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Medicine > Antibiotics > Flashcards

Antibiotics Flashcards

0
Q

Community/hospital-acquired septicaemia (unknown source) - penicillin allergy

A

Ciprofloxacin 400mg IV bd + Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg)

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1
Q

Community-acquired septicaemia (unknown source) - 1st line for non-penicillin allergic

A

Cefuroxime 1.5g IV tds

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2
Q

Community/hospital-acquired septicaemia (unknown source) + hypotension

A

+ Gentamycin 7mg/kg IV stat

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3
Q

Community/hospital-acquired septicaemia (unknown source) - anaerobe suspected e.g. bowel-derived flora

A

+ Metronidazole 500mg IV tds

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4
Q

Hospital-acquired septicaemia (unknown source) - 1st line for non-penicillin allergic

A

Piperacillin/tazobactam 4.5g IV tds

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5
Q

Neutropenic sepsis (all haematology except myeloma, all oncology except high risk neuroblastoma/sarcoma) - 1st line for non-penicillin allergic

A

Piperacillin/tazobactam 4.5g IV tds + Gentamycin 7mg/kg IV od
Avoid Gentamycin if creatinine clearance <70ml/min)
Stop gentamycin after 1 dose if cultures negative

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6
Q

Neutropenic sepsis (all haematology except myeloma, all oncology except high risk neuroblastoma/sarcoma) + endoprosthesis in situ/tunnel infection/rigors with central line access/suspicion of line colonisation

A

+ Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg)

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7
Q

Mild-moderate CAP (CURB-65 0-2) - 1st line for non-penicillin allergic

A

Amoxicillin 500mg-1g IV tds +/- Clarithromycin 500mg IV bd
Switch to oral when appropriate
Total duration 5 days

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8
Q

Mild-moderate CAP (CURB-65 0-2) - penicillin allergy

A

Clarithromycin 500mg IV bd
Switch to oral when appropriate
Total duration 5 days

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9
Q

Severe CAP (CURB-65 3+ or clinical judgement) - 1st line for non-penicillin allergic

A

Co-amoxyclav 1.2g IV tds + Clarithromycin 500mg IV bd
Switch to oral when appropriate
Total duration 7 days

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10
Q

Severe CAP (CURB-65 3+ or clinical judgement) - Non-severe penicillin allergic (e.g. delayed rash)

A

Cefuroxime 1.5g IV tds + Clarithromycin 500mg IV bd
Switch to oral when appropriate
Total duration 7 days

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11
Q

Severe CAP (CURB-65 3+ or clinical judgement) - Severe penicillin allergic (e.g. anaphylaxis, bronchospasm, urticaria)

A

Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg) + Clarithromycin 500mg IV bd
Switch to oral when appropriate
Total duration 7 days

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12
Q

Simple HAP (early admission, no ITU) - 1st line for non-penicillin allergic

A

Cefuroxime 1.5g IV tds -or- Co-amoxyclav 1.2g IV tds
Switch to oral when appropriate
Total duration 5 days

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13
Q

Simple HAP (early admission, no ITU) - penicillin allergy

A

Clarithromycin 500mg IV bd
Switch to oral when appropriate
Total duration 5 days

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14
Q

Aspiration pneumonia - 1st line for non-penicillin allergic

A

Co-amoxyclav 1.2g IV tds -or- 625mg PO tds
Review diagnosis after 3 days
Total duration 5 days

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15
Q

Aspiration pneumonia - penicillin allergy

A

Clindamycin 300mg IV/PO qds
Review diagnosis after 3 days
Total duration 5 days

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16
Q

Infective exacerbation of COPD (no consolidation on CXR) - 1st line for non-penicillin allergic

