DIP Episode 41 - USMLE Antibiotic Guide

Okay, welcome. My name is Devine. I am a PGY1 resident. This is the 41st episode of the Divine Intervention Podcasts and really today we're going to be talking about basically the topic is the USMLE Anti-Bioid Guide. This is meant to be a very high level, very high yield review of antibiotics for all the USMLE exams. I will say this is probably most relevance to people that are taking step two and step three because I've got many requests for these people say, oh, they keep asking about this antibiotic, that antibiotic, how do I know what to use on the what circumstance and all that stuff. So I decided to make a very high level review that should help you get most of your antibody questions correct on the USMLE exams. Again, this is not supposed to be a guide to treatment although it will probably be useful for you in clinical practice but the main purpose here is to get to you exam questions correct. So let's begin. So the first one says a new one presenting with no co-rigidity, right? So remember in the first 20 days of life, the most common cause of essentially an in notable infection, right, is group B strap, right? So this kid probably has meningitis and the thing is in general for meningitis in the first 20 days of life on your exam, the antibiotic regimen you want to choose should be one that includes just remember the term CVA like CVA tenderness like CVA. The C stands for third generation cephalosporing. In this case, you'll be cephotaxim.

Do not give ceph triaxone to a newborn. It causes like some liver problems in the newborn so you want to avoid that. So you give cephotaxim plus vancomycin plus ampicillin, okay? So newborn meningitis, cephotaxim, vancomycin plus ampicillin. The ampicillin helps you cover the hysteria, okay? The vancomycin helps you cover merse and then the cephotaxim helps you cover like group B strap slash strap new mo. And another regimen you may see what is becoming less emphasized on the exam is ampicillin plus gentamysin, just another thing to keep in mind. Okay. Now next one says 65 year old male presenting with no co-rigidity, fever and headache, right? So again, this is a patient. The big thing I want you to cut here. So this patient obviously has meningitis, okay? But this patient is more than 50 years old. That's the high youth and I want you to pick out here. More than 50 years old, you essentially use the same CVA numonic I talked about for the first question. But in this case, instead of using cephotaxim, you can use ceph triaxone. So you can use ceph triaxone, vancomycin and ampicillin. If a patient is a newborn like first 20 days of life or more than 50 years old, you almost always want to add ampicillin to the drug regimen to cover this area because it's like almost 100% fatal if it's not treated, right? So ceph triaxone, vancomycin and am, I'm sorry, and am picillin. The ceph triaxone helps you cover niacere aminegiditis.

And the cephotaxim in the newborn also helps cover niacere aminegiditis. Okay. Now 33 year old female with no relevant pass medical history presenting with no co-rigidity, chronic and fever, right? So again, this is just a guardian variety person, no risk factors, presenting with meningitis. You don't use CVA for these people, you use CV. You use ceph triaxone and vancomycin. ceph triaxone and vancomycin. Again, ceph triaxone and vancomycin. And then as an aside, how is hospital associated bacterial meningitis or post neurosurgical procedure, bacterial meningitis, meningitis? Well, for this, you begin to have some more different considerations. Basically, whenever a patient develops a serious infection in the hospital, the two bugs you almost always want to cover as pseudomonas and mersa. Okay. So for this, you don't pick ceph triaxone because ceph triaxone does not cover pseudomonas. You want to pick either a third genocidal sphorin that covers pseudomonas or a fourth genocidal sphorin that covers pseudomonas plus vancomycin. So for this post neurosurgical procedure meningitis or hospital associated bacterial meningitis, you give vancomycin plus either septazidine. Septazidine remembers the only third gen cephylosporin that covers pseudomonas or septepim, right? So again, septepim, which is a fourth gen cephylosporin or septazidine, which is a third gen cephylosporin, those both covers pseudomonas plus vancomycin.

Now for the next slide, a patient presents with headache, no corrigidity and fever, LP reveals gram positive diplococci and a neutrophilic predominance. So this is obviously strep pneumo. And then in addition to the standard antibiotic therapy, which I've talked about for the higher populations in the previous slides, how can patient morbidity and mortality be reduced, right? So for this case, you want to add IV dexamethosone. In fact, this is classically given like a few minutes to hours before the first antibiotic regimen is given, because you want to prevent sequely like a hearing loss, for example. Okay? So you decrease the morbidity and mortality associated with pneumococcal meningitis by giving IV dexamethosone before you give the first course of antibiotics. Now, next question, a HIV positive patient presents with a severe headache and no corrigidity. Papillodema is detected on a fondoscopic exam, right? So those are signs of increased intra-cranial pressure. Now, what will a lumbar puncturum most likely reveal? Well, hopefully you're thinking about cryptococcal meningitis. Okay? So you'll find a lot of lymphocytes when you do a CSF studies, right? So you'll find like low glucose, hyperteen, you'll see an elevated white cell count, but it won't be neutrophils that'll be elevated. You'll be lymphocytes that'll be elevated. And the boggur of, again, talking about here, is cryptococcal meningitis. I mean, cryptococcus, new formants, right? And you cover this bog.

