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Infectious Diseases - Tayside Antiobiotic man, organisms and antibiotic rationale > Antibiotic man > Flashcards

Antibiotic man Flashcards

1
Q

Management of meningitis?

A
  • Ceftriaxone 2g IV BD
    + Dexamethasone 10mg IV QDS.
    + Amoxicillin IV 2g 4-hourly if >60 or immunocompromised (listeria).
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2
Q

Common causes of bacterial meningitis?

A
  • Strep. pneumoniae.
  • Neisseria meningitidis.
  • HiB.
  • Group B Strep. (e.g. agalactiae).
  • Listeria.
  • Gram negatives e.g. Enterobacter, Enterococci, E. coli.
  • Staph. aureus, Staph. epidermidis.
  • Pseudomonas.
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3
Q

When should dexamethasone be continued in bacterial meningitis?

A

If confirmed pneumococcal cause.

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4
Q

What would you add to the treatment regime?
- Bacterial meningitis.
+ Recent travel to a country with high rates of penicillin resistant pneumococci.

A

Vancomycin IV (aim for pre-dose level of 15-20mg/L).
OR
Rifampicin IV/PO 600mg BD.

(Countries such as turkey, spain, italy, greece, china, poland, canada, mexico, USA, croatia).

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5
Q

Pathogens associated with ventriculitis and meningitis-shunt associated or post-operative?

A
  • Pseudomonas.
  • Gram-negatives.
  • Staph. aureus, Staph. epidermidis.
  • Propionibacterium sp.
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6
Q

Pathogens associated with meningitis post-trauma?

A
  • Pneumococci.
  • H. influenzae.
  • Streptococci.
  • Anaerobes.
    (Often URTI pathogens)
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7
Q

Management of meningitis post-trauma?

A
  • Ceftriaxone IV 2g BD

+ Metronidazole IV 500mg TDS.

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8
Q

Management of brain abscess?

A

Ceftriaxone IV 2g BD.
+ Metronidazole IV 500mg 8-hourly.
+ if staph. suspected, then add IV Flucloxacillin or Vancomycin if allergic or MRSA.
TREAT FOR 4 WEEKS MINIMUM.

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9
Q

Pathogens associated with brain abscess?

A
  • Streptococci.

- Bacteroids.

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10
Q

Pathogens associated with viral encephalitis?

A
  • Herpes virus (HSV, Varicella Zoster, CMV, EBV).
  • Enteroviruses (Coxsackie, poliovirus).
  • Flaviviruses (West Nile, Japanese encephalitis, tick-borne, Dengue).
  • Paramyxovirus (mumps, measles, RSV).
  • Arboviruses (spread by ticks and mosquitos).
  • Parvovirus B19.
  • Adenovirus.
  • Influenza.
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11
Q

Management of viral encephalitis?

A

IV Aciclovir 10mg/kg 8-hourly for 14 days then repeat LP.
(21 days if immunocompromised).
> HSV PCR +ve then continue treatment and weekly PCR until negative.

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12
Q

Causes of viral meningitis?

A
  • Enteroviruses.
  • Herpes simplex.
  • Varicella zoster.
  • Paramyxovirus.
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13
Q

How is viral meningitis managed?

A

As per community acquired bacterial meningitis.

- Manage symptomatically (stop all other treatment) if enteroviral or mumps meningitis confirmed.

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14
Q

Management of epiglottitis/ supraglottitis?

A

Ceftriaxone IV 2g OD.

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15
Q

Management of mild/moderate CAP (CURB 0-2)?

A

Amoxicillin IV/PO 1g TDS.
- Doxycycline PO 200mg on day 1, then 100mgOD if pen-allergic OR IV Clarithromycin if NBM.

5 days total IV/PO.

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16
Q

Management of severe CAP (CURB 3-5)?

A
  • Co-amoxiclav IV 1.2g TDS + Doxycycline PO 100mg BD.

OR if pen-allergic Levofloxacin IV 500mg BD.

