Antibiotic man Flashcards
Management of meningitis?
- Ceftriaxone 2g IV BD
+ Dexamethasone 10mg IV QDS.
+ Amoxicillin IV 2g 4-hourly if >60 or immunocompromised (listeria).
Common causes of bacterial meningitis?
- 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.
When should dexamethasone be continued in bacterial meningitis?
If confirmed pneumococcal cause.
What would you add to the treatment regime?
- Bacterial meningitis.
+ Recent travel to a country with high rates of penicillin resistant pneumococci.
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).
Pathogens associated with ventriculitis and meningitis-shunt associated or post-operative?
- Pseudomonas.
- Gram-negatives.
- Staph. aureus, Staph. epidermidis.
- Propionibacterium sp.
Pathogens associated with meningitis post-trauma?
- Pneumococci.
- H. influenzae.
- Streptococci.
- Anaerobes.
(Often URTI pathogens)
Management of meningitis post-trauma?
- Ceftriaxone IV 2g BD
+ Metronidazole IV 500mg TDS.
Management of brain abscess?
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.
Pathogens associated with brain abscess?
- Streptococci.
- Bacteroids.
Pathogens associated with viral encephalitis?
- 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.
Management of viral encephalitis?
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.
Causes of viral meningitis?
- Enteroviruses.
- Herpes simplex.
- Varicella zoster.
- Paramyxovirus.
How is viral meningitis managed?
As per community acquired bacterial meningitis.
- Manage symptomatically (stop all other treatment) if enteroviral or mumps meningitis confirmed.
Management of epiglottitis/ supraglottitis?
Ceftriaxone IV 2g OD.
Management of mild/moderate CAP (CURB 0-2)?
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.
Management of severe CAP (CURB 3-5)?
- Co-amoxiclav IV 1.2g TDS + Doxycycline PO 100mg BD.
OR if pen-allergic Levofloxacin IV 500mg BD.
TOTAL IV/PO - 7 days..
ALL patients with severe CAP should be stepped down to?
Doxycycline PO 100mg BD.
TOTAL IV/PO 7 days.
Likely causative organisms of epiglottitis?
- H. influenzae.
- Streptococci.
Likely causative organisms of tonsillitis?
Group A Strep. (pyogenes, agalactiae).
Likely causative organisms of sinusitis?
Pneumococcus.
Likely causative organisms of acute otitis media?
- Pneumococcus.
- H. influenzae.
Management of non-severe hospital acquire pneumonia?
- PO Amoxicillin 1g TDS 5 days.
OR Doxycycline 100mg BD.
TOTAL - 5 days.
Management of severe hospital acquired pneumonia?
IV amoxicillin 1g TDS.
+ IV Gentamicin.
(if pen-allergic then Co-trimoxazole 960mg BD + Gentamicin).
Step-down of severe hospital acquired pneumonia?
PO Co-trimoxazole 960mg BD.
- Total IV/PO 7 days.
Why use amoxicillin?
- Beta-lactam, bactericidal - inhibits cell wall .
- Active against gram positives (Strep., Enterococci, Listeria, Clostridium) and some gram negatives (Bacteroides, H. influenzae, Neisseria, E. coli).
Why use gentamicin?
- Aminoglycoside, bactericidal - binds to ribosomes inhibiting protein synthesis.
- Active against gram negatives e.g. coliforms (E. coli, Enterobacter, Klebsiella, Proteus) and Pseudomonas.
Why use metronidazole?
- Inhibits nucleic acid synthesis.
- Active against anaerobes e.g. C. diff, trichomoniasis, Gardnerella (bacterial vaginosis), amoebiasis.
MRSA is resistant to?
Beta-lactams (penicillins, flucloxacillin, piperacillin-tazobactam, cephalosporins and meropenem).
What are the beta-lactam antibiotic groups?
- Penicillins.
- Flucloxacillin.
- Pip-taz.
- Cephalosporins.
- Meropenem.
Why use Cephalosporins?
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).
Why use Flucloxacillin?
Narrow spec - staph and strep.
- Especially in skin, soft tissue, wound infection, cellulitis.
STAPH. AUREUS = FLUCLOX.
Amoxicillin is ineffective against organisms that produce?
Beta-lactamase.
What is co-amoxiclav?
Amoxicillin + clavulanic acid (beta-lactamase inhibitor).
Co-amoxiclav is not active against?
Pseudomonas, some E. coli and MRSA.
Co-amoxiclav is active against anaerobes - true or false?
True so negates need for Metronidazole.
Beta-haemolytic streps (group A, C, G) are sensitive to?
Penicillin and Flucloxacillin.
Pip-taz will treat almost everything apart from?
- MRSA.
- ESBL (very resistant coliforms)
ESBLs are sensitive to?
- Temocillin.
- Pivmecillinam.
- Meropenem.
Management of native valve indolent (subacute) endocarditis?
Amoxicillin IV 2g 4-hourly + Gentamicin 1mg/kg BD (use actual body weight - max 120mg/dose).
Management of native valve acute, severe sepsis?
Flucloxacillin IV 2g 6-hourly (4-hourly if >85kg).
Management of prosthetic valve or suspected MRSA endocarditis?
Vancomycin IV
+ Gentamicin IV 1mg/kg BD (actual body weight, max. 120mg/dose).
+ when vancomycin reaches therapeutic levels add Rifampicin PO 600mg BD.
Management of non-severe C. diff?
Metronidazole PO 400mg TDS for 10 days.
Management of severe C. diff?
Vancomycin 125mg QDS PO / NG
+/-IV Metronidazole.
FOR 10 DAYS.
Management of mild, proven spontaneous bacterial peritonitis?
Co-trimoxazole PO 960mg BD.
FOR 5-7 DAYS.
Management of severe, proven spontaneous bacterial peritonitis?
Piperacillin Tazobactam IV 4.5g TDS
Then step down to Co-trimoxazole PO.
Management of peritonitis / biliary tract / intra-abdominal sepsis?
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.
Management for catheterised patients with suspected UTI?
Do not use urinalysis, do not treat unless clinical signs/ symptoms of infection. If definite infection then treat as complicated UTI.
Management of complicated UTI / pyelonephritis / urosepsis?
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.
Management of uncomplicated female lower UTI?
Nitrofurantoin 100mg MR BD (or 50mg QDS)
OR Trimethoprim 200mg BD (not in first trimester).
treat for 3 days.
Management of uncatheterised male UTI?
Nitrofurantoin 100mg MR BD (or 50mg QDS)
OR Trimethoprim 200mg BD
Treat for 7 days.
Management of cellulitis?
Flucloxacillin 1g QDS (oral if mild, IV if sepsis).
If pen-allergic: Doxycycline 100mg BD.
OR Clindamycin
TOTAL IV/PO 7 DAYS.
Management of mild diabetic foot infection?
Flucloxacillin 1g QDS PO
(pen-allergic: Doxycycline 100mg BD.
TOTAL 7 DAYS
Management of moderate diabetic foot infection?
Flucloxacillin 1g QDS + Metronidazole 400mg TDS.
pen-allergic: doxycycline 100mg BD + Met
Open fracture prophylaxis?
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.
Management of acute septic arthritis / osteomyelitis?
Seek ID advice.
- IV Flucloxacillin 2g QDS.
Management of severe systemic infection of unknown source?
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.
Management of acute exacerbation of COPD?
ABx only if purulent sputum or consolidation on CXR or signs of pneumonia.
- Amoxicillin 500mg TDS.
- Doxycycline 200mg Day 1, then 100mg OD for 5 days total.
