What's the drug of choice for Listeria monocytogenes, Salmonella, and Shigella spp?

Ampicillin. Note those are all G+.

What are the two penicillin-derived drugs that are extended spectrum for pseudomonas infections? Which one is first line and which one is more potent?
- Ticarcillin (and its derivatives; Timentin) -- 1st line - Piperacillin (and its derivates w/ tazobactam; Zosyn) -- this is the broadest spectrum.

What is the DOC to treat Clostridium Perfringens? what does this bacteria cause?
Penicillin G. Bacteria causes gas gangrene.

What is the DOC to treat treponema pallidum? What condition does the bacteria cause?
Penicillin G Bacteria causes syphilis.

What is the DOC to treat Listeria Monocytogenes sepsis and meningitis?

ampicillin

What is the DOC to treat MRSA?

Vancomycin

What is the DOC for surgical prophylaxis? Why? How is it administered?

- Cefazolin - By injection Used b/c of high bone penetration, and because it's a good alternative to anti-staph penicillins in penicillin-allergic patients.

What is the first line agent used to treat mixed intra-abdominal infections by Bacteroides?
Cefoxitin (2nd Gen)

What are the two first line agents used to treat H. influenzae infections?
Ceftriaxone (3rd) Cefotoxime (3rd)

Cephalosporins are the go-to drugs to treat meningitis except for meningitis caused by what bacteria?
Listeria monocytogenes.

What is the first line agent used to treat Clostridium tetani infections?
Vancomycin.

Which two cephalosporins are the first line agents used to treat Neisseria gonorrhoeae?
- Ceftriaxone (3rd G) - Cefixime (3rd G)

What cephalosporin is the first line agent used to treat Typhoid Fever due to salmonella?
Ceftriaxone (Rocephin; 3rd G)

What are the three first line agents used to treat penicillin-resistant pneumococci?
Ceftriaxone (3rd G) Cefotaxime (3rd) Vancomycin

What are the five first line agents used to treat systemic pseudomonas aeruginosa infections?
Ticarcillin Piperacillin Ceftazidime (3rd) Cefepime (4th G) Tobramycin

How do you treat antibiotic-induced enterocolitis d/t Staph or C diff? Why?

- w/ Vancomycin PO - Because it's poorly absorbed orally and will therefore be very active against the G+ bacteria in the intestine causing the colitis.

What's the DOC for Rickettsia?

Doxycycline

What's they DOC for Chlamydia?

Doxycycline

DOC for Ureaplasma

Doxycycline

DOC for Mycoplasma

Doxycycline

DOC for Borrelia

Doxycycline

DOC for Yersinia

Streptomycin

DOC for Francisella

Streptomycin

DOC for Enterococcus

Gentamicin (combo)

First line for Helicobacter pylori

Tetracycline

First line for Vibrio spp.

Doxycyclin

First lines for Brucella

Doxycyclin + Gentamicin

First line for Chlamydia

Doxycyclin

First line for Nocardia

Minocyclin

First line for Viridans streptococci (serious infections)

Gentamicin

First line for Strep agalactiae (serious infections)

Gentamicin

First line for Listeria meningitis

Gentamicin

First line for Campylobacter (serious infections)

Gentamicin

What's the drug of choice for chlamydia trachomatis?

Azithromycin

What's the DOC for Nocardia & Pneumocystis pneumonia?

Co-trimoxazole. Drugs of Choice

This page summarizes primary and alternative drugs for the treatment of specific fungal infections. This page focuses on medical therapeutic approaches and it must be remembered that other therapeutic measures (most commonly, surgical excision and debridement) are required in combination with antifungal therapy for some fungal infections. Please refer to the related page about each fungal infection for additional data. Please also see our discussion on cost analysis and pharmacoeconomic analysis of antifungal therapy.

The tables are presented in two sections. The first table shows drugs of choice and the second table shows suitable dosages. These abbreviations are used throughout the tables:

AMB: Amphotericin B deoxycholate (Fungizone) ABLC: Amphotericin B lipid complex (Abelcet) ABCD: Amphotericin B colloidal dispersion (Amphotec) LAMB: Liposomal amphotericin B (AmBisome) Echinocandin: Caspofungin, micafungin or anidulafungin

Drugs of Choice The following table summarizes the therapeutic options in the more frequent systemic fungal infections [85, 99, 114, 291, 421, 525, 795, 946, 1000, 1001, 1003, 1168, 1406, 1623, 1737, 1915, 1934, 1993, 2163, 2290, 2415]. Some of the treatment modalities have not been formally approved by the US Food and Drug Administation. MYCOSES Aspergillosis DRUG OF CHOICE Voriconazole An AMB preparation
a

ALTERNATIVE(S) Itraconazole Echinocandin Posaconazole

Itraconazole (used in milder forms or after more severe disease is stabilized with an AMB preparation)a Blastomycosis An AMB preparationa Itraconazole capsule (for mild to moderate disease) Candidiasisb Candidemia and invasive candidiasis Echinocandin An AMB preparationa Fluconazoleb IV or PO

