This agent is rarely used

duetoGI upset

clarithromycin (Biaxin ') See above,some mycobacteria See above See above Susceptible RTI.skin infections,nontuberculous mycobacterial infections,part of macrolides

multidrug therapy for W.pylori treatment

Susceptible RTI, acute exacerbations of

COPD,community-acquired pneumonia,

skin infections,Campylobacter infections if

treatment indicated,chlamydia

Hypersensitivity to

azithromycin (Zilhromax :

) See above,some mycobacteria See above See above Hypersensitivity to

macrolides

Lincosamides

clindamycin (Oalacin') GP except [nlerococcus,most

community- acquired MRSA

anaerobes

Inhibits peptide bond Pseudomembranous colitis

formation at SOS ribosome and C. difficileGl upset

Treatmentof suspected or proven infections

caused by GP,anaerobes including skin and

skin structure infections,oropharyngeal

infections,in combination with GN coverage

for intra-abdominal and pelvic infections

Hypersensitivity to

clindamycin

Infants <30 d

Concurrent use orwithin

2 wk of monoamine

oxidase (MAO) inhibitors

Hypersensitivity to

chloramphenicol

chloramphenicol GP Serious infections by susceptible organisms

when suitable alternatives are not available

including meningococcal disease in patients

with anaphylaxis to 0-lactams

Vancomycin resistant [nlerococcus toecium

infections including intra-abdominal,

skin and skin structure,and urinary tract

infections.MRSA infections as outpatient

therapy

Inhibits peptidyl

transferase action of tRNA Grey Baby syndrome

at SOS ribosome

Aplastic anemia

GN

Anaerobes

GP including VRE

- MRSA Binds SOS ribosome and

prevents functional 70S

initiation complex

HIN lads as MAO inhibitor)

Risks with prolonged use:

myclosupptcssion. optic

neuropathy,peripheral

neuropathy

linetolid (Zyvoxam ) Hypersensitivity to

linetolid, concurrent use

or within 2 wk of MAO

inhibitors

PROTEIN SYNTHESIS INHIBITORS (30S RIBOSOME)

Aminoglycosides

gentamicin

tobramycin

amikacin (Amikin')

plazomicin*

Pre-existing hearing loss

exist,tills,used in low doses for synergy and renal dysfunction

with 0 - lactams or with vancomycin lor the

licalmenl of serious entcrococcal infections

GN (includes Pseudomonas ) Binds 30S subunit of

ribosome inhibiting

protein synthesis

Nephrotoxicity (reversible) GN infections when alternatives do not

Vestibular and ototoxicity

(irreversible)

Vestibular toxicity is

the most important

aminoglycoside toxicity

Tetracyclines

tetracycline

(Apo-Ietra’,

Hu-letraT )

minocycline

(Mmocinl ')

doxycydine

(Ooiycin'

)

tigecyclincllygacil )

GP Binds 30S subunit of

nbosomc inhibiting

protein synthesis

Gl upset

Hepalotoxlcity

Fanconl's syndrome

Photosensitivity

Teratogenic

Yellow teeth and stunted

bone growth in children

Blckettsial infections,Cblamydophila. acne

(tetracycline,minocycline).

Pelvic Inflammatory Oiscase|PI0) (stepdown),malaria prophylaxis (doxycydine)

Severe renalor hepatic

dysfunction

Pregnancy or lactation

Children under 12 yr

Anaerobes

"Atypicals":Chlamydopltilo,

Mycoplasma, ffickettsia.Bonelio

borgdorleti

treponema

Malaria prophylaxis

(doxycydine)

Tigccydinc has activity against

MRSA.VRE. and ESBl producing

[. coli/K. pneumoniae

'Available in Conndo through the Special Access Program

+

Activate Windows

Go to Settings to activate Windows.

ID51 Infectious Disease Toronto Xotes 2023

Table 33. Antibiotics

Class and Drugs Coverage Mechanism of Action Adverse Effects Indications Contraindications

T0P0IS0MERASE INHIBITORS

Fluoroquinolones (FOs)

ciprofloxacin (Cipro *

)

norfloxacin

(Apo-Horflox‘

)

ofloxacin (Floxin:

|

Respiratory FOs:

levofloxacin

(Levaquinr )

moxifloxacin

(Avelox1)

Upper and lower RTI (not ciprofloxacin

unless susceptible organism isolated).UTI.

prostatitis (not moiifloxacin).bone and

[

pint infections for susceptible organisms,

skin and soft tissueinfections (levofloxacin.

(levofloxacin.moxifloxacin) moiifloxadn).infectious diarrhea.

Tendonitis

Tendonrupture

Variable GP activity

GN (includes

Pseudomonos)

"Atypicals"

levofloiacm andmoxifloiacin

coverS.pneumonine

moufloiaun also has additional

anaerobic coverage

Inhibits DNAgytase Headache,dirtiness Pregnancy or lactation

Children under 18 yr

Concomitant use of

medications that prolong

OTinterval

Allergy

Seizures

Prolonged 01

Dysglycemia

meningococcal prophylaxis,intra-abdominal

infections (monfloxacin.ciprofloxacin

in combination withmetronidazole

or clindamycin),febrileneutropenia

prophylaxis (ciprofloxacin,levofloxacin)

or management of“low-risk"febrile

neutropenia (ciprofloxacinin combination

with amoxidtiin-clavulanate)

OTHER

rifampin GP cocci

#.meningitidis

H.inSaenae

Mytohactena

Inhibits RNA polymerase Hepatic dysfunction.P450

enzyme induction

Orange tears/saliva,

'

urine

Part of multidrug treatment for active T3.

alone for treatment of latentIB,part of

multidrug treatment for other mycobacterial

infections,endocaiditis involving proslhetic

valve or other prosthetic device infections

in combination with other antibiotic agents,

prophylaxis for those exposed to people with

M. mtnmgttfts or HiBmeningitis

Protozoal infections (trichomoniasis,

amebiasis,giardiasis),bacterial vaginosis,

anaerobic bacterialinfections

Jaundice

Not to be used as

monotherapy (except lor

prophylaxis)

metronidazole(Flagyl ) Anaerobes,protozoa Forms toxic metabolites

in bacterial cell which

damage mictobialDNA

Oisulfiram-type reaction

with EtOH

Seizures

Peripheral neuropathy

Pregnancy with

trichomoniasis

Disulfiram within 2 wk.

alcohol within 3 d

Active neurological

disorders

Hypothyroidism

Hypoadrenalism

Known hypersensitivity

Inactivated by surfactant,

therefore not used in

MRSA pneumonia Tx

Hypersensitivity,renal

failure

daptomycin GP.including MRSA and VRE Binds to cell wall and Skeletal muscle injury

forms channels leading to at high doses (elevated

intracellular K'

depletion creatrnephosphokinase)

Peripheral neuropathy

Disrupts bacterial cell Renal toxicity

membranes

Bactererrra.endocarditis,skinand soft

tissue,and other infections due to resistant

GP infections including MRSA and VRE

colistin GN Bacteremia,pneumoniae

ANTI-METABOLITE

GP.especiallyS aureus

(including most MRSA)

GN:enteric

Moccrdia

Other Pneumoqrstis.

lompktsaa

Inhibits folic acid pathway Hepatitis

(IMP inhibits

dihydrofolate reductase

(DHFR) andSMX

Susceptible UTI.RTI.Gl

Slevens-Johnson syndrome infections,skin and soft

Bone marrow suppression tissue infections caused by staphylococcal

species,treatment

and prophylaxis of P.proveca pneumonia

Hypersensitivity to TMPSMX, sulfa drugs

Infants «4 wk

Hepatic or renal

dysfunction

Pregnancy and lactation

trimethoprimsulfamethoxazole

(TMP.SMX)

(Septra1

.Bactrim1) Hyperkalemia

competes with (para- Drug toxicity (increases

aminobenzoic acid) PABA) free levels of many drugs.

including glyburide.

warfarin)

Inttroaxcus.

