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Y4 Infectious diseases > Antibiotic man > Flashcards

Antibiotic man Flashcards

1
Q

What NEWS score coupled with infection would make you think Sepsis and what do you need to complete thereafter ?

A

A NEWS score of equal to or greater than 5

You must complete sepsis 6 bundle within 1 hr (BUFALO)

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2
Q

What SIRS score and likely source of infection would make you think Sepsis and thereafter what must you do ?

A

SIRS of equal to or greater than 2:

  • Temperature >38°C < 36°C
  • HR > 90 beats per minute
  • Altered mental state
  • RR >20 breaths/min
  • WCC <4 or >12
  • Known or suspected neutropenia

Complete Sepsis 6 bundle within 1 hr (BUFALO)

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3
Q

How often should IV antibiotic therapy be reviewed ?`

A

Every 12-24hrs

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4
Q

What are the indications to continue with IV antibiotics and not change to oral ?

A

Continuing serious sepsis (2 or more of the following):

  1. temp > 38°C or < 36°C
  2. tachycardia ≥ 90/min
  3. tachypnoea > 20 breaths/min
  4. WCC > 12 or < 4
  5. Febrile with neutropenia (WCC <1.0) or immunosuppression

Specific infections which require high dose IV therapy eg endocarditis, septic arthritis, osteomyelitis, meningitis, abscess, cystic fibrosis patients, prosthetic infection

Oral route compromised:

  1. vomiting
  2. nil by mouth
  3. reduced absorption e.g. severe diarrhoea or steatorrhoea
  4. mechanical swallowing disorder
  5. unconscious

Patient post surgery not tolerated 1 litre of oral fluids

IV antibiotic not included in IVOST protocol

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5
Q

What should you always check prior to prescribing gentamicin ?

A

Exclusion criteria

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6
Q

What is the exclusion criteria for giving a patient Gentamicin?

A
  • Children < 16 years old
  • Ascites > 20% body weight
  • Major burns > 20% body surface
  • Decompensated Liver Disease
  • Myasthenia Gravis
  • Renal Transplant
  • Acute Kidney Injury (AKI 3) on dialysis or eGFR <20ml/min
  • End stage renal failure on dialysis with residual kidney function
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7
Q

What 3 things should be done if IV gentamicin is still indicated after 72hrs of treatment (or if poor/deteriorating renal function)?

A
  1. Check microbiology results & sensitivities
  2. Consider switch to aztreonam
  3. If required ask Infectious diseases (ID) or microbiology for advice
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8
Q

What is the standard treatment for bacterial meningitis ?

A

IV ceftriaxone + IV dexamethasone (started with or just before first dose of antibiotics)

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9
Q

What is the treatment of bacterial meningitis in those equal to or >60 or immunocompromised ?

A

IV ceftriaxone + IV dexamethasone + IV amoxicillin

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10
Q

What is the treatment of suspected encephalitis ?

A

IV aciclovir

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11
Q

What is the treatment of epiglottis/supraglottis ?

A
  1. IV ceftriaxone
  2. Step down to Co-amoxiclav PO (or in penicillin allergy: PO Doxycycline + Metronidazole)
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12
Q

What should be done to assess the severity of a pneumonia and ==> decide the treatment ?

A

CURB65 score

  • Confusion
  • Urea > or equal to 7 mmol/l
  • RR > or equal to 30
  • BP: SBP < 90 or DBP < 60
  • Age > or equal to 65
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13
Q

What is the treatment of a mild/moderate community acquired pneumonia (CAP) and what CURB65 score classifys it as one ?

A

Score of 0-2

Amoxicillin IV/PO (If penicillin allergic: Doxycycline PO on day 1 then or IV Clarithromycin if NBM - nil by mouth)

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14
Q

What is the standard treatment of a severe CAP and what CURB65 score classifys it as one ?

A
  • Score of 3-5
  • Co-amoxiclav IV + Doxycycline PO (If penicillin allergic: IV Levofloxacin)
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15
Q

What is the standard treatment of a severe CAP in ICU/HDU or one who is NBM ?

A

Co-amoxiclav IV + Clarithromycin IV (If penicillin allergic: IV Levofloxacin)

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16
Q

What is the stepdown treatment for ALL patients with severe CAP?

A

Doxycycline IV/PO

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17
Q

What is the treatment of a non-severe hospital acquired pneumonia (HAP)?

A

PO Amoxicillin (If penicillin allergic: Doxycycline)

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18
Q

What is the treatment of a severe HAP ?

A

IV Amoxicillin + Gentamicin (If penicillin allergic:IV Co-trimoxazole + Gentamicin)

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19
Q

What is the step down treatment of a severe HAP ?

