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Abx Prescribing Pathways Flashcards

https://www.bnf.org/wp-content/uploads/2022/03/summary-antimicrobial-prescribing-guidance_mar-22_v0.2.pdf?UNLID=9554059142022101301458

1
Q

What other Abx does a penicillin-allergic pt need to avoid?

A
  • There’s cross-sensitivity with cephalosporins and other B-lactam Abx.
  • Good alts, would be macrolides AND metronidazole in dental infection
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2
Q

In pregnancy what is the safest Abx?

A

Penicillin or cephalosporins

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3
Q

In pregnancy, which Abx should you avoid?

A
  • C/I = tetracyclines and trimethoprim
  • Nitrofurantoin causes N, thus, avoid at term
    AVOID: (MCAT)
  • metronidazole, chloramphenicol, aminoglycosides, tetracycline
  • quinolones
  • sulphonamides
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4
Q

Human and animal bites

A

1st line: Co-amoxiclav 250mg/125mg or 500/125mg TDS
2nd: Doxycycline 200mg on day 1, then 100mg or 200md OD AND Metronidazole 400mg TDS
Prophylaxis: 3 days
Treatment: 5 days

Human and animal scratches: Flucloxacillin

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5
Q

Tick bites (can cause Lyme disease)

A

1st: Doxycycline 100mg BD for 21 days of treatment
2nd: Amoxicillin 100mg TDS

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6
Q

Diabetic foot infection - MILD (less than 2cm)

A
  • Flucloxacillin 500mg to 1g QDS for 7 days
  • If penicillin allergy, clarithromycin 500mg BD, erythromycin (in pregnancy) 500mg QDS, doxycycline 200mg on day 1 and then 100mg OD.
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7
Q

Diabetic foot infection - Moderate/Severe (abscess, osteomyelitis - infection that causes pain in the longs bones in the leg)

A
  • Flucloxacillin or co-amoxiclav +/- gentamicin
  • Penicillin allergy => Co-trimoxazole +/- gentamicin
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8
Q

Cellulitis

A

1st line: Flucloxacillin 500mg to 1g QDS for 5 - 7 days

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9
Q

Cellulitis - penicillin allergy or if flucloxacillin unsuitable?

A
  • clarithromycin 500mg BD or erythromycin (in pregnancy) 500mg QDS
  • doxycycline 200mg on day 1 then 100mg OD
  • co-amoxiclav 500mg/125mg TDS for children
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10
Q

Cellulitis - for infections near eyes or nose

A
  • Co-amoxiclav
  • Penicillin allergic => Clarithromycin AND Metronidazole
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11
Q

CAP - low severity - 5 days

C - confusion?
U - Urea > 7mmol/L
R - RR > or = 30/min
B - BP at <90mmHg for systolic, and < or = 60mmHg diastolic
65 - > or = 65 years

A

1st line: Amoxicllin 500mg TDS for 5 days
2nd: Doxycycline 200mg on day 1, then 100mg OD or clarithromycin 500mg BD (erythromycin 500mg QDS in pregnancy)

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12
Q

CAP - moderate severity - 5 days

A

1st: Amoxicllin AND (if atypical pathogens suspected) clarithromycin (erythromycin in pregnancy)
2nd: Doxycyline or Clarithromycin

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13
Q

CAP - high severity - 5 days

A

1st: Co-amoxiclav 500/125mg TDS AND clarithromycin 500mg BD (erythromycin 500mg QDS in pregnancy)
2nd: Levofloxacin

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14
Q

Diarrhoea - C.difficile?

A

10 days treatment
1st line: Vancomycin
2nd: Fidaxomicin
Life threatening: Vancomycin AND IV Metronidazole

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15
Q

Diarrhoea - traveller’s diarrhoea?

A

Standby: Azithromycin 500mg OD for 1 to 3 days
Prophylaxis/Treatment: Bismuth Subsalicylate

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16
Q

Infective Diarrhoea

A

If Campylobacter suspected - Clari 250mg - 500mg BD for 5 - 7 days

If Gardia suspected - Tinidazole 2g single dose

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17
Q

Ear infections - Otitis Externa

A

1st: Topical acetic acid 2%
2nd: Topical neomycin sulphate with corticosteroid (usually hydrocortisone)
If systemic treatment needed, i.e. cellulitis: Flucloxacillin

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18
Q

Ear infections - Otitis media

A

1st: Amoxicillin for 5 to 7 days
2nd: (worsening symptoms despite 2 - 3 days treatment) Co-amoxiclav
Penicillin allergy: Clarithromycin, erythromycin in pregnancy

