Abx ~ prophylaxis

Question 1

Rheumatic fever: prevention of recurrence TX

Answer 1

Phenoxymethylpenicillin OR sulfadiazine

Question 2

Invasive group A streptococcal infection: prevention of secondary cases

Answer 2

~ Phenoxymethylpenicillin.
~ penicillin allergic: azithromycin [unlicensed use], or clarithromycin [unlicensed use], or erythromycin (in pregnancy or within 28 days of giving birth).

Question 3

Meningococcal disease: prevention of secondary cases

Answer 3

1st line:
Ciprofloxacin;

~ Alternative if unsuitable, or if recent travel to Middle East or Asia:
Rifampicin.
~ In pregnancy:
Ciprofloxacin, ceftriaxone [unlicensed use], or azithromycin [unlicensed use].

Question 4

Haemophilus influenzae type b infection: prevention of secondary disease

Answer 4

~ 1st line:
Rifampicin;
~ Alternative if unsuitable: ceftriaxone [unlicensed] (based on limited evidence), or oral ciprofloxacin [unlicensed] or azithromycin [unlicensed] (however effectiveness in healthy individuals has not been determined).

Question 5

Diphtheria: prevention of secondary cases

Answer 5

1st line:
Azithromycin [unlicensed use], or clarithromycin [unlicensed use], or erythromycin (in pregnancy);
~ Alternative if more easily administered: benzathine benzylpenicillin [unlicensed use].

Question 6

Pertussis: prevention of secondary cases

Answer 6

~ 1st line:
Azithromycin [unlicensed use], clarithromycin, or erythromycin;
Alternative if macrolides contraindicated or not tolerated: co-trimoxazole [unlicensed use].
~ In pregnancy:
Erythromycin = preferred macrolide, with azithromycin [unlicensed use] 2nd line, and clarithromycin 3rd line.

Question 7

Pneumococcal infection in asplenia or in patients with sickle-cell disease, antibacterial prophylaxis

Answer 7

~ Phenoxymethylpenicillin.
~ If penicillin-allergic, erythromycin.
~ Antibacterial prophylaxis not fully reliable. Antibacterial prophylaxis may be discontinued in children >5 years of age with sickle-cell disease who have received pneumococcal immunisation and who do not have a history of severe pneumococcal infection.

Question 8

Gastro-intestinal procedures, Abx prophylaxis
~ Operations on stomach or oesophagus

Answer 8

~ Single dose of IV gentamicin or IV cefuroxime or IV co-amoxiclav (additional intra-operative or postoperative doses may be given for prolonged procedures or if major blood loss).
~ given up to 30 minutes before procedure.

~ Add IV teicoplanin (or vancomycin) if high risk of MRSA

Question 9

Gastro-intestinal procedures, Abx prophylaxis
~ Open biliary surgery

Answer 9

~ Single dose of IV cefuroxime + IV metronidazole or IV gentamicin + IV metronidazole or IV co-amoxiclav alone (additional intra-operative or postoperative doses may be given for prolonged procedures or if major blood loss).
~ given up to 30 minutes before procedure.

Where IV metronidazole suggested, it may alternatively be given by suppository but to allow adequate absorption, it should be given 2 hours before surgery.

Add IV teicoplanin (or vancomycin) if high risk of MRSA