Antibiotic Man Primary Care Flashcards
When to give antibiotics for suspected meningitis
Give antibiotics if non-blanching rash, in combination with signs of meningism or sepsis, and time permits.
If time transfer is > 1 hour
What antibiotics are given for meningitis
Benzylpenicillin (IV/IM) 1.2g or if known anaphylaxis Cefotaxime 2g (IV/IM)
Meningitis prophylaxis for contacts
Ciprofloxacin
Orbital cellulitis
transfer to hospital immediately
Ceftriaxone IV 2g bd + Flucloxacillin IV 2g qds + Metronidazole IV 500mg tds (Penicillin allergy: seek advice)
Step down to Co-amoxiclav PO 625mg tds (10-14 days total)
Ophthalmic shingles
Start treatment up to 7 days after onset of rash
Refer to ophthalmology if eye involvement
Aciclovir 800mg 5 times daily or valaciclivor 1g tds (7 days) + lubricating eye drops if lesions near eyelid
Dental abscess
Penicillin V 500mg qds or metronidazole 4000mg tds (5 days)
tonsilitis/pharyngitis/sore throat
if >/= 4 on FeverPain
1st line- penicillin V 1g bd or 500mg qds (5 days)
2nd line- clarithromycin 500mg bd (5 days)
Unable to swallow: Benzylpenicillin IV 1.2g qds (penicillin allergy: clarithromycin IV 500mg bd)
Sinusitis
If ≤10 days symptoms there is no benefit from antibiotics unless clear evidence of systemic illness. If >10 days multiple or worsening symptoms consider back up antibiotic.
1st LINE Penicillin V 500mg qds or 1g bd (5 days)
2nd LINE Doxycycline 200mg day 1 then 100mg daily (5 days total)
Epiglottitis/supraglottitis
medical emergency- hospital transfer
Otitis media
Most cases will resolve without antibiotics and if used, they generally reduce symptom duration by <1 day. Consider antibiotics if otorrhoea present.
1st LINE Amoxicillin 500mg tds
2nd LINE Clarithromycin 500mg bd (5 days)
Otitis externa
Provide information on aural care. Mild – do not swab. Acetic acid 2% tds (EarCalm®) continuing for 2 days after
resolution (max 7 days). Moderate – do not swab. Sofradex® or Otomize® tds.
Severe- seek ENT guidance
Oral candidiasis
1ST LINE Miconazole gel qds or Nystatin 1ml qds
2ND LINE Fluconazole 50mg daily (Immunocompromised 100mg) (7 days)
*Clindamycin oral dosing
<50kg 300mg tds
50-90kg 450mg tds
>90kg or very severe illness 600mg tds or 450mg
Peritonsilar cellulitis
Benzylpenicillin IV 1.2g qds or Penicillin V oral 500mg qds or 1g bd.
Total duration IV/PO: 10 days
Penicillin allergy: Clindamycin* oral (10 days)
If unable to swallow IV Clindamycin 600mg – 1.2g qds
Supraglottitis
Ceftriaxone IV 2g od
Send blood cultures
Step down to Co-amoxiclav PO 625mg tds
(or in penicillin allergy: Doxycycline PO 100mg bd +
Metronidazole 400mg tds)
Post tonsillectomy haemorhage
If evidence of infection Amoxicillin IV 1g tds or Clarithromycin IV 500mg bd
Switch to oral Amoxicillin 500mg tds or Clarithromycin 500mg bd as soon as possible
Duration: 7 days total IV/PO
Consider use of tranexamic acid if no evidence of infection
acute rhinosinusitis
Penicillin V oral 500mg qds or 1g bd (7 days)
Penicillin allergy: Doxycycline 200mg on day 1 then 100mg thereafter (7 days)
Epistaxis
If packing has been in for >48hours – Flucloxacillin PO 1g qds – STOP when packing removed
Acute parotitis
Consider mumps as differential diagnosis. Ensure strict oral hygiene and appropriate management of dry mouth.
Flucloxacillin 500mg qds plus Metronidazole 400mg tds (5 days)
Penicillin allergy: Doxycycline 100mg od plus Metronidazole 400mg tds
Facial cellulitis dental/mandibular/sinus source
PO Co-amoxiclav 625mg tds or Clindamycin* (7 days)
peri-orbital/pre-septal cellulitis
Co-amoxiclav PO 625mg tds or IV 1.2g tds (pencillin allergy: Clindamycin*) Duration: 7-10 days
Skull base osteomyelitis
Piperacillin/tazobactam IV 4.5g tds (as 30min infusion).
If penicllin allergy or oral route suitable Ciprofloxacin PO
750mg bd.
Sensitivities essential.
Treat for 6 weeks initially then reassess.
If continued inflammation on scan or high CRP continue for a further 6 weeks. May require up to 6-12 months of treatment
Exacerbation of COPD
Treat if increased sputum purulence. If no increased sputum purulence no antibiotics unless pneumonia or consolidation on CXR.
1st LINE Amoxicillin 500mg tds
2nd LINE Doxycycline 200mg day 1 then 100mg daily (5 days total)
Acute cough/bronchitis
Antibiotics give no significant benefit in clinical improvement but may be considered in the frail elderly.
