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Chapter 5 - Infection > 2. Bacterial Infection > Flashcards

2. Bacterial Infection Flashcards

1
Q

Viral infections should not be treated with antibacterials unless…

A

Antibacterials are being used to treat bacterial infections secondary to a viral infection

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2
Q

In regards to spectrum, which type of antibacterials are preferred

A

Generally narrow-spectrum antibacterials are preferred to broad-spectrum antibacterials unless there is a clear clinical need, such as sepsis

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3
Q

Infections treated over a prolonged period

A

Tuberculosis, osteomyelitis

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4
Q

Adverse reactions related to cephalosporins

A

Superinfection due to the selection of resistant organisms, e.g fungal infections or pseudomembranous colitis. Further problems related to superinfection include vaginitis and pruritus

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5
Q

Broad spectrum antibiotics

A

Aminoglycosides
Amoxicillin & Ampicillin
Quinolones
Tetracyclines
Cephalosporins
Carbapenems
Chloramphenicol

(Arteries Are Always Quickly Travelling Cellular Critical Components)

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6
Q

Narrow spectrum antibiotics

A

Benzylpenicillin
Clindamycin
Glycopeptides
Metronidazole
Nitrofurantoin
Phenoxymethylpenicillin
Linezolid

(Blood Clotting Generates Many New Plate-Lets)

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7
Q

Notifiable diseases medical professionals are responsible for notifying

A

Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria*
Measles*
Meningitis*
Meningococcal septicaemia
Monkeypox
Mumps
Plague
Rabies*
Rubella
Severe Acute Respiratory Syndrome (SARS)*
Scarlet fever*
Smallpox
Tetanus
Tuberculosis*
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough*
Yellow fever

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8
Q

Signs and symptoms of sepsis

A

S - slurred speech or confusion
E - extreme dizziness or muscle pain
P - passing no urine
S - severe breathlesness
I - it feels like you’re going to die
S - skin discoloured

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9
Q

Signs and symptoms of an infection

A

Malaise, aches, pain, inflammation, swelling, pus

Confusion in elderly, worsening renal function, breathing difficulties

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10
Q

Clinical biomarkers for infection

A

Raised CRP, temperature respiration rate, glucose concentration (impacts diabetics)

Reduced blood pressure

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11
Q

Management of early sepsis

A

In community aqcuired septicaemia:
1st line: broad spectrum antipseudomonal penicillin: ticarillin or piperacillin
Or broad spectrum cephalosporin: ceftazidime

In hospital acquired septicaemia:
1st line: broad spectrum antipseudomonal beta lactam: penicillin, cephalosporin, carbapenem or monobactam.
if MRSA is suspected: ADD vancomycin to treatment
If anaerobic bacteria is suspected: ADD metronidazole to treatment

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12
Q

If source of infection is identified in septic patient vs if it is not identified

A

If source of infection is identified, treat in line with local antibacterial guidance or susceptibility results.
If source of infection is not identified, treat with IV antibiotics from local formulary in line with national guidelines

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13
Q

How frequently are risk septic patients monitored

A

No less than every 30 minutes

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14
Q

Apropriateness of antibiotics in pregnancy

A

Metronidazole
Chloramphenicol (grey baby), Quinolones (arthropathy) Aminoglycosides
Nitrofurantoin (should be avoided during 3rd trimester )
Tetracyclines
Trimethoprim/co-trimaxazole (avoided in first trimester)

MCQANTT

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15
Q

Consequences of a superinfection

A
  • Candidiasis
  • Colitis (caused by clindamycin, and broad spectrum antibiotics: amoxicillin, ampicillin, 3rd and 4th gen cephalosporins, quinolones)
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16
Q

Alternative drugs for patients allergic to with immediate hypersensitivity to penicillins

A
  • Macrolides
  • Metronidazole (dental infections)
17
Q

Nephrotoxic antibiotics

A

Aminoglycosides
Glycopeptides
Tetracyclines (except doxycycline and minocycline)
Nitrofurantoin (as it depends on renal clearance, patients must have a certain level of eGFR )