S. saprophyticus

GN (coliforms)

Reactive metabolites

inhibit tibosomal protein

synthesis

Cholestasis,hepatitis

Hemolysis if G6PD

deficiency

Interstitial lung disease

with chronic use

lower UTt notpyelonephritis or bacteremia Anuiia. oliguria,

or significant renal

impairment

During or imminent

labour

Infants <1mo of age

nitrofurantoin

(MacroBID .

(Macrodantin“)

ANTI-MYCOBACTERIALS

isoniazid (INH) Inhibits mycotic acid

synthesis

Hepatotoxicity

Hepatitis

Drug-inducedSLE

Peripheral neuropathy

Hepatotoxicity

P450 enzyme inducer

Orange tears,saliva,urine

Part of multidrug treatment for active TB.

alone for treatment of latent TB

Drug-induced hepatitis or

acute liver disease

Mycobacteria

Mycobacteria Inhibits RNA polymerase Part of multidrug treatment for active TB.

alone for treatment of latent TB,part of

multidrug treatment for other mycobacterial

infections,adjunct for treating prosthetic

device infection (bacterial biofilm),always

useincombination withother antimicrobials

to reduce emergenceof resistance

Part of multidrug treatment for active IB and

other mycobacterial infections

Jaundice

Not to be used as

monotherapy (except for

prophylaxis)

rifampin (RIF)

Inhibits mycotic acid

synthesis

Loss of central and colour

vision

Neuropathy

Hepatotoxicity

ethambutol Mycobacteria Renal failure

r i

Severe hepatic damage or

acute liver disease

Patients with acute gout

pyrazinamide (PZA) Mycobacteria Unknown Part of multidrug treatment for active IB i.J

Gout

Gastric irritation

SULFOHES

Inhibit folicacid synthesis Rash

by competition with PABA Drug fever

Agranulocytosis

Part of multidrug treatment fotU. leprae. G6PD Deficiency

part of treatment for P. proved pneumonia

(withIMP).P.proved pneumonia

prophylaxis,toxoplasmosis prophylaxis with

pyrimethamine

M.leprae.P.jirovecii.

Toxoplasma

dapsone

sulfoxone +

'Available in Canada through tfte Special Access Program

Activate Windows

•

gertcrSettingrtcractivate Windc

ID52 Infectious Disease Toronto Notes 2023

Table 34. Antibiotics for Selected Bacteria

Pseudomonas S. aureus Enterococcus H.influenzae Anaerobes

ciprofloxacin

gentamicin

tobramycin

amikacin

piperacillin/

tazobactam

ceftazidime

cefepime

doxacillin|MSSA)

1°

cephalosporin|MSSA)

ampicillin

amoxicillin

amoxicillin-clavulanate

2"

/3'

cephalosporin

metronidazole

clindamycin

macrolides (clarithromycin, amoxicillin-clavulanale

azithromycin)

clindamycin vancomycin

cotrimoxazole(including MRSA) nitrofurantoin (lower UII) levofloxacin

vancomycin (including MRSA) linezolid for VRE

cefoxitin

moxifloxacin piperacillinftazobactam

imipenem linezolid (including MRSA) daptomycin for VRE

daptomycin (includingMRSA) tigecydine for VRE

moxifloxacin

erlaponem,imipenem,

meiopenem

tigecydine (Including MRSA)

doxycycline (MSSA/MRSA)

penicillin

imipenem

Antivirals

Table 35. Antivirals

Class and Drugs Coverage Mechanism of Action Adverse Effects Contraindications

ANTI-HERPESVIRUS

HSV-1,2 Guanosine analogue inhibits viral DNA

polymerase

PO:well-tolerated

IV:nephrotoxicity.CMS

acyclovir Hypersensitivity to acyclovir or valacydovir

valacydovir

(Vallrex - )

(prodrug of acyclovir)

famciclovir (Famvir •

) HSV-1,2

pencidovir

ganciclovir

(Cytovene •)

valgancidovir

(prodrug of

ganciclovir)

VZV

See above Headache,nausea Hypersensitivity to famciclovir or pencidovir

VZV

CMV See above Hematologic:neutropenia,

thrombocytopenia,anemia

Hypersensitivity to ganciclovir or valgancidovir

Possible cross-hypersensitivity between acyclovir and

valacydovir

HSV-1,2.VZV. HHV 6.

EBV

CMV Pyrophosphate analogue inhibits viral

Acyclovir-resistant HSV. DNA polymerase

Nephrotoxicity

Anemia

Electrolyte disturbance

foscarnet Hypersensitivity to foscarnet

VZV

OTHER ANTIVIRALS

Chronic hepatitis B “Flu-like" syndrome

Depression

Bone marrow suppression

See HIV andAIDS.102/

See HIV and AIDS,102/

Increased serum ALT.bilirubin

Skin rash

Glycosuria,hyperglycemia

Hypersensitivity to any interferon

Cannot use in combination with ribavirinif renal

impairment

See HIV and AIDS.102/

See HIV and AIDS.ID27

Hypersensitivity to entecavir or any component of the

formulation

HIV co-infection (if monotherapy)

(pcgylaled) Inhibits viral protein synthesis

interferon a 2a or- 2b

lamivudine (Epivir )

tenofovir

entecavir

See HIV and AIDS.102/

See HIV ondAIDS.102/

Deoxyguanosine analogue

Inhibits viral DNA polymerase reducing

viral DNA synthesis

Chronic hepatitis B.HIV

Chronic hepatitis B.HIV

Chronic hepatitis B

Cl

Hematuria

Fatigue,headache

Increased serum Cr

Nausea, diarrhea

Fatigue,headache

Pruritus

Increased serum bilirubin

glecaprevir and

pibrentasvir

Chronic hepatitis C glecaprevir: HCV NS3/4A protease

inhibitor

pibrentasvir: HCV Nonstructural protein

SA inhibitor (NS5A) that is essential for

viral RNA replication and virion assembly

velpatasvir:HCV NS5A protein inhibitor

sofosbuvir:prodrug.inhibits NSS6 RNAdependent RNA polymerase

Moderate/severe hepatic impairment or history of hepatic

decompensation

Coadministration:atazanavir,rifampin,atorvastatin.

dabigatran.ethinylestradiol,or simvastatin

Chronic hepatitis C Fatigue,headache

Increased serum creatine kinase

Skin rash

Increased serum lipase

Nausea

Insomnia,irritability

Asthenia

HBV reactivation (in H8V/HCV coinfection)

Hemolytic anemia

Rash,conjunctivitis

Highly teratogenic

Hypersensitivity to sofosbuvir,velpatasvir.or any

component of the formulation

sofosbuvir and

velpatasvir

Chronic hepatitis C (in

combination withdirectacting antivirals).RSV

Lassa fever

Adenovirus

CMVrcllnitls

Acyclovir and foscarnet

resistant HSV

Guanosine analog with multiple

postulated mechanisms of action

Pregnant women and partners

Hemoglobinopathies

Concomitant o interferon use

ribavirin (Virazole ) r T

i

_ J

cidofovir Deoxycylidine analogue Inhibits DNA

synthesis

Nephrotoxicity (proximal tubule

dysfunction)

Renal failure:probenecid can reduce renal toxicity

+

Activate Windows

Go to Settings to activate Windows.