TOTAL IV/PO - 7 days..

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17
Q

ALL patients with severe CAP should be stepped down to?

A

Doxycycline PO 100mg BD.

TOTAL IV/PO 7 days.

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18
Q

Likely causative organisms of epiglottitis?

A
  • H. influenzae.

- Streptococci.

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19
Q

Likely causative organisms of tonsillitis?

A

Group A Strep. (pyogenes, agalactiae).

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20
Q

Likely causative organisms of sinusitis?

A

Pneumococcus.

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21
Q

Likely causative organisms of acute otitis media?

A
  • Pneumococcus.

- H. influenzae.

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22
Q

Management of non-severe hospital acquire pneumonia?

A
  • PO Amoxicillin 1g TDS 5 days.
    OR Doxycycline 100mg BD.

TOTAL - 5 days.

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23
Q

Management of severe hospital acquired pneumonia?

A

IV amoxicillin 1g TDS.
+ IV Gentamicin.

(if pen-allergic then Co-trimoxazole 960mg BD + Gentamicin).

24
Q

Step-down of severe hospital acquired pneumonia?

A

PO Co-trimoxazole 960mg BD.

- Total IV/PO 7 days.

25
Q

Why use amoxicillin?

A
  • Beta-lactam, bactericidal - inhibits cell wall .
  • Active against gram positives (Strep., Enterococci, Listeria, Clostridium) and some gram negatives (Bacteroides, H. influenzae, Neisseria, E. coli).
26
Q

Why use gentamicin?

A
  • Aminoglycoside, bactericidal - binds to ribosomes inhibiting protein synthesis.
  • Active against gram negatives e.g. coliforms (E. coli, Enterobacter, Klebsiella, Proteus) and Pseudomonas.
27
Q

Why use metronidazole?

A
  • Inhibits nucleic acid synthesis.

- Active against anaerobes e.g. C. diff, trichomoniasis, Gardnerella (bacterial vaginosis), amoebiasis.

28
Q

MRSA is resistant to?

A

Beta-lactams (penicillins, flucloxacillin, piperacillin-tazobactam, cephalosporins and meropenem).

29
Q

What are the beta-lactam antibiotic groups?

A
  • Penicillins.
  • Flucloxacillin.
  • Pip-taz.
  • Cephalosporins.
  • Meropenem.
30
Q

Why use Cephalosporins?

A

Beta-lactams - Bactericidal - inhibit cell wall synthesis by preventing cross-linking of peptido-glycan.

  • High CSF concentration in meningitis.
  • High tissue levels good for epiglottitis (life-threatening + potential amoxicillin resistance).
31
Q

Why use Flucloxacillin?

A

Narrow spec - staph and strep.
- Especially in skin, soft tissue, wound infection, cellulitis.
STAPH. AUREUS = FLUCLOX.

32
Q

Amoxicillin is ineffective against organisms that produce?

A

Beta-lactamase.

33
Q

What is co-amoxiclav?

A

Amoxicillin + clavulanic acid (beta-lactamase inhibitor).

34
Q

Co-amoxiclav is not active against?

A

Pseudomonas, some E. coli and MRSA.

35
Q

Co-amoxiclav is active against anaerobes - true or false?

A

True so negates need for Metronidazole.

36
Q

Beta-haemolytic streps (group A, C, G) are sensitive to?

A

Penicillin and Flucloxacillin.

37
Q

Pip-taz will treat almost everything apart from?

A
  • MRSA.

- ESBL (very resistant coliforms)

38
Q

ESBLs are sensitive to?

A
  • Temocillin.
  • Pivmecillinam.
  • Meropenem.
39
Q

Management of native valve indolent (subacute) endocarditis?

A

Amoxicillin IV 2g 4-hourly + Gentamicin 1mg/kg BD (use actual body weight - max 120mg/dose).

40
Q

Management of native valve acute, severe sepsis?