A

PO Co-trimoxazole

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20
Q

What should be done if a patient has a severe HAP with a previous ICU admission or history of MRSA?

A

seek advice

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21
Q

What is the treatment of a non-severe aspiration pneumonia ?

A

PO Amoxicillin + Metronidazole (If penicillin allergic: PO Doxycycline + Metronidazole)

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22
Q

What is the treatment of a severe aspiration pneumonia ?

A

IV Amoxicillin + Metronidazole + Gentamicin (If penicillin allergic: replace amoxicillin with PO Doxycycline or IV Clarithromycin)

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23
Q

What is the stepdown treatment of a severe aspiration pneumonia ?

A

PO Amoxicillin + Metronidazole (If pencillin allergic replace amoxicillin with doxycyline)

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24
Q

When should antibiotics be given and when should they not be in an acute exacerbation of COPD?

A
  1. Give antibiotics if ↑ sputum purulence.
  2. If no ↑ sputum purulence then no antibiotics unless consolidation on CXR or signs of pneumonia
25
Q

What is the 1st and 2nd line treatment of acute exacerbations of COPD ?

A
  • 1st line = Amoxicillin
  • 2nd line = Doxycyline
26
Q

When are antibiotics given for acute cough/bronchitis ?

A

They are not usually given as they provide no significant benefit in clinical improvement but may be considered in the frail elderly

27
Q

If antibiotics where to be given for acute cough/bronchitis what is 1st and 2nd line ?

A
  • 1st line = Amoxicillin
  • 2nd line = Doxycyline
28
Q

What 3 things should always be done for endocarditis?

A
  1. Take blood cultures
  2. Start empirical antibiotic therapy and refer to ID/microbiology
  3. Always check full endocarditis guidance for gentamicin/vancomycin dosing especially if reduced renal function
29
Q

What is the treatment of Native valve indolent (Subacute) endocarditis ?

A

IV Amoxicillin + Gentamicin (If true penicillin allergy use Vancomycin + Gentamicin)

30
Q

What is the treatment of Native valve severe sepsis (Acute) endocarditis ?

A

IV Flucloxacillin (If true penicillin allergy use Vancomycin + Gentamicin)

31
Q

What is the treatment of Prosthetic valve or Suspected MRSA endocarditis ?

A

IV Vancomycin + Gentamicin + when therapeutic vancomycin levels reached add Rifampicin PO

32
Q

How is the severity of C.diff assessed ?

A

Severe if one or more of the following severity markers:

  • Temperature > 38.5°C
  • Ileus, colonic dilatation >6cm on AXR/CT, toxic megacolon and/or pseudomembranous colitis
  • WBC >15 cells x 109 L
  • Acute rising serum creatinine >1.5 x baseline
  • Has persisting CDI where the patient has remained symptomatic and toxin positive despite 2 courses of appropriate therapy
33
Q

What is the treatment of non-severe C.diff ?

A
  • 1st line = Metronidazole PO
  • 2nd line = Vancomycin
34
Q

What is the 1st and 2nd line treatment of severe C.diff?

A
  • 1st line = PO Vancomycin if oral not available give via NG tube
  • 2nd line = If ileus is detected or NG route not available treat with IV metronidazole + vancomycin (via NG or intracolonic) until ileus is resolved.
35
Q

What is classified as recurrent C.diff infection and what is the treatment of it ?

A

Recurrent if positive CDI in previous 8 weeks

Fidaxomicin +/- Vancomycin tapering regime

36
Q

What is the antibiotic treatment of acute gastroenteritis or acute pancreatitis ?

A

Antibiotics unlikely to affect outcome. Seek advice

37
Q

What is the treatment of Peritonitis/biliary tract/ intra-abdominal infection ?

A
  • IV Amoxicillin + Metronidazole + Gentamicin (Think GAM)
  • (If penicillin allergic: IV Vancomycin + Metronidazole + Gentamicin
38
Q

What is the step-down treatment of Peritonitis/biliary tract/ intra-abdominal infection ?

A

PO Co-trimoxazole + Metronidazole

39
Q

What is the treatment of mild proven spontaneous bacterial peritonitis ?

A

PO Co-trimoxazole

40
Q

What is the initial and stepdown treatment of severe proven spontaneous bacterial peritonitis ?

A
  • IV Piperacillin/Tazobactam
  • then step down to Co-trimoxazole PO
41
Q

What are the 3 key things to remember when investigating and treating UTI’s in catheterised patients ?

A
  1. Do not use urinanalysis
  2. Do not treat unless clinical signs/symptoms of infection
  3. If definite infection treat as per complicated UTI guidance
42
Q

What are the 3 key things to remember when investigating and treating UTI’s in older adults ?

