G(+) cover

pencillinase-resistant penicillins (semi synthetic)

Penicillins
1/2-G cephalosporin
Broad spec - vancomycin, linezolid
Macrolide
Fluoroquinolone

Anaerobic cover
Metronidazole
CLindamycin (only mouth and lung abscness)
Carbapenem (best)
beta lactam/lactamase

ESBL
Imipenem x 6 wk + admission

G(-) bacilli/rod
Penicillin + lactamase inhib
3/4-G cephalosporin (NOT pseudomonas)
QUinolone
Aminoglycoside
Carbapenem

Penicillase-resistant Penicillins ?
Ox - Clox - Diclox - Nafcillin
Nafcillin best

Penicillin coverages
G+ cocci - pen G, ampicillin, amoxicillin
G- bacilli - piperacillin, ticarcillin, mezlocillin

Quinolone
ciprofloxacin = G(-) and pseudomonas (no G(+)
levo / gemi / moxi - FLOXACIN = G(+) + G(-) + atypicals

Aminoglycosides
"Ami = your friend is gentle = gentamicin"
Gentamycin, tobramycin, amikacin
aztreonam (mono bactam)

Macrolide
erythromycin, clari, azithromycin

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S Aureus
COCCI
G (+)
Cat (+)
Coag (+)
Yellow
MSSA - nafcillin
MRSA - vancomycin
VRSA - quinupristin
MRSA + Vanc allergy - daptomycin (but no for pneumonia)
MRSA + Vanc allergy/resistance + pneumonia - Linezolid

S Epidermidis
COCCI
G (+)
Cat (+)
Coag (-)
biofilm (+)
Novobiocin (+)
nafcillin

S Saprophyticus
COCCI
G (+)
Cat (+)
Coag (-)
Novobiocin (-)
nafcillin

N Meningitidis
COCCI - diplococci - kidney shaped
G (-)
Cat (+)
Ox (+)
Maltose (+)
MX
LP
Ceft + Vanc + Amp + Dex
(amp to cover Listeria)

N Gonorrhoeae
COCCI - diplococci - kidney shaped
G (-)
Cat (+)
Ox (+)
Maltose (-)
Dx -
urine dna-pcr
urine ligase chain reaction
Outpt:
IM Ceft + PO azithromycin (chlamydia cover)
alt = IM Ceft x 1 time + PO Doxycycline x 2 wk
Inpt: Doxycycline + Cefotetan
PID: IM ceft x 1 + PO doxycycline x 2 wk

Strep Pneumoniae
Cocci - lancet shaped diplococci
G (+)
Cat (-)
Optochin (+)
Alpha (+)
Mx
Azithromycin + ceftriaxone
Allergy = azithromycin + vancomycin

Viridans (Strep sanguis / mutans)

Cocci
G (+)
Cat (-)
Alpha (+)
Optochin (-)
Mutans has biofilm (+)
Penicillin G + gentamicin
Endocarditis
IV Pen 4 wk, or
IV Pen + gent 2 wk, or
IV Ceft + get 2 wk
allergy = vanc

Grp A - Strept Pyogenes

Cocci
G (+)
Cat (-)
Beta (+)
Bacitracin (+)
Penicillin G + clindamycin
(clindamycin inhibits exotoxin production that makes cellulitis more severe)

Grp B - Strept Agalactiae

Cocci
G (+)
Cat (-)
Beta (-)
Bacitracin (-)
Ampicillin + gentamycin

Enterococcus Faecalis
Cocci
G (+)
Cat (-)
Delta (+)
NacL culture (+)
Ampicillin + gentamycin 6 wk

Strept Bovis
Cocci
G (+)
Cat (-)
Delta (-)
NacL culture (-)

Listeria Monocytogenes
Rod
G (+)
NON-spore
Aerobic
Tumbling motility
Beta hemolytic
Ampicillin

Coryne Diphtheriae
Rod
G (+)
NON-spore
Aerobic
NON-motility
Beta hemolytic
Toxoid vaccine + Diptheria Ig + Erythromycin

Neisseria Asteroides
Rod
G (+)
NON-spore
Aerobic
NON-motility
urease
Sulfonamide

Actinomyces Israelii
Rod + branch
G (+)
Anaerobic (+)
NON-spore
NON-motile
Sulfur granules
Penicillin + drain

Bacillus Cereus
Rod
G(+)
spore (+)
Motile (+)
Aerobic (+)
fried rice

Bacillus Anthracis
Rod
G(+)
spore (+)
Motile (+)
Aerobic (+)
Doxycyclin

Clostridium Tetani
Rod
G(+)
spore (+)
Motile (+)
Anaerobic (+)
Tetanus-Ig + penicillin

Clostridium Botulinum
Rod
G(+)
spore (+)
Motile (+)
Anaerobic (+)
Botox-Ig + penicillin

Clostridium Difficile
Rod
G(+)
spore (+)
Motile (+)
Anaerobic (+)
Severe = wbc > 15000, Cr > 15 = PO Vanc
Toxic megacolon = IV vanc + metronidazole
On 1st presentation = PO metro
On 1st recurrence = PO metro
On 2nd recurrence = PO vanc + taper + probiotic
On 3rd recurrence = Fidomoxicin
On 4th recurrence = faecal transplant

Clostridium Perfringens
Rod
G(+)
spore (+)
non-Motile (+)
Anaerobic (+)
PenG + clindamycin + debride