1st LINE Amoxicillin 500mg tds
2nd LINE Doxycycline 200mg day 1 then 100mg daily (5 days total)
Community acquired pneumonia
0 = Usually treat at home
Amoxicillin 1g tds or Doxycycline 200mg day 1 then 100mg daily (5 days)
1-2= usually treat at home
Consider hospital referral (in particular if major co-morbidity)
3-4= Urgent hospital admission
Give Amoxicillin 1g oral or Benzylpenicillin 1.2g IV before transfer (withhold if known anaphylaxis)
Non-severe CDI
- Treat with oral metronidazole 400mg tds for 10 days
- Document indication and duration on medicine chart
- If oral route not available IV metronidazole 500mg tds
- Rehydrate patient
If no improvement after 5 days of treatment with
metronidazole or worsens at any time, switch to treatment with vancomycin 125mg qds for 10 days.
If after 10 days of treatment diarrhoea still persists, seek
specialist advice and investigate other pathologies that could be responsible for diarrhoea.
Test of cure should NOT be performed
Severe CDI
-Treat with oral vancomycin 125mg qds for 10 days
• Document indication and duration on medicine chart
• If oral route not available give via NG tube
• Rehydrate patient and consider referral to hospital or healthcare facility if patient at home
Ileus in severe CDI
If ileus is detected or NG route not available treat with IV metronidazole 500mg tds plus vancomycin 500mg qds (via NG or intracolonic) until ileus is resolved.
Antibiotics in diverticulitis
Uncomplicated acute diverticulitis may respond to analgesia and dietary modification. If antibiotics are indicated use Metronidazole 400mg tds plus Co-trimoxazole 960mg bd for 5 days
Uncomplicated female lower UTI
Single symptom: self care advice
≥2 symptoms: dipstick for nitrites if feasible and <65 years
+ve & mild symptoms: self care advice or back up prescription
+ve & severe symptoms:
1ST LINE Nitrofurantoin 100mg MR bd
2nd LINE Trimethoprim 200mg bd (3 days)
RECURRENT UTI WOMEN (>2/6month or >3/year)
Consider other options before prophylaxis.
Some women may wish to try cranberry or d-mannose to reduce recurrence.
> 3/year Methenamine 1g bd may be considered – no evidence of benefit if renal tract abnormalities or
neuropathic bladder.
Consider a prescription for ‘stand-by’ antibiotic prior to considering prophylaxis.
If antibiotic prophylaxis considered follow national advice on counselling prior to initiation, review after 3-6 months with a view to stopping at 6 months.
Trimethoprim 100mg or Nitrofurantoin 50-100mg at night (or post coital).
Consider renal/respiratory cautions.
Pyelonephritis (male or female)
Send MSSU. Co-trimoxazole 960mg bd or Co-amoxiclav 625mg tds (7 days)
CKD UTIs
trimethoprim or pivemecillinam
Uncatheterised male UTI
Send MSSU.
1st LINE Nitrofurantoin MR 100mg bd or 50mg qds
2nd LINE Trimethoprim 200mg bd (7 days)
Catheterised UTIs
DO NOT USE URINALYSIS. DO NOT TREAT UNLESS CLINICAL SIGNS/SYMPTOMS OF INFECTION.
Antibiotic prophylaxis for UTI if catheter in situ is not recommended. Check decision aid before prescribing.
Co-trimoxazole 960mg bd or Co-amoxiclav 625mg tds (7 days).
Change catheter as soon as possible.
Prostatitis
ofloxacin 200mg bd or ciprofloxacin 500mg bd
If high risk CDI: trimethoprim 200mg bd (all 28 days)
Epididymo-orchitis
Send MSSU, gonorrhoea and chlamydia tests
If STI likely (<35 or new partner in 3/12) Doxycycline 100mg bd (14 days)
If UTI likely (>35 no new partner) Ofloxacin 200mg bd or ciprofloxacin 500mg bd (14 days)
Uncomplicated chlamydia
Doxycycline 100mg bd (7 days)
If tolerant Azithromycin 1g od day 1 then 500mg od for 2 days
PID
metronidazole 400mg bd + ofloxacin 400mg bd (14 days)
bacterial vaginosis
metronidazole 400mg bd (5 days) or 2g single dose
Vulvovaginal candidiasis
Fluconazole 150mg single dose or clotrimazole 500mg pessary single dose
Cellulitis
Flucloxacillin 1g qds or Doxycycline 100mg bd (5 days)
If systemically unwell or not responding refer to ID: may be suitable for outpatient IV therapy (OHPAT).
Consider swabbing for Panton-Valentine Leucocidin if recurrent boils or abscesses.
If history or risk of MRSA Doxycycline 100mg bd
Diabetic foot
Mild: Flucloxacillin 1g qds or Doxycycline 100mg bd.
Moderate: Flucloxacillin 1g qds + Metronidazole 400mg tds
or
Doxycycline 100mg bd + Metronidazole 400mg tds.
Impetigo
Localised lesions: topical hydrogen peroxide 1% cream or fusidic acid 2% cream tds (5 days)
If more widespread lesions:
1st LINE Flucloxacillin 500mg qds
2nd LINE Clarithromycin 500mg bd (5 days)
Chickenpox
Consider antiviral if patient presents within 24 hours of onset of rash or immunocompromised:
Aciclovir 800mg 5 times daily (7 days)
Shingles
Must present within 72 hours of onset of rash: Aciclovir 800mg 5 times daily or Valaciclovir 1g tds (7 days)
Bites dog/cat/human
1ST LINE Co-amoxiclav 625mg tds
2ND LINE metronidazole 400mg tds + doxycycline 100mg bd
PROPHYLAXIS FOR UNINFECTED BITE: 3 days TREATMENT FOR INFECTED BITE: 5 days