I mean, you can test for this infection, one by doing an India ink stain of the CSF, or you can do like a latex, it's called, I believe, a latex particle agglutination assay of the CSF. You can do that for cryptococcal meningitis. And really, the way you treat this is amphotericin B plus flu cytosine. Okay? Remember, amphotericin B is the thing that binds the gastrolamblows holes in the walls of our fungal cells. I mean, in the membranes, not walls, membranes of fungal cells, it binds to a gastro, and then flu cytosine is converted by cytosine diaminist to 5 FU, and then it inhibits timidlythin-thesian cryptococcus. So you give five flu cytosine and amphotericin B. Okay? Cryptococcal meningitis is treated with amphotericin B. And remember, if you give the liposomal formulation of amphotericin B, you decrease the nephrotoxicity associated with amphotericin B. And after treatment, for like a year, you actually have to place those patients on maintenance of lachonosol. Okay? So just something how you to keep in mind. And then, so that's what I mean by how is this box treated after the fact? And if a patient with HIV has but terminin gytis, you use that CV-8 treatment regimen I talked about for a patient that's greater than 50 years old, right? So, septaraxone, vancomycin, and ampecile. Now, HIV prophylaxis for the following scenarios, right? So, if you have a CD4 count less than 250 and you live in Arizona, okay?

So, you live in a susceptible area, you're thinking about cryptococ- uh, uh, coxidiumicosis, okay? Sorry, I'm giving this from memory. So, coxidiumicosis, and for that, you can prophylaxis with itraconozone. Now, if your CD4 count is less than 200, right? Hopefully you're thinking about newmosisthesiderovetsi, okay? So, you can prophylaxis against that with back trim, trimethoprim, sulfonethoxazone. If that's not an answer choice on an exam, you can choose aerosolisepentamidine, or you can choose um, dapso, okay? Those are the more high yield ones that are tested on exams. Occasionally, you may see them refer to like a tovacone, clindamysen, but those are lower yield, so I probably wouldn't worry about those if I were yield. Now, CD4 less than 150 living in Kentucky, right? So, again, you're living in a susceptible area, like Kentucky, Ohio, Missouri, and the works, okay? And they tell you that it's a HIV-positive patient, CD4 count is less than 150. You're trying to cover histoplasmosis, okay? Histoplasma capsulatum, you cover that with itraconozone. Now, CD4 less than 100, right? So, this is a bug that you should already have covered. If you, if you gave a prophylaxis at a CD4 count of 200, right? So, here I'm referring to to toxoplasma-gondi, you prophylax with TMPSMX, okay? Backtrem, trimethoprem, sophomethoxazone. I remember that trimethoprem inhibits dihydrofolyl reductase, and sophomethoxazone inhibits a dihydrothorite synthetase.

And then if the CD4 count is less than 50, you're trying to cover a mac, the micro-bacterium avium complex, it's also known as micro-bacterium avium intracellularity. You do that with this etromycin. Next slide. Now, patient on chemotherapy develops a fever. White count is 2 grams or 2,000. Now, what are the two bugs you're trying to cover, right? So, this patient has a neutropinic fever, okay? You always want to cover pseudomonas and mersa, okay? So, in general, on exams, the antibiotic regimen you're going for a septazidine plus vancomycin or septepine plus vancomycin. Very high you to know that. Next slide. Now, a HIV positive patient presents with seizures. MRI reveals multiple ring enhancing lesions in the brain, okay? So, for this, hopefully you're thinking about toxoplasmosis, okay? Cosbytoxoplasma gondii. And the way you treat this is with pyramethamine and sulphurizing. So, here's how they will try to get you on exams. They will try to get you to pick tri-method-prim-sulfur methoxas or do not pick that answer. That is what is used for prophylaxis against toxoplasmosis. Well, if you actually want it to treat toxoplasmosis, you use pyramethamine and sulphurizing. So, for digestion inhibits dihydroethyrate syntheties and then pyramethamine inhibits dihydrofoli-reductives.

And then, if the patient has signs of elevated intra-cranial pressures like the half-papilladema or the half-altred mental status and stuff like that, you want to go ahead and add dixamethos and you want to go ahead and add steroids to the treatment regimen. And just, this is not in the slides, but I'm just going to say it out loud. If a patient has neurocystic aracosis from tinius solium, you actually do not give those patients like warm treatment like how bendazol, mebendazol, firebendazol, and the works. You actually treat those seizures with fennitone. You don't give the anti-helmetic meds because if you do that, you can have a severe inflammatory response and that would actually kill the patient. So, you don't do that, you give fennitone. Now, HIV positive patient presents with headache and no-corrigidity. Number of puncture is positive for CSF with 500 red cells, ting-ding-ding. MRI reveals hyperintensions in the temporal lobe. So, what's the bug? So, hopefully again, you're thinking about HSV. So, the herpes simplex virus. And for this, you give IV cyclover. If that's not an answer choice on exams, go for FOSCAR-net. So, if you see CSF studies revealing like a ton of red cells, think about HSV. However, if a patient has a sudden onset, severe headache and no-corrigidity, let's say like 30 minutes ago, and you do a number of punctures, you're a ton of red cells. Think more about a subarachnoid hemorrhage with that. Okay, next question.