18
Q

Hepatotoxic antibiotics

A

Tetracyclines
Rifampicin
Co-amoxiclav (causes choleostatic jaundice)
Flucloxacillin (causes chleostatic jaundice)

19
Q

Antibiotics which are typically used for the following bacteria

  1. Staphylocci
  2. MRSA
  3. Streptocci
  4. Anaerobic bacteria
  5. Pseudomonal aeruginosa
A
  1. Flucloxacillin
  2. Vancomycin (or Teicoplanin) (or Linezolid for certain infections)
  3. Phenoxymethylpenicillin sore throats commonly caused by steptococci
  4. Metronidazole, dental infections are commonly caused by anaerobic bacteria
  5. Gentamicin or an Antipseudomonal penicillin
20
Q

Common gastro-intestinal infections

A

Gastro-enteritis is a stomach bug and causes diarrhoea and vomiting. Typically caused by food poisioning from salmonella or E.coli or rotavirus or norovirus.
It is self-limiting and does not need to be treated with an antibiotic.

C.difficile is a bowel infection. It causes water diarrhoea. Occurs when the gut flora is supressed, allowing C.difile producing bacteria to multiply. Commonly occurs with clindamycin, quinolones, amipicillin,amoxicillin and 3rd/4th gen cephalosporins. Patients over 65 years, taking PPI’s or in hospital for a long time.

21
Q

How do you treat First episode of mild, moderate, or severe C. difficile infection

A

Gastro-enteritis is self-limiting and does not require antibiotics.

C.dificile treatment:
1st line: oral vancomycin
2nd line: fidaxomicin

In further episodes:
If its been <12 weeks since last episode: fidoxamicin

If its been >12 weeks since last episode: fidoxamicin OR oral vancomycin

Life threatening infections: treated by specialists
ORAL vancomycin with IV metronidazole

22
Q

Common cardiovascular infections

A

Endocarditis, where the linining of the heart (endocardium) becomes infected. Caused by bacteria entering the blood stream and entering the heart. Risk is increased with parenteral procedures or dental infection.
Caused by stapphylococci, streptococci, enterococci and HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella: all HACEK members are fastidious Gram-negative bacteria)

23
Q

Treatment of common cardiovascular conditions

A

Endocarditis treatment:
Treatment will depend on if the patient has a natural or artificial heart valve and causative organisms.

BLIND THERAPY
Natural heart valve:
1st line; Broad spectrum penicillin: Ampicillin or amoxicillin +/- low-dose Gentamicin

If patient is allergic to penciillin, vancomycin +/- low-dose Gentamicin

Prosthetic heart valve:
Vancomycin AND Rifampicin AND low dose gentamicin

When culture and sensitivity test comes back and the organism is identified, specific antibiotics are then given.

If causative organism is:
MRSA- vancomycin
Staphylococci- Flucloxacillin
Streptococci - Benzylpenicillin

Follows general principles

24
Q

Common respiratory tract infections

A

Coughs caused by cold and flu viruses

Pneumonia, a lung infection where the alveoli become inflammed and fill with fluid.

Signs and symptoms include: breathing difficulty, chest pain, fever and cough. Commonly caused by streptococci pneumoniae and H.influenzae.
HAP - if contracted after 48 hrs in hospital
CAP - if contracted less than 48 hrs in hospital

25
Q

Treatment of common respiratory tract infections

A

Community acquired pneumonia (CAP) treatment:

Low severity OR moderate severity
1st line: Amoxicillin 500mg- 1g TDS (5 days). This is the adult dose.

Child 1–11 months
125 mg 3 times a day for 5 days; increased if necessary up to 30 mg/kg 3 times a day.
Child 1–4 years
250 mg 3 times a day for 5 days; increased if necessary up to 30 mg/kg 3 times a day.
Child 5–11 years
500 mg 3 times a day for 5 days; increased if necessary up to 30 mg/kg 3 times a day (max. per dose 1 g 3 times a day).
Child 12–17 years
500 mg 3 times a day for 5 days; increased if necessary up to 1 g 3 times a day.