ID53 Infectious Disease Toronto Notes 2023

Table 35. Antivirals

Class and Drugs Coverage Mechanism of Action Adverse Effects Contraindications

Neuraminidase

inhibitors:

zanamivir (Relenaa ~

)

oseltarnivir

(Tamiflu )

remdesivir

Gl:nausea/vomiting,diarrhea

8ronchospasm with zanamivir

Inhibits neuraminidase,an enzyme

treatment and prophylaxis required lor release ol virus liom

infected cells leading to prevention ol

viral aggregation

Influenza A and B: Hypersensitivity to the neuraminidase inhibitors

Hospitalized COVID 19 Adenosine triphosphate analog

Inhibitor of the SAR& CoV- 2 RNA

dependent RNA polymerase

Inhibits viral RNA synthesis

Bradycardia, hypotension

Increased serum All.ASI

Hypersensitivity reactions|e.g.

anaphylaxis,angioedema)

Skinrash

Hypersensitivity toremdesivir or any component of the

formulation

Gl

Prolonged prothrombin lime

Seizure

nirmatrelvir/ritonavir COVID-19 infection within S nirmatielvir:Pcplidomimclic inhibitor ot Hypertension

(Paxlovid )

Hypersensitivity to niimatielvir.ritonavir or any

component ol the formulation

Co-administration ot highly dependent CYP3A substiates

otpotentCYP3A inducers

days ot symptom onset SARSCoV-2 protease

ritonavir:CYP3A inhibitor,increasing

concentrations olnirmatrclvir

Diarrhea. Oysgeusia

Myalgia

Antifungals

Table 36. Antifungals

Class and Drugs Coverage Mechanism of Action Adverse Effects Contraindications

POLYENES

Endemic mycoses:

Histoplasmosis

Hypersensitivity toamphotericin or any componentof the

formulation

amphotericin B

(liposomal

formulation isless Blastomycosis

Coccidioidomycosis

Pulmonary:

Aspergillosis

A polyene antimicrobial: Nephrotoxicity

inserts into fungal cytoplasmic Hypo.

'

hyperkalemia

membrane causing altered Infusion reactions:chills,fevers,headache

membrane permeability and Peripheral phlebitis

cell death

toxic)

CHS:

Cryptococcus

Candidiasis:

mucocutaneous.Gl.oral Not absorbed from the Gl tract Highly toxic if given IV

(thrush).vaginal

nystatin (oral, See above Gl:nausea/vomiting,diarrhea

topical)

Hypersensitivity to nystatin or any component ot formulation

IMIDAZOLES

Oral and vulvovaginal

candidiasis

Oermatomycoses

All azoles:inhibit ergosterol Pruritus,skin irritation

synthesis and thereby

alter fungal cell membrane

permeability

clotrimazole Hypersensitivity toclotrimazole or any componentof formulation

(Canesten -

)

miconazole

Mornst.it ,

Ilicozole )

ketoconazole

(Nizoral •

(

Vulvovaginal

candidiasis

Oermatomycoses

Oermatomycoses

Seborrheic dermatitis

Vaginal burning

Nauscafvomiting

Hypersensitivity tomiconazole,milk protein concentrate,or any

component ol formulation I!

Pruritus,skin irritation.Gl nonspecific

Results In decreased andtogen and

testosterone synthesis

Cross-sensitivity with other azolespossible

Hepatic dysfunction

Pregnant women ot those that may become pregnant

TRIA 20LES

fluconazole

(Diflucan )

CarnMa infections All azoles:inhibit crgosteiol

(mucosal and invasive) synthesis and thereby

Ciyptococcal meningitis altei fungal celt membrane

(step-down therapy) permeability

Sporotrichosis

Onychomycoses

Endemic mycoses:

Histoplasmosis

Blastomycosis

Coccidioidomycosis

Aspergillosis

Candidiasis

Elevated liver enzymes Gl nonspecific Cross- sensitivity withother azotes unknown

terfenadine olmultiple doses z400 mg

CYP3A4 substiates (Oleprolongation risk)

itraconazole

(Sporanox )

Elevated liver enzymes Cross- sensitivity withother azoles unknown

Severe ventricular dysfunction

Pregnant women or planning

CYP2D6 inhibitors or eliglustal

Hepatic and renal impairment

Rash

Gl

Nonspecific H1N

Hyperkalemia

Peripheral edema

voriconazole

(Vfend )

Visual disturbance (30%)

Hepatotoxicity

Cutaneous photosensitivity

Cutaneous squamous cell carcinoma with long- ritonavir,

term use in immunosuppressed patients

Prolonged OT

Periostitis

Neurologic toxicity

Elevated liver enzymes

Headache

Prolonged OT

Cross-sensitivity withotheiazoles unknown

May avoid or alter doses if co administered with other CYP3A4

substratess.rifampin,carbamazepine.long-acting barbiturates,

efavirenz.sirolimus.rifabutin,ergot alkaloids,St.John's

wort venetodai.ivabradine

posaconazole

(Posanol ',

NoxafiT')

Candidiasis

Aspergillosis

Mucormycosis

Coadministration of cisapride,ergot alkaloids,or sirolimus

CYP3A4 substrates:HMG-CoA reductase inhibitors (e.g.

atorvastatin.lovastatin.simvastatin)

OT interval prolonging (e.g.pimozide,quinidine)

Hypersensitivity to isavuconazole or any component of the

formulation

Strong CYP3A4 inhibitors (e.g.ketoconazole,ritonavir)

Strong CYP3A4 inducers (e.g.rifampin,carbamazepine. St.

John's wort. long acting barbiturates)

Moderate CYP3A4/5 inducers (e.g.efavirenz,etravirine)

Familial short OT syndrome

Pregnant women or planning

r t

LJ

isavuconazole Candidiasis

(esophageal) - off label

for HIV patients

Aspergillosis

Mucormycosis

Peripheral edema

Headache,fatigue,insomnia

Hypokalemia

Gl

Elevated liver enzymes +

Dyspnea,cough

Activate Windows

Go to Settings to activate Windows.

ID51 Infectious Disease Toronto Notes 2023

Table 36. Antifungals

Class and Drugs Coverage Mechanism of Action Adverse Effects Contraindications

AUYIAMINES

terbinafine Active liver disease

(lamlsll®)

Dermatomycoses

Onychomycoses

Inhibits enzyme needed lor

ergosterol synthesis

Rash,local irritation

Gl nonspecific

Transaminitis

ECHINOCANDIMS

caspofungin

micafungin

anidulafungin

Refractory aspergillosis inhibits1-3 0 0 glucan

Candidemia (azoleresistant)

Hepaloloxicity infusion and injection site

synthesis (needed for fungal reactions

cell wall)

; Griseofulvln Flucytosine

Echinocandins:

Caspofungin

0 0 0

i

.V

'

Cell wall fee

Protein

synthesis

-

Mitochondrion

Preci/sors: (Pyrimidines; NucleicAcids |

H-a dimethylase

Squalene — TanosteroT — Ergostero !

