''<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''Enterococcus spp.''<br />
<br />
Occasional gram negative rods<br />
<br />
HACEK < 5%<br />
|'''Vancomycin'''<br />
WITH or WITHOUT*<br />
<br />
'''Ceftriaxone'''<br />
<br />
2 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH or WITHOUT*<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
|<br />
* Narrow coverage to microbiologically confirmed pathogens<br />
<br />
* Addition of Gram-negative coverage should be considered if the patient has a sub-acute presentation.<br />
|-<br />
|'''Prosthetic Valve'''<br />
|''S. aureus''<br />
''S. epidermidis''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Rifampin'''300 mg PO q8h<br />
<br />
PLUS<br />
<br />
'''Gentamicin''' 1 mg/kg/dose IV q8h for initial two weeks only<br />
<br />
Single daily dose of gentamicin is not recommended<br />
|<br />
|Rifampin has numerous clinically significant drug interactions. Medication lists should be reviewed for potential drug-drug interactions with rifampin.<br />
|}<br />
{| class="wikitable"<br />
|'''Spontaneous Bacterial Peritonitis (SBP)'''<br />
|''E. coli''<br />
''Klebsiella spp.''<br />
<br />
'<nowiki/>'''Streptococci. spp''.'''''<br />
|'''Ceftriaxone''' 1 g IV daily x 5 days<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Mild-Moderate''' intra-abdominal abscess<br />
|''E. coli''<br />
''Klebsiella'' <br />
<br />
''B. fragilis''<br />
<br />
''Streptococci spp''<br />
<br />
''S. aureus''<br />
|'''Ertapenem''' 1g IV daily<br />
OR<br />
<br />
'''Piperacillin/tazobactam''' 3.375 g IV q6h - 4.5g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Severe''' (major peritoneal soilage, large or multiple abscesses, patient hemodynamically unstable)<br />
|''E. coli'' <br />
''Klebsiella''<br />
<br />
''B. fragilis'' <br />
<br />
''P. aeruginosa''<br />
<br />
''Enterococcus spp.''<br />
<br />
''Streptococcus spp''<br />
<br />
''S. aureus''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|For hemodynamically unstable health-care associated infection, consider meropenem.<br />
|-<br />
|''Clostridium difficile''-associated diarrhea<br />
|''Clostridium difficile''<br />
|Initial episode, mild to moderate disease<br />
(WBC ≤15K and SCr less than 1.5 times premorbid level)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days. If unable to obtain at discharge, can complete course with '''Metronidazole'''500mg po q8h<br />
<br />
Initial episode, severe disease<br />
<br />
(WBC >15k and/or 50% increase in SCr)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days.<br />
<br />
Initial episode, severe disease with complications<br />
<br />
(Severe disease with hypotension, shock, ilios, and/or megacolon)<br />
<br />
'''Vancomycin''' 500mg PO/NG q6h x 10-14 days<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h x 10-14 days<br />
<br />
WITH OR WITHOUT<br />
<br />
'''Vancomycin''' PR Rectal vancomycin should be considered in patients with ileus. It is given as 500 mg in 100 mL of 0.9% NaCl and instilled q6h (retain each dose for 1h)<br />
* First recurrence<br />
Same therapy as initial episode, stratified by illness severity<br />
* First recurrence, special population (hematologic malignancy with >30 days expected neutropenia, recent HSCT, recent treatment for GVHD, solid organ transplant <3 months)<br />
'''Fidaxomicin'''ID-R: UCSF SFGH VASF 200mg PO BID x10 days<br />
* Second recurrence<br />
'''Vancomycin''' with tapered or pulsed regimen<br />
<br />
PLUS<br />
<br />
Consult ID, GI<br />
<br />
PLUS<br />
<br />
Evaluate for fecal microbiota transplant<br />
|<br />
* IV metronidazole alone is not indicated for treatment of ''C. difficile'' diarrhea.<br />
<br />
* IV metronidazole should only be used in combination with PO vancomycin in the ICU.<br />
<br />
* Recurrence in 5-30% of patients after first episode and 33-60% after second episode.<br />
<br />
* ID CONSULT recommended in patients with severe disease with complications or multiply recurrent disease, and for consideration of rectal vancomycin administration.<br />
|<br />
|}<br />
{| class="wikitable"<br />
|'<nowiki/>'''''Endometritis'''''' <br />
|''Bacteroides''<br />
''Prevotella bivia''<br />
<br />
Group B & Astreptococci<br />
<br />
Enterobacteriaceae<br />
<br />
''M. hominis''<br />
|'''''1st line:'''''<br />
'''Cefoxitin''' 2 g IV q6h <br />
<br />
'''''2nd line:'''''<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
'''''3rd line:'''''<br />
<br />
'''Ampicillin/sulbactam''' 3 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Gentamicin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q12h<br />
|<br />
* If test for chlamydia is positive add azithromycin or doxycycline.<br />
<br />
* Continue antibiotics until afebrile for 24-48 hours.<br />
<br />
* If still febrile > 48 hours and on cefoxitin or clindamycin/gentamicin postpartum, switch to ertapenem.<br />
<br />
* Wait 48 hours on an antibiotic regimen before considering regimen failed.<br />
|}<br />
{| class="wikitable"<br />
|'''Peritonsillar abscess,''' deep neck infections<br />
|Group A streptococci<br />
Anaerobes<br />
<br />
''S. aureus''<br />
|'''Ampicillin/sulbactam''' 3 g IV q6h<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Metronidazole''' 500 mg IV/PO q8h<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV q24h<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Clindamycin'''ID-R: VASF 600 – 900 mg IV q8h<br />
<br />
PLUS<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg IV daily<br />
|Often polymicrobial<br />
* Combinations of piperacillin/tazobactam, ampicillin/sulbactam, or ertapenem PLUS metronidazole should not be used.<br />
<br />
* Consider vancomycin use for patients at high risk for MRSA<br />
|}<br />
{| class="wikitable"<br />
|'''Line-related bacteremia''' <br />
|''S. epidermidis''<br />
''S. aureus''<br />
<br />
''Enterococci spp.''<br />
<br />
Gram-negative rods*<br />
<br />
''Yeast**''<br />
|'''Vancomycin'''<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Piperacillin/tazobactam'''<br />
<br />
ID-R: SFGH<br />
<br />
4.5 g IV q6h<br />
<br />
OR<br />
<br />
'<nowiki/>''Cefepime'''I'<nowiki/>''''' 2 g IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Aztreonam''' ID-R: SFGH 2 g q8h<br />
|<br />
* Remove the offending intravascular device immediately, if possible.<br />
<br />
* Consider Gram-negative coverage for immunocompromised patients or those with prolonged hospitalization, recent antibiotic exposure or sepsis.<br />
|}<br />
{| class="wikitable"<br />
| rowspan="2" |'''Community-Acquired Pneumonia''' <br />
|'''Immunocompetent patient''' – Medical Ward<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''(alcoholics)''<br />
|No Recent antibiotic therapy:*<br />
'''Ceftriaxone''' 1 g IV daily<br />
<br />
PLUS<br />
<br />
'<nowiki/>'''''Doxycycline''''''100 mg PO/IV q12h<br />
|For severe PCN allergy:<br />
'''Levofloxacin''' 750 mg PO/IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO/IV daily<br />
|<br />
* If patient has had recent antibiotic therapy, antibiotics from a different class should be selected (i.e. recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa).<br />
<br />
* Consider influenza testing and treatment with oseltamivir.<br />
|-<br />
|'''Community-Acquired Pneumonia'''<br />
'''Immunocompetent patient''' – ICU<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
(alcoholics)<br />
<br />
''S. aureus''<br />
|'''Ceftriaxone''' 1 g IV daily<br />
PLUS<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin''' 400 mg IV daily<br />
|<br />
* MRSA risk factors: prior influenza, presence cavitary disease, empyema.<br />
<br />
* Consider influenza testing and treatment with oseltamivir.<br />
<br />
* If no microbiologic confirmation of MRSA then discontinue vancomycin.<br />
<br />
* See HCAP for risk factors for infection with ''Pseudomonas aeruginosa.''<br />
|-<br />
|'''Healthcare –associated pneumonia (HCAP):'''<br />
acquired in long-term care facility where antimicrobials used or ''Pseudomonas'' risk factors (see Comments)<br />
|''S.aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
<br />
''P. aeruginosa (''if risk factors present)<br />
|Hemodynamically stable & no ''Pseudomonas'' risk factors<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV/PO daily<br />
<br />
Hemodynamically unstable or ''Pseudomonas'' risk factors<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam'''ID-R: SFGH 4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime'''ID-R: SFGH VASF 2 g IV q8h-q12h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|<br />
|<br />
* ''Pseudomonas'' risk factors include: structural lung disease, repeated exacerbations of severe COPD leading to frequent steroid and/or antibiotic use, recent mechanical ventilation, recent prior exposure to broad-spectrum antibiotics<br />
<br />
* Avoid using levofloxacin if the patient has recently been treated with a fluoroquinolone.<br />
<br />
* For patients admitted from the community with HCAP and not treated with levofloxacin, consider adding atypical coverage with doxycycline (floor patients) or azithromycin (ICU patients).<br />
|-<br />
| rowspan="2" |'''Hospital-acquired pneumonia''' <br />
|'''EARLY ONSET'''<br />
including ventilator-associated or less than 5 days of hospitalization, no risk factors for drug-resistant organisms*<br />
|''S. aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
|'''Vancomycin'''<br />
PLUS one of<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily <br />
|<br />
|<br />
* Risk factors include recent antibiotic exposure (within 30 days).<br />
<br />
* Consider influenza testing and treatment with oseltamivir when influenza is known to be circulating.<br />
|-<br />
|'''LATE ONSET'''<br />
including ventilator-associated OR ≥ 5 days of hospitalization or risk factors for resistant organisms*<br />
|''E. coli''<br />
''Enterobacter aerogenes''<br />
<br />
''P. aeruginosa''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
'<nowiki/>'''S. aureus'''' <br />
|'''Vancomycin'''<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h <br />
<br />
OR<br />
<br />
'''Cefepime''' 2 g IV q8-12h<br />
<br />
''Alternatively'':<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Meropenem''' 1-2 g IV q8h**<br />
|For severe PCN allergy:<br />
'''Vancomycin'''2<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
WITH OR WITHOUT***:<br />
<br />
'''Tobramycin'''<br />
|**Consider use in patients with current or recent use (< 7 days) of piperacillin/tazobactam or cefepime and in patients with recent infection with multidrug resistant gram-negative bacteria.<br />
<nowiki>***</nowiki>Weigh risks and benefits of adding aminoglycoside for critical illness, immunocompromise, or history of infection or colonization with drug-resistant Gram-negative rods.<br />
|}<br />
{| class="wikitable"<br />
|'<nowiki/>'''''Septic Shock''''''<br />
Community onest, no recent healthcare exposure<br />
|Enterobacteriaceae<br />
''S. aureus''<br />
<br />
''Streptococci spp.''<br />
|'''Vancomycin'''<br />
PLUS one of:<br />
<br />
'''Piperacillin/'''<br />
<br />
'''Tazobactam'''ID-R: SFGH 4.5 g IV q8h<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ertapenem'''''' 1 g IV daily<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV/PO q8h<br />
<br />
PLUS one of<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
OR<br />
<br />
'''Tobramycin'''<br />
|<br />
|-<br />
|'''Healthcare-associated and/or previous antibiotic therapy'''<br />
|Enterobacteriaceae<br />
''S. aureus''<br />
<br />
''Streptococci spp.''<br />
<br />
''P. aeruginosa''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/'''<br />
<br />
'''Tazobactam''' 4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime''' 2 g IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h<br />
<br />
AND<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
WITH OR WITHOUT:<br />
<br />
'''Tobramycin'''<br />
|''For patients with neutropenia, organ transplant, severe hepatic failure, or current/recent (<7 days) piperacillin/tazobactam or cefepime:''<br />
'''Vancomycin'''<br />
<br />
''Plus''<br />
<br />
'''Meropenem''' 1-2 g IV q8h<br />
|}<br />
{| class="wikitable"<br />
|'<nowiki/>'''''Abscess''''''<br />
|'<nowiki/>'''S.aureus''''<br />
|Vancomycin<br />
|Empirical Gram-negative and/or anaerobic coverage is not routinely indicated.<br />
Incision and drainage is primary therapy for abscesses. After incision and drainage and once patient is stable, switch to oral antibiotics based on culture and susceptibility results.<br />
|-<br />
|'<nowiki/>'''''Cellulitis''''''<br />
|Group A streptococci<br />
Other beta-hemolytic streptococci<br />
<br />
''S.aureus''<br />
|'''Vancomycin'''<br />
''Alternatively:''<br />
<br />
'''Cefazolin''' 1 g IV q8h if patient is stable and cellulitis is not associated with an abscess or other purulent focus of infection<br />
|Empirical Gram-negative and/or anaerobic coverage is not routinely indicated.<br />
|-<br />
|'''Necrotizing fasciitis or suspected deep tissue extension'''<br />
|Group A streptococci<br />
''S. aureus''<br />
<br />
Anaerobes<br />
<br />
Gram-negative rods<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
ALL WITH:<br />
<br />
'''Clindamycin'''600 – 900 mg IV q8h <br />
<br />
Alternatively if infection is health-care associated:<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Meropenem'''1-2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Clindamycin'''600-900 mg IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Clindamycin''' ID-R: VASF 600-900 mg IV q8h<br />
<br />
Clindamycin added for anti-toxin properties. Limited data support use for infections caused by Group A streptococci and ''Clostridium perfringens.'' Discontinue clindamycin once adequate surgical debridement is achieved. <br />
|}<br />
{| class="wikitable"<br />
|'''Asymptomatic bacteriuria'''<br />
|Enterobacteriaceae<br />
''Enterococcus''species<br />
|No treatment required<br />
|Exceptions: pregnant women, patients having traumatic urologic procedures, recent kidney transplant .<br />
|-<br />
|'''Catheter-associated candiduria'''<br />
|'''''Candida'' species'''<br />
|No treatment required<br />
|Pyuria alone is not an indication for treatment.<br />
|-<br />
|'''Community-acquired Pyelonephritis''' <br />
|Enterobacteriaceae ''(E. coli)''<br />
|'''Ceftriaxone'''<br />
1 g IV q24h<br />
<br />
OR<br />
<br />
'''Cefazolin''' 1g IV q8h (VASF only)<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF EITHER:<br />
<br />
'''Gentamicin'''<br />
<br />
OR<br />
<br />
'''Aztreonam''' ID-R: SFGH<br />
<br />
2 g IV q8h<br />
<br />
'''Duration of therapy 7-14 days based on clinical response.'''<br />
|-<br />
|'''Healthcare-associated UTI'''<br />
|Enterobacteriaceae ''(e.g. E. coli)''<br />
''P. aeruginosa'' (less common)<br />
|'''Ceftriaxone'''<br />
1 g IV q24h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1g IV daily<br />
<br />
OR<br />
<br />
'''Piperacillin/tazobactam'''ID-R: SFGH 4.5g IV q8h<br />
|For '''severe''' PCN allergy:<br />
ONE OF:Criteria: signs and symptoms compatible with a UTI, no other identified source of infection, & ≥ 1000 cfu of ≥ 1 bacterial species on urine culture<br />
<br />
'''Gentamicin'''<br />
<br />
OR<br />
<br />
'''Aztreonam''' ID-R: SFGH<br />
<br />
2 g IV q8h<br />
<br />
BOTH WITH OR WITHOUT:<br />
<br />
'''Vancomycin'''<br />
<br />
* Pyuria alone is not an indication for treatment.<br />
<br />
* A negative urinalysis suggests an alternative source of infection.<br />
<br />
* Remove catheter if possible.<br />
<br />
* Switch to oral therapy when susceptibilities known and patient stable.<br />
<br />
* 7 days of therapy is recommend if patient has prompt resolution of symptoms<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322098Sandbox:Reddy 22017-06-29T19:38:59Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Brain abscess'''<br />
|Streptococci (anaerobic or aerobic)<br />
''Bacteroides spp''<br />
<br />
''Prevotella'' spp<br />
<br />
Enterobacteriacea<br />
|'''Ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|'''Aztreonam'''<br />
2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
|Consider expanded Gram-positive coverage if patient at risk for drug-resistant streptococci or MRSA<br />
|-<br />
|'''Meningitis'''<br />
Community-onset<br />
|''S. pneumoniae''<br />
<br />
''Neisseria meningitidis''<br />
<br />
''Listeria'' (especially in immuno-compromised, elderly patients, and alcoholics)<br />
|'''ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''TMP/SMX''' 15 mg/kg/day (in divided doses)<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ampicillin'''''' 2 g IV q4h<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''2 g IV q6h-q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''TMP/SMX''' (if ''Listeria'') 15 mg/kg/day (in divided doses)<br />
|Therapy should be guided by Gram stain.<br />
If bacterial meningitis suspected'','' dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics. <br />
<br />
'''*'''Coverage for ''Listeria'' with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.<br />
|-<br />
|'''Meningitis'''<br />
Post-neurosurgical or device associated<br />
|''S. aureus''<br />
Coagulase negative<br />
<br />
Staphylococci<br />
<br />
Gram negative rods<br />
|'''Cefepime'''<br />
PLUS<br />
<br />
'<nowiki/>'''''Vancomycin'''''' <br />
|For '''severe''' PCN allergy:<br />
'''Aztreonam''' 2 g IV q6h-q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
|<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Native Valve'''<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''Enterococcus spp.''<br />
<br />
Occasional gram negative rods<br />
<br />
HACEK < 5%<br />
|'''Vancomycin'''<br />
WITH or WITHOUT*<br />
<br />
'''Ceftriaxone'''<br />
<br />
2 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH or WITHOUT*<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
|Narrow coverage to microbiologically confirmed pathogens<br />
<nowiki>*</nowiki>Addition of Gram-negative coverage should be considered if the patient has a sub-acute presentation.<br />
|-<br />
|'''Prosthetic Valve'''<br />
|''S. aureus''<br />
''S. epidermidis''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Rifampin'''300 mg PO q8h<br />
<br />
PLUS<br />
<br />
'''Gentamicin''' 1 mg/kg/dose IV q8h for initial two weeks only<br />
<br />
Single daily dose of gentamicin is not recommended<br />
|<br />
|Rifampin has numerous clinically significant drug interactions. Medication lists should be reviewed for potential drug-drug interactions with rifampin.<br />
|}<br />
{| class="wikitable"<br />
|'''Spontaneous Bacterial Peritonitis (SBP)'''<br />
|''E. coli''<br />
''Klebsiella spp.''<br />
<br />
'<nowiki/>'''Streptococci. spp''.'''''<br />
|'''Ceftriaxone''' 1 g IV daily x 5 days<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Mild-Moderate''' intra-abdominal abscess<br />
|''E. coli''<br />
''Klebsiella'' <br />
<br />
''B. fragilis''<br />
<br />
''Streptococci spp''<br />
<br />
''S. aureus''<br />
|'''Ertapenem''' 1g IV daily<br />
OR<br />
<br />
'''Piperacillin/tazobactam''' 3.375 g IV q6h - 4.5g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Severe''' (major peritoneal soilage, large or multiple abscesses, patient hemodynamically unstable)<br />
|''E. coli'' <br />
''Klebsiella''<br />
<br />
''B. fragilis'' <br />
<br />
''P. aeruginosa''<br />
<br />
''Enterococcus spp.''<br />
<br />
''Streptococcus spp''<br />
<br />
''S. aureus''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|For hemodynamically unstable health-care associated infection, consider meropenem.<br />
|-<br />
|''Clostridium difficile''-associated diarrhea<br />
|''Clostridium difficile''<br />
|Initial episode, mild to moderate disease<br />
(WBC ≤15K and SCr less than 1.5 times premorbid level)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days. If unable to obtain at discharge, can complete course with '''Metronidazole'''500mg po q8h<br />
<br />
Initial episode, severe disease<br />
<br />
(WBC >15k and/or 50% increase in SCr)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days.<br />
<br />
Initial episode, severe disease with complications<br />
<br />