Penicillin allergy: Macrolides: Clarithromycin or Doxycycline. If patient is pregnant, erythromycin is preferred.

High severity:
1st line: Co-amoixiclav AND Clarithromycin OR Erythromycin if patient is pregnant

In penicilliin allergy: Levofloxacin

HOSPITAL ACQUIRED PNEUMONIA

Non-severe HAP/Patients NOT at a higher risk of resistance:
1st line: Co-amoxiclav
In penicillin allergy; Doxycycline or Cefalexin

Severe HAP/Patients AT a high risk of resistance:
1st line: Piperacillin AND Tazobactam

26
Q

Common central nervous system infections

A

Meningitis is characterised by the inflammation of the meninges. Signs and symptoms include: Headache, seizures, stiff neck, drowsiness or unresponsiveness, dislike of bright nights, blotchy rash, high temperature (fever) over 37.5. This is a MEDICAL EMERGENCY.

27
Q

Treatment of common central nervous system infections

A

Treatment of meningitis

Blind therapy:

1st line: Benzylpenicillin
In penicillin allergy: Cefotaxime
Patients with an immediate hypersensitivty: Chloramphenicol

Cefotaxime may be an alternative in penicillin allergy; chloramphenicol may be used if history of immediate hypersensitivity reaction to penicillin or to cephalosporins.

28
Q

Common muscoskeletal infections

A

Oseteomyelitis is a bone infection

Septic arthritis is a joint infection, which may occur following an open fracture or during surgery.

29
Q

Treatment of common muscoskeletal infections

A

Osteomyelitis and Septic arthritis treatment

1st line: Flucloxacillin
In penicillin allergy: Clindamycin.
If MRSA is suspected, offer vancomycin

Osteomyelitis ~ 6 weeks:
Rifampicin OR Fuscidic acid for 2 weeks

Septic arthritis ~ 4-6 weeks
Cefotaxime (ceftriaxone) if gonoccoal or gram negative is suspected

30
Q

Common skin infections

A

Impetigo - contagious superficial skin infection, common in young children. Can also be a secondary complication from eczema or chicken pox, due to scratching
Two types bullous vs non-bullous

Cellulitis - inflammation in the subcutaenous infection. Infections spreading around the wound, or lower leg infections are usually cellulitis.

Skin infections are usually caused by stapphylococci aureus.

Animal and human bites are also another common skin infection.

31
Q

Treatment of common skin infections

A

Impetigo non-bullous AND restricted to small area
1st line: hydrogen peroxide cream. Canot be used near the eyes.
Alternatively: Fuscidic acid cream.

Impetigo non-bullous AND widespead
1st line: Flucloxacillin OR Fuscidic acid

If a patient is systemically unwell, have a high risk of complications of have bullous impetigo:
1st line: Flucloxacillin
In penicillin allergy: Clarithromycin or Erythromycin if they are pregnant

Cellulitis
First line: Flucloxacillin oral/IV
In penicillin allergy: Clarithromycin or Erythromycin in pregnant patients OR Doxycicline

If the cellulitis is near the eyes or nose:
1st line: Co-amoxiclav oral/IV
In penicllin allergy: Clarithromycin + Metronidazole

Animal and human bites
1st line: Co-amoxiclav oral IV
In penicilllin allergy: Doxycicline + Metronidazole

32
Q

What are common dental infections

A

Are commonly caused by anaerobic bacteria

  • Gingivitis Acute necrotizing ulcerative gingivitis (ANUG) - painful infection of the gums.
  • Pericoronitis - inflammation of the gum tissue around your wisdom teeth.
  • Periapical abscess - a pocket of infection (pus) around your tooth root.
  • Periodontal abscess - is a pocket of pus in the tissues of the gum
  • Periodonitis - severe infalmmation of the gums. It is a gum disease.
33
Q

Treatment of common dental infections

A

Pericoronitis/ANUG ~ 3 days
1st line: Metronidazole 400/500mg TDS
Alternatively: Amoxicllin 500mg-1g TDS