Ketoconazole Fluconazole PO

ABLC

ABCD LAMB

Oropharyngeal candidiasis Fluconazoleb PO

Ketoconazole Itraconazole Clotrimazole troche Nystatin oral suspension

AMB oral suspension AMB IVc Esophageal candidiasis Fluconazoleb PO Ketoconazole Itraconazole AMB IVc Echinocandind Vulvovaginal candidiasis Fluconazoleb, e PO single dose Topical azole preparations Nystatin vaginal tablet Coccidioidomycosis An AMB preparationa (for rapidly progressive disease) Ketoconazole Itraconazole Boric acid Ketoconazole Itraconazole Voriconazole Posaconazole Fluconazole PO or IV (for subacute/chronic disease or coccidioidal meningitis) Cryptococcosis AMB intrathecalf

An AMB preparationa+Flucytosine LAMB Voriconazole Posaconazole Chronic suppressive therapy with fluconazole PO in AIDS patients (lifelong) Itraconazole capsule Chronic suppressive therapy with itraconazole capsule or AMB (weekly) in AIDS patients (lifelong) Griseofulvin Fluconazole Topical therapy ABLC ABCD

Dermatophytosisg (other than dermatophytic onychomycosis) Histoplasmosis

Terbinafine Itraconazole capsule AMB (for severe disease) Itraconazole (for mild to moderate disease)

LAMB Ketoconazole Fluconazole Chronic suppressive therapy with itraconazole capsule in AIDS patients (lifelong) Chronic suppression therapy with itraconazole capsule, fluconazole PO or AMB (weekly) in AIDS patients (lifelong)

Onychomycosis Candida onychomycosis Dermatophytic onychomycosis Itraconazole capsule Terbinafine Itraconazole oral capsule Griseofulvin Topical cicloprox olamine Fluconazole Paracoccidioidomycosis An AMB preparation Itraconazole (for mild to moderate disease) Voriconazole Itraconazole Ketoconazole Posaconazole Sporotrichosis Cutaneous and lymphocutaneous sporotrichosis Systemic sporotrichosis Itraconazole Potassium iodide Fluconazole PO An AMB preparation (for severe disease) Itraconazole (for mild to moderate disease) Chronic suppressive therapy with itraconazole capsule in AIDS patients (lifelong) Zygomycosis An AMB preparationa Posaconazole
a a

Ketoconazole

Pseudallescheriasis

Fluconazole PO

a. The lipid formulations of amphotericin B are licensed for use in patients whose infection is intolerant or refractory to amphotericin B deoxycholate treatment. However, a lipid AMB (ABLC, ABCD, or LAMB) can generally be substituted and is often preferred for mould infections. b. Fluconazole should not be used in any clinical form of candidiasis due to Candida krusei as this species is felt to be intrinsically resistant to fluconazole. For other Candida spp., such as Candida glabrata, in vitro antifungal susceptibility test results may be used to determine whether the infecting strain is susceptible to fluconazole. See our discussion of the usual susceptibility patterns of Candida spp. c. Indicated only in azole-refractory or azole-resistant infections. d. Caspofungin has activity here, but is not licensed for this indication. Limited safety data exist for caspofungin and the risk/benefit ratio for its use here would need to be carefully evaluated. e. 150 mg single dose therapy. f. May be indicated in patients who do not respond to fluconazole. g. In patients with widespread skin lesions and tinea capitis, oral therapy is indicated since topical therapy frequently fails. Dosages Below are the generally recommended doses of systemically administered antifungal agents. The optimal dose may need to be modified depending on the severity of the infection as well as the immune status of the host. Thus, the recommendations below are not strict and their use requires cautious individual evaluation of each patient. DRUG AMB USUAL DOSE 0.6-1.5 mg/kg/day IV (doses above 1 mg/kg/d tend to be highly nephrotoxic and must be administered with great caution) 10 g intravitreal Oral suspension 100 mg (1 ml) four times daily 3-4 mg/kg/day IV 5 mg/kg/day IV 3-6 mg/kg/day IV 600 mg gelatin capsule once daily intravaginal Loading dose of 70 mg/day, followed by 50 mg/day IV

ABCD ABLC LAMB Boric acid Caspofungin

Micafungin Anidulafungin Clotrimazole troche Fluconazole

50-150 mg/day Loading dose of 100-200 mg/day, followed by 50-100 mg/day 10 mg five times daily PO 100-800 mg once/bid PO 150 mg PO single dose therapy (for vulvovaginal candidiasis) 400-800 mg IV 25 mg/kg qid PO 10-20 mg/kg/day PO tablet/syrup 200-400 mg capsule once/bid PO Oral solution 200 mg (20 ml) once daily 6 mg/kg q12h day#1, the 3-4 mg/kg/q12h IV 200 mg qid PO 800 mg/day PO divided doses (bid-qid) 400-800 mg once/bid PO 500,000 U (5 ml) oral suspension four times daily PO 100,000 U vaginal tablet once daily 1-5 ml tid PO 250 mg/day PO

Flucytosine Griseofulvin Itraconazole Voriconazole Posaconazole Ketoconazole Nystatin Potassium iodide (saturated solution) Terbinafine