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Antibiotics > Antibiotic Man > Flashcards

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
Q

What antibiotics would you consider if patient was septic with coliforms?

A

1st Line: IV gentamicin (IV aztreonam if contraindications)

Step down: oral co-trimoxazole

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26
Q

What antibiotics would you consider if patient was septic with anaerobes?

A

1st Line: IV metronidazole

Step down: oral metronidazole

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27
Q

What antibiotics would you consider if patient was septic with enterococci?

A

1st Line: IV Amoxicillin (IV co-trimoxazole if contraindications)
Step down: oral co-trimoxazole

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28
Q

What steps are in Sepsis 6 protocol?

A
  1. Administer Oxygen
  2. Take blood cultures
  3. Give IV antibiotics
  4. Give IV fluids
  5. Serum Lactate
  6. Measure Urine output
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29
Q

What should you consider when obtaining blood cultures in pneumonia?

A

In mild disease only 5-15% posistive
In severe disease posistive in early disease
Collect sufficient volume, preferably before antibiotics

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30
Q

What plate matter should you use to grow suspected Haemophilus Influenzae?

A

Chocolate agar media

31
Q

With atypical pneumonia - what are your best treatment options?

A

Doxycycline, clarithromycin

32
Q

What is a complication of Coxiella burnetti (Q fever)?

A

Culture negative endocarditis

33
Q

How should you confirm Influenza?

A

VIRUS = PCR

antibody detection but this isn’t really done

34
Q

How would you tets for Legionella?

A

Urine Legionella Antigen

35
Q

When would you use a urine culture?

A

When complicated UTI is suspected

36
Q

When should you avoid using a urine culture?

A

In the elderly and catherterised

37
Q

Difference between bacteriostatic and bactercidal antibiotics

A

Bactericidal is an agent that causes 1000-fold decline whilst bacteriostatic agnets cause <1000fold decline

38
Q

Factors that can effect how bacteria can acquire resistance

A

Organism specific rate of mutation, random mutations, bacterial burden, drug penetration, efflux pumps

39
Q

What does the Mean Inhibitory Concentration (MIC) mean?

A 
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
Q

What time frame should sepsis 6 be deliver in?

A

1 hour

41
Q

What are the 4 Ds in Antimicrobial Stewardship?

A

Drug, Dose, Duration and De-escalation

42
Q

3 Key Principles of fighting AMR

A
  1. Prevent infection and transmission of infection
  2. Develop new antimicrobials
  3. Preserve existing and new antimicrobials = Stewardship
43
Q

What effect do the 4Cs have on the body and what are the risks associated?

A

Alters normal gut flora causing clostridium difficile to proliferate resulting in diarrhoea

44
Q

Name 3 pathogens with a gram posistive chain structure

A

strep pneumoniae, strep virdians, strep enterococci

45
Q

What 2 conditions are cuased by siprochete shaped organisms?

A

Syphilus and Lymes Disease

46
Q

What are the differences between Alpha, beta and gamma haemolyism?

A 
Alpha = partial
Beta = total
Gamma = none
47
Q

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

A

D) Escherichia species

48
Q

Definition of a Chronic Infection

A

> 3months

49
Q

Potential complication associated with giving antibiotics to treat E.coli?

A

Haemolytic-uremic syndrome

50
Q

What is the usual source of the Strep Virdans pathogen?

A

GI tract

51
Q

What criteria do you use to assess endocarditis?

A

Dukes Criteria

52
Q

What is the best way in NHS tayside to diagnosis C.Difficle?

A

Stool toxin test

53
Q

What factors cause an increase in risk of C.Difficle?

A

Prolonged Hospitalisation, immunosuppression, antibiotics within the preceding 3 months, PPIs

54
Q

Petting zoo and BBQ =

A

E.COLI

55
Q

What antibiotics would you give to treat E.coli

A

NO ANTIBIOTICS!!!

56
Q

What cultures would you send to lab as part of sepsis 6 with regards to e.coli?

A

1st Blood Cultures

2nd Stool culture

57
Q

What are the gram characteristics of e.coli

?

A

Gram negative rod/ bacillus

58
Q

What bacteria does someone with food posioning due to reheated rice have, and how would you treat?

A

Bacillus cerus causing gastroenteritis - supportive treatment only

59
Q

Which of the following antibiotic has no activity against anaerobes?

a) Gentamicin
b) Piperacillin – tazobactam
c) Clindamycin
d) Co-amoxyclav
e) Metronidazole

A

Gentamicin

60
Q

Which antibiotic is active against gram positive organisms only?

a) Gentamicin
b) Metronidazole
c) Co-amoxyclav
d) Clindamycin
e) Vancomycin

A

Vancomycin

61
Q

Which antibiotic is active against gram negative organisms only?

a) Gentamicin
b) Metronidazole
c) Co-amoxyclav
d) Clindamycin
e) Vancomycin

A

Gentamicin

62
Q

What is the management of C.Difficle infection?

A

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
Q

What is the treatment of Peritonitis?

A 
IV Amoxicillin (or Vancomycin) + Metronidazole + Gentamicin
then step down to PO Co-trimoxazole + Metronidazole
64
Q

What is the treatment of Bilary Tract Infection?

A 
IV Amoxicillin (or Vancomycin) + Metronidazole + Gentamicin
then step down to PO Co-trimoxazole + Metronidazole
65
Q

What is the management of Intra-Abdominal Infection?

A 
IV Amoxicillin (or Vancomycin) + Metronidazole + Gentamicin
then step down to PO Co-trimoxazole + Metronidazole
66
Q

What is the treatment of UTI’s in catheterised patients?

A

No treatment

67
Q

What is the treatment of UTI’s in the elderly?

A

No treatment

68
Q

What is the treatment of Uncomplicated Lower UTIs in Females, or uncatheterised UTI’s in males?

A

Nitrofurantoin 50mg qds or 100mg MR bd or Trimethoprim 200mg bd (3 days)

69
Q

What is the treatment of complicated UTIs?

A

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
Q

Management of Cellulitis

A

Flucloxacillin 1g qds (If penicillin allergic: Doxycycline 100mg bd PO)

71
Q

Management of Septic Arthritis or Osteomyelitis

A

IV Flucloxacillin 2g qds

72
Q

What prophylaxis is given for open fractures?

A

IV Co-amoxiclav 1.2g tds (or IV Co-trimoxazole 960mg bd +

Metronidazole 500mg tds) Start within 3 hours for max 72 hours

73
Q

What is the management of diabetic foot infections?

A

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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