Periapical OR periodental abscess up to 5 days
1st line: Phenoxymethylpenicilllin or amoxicillin
In penicillin allergy: Clarithromycin

If there are signs of spreading infection, ADD metronidazole

34
Q

Common infections of the ear, nose and throat

A

Otits externa - infection of the outer ear canal. Commonly caused by stapphylococcal aureus and pseudomonal aeurginosa

Otitis interna infection of the middle ear causing a build up of fluid. Commonly caused by haemophilus influenzae, streptococcus pyogenes and pneumoniae

Sinusitis - inflammation of the sinuses. Commonly caused by streptococcus pneumoniae, haemophilus influenzae. Staphylococcus aureus.

Sore throat - commonly caused by streptococcus pyogenes. AKA stret throat

35
Q

Treatment for infections of the ear, nose and throat

A

Ear infections, sinusitis and sore throat are self-limiting. A secondary bacterial infection may arise.

Otitis externa:
1st line: Flucloxacillin
In penicillin allergy: Clarithromycin or Azithromycin. Eryhtromycin if patient is pregnant
If pseudomonas is suspected, offer ciprofloxacin or an aminoglycoside (gentamicin)

Otitis media
1st line: Amoxicillin
If symptoms still worsen after 2/3 days of treatment, offer co-amoxiclav

In penicillin allergy: Clarithromycin or Erythromycin if patient is pregnant

Sinusitis
1st line: Phenoxymethylpenicillin
If symptoms still worsen after 2/3 days of treatment, offer co-amoxiclav

If patient is systemically unwell, has a high risk of complications, has signs of a more serious illness
Offer: co-amoxiclav

In penicillin allergy: Clarithromycin OR Doxycycline. Erythromycin should be offered if patient is pregnant

Acute Sore Throat
1st line: Phenoxymethylpenicillin for 5 - 10 days
In penicillin allergy: Clarithromycin. Erythromycin should be offered if patient is pregnant

36
Q

Common genito-urinary infections

A

Chlamydia - common STD. Caused by chlamydia trachomatis

Bacterial vaginosis - caused by excessive growth of bacteria found in the vagina. Increases the risk of contracting an STD.

Urinary tract infection - inflammation of the bladder. Commonly caused by E.coli. A lower UTI can develop into an upper UTI where the kidneys become affected.

37
Q

Treatment for common genito-urinary infections

A

Chlamydia
1st line: Doxycyline
Alternatively: Azithromycin, the dose is 1g dose on the first day the 500mg dose for the next 2 days

Bacterical vaginosis
1st line: Metronidazole 2g as single dose OR 400 - 500mg BD for 5 - 7 days
Alternatively can be treated with vaginal preparations of metronidazole or clindamycin

Lower-UTI
1st line: Nitrofuranotin OR trimethoprim (if there is a low risk of resistance)
Females: 3 days
Males: 7 days

If there is no improvement after 48 hours,
2nd line for females: Nitrofurantoin (if this was not previously given) Fosfomycin or Pivmecillinam

In men consider an alternative diagnosis such as kidney infection or prostatitis

In pregnant woman: Nitrofurantoin for 7 days. Should be AVOIDED at term
2nd line for pregnant woman: Amoxicillin of Cefalexin.

Should always treat asymptomatic bacteruria in pregnant woman, can be treated with any of the above antibiotics.

38
Q

What is tuberculosis and what are the signs and symptoms

A

Tuberculosis is a bacterial ifnection caused by myobacterium tuberculosus and is spread through coughs and sneezes.

Symptoms include a cough for over 3 weeks, weight loss, night sweats, loss of apetite and neck swelling

39
Q

Tuberculosis treatment

A

Active tuberculosis is treated in 2 phases and lasts 6 months in total.

In the initial phase, four drugs are taken for 2 months: Rifampicin, Isoniazid, Pyrazinimide, Ethambutol (RIPE).

In the continuation phase Rifampicin and Isoniazid are taken for 4 months

Chapter 5 - Infection (21 decks)

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