Antibiotic Essentials Burke A. Cunha, Cheston B. Cunha
INDEX
A-flavus, endophthalmitis ………… 37
A. fumigatus, endophthalmitis ………… 37
A. hemolyticum, pharyngitis ………… 42
Abacavir (ABC) ………… 546
Abacavir + lamivudine (Epzicom) ………… 547
Abacavir + lamivudine + zidovudine (trizivir) ………… 548
ABC (abacavir) ………… 546
ABCD ………… 564
ABC/3TC (Epzicom) ………… 547
ABC/3TC/ZDV (Trizivir) ………… 548
Abdominal abnormalities (DDx)
abdominal wall nodules ………… 504t
abdominal wall sinus tract ………… 505t
abdominal wall tenderness ………… 504t
abdominal tenderness (2° to pancreatitis) ………… 504t
ascites ………… 506t
hepatomegaly ………… 505t
hepatosplenomegaly ………… 492t
left upper abdominal quadrant tenderness (splenic tenderness) ………… 505t
perubilical purpura (thumbprint sign) ………… 505t
right lower quadrant tenderness ………… 505t
right upper quadrant mass ………… 505t
right upper quadrant tenderness ………… 505t
right upper quadrant tympany ………… 505t
rose spots ………… 504t
splenomegaly ………… 506t
Abdominal tenderness, abdominal abnormalities (DDx), ………… 504t
Abdominal wall sinus tract, abdominal abnormalities (DDx) ………… 504t
Abdominal wall tenderness, abdominal abnormalities (DDx) ………… 504t
Abelcet ………… 561
ABLC ………… 561
Abortion, septic ………… 122
Abscess
brain ………… 28
cutaneous ………… 151
gallbladder wall ………… 100t
intraabdominal ………… 110
intrarenal ………… 118
ischiorectal ………… 162
liver ………… 102
lung ………… 72
necrotizing ………… 147
pancreatic ………… 102
pelvic ………… 110
perirectal ………… 162
prostatic ………… 119
renal ………… 118
tuboovarian ………… 122
Absidia
cutaneous zygomycosis ………… 308
pulmonary zygomycosis ………… 283
Acanthamoeba
granulomatous amebic encephalitis ………… 274
keratitis ………… 33
meningitis ………… 21
A-cillin ………… 554
Acinetobacter baumanii, acute bacterial meningitis ………… 19
Acinetobacter baumanii, lwoffi, calcoaceticus, haemolyticus ………… 228t
Acquired resistance ………… 3
Actinobacillus, endocarditis ………… 78
Actinomyces, brain abscess ………… 28
Actinomyces israelii ………… 246t
cutaneous actinomycosis ………… 302
pulmonary actinomycosis ………… 285
Actinomyces odontolyticus ………… 246t
Acute bacterial endocarditis (ABE) ………… 80
Acute bacterial meningitis (ABM), empiric therapy ………… 18
Acute bacterial sinusitis ………… 31
Acute exacerbation of chronic bronchitis (AECB) ………… 50
chronic medical prophylaxis ………… 385t
Acute non-bacterial meningitis ………… 21
Acute otitis media ………… 39
Acute rheumatic fever (ARF), chronic medical prophylaxis ………… 385t
Acyclovir ………… 549
Adefovir dipivoxil ………… 550
Adenosine deaminase levels
CSF ………… 525
pleural fluid ………… 524
Adenovirus
conjunctivitis ………… 34
transplant infections ………… 175
Adult immunizations ………… 399
Bacille Calmette-Guérin (BCG) ………… 399t
hemophilus influenzae ………… 399t
hepatitis A ………… 399t
hepatitis B ………… 400t
herpes zoster (HZV) ………… 400t
influenza ………… 401t
measles401t
meningococcus (invasive disease) ………… 401t
mumps ………… 402t
papilloma (human) virus ………… 402t
pertussis ………… 402t
pneumococcal (S. pneumoniae) 402t
rubella ………… 403t
tetanus-diphtheria (TD) ………… 403t
varicella (VZV) chickenpox ………… 403t
Adverse side effects, explanation ………… 543
Aerobic GNBs ………… 5, ………… 540
acute pancreatitis ………… 101
endocarditis ………… 81
IV line (CVC) infections ………… 85
liver abscess ………… 102
pacemaker infections (PPM) ………… 85
pancreatic abscess ………… 102
surgical prophylaxis ………… 376t
Aeromonas hydrophila ………… 228t
African tick bite fever ………… 313
Agent-specific antibiotic resistance ………… 2
Aggegatibacter (actinobacillus) actinomycetemcomitans ………… 208t
AIDS. see HIV
Alcaligenes xylosoxidans ………… 229t
Alcoholics, pneumonia ………… 71
Alinia ………… 704
Alkaline phosphatase (AP), elevations, liver test abnormalities (DDx) ………… 521t
Allergic potential, explanation ………… 543
Allogeneic BMT/lung transplants, transplant prophylaxis (BMT/SOT) ………… 389t
Alopecia, localized/generalized, head abnormalities (DDx) ………… 497t
Alternaria alternata, cutaneous alternaria ………… 307
Alveolar echinococcosis ………… 279
Amantadine ………… 551
AmBisome ………… 563
Amebiasis ………… 292
(see also Entamoeba histolytica)
American trypanosomiasis ………… 265
(see also Chagas‘ disease)
Amikacin ………… 552
pearls & pitfalls ………… 533
susceptibility profiles ………… 208t
Amikin ………… 552
Aminoglycosides
pearls & pitfalls ………… 533
susceptibility profiles ………… 208t
Amoxicillin ………… 554
pearls & pitfalls ………… 528
susceptibility profiles ………… 196t
Amoxicillin/clavulanic acid ………… 556
pearls & pitfalls ………… 528
susceptibility profiles ………… 196t
Amoxicillin/clavulanic acid ES- 600 ………… 558
Amoxicillin/clavulanic acid XR ………… 559
Amoxil ………… 554
Amphotec ………… 564
Amphotericin B ………… 560
cholesteryl sulfate complex ………… 564
colloidal dispersion ………… 564
lipid complex ………… 561
liposomal ………… 563
Ampicillin ………… 565
pearls & pitfalls ………… 528
susceptibility profiles ………… 196t
Ampicillin/sulbactam ………… 566
pearls & pitfalls ………… 532
susceptibility profiles ………… 196t
Amylase, elevation pleural fluid abnormalities (DDx) ………… 524t
Anaerobes, brain abscess ………… 28
Anaerobic isolates, clinical significance, pending susceptibility testing ………… 218t
Anaerobic streptococci
complicated skin/skin structure tissue infections ………… 145
surgical prophylaxis ………… 376t
Anaplasma phagocytophilum ………… 271
Anaplasmosis (HGA) ………… 271
Ancef ………… 582
Ancobon ………… 656
Ancylostoma braziliense, cutaneous larva migrans ………… 306
Ancylostoma duodenale, hookworm ………… 294
Anemia, acute, RBC abnormalities (DDx) ………… 517t
Angiostrongyliasis ………… 294
Angiostrongylus cantonensis ………… 294
Angiotensin-converting enzyme levels (ACE), rheumatic test abnormalities (DDx) ………… 522t
Angular chelitis, mouth abnormalities (DDx) ………… 501t
Anidulafungin ………… 568
Animal bites ………… 157
pediatric ………… 433
septic arthritis secondary to ………… 136
Aniscoria, neurological abnormalities (DDx) ………… 513t
Anterior cervical adenopathy, lymph node abnormalities (DDx) ………… 507t
Anthrax
bioterrorist ………… 186
post-exposure prophylaxis ………… 382t
Antibiotic failure ………… 13
Antibiotic failure (DDx) apparent, causes of ………… 13t
Antibiotic resistance ………… 3t, ………… 217t, ………… 256
Antibiotic selection, factors in2, ………… 217t
antibiotic resistance ………… 2
cost ………… 4
isolate known (Table 3.13.3) ………… 195
safety profile ………… 4
spectrum ………… 2
susceptibility testing in vitro vs.
in vivo6
tissue penetration ………… 2
Antibiotic selection based on
resistance potential ………… 217t
Antibiotic spectrum, defined ………… 2
Antibiotic susceptibility profiles ………… 195
aminoglycosides, fluoroquinolones carbapenems, others ………… 208t
cephalosporins ………… 201t
penicillins, macrolides, tetracyclines, others ………… 196t
Antibiotic therapy
bactericidal vs. bacteriostatic therapy ………… 7
bioavailability ………… 8t
cytochrome P450 isoenzymes ………… 545t
dosing (see individual DS in Chap ………… 11) ………… 3
renal insufficiency dosing (see individual DS in Chap ………… 11)
HD dosing only ………… 4
intra-HD dosing (see individual DS in Chap ………… 11)
duration of therapy ………… 9
empiric therapy ………… 258
failure (true vs. apparent) ………… 13
intravenous vs. oral switch therapy ………… 7
mechanisms of action and resistance (Table 3.10) ………… 256
monotherapy vs. combination therapy ………… 7
pearls & pitfalls ………… 527
PK/PD considerations ………… 6t
bactericidal vs. bacteriostatic therapy ………… 7
bioavailability of oral antimicrobials(Table 1.5) ………… 8t
concentration vs. time dependent kinetics (Table 1.4) ………… 6t
duration of antibiotic therapy ………… 9
IV to PO switch therapy ………… 7
monotherapy vs. combination therapy ………… 7
OPAT ………… 8
problem pathogens (Table 3.11) ………… 258
resistance potential ………… 2, ………… 3t
Antifungal serum tests (DDx) ………… 518t
Antimicrobial stewardship: principles and practice (Table 1.14) ………… 13
antibiotic resistance (also see Table 1.1) ………… 14
antibiotic de-escalation ………… 15
C. difficile diarrhea/colitis ………… 15
colonization vs. infection (also see Tables 1.61.10) ………… 13
empiric antibiotics for fever and leukocytosis ………… 15
monotherapy vs. combination therapy ………… 14
narrow vs. broad spectrum therapy ………… 13
pharmacoeconomic considerations ………… 16
PO and IV-to-PO switch antibiotic therapy (also see Table 1.5) ………… 15
Anti-nuclear antibody titers (ANA), elevation, rheumatic test abnormalities (DDx) ………… 522t
Antiretroviral therapy ………… 329t
Anti-smooth muscle antibodies (ASM), elevation, rheumatic test abnormalities (DDx) ………… 522t
Aortic graft infection ………… 89
Aphthous ulcers ………… 47
Appendicitis ………… 110
Aptivus (tipranavir) ………… 759
Arachnia propionica ………… 247
Arava ………… 678
Arboviral encephalitis ………… 410
Arcanobacterium, pharyngitis ………… 42
Arcanobacterium (Corynebacterium) haemolyticum ………… 225t
Argyll-Robertson pupils, eye abnormalities (DDx) ………… 498t
Arm lesions
nodular, extremity abnormalities (DDx) ………… 511t
verrucous ………… 509t
Arthritis, Lyme ………… 138
Arthritis, septic ………… 132
extremity abnormality (DDx) ………… 509t
pediatric ………… 429
Arthroscopy, surgical prophylaxis ………… 377t
ART therapy, HIV infection, ………… 330t
Ascariasis ………… 294
Ascaris lumbricoides ………… 294
Ascites, abdominal abnormalities (DDx) ………… 506t
Aspergilloma, pulmonary ………… 280
Aspergillus ………… 252t
acute pneumonia ………… 72
bronchopulmonary aspergillosis (BPA) ………… 285
chronic medical prophylaxis ………… 384t
community acquired pneumonia ………… 57
cutaneous aspergillosis ………… 308
febrile neutropenia ………… 171
HIV ………… 341
organ transplants ………… 71
pneumonia
acute invasive ………… 282
chronic ………… 57
pulmonary aspergilloma ………… 282
sepsis ………… 167
transplant infections ………… 176
Aspergillus galactomannan (AG) ………… 520t
Aspiration pneumonia ………… 69
Asplenia ………… 169
Asplenia/impaired splenic function, chronic medical prophylaxis ………… 384t
Asymptomatic bacteriuria in pregnancy, chronic medical prophylaxis ………… 384t
Atazanavir (ATV) ………… 569
Atelectasis, unilateral focal segmental/lobar infiltrate without effusion ………… 448
Athlete‘s foot ………… 160
Atovaquone ………… 571
Atovaquone + proguanil ………… 572
Atripla [efavirenz (EFV)+(emtricitabine (FTC)+tenofovir (TDF)] ………… 638
ATV (atazanavir) ………… 569
Atypical lymphocytes, WBC abnormalities (DDx) ………… 515t
Augmentin ………… 556
ES- 600 ………… 558
XR formulation ………… 559
Avelox ………… 698
AV graft infection ………… 89
Avian influenza ………… 65
community acquired pneumonia ………… 58
post-exposure prophylaxis ………… 379t
Avycaz ………… 599
Axillary adenopathy, lymph node abnormalities (DDx) ………… 507t
Azactam ………… 575
Azidothymidine ………… 775
Azithromycin ………… 573
pearls & pitfalls ………… 538
susceptibility profiles ………… 196t
AZT (zidovudine) ………… 775
Aztreonam ………… 575
pearls & pitfalls ………… 531
B-cepacia, community acquired pneumonia ………… 56
Babesia microti ………… 271
Babesiosis ………… 271
Bacillary angiomatosis ………… 307
Bacille-Calmette-Guérin (BCG)
adult immunization ………… 399t
granulomatous hepatitis ………… 104
miliary ………… 167
Bacillus anthracis ………… 225
anthrax ………… 186
post-exposure prophylaxis ………… 382t
Bacillus cereus
keratitis ………… 33
subtilis, megaterium ………… 225t
Back abnormalities (DDx)
D'espine's sign ………… 503t
spinal tenderness ………… 503t
unilateral CVA tenderness ………… 503t
Bacteremias transplant infections ………… 172
Bacteremia vs positive BC's ………… 11
Bacterial conjunctivitis ………… 34
Bacterial endophthalmitis ………… 37
Bacterial pharyngitis ………… 42
Bacterial sinusitis ………… 31
Bactericidal antibiotics ………… 7
Bacteriostatic antibiotics ………… 7
Bacteroides fragilis250t
acute pancreatitis ………… 101
chorioamnionitis ………… 122
decubitus ulcers ………… 150
diabetic foot ulcers ………… 150
endometritis ………… 122
group ………… 250t
intraabdominal abcess ………… 108
ischiorectal/perirectal abscess ………… 162
liver abscess ………… 102
osteomyelitis ………… 140
pancreatic abscess ………… 102
PID ………… 122
salpingitis ………… 122
sepsis ………… 163
septic abortion ………… 122
surgical prophylaxis ………… 376t
tuboovarian abscess ………… 122
Bactrim ………… 763
Balanitis ………… 125
Balantidiasis ………… 293
Balantidium coli ………… 293
Baraclude ………… 646
Bartonella henselae
cat scratch disease (CSD) ………… 157
quintana, bacilliformis ………… 229t
Bartonella sp. bacillary angiomatosis ………… 307
Basophilia WBC abnormalities (DDx) ………… 516t
Beef tapeworm ………… 297
Bell‘s palsy, neurological abnormalities (DDx) ………… 513t
BG (β ………… 1, ………… 3 D-glucan) ………… 520t
β-lactams. (see individual penicillins cephalosporins)
β-lactamase inhibitor combinations, pearls & pitfalls ………… 532
Biaxin ………… 615
Biaxin XL ………… 616
Bifidobacterium sp. ………… 247
Biliary tract penetration explanation ………… 543
Biliary tract surgery surgical prophylaxis ………… 376t
Bilirubin, total, elevation, liver test abnormalities (DDx) ………… 521t
Bioavailability
explanation ………… 541
oral antimicrobials (bioavailability) ………… 8t
Bioterrorist agents in adults
treatment ………… 186
anthrax ………… 186
botulism ………… 187
Ebola ………… 187
pneumonic plague ………… 187
smallpox ………… 187
tularemic pneumonia ………… 186
BK virus, transplant infections ………… 172
Blastocystis hominis ………… 297
Blastomyces dermatitidis
cutaneous blastomycosis ………… 301
epididymitis ………… 114
pulmonary blastomycosis ………… 281
Blood, parasites, fungi, unusualorganisms in ………… 264
Bloody pleural fluid abnormalities (DDx) ………… 524t
Body fluid secretions, travel precautions ………… 393t
Body lice ………… 161
Bone infections, empiric therapy of ………… 429
Bone marrow transplant (BMT), transplant infections ………… 172
Bordetella pertussis ………… 229t
community acquired pneumonia ………… 58
post-exposure prophylaxis ………… 372t
Borrelia burgdorferi ………… 243
Lyme disease ………… 268
meningitis ………… 21
pericarditis/myocarditis ………… 84
post-exposure prophylaxis ………… 381t
Borrelia recurrentis ………… 244t
relapsing fever ………… 268
Botulism ………… 183
bioterrorist ………… 186
Boutonneuse fever ………… 315
Brachiola, microsporidia enteritis ………… 354
Bradycardia, relative ………… 12t
DDx ………… 494
Brain
cysts/mass lesions in ………… 274
parasites, fungi, unusual organisms in ………… 274
Brain abscess ………… 28
cardiac source ………… 29
dental source ………… 29
mastoid/otitic source ………… 29
neurosurgical procedure ………… 28
open trauma ………… 28
pulmonary source ………… 28
sinus source ………… 29
transplant infections ………… 176
Bronchiectasis ………… 71
Bronchitis, acute bacterial exacerbation of chronic (AECB) ………… 50
Bronchopulmonary aspergillosis (BPA) ………… 285
Brownish pleural fluid abnormalities (DDx) ………… 524t
Brucella .
endocarditis ………… 78
meningitis ………… 22
septic arthritis ………… 141
Brugia malayi ………… 264
Bullae skin ………… 306
Bull neck, neck abnormalities (DDx) ………… 502t
Burkholderia cepacia ………… 230t
Burkholderia pseudomallei ………… 230t
Bursitis septic ………… 133
Buruli ulcer ………… 302
C-alf tenderness, extremity abnormality (DDx) ………… 510t
California encephalitis (CE) ………… 26
Camelback fever pattern, fever curves (DDx) ………… 494t
Campylobacter sp.
fetus ………… 230
infectious diarrhea ………… 92
jejuni ………… 231
travel prophylaxis ………… 394t
CA-MRSA. see Community acquired MRSA (CA-MRSA)
c-ANCA, elevation, rheumatic test abnormalities (DDx) ………… 522t
Candida albicans ………… 252t
candidemia ………… 178
catheter associated candiduria (CAC) ………… 113
chorioretinitis ………… 35
chronic medical prophylaxis ………… 384t
endophthalmitis ………… 36
esophagitis ………… 90
febrile neutropenia ………… 171
fungal cystitis ………… 112
fungal peritonitis/abscess ………… 108
hepatosplenic candidiasis ………… 103
IV line infection ………… 85
mucocutaneous candidiasis ………… 159
onychomycosis ………… 159
sepsis ………… 163
thrush ………… 44
vaginitis, HIV ………… 358
Candida chorioretinitis ………… 36
Candidadiasis, oropharyngeal/esophageal, HIV ………… 355
Candida non-albicans ………… 253
candidemia ………… 165
chronic medical prophylaxis ………… 384t
febrile neutropenia ………… 171
IV line (CVC) infection ………… 85
pacemaker infection (PPM) ………… 85
sepsis ………… 165
catheter associated candiduria (CAC) ………… 113
nodular/pustular candidiasis ………… 308
prosthetic valve endocarditis ………… 82
Candida vaginitis, balanitis ………… 125
Candidemia, transplant infections ………… 178
Capastat ………… 577
CAPD associated peritonitis ………… 109
Capillaria philippinensis ………… 295
Capillariasis ………… 295
Capnocytophaga canimorsus/cynodegni ………… 245t
Capnocytophaga canimorsus (DF2), animal bite wounds ………… 155
Capnocytophaga ochraceus ………… 245t
Capnophilic isolates, clinical significance, pending susceptibility testing ………… 245t
Capreomycin ………… 577
Carbapenems
pearls & pitfalls ………… 531
susceptibility profiles ………… 208t
Cardiac conditions, indications for infective endocarditis (IE) prophylaxis ………… 390t
Cardiac valve replacement, surgical prophylaxis ………… 375t
Cardiobacterium hominis ………… 231
endocarditis ………… 78
Cardiovascular infections, empiric therapy ………… 76
Carpal tunnel syndrome, extremity abnormalities (DDx) ………… 509t
Caspofungin577
Catheter associated bacteriuria (CAB) ………… 113
Catheter associated candiduria (CAC) ………… 113
Cat scratch disease (CSD) ………… 155
pediatric ………… 433
Cavernous vein thrombosis ………… 28
CD4 counts, HIV ………… 320
Ceclor ………… 579
Cedax ………… 601
Cefaclor ………… 579
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefadroxil ………… 580
susceptibility profiles ………… 201t
Cefamandole ………… 581
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefazolin ………… 582
pearls & pitfalls ………… 529
susceptibility profiles ………… 201t
Cefdinir ………… 584
pearls & pitfalls ………… 531
susceptibility profiles ………… 201t
Cefditoren ………… 584
pearls & pitfalls ………… 531
susceptibility profiles ………… 201t
Cefepime ………… 586
pearls & pitfalls ………… 531
susceptibility profiles ………… 201t
Cefixime ………… 588
pearls & pitfalls ………… 531
susceptibility profiles ………… 201t
Cefizox ………… 602
Cefobid ………… 589
Cefoperazone ………… 589
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefotan ………… 591
Cefotaxime ………… 590
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefotetan ………… 591
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefoxitin ………… 592
