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Other ID Pearls

 In Pts W/ Mild Egg Allergy-It Is Okay to Give Inactivated Influenza Vaccine. However, Live Attenuated
Influenza Vaccine Is Contraindicated.
 Pneumococcal Vaccination Strategy = PCV 13 First, Then Followed by PPSV 23 In 8 Weeks.
 Tdap/Td Vaccine = Inactivated.
 Pregnant Women Should Receive a Single Dose of Tdap Vaccine between 27-36 Weeks, Regardless of
When They Last Received Td or Tdap Vaccination.
 For suspected osteomyelitis, Always check Bone Biopsy & Culture.
 Cover Septic Bacterial Arthritis For MRSA & Pseudomonas (I.E. Vancomycin + Ceftazidime).
 1st-Line Abx Tx for Lyme-Linked Arthritis = Doxycycline/Amoxicillin × 28 Days.
 Tx of Asymptomatic Urinary Catheter-Linked Candiduria = Catheter Replacement, Antifungal Tx is
usually not necessary.
 Empirics Tx of Septic Meningitis: must cover for Pseudomonas, MRSA.
 Zosyn = Insufficient Penetration into the CSF, not used for meningitis Tx.
 MC Pathogen causing New Fever & Diarrhea 1 month after Liver Transplant = Clostridium difficile. Not
CMV.
 Pts<55 w/ new-onset Uncomplicated Dyspepsia should be evaluated w/ Noninvasive test for H pylori
infection.
 MCC of acute gastroenteritis between 24-48 hours w/ N/V + noninflammatory diarrhea = Norovirus.
 Gastroenteritis from Preformed Toxins (Bacillus or Staph) = <24 hours.
 Abxs for uncomplicated community acquired diverticulitis = Zosyn, Meropenem, Imipenem,
Metronidazole + Cefepime. No need for MRSA coverage.
 VZV vaccine indicated for: anyone >60, past zoster, chronic medical condition. Okay to give Pts on Mild
immunosuppression (low-dose steroids/methotrexate), okay w/ Hydroxychloroquine.
 It is okay to give influenza vaccine to Pts w/ mild or unknown egg allergies, however if the Pt has had
severe/life-threatening reactions will need to be evaluated by an expert before receiving an influenza
vaccine.
 Goal of PEP testing is to determine whether or not Pt has a previous infection, if so, this changes the
medication used from PEP medication to medication for active Dz Tx.
 Do not check HIV RNA load for PEP testing.
 Key infectious Dz prophylaxis for a Pt traveling to Dominican Republic = malaria prophylaxis.
 13-/23-pneumococcal vaccine for all adults ≥ 65, HIV, malignancies, functional/anatomic asplenia, CSF
leaks, cochlear implants, smokers, nursing home, chronic heart dz (excluding HTN), chronic lung dz, DM,
chronic Liver Dz, ETOHism.
 Pts of high risk groups who have not received any pneumococcal vaccine should receive 13-initially,
followed by 23-at least 8 weeks later. One-time dose of 23-booster is recommended 5 years after the 1st
dose for adults aged 19-64 who have chronic renal failure, nephrotic syndrome, immuno compromising
condition, asplenia.
 Give Both HAV vaccine & IG to the following Pts were traveling w/in 2 weeks: Elderly,
Immunocompromised, Chronic Liver Dz.
 Pre-Vaccination HAV serology testing is only recommended for Pts w/ the following risk factors:
born/living in HAV endemic areas, history of illegal drug use, Male-Male sexual encounter.
 Mycoplasma pneumonia S/S: erythema multiform (erythematous, macular, target-like lesion), mild
hemolytic anemia (decrease hemoglobin, increase retic, normal WBC), CXR = bilateral reticulonodular
infiltrates.
 Criteria for PPD Test Positivity:
* ≥ 5 mm, is Positive for the following: HIV, Close Contact w/ People W/ TB, CXR Suggesting past TB,
Currently Immunosuppressed.
* ≥ 10 mm, Is Positive For the Following: Immigrant From a TB-Endemic Area w/in the Last 5 Years,
Healthcare Workers, IV Drug Users, Homeless People, Resident or Staff of Long-Term Care Facility,
Children <4, Pts w/ Recent PPD Test Positive.
* ≥ 15 mm, Is Positive For the Following: Everyone Else.
 Acute Bacterial Rhino Sinusitis: Fever, Chills, Purely Nasal Discharge, Facial Pain, Headaches, Persistent
Symptoms >10 Days. Tx = Augmentin B.I.D. 5-7 Days.
 Inhaled Zanamivir is not used for Influenza in pt w/ underlying resp. dz.
 Acute Influenza in a COPD, use PO Oseltamivir.
 Plural TB S/S = Bloody Exudative Pleural Effusion, Hilar Lymphadenopathy, Sometimes Negative PPD.
Best Test for Plural TB Diagnosis = Pleural Biopsy w/ Culture.
 Tx of Neurosyphilis = 1st Line, IV Aqueous Crystalline PCN-G × 10-14 Days.
 MC Complication of Rheumatic Heart Dz in Young Adults = Mitral Regurgitation = Holosystolic Murmur at
the Apex.
