Antibacterial therapy guidelines bnf Flashcards
Septicaemia (community acquired)
1) A broad spectrum antipseudomonal penicillin ( e.g. Piptaz) OR a broad spectrum cephalosporin (e.g. cefuroxime)
MRSA = add Vancomycin
Meningiococcal septicaemia
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
Endocarditis initial blind therapy for native valve endocarditis
Amoxicillin (or ampicillin) consider adding low dose gent. If pen allergic or MRSA use vancomycin + low dose gent. If severe sepsis use Vancomycin + meropenem.
Endocarditis initial blind therapy for prosthetic valve endocarditis
Vancomycin + rifampicin + low-dose gentamicin
In hospital what is the adjunctive treatment for meningitis?
dexamethasone but avoid in septic shock
In hospital for meningitis initial empirical therapy what do you give for <50yrs?
Cefotaxime (or ceftriaxone).
In hospital for meningitis initial empirical therapy what do you give for > 50yrs?
cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin).
When do you add vancomycin for hospital meningitis initial empircial therapy?
If prolonged use of other antibacterials in the last 3 months or if travelled in the last 3 months
What is the suggested duration of treatment for meningitis intial empirical therapy?
10 days
What is first line for meningitis caused by penumococci?
cefotaxime or ceftriaxone (with dexamethasone)
What is first line for meningitis caused by haemophilus influenzae?
cefotaxime or ceftriaxone (with dexamethasone)
Meningitis caused by Listeria
Amoxicillin (or ampicillin) + gentamicin. For 21 days
What is first line for mild diabetic foot infection?
1) Flucloxacillin
2) clarithromycin, doxycycline or erythromycin (in pregnancy)
What bacteria can cause otitis externa?
Pseudomonas aeruginosa or Staphylococcus aureus
If antibiotics are needed for otitis externa, what is first line?
1) Flucloxacillin
2) If allergy (clarithromycin)
If antibiotics are needed for otitis externa, what is first line if pseudomonas is suspected?
ciprofloxacin (or an aminoglycoside)
What bacteria causes acute otitis media?
Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes, and Moraxella catarrhalis
What is first line for otitis media if needed?
1) amoxicillin
2) if worsening use co-amoxiclav
Gastro-enteritis
self limiting
Campylobacter enteritis
Self limiting
1) clarithromycin (or azithromycin or erythromycin)
2) alternative is ciprofloxacin
Suspected or confirmed uncomplicated acute diverticulitis
1) co-amoxiclav
2) If pen allergic use cefalexin
Salmonella (non-typhoid)
Only treat invasive or severe infection. Ciprofloxacin or cefotaxime
Shigellosis
Antibacterial not normally needed. Ciprofloxacin or azithromycin
Typhoid fever
1) cefotaxime (or ceftriaxone)
Clostridioides difficile
1) oral metronidazole for 10-14 days
2) If severe use oral vancomycin for 10-14 days
3) If multiple co-morbidities give fidaxomicin
Biliary tract infection
ciprofloxacin or gentamicin or cephalosporin
Bacterial vaginosis
1) Oral metronidazole 400-500mg BD for 5-7 days OR 2g single dose
OR
Topical metronidazole (5days) or topical clindamycin (7 days)
CONTACT TRACING. Uncomplicated chlamydia
1) doxycycline 100mg BD for 7 days
2) azithromycin 1g for 1 dose
CONTACT TRACING. Uncomplicated gonorrhoea for patient and partner(s)
1) IM ceftriaxone
2) Oral ciprofloxacin
What additional advice is recommended in gonorrhoea
contact tracing and don’t have sex for 7 days AFTER treatment has finished.
Do you treat the partners of people with STIs (gonorrhoea or chlamydia0
Yes, even if they do not have symptoms
CONTACT TRACING. Pelvic inflammatory disease
Doxycyline + metronidazole + single dose of I/M ceftriaxone
CONTACT TRACING. Early syphilis (less than 2 years)
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
Late Latent syphilis >2 yrs
1) Benzathine benzylpenicillin. Once weekly for 2 weeks
2) doxycyline for 28 days
Asymptomactic contacts of patients with infectious syphilis
Doxycyline for 14 days
Osteopmyelitis
Flucloxacilin for 6 weeks (add fusidic acid or rifampicin for initial 2 weeks)
If pen allergic in osteomyelitis
Clindamycin for 6 weeks. (add fusidic acid or rifampicin for initial 2 weeks)
If MRSA suspected
Vancomycin or teicoplanin for 6 weeks (add fusidic acid or rifampicin for initial 2 weeks)
Spetic arthritis
Flucloxacillin (4-6 weeks)
What bacteria causes acute sinusitis?
