• complicated: upper tract infection in
• women or
• any UTI in men or
• pregnant women or
• UTI with underlying structural disease or immunosuppression

•  Surgery should be considered for any of the following:

• acute osteo that fails to respond to medical Rx,
• chronic osteo,

• complications of pyogenic vertebral osteo (eg,
• early signs of cord compression,
• spinal instability,
• epidural abscess) or

• infected prosthesis

Consider head CT to r/o mass effect before LP if presence of high-risk feature

• age>60 y,

• immunosupp.,

• h/o CNS disease,

• new-onset seizure,

• Δ MS,

• focal neuro findings,

• papilledema;
• absence of all these has NPV 97%;
• however, in Pts w/ mass effect, herniation may occur w/o LP and may not occur even w/ LP (NEJM 2001;345:1727)

Rifampicin 600mg PO bid x 2D

Ciprofloxacin 500mg PO 1D

Ceftriaxone 250 mg IM 1D

•  Rx if can initiate w/in 72 h of skin lesions in healthy Pt or at any time in immunosupp.

•  Valacyclovir or famciclovir × 7–14 d, or until lesions fully crusted;

• acyclovir 10 mg/kg IV q8h if dissem. or high-risk Pt
• medically ill,
• immunosupp.,
• V1 zoster w/ ophthalmic s/s, etc.

• TEE if
• (i) mod-to-high suspicion,
• (ii) high-risk Pt (prosthetic valve, prior IE, congenital heart dis),
• (iii) TTE nondx,
• (iv) TTE [-]  but high-risk endocarditis, or
• (v) suspect progressive or invasive infection (eg,
• persistent bacteremia or fever,
• new conduction abnl, etc.) (Circ 2005;111:e394)

• PVE (Prosthetic valve endocarditis):
• early (≤60 d):
• vanco + cefepime + gent;

• PVE (Prosthetic valve endocarditis):
• early (≤60 d):
• vanco + cefepime + gent;
• intermediate (60–365 d):
• vanco + gent;
• late (>1 y):
• vanco + CTX + gent

•  Organism:

• consider surgery forS. aureus, fungal or multiRx resistant organisms

Quinolone (Moxifloxacin):

GI upset, tendinopathy, prol  QT

Opciones de tratamiento para neumonia por p. jiroveci (Pocket)

1. TMP-SMX

2. Dapsone/TMP

Clindamicina/Primaquina

Atovacuona

Pentamidina

(John Hopkins)

3rd gen ceph/amp-sulbactam

+

macrolide/FQ

Neumonia hosp acquired an risk for MDR path

Tx?

antipseudomonal PCN/ ceph/carbapenem

+

FQ/[Gentam+azithro]

+/-

MNZ/clindamicin

antipseudomonal PCN/ ceph/carbapenem

+

FQ/[Gentam+azithro]

+/-

MNZ/clindamicin

+/-

TMP-SMX+/-steroids to cover PCP

FQ / CTX+clinda

or

amp-sulbactam

or

ticar-clav

or

ertapenem

Pac con inf cronica de pie diabetico con cultivo MRSA [+]

tx:

FQ / CTX+clinda

or

amp-sulbactam

or

ticar-clav

or

ertapenem

ADD

Vanco / TMP-SMX/ Linezolid / Telavancin / Dapto / Ceftaroline

Ampiciclin + Ceftazidime (3rd gen ceph)+

Vanco+acyclovir

Treatment

•  Rx if can initiate w/in 72 h of skin lesions in healthy Pt or at any time in immunosupp.

•  Valacyclovir or famciclovir × 7–14 d, or until lesions fully crusted;

• acyclovir 10 mg/kg IV q8h if dissem. or high-risk Pt
• medically ill,
• immunosupp.,
• V1 zoster w/ ophthalmic s/s, etc.

•  Prevention: vaccine approved for Pts >50 y (↓ lifetime risk from 20% to 10%, also ↓

PHN)

• PVE (Prosthetic valve endocarditis):
• early (≤60 d):
• vanco + cefepime + gent;

• Ppx
• Cardiac conditions
• Proshtetic valve
• Previous NVE
• Congenital HD
• Unrepairer or incompletely repaired cyanotic CHD (palliatice shunts or conduits)
• 1st 6mo aftes completely repaired CHD using prosthetic material
• Cardiac transplant recipients w/ valvulopathy

Tenofovir (TDF)

Componente de truvada

[TDF+FTC]

ITRNoNucleosido que presenta como EA:

CNS(confusion, nightmares). teratogenic

Diarrea, lipodistrofia, obesidad central con desgaste periferico, hiperlipidemia y resistencia a la insulina

Atazanavir: hiperbilirrubinemia

Indinavir: nefrolitiasis

Saquinavir: prol QT

Tipranacir: hemorragia cerebral

MA enfuvirtide

Intol GI

Lipoatrophy

Lactic acidosis

(less w/ 3TC, ABC, FTC, TDF)