Now, HIV positive patient presents with headache and no-corrigidity. L Ps positive for CSF with a lymphocytic pleocytosis. Now, brain imaging reveals enhancement at the base of the brain. That's the high yield term there, at the base of the brain. Okay? Or you can say, they could tell you in the Houston, they could say, in basalers systems. The bug you're thinking about here is actually TB. Okay? And how do you treat TB? You treat it with a ripe regimen, right? So, ripe phampine. That's an RNA polymerase inhibitor. Isoniasate, which can cause drug induced lupus, pyrazinamide, right? And ethambutol that can cause eye problems, right? So, ripampine, isoniasate, pyrazinamide, and ethambutol. And remember, so that you add vitamin B6, right? Or pyridoxyl phosphate. Good. Next question. A patient presents with a tender lesion on the left-low extremity. Physical exam reveals a well-circumstriped erythematous lesion on the calf. The patient's vital signs are within normal limits, right? So, like, no feverers, for example. What's the diagnosis? Well, hopefully you're thinking about cellulitis. Now, on exams, if you want to treat cellulitis, these are the drugs you want to go after. You either, and really, the most common cause of cellulitis for the most part is stuff for you. So usually on exams, the antibiotics you choose. The most common answer on exams is clindamycin. If clindamycin is not an answer choice, go for backtrip. Another answer choice you can go for is cephalectic. Okay?

Cephalectic, backtrip, or clindamycin. Those work really well for cellulitis. And please be able to differentiate cellulitis from erycipilus. Erycipilus, a classically like very red, very tender, and they are usually very well circumscribed and elevated, relative to the surrounding skin, and usually on the face on exams. Those are most commonly caused by strep pyogenes, okay? Not staff-orius. So that's one high-yield thing you want to keep in mind. And then don't forget that folliculitis, which is another, again, infection of hair follicles, is classically caused by staff-orius. And then also don't forget if you tell you that a patient has folliculitis, and they were recently in a hot tub, hopefully that makes you think about a pseudomonal infection. Okay, next question. Empiric management of animal and human bite wounds, right? So if a patient has an animal or a human bite wound, are you on exams? You want to go ahead and give them a moxicillin plus clavolaniac acid. That is the answer you want to go with on exams. Okay, good. So let's go on to the next slide. So this will be slide 13. Now, Empiric management of community acquired pneumonia, for that you want to go with a macrolid, like a zythromycin, or you want to go with a doxycycline, okay? So you either use a macrolid or doxycycline. And the way to remember that is just remember like MD, right? So like your medical doctor, MD, macrolid or doxycycline.

Now, if a patient has hospital acquired pneumonia, on your exam, you want to choose one of two things. You want to choose a macrolid or doxycycline plus something that belongs to the cephalosporine class, okay? So macrolid or doxycycline plus either like sef triaxone, for example, okay? But if those are not answer choices or they tell you that the patient is penicillin allergic, you can actually go ahead and use monotherapy, like a fluoroquinolone. So you can give them like moxifloxicin or livofloxicin as monotherapy. Now, if they mention that the if the cuset mentions that the patient has like a cavitory infiltrate, then you're probably beginning to think about like stuff or else like merse. So for that you either want to basically pick the answer that includes like clinda mason or vancomycin or linizolid, very high yield to remember that. Now, next slide. Now, these people are all from Boston, okay? Don't where I have nothing against the Harvard people, but well, maybe I have something against the Harvard people. I'm just kidding. Okay, so both Irish and a seven-year-old male, right? So this is obviously Lyme disease. The way you treat this, if you're seven, if you're less than eight years old, and you have Lyme disease, you treat with a moxifloxicin. You do not use doxicicin, okay? Very high yield to know that. Now, both Irish and a 30-year-old female, right? So this person is more than eight years old. So again, this is Lyme disease. You treat that with doxicin.

