antibiotic regime Flashcards
low severity CAP
Monotherapy (5-7 days)
- oral amoxicilin
- doxycycline
- > if atypical suspected
- > hypersensitivity to penicilin
moderate severity CAP
Combined therapy (5-7 days)
- benzylpenicilin IV + doxycycline oral
- > switch to amoxicilin oral + doxy oral once stable
- hypersensitivity to penicillin
- > cefotaxime/ceftriaxone IV + doxy oral
If atypical
- doxycycline
- or macrolide
- > oral clarithromycin
- > IV azithromycin
high severity CAP
Combined therapy
-ceftriaxone/cefetaxime IV + azithromycin IV
If staph aureus suspected
-IV vancomycin
If anaerobes suspected (lung abscess)
-add IV metronidazole
If atypical
- doxycycline
- or macrolide
- > oral clarithromycin
- > IV azythromycin
H pylori treatment
First line: “Antibiotics Cure Pylori”
- amoxicilin
- clarithromycin
- ppi (esomeprazole)
- (oral, 7 days)
- (85-90% effective)
- resistance to clarithromycin in 5-10%
Penicilin hypersensitivity
- metronidazole
- ppi
- clarithromycin
- (80% effective)
- (resistance to metronidazole = 50%)
Treatment failure: Please Boost My Therapy
- PPI
- Bismuth
- Metronidazole
- Tetracycline
- (14 days)
- (85% effective)
- levofloxacin (no resistance recorded)
- amoxacilin
- ppi
- (10 days)
- (85% effective)
Continue PPI for 8 weeks if complicated ulcer
Meningitis treatment
Cure Bacterial Meningitis
- ceftriaxone/cefetaxime
- > covers everything but listeria
- benzylpenicillin if listeria suspected
- moxifloxacin if penicilin allergy
Targeted (allergy -> quinolones)
- gram positive
- > benzyl penicillin
- > moxifloxacin if allergic
- gram negative
- > ceftriaxone/cefetaxime
- > ciprofloxacin if allergic
Treat PID
Non severe (Cervix Mending Antibiotic Drugs): ceftriaxone IV single dose \+ metronidazole \+ azithromycin or doxycycline
If severe
- all become IV
- ceftriaxone dosing for full course
Councelling
- protection
- HPV vaccination
- sexual contact tracing
acute bronchitis
eTG recommends no antibiotics
Counselling
- aetiology of acute bronchitis is viral
- ineffectiveness of antibiotics
- risks of antibiotics
Treat
- fluids
- rest
- pain management
Safety net
- cough usually resolves by 4 weeks
- > can last up to 8
- represent
- > with worsening symptoms or fever
- > cough >4 weeks
antibiotics exacerbation of COPD
antibiotic stewardship
- don’t use unless clear evidence of bacterial infection
- NNT in inpatient (not ICU) and outpatient is approx 12
- > improvement at 1 month
- discuss risks of antibiotics etc
- shared decision making
choice of antibiotics
- amoxicilin oral
- doxycyclin oral
IE management
Benzylpenicilin IV
- replace with vancomycin if
- > IVD
- > prosthetic valves
Flucloxacillin IV
Gentamycin IV
treatment pyelonephritis
non severe
- oral amoxicilin with clavulonate
- > ciprofloxacin if hypersensitivity
severe (Genital Antibiotics)
- gentamycin + amoxicillin
- > ceftriaxone/cefotaxime if gent contraindicated
gentamycin use
duration
- don’t use empirically for more than 48 hrs
- > reversible nephrotoxicity and irreversible auditory /vestibular toxicity with prolonged use
monitoring
- plasma levels
- > recommended every 48hrs
- GFR
- > baseline
- > every 2/3 days
- vestibular/auditory function
- > baseline
- > periodically
GFR
- <40mL/min/1.73
- > safe for single dose which may be life saving
- > repeated dosing is common but requires expert input
treatment whooping cough
within 3 weeks of cough
- azithromycin oral
- > little evidence to show effect
- > does clear nasopharynx and reduce infectivity
after 3 weeks of cough
- no longer infectious
- antibiotics unlikely to alter coarse
prevention
- notifiable disease
- any one within 1 meter is contact
- consider antibiotic prophylaxis for
- > infants <6 months (highest risk)
- > women in last month of pregnancy
- > childcare workers
- > household
typhoid
severe
-IV cephtriaxone/cephotaxime
non-severe
- MDR is common for
- empirical quinolone is first line
- > resistance is high
- > susceptibility testing needed
- if resistant to quinolone
- > azithromycin