A

Amoxicillin 500mg PO tds

Total duration 5 days

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17
Q

Infective exacerbation of COPD (no consolidation on CXR) - penicillin allergy

A

Doxycycline 200mg PO od

Total duration 5 days

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18
Q

Uncomplicated community-acquired lower UTI - 1st line

A

Trimethoprim 200mg PO bd
F: 3 days
M: 7 days

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19
Q

Uncomplicated community-acquired lower UTI - alternative unless creatinine clearance <60ml/min

A

Nitrofurantoin 50mg PO qds
F: 3 days
M: 7 days

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20
Q

Uncomplicated community-acquired lower UTI - pregnant

A

Cefadroxil 500mg PO bd

7 days

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21
Q

Uncomplicated hospital-acquired lower UTI - 1st line

A

Trimethoprim 200mg PO bd

7 days

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22
Q

Uncomplicated hospital-acquired lower UTI - alternative unless creatinine clearance <60ml/min

A

Nitrofurantoin 50mg PO qds

7 days

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23
Q

Acute pyelonephritis - 1st line for non-penicillin allergic

A 
Cefuroxime 750mg-1.5g IV tds for 48h
Then
Oral therapy per sensitivities -or-
If no sensitivities, Ciprofloxacin 500mg PO bd
Total duration
7 days if Ciprofloxacin
10 days for all other antibiotics
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24
Q

Acute pyelonephritis - penicillin allergy

A

Ciprofloxacin 500mg PO bd

7 days

25
Q

Acute pyelonephritis + refractory hypotension (septic shock)

A

+ Gentamycin 7mg/kg IV od

26
Q

Mild-moderate cellulitis - 1st line for non-penicillin allergic

A

Flucloxacillin 500mg-1g PO qds (or 1g IV qds if oral route compromised)
7 days

27
Q

Mild-moderate cellulitis - penicillin allergy

A

Clindamycin 300mg-450mg PO qds (or 600mg IV tds if oral route compromised)
7 days

28
Q

Severe cellulitis - 1st line for non-penicillin allergic

A

Benzylpenicillin 1.2g IV qds + Flucloxacillin 2g IV qds
Switch to oral when appropriate
Flucloxacillin 1g PO qds
Total duration 14 days

29
Q

Severe cellulitis - penicillin allergy

A

Clindamycin 600mg IV tds
Switch to oral when appropriate
Clindamycin 600mg PO qds
Total duration 14 days

30
Q

Community-acquired necrotising fasciitis - 1st line for non-penicillin allergic

A

Benzylpenicillin 2.4g IV 2-4 hourly + Ciprofloxacin 400mg IV bd + Clindamycin 600mg IV qds

31
Q

Community-acquired necrotising fasciitis - penicillin allergy

A

Ciprofloxacin 400mg IV bd + Clindamycin 600mg IV qds

32
Q

Facial / peri-orbital cellulitis - 1st line for non-penicillin allergic

A

Co-amoxyclav 625mg PO tds

10 days

33
Q

Facial / peri-orbital cellulitis - penicillin allergy

A

Clindamycin 300mg PO qds

10 days

34
Q

Animal and human bites - 1st line for non-penicillin allergic

A

Co-amoxyclav 625mg PO tds

7 days

35
Q

Animal and human bites - penicillin allergy

A

Metronidazole 400mg PO tds + Doxycycline 100mg PO bd

7 days

36
Q

Acute osteomyelitis / Septic arthritis - 1st line for non-penicillin allergic

A

Flucloxacillin 1-2g IV qds + Sodium fusidate 500mg PO tds

37
Q

Acute osteomyelitis / Septic arthritis - penicillin allergy

A

Clindamycin 600mg IV qds

38
Q

Acute osteomyelitis / Septic arthritis - MRSA

A

Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg) + Sodium fusidate 500mg PO tds
Minimum duration 6 weeks (IV for first 2 weeks)

39
Q

Acute prosthetic joint injection

A

Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg) + Sodium fusidate 500mg PO tds
Total duration 2 weeks, then discuss with microbiology

40
Q

MRSA infection

A

Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg)
MRSA is resistant to all penicillins, cephalosporins, carbapenems