^

Cytoplasmic

cellmembrane :

Nucleus :

0 0 0

:

I

1

r Azofesr

Fluconazole.Itraconazole,

Ketoconazole,Miconazole

• Morpholines

Terbinafine

Tolnaftate

I

! Terbinafine J

:

Polyenes:

Amphotericin

Nystatin r.

e

Figure 18. Mechanism of action of antifungals

r T

t. J

+

Activate Windows

Go to Settings to activate Windows

ID55 Infectious Disease Toronto Notes 2023

Antiparasitics

Table 37. Antiparasitics

Class and Drugs Coverage Mechanism of Action Adverse Effects Contraindications

AMTIMALARIALS

Malaria:treatment of erythrocytic phase Inhibits parasite heme

of all five species of Plasmodium that polymerase

infect humans Note:High resistance

ol P. falciparum and P man In certain

geographic areas

Malaria:treatment olall five species

of Plasmodium that infect humans,

including chloroquine-resistant Z5

.

falciparum

CHS:blurred vision,retinopathy,

dizziness

chloroquine Hypersensitivity to chloroquine or

other 4- aminoquinoline

Nonspccilic Gl (rare with prophylaxis) Retinal or visual field changes

quinine Crnchonism:ears(tinnitus, vertigo). Hypersensitivity to quinine,may

eyes (visual disturbance),Gl (nausea/ have cross-sensitivity with quinidine

vomiting,diarrhea).CHS (headache. Tinnitus,optic neuritis,

hypoglycemia,history of blackwaler

fever or thrombocytopenic purpura

due to quinine use

Prolonged 01

Myasthenia gravis

History of seicures.psychosis,

aniiety.depression,or other mental

health diagnoses

G6PD deficiency

Concurrent or recent use of

quinacrine

Piegnancy

fever)

Hypoglycemia

CHS/Psych:irritability,nightmares,

psychoses,suicide,depression,

seizures,headache

Hemolytic anemia inGGPD deficient

Gl upset (take with food)

mefloquine (Lariam ) Malaria: prophylaxis

primaquine Malaria:treatment of liver hypnozoites Interferes with mitochondrial

off. mat andP.ovale'

,prophylaxis of all function

Plasmodium spp.

Pneumocystis jiroyecii (withclindamycin)

Malaria:treatment and prophylaxis ol

P. falciparum

Nausea/vomiling. anorexia, diarrhea. Hypersensitivity lo alovaquone or

abdominal pain(take with food) proguanil

Severe renal impairment

Hypersensitivity to artemisinins

Inhibits mitochondrial electron

transport and dihydrofolate

reductase

Binds iron,leading to formation

of free radicals that damage

parasite proteins

alovaquone/pioguanil (Malarone ' )

artemisinin derivatives (artemetfier,

artesunate, etc.) Note:marketed

throughout the word in both endemic

and non-endemic countries;neither

licensednor maiketed in Canada,

therefore available only via Health

Canada Special Access Program

Transient neurologic deficits

Inystagmus.balance disturbance)

Transient neutropenia (at high doses

of oral artesunate)

Delayed hemolysis

Malaria:treatment of all Plasmodium

spp.

Severe malaria (IV artesunate)

Typically used in combination with a

longer- acting agent from above

OTHER ANTI PROTOZOAL

Contact amebicide that acts in

intestinal lumen byuncertain

mechanism

Gl:nausea/vomiting,diarrhea,

abdominal pain

CHS: headache,seizures,encephalitis Patients with hepatic damage or

optic neuropathy

Piegnancy

Hypersensitivity to any 8-hydroxyquinoline or iodine

iodoquinol (Diodoquin -) Amebiasis:£.histolytica.Dientamaeba

fragilis.Balantidium call. Blastocyslis

hominis

Amebiasis:l histolytica.I. vogmahs.

giardiasis.0.fragilis

Cryptosporidium,giardiasis,

cydosporiasis

metronidazole See antibiotics.1050

nitazoxanide Interferes with parasite Hypersensitivity to nitazoxanide

anaerobic metabolism

Hausea/vomiting.diarrhea,

abdominal pain,headache

ANTI-HELMINTHICS

Increases CaZ'permeability

of helminth cell membrane,

causing paralysis and

detachment

Intestinal roundworms Heuracysticercosis Inhibits glucose uptake into

[chinococcus

Hydatid disease

Schistosomiasis and oilier flukes

Tapeworms

Ocular cyslicercosis

Concomitant use with strong CYP4S0

inducers

praziquantel Hauseaivomiling.lever,dizziness

albendazole Elevated liver enzymes

Alopecia

Gl nonspecific

Agranulocytosis

Nonspccilic Gl

Piegnancy

Ocular cysticercosis or

intraventricular cysticercosis

susceptible parasites

Microtubule inhibitor

Intestinal roundworms:pinworm,

whipworm,hookworm,roundworm

Ic.g.Asco/rs)

Strongyloidiasis

Onchocerciasis

Scabies

Inhibits microtubule formation

and glucose uptake

Pregnancy

Inlants

mebendazole (Verrno

*

)

ivermectin Interferes with polarization

of nerve and muscles cells in

susceptible parasites leading

to paralysis

Nausea,bloating,diarrhea, myalgias. Hypersensitivity to ivermectin

lightheadedness,headache Pregnancy

Wuchereria bancrolti

Loa loa

Thought loimmobilize

microfilariae and disrupt surface

membrane lo enhance killing by retinal hemorrhage High- grade microfilaremia due to

host immune system MeizzoMi reaction if coinfected with too loo

onchocerciasis

Anorexia,nauseafvomiting,

headache,drowsiness, encephalitis. Onchocerciasis

diethyfearbamazine Pregnancy

I

r

_l ' 1

\ L J ;

+

Activate Windows

Go to Settings to activate Windows.

ID56 Infectious Disease Toronto Notes 2023

Quick Reference:Common Infections and Their Antibiotic

Management

• see lamilv Medicine.1 M5-4

Landmark Infectious Diseases Trials

Trial Name Reference Clinical Trial Details

Respiratory Infections

EPIC-HR Title:Oral Nirmatrelvir for High-Risk,Non hospitalized Adults withC0VID-T9

Purpose:lodetermine whether niimatrelvin’

ritonavir is safe and effective lor the treatment of adults who are ill with C0VI0-19 and do

not need to be in the hospital but are at an increased risk of developing severe illness.

Methods:2246 participants with confirmed diagnosis of SARS CoV-2 infection were randomized (1:1) to receive nirmalrelvir 'ritonavir or

placebo orally every 12hours for 5 days (10 doses total).

Results:Primary outcome measure was proportion of participants with COVID-19 related hospitalization or death from any cause:

incidence was lower on day 28by 6.32%innirmatelvir group compared to placebo (relative risk reduction of 89.1%;P- 0.0001).

Conclusions:In early treatment of patients with both symptomatic COVID-19 and at high risk of progressing to severe illness,

nirmatrelvir.'ritonavir significantly reduces hospitalization and death.