(Severe disease with hypotension, shock, ilios, and/or megacolon)<br />
<br />
'''Vancomycin''' 500mg PO/NG q6h x 10-14 days<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h x 10-14 days<br />
<br />
WITH OR WITHOUT<br />
<br />
'''Vancomycin''' PR Rectal vancomycin should be considered in patients with ileus. It is given as 500 mg in 100 mL of 0.9% NaCl and instilled q6h (retain each dose for 1h)<br />
<br />
First recurrence<br />
<br />
Same therapy as initial episode, stratified by illness severity<br />
<br />
First recurrence, special population (hematologic malignancy with >30 days expected neutropenia, recent HSCT, recent treatment for GVHD, solid organ transplant <3 months)<br />
<br />
'''Fidaxomicin'''ID-R: UCSF SFGH VASF 200mg PO BID x10 days<br />
<br />
Second recurrence<br />
<br />
'''Vancomycin''' with tapered or pulsed regimen<br />
<br />
PLUS<br />
<br />
Consult ID, GI<br />
<br />
PLUS<br />
<br />
Evaluate for fecal microbiota transplant<br />
|IV metronidazole alone is not indicated for treatment of ''C. difficile'' diarrhea.<br />
IV metronidazole should only be used in combination with PO vancomycin in the ICU.<br />
<br />
Recurrence in 5-30% of patients after first episode and 33-60% after second episode.<br />
<br />
ID CONSULT recommended in patients with severe disease with complications or multiply recurrent disease, and for consideration of rectal vancomycin administration.<br />
|<br />
|}<br />
{| class="wikitable"<br />
|'<nowiki/>'''''Endometritis'''''' <br />
|''Bacteroides''<br />
''Prevotella bivia''<br />
<br />
Group B & Astreptococci<br />
<br />
Enterobacteriaceae<br />
<br />
''M. hominis''<br />
|'''''1st line:'''''<br />
'''Cefoxitin''' 2 g IV q6h <br />
<br />
'''''2nd line:'''''<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
'''''3rd line:'''''<br />
<br />
'''Ampicillin/sulbactam''' 3 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Gentamicin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q12h<br />
|If test for chlamydia is positive add azithromycin or doxycycline.<br />
Continue antibiotics until afebrile for 24-48 hours.<br />
<br />
If still febrile > 48 hours and on cefoxitin or clindamycin/gentamicin postpartum, switch to ertapenem.<br />
<br />
Wait 48 hours on an antibiotic regimen before considering regimen failed.<br />
|}<br />
{| class="wikitable"<br />
|'''Peritonsillar abscess,''' deep neck infections<br />
|Group A streptococci<br />
Anaerobes<br />
<br />
''S. aureus''<br />
|'''Ampicillin/sulbactam''' 3 g IV q6h<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Metronidazole''' 500 mg IV/PO q8h<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV q24h<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Clindamycin'''ID-R: VASF 600 – 900 mg IV q8h<br />
<br />
PLUS<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg IV daily<br />
|Often polymicrobial<br />
Combinations of piperacillin/tazobactam, ampicillin/sulbactam, or ertapenem PLUS metronidazole should not be used.<br />
<br />
<nowiki>*</nowiki>Consider vancomycin use for patients at high risk for MRSA<br />
|}<br />
{| class="wikitable"<br />
|'''Line-related bacteremia''' <br />
|''S. epidermidis''<br />
''S. aureus''<br />
<br />
''Enterococci spp.''<br />
<br />
Gram-negative rods*<br />
<br />
''Yeast**''<br />
|'''Vancomycin'''<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Piperacillin/tazobactam'''<br />
<br />
ID-R: SFGH<br />
<br />
4.5 g IV q6h<br />
<br />
OR<br />
<br />
'<nowiki/>''Cefepime'''I'<nowiki/>''''' 2 g IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Aztreonam''' ID-R: SFGH 2 g q8h<br />
|Remove the offending intravascular device immediately, if possible.<br />
<nowiki>*</nowiki>Consider Gram-negative coverage for immunocompromised patients or those with prolonged hospitalization, recent antibiotic exposure or sepsis.<br />
|}<br />
{| class="wikitable"<br />
| rowspan="2" |'''Community-Acquired Pneumonia''' <br />
|'''Immunocompetent patient''' – Medical Ward<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''(alcoholics)''<br />
|No Recent antibiotic therapy:*<br />
'''Ceftriaxone''' 1 g IV daily<br />
<br />
PLUS<br />
<br />
'<nowiki/>'''''Doxycycline''''''100 mg PO/IV q12h<br />
|For severe PCN allergy:<br />
'''Levofloxacin''' 750 mg PO/IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO/IV daily<br />
|If patient has had recent antibiotic therapy, antibiotics from a different class should be selected (i.e. recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa).<br />
Consider influenza testing and treatment with oseltamivir.<br />
|-<br />
|'''Community-Acquired Pneumonia'''<br />
'''Immunocompetent patient''' – ICU<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
(alcoholics)<br />
<br />
''S. aureus''<br />
|'''Ceftriaxone''' 1 g IV daily<br />
PLUS<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin''' 400 mg IV daily<br />
|MRSA risk factors: prior influenza, presence cavitary disease, empyema.<br />
Consider influenza testing and treatment with oseltamivir.<br />
<br />
If no microbiologic confirmation of MRSA then discontinue vancomycin.<br />
<br />
See HCAP for risk factors for infection with ''Pseudomonas aeruginosa.''<br />
|-<br />
|'''Healthcare –associated pneumonia (HCAP):'''<br />
acquired in long-term care facility where antimicrobials used or ''Pseudomonas'' risk factors (see Comments)<br />
|''S.aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
<br />
''P. aeruginosa (''if risk factors present)<br />
|Hemodynamically stable & no ''Pseudomonas'' risk factors<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV/PO daily<br />
<br />
Hemodynamically unstable or ''Pseudomonas'' risk factors<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam'''ID-R: SFGH 4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime'''ID-R: SFGH VASF 2 g IV q8h-q12h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|<br />
|''Pseudomonas'' risk factors include: structural lung disease, repeated exacerbations of severe COPD leading to frequent steroid and/or antibiotic use, recent mechanical ventilation, recent prior exposure to broad-spectrum antibiotics<br />
Avoid using levofloxacin if the patient has recently been treated with a fluoroquinolone.<br />
<br />
For patients admitted from the community with HCAP and not treated with levofloxacin, consider adding atypical coverage with doxycycline (floor patients) or azithromycin (ICU patients).<br />
|-<br />
| rowspan="2" |'''Hospital-acquired pneumonia''' <br />
|'''EARLY ONSET'''<br />
including ventilator-associated or less than 5 days of hospitalization, no risk factors for drug-resistant organisms*<br />
|''S. aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
|'''Vancomycin'''<br />
PLUS one of<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily <br />
|<br />
|Risk factors include recent antibiotic exposure (within 30 days).<br />
Consider influenza testing and treatment with oseltamivir when influenza is known to be circulating.<br />
|-<br />
|'''LATE ONSET'''<br />
including ventilator-associated OR ≥ 5 days of hospitalization or risk factors for resistant organisms*<br />
|''E. coli''<br />
''Enterobacter aerogenes''<br />
<br />
''P. aeruginosa''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
'<nowiki/>'''S. aureus'''' <br />
|'''Vancomycin'''<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h <br />
<br />
OR<br />
<br />
'''Cefepime''' 2 g IV q8-12h<br />
<br />
''Alternatively'':<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Meropenem''' 1-2 g IV q8h**<br />
|For severe PCN allergy:<br />
'''Vancomycin'''2<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
WITH OR WITHOUT***:<br />
<br />
'''Tobramycin'''<br />
|**Consider use in patients with current or recent use (< 7 days) of piperacillin/tazobactam or cefepime and in patients with recent infection with multidrug resistant gram-negative bacteria.<br />
<nowiki>***</nowiki>Weigh risks and benefits of adding aminoglycoside for critical illness, immunocompromise, or history of infection or colonization with drug-resistant Gram-negative rods.<br />
|}<br />
{| class="wikitable"<br />
|'<nowiki/>'''''Septic Shock''''''<br />
Community onest, no recent healthcare exposure<br />
|Enterobacteriaceae<br />
''S. aureus''<br />
<br />
''Streptococci spp.''<br />
|'''Vancomycin'''<br />
PLUS one of:<br />
<br />
'''Piperacillin/'''<br />
<br />
'''Tazobactam'''ID-R: SFGH 4.5 g IV q8h<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ertapenem'''''' 1 g IV daily<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV/PO q8h<br />
<br />
PLUS one of<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
OR<br />
<br />
'''Tobramycin'''<br />
|<br />
|-<br />
|'''Healthcare-associated and/or previous antibiotic therapy'''<br />
|Enterobacteriaceae<br />
''S. aureus''<br />
<br />
''Streptococci spp.''<br />
<br />
''P. aeruginosa''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/'''<br />
<br />
'''Tazobactam''' 4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime''' 2 g IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h<br />
<br />
AND<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
WITH OR WITHOUT:<br />
<br />
'''Tobramycin'''<br />
|''For patients with neutropenia, organ transplant, severe hepatic failure, or current/recent (<7 days) piperacillin/tazobactam or cefepime:''<br />
'''Vancomycin'''<br />
<br />
''Plus''<br />
<br />
'''Meropenem''' 1-2 g IV q8h<br />
|}<br />
{| class="wikitable"<br />
|''''''Abscess''''''<br />
|''''S.aureus''''<br />
|Vancomycin<br />
|Empirical Gram-negative and/or anaerobic coverage is not routinely indicated.<br />
Incision and drainage is primary therapy for abscesses. After incision and drainage and once patient is stable, switch to oral antibiotics based on culture and susceptibility results.<br />
|-<br />
|''''''Cellulitis''''''<br />
|Group A streptococci<br />
Other beta-hemolytic streptococci<br />
<br />
''S.aureus''<br />
|'''Vancomycin'''<br />
''Alternatively:''<br />
<br />
'''Cefazolin''' 1 g IV q8h if patient is stable and cellulitis is not associated with an abscess or other purulent focus of infection<br />
|Empirical Gram-negative and/or anaerobic coverage is not routinely indicated.<br />
|-<br />
|'''Necrotizing fasciitis or suspected deep tissue extension'''<br />
|Group A streptococci<br />
''S. aureus''<br />
<br />
Anaerobes<br />
<br />
Gram-negative rods<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
ALL WITH:<br />
<br />
'''Clindamycin'''600 – 900 mg IV q8h <br />
<br />
Alternatively if infection is health-care associated:<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Meropenem'''1-2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Clindamycin'''600-900 mg IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Clindamycin''' ID-R: VASF 600-900 mg IV q8h<br />
<br />
Clindamycin added for anti-toxin properties. Limited data support use for infections caused by Group A streptococci and ''Clostridium perfringens.'' Discontinue clindamycin once adequate surgical debridement is achieved. <br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322096Sandbox:Reddy 22017-06-29T19:36:03Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Brain abscess'''<br />
|Streptococci (anaerobic or aerobic)<br />
''Bacteroides spp''<br />
<br />
''Prevotella'' spp<br />
<br />
Enterobacteriacea<br />
|'''Ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|'''Aztreonam'''<br />
2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
|Consider expanded Gram-positive coverage if patient at risk for drug-resistant streptococci or MRSA<br />
|-<br />
|'''Meningitis'''<br />
Community-onset<br />
|''S. pneumoniae''<br />
<br />
''Neisseria meningitidis''<br />
<br />
''Listeria'' (especially in immuno-compromised, elderly patients, and alcoholics)<br />
|'''ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''TMP/SMX''' 15 mg/kg/day (in divided doses)<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ampicillin'''''' 2 g IV q4h<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''2 g IV q6h-q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''TMP/SMX''' (if ''Listeria'') 15 mg/kg/day (in divided doses)<br />
|Therapy should be guided by Gram stain.<br />
If bacterial meningitis suspected'','' dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics. <br />
<br />
'''*'''Coverage for ''Listeria'' with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.<br />
|-<br />
|'''Meningitis'''<br />
Post-neurosurgical or device associated<br />
|''S. aureus''<br />
Coagulase negative<br />
<br />
Staphylococci<br />
<br />
Gram negative rods<br />
|'''Cefepime'''<br />
PLUS<br />
<br />
'<nowiki/>'''''Vancomycin'''''' <br />
|For '''severe''' PCN allergy:<br />
'''Aztreonam''' 2 g IV q6h-q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
|<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Native Valve'''<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''Enterococcus spp.''<br />
<br />
Occasional gram negative rods<br />
<br />
HACEK < 5%<br />
|'''Vancomycin'''<br />
WITH or WITHOUT*<br />
<br />
'''Ceftriaxone'''<br />
<br />
2 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH or WITHOUT*<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
|Narrow coverage to microbiologically confirmed pathogens<br />
<nowiki>*</nowiki>Addition of Gram-negative coverage should be considered if the patient has a sub-acute presentation.<br />
|-<br />
|'''Prosthetic Valve'''<br />
|''S. aureus''<br />
''S. epidermidis''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Rifampin'''300 mg PO q8h<br />
<br />
PLUS<br />
<br />
'''Gentamicin''' 1 mg/kg/dose IV q8h for initial two weeks only<br />
<br />
Single daily dose of gentamicin is not recommended<br />
|<br />
|Rifampin has numerous clinically significant drug interactions. Medication lists should be reviewed for potential drug-drug interactions with rifampin.<br />
|}<br />
{| class="wikitable"<br />
|'''Spontaneous Bacterial Peritonitis (SBP)'''<br />
|''E. coli''<br />
''Klebsiella spp.''<br />
<br />
'<nowiki/>'''Streptococci. spp''.'''''<br />
|'''Ceftriaxone''' 1 g IV daily x 5 days<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Mild-Moderate''' intra-abdominal abscess<br />
|''E. coli''<br />
''Klebsiella'' <br />
<br />
''B. fragilis''<br />
<br />
''Streptococci spp''<br />
<br />
''S. aureus''<br />
|'''Ertapenem''' 1g IV daily<br />
OR<br />
<br />
'''Piperacillin/tazobactam''' 3.375 g IV q6h - 4.5g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Severe''' (major peritoneal soilage, large or multiple abscesses, patient hemodynamically unstable)<br />
|''E. coli'' <br />
''Klebsiella''<br />
<br />
''B. fragilis'' <br />
<br />
''P. aeruginosa''<br />
<br />
''Enterococcus spp.''<br />
<br />
''Streptococcus spp''<br />
<br />
''S. aureus''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|For hemodynamically unstable health-care associated infection, consider meropenem.<br />
|-<br />
|''Clostridium difficile''-associated diarrhea<br />
|''Clostridium difficile''<br />
|Initial episode, mild to moderate disease<br />
(WBC ≤15K and SCr less than 1.5 times premorbid level)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days. If unable to obtain at discharge, can complete course with '''Metronidazole'''500mg po q8h<br />
<br />
Initial episode, severe disease<br />
<br />
(WBC >15k and/or 50% increase in SCr)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days.<br />
<br />
Initial episode, severe disease with complications<br />
<br />
(Severe disease with hypotension, shock, ilios, and/or megacolon)<br />
<br />
'''Vancomycin''' 500mg PO/NG q6h x 10-14 days<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h x 10-14 days<br />
<br />
WITH OR WITHOUT<br />
<br />
'''Vancomycin''' PR Rectal vancomycin should be considered in patients with ileus. It is given as 500 mg in 100 mL of 0.9% NaCl and instilled q6h (retain each dose for 1h)<br />
<br />
First recurrence<br />
<br />
Same therapy as initial episode, stratified by illness severity<br />
<br />
First recurrence, special population (hematologic malignancy with >30 days expected neutropenia, recent HSCT, recent treatment for GVHD, solid organ transplant <3 months)<br />
<br />
'''Fidaxomicin'''ID-R: UCSF SFGH VASF 200mg PO BID x10 days<br />
<br />
Second recurrence<br />
<br />
'''Vancomycin''' with tapered or pulsed regimen<br />
<br />
PLUS<br />
<br />
Consult ID, GI<br />
<br />
PLUS<br />
<br />
Evaluate for fecal microbiota transplant<br />
|IV metronidazole alone is not indicated for treatment of ''C. difficile'' diarrhea.<br />
IV metronidazole should only be used in combination with PO vancomycin in the ICU.<br />
<br />
Recurrence in 5-30% of patients after first episode and 33-60% after second episode.<br />
<br />
ID CONSULT recommended in patients with severe disease with complications or multiply recurrent disease, and for consideration of rectal vancomycin administration.<br />
|<br />
|}<br />
{| class="wikitable"<br />
|'<nowiki/>'''''Endometritis'''''' <br />
|''Bacteroides''<br />
''Prevotella bivia''<br />
<br />
Group B & Astreptococci<br />
<br />
Enterobacteriaceae<br />
<br />
''M. hominis''<br />
|'''''1st line:'''''<br />
'''Cefoxitin''' 2 g IV q6h <br />
<br />
'''''2nd line:'''''<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
'''''3rd line:'''''<br />
<br />
'''Ampicillin/sulbactam''' 3 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Gentamicin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q12h<br />
|If test for chlamydia is positive add azithromycin or doxycycline.<br />
Continue antibiotics until afebrile for 24-48 hours.<br />
<br />
If still febrile > 48 hours and on cefoxitin or clindamycin/gentamicin postpartum, switch to ertapenem.<br />
<br />
Wait 48 hours on an antibiotic regimen before considering regimen failed.<br />
|}<br />
{| class="wikitable"<br />
|'''Peritonsillar abscess,''' deep neck infections<br />
|Group A streptococci<br />
Anaerobes<br />
<br />
''S. aureus''<br />
|'''Ampicillin/sulbactam''' 3 g IV q6h<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Metronidazole''' 500 mg IV/PO q8h<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV q24h<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Clindamycin'''ID-R: VASF 600 – 900 mg IV q8h<br />
<br />
PLUS<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg IV daily<br />
|Often polymicrobial<br />
Combinations of piperacillin/tazobactam, ampicillin/sulbactam, or ertapenem PLUS metronidazole should not be used.<br />
<br />
<nowiki>*</nowiki>Consider vancomycin use for patients at high risk for MRSA<br />
|}<br />
{| class="wikitable"<br />
|'''Line-related bacteremia''' <br />
|''S. epidermidis''<br />
''S. aureus''<br />
<br />
''Enterococci spp.''<br />
<br />
Gram-negative rods*<br />
<br />
''Yeast**''<br />
|'''Vancomycin'''<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Piperacillin/tazobactam'''<br />
<br />
ID-R: SFGH<br />
<br />
4.5 g IV q6h<br />
<br />
OR<br />
<br />
'<nowiki/>''Cefepime'''I'<nowiki/>''''' 2 g IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Aztreonam''' ID-R: SFGH 2 g q8h<br />
|Remove the offending intravascular device immediately, if possible.<br />
<nowiki>*</nowiki>Consider Gram-negative coverage for immunocompromised patients or those with prolonged hospitalization, recent antibiotic exposure or sepsis.<br />
|}<br />
{| class="wikitable"<br />
| rowspan="2" |'''Community-Acquired Pneumonia''' <br />
|'''Immunocompetent patient''' – Medical Ward<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''(alcoholics)''<br />
|No Recent antibiotic therapy:*<br />
'''Ceftriaxone''' 1 g IV daily<br />
<br />
PLUS<br />
<br />
'<nowiki/>'''''Doxycycline''''''100 mg PO/IV q12h<br />
|For severe PCN allergy:<br />
'''Levofloxacin''' 750 mg PO/IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO/IV daily<br />
|If patient has had recent antibiotic therapy, antibiotics from a different class should be selected (i.e. recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa).<br />
Consider influenza testing and treatment with oseltamivir.<br />
|-<br />
|'''Community-Acquired Pneumonia'''<br />
'''Immunocompetent patient''' – ICU<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
(alcoholics)<br />
<br />