A

Flucloxacillin IV 2g 6-hourly (4-hourly if >85kg).

41
Q

Management of prosthetic valve or suspected MRSA endocarditis?

A

Vancomycin IV
+ Gentamicin IV 1mg/kg BD (actual body weight, max. 120mg/dose).
+ when vancomycin reaches therapeutic levels add Rifampicin PO 600mg BD.

42
Q

Management of non-severe C. diff?

A

Metronidazole PO 400mg TDS for 10 days.

43
Q

Management of severe C. diff?

A

Vancomycin 125mg QDS PO / NG
+/-IV Metronidazole.
FOR 10 DAYS.

44
Q

Management of mild, proven spontaneous bacterial peritonitis?

A

Co-trimoxazole PO 960mg BD.

FOR 5-7 DAYS.

45
Q

Management of severe, proven spontaneous bacterial peritonitis?

A

Piperacillin Tazobactam IV 4.5g TDS

Then step down to Co-trimoxazole PO.

46
Q

Management of peritonitis / biliary tract / intra-abdominal sepsis?

A

IV Amoxicillin 1g TDS + Metronidazole 400mg TDS + Gentamicin. (if pen-allergic > IV Vancomycin + Met + Gent).
TOTAL IV/PO 7 DAYS.

Step down to PO Co-trimoxazole + Metronidazole.

47
Q

Management for catheterised patients with suspected UTI?

A

Do not use urinalysis, do not treat unless clinical signs/ symptoms of infection. If definite infection then treat as complicated UTI.

48
Q

Management of complicated UTI / pyelonephritis / urosepsis?

A

IV Amoxicillin 1g TDS + Gentamicin
(or if pen-allergic: IV Co-trimoxazole + Gent).

Step down to Co-trimoxazole PO or as per sensitivities.
TOTAL IV/PO - 7 DAYS.

49
Q

Management of uncomplicated female lower UTI?

A

Nitrofurantoin 100mg MR BD (or 50mg QDS)
OR Trimethoprim 200mg BD (not in first trimester).
treat for 3 days.

50
Q

Management of uncatheterised male UTI?

A

Nitrofurantoin 100mg MR BD (or 50mg QDS)
OR Trimethoprim 200mg BD
Treat for 7 days.

51
Q

Management of cellulitis?

A

Flucloxacillin 1g QDS (oral if mild, IV if sepsis).
If pen-allergic: Doxycycline 100mg BD.
OR Clindamycin
TOTAL IV/PO 7 DAYS.

52
Q

Management of mild diabetic foot infection?

A

Flucloxacillin 1g QDS PO
(pen-allergic: Doxycycline 100mg BD.
TOTAL 7 DAYS

53
Q

Management of moderate diabetic foot infection?

A

Flucloxacillin 1g QDS + Metronidazole 400mg TDS.

pen-allergic: doxycycline 100mg BD + Met

54
Q

Open fracture prophylaxis?

A

IV Co-amoxiclav 1.2g TDS (or IV Co-trimoxazole 960mg BD).
+ Metronidazole 500mg TDS
Start within 3 hours for a max of 72 hours.

55
Q

Management of acute septic arthritis / osteomyelitis?

A

Seek ID advice.

- IV Flucloxacillin 2g QDS.

56
Q

Management of severe systemic infection of unknown source?

A

IV Amoxicillin 1g TDS + Metronidazole 500mg TDS + Gentamicin.
Add Staph. aureus cover if PWID - IV Flucloxacillin 2g QDS.

IF PEN-ALLERGIC:
IV Vancomycin + Metronidazole + gentamicin.

57
Q

Management of acute exacerbation of COPD?

A

ABx only if purulent sputum or consolidation on CXR or signs of pneumonia.

  1. Amoxicillin 500mg TDS.
  2. Doxycycline 200mg Day 1, then 100mg OD for 5 days total.

Infectious Diseases - Tayside Antiobiotic man, organisms and antibiotic rationale (2 decks)

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