Title:Dexamethasone in Hospitalized Patients with COVID-19

Purpose:!o assess if glucocorticoids can protect against inflammation-mediated lung injury and reduce progression to respiratory

failure and death.

Methods:6425 hospitalized SARS-CoV-2 patients were randomized to receive either (1) dexamethasone (oral or IV.6mg daily) for up to

10 d or (2) usual standard of care alone.

Results:Dexamethasone significantly reduced incidence of death as compared to usual care alone in patients receiving mvasnre

roecheTcal ventilation (29.3% vs.41.4%:RR 0.64:95% Cl 0.51-0.81) and among those receiving oxygen (23.3% vs.26.2%:RR 0.82:95%

O0.72-0.94) butnot among those without respiratory support (17.8% vs.14.0%;RR 1.19:95%CI 0.92-1.55).

Conclusion:Inpatients hospitalized with COVID-19,dexamethasone lowers 28-d mortality in those receiving invasive mechanical

ventilation oroxygen alone.

Title:Comparison of 8 vs.15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults:A Randomized Trial

Purpose:To identify the optimal duration of antimicrobial treatmentfor ventilator-associated pneumonia (VAP).

Methods:401patients with VAP diagnosed by quantitative culture of bronchoscopic specimens who had received initial empiric

antibiotic therapy were randomly assigned to receive either 8 d or 15 d of antibiotic therapy (regimen selected by treating physioan).

Results:As compared to15-d therapy.8-d therapy did not result in a significant difference inmortality (18.8% vs.17.2% in 8-d and15-d

group,respectively:difference,1.6%:90% Cl,-3.7% to 6.9%) or recurrent infections (28.9% vs.26.0%;difference.2.9%:90% Cl.-3.2%

to 9.1%).8-d therapy was associated with more mean antibiotic-free days (13.1vs.8.7;P-0.001).

Conclusion:8- and15-d antibiotic treatmentregimens demonstrated comparable clinical efficacy against VAP amongpatients who had

received appropriateinitialempiric therapy.

NEJM 2022:386:1397-1408

RECOVERY NEJM 2021:384:693-704

PneumA JAMA 2003:2902588 98

Meningitis

Dexamethasone in Adults NEJM 2002:347:1549-56

with Bacterial Meningitis.

Cans etal.2002

Title:Dexamethasone in Adults with Bacterial Meningitis

Purpose:To assess the efficacy of corticosteroids as an adjuvant treatment of acute bacterial meningitis in adults.

Methods:301patients were randomly assigned to receive dexamethasone (10 mg) or placebo 15-20 min before of with the first dose of

antibiotics and subsequently every 6 h for 4 d.

Results:Dexamethasone treatment was associated with a significant reduction in the risk of an unfavourable outcome,defined as a

score of1-4 on the 6lasgow Outcome Scale at 8 wk (relative risk (RR ),0.59;95% Cl.0.37-0.94;P‘

0.03).as wellas a significant reduction

ininmortality (RR.0.48.95% Cl,0.24- 0.96;P’

0.04).

Conclusion:Inadults with acute bacterial meningitis,early treatment with dexamethasone significantly improves outcomes and does

not increase tberisk of 61bleeding.

Infective Endocarditis

NEJM 2019:380:415-24 Title:Partial Oral versus IntravenousAntibiotic Treatment of Endocarditis

Purpose:To investigate whether a change from IV lo oral antibiotics in stable left-sided IE would result in efficacy and safety profiles

similar to those with continued IV treatment.

Methods:400 adults with IE on the left side of the heart,in stable condition,being treated with IV antibiotics|mmimum10 d) were

randomized to continue IV treatment or to switch to oralantibiotics.

Primary Outcome:Composite of all-cause mortality,embolic events,unplanned cardiac surgery,or relapse of bacteremia with the

primary pathogen,from the time of randomization until 6 mo following completion of antibiotics.

Results:Tneprimary composite outcome occurred in 12.1%in the IV group and 9.0% in the oral group (between-group difference.3.1

percentage points:95% Cl.-3.4 to 9.6:P’

0.40),thus meeting noninferiority.

Conclusion:Shifting to oral antibiotics was noninferior to continued IV antibiotics in patients with IE on the left side of the heart in

stable condibon.

POET

Intraabdominal Infections

STOP IT NEJM 2015:372:1996-2005 Title:Trial ofShort-Course Antimicrobial Therapy for Intraabdominal Infection

Purpose:To determine the appropriate duration of antimicrobial therapy for intraabdominal infection.

Methods:518 patients with complicated intraabdominal infection and adequate source control were randomly assigned to receive a

fixed course of antibiotics for 4t1d (experimental group) or until 2 d following the resolution of fever,leukocytosis,and ileus,up to

maximum10 d(control group).

Results:There were no significant differences in the rates of surgical-site infection,recurrent intraabdominal infection,or death

between treatment groups (21.8% vs.22.3% in the experimental and control groups,respectively:absolute difference.-0.5:95% CL

-7.0 to 8.0:P’0.92).The experimental group experienced a significantly shorter median duration of antibiotic therapy (4.0 d vs.8.0ct

absolute difference.- 4.0:95% CL - 4.7 to -3.3;P- 0.001).

Conclusion:The outcomes after fixed-duration antibiotic therapy were similar to those after a longer course of antibiotics in patients

with intraabdominal infections with adequate source control.

r ~t

u. j

+

Activate Windows

Go to Settings to activate Window

ID57 Infectious Disease Toronto Notes 2023

Trial Name Reference Clinical Trial Details

HIV and AIDS

NEJM 2010:363:2587 99 Title:Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex With Men

Purpose:toinvestigate the efficacy and safety of antiretroviral chemoprophylaxis for the prevention of HIV acquisition.

Methods:2499 HIV-seronegative men or transgender women who have sex with men were randomly assigned to receive emtricilabine

plus tenofovir disoproxil fumarate (FTC-TDF),or placebo daily.

Results:During median1.2 yr follow-up,100 participants became infected|36 in the FTC-TDF group vs.64in the placebo group),

representing a 44% reduction in the incidence of HIV (95% Cl,15- 63; P‘0.005).Similar rates of serious adverse events were observed in

both groups (P~0.57).

Conclusion:Preexposure prophylaxis with antiretrovirals significantly reduced HIV infection risk in HIV-negatrve men and transgender

women whohave sexwith men.

Title:Prevention ol HIV-1Infection With Early Antiretroviral therapy

Purpose:toinvestigate if immediate antiretroviral Iherapy could limit the transmission of HIV inserodiscordant couples.

Methods:1763 HIV 1 positive adults with an HIV negative pailncr were randomly assigned lo receive antiretroviral therapy either

immediately or after a decline in the CD4 count or the onset of HIV-1-relatcd symptoms.

Results:Of the 39 HIV-1transmissions observed,28 were vitologically linked to the infected partner (incidence rale.0.9 per 100

person-years.95% Cl, 0.6-1.3).Of the 28 linked transmissions,1occurred in the early-lherapy group (hazard ratio.0.04;95% Cl,0.01-

0.27:P‘

0.001).

Conclusion:Rates of HIV-1transmission and clinical events were reduced by early initiation of antiretroviral therapy,suggesting

personal and public health benefits.

iPrEx

Prevention of HIV-1

Inlection V/ith Early

Antiretroviral Therapy.