''S. aureus''<br />
|'''Ceftriaxone''' 1 g IV daily<br />
PLUS<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin''' 400 mg IV daily<br />
|MRSA risk factors: prior influenza, presence cavitary disease, empyema.<br />
Consider influenza testing and treatment with oseltamivir.<br />
<br />
If no microbiologic confirmation of MRSA then discontinue vancomycin.<br />
<br />
See HCAP for risk factors for infection with ''Pseudomonas aeruginosa.''<br />
|-<br />
|'''Healthcare –associated pneumonia (HCAP):'''<br />
acquired in long-term care facility where antimicrobials used or ''Pseudomonas'' risk factors (see Comments)<br />
|''S.aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
<br />
''P. aeruginosa (''if risk factors present)<br />
|Hemodynamically stable & no ''Pseudomonas'' risk factors<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV/PO daily<br />
<br />
Hemodynamically unstable or ''Pseudomonas'' risk factors<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam'''ID-R: SFGH 4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime'''ID-R: SFGH VASF 2 g IV q8h-q12h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|<br />
|''Pseudomonas'' risk factors include: structural lung disease, repeated exacerbations of severe COPD leading to frequent steroid and/or antibiotic use, recent mechanical ventilation, recent prior exposure to broad-spectrum antibiotics<br />
Avoid using levofloxacin if the patient has recently been treated with a fluoroquinolone.<br />
<br />
For patients admitted from the community with HCAP and not treated with levofloxacin, consider adding atypical coverage with doxycycline (floor patients) or azithromycin (ICU patients).<br />
|-<br />
| rowspan="2" |'''Hospital-acquired pneumonia''' <br />
|'''EARLY ONSET'''<br />
including ventilator-associated or less than 5 days of hospitalization, no risk factors for drug-resistant organisms*<br />
|''S. aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
|'''Vancomycin'''<br />
PLUS one of<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily <br />
|<br />
|Risk factors include recent antibiotic exposure (within 30 days).<br />
Consider influenza testing and treatment with oseltamivir when influenza is known to be circulating.<br />
|-<br />
|'''LATE ONSET'''<br />
including ventilator-associated OR ≥ 5 days of hospitalization or risk factors for resistant organisms*<br />
|''E. coli''<br />
''Enterobacter aerogenes''<br />
<br />
''P. aeruginosa''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
'<nowiki/>'''S. aureus'''' <br />
|'''Vancomycin'''<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h <br />
<br />
OR<br />
<br />
'''Cefepime''' 2 g IV q8-12h<br />
<br />
''Alternatively'':<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Meropenem''' 1-2 g IV q8h**<br />
|For severe PCN allergy:<br />
'''Vancomycin'''2<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
WITH OR WITHOUT***:<br />
<br />
'''Tobramycin'''<br />
|**Consider use in patients with current or recent use (< 7 days) of piperacillin/tazobactam or cefepime and in patients with recent infection with multidrug resistant gram-negative bacteria.<br />
<nowiki>***</nowiki>Weigh risks and benefits of adding aminoglycoside for critical illness, immunocompromise, or history of infection or colonization with drug-resistant Gram-negative rods.<br />
|}<br />
{| class="wikitable"<br />
|''''''Septic Shock''''''<br />
Community onest, no recent healthcare exposure<br />
|Enterobacteriaceae<br />
''S. aureus''<br />
<br />
''Streptococci spp.''<br />
|'''Vancomycin'''<br />
PLUS one of:<br />
<br />
'''Piperacillin/'''<br />
<br />
'''Tazobactam'''ID-R: SFGH 4.5 g IV q8h<br />
<br />
OR<br />
<br />
''''''Ertapenem'''''' 1 g IV daily<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV/PO q8h<br />
<br />
PLUS one of<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
OR<br />
<br />
'''Tobramycin'''<br />
|<br />
|-<br />
|'''Healthcare-associated and/or previous antibiotic therapy'''<br />
|Enterobacteriaceae<br />
''S. aureus''<br />
<br />
''Streptococci spp.''<br />
<br />
''P. aeruginosa''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/'''<br />
<br />
'''Tazobactam''' 4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime''' 2 g IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h<br />
<br />
AND<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
WITH OR WITHOUT:<br />
<br />
'''Tobramycin'''<br />
|''For patients with neutropenia, organ transplant, severe hepatic failure, or current/recent (<7 days) piperacillin/tazobactam or cefepime:''<br />
'''Vancomycin'''<br />
<br />
''Plus''<br />
<br />
'''Meropenem''' 1-2 g IV q8h<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322093Sandbox:Reddy 22017-06-29T19:33:12Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Brain abscess'''<br />
|Streptococci (anaerobic or aerobic)<br />
''Bacteroides spp''<br />
<br />
''Prevotella'' spp<br />
<br />
Enterobacteriacea<br />
|'''Ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|'''Aztreonam'''<br />
2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
|Consider expanded Gram-positive coverage if patient at risk for drug-resistant streptococci or MRSA<br />
|-<br />
|'''Meningitis'''<br />
Community-onset<br />
|''S. pneumoniae''<br />
<br />
''Neisseria meningitidis''<br />
<br />
''Listeria'' (especially in immuno-compromised, elderly patients, and alcoholics)<br />
|'''ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''TMP/SMX''' 15 mg/kg/day (in divided doses)<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ampicillin'''''' 2 g IV q4h<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''2 g IV q6h-q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''TMP/SMX''' (if ''Listeria'') 15 mg/kg/day (in divided doses)<br />
|Therapy should be guided by Gram stain.<br />
If bacterial meningitis suspected'','' dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics. <br />
<br />
'''*'''Coverage for ''Listeria'' with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.<br />
|-<br />
|'''Meningitis'''<br />
Post-neurosurgical or device associated<br />
|''S. aureus''<br />
Coagulase negative<br />
<br />
Staphylococci<br />
<br />
Gram negative rods<br />
|'''Cefepime'''<br />
PLUS<br />
<br />
'<nowiki/>'''''Vancomycin'''''' <br />
|For '''severe''' PCN allergy:<br />
'''Aztreonam''' 2 g IV q6h-q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
|<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Native Valve'''<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''Enterococcus spp.''<br />
<br />
Occasional gram negative rods<br />
<br />
HACEK < 5%<br />
|'''Vancomycin'''<br />
WITH or WITHOUT*<br />
<br />
'''Ceftriaxone'''<br />
<br />
2 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH or WITHOUT*<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
|Narrow coverage to microbiologically confirmed pathogens<br />
<nowiki>*</nowiki>Addition of Gram-negative coverage should be considered if the patient has a sub-acute presentation.<br />
|-<br />
|'''Prosthetic Valve'''<br />
|''S. aureus''<br />
''S. epidermidis''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Rifampin'''300 mg PO q8h<br />
<br />
PLUS<br />
<br />
'''Gentamicin''' 1 mg/kg/dose IV q8h for initial two weeks only<br />
<br />
Single daily dose of gentamicin is not recommended<br />
|<br />
|Rifampin has numerous clinically significant drug interactions. Medication lists should be reviewed for potential drug-drug interactions with rifampin.<br />
|}<br />
{| class="wikitable"<br />
|'''Spontaneous Bacterial Peritonitis (SBP)'''<br />
|''E. coli''<br />
''Klebsiella spp.''<br />
<br />
'<nowiki/>'''Streptococci. spp''.'''''<br />
|'''Ceftriaxone''' 1 g IV daily x 5 days<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Mild-Moderate''' intra-abdominal abscess<br />
|''E. coli''<br />
''Klebsiella'' <br />
<br />
''B. fragilis''<br />
<br />
''Streptococci spp''<br />
<br />
''S. aureus''<br />
|'''Ertapenem''' 1g IV daily<br />
OR<br />
<br />
'''Piperacillin/tazobactam''' 3.375 g IV q6h - 4.5g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Severe''' (major peritoneal soilage, large or multiple abscesses, patient hemodynamically unstable)<br />
|''E. coli'' <br />
''Klebsiella''<br />
<br />
''B. fragilis'' <br />
<br />
''P. aeruginosa''<br />
<br />
''Enterococcus spp.''<br />
<br />
''Streptococcus spp''<br />
<br />
''S. aureus''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|For hemodynamically unstable health-care associated infection, consider meropenem.<br />
|-<br />
|''Clostridium difficile''-associated diarrhea<br />
|''Clostridium difficile''<br />
|Initial episode, mild to moderate disease<br />
(WBC ≤15K and SCr less than 1.5 times premorbid level)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days. If unable to obtain at discharge, can complete course with '''Metronidazole'''500mg po q8h<br />
<br />
Initial episode, severe disease<br />
<br />
(WBC >15k and/or 50% increase in SCr)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days.<br />
<br />
Initial episode, severe disease with complications<br />
<br />
(Severe disease with hypotension, shock, ilios, and/or megacolon)<br />
<br />
'''Vancomycin''' 500mg PO/NG q6h x 10-14 days<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h x 10-14 days<br />
<br />
WITH OR WITHOUT<br />
<br />
'''Vancomycin''' PR Rectal vancomycin should be considered in patients with ileus. It is given as 500 mg in 100 mL of 0.9% NaCl and instilled q6h (retain each dose for 1h)<br />
<br />
First recurrence<br />
<br />
Same therapy as initial episode, stratified by illness severity<br />
<br />
First recurrence, special population (hematologic malignancy with >30 days expected neutropenia, recent HSCT, recent treatment for GVHD, solid organ transplant <3 months)<br />
<br />
'''Fidaxomicin'''ID-R: UCSF SFGH VASF 200mg PO BID x10 days<br />
<br />
Second recurrence<br />
<br />
'''Vancomycin''' with tapered or pulsed regimen<br />
<br />
PLUS<br />
<br />
Consult ID, GI<br />
<br />
PLUS<br />
<br />
Evaluate for fecal microbiota transplant<br />
|IV metronidazole alone is not indicated for treatment of ''C. difficile'' diarrhea.<br />
IV metronidazole should only be used in combination with PO vancomycin in the ICU.<br />
<br />
Recurrence in 5-30% of patients after first episode and 33-60% after second episode.<br />
<br />
ID CONSULT recommended in patients with severe disease with complications or multiply recurrent disease, and for consideration of rectal vancomycin administration.<br />
|<br />
|}<br />
{| class="wikitable"<br />
|''''''Endometritis'''''' <br />
|''Bacteroides''<br />
''Prevotella bivia''<br />
<br />
Group B & Astreptococci<br />
<br />
Enterobacteriaceae<br />
<br />
''M. hominis''<br />
|'''''1st line:'''''<br />
'''Cefoxitin''' 2 g IV q6h <br />
<br />
'''''2nd line:'''''<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
'''''3rd line:'''''<br />
<br />
'''Ampicillin/sulbactam''' 3 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Gentamicin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q12h<br />
|If test for chlamydia is positive add azithromycin or doxycycline.<br />
Continue antibiotics until afebrile for 24-48 hours.<br />
<br />
If still febrile > 48 hours and on cefoxitin or clindamycin/gentamicin postpartum, switch to ertapenem.<br />
<br />
Wait 48 hours on an antibiotic regimen before considering regimen failed.<br />
|}<br />
{| class="wikitable"<br />
|'''Peritonsillar abscess,''' deep neck infections<br />
|Group A streptococci<br />
Anaerobes<br />
<br />
''S. aureus''<br />
|'''Ampicillin/sulbactam''' 3 g IV q6h<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin''' <br />
<br />
Alternatively:<br />
<br />
'''Metronidazole''' 500 mg IV/PO q8h<br />
<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV q24h<br />
<br />
WITH OR WITHOUT*<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Clindamycin'''ID-R: VASF 600 – 900 mg IV q8h<br />
<br />
PLUS<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin'''ID-R: VASF 500 mg IV daily<br />
|Often polymicrobial<br />
Combinations of piperacillin/tazobactam, ampicillin/sulbactam, or ertapenem PLUS metronidazole should not be used.<br />
<br />
<nowiki>*</nowiki>Consider vancomycin use for patients at high risk for MRSA<br />
|}<br />
{| class="wikitable"<br />
|'''Line-related bacteremia''' <br />
|''S. epidermidis''<br />
''S. aureus''<br />
<br />
''Enterococci spp.''<br />
<br />
Gram-negative rods*<br />
<br />
''Yeast**''<br />
|'''Vancomycin'''<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Piperacillin/tazobactam'''<br />
<br />
ID-R: SFGH<br />
<br />
4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime'''I'''''' 2 g IV q8h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''Aztreonam''' ID-R: SFGH 2 g q8h<br />
|Remove the offending intravascular device immediately, if possible.<br />
<nowiki>*</nowiki>Consider Gram-negative coverage for immunocompromised patients or those with prolonged hospitalization, recent antibiotic exposure or sepsis.<br />
|}<br />
{| class="wikitable"<br />
| rowspan="2" |'''Community-Acquired Pneumonia''' <br />
|'''Immunocompetent patient''' – Medical Ward<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''(alcoholics)''<br />
|No Recent antibiotic therapy:*<br />
'''Ceftriaxone''' 1 g IV daily<br />
<br />
PLUS<br />
<br />
''''''Doxycycline''''''100 mg PO/IV q12h<br />
|For severe PCN allergy:<br />
'''Levofloxacin''' 750 mg PO/IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin'''ID-R: SFGH 400 mg PO/IV daily<br />
|If patient has had recent antibiotic therapy, antibiotics from a different class should be selected (i.e. recent use of a fluoroquinolone should dictate selection of a non-fluoroquinolone regimen, and vice versa).<br />
Consider influenza testing and treatment with oseltamivir.<br />
|-<br />
|'''Community-Acquired Pneumonia'''<br />
'''Immunocompetent patient''' – ICU<br />
|''S. pneumoniae''<br />
''Mycoplasma pneumoniae''<br />
<br />
''Chlamydia pneumoniae''<br />
<br />
''H. influenzae''<br />
<br />
''Legionella pneumophilia''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
(alcoholics)<br />
<br />
''S. aureus''<br />
|'''Ceftriaxone''' 1 g IV daily<br />
PLUS<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Moxifloxacin''' 400 mg IV daily<br />
|MRSA risk factors: prior influenza, presence cavitary disease, empyema.<br />
Consider influenza testing and treatment with oseltamivir.<br />
<br />
If no microbiologic confirmation of MRSA then discontinue vancomycin.<br />
<br />
See HCAP for risk factors for infection with ''Pseudomonas aeruginosa.''<br />
|-<br />
|'''Healthcare –associated pneumonia (HCAP):'''<br />
acquired in long-term care facility where antimicrobials used or ''Pseudomonas'' risk factors (see Comments)<br />
|''S.aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
<br />
''P. aeruginosa (''if risk factors present)<br />
|Hemodynamically stable & no ''Pseudomonas'' risk factors<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV/PO daily<br />
<br />
Hemodynamically unstable or ''Pseudomonas'' risk factors<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam'''ID-R: SFGH 4.5 g IV q6h<br />
<br />
OR<br />
<br />
'''Cefepime'''ID-R: SFGH VASF 2 g IV q8h-q12h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS one of:<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h<br />
<br />
WITH OR WITHOUT one of*:<br />
<br />
'''Doxycycline''' 100 mg IV/PO BID<br />
<br />
OR<br />
<br />
'''Azithromycin''' 500 mg IV daily<br />
|<br />
|''Pseudomonas'' risk factors include: structural lung disease, repeated exacerbations of severe COPD leading to frequent steroid and/or antibiotic use, recent mechanical ventilation, recent prior exposure to broad-spectrum antibiotics<br />
Avoid using levofloxacin if the patient has recently been treated with a fluoroquinolone.<br />
<br />
For patients admitted from the community with HCAP and not treated with levofloxacin, consider adding atypical coverage with doxycycline (floor patients) or azithromycin (ICU patients).<br />
|-<br />
| rowspan="2" |'''Hospital-acquired pneumonia''' <br />
|'''EARLY ONSET'''<br />
including ventilator-associated or less than 5 days of hospitalization, no risk factors for drug-resistant organisms*<br />
|''S. aureus''<br />
''S.pneumoniae''<br />
<br />
''H.influenzae'' <br />
<br />
Antibiotic sensitive enteric gram negative bacilli:<br />
<br />
''E. coli''<br />
<br />
''Enterobacter aerogenes''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''Proteus mirabilis''<br />
<br />
''Serratia marcesans''<br />
|'''Vancomycin'''<br />
PLUS one of<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily <br />
|<br />
|Risk factors include recent antibiotic exposure (within 30 days).<br />
Consider influenza testing and treatment with oseltamivir when influenza is known to be circulating.<br />
|-<br />
|'''LATE ONSET'''<br />
including ventilator-associated OR ≥ 5 days of hospitalization or risk factors for resistant organisms*<br />
|''E. coli''<br />
''Enterobacter aerogenes''<br />
<br />
''P. aeruginosa''<br />
<br />
''Klebsiella pneumoniae''<br />
<br />
''''S. aureus'''' <br />
|'''Vancomycin'''<br />
PLUS one of:<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h <br />
<br />
OR<br />
<br />
'''Cefepime''' 2 g IV q8-12h<br />
<br />
''Alternatively'':<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Meropenem''' 1-2 g IV q8h**<br />
|For severe PCN allergy:<br />
'''Vancomycin'''2<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
WITH OR WITHOUT***:<br />
<br />
'''Tobramycin'''<br />
|**Consider use in patients with current or recent use (< 7 days) of piperacillin/tazobactam or cefepime and in patients with recent infection with multidrug resistant gram-negative bacteria.<br />
<nowiki>***</nowiki>Weigh risks and benefits of adding aminoglycoside for critical illness, immunocompromise, or history of infection or colonization with drug-resistant Gram-negative rods.<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322068Sandbox:Reddy 22017-06-29T19:09:55Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Brain abscess'''<br />
|Streptococci (anaerobic or aerobic)<br />
''Bacteroides spp''<br />
<br />
''Prevotella'' spp<br />
<br />
Enterobacteriacea<br />
|'''Ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|'''Aztreonam'''<br />
2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
|Consider expanded Gram-positive coverage if patient at risk for drug-resistant streptococci or MRSA<br />
|-<br />
|'''Meningitis'''<br />
Community-onset<br />
|''S. pneumoniae''<br />
<br />
''Neisseria meningitidis''<br />
<br />
''Listeria'' (especially in immuno-compromised, elderly patients, and alcoholics)<br />
|'''ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''TMP/SMX''' 15 mg/kg/day (in divided doses)<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ampicillin'''''' 2 g IV q4h<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''2 g IV q6h-q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''TMP/SMX''' (if ''Listeria'') 15 mg/kg/day (in divided doses)<br />
|Therapy should be guided by Gram stain.<br />
If bacterial meningitis suspected'','' dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics. <br />
<br />
'''*'''Coverage for ''Listeria'' with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.<br />
|-<br />
|'''Meningitis'''<br />
Post-neurosurgical or device associated<br />
|''S. aureus''<br />
Coagulase negative<br />
<br />
Staphylococci<br />
<br />
Gram negative rods<br />
|'''Cefepime'''<br />
PLUS<br />
<br />
'<nowiki/>'''''Vancomycin'''''' <br />
|For '''severe''' PCN allergy:<br />
'''Aztreonam''' 2 g IV q6h-q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
|<br />
|}<br />
{| class="wikitable"<br />
|-<br />
|'''Native Valve'''<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''Enterococcus spp.''<br />
<br />
Occasional gram negative rods<br />
<br />
HACEK < 5%<br />
|'''Vancomycin'''<br />
WITH or WITHOUT*<br />
<br />
'''Ceftriaxone'''<br />
<br />
2 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH or WITHOUT*<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
|Narrow coverage to microbiologically confirmed pathogens<br />