 Tx for MSSA Prosthetic Valve Endocarditis = Nafcillin + Rifampin + IV Gentamicin × 1st 2 Weeks, Then
Continue Nafcillin + Rifampin For 4 Weeks.
 Tx of Choice for Severe Pulmonary Histoplasmosis = Amphotericin B, Followed by Oral Itraconazole.
 4-Point Centor Criteria for Pharyngitis = Fever, Absence of Cough, Tender Cervical Lymphadenopathy,
Tonsillar Exudate. A Score = 0 = No Tx No Testing, A Score >2 = Testing by RSA & Throw Culture-Tx
Positive.
 Prophylactic Abxs For Sexual Assault Must Cover: Gonorrhea, Trichomonas, Chlamydia. (Ceftriaxone,
Metronidazole, Azithromycin)
 To Prevent HSV Infection, Daily Oral Acyclovir(1st)/Val Acyclovir/Famiclovir Is Recommended.
 UTI that recurs >1 Month After Successfully Being Txed w/ Abx, Should Be Txed W/ a New Abx.
 1st Line Abx for Acute Uncomplicated Pyelonephritis = Fluoroquinolone (Ciprofloxacin).
 For Pt Being Txed for Acute Pyelonephritis, W/ No Improvement In 48 Hours On Appropriate Abxs, Check
CT Abdomen/Pelvis To Rule out Complications Of Pyelonephritis.
 For Pts w/ Rheumatic Heart Dz & Valvular Complications, Secondary Abx (Monthly IM PCN-G) Prophylaxis
Should Be Continued for 10 Years or until 40 Years of Age Whichever Is Longer.
 Gastroenteritis Linked w/ Mexican-Style Cheese = Listeria (Gram-Positive Rods). Tx of Choice = IV
Ampicillin.
 Empirical Tx for Bacterial Conjunctivitis In Contact Lens Wearers, THAT PERSISTS after removing contact
lenses = Fluoroquinolone Eyedrops.
 Only PCN Is The Abx Approved for Reducing The Risk of Recurrent Lower Extremity Cellulitis.
 Empirical Abx Tx for Toxic Shock Syndrome = Zosyn + Vancomycin + Clindamycin.
 Preferred Tx for a Pt w/ Arthroplasty W/ MRSA Bacteremia = IV Vancomycin × 4-6 Weeks.
 Pt w/ Acute Febrile Illness Linked w/ Petechial Rash, Leukopenia, Thrombocytopenia, Negative Malaria =
Dengue Fever.
 Tx of Choice for Chlamydial & Non-Gonococcal Urethritis = Azithromycin/Doxycycline.
 Tx of Choice for Gonococcal Urethritis = Ceftriaxone + Azithromycin.
 Linezolid Linked w/ Increased Risk Of Serotonin Syndrome.
 Indications for Abx Tx For Shigella Infection: Severe Dz, Weak Immune System, Children & Caregivers in
a Daycare Center.
 Abx Tx For Shigella Dysentery = Ciprofloxacin/Other Fluoroquinolones × 3 Days.
 Tx of HCV-1 in pt w/ Severe Depression = Sofosbuvir + Simeprevir +/- Ribavirin.
 First-Line Antiviral Tx for Chronic Hep B Infection = Tenofovir or Entecavir.
 Indications for Starting HBV Antiviral In Chronic HBV Infection W/ Negative HBeAg = Viral Load >20,000,
Or, ALT >2X Normal.
 Enterococcus Endocarditis Tx = Ampicillin/PCN + Gentamicin. Ampicillin Is Preferred Over Vancomycin.
Alternative = Ampicillin + Ceftriaxone, Especially for Pts w/ Renal Dysfunction.
 Maltese Cross = Babesia: ARDS In Pts Who Are Asplenic, Immunocompromised, Elderly.
 Blood Culture Shows Gram-Positive Organism W/ Pseudo-Hyphae = Candida Albicans.
 Tx of Disseminated MAC = Clarithromycin/Azithromycin + Ethambutol.
 Pts Who Take Inhaled Glucocorticoids & Also Protease Inhibitors Are at Increased Risk to Develop
Cushing's Syndrome.
 Oseltamivir & Zanamivir & Inactivated Flu Vaccine = Ok in Pregnancy.
 Consider Prophylaxis For Endocarditis for ONLY DENTAL procedures, If the Pt Has the Following: Presence
of Prosthetic Valve, History of Effective Endocarditis, Unrepaired Cyanotic Congenital Heart Dz,
Congenital Heart Dz Repair w/ Prosthetic Material, Presence of Pallets of Shunts/Conduits, Cardiac
Valvular Issues in a Cardiac Transplant Recipient.
 Oral Candidiasis w/ Esophageal Involvement (Difficulty Swallowing), Tx = Oral Fluconazole.
 Atorvastatin in Low Doses Are Okay for Hyperlipidemia In HIV. But Not Simvastatin.
 Duration of TB Meningitis = 9-12 Months.
 Clenched Fist Injury Prophylactic Abx = 1st = Augmentin, If PCN-Allergic Prophylaxis = Clindamycin +
Moxifloxacin.
 Malaria Prophylaxis for Pregnant Pts = Mefloquine (2nd/3rd Trimester).
 Abxs for Endocarditis Prophylaxis: 1st = PCN, If PCN-Allergic = Clindamycin/Azithromycin/Clarithromycin.