Colienet al. 2011

HEJM 2011;365:493- 505

Sepsis and SepticShock

C0RTICUS Title:Hydrocortisone Therapy for Patients With Septic Shock

Purpose:To investigate the efficacy of hydrocortisone administration in patients with septic shock who were either responsive or

unresponsive to corticotropin.

Methods:499 patients were randomly assigned to receive 50 mg IV hydrocortisone or placebo every 6 h for 5 d with dose tapering over

the following 6 d.

Results:Ho significant dillcrcnceinmortality at 28 d between patients in groups lhal did not respond lo corticotropin (39.2% in the

hydrocortisone group and 36.1% In the placebo group.P*0.69) or between those that did response lo corticotropin (28.8% and 28.7%,

P-1.00).

ConclusionrSuivival was not improved by hydrocortisone in patients with septic shock.

Title:Intensive Insulin Theiapy and Pentastarch Resuscitation inSevere Sepsis

Purpose:To investigate the role of intensive insulin therapy and the choice of either crystalloids or colloids inpatients with severe

sepsis.

Methods:Patients received either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10%

pentastarch or modifiedRinger's lactate for fluid resuscitation.

Resulls:Trial stopped for safety reasons.Intensive insulin therapy was associated with increased rates of hypoglycemia (17.0% vs.

4.1%,P

‘

0.001) and serious adverse events (10.9% vs.5.2%.P-0.01).Higher rates of acute renal failure and renal-replacement were

seen in pentastarch as compared to Ringer’s lactate.

Conclusion:In critically illpatients with sepsis,intensive insulin therapy increased the risk of serious adverse events related to

hypoglycemia.Pentastarch washarmful.

NEJM 2008:358:111-24

Intensive Insulin

Therapy and Pentastarch

Resuscitation in Severe

Sepsis. Brunkhorstet

al. 2008

IIEJM 2008:358:125-39

Bone and JointInfections

NEJM 2019:380:425 36 Title:Oral versus Intravenous Antibiotics lor Bone and Joint Infection

Purpose:loassess iloralanlibiolics are noninferior loIVonlibiolic lieatmenllor managing complex orthopaedic infections.

Methods:Within1wk post- surgery,1054 patients were randomly assigned to receive IV or oral antibiotics for 6 wk. Both groups were

permitted follow-on oial antibiotics.

Results:There was no significant differencein risk of treatment failure between oral and IV groups (-1.4%:95%Cl. -S.6-2.9),indicating

noninferiority.There was no significant difference in the rales of serious adverseevents between groups.

Conclusion:Oral antibiotics were noninferior to IV antibiotics for the treatment of complex orthopaedic infections when used for 6 wk.

Title:Antibiotic Iherapy for 6 or 12 Weeks for Prosthetic Joint Infection

Purpose:loidentify the appropriate duration of antimicrobial therapy for the management of prosthetic jointinfection.

Methods:410 patients with microbiologically confirmed prosthetic joint infection that hadbeen managed with an appropriatesurgical

procedure were randomly assigned to receive either 6 wk or 12 wk of antibiotic therapy as soon as possible after surgery.

Results:Rates of persistent infection were significantly higher in the 6-wk group as compared to the12-wk group (18.1% vs.9.4%:risk

difference.8.7%:95% Cl,1.8%-15.6%).

Conclusion:Antibiotic Iherapy for 6 wk was not noninferior to 12- wk therapy and resulted in more unfavourable outcomes in patients

with prosthetic joint infections managed with standard surgical procedures.

0VIVA

DATIPO HEJM 2021:384:1991-2001

Blood and Tissue Infections

Title:Seasonal Malaria Vaccination with or without Seasonal MalariaChemoprevention

Purpose:the study compared the efficacy ol RTS.S to that of SMC.which is the standard treatment lor children in areas with highly

seasonal malaria transmission.

Methods:Randomly assigned 6861 children 5 to 17 months of age to receive sulladoxme-pyrimethamine and amodiaquine (2287

children fchemoprevention-alone group)),RTS.S/AS01E (2288 children [vaccine-alone groupl),or chemoprevention and RTS.S,

'

AS01E

(2286 children (combination group])

Results:Demonstrated that notonly is RTS.S comparable to SMC in preventing malaria,but that combining the two interventions is

markedly superior to either intervention alone.

Conclusion:Use of the two interventions together resulted in an

approximately 70 percent further reduction in malaria deaths and hospitalizations, and a 60 percent reduction in uncomplicatedmalaria

overuse of SMC alone.

Seasonal Malaria

Vaccination with or

wilhout Seasonal Malaria

Chemoprevention.Zongo

elal.2021

NEJM 2021:

385:1005-1017

HEJM 2015:373:1295 306 Title:Randomized Trial of Benznidazole for Chronic Chagas'Cardiomyopathy

Purpose:loinvestigate the efficacy of trypanocidal theiapy inpatients with Chagas' cardiomyopathy.

Methods:2854 patients with Chagas' cardiomyopathy were randomly assigned to receive benznidazole or placebo for up to 80 d.

Results:Rates of conversion lo negative Upamomocwvf(M results were 66.2% In the benznidazole group and 33.5% In the placebo

group at lire end of treatment, 55.4% and 35.3% at 2 yr.and 46.7% and 33.1% at >5 yr (P<0.001for all).PCR conversion rales did not

correspond to clinical outcomes.

Conclusion:Inpatients with Chagas'cardiomyopathy,trypanocidal theiapy reduced serum parasite levelsbut did not improve cardiac

deterioration.

BENEFIT

+

Activate Windows

Go to Settings to activate Windows.

ID58 Infectious Disease Toronto Notes 2023

Trial Name Reference Clinical Trial Details

Fungal Infections

Voriconazole Versus

Amphotericin B for Primary

Therapy of Invasive

Aspergillosis. Herbrechlet

al.2002

Title:Voriconazole Versus Amphotericin B for Primary Therapy of Invasive Aspergillosis

Purpose:To compare voriconazole vs.amphotericin B for primary therapy of invasive aspergillosis.

Methods:277 patients randomly assigned toreceive IV voriconazole followed by oral voriconazole BIO or IV amphotericinB

deoiycholate.

Results:Successful outcomes occurred in 52.8% of patients on voriconazole and 31.6% on amphotericin B al wk12 (absolute difference.

21.2%:95% Cl.10-

4-32.9).Rate of survival was 70.8% in the voriconazole group and 57.9% In the amphotericin B group [hazard ratio.

0.59:95% 0.0.40-0.88).Voriconazole was associated vrith significantly fewer severe adverse events.

Conclusion:Initial therapy with voriconazoleis more clinically effective with fewer side effects than the standard approach with

amphotericinB.

IIEJM 2002:347:408-15

References

Principles of Microbiology

AndreoliH.BenjaminI.Griggs RC.el al.Cecil essentials of med.c ne.8tb e±Philadelphia:WB Saunders:2010.

Hawley LB.High yield microbiology andinfectious diseases.Uppmcott Wiliams S Wilkins;2000.

Levinson W,Jawetz f.Medical microbiology andimmunology:examination andboardrev.ew.7th ed.McGraw Hill;2003.

Mandell GL. Bennett Jf.Bolin R.Harden.Douglas,andBennett's principles andpractice of infectious disease.7th ed.Churchill Livingstone; 2009.

Schacchler M.fnglebetg N. Cisenstein 8. et el.Mechanisms of microbial disease,lippincott Williams t Wilkins:1998.