Streptococcus pneumoniae, Haemophylus influenzae, Moraxella catharrhalis, or Staphylococcus aureus.
When should you consider antibiotics for sinusitis?
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
What is the first line for sinusitis?
1) phenoxymethylpenicillin
2) co-amoxiclav
If pen allergic:
1) doxycyline or clarithromycin
Oral infections
Most are resolved by early drainage and removal of the cause
Dentoalveolar abcess
phenoxymethylpenicillin
Vincent’s infection (acute necrotising ulcerative gingivitis)
Metronidazole
Epiglottis (haemophilus influenzae)
cefotaxime or ceftriaxone
If allergic then = chloramphenicol
Acute exacerbation of bronchiectasis
1) amoxicillin, clarithromycin or doxycycline for 7-14 days
COPD acute exacerbation
1) amoxicillin, clarithromycin or doxycycline for 5 days
Acute cough if antibiotics are needed
1) Doxycycline for 5 days
Community acquired pneumonia (base it on the CURB65 score)
1) Amoxicillin for low to moderate severity
2) High severity = Oral or IV co-amoxiclav with clarithromycin or erythromycin (in pregnancy)
Hospital acquired pneumonia
develops 48 hours or more after hospital admission
When to treat hospital acquired pneumonia
ASAP (within 4 hours of diagnosis)
Hospital acquired pneumonia
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
Non-bullous impetigo (most common)
thin-walled vesicles or pustules that rupture quickly forming a golden-brown crust
bullous impetigo
prescence of fluid filled vesicles and blisters that rupture leaving a thin, flat, yellow-brown crust
In localised non-bullous impetigo
1) hydrogen peroxide 1% cream to the skin 2-3 times a day for 5-7 days. AVOID EYES
In patients with widespread non-bullous impetigo who are not systemically unwell
topical or oral antibacterial
In patients with non- bullous impetio or all patients with bullous impetigo
oral antibacterial.
Combination of an oral and topical antibiotic is NOT recommended
When to refer to hospital?
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
What are the topical first line for impetigo?
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
What is oral first line for impetigo?
1) Flucloxacillin 500mg QDS for 5-7 days
2) If penicillin allergic then use clarithromycin or erythromycin (in pregnancy)
What first line for cellulitis/ erysipelas?
1) Flucloxacillin 0.5-1g QDS for 5-7 days then review
When do you refer cellulitis/ erysipelas to hospital?
- eye involvement
- bone involvement
- septic arthritis
- necrotising faciitis
- sepsis
What is first line for cellulitis/ erysipelas if there is infection near the eyes or nose?
1) co-amoxiclav 500/125 mg every 8 hours for 7 days then review
2) In pen allergy give clarithromycin with metronidazole
When do you consider antibacterial prophylaxis for cellulitis or erysipelas?
Is there is at least 2 separate episodes of cellulitis or erysipelas in the previous 12 months . Review every 6 months
Leg ulcer
Develop on the lower leg between the shin and ankle and take more than 4-6 weeks to heal.
What are signs of infected leg ulcer?
Redness, swelling spreading beyond the ulcer, localised warmth, increased pain or fever.
First line for leg ulcer in non severely unwell patients
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
First line for leg ulcer in severely unwell patients
1) PO/IV flucloxacillin with or without IV gentamicin and/or metronidazole
If MRSA leg ulcer
ADD IV vancomycin, IV teicoplanin or linezolid
Human, cat, dog or other traditional pet bite prophylaxis or treatment (oral)
1) co-amoxiclav 250/125mg TDS for 3 days
2) In pen allergy give doxycyline with metronidazole
Human, cat, dog or other traditional pet bite prophylaxis or treatment (IV)
1) co-amoxiclav
2) If pen allergy give: cefuroxime OR ceftriaxone with metronidazole
When do you offer prophylaxis for a human, cat, dog or other traditional pet bite?
If there has been broken skin or drawn blood
Secondary bacterial infection of common skin conditions like chickenpox, eczema, psoriasis, scabies and shingles
Topical first line: fusidic acid
Oral first line: flucloxacillin
Mastitis during breast feeding (inflammation of mammary gland)
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