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefpodoxime ………… 594
pearls & pitfalls ………… 531
susceptibility profiles ………… 201t
Cefprozil ………… 595
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Ceftaroline fosamil ………… 596
pearls & pitfalls ………… 531
susceptibility profiles ………… 201t
Ceftazidime ………… 597
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Ceftazidime/avibactam ………… 599
pearls & pitfalls ………… 532
susceptibility profiles ………… 201t
Ceftibuten ………… 601
pearls & pitfalls ………… 531
susceptibility profiles ………… 201t
Ceftin ………… 606
Ceftizoxime ………… 602
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Ceftolozane/tazobactam ………… 603
pearls & pitfalls ………… 532
susceptibility profiles ………… 201t
Ceftriaxone ………… 604
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefuroxime ………… 606
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Cefzil ………… 595
Cellulitis
above-the-waist ………… 144
below-the-waist ………… 144
facial ………… 30
pediatric ………… 433
periorbital ………… 30
Central IV line (CVC) infections ………… 423
Cephalexin ………… 607
Cephalosporins, susceptibility profiles ………… 201t
Cerebral amebiasis ………… 274
Cerebral coenurosis ………… 275
Cerebral echinococcosis (hydatid cyst disease) ………… 275
Cerebral gnathostomiasis ………… 275
Cerebral nocardiosis ………… 274
Cerebral paragonimiasis (lung fluke) ………… 275
Cerebral toxoplasmosis ………… 275
Cerebrospinal fluid (CSF) abnormalities (DDx) ………… 525
Cervicitis
gonococcal ………… 123
non-gonococcal ………… 123
Cestodes (tapeworms), intestinal ………… 297
Chagas‘ disease (American trypanosomiasis)
blood ………… 265
cerebral ………… 275
heart ………… 288
Chancroid ………… 127
post-exposure prophylaxis ………… 380t
Chest abnormalities (DDx)
chest dullness, consolidation/pleural effusion ………… 503t
chest wall sinuses ………… 503t
costochondral tenderness ………… 503t
diffuse wheezing ………… 503t
shoulder tenderness ………… 503t
spontaneous pneumothorax ………… 503t
sternal tenderness ………… 503t
trapezius tenderness ………… 503t
Chest dullness, consolidation/pleural effusion, chest abnormalities (DDx) ………… 503t
Chest wall sinuses, chest abnormalities (DDx) ………… 503t
Chest x-ray (CXR) atlas ………… 445
bilateral infiltrates with effusion ………… 477
infectious causes ………… 477
noninfectious causes ………… 479
bilateral infiltrates without effusion ………… 467
infectious causes ………… 467
non-infectious causes ………… 472
cavitary infiltrates (thick-walled) ………… 482
infectious causes ………… 482
infectious causes based on speed of cavitation ………… 482
non-infectious causes ………… 487
cavitary infiltrates (thin-walled) ………… 489
infectious causes ………… 489
non-infectious causes ………… 491
unilateral focal segmental/lobar infiltrate with effusion ………… 451
infectious causes ………… 451
non-infectious causes ………… 454
unilateral focal segmental/lobar infiltrate without effusion ………… 446
infectious causes ………… 446
non-infectious causes ………… 448
unilateral ill-defined infiltrates with effusion ………… 463
infectious causes ………… 463
non-infectious causes ………… 464
unilateral ill-defined infiltrates without effusion ………… 456
infectious causes ………… 456
non-infectious causes ………… 460
Chickenpox
pediatric ………… 434
post-exposure prophylaxis ………… 380t
therapy ………… 153
Chlamydia trachomatis
conjunctivitis ………… 34
dysuria-pyuria syndrome ………… 111
endometritis ………… 122
epididymitis ………… 114
lymphogranuloma venereum (LGV) ………… 128
PID ………… 122
post-exposure prophylaxis ………… 380t
salpingitis ………… 122
septic abortion ………… 122
tuboovarian abscess ………… 122
urethritis/cervicitis ………… 123
Chlamydophilia
community-acquired pneumonia ………… 58
pharyngitis ………… 41
Chlamydophilia (Chlamydia) pneumoniae ………… 61
community acquired pneumonia (CAP) ………… 58
pharyngitis ………… 43
Chlamydophilia (Chlamydia) psittaci (psittacosis)
community acquired pneumonia (CAP) ………… 58
endocarditis (CNE) ………… 78
zoonotic atypical pneumonia ………… 63
Chloramphenicol ………… 608
pearls & pitfalls ………… 532
Chloromycetin ………… 608
Cholangitis ………… 100
Cholecystitis ………… 99
emphysematous ………… 99
Chorioamnionitis ………… 122
Chorioretinitis ………… 35
eye abnormalities (DDx) ………… 499t
Chromobacterium violaceum ………… 231
Chromomycosis ………… 309
Chronic bacterial sinusitis ………… 32
Chronic fatigue syndrome (CFS) ………… 44
Chronic infections. (see specific clinical syndromes)
Chronic mastoiditis ………… 41
Chronic medical prophylaxis ………… 384t
acute exacerbation of chronic bronchitis (AECB) ………… 385t
acute rheumatic fever (ARF) ………… 385t
asplenia/impaired splenic function ………… 384t
asymptomatic bacteriuria in pregnancy ………… 384t
neonatal group B streptococcal (GBS) infection (primary prevention) ………… 385t
prophylaxis of fungal infections in neutropenic patients ………… 384t
recurrent genital herpes (less than ………… 6 episodes/year) ………… 384t
recurrent genital herpes (more than ………… 6 episodes/year) ………… 385t
UTIs (recurrent) ………… 384t
Chronic meningitis ………… 22
Chryseobacterium (Flavobacterium) meningosepticum ………… 231
Chyluria, urinary abnormalities (DDx) ………… 524t
Cidofovir ………… 610
Cipro ………… 611
Ciprofloxacin ………… 611
pearls & pitfalls ………… 535
susceptibility profiles ………… 208t
extended-release ………… 614
Cipro XR ………… 614
Citrobacter sp. ………… 232t
Cladosporium/Fonsecaea, myositis ………… 317
Claforan ………… 590
Clarithromycin ………… 615
pearls & pitfalls ………… 538
susceptibility profiles ………… 198t
Clarithromycin XL ………… 616
Cleocin ………… 617
Clindamycin ………… 617
pearls & pitfalls ………… 533
susceptibility profiles ………… 198t
Clonorchiasis ………… 288
Clostridial myonecrosis ………… 145
Clostridium botulinum ………… 247
botulism ………… 184
Clostridium difficile ………… 248
diarrhea ………… 15
colitis ………… 15
Clostridium difficile diarrhea, HIV ………… 351
Clostridium perfringens
cholecystitis ………… 99
C. septicum, C. novyi ………… 248t
Clostridium sordelli
septic abortion ………… 122
toxic shock syndrome ………… 182
Clostridium sp. complicated skin/skin structure tissue infections ………… 145
Clostridium tetani ………… 248
tetanus ………… 183
Clubbing, extremity abnormalities (DDx) ………… 509t
CNS infections, empiric therapy ………… 18
CNS shunt, surgical prophylaxis ………… 375t
CNS shunt infections, acute bacterial meningitis ………… 21
Coccidioides immitis
chronic septic arthritis ………… 137
cutaneous coccidioidomycosis ………… 302
fungal arthritis ………… 134
HIV ………… 358
pulmonary coccidioidomycosis ………… 286
Coccidiomycosis
cutaneous ………… 303
meningitis ………… 21
Coin lesions, pulmonary ………… 280
Cold abscesses, cutaneous, extremity abnormalities (DDx) ………… 511t
Cold agglutinins, elevated, serum test abnormalities (DDx) ………… 519t
Colistin methanesulfonate ………… 618
Colistin/Polymyxin E ………… 618
Colon surgery, surgical prophylaxis ………… 376t
Colonization vs. infection ………… 9
Coly-Mycin M ………… 618
Combination therapy vs. monotherapy ………… 14
Combivir [Lamivudine (3TC) + Zidovudine (ZDV)] ………… 677
Community acquired pneumonia (CAP) ………… 58
atypical (CAP) pathogens ………… 58
avian influenza (H5N1, H7N9) ………… 65
C. pneumoniae ………… 53
C. psittaci (psittacosis) ………… 53
Coxiella burnetii (Q fever) ………… 53
Francisella tularensis (tularemia) ………… 53
influenza A ………… 53
Legionella ………… 53
M. pneumoniae ………… 53
swine influenza (H1N1) ………… 53
typical (CAP) pathogens ………… 58
B. pertussis ………… 51
H. influenzae ………… 51
M. catarrhalis ………… 51
S. pneumoniae ………… 51
S. aureus (MSSA/MRSA) ………… 69
Complera [Emtricitabine (FTC) + Rilpivirine (RPV) + Tenofovir (TDF)] ………… 644
Complicated skin/skin structure tissue infections (cSSSIs) ………… 144
CO-MRSA. (see Community onset MRSA)
Concentration-dependent kinetics, antibiotics with ………… 6t
Condylomata acuminata ………… 128
Congestive heart failure
bilateral infiltrates with effusion ………… 479
unilateral ill-defined infiltrates without effusion ………… 461
Conjunctival suffusion, eye abnormalities (DDx) ………… 498t
Conjunctivitis ………… 34
bacterial ………… 34
trachoma ………… 35
unilateral/bilateral, eye abnormalities (DDx) ………… 498t
viral ………… 34
Copegus ………… 732
Corneal haziness, eye abnormalities (DDx) ………… 499t
Corneal ulcers, eye abnormalities (DDx) ………… 499t
Coronary artery bypass graft (CABG), surgical prophylaxis ………… 375t
Corynebacterium diphtheriae ………… 226
diphtheria ………… 183
pericarditis/myocarditis ………… 84
pharyngitis ………… 41
post-exposure prophylaxis ………… 379t
Corynebacterium hemolyticum, pharyngitis ………… 41
Corynebacterium jeikeium (JK) ………… 226
Corynebacterium minutissimum, erythrasma ………… 300
Costochondral tenderness, chest abnormalities (DDx) ………… 503t
Coxiella burnetii (Q fever)
community acquired pneumonia ………… 53
endocarditis (CNE) ………… 76
zoonotic atypical pneumonia ………… 63
Coxsackie A virus
herpangina ………… 45
pericarditis/myocarditis ………… 84
CPK ………… 519
Crabs ………… 161
Cranial nerve abnormalities, unilateral/bilateral, neurological abnormalities (DDx) ………… 513t
Cresemba ………… 670
Crimson crescents, mouth abnormalities (DDx) ………… 502t
Crixivan (Indinavir) ………… 668
Cryptococcomas/meningitis ………… 274
Cryptococcosis, cutaneous ………… 308
Cryptococcus meningitis ………… 25
Cryptococcus neoformans ………… 253
cryptococcomas/meningitis ………… 274
cutaneous cryptococcosis ………… 308
meningitis ………… 22
HIV ………… 348
pulmonary cryptococcosis ………… 283
transplant infections ………… 177
Cryptosporidia ………… 292
chronic watery diarrhea ………… 94
travel prophylaxis ………… 394t
CSF
cysts/mass lesions ………… 274
parasites, fungi, unusual organisms ………… 274
CSF abnormalities (DDx)
ADA levels ………… 525t
CSF eosinophils ………… 526t
CSF lactic acid levels ………… 525t
CSF plasma cells ………… 525t
CSF with negative Gram stain and predominantly lymphocytes/decreased glucose ………… 525t
CSF with negative Gram stain and predominantly lymphocytes/normal glucose ………… 525t
CSF with negative Gram stain and predominantly PMNs/decreased glucose ………… 525t
highly elevated CSF protein ………… 525t
purulent CSF with negative Gram stain ………… 525t
RBCs in CSF ………… 525t
CSF Gram stain, clinical use ………… 260t
CSF lactic acid levels, elevation, CSF abnormalities (DDx) ………… 526t
CSF protein, highly elevated, CSF abnormalities (DDx) ………… 525t
Cubicin ………… 624
Culture negative endocarditis (CNE) ………… 79
Cutaneous actinomycosis ………… 302
Cutaneous alternaria ………… 307
Cutaneous amebiasis ………… 302
Cutaneous aspergillosis ………… 308
Cutaneous blastomycosis ………… 301
Cutaneous coccidioidomycosis ………… 302
Cutaneous cold abscesses, extremity abnormalities (DDx) ………… 511t
Cutaneous cryptococcosis ………… 308
Cutaneous fusarium ………… 307
Cutaneous gnathostomiasis ………… 306
Cutaneous histoplasmosis ………… 301
Cutaneous larva migrans (creeping eruption) ………… 306
Cutaneous leishmaniasis (Old World/New World) ………… 300
Cutaneous MAI ………… 302
Cutaneous mycobacteria ………… 302
Cutaneous nocardiosis ………… 302
Cutaneous onchocerciasis ………… 308
Cutaneous penicillium ………… 307
Cutaneous prototheca ………… 307
Cutaneous sporotrichosis ………… 308
Cutaneous zygomycosis (mucormycosis) ………… 308
CVA tenderness, unilateral, back abnormalities (DDx) ………… 503t
Cycloserine ………… 621
Cyclospora ………… 293
diarrhea ………… 97
travel prophylaxis ………… 392t
Cystic fibrosis ………… 71
Cystic lesions/masses
CSF/brain ………… 274
liver flukes ………… 288
pulmonary ………… 279
Cystitis ………… 112
bacterial ………… 111
candidal ………… 112
Cystoscopy, surgical prophylaxis ………… 377t
Cysts/masses, infected ………… 151
Cytochrome P450 isoenzymes ………… 545t
Cytoid bodies (cotton wool spots), eye abnormalities (DDx) ………… 499
Cytomegalovirus (CMV)
community acquired pneumonia ………… 58
colitis ………… 93
encephalitis ………… 25
HIV ………… 347
esophagitis ………… 90
HIV ………… 352
hepatitis ………… 107
infectious mononucleosis ………… 43
meningitis (aseptic) ………… 22
pharyngitis ………… 41
retinitis, HIV ………… 345
transplant infections ………… 174
Cytovene ………… 662
D-actylitis, extremity abnormalities (DDx) ………… 509t
Dalbavancin ………… 622
pearls & pitfalls ………… 539
susceptibility profiles ………… 196t
Dalvance ………… 622
Dapsone ………… 623
Daptomycin ………… 624
pearls & pitfalls ………… 537
susceptibility profiles ………… 208t
Daraprim ………… 728
Darunavir ………… 628
Daskil ………… 750
ddl (didanosine) ………… 630
Deafness
acute, ear abnormalities (DDx) ………… 500t
transient, neurological abnormalities (DDx) ………… 513t
Decubitis ulcers ………… 148
Delavirdine (DLV) ………… 629
Dental infections, severe ………… 48
Dermatophyte nail infections ………… 161
D‘espines sign, back abnormalities (DDx) ………… 503t
Desquamation of hands/feet, extremity abnormalities (DDx) ………… 512t
d4T (stavudine) ………… 742
Diabetes mellitus, chronic osteomyelitis ………… 140
Diabetic foot ulcers ………… 149
Diarrhea, infectious ………… 92
acute watery ………… 92
C. difficile ………… 92
chronic, watery ………… 94
typhoid/enteric fever ………… 94
Didanosine EC (ddI) ………… 630
Dientamoeba fragilis ………… 292
Dientamoebiasis ………… 292
Differential diagnosis (DDx) ………… 493
abdominal abnormalities ………… 504t
back abnormalities ………… 503t
chest abnormalities ………… 503t
CSF abnormalities ………… 525t
ear abnormalities ………… 500t
extremity abnormalities ………… 509t
eye abnormalities ………… 497t
fever curves ………… 494t
general appearance abnormalities ………… 495t
genitourinary abnormalities ………… 508t
head abnormalities ………… 496t
heart abnormalities ………… 504t
liver test abnormalities ………… 521t
lymph node abnormalities ………… 507t
mouth abnormalities ………… 501t
nasal abnormalities ………… 500t
neck abnormalities ………… 502t
neurological abnormalities ………… 512t
platelet abnormalities ………… 518t
pleural fluid abnormalities ………… 524t
RBC abnormalities ………… 516t
rheumatic test abnormalities ………… 522t
serum test abnormalities ………… 518t
urinary abnormalities ………… 522t
WBC abnormalities ………… 514t
Diflucan ………… 655
Digital gangrene, extremity abnormalities (DDx) ………… 509t
Diphtheria ………… 183
adult immunization ………… 403t
post-exposure prophylaxis ………… 379t
travel prophylaxis ………… 396t
Diphyllobothrium latum, fish tapeworm ………… 297
Dirofilaria immitis, dog heartworm ………… 281
Distal small bowel surgery, surgical prophylaxis ………… 376t
Diverticulitis ………… 110
DLV (delavirdine) ………… 629
Dog heartworm ………… 280
Dolutegravir/Abacavir/Lamivudine ………… 330
Dolutegravir (Tivicay) DTG ………… 631
Donovan bodies, granuloma inguinale ………… 128
Doribax ………… 633
Doripenem ………… 633
pearls & pitfalls ………… 531
susceptibility profiles ………… 208t
Dosing
adjustments, explanation ………… 542
factors in ………… 3
recommendations, explanation ………… 420
Double quotidian fevers, fever curves (DDx) ………… 494t
Double stranded DNA (DS-DNA), elevation, rheumatic test abnormalities (DDx) ………… 522t
Doxycycline ………… 634
pearls & pitfalls ………… 532
susceptibility profiles ………… 196t
Dracunculus medinensis, Guinea worm ………… 306
Drug fever ………… 12
Drug fever, clinical features ………… 12t
Drug summaries, (explanations) ………… 541
DRV (darunavir) ………… 628
Dry eyes, eye abnormalities (DDx), ………… 499t
DTG (dolutegravir) ………… 631
Duration of antibiotic therapy ………… 9
Duricef ………… 580
Dwarf tapeworm ………… 297
Dysentery, acute
E. histolytica ………… 98
Shigella ………… 98
Dysuria-pyuria syndrome (acute urethral syndrome) ………… 111
E-Ear abnormalities (DDx)
acute deafness ………… 500t
external ear lesions ………… 500t
Ear lesions, external, ear abnormalities (DDx) ………… 500t
East African trypanosomiasis ………… 266
Eastern equine encephalitis (EEE) ………… 26
Ebola virus ………… 187
Ebstein Barr virus (EBV)
hepatitis ………… 107
pharyngitis ………… 42
transplant infections ………… 175t
Ecalta ………… 568
Echinococcus granulosus
cerebral ………… 275
hepatic echinococcosis ………… 289
Echinococcus multilocularis
alveolar echinococcosis ………… 279
cerebral ………… 274
Edema, generalized, general appearance abnormalities (DDx) ………… 495t
Edematous pancreatitis ………… 101
Edurant (rilpivirine) ………… 736
Edwardsiella tarda ………… 232t
Efavirenz (EFV) ………… 637
Efavirenz + emtricitabine + tenofovir disoproxil fumarate (Atripla) ………… 638
EFV (efavirenz) ………… 637
EFV/FTC/TDF (Atripla) ………… 638
Ehrlichiosis/anaplasmosis ………… 271
Eikenella corrodens ………… 245t
endocarditis ………… 78
human bite wounds ………… 155
septic arthritis ………… 132
Elephant skin, general appearance abnormalities (DDx) ………… 496t
Elvitegravir + Combicistat + Emtricitabine + Tenofovir (Stribild) ………… 641
EMB ………… 651
Emphysematous cholecystitis ………… 99
Empiric antibiotic therapy pending susceptibility testing (Tables 3.63.8). ………… 218
Empiric therapy
bone and joint infections ………… 132
pediatric ………… 429
cardiovascular infections ………… 76
CNS infections ………… 18
pediatric ………… 405
gastrointestinal tract infections ………… 90
pediatric ………… 425
genitourinary tract infections ………… 111
HEENT infections ………… 30
pediatric ………… 411
lower respiratory tract infections ………… 50
pediatric ………… 417
pending susceptibility testing (Tables 3.63.8). ………… 218
problem pathogens ………… 258t
sexually transmitted diseases ………… 123
skin and soft tissue infections ………… 144
pediatric ………… 433
syndrome based ………… 17
vascular infections, pediatric ………… 423
Empyema ………… 72
subdural ………… 28
Emtricitabine (FTC) ………… 642
Emtricitabine + Rilpivirine + Tenofovir (Complera) ………… 644
Emtricitabine (FTC) + tenofovir (TDF) [Truvada] ………… 643
Emtriva (emtricitabine) ………… 642
Encephalitis ………… 25
amebic, granulomatous ………… 276
arboviral ………… 26
CMV (HIV) ………… 345
HHV- ………… 626
HSV- ………… 126
Listeria ………… 26
Mycoplasma ………… 27
pediatric ………… 409
primary amebic meningo-encephalitis ………… 274
toxoplasma, (HIV) ………… 349
Encephalopathy, acute, neurological abnormalities (DDx) ………… 512t
Endocarditis
acute bacterial (ABE) ………… 81
IV drug abusers ………… 81
prosthetic valve (PVE) ………… 82
subacute bacterial (SBE) ………… 76
culture negative (CNE) ………… 77
GI/GU source ………… 77
no obvious source ………… 76
Endocarditis prophylaxis for above-the-waist (dental, oral, esophageal, respiratory tract) procedures
IV prophylaxis ………… 391t
oral prophylaxis ………… 391t
Endocarditis prophylaxis for below-the-waist (genitourinary, gastrointestinal) procedures
IV prophylaxis ………… 392t
oral prophylaxis ………… 391t
Endometritis ………… 122
Endomyometritis ………… 122
Endophthalmitis ………… 36
bacterial ………… 36
eye abnormalities (DDx) ………… 499t
fungal ………… 37
infected lens implant ………… 37
tuberculosis ………… 37
ENF (enfuvirtide) ………… 645
Enfuvirtide (T20) ………… 645
Enlarged greater auricular nerve, neck abnormalities (DDx) ………… 502t
Entamoeba histolytica ………… 274
amebic dysentery ………… 98
cerebral amebiasis ………… 274
cutaneous amebiasis ………… 302
hepatic amebiasis ………… 289
liver abscess ………… 102
pulmonary amebiasis ………… 279
Entecavir ………… 646
Enterobacteriaceae. see also Citrobacter, Edwardsiella; Enterobacter, Escherichia coli, Klebsiella, Proteus, Providencia, Salmonella, Serratia, Shigella
acute bacterial pyelonephritis ………… 115
bacterial cystitis ………… 111
brain abscess ………… 28
CAPD associated peritonitis ………… 109
chronic pyelonephritis ………… 116
complicated skin/skin structure tissue infections ………… 145
endophthalmitis ………… 36
febrile neutropenia ………… 171
intraabdominal abscess ………… 110
ischiorectal/perirectal abscess ………… 162
osteomyelitis ………… 140
prostatitis/prostatic abscess ………… 119
prosthetic valve endocarditis ………… 82
renal abscess ………… 118
sepsis ………… 163
septic arthritis ………… 133
solid organ transplant ………… 172
suppurative parotitis ………… 41
urosepsis ………… 120
Enterobacter sp. ………… 233t
brain abscess ………… 28
burn wounds ………… 156
meningitis ………… 19
sepsis ………… 164
Enterobius vermicularis, pinworm ………… 295
Enterococci
cholangitis ………… 100
cholecystitis ………… 99
chronic medical prophylaxis ………… 384t
gallbladder abscess ………… 100
liver abscess ………… 102
vascular graft infections ………… 88
Enterococcus faecalis (VSE) ………… 220t
catheter associated bacteriuria (CAB) ………… 113
cholangitis ………… 100
cholecystitis ………… 99
cystitis (AUC) ………… 111
endocarditis ………… 77
pyelonephritis ………… 115
sepsis ………… 163
surgical prophylaxis ………… 376t
urosepsis ………… 120
Enterococcus faecium (VRE) ………… 221t
catheter associated bacteriuria (CAB) ………… 113
cystitis (AUC) ………… 111
endocarditis ………… 77
pyelonephritis ………… 115
urosepsis ………… 163
Enterocytozoon bienuesi, microsporidia enteritis ………… 354
Enteroviruses
meningitis (aseptic) ………… 21
travel prophylaxis ………… 394t
Entomophthoromycosis ………… 307
Eosinopenia (DDx) ………… 516t
Eosinophilia, WBC abnormalities (DDx) ………… 516t
Eosinophilic folliculitis ………… 316
Eosinophils
CSF abnormalities (DDx) ………… 526t
Eosinophiluria, urinary abnormalities (DDx) ………… 524t
Epidemic (louse-borne) typhus ………… 313
Epidermophyton floccosum
onychomycosis ………… 159
tinea corporis ………… 159
Epididymitis, acute and chronic ………… 114
Epididymoorchitis, genitourinary abnormalities (DDx) ………… 508t
Epiglottitis ………… 49
Episcleritis, eye abnormalities (DDx) ………… 499t
Epistaxis, nasal abnormalities (DDx) ………… 500t
Epitrochlear adenopathy, lymph node abnormalities (DDx) ………… 507t
Epivir (lamivudine) ………… 676
Epzicom [Abacavir (ABC) + Lamivudine (3TC)] ………… 547
Eraxis ………… 568
Ertapenem ………… 647
pearls & pitfalls ………… 531
susceptibility profiles ………… 208t
Erysipelas ………… 144
Erysipelothrix rhusiopathiae ………… 226t
Erythema multiforme, extremity abnormalities (DDx) ………… 512t
Erythema nodosum, extremity abnormalities (DDx) ………… 512t
Erythrasma ………… 300
Erythrocyte sedimentation rate (ESR), serum test abnormalities (DDx) ………… 518t
Erythroderma, general appearance abnormalities (DDx) ………… 495t
Erythromycin
pearls & pitfalls ………… 538
susceptibility profiles ………… 196t
Erythromycin base (various) ………… 650
Eschar, extremity abnormalities (DDx) ………… 511t
Escherichia coli ………… 233t
acute bacterial meningitis (ABM) ………… 19
catheter-associated bacteriuria (CAB) ………… 113
cholangitis ………… 100
cholecystitis ………… 99
dysuria-pyuria syndrome ………… 111
diarrhea ………… 92
ischemic foot ulcers ………… 150
osteomyelitis ………… 141
pneumonia ………… 73
sepsis ………… 163
skin abscesses/infected cysts ………… 151
surgical prophylaxis ………… 376t
travel prophylaxis ………… 394t
urosepsis120
Esophageal candidiasis, HIV ………… 355
Esophagitis ………… 90
fungal ………… 90
viral ………… 90
Ethambutol ………… 651
Ethionamide ………… 652
Ethmoid sinus, acute bacterial sinusitis ………… 31
ETR (etravirine) ………… 653
Etravirine (ETR) ………… 653
Eubacterium sp. ………… 249t
EVD associated ABM ………… 526t
EVG/COBI/FTC/TDF (Stribild) ………… 641
Excreted unchanged, explanation ………… 541
External otitis ………… 38
benign ………… 38
malignant ………… 39
Extremity abnormalities (DDx)
arthritis (septic/reactive) ………… 510t
calf tenderness ………… 510t
carpal tunnel syndrome ………… 509t
clubbing ………… 509t
cutaneous cold abscesses ………… 511t
dactylitis ………… 509t
desquamation of hands/feet ………… 512t
digital gangrene ………… 509t
edema of dorsum of hand/foot ………… 509t
erythema multiforme ………… 512t
erythema nodosum ………… 512t
eschar ………… 511t
foot/leg ulcers ………… 510t
hyperpigmented shins ………… 511t
leg edema, unilateral/bilateral ………… 510t
lymhangitis ………… 509t
migratory rashes ………… 511t
nodular arm/leg lesions ………… 511t
nodular lymhangitis ………… 509t
painful leg nodules ………… 511t
painless purple palm/sole lesions ………… 509t
palpable purpura ………… 511t
papular axillary lesions ………… 510t
plantar hyperkeratoses ………… 512t
purple nodules ………… 511t
rash of palms/soles ………… 512t
splinter hemorrhages ………… 509t
tender fingertips ………… 509t
tender muscles ………… 510t
tenosynovitis ………… 510t
thigh tenderness (bilateral) ………… 510t
thrombophlebitis ………… 510t
verrucous foot/leg lesions ………… 510t
verrucous hand/arm lesions ………… 509t
wrist swelling ………… 510t
Eye abnormalities (DDx)
Argyll-Robertson pupils ………… 498t
bilateral lid edema ………… 497t
bilateral upper lid edema ………… 497t
chorioretinitis ………… 499t
conjunctivitis, unilateral/bilateral ………… 498t
conjunctival suffusion ………… 498t
corneal haziness ………… 499t
corneal ulcers ………… 499t
cytoid bodies (cotton wool spots) ………… 499t
dry eyes ………… 499t
endophthalmitis ………… 499t
episcleritis ………… 499t
heliotrope eyelid discoloration ………… 498t
hemorrhagic conjunctivitis, unilateral/bilateral ………… 498t
iritis ………… 498t
keratitis ………… 499t
periorbital edema, unilateral/bilateral ………… 498t
periphlebitis (candle wax drippings) ………… 500t
Roth spots ………… 500t
scleral nodules ………… 499t
subconjunctival hemorrhage ………… 498t
uveitis ………… 499t
watery eyes ………… 499t
Eyebrow loss, total/partial, head abnormalities (DDx) ………… 497t
Eyelashes, long, head abnormalities (DDx) ………… 497t
Eyelid edema, bilateral, eye abnormalities (DDx) ………… 497t
Eyelid edema, bilateral upper, eye abnormalities (DDx) ………… 497t
F-acial cellulitis ………… 30
Facial erythema, head abnormalities (DDx) ………… 497t
Facial red spots, head abnormalities (DDx) ………… 496t
Facial swelling (edema), head abnormalities (DDx) ………… 496t
Famciclovir ………… 654
Famvir ………… 654
Fasciola gigantica ………… 288
Fasciola hepatica ………… 288
Fascioliasis ………… 288
Fasciolopsiasis ………… 298
Fasciolopsis buski ………… 298
Fascitis ………… 147
Febrile neutropenia ………… 171
Feet, desquamation of, extremity abnormalities (DDx) ………… 512t
Ferritin levels, elevated (acute/chronic), serum test abnormalities (DDx) ………… 519t
Fever and chills (DDx) ………… 494t
Fever and night sweats (DDx) ………… 494t
Fever curves (DDx) ………… 494t
camelback fever pattern ………… 494t
double quotidian fevers ………… 494t
morning (am) temperature spikes ………… 494t
relative bradycardia ………… 494t
relative tachycardia ………… 494t
single fever spikes ………… 494t
Filariasis
Brugia malayi ………… 264
Wuchereria bancrofti ………… 264
Fingertip tenderness, extremity abnormalities (DDx) ………… 509t
Fish tapeworm ………… 298
5-FC (Flucytosine) ………… 656
Flaccid paralysis (acute), neurological abnormalities (DDx) ………… 514t
Flagyl ………… 692
Fluconazole ………… 655
Fluconazole resistant Candida
catheter associated candiduria (CAC) ………… 113
fungal cystitis ………… 112
thrush ………… 44
Flucytosine ………… 656
Flukes
intestinal ………… 298
liver ………… 288
lung ………… 279
Flumadine ………… 737
Fluoroquinolones
susceptibility profiles ………… 208t
Flying insects, travel precautions ………… 393t
Flying squirrel typhus ………… 313
Fonsecaea pedrosoi/compactum, chromomycosis ………… 307
Food-borne infectious disease (fecally-contaminated), travel precautions ………… 393t
Foot edema, dorsum, extremity abnormality (DDx) ………… 509t
Foot lesions, verrucous, extremity abnormality (DDx) ………… 510t
Foot ulcers, extremity abnormality (DDx) ………… 510t
Fortaz ………… 597
Fosamprenavir (FPV) ………… 657
Foscarnet ………… 659
Foscavir ………… 659
Fosfomycin ………… 660
pearls & pitfalls ………… 539
susceptibility profiles ………… 208t
Fournier‘s gangrene ………… 145
FPV (fosamprenavir) ………… 657
Francisella tularensis (tularemia) ………… 233
community acquired pneumonia ………… 58
post-exposure prophylaxis ………… 383t
tularemia pneumonia ………… 187
zoonotic atypical pneumonia ………… 63
Frenal ulcer, mouth abnormalities (DDx) ………… 501t
Freshwater wounds ………… 157
FTC (emtricitabine) ………… 642
FTC/RPV/TDF (Complera) ………… 644
FTC/TDF (Truvada) ………… 643
Fulvicin ………… 666
Fungal (candida) esophagitis ………… 90
Fungal (cryptococcal) meningitis ………… 25
Fungal endophthalmitis ………… 37
Fungal infections
in neutropenic patients, chronic medical prophylaxis ………… 385t
of skin/nails ………… 158
Fungizone ………… 560
Furunculosis ………… 151
Fusarium, cutaneous ………… 307
Fusarium solani, cutaneous fusarium ………… 307
Fusobacterium necrophorum, Lemierre‘s syndrome ………… 48
Fusobacterium nucleatum ………… 250t
complicated skin/skin structure tissue infections ………… 146
Vincent‘s angina ………… 46
Fuzeon (enfuvirtide) ………… 645
G-allbladder wall abscess/perforation ………… 100
Ganciclovir ………… 662
Gangrene, digital ………… 509t
Garamycin ………… 663
Gardnerella vaginalis ………… 125
Gas gangrene ………… 145
Gastric perforation ………… 91
Gastroenteritis, pediatric ………… 425
Gastrointestinal tract infections
empiric therapy ………… 90
opportunistic ………… 351
General appearance abnormalities (DDx)
bullae ………… 495t
erythroderma ………… 495t
generalized edema/nephrotic syndrome ………… 495t
hyperpigmentation ………… 495t
hypotension/shock ………… 495t
jaundice ………… 496t
lizard/elephant skin ………… 496t
rash (below waist) ………… 496t
soft tissue crepitance ………… 495t
urticaria ………… 496t
vitiligo ………… 496t
Genital herpes ………… 126
recurrent
chronic medical prophylaxis ………… 384t
Genital ulcers ………… 127
Genital vesicles ………… 126
Genital warts ………… 128
Genitourinary abnormalities (DDx)
epididymoorchitis ………… 508t
groin mass ………… 508t
perirectal fistula ………… 508t
perirectal ulcer ………… 508t
prostate enlargement/tenderness ………… 508t
scrotal enlargement ………… 508t
Genitourinary tract infections, empiric therapy ………… 111
Gentamicin ………… 663
pearls & pitfalls ………… 533
susceptibility profiles ………… 208t
GGT (GGTP), elevation, liver test abnormalities (DDx) ………… 521t
Giardia lamblia ………… 292
diarrhea ………… 94
travel prophylaxis ………… 394t
Giardiasis ………… 292
Gingivitis, mouth abnormalities (DDx) ………… 501t
Gnathostoma spinigerum
cerebral ………… 275
cutaneous gnathostomiasis ………… 306
Gnathostomiasis, cutaneous ………… 306
Gonorrhea (GC), post-exposure prophylaxis ………… 380t
Gram negative bacilli (GNB)
aerobic ………… 228t
anaerobic ………… 250t
capnophilic ………… 245t
chronic medical prophylaxis ………… 385t
Gram negative cocci ………… 224t
aerobic, pairs ………… 224t
Gram positive bacilli
aerobic ………… 225t
anaerobic ………… 246t
Gram positive cocci (GPCs)
aerobic ………… 220t
chains ………… 220t
clusters ………… 218t
pairs ………… 223t
Gram stains
CSF ………… 260t
sputum ………… 261t
urine ………… 261t
Granuloma inguinale (Donovanosis) ………… 128
Granulomatous amebic encephalitis ………… 274
Granulomatous amebic meningoencephalitis ………… 23
Granulomatous hepatitis (BCG) ………… 104
Gray hair (premature), head abnormalities (DDx) ………… 496t
Grifulvin ………… 666
Grisactin ………… 666
Griseofulvin ………… 666
Gris-PEG ………… 666
Groin mass, genitourinary abnormalities (DDx) ………… 508t
Group A streptococci (GAS) ………… 221
animal bite wounds ………… 155
burn wounds ………… 156
cellulitis ………… 30
complicated skin/skin structure tissue infections ………… 145
decubitus ulcers ………… 148
diabetic foot ulcers ………… 149
human bite wounds ………… 155
ischemic foot ulcers ………… 150
Ludwig‘s angina ………… 45
osteomyelitis ………… 141
pharyngitis ………… 41
septic arthritis ………… 132
Group B streptococci (GBS) ………… 221
bacterial cystitis ………… 111
cellulitis ………… 144
diabetic foot ulcers ………… 149
endocarditis ………… 76
osteomyelitis ………… 141
septic arthritis ………… 132
urosepsis ………… 120
Group C streptococci ………… 222
endocarditis ………… 76
septic arthritis ………… 132
Group F streptococci ………… 222
Group G streptococci ………… 222
septic arthritis ………… 132
Guillain-Barré syndrome (GBS), neurological abnormalities (DDx) ………… 514t
Guinea worm ………… 306
H-aemophilus. (see Hemophilus)
Hafnia alvei ………… 234
Hairy leukoplakia ………… 45
HA-MRSA. see Hospital-acquired MRSA
Hand edema, dorsum, extremity abnormality (DDx) ………… 509t
Hand lesions, verrucous ………… 509t
Hands, desquamation of, extremity abnormalities (DDx) ………… 512t
Harvoni ………… 106t, ………… 368t
Head abnormalities (DDx)
facial erythema ………… 497t
facial red spots ………… 496t
facial swelling (edema) ………… 496t
generalized alopecia ………… 497t
lacrimal gland enlargement (unilateral/bilateral) ………… 497t
localized alopecia ………… 497t
long eyelashes ………… 497t
parotid enlargement ………… 497t
prematurely gray hair ………… 496t
scalp nodules ………… 497t
severe seborrheic dermatitis ………… 496t
temporal muscle wasting ………… 496t
total/partial eyebrow loss ………… 497t
Head lice ………… 161
Heart
Chagas‘ disease ………… 288
parasites, fungi, unusual organisms in ………… 288
Heart abnormalities (DDx)
heart block, acute/chronic ………… 504t
heart murmur ………… 504t
pericardial effusion ………… 504t
tachycardia ………… 504t
Heart murmur, heart abnormalities (DDx) ………… 504t
Heart transplants, transplant prophylaxis (BMT/SOT) ………… 389t
HEENT infections, empiric therapy ………… 30
Helicobacter pylori ………… 234
peptic ulcer disease ………… 91
Heliotrope eyelid discoloration, eye abnormalities (DDx) ………… 498t
Hematuria, gross/microscopic, urinary abnormalities (DDx) ………… 523t
Hemiplegia/hemiparesis, neurological abnormalities (DDx) ………… 514t
Hemodialysis dosing
intra-HD dosing (see individual DS in Chap ………… 11)
HD dosing only ………… 4
Hemophagocytosis (erythrophagocytosis), RBC abnormalities (DDx) ………… 517t
Hemophilus aphrophilus ………… 235t
Hemophilus ducreyi
chancroid ………… 127
post-exposure prophylaxis ………… 380t
Hemophilus influenzae ………… 235t
acute bacterial exacerbation of chronic bronchitis (AECB) ………… 50
acute bacterial meningitis (ABM) ………… 18
acute otitis media ………… 39
adult immunization ………… 399t
brain abscess ………… 28
cellulitis ………… 30
chronic medical prophylaxis ………… 384t
community acquired pneumonia (CAP) ………… 51
conjunctivitis ………… 34
endophthalmitis ………… 36
epiglottitis ………… 49
mastoiditis ………… 40
post-exposure prophylaxis ………… 378t
sepsis ………… 163
Hemophilus parainfluenzae ………… 235t
Hemophilus paraphrophilus ………… 235t
Hemophilus sp. ………… 78
Hemorrhagic conjunctivitis, unilateral/bilateral, eye abnormalities (DDx) ………… 498t
Hemorrhagic/necrotizing pancreatitis ………… 101
Hepatic amebiasis ………… 289
Hepatic echinococcosis (hydatid cyst disease) ………… 290
Hepatic surgery, surgical prophylaxis ………… 376t
Hepatitis
acute viral (HAV) ………… 107
chronic viral (HBV, HCV) ………… 105t, ………… 106t
CMV ………… 107
organ transplants ………… 174
EBV ………… 107
granulomatous (BCG) ………… 104
hepatitis A (HAV)
adult immunization ………… 399t
prophylaxis in HIV ………… 337
post-exposure prophylaxis ………… 381t
travel prophylaxis ………… 394t
therapy ………… 105t
hepatitis B (HBV)
adult immunization ………… 400t
HIV coinfection ………… 365
prophylaxis in HIV ………… 337
post-exposure prophylaxis ………… 381t
hepatitis C (HCV) ………… 106
HBV/HCV ………… 365
HIV ………… 368t
transplant infections ………… 178
therapy ………… 106t
Hepatobiliary route of elimination ………… 5t
Hepatomegaly
abdominal abnormalities (DDx) ………… 505t
Hepatosplenic candidiasis ………… 103
Hepatosplenomegaly, abdominal abnormalities (DDx) ………… 506t
Hepsera ………… 550
Herpangina ………… 45
Herpes encephalitis ………… 26
Herpes labialis ………… 46
mouth abnormalities (DDx) ………… 501t
Herpes simplex (HSV) ………… 153
genital, HIV ………… 359
skin vesicles/bullae ………… 306
Herpes simplex virus-1 (HSV-1)
encephalitis ………… 25
esophagitis ………… 90
herpes gingivostomatitis ………… 46
herpes labialis ………… 46
herpes whitlow ………… 153
keratitis ………… 33
meningitis (aseptic) ………… 23
pneumonia (VAP) ………… 74
Herpes simplex virus-2 (HSV-2)
chronic medical prophylaxis ………… 384t
encephalitis ………… 25
meningitis (aseptic) ………… 21
Herpes whitlow ………… 153
Herpes zoster (VZV) ………… 153
adult immunization ………… 400t
encephalitis, ………… 25
pediatric ………… 434
skin vesicles/bullae ………… 306
Heterophyes heterophyes ………… 299
Heterophyiasis ………… 299
HHV- ………… 6
encephalitis ………… 25
infectious mononucleosis ………… 43
meningitis (aseptic) ………… 23
pharyngitis ………… 43
transplant infections ………… 174
Hickman/Broviac infection ………… 85
High level (absolute) resistance ………… 2
Hiprex ………… 691
Hip (total) replacement surgery, surgical prophylaxis ………… 377t
Histoplasma capsulatum ………… 254t
cutaneous histoplasmosis ………… 301
meningitis ………… 22
pulmonary histoplasmosis ………… 282
Histoplasmosis, disseminated, HIV ………… 361
HIV ………… 320
acute infection ………… 322
failure ………… 334
indications ………… 329t
initial therapy ………… 332t
therapy ………… 330t
approach to testing ………… 323
ELISA ………… 323
HIV RNA viral load assays ………… 324
Western blot ………… 323
ART therapy, ………… 330t
CNS opportunistic infection ………… 345
coinfections ………… 365
HBV coinfection ………… 105
HCV coinfection ………… 106
initial assessment ………… 326
baseline laboratory testing ………… 327t
CD4 count327, ………… 329t
clinical evaluation ………… 326
opportunistic infections
overview ………… 320
prophylaxis ………… 339t
respiratory tract ………… 341
treatment ………… 340
post-exposure prophylaxis (PEP) ………… 372t
pre-exposure prophylaxis (PrEP) ………… 372t
prophylaxis of opportunistic infections ………… 386t
HIV coinfections (HBV/HCV) ………… 365
Hoarseness, mouth abnormalities (DDx), ………… 502t
Home IV therapy (OPAT) ………… 7
Hookworm ………… 294
Hospital-acquired pneumonia (HAP) ………… 74
Howell-Jolly bodies, RBC abnormalities (DDx) ………… 517t
Human bite ………… 155
pediatric ………… 433
Human granulocytic anaplasmosis (HGA) ………… 271
Human monocytic ehrlichiosis (HME) ………… 271
Human papilloma virus (HPV)
adult immunization ………… 402t
genital/perianal warts ………… 128
Hydradenitis suppurativa ………… 152
Hymenolepis nana, dwarf tapeworm ………… 297
Hyperinfection syndrome ………… 177
Hyperpigmentation, general appearance abnormalities (DDx) ………… 495t
Hyperpigmented shins, extremity abnormalities (DDx) ………… 511t
Hyposplenia ………… 169
Hypotension, general appearance abnormalities (DDx) ………… 495t
I-diopathic pulmonary hemosiderosis (IPH), bilateral infiltrates without effusion ………… 476
IDV (indinavir) ………… 668
Imipenem/cilastatin ………… 666
pearls & pitfalls ………… 531
susceptibility profiles ………… 208t
Immunizations. (see also Adult immunizations)
Immunoblasts, WBC abnormalities (DDx) ………… 515t
Impetigo ………… 47
pediatric ………… 433
Indian (Bihar state) visceral leishmaniasis (Kala-azar) ………… 290
Indinavir (IDV) ………… 668
Infective endocarditis (IE) prophylaxis, indications for ………… 390t
Influenza
adult immunization ………… 401t
avian ………… 65
bilateral infiltrates without effusion ………… 467
HIV, prophylaxis ………… 337
pneumonia ………… 65
seasonal (types A/B) ………… 65
post-exposure prophylaxis ………… 378
prophylaxis of opportunistic infections ………… 386t
Influenza A
clinical presentations ………… 67
community acquired pneumonia ………… 53
with S. aureus (MSSA/MRSA) CAP ………… 69
sepsis ………… 164
Influenza B, community acquired pneumonia ………… 54
Infraclavicular adenopathy, lymph node abnormalities (DDx) ………… 507t
Inguinal adenopathy, unilateral/bilateral, lymph node abnormalities (DDx) ………… 508t
INH ………… 671
Initial dose in renal failure (vs. loading dose) ………… 544
Intelence (etravirine) ………… 653
Intestinal
cestodes ………… 297
nematodes ………… 295
protozoa ………… 292
trematodes ………… 298
Intestines, parasites, fungi, unusual organisms in ………… 292
Intraabdominal abscess ………… 108
Intracellular inclusion bodies in blood ………… 271
Intrarenal abscess ………… 118
Invanz ………… 647
Invirase (saquinavir) ………… 740
In vitro susceptibility testing vs. in vivo effectiveness ………… 6t
factors dependent on ………… 5
In vitro vs. In vivo susceptibility ………… 5
Iodoquinol, pediatric dose ………… 441
Iritis, eye abnormalities (DDx) ………… 498t
Isavuconazole ………… 670
Ischemic foot ulcers ………… 151
Ischiorectal abscess ………… 162
Isentress (raltegravir) ………… 731
Isoniazid ………… 671
Isospora, chronic watery diarrhea ………… 97
Isospora belli ………… 292
HIV ………… 353
Isosporiasis ………… 292
Israeli spotted fever ………… 313
Itraconazole ………… 672
IV drug abusers, acute bacterial endocarditis ………… 81
IV line (CVC) infections ………… 87
pediatric ………… 423
IV to PO switch therapy ………… 7
J-apanese encephalitis (JE) ………… 26
travel prophylaxis ………… 395t
Jaundice, general appearance abnormalities (DDx) ………… 496t
Jock itch ………… 160
Joint infections, empiric therapy ………… 132
Joint prosthesis, infected ………… 139
Jugular vein tenderness, neck abnormalities (DDx) ………… 502t
K-ala-azar ………… 290
Kaletra [Lopinavir (LPV) + Ritonavir (RPV)] ………… 685
Kaposi‘s sarcoma, HIV infection ………… 320
Keflex ………… 607
Kefurox ………… 606
Kefzol ………… 582
Keratitis ………… 33
amebic ………… 33
bacterial ………… 33
eye abnormalities (DDx) ………… 499t
viral, HSV- ………… 133
Ketek ………… 747
Ketoconazole ………… 675
Kingella kingae ………… 235t
endocarditis ………… 78
Klebsiella ………… 235t
cholangitis ………… 100
cholecystitis ………… 99
gallbladder wall abscess ………… 100
pneumonia ………… 71
sepsis ………… 164
surgical prophylaxis ………… 376t
urosepsis ………… 121
Klebsiella (Calymmatobacterium) granulomatosis, granuloma inguinale ………… 128
Klebsiella oxytoca ………… 235t
Klebsiella ozaenae, rhinoscleromatis ………… 236t
Klebsiella pneumoniae ………… 235t
acute bacterial meningitis (ABM) ………… 19
alcoholics ………… 73
community acquired pneumonia ………… 52
lung abscess/empyema ………… 72
osteomyelitis ………… 141
pneumonia ………… 71
sepsis ………… 164
Knee (total) replacement surgery, surgical prophylaxis ………… 377t
L-acrimal gland enlargement, head abnormalities (DDx) ………… 497t
Lactate dehydrogenase (LDH), elevated, serum test abnormalities (DDx) ………… 520t
Lactate ………… 520t
serum ………… 520t
CSF (lactic acid) ………… 526t
Lactobacillus sp. ………… 249
Lamisil ………… 750
Lamivudine ………… 676
Lamivudine + zidovudine (Combivir) ………… 677
Lassa fever ………… 199
post-exposure prophylaxis ………… 383t
LCM, meningitis ………… 21
Ledipasvir/Sofosbuvir ………… 106t
Leflunomide ………… 678
Left upper abdominal quadrant tenderness (splenic tenderness), abdominal abnormalities (DDx) ………… 505t
Leg edema, unilateral/bilateral, extremity abnormalities (DDx) ………… 510t
Legionnaire's disease ………… 53
Legionella sp. ………… 236t
community acquired pneumonia ………… 53
endocarditis ………… 78
transplant infections ………… 177
Leg lesions, nodular, extremity abnormalities (DDx) ………… 511t
Leg lesions, verrucous, extremity abnormality (DDx) ………… 510t
Leg nodules, painful, extremity abnormalities (DDx) ………… 511t
Leg ulcers, extremity abnormality (DDx) ………… 510t
Leishmania braziliensis ………… 300
Leishmania donovani, visceral leishmaniasis ………… 290
Leishmania major ………… 300
Leishmania mexicana ………… 300
Leishmaniasis
cutaneous (Old World/New World) ………… 300
visceral (Kala-azar) ………… 290
Leishmania tropica ………… 300
Lemierre‘s syndrome ………… 48
Lens implant, infected, endophthalmitis ………… 37
Leprosy ………… 300
Leptospira interrogans ………… 236t
Leptospirosis ………… 104
Leptospirosis, meningitis ………… 22
Leuconostoc ………… 223t
Leukocyte esterase, urinary abnormalities (DDx) ………… 523t
Leukocytosis, WBC abnormalities (DDx) ………… 514t
Leukopenia, WBC abnormalities (DDx) ………… 514t
Leukoplakia, mouth abnormalities (DDx) ………… 501t
Leukostasis, bilateral infiltrates without effusion ………… 475
Levaquin ………… 679
Levofloxacin ………… 679
pearls & pitfalls ………… 535
susceptibility profiles ………… 208t
Lexiva (fosamprenavir) ………… 657
Lice infestations, body, head, pubic ………… 161
Linezolid ………… 682
pearls & pitfalls ………… 537
susceptibility profiles ………… 208t
Listeria monocytogenes ………… 227t
acute bacterial meningitis (ABM) ………… 18
encephalitis ………… 26
Liver
abscess ………… 102
cystic masses ………… 289
hepatomegaly ………… 290
parasites, fungi, unusual organisms in ………… 288
Liver flukes ………… 288
Liver test abnormalities (DDx)
alkaline phosphatase (AP), elevation ………… 521t
GGT (GGTP), elevation ………… 521t
serum transaminases (AST/ALT), elevation ………… 521t
total bilirubin, elevation ………… 521t
Liver transplants, transplant prophylaxis (BMT/SOT) ………… 389t
Lizard skin, general appearance abnormalities (DDx) ………… 496t
Loading doses ………… 541
(also see individual DS in Chap ………… 11)
Loa Loa (Loiasis) ………… 265
Lopinavir + ritonavir (Kaletra) ………… 685
Lorabid ………… 686
Loracarbef ………… 686
pearls & pitfalls ………… 530
susceptibility profiles ………… 201t
Louse-borne relapsing fever (LBRF) ………… 269
LPV/RTV (Kaletra) ………… 685
Ludwig‘s angina ………… 46
Lung fluke. see Paragonimus westermani
Lungs, parasites, fungi, unusual organisms in ………… 279
Lyme arthritis ………… 138
Lyme disease, post-exposure prophylaxis ………… 381t
Lymphadenopathy, generalized, lymph node abnormalities (DDx) ………… 508t
Lymphangitis ………… 144
extremity abnormalities (DDx) ………… 509t
Lymph node abnormalities (DDx)
anterior cervical adenopathy ………… 507t
axillary adenopathy ………… 507t
epitrochlear adenopathy ………… 507t
generalized lymphadenopathy ………… 508t
infraclavicular adenopathy ………… 507t
inguinal adenopathy, unilateral/bilateral ………… 508t
occipital adenopathy ………… 507t
periumbilical nodule ………… 507t
posterior cervical adenopathy, unilateral/bilateral ………… 507t
preauricular adenopathy ………… 507t
supraclavicular adenopathy ………… 507t
ulcer-node syndromes ………… 507t
Lymphocytes, pleural fluid abnormalities (DDx) ………… 524t
Lymphocytosis, WBC abnormalities (DDx) ………… 515t
Lymphogranuloma venereum (LGV) ………… 128
M-acrobid ………… 705
Macrodantin ………… 705
Macrolides
pearls & pitfalls ………… 538
susceptibility profiles ………… 196t
Malaria (worldwide) ………… 272
prophylaxis ………… 396t
severe ………… 271
uncomplicated ………… 272
Malarone ………… 572
Malassezia furfur ………… 254t
eosinophilic folliculitis ………… 316
tinea versicolor/pityriasis ………… 316
Mandelamine ………… 691
Mandol ………… 581
Maraviroc (MVC) ………… 687
Marburg virus disease ………… 192
Mastitis ………… 144
Mastoiditis ………… 40
pediatric ………… 414
Maxillary sinus, acute bacterial sinusitis ………… 31
Maxipime ………… 586
MDR
acute bacterial meningitis (ABM) ………… 19
community acquired pneumonia ………… 56
nosocomial pneumonia (VAP) ………… 74
MDR GNBs, bacterial cystitis (AUC) ………… 111
catheter-associated bacteriuria (CAB)9, ………… 113
MDROs. (see Multi-drug resistant organisms)
Measles
adult immunization ………… 401t
Measles, mumps, rubella, prophylaxis ………… 340
Mediastinitis ………… 51
Mediterranean spotted fever ………… 313
Mefoxin ………… 592
Melioidosis, cavitary infiltrates (thick-walled) ………… 485
Membranous pharyngitis ………… 42
Meningitis, acute bacterial (ABM)
CNS shunt infections ………… 21
elderly ………… 20
empiric therapy ………… 18
EVD associated ABM ………… 526t
malignancy ………… 20
normal host ………… 20
pediatric ………… 406
acute non-bacterial ………… 21
amebic
granulomatous ………… 23
primary ………… 23
aseptic ………… 23
chronic ………… 21
cryptococcal ………… 25
HIV ………… 348
post-exposure prophylaxis ………… 378t
tuberculosis ………… 24
viral ………… 23
Meningococcal meningitis, travel prophylaxis ………… 394t
Meningococcus (invasive disease), adult immunization ………… 401t
Mental confusion, neurological abnormalities (DDx) ………… 512t
Mepron ………… 571
Meronem ………… 689
Meropenem ………… 689
pearls & pitfalls ………… 531
susceptibility profiles ………… 208t
Merrem ………… 689
MERS (Middle East Respiratory Syndrome) ………… 65
Metagonimus yokogawai, heterophyiasis ………… 298
Methenamine hippurate ………… 691
Methenamine mandelate ………… 691
Metronidazole ………… 692
pearls & pitfalls ………… 538
susceptibility profiles ………… 196t
Mezlin ………… 694
Mezlocillin ………… 694
Micafungin ………… 695
Microbiology susceptibility testing ………… 5
limitations of ………… 5
Microfilaria in blood ………… 264
Microsporidia enteritis, HIV ………… 354
Microsporum canis, tinea corporis ………… 158
Migratory rashes, extremity abnormalities (DDx) ………… 511t
Miliary (disseminated) BCG ………… 170
Miliary TB ………… 170
Minocin ………… 696
Minocycline ………… 696
pearls & pitfalls ………… 532
susceptibility profiles ………… 196t
Mixed aerobic/anaerobic deep soft tissue infection ………… 146
Mobiluncus ………… 125
Mode of elimination, explanation ………… 542
Monobactams, pearls & pitfalls ………… 531
Monoclonal gammopathy, serum test abnormalities (DDx) ………… 519t
Monocytosis, WBC abnormalities (DDx) ………… 515t
Mononeuritis multiplex, neurological abnormalities (DDx) ………… 514t
Monospot test (false+) (DDx) ………… 519t
Monotherapy vs. combination therapy ………… 7
Monurol ………… 660
Moraxella catarrhalis ………… 237
acute bacterial exacerbation of chronic bronchitis (AECB) ………… 50
acute otitis media ………… 39
community acquired pneumonia (CAP) ………… 51
conjunctivitis ………… 34
keratitis ………… 33
Morganella morganii ………… 237
Morning temperature spikes, fever curves (DDx) ………… 494t
Mouth abnormalities (DDx)
angular chelitis ………… 501t
crimson crescents ………… 502t
frenal ulcer ………… 501t
gingivitis ………… 501t
herpes labialis ………… 501t
hoarseness ………… 502t
leukoplakia ………… 501t
oral ulcers, solitary/multiple ………… 501t
palatal perforation ………… 502t
palatal petechiae ………… 501t
palatal vesicles ………… 502t
tongue tenderness ………… 501t
tongue ulcers ………… 501t
tonsillar membranes ………… 502t
tonsillar ulcers ………… 502t
trismus ………… 501t
uvular edema ………… 502t
Mouth ulcers/vesicles ………… 45
Moxifloxacin ………… 698
pearls & pitfalls ………… 535
susceptibility profiles ………… 208t
MRSA. see Methicillin resistant staphylococcus aureus (MRSA)
MSSA, brain abscess ………… 28
Mucocutaneous (local/non-disseminated) candidiasis ………… 158
Mucor
cutaneous zygomycosis ………… 308
pulmonary zygomycosis ………… 283
Mucormycosis ………… 283
Mumps
adult immunization ………… 402t
meningitis (aseptic) ………… 21
Murine (flea-borne) typhus ………… 313
Muscle rigidity, general, neurological abnormalities (DDx) ………… 513t
Muscles
parasites, fungi, unusual organisms in ………… 300
tenderness in, extremity abnormality (DDx) ………… 510t
MVC (maraviroc) ………… 687
Myambutol ………… 651
Mycamine ………… 695
Mycobacterium avium-intracellulare (MAI) community-acquired cutaneous ………… 302
HIV/AIDS ………… 362
prophylaxis ………… 337
pneumonia ………… 70
prophylaxis of opportunistic infections ………… 387t
Mycobacterium chelonae, cutaneous ………… 304
Mycobacterium fortuitum, cutaneous ………… 305
Mycobacterium genitalium, post-exposure prophylaxis ………… 380t
Mycobacterium haemophilum ………… 304
cutaneous ………… 304
Mycobacterium hominis ………… 125
Mycobacterium kansasii pneumonia ………… 55
Mycobacterium leprae, leprosy ………… 300
Mycobacterium marinum, swimming pool granuloma ………… 305
Mycobacterium scrofulaceum, scrofula ………… 304
Mycobacterium tuberculosis (TB)
chronic pyelonephritis ………… 116
chronic tuberculosis peritonitis ………… 111
community acquired pneumonia ………… 55
cutaneous ………… 302
endophthalmitis ………… 37
epididymitis ………… 114
HIV
extrapulmonary ………… 355
prophylaxis ………… 337
meningitis ………… 22
miliary tuberculosis ………… 167
organ transplants ………… 179
pediatrics ………… 421
pericarditis ………… 84
pneumonia ………… 70
HIV ………… 328
post-exposure prophylaxis ………… 379t
prophylaxis of opportunistic infections ………… 387t
renal TB ………… 116
transplant infections ………… 177
tuberculosis arthritis ………… 134
tuberculosis osteomyelitis ………… 142
Mycobacterium ulcerans, Buruli ulcer ………… 305
Mycobutin ………… 733
Mycoplasma encephalitis ………… 27
Mycoplasma genitalium, urethritis/cervicitis ………… 123
Mycoplasma pneumoniae ………… 60
community acquired pneumonia ………… 51
encephalitis ………… 25
pharyngitis ………… 42
pneumonia ………… 60
Myocarditis ………… 84
Myoglobinuria (2° to rhabdomyolysis), urinary abnormalities (DDx) ………… 524t
Myositis ………… 317
N-Naegleria fowleri, meningitis ………… 21
Nafcillin ………… 700
susceptibility profiles ………… 196t
Nails, fungal infections ………… 158
Nasal abnormalities (DDx)
epistaxis ………… 500t
nasal septal perforation ………… 500t
nose tip gangrene ………… 500t
purple nose tip ………… 500t
Nasal septal perforation, nasal abnormalities (DDx) ………… 500t
Naturally/intrinsically resistant pathogens ………… 2
Nebcin ………… 760
NebuPent ………… 717
Necator americanus, hookworm ………… 294
Neck abnormalities (DDx)
bull neck ………… 502t
enlarged greater auricular nerve ………… 502t
jugular vein tenderness ………… 502t
neck sinus tract ………… 502t
superior vena cava syndrome ………… 502t
Neck infections, deep ………… 48
Neck sinus tract, neck abnormalities (DDx) ………… 502t
Necrotizing abscesses ………… 146
Necrotizing fasciitis ………… 145
Neisseria gonorrhoeae (GC) ………… 197
cervicitis ………… 123
endometritis ………… 122
PID ………… 122
post-exposure prophylaxis ………… 380t
salpingitis ………… 122
septic abortion ………… 122
septic arthritis ………… 133
tuboovarian abscess ………… 122
urethritis ………… 123
Neisseria meningitidis (MC) ………… 197t, ………… 224t
acute bacterial meningitis (ABM) ………… 18
chronic medical prophylaxis ………… 384t
post-exposure prophylaxis ………… 378t
sepsis (meningococcemia) ………… 166
travel prophylaxis ………… 394t
Nelfinavir (NFV) ………… 701
Nematodes (roundworms), intestinal ………… 294
Neonatal Group B streptococcal (GBS) infection (primary prevention), chronic medical prophylaxis ………… 385t
Nephrotic syndrome, general appearance abnormalities (DDx) ………… 495t
Neuroborreliosis ………… 24
Neurobrucellosis ………… 22
Neurocysticercosis ………… 275
Neurological abnormalities (DDx)
anisocoria ………… 513t
Bell‘s palsy ………… 513t
cranial nerve abnormalities, unilateral/bilateral ………… 513t
flaccid paralysis (acute) ………… 514t
general muscle rigidity ………… 513t
Guillain-Barré syndrome (GBS) ………… 514t
hemiplegia/hemiparesis ………… 514t
mental confusion/encephalopathy (acute) ………… 512t
mononeuritis multiplex ………… 514t
nuchal rigidity ………… 512t
optic nerve atrophy ………… 513t
papilledema ………… 513t
transient deafness ………… 513t
transverse myelitis ………… 514t
Neurosyphilis ………… 129
Nevirapine (NVP) ………… 703
NFV (nelfinavir) ………… 701
Nitazoxanide ………… 704
Nitrite positive, urinary abnormalities (DDx) ………… 523t
Nitrofurantoin ………… 705
pearls & pitfalls ………… 536
susceptibility profiles ………… 208t
Nizoral ………… 675
Nocardia asteroides ………… 237t
pulmonary nocardiosis ………… 286
Nocardia brasiliensis ………… 237t
Nocardia sp. ………… 198t
cerebral nocardiosis ………… 274
cutaneous nocardiosis ………… 302
transplant infections ………… 176
Nodular arm/leg lesions, extremity abnormalities (DDx) ………… 511t
Nodular lymphangitis, extremity abnormalities (DDx) ………… 509t
Nodular/pustular candidiasis ………… 308
Nodules, skin ………… 307
Non-aeruginosa Pseudomonas, urosepsis ………… 121
Non-cholera vibrios, travel prophylaxis ………… 394t
Non-gonococcal urethritis (NGU), post-exposure prophylaxis ………… 380t
Norvir (ritonavir) ………… 738
Nose tip gangrene, nasal abnormalities (DDx) ………… 500t
Nosocomial pneumonia (NP), ………… 74
Noxafil ………… 724
Nuchal rigidity, neurological abnormalities (DDx) ………… 512t
Nuritionally-variant streptococci (NVS), endocarditis ………… 76
Nursing home acquired pneumonia (NHAP) ………… 73
NVP (nevirapine) ………… 703
Nystatin, pediatric dose ………… 442
O-ccipital adenopathy, lymph node abnormalities (DDx) ………… 507t
Ochrobactrum anthropi (CDC group Vd) ………… 237t
Oflox ………… 707
Ofloxacin ………… 707
pearls & pitfalls ………… 535
susceptibility profiles ………… 208t
Olysio ………… 106t
Omnicef ………… 584
Onchocerca volvulus, cutaneous onchorcerciasis ………… 308
Onchocerciasis, cutaneous ………… 308
Onychomycosis ………… 159
OPAT ………… 8
Opisthorchiasis ………… 288
Opisthorchis viverrini ………… 288
Opportunistic infections. see HIV and transplant infection
Optic nerve atrophy, neurological abnormalities (DDx) ………… 513t
Oral anaerobes ………… 51
brain abscess ………… 28
community acquired pneumonia ………… 55
deep neck infections ………… 48
dental infections ………… 48
gastric perforation ………… 91
human bite wounds ………… 155
lung abscess/empyema ………… 72
Oral anti-pseudomonal penicillins, pearls & pitfalls ………… 529
Oral anti-staphylococcal penicillins, pearls & pitfalls ………… 529
Oral first generation cephalosporins, pearls & pitfalls ………… 529
Oral second generation cephalosporins
pearls & pitfalls ………… 530
Oral third generation cephalosporins pearls & pitfalls ………… 531
Oral ulcers, solitary/multiple, mouth abnormalities (DDx) ………… 501t
Orbactiv ………… 708
Orbital cellulitis, pediatric ………… 411
Organ transplants
bacteremia or candidemia ………… 172
brain abscess/mass lesion ………… 176
encephalitis/meningitis ………… 176
hepatitis ………… 178
pneumonia (CAP) ………… 177
Orientia (Rickettsia) tsutsugamushi ………… 313
Oritavancin ………… 708
pearls & pitfalls ………… 539
susceptibility profiles ………… 208t
Oropharyngeal candidiasis, HIV ………… 355
Orthopedic prosthetic implant surgery, surgical prophylaxis ………… 377t
Orthopedic surgery (open fracture), surgical prophylaxis ………… 377t
Oseltamivir ………… 710
Osteochondritis, pediatric ………… 430
Osteomyelitis ………… 140
acute, pediatric ………… 430
chronic ………… 141
Otitis externa ………… 38
pediatric ………… 413
Otitis media
acute ………… 39
malignant external otitis ………… 39
pediatric ………… 413
Oxacillin ………… 711
P-cepacia, surgical prophylaxis ………… 377t
P. maltophilia, surgical prophylaxis ………… 377t
Pacemaker infections ………… 85
Painless purple palm/sole lesions, extremity abnormalities (DDx) ………… 509t
Palatal perforation, mouth abnormalities (DDx) ………… 502t
Palatal petechiae, mouth abnormalities (DDx) ………… 501t
Palatal vesicles, mouth abnormalities (DDx) ………… 502t
Palm lesions, painless, extremity abnormalities (DDx) ………… 509t
Palm rashes, extremity abnormalities (DDx) ………… 512t
Palpable purpura, extremity abnormalities (DDx) ………… 511t
Pancreas transplants, transplant prophylaxis (BMT/SOT) ………… 389t
Pancreatic abscess ………… 102
Pancreatic pseudocyst, infected ………… 102
Pancreatitis
acute ………… 107
edematous ………… 107
hemorrhagic/necrotizing ………… 107
Pancytopenia, platelet abnormalities (DDx) ………… 518t
Papilledema, neurological abnormalities (DDx) ………… 513t
Papular axillary lesions, extremity abnormality (DDx) ………… 510t
Papules, skin ………… 307
Paracoccidioides brasiliensis, pulmonary paracoccidioidomycosis ………… 282
Paragonimiasis, cavitary infiltrates (thin-walled) ………… 490
Paragonimus westermani
cerebral paragonimiasis (lung fluke) ………… 275
pulmonary paragonimiasis ………… 279
Parenteral first generation cephalosporins pearls & pitfalls ………… 529
Parenteral second generation cephalosporins
pearls & pitfalls ………… 530
Parenteral third generation cephalosporins
pearls & pitfalls ………… 530
Parenteral fourth generation cephalosporins pearls & pitfalls ………… 531
Paritaprevir/ritonavir/ombitasvir/
dasabuvir ………… 106t
Parotid enlargement, head abnormalities (DDx) ………… 497t
Parotitis, suppurative ………… 41
Parvo B19, meningitis ………… 21
Pasteurella multocida ………… 237t
animal bite wounds ………… 155
septic arthritis ………… 134
PCP
CAP, HIV ………… 342
HIV, prophylaxis ………… 337t
prophylaxis in opportunistic infections ………… 386t
transplants ………… 180
Pediatric infectious diseases ………… 405
bone and joint ………… 429
CNS ………… 406
dosing ………… 436
gastrointestinal ………… 425
HEENT ………… 411
lower respiratory ………… 417
skin and soft tissue ………… 433
vascular ………… 423
Pediculus humanus var. capitis, head lice ………… 161
Pediculus humanus var. corporis, body lice ………… 161
Pegasys ………… 712
Peg-Intron ………… 713
Pegylated interferon
alfa-2a ………… 712
alfa-2b ………… 713
Peliosis hepatitis ………… 309
Pelvic inflammatory disease (PID) ………… 122
Pelvic (OB/GYN) surgery, surgical prophylaxis ………… 376t
Pelvic peritonitis/abscess108, ………… 110
Penicillin G ………… 715
pearls & pitfalls ………… 528
susceptibility profiles ………… 196t
Penicillin V ………… 716
Penicillium, cutaneous307, ………… 310
Penicillium marneffei ………… 255t
cutaneous penicillium ………… 307
Pentam 300 ………… 717
Pentamidine ………… 717
Peptic ulcer disease ………… 91
Peptococcus ………… 246t
Peptostreptococcus ………… 246t
Peramivir ………… 718
Perianal warts ………… 128
Pericardial effusion, heart abnormalities (DDx) ………… 504t
Pericarditis ………… 84
Periorbital cellulitis ………… 30
pediatric ………… 411
Periorbital edema, unilateral/bilateral, eye abnormalities (DDx) ………… 498t
Peripheral vascular disease (PVD), non-diabetics with, osteomyelitis ………… 143
Perirectal abscess ………… 162
Perirectal fistula, genitourinary abnormalities (DDx) ………… 508t
Perirectal ulcer, genitourinary abnormalities failure (DDx) ………… 508t
Peritonitis
CAPD associated ………… 109
chronic tuberculosis ………… 109
spontaneous bacterial ………… 109
Periumbilical nodule, lymph node abnormalities (DDx) ………… 507t
Periumbilical purpura (thumbprint sign), abdominal abnormalities (DDx) ………… 505t
Persistent fevers, antibiotic failure ………… 13
Pertussis ………… 58
adult immunization ………… 402t
community acquired pneumonia ………… 58
pediatric ………… 420
post-exposure prophylaxis ………… 379t
travel prophylaxis ………… 396t
pH
urinary ………… 523t
Pharyngitis ………… 41
bacterial ………… 41
membranous ………… 42
other ………… 42
pediatric ………… 415
viral ………… 42
Phialophora verrucosa, chromomycosis ………… 307
Phlegmon ………… 145
Phthirus pubis, pubic lice ………… 161
Pilonidal cysts, infected ………… 152
Pinworms ………… 295
Piperacillin ………… 719
pearls & pitfalls ………… 532
susceptibility profiles ………… 196t
Piperacillin/tazobactam ………… 720
pearls & pitfalls ………… 532
susceptibility profiles ………… 196t
Pipracil ………… 719
Plague
bioterrorist ………… 187
pneumonic ………… 190
post-exposure prophylaxis ………… 383t
Plantar hyperkeratoses, extremity abnormalities (DDx) ………… 512t
Plasma protein binding, explanation ………… 541
Plasmodium falciparum, malaria ………… 272
Plasmodium knowlesi, malaria ………… 272
Plasmodium malariae, malaria ………… 272
Plasmodium ovale, malaria ………… 272
Plasmodium vivax, malaria ………… 272
Platelet abnormalities (DDx)
pancytopenia ………… 518t
thrombocytopenia ………… 518t
thrombocytosis ………… 518t
Plesiomonas shigelloides ………… 238t
Pleural fluid abnormalities (DDx)
ademosine deaminase (ADA) ………… 524t
amylase ………… 524t
glucose ………… 524t
lymphocytes ………… 524t
PMNs ………… 524t
protein ………… 524t
Pneumococcus, adult immunization ………… 402t
Pneumocystis (carinii) jiroveci pneumonia (PCP)
community acquired pneumonia ………… 57
HIV ………… 342
Pneumonia
alcoholics ………… 56
Aspergillus ………… 57
aspiration ………… 55
atypical pathogens, non-zoonotic ………… 53
atypical pathogens, zoonotic ………… 53
bacterial pathogens ………… 52
bronchiectasis ………… 56
chickenpox ………… 54
chronic steroid use ………… 57
community-acquired ………… 51
pediatric ………… 417
cystic fibrosis ………… 56
HIV
Aspergillus ………… 341
CAP ………… 70
M. tuberculosis ………… 344
P. (carinii) jiroveci (PCP) ………… 342
hospital-acquired (HAP) ………… 74
influenza ………… 65
MERS ………… 65
M. avium-intracellulare (MAI) ………… 70
M. kansasii ………… 70
M. pneumoniae ………… 60
MSSA/MRSA ………… 69t
M. tuberculosis (TB) ………… 70
non-zoonotic atypical, diagnostic features ………… 62t
nosocomial (NP) ………… 74
nursing home acquired (NHAP) ………… 73
organ transplants ………… 71
SARS ………… 64
S. aureus ………… 69t
transplant infections ………… 177
tuberculosis ………… 55
ventilator associated (VAP) ………… 74
zoonotic atypical ………… 63
Pneumonic plague ………… 187
post-exposure prophylaxis ………… 383t
Pneumothorax, spontaneous, chest abnormalities (DDx) ………… 503t
Polymox ………… 554
Polymyxin B ………… 722
Polymyxin B/Colistin
pearls & pitfalls ………… 540
susceptibility profiles ………… 208t
Pork tapeworm ………… 298
Posaconazole ………… 724
Positive blood cultures vs. bacteremia
(MSSA, MRSA, CoNS)11t
Posterior cervical adenopathy, unilateral/bilateral, lymph node abnormalities (DDx) ………… 507t
Post-exposure prophylaxis
anthrax (inhalation/cutaneous) ………… 383t
avian influenza (H5N1, H7N9) ………… 379t
chancroid ………… 380t
diphtheria ………… 379t
gonorrhea ………… 380t
hepatitis A (HAV) ………… 381t
hepatitis B (HBV) ………… 381t
influenza ………… 378t
Lyme disease ………… 381t
meningitis ………… 378t
non-gonoccocal urethritis (NGU) ………… 380t
pertussis ………… 379t
pneumonic plague ………… 383t
rabies ………… 382t
Rocky Mountain spotted fever ………… 381t
smallpox ………… 383t
swine influenza A (H1N1) ………… 379t
syphilis ………… 380t
tuberculosis ………… 379t
tularemic pneumonia ………… 383t
varicella (chickenpox) ………… 380t
viral hemorrhagic fever ………… 383t
zoonotic diseases (plague, anthrax) ………… 382t
Preauricular adenopathy, lymph node abnormalities (DDx) ………… 507t
Pregnancy
asymptomatic bacteriuria in ………… 384t
Prevotella sp. ………… 250t
Prezista (darunavir) ………… 628
Primaquine ………… 726
Primary amebic meningoencephalitis (PAM) ………… 23
Primaxin ………… 666
Problem pathogens,
empiric therapy ………… 258t
Procalcitonin levels (PCT), elevated, serum test abnormalities (DDx) ………… 520t
Progressive multifocal encephalopathy (PML), HIV ………… 349
Proloprim ………… 762
Prophylaxis, antibiotic
chronic medical ………… 384t
endocarditis (SBE) ………… 390t
HIV
opportunistic infections ………… 386t
pre-exposure (PrEP) ………… 386t
post-exposure ………… 386t
malaria ………… 396t
post-exposure ………… 378t
surgical ………… 375t
tetanus ………… 398t
transplant (BMT/SOT) ………… 388t
travel ………… 392t
Propionibacterium acnes ………… 249t
Prostaphlin ………… 711
Prostate enlargement/tenderness, genitourinary abnormalities (DDx) ………… 511t
Prostatic abscess ………… 119
Prostatitis ………… 119
Prosthetic valve endocarditis (PVE) ………… 82
Protein, elevation, pleural fluid abnormalities (DDx) ………… 524t
Proteinuria, urinary abnormalities (DDx) ………… 523t
Proteus mirabilis, vulgaris ………… 238t
Prototheca, cutaneous ………… 307
Prototheca wikermanii, cutaneous prototheca ………… 307
Protozoa, intestinal ………… 292
Providencia sp. ………… 239t
Pseudallescheria boydii, pulmonary pseudallescheriasis ………… 283
Pseudomonas aeruginosa ………… 239t
acute bacterial meningitis (ABM) ………… 19
bone marrow transplants (BMT) ………… 172
brain abscess ………… 28
burn wounds ………… 156
community acquired pneumonia ………… 56
endocarditis ………… 81
epididymitis ………… 114
external otitis (malignant) ………… 38
febrile neutropenia ………… 171
HIV ………… 341
mastoiditis ………… 40
pneumonia (nosocomial) ………… 74
sepsis ………… 164
septic arthritis ………… 133
surgical prophylaxis ………… 377t
urosepsis (nosocomial) ………… 121
Pseudomonas (Chryseomonas) luteola (CDC group Ve-1) ………… 239t
Pseudomonas (Flavimonas) oryzihabitans (CDC group Ve-2) ………… 240t
Pubic lice ………… 161
Pulmonary actinomycosis ………… 282
Pulmonary alveolar proteinosis (PAP), bilateral infiltrates without effusion ………… 476
Pulmonary amebiasis ………… 279
Pulmonary aspergillosis ………… 282
Pulmonary blastomycosis ………… 281
Pulmonary coccidioidomycosis ………… 282
Pulmonary coin lesions ………… 280
Pulmonary cryptococcosis ………… 283
Pulmonary histoplasmosis ………… 282
Pulmonary infiltrates/mass lesions ………… 281
Pulmonary nocardiosis ………… 283
Pulmonary paracoccidioidomycosis (South American blastomycosis) ………… 282
Pulmonary pseudallescheriasis ………… 283
Pulmonary sporotrichosis ………… 283
Pulmonary zygomycosis (mucormycosis) ………… 283
Purple nodules, extremity abnormalities (DDx) ………… 511t
Purple nose tip, nasal abnormalities (DDx) ………… 500t
Pyelonephritis
acute ………… 115
chronic ………… 116
Pyodermas abscesses, severe, pediatric ………… 433
Pyomyositis ………… 146
Pyrazinamide ………… 727
Pyrimethamine ………… 728
Pyuria, urinary abnormalities (DDx) ………… 522t
PZA ………… 727
Q-fever
community-acquired pneumonia ………… 53
endocarditis ………… 78
Quinine sulfate ………… 728
Quinolones
pearls & pitfalls ………… 535
susceptibility profiles ………… 208t
Quinupristin/dalfopristin ………… 729
pearls & pitfalls ………… 537
susceptibility profiles ………… 208t
R-rickettsia, post-exposure prophylaxis ………… 381t
Rabies
post-exposure prophylaxis ………… 382t
travel prophylaxis ………… 396t
RAL (raltegravir) ………… 731
Raltegravir (RAL) ………… 731
Rapivab ………… 718
Rash
below waist, general appearance abnormalities (DDx) ………… 496t
migratory, extremity abnormalities (DDx) ………… 511t
palms/soles, extremity abnormalities (DDx) ………… 512t
Rat bite fever (Streptobacillus monilaformis, spirillum minus) ………… 268
RBC abnormalities (DDx)
anemia (acute) ………… 517t
hemophagocytosis (erythrophagocytosis) ………… 517t
Howell-Jolly bodies ………… 517t
RBC inclusions ………… 517t
schistocytes (microangiopathic hemolytic anemia) ………… 516t
spherocytes ………… 517t
target cells ………… 517t
RBC inclusions, RBC abnormalities (DDx) ………… 517t
RBCs in CSF, CSF abnormalities (DDx) ………… 525t
Rebetol ………… 732
Relapsing fever (B, recurrentis), louse-borne and tick-borne ………… 268
Relative bradycardia
defined ………… 12
fever curves (DDx) ………… 494t
temperature-pulse relationships ………… 12t
Relative lymphocytosis, WBC abnormalities (DDx), ………… 515t
Relative lymphopenia, WBC abnormalities (DDx) ………… 515t
Relative tachycardia, fever curves (DDx) ………… 494t
Renal abscess ………… 118
intrarenal/perinephric ………… 118
Renal insufficiency, dosing strategies (see individual DS in Chap ………… 11)
Renal route of elimination ………… 5t
Renal TB ………… 116
Rescriptor (delavirdine)14, ………… 629
Resistance, antibiotic2, ………… 3t, ………… 14, ………… 217t, ………… 256t
Respiratory viruses
epiglottitis ………… 49
pharyngitis ………… 41
Retinitis. see Chorioretinitis
Retrovir (zidovudine) ………… 775
Reyataz (atazanavir) ………… 569
Rheumatic test abnormalities (DDx)
angiotensin-converting enzyme levels (ACE), elevated ………… 522t
anti-nuclear antibody titers (ANA), elevated ………… 522t
anti-smooth muscle antibodies (ASM), elevated ………… 522t
c-ANCA, elevated ………… 522t
double stranded DNA (DS-DNA), elevated ………… 522t
rheumatoid factors (RF), elevated ………… 522t
Rheumatoid factor (RF)
elevation, rheumatic test abnormalities (DDx) ………… 522t
Rhizopus
cutaneous zygomycosis ………… 308
pulmonary zygomycosis ………… 283
Rhodococcus equi ………… 227
Ribavirin ………… 732
Rickettsia africae ………… 313
Rickettsia akari ………… 313
Rickettsia conorii ………… 313
Rickettsialpox ………… 313
Rickettsia parkeri ………… 313
Rickettsia prowazekii ………… 313
Rickettsia ricketsii (tick borne), Rocky Mountain spotted fever (RMSF) ………… 313
Rickettsia (Orientia) tsutsugamushi ………… 313
Rickettsia typhi ………… 313
Rifabutin ………… 733
Rifadin ………… 734
Rifampin ………… 734
Rifapentine ………… 379
Right lower quadrant tenderness, abdominal abnormalities (DDx) ………… 505t
Right upper quadrant mass, abdominal abnormalities (DDx) ………… 505t
Right upper quadrant tenderness, abdominal abnormalities (DDx) ………… 505t
Right upper quadrant tympany, abdominal abnormalities (DDx) ………… 505t
Rilpivirine (RPV) ………… 736
Rimactane ………… 734
Rimantadine ………… 737
Ringworm
body ………… 158
scalp ………… 158
Ritonavir (RTV) ………… 738
Rocephin ………… 604
Rocky Mountain spotted fever (RMSF) ………… 313
post-exposure prophylaxis ………… 381t
Rose spots, abdominal abnormalities (DDx) ………… 504t
Rotavirus, travel prophylaxis ………… 394t
Roundworms, intestinal ………… 294
RPV (rilpivirine) ………… 736
RSV
community acquired pneumonia (CAP).. ………… 68
pediatric ………… 417
transplant infections ………… 175t
RTV (ritonavir) ………… 738
Rubella, adult immunization ………… 403t
S-agalactiae, bacterial cystitis ………… 111
Safety in pregnancy, explanation ………… 543
Safety profile, antibiotics ………… 4
Salmonella sp. ………… 240
septic arthritis ………… 136
travel prophylaxis ………… 394t
typhi, non-typhi ………… 240t
HIV ………… 356
typhi, travel prophylaxis ………… 395t
typhi/paratyphi, typhoid (enteric) fever ………… 94
Salpingitis ………… 122
Saltwater wounds ………… 156
Saquinavir (SQV) ………… 740
Sarcoptes scabiei, scabies ………… 161
SARS ………… 64
S aureus (MSSA/MRSA) pneumonia ………… 69
Scabies ………… 161
Scalp nodules, head abnormalities (DDx) ………… 497t
Scedosporium apiospermum, pulmonary pseudallescheriasis ………… 283
Schistocytes (microangiopathic hemolytic anemia), RBC abnormalities (DDx) ………… 516t
Schistosoma mansoni, japonicum ………… 290
Schistosomiasis ………… 290
Scleral nodules, eye abnormalities (DDx) ………… 499t
Scrofula ………… 302
Scrotal enlargement, genitourinary abnormalities (DDx) ………… 508t
Scrub (chigger/mite-borne) typhus ………… 313
Seborrheic dermatitis, severe, head abnormalities (DDx) ………… 496t
Selzentry (maraviroc) ………… 687
Sepsis ………… 163
asplenia/hyposplenia ………… 166
candidemia ………… 165
intraabdominal/pelvic source ………… 165
IV line (CVC) source ………… 167
lung source ………… 163
miliary BCG ………… 167
miliary TB ………… 167
mimics ………… 167
overwhelming, with purpura ………… 166
unknown source ………… 163
urosepsis ………… 169
Septic abortion ………… 122
Septic arthritis ………… 132
acute ………… 132
animal bite ………… 134
fungal ………… 134
pediatric ………… 429
TB ………… 134
Septic pelvic thrombophlebitis ………… 110
Septic shock ………… 163
Septic thrombophlebitis ………… 88
Septra ………… 763
Seromycin ………… 621
Serpiginous lesions, subcutaneous ………… 306
Serratia marcescens ………… 240
acute bacterial meningitis (ABM) ………… 19
endocarditis ………… 81
pneumonia (nosocomial) ………… 74
sepsis ………… 164
urosepsis ………… 122
Serum half-life (normal/ESRD), explanation ………… 541
Serum test abnormalities (DDx)
elevated cold agglutinins ………… 519t
elevated ferritin levels, (acute/chronic) ………… 519t
erythrocyte sedimentation rate (ESR) ………… 518t
lactate dehydrogenase (LDH) ………… 520t
monospot (false +) ………… 519t
procalcitonin levels (PCT) ………… 520t
SPEP (monoclonal, polyclonal gammopathy) ………… 519t
Serum transaminases (AST/ALT) liver test abnormalities (DDx) ………… 521t
Severe acute respiratory syndrome (SARS) ………… 64
Sexually transmitted diseases (STDs) empiric therapy ………… 123
Shigella sp. ………… 241
dysentery ………… 98
HIV ………… 357
travel prophylaxis ………… 394t
Shingles ………… 154
Shin hyperpigmentation, extremity abnormalities (DDx) ………… 511t
Shock, general appearance abnormalities (DDx) ………… 495t
Shoulder tenderness, chest abnormalities (DDx) ………… 503t
Shunt infections, CNS, acute bacterial meningitis ………… 21
Side effects, adverse ………… 543
Simeprevir ………… 106t
Single fever spikes, fever curves (DDx) ………… 494t
Sinusitis
acute bacterial ………… 31
chronic bacterial ………… 32
pediatric ………… 412
Sivextro ………… 745
Skin
boils ………… 151
fungal infections ………… 158
infections, empiric therapy ………… 144
infestations (body lice, head lice, pubic lice, scabies) ………… 161
other lesions ………… 316
papules/nodules/abscesses ………… 307
parasites, fungi, unusual organisms ………… 300
pustules ………… 151
rickettsia ………… 313
subcutaneous lesions ………… 300
subcutaneous serpiginous lesions ………… 306
ulcers ………… 148
decubitus ulcers ………… 148
diabetic foot ulcers ………… 149
ischemic foot ulcers ………… 150
ulcers/skin tracts/abscesses ………… 301
vesicles/bullae ………… 153
Sleeping sickness ………… 263
Smallpox ………… 187
bioterrorist ………… 186
post-exposure prophylaxis ………… 383t
Sofosbuvir ………… 106t
Soft tissue crepitance, general appearance abnormalities (DDx) ………… 495t
Soft tissue infections, empiric therapy ………… 144
Sole lesions, painless, extremity abnormalities (DDx) ………… 509t
Sole rashes, extremity abnormalities (DDx) ………… 512t
Solid organ transplant (SOT), transplant infections ………… 172
Sovaldi ………… 106t
Specific gravity, decreased, urinary abnormalities (DDx) ………… 523t
Spectam ………… 742
Spectinomycin ………… 742
Spectracef ………… 584
SPEP (monoclonal, polyclonal gammopathy), (DDx) ………… 519t
Sphenoid sinus, acute bacterial sinusitis ………… 31
Spherocytes, RBC abnormalities (DDx) ………… 517t
Spinal tenderness, back abnormalities (DDx) ………… 503t
Spirillum minus (rat bite fever) ………… 268
Spirochetes
aerobic ………… 244t
blood ………… 268
Splenomegaly, abdominal abnormalities (DDx) ………… 506t
Splinter hemorrhages, extremity abnormalities (DDx) ………… 509t
Spontaneous bacterial peritonitis (SBP) ………… 110
Sporanox ………… 672
Sporothrix schenckii
chronic septic arthritis ………… 137
cutaneous sporotrichosis ………… 308
fungal arthritis ………… 134
pulmonary sporotrichosis ………… 283
Sputum gram stain, clinical use ………… 261t
Squamous cell carcinoma, cavitary infiltrates (thick-walled) ………… 487
SQV (saquinavir) ………… 740
St. Louis encephalitis (St.LE) ………… 26
Staphylococcus aureus ………… 218
acute bacterial meningitis (ABM) ………… 19
animal bite wounds ………… 155
bacteremia vs + blood cultures ………… 11t
bone marrow transplant infection ………… 172
brain abscess ………… 28
burn wounds ………… 156
CAPD associated peritonitis ………… 109
cavitary infiltrates (thick-walled) ………… 483
complicated skin/skin structure tissue infections ………… 145
decubitus ulcers ………… 148
diabetic foot ulcers ………… 149
endocarditis ………… 81
acute bacterial (ABE) ………… 81
prosthetic valve (PVE) ………… 82
endophthalmitis ………… 36
human bite wounds ………… 155
infected joint prosthesis ………… 139
ischemic foot ulcers ………… 150
IV line (CVC) infections ………… 87
keratitis ………… 33
lung abscess/empyema ………… 72
mastoiditis ………… 40
osteomyelitis ………… 140
pacemaker infections ………… 85
pericarditis ………… 84
pneumonia (CAP) ………… 69
positive BCs vs. bacteremia ………… 11t
renal abscess ………… 118
sepsis ………… 164
septic arthritis ………… 132
skin abscesses/infected cysts ………… 151
solid organ transplant ………… 173
suppurative parotitis ………… 41
toxic shock syndrome (TSS) ………… 182
transplant infections ………… 172
vascular graft infections ………… 88
Staphylococcus epidermidis (CoNS) ………… 219t
brain abscess ………… 28
CAPD associated peritonitis ………… 109
CNS shunt infection ………… 19
endocarditis (PVE) ………… 83
infected joint prosthesis ………… 139
pacemaker infection (PPM) ………… 86
surgical prophylaxis ………… 375t
Staphylococcus lugdunensis ………… 219t
Staphylococcus saprophyticus ………… 220t
cystitis ………… 111
dysuria-pyuria syndrome ………… 111
Stavudine (d4T) ………… 742
Stenotrophomonas maltophilia ………… 241t
community acquired pneumonia ………… 56
Sternal tenderness, chest abnormalities (DDx) ………… 503t
Steroid therapy, chronic, pneumonia ………… 72
Stomach, upper small bowel surgery, surgical prophylaxis ………… 376t
Stomatitis ………… 45
Stool, parasites, fungi, unusual organisms in ………… 292
Streptobacillus moniliformis ………… 241t
septic arthritis ………… 134
Streptococcus anginosus (S. milleri) group (S. intermedius, S. anginosus, S. constellatus) ………… 223
Streptococcus (bovis) gallolyticus ………… 223t
endocarditis ………… 77
Streptococci. see Group A streptococci; Group B streptococci; Groups C, F, G streptococci; nutritionally-variant streptococci (NVS)
deep neck infections ………… 48
dental infections ………… 48
Streptococcus pneumoniae ………… 223t
acute bacterial exacerbation of chronic bronchitis (AECB) ………… 50
acute bacterial meningitis (ABM) ………… 18
acute otitis media ………… 39
adult immunization ………… 402t
brain abscess ………… 28
chronic medical prophylaxis ………… 384t
community acquired pneumonia (CAP) ………… 51
conjunctivitis ………… 34
epiglottitis ………… 49
HIV infection ………… 339t
prophylaxis ………… 337
keratitis ………… 33
lung abscess/empyema ………… 72
mastoiditis ………… 40
pericarditis ………… 84
prophylaxis of opportunistic infections ………… 337t
sepsis ………… 163
Streptomycin ………… 744
Stribild [elvitegravir (EVG) + combicistat (COBI) + emtricitabine (FTC) + tenofovir (TDF)] ………… 641
Strongyloides stercoralis ………… 294
transplant infections ………… 177
Strongyloidiasis ………… 294
Subacute bacterial endocarditis (SBE) ………… 76
Subconjunctival hemorrhage, eye abnormalities (DDx) ………… 498t
Subcutaneous serpiginous lesions ………… 306
Subdural empyema ………… 28
Superior vena cava syndrome, neck abnormalities (DDx) ………… 502t
Suppurating inguinal adenopathy ………… 128
Suppurative parotitis ………… 41
Suppurative pericarditis ………… 84
Supraclavicular adenopathy, lymph node abnormalities (DDx) ………… 507t
Suprax ………… 588
Surgical prophylaxis
arthroscopy ………… 377t
biliary tract surgery ………… 376t
cardiac valve replacement surgery ………… 375t
CNS shunt (VP/VA) placement, craniotomy, open CNS trauma ………… 375t
coronary artery bypass graft (CABG) surgery ………… 375t
distal small bowel, colon surgery ………… 376t
factors affecting efficacy of ………… 374t
hepatic surgery ………… 376t
orthopedic prosthetic implant surgery (total hip/knee replacement) ………… 377t
orthopedic surgery (open fracture) ………… 377t
pelvic (OB/GYN) surgery ………… 376t
stomach, upper small bowel surgery ………… 376t
thoracic (non-cardiac) surgery ………… 375t
TURP, cytoscopy ………… 377t
urological implant surgery ………… 377t
Sustiva ………… 637
Swimmers ear (external otitis) ………… 39
Swimming pool granuloma ………… 302
Swine influenza (H1N1) ………… 67
community acquired pneumonia ………… 53
post-exposure prophylaxis ………… 379t
Symmetrel ………… 551
Synercid ………… 729
Synergistic gangrene ………… 145
Syphilis ………… 129
latent ………… 129
neurosyphilis ………… 129
post-exposure prophylaxis ………… 380t
primary ………… 129
secondary ………… 129
tertiary ………… 129
T-achycardia, heart abnormalities (DDx) ………… 504t
Taenia multiceps, cerebral coenurosis ………… 277
Taenia saginata, beef tapeworm ………… 297
Taenia solium, neurocysticercosis ………… 277
Taenia solium, pork tapeworm ………… 297
Tamiflu ………… 710
Tapeworms, intestinal ………… 297
Target cells, RBC abnormalities (DDx) ………… 517t
Tazicef ………… 597
Tazidime ………… 597
Tazocin ………… 720
TB osteomyelitis ………… 143
TDF (tenofovir) ………… 749
Tedizolid ………… 745
pearls & pitfalls ………… 537
susceptibility profiles ………… 208t
Teflaro ………… 596
Teichoic acid antibody
titers (TAA) ………… 520t
Telavancin ………… 746
pearls & pitfalls ………… 539
susceptibility profiles ………… 208t
Telithromycin ………… 747
Temporal muscle wasting, head abnormalities (DDx) ………… 496t
Tender fingertips, extremity abnormalities (DDx) ………… 509t
Tenofovir disoproxil fumarate ………… 749
Tenosynovitis, extremity abnormality (DDx) ………… 510t
Terbinafine ………… 750
Tetanus ………… 183
adult immunization ………… 403t
travel prophylaxis ………… 395t
Tetanus prophylaxis in routine wound management
unknown or less than ………… 3 doses ………… 398t
Tetracycline ………… 750
pearls & pitfalls ………… 532
susceptibility profiles ………… 196t
Thigh tenderness (bilateral), extremity abnormality (DDx) ………… 510t
Thoracic surgery, surgical prophylaxis ………… 375t
3TC (lamivudine) ………… 676
3TC/ZDV (Combivir) ………… 677
Thrombocytopenia, platelet abnormalities (DDx) ………… 518t
Thrombocytosis, platelet abnormalities (DDx) ………… 518t
Thrombophlebitis
extremity abnormality (DDx) ………… 510t
intracranial suppurative ………… 28
septic ………… 87
septic pelvic ………… 110
Thrush ………… 44
HIV ………… 355
Ticar ………… 752
Ticarcillin ………… 752
Tivicay (dolvtegravir) ………… 631
Ticarcillin/clavulanate ………… 753
pearls & pitfalls ………… 532
susceptibility profiles ………… 196t
Tick-borne relapsing fever (TBRF) ………… 268
Tick typhus ………… 313
Tigecycline ………… 754
pearls & pitfalls ………… 538
susceptibility profiles ………… 208t
Time-dependent kinetics, antibiotics ………… 6t
Timentin ………… 753
Tinea capitis (scalp ringworm) ………… 160
Tinea corporis (body ringworm) ………… 158
Tinea cruris (jock itch) ………… 158
Tinea pedis ………… 159
Tinea versicolor (pityriasis) ………… 159
Tinidazole, pediatric dose ………… 443
Tipranavir (TPV) ………… 759
Tissue penetration, factor in antibiotic selection ………… 2
TMP ………… 762
TMP-SMX ………… 763
pearls & pitfalls ………… 535
susceptibility profiles ………… 196t
Tobramycin ………… 760
pearls & pitfalls ………… 533
susceptibility profiles ………… 208t
Tongue tenderness, mouth abnormalities (DDx) ………… 501t
Tongue ulcers, mouth abnormalities (DDx) ………… 501t
Tonsillar membranes, mouth abnormalities (DDx) ………… 502t
Tonsillar ulcers, mouth abnormalities (DDx) ………… 502t
Toxic shock syndrome (TSS) ………… 182
Toxin-mediated infectious diseases ………… 182
botulism ………… 183
diphtheria ………… 183
tetanus ………… 183
toxic shock syndrome (TSS) ………… 182
Toxoplasma gondii
cerebral toxoplasmosis ………… 275
chorioretinitis ………… 35
encephalitis ………… 26
HIV ………… 349
HIV, prophylaxis ………… 337
meningitis ………… 22
prophylaxis of opportunistic infections ………… 337
transplant infections ………… 136
TPV (tipranavir) ………… 759
Trachipleistophora, microsporidia enteritis ………… 354
Trachoma conjunctivitis ………… 35
Transplant prophylaxis (BMT/SOT) ………… 388t
Aspergillus sp. ………… 389t
Candida sp. ………… 389t
cytomegalovirus (CMV) ………… 389t
Herpes simplex (HSV) ………… 388t
PCP ………… 389t
toxoplasmosis ………… 389t
varicella zoster virus (VZV) ………… 388t
Transverse myelitis, neurological abnormalities (DDx) ………… 514t
Trapezius tenderness, chest abnormalities (DDx) ………… 503t
Travel prophylaxis ………… 392t
general infectious disease travel precautions ………… 392t
hepatitis A (HAV) ………… 394t
Japanese encephalitis (JE) ………… 395t
meningococcal meningitis ………… 394t
rabies ………… 396t
tetanus, diphtheria, pertussis ………… 396t
traveler‘s diarrhea ………… 394
typhoid fever ………… 395t
yellow fever ………… 395t
Travel vaccines, HIV ………… 340
Trecator ………… 652
Trematodes (flukes/flatworms), intestinal ………… 298
Treponema pallidum
post-exposure prophylaxis ………… 380t
syphilis ………… 129
Trichinella spiralis ………… 317
Trichinosis ………… 317
Trichomonas vaginalis, urethritis/cervicitis ………… 124
Trichophyton mentagrophytes, onychomycosis ………… 159
tinea corporis ………… 158
Trichophyton rubrum
onychomycosis ………… 159
tinea corporis ………… 158
Trichosporon beigelii, trichosporon ………… 307
Trichostrongyliasis ………… 294
Trichostrongylus orientalis ………… 294
Trichuris trichiura ………… 297
Trimethoprim ………… 762
Trimethoprim-sulfamethoxazole ………… 763
Trimox ………… 554
Trimpex ………… 762
Trismus, mouth abnormalities (DDx) ………… 501t
Triumeq ………… 333t
Trizivir [abacavir (ABC) + lamivudine (3TC) + zidovudine (ZDV)] ………… 548
Trobicin ………… 742
Tropheryma whippelli, Whipple‘s disease ………… 299
Truvada [emtricitabine (FTC) + tenofovir (TDF)] ………… 643
Trypanosoma brucei
cruzi ………… 265
gambiense ………… 265
rhodesiense ………… 266
Trypanosoma brucei cruzi, Chagas‘ disease ………… 288
Trypanosomes in blood ………… 265
Trypanosomiasis
American ………… 265
East African ………… 266
West African ………… 265
Tsutsugamushi fever ………… 313
Tuberculosis. see Mycobacterium tuberculosis
Tuberculosis endophthalmitis ………… 36
Tuboovarian abscess ………… 122
Tularemia pneumonia ………… 187
bioterrorist ………… 187
post-exposure prophylaxis ………… 383t
TURP, surgical prophylaxis ………… 377t
Tygacil ………… 754
Typhoid fever ………… 94
travel prophylaxis ………… 395t
Typhus
epidemic ………… 314
flying squirrel ………… 313
murine ………… 314
scrub ………… 315
tick ………… 315
T20 (enfuvirtide) ………… 645
U-lcer-node syndromes, lymph node abnormalities (DDx) ………… 507t
Ulcers
Buruli ………… 302
foot/leg ………… 510t
frenal ………… 501t
genital ………… 127
mouth ………… 45
oral ………… 501t
peptic ………… 91
perirectal ………… 508t
skin ………… 148
tongue ………… 501t
tonsillar ………… 502t
Ultra ………… 666
Ultracef ………… 580
Unasyn ………… 566
Unipen ………… 700
Unsafe water (fecally-contaminated), infectious disease travel precautions ………… 392t
Ureaplasma urealyticum
post-exposure prophylaxis ………… 380t
urethritis/cervicitis ………… 123
Urethritis
gonoccocal (GC) ………… 123
non-gonococcal (NGU) ………… 123
Urex ………… 691
Urinary abnormalities (DDx)
chyluria ………… 524t
eosinophiluria ………… 524t
hematuria, gross/microscopic ………… 523t
leukocyte esterase ………… 523t
myoglobinuria (2° to rhabdomyolysis) ………… 524t
nitrite positive ………… 523t
proteinuria ………… 523t
pyuria ………… 522t
specific gravity, decreased ………… 523t
urinary pH, alkaline/acidic ………… 523t
Urinary pH, alkaline/acidic, urinary abnormalities (DDx) ………… 523t
Urinary tract infections (UTIs), chronic medical prophylaxis ………… 384t
Urine gram stain, clinical use ………… 261t
Urological implant surgery, surgical prophylaxis ………… 377t
Urosepsis ………… 120
community-acquired ………… 120
urologic procedure ………… 121
Urticaria, general appearance abnormalities (DDx) ………… 496t
USFDA use-in-pregnancy letter code ………… 545t
Usual dose, explanation ………… 541
Uveitis, eye abnormalities (DDx) ………… 499t
Uvular edema, mouth abnormalities (DDx) ………… 502t
V-accinations. (see Adult immunizations) Immunizations
Vaginosis ………… 125
Vaginitis ………… 125
Vaginitis, Candida (HIV) ………… 358
Valacyclovir ………… 766
Valcyte ………… 767
Valganciclovir ………… 767
Valtrex ………… 766
Vancocin ………… 769
Vancomycin ………… 769
pearls & pitfalls ………… 536
susceptibility profiles ………… 208t
Vancomycin resistant enterococci (VRE) ………… 221
Vancomycin sensitive enterococci
(VSE) ………… 220
Vantin ………… 594
Varicella (VZV) chickenpox
adult immunization ………… 403t
post-exposure prophylaxis ………… 380t
Varicella zoster virus (VZV). (see also Herpes zoster)
chickenpox ………… 154
encephalitis ………… 25
herpes zoster ………… 328
HIV ………… 363
shingles ………… 154
Variola virus
post-exposure prophylaxis ………… 383t
smallpox ………… 187
Vascular graft infections ………… 88
Venezuelan equine encephalitis (VEE) ………… 26
Ventilator-associated pneumonia (VAP) ………… 74
Verrucous foot/leg lesions, extremity abnormality (DDx) ………… 510t
Verrucous hand/arm lesions, extremity abnormality (DDx) ………… 511t
Vesicles, skin ………… 306
Vfend ………… 772
Vibativ ………… 746
Vibramycin ………… 634
Vibra-tabs ………… 634
Vibrio alginolyticus ………… 242t
Vibrio cholerae ………… 242t
travel prophylaxis ………… 395t
Vibrio parahaemolyticus ………… 242t
Vibrio sp. saltwater wounds ………… 156
Vibrio vulnificus ………… 242t
saltwater wounds ………… 156
Videx (didanosine) ………… 630
Viekira Pak ………… 106t
Vincent‘s angina ………… 45
Viracept (nelfinavir) ………… 701
Viral conjunctivitis ………… 34
Viral esophagitis ………… 91
Viral hemorrhagic fever, post-exposure prophylaxis ………… 383t
Viral hepatitis ………… 105
Viral influenza (human seasonal), post-exposure prophylaxis ………… 378t
Viral pharyngitis ………… 43
Viramune (nevirapine) ………… 703
Viread (tenofovir) ………… 749
Viridans streptococci endocarditis prosthetic, subacute (SBE) ………… 76
Viridans prosthetic valve endocarditis ………… 83
streptococci ………… 223t
bone marrow transplant infection ………… 172
Visceral leishmaniasis (kala-azar) ………… 290
Vistide ………… 610
Vitiligo, general appearance abnormalities (DDx) ………… 496t
Volume of distribution, explanation ………… 542
Voriconazole ………… 772
VRE. see Vancomycin-resistant enterococci (VRE)
VZV
community acquired pneumonia ………… 54
conjunctivitis ………… 34
encephalitis ………… 25
HIV, prophylaxis ………… 337
meningitis (aseptic) ………… 21
ophthalmicus ………… 35
post-exposure prophylaxis ………… 380t
prophylaxis of opportunistic infections ………… 388t
W-arts, genital/perianal ………… 128
Watery eyes, eye abnormalities (DDx) ………… 499t
WBC abnormalities (DDx)
atypical lymphocytes ………… 515t
basophilia ………… 516t
eosinophilia ………… 516t
immunoblasts ………… 515t
leukocytosis ………… 514t
leukopenia ………… 514t
lymphocytosis ………… 515t
monocytosis ………… 515t
relative lymphocytosis, ………… 515t
relative lymphopenia ………… 515t
WBC inclusions ………… 516t
WBC inclusions, WBC abnormalities (DDx) ………… 516t
West African trypanosomiasis ………… 265
Western equine encephalitis (WEE) ………… 26
West Nile encephalitis (WNE) ………… 26
meningitis ………… 21
Wheezing, diffuse, chest abnormalities (DDx) ………… 503t
Whipple‘s disease ………… 299
Whipworm ………… 295
Wound infections ………… 155
animal bite ………… 155
burns ………… 156
cat scratch disease (CSD) ………… 155
freshwater ………… 156
human bite ………… 155
saltwater ………… 156
Wrist swelling, extremity abnormality (DDx) ………… 510t
Wuchereria bancrofti ………… 264
Wymox ………… 554
Y-easts/fungi, clinical significance, pending susceptibility testing ………… 252t
Yellow fever ………… 194
travel prophylaxis ………… 395t
Yersinia
diarrhea ………… 92
travel prophylaxis ………… 394t
Yersinia enterocolitica ………… 242t
Yersinia pestis (plague) ………… 243t
bioterrorist, pneumonic plague ………… 187
post-exposure prophylaxis ………… 382t
Z-ZDV (zidovudine) ………… 775
Zerbaxa ………… 603
Zerit (stavudine) ………… 742
Ziagen (ABC) ………… 546
Zidovudine (ZDV) ………… 548
Zinacef ………… 606
Zithromax ………… 573
Zoonotic atypical pneumonias ………… 66t
diagnostic features ………… 66t
Zosyn ………… 720
Zovirax ………… 549
Zygomycosis, cutaneous ………… 308
Zyvox ………… 682
Note: Tables are noted with a t.
×
Chapter Notes

Save Clear


Overview of Antimicrobial TherapyChapter 1

Cheston B. Cunha, MD, Burke A. Cunha, MD
  • Factors in Antibiotic Selection ……………… 2
    • Spectrum ……………… 2
    • Tissue Penetration ……………… 2
    • Antibiotic Resistance Potential (Table 1.1) ……………… 3
    • Safety Profile ……………… 4
    • Cost ……………… 4
  • Hemodialysis Dosing Strategies (Table 1.2) ……………… 4
  • Microbiology and Susceptibility Testing ……………… 5
    • In Vitro vs. In Vivo Susceptibility (Table 1.3) ……………… 5
  • PK/PD and Other Considerations in Antimicrobial Therapy ………………6
    • Concentration vs. Time Dependent Kinetics (Table 1.4) Bactericidal vs. Bacteriostatic Therapy ……………… 7
    • Monotherapy vs. Combination Therapy. ……………… 7
    • IV to PO Switch Therapy ……………… 7
    • Bioavailability of Oral Antimicrobials (Table 1.5) ……………… 8
    • OPAT ……………… 8
    • Duration of Antibiotic Therapy ……………………… 9
  • Colonization vs. Infection ………………9
    • Urine (AUC and CAB) (Table 1.6) ………………………9
    • Respiratory Secretions (Table 1.7) …………………… 10
    • Wounds (Table 1.8) ……………………………… 10
    • Sacral Decubitus Ulcers and Diabetic Foot Ulcers (Table 1.9) ……………………………… 11
    • Positive Blood Cultures vs. Bacteremia (MSSA, MRSA, CoNS) (Table 1.10). ……………………………… 11
  • Drug Fever (Table 1.11). ……………………………… 12
    • Relative Bradycardia (Table 1.12) ……………………………… 12
  • Antibiotic Failure (Table 1.13). ……………………………… 13
  • Antimicrobial Stewardship: Principles and Practice (Table 1.14). ……………………………… 132
Overview of Antimicrobial Therapy
 
FACTORS IN ANTIBIOTIC SELECTION
 
Spectrum
  • Antibiotic spectrum refers to the range of microorganisms an antibiotic is usually effective against, and is the basis for empiric antibiotic therapy.
  • In vitro susceptibility does not always predict in vivo effectiveness.
 
Tissue Penetration
  • Antibiotics unable to reach the site of infection will be ineffective. Antibiotic tissue penetration depends on antibiotic properties, e.g., lipid solubility, molecular size, adequacy of blood supply and presence of inflammation.
  • Antibiotics cannot be expected to eradicate organisms from difficult to penetrate areas. Abscesses usually require surgical drainage for cure.
  • Device associated infections usually need device removal for cure.
 
Antibiotic Resistance
  • Bacterial resistance to antimicrobial therapy may be classified as natural/intrinsic or acquired relative or absolute.
  • Pathogens not covered by the usual spectrum of an antibiotic are termed naturally/intrinsically resistant, e.g., 25% of S. pneumoniae are naturally resistant to macrolides.
  • Acquired resistance refers to a previously susceptible pathogen that is no longer susceptible to an antibiotic, e.g., ampicillin resistant H. influenzae. Organisms with intermediate level (relative) resistance manifest as an increase in minimum inhibitory concentrations (MICs), but are susceptible if achievable serum/tissue concentrations > MIC, e.g., penicillin resistant S. pneumoniae and PCN.
  • Organisms with high level (absolute) resistance cannot be overcome by higher-than-usual antibiotic doses, e.g., gentamicin resistant P. aeruginosa.
  • Most acquired antibiotic resistance is agent specific, not class related resistance (usually limited to one or two species).
  • Resistance is not related, per se, to volume or duration of use, e.g., doxycycline, ceftriaxone.
  • Some antibiotics have little resistance potential, i.e., “low resistance” potential even when used in high volume. Other antibiotics can induce resistance, e.g., “high resistance” potential even with limited use.3
Table 1.1   Resistance Potential of Selected Antibiotics
“High Resistance Potential” Antibiotics to Avoid
Usual Organism(s) Resistant to Each Antibiotic
Preferred “Low Resistance Potential” Antibiotic Alternatives in Same Class
Preferred “Low Resistance Potential” Antibiotic Alternatives in Different Classes
Aminoglycosides
Gentamicin or Tobramycin
P. aeruginosa
Amikacin
Levofloxacin, Colistin, Cefepime
Cephalosporins
Ceftazidime
P. aeruginosa
Cefepime
Levofloxacin, Colistin, Polymyxin B
Tetracyclines
Tetracycline
S. pneumoniae S. aureus
Doxycycline, Minocycline
Levofloxacin, Moxifloxacin
Quinolones
Ciprofloxacin
S. pneumoniae
Levofloxacin, Moxifloxacin
Doxycycline
Ciprofloxicin
P. aeruginosa
Levofloxacin
Amikacin, Colistin, Cefepime
Glycopeptides
Vancomycin
MSSA MRSA
None
Linezolid, Daptomycin, Minocycline, Tigecycline
Carbapenems
Imipenem
P. aeruginosa
Meropenem,
Doripenem
Amikacin, Cefepime, Colistin, Polymyxin B
Macrolides
Azithromycin
S. pneumoniae
None
Doxycycline, Levofloxacin, Moxifloxacin
Dihydrofolate Reductase Inhibitors
TMP-SMX
S. pneumoniae
None
Doxycycline, Levofloxacin, Moxifloxacin
4
 
Safety Profile
  • Whenever possible, avoid antibiotics with serious/frequent side effects.
 
Mode of Antibiotic and Excretion/Excretory Organ Toxicity
  • The mode of elimination/excretion does not predispose to excretory organ toxicity per se, e.g., nafcillin (hepatically eliminated) is not hepatotoxic, and it's main side effect is nephrotoxicity (interstitial nephritis). In contrast, oxacillin (renally eliminated), is not nephrotoxic, it's main side effect is hepatotoxicity (hepatitis).
  • The primary route of antibiotic elimination is protective and does not predispose to excretory organ toxicity.
 
Cost
  • Switching early from IV to PO antibiotics is the single most important cost saving strategy in hospitalized patients.
  • Institutional cost of IV administration (~ $10/dose) may exceed the cost of the antibiotic.
  • Antibiotic costs can also be minimized by using antibiotics with long half-lives, by choosing monotherapy over combination therapy, and decreasing duration of therapy.
 
HEMODIALYSIS (HD) DOSING STRATEGIES
 
Intra-HD Dosing
  • For renally eliminated antibiotics, begin therapy with the usual initial dose, then decrease the maintenance doses/intervals for a CrCl < 10 mg/min (for specific antibiotics, see Chapter 11, Drug Summaries).
  • For antibiotics partially/totally removed by HD, a post-HD is needed (for specific antibiotics, see Chapter 11, Drug Summaries).
 
HD Dosing Only
  • For selected antibiotics with the requisite PK/PD properties, treatment may be given at each HD (Table 1.2).
Table 1.2   Selected Antibiotics for Dialysis Dosing (Regimens that do not require Intra-HD Dosing)
Antibiotic
ESRD (t½h)
Clinical Spectrum
Resistance Potential
Dialysis Dosing
Cefazolin
40 hours
MSSA,
Klebsiella pneumoniae,
E. coli
Low
2 gm (IV) q HD
Cefepime
18 hours
P. aeruginosa,
Aerobic GNBs
Low
2 gm (IV) q HD5
Ceftazidime
21 hours
P. aeruginosa,
Aerobic GNB
High
(P. aeruginosa)
2 gm (IV) q HD
Daptomycin
30 hours
MSSA, MRSA,
VSE, VRE
Low
6-12 mg/kg (IV) q HD*
Levofloxacin
40 hours
P. aeruginosa,
Aerobic GNBs,
MSSA
Low
500 mg (IV/PO) q HD
Meropenem
7 hours
P. aeruginosa, Aerobic GNBs, MSSA, VSE
Low
2 gm (IV) q HD
* For bacteremia due to MSSA/MRSA use 6 mg/kg, for VSE/VRE use 12 mg/kg.
 
MICROBIOLOGY AND SUSCEPTIBILITY TESTING
Limitations of Microbiology Susceptibility Testing
  • In vitro data do not differentiate between colonizers and pathogens.
  • In vitro data do not necessarily translate into in vivo efficacy.
  • Antibiotic activity-effectiveness depends on body site concentrations local pH, degree of inflammation, cellular debris, local oxygen levels, blood supply and penetrability.
  • In vitro susceptibility testing is dependent on the microbe, methodology, pH, and antibiotic concentration.
  • In vitro susceptibility testing assumes the isolate was recovered from blood, using serum concentrations of an antibiotic given in the usual dose.
  • Since some body site, e.g., bladder urine contains higher antibiotic concentrations than found in serum, and other body sites, e.g., CSF levels may be lower than in serum, i.e., in vitro susceptibility may be misleading for non-bloodstream infections.
  • Antibiotics should be prescribed at the usual recommended doses; attempts to lower cost by reducing dosage may decrease antibiotic efficacy, e.g., cefoxitin 2 gm IV inhibits ~ 85% of B. fragilis, whereas 1 gm IV inhibits only ~ 20%.6
Table 1.3   Antibiotic-Organism Combinations for Which In Vitro Susceptibility Testing Does Not Predict In Vivo Effectiveness
Antibiotic
“Susceptible” Organism
Penicillin
H. influenzae, Yersinia pestis, VSE*
TMP–SMX
Klebsiella, VSE, Bartonella
Polymyxin B
Proteus, Salmonella
Imipenem
Stenotrophomonas maltophilia
Vancomycin
Erysipelothrix rhusiopathiae
Gentamicin
Mycobacterium tuberculosis
Aminoglycosides
Streptococci, Salmonella, Shigella
Clindamycin
Fusobacteria, Clostridia, Listeria
Macrolides
P. multocida
1st, 2nd generation cephalosporins
Salmonella, Shigella, Bartonella
3rd, 4th generation cephalosporins
Listeria, Bartonella, MRSA
Quinolones
MRSA
In spite of apparent in vitro susceptibility of antibiotics against MRSA, only vancomycin, minocycline, quinupristin/dalfopristin, linezolid, tedizolid, daptomycin, ceftaroline fosamil, telavancin, dalbavancin, oritavancin, and tigecycline are effective in vivo. * Effective penicillin therapy for systemic enterococcal infections due to VSE requires an aminoglycoside, e.g., gentamicin.
 
PK/PD AND OTHER CONSIDERATIONS IN ANTIMICROBIAL THERAPY
 
Antibiotic Dosing: Concentration vs. Time Dependent Kinetics
Table 1.4   Pharmacokinetic/Pharmacodynamic (PK/PD) Considerations
Antibiotics
Optimal Dosing Strategies
Concentration Dependent Antibiotics (Cmax: MIC)
  • Quinolones
  • Aminoglycosides
  • Vancomycin (if MIC ≥ 1 mcg/ml) use 2 gm (IV) q12h
  • Doxycycline
  • Tigecycline
  • Colistin/ Polymyxin B
Use highest effective dose (without toxicity)7
Time Dependent Antibiotics (T > MIC)
  • PCN: maintain concentrations > MIC for ≥ 60% of the dosing interval
  • β-lactams: maintain concentrations > MIC for ≥ 75% of the dosing interval
  • Carbapenems: maintain concentrations > MIC for ≥ 40% of the dosing interval
  • Vancomycin (if MIC ≤ 1 mcg/mL) use 1 gm (IV) q12h
Use high doses (which increase serum concentrations which also increase T > MIC for more of the dosing interval)
Other Antibiotics (Cmax: MIC/T>MIC and or AUC 0-24/MIC)
  • Quinolones
    > 125 (effective)
    > 250 (more effective)
Use highest effective dose (without toxicity)
 
Bactericidal vs. Bacteriostatic Therapy
  • For most infections, bacteriostatic and bactericidal antibiotics inhibit/kill organisms at the same rate, and should not be a factor in antibiotic selection.
  • Bactericidal antibiotics have an advantage in certain infections, such endocarditis, meningitis, and febrile leukopenia, but there are exceptions even in these cases.
 
