Microbe
S. aureus
Dx / Characteristics
Catalase +, coagulase +, beta
hemolytic, mannitol fermenter
Catalase-, alpha hemolytic,
Optochin ѕ, bile soluble
Tx
Nafcillin, Oxacillin. MRSA: Vancomycin.
VRSA: Quinupristin/Dalfopristin
S. pneumoniae
Pneumonia: macrolides
Meningitis: ceftriaxone or Cefotaxime. Vancomycin if ®
Otitis media, sinusitis: amoxicillin or erythromycin if ®
Viridans group (S.
Catalase-, alpha hemolytic,
Penicillin G + aminoglycosides
sanguis, S. mutans)
Optochin ®
Prophylaxis prior dental work.
S. pyogenes (GAS)
Catalase -, beta hemolytic,
Beta-lactams (Aminopenicillins). Macrolides if allergic
Bacitracin ѕ, PYR+, ASO>200
5year prophylaxis if rheumatic fever
S. agalactiae (GBS)
Catalase -, beta hemolytic, Bacitracin ®, CAMP+ Ampicillin + Aminoglycoside or Cephalosporin
Enterococcus
PYR+
Vancomycin (usually ®)
faecalis/faecium (GDS)
Prophylaxis in previous <3 valve damage: Penicillin + Gentamycin
Bacillus anthracis
Spore-forming rod
Ciprofloxacin + Doxycycline
Clostridium tetani
Racket shape rod
TIG: hyperimmune super globuline + Debride & delay closure +
Metronidazole or Penicillin + Diazepam (spasmolytic)
Adults: respiratory support (rs)+ trivalent antitoxin
Clostridium botulinum
Infants (<2y): rs + Hyperimmune human serum. NO AB!!!
Wound: debridement, no closure + Amoxicillin + rs + antitoxin
Clostridium perfringes
Nagler rx (stormy fermentation Clindamycin + Penicillin.
in milk media)
Debridement + delayed closure. Hyperbaric chamber
Clostridium difficile
Yellow plaques in colon
Mild: discontinue AB therapy (causative agents: Amoxi, Clinda)
Severe: 1° DOC Metronidazole. 2° DOC Vancomycin
Lysteria monocytogenes Tumbling motility
Ampicillin. If immunosuppressed: + Gentamycin
C. dyptheriae
Chinese letters. Elek test +
Erythromycin + antitoxin
Endocarditis: Penicillin IV + aminoglycosides 4-6w
Actinomyces israelii
Molar tooth in culture. Sulfur granules Ampicillin or Penicillin G. Drain abscess
Nocardia
Urease +
TMP-SMX (DOC) or Sulfonamides
2m: Rifampin + Isoniazid + Pirazinamide + Ethambutol
M. tuberculosis
Acid fast
4m: Isoniazid + Rifampin
Streptomycin if ®
Tuberculoid leprosy: Dapsone + Rifampin
M. leprae
Lepromatous leprosy: cLofazimine + Dapsone + Rifampin
Contacts: dapsone
MAC
Nonchromogen
Macrolide + Ethambutol
M kansaii, M. marinum
Photochromogen
Rifampin + Isoniazid + Ethambutol
M. scrofulaceum
Scotochromogen
Qx
Neonates & Infants: Ampicillin + Cefotaxime
N. meningitidis
Maltose & Glucose fermenters Rest: Ceftriaxone or Cefotaxime w/ or w/o Vancomycin
Contacts: Rifampin or Ciprofloxacin
N. gonorrhoeae
IC gram- diplococcic in PMN
Neonatal ophtalmia: prophylaxis w/ Erythromycin ophthalmic
STD: Ceftriaxone (and always test for Chlamydia trachomatis)
Moraxella catharralis
Amoxicillin/Clavunate or 2°G, 3°G Cephalosporin or TMP-SMX
Pseudomona aeruginosa Ticarcilline or Pipercilline + Aminoglycoside
Legionella pneumophila Silver stain & DFA+ (Direct
Eritrhomycin or Azithromycin or Fluoquinolones + Rifampin
(Hyponatremia + diarrhea +
Fluoresent Ab) on bx
pneumonia)
Francisella tularensis
Bordetella pertussis
Brucella sp
Campylobacter jejuni
H. pylori
Tick bite
Streptomycin. Attenuated (live) vaccine for high risk pts.
DFA, PCR
Erythromycin 14d. contacts included
Bordet-Gengou or Regan-Lowe DTaP (acellular pertussis) vaccine
media
Supportive care. Hospitalization
Serum agglutination test: Ab
Adults: Rifampin + Doxycycline
against Brucella <1:60 = (+)
Children: Rifampin + TMP-SMX
Skirrow agar at 42°C
Erythromycin or Fluorquinolones
Campy medium
Bx + culture (Skirrow or Campy)
O meprazol
B ismuth
Breath test 13C urea swallowed, ammonia 13CC larythromycin
or
M etronidazol
CO2 produced
A moxicillin
T etracyclines
Vibrio cholera
Vibrio vulnificus
TCBS medium
Doxycycline or Ciprofloxacin
Tetracyclines or 3°G Cephalosporins
UTI: Fluorquinolones or Sulfonamides
Neonatal sepsis/meningitis: Ceftriaxone
E. coli
All sorbitol fermenters except
Sepsis: Fluorquinolones or 3°Cephaloporins
EHEC
ETEC: TMP-SMX (shortens sx, self limited)
EHEC: DO NOT GIVE AB, increases risk of HUS
EPEC, EIEC: fluorquinolones
Klebsiella pneumoniae
Oxidase 3°G cephalosporins w/ or w/o aminoglycosides
Fluorquinolones
Shiguella
Agglutination test: anti-O Ab
Fluid and electrolyte therapy (AB® plasmid encoded)
Yersinia pestis
Coagulase +
Streptomycin
Proteus mirabilis, vulgaris
Swarming motility in blood agar Fluorquinolones or TMP-SMX or 3°G Ceph. Remove calculi: qx
Salmonella typhi,
Blood culture (+) 1° week
Fluorquinolones or
paratyphica
Rose spots 25% pts  bx!