41
Q

Mild-moderate C.difficile - 1st line

A

Stop precipitating antibiotics, if possible
Metronidazole 400mg PO tds
10-14 days

42
Q

Mild-moderate C.difficile - 2nd line

A

If not responding to 1st line after 1 week, switch to
Vancomycin 125mg PO qds
10-14 days

43
Q

Severe C.difficile (WBC>15, acute rising creatinine >50% above baseline, temp >38.5oC, dilated oedematous colon on AXR)

A

Vancomycin 125mg PO qds

10-14 days

44
Q

Mild acute gastroenteritis / travellers’ diarrhoea

A

Antibiotics not necessary

45
Q

Moderate-severe acute gastroenteritis / travellers’ diarrhoea - 1st line

A

Ciprofloxacin 500mg PO bd

3 days

46
Q

Moderate-severe acute gastroenteritis / travellers’ diarrhoea - 2nd line/SE Asia

A

Azithromycin 500mg PO od

3 days

47
Q

Acute colangitis - 1st line for non-penicillin allergic

A

Co-amoxyclav 1.2g IV tds

48
Q

Indolent native valve infective endocarditis - 1st line for non-penicillin allergic

A

Amoxicillin 2g IV 4o + Gentamycin 1mg/kg (Max 80mg) IV bd

49
Q

Rapidly progressing native valve infective endocarditis or IVDU - 1st line for non-penicillin allergic

A

Flucloxacillin 2g IV 4o (>85kg) or 6o (<85kg)

50
Q

Native valve infective endocarditis - penicillin allergy

A

Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg) + Gentamycin 1mg/kg (max 80mg) IV bd

51
Q

Prosthetic valve infective endocarditis

A

Teicoplanin 400mg IV bd (6mg/kg if >85kg) for 3 doses, then 400mg IV od (6mg/kg if >85kg) + Gentamycin 1mg/kg (max 80mg) IV bd + Rifampicin 300mg PO bd

52
Q

Meningitis - 1st line for non-penicillin allergic

A

Ceftriaxone 2g IV bd (IM if no IV access)

53
Q

Meningitis - penicillin allergy

A

Chloramphenicol 12.5mg/kg (max 1g) IV qds

54
Q

Meningitis + Gram positive cocci

A

+ Dexamethasone 0.15mg/kg IV qds

4 days

55
Q

Meningitis + GCS<15, recent seizures or suspect acute viral encephalitis

A

+ Aciclovir 10mg/kg IV tds

56
Q

Meningitis + >50y, immunocompromised or pregnant

A

Discuss with microbiology as may be Listeria monocytogenes

57
Q

Meningitis - treatment duration

A

Organism not identified: 7-14 days per clinical response
Neisseria meningitidis: 7 days
Strep. pneumoniae: 14 days
HSV/VZV: Acyclovir IV 14-21 days

58
Q

Gentamycin dosing

A

7mg/kg OD unless
>70y, creatinine clearance <1mg/L
- Post (peak) 3-5mg/L

59
Q

Penicillin allergy - contra-indicated (red)

A 
Amoxicillin
Co-amoxyclav (Augmentin)
Flucloxacillin
Benzylpenicillin
Penicillin V (Phenoxymenthylpenicillin)
Piperacillin/Tazobactam (Tazocin)
60
Q

Penicillin allergy - use with caution provided no Hx of severe allergy (amber)

A

Cephalosporins: Cefadroxil, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefixime
Carbapenems: Meropenem, imipenem, ertapenem

61
Q

Penicillin allergy - safe (green)

A

Amikacin, azithromycin, ciprofloxacin, clarithromycin, clindamycin, chloramphenicol, colistin, co-trimoxazole, doxycycline, erythromycin, gentamycin, linezolid, metronidazole, nitrofurantoin, rifampicin, sodium fusidate, teicoplanin, tetracycline, trimethoprim, vancomycin

Medicine (10 decks)

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