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Infection > Antibacterial therapy guidelines bnf > Flashcards

Antibacterial therapy guidelines bnf Flashcards

1
Q

Septicaemia (community acquired)

A

1) A broad spectrum antipseudomonal penicillin ( e.g. Piptaz) OR a broad spectrum cephalosporin (e.g. cefuroxime)
MRSA = add Vancomycin

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2
Q

Meningiococcal septicaemia

A

Single dose benzylpenicillin BEFORE transfer to hospital as long as it does not delay transfer. If pen allergic give cefotaxime. If immediate hypersensitivity to penicillin or cephalosporins then give chloramphenicol

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3
Q

Endocarditis initial blind therapy for native valve endocarditis

A

Amoxicillin (or ampicillin) consider adding low dose gent. If pen allergic or MRSA use vancomycin + low dose gent. If severe sepsis use Vancomycin + meropenem.

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4
Q

Endocarditis initial blind therapy for prosthetic valve endocarditis

A

Vancomycin + rifampicin + low-dose gentamicin

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5
Q

In hospital what is the adjunctive treatment for meningitis?

A

dexamethasone but avoid in septic shock

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6
Q

In hospital for meningitis initial empirical therapy what do you give for <50yrs?

A

Cefotaxime (or ceftriaxone).

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7
Q

In hospital for meningitis initial empirical therapy what do you give for > 50yrs?

A

cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin).

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8
Q

When do you add vancomycin for hospital meningitis initial empircial therapy?

A

If prolonged use of other antibacterials in the last 3 months or if travelled in the last 3 months

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9
Q

What is the suggested duration of treatment for meningitis intial empirical therapy?

A

10 days

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10
Q

What is first line for meningitis caused by penumococci?

A

cefotaxime or ceftriaxone (with dexamethasone)

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11
Q

What is first line for meningitis caused by haemophilus influenzae?

A

cefotaxime or ceftriaxone (with dexamethasone)

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12
Q

Meningitis caused by Listeria

A

Amoxicillin (or ampicillin) + gentamicin. For 21 days

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13
Q

What is first line for mild diabetic foot infection?

A

1) Flucloxacillin

2) clarithromycin, doxycycline or erythromycin (in pregnancy)

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14
Q

What bacteria can cause otitis externa?

A

Pseudomonas aeruginosa or Staphylococcus aureus

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15
Q

If antibiotics are needed for otitis externa, what is first line?

A

1) Flucloxacillin

2) If allergy (clarithromycin)

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16
Q

If antibiotics are needed for otitis externa, what is first line if pseudomonas is suspected?

A

ciprofloxacin (or an aminoglycoside)

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17
Q

What bacteria causes acute otitis media?

A

Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes, and Moraxella catarrhalis

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18
Q

What is first line for otitis media if needed?

A

1) amoxicillin

2) if worsening use co-amoxiclav

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19
Q

Gastro-enteritis

A

self limiting

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20
Q

Campylobacter enteritis

A

Self limiting

1) clarithromycin (or azithromycin or erythromycin)
2) alternative is ciprofloxacin

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21
Q

Suspected or confirmed uncomplicated acute diverticulitis

A

1) co-amoxiclav

2) If pen allergic use cefalexin

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22
Q

Salmonella (non-typhoid)

A

Only treat invasive or severe infection. Ciprofloxacin or cefotaxime

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23
Q

Shigellosis

A

Antibacterial not normally needed. Ciprofloxacin or azithromycin

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24
Q

Typhoid fever

A

1) cefotaxime (or ceftriaxone)

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25
Q

Clostridioides difficile

A

1) oral metronidazole for 10-14 days
2) If severe use oral vancomycin for 10-14 days
3) If multiple co-morbidities give fidaxomicin

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26
Q

Biliary tract infection

A

ciprofloxacin or gentamicin or cephalosporin

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27
Q

Bacterial vaginosis

A

1) Oral metronidazole 400-500mg BD for 5-7 days OR 2g single dose

OR

Topical metronidazole (5days) or topical clindamycin (7 days)

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28
Q

CONTACT TRACING. Uncomplicated chlamydia

A

1) doxycycline 100mg BD for 7 days

2) azithromycin 1g for 1 dose

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29
Q

CONTACT TRACING. Uncomplicated gonorrhoea for patient and partner(s)

A

1) IM ceftriaxone

2) Oral ciprofloxacin

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30
Q

What additional advice is recommended in gonorrhoea

A

contact tracing and don’t have sex for 7 days AFTER treatment has finished.

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31
Q

Do you treat the partners of people with STIs (gonorrhoea or chlamydia0

A

Yes, even if they do not have symptoms

32
Q

CONTACT TRACING. Pelvic inflammatory disease

A

Doxycyline + metronidazole + single dose of I/M ceftriaxone

33
Q

CONTACT TRACING. Early syphilis (less than 2 years)

A

1) Benzathine benzylpenicillin as a single dose or repeat after 7 days for women in thrid trimester of pregnancy
2) doxycyline or erythromycin for 14 days

34
Q

Late Latent syphilis >2 yrs

A

1) Benzathine benzylpenicillin. Once weekly for 2 weeks

2) doxycyline for 28 days

35
Q

Asymptomactic contacts of patients with infectious syphilis

A

Doxycyline for 14 days

36
Q

Osteopmyelitis

A

Flucloxacilin for 6 weeks (add fusidic acid or rifampicin for initial 2 weeks)

37
Q

If pen allergic in osteomyelitis

A

Clindamycin for 6 weeks. (add fusidic acid or rifampicin for initial 2 weeks)

38
Q

If MRSA suspected

A

Vancomycin or teicoplanin for 6 weeks (add fusidic acid or rifampicin for initial 2 weeks)

39
Q

Spetic arthritis

A

Flucloxacillin (4-6 weeks)

40
Q

What bacteria causes acute sinusitis?

A

Streptococcus pneumoniae, Haemophylus influenzae, Moraxella catharrhalis, or Staphylococcus aureus.

41
Q

When should you consider antibiotics for sinusitis?

A

At around 10 days or more with no improvememnt prescribe a back up antibiotic prescription which can be used if symptoms do not improve within 7 days

42
Q

What is the first line for sinusitis?

A

1) phenoxymethylpenicillin
2) co-amoxiclav

If pen allergic:

1) doxycyline or clarithromycin

43
Q

Oral infections

A

Most are resolved by early drainage and removal of the cause

44
Q

Dentoalveolar abcess

A

phenoxymethylpenicillin

45
Q

Vincent’s infection (acute necrotising ulcerative gingivitis)

A

Metronidazole

46
Q

Epiglottis (haemophilus influenzae)

A

cefotaxime or ceftriaxone

If allergic then = chloramphenicol

47
Q

Acute exacerbation of bronchiectasis

A

1) amoxicillin, clarithromycin or doxycycline for 7-14 days

48
Q

COPD acute exacerbation

A

1) amoxicillin, clarithromycin or doxycycline for 5 days

49
Q

Acute cough if antibiotics are needed

A

1) Doxycycline for 5 days

50
Q

Community acquired pneumonia (base it on the CURB65 score)

A

1) Amoxicillin for low to moderate severity

2) High severity = Oral or IV co-amoxiclav with clarithromycin or erythromycin (in pregnancy)

51
Q

Hospital acquired pneumonia

A

develops 48 hours or more after hospital admission

52
Q

When to treat hospital acquired pneumonia

A

ASAP (within 4 hours of diagnosis)

53
Q

Hospital acquired pneumonia

A

1) co-amoxiclav
2) doxycyline, cefalexin, co-trimoxazole or levofloxacin

If severe:

1) IV Piptaz, ceftazidime, ceftazidime with avibactam, ceftriaxone, cefuroxime, levofloxacin or meropenem
2) If MRSA confirmed or suspected add vancomycin or teicoplanin or linezolid

