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Antibiotic Man Flashcards

1
Q

What are the indications for IV delivery of antibiotics?

A

2 or more from sepsis criteria (Temp >38 or <36, HR >90, altered mental state, WC <4000 or >12000, RR >20)
Febrile with neutropenia or immunosuppression
Specific Indications - endocarditis, septic arthritis, abscess, meningitis, osteomyleitis
Oral route is compromised
Post surgery
unable to tolerate 1l of fluid
No oral formulation available

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2
Q

In which conditions would you give IV antibiotics?

A

endocarditis, septic arthritis, abscess, meningitis, osteomyleitis

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3
Q

What are the 4Cs of antibiotics?

A

fluoroquinolones, clindamycin, co-amoxiclav, and cephalosporins

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4
Q

Examples of fluoroquinolones

A

ciprofloxacin, garenoxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin

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5
Q

Examples of cephalosporins

A

CEFACLOR, CEFADROXIL, CEFALEXIN, CEFIXIME,
CEFOTAXIME, CEFRADINE,
CEFTAROLINE FOSAMIL, CEFTAZIDIME, CEFTRIAXONE, CEFUROXIME

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6
Q

What is the difference between Meningitis and Encephalitis?

A

Meningitis is inflammation of the meninges and presents with Meningism (neck stiffness, photophobia and headache)
Encephalitis is inflammation of the brain parenchyma - more likely viral - and presents with less prominent meningeal signs.

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7
Q

1st line treatment of Meningitis

A

Ceftrixone IV 2g bd + Dexamethasone IV 10mg qds for 4 days

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8
Q

What can you add to the treatment of meningitis?

A 
Aciclovir IV (10mg/kg tds) if encephalitis suspected 
Amoxicillin IV 2g 4 hourly if immunosuppressed
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9
Q

Treatment of Tonsillitis

A

if uncomplicated avoid antibiotics
if >4 FeverPAIN score Penicillin V oral 500mg qds or 1g bd (10 days)
If unable to swallow benzypenicillin IV 1.2g qds

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10
Q

Treatment of Supraglottitis

A

Ceftrixone IV 2g od

Step down to Co-amoxiclav PO 625mg

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11
Q

Treatment of Glandular Fever

A

STOP antibiotics

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12
Q

Treatment of Otitis Media

A

60% cases resolve in 24 hrs without antibitoic. Consider if <2, bilateral or bulging membrabe
1st line - amoxicillin 95 days)
If recurrent consider amoxicillin od or bd

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13
Q

Treatment of Otitis Externa

A

Mild: Acetic acid
Moderate: Otomize or Sofradex
If unresolved swab: gentamicin or ciprofloxacin drops
Fungal: clotrimazole solution

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14
Q

Treatment of Orbital Cellulitis

A

Ceftriaxone IV 2g bd + Flucloxacillin IV 2g qds + Metronidazole IV 500mg tds (Penicillin allergy: seek advice)
Step down to Co-amoxiclav oral 625mg tds (10-14 days total)

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15
Q

Treatment of acute exacerbation of COPD

A

1ST LINE Amoxicillin 500mg tds 2ND LINE Doxycycline 200mg on day 1 then 100mg daily (5 days)

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16
Q

Treatment of acute bronchitis

A

1ST LINE Amoxicillin 500mg tds 2ND LINE Doxycycline 200mg on day 1 then 100mg daily (5 days)

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17
Q

Treatment of Mild/Mod CAP

A

Amoxicillin 1g tds IV/PO (5 days) If penicillin allergic:Doxycycline PO 200mg on day 1 then 100mg od (or IV Clarithromycin if NBM)

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18
Q

Treatment of Severe CAP

A

Co-amoxiclav IV 1.2g tds + Doxycycline PO 100mg bd If penicillin allergic: IV Levofloxacin 500mg bd

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19
Q

Treatment of Severe HAP

A

IV Amoxicillin + Metronidazole + Gentamicin If penicillin allergic: IV Co-trimoxazole + Metronidazole +/- Gentamicin
Step down to PO Co-trimoxazole + Metronidazole (TOTAL IV/PO 7 days)