Bordetella Pertussin

Pseudomonas Aeruginosa

Bacteroides Sp

Treponema Sp

H influenzae

Campylobacter jejuni
G(-) rod
fac anaerobe (+)
erythromycin, fluoroquinolones

Helicobacter pylori
G(-) rod
fac anaerobe
motile, flagella
ox (+)
cat (+)
urease (+)
omeprazole + amoxicillin + clarithromycin

Vibrio vulnificus
G(-) rod
fac anaerobe (+)
motile, flagella
ox (+)
cat (+)
oysters, fisherman
must have liver dz - cirrhosis, etoh, haemochromatosis, hepatitis, HBV/HCV
tetracycline

Enterobacteriaceae species
G(-) rod
fac anaerobe (+)
Gluc (+)
Ox (-)
Cat (+)
Nitrate red (+)
Lactose (+) = Ecoli, Klebs Pneumo
Lactose (-) = Serratia, Proteus, Salmonella typhi, Shigella, Yersinia Pestis

E coli
G(-) rod
ennterobacteriaceae
Lactose (+)
 fac anaerobe (+)
Gluc (+)
Ox (-)
Cat (+)
Nitrate red (+)
Ampicillin, sulfonamides, cephalosporine

Klebsiella Pneumoniae
G(-) rod
ennterobacteriaceae
lactose (+)
fac anaerobe (+)
Gluc (+)
Ox (-)
Cat (+)
Nitrate red (+)
cephalosporin + aminoglycoside

Serratia Marcescens
G(-) rod
ennterobacteriaceae
lactose (+)
fac anaerobe (+)
Gluc (+)
Ox (-)
Cat (+)
Nitrate red (+)
RED pigment
motile
DNAase, lipase, gelatinase, casein hydralase
biofilm/catheter
Amikacin + Aztreonam
Meningitis - meropenem

Proteus sp

Salmonella enterica

Shigellla sp

Yersinia pestis
G(-) rod
ennterobacteriaceae
lactose (-)
fac anaerobe (+)
Gluc (+)
Ox (-)
Cat (+)
coag (+)
Nitrate red (+)
Streptomycin + quarantine

Mycobacter Tuberculosis
G(+) but poor
acid fast
Latent
PPD(+) / IFN-gamma(+) + CXR(-)
Isoniazid INH x 9 mo
Active
 Sputum/Culture (+) or CXR(+)
RIPE x 2 mo - (rifampin, isoniazid, pyrazinamide, ethambutol), followed
by
INH + rifampin x 4 mo
Drug resistant
1o - streptomycin, kanamycin
2o - levofloxacin

Mycobacteria avium-intracellulare
G(+), acid fast

Mycobacter Leprae

Rickettsias rickettsi
G(-)
Doxycycline

bartonella henselae

Ehrlichia
Ixhodes tick
doxycycline

Chlamydia trachomatis

Chlamydophila penumoniae

Mycoplasma pneumoniae

Clostridium Difficile
G(+) rod
spore (+)
Anaerobic (+)
motile (+)
1st presentation: PO metro
1st reoccurrence: PO metro
2nd reoccurrence: PO Vanc + taper + probiotic
3rd reoccurrence: fidomoxicin
4th reoccurrence: faecal transX
Severe (WBC > 15000, Cr > 1.5) = PO Vanc
toxic megacolon: IV vanc + metronidazole

Clostridium perfringens
G(+) rod
spore (+)
Anaerobic (+)
motile (-)
Pen G + CLindamycin + debride + hyperbaric O2

-------------------------------------------
Ceftriaxone indications:
1. pyelonephritis
2. lyme dz - serious/complic (AV-block, meningitis)
3. septic arthritis + vanc
4. CAP = ceftriaxone + azithromycin (or doxycycline) - to cover atypicals)
5.Gonorrhea
6. Meningitis - ceftriaxone + vancomycin + ampicillin (amp cover for Listeria -
>50yo, <3mo, steroids, pregnant, HIV, transplant)
7. Cirrhosis + esophageal varices bleed
8. SBP (or cefotaxime)
9. vibrio vulnificus - ceftriaxone + ciprofloxacin (or doxycycline)
10. strept viridan endocarditis (or just penicillin)
11. Ceftriaxone doesn't cover pseudomonas (tf cannot use it for neutropenic fever,
CF, burns, nosocomial infections)
-------------------------------------------
Pregnant + HIV:
Immediate triple therapy (2NRTI + (NNRT or PI or 2xPI)
Give AZT during birth
Give AZT to baby for 6 mo
C-section if viral load > 1000
baby doesn't need PCP prophylaxis
--------------------------------------------
Raltegravir:
integrase inhibitor
used for resistant HIV to rever transcriptase inhib or protease inhib
--------------------------------------------
Acute HIV:
occurs in 1st weeks (no anti-bodies yet)
pharyngitis, LNpathy, fever, rash (diffuse/red), mouth ulcers
Dx - PCR-HIV
--------------------------------------------
HIV therapy:
start at CD4 < 500
2 NRTI + (NNRT or PI or 2xPI (rotanavir boost + other PI)
NRTI = "-INE"
zidovudine
didanosine
stavudine
lamivudine
emtricitabine
tenovofir
abacavir
zalcitabine
NNRTI = "apine"
efavirenz
nevirapine
delavirdine
rilpivirine
PI = "-avir"
nelfinavir
indinavir
ritonavir
saquinavir
amprenavir
lopinavir/ritonavir combo
atazanavir

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