Under 18s:
1st topical: Phenazone 40mg/g with lidocaine 10mg/g - 4 drops BD/TDS for 7 days

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19
Q

H. Pylori

A

Triple therapy:
- PPI: Omeprazole, esmoprazole, lansoprazole etc.
If omeprazole is given with clopidogrel => give lanosprazole instead!
- 2 x Abx: Amoxicillin 1000mg BD and Clarithromycin 500mg BD or Metrondazole 400mg BD for 7 days
OR Metronidazole 400mg BD and Clarithromycin 500mg BD for 7 days

Amoxicillin tends to be included in triple therapy unless penicillin allergy

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20
Q

H. Pylori - 13C Breath test

A

Helicobacter Pylori is diagnosed by Urea (13C) Breath Test.
- PPI use: It shouldn’t be performed within 2 WEEKS of taking PPIs
- Abx: Shouldn’t be performed within 4 WEEKS of taking Abx

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21
Q

HAP - non-severe - 5 days then review

A

1st: Co-amoxiclav 500mg/125mg TDS
2nd: (adults) doxycycline 200mg on day 1 then 100mg OD (teeth deposits, bone deposits, discoloration of teeth - avoid in age 12 and below) OR cefalexin 500mg BD or TDS OR co-trimoxazole 960mg BD OR levofloxacin
2nd: (children) clarithromycin

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22
Q

Impetigo - localised non-bullous

A

1st: Hydrogen peroxide 1% BD/TDS for 5 days
2nd: Fusidic acid 2% TDS for 5 days or (mupirocin 2% TDS if fusidic acid resistance suspected)

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23
Q

Impetigo - widespread non-bullous

A

Widespread - upper lip, chin and nose
1st: Fusidic acid 2% TDS for 5 days (mupirocin 2% if resistance suspected)

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24
Q

Impetigo - bullous or patients who are systemically unwell

A

1st: flucloxacillin 500mg QDS
2nd: clarithromycin 250mg QDS (erythromycin in pregnancy)