<nowiki>*</nowiki>Addition of Gram-negative coverage should be considered if the patient has a sub-acute presentation.<br />
|-<br />
|'''Prosthetic Valve'''<br />
|''S. aureus''<br />
''S. epidermidis''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Rifampin'''300 mg PO q8h<br />
<br />
PLUS<br />
<br />
'''Gentamicin''' 1 mg/kg/dose IV q8h for initial two weeks only<br />
<br />
Single daily dose of gentamicin is not recommended<br />
|<br />
|Rifampin has numerous clinically significant drug interactions. Medication lists should be reviewed for potential drug-drug interactions with rifampin.<br />
|}<br />
{| class="wikitable"<br />
|'''Spontaneous Bacterial Peritonitis (SBP)'''<br />
|''E. coli''<br />
''Klebsiella spp.''<br />
<br />
''''Streptococci. spp''.''<br />
|'''Ceftriaxone''' 1 g IV daily x 5 days<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Mild-Moderate''' intra-abdominal abscess<br />
|''E. coli''<br />
''Klebsiella'' <br />
<br />
''B. fragilis''<br />
<br />
''Streptococci spp''<br />
<br />
''S. aureus''<br />
|'''Ertapenem''' 1g IV daily<br />
OR<br />
<br />
'''Piperacillin/tazobactam''' 3.375 g IV q6h - 4.5g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|<br />
|-<br />
|'''Secondary Peritonitis'''<br />
'''Severe''' (major peritoneal soilage, large or multiple abscesses, patient hemodynamically unstable)<br />
|''E. coli'' <br />
''Klebsiella''<br />
<br />
''B. fragilis'' <br />
<br />
''P. aeruginosa''<br />
<br />
''Enterococcus spp.''<br />
<br />
''Streptococcus spp''<br />
<br />
''S. aureus''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Piperacillin/tazobactam''' 4.5 g IV q6h<br />
|For severe PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Metronidazole'''500 mg IV q8h<br />
|For hemodynamically unstable health-care associated infection, consider meropenem.<br />
|-<br />
|''Clostridium difficile''-associated diarrhea<br />
|''Clostridium difficile''<br />
|Initial episode, mild to moderate disease<br />
(WBC ≤15K and SCr less than 1.5 times premorbid level)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days. If unable to obtain at discharge, can complete course with '''Metronidazole'''500mg po q8h<br />
<br />
Initial episode, severe disease<br />
<br />
(WBC >15k and/or 50% increase in SCr)<br />
<br />
'''Vancomycin''' 125mg PO q6h x 10-14 days.<br />
<br />
Initial episode, severe disease with complications<br />
<br />
(Severe disease with hypotension, shock, ilios, and/or megacolon)<br />
<br />
'''Vancomycin''' 500mg PO/NG q6h x 10-14 days<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg IV q8h x 10-14 days<br />
<br />
WITH OR WITHOUT<br />
<br />
'''Vancomycin''' PR Rectal vancomycin should be considered in patients with ileus. It is given as 500 mg in 100 mL of 0.9% NaCl and instilled q6h (retain each dose for 1h)<br />
<br />
First recurrence<br />
<br />
Same therapy as initial episode, stratified by illness severity<br />
<br />
First recurrence, special population (hematologic malignancy with >30 days expected neutropenia, recent HSCT, recent treatment for GVHD, solid organ transplant <3 months)<br />
<br />
'''Fidaxomicin'''ID-R: UCSF SFGH VASF 200mg PO BID x10 days<br />
<br />
Second recurrence<br />
<br />
'''Vancomycin''' with tapered or pulsed regimen<br />
<br />
PLUS<br />
<br />
Consult ID, GI<br />
<br />
PLUS<br />
<br />
Evaluate for fecal microbiota transplant<br />
|IV metronidazole alone is not indicated for treatment of ''C. difficile'' diarrhea.<br />
IV metronidazole should only be used in combination with PO vancomycin in the ICU.<br />
<br />
Recurrence in 5-30% of patients after first episode and 33-60% after second episode.<br />
<br />
ID CONSULT recommended in patients with severe disease with complications or multiply recurrent disease, and for consideration of rectal vancomycin administration.<br />
|<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322063Sandbox:Reddy 22017-06-29T19:05:41Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}<br />
{| class="wikitable"<br />
!<br />
!<br />
!<br />
!<br />
!<br />
|-<br />
|'''Brain abscess'''<br />
|Streptococci (anaerobic or aerobic)<br />
''Bacteroides spp''<br />
<br />
''Prevotella'' spp<br />
<br />
Enterobacteriacea<br />
|'''Ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|'''Aztreonam'''<br />
2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
|Consider expanded Gram-positive coverage if patient at risk for drug-resistant streptococci or MRSA<br />
|-<br />
|'''Meningitis'''<br />
Community-onset<br />
|''S. pneumoniae''<br />
<br />
''Neisseria meningitidis''<br />
<br />
''Listeria'' (especially in immuno-compromised, elderly patients, and alcoholics)<br />
|'''ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''TMP/SMX''' 15 mg/kg/day (in divided doses)<br />
<br />
OR<br />
<br />
'<nowiki/>'''''Ampicillin'''''' 2 g IV q4h<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''2 g IV q6h-q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''TMP/SMX''' (if ''Listeria'') 15 mg/kg/day (in divided doses)<br />
|Therapy should be guided by Gram stain.<br />
If bacterial meningitis suspected'','' dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics. <br />
<br />
'''*'''Coverage for ''Listeria'' with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.<br />
|-<br />
|'''Meningitis'''<br />
Post-neurosurgical or device associated<br />
|''S. aureus''<br />
Coagulase negative<br />
<br />
Staphylococci<br />
<br />
Gram negative rods<br />
|'''Cefepime'''<br />
PLUS<br />
<br />
'<nowiki/>'''''Vancomycin'''''' <br />
|For '''severe''' PCN allergy:<br />
'''Aztreonam''' 2 g IV q6h-q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
|<br />
|}<br />
{| class="wikitable"<br />
!<br />
!<br />
!<br />
!<br />
!<br />
|-<br />
|'''Native Valve'''<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''Enterococcus spp.''<br />
<br />
Occasional gram negative rods<br />
<br />
HACEK < 5%<br />
|'''Vancomycin'''<br />
WITH or WITHOUT*<br />
<br />
'''Ceftriaxone'''<br />
<br />
2 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
WITH or WITHOUT*<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
|Narrow coverage to microbiologically confirmed pathogens<br />
<nowiki>*</nowiki>Addition of Gram-negative coverage should be considered if the patient has a sub-acute presentation.<br />
|-<br />
|'''Prosthetic Valve'''<br />
|''S. aureus''<br />
''S. epidermidis''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Rifampin'''300 mg PO q8h<br />
<br />
PLUS<br />
<br />
'''Gentamicin''' 1 mg/kg/dose IV q8h for initial two weeks only<br />
<br />
Single daily dose of gentamicin is not recommended<br />
|<br />
|Rifampin has numerous clinically significant drug interactions. Medication lists should be reviewed for potential drug-drug interactions with rifampin.<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322062Sandbox:Reddy 22017-06-29T19:03:23Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam''' 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin''' 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}<br />
{| class="wikitable"<br />
!<br />
!<br />
!<br />
!<br />
!<br />
|-<br />
|'''Brain abscess'''<br />
|Streptococci (anaerobic or aerobic)<br />
''Bacteroides spp''<br />
<br />
''Prevotella'' spp<br />
<br />
Enterobacteriacea<br />
|'''Ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''Vancomycin'''<br />
|'''Aztreonam'''<br />
2 g IV q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Metronidazole''' 500 mg PO/IV q8h<br />
|Consider expanded Gram-positive coverage if patient at risk for drug-resistant streptococci or MRSA<br />
|-<br />
|'''Meningitis'''<br />
Community-onset<br />
|''S. pneumoniae''<br />
<br />
''Neisseria meningitidis''<br />
<br />
''Listeria'' (especially in immuno-compromised, elderly patients, and alcoholics)<br />
|'''ceftriaxone'''<br />
2 g IV q12h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
<br />
WITH OR WITHOUT* one of:<br />
<br />
'''TMP/SMX''' 15 mg/kg/day (in divided doses)<br />
<br />
OR<br />
<br />
''''''Ampicillin'''''' 2 g IV q4h<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS<br />
<br />
'''Aztreonam'''2 g IV q6h-q8h<br />
<br />
WITH OR WITHOUT*:<br />
<br />
'''TMP/SMX''' (if ''Listeria'') 15 mg/kg/day (in divided doses)<br />
|Therapy should be guided by Gram stain.<br />
If bacterial meningitis suspected'','' dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics. <br />
<br />
'''*'''Coverage for ''Listeria'' with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.<br />
|-<br />
|'''Meningitis'''<br />
Post-neurosurgical or device associated<br />
|''S. aureus''<br />
Coagulase negative<br />
<br />
Staphylococci<br />
<br />
Gram negative rods<br />
|'''Cefepime'''<br />
PLUS<br />
<br />
''''''Vancomycin'''''' <br />
|For '''severe''' PCN allergy:<br />
'''Aztreonam''' 2 g IV q6h-q8h<br />
<br />
PLUS<br />
<br />
'''Vancomycin'''<br />
|<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322055Sandbox:Reddy 22017-06-29T18:56:49Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>Hospitalized patients <br />
{| class="wikitable"<br />
!Infection<br />
!<br />
!Organisms<br />
!First DOC <br />
!Alternative <br />
!<br />
|-<br />
| rowspan="2" |'''Osteomyelitis'''<br />
|Presumed hematogenous source or contiguous without vascular insufficiency<br />
|''S. aureus''<br />
|Vancomycin<br />
|Vanc<br />
|If ''S. aureus'' is methicillin-susceptible then cefazolin 2 g IV q8h or nafcillin 2 g IV q4h are the antibiotics of choice.<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if blood cultures are negative and patient clinically stable.<br />
|-<br />
|With vascular insufficiency or diabetes mellitus (e.g. severe diabetic foot ulcer)<br />
|''S. aureus'' <br />
Enterobacteriaceae<br />
<br />
Anaerobes<br />
|'''Vancomycin'''<br />
PLUS ONE OF:<br />
<br />
'''Piperacillin/Tazobactam'''ID-R: SFGH 4.5 g IV q6-8h<br />
<br />
OR<br />
<br />
'''Ertapenem''' 1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' ID-R: VASF 750 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam''' ID-R: SFGH 2 g IV q8h<br />
<br />
ALL WITH OR WITHOUT:<br />
<br />
'''Metronidazole'''500 mg IV q8h (if patient critically ill)<br />
|Other organisms are possible, esp. with hardware microbiologic diagnosis and ID consultation recommended<br />
Obtain bone biopsy to determine microbiologic cause prior to initiation of antimicrobial therapy if patient clinically stable<br />
<br />
Once stable, switch to oral antibiotics based on susceptibility results.<br />
|-<br />
|'''Septic Arthritis'''<br />
|<br />
|''S. aureus''<br />
''Streptococci spp.''<br />
<br />
''N. gonorrhoeae''<br />
<br />
''Enterobacteriaceae (rarely)''<br />
|'''Vancomycin'''<br />
PLUS<br />
<br />
'''Ceftriaxone'''1 g IV daily<br />
|For '''severe''' PCN allergy:<br />
'''Vancomycin'''<br />
<br />
PLUS ONE OF:<br />
<br />
'''Ciprofloxacin'''ID-R: VASF 400 mg IV q12h<br />
<br />
OR<br />
<br />
'''Levofloxacin''' ID-R: VASF 500 mg IV daily<br />
<br />
OR<br />
<br />
'''Aztreonam'''ID-R: SFGH 2 g IV q8h if gonococcus is strongly suspected<br />
|Gram stain recommended to guide therapy.<br />
Narrow coverage to microbiologically confirmed pathogens.<br />
|}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Sandbox:Reddy_2&diff=1322053Sandbox:Reddy 22017-06-29T18:51:40Z<p>Aravind Kuchkuntla: Blanked the page</p>
<hr />
<div></div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_differential_diagnosis&diff=1321682Echinococcosis differential diagnosis2017-06-28T17:58:34Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
==Overview==<br />
Cystic echinococcosis must be differentiated from other diseases presenting with similar features of right sided abdominal pain such as pyogenic liver abscess and amebic liver abscess and fungal liver abscess.<br />
<br />
==Differential Diagnosis==<br />
Echinococcal cyst must be differentiated from:<br />
<small><br />
{| class="wikitable"<br />
! rowspan="3" |Disease<br />
! rowspan="3" |Causes<br />
! colspan="11" |symptoms<br />
! rowspan="3" |Lab Findings<br />
! rowspan="3" |Imaging Findings<br />
! rowspan="3" |Other Findings<br />
|-<br />
! rowspan="2" | Fever<br />
! colspan="2" | Pain<br />
! rowspan="2" | cough<br />
! rowspan="2" | Hepatomegaly<br />
! rowspan="2" | Jaundice<br />
! rowspan="2" | Weight loss<br />
! rowspan="2" | Anorexia<br />
! rowspan="2" | Diarrhoea<br />
or Dysentry<br />
! rowspan="2" | Nausea and <br />
vomiting<br />
! rowspan="2" | Stool<br />
|-<br />
! Abdominal pain<br />
(right upper quadrant pain)<br />
! Pleuritic pain<br />
|-<br />
|[[Amoebic liver abscess]]<br />
|[[Entamoeba histolytica]]<br />
|✔✔✔<br />
|✔✔✔<br />
|✔/✘<br />
|✔<br />
|✔✔/✘<br />
|✔<br />
(late stages)<br />
|✔<br />
(late stages)<br />
|✔<br />
|✔<br />
|✔<br />
|<br />
|[[Hypoalbuminemia]]<br />
<br />
(✔)<br />
|<br />
* [[Ultrasound]] is the gold standard technique for diagnosing [[amoebic liver abscess]]<br />
|<br />
* Respond well to [[chemotherapy]] and rarely require drainage<br />
* Marked male predominance<br />
* More common in developing countries<br />
* [[Sero-positive]]<br />
* Right lobe is more frequently involved<br />
|-<br />
|[[Pyogenic liver abscess]]<br />
|Bacteria<br />
* [[Gram-positive]] [[aerobes]]<br />
* [[Gram-negative]] enterics<br />
* [[Anaerobic]] organisms<br />
* [[Acid fast bacilli]] <br />
|✔<br />
|✔<br />
|✔✔<br />
|✔✔<br />
|✔/✘<br />
|✔✔✔<br />
|✔<br />
(acute loss)<br />
|✔<br />
|<br />
|✔<br />
|Pale/dark<br />
|[[Hypoalbuminemia]]<br />
<br />
(✔✔✔)<br />
|Cluster sign<br />
* [[CT scan]] shows cluster sign<br />
* Aggregation of multiple low attenuation [[liver]] lesions in a localized area to form a solitary larger [[abscess]] cavity<br />
|<br />
* Abnormal pulmonary findings<br />
* [[Diabetes mellitus]] increases the risk<br />
* Medical-surgical approach is indicated<br />
* More common in developed countries<br />
* Culture positive and [[sero-negative]]<br />
* Both lobes are commonly involved<br />
|-<br />
|Fungal liver abscess<br />
|''[[Candida|Candida species]]''<br>[[Aspergillus|Aspergillus species]]<br />
|✔<br />
|✔<br />
|✔/✘<br />
|✔<br />
|✔<br />
|✔<br />
|✔<br />
|✔<br />
|✔<br />
|✔<br />
|<br />
|<br />
|CT and Us findings with four patterns of presentation:<br />
* Wheel-within-a-wheel pattern<br />
* Bull’s-eye configuration pattern<br />
* Uniformly hypoechoic nodule<br />
* Echogenic foci with variable degrees of posterior acoustic shadowing<br />
|<br />
* Less common<br />
* Pure fungal abscess or associated with [[pyogenic abscess]]<br />
* [[Candida]] and [[Aspergillus]] are commonly found in the culture of aspirated pus<br />
* Associated with underlying [[malignancy]] or [[DM]]<br />
|-<br />
|[[hydatid cyst|Echinococcal (hydatid) cyst]]<br />
|[[Echinococcus granulosus]]<br />
|<br />
|✔<br />
|<br />
|✔<br />
<br />
|<br />
|✔<br />
([[Obstructive jaundice]])<br />
|✔<br />
|✔<br />
|<br />
|<br />
|<br />
|Histology: [[Hydatid cyst]] with three layers<br />
<br />
a.The outer pericyst, which corresponds with compressed and fibrosed [[liver]] tissue<br />
<br />
b.The endocyst, an inner germinal layer<br />
<br />
c.The ectocyst, a thin, translucent interleaved membrane<br />
|Ultrasound:<br />
* Cystic to solid-appearing pseudotumors<br />
* Water lily sign<br />
* [[Calcifications]] seen peripherally<br />
|<br />
* Blood or liquid from the ruptured cyst may be coughed up<br />
* [[Pruritis]]<br />
|-<br />
|Malignancy<br />
(Hepatocellular carcinoma/Metastasis)<br />
|<br />
*[[Hepatitis B]] and [[hapatitis C|C]]<br />
*[[Aflatoxins]]<br />
*[[Alcohol]]<br />
*[[Hemochromatosis]]<br />
*[[Alpha 1 antitrypsin deficiency]]<br />
*[[Non alcoholic fatty liver disease]]<br />
|✔<br />
|✔<br />
<br />
(uncommon)<br />
|<br />
|<br />
|✔<br />
|✔<br />
|✔✔<br />
|<br />
|<br />
|✔✔<br />
|Pale/Chalky<br />
|<br />
* High levels of [[alpha-fetoprotein|AFP]] in serum<br />
* Abnormal [[liver function test]]s<br />
|<br />
* [[Liver biopsy]]<br />
|Other symptoms:<br />
* [[Splenomegaly]]<br />
* [[Variceal bleeding]]<br />
* [[Ascites]]<br />
* [[Spider nevi]]<br />
* [[Asterixis]]<br />
|}<br />
</small><br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
[[Category:Needs content]]<br />
[[Category:Disease]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321674Echinococcosis pathophysiology2017-06-28T17:48:07Z<p>Aravind Kuchkuntla: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
==Overview==<br />
The transmission of infection from the definite host to the intermediate host is by ingestion of embryonated eggs passed in the feces. Once the eggs are ingested they hatch in the small intestine and develop into onchospheres. There oncospheres reach various organs by migration through the vascular system and develop into cysts producing protoscolices. The definitive host is infected by ingestion of the organs infected with the cysts. After ingestion of the cysts they evaginate and invade the intestinal mucosa and develop into adult worms.<br />
<br />
==Pathophysiology==<br />
===Life cycle===<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
<small>'''(1)'''The adult [[Echinococcus granulosus]] '''(2)''' Embryonated eggs '''(3)''' [[Oncosphere]] '''(4)''' Cyst '''(5)''' Protoscolices '''(6)''' Protoscolices evaginating.</small><br />
===Trasmission of infection===<br />
*The transmission of infection from the definitive host to the intermediate host occurs by the ingestion of embryonated eggs passed in the feces.<br />
*The definitive host is infected by the ingestion of cyst containing organs of the infected intermediate host.<br />
===Pathogenesis===<br />
*The embronated eggs are excreted in the feces of the definitive host, which include dogs and other carnivores.<br />
*The intermediate hosts include: sheep, cattle, horses and camel. Once ingested the eggs hatch in the small bowel and release oncospheres.<br />
*The onchospheres penetrate the intestinal wall and migrate through the vascular system to organs such as liver and lung.<br />
*In the lungs and liver the oncospheres develop into a cyst producing protoscolices and daughter cysts which fill the interior of the cyst.<br />
*The definite host will be infected if they ingest the cyst containing organs.<br />
*Once ingested the protoscolices evaginate and attach the intestinal mucosa. <br />
*In 32 to 80 days after evagination the protoscolices develop into adult tape worm.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*In the life cycle of E. vogeli the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321672Echinococcosis pathophysiology2017-06-28T17:44:07Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
==Overview==<br />
The transmission of infection from the definite host to the intermediate host is by ingestion of embryonated eggs passed in the feces. Once the eggs are ingested they hatch in the small intestine and develop into onchospheres. There oncospheres reach various organs by migration through the vascular system and develop into cysts producing protoscolices. The definitive host is infected by ingestion of the organs infected with the cysts. After ingestion of the cysts they evaginate and invade the intestinal mucosa and develop into adult worms.<br />
<br />
==Pathophysiology==<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
<small>'''(1)'''The adult [[Echinococcus granulosus]] '''(2)''' Embryonated eggs '''(3)''' [[Oncosphere]] '''(4)''' Cyst '''(5)''' Protoscolices '''(6)''' Protoscolices evaginating.</small><br />
===Trasmission of infection===<br />
*The transmission of infection from the definitive host to the intermediate host occurs by the ingestion of embryonated eggs passed in the feces.<br />
*The definitive host is infected by the ingestion of cyst containing organs of the infected intermediate host.<br />
===Pathogenesis===<br />
*The embronated eggs are excreted in the feces of the definitive host, which include dogs and other carnivores.<br />
*The intermediate hosts include: sheep, cattle, horses and camel. Once ingested the eggs hatch in the small bowel and release oncospheres.<br />
*The onchospheres penetrate the intestinal wall and migrate through the vascular system to organs such as liver and lung.<br />