Monotherapy vs. Combination Therapy
  • Monotherapy is preferred to combination therapy for nearly all infections.
  • In addition to cost savings, monotherapy results in less chance of medication error and fewer missed doses/drug interactions.
  • Combination therapy may be useful for drug synergy or for extending spectrum beyond what can be obtained with a single drug.
  • Combination therapy is not effective in preventing antibiotic resistance, except in very few situations.
 
IV to PO Switch Therapy
  • Patients admitted to the hospital are usually started on IV antibiotic therapy, then switched to equivalent oral therapy after clinical improvement/defervescence (usually within 72 hours).
  • Advantages of early IV-to-PO switch programs include reduced cost, early hospital discharge, less need for home IV therapy, and virtual elimination of IV line infections.
  • Drugs well-suited for IV-to-PO switch or for treatment entirely by the oral route have high bioavailibility, e.g., doxycycline, minocycline, clindamycin, metronidazole, chloramphenicol, amoxicillin, trimethoprim-sulfamethoxazole, quinolones, and linezolid.8
Table 1.5   Bioavailability of Oral Antimicrobials
Bioavailability
Antimicrobials
Excellent (> 90%)
Amoxicillin
Cephalexin
Cefprozil
Cefadroxil
Clindamycin
Quinolones
Chloramphenicol
TMP
TMP–SMX
Doxycycline
Minocycline
Fluconazole
Metronidazole Cycloserine
Linezolid
Tedizolid
Isavuconazole
Voriconazole
Rifampin
Isoniazid
Pyrazinamide
Good (60–90%)
Cefixime
Cefpodoxime
Ceftibuten
Cefuroxime
Valacyclovir
Famciclovir
Valganciclovir
Macrolides
Cefaclor
Nitrofurantoin
Ethambutol
5-Flucytosine
Posaconazole
Itraconazole (solution)
Nitazoxanide (with food)
Poor (< 60%)
Vancomycin
Acyclovir
Cefdinir
Cefditoren
Nitazoxanide (without food)
Fosfomycin
 
Oral Antibiotic Therapy for Serious Systemic Infections
  • Most infectious diseases should be treated orally unless the patient is critically ill, cannot take antibiotics by mouth, or there is no equivalent oral antibiotic.
  • If the patient is able to take/absorb oral antibiotics, there is no difference in clinical outcome using equivalent IV or PO antibiotics.
  • It is more important to think in terms of antibiotic spectrum, bioavailability and tissue penetration, rather than route of administration.
  • Nearly all non-critically ill patients may be treated in part or entirely with oral antibiotics.
  • When switching from IV to PO therapy, oral antibiotic chosen should have the same spectrum/degree of activity against the presumed/known pathogen and achieve the same blood and tissue levels as the equivalent IV antibiotic.
 
OPAT (outpatient parenteral antibiotic therapy)
  • OPAT has been used to treat infections IV on an outpatient basis or to complete IV therapy begun during hospitalization. Preferred OPAT antibiotics are those with few adverse effects and those with a long serum half life. The most frequently used OPAT antibiotics are ceftriaxone and vancomycin.9
  • Other agents with long t1/2 ideal for OPAT of Gram positive cSSSIs due to MRSA are telavancin 10 mg (IV) q 24 h, dalbavancin 1 gm (IV) × 1 doses then 500 mg (IV) × 1 dose 7 days later; tedizolid 200 mg (IV)q 24 h × 6 days, then 200 mg (PO) q 24 h × 6 days; and oritavancin 1200 mg (IV) × 1 dose.
  • The preferred alternative to OPAT is oral antibiotic therapy, e.g., for MRSA, minocycline or linezolid are equally efficacious as OPAT regimens.
 
Duration of Therapy
  • Most bacterial infections in normal hosts are treated with antibiotics for 1–2 weeks.
  • The duration of therapy may need to be extended in patients with impaired immunity, e.g., diabetes, SLE, alcoholic liver disease, neutropenia, diminished splenic function, etc., chronic bacterial infections e.g., endocarditis, osteomyelitis, chronic viral and fungal infections, or certain bacterial intracellular pathogens.
 
COLONIZATION VS. INFECTION
Table 1.6   Colonization vs. Infection†: Acute Uncomplicated Cystitis (AUC) and Catheter Associated Bacteriuria (CAB)*
Inflammation
  • Pyuria (> 30 WBCs/hpf) with no or low grade bacteriuria (< 50 cfu/mL).
Colonization
  • AUC: bacteriuria with minimal pyuria (< 10 WBCs/hpf) and low grade bacteriuria (< 50 cfu/mL).
  • CAB: bacteriuria with pyuria (> 10 WBCs/hpf)§ and bacteriuria (> 50 cfu/mL)
Infection
  • AUC with moderate – high grade pyuria (>10 WBCs/hpf) and high grade bacteriuria (>100 cfu/mL)*.
  • CAB (UA/UC after Foley removed/replaced) with >10 WBCs/hpf and high grade bacteriuria (> 100 cfu/mL)*
* If indwelling urinary catheter, change/replace catheter and repeat AU/UC before considering treatment UTI = high grade pyuria with high grade bacteriuria. Pyuria ≠ UTI; Dysuria ≠ UTI; Bacteriuria ≠ UTI § clumps = high grade pyuria.10
 
COLONIZATION VS. INFECTION
Table 1.7   Colonization vs. Infection: Respiratory Secretions
  • Colonization of respiratory secretions in ventilated patients is the rule and a function of days intubated.
  • GNB from the ICU milieu colonize respiratory secretions.
  • Common GNB colonizers include Klebsiella, Enterobacter, Serratia, S. maltophilia, B. cepacia and P. aeruginosa.
  • Most GNB colonizing organisms rarely, if ever, cause NP/VAP, e.g., Enterobacter, S. maltophilia, B. cepacia.
  • In ventilated patients with fever, leukocytosis, and infiltrates on CXR organisms cultured from respiratory secretions should be considered as airway colonizers and not the cause of NP/VAP unless accompanied by the characteristic clinical features of the pathogen.
  • Klebsiella pneumonia presents with fevers and rapid cavitation (3-5 days after infiltrates) P. aeruginosa pneumonia presents with high spiking fevers, and rapid cavitation (<3 days after infiltrates).
  • Ventilated patients treated with antibiotics with minimal S. aureus activity, e.g., ciprofloxacin, ceftazidime are often colonized with MSSA or MRSA, but do not develop S. aureus NP/VAP.
  • S. aureus (MSSA or MRSA) may cause CAP with influenza pneumonia but rarely, if ever, causes NP/VAP.
  • Data suggesting that S. aureus in ventilated patients with fever, leukocytosis and infiltrates on CXR is a common cause of NP/VAP is based on respiratory secretion cultures and represents colonization and not the cause of NP.
  • Such data represents colonization of respiratory secretions in ventilated patients. Without the distinctive clinical features of MSSA or MRSA pneumonia, e.g., high fevers, clinical deterioration and rapid cavitation (<3 days) on CXR the patients should be considered as colonized or may have tracheobronchitis.
 
COLONIZATION VS. INFECTION
Table 1.8   Colonization vs. Infection: Draining Wounds
Wound drainage
Wound Gram stain
Wound culture
Diagnosis
Clear
Few or some WBCs
+
Colonization
Serous
Few or some WBCs
+
Colonization
Serosanguineous
Few or some WBCs
+
Colonization
Purulent
Abundant WBCs
+
Infection
11
Table 1.9   Colonization vs. Infection: Sacral Decubitus (Stage III/IV) and Diabetic Foot Ulcers (± osteomyelitis)
Always treat the usual pathogens (related to body site flora) rather than just “covering the cultured organism” (particularly if the specimen is not representative of the infected tissue).
  • Diabetic foot ulcers with infections at the body site, chronic osteomyelitis
    Cover the usual pathogens: GAS, GBS, common coliforms, S. aureus, and B. fragilis (not P. aeruginosa)
    Do not cover surface ulcer colonizers cultured: P. aeruginosa, Acinetobactor, VSE/VRE, Enterobacter, Burkholderia, Stenotrophomonas
    • Do not rely on deep ulcer/fistula cultures (which represent skin flora) and are not reflective of bone pathogens, i.e., osteomyelitis.
    • If P. aeruginosa is cultured from deep ulcer/fistula, do not cover only for P. aeruginosa. Over 95% of diabetic foot ulcers/fistulas will be culture positive from P. aeruginosa (due to P. aeruginosa colonization from wet socks, wet dressings, whirlpool baths). In aseptically collected bone specimens in the OR, P. aeruginosa is NOT a bone pathogen in diabetics with chronic osteomyelitis.
  • Sacral decubitus ulcers (stage III/IV) = chronic osteomyelitis
    Cover the usual pathogens:
       GAS, GBS, S. aureus, common coliforms, and B. fragilis.
    Do not cover ulcer surface colonizers cultured:
       Stenotrophomonas, Acinetobacter, Enterobacter, P. aeruginosa, Burkholderia
Table 1.10   Positive Blood Cultures vs. Bacteremia (MSSA, MRSA, CoNS)
Factors Favoring + Blood Cultures (not bacteremia)
Factors Favoring Bacteremia (not BC skin contaminants)
MSSA/MRSA + BCs (skin contamination likely) with:
MSSA/MRSA Bacteremia with:
  • Intermittently positive BCs
  • Low level/low grade BC positivity (1/4 – 2/4 BCs +)
  • TTPC = > 2 days
  • No clinical source of MSSA/MRSA bacteremia (CVC, abscesses, osteomyelitis, ABE)
  • Persistently positive BCs
  • High level/high grade bacteremia (3/4 – 4/4 BCs +)
  • TTPC = < 2 days
  • Clinical source of MSSA/MRSA bacteremia clinically apparent (CVC, abscesses, osteomyelitis, ABE)
CoNS (skin contamination likely) with:
  • Intermittently positive BCs
  • Low level/low grade BC positivity (1/4 − 2/4 + BCs)
  • TTPC = > 2 days
  • No clinical source of CoNS + BCs (CVC, implanted orthopedic/cardiac devices, prosthetic materials, severe/prolonged neutropenia)
CoNS Bacteremia (infection likely) with:
  • Persistently positive BCs
  • High level/high grade bacteremia (3/4 – 4/4 BCs +)
  • TTPC = < 2 days
  • Clinical source of + BCs for CoNS apparent (CVC, implanted orthopedic/cardiac devices, pros- thetic materials, severe/prolonged neutro- penia)
12
Implanted/prosthetic device associated: Dx = gallium or indium scan. ABE: Dx = cardiac vegetation. Abscess Dx = Gallium scan or CT scan. CVC associated: Dx = SQ removed CVC tip culture with > 15 col of same organism as in BCs not drawn from the CVC. TTPC = time to positive culture
Table 1.11   Clinical Features of Drug Fever
History
  • Many but not all individuals are atopic
  • Patients have been on a sensitizing medication for days or years “without a problem”
Physical exam
  • Relative bradycardia
  • Fevers may be low- or high-grade, but usually range between 102°–104°F and may exceed 106°F
  • Patient appears “inappropriately well” for degree of fever
Laboratory tests
  • Elevated WBC count (usually with left shift)
  • Eosinophils almost always present, (but eosinophilia is uncommon)
  • Elevated erythrocyte sedimentation rate in most
  • Early, transient, mild elevations of serum transaminases (common)
  • Negative blood cultures (excluding contaminants)
Table 1.12   Relative Bradycardia: Pulse/Temperature-Pulse Relationships*
Temperature
Appropriate Pulse Response (beats/min)
If Relative Bradycardia Pulse (beats/min)
106°F (41.1°C)
105°F (40.6°C)
104°F (40.7°C)
103°F (39.4°C)
102°F (38.9°C)
150/min
140/min
130/min
120/min
110/min
< 140/min
< 130/min
< 120/min
< 110/min
< 100/min
* Relative bradycardia refers to heart rates that are inappropriately slow relative to body temperature (pulse must be taken simultaneously with temperature elevation).
  • Applies to adult patients with temperature ≥ 102°F
  • Does not apply to patients with second/third-degree heart block, pacemaker-induced rhythms, or those taking beta-blockers, diltiazem, or verapamil.
13
 
ANTIBIOTIC FAILURE
Table 1.13   Causes of Apparent/Actual Antibiotic Failure
Microbiologic Factors
  • In vitro susceptibility but ineffective in vivo
  • Antibiotic “tolerance” with Gram-positive cocci
  • Treating colonization (vs. infection)
Antibiotic Factors
  • Inadequate antimicrobial spectrum
  • Inadequate antibiotic blood/tissue levels
  • Decreased antibiotic activity in tissue
  • Drug-drug interactions (inactivation/antagonism)
Antibiotic Penetration Problems
  • Undrained abscess
  • Foreign body associated infection
  • Protected focus e.g., cerebrospinal fluid
  • Organ hypoperfusion/diminished blood supply, e.g. DM, PVD
Non-infectious Diseases
  • Medical disorders mimicking infection e.g., SLE, malignancies
  • Drug fever
Antibiotic Unresponsive Infectious Diseases
  • Viral or fungal infections
 
ANTIMICROBIAL STEWARDSHIP: PRINCIPLES AND PRACTICE
Table 1.14   Antimicrobial Stewardship: Principles and Practice
Colonization vs. Infection (see also Tables 1.61.10)
  • Treat infection, not colonization.
  • Provide empiric coverage primarily directed against the most probable pathogens causing the infection at the body site.
  • Avoid “covering” or “chasing” multiple organisms cultured that are (pathogens and non-pathogens) at the body site cultured.
  • Selectively treat CAB in immunocompromised hosts. Avoid treating CAB in normal hosts.
  • Colonization of respiratory secretions, wounds, or urine with “water” (S. maltophilia, B. cepacia, P. aeruginosa) or skin organisms (MSSA, MRSA, CoNS, VSE, VRE) is the rule.
Narrow vs. Broad Spectrum Therapy
  • Narrow vs broad spectrum doesn't prevent resistance, e.g., in treating E. coli urosepsis switching from a carbapenem (broad spectrum) to ampicillin (narrow spectrum) may actually increase resistance potential.14
  • Narrow spectrum vs broad spectrum is not clinically superior to well chosen broad spectrum therapy, e.g., switching from ceftriaxone (broad spectrum) to penicillin (narrow spectrum in treating S. pneumoniae has no clinical rationale or clinical advantage and has no effect on controlling resistance.
  • Antibiotic resistance potential is related to individual antibiotics and not antibiotics class, e.g., meropenem (low resistance potential) vs. imipenem (high resistance potential).
  • Antibiotic resistance is not related to spectrum narrowness or broadness, e.g., levofloxacin (broad spectrum but “low resistance potential”) vs ampicillin (narrow spectrum but “high resistance potential”).
Antibiotic Resistance (see also Table 1.1)
  • The best way to control resistance is a selectively restricted formulary; restricted only to “high resistance potential” antibiotics, e.g., ciprofloxacin (not levofloxacin or moxifloxacin), imipenem (not meropenem or ertapenem), cefazidime (not other 3rd of 4th GC), gentamicin/tobramycin (not amikacin).
  • Some antibiotics may be restricted for other reasons, e.g., excessive vancomycin (IV not PO) use predisposes to VRE emergence and vancomycin may cause cell wall thickening in S. aureus resulting in permeability related resistance (to vancomycin and other antibiotics, e.g., daptomycin).
  • Over-restriction of antibiotics may impair timely effective therapy and does not, per se, decrease resistance.
  • Preferentially select antibiotics (all other things being equal) with a “low resistance potential”. Avoid, if possible, “high resistance potential” antibiotics, e.g., macrolides (for respiratory infections), TMP-SMX (for UTIs).
  • Except for TB therapy, combination therapy doesn't prevent resistance. The only examples of combination therapies that prevent resistance are carbenicillin + gentamicin and FC + amphotericin B.
  • Since resistance is, in part, concentrations dependant, subtherapeutic or low antibiotic tissue concentrations, (all other things being equal) predisposes to resistance.
  • Suboptimal dosing or usual dosing with inadequate tissue penetration, e.g., into the body fluids or undrained abscesses (source control is key) also predisposes to resistance.
  • Treat for the shortest duration of therapy that is effective in eliminating the infection.
Monotherapy vs. Combination Therapy
  • Preferably use monotherapy whenever possible to cover the most likely pathogen or cultured pathogen clinically relevant to the site of infection.
  • Combination therapy should be avoided if possible. Always tty to preferentially use monotherapy.
  • Monotherapy is usually less expensive than combination therapy and has less potential for adverse effects and drug-drug interactions.15
  • Combination therapy is often used for potential synergy (rarely occurs and if used must be based on microbiology laboratory synergy studies), to increase spectrum (preferable to use monotherapy with same spectrum), or to prevent resistance (except for TB, ineffective in nearly all contributors).
PO and IV-to-PO Switch Antibiotic Therapy (see also Table 1.5)
  • Wherever possible, treat with entirely oral antibiotic therapy instead of IV therapy.
  • Switch from IV-to-PO antibiotic therapy after clinical defervescence (usually < 72 hours).
  • Early IV-to-PO switch therapy eliminates phlebitis and IV line associated infections.
Antibiotic De-escalation
  • De-escalation is problematic if based on microbiology data alone without site-pathogen correlation.
  • De-escalation is appropriate in the setting of broad spectrum coverage of “presumed urosepsis” which can be narrowed after the uropathogen is identified in blood/urine.
  • In intubated/ventilate patients, microbiology data from respiratory secretion cultures are usually misleading and not representative of NP or VAP lung pathogens.
  • In patients with NP or VAP, it is more prudent to treat the most likely pathogen, e.g., P. aeruginosa (even if not cultured from respiratory secretions) than to be misguided into treating multiple colonizing organisms in respiratory secretions.
  • De-escalation can be harmful if microbiology data is misleading, e.g., represents colonization rather than being reflective of the pathogen (underlying bone pathogen, not ulcer organisms), e.g., diabetic foot ulcers/chronic osteomyelitis or sacral ulcers/chronic osteomyelitis.
C. difficile Diarrhea/Colitis
  • Preferentially select antibiotics (all other things being equal) with low C. difficile potential.
  • Predisposing factors to C. difficile include relatively few antibiotics, e.g., clindamycin, b-lactams, ciprofloxacin.
  • Most antibiotics have little/no C. difficile potential, e.g., aminoglycosides, aztreonam, maerolides, TMP-SMX, colistin, polymyxin B, daptomycin, Q/D, doxycycline, minocycline, tigecycline, vancomycin, linezolid.
  • Some antibiotics are protective against C. difficile, e.g., doxycycline, tigecycline.
  • Always consider non-antibiotic factors that may predispose to C. difficile, e.g., cancer chemotherapy, anti-depressants, statins, PPIs.
  • Also consider person to person spread or acquisition for the environment.
Empiric Antibiotics for Fever and Leukocytosis
  • Avoid treating unexplained fever/leukocytosis. If due to infection, let the infection declare itself and then initiate early therapy.
  • Try to diagnose the many non-infectious causes of fever/leukocytosis rather than treating empirically with antibiotics.16
  • Avoid prolonged antibiotic therapy of fever/leukocytosis in the presence of a device associated infection or undrained/inadequately drained abscesses.
  • Avoid antibiotic therapy of non-infectious fevers or non-antibiotic responsive infections, e.g., drug fevers, malignancies, hematomas, rheumatic/inflammatory disorders, viral infections.
Pharmacoeconomic Considerations
  • The least expensive therapy is usually not the best therapy.
  • The least expensive antibiotic (acquisition cost) may, in fact, be expensive (re: total cost) when considering the cost implications to the institution of dosing frequency, C. difficile potential, resistance potential, and degree of activity against the known or likely pathogen, and the cost of potential therapeutic failure vis-à-vis ↑ LOS and medicolegally.
  • Stewardship savings are best achieved by decreasing duration of antibiotic therapy, and by treating entirely with oral antibiotic therapy or early IV-to-PO switch therapy.
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