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25
Lower UTIs - MEN
1st: nitrofurantoin 100mg MR BD (if eGFR > 45mL/min) or trimethoprim 200mg BD if low resistance risk 7 days treatment in men
26
Lower UTIs - NON-PREGNANT WOMEN
1st: nitrofurantoin 100mg MR BD (if eGFR > 45 mL/min) or trimethoprim 200mg BD (if low resistance risk) 2nd: pivmecillinam or fosfomycin Uncomplicated: 3 days treatment
27
Lower UTI - PREGNANT WOMEN
1st: nitrofurantoin (if eGFR > 45mL/min and avoid at term) 2nd: Cefalexin 500mg BD or amoxicillin 500mg TDS Pregnancy: 7 days treatment
28
For lower UTIs, for which types of patients does it need to be 7 days treatment?
Men Pregnant people Catheter associated
29
When should you avoid using nitrofurantoin in terms of eGFR?
eGFR < 45mL/min
30
Strep throat and Scarlett fever
1st: phenoxymethylpenicillin 500mg QDS for 10 days (take on an empty stomach 1h before food and 2h after food) 2nd: clarithromycin, erythromycin in pregnancy
31
What are the symptoms to scarlet fever?
- flu like symptoms, high temperature, swollen neck glands - red rash with small raised bumps, feels rough like sandpaper - white coating on tongue that can lead to a "strawberry" tongue
32
Acne Vulgaris
Review first line treatment after 12 weeks! ACNE OF ANY SEVERITY: - fixed combo of topical adapalene with topical benzyl peroxide => not for under 9yo OR - fixed combination of topical clindamycin or topical tretinoin => not for under 12yo MILD - MODERATE ACNE: - fixed combination of topical clindamycin with topical benzoyl peroxide => not for under 12s; mild-moderate acne MODERATE - SEVERE ACNE: - fixed combination of topical adapalene with topical benzyl peroxide AND either PO lymecycline or PO doxycycline => not for under 12s; moderate-severe acne
33
Bacterial vaginosis (strong fishy smell) and trichomoniasis (thick, thin or frothy and yellow-green in colour)
Metronidazole 400mg BD for 7 days
34
Chlamydia
1st: Doxycycline 100mg BD for 7 days 2nd: azithromycin 1000mg STAT then 500mg OD for 2 days (3 days in total)
35
Conjunctivitis and blepharitis
Conjunctivitis: 1st: chloramphenicol 2hourly for 2 days, then reduce frequency to TDS-QDS 2nd: (1st line is CI, e.g. pregnant) Fusidic acid 1% eye drops — apply 1 drop BD. Continue use until 48 hours after the infection has cleared. Blepharitis: 1st: topical chloramphenicol 1% ointment BD
36
Dental abscess
1st: amoxicillin 500mg TDS for 5 days OR phenoxymethylpenicillin 500mg QDS for 5 days OR metronidazole 400mg TDS for 5 days
37
Gonorrhoea
Ceftriaxone 1g IM OR Ciprofloxacin 500mg STAT
38
Meningitis
Benzylpenicillin IV or IM (if vein can't be accessed) - kid <1 year 300mg - kid 1 - 9 years: 600mg - adult/kid 10+: 1.2g Causative agent: Neisseria meningitidis or if history of allergy to penicillin IV (IM if venous access not available) Cefotaxime injection (1 g) NEONATE 50 mg/kg CHILD 1 MONTH–11 YEARS 50 mg/kg (max. 1 g) CHILD 12–17 YEARS 1 g ADULT 1 g or if history of immediate hypersensitivity reaction (including anaphylaxis, angioedema, urticaria, or rash immediately after administration) to penicillin or to cephalosporins IV Chloramphenicol injection (1 g) CHILD 12.5–25 mg/kg ADULT 12.5–25 mg/kg
39
Scabies - red spots with silvery interlinking lines, usually in webbing of fingers / toes
1st: Permethrin 5% cream 2nd: Malathion 0.5% aq liquid if permethrin allergic Apply OW for 2 doses => 1 WEEK APART Apply to the whole body INCLUDING SCALP, NECK, FACE AND EARS Treat ALL members of the family and avoid physical contact with other members of the family Home/sexual contacts => treat within 24h
40
Headlice
Wet combing = comb for 30min at 4-day intervals until no lice found for 3 sessions (min. 2 weeks) DIMETICONE = apply for 8h to dry naturally - repeated AFTER 7 days MALATHION = apply for 12h to dry naturally - repeated AFTER 7 days - AVOID in severe eczema or asthma due to alcohol contents BENZYL BENZOATE and PERMETHRIN - not recommended MHRA = some preps are flammable!
41
Sinusitis
1st: phenoxymethylpenicillin 500mg QDS for 5 days 2nd: penicillin allergic - doxycycline 200mg on day 1, then 100mg OD for 5 days
42
Acute Cough
Adults: - 1st line: DOXY 200mg on day 1, then 100mg OD for 5 days - Alt 1st line: AMOXICILLIN 500mg TDS for 5 days OR Clari 250mg - 500mg BD for 5 days, OR Erythromycin 250mg - 500mg QDS or 500mg - 1g BD for 5 days Kids: - 1st line: Amoxicillin - 2nd: Clari OR Erythro OR Doxy (if 12+)
43
Influenza
- annual vaccination is essential for all those "at risk" of influenza - antivirals are typically not recommended for healthy adults - Treat "at risk" pts with OSELTAMIVIR 75mg BD for 5 days => this is primarily for when influenza is circulating in the community, and within 48h of onset (36h for zanamivir treatment in kids - only licensed for >5 YEARS.), or in a care home - AT RISK: => pregnant (& up to 2-weeks post-partum) => <6 months => 65 + => COPD, asthma => CVS, NOT HTN => severe immunosuppression => renal or liver disease => DM => morbid obesity (BMI>40) - In SEVERE immunosuppression or oseltamivir resistance, use ZANAMIVIR 10mg BD (2 inhalations BD by diskhaler for up to 10 days) and seek advice