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20
Q

Treatment of non-severe HAP

A

PO Amoxicillin + Metronidazole (5 days)

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21
Q

Treatment of endocarditis in a native valve

A

Subacute: Amoxicillin IV 2g 4 hourly + Gentamicin 1mg/kg bd
Acute: Flucloxacillin IV 2g 6 hourly (4 hourly if >85kg)
Sepsis: :Vancomycin IV + Meropenem IV 2g tds

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22
Q

Treatment of endocarditis in a prosthetic valve

A

Vancomycin IV + Rifampicin PO 600mg bd + Gentamicin IV 1mg/kg

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23
Q

Things to consider when taking blood culturesfor endocarditis

A

must be taken prior to starting treatmenrt, aseptic techniques,3 sets of cultures from peripheral sites wirh >6 hours between them (or 2 sets within 1 hour if severe sepsis)

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24
Q

What should you do of patient is still on IV gentamicin after 72 hours?

A
  1. Check microbiology results and sensitivities
  2. Consider switch to aztreonam
  3. If required ask for advice
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25
What antibiotics would you consider if patient was septic with coliforms?
1st Line: IV gentamicin (IV aztreonam if contraindications) | Step down: oral co-trimoxazole
26
What antibiotics would you consider if patient was septic with anaerobes?
1st Line: IV metronidazole | Step down: oral metronidazole
27
What antibiotics would you consider if patient was septic with enterococci?
1st Line: IV Amoxicillin (IV co-trimoxazole if contraindications) Step down: oral co-trimoxazole
28
What steps are in Sepsis 6 protocol?
1. Administer Oxygen 2. Take blood cultures 3. Give IV antibiotics 4. Give IV fluids 5. Serum Lactate 6. Measure Urine output
29
What should you consider when obtaining blood cultures in pneumonia?
In mild disease only 5-15% posistive In severe disease posistive in early disease Collect sufficient volume, preferably before antibiotics
30
What plate matter should you use to grow suspected Haemophilus Influenzae?
Chocolate agar media
31
With atypical pneumonia - what are your best treatment options?
Doxycycline, clarithromycin
32
What is a complication of Coxiella burnetti (Q fever)?
Culture negative endocarditis
33
How should you confirm Influenza?
VIRUS = PCR | antibody detection but this isn't really done
34
How would you tets for Legionella?
Urine Legionella Antigen
35
When would you use a urine culture?
When complicated UTI is suspected
36
When should you avoid using a urine culture?
In the elderly and catherterised
37
Difference between bacteriostatic and bactercidal antibiotics
Bactericidal is an agent that causes 1000-fold decline whilst bacteriostatic agnets cause <1000fold decline
38
Factors that can effect how bacteria can acquire resistance
Organism specific rate of mutation, random mutations, bacterial burden, drug penetration, efflux pumps
39
What does the Mean Inhibitory Concentration (MIC) mean?
``` concentration required for kill of 99.9% of organisms during 18 to 24 hours OR the concentration of drug that allows a tube (or well) containing the pathogen to remain clear by visual examination after 18 to 24 hours ```
40
What time frame should sepsis 6 be deliver in?
1 hour
41
What are the 4 Ds in Antimicrobial Stewardship?
Drug, Dose, Duration and De-escalation
42
3 Key Principles of fighting AMR
1. Prevent infection and transmission of infection 2. Develop new antimicrobials 3. Preserve existing and new antimicrobials = Stewardship
43
What effect do the 4Cs have on the body and what are the risks associated?
Alters normal gut flora causing clostridium difficile to proliferate resulting in diarrhoea
44
Name 3 pathogens with a gram posistive chain structure