Now, both Irish and a 35-year-old pregnant female, this is basically the exception to being greater than eight years old with a doxicin. For this case, you also give a moxifloxicin. And remember that for Lyme disease, right? You diagnostic test in pathway. You start with an ELISA test, right? That's your screening test. And then your confirmatory test is a Western blood. Now, how do you manage meningitis, slash chest pain, slash myocarditis, in a patient with Lyme disease? For this one, you go with septal axon. Okay, doxicin is not going to cut it here. You go for the nuclear option. You go with a septal axon. Now, next slide. Now, empiric management of, wait, am I repeating myself? Oh, whoops. I repeated a slide. Sorry about that. I'll just leave that in for now, correct, later. Okay. Now, next question. Patient from North Carolina, ding, ding, ding, presents to the EDU with severe headache and a temperature of 104. Physical exam reveals a rash on the palms and souls. Okay, rash on the palms and souls. That's a classic exam trigger for Rocky Mountain spotted fever. Okay. Now, how do you treat Rocky Mountain? And that's caused by a Ketzieric Ketzai. Okay. Remember, that usually I believe has a positive will philix test. If I'm not misquite, is it negative? Yeah, I think it has a positive will philix test. I'll probably talk about that in a little podcast. I think I've actually talked about it in a previous podcast, but anyway, so, how do you treat this in a seven-year-old?

Okay. And how do you treat this in a 25-year-old? How do you treat this in a 25-year-old pregnant female? So, here's the thing. And here's how they will try to get you on exams. If a patient has Rocky Mountain spotted fever, if they're pregnant, you actually treat that with Clarem Finicol. That is essentially the only time that Clarem Finicol will ever be the right answer as the treatment for any bug on any exam you take, at least in the US. Now, if any other kind of patient has Rocky Mountain spotted fever, the drug of choice is doxycycline, even if you're less than eight years old. They will try to get you on an exam by slotting in a moxicillin or a macrolyther as an answer choice. Do not pick those as answer choices. If a person, any person that is not pregnant that has Rocky Mountain spotted fever is treated with doxycycline, because it's almost a 100% fetal if it is not treated. Now, next question. 23-year-old non-pregnant female presents with supropubic pain and increased urinary frequency and bringing with urination. Obviously, this is cystitis and the most common bug is E coli. For this, you want to treat with one of three options. You either want to give mitrofyrantone or you want to give a fluorocuinolone like siperofloxacin or you want to give back trim, trim ethylper himself or methoxazole. An alternative is also a drug known as phosphomycin. That's TMPSMX. Siperofloxacin or nitrofyrantone.

Now, I remember that you don't want to use, in general, you want to avoid back trim and siperofloxacin in a pregnant female, because back trim can cause some problems for the fetus like neuro tube defects and siperofloxacin can cause like heart-leached problems in the fetus as well. Now, CV-10-NS plus signs of dysuria, so this is pylonofritis. On exams, the one big thing you want to go after is septraxone. Septraxone is basically the drug of choice for the treatment of pylonofritis on any exam you take. If septraxone is not an answer choice, go for a fluorocuinolone. Very high up to know that. But again, if a lady is pregnant, no fluorocuinolone. You choose septraxone. Now, next question says 31-year-old female presents with fever and uterine tenderness two days after a C-section. So, hopefully you're thinking about endometritis. And how do you treat this? So, just remember the numonic ECG. The E stands for endometritis, and then the C and the G stands for clindamysin plus gentamysin. So endometritis is treated with ECG endometritis, clindamysin plus gentamysin. And then a 33-year-old female is in labor. Her temperature is 102, and the fetal heart rate is 190 beats per minute. So, again, if you basically see this cluster of maternal fever and fetotachicardia, the very first thing I want you to think about on exams is choral amnionitis. For choral amnionitis, your treatment remember that with the mnemonic C-A-G, right? So, like the C-A-G repeats in hauntings disease.

C for choral amnionitis, the A stands for ampecellin, and the G stands for gentamysin. The reason you add ampecellin here is you want to cover this theory. So, C-A-G, choral amnionitis is treated with ampecellin plus gentamysin. Endometritis is ECG treated with clindamysin plus gentamysin. Now, next question, how do you treat leaf end TB? Basically, you can give ripe fampin for four months, or isoniasid for nine months, okay? Although, usually on exams, the most common answer you see, like 99% of the time, is isoniasid for nine months. And remember, you need to add vitamin B6, also known as pyridoxyl phosphate with that. And then for active TB, use the ripe regimen, right? So, like ripe fampin, isoniasid, pericenamide, and ethymbutyl plus vitamin B6. Now, 21-year-old sexually active female with inconsistent condom use presents with a vaginal discharge, or they tell you that she has cervical motion plus adnexaltenderness, right? So, that's like a pyd-like picture, right? Pelvic inflammatory disease. So, the bugs you're thinking about here are myseria gonorrhea, right? And chlamydia. So, for this, you generally want to cover with septraaxom plus isythromycer. The septraaxom covers the niceria, and then the isythromycerin covers covers chlamydia, right? If they don't put isythromycerin as the second thing can choose doxycycline. Doxycycline also covers chlamydia pretty well.

