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CR3 > Antibiotics in Cardio-Respiatory Infections > Flashcards

Antibiotics in Cardio-Respiatory Infections Flashcards

1
Q

Infections of the respiratory tract

A
  • sinusitis
  • tonsillitis
  • pharyngitis
  • tracheitis
  • laryngitis
  • pleurisy
  • bronchioloitis
  • bronchitis
  • pneumonia
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2
Q

Types of organisms in the URT

A
  • normal flora
  • temporary colonisers
  • pathogens
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3
Q

Examples of organisms in the URT

A
  • strep pneumonie
  • viridians streptococci
  • staph aureus
  • candida
  • Corynebacterium diptheria
  • haemophilus influenzae
  • Group A Strep
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4
Q

Example of normal flora in URT

A

Viridans Streptococci

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5
Q

Example of temporary colonisers in URT

A

Staph aureus

Candida

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6
Q

Example of pathogens in URT

A
  • group A strep

- Corynebacterium diptheria

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7
Q

URTI Bacteria Common

A

Strep pyogenes = group A
Strep pneumonia
Haemophilus influenzae

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8
Q

Uncommon causes of URTI

A

Cornebacterium diphtheriae

Nesisseria meningitidis

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9
Q

URTI Viruses Common

A 
Rhinovirus
Influenza/parainfluenza
Coronavirus
Adenovirus
RSV
Coxsackie
Enterovirus
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10
Q

Influenza Presentation

A 
Fever
Headache
Malaise
Myalgia
Arthralgia
GI Symptoms
Coryza
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11
Q

Treatment for uncomplicated influenza

A
  • if previously healthy = none

- if at risk = oseltamivir 75mg PO within 48 hours of onset

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12
Q

Treatment for complicated influenza

A
  • oseltamivir PO/NG 1st line, zanamivir INH, NEB or IV 2nd line
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13
Q

Define complicated influenza

A

Requires hospital admission AND OR

  • pneumonia/hypoxaemia
  • CNS = meningitis
  • co-morbidity exacerