TUBERCULOSIS

First-line antituberculosis drugs

Drug MOA Dosing Resistance Adverse effects

Isoniazid -Excellent bactericidal activity Children: Amino acid changes in Drug-induced liver injury and
(H) against both intracellular and 5mg/kg/d either the catalase- peripheral neuropathy
extracellular, actively dividing M. ay peroxidase gene (katG) ot
tuberculosis InhA Rash, fever, anemia, acne, arthritic
Adults: symptoms, SLE-like syndrome, optic
-Bacteriostatic against slowly 300- Less frequently: atrophy, seizures, psychiatric symptoms
dividing organisms 400mg PO Alterations in kasA and loss
of NADH dehydrogenase 2
-a prodrug activated by the activity
mycobacterial KatG
catalase/peroxidase coupled
with NADH isonicotinic acyl-
NADH complex blocks
InhAinhibits fatty acid
synthase inhibition of mycolic
acid synthesis
Rifampicin -bactericidal against both Children: Missense point mutations Hepatotoxicity
(R) dividing and nondividing M. 10- in the gene coding for rpoB
tuberculosis with sterilizing 20mg/kg/ Orange urine, sweat, tears and contact
activity day lenses (harmless),
rash, pruritus, thrombocytopenia,
-exerts both intracellular and Adults: nephritis
extracellular bactericidal activity 450-
600mg PO
-binds to and inhibits
mycobacterial DNA-dependent
RNA polymeraseblocks RNA
synthesis
Pyrazinami -Allows treatment duration to be Children: Mutation in the pncA gene Hepatotoxicity
de (P) shortened from 9 mos to 6 mos 20- coding for pyrazinamidase Hyperuricemia
and decreases rates of relapse 30mg/kg/ Clinical gout
day
-more active against slowly
replicating organisms than Adults:
against actively replicating 1500mg/d
organisms ay PO

-prodrug converted by
mycobacterial pyrimidase to
active form, pyrazinoic acid
fatty acid synthase I inhibition

-active only in acidic

environments as are found
within phagocytes or granulomas
Ethambutol -bacteriostatic Children: Missense mutations in the Optic neuritis (reduced visual acuity,
(E) -provides synergy with other 15- embB gene that encodes for central scotoma, loss of the ability to see
drugs in the regimen 20mg/kg/ arabinosyltransferase green, less commonly red)
-least potent against M. day
tuberculosis
-used in combination with other Adults:
agents in the continuation phase 800-
of treatment 1000mg/d
ay PO
- inhibition of the
arabinosyltransferase involved
in cell wall synthesis which
probably inhibits formation of
arabinogalactan and
lipoarabinomannan
Streptomyci -has only low-level early Children: Mutations in 16S rRNA Ototoxicity (primarily
 n bactericidal activity 10- gene or the gene encoding vestibulotoxicity), neuropathy, renal
18mg/kg/ ribosomal protein S12 toxicity
-inhibits protein synthesis by day (rpsL)
binding at a site on the 30S
mycobacterial ribosome Adults:
1g IM

Duration of treatment if with involvement of lymph nodes: 6 months (4HRZE/4HR)

–Extrapulmonary TB (except TB of the CNS, bone or joint for which some expert groups suggest longer therapy) should receive a regimen
containing 6 months of Rifampicin: 2HRZE/4HR

Duration of treatment if with brain involvement:

- 9-12 months

Duration of treatment if with bone and joint involvement:

- 6-9 months

CEPHALOSPORINS

1st generation: cefadroxil (PO), cefazolin(IV), cephalexin(PO), cephalothin, cephapirin, cephradine(PO)

2nd generation: Cefoxitin (IV), Cefotetan (IV), Cefuroxime (IV), Cefuroxime axetil (PO), Cefaclor, Cefamandole, Cefonicid, Cefprozil,
Ceforanide

3rd generation: cefoperazone, cefotaxime (IV), ceftazidime (IV), ceftizoxime, ceftriaxone (IV), cefixime, cefpodoxime proxetil, cefdinir,
cefditoren pivoxil, ceftibuten and moxalactam

4th generation: Cefepime (IV)

DRUGS OF CHOICE FOR DIFFERENT INFECTIOUS DISEASES

Disease DOC
Meningitis Penicillin G 20-24 million U/day IV q4h; ceftriaxone 4g/day IV q12h; cefotaxime 12g/day IV q4h; ampicillin
(bacterial) 12g/day IV q4h
Gonorrhea Ceftriaxone 250mg IM, single dose or Cefixime 400mg PO, single dose + treatment for Chlamydia if chlamydial
infection is not ruled out: Azithromycin 1g PO, single dose or Doxycycline 100mg PO BID for 7 days
Syphilis Primary, secondary or early latent: Penicillin G benzathine single dose of 2.4 mU IM (Tetracycline HCl 500mg
PO QID or Doxycycline 100mg PO BID for 2 weeks if with penicillin allergy)

Late latent, cardiovascular or benign tertiary: Penicillin G Benzathine 2.4 mU IM weekly for 3 weeks
(Tetracycline HCl 500 mg PO QID or Doxycycline 100mg PO BID for 4 weeks if with penicillin allergy)

Neurosyphilis: Aqueous crystalline penicillin G (18-24 mU/d IV, given as 3-4 mU q4h or continuous infusion)
for 10-14 days or aqueous procaine penicillin 2.4 mU/d IM plus oral probenecid 500mg QID both for 10-14
days
Meningococcemia Ceftriaxone 75-100mg/kg/day max of 4g/day in one or two divided IV doses or Cefotaxime 200mg/kg/day
max 8g/day in four divided IV doses; duration of 7 days but a single dose of ceftriaxone has been successfully
treated in resource-poor settings
Tetanus Metronidazole 400mg rectally or 500mg IV q6h for 7 days
Single dose of tetanus immune globulin 3000-6000 IU per IM or equine antitoxin 10000-20000 IU
Leptospirosis Mild: Doxycycline 100mg PO BID or Amoxicillin 500mg PO TID or Ampicillin 500mg PO TID

Moderate/Severe: Penicillin 1.5 million units IV or IM q6h or Ceftriaxone 1g/d IV or Cefotaxime 1g IV q6h

Chemoprophylaxis: Doxycycline 200mg PO once a week or Azithromycin 250mg PO once or twice a week

HEPATITIS B SEROLOGY

HBsAg – acute or chronic infection; protein on the surface of HBV

Anti-HBs- recovery and immunity from HBV infection; also develops in persons successfully vaccinated
IgM anti-HBc – early anti-HBc indicative of acute or recent infection (6 months or less)
HBeAg- marker of viral replication and infectivity

Interpretation
Test results Interpretation
(-) HBsAg Susceptible
(-) Anti-HBc
(-) Anti-HBs
(-) HBsAg Immune due to natural infection
(+) Anti-HBc
(+) Anti-HBs
(-) HBsAg Immune due to Hepatitis B vaccination
(-) Anti-HBc
(+) Anti-HBs
(+) HBsAg Acutely infected
(+) Anti-HBc
(+) IgM anti-HBc
(-) Anti-HBs
(+) HBsAg Chronically infected
(+) Anti-HBc
(-) IgM anti-HBc
(-) Anti-HBs

HIV/AIDS

Some diseases of AIDS:

- Kaposi's sarcoma- a multicentric neoplasm consisting of multiple vascular nodules appearing in the skin, mucous membranes, and
viscera. The course ranges from indolent, with only minor skin or lymph node involvement, to fulminant, with extensive cutaneous
and visceral involvement.
- etc

Screening test for HIV infection

- ELISA (aka EIA- enzyme immunoassay) –standard blood screening test (highly sensitive but not specific)
- P24 antigen assay- for acute HIV syndrome
- Nucleic acid testing – for blood donor screening
Confirmatory test for HIV infection
- Western blot –most commonly used
- HIV RNA assay- can be used to determine prognosis and evaluate treatment response
- HIV DNA PCR
- specific serologic testing for HIV-2
Note:
- positive or indeterminate EIA but negative Western blot = false positive EIA reactivity
- Western blot demonstrating antibodies to products of all three of the major genes of HIV (gag, pol, and env) is conclusive evidence
of infection with HIV
- Western blot is positive if antibodies exist to two of the three HIV proteins: p24, gp41, and gp120/160

STAGES OF DHF:
- Febrile (2-7days): viremia-driven high fever
- Critical/plasma leak phase (24-48 hours): sudden onset of varying degrees of plasma leak into the pleural and abdominal cavities
- Recovery/Convalescence/reabsorption phase (2-4 days): sudden arrest of plasma leak with concomitant reabsorption of extravasated
plasma and fluids

for more info: www.cdc.gov/dengue/clinicallab/clinical.html

WEIL’S SYNDROME
- severe form of Leptospirosis characterized by jaundice, renal dysfunction, and hemorrhagic diathesis
- mortality is due to hemorrhage
- findings:
o renal failure- develop during 2nd week of illness; decreased colume and renal perfusion  acute tubular necrosis
o pulmonary involvement- occurs frequently; presents with cough, dyspnea, chest pain, and blood-stained sputum,
sometimes hemoptysis or even respiratory failure
o hemorrhagic manifestations- common are epistaxis, petechiae, purpura, ecchymoses; rare are severe GI bleeding, adrenal
or subarachnoid hemorrhage
o others- rhabdomyolysis, hemolysis, myocarditis, pericarditis, CHF, cardiogenic shock, ARDS, multiorgan failure
MALARIA

Cause of relapse in P. vivax and P. ovale- failure to eradicate the persistent hepatic stage

Recrudescence- recurrence of asexual parasitemia after treatment of the infection with the same species of Plasmodium that caused the
original infection due to failure to completely eradicate the parasite because of resistance (P. falciparum)

Plasmodium falciparum- can cause cerebral malaria

SIRS (Systemic inflammatory response syndrome)

- defined as 2 or more of the following:
o fever of >38°C or <36°C
o heart rate of >90 beats/minute
o respiratory rate of >20 breaths/minute or PaCO2 <32mmHg
o abnormal WBC (>12000/uL or <4000/uL or >10% immature band forms)

CSF FORMULAS
Cells Protein Glucose Other features
Bacterial infection WBC >50/mm3, often 100-250 mg% 20-50mg%; usually Gram stain shows
greatly increased lower than 50% of blood organisms, high opening
glucose level pressure
Viral, fungal, spirochetal WBC 10-100/mm3 50-200mg% Normal or slightly Special culture
reduced techniques required,
presence of normal or
increased pressure
Tuberculous infection WBC >25/mm3 100-1000mg% <50, often markedly Special culture technique
reduced and PCR may be needed
to detect organisms
LIGHT’S CRITERIA
If any of the following is met, pleural fluid is exudate; if not, transudate.
- PF/serum protein >0.5
- PF/serum LDH >0.6
- PF LDH >2/3 upper normal serum limit

DRUGS OF CHOICE:
Multi-drug resistant typhoid: Ciprofloxacin 500mg BID PO or 400mg q12h IV for 5-7 days; Ceftriaxone 2-3g/day IV for 7-14 days;
Azithromycin 1g/day PO for 5 days

Poliomyelitis: no cure; supportive treatment

Pregnant with Measles- hyperimmune globulin

Pregnant with Hepatitis- alpha-interferon, Lamivudine
Pregnant with Varicella- Acyclovir 800mg PO 5 times a day for 7 days or Valacyclovir 1000mg PO TID for 7days

(paki-check please ng mga drugs of choice, thanks  )

RABIES

Management:

-Local wound care

-All previously vaccinated patients should receive human rabies immune globulin (RIG, 20 IU/kg; 40 IU/kg for equine RIG) no later than 7
days after the first vaccine dose. The entire dose should be infiltrated at the site of the bite; if not anatomically feasible, the residual RIG
should be given at a distant site.

-Inactivated rabies vaccine should be given as soon as possible (1 mL IM in the deltoid region) and repeated on days 3, 7, and 14 for
previously unvaccinated patients; previously vaccinated patients require booster doses only on days 0 and 3.

-Preexposure prophylaxis is occasionally given to persons at high risk (including certain travelers to rabies-endemic areas). A primary
vaccine schedule is given on days 0, 7, and 21 or 28.