And then the idiosyncrasy here is that, if they tell you that, oh, you do like whatever, and you just see chlamydia, if you actually detect chlamydia, you actually only treat chlamydia. So, you give the patient either isythromycin or doxycycline. You do not need to empirically treat for niceria. But if you detect niceria, you empirically have to treat for chlamydia. So, septraaxom plus isythromycin or septraaxom plus doxycycline. Now, just real quick, if a patient that has a history of pyd presents with like right upper quadrant pain, what are you thinking about? Well, I hope you're thinking about a period hepatitis, right? That's what's known as a fethucardis syndrome. Now, female with a fishy smelling gray vaginal discharge, so what's the bug? Right? So, hopefully you're thinking about a gannerella vaginalis, okay? So, that's the cause of bacterial vaginalis. And remember, classically, the pH is greater than 4.5 and you treat that with metronidousol. And then, a female with a frothy green false-melin vaginal discharge, that should hopefully get you thinking about trigomonas vaginalis, okay? Remember the strawberry-shaped vagina or something like that? And for that, or strawberry-shaped-strobory cervix. And for that, again, the pH is usually greater than 4.5 and you treat that with metronidousol as well. And then, cottage cheese discharge, hopefully thinking about a gannerella, I'll be careful. Remember, it's a thing that grows at drum tubes at 37 degrees.

The pH is usually less than 4.5. So, if they give you any female vaginal discharge, pH is less than 4.5. The only thing you should be thinking about on the exam is candida, okay? And candida, you can treat it with an azol, like flokona-zol, okay? And just real quick, I think this is coming up in the latest slide, but just in case it is not disseminated candidemia, you can actually treat that with, I mean, you can use them for terracing B, but probably a better answer on an exam is an echinocondent, like a cuspophongen or mica-phongen or anidula-phongen. Now, next slide, classic presentation of aspergillosis. So, here's how aspergillosis is going to present on an exam. It's going to be a person that is immunocompromised for some reason. Usually, it's a patient on chemotherapy, some patient with like neutropenia, okay? And then, they will tell you that the eocino-feels that elevated in the question and then, usually, they may tell you the patient presents with like cough and hemoptysis, okay? If you see that, think about aspergillosis, okay? Or they may tell you that a patient has like a pneumonia that does not appear to be resolving with a standard treatment, think about aspergillosis. And for that, the drug of choice on the exam is voreconozol. Voreconozol is the agent of choice for the treatment of aspergillosis. Remember, it grows at acute angles, okay? At 45 degree angles, versus your mucus species that grow at 90 degree angles, right? And don't forget that for mu core.

If you describe facial pain in a diabetic, usually in DKA, you want to think about mu core. Your treatment is surgical debridement plus amphotericin B. Okay. Now, for allergic bronchopromenia aspergillosis, I'm just going to throw this in here. You should that with oral glucocorticoids, okay? Now, candidate blood infections already talked about that. You can use an echinocundin like Caspo fongin, Micophongin, or anidolo fongin, or for oral candidysis, you can consider nice studying, swish and swallow, or swish and spit, whatever floats you about. Now, for endemic fungal infections, right? So for this, I'm referring to Cocidiumicosis, Blasto-micosis, or histoplasmosis. Classically, on the exam, you go to Etraconozol for that. But if people have like disseminated infections, go ahead with amphotericin B. Basically, any like bad, bad, bad fongolin infection that's disseminated, or like fongolin ingitis, go for amphotericin B. And don't forget that crypto-Cocidiumicosis is a serothelarithemano dosa. It's just one of those weird things you want to, like, sort of lock in your mind for exams. Now, for tinii infections, right? So like tiniia, this tiniia, that blah, blah, blah. In general, you want to treat with an or with a topical antifongal. However, there are two exceptions, okay? There are two exceptions. There's onychomicosis that's like nail fungus, or tiniacapitis, that's like head fungus.

If a person has those problems, you actually treat with oral medications, not topical medications. You treat either with oral trebinofin or oral grizzofu, remember, grizzofu, is that thing that collects really well in in keratin rich tissue. And it's also an inducer of cytochrome P450. And the classic bugs that are tested with regards to the tinias, right? It's either trichofitin, micro sporum, or epidermal fighting. Those are very high-eal things you want to know. Trichofitin, micro sporum, or epidermal fighting. And then for sporotricosis, right? So sporotricosis is caused by a sporotric shenkii. This is classically described in exams as a person like a rose gardener that has like lesions along a lymph node chain, okay? And then they tell you that, oh, the patient has lymphatic anopathy. Generally for that, you cover that with itraconozone. You treat the sporotricosis with itraconozone. And then again, in VC fungal infections, you treat that with with amphoteric and photoresin B. Okay. Now, next slide. Management of most stages of syphilis. You give a benzethina penicillin G, okay? So like IV penicillin. If a patient is penicillin allergic, you can give them a microlete, like erythromycin. You can also use doxycycline, actually. And then if a patient is pregnant and they have syphilis, you actually use penicillin. In fact, I should modify this. If a patient is pregnant and let's assume they have a penicillin allergy, you actually do not use a microlete.