*In the lungs and liver the oncospheres develop into a cyst producing protoscolices and daughter cysts which fill the interior of the cyst.<br />
*The definite host will be infected if they ingest the cyst containing organs.<br />
*Once ingested the protoscolices evaginate and attach the intestinal mucosa. <br />
*In 32 to 80 days after evagination the protoscolices develop into adult tape worm.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*In the life cycle of E. vogeli the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321669Echinococcosis pathophysiology2017-06-28T17:28:04Z<p>Aravind Kuchkuntla: /* Pathogenesis */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
<br />
==Pathophysiology==<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
<small>'''(1)'''The adult [[Echinococcus granulosus]] '''(2)''' Embryonated eggs '''(3)''' [[Oncosphere]] '''(4)''' Cyst '''(5)''' Protoscolices '''(6)''' Protoscolices evaginating.</small><br />
===Trasmission of infection===<br />
*The transmission of infection from the definitive host to the intermediate host occurs by the ingestion of embryonated eggs passed in the feces.<br />
*The definitive host is infected by the ingestion of cyst containing organs of the infected intermediate host.<br />
===Pathogenesis===<br />
*The embronated eggs are excreted in the feces of the definitive host, which include dogs and other carnivores.<br />
*The intermediate hosts include: sheep, cattle, horses and camel. Once ingested the eggs hatch in the small bowel and release oncospheres.<br />
*The onchospheres penetrate the intestinal wall and migrate through the vascular system to organs such as liver and lung.<br />
*In the lungs and liver the oncospheres develop into a cyst producing protoscolices and daughter cysts which fill the interior of the cyst.<br />
*The definite host will be infected if they ingest the cyst containing organs.<br />
*Once ingested the protoscolices evaginate and attach the intestinal mucosa. <br />
*In 32 to 80 days after evagination the protoscolices develop into adult tape worm.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*In the life cycle of E. vogeli the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321668Echinococcosis pathophysiology2017-06-28T17:27:13Z<p>Aravind Kuchkuntla: /* Pathogenesis */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
<br />
==Pathophysiology==<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
<small>'''(1)'''The adult [[Echinococcus granulosus]] '''(2)''' Embryonated eggs '''(3)''' [[Oncosphere]] '''(4)''' Cyst '''(5)''' Protoscolices '''(6)''' Protoscolices evaginating.</small><br />
===Trasmission of infection===<br />
*The transmission of infection from the definitive host to the intermediate host occurs by the ingestion of embryonated eggs passed in the feces.<br />
*The definitive host is infected by the ingestion of cyst containing organs of the infected intermediate host.<br />
===Pathogenesis===<br />
*The embronated eggs are excreted in the feces of the definitive host, which include dogs and other carnivores.<br />
*The intermediate hosts include: sheep, cattle, horses and camel. Once ingested the eggs hatch in the small bowel and release oncospheres.<br />
*The onchospheres penetrate the intestinal wall and migrate through the vascular system to organs such as liver and lung.<br />
*In the lungs and liver the oncospheres develop into a cyst producing protoscolices and daughter cysts which fill the interior of the cyst.<br />
*The definite host will be infected if they ingest the cyst containing organs.<br />
*Once ingested the protoscolices evaginate and attach the intestinal mucosa. <br />
*In 32 to 80 days after evagination the protoscolices develop into adult tape worm.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*Life cycle of E. vogeli (up to 5.6 mm long), the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321666Echinococcosis pathophysiology2017-06-28T17:26:37Z<p>Aravind Kuchkuntla: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
<br />
==Pathophysiology==<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
<small>'''(1)'''The adult [[Echinococcus granulosus]] '''(2)''' Embryonated eggs '''(3)''' [[Oncosphere]] '''(4)''' Cyst '''(5)''' Protoscolices '''(6)''' Protoscolices evaginating.</small><br />
===Trasmission of infection===<br />
*The transmission of infection from the definitive host to the intermediate host occurs by the ingestion of embryonated eggs passed in the feces.<br />
*The definitive host is infected by the ingestion of cyst containing organs of the infected intermediate host.<br />
===Pathogenesis===<br />
*The embronated eggs are excreted in the feces of the definitive host, which include dogs and other carnivores.<br />
*The intermediate hosts include: sheep, cattle, horses and camel. Once ingested the eggs hatch in the small bowel and release oncospheres.<br />
*The onchospheres penetrate the intestinal wall and migrate through the vascular system to organs such as liver and lung.<br />
*In the lungs and liver the oncospheres develop into a cyst producing protoscolices and daughter cysts which fill the interior of the cyst.<br />
*The definite host will be infected if they ingest the cyst containing organs.<br />
*Once ingested the protoscolices evaginate and attach the intestinal mucosa. In 32 to 80 days after evagination the protoscolices develop into adult tape worm.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*Life cycle of E. vogeli (up to 5.6 mm long), the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321663Echinococcosis pathophysiology2017-06-28T17:17:49Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
<br />
==Pathophysiology==<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
<small>'''(1)'''The adult [[Echinococcus granulosus]] '''(2)''' Embryonated eggs '''(3)''' [[Oncosphere]] '''(4)''' Cyst '''(5)''' Protoscolices '''(6)''' Protoscolices evaginating.</small><br />
The adult [[Echinococcus granulosus]] (3 to 6 mm long) '''(1)''' resides in the small bowel of the [[definitive host]]s, dogs or other canids. Gravid proglottids release eggs '''(2)''' that are passed in the feces. After ingestion by a suitable intermediate host (under natural conditions: sheep, goat, swine, cattle, horses, camel), the egg hatches in the small bowel and releases an [[oncosphere]] '''(3)''' that penetrates the [[intestinal wall]] and migrates through the circulatory system into various [[organ]]s, especially the liver and lungs. In these organs, the oncosphere develops into a cyst '''(4)'''that enlarges gradually, producing [[protoscolices]] '''(5)''' and daughter [[cyst]]s that fill the cyst interior. The definitive host becomes infected by ingesting the cyst-containing organs of the infected [[intermediate host]]. After ingestion, the protoscolices evaginate, attach to the [[intestinal mucosa]] '''(6)''' , and develop into adult stages '''(1)''' in 32 to 80 days.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*Life cycle of E. vogeli (up to 5.6 mm long), the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321661Echinococcosis pathophysiology2017-06-28T17:16:46Z<p>Aravind Kuchkuntla: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
<br />
==Pathophysiology==<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
<small>'''(1)'''The adult [[Echinococcus granulosus]] '''(2)''' Eggs '''(3)''' [[Oncosphere]] '''(4)''' Cyst '''(5)''' [[protoscolices]] '''(6)''' Protoscolices evaginating and attaching to the intestinal lumen.</small><br />
The adult [[Echinococcus granulosus]] (3 to 6 mm long) '''(1)''' resides in the small bowel of the [[definitive host]]s, dogs or other canids. Gravid proglottids release eggs '''(2)''' that are passed in the feces. After ingestion by a suitable intermediate host (under natural conditions: sheep, goat, swine, cattle, horses, camel), the egg hatches in the small bowel and releases an [[oncosphere]] '''(3)''' that penetrates the [[intestinal wall]] and migrates through the circulatory system into various [[organ]]s, especially the liver and lungs. In these organs, the oncosphere develops into a cyst '''(4)'''that enlarges gradually, producing [[protoscolices]] '''(5)''' and daughter [[cyst]]s that fill the cyst interior. The definitive host becomes infected by ingesting the cyst-containing organs of the infected [[intermediate host]]. After ingestion, the protoscolices evaginate, attach to the [[intestinal mucosa]] '''(6)''' , and develop into adult stages '''(1)''' in 32 to 80 days.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*Life cycle of E. vogeli (up to 5.6 mm long), the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_pathophysiology&diff=1321657Echinococcosis pathophysiology2017-06-28T17:13:25Z<p>Aravind Kuchkuntla: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
<br />
==Pathophysiology==<br />
[[Image:Echinococcus LifeCycle.gif|450px|center]]<br />
The adult [[Echinococcus granulosus]] (3 to 6 mm long) '''(1)''' resides in the small bowel of the [[definitive host]]s, dogs or other canids. Gravid proglottids release eggs '''(2)''' that are passed in the feces. After ingestion by a suitable intermediate host (under natural conditions: sheep, goat, swine, cattle, horses, camel), the egg hatches in the small bowel and releases an [[oncosphere]] '''(3)''' that penetrates the [[intestinal wall]] and migrates through the circulatory system into various [[organ]]s, especially the liver and lungs. In these organs, the oncosphere develops into a cyst '''(4)'''that enlarges gradually, producing [[protoscolices]] '''(5)''' and daughter [[cyst]]s that fill the cyst interior. The definitive host becomes infected by ingesting the cyst-containing organs of the infected [[intermediate host]]. After ingestion, the protoscolices evaginate, attach to the [[intestinal mucosa]] '''(6)''' , and develop into adult stages '''(1)''' in 32 to 80 days.<br />
*The life cycle of [[E. multilocularis]] is similar to the life cycle of Echinococcus granulosus, but with the following differences: The definitive hosts are foxes, and to a lesser extent dogs, cats, coyotes and wolves. The intermediate host are small rodents and the larval growth (in the [[liver]]) remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues. <br />
*Life cycle of E. vogeli (up to 5.6 mm long), the definitive hosts are bush dogs and dogs. The intermediate hosts are rodents and the larval stage in the [[liver]], [[lung]] develops both externally and internally, resulting in multiple vesicles. <br />
*E. oligarthrus (up to 2.9 mm long) has a life cycle that involves wild felids as definitive hosts and rodents as intermediate hosts. Humans become infected by ingesting eggs , with resulting release of oncospheres in the intestine and the development of cysts in various organs.<br />
===Gross Pathology===<br />
Shown below is an image of a typical cyst at removal.<br />
[[Image:hydatid_cyst_membrane.jpg|center|250 px]]<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_classification&diff=1321656Echinococcosis classification2017-06-28T17:08:03Z<p>Aravind Kuchkuntla: </p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
==Overview==<br />
Echinoccocosis is classified based on the site of infection and the type of tape worm causing the infection into cystic echinococcosis and alveolar echinococcosis. It can also be classified based on the ultrasound findings and appearance.<br />
==Classification==<br />
*Based on International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings cystic echinococcosis is classified into:<ref name="Working Group2003">{{cite journal|last1=Working Group|first1=WHO Informal|title=International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings|journal=Acta Tropica|volume=85|issue=2|year=2003|pages=253–261|issn=0001706X|doi=10.1016/S0001-706X(02)00223-1}}</ref><br />
**Cystic echinococcosis cyst type 1 and 2: Cysts are active fertile cysts and contain viable protoscoleces.<br />
**Cystic echinococcosis type 3: Cysts in transitional stage, as a result of host immune response or therapy.<br />
**Cystic echinococcosis cyst type 4 and 5: Inactive cysts which have lost their fertility and are degenerative.<br />
*Based on the site of infection, echinococcosis can be classified into: <br />
**'''Cystic echinococcosis:''' It is due to infection of the host by the larval stage of Echinococcus granulosus. It causes a chronic asymptomatic infection affecting the lungs and liver. Infection will lead to the formation of enlarging cysts in the liver and lungs.<br />
**'''Alveolar echinococcosis:'''It is due to the infection of the host by the larval stage of Echinococcus multilocularis. It is common in endemic areas and results in the formation of parasitic tumors in the liver, lungs and brain.<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_classification&diff=1321655Echinococcosis classification2017-06-28T17:05:36Z<p>Aravind Kuchkuntla: /* External Link */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
==Classification==<br />
*Based on International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings cystic echinococcosis is classified into:<ref name="Working Group2003">{{cite journal|last1=Working Group|first1=WHO Informal|title=International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings|journal=Acta Tropica|volume=85|issue=2|year=2003|pages=253–261|issn=0001706X|doi=10.1016/S0001-706X(02)00223-1}}</ref><br />
**Cystic echinococcosis cyst type 1 and 2: Cysts are active fertile cysts and contain viable protoscoleces.<br />
**Cystic echinococcosis type 3: Cysts in transitional stage, as a result of host immune response or therapy.<br />
**Cystic echinococcosis cyst type 4 and 5: Inactive cysts which have lost their fertility and are degenerative.<br />
*Based on the site of infection, echinococcosis can be classified into: <br />
**'''Cystic echinococcosis:''' It is due to infection of the host by the larval stage of Echinococcus granulosus. It causes a chronic asymptomatic infection affecting the lungs and liver. Infection will lead to the formation of enlarging cysts in the liver and lungs.<br />
**'''Alveolar echinococcosis:'''It is due to the infection of the host by the larval stage of Echinococcus multilocularis. It is common in endemic areas and results in the formation of parasitic tumors in the liver, lungs and brain.<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_classification&diff=1321654Echinococcosis classification2017-06-28T17:05:27Z<p>Aravind Kuchkuntla: /* Classification */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
==Classification==<br />
*Based on International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings cystic echinococcosis is classified into:<ref name="Working Group2003">{{cite journal|last1=Working Group|first1=WHO Informal|title=International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings|journal=Acta Tropica|volume=85|issue=2|year=2003|pages=253–261|issn=0001706X|doi=10.1016/S0001-706X(02)00223-1}}</ref><br />
**Cystic echinococcosis cyst type 1 and 2: Cysts are active fertile cysts and contain viable protoscoleces.<br />
**Cystic echinococcosis type 3: Cysts in transitional stage, as a result of host immune response or therapy.<br />
**Cystic echinococcosis cyst type 4 and 5: Inactive cysts which have lost their fertility and are degenerative.<br />
*Based on the site of infection, echinococcosis can be classified into: <br />
**'''Cystic echinococcosis:''' It is due to infection of the host by the larval stage of Echinococcus granulosus. It causes a chronic asymptomatic infection affecting the lungs and liver. Infection will lead to the formation of enlarging cysts in the liver and lungs.<br />
**'''Alveolar echinococcosis:'''It is due to the infection of the host by the larval stage of Echinococcus multilocularis. It is common in endemic areas and results in the formation of parasitic tumors in the liver, lungs and brain.<br />
<br />
==External Link==<br />
http://www.cdc.gov/parasites/echinococcosis/<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_classification&diff=1321653Echinococcosis classification2017-06-28T17:05:10Z<p>Aravind Kuchkuntla: /* Classification */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
<br />
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
==Classification==<br />
*Based on International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings cystic echinococcosis is classified into:<ref name="Working Group2003">{{cite journal|last1=Working Group|first1=WHO Informal|title=International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings|journal=Acta Tropica|volume=85|issue=2|year=2003|pages=253–261|issn=0001706X|doi=10.1016/S0001-706X(02)00223-1}}</ref><br />
**Cystic echinococcosis cyst type 1 and 2: Cysts are active fertile cysts and contain viable protoscoleces.<br />
**Cystic echinococcosis type 3: Cysts in transitional stage, as a result of host immune response or therapy.<br />
**Cystic echinococcosis cyst type 4 and 5: Inactive cysts which have lost their fertility and are degenerative.<br />
*Based on the site of infection, echinococcosis can be classified into: <br />
**'''Cystic echinococcosis:''' It is due to infection of the host by the larval stage of Echinococcus granulosus. It causes a chronic asymptomatic infection affecting the lungs and liver. Infection will lead to the formation of enlarging cysts in the liver and lungs.<br />
*'''Alveolar echinococcosis:'''It is due to the infection of the host by the larval stage of Echinococcus multilocularis. It is common in endemic areas and results in the formation of parasitic tumors in the liver, lungs and brain.<br />
<br />
==External Link==<br />
http://www.cdc.gov/parasites/echinococcosis/<br />
<br />
== References ==<br />
{{reflist|2}}<br />
<br />
[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Hemorrhoids_secondary_prevention&diff=1321454Hemorrhoids secondary prevention2017-06-27T19:02:36Z<p>Aravind Kuchkuntla: /* Secondary Prevention */</p>
<hr />
<div>__NOTOC__<br />
{{Hemorrhoids}}<br />
{{CMG}}; {{AE}}{{AY}}<br />
<br />
==Overview==<br />
Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.<br />
<br />
==Secondary Prevention==<br />
Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Hemorrhoids_physical_examination&diff=1321453Hemorrhoids physical examination2017-06-27T18:58:00Z<p>Aravind Kuchkuntla: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Hemorrhoids}}<br />
{{CMG}}; {{AE}}{{AY}}<br />
<br />
==Overview==<br />
Patients with acute prolapsed or thrombosed hemorrhoids usually appear ill and in pain. Physical examination of patients with hemorrhoids is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
<br />
==Physical Examination==<br />
===General appearance===<br />
Patients with acute prolapsed or thrombosed hemorrhoids usually appear ill and in pain.<ref name="pmid28567655">{{cite journal |vauthors=Guttenplan M |title=The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist |journal=Curr Gastroenterol Rep |volume=19 |issue=7 |pages=30 |year=2017 |pmid=28567655 |doi=10.1007/s11894-017-0574-9 |url=}}</ref><br />
===Vital signs===<br />
Unless the hemorrhoids are infected, vital signs are usually within normal limits<br />
===Skin examination===<br />
*Inspection of the anal verge may show itching marks and skin tags.<br />
*Inspection also may reveal external hemorrhoids or prolapsed internal hemorrhoids<br />
===Digital rectal examination===<br />
*Digital rectal examination reveals the size and location of hemorrhoids.<br />
*Thrombosed hemorrhoids are tender to palpation.<br />
*Internal hemorrhoids are not palpable by digital rectal examination and the use of anoscope is mandatory.<br />
<br />
{| class="wikitable"<br />
![[Image:By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660152.JPG|center|300px|thumb|By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660152]]<br />
![[Image:Haemorrhoiden 1Grad endo 01 - By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660115.jpg|center|300px|thumb| By Dr. Joachim Guntau - www.Endoskopiebilder.de, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=18660115]]<br />
|-<br />
