Antibiotic Treatment Flashcards
CURB 65
Confusion of recent onset Urea >7 mmol/l Resp rate =/> 30 per minute Low systolic BP (<90) Low diastolic BP (=/<60) Age 65 or over
CURB65=2
Community acquired pneumonia
Amoxicillin 1g tds IV/PO 5 days
CURB65=4
Community acquired pneumonia
Co-amoxiclav IV + 1.2g tds + Doxycycline PO 100mg
ICU patient
CURB65=5
Community acquired pneumonia
Co-amoxiclav IV + 1.2g tds + Clarithromycin IV 500mg
Then step down to doxycycline 100mg
Penicillin allergic
CURB65=1
Community acquired pneumonia
Doxycycline 200mg on day 1 (PO)
100mg od or clarithromycin id NBM
CURB65=4 Penicillin allergic NBM
Community acquired pneumonia
IV Levofloxacin 500mg td
CURB65=5 Penicillin allergic
Community acquired pneumonia
IV Levofloxacin 500mg td
Hospital Acquired pneumonia CURB65=4
IV amoxicillin + Metronidazole + Gentamicin
Step down to PO co-trimoxazole + metronidazole (Total IV/PO 7 days)
Hospital Acquired pneumonia
CURB65=2
PO Amoxicillin + Metronidazole (5 days)
Hospital Acquired pneumonia
CURB65=2
Penicillin allergic
PO Co-trimoxazole+ Metronidazole
Hospital Acquired pneumonia
CURB65=5
Penicillin allergic
IV Co-trimoxazole + Metronidazole +/- Gentamicin
Total IV/PO 7 days
Hospital Acquired pneumonia
CURB65=5
Previous ICU admission
Seek advice
Hospital Acquired pneumonia
CURB65=5
Previous MRSA
Seek advice
Acute exacerbation of COPD
Increased sputum purulence
1st line Amoxicillin 500mg tds
2nd line Doxycycline 200mg on day one then 100mg daily (5 days)
Acute exacerbation of COPD
No increased sputum purulence
Consolidation on CXR
1st line Amoxicillin 500mg tds
2nd line Doxycycline 200mg on day one then 100mg daily (5 days)
Acute Cough/ Bronchitis
76 frail
1st line amoxicillin 500mg tds
2nd line doxycycline 200mg on day one then 100mg daily (5 days)
Endocarditis
Start empirical therapy and refer to ID/microbiology
Native valve indolent (Subacute)
Amoxicillin IV 2g 4 hourly + Gentamicin 1mg/kg bd (use actual body weight - max 120mg/dose)
Native valve severe sepsis (Acute)
Flucloxacillin IV 2g 6 hourly (4 hourly if >85kg)
Prosthetic valve or Suspected MRSA
Vancomycin IV + Rifampicin PO 600mg bd + Gentamicin IV 1mg/kg bd (use actual body weight - max 120mg/dose)
Native valve severe sepsis + risk factors for resistant pathogens (
Vancomycin IV + Meropenem IV 2g tds (requires ID/Micro approval)
Clostridium Difficile Infection risk factors
History of recent (<3m) or current antibiotic use
• Prolonged recent hospital stay
• Use of PPI
• Increasing age especially > 65y
• Surgical procedure (in particular bowel procedures) • Immunosuppression
What is the severity assessment for C.Diff?
One or more of the following severity markers:
Temperature > 38.5°C
Ileus, colonic dilatation >6cm on AXR/CT, toxic megacolon and/or pseudomembranous colitis
WCC >15 cells x 109L
Acute rising serum creatinine >1.5 x baseline
Has persisting CDI where the patient has remained symptomatic and toxin positive despote 2 courses of appropriate therapy
How would you treat non-severe c.diff
Metronidazole PO 400mg tds (10days)