54
Q

Non-bullous impetigo (most common)

A

thin-walled vesicles or pustules that rupture quickly forming a golden-brown crust

55
Q

bullous impetigo

A

prescence of fluid filled vesicles and blisters that rupture leaving a thin, flat, yellow-brown crust

56
Q

In localised non-bullous impetigo

A

1) hydrogen peroxide 1% cream to the skin 2-3 times a day for 5-7 days. AVOID EYES

57
Q

In patients with widespread non-bullous impetigo who are not systemically unwell

A

topical or oral antibacterial

58
Q

In patients with non- bullous impetio or all patients with bullous impetigo

A

oral antibacterial.

Combination of an oral and topical antibiotic is NOT recommended

59
Q

When to refer to hospital?

A

1) if systemically unwell
2) high risk of complications
3) difficult to treat e.g. bullous impetigo in children under 1 year or recurrent impetigo

60
Q

What are the topical first line for impetigo?

A

1) hydrogen peroxide 2-3 times a day for 5-7 days AVOID EYES
2) fusidic acid 2% cream 3 times a day for 5-7 days
3) Mupirocin cream 3 times a day for 5-7 days

61
Q

What is oral first line for impetigo?

A

1) Flucloxacillin 500mg QDS for 5-7 days

2) If penicillin allergic then use clarithromycin or erythromycin (in pregnancy)

62
Q

What first line for cellulitis/ erysipelas?

A

1) Flucloxacillin 0.5-1g QDS for 5-7 days then review

63
Q

When do you refer cellulitis/ erysipelas to hospital?

A
  • eye involvement
  • bone involvement
  • septic arthritis
  • necrotising faciitis
  • sepsis
64
Q

What is first line for cellulitis/ erysipelas if there is infection near the eyes or nose?

A

1) co-amoxiclav 500/125 mg every 8 hours for 7 days then review
2) In pen allergy give clarithromycin with metronidazole

65
Q

When do you consider antibacterial prophylaxis for cellulitis or erysipelas?

A

Is there is at least 2 separate episodes of cellulitis or erysipelas in the previous 12 months . Review every 6 months

66
Q

Leg ulcer

A

Develop on the lower leg between the shin and ankle and take more than 4-6 weeks to heal.

67
Q

What are signs of infected leg ulcer?

A

Redness, swelling spreading beyond the ulcer, localised warmth, increased pain or fever.

68
Q

First line for leg ulcer in non severely unwell patients

A

1) Flucloxacillin 0.5-2g QDS for 7 days OR if pen allergy then use doxycyline, clarithromycin or erythromycin
2) Co-amoxiclav. In pen allergy use co-trimoxazole

69
Q

First line for leg ulcer in severely unwell patients

A

1) PO/IV flucloxacillin with or without IV gentamicin and/or metronidazole

70
Q

If MRSA leg ulcer

A

ADD IV vancomycin, IV teicoplanin or linezolid

71
Q

Human, cat, dog or other traditional pet bite prophylaxis or treatment (oral)

A

1) co-amoxiclav 250/125mg TDS for 3 days

2) In pen allergy give doxycyline with metronidazole

72
Q

Human, cat, dog or other traditional pet bite prophylaxis or treatment (IV)

A

1) co-amoxiclav

2) If pen allergy give: cefuroxime OR ceftriaxone with metronidazole

73
Q

When do you offer prophylaxis for a human, cat, dog or other traditional pet bite?

A

If there has been broken skin or drawn blood

74
Q

Secondary bacterial infection of common skin conditions like chickenpox, eczema, psoriasis, scabies and shingles

A

Topical first line: fusidic acid

Oral first line: flucloxacillin

75
Q

Mastitis during breast feeding (inflammation of mammary gland)

A

Treat if severe, systemically unwell, nipple fissure present, if symptoms do not improve after 12-24 hours after milk removal. Continue breast feeding or expressing milk during treatment

1) Flucloxacillin for 10-14 days
2) Erythromycin for 10-14 days

Infection (2 decks)

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