|[[Image:Hemorrhoid with skin tags - By Tmalonetn - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=10358212.jpg|center|300px|thumb|By Tmalonetn - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=10358212]]<br />
|[[Image:Hemorrhoids - By Internet Archive Book Images - httpswww.flickr.comphotosinternetarchivebookimages14784684835Source book page httpsarchive.orgstreamdiseasesofrectum00gantdiseasesofrectum00gant-pagen490mode1up, No restrictions, ht.jpg|center|300px|thumb|By Internet Archive Book Images - httpswww.flickr.comphotosinternetarchivebookimages14784684835Source book page httpsarchive.orgstreamdiseasesofrectum00gantdiseasesofrectum00gant-pagen490mode1up, No restrictions, ht]]<br />
|}<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Hemorrhoids_differential_diagnosis&diff=1321452Hemorrhoids differential diagnosis2017-06-27T18:55:51Z<p>Aravind Kuchkuntla: /* Differentiating Hemorrhoids from other Diseases */</p>
<hr />
<div>__NOTOC__<br />
{{Hemorrhoids}}<br />
{{CMG}}; {{AE}}{{AY}}<br />
<br />
==Overview==<br />
Hemorrhoids should be differentiated from other diseases causing anal discomfort and pain with defecation such as [[rectal cancer]], [[anal fissure]], [[anal abscess]], [[anal fistula]].<br />
<br />
==Differentiating Hemorrhoids from other Diseases==<br />
<br />
Hemorrhoids should be differentiated from other diseases causing anal discomfort and pain with defecation.<br />
<br />
{| class="wikitable"<br />
!Disease<br />
!History<br />
!Physical exam findings<br />
!Sample image<br />
|-<br />
|Anal fissure <br />
|<br />
* [[Fissure|Anal fissure]] usually presents with tearing pain with every bowel movement.<ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref><br />
* Pain usually lasts for minutes to hours after every bowel movements.<br />
* Patient is typically afraid of going to the bathroom to avoid the pain, which leads to a viscious cycle. The [[Anal fissure|fissure]] worsens the [[constipation]] and the [[constipation]] (hard stool) aggravates the [[Anal fissure|fissure]].<br />
* About two thirds of the patients present with bright red blood streaks on toilet papers or on the surface of stools.<br />
* May be accompanied by [[pruritis]] and [[discharge]].<br />
|<br />
* Most [[Anal fissure|fissures]] occur in the posterior midline of the [[Anus|anal canal]].<ref name="pmid26929749">{{cite journal |vauthors=Beaty JS, Shashidharan M |title=Anal Fissure |journal=Clin Colon Rectal Surg |volume=29 |issue=1 |pages=30–7 |year=2016 |pmid=26929749 |pmc=4755763 |doi=10.1055/s-0035-1570390 |url=}}</ref><br />
* [[Skin tags]] in the perianal area may accompany chronic anal fissures.<br />
|[[Image:Anal fissure 1 - By Bernardo Gui - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750.jpg|center|300px|thumb|Anal fissure - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750]]<br />
|-<br />
|[[Rectal prolapse]]<br />
|<br />
* [[Rectal prolapse]] most commonly occurs in multiparous females over 40 years old.<ref name="pmid28144208">{{cite journal |vauthors=Cannon JA |title=Evaluation, Diagnosis, and Medical Management of Rectal Prolapse |journal=Clin Colon Rectal Surg |volume=30 |issue=1 |pages=16–21 |year=2017 |pmid=28144208 |doi=10.1055/s-0036-1593431 |url=}}</ref><br />
* Progressive mass protrusion from the anus. Protrusion at first with straining and defecation then progresses to the degree that it is no longer be replaced back.<br />
* It presents with [[abdominal discomfort]] and incomplete defecation.<br />
* [[Fecal incontinence]] and anal discharge.<br />
* Pain is not usually present.<br />
|<br />
* Mass protruding from the anus.<ref name="pmid28144206">{{cite journal |vauthors=Blaker K, Anandam JL |title=Functional Disorders: Rectoanal Intussusception |journal=Clin Colon Rectal Surg |volume=30 |issue=1 |pages=5–11 |year=2017 |pmid=28144206 |doi=10.1055/s-0036-1593433 |url=}}</ref><br />
* Concentric mucosal rings are characteristic for rectal prolapse.<br />
|[[Image:Prolapse of rectum 01- By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main - Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, httpscommons.wikimedia.orgwindex.phpcurid=20649968.jpg|center|300px|thumb|Rectal prolapse - By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main - Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, httpscommons.wikimedia.orgwindex.phpcurid=20649968]]<br />
|-<br />
|[[Perianal abscess]]<br />
|<br />
* Perianal abscess presents with severe continuous dull aching pain in the perianal area.<ref name="pmid28223268">{{cite journal |vauthors=Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK |title=Perianal abscess |journal=BMJ |volume=356 |issue= |pages=j475 |year=2017 |pmid=28223268 |doi= |url=}}</ref><br />
* Pain is exacerbated with bowel movements but is not exclusive with it.<br />
* Constipation due to fear of bowel movements.<br />
* Fever, headache and chills might accompany the pain.<br />
* If abscess starts to drain, discharge of purulent or bloody fluid may be noticed.<br />
|<br />
* Flatulent, erythematous and tender area of skin overlying the abscess.<br />
* If abscess is deep, tenderness is elicited with digital rectal examination.<br />
|[[Image:Gu perirectal abscess2.jpg|center|300px|thumb|Perianal abscess]]<br />
|-<br />
|[[anal cancer]]<br />
|<br />
* Rectal bleeding is the most common presentation.<ref name="pmid28610905">{{cite journal |vauthors=Moureau-Zabotto L, Vendrely V, Abramowitz L, Borg C, Francois E, Goere D, Huguet F, Peiffert D, Siproudhis L, Ducreux M, Bouché O |title=Anal cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatment and follow-up |journal=Dig Liver Dis |volume= |issue= |pages= |year=2017 |pmid=28610905 |doi=10.1016/j.dld.2017.05.011 |url=}}</ref><br />
* Mass sensation in the anus.<br />
* Mucoid discharge may occur.<br />
* Patient may give a history of anal condyloma (especially homosexual men).<ref name="pmid28528690">{{cite journal |vauthors=Prigge ES, von Knebel Doeberitz M, Reuschenbach M |title=Clinical relevance and implications of HPV-induced neoplasia in different anatomical locations |journal=Mutat. Res. |volume=772 |issue= |pages=51–66 |year=2017 |pmid=28528690 |doi=10.1016/j.mrrev.2016.06.005 |url=}}</ref><br />
* Fecal incontinence.<br />
*<br />
|<br />
* On digital rectal examination, solid hemorrhagic mass that is firmly fixed to the surrounding structures is noted.<br />
* Femoral and inguinal lymph nodes may show lymphadenopathy secondary to spread of cancer.<br />
|[[Image:Anal CA - By Internet Archive Book Images - httpswww.flickr.comphotosinternetarchivebookimages14598073128Source book page httpsarchive.orgstreamdiseasesofrectum00gantdiseasesofrectum00gant-pagen653mode1up, No restrictions, httpsc.jpg|center|300px|thumb|Anal Cancer - By Internet Archive Book Images - httpswww.flickr.comphotosinternetarchivebookimages14598073128Source book page httpsarchive.orgstreamdiseasesofrectum00gantdiseasesofrectum00gant-pagen653mode1up, No restrictions, httpsc]]<br />
|-<br />
|[[Condylomata acuminata]]<br />
|<br />
* Patient may give a history of anal unprotected sex with an infected partner.<br />
* Multiple sexual partners is a risk factor and should be investigated.<ref name="pmid28160045">{{cite journal |vauthors=Wieland U, Kreuter A |title=[Genital warts in HIV-infected individuals] |language=German |journal=Hautarzt |volume=68 |issue=3 |pages=192–198 |year=2017 |pmid=28160045 |doi=10.1007/s00105-017-3938-z |url=}}</ref><br />
* Condyloma accuminata presents with a painless warts that varies in size, shape and color.<br />
* Pruritis and discharge might accompany the warts.<br />
|<br />
* Anal condyloma accuminata may be accompanied by cervical, vaginal or even ororpharyngeal warts, so the patient should be examined thoroughly.<ref name="pmid27364818">{{cite journal |vauthors=Köhn FM, Schultheiss D, Krämer-Schultheiss K |title=[Dermatological diseases of the external male genitalia : Part 2: Infectious and malignant dermatological] |language=German |journal=Urologe A |volume=55 |issue=7 |pages=981–96 |year=2016 |pmid=27364818 |doi=10.1007/s00120-016-0163-9 |url=}}</ref><br />
|[[Image:SOA-Condylomata-acuminata-female.jpg|center|300px|thumb|Condylomata acuminata]]<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Hemorrhoids_classification&diff=1321450Hemorrhoids classification2017-06-27T18:53:29Z<p>Aravind Kuchkuntla: /* By degree of prolapse */</p>
<hr />
<div>__NOTOC__<br />
{{Hemorrhoids}}<br />
{{CMG}}; {{AE}}{{AY}}<br />
<br />
==Overview==<br />
Hemorrhoids can be classified according to their site into external and internal hemorrhoids. Furthermore, internal hemorrhoids can be graded according to severity into 4 grades.<br />
==Classification==<br />
Hemorrhoids can be classified according to their site into external and internal hemorrhoids.<ref name="pmid21825884">{{cite journal |vauthors=Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL |title=Practice parameters for the management of hemorrhoids (revised 2010) |journal=Dis. Colon Rectum |volume=54 |issue=9 |pages=1059–64 |year=2011 |pmid=21825884 |doi=10.1097/DCR.0b013e318225513d |url=}}</ref><br />
===External hemorrhoids===<br />
<br />
{| style="float: right; width: 350px;"<br />
| [[Image:Blausen 0408 Hemorrhoids.png|right|400px|By BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=27924388]]<br />
|}<br />
<br />
*External hemorrhoids are those that occur below the dentate line. <br />
*They are sometimes painful, and can be accompanied by swelling and irritation.<br />
*Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.<br />
*External hemorrhoids are prone to [[thrombosis]]: if the vein ruptures and a [[blood clot]] develops, the hemorrhoid becomes a [[thrombosed]] hemorrhoid.<ref>E. Gojlan, ''Pathology, 2nd ed.'' Mosby Elsevier, Rapid Review series.</ref><br />
===Internal hemorrhoids=== <br />
*Internal hemorrhoids are those that occur above the dentate line. <br />
*As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. <br />
*Internal hemorrhoids, however, may bleed when irritated. <br />
*Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: ''prolapsed'' and ''strangulated hemorrhoids'':<br />
<br />
====By degree of prolapse====<br />
Furthermore, internal hemorrhoids can be graded according to severity into 4 grades. The most common grading system was developed by Banov:<ref name=". <ref">name="pmid3861909">{{cite journal |author=Banov L, Knoepp LF, Erdman LH, Alia RT |title=Management of hemorrhoidal disease |journal=J S C Med Assoc |volume=81 |issue=7 |pages=398–401 |year=1985 |pmid=3861909 |doi=}}</ref><br />
* '''Grade I:''' The hemorrhoids do not prolapse.<br />
* '''Grade II:''' The hemorrhoids prolapse upon defecation but spontaneously reduce.<br />
* '''Grade III:''' The hemorrhoids prolapse upon defecation, but must be manually reduced.<br />
* '''Grade IV:''' The hemorrhoids are prolapsed and cannot be manually reduced.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Hemorrhoids_historical_perspective&diff=1321449Hemorrhoids historical perspective2017-06-27T18:52:42Z<p>Aravind Kuchkuntla: /* Historical Perspective */</p>
<hr />
<div>__NOTOC__<br />
{{Hemorrhoids}}<br />
{{CMG}}; {{AE}}{{AY}}<br />
<br />
==Overview==<br />
Hemorrhoids were first discovered by ancient Egyptians more than 3700 years ago.<br />
==Historical Perspective==<br />
*Hemorrhoids were known 3700 years ago by ancient egyptians. A recipe for an ointment made of ground acacia leaves was described in an ancient Egyptian manuscript.<br />
*The ancient greek medical textbook “Hippocratic corpus” described a maneuver that is similar to [[rubber band ligation]] as we know it today.<br />
*Roman encyclopaedist Aulus Cornelius Celsus described band ligation and discussed possible complications. Roman surgeon Galen suggests severing the connection between [[arteries]] and [[veins]] in an attempt to relieve the pain and the spread of infection.<br />
*During the sixth century, hemorrhoids were known as saint Fiacre’s curse after a saint who developed them after working in his farm.<br />
*In 1398, the “hemorrhoids” word was first used in English in after the french word “emorroides” which was developed from the latin word “ hæmorrhoida”. Hæmorrhoida means liable to [[bleeding]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs content]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Primary care]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_history_and_symptoms&diff=1321363Q fever history and symptoms2017-06-27T16:38:30Z<p>Aravind Kuchkuntla: /* Hepatic manifestations: */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
{{Q fever}}<br />
==Overview==<br />
Acute Q fever presents with [[Flu|flu like symptoms]], [[pneumonia]] and [[hepatitis]]. Chronic Q fever almost always presents with [[endocarditis]] and sometimes gives [[musculoskeletal]] and [[vascular]] manifestations.<br />
<br />
==History and symptoms==<br />
*Q fever can present with a wide variety of symptoms related to multiple organs involved. Q fever can be classified into acute and chronic based on the onset of symptoms.<ref name="pmid88923">{{cite journal |vauthors=Ishikawa H, Maeda H, Takamatsu H, Saito Y |title=Systemic hyalinosis (juvenile hyaline fibromatosis). Ultrastructure of the hyaline with particular reference to the cross-banded structure |journal=Arch. Dermatol. Res. |volume=265 |issue=2 |pages=195–206 |year=1979 |pmid=88923 |doi= |url=}}</ref><ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
*[[Incubation period]] is usually 2 to 3 weeks.<br />
<br />
===Acute Q fever:===<br />
<br />
====Flu like symptoms:====<br />
The most common manifestation is flu-like symptoms with abrupt onset of: <br />
*[[Fever|High grade fever]]: Fever is usually accompanied by [[chills]] and sweats<ref name="pmid18452690">{{cite journal |vauthors=Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF |title=Q fever: epidemiology, diagnosis, and treatment |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=574–9 |year=2008 |pmid=18452690 |doi=10.4065/83.5.574 |url=}}</ref><br />
*[[Headache|Headaches]]: Retrobulbar and associated with [[photophobia]] <br />
*[[Arthralgia|Arthralgias]]<br />
<br />
====Pneumonia:====<br />
Usually mild and accidentally discovered on [[X rays]]<br />
*If accompanied by [[a cough]], cough is dry and nonproductive.<ref name="pmid2731605">{{cite journal |vauthors=Sobradillo V, Ansola P, Baranda F, Corral C |title=Q fever pneumonia: a review of 164 community-acquired cases in the Basque country |journal=Eur. Respir. J. |volume=2 |issue=3 |pages=263–6 |year=1989 |pmid=2731605 |doi= |url=}}</ref><br />
*[[Dyspnea]]<br />
*[[Pleuritic chest pain]]<br />
*Rarely progresses to [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] which can be life threatening.<br />
<br />
====Hepatitis:====<br />
*[[Right upper quadrant pain|Abdominal right upper quadrant pain]]<br />
*[[Jaundice]]<br />
*[[Gastrointestinal tract|GI]] symptoms as [[nausea]], [[malaise]], [[vomiting]], [[diarrhea]] and [[bloating]].<br />
<br />
====Rare acute Q fever symptoms:====<br />
<br />
====Pericarditis and myocarditis:====<br />
<br />
*[[Myocarditis]] is rare but carries a bad prognosis<ref name="pmid6622891">{{cite journal |vauthors=Derrick EH |title="Q" fever, a new fever entity: clinical features, diagnosis and laboratory investigation |journal=Rev. Infect. Dis. |volume=5 |issue=4 |pages=790–800 |year=1983 |pmid=6622891 |doi= |url=}}</ref><br />
*[[Chest pain]]<br />
*[[Dyspnea]]<br />
*[[Palpitation]]<br />
<br />
====Neurologic findings:====<br />
*Q fever can present with [[meningoencephalitis]]<br />
*[[Headache]]<br />
*[[Confusion]]<br />
*[[Seizures]]<br />
<br />
====Dermatologic findings:====<br />
*[[Maculopapular rash]]<br />
*[[Rash|Diffuse punctate rash]]<br />
*[[Erythema nodosum]]<br />
<br />
====Q fever during pregnancy:====<br />
Most [[Coxiella burnetii|C. brutenii]] infection during pregnancy pass [[asymptomatic]] but in rare cases it can be complicated with:<br />
*[[Intrauterine growth retardation|Intrauterine growth retardation (IUGR)]]<ref name="pmid9770161">{{cite journal |vauthors=Stein A, Raoult D |title=Q fever during pregnancy: a public health problem in southern France |journal=Clin. Infect. Dis. |volume=27 |issue=3 |pages=592–6 |year=1998 |pmid=9770161 |doi= |url=}}</ref><br />
*Intrauterine fetal death (IUFD)<br />
*[[Abortion]]<br />
<br />
Infection during [[first trimester]] and [[placental]] infection are associated with increased risk of fetal compromise.<br />
<br />
===Chronic Q fever:===<br />
Chronic Q fever, characterized by [[infection]] that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection.<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
<br />
====Endocarditis:====<br />
<br />
[[Endocarditis]] is the main manifestation of Q fever.<br />
*Characterized by being [[Endocarditis|culture negative endocarditis]]<br />
*Patients who are predisposed to [[endocarditis]] include patients with [[Valvular heart disease|valvular lesions]], [[prosthetic valves]] and [[Immunocompromised|immunocompromised patients]]<br />
*Presents with:<br />
**[[Low-grade fever|Low grade fever]]<br />
**[[Palpitations]]<br />
**[[Dyspnea]] <br />
**[[Embolic|Embolic manifestations]]<br />
<br />
====Skeletal manifestations:====<br />
*[[Bone]] and [[joint]] infections are common manifestations of chronic Q fever.<br />
*Presents with:<br />
**[[Low-grade fever|Low grade fever]]<br />
**Bone and joint pain as in chronic [[osteomyelitis]]<br />
<br />
====Vascular lesions:====<br />
*Usually in previously affected vessel (e.g. [[aneurysm]])<br />
<br />
====Cardiopulmonary affection:====<br />
*Chronic [[pleural]] or [[pericardial]] effusion and Interstitial [[pulmonary fibrosis]] present with [[dyspnea]] and [[fatigue]].<br />
<br />
====Hepatic manifestations:====<br />
*[[Hepatic fibrosis|Liver fibrosis]] or [[cirrhosis]] presents with symptoms of chronic [[Hepatic failure|hepatic decompensation]] (e.g [[jaundice]], [[abdominal pain]], [[fatigue]], etc).<br />
<br />
====Chronic fatigue syndrome:====<br />
*Presents in up to 10% of chronic Q fever patients.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs overview]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_history_and_symptoms&diff=1321361Q fever history and symptoms2017-06-27T16:37:18Z<p>Aravind Kuchkuntla: /* Flu like symptoms: */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
{{Q fever}}<br />
==Overview==<br />
Acute Q fever presents with [[Flu|flu like symptoms]], [[pneumonia]] and [[hepatitis]]. Chronic Q fever almost always presents with [[endocarditis]] and sometimes gives [[musculoskeletal]] and [[vascular]] manifestations.<br />
<br />
==History and symptoms==<br />
*Q fever can present with a wide variety of symptoms related to multiple organs involved. Q fever can be classified into acute and chronic based on the onset of symptoms.<ref name="pmid88923">{{cite journal |vauthors=Ishikawa H, Maeda H, Takamatsu H, Saito Y |title=Systemic hyalinosis (juvenile hyaline fibromatosis). Ultrastructure of the hyaline with particular reference to the cross-banded structure |journal=Arch. Dermatol. Res. |volume=265 |issue=2 |pages=195–206 |year=1979 |pmid=88923 |doi= |url=}}</ref><ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
*[[Incubation period]] is usually 2 to 3 weeks.<br />
<br />
===Acute Q fever:===<br />
<br />
====Flu like symptoms:====<br />
The most common manifestation is flu-like symptoms with abrupt onset of: <br />
*[[Fever|High grade fever]]: Fever is usually accompanied by [[chills]] and sweats<ref name="pmid18452690">{{cite journal |vauthors=Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF |title=Q fever: epidemiology, diagnosis, and treatment |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=574–9 |year=2008 |pmid=18452690 |doi=10.4065/83.5.574 |url=}}</ref><br />
*[[Headache|Headaches]]: Retrobulbar and associated with [[photophobia]] <br />
*[[Arthralgia|Arthralgias]]<br />
<br />
====Pneumonia:====<br />
Usually mild and accidentally discovered on [[X rays]]<br />
*If accompanied by [[a cough]], cough is dry and nonproductive.<ref name="pmid2731605">{{cite journal |vauthors=Sobradillo V, Ansola P, Baranda F, Corral C |title=Q fever pneumonia: a review of 164 community-acquired cases in the Basque country |journal=Eur. Respir. J. |volume=2 |issue=3 |pages=263–6 |year=1989 |pmid=2731605 |doi= |url=}}</ref><br />
