Antharax, leprosy, lyme disease, MRSA

Question 1

outline the treatment or the prophylaxis of antharax

Answer 1

1) Ciprofloxacin or doxycycline may be given for post-exposure prophylaxis.
2) If exposure is confirmed, antibacterial prophylaxis should continue for 60 days.
3) Vaccination may allow the duration of antibacterial prophylaxis to be shortened

Question 2

how should the Inhalation or gastro-intestinal anthrax be treated?

Answer 2

1) initially with either ciprofloxacin or doxycycline combined with one or two other antibacterials
2) Treatment should continue for 60 days because germination may be delayed

Question 3

How should cutaneous anthrax be treated?

Answer 3

Either ciprofloxacin or doxycycline for 7 days

Question 4

1) what are the recommended drugs for leprosy ? (Mycobacterium leprae)
2) what regimen is recommended?

Answer 4

1) Dapsone, rifampicin, and clofazimine

2) A 3 drug regimen is recommended for multibacillary leprosy, and a 2 drug regimen for paucibacillary leprosy

Question 5

how long should Multibacillary leprosy should be treated for?

Answer 5

combination of rifampicin, dapsone and clofazimine for at least 2 years

Question 6

how should type I and type II reversal reactions be managed in the treatment of leprosy?

Answer 6

1) continued unchanged during both type I or type II reactions.
2) Neuritic pain or weakness can herald the rapid onset of permanent nerve damage. Give prednisolone at once. mild reactions respond to aspirin.

Question 7

how should Paucibacillary leprosy be treated?

Answer 7

rifampicin and dapsone for 6 months. If treatment is interrupted the regimen should be recommenced where it was left off to complete the full course.

Question 8

how should treatment for resistant MRSA be guided?

Answer 8

by the sensitivity of the infecting strain

Question 9

how should skin and soft-tissue infections caused by MRSA be treated?

Answer 9

1) Tetracycline or a combination of rifampicin and fusidic acid
2) A glycopeptide (e.g. vancomycin) if severe

Question 10

How should bronchiectasis caused by MRSA be treated?

Answer 10

1) A tetracycline or clindamycin

2) A glycopeptide can be used for pneumonia associated with MRSA

Question 11

how are urinary-tract infections caused by MRSA treated?

Answer 11

1) A tetracycline

2) trimethoprim or nitrofurantoin are alternatives. A glycopeptide for severe or resistant cases

Question 12

how should septicaemia associated with MRSA be treated?

Answer 12

A glycopeptide can be used for septicaemia associated with MRSA.

Question 13

Prophylaxis with vancomycin or teicoplanin is appropriate for patients undergoing surgery if they meet what criteria?

Answer 13

1) History of MRSA colonisation or infection without documented eradication
2) risk that the patient’s MRSA carriage has recurred
3) comes from an area with a high prevalence of MRSA

Question 14

lymes disease is caused by Borrelia burgdorferi, it is transmitted to humans from an infected tick. what are the characteristics of a tick bite and what are the symptoms?

Answer 14

1) Characteristic erythema migrans rash
2) Becomes visible 1–4 weeks after bite, but can appear from 3 days to 3 months, and last several weeks
3) May have fever, swollen glands, malaise, fatigue, neck pain or stiffness, joint or muscle pain, headache, cognitive impairment
4) Some may appear months or years after the initial infection e.g. focal, neurological, joint, cardiac or skin manifestations

Question 15

Most tick bites do not cause Lyme disease, and the prompt and correct removal of the tick reduces the risk of infection. what are the drug treatments for this disease?

Answer 15

1) if present with focal symptoms specialist referral should be considered, but should not delay treatment.
2) if presenting with erythema migrans rash with or without non-focal symptoms,] doxycycline first-line. if C/I amoxicillin alternative

Question 16

In patients presenting with symptoms of central nervous system involvement following a tick bite, what is the preferred treatment?

Answer 16

1) IV ceftriaxone first-line treatment
2) Oral doxycycline is an alternative
- same treatment for Lyme carditis who are haemodynamically unstable

Question 17

In patients with symptoms of Lyme arthritis or acrodermatitis, chronica atrophicans, Lyme carditis who are haemodynamically stable what is the treatment of choice?

Answer 17

1) Doxycycline

2) ceftriaxone alternative

Question 18

how should patients presenting with ongoing symptoms of lymes disease be managed?

Answer 18

1) Assess for re-infection , treatment failure or non-adherence, or progression to organ damage caused by Lyme disease (such as nerve palsy)
2) A second course given to patients presenting with signs and symptoms of re-infection. if this fails an alternative antibacterial drug considered. A third course should not be considered, refer to specialist