3°G ceph
Stool culture (+) 3° week
Salmonella enteritidis,
Gastroenteritis: self-limiting
typhimurium
Sepsis, osteomyelitis (HbS): Ampicillin or 3°G ceph or TMP-SMX or fluoroquinolones.
H. influenzae
Vaccine: anti PRP Ab
Ceftriaxone or Cefotaxime
Satellite phenomenon in
Nasal Carrier: rifampin
chocolate agar with S. aureus
Vaccination: 2, 4, 6m. booster: 15m
H. ducreyi
DNA probe
Azithromycin or Ceftriaxone or Ciprofloxacin
Gardnerella vaginalis
Oxidase –
Clue cells
Metronidazole or
Whiff test: KOH: fishy odor
Clindamycin
Pasteurella multocida
Amoxicillin/Clavunate (prophylaxis if human bites)
Eikenella corrodens
Bleach-like odor
Capnocytophaga
Cellulitis and sepsis (if
canimorsus
splenectomy)
H aemophilus aprophilus
3°G ceph or FQ
A ctinobacillus actinomycetemcomitans
C ardiobacterium hominis
E ikenella corrodens
K nigella kingae
Bartonella henselae
Azithromycin or Doxycyclin
Bacterioides fragilis
Metronidazole or Clindamycin or Cefoxitin.
Qx: drain abscess
1°= dark field (GS)
Treponema pallidum
2°, 3°= antibodies serology
Benzathine penicillin
 Non-specific: VRDL, RPR, ART.
 Specific: FTA-ABS, MHA-TP
IFA
Early localized: doxycycline or Amoxicillin or Azithromycin or Clarithromycin
Borrelia burgdorferi
ELISA
Early disseminated: ceftriaxone
WB
Lated disseminated: ceftriaxone or doxycycline
Leptospira interrogans
Dark field, agglutination test, culture
Doxycycline or Penicillin G
Chlamydia trachomatis
DNA probes, PCR, DFA, ELISA.
Azithromycin or
Cytoplasmic inclussions in epithelial cells (Giemsa)
Doxycycline
Chlamidophila
Complement fixation
Macrolides or
pneumoniae
Microimmuno fluorescence
Tetracyclines
Chlamidophila psittaci
Complement fixation
Farfold rise in antibody
Rickettsia rickettsi
IFA.
Weil-Felix test
Doxycycline
Erlichia chaffeensis &
Giemsa stain: morulae – mulberry like structure
phagocytopila
 E. chaffeensis: monocytic  macrophages, monocytes
 E. phagocytophila: granulocytic  PMN
Fried egg colonies all mycoplasma except this one
Erythromycin or
Mycoplasma
ELISA, IFA
Clarithromycin or
pneumoniae
Cold agglutinins (+) autoAb to RBCs
Azithromycin
Mulberry shaped colonies in sterol media
Ureaplasma urealyticum Normal when pt is sexually active, if present in children, think child abuse
Erythromycin or tetracyclins
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Metronidazole: Giardia lamblia, Trichomona vaginalis, Entamoeba hystolytica
Nitazoxanide: Cryptosporidium
Pyrimethamine + Sulfadiazine: Toxoplasma gondii
Suramin: Trypanosma bruceii (blood borne)
Melarsoprol: Trypanosoma bruceii (CNS)
Nifurtimox or Benznidazole: Trypanosoma cruzi
Amphotericin B: Naegleria fowleri, Leishmania donovani
Sodium stibogluconate: Leishmania donovani
Cloroquine: Plasmodium falciparum, Plasmodium malariae
Cloroquine + Primaquine: Plasmodium ovale, Plasmodium vivax
Quinidine (IV): severe Plasmodium infx
Mefloquine or Atovaquone/Proguanil: Plasmodium resistant
Atovaquone + Azythromycin: Babesia
Diethylcarbamazine (DEC): Loa loa, Wucheria bancrofti
Ivermectin: Onchocerca volvulus, Strongyloides stercolaris
Bendazoles or Pyrantel Pa M oate: Enterobius vermicularis, Ascaris lumbricoides, Ancylostoma duodenale, Necator
americanus (ne M atodes)
M ebendazole: Toxocara canis
Albendazole: Strongyloides stercolaris, Toxocara canis, neurocysticercosis, Echinococcus granulosus.
P raziquantel: Taenia solium, Schistosoma, Diphylobotrium latum, Clonorchis (P latyhelminthes)