Antibiotic Man - Hospital and Primary Care Flashcards
Meningitis
Ceftriaxone (IV) + Dexamethasone (IV)
Aciclovir (IV)- if encephalitis suspected
Amoxicillin (IV)- if immunocompromised
Epiglottitis
Ceftriaxone (IV)
Community Acquired Pneumonia (CAP)
Mild: Amoxicillin (IV)
Severe: Co-amoxiclav (IV) + Doxycycline (PO)
ICU/HDU: Co-amoxiclav (IV) + Clarithromycin (IV)
Penicillin allergic:
Switch Amoxicillin for Doxycycline (PO)
Switch Co-amociclav for Levofloxacin (IV)
Hospital Acquired Pneumonia (HAP)
Non-severe: Amoxicillin (IV) + Metronidazole (IV)
Severe: Amoxicillin (IV) + Metronidazole (IV) + Gentamicin (IV)
Penicillin allergic:
Switch Amoxicillin for Co-trimoxazole
Acute exacerbation of COPD
- Amoxicillin
- Doxycycline
Only give if:
- increased sputum purulence
- consolidations on CXR
- signs of pneumonia
Acute cough/ bronchitis
N/A, unless elderly and frail:
- Amoxicillin
- Doxycycline
Native Valve Endocarditis
Take blood cultures
Start empirical therapy
Subacute/ indolent: Amoxicillin (IV) + Gentamicin (IV)
Acute/ severe: Flucloxicillin (IV)
Severe + potential resisetant pathogens: Vancomycin (IV) + Meropenem (IV)
Prosthetic Valve Endocarditis
Vancomycin (IV) + Rifampicin (PO) + Gentimicin (IV)
C. difficile Infection
Non-severe: Metronidazole (PO)
Severe: Vancomycin (PO) + Metronidazole (PO)
Peritonitis / Biliary tract infection / Intra-abdominal infection
Amoxicillin (IV) + Gentamicin (IV) + Metronidazole (IV)
Penicillin allergic: Switch Amoxicillin with Vancomycin
Step down to: Co-trimoxazole + Metronidazole
Acute Gastroenteritis
N/A
Acute pancreatitis
N/A, unlikely to help
Proven Spontaneous Bacterial Peritonitis
Mild: Co-trimoxazole (PO)
Severe: Piperacillin (IV) / Tazobactam (IV)
Infection of catheterised adult
Do not treat unless signs and symptoms of infection.
Do not use urinalysis.
If you must: treat as complicated UTI
Complicated UTI
Amoxicillin (IV) + Gentamicin (IV)
Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)
Step down to: Co-trimaxazole (IV)
Pylonephritis
Pyelonephritis is a kidney infection that occurs when bacteria from a urinary tract infection spreads to the kidney.
Amoxicillin (IV) + Gentamicin (IV)
Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)
Step down to: Co-trimaxazole (IV)
Uncomplicated Female UTI
Nitrofurantoin or Trimethoprim
Urosepsis
Urosepsis is sepsis with a source localised to the urinary tract (or male genital tract, e.g. prostate)
Amoxicillin (IV) + Gentamicin (IV)
Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)
Step down to: Co-trimaxazole (IV)
Uncatheterised Male UTI
Nitrofurantoin or Trimethoprim
Cellulitis
Flucloxacillin
Penicillin allergic: Doxycycline (PO)
If risk of MRSA: Doxycycline
Acute Septic Arthritis
Flucloxacillin (IV)
Osteomyelitis
Flucloxacillin (IV)
Diabetic Foot Infection
Mild: Flucloxacillin or Doxycycline
Moderate: Flucloxacillin + Metronidazole or Doxycycline + Metronidazole
Open Fracture Prophylaxis
Co-amoxiclav (IV) + Metronidazole or
Co-trimoxazole (IV) + Metronidazole
Start within 3 hours
Unknown source
Amoxicillin (IV) + Gentamicin (IV) + Metronidazole (IV)
Penicillin allergy: Switch Amoxicillin with Vancomycin
If Staphlococci: Add Flucloxacillin + Vancomycin
Conjunctivitis
Usually self-limiting. Chloramphenicol
Ophthalmic shingles
Aciclovir
Tonsillitis
Most are viral. If Fever PAIN score is >4 and severe then treat with:
Penicillin
Penicillin allergy: Clarithromycin
Pharyngitis
Most are viral. If Fever PAIN score is >4 and severe then treat with:
Penicillin
Penicillin allergy: Clarithromycin
Sore throat
Most are viral. If Fever PAIN score is >4 and severe then treat with:
Penicillin V
Penicillin allergy: Clarithromycin
Sinusitis
If >7 days
- Penicillin V
- Doxycycline
Otitis Media
Most cases will resolve without antibiotics. Consider antibiotics if otorrhoea (discharge) is present:
- Amoxicillin
- Clarithromycin
Otitis Externa
Mild: Acetic acid
Moderate: Sofradex or Otomize. Basically Dexamethasone and an antibiotic.
Severe: ENT referral
Sofradex: Dexamethasone (corticosteroid), framycetin and gramicidin (antibiotics).
Otomize: Dexamethasone, neomycin (antibiotic) and acetic acid.
Oral thrush
- Miconazole gel
2. Fluconazole
Diverticulitis
Uncomplicated acute diverticulitis may respond to analgesia and dietary modification.
If needed use: Metronidazole 400mg + Co-trimoxazole
UTI or bacteriuria in pregnancy
1st-2nd trimester: Nitrofurantoin
3rd trimester: Trimethoprim
2nd line: Cefalexin
Prostatitis
Ofloxacin or Ciprofloxacin
High risk of C. difficile: Trimethoprim
Epididymo-orchitis
Send MSSU, gonorrhoea & chlamydia tests.
If STI likely (<35 or new partner in last 3mth): Doxycycline
If UTI likely (>35 and no new partner): Ofloxacin or Ciprofloxacin
Uncomplicated Chlamydia
Azithromycin or Doxycycline
Pelvic Inflammatory Disease
Metronidazole + Ofloxacin
Trichomoniasis
Trichomoniasis (or “trich”) is a very common sexually transmitted disease (STD). It is caused by infection with a protozoan parasite called Trichomonas vaginalis.
Metronidazole
Bacterial vaginosis
Metronidazole
Tinea pedis
Topical 1% Terbinafine
Dermatophyte nail infection
Confirm with nail clippings
Terbinafine
Fingers: 6-12 weeks
Toes: 3-6 months
Diabetic Foot Infection
Mild: Flucloxacillin or Doxycycline
Moderate: Flucloxacillin + Metronidazole or Doxycycline + Metronidazole
Impetigo
Localised lesions: Topical Fusidic Acid
Non localised: 1. Flucloxacillin
2. Clarithromycin
Chickenpox
Aciclovir
Shingles
Aciclovir or Valaciclovir
Bites (assuming from animals etc)
- Co-amoxiclav
2. Metronidazole + Doxycycline