That won't work, okay? The drug of choice for syphilis in a pregnant patient, even with a penicillin allergy, is still penicillin. You desensitize the patient and give them penicillin. If a patient has neuro syphilis, for example, okay? You actually, again, you give them penicillin. There is no other drug that works. So even if they have penicillin allergic, you desensitize them and still give penicillin, okay? So pen allergic patients that are pregnant or have neuro syphilis, it does not matter. You desensitize them and give them penicillin. Now, for most giant infections like diverticulitis, appendicitis, colisostitis, eugenural management strategy is to give MAG, right? So remember, M-A-G, metronidazole, amoxicillin, and gentamysin, okay? So MAG, metronidazole, amoxicillin, gentamysin. Another regimen you can use is the CM regimen, so syprophloxicin plus metronidazole. And then, most causes of gastroenteritis can easily be covered with either a fluoroquine alone or a microlete. Well, classicly on exams go for a fluoroquine alone. So if a patient has like salmonella gastroenteritis or like shigella and all that stuff, go ahead and give them fluoroquine alone. That's the most common answer in exams. Now, for malaria, right? You can use fluoroquine, but basically you should maybe never choose that on an exam because it's like resistance, like almost everywhere in the world.

So other things you can choose, you can choose methlocuin, you can choose atovacone plus peraguanial, you can also choose at the mether plus lumefantre. I know these words kind of some bizarre, but you should be able to recognize them if you see them as an answer choice. So you can choose methlocuin, don't choose chloroquine. Well, I mean, you can, but probably not, but methlocuin at the mether lumefantre and atovacone proguanial, those are work well for malaria. And then the most common prophylactic regimen for malaria on exams is methlocuin. Now, how do you kill hypnosells? Right? So remember, malaria can reactivate because a latent infection can be established by plasmodium vivax and plasmodium ovali in the liver. Those are the hypnosellic forms. You can actually cover those with primacquine. Remember, you want to be careful with primacquine in patients that have a g6pd deficiency. And then the high-yout HIV met side effects. The big ones I'm just going to mention here, if you have, if a patient is taking like diagnosed in a stavidine, you generally want to go ahead and think about a pancreatitis. If a patient is taking a predis inhibitor, don't forget your fat redistribution. Like the fat lipodistrophy. If a patient is taking backtrem, right? And they have like a hemolytic anemia. Think about g6pd deficiency. If a patient is taking a favirance, think about vividrems. Remember, you don't want to give a favirance to a pregnant female, right? Because it's a teradogen.

So just those high-youtines, you want to keep in mind for a back of year, right? For a back of year, you generally want to think about a HLEB57 associated life-threatening hypersensitivity reaction. So you want to test for HLEB57 before you place patients on a back of year. And then just when we're thin, that just came to mind. Again, it's not in the slide, but just keep this in mind. If a patient with HLEB has a bacillary and geometosis, which is classically caused by banella, hencely, you generally want to go with a macrolid, right? So like is it through my skin, clarithromycin or erythromycin? Alternatively, you can actually use doxycycline. But if a patient has like a life-threatening banella infection, they're like circling the drain, they have like very abnormal vital signs. In general, you want to give them again, you can give them doxycycline or a macrolid, but you also want to add on rifampin, okay? It's just one of those things that are low yield, but if they show up, it's one of those things that almost everyone will get wrong going to test. So just to keep that in mind. Now, next slide. So empiric management, so this is the last slide. So this is just a grab bug of like one-liners that you just basically need to know about, right? So post antibiotic diarrhea, you're thinking about C-DeF, right? Close-treatment deficiency. Remember, you prevent the spread of C-DeF with hand wash. Now, C-DeF before the first line medication was metronidazone.

That is no longer the case as of a few weeks ago. Right now, the first line treatment for C-DeF colitis is actually vancomycin. Vancomycin is the drug of choice for the management of C-DeF. However, if the MBME does not update their exam, go with metronidazone, okay? But for people taking like internal medicine boards or anything of that sort, you probably want to go ahead and go with vancomycin. Vancomycin is now the drug of choice for the treatment of C-DeF. Now, C-DeF, I said you can also share with metronidazone, alternatively you can treat it with non-reabsorbable macrolid like phidaxomycin, okay? Now, bloodied diarrhea plus liver abscess. Hopefully that gets you thinking of intamibah histolyrica. Remember, that's like the only high-yield protozoal cause of bloodied diarrhea. You treat that with metronidazone. Remember, you'll get gap on the metronomonic for metronidazone. The G-4 G-R-D-A, the E-4 intamibah, the T-4-tricomones. So, G-R-D-A remember, it's the false-melendiria after drinking from a stream. The intamibah is the bloodied diarrhea plus liver abscess, the T-4-tricomones. Remember, the strawberry cervix, and then the gap, the G-s for Gardenerola vaginalis, right? So, like fishy smelling vaginal discharge with clusels on imaging, I mean on microscopy, and then they tell you the pH is more than 4.5. The A-s for anaerobes, okay? Remember, metronidazone, covers anaerobes really well.

