MRSA bacteremia

- Vancomycin
- Daptomycin
o Issue is inactivated by surfactant

MRSA skin and soft tissue

- Clindamycin
- Doxycycline
- Minocycline
- Bactrim
- Linezolid
o Good for skin soft tissue, BAD for bacteremia
o Bacteriostatic

TSS – strep pyogenes

- Ceftriaxone
- Toxin inhibitors: clindamycin and linezolid

Osteomyelitis

- Linezolid does not work

- Ciprofloxacin can be used, gram negative bone culture proven
o Penetration is equivalent in PO to IV

MSSA

- Bacteremia
o Vanc, nafcillin, oxacillin, and cefazolin
o Studies show nafcillin and oxacillin has better cidal activity than vancomycin
o Recent studies/use is ancef (cefazolin)
 Easy to monitor
 1 time a day dosing
 High recurrence rate
Meningitis

- Strep pneumo #1, h. flu, n. gonorrhea, meningococcus

- brudzinski, kernig, and jolt sign
- immunocompromised: CT before LP
o space occupying lesion
o focal neuro deficits
o papilledema
o risk of herniation
- bacterial
o give steroids within 4hrs of LP
 prevents focal neurological deficits
o start on antibiotics
 ceftriaxone 2g (double dosing
 vancomycin
 strep pneumo (resistant to ceftriaxone)
- listeria
o ampicillin
- viral
o acyclovir
- bacteria: low glucose, high protein, high WBC
o leptomeningeal involvement of cancer
- neurosyphilis
o AMS, headache, vague signs
o Penicillin

Pneumonia

- Strep pneumoniae
o Levofloxacin
o Azithromycin + ceftriaxone
o augmentin
- Legionella
o Diarrhea
o Neurological (AMS, headache)
o Dx: urine histoantigen
o Legionnaires disease
- HCAP
o Zosyn, vanc
o Cipro – needs the pseudomonas double coverage w/ zosyn
- Sputum gram stain and culture
o Squam and WBC count >20-30
UTI

- Urine culture with UA

o Nitrite and LE positive
- Fevers, chills, nausea/vomiting
- E. coli, klebsiella
o Rocephin 5-7days
o Pyelo: Cipro/levo 2 weeks
o Macrobid (nitrofurantoin)
- Imaging??

Diverticulitis

- Cipro flagyl 10-14 days

Procalcitonin

- Tells you whether or not you have bacteria vs viral infection

- Elevated in bacterial infection