44
Threadworm
1st: Mebendazole for a child above 6 months, 100mg STAT (OTC: over 2 years), repeat in 2 weeks if persistent. With Mebendazole, treat with hygiene measures for 2 weeks! TREAT ALL HOUSEHOLD CONTACTS AT SAME TIMES If x < 6 months or pregnant, ONLY hygiene measure for 6 weeks.
45
TB - initial phase
Initial phase is 2 months - rifampicin - isoniazid - pyrazinamide - ethambutol
46
TB - continuation phase
Continuation phase is 4 months - rifampicin - isoniazid
47
TB - latent TB
3 months of rifampicin + isoniazid OR 6 months of isoniazid Latent TB is where you've been infected with the TB bacteria, but do not have any symptoms of active infection.
48
Fungal infections - ASPERGILLOSIS Most commonly affects the respiratory tract but in severely immunocompromised patients, invasive forms can affect the heart, brain, and skin.
Voriconazole
49
Fungal infections - CRYPTOCOCCOSIS Uncommon but infection in the immunocompromised, especially in HIV-positive patients, can be life-threatening; cryptococcal meningitis is the most common form of fungal meningitis.
Amphotericin B
50
Fungal infections - THRUSH
- Vaginal: Clotrimazole/Fluconazole => resistant: itraconazole - PO: 1st: Oral Miconazole gel, then 2nd: Nystatin suspension, then 3rd: fluconazole 50mg OD for 7 days if infection is severe or extensive => resistant: itraconazole
51
Fungal infections - SKIN AND NAIL INFECTIONS
Skin: - 1st: topical terbinafine 1% OD to BD for 1-4 weeks OR topical imidazole 1% OD to BD for 4 - 6 weeks Nail: 1st: Terbinafine 250mg OD for 6 weeks on fingers and 12 weeks on toes 2nd: itraconazole 200mg BD for 1 week a month (fingers = 2 course; toes = 3 courses).
52
Fungal infections - TINEA (ringworm) What are the different types of ringworm called?
- Tinea capitis = head - Tinea corporis = body - Tinea cruris = groin - Tinea pedis = feet - Tinea unguium/onychomycosis = nails
53
Fungal infections - TINEA (ringworm) What would you treat it with?
Nail region: PO: Terbinafine 250mg OD for between 6 weeks and 3 months for fingernails, and 3 - 6 months for toenails. Topical: Amorolfine 5% nail lacquer. Applied once or twice weekly. Cont. treatment for 6 months for fingernails and 9 - 12 months for toenails. Refer to GP if under 18, more than 2 nails affected, diabetic or pregnant/breastfeeding. This isn't licensed for children under 12. Nail polish and artificial nails should be avoided while using the treatment.
54
Viral infections - Varicella zoster/chicken pox/herpes zoster/shingles
1st: Aciclovir 800mg 5 times daily for chicken pox and shingles 2nd: Famciclovir 250mg - 500mg TDS OR 750mg BD for shingles if poor compliance. NOT FOR KIDS. Chicken pox = pts 14 years and above, should take antiviral (aciclovir) 24h on onset.
55
Which antimalarials are used for malaria?
- Malarone (atovaquone with proguanil) - Chloroquine - LT; okay for pregnant ppl - Proguanil - LT; okay for pregnant ppl - Mefloquine - Doxycycline
56
Oral candidiasis
Topical azoles are more effective than topical nystatin 1st: Miconazole oral gel 2.5mL 24mg/mL QDS for 7 days and continue 7 days after resolved 2nd: Nystatin suspension 1mL (100,000units/mL) QD (half each side) for 7 days, then continue for 2 days after resolved. 3rd: Fluconazole 50mg/100mg caps OD for 7 - 14 days
57
Cold sores
Most resolve within 5 days without treatment! 1st: Topical antivirals such as ACICLOVIR CREAM applied early on. If frequent/severe: give PO prophylaxis of aciclovir 400mg BD for 5 - 7 days
58
What is the SEPSIS 6 protocol?
1. give high flow O2 2. give IV abx within 1h 3. give fluids - helps to increase BP 4. take blood cultures to determine narrow abx treatment 5. measure lactate measurements - indication of anaerobic respiration 6. measure urine output - indication of kidney impairment
59
Acute Infective Exacerbation of COPD
3 choices used for 5 days: - Amoxicillin 500mg TDS - Doxycycline 200mg on day 1, then 100mg OD - Clarithromycin 500mg BD High risk of treatment failure: - Co-trimoxazole 960mg BD, or co-amoxiclav 500/125mg TDS
60
Acute Exacerbation of Bronchiectasis (Non-Cystic Fibrosis)
3 choices used for 7 - 14 days: - Amoxicillin 500mg TDS - preferred if pregnant - Doxycycline 200mg on day 1, then 100mg OD - Clarithromycin 500mg BD High risk of treatment failure: - Co-amoxiclav 500/125mg TDS, or Levofloxacin 500mg OD (adults ONLY), or, Ciprofloxacin 500mg OD or BD (kids ONLY)
61
Acute diverticulitis
1st: Co-amoxiclav 500/125mg TDS For 5 days 2nd: Cefalexin 500mg BD/TDS AND Metronidazole 400mg TDS for 5 days OR: Trimethoprim 200mg BD AND Metronidazole 400mg TDS for 5 days

Paeds, MEP, OTC & Misc. (28 decks)

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