That's why it's used for most GI antibiotic arrangements, and then the P-s for protozoans. And then, watery diarrhea and ate-spatient. Hopefully, that gets you thinking of cryptosporidium parvum. Remember, it's acid fast, okay? And you treat that with anhydrousoxenite. Nytaroxenite. Now, diarrhea in a post-transplant patient. Hopefully, this gets you thinking of CMV colitis. You cover CMV with G-siclover, okay? So, you gung up against CMV with G-siclover. And then, what causes- this is more a microquestion, right? So, what causes kidney infections in post- kidney transplant patients? Hopefully, this gets you thinking of the BK virus, the BK polioma virus, just so to keep that weird association locked somewhere in your mind. Now, pneumonia in a HIV positive patient with intestinal infiltration on X-ray. That's pretty classic for a pneumocystis-jurvetse, okay? And for that, you use trimethyprem sulfamethoxazone, or IV pentamidine, if TMPSMX is not an answer choice. And remember that if a patient has pneumocystis, a carinia pneumonia, right? And they have an AA gradient that is greater than 35, or they have a P little AO2 that's less than 70, so that just double 35, or they have an O2-sad that's less than 92%, okay? You go ahead and add steroids to that treatment regimen. Very high O2, no, those three things. AA gradient greater than 35, P little AO2 less than 70, or SAO2 less than 92%, in addition to back trim, you go ahead and add steroids. Now, influenza, right?

So the our cutoff is 48 hours, right? If it's more than 48 hours, you don't treat, you just recommend supportive care, whatever that means. But if it's less than 48 hours, you can give oceltami-vir or zanami-vir. Remember, those are your aminides inhibitors. And those just decrease the duration of symptoms. Now, from a stydus, right? So this will be a postpartum lady with unilateral breast tenderness and fever. If you see that, think about a stydus, the bog you're trying to cover is stuff-orius, and classically on exams, the right answer is naphthalene or dichloxacelene. I'll say that dichloxacelene is probably the most common answer you will see on exams. So you choose the anti-staff lococo penicillins. And don't forget, don't get dinged by this on an exam. If you describe a postpartum lady with fever and bilateral breast tenderness, that is not moustitis. You really want to think more about a breast engorgement with that. Now, general HIV regimen, you generally want to use triple therapy, right? So highly active anti-retroviral therapy or heart. And triple therapy, classically on exams, involves two NRT Is, okay, plus one other drug. The one other drug would be an integrated inhibitor or an NRTI or a pretty easy inhibitor, okay? So just keep that in mind. So, classically on exams, it's usually like ten-off-or-veer, and tracitabine plus some other drug that belongs to those three classes I mentioned.

You could also use like maraviroc, although that's like pretty bizarre, right? I've probably never seen that used like ever, like in the real world, like maraviroc or like what's the other one. Maraviroc and there is one weird drug. Well, maybe we'll come to my mind by the end. Okay, now, first million thereafter drinking from a stream that's GRDR, give metronidazole, conjon tival injection after returning from Hawaii. That is leptospirosis, okay? So that's caused by leptospirin tear against. You cover that with doxycycline. And one thing I forgot to mention when I was talking about Rocky Mountain spotted fever, classically on exams, in addition to the Russian the pumps and soles, they usually have thrombocytopenia on laps. So that's just one thing you want to keep in mind. If you see thrombocytopenia on laps in a patient, really begin to think about things like anaplasmosis or early ciosis or Rocky Mountain spotted fever caused by rickets here, rickets side. And one thing again that just came to mind, if a patient has a legionella, right, you give them a macrolid, right? So like is it thromising, clarif thromising or arithromising? Another thing that came to mind is what is this thing called H-pilory, right? So for H-pilory, you want to choose triple therapy, right? So remember your capnomonic for that, clarif thromising, amoxicillin plus a ppi.

If that's not an answer choice on your exam, go with quadruple therapy, that's like M, B, T, P, the M for metronidusol, the B for B smooth, the T for tetracycline, and then the P for a ppi. And then back to this slide, the bug you classically want to cover in osteomyelitis is stuff for you. So pick something that covers stuff and I'll talk about that right now. So let's talk about the drugs that cover MRSA. It's a super high yield list you want to know for tests. MRSA is covered by Vencomisin, okay? It's covered by DAPTO-Misin, it's covered by Septaroline, that's a fifth generation Septal Luspouring, but Trimethoprim-Sophyrmethoxisol also covers MRSA, Clindamisin also covers MRSA. Remember, Clindamisin is that drug that's classically associated with C-difcolitis, Linesolid, that's your 50th inhibitor that prevents initiation, also covers MRSA. Remember, it's a weak monamine oxidase inhibitor, so you could trigger serotonin syndrome, and then for pseudomonas, and actually one last thing for MRSA, you can also cover that with your streptogramming, classically that's a DAPTO-PRISTING-QUINNO-PRISTING, okay?