*[[Dyspnea]]<br />
*[[Pleuritic chest pain]]<br />
*Rarely progresses to [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] which can be life threatening.<br />
<br />
====Hepatitis:====<br />
*[[Right upper quadrant pain|Abdominal right upper quadrant pain]]<br />
*[[Jaundice]]<br />
*[[Gastrointestinal tract|GI]] symptoms as [[nausea]], [[malaise]], [[vomiting]], [[diarrhea]] and [[bloating]].<br />
<br />
====Rare acute Q fever symptoms:====<br />
<br />
====Pericarditis and myocarditis:====<br />
<br />
*[[Myocarditis]] is rare but carries a bad prognosis<ref name="pmid6622891">{{cite journal |vauthors=Derrick EH |title="Q" fever, a new fever entity: clinical features, diagnosis and laboratory investigation |journal=Rev. Infect. Dis. |volume=5 |issue=4 |pages=790–800 |year=1983 |pmid=6622891 |doi= |url=}}</ref><br />
*[[Chest pain]]<br />
*[[Dyspnea]]<br />
*[[Palpitation]]<br />
<br />
====Neurologic findings:====<br />
*Q fever can present with [[meningoencephalitis]]<br />
*[[Headache]]<br />
*[[Confusion]]<br />
*[[Seizures]]<br />
<br />
====Dermatologic findings:====<br />
*[[Maculopapular rash]]<br />
*[[Rash|Diffuse punctate rash]]<br />
*[[Erythema nodosum]]<br />
<br />
====Q fever during pregnancy:====<br />
Most [[Coxiella burnetii|C. brutenii]] infection during pregnancy pass [[asymptomatic]] but in rare cases it can be complicated with:<br />
*[[Intrauterine growth retardation|Intrauterine growth retardation (IUGR)]]<ref name="pmid9770161">{{cite journal |vauthors=Stein A, Raoult D |title=Q fever during pregnancy: a public health problem in southern France |journal=Clin. Infect. Dis. |volume=27 |issue=3 |pages=592–6 |year=1998 |pmid=9770161 |doi= |url=}}</ref><br />
*Intrauterine fetal death (IUFD)<br />
*[[Abortion]]<br />
<br />
Infection during [[first trimester]] and [[placental]] infection are associated with increased risk of fetal compromise.<br />
<br />
===Chronic Q fever:===<br />
Chronic Q fever, characterized by [[infection]] that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection.<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
<br />
====Endocarditis:====<br />
<br />
[[Endocarditis]] is the main manifestation of Q fever.<br />
*Characterized by being [[Endocarditis|culture negative endocarditis]]<br />
*Patients who are predisposed to [[endocarditis]] include patients with [[Valvular heart disease|valvular lesions]], [[prosthetic valves]] and [[Immunocompromised|immunocompromised patients]]<br />
*Presents with:<br />
**[[Low-grade fever|Low grade fever]]<br />
**[[Palpitations]]<br />
**[[Dyspnea]] <br />
**[[Embolic|Embolic manifestations]]<br />
<br />
====Skeletal manifestations:====<br />
*[[Bone]] and [[joint]] infections are common manifestations of chronic Q fever.<br />
*Presents with:<br />
**[[Low-grade fever|Low grade fever]]<br />
**Bone and joint pain as in chronic [[osteomyelitis]]<br />
<br />
====Vascular lesions:====<br />
*Usually in previously affected vessel (e.g. [[aneurysm]])<br />
<br />
====Cardiopulmonary affection:====<br />
*Chronic [[pleural]] or [[pericardial]] effusion and Interstitial [[pulmonary fibrosis]] present with [[dyspnea]] and [[fatigue]].<br />
<br />
====Hepatic manifestations:====<br />
*[[Hepatic fibrosis|Liver fibrosis]] or [[cirrhosis]] presents with symptoms of chronic [[Hepatic failure|hepatic decompensation]] (e.g [[jaundice]], [[abdominal pain]], [[fatigue]], etc)<br />
<br />
====Chronic fatigue syndrome:====<br />
*Presents in up to 10% of chronic Q fever patients.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs overview]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_natural_history,_complications,_and_prognosis&diff=1321358Q fever natural history, complications, and prognosis2017-06-27T16:36:15Z<p>Aravind Kuchkuntla: /* Acute Q fever */</p>
<hr />
<div>__NOTOC__<br />
{{Q fever}}<br />
{{CMG}};{{AE}}{{AY}}<br />
==Overview==<br />
Acute Q fever has a good prognosis even without treatment. Chronic Q fever has a less favorable prognosis.<br />
==Natural history==<br />
===Acute Q fever===<br />
*If left untreated, most patients will recover within several month.<ref name="pmid88923">{{cite journal |vauthors=Ishikawa H, Maeda H, Takamatsu H, Saito Y |title=Systemic hyalinosis (juvenile hyaline fibromatosis). Ultrastructure of the hyaline with particular reference to the cross-banded structure |journal=Arch. Dermatol. Res. |volume=265 |issue=2 |pages=195–206 |year=1979 |pmid=88923 |doi= |url=}}</ref><br />
<br />
===Chronic Q fever===<br />
*If left untreated, it is usually deadly. However, with appropriate treatment this lethality is around 10%.<ref name="pmid88923">{{cite journal |vauthors=Ishikawa H, Maeda H, Takamatsu H, Saito Y |title=Systemic hyalinosis (juvenile hyaline fibromatosis). Ultrastructure of the hyaline with particular reference to the cross-banded structure |journal=Arch. Dermatol. Res. |volume=265 |issue=2 |pages=195–206 |year=1979 |pmid=88923 |doi= |url=}}</ref><br />
<br />
==Complications==<br />
===Pulmonary ===<br />
*[[Atypical pneumonia]]<br />
*[[Acute respiratory distress syndrome]] [[Acute respiratory distress syndrome|ARDS]] in rare cases<br />
===Cardiac ===<br />
*[[Endocarditis]]<br />
*[[Pericarditis]] or [[myocarditis]]<br />
*[[Pericardial effusion]]<br />
===Hepatic ===<br />
*[[Hepatic fibrosis]] and [[cirrhosis]]<br />
===Musculoskeletal ===<br />
*[[Osteomyelitis]]<br />
*[[Arthritis]]<br />
===Obstetric ===<br />
*[[Abortion]]<br />
*[[IUGR]]<br />
*Intrauterine fetal death<br />
<br />
==Prognosis==<br />
===Acute Q fever===<br />
* Acute Q fever is responsive to treatment and even without treatment, [[mortality rate]] is 1-2%.<br />
===Chronic Q fever===<br />
* Chronic Q fever is more serious with [[Mortality rate|lethaity]] of 10% after treatment.<ref name="pmid18452690">{{cite journal |vauthors=Hartzell JD, Wood-Morris RN, Martinez LJ, Trotta RF |title=Q fever: epidemiology, diagnosis, and treatment |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=574–9 |year=2008 |pmid=18452690 |doi=10.4065/83.5.574 |url=}}</ref><br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs content]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{Help Menu}}<br />
{{Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_pathophysiology&diff=1321354Q fever pathophysiology2017-06-27T16:33:44Z<p>Aravind Kuchkuntla: /* Large cell form: */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
{{Q fever}}<br />
==Overview==<br />
Q fever is a disease caused by [[Coxiella burnetii|C. brutenii]], an intracellular [[gram-negative]] proteobacterium. The disease can have a wide range of clinical presentations and affect many organ systems due to the unique [[virulence factors]] of the [[organism]].<br />
<br />
==Pathophysiology==<br />
===Transmission:===<br />
The organism is transmitted through:<ref name="pmid17423643">{{cite journal |vauthors=Marrie TJ |title=Q fever - a review |journal=Can. Vet. J. |volume=31 |issue=8 |pages=555–63 |year=1990 |pmid=17423643 |pmc=1480833 |doi= |url=}}</ref><br />
*Aerosoloes: Inhalation of contaminated aerosoles is the main mode of transmission.<br />
*Ingestion of raw dairy products<br />
*Vertical (mother to fetus) transmission has been reported<br />
*Parentral<br />
*Through [[tick bites]]<br />
<br />
===Pathogenesis:===<br />
<br />
[[Coxiella burnetii|C. Brutenii]] has the ability to exist in 2 forms:<br />
<br />
====Small cell form:<ref name="urlDiagnosis of Q Fever">{{cite web |url=http://jcm.asm.org/content/36/7/1823.short |title=Diagnosis of Q Fever |format= |work= |accessdate=}}</ref>====<br />
Often described as the spore form of [[Coxiella burnetii|C. Brutenii]]<br />
Resists the external environmental factors as heat, pressure and disinfectants for long periods.<br />
<br />
====Large cell form:====<br />
The active form of the [[organism]]<br />
large cell form persists in the [[macrophages]] inside acidic vacuoles.<br />
<br />
*Small and large cell forms are [[Antigen|antigenically different]] and this plays a role in the [[virulence]] of the [[organism]].<br />
*The [[genome]] of [[Coxiella burnetii|C. Brutenii]] has been analyzed in 1995. Multiple [[genes]] encoding for Na/ ion proton exchanger have been discovered and this explains the ability of the organism to survive in [[PH|low PH]].<br />
*The infection has 2 phases that correlate with changes in the [[lipopolysaccharide]] of [[Coxiella burnetii|C. Brutenii]]:<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
**Phase I: characterized by smooth [[lipopolysaccharide]] capsule. Despite being less efficient in the invasion of host cells, [[antibodies]] against phase I is always isolated from acute Q fever patients. <br />
**Phase II: characterized by rough [[lipopolysaccharide]] capsule and [[antibodies]] against phase II have been isolated from chronic Q fever patients.<br />
<br />
===Q fever as a biological weapon:===<br />
<br />
*Because of its route of infection it can be used as a [[biological warfare]] agent.<br />
*Q-fever is category "B" agent. It is highly contagious and very stable in aerosols in a wide range of temperatures. <br />
*Just 1-2 particles are enough to infect an individual. <br />
*Q-fever [[microorganisms]] may survive on surfaces up to 60 days (like sporulating bacteria).<br />
*According to [[WHO]] estimates<ref name="urlapps.who.int">{{cite web |url=http://apps.who.int/iris/bitstream/10665/39444/1/24039.pdf |title=apps.who.int |format= |work= |accessdate=}}</ref>, an amount of 50 kg of [[Coxiella burnetii|C. Brutenii]] if spread in an area of 2 square kilometers is capable of:<br />
:*Infecting 500,000 humans<br />
:*Killing 150 individuals<br />
:*Causing acute illness in 125,000 individuals<br />
:*Causing chronic illness in 9,000 individuals<br />
<br />
==Microscopic pathology:==<br />
<br />
*[[Coxiella burnetii|C. Brutenii]] is a [[gram negative]] polymorphic [[Intracellular|intracellular organism]].<ref name="urlQ Fever on JSTOR">{{cite web |url=http://www.jstor.org/stable/4458369?seq=1#page_scan_tab_contents |title=Q Fever on JSTOR |format= |work= |accessdate=}}</ref><br />
*It was previously classified as a [[Rickettsiae|rickettsia]], but now is considered a [[Proteobacteria|proteobacterium]].<br />
{| class="wikitable"<br />
![[Image:Q_fever.jpg|center|300px|thumb|Coxiella brutenii ]]<br />
![[Image:Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever endocarditis - By Mahamat A, Edouard S, Demar M, Abboud P, Patrice J-Y, La Scola B, et al. -Public domain-, via Wikime.jpg|center|300px|thumb|Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever - By Mahamat A, Edouard S, Demar M, Abboud P, Patrice J-Y, La Scola B, et al. -Public domain-, via Wikime ]]<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs overview]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{Help Menu}}<br />
{{Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_pathophysiology&diff=1321353Q fever pathophysiology2017-06-27T16:33:03Z<p>Aravind Kuchkuntla: /* Large cell form: */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
{{Q fever}}<br />
==Overview==<br />
Q fever is a disease caused by [[Coxiella burnetii|C. brutenii]], an intracellular [[gram-negative]] proteobacterium. The disease can have a wide range of clinical presentations and affect many organ systems due to the unique [[virulence factors]] of the [[organism]].<br />
<br />
==Pathophysiology==<br />
===Transmission:===<br />
The organism is transmitted through:<ref name="pmid17423643">{{cite journal |vauthors=Marrie TJ |title=Q fever - a review |journal=Can. Vet. J. |volume=31 |issue=8 |pages=555–63 |year=1990 |pmid=17423643 |pmc=1480833 |doi= |url=}}</ref><br />
*Aerosoloes: Inhalation of contaminated aerosoles is the main mode of transmission.<br />
*Ingestion of raw dairy products<br />
*Vertical (mother to fetus) transmission has been reported<br />
*Parentral<br />
*Through [[tick bites]]<br />
<br />
===Pathogenesis:===<br />
<br />
[[Coxiella burnetii|C. Brutenii]] has the ability to exist in 2 forms:<br />
<br />
====Small cell form:<ref name="urlDiagnosis of Q Fever">{{cite web |url=http://jcm.asm.org/content/36/7/1823.short |title=Diagnosis of Q Fever |format= |work= |accessdate=}}</ref>====<br />
Often described as the spore form of [[Coxiella burnetii|C. Brutenii]]<br />
Resists the external environmental factors as heat, pressure and disinfectants for long periods.<br />
<br />
====Large cell form:====<br />
The active form of the [[organism]]<br />
large cell form persists in the [[macrophages]] inside acidic vacuoles.<br />
<br />
*Small and large cell forms are [[Antigen|antigenically different]] and this plays a role in the [[virulence]] of the [[organism]].<br />
*The [[genome]] of [[Coxiella burnetii|C. Brutenii]] has been analyzed in 1995. Multiple [[genes]] encoding for Na/ ion proton exchanger have been discovered and this explains the ability of the organism to survive in [[PH|low PH]].<br />
<br />
The infection has 2 phases that correlate with changes in the [[lipopolysaccharide]] of [[Coxiella burnetii|C. Brutenii]]:<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
**Phase I: characterized by smooth [[lipopolysaccharide]] capsule. Despite being less efficient in the invasion of host cells, [[antibodies]] against phase I is always isolated from acute Q fever patients. <br />
**Phase II: characterized by rough [[lipopolysaccharide]] capsule and [[antibodies]] against phase II have been isolated from chronic Q fever patients.<br />
<br />
===Q fever as a biological weapon:===<br />
<br />
*Because of its route of infection it can be used as a [[biological warfare]] agent.<br />
*Q-fever is category "B" agent. It is highly contagious and very stable in aerosols in a wide range of temperatures. <br />
*Just 1-2 particles are enough to infect an individual. <br />
*Q-fever [[microorganisms]] may survive on surfaces up to 60 days (like sporulating bacteria).<br />
*According to [[WHO]] estimates<ref name="urlapps.who.int">{{cite web |url=http://apps.who.int/iris/bitstream/10665/39444/1/24039.pdf |title=apps.who.int |format= |work= |accessdate=}}</ref>, an amount of 50 kg of [[Coxiella burnetii|C. Brutenii]] if spread in an area of 2 square kilometers is capable of:<br />
:*Infecting 500,000 humans<br />
:*Killing 150 individuals<br />
:*Causing acute illness in 125,000 individuals<br />
:*Causing chronic illness in 9,000 individuals<br />
<br />
==Microscopic pathology:==<br />
<br />
*[[Coxiella burnetii|C. Brutenii]] is a [[gram negative]] polymorphic [[Intracellular|intracellular organism]].<ref name="urlQ Fever on JSTOR">{{cite web |url=http://www.jstor.org/stable/4458369?seq=1#page_scan_tab_contents |title=Q Fever on JSTOR |format= |work= |accessdate=}}</ref><br />
*It was previously classified as a [[Rickettsiae|rickettsia]], but now is considered a [[Proteobacteria|proteobacterium]].<br />
{| class="wikitable"<br />
![[Image:Q_fever.jpg|center|300px|thumb|Coxiella brutenii ]]<br />
![[Image:Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever endocarditis - By Mahamat A, Edouard S, Demar M, Abboud P, Patrice J-Y, La Scola B, et al. -Public domain-, via Wikime.jpg|center|300px|thumb|Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever - By Mahamat A, Edouard S, Demar M, Abboud P, Patrice J-Y, La Scola B, et al. -Public domain-, via Wikime ]]<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs overview]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{Help Menu}}<br />
{{Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_pathophysiology&diff=1321351Q fever pathophysiology2017-06-27T16:32:39Z<p>Aravind Kuchkuntla: /* Small cell form:[2] */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
{{Q fever}}<br />
==Overview==<br />
Q fever is a disease caused by [[Coxiella burnetii|C. brutenii]], an intracellular [[gram-negative]] proteobacterium. The disease can have a wide range of clinical presentations and affect many organ systems due to the unique [[virulence factors]] of the [[organism]].<br />
<br />
==Pathophysiology==<br />
===Transmission:===<br />
The organism is transmitted through:<ref name="pmid17423643">{{cite journal |vauthors=Marrie TJ |title=Q fever - a review |journal=Can. Vet. J. |volume=31 |issue=8 |pages=555–63 |year=1990 |pmid=17423643 |pmc=1480833 |doi= |url=}}</ref><br />
*Aerosoloes: Inhalation of contaminated aerosoles is the main mode of transmission.<br />
*Ingestion of raw dairy products<br />
*Vertical (mother to fetus) transmission has been reported<br />
*Parentral<br />
*Through [[tick bites]]<br />
<br />
===Pathogenesis:===<br />
<br />
[[Coxiella burnetii|C. Brutenii]] has the ability to exist in 2 forms:<br />
<br />
====Small cell form:<ref name="urlDiagnosis of Q Fever">{{cite web |url=http://jcm.asm.org/content/36/7/1823.short |title=Diagnosis of Q Fever |format= |work= |accessdate=}}</ref>====<br />
Often described as the spore form of [[Coxiella burnetii|C. Brutenii]]<br />
Resists the external environmental factors as heat, pressure and disinfectants for long periods.<br />
<br />
====Large cell form:====<br />
The active form of the [[organism]]<br />
Large cell form persists in the [[macrophages]] inside acidic vacuoles.<br />
<br />
*Small and large cell forms are [[Antigen|antigenically different]] and this plays a role in the [[virulence]] of the [[organism]].<br />
*The [[genome]] of [[Coxiella burnetii|C. Brutenii]] has been analyzed in 1995. Multiple [[genes]] encoding for Na/ ion proton exchanger have been discovered and this explains the ability of the organism to survive in [[PH|low PH]].<br />
<br />
The infection has 2 phases that correlate with changes in the [[lipopolysaccharide]] of [[Coxiella burnetii|C. Brutenii]]:<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
**Phase I: characterized by smooth [[lipopolysaccharide]] capsule. Despite being less efficient in the invasion of host cells, [[antibodies]] against phase I is always isolated from acute Q fever patients. <br />
**Phase II: characterized by rough [[lipopolysaccharide]] capsule and [[antibodies]] against phase II have been isolated from chronic Q fever patients.<br />
<br />
===Q fever as a biological weapon:===<br />
<br />
*Because of its route of infection it can be used as a [[biological warfare]] agent.<br />
*Q-fever is category "B" agent. It is highly contagious and very stable in aerosols in a wide range of temperatures. <br />
*Just 1-2 particles are enough to infect an individual. <br />
*Q-fever [[microorganisms]] may survive on surfaces up to 60 days (like sporulating bacteria).<br />
*According to [[WHO]] estimates<ref name="urlapps.who.int">{{cite web |url=http://apps.who.int/iris/bitstream/10665/39444/1/24039.pdf |title=apps.who.int |format= |work= |accessdate=}}</ref>, an amount of 50 kg of [[Coxiella burnetii|C. Brutenii]] if spread in an area of 2 square kilometers is capable of:<br />
:*Infecting 500,000 humans<br />
:*Killing 150 individuals<br />
:*Causing acute illness in 125,000 individuals<br />
:*Causing chronic illness in 9,000 individuals<br />
<br />
==Microscopic pathology:==<br />
<br />
*[[Coxiella burnetii|C. Brutenii]] is a [[gram negative]] polymorphic [[Intracellular|intracellular organism]].<ref name="urlQ Fever on JSTOR">{{cite web |url=http://www.jstor.org/stable/4458369?seq=1#page_scan_tab_contents |title=Q Fever on JSTOR |format= |work= |accessdate=}}</ref><br />
*It was previously classified as a [[Rickettsiae|rickettsia]], but now is considered a [[Proteobacteria|proteobacterium]].<br />
{| class="wikitable"<br />
![[Image:Q_fever.jpg|center|300px|thumb|Coxiella brutenii ]]<br />
![[Image:Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever endocarditis - By Mahamat A, Edouard S, Demar M, Abboud P, Patrice J-Y, La Scola B, et al. -Public domain-, via Wikime.jpg|center|300px|thumb|Immunohistochemical detection of Coxiella burnetii in resected cardiac valve of a 60-year-old man with Q fever - By Mahamat A, Edouard S, Demar M, Abboud P, Patrice J-Y, La Scola B, et al. -Public domain-, via Wikime ]]<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs overview]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{Help Menu}}<br />
{{Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_classification&diff=1321350Q fever classification2017-06-27T16:31:39Z<p>Aravind Kuchkuntla: /* Classification */</p>