strep pneumoniae, strep virdians, strep enterococci
45
What 2 conditions are cuased by siprochete shaped organisms?
Syphilus and Lymes Disease
46
What are the differences between Alpha, beta and gamma haemolyism?
``` Alpha = partial Beta = total Gamma = none ```
47
Which of the following is not a typical organism i teh major criteria for diagnosing endocarditis? a) Staph Aureus b) Enterococcus faecalis c) Virdans group strep d) Escherichia species e) HACEK group organisms
D) Escherichia species
48
Definition of a Chronic Infection
>3months
49
Potential complication associated with giving antibiotics to treat E.coli?
Haemolytic-uremic syndrome
50
What is the usual source of the Strep Virdans pathogen?
GI tract
51
What criteria do you use to assess endocarditis?
Dukes Criteria
52
What is the best way in NHS tayside to diagnosis C.Difficle?
Stool toxin test
53
What factors cause an increase in risk of C.Difficle?
Prolonged Hospitalisation, immunosuppression, antibiotics within the preceding 3 months, PPIs
54
Petting zoo and BBQ =
E.COLI
55
What antibiotics would you give to treat E.coli
NO ANTIBIOTICS!!!
56
What cultures would you send to lab as part of sepsis 6 with regards to e.coli?
1st Blood Cultures | 2nd Stool culture
57
What are the gram characteristics of e.coli | ?
Gram negative rod/ bacillus
58
What bacteria does someone with food posioning due to reheated rice have, and how would you treat?
Bacillus cerus causing gastroenteritis - supportive treatment only
59
Which of the following antibiotic has no activity against anaerobes? a) Gentamicin b) Piperacillin – tazobactam c) Clindamycin d) Co-amoxyclav e) Metronidazole
Gentamicin
60
Which antibiotic is active against gram positive organisms only? a) Gentamicin b) Metronidazole c) Co-amoxyclav d) Clindamycin e) Vancomycin
Vancomycin
61
Which antibiotic is active against gram negative organisms only? a) Gentamicin b) Metronidazole c) Co-amoxyclav d) Clindamycin e) Vancomycin
Gentamicin
62
What is the management of C.Difficle infection?
Non severe: Metronidazole PO 400mg tds (10 days) • Severe: Vancomycin 125mg qds PO/NG (10 days) +/- IV Metronidazole • Recurrent: positive CDI in previous 8 weeks - see guidance
63
What is the treatment of Peritonitis?
``` IV Amoxicillin (or Vancomycin) + Metronidazole + Gentamicin then step down to PO Co-trimoxazole + Metronidazole ```
64
What is the treatment of Bilary Tract Infection?
``` IV Amoxicillin (or Vancomycin) + Metronidazole + Gentamicin then step down to PO Co-trimoxazole + Metronidazole ```
65
What is the management of Intra-Abdominal Infection?
``` IV Amoxicillin (or Vancomycin) + Metronidazole + Gentamicin then step down to PO Co-trimoxazole + Metronidazole ```
66
What is the treatment of UTI's in catheterised patients?
No treatment
67
What is the treatment of UTI's in the elderly?
No treatment
68
What is the treatment of Uncomplicated Lower UTIs in Females, or uncatheterised UTI's in males?
Nitrofurantoin 50mg qds or 100mg MR bd or Trimethoprim 200mg bd (3 days)
69
What is the treatment of complicated UTIs?
IV Amoxicillin + Gentamicin (If penicillin allergic IV Co-trimoxazole + Gentamicin) Step down to PO Co-trimoxazole or as per sensitivities TOTAL IV/PO 7 days
70
Management of Cellulitis
Flucloxacillin 1g qds (If penicillin allergic: Doxycycline 100mg bd PO)
71
Management of Septic Arthritis or Osteomyelitis
IV Flucloxacillin 2g qds
72
What prophylaxis is given for open fractures?
IV Co-amoxiclav 1.2g tds (or IV Co-trimoxazole 960mg bd + | Metronidazole 500mg tds) Start within 3 hours for max 72 hours
73
What is the management of diabetic foot infections?
Mild: Flucloxacillin 1g qds or Doxycycline 100mg bd Moderate: Flucloxacillin 1g qds + Metronidazole 400mg tds or Doxycycline 100mg bd + Metronidazole 400mg

Antibiotics (1 decks)

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