Sachse K.Bavoil PM.Kaltenboeck B.etal.Emendation of the farady Chtenydieceae:proposal of a single genus.Chlamydia, to include all currently recognized species. SyslAppl Microbiol 2015:38|2):99-103.

NeurologicalInfections

Bloch KC,Glaser C.Diagnostic approaches for patients withsuspectedencephalitis.Cuir Infect Dis Rep 2007:9:315-322.

le Saun N.Guidelines lor the management of suspected and confirmed bacterial men ngrtrsn Canadianchildien older than one month of age.Paedialr ChildHealth 2014:19(3):141 6.

Peterson LR.Marlin AA.Gubler DJ.West Nile virus.JAMA 2003:290:524 527.

Roberts L.Mosquitos and disease.Science 2002:298:32 S3.

Rupprecht CE.Gibbons RV.Prophylaxis against tab es.XEJM 2004:351:2626-2635.

Rupprecht CE.Hanlon CA.Kemachudha T.Rabiesre-eiammed.Lancet hfect Dis 2002:2:327-343.

lunkel AR.Glaser CA.Bloch KC.et al.The Management of Encephalic:OmcalPractice Gudelnes by the InfeChous Diseases Society of America.ClinInfect Ois 2008:47(3):303-27.

World Health Organization [Internet.Geneva:WorldHealthOrganization:Rabies:2020 Apr 21[cited 2020Jun17],Available from:https:ASvww.who.inttoews-raonrtlact-sheetsIdetaill

rabiesJ:

'’

:text-Symptoms.virus%20entjy%20and%20v:rat%20loadSkin and Soft Tissue Infections

Gonsalves WC.Chi AC.Neville BW.Common oral lesions:PartLSuperficial mucosal lesions.Am Fam Physician 2007:75(4):501-507.

Lipsky BA.Berendl AR.CormaPB.etal.2012Infectious DiseasesSociety of America CbnicalPracbce Guideline for the Diagnosis and Treatment of Diabetic FODI Infections.Clin Infect Dis 2012:54(12):e132-173.

Stevens DL.Bisno AL Chambers HF.et al.ExecutiveSummary:PracticeGuidelines for the Diagnosis and Management of Skin andSoft Tissue Infections:2014 Update by the Infectious Diseases Society of America.

Clin Infect Dis 2014:59(2):147-159.

Nosocomial Infections

McDonald LC.Gerding ON,JohnsonS.etalClinicalPracticeGuidelines for Qostndium difficileInfection inAdults andChildren:2017 Update by the Infectious DiseasesSociety of America (IDSA) andSociety for

Healthcare Epidemiology of America (SHEA).OinInfectDis 2018;66(7):e1- 48.

Nosocomial Infections

Pickering LK.Baker CJ.Long SS.etal.(editors).Red book:2006 report of thecomncttee on infectious diseases.27th ed.Elk Grove Village:American Academy of Pediatrics:2006.Staphylococcal infections.

Simar AE.Ofner Agostini M.Gravel D.etal.Surveillance for methci in resistant staphylococcus aureus in Canadian hospitals - a report update from theCanadian Nosocomial Infection SurveillanceProgram.

CCDR 2005:31(3):1-7.

Simar AE.Phillips E,McGeer A.etal.Randomized contra led trial of chlorheiidine gluconate for washing,intranasal mupirocin,andrifampin and doxycydine vs.no treatment for the eradication of methicillinresistant Staphylococcus aureus colonization.Clm Infect Dis 2007:44:178185.

Respiratory Infections

Cenlers for Disease Control andPrevention [Internet).Atlanta:Centers for DiseaseControl andPrevention:2009 H1N1Flu:[Updated 2010 Aug 11; cited 2020 Aug11|.Available from:httpri/www.cdc.gov.'hlnlfle1

.

COVID-19 vaccine:Canadian Immunzahon Guide.Canadaca.UpdatedApnl 2$.2022.AccessedApnl 28.2022.httpsc

'

/www.canada.caien/public-hcallWserviccs

'

publicalionsi'hcalthyliving'

canadian.

immunization-guide -part-4-active vaccines.'page-26-covid-19 vaccine.html

Ebell MH.Outpatient vs.inpatient treatment of community acquired pneumonia.FamPract Manag 2006 Apr;13(4):41-44.

Fine MJ.Auble IE.Yealy DM.et al.APrediction Rule toIdentify Low Risk Patients with Community-Acquired Pneumonia.NEJM 1997:336(4):243-250.

HealthOualily Ontario:Ministry ol Health and Long-Term Care[Internet).Ouahty based proceduresClinical handbook for community-acquucd pneumonia. Toronto: HealthOualily Ontario:2014 February. 67 p.

Available from: www.hgonlatio.ca'evideoce'

evidence-process.'episodes-of-caielcominority-acquiled-pneumonia.

Metlay JP.Walerer GW.Long AC.el al.Diagnosis and treatment of adults with community acquued pneumonia.An official clinical practice guideline of the American Thoracic Society andInfectious Diseases

Society of America.Am J Respir Crit Care Med 20l9:200(7):e4S e67.

Ontario COVID-19 Drugs and Biologies ClmicalPracbce Guidelines Work-ngGroup.Clinicalpractice guideline summary:recommended drugs and biologies inadult patients with COVID-19.OntarioCOVID-19 Science

Advisory Table. 2022:Version11.0.Accessed April 28.2022 bttps:. do< -org

,

10.47326,

ocsaLcpg.2022.11.0

Rodriguez Morales AJ.Cardona Ospma JA.Guberrez-Ocampo E.etal.Cbnical.laboratory and imaging features of COVID-19:A systematic review and meta-analysis.Travel Med Infect Dis 2020:34:101623.

Xu X W.Wu X-X.Jiang X-G. et al.Omcal findings ina group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan.China:retraspective case series.BMJ 2020:368:m606.

Wang D. Hu B.Hu C.el al.Clinical Charactensbcs of 138 Hospitalized Patients With 2019 Novel Coronavinis—InfectedPneumonia in Wuhan. China.JAMA 2020:323(11):p.1061.

Uyeki TM.Bernstein HH.Bradley JS.etal.Cknical Pracbce 6urdel nesby theInfectious Diseases Society of America:2018 Update on Diagnosis.Treatment.Chemoprophylaxis,and InstitutionalOutbreak

Management of Seasonal Influenza.Om InfectDa 2019:68|6):S9S-902

Cardiac Infections

Baddour IM.Wilson WR.Bayer AS.etal.Infectrve endocarrtbs:diageosa.anbrncrobial therapy,and management complications.Circulation 2015:132:e1435-e1486.

Li JS,Sexton DJ.Mick N.etal.Proposedmodifications to theDuke criteria for thediagnosis of Infective endocardibs.ClinInfect Dis 2000:30:633-638.

Wilson W. Tauberl KA.Gewitz M.elal.Prevention of mfecbve endocarditis:guidelines Rom the AmericanHeart Association. Circulation 2007:116:1736-1754.

Gastrointestinal Infections

Dupont HL.Bacterial diarrhea.NEJM 2009:35t1560-1569-

Gotllieb T.Heather CS.OiarrheaIn adults (acute).BMJCinbid2011:02901

Jelinek T.Kollaritsch H.Vacdnabon withDukoral aga nst travelers'diarrhea (ETEC)and cholera.Expert Rev Vacdnes 2008;7(5):5G1-5G7.