Now for pseudomonas, again, very high yield list you know, so domonas is covered by Septazidine, that's a third generation Septal Luspouring, it is covered by Septepine, that's a fourth generation Septal Luspouring, it is covered by your fluorochina loans like Cyprophloxacin, and in fact that's Cyprophloxacin is just one of those things you never really think about for pseudomonas, but it actually covers pseudomonas pretty well. Your amino glycosides also covers pseudomonas, right? So remember like cystic fibrosis-pecians, they classically get inhaled to bromise, that helps them cover that chronic pseudomonas infection. Remember, patients with CF, more than 20 years old, classically get pneumonia with pseudomonas, versus patients with CF that are less than 20 years old, that tend to get pneumonia with Staphorias. And then, other things that cover pseudomonas, your cover penems like imipenem, meropenem, eropenem, duri-penem, those all cover pseudomonas. And then your, there's one more thing, as trionam, as trionam also covers pseudomonas, and also vitamin Z, so said, right? Everyone gets this in the hospital. Piparasitin and Tizobactem also covers pseudomonas, very high yield to notice list, okay? Very high yield to know that. Now, pertosis, right?

So if they describe a person that has like a chronic cough, or a cough that is so bad that they have a subconjunctival hemorrhage with the cough, or they have like vomiting, like an episode of vomiting after the cough, think about, where the telepertosis is, something you'll get if you vaccinate your children, and again, as a public service announcement, vaccines do not cause autism. Okay, back to this. So pertosis, you cover that with erythromycin, or any other microlit, okay? And you also prophylax close contacts with a microlit, again, also like erythromycin. Remember erythromycin can also be used to treat gastroperesis, because it's a multilay receptor agonist. Now, close contact meningitis, prophylaxes, you can choose one of three drugs, you can choose right phampin, that's actually preferred. Alternatively, you can choose syperfloxicin, or you can choose septriaxone, okay? So if a patient has my seramine ingitis, and they have close contacts, you want to prophylax those people so they don't get meningitis as well, with either erythromycin, that's preferred, or syperfloxicin, or septriaxone. And then for tightest media, right, you generally want to treat with amoxicillin plus a clavolanic acid on exams, or you can treat with just amoxicillin, or you can also treat with septuroxin, that's just one of those weird things that occasionally shows up on tests.

And then if it's a tightest external, hopefully you're thinking about pseudomonas, you generally want to use like fluoroquinoleon drop, okay? Or, or yeah, generally I'll say fluoroquinoleon eardrop is probably the correct answer on tests. And then for a patient that has conjunctivitis, and they wear contact lens, or they have a conial ulcer, and they wear contact lens, you also want to cover pseudomonas, okay? You want to give a drug that covers pseudomonas in some way, shape or form. And then the last thing that came to mind if a patient has measles, there's generally nothing you can do, okay? But you could try supplementing vitamin A for those people. Let's see, so this is kind of me freestyling at this point. I'm just trying to think of any high-ealth and I didn't put in this light set that may show up on a test. Let's see, just give me a second, let me do some thinking. Let's see, well, nothing is really coming to mind. Crop, I guess, caused by the parian friends of virus, that could be treated with like a racemic epinephrine. Let's see, what else? If a patient has... Let's see, yeah, nothing else is really coming to mind, but just hopefully you find this podcast to be pretty helpful. I know I was kind of all over the place with this, but I mean, somewhat organized, but I was also all over the place because as I was going through this, more and more thoughts were coming to my head. So, just keep this in mind.

This is a podcast you probably want to listen to like more than one, so like, make good notes the first time and go right over and over again. It's just one of these things where, if you're taking a step one or a step two or a step three, you probably get like 20 questions correct just from listening to this podcast. So I hope you find this helpful, have a wonderful rest of your day and God bless. I'll see you in the next podcast. Thank you.

C (Third generation cephalosporin, e.g., Cefotaxime), V (Vancomycin), and A (Ampicillin).

It can cause liver problems/hepatotoxicity in the newborn.

Diagnosis via India ink stain or latex agglutination assay; Treatment is Amphotericin B plus Fluconazole.

IV Dexamethasone, ideally administered minutes to hours before the first antibiotic dose.

TMP-SMX (Trimethoprim/Sulfamethoxazole).

Metronidazole; it treats the condition when the vaginal pH is > 4.5.

Amphotericin B.

Vancomycin (or Fidaxomicin); Vancomycin is now the drug of choice.

The RIPE regimen (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) plus Vitamin B6.

Moxifloxacin.

Clindamycin plus Gentamicin (C-G).

Tuberculosis (Mycobacterium tuberculosis), treated with RIPE regimen.

Septazidime or Cefepime, combined with Vancomycin.

Amphotericin B.

Vancomycin (or Fidaxomicin); Vancomycin is now the drug of choice.

The RIPE regimen (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) plus Vitamin B6.

Moxifloxacin.

Clindamycin plus Gentamicin (C-G).

Tuberculosis (Mycobacterium tuberculosis), treated with RIPE regimen.

Septazidime or Cefepime, combined with Vancomycin.