A
  1. Do not use urinanalysis
  2. Do not treat unless clinical signs/symptoms of infection
  3. If definite infection treat as per normal guidelines
43
Q

What is the initial and step-down treatment of complicated UTI/pyelonephritis/ urosepsis ?

A
  1. IV Amoxicillin + Gentamicin (If penicillin allergic: IV Co-trimoxazole + Gentamicin)
  2. Step down: PO Co-trimoxazole or as per sensitivities
44
Q

What is the treatment of uncomplicated female lower UTI’s and for how long?

A
  • 1st line = Nitrofurantoin
  • 2nd line = Trimethoprim

3 days

45
Q

What is the treatment of uncatheterised male UTI’s and for how long?

A
  1. 1st line = Nitrofurantoin
  2. 2nd line = Trimethoprim

7 days

46
Q

What is the treatment of acute bacterial prostatits ?

A

1st line = PO Ofloxacin or Ciprofloxacin or PO Trimethoprim if high CDI risk

If IV required: Amoxicillin IV + Gentamicin IV then step down as per oral options above

47
Q

What is the treatment of Epididymo-orchitis ?

A
  1. If urethral discharge, new sexual partner in last 3/12 or <35yrs old then treat as likely STI and give Doxycyline (unless history of anal then give Ofloxacin or ciprofloxacin)
  2. If no urethral discharge, No recent change sexual partner And >35 years old then ask about Any fever or back pain or signs of sepsis? ==> If YES then treat as Upper UTI, if NO then treat with Ofloxacin or ciprofloxacin
48
Q

How is the severity of cellulitis assessed ?

A

(essentially assessing if they have sepsis or not)

  1. Mild = No signs of systemic toxicity
  2. Sepsis = Systemically unwell and/or NEWS ≥5
  3. Septic Shock and/or Necrotising Fasciitis (NF) = Evidence of end organ dysfunction despite fluid resuscitation and/or local signs of necrotising fasciitis (e.g. pain / systemic upset disproportionate to appearance, bullae, haemorrhage / bruising, rapid progression, crepitus)
49
Q

What is the treatment of mild cellulitis ?

A
  • 1st line = Flucloxacillin PO for 7 days
  • 2nd line = If not resolving or penicillin allergy: Doxycycline for 7 days
50
Q

What is the treatment for septic cellulitis ?

A

1st line = IV flucloxacillin with stepdown to PO flucloxacillin (if penicillin allergy IV vancomycin with stepdown to PO doxycycline)

51
Q

What is the treatment of Septic Shock and/or Necrotising Fasciitis cellulitis ?

A

1st line = IV Flucloxacillin + Clindamycin + Gentamicin (if penicillin allergy then IV Clindamycin + Gentamicin +/- Vancomycin if risk of MRSA)

52
Q

How is the severity of diabetic foot infections classified ?

A

Mild:

  • Either: 2 or more features of inflammation: pus,erythema, pain, tender, warmth, induration Or (b) Cellulitis <2cm. Confined to skin or subcutaneous tissue and No evidence of systemic illness

Moderate:

  • As per mild with either: (a) Lymphatic streaking, deep tissue infection (subcutaneous, fascia, tendon, bone), abscess Or (b) Cellulitis >2cm and No evidence of systemic illness

Severe:

  • Any infection with evidence of severe sepsis.

Osteomyelitis

53
Q

What is the treatment of a mild infected diabetic foot ?

A
  • 1st line = PO flucloxacillin
  • 2nd line = PO doxycycline
54
Q

What is the treatment of a moderate infected diabetic foot ?

A
  • 1st line = PO Flucloxacillin + Metronidazole
  • 2nd line = If deep tissue infection: IV Flucloxacillin + PO Metronidazole
55
Q

What is the treatment of a severe diabetic infected foot ?

A
  • IV Flucloxacillin + Gentamicin (or Aztreonam) + IV/PO Metronidazole
56
Q

What is the treatment of acute septic arthritis/ostemyelitis ?

A
  • IV flucloxacillin and seek ID advice
57
Q

What is the open fracture prophylaxis treatment and when should it be started ?

A
  • IV Co-amoxiclav (or IV Co-trimoxazole + Metronidazole)
  • Start within 3 hours for max 72 hours
58
Q

What is the antibiotic treatment for severe systemic infections of unknown origin ?

A

1st line = IV Amoxicillin + Metronidazole + Gentamicin (GAM) (If PWID add S. aureus cover IV Flucloxacillin)

(If penicillin allergy IV Vancomycin + Metronidazole + Gentamicin)

Y4 Infectious diseases (7 decks)

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