McDonald LC.Gerdmg OH.JohnsonS.etalCincalPracriceGindelines for Oostndrum difficleInfection inAdults andChildren:2017 Update by the Infectious Diseases Society of America (I0SA)andSociety for

Healthcare Epidemiology of America (SHEA).OinInfectDis 2018:66:148.

Pickering LK,Baker CJ.Long SS.etal.(editors).Red hook:2006report of thecommttee oninfeebous diseases.27th ed.Elk Grove Village:American Academy of Pediatrics:2006.

Thielman HM,GuerranlRL AcuteInfectious diarrhea.NEJM 2004:350:3847.

rn

i j

+

Bone and Joint Infections

Bu[alia S,PaIda VA.Sargeanl RJ.etat Ooes this patient with diabetes haveosteomyetbs of the lower extremity? JAMA 2008:299:806- 813.

CraigJ.Moayedi Y.BuncePL A purulent foot ulcer «amanwith diabetes meffibrs.CMAJ 2013:185:579- 80.

Activate Windows

Go to Settings to activate Window:

ID59 Infectious Disease Toronto Notes 2023

Gilbert UN,Moeller!nq DC. Ellopoulos GM,elal.theSanford guide to antimicrobial therapy.38th cd.2008.

Heilman OB.Imboden JB. Musculoskeletal and immunologic disorders. 2010.

lipsky BA.Beiendt AB.Corma PB,cl al. 2012 Infectious Diseases Society ol America clinical practice guideline lor the diagnosis and treatment oldiabetic foolinfections.Clin Infect DIs 2012:S4:e132 e173.

Margarctlcn ME.Kohhvcs J,Moore 0.cl al.Ooes this adult patient have septic arthritis? JAMA 2002:292:14/81488

McPhec Si. Papadakis MA (editors). Current medical diagnosis and treatment.New York:McGraw-Hill; 2010.

Systemic Infections

Balt J. Khan K. Responsible use olrifampin for the treatment ollatent tuberculosis infection.CMAJ 2019;191(25):E6/8 E6/9.

Bouchard C,Oibernardo A,Kofli J.WoodH. LeightonPA.Lindsay LR.Increased risk of tick-borne diseases with climate and environmental changes. Can Commun Ois Rep 2019; 4!>(4):81-9.https:Wdoi.org210.14/45.1

ccdr.v45i04a02

Centers for Disease Control andPrevention [Internet]

.Atlanta:Centeis tor Disease Control andPrevention:Syphilis - CDC fadsheet (detailed);[updated 2012 Jan 30:cited 2020 May 5].Available from:https://

www.cdc.gov/stdisyphilisfstdlact-syphilis- delailed.hlm.

Howell MD.Davis AM. Managementof sepsis and septic shock.JAMA 2017:312:847.

Huntzinger A. Guidelines for the diagnosis andtreatment of tick-borne rickettsial diseases.Am Earn Physician 2007:76(11:137-139.

Klotz SA.lanas V,Elliott SP.Cat-scratch disease.Am Earn Physician2011;83(2):152-155.

Peterson LR.MarfinAA,Gubler DJ.West Nile virus.JAMA 2003:290:524-527.

Public Health Agency of Canada [Internet].Ottawa:Government of Canada:Canadian Guidelineson Sexually TransmittedInfections:[updated 2016 Dec13:cited 2020 May 5],Available from:htlps://www.canada.

ca/en/public-heallh/services/infectious-diseases/sexual-health-sexually-tzansmitted-infections/canadian-guidelines.html.

Public Health Agency of Canada [Internet].Ottawa:GovernmentalCanada;Canadian Tuberculosis Standards 7thEdition:2014;[updated 2014Eeb 17:died 2021April 23],Available from:https://www.canada.ca/

enfpublic'health/services

'

infectious'diseases/canadian'tuberculosis’standards'7th'edition/edltiofl'15.html4s5'1.

Rhodes A.Evans LE.AlhazzaniW.etal.Surviving sepsis campaign International guidelines for management of sepsis and septic shock:2016.IntensiveCare Med 2017;43:304.

Singer M.Deulschman CS.Seymour CW.etal.The third international consensus definitions for sepsis and septic shock (Sepsis-3).JAMA 2016:315:801.

Smieja MJ,Marchetti CA,Cook DJ,et al.Isoniazid for preventing tuberculosis in non-HIV infected persons.Cochrane DB Syst Rev 2000:2:CD001363.

Steere AC. Lyme disease. NEJM 2001;345:115-125.

Stevens DL.Bisno AL.Chambers HE.etal.Practice guidelines for the diagnosis and management of skin andsoft tissue infections:2014Update by theInfectiousDiseases Society of America. Clin Infect Ois

2014;59|2):e10-52.

World HealthOrganization [Internet],Guidelines for the diagnosis, treatment,and prevention of leprosy.New Delhi: World Health Organization. 2018. Available from:https:2iapps.who.int/iris/bitstreamihand

Ie(10665/274127f9789290226383-eng.pdf?ua-1.

HIV and AIDS

Public Health Agency of Canada |lnlernet|. Ottawa:Government of Canada:Summaiy:Measuring Canada'sProgress on the 90-90-90 HIV fargets:[updated 2017 Apr 12;cited 2020 May 5).Available from: https://

www.canada.ca/conlenl/dam/phac- aspc /documents/scrvices/publications/dlseases condltions/summary-measuring canada-progress-90-90-90 hiv targets/hiv90 eng.pdl

Department ol Justice Canada [Internet].Ottawa: Government of Canada:Government releases Repoil on the Criminality ol HIV nondisclosure;[updated 2012 Dec 1;cited 2020 May 5].Available from: https://

www.canada.caienidcpar!mcnt- justice/news/2017/12igovernmont rclcascsrepoitontheciimlnalityofhivnon-disclosure.html.

Guidelines for preventing opportunistic infections among HIV infected persons - 2002|lntcrncl|.Recommendations ol the U.S. Public HealthService and the Infectious Diseases Society ol America.Available from:

https://vuuvvu.cdc.gow/mmwr/P0E/rr/rr5108.pdf.

Department olHealth and Human Services.Panel on AntiretroviralGuidelines for Adults and Adolescents.Guidelines for the Use olAntiretroviral Agents m Adults and Adolescents with HIV;|citcd 2021October 3|.

Available from: https://clinicalinfo.hiv.gov/sites/delault/files/guidelincs/documents/AdultandAdolescentGL.pdf.

Hammer SM.Saag MS.SchechetcrM.etal.Ireatment tor adult HIVinfeclion:2006 recommendations ol the International AIDSSociety:USA panel. JAMA 2006;296:827-843.

Hladik F,McElrath MJ.Setting the stage:host invasion by HIV.Nat Rev Immunol 2008:8:447-457.

Moyletl EH,Shearer WT. HIV:clinical manifestations.J Allergy Clin Immunol 2002:110:3-16.

Okwundu Cl,Uthman OA.OkoromahCAN.Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV inhigh-risk individuals.Cochrane DB Syst Rev 2012:7:CD007189.

World Health Organization [Internet],Geneva:World HealthOrganizabon;Key facts and latest estimates on theglobal HIV epidemic -

2020;[cited 2021October 3[.Available from:httpsV/cdn.who.int/media2docs

'