Antibiotics & Epilepsy Mg Flashcards
Respiratory system:
Exacerbations of chronic bronchitis
(ATC)
Amoxicillin or
tetracycline or
clarithromycin
Uncomplicated community-acquired pneumonia
(ADC):
-Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)
Pneumonia possibly caused by atypical pathogens
-Clarithromycin
Hospital-acquired pneumonia
Within 5 days of admission:
co-amoxiclav or cefuroxime
More than 5 days after admission:
-piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
Urinary tract:
Lower urinary tract infection
-Trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin
Acute pyelonephritis
-Broad-spectrum cephalosporin or quinolone
Acute prostatitis
-Quinolone or trimethoprim
Skin:
Impetigo
-Topical hydrogen peroxide,
-oral flucloxacillin or erythromycin if widespread
Cellulitis
-Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
Cellulitis (near the eyes or nose)
-Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)
Erysipelas
-Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
Animal or human bite
-Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)
Mastitis during breast-feeding
-Flucloxacillin
ENT: Throat infections
-Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)
Sinusitis
-Phenoxymethylpenicillin
Otitis media
-Amoxicillin (erythromycin if penicillin-allergic)
Otitis externa
-Flucloxacillin (erythromycin if penicillin-allergic)
Periapical or periodontal abscess
-Amoxicillin
Gingivitis: acute necrotising ulcerative
-Metronidazole
Genital system: Gonorrhoea
Intramuscular ceftriaxone
Chlamydia
Doxycycline or azithromycin
Pelvic inflammatory disease
Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
Syphilis Rx
Benzathine benzylpenicillin or doxycycline or erythromycin
Rx. of Bacterial vaginosis
Oral or topical metronidazole or topical clindamycin
Gastrointestinal:
Clostridioides difficile
First episode: oral vancomycin
Second or subsequent episode of infection:
Within 12 weeks: Oral fidoxamin
After 12 weeks: oral fidaxomicin/fidoxamin
Campylobacter enteritis
Clarithromycin
Salmonella (non-typhoid)
Ciprofloxacin
Shigellosis Rx
Ciprofloxacin
Hospital Management of Acute COPD
Generalised tonic-clonic seizures
males: sodium valproate
females: lamotrigine or levetiracetam
Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
Absence seizures (Petit mal)
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures
Myoclonic seizures
males: sodium valproate
females: levetiracetam
Tonic or atonic seizures
males: sodium valproate
females: levetiracetam
Quick comparison: Epilepsy: first-line medications
Lamotrigine or levetiracetam
focal seizures (male patient)
Quick comparison: Epilepsy: first-line medications
Sodium valproate
generalised tonic-clonic seizures (male patient)
myoclonic seizures (male patient)
tonic or atonic seizures (male patient)
Quick comparison: Antibiotic guidelines
Flucloxacillin (Flu to CEO)
Cellulitis (NOT near the eyes or nose)
Erysipelas
Otitis externa (severe)
Quick comparison: Antibiotic guidelines
Co-amoxiclav
Cellulitis (near the eyes or nose)
Animal or human bite
Side-effects of common drugs: antibiotics
Amoxicillin
Rash with infectious mononucleosis
Co-amoxiclav AE
Cholestasis
Flucloxacillin
Cholestasis
Erythromycin AEs
Gastrointestinal upset
Prolongs QT interval
Ciprofloxacin
Lowers seizure threshold
Tendonitis
Metronidazole
Disulfiram like reaction (Reaction following alcohol ingestion)
Doxycycline
Photosensitivity
Trimethoprim
Rashes, including photosensitivity
Pruritus
Suppression of haematopoiesis
Aminoglycosides AEs
Nephrotoxic & Ototoxicity
Contraindications myasthenia gravis
Genital Ulcers
A. Painful:
a. Multiple painful: Herpes simplex virus
b. Single painful: Chancroid (Haemophilus ducreyi)
B. Painless:
a. Single/Multiple painless: LGV
b. Single painless: Syphilis
c. Granuloma inguinale by K. granulomatis
Anti-Tuberculosis: drug side-effects
Rifampicin
Orange bodily fluids, rash, hepatotoxicity, drug interactions
Isoniazid
Peripheral neuropathy, psychosis, hepatotoxicity
Pyrazinamide Paoooon
Gout, Arthralgia, hepatotoxicity, nausea
Ethambutol Eye
Optic neuritis, rash
Prescribing in pregnant patients
Harmful:
Antibiotics
-tetracyclines
-aminoglycosides
-sulphonamides and trimethoprim
-quinolones: the BNF advises to avoid due to arthropathy in some animal studies
Other drugs
-ACE inhibitors, angiotensin II receptor antagonists
-statins
-warfarin
-sulfonylureas
-retinoids (including topical)
-cytotoxic agents
The majority of antiepileptics including valproate, carbamazepine and phenytoin are known to be potentially harmful.
Prescribing in patients with renal failure
Avoid in RF: NAML - Trtra Nitro
-antibiotics: tetracycline, nitrofurantoin
-NSAIDs
-lithium
-metformin
Need dose adjustment - accumulate in chronic kidney disease
-most antibiotics including penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
-digoxin, atenolol
-methotrexate
-sulphonylureas
-furosemide
-opioids
Relatively safe - can sometimes use normal dose depending on the degree of chronic kidney disease
-antibiotics: erythromycin, rifampicin
-diazepam
-warfarin
Side-effects of common drugs: diabetes drugs
Metformin
-Gastrointestinal side-effects
-Lactic acidosis
Sulfonylureas
Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)
Glitazones
-Weight gain
-Fluid retention
-Liver dysfunction
-Fractures
Gliptins
Pancreatitis