<hr />
<div>__NOTOC__<br />
{{Q fever}}<br />
{{CMG}};{{AE}}{{AY}}<br />
==Overview==<br />
According to the onset of symptoms, Q fever can be classified into acute and chronic.<br />
<br />
==Classification==<br />
According to the onset of symptoms, Q fever can be classified into:<br />
<br />
===Acute Q fever:===<br />
*Characterized by a very rapid onset of [[Flu|flu-like symptoms]], [[pneumonia]], and [[hepatitis]].<br />
*Resolution of infection in less than 6 months.<br />
<br />
===Chronic Q fever:===<br />
*Characterized by persistence of infection (clinically or serologically) for more than six months.<ref name="pmid1489455">{{cite journal |vauthors=Choyce DP |title=Anterior chamber lens exchange |journal=J Cataract Refract Surg |volume=18 |issaue=5 |pages=537 |year=1992 |pmid=1489455 |doi= |url=}}</ref><br />
*Chronic Q fever almost always means [[endocarditis]].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Overview complete]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
[[pl:Gorączka Q]]<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_historical_perspective&diff=1321349Q fever historical perspective2017-06-27T16:31:01Z<p>Aravind Kuchkuntla: /* Historical Perspective */</p>
<hr />
<div>__NOTOC__<br />
{{Q fever}}<br />
{{CMG}}<br />
==Overview==<br />
The disease was first described by Edward Holbrook Derrick in Australia while the pathogen was first described in 1937 by Frank Macfarlane Burnet.<br />
<br />
== Historical Perspective ==<br />
* It was first described by [[Edward Holbrook Derrick]] in [[Slaughterhouse|abattoir]] workers in [[Brisbane]], [[Queensland]], [[Australia]].<ref>Derrick EH. ''Q" fever a new fever entity: clinical features. diagnosis, and laboratory investigation. Med J Aust. 1937;11:281-299.''</ref> <br />
* The "Q" stands for "query" and was applied at a time when the causative agent was unknown; it was chosen over suggestions of "abattoir fever" and "Queensland rickettsial fever", to avoid directing negative connotations at either the cattle industry or the state of Queensland.<ref>{{cite book | author = Joseph E. McDade | chapter = Historical Aspects of Q Fever | title = Q Fever, Volume I: The Disease | editor = Thomas J. Marrie | publisher = CRC Press | year = 1990 | isbn = 0-8493-5984-8 | page = 8}}</ref><br />
* The [[pathogen]] of Q fever was discovered in 1937, when [[Frank Macfarlane Burnet]] and Mavis Freeman isolated the bacterium from one of Derrick’s patients.<ref>Burnet FM, Freeman M. Experimental studies on the virus of “Q” fever. Med J Aust 1937; 2: 299-305.</ref><br />
* It was originally identified as a species of ''[[Rickettsia conorii|Rickettsia]]''. [[H.R. Cox]] and [[Gordon Davis (scientist)|Gordon Davis]] isolated it from [[tick]]s in [[Montana]], [[USA]] in 1938.<ref>Davis, G. E., and H. R. Cox. 1938. [http://www.jstor.org/pss/4582746 A filter-passing infectious agent isolated from ticks. I. Isolation from Dermacentor andersonii, reactions in animals, and filtration.] Public Health Rep. 53:2259-2282.</ref> It is a zoonotic disease whose most common animal reservoirs are cattle, sheep and goats. ''[[Coxiella burnetii]]'' is no longer regarded as closely related to [[Rickettsiae]], but as similar to ''[[Legionella]]'' and ''[[Francisella]]'', and is a [[proteobacteria|proteobacterium]].<br />
<br />
=== Biological warfare ===<br />
* Q fever has been described as a possible biological weapon.<ref name="pmid14592601">{{cite journal |author=Madariaga MG, Rezai K, Trenholme GM, Weinstein RA |title=Q fever: a biological weapon in your backyard |journal=Lancet Infect Dis |volume=3 |issue=11 |pages=709–21 |year=2003 |month=November |pmid=14592601 |doi= 10.1016/S1473-3099(03)00804-1|url=http://linkinghub.elsevier.com/retrieve/pii/S1473309903008041}}</ref><br />
* The United States investigated Q fever as a potential biological warfare agent in the 1950s, with eventual standardization as agent OU. At Fort Detrick and Dugway Proving Ground, human trials were conducted on [[Operation Whitecoat|Whitecoat volunteers]] to determine the median infective dose (18 MICLD<sub>50</sub>/person i.h.) and course of infection. <br />
* As a standardized biological, it was manufactured in large quantities at [[Pine Bluff Arsenal]], with 5,098 gallons in the arsenal in bulk at the time of demilitarization in 1970.<br />
* Q fever is a category "B" agent.<ref name="pmid12704232">{{cite journal |author=Seshadri R, Paulsen IT, Eisen JA, ''et al.'' |title=Complete genome sequence of the Q-fever pathogen Coxiella burnetii |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=100 |issue=9 |pages=5455–60 |year=2003 |month=April |pmid=12704232 |pmc=154366 |doi=10.1073/pnas.0931379100 |url=http://www.pnas.org/cgi/pmidlookup?view=long&pmid=12704232}}</ref> It can be contagious, and is very stable in aerosols in a wide range of temperatures. Q fever [[microorganisms]] may survive on surfaces up to 60 days.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs overview]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{Help Menu}}<br />
{{Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_overview&diff=1321348Q fever overview2017-06-27T16:29:37Z<p>Aravind Kuchkuntla: /* MRI */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
{{Q fever}}<br />
<br />
==Overview==<br />
'''Q fever''' is caused by infection with ''[[Coxiella burnetii]]''. This organism is uncommon but may be found in cattle, sheep, goats and other domestic mammals, including cats and dogs. The infection results from [[inhalation]] of contaminated particles in the air, and from contact with the vaginal mucus, milk, feces, urine or semen of infected animals. The [[Incubation period|incubation time]] is 9-40 days. It is considered possibly the most infectious disease in the world, as a human being can be infected by a single bacterium <ref>http://www.cdc.gov/ncidod/dvrd/qfever/</ref>.<br />
<br />
==Historical prespective==<br />
The disease was first described by Edward Holbrook Derrick in Australia while the pathogen was first described in 1937 by Frank Macfarlane Burnet.<br />
<br />
==Classification==<br />
According to the onset of symptoms, Q fever can be classified into acute and chronic.<br />
<br />
==Pathophysiology==<br />
Q fever is a disease caused by [[Coxiella burnetii|C. brutenii]], an intracellular [[gram-negative]] proteobacterium. The disease can have a wide range of clinical presentations and affect many organ systems due to the unique [[virulence]] factors of the organism.<br />
<br />
==Causes==<br />
Q fever is caused by the bacteria [[Coxiella burnetii]], which lives in domestic animals such as cattle, sheep, goats, birds, and cats. Some wild animals and [[Tick|ticks]] also carry the [[bacteria]]. Q fever may be contracted through drinking raw (unpasteurized) milk, or after inhaling dust or droplets in the air that are contaminated with animal feces, blood, or birth products.<br />
<br />
==Differential diagnosis==<br />
Q fever must be differentiated from other diseases that cause [[atypical pneumonia]] such as [[mycoplasma pneumonia]] and [[legionella pneumonia]].<br />
<br />
==Epidemiology and demographics==<br />
[[Coxiella burnetii|C.brutenii]] is found everywhere except Antarctica and New Zealand.The disease is slightly more prevalent in elder people and in males.<br />
<br />
==Risk factors==<br />
The organism is present mainly in the secretions of cattle and sheep. Any occupation that involves contact with cattle and sheep increases the risk of the disease.<br />
<br />
==Natural history, complications, and prognosis==<br />
Acute Q fever has a good prognosis even without treatment. Chronic Q fever has a less favorable prognosis.<br />
<br />
==History and symptoms==<br />
Acute Q fever presents with [[Flu|flu-like symptoms]], [[pneumonia]], and [[hepatitis]]. Chronic Q fever almost always presents with [[endocarditis]] and sometimes gives [[musculoskeletal]] and vascular manifestations.<br />
<br />
==Physical examination==<br />
Patients with Q fever usually appear ill. Physical examination of patients with Q fever is usually remarkable for [[fever]], [[pneumonia]], and [[hepatomegaly]].<br />
<br />
==Laboratory Findings==<br />
Laboratory findings consistent with the diagnosis of Q fever include positive serology for [[antibodies]] (especially [[Immunofluorescence assay|Indirect immunofluorescence (IIF)]], positive [[PCR]], and [[Liver enzymes|elevated liver enzymes]].<br />
<br />
==Chest X Ray==<br />
On [[chest X-ray]], Q fever is characterized by either signs of [[atypical pneumonia]] (hazy nonlocalized airspace opacities) or it may show signs of [[Pneumonia|typical pneumonia]] ([[Consolidation (medicine)|lobar consolidation]] and occasional [[Pleural effusion|pleural effusions]]) in few patients.<br />
<br />
==CT==<br />
[[CT|Chest CT]] scan may be helpful in the diagnosis of Q fever. Findings on [[CT]] scan suggestive of Q fever include scattered [[Consolidation (medicine)|consolidation]] and opacities or lobar consolidation in one specific lobe.<br />
<br />
==MRI==<br />
There are no additional [[MRI]] findings associated with Q fever. [[Chest X-ray]] and [[CT]] are usually sufficient to diagnose Q fever.<br />
<br />
==Other imaging findings==<br />
There are no other specific imaging findings for Q fever.<br />
<br />
==Other diagnostic studies==<br />
There are no additional diagnostic findings for Q fever.<br />
<br />
==Medical Therapy==<br />
The mainstay of therapy for Q fever is [[doxycycline]]. The chronic form is more difficult to treat and can require up to two years of treatment with [[doxycycline]] and [[Hydroxychloroquine]]. Q fever in pregnancy is especially difficult to treat because [[doxycycline]] is contraindicated in pregnancy and so preferred treatment is [[Sulfamethoxazole-Trimethoprim|Trimethoprim/Sulfamethoxazole]].<br />
<br />
==Surgery==<br />
Surgical intervention is not recommended for the management of Q fever.<br />
<br />
==Primary prevention==<br />
Effective measures for the primary prevention of Q fever include educating the public on sources of infection, appropriate disposal of the placenta, birth products, fetal membranes, and aborted fetuses at facilities housing sheep and goats and restricting access to barns and laboratories used in housing potentially infected animals.<br />
<br />
==Secondary prevention==<br />
There are no secondary preventive measures available for Q fever.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Overview complete]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Q_fever_overview&diff=1321347Q fever overview2017-06-27T16:29:16Z<p>Aravind Kuchkuntla: /* Chest X Ray */</p>
<hr />
<div>__NOTOC__<br />
<br />
{{CMG}}<br />
{{Q fever}}<br />
<br />
==Overview==<br />
'''Q fever''' is caused by infection with ''[[Coxiella burnetii]]''. This organism is uncommon but may be found in cattle, sheep, goats and other domestic mammals, including cats and dogs. The infection results from [[inhalation]] of contaminated particles in the air, and from contact with the vaginal mucus, milk, feces, urine or semen of infected animals. The [[Incubation period|incubation time]] is 9-40 days. It is considered possibly the most infectious disease in the world, as a human being can be infected by a single bacterium <ref>http://www.cdc.gov/ncidod/dvrd/qfever/</ref>.<br />
<br />
==Historical prespective==<br />
The disease was first described by Edward Holbrook Derrick in Australia while the pathogen was first described in 1937 by Frank Macfarlane Burnet.<br />
<br />
==Classification==<br />
According to the onset of symptoms, Q fever can be classified into acute and chronic.<br />
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==Pathophysiology==<br />
Q fever is a disease caused by [[Coxiella burnetii|C. brutenii]], an intracellular [[gram-negative]] proteobacterium. The disease can have a wide range of clinical presentations and affect many organ systems due to the unique [[virulence]] factors of the organism.<br />
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==Causes==<br />
Q fever is caused by the bacteria [[Coxiella burnetii]], which lives in domestic animals such as cattle, sheep, goats, birds, and cats. Some wild animals and [[Tick|ticks]] also carry the [[bacteria]]. Q fever may be contracted through drinking raw (unpasteurized) milk, or after inhaling dust or droplets in the air that are contaminated with animal feces, blood, or birth products.<br />
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==Differential diagnosis==<br />
Q fever must be differentiated from other diseases that cause [[atypical pneumonia]] such as [[mycoplasma pneumonia]] and [[legionella pneumonia]].<br />
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==Epidemiology and demographics==<br />
[[Coxiella burnetii|C.brutenii]] is found everywhere except Antarctica and New Zealand.The disease is slightly more prevalent in elder people and in males.<br />
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==Risk factors==<br />
The organism is present mainly in the secretions of cattle and sheep. Any occupation that involves contact with cattle and sheep increases the risk of the disease.<br />
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==Natural history, complications, and prognosis==<br />
Acute Q fever has a good prognosis even without treatment. Chronic Q fever has a less favorable prognosis.<br />
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==History and symptoms==<br />
Acute Q fever presents with [[Flu|flu-like symptoms]], [[pneumonia]], and [[hepatitis]]. Chronic Q fever almost always presents with [[endocarditis]] and sometimes gives [[musculoskeletal]] and vascular manifestations.<br />
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==Physical examination==<br />
Patients with Q fever usually appear ill. Physical examination of patients with Q fever is usually remarkable for [[fever]], [[pneumonia]], and [[hepatomegaly]].<br />
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==Laboratory Findings==<br />
Laboratory findings consistent with the diagnosis of Q fever include positive serology for [[antibodies]] (especially [[Immunofluorescence assay|Indirect immunofluorescence (IIF)]], positive [[PCR]], and [[Liver enzymes|elevated liver enzymes]].<br />
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==Chest X Ray==<br />
On [[chest X-ray]], Q fever is characterized by either signs of [[atypical pneumonia]] (hazy nonlocalized airspace opacities) or it may show signs of [[Pneumonia|typical pneumonia]] ([[Consolidation (medicine)|lobar consolidation]] and occasional [[Pleural effusion|pleural effusions]]) in few patients.<br />
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==CT==<br />
[[CT|Chest CT]] scan may be helpful in the diagnosis of Q fever. Findings on [[CT]] scan suggestive of Q fever include scattered [[Consolidation (medicine)|consolidation]] and opacities or lobar consolidation in one specific lobe.<br />
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==MRI==<br />
There are no additional [[MRI]] findings associated with Q fever. [[Chest X-ray]] and [[CT]] are usually sufficient.<br />
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==Other imaging findings==<br />
There are no other specific imaging findings for Q fever.<br />
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==Other diagnostic studies==<br />
There are no additional diagnostic findings for Q fever.<br />
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==Medical Therapy==<br />
The mainstay of therapy for Q fever is [[doxycycline]]. The chronic form is more difficult to treat and can require up to two years of treatment with [[doxycycline]] and [[Hydroxychloroquine]]. Q fever in pregnancy is especially difficult to treat because [[doxycycline]] is contraindicated in pregnancy and so preferred treatment is [[Sulfamethoxazole-Trimethoprim|Trimethoprim/Sulfamethoxazole]].<br />
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==Surgery==<br />
Surgical intervention is not recommended for the management of Q fever.<br />
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==Primary prevention==<br />
Effective measures for the primary prevention of Q fever include educating the public on sources of infection, appropriate disposal of the placenta, birth products, fetal membranes, and aborted fetuses at facilities housing sheep and goats and restricting access to barns and laboratories used in housing potentially infected animals.<br />
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==Secondary prevention==<br />
There are no secondary preventive measures available for Q fever.<br />
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==References==<br />
{{Reflist|2}}<br />
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[[Category:Overview complete]]<br />
[[Category:Infectious disease]]<br />
[[Category:Bacterial diseases]]<br />
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{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Whipworm_infection_classification&diff=1319866Whipworm infection classification2017-06-21T18:57:33Z<p>Aravind Kuchkuntla: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{Whipworm infection}}<br />
{{CMG}}<br />
==Overview==<br />
[[Trichuriasis]] infection is classified by [[WHO]] for helminth control programs based on the number of eggs per gram of feaces into light, moderate and heavy infection.<br />
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==Classification==<br />
[[Trichuriasis]] infection is classified by [[WHO]] for helminth control programs based on the number of eggs per gram of feces:<ref name="StephensonHolland2001">{{cite journal|last1=Stephenson|first1=L.S.|last2=Holland|first2=C.V.|last3=Cooper|first3=E.S.|title=The public health significance of Trichuris trichiura|journal=Parasitology|volume=121|issue=S1|year=2001|pages=S73|issn=0031-1820|doi=10.1017/S0031182000006867}}</ref><br />
*'''Light infection:''' 1-999 eggs per gram of [[faeces]].<br />
*'''Moderate infection:''' 1000 - 9999 eggs per gram of [[faeces]].<br />
*'''Heavy infection:''' Greater than 10,000 eggs per gram of [[faeces]].<br />
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==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs content]]<br />
[[Category:Disease]]<br />
[[Category:Infectious disease]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Conditions diagnosed by stool test]]<br />
[[Category:Primary care]]<br />
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{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntlahttps://www.wikidoc.org/index.php?title=Echinococcosis_classification&diff=1319761Echinococcosis classification2017-06-21T15:37:57Z<p>Aravind Kuchkuntla: /* Cystic echinocccosis */</p>
<hr />
<div>__NOTOC__<br />
{{Echinococcosis}}<br />
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{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}; {{KD}}<br />
==Classification==<br />
*Based on International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings cystic echinococcosis is classified into:<ref name="Working Group2003">{{cite journal|last1=Working Group|first1=WHO Informal|title=International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings|journal=Acta Tropica|volume=85|issue=2|year=2003|pages=253–261|issn=0001706X|doi=10.1016/S0001-706X(02)00223-1}}</ref><br />
**Cystic echinococcosis cyst type 1 and 2: Cysts are active fertile cysts and contain viable protoscoleces.<br />
**Cystic echinococcosis type 3: Cysts in transitional stage, as a result of host immune response or therapy.<br />
**Cystic echinococcosis cyst type 4 and 5: Inactive cysts which have lost their fertility and are degenerative.<br />
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==External Link==<br />
http://www.cdc.gov/parasites/echinococcosis/<br />
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== References ==<br />
{{reflist|2}}<br />
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[[Category:Parasitic diseases]]<br />
[[Category:Infectious disease]]<br />
[[Category:Disease]]<br />
[[Category:Needs overview]]<br />
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{{WH}}<br />
{{WS}}</div>Aravind Kuchkuntla