Transcript CNS Infections

Impetigo
The best topical agent is mupirocin; other agents, such as
bacitracin and neomycin, are less effective.
Patients who have numerous lesions or who are not
responding to topical agents should receive oral
antimicrobials effective against both S. aureus and S.
pyogenes.
Impetigo
Folliculitis
Local measures such as saline compresses and topical
antibacterials (e.g., mupirocin) are usually sufficient to control the
infection.
Furuncles and Carbuncles
Most furuncles: moist heat.
carbuncle, a furuncle with surrounding cellulitis or fever, or a
furuncle located about the midface: an antistaphylococcal
antibiotic (e.g., dicloxacillin).
In a penicillin-allergic adult: clindamycin, or co-trimoxazole.
Patients with moderate to severe disease are best treated with
initial parenteral therapy (e.g., vancomycin, linezolid, or
daptomycin)
Erysipelas
Mild early cases of erysipelas in an adult may be treated with oral
penicillin V (500 mg every 6 hours) or initial IM procaine
penicillin (600,000 units once or twice daily). Erythromycin (250
to 500 mg orally every 6 hours) or other macrolides are suitable
alternatives.
More extensive erysipelas, hospitalization and parenteral aqueous
penicillin G (2,000,000 units every 6 hours).
If differentiation from cellulitis is difficult: a PRP (nafcillin or
oxacillin), a cephalo 1, or therapy against MRSA.
cellulitis
 Outpatient:
PRP (nafcillin or oxacillin), cephalo 1
MRSA is suspected: clindamycin, TMP-SMX, doxycycline or
minocycline + B-lactam (eg, amoxicillin), linezolid.
 Inpatient:
PRP, cephalo 1
MRSA is suspected:
clindamycin
vancomycin,
linezolid,
daptomycin,
Diabetic Ulcers
Mild: PO
cephalexin, dicloxacillin, clindamycin
Moderate to severe: IV
clindamycin plus a cephalo 3, clindamycin plus a fluoroquinolone,
piperacillin-tazobactam,
carbapenem,
ampicillin-sulbactam,
ticarcillin-clavulanate.
Diabetic Ulcers
Gastroenteritis
ciprofloxacin, ofloxacin and levofloxacin, norfloxacin
Azithromycin
Typhoid Fever
Gastroenteritis (nosocomial)
CNS Infections (Meningitis)
CNS Infections (Brain Abscess)
CNS Infections (Shunt Infection)
vancomycin plus either cefepime, ceftazidime, or meropenem
CNS Infections
(Subdural Empyema, Epidural Abscess)
vancomycin plus
cefepime or ceftazidime + metronidazole
or
meropenem
In spinal cases, anaerobic coverage is not required.
CNS Infections
(Suppurative Intracranial Thrombophlebitis)
vancomycin plus
cephalo 3 or 4 + metronidazole
or
meropenem
UTIs (Cystitis)
Fluoroquinolones, TMP/SMX, nitrofurantoin, amoxicillinclavulanate, cephalosporins, tetracyclines, and fosfomycin.
Most women: 3 days
women who have a history of previous UTI caused by
antibiotic-resistant organisms or more than 7 days of
symptoms, and in men: 7 days
UTIs
UTIs
UTIs (HCA)
Mild to moderate illness without alterations in mental status
or hemodynamic status may be treated with a urinary
fluoroquinolone, such as ciprofloxacin or levofloxacin, or a
broad-spectrum cephalosporin such as cefepime.
If the patient has evidence of pyelonephritis or urosepsis, one
should consider a broader-spectrum drug such as piperacillintazobactam or a carbapenem for empiric treatment.
If the urine Gram stain shows gram-positive cocci (most
likely enterococci or staphylococci), treatment with
vancomycin is reasonable.
STDs (urethritis)
Ceftriaxone, 250 mg IM; or
Cefpodoxime, 400 mg PO; or
Cefixime, 400 mg PO
Plus
Azithromycin, 1 g PO; or
Doxycycline, 100 mg bid PO for 7 days
All sex partners within the preceding 60 days should be referred
for evaluation, testing, and empiric treatment with a drug regimen
effective against chlamydia and gonorrhea.
STDs (Chancroid)
Partners: Rx if they had sexual contact with the patient
during the 10 days preceding the patient’s onset of
symptoms.
STDs (Granuloma Inguinale (Donovanosis))
Persons who have had sexual contact with a patient who has
granuloma inguinale within the 60 days before onset of the patient’s
symptoms should be examined and offered therapy.
STDs (Lymphogranuloma Venereum)
Persons who have had sexual contact with a patient who has LGV
within the 60 days before onset of the patient’s symptoms should be
examined, tested for urethral or cervical chlamydial infection, and
treated with a chlamydia regimen (azithromycin 1 gm orally single
dose or doxycycline 100 mg orally twice a day for 7 days).
STDs (Syphilis)
STDs (Trichomoniasis)
male partners should be evaluated and treated with
either tinidazole in a single dose of 2 g orally or
metronidazole twice a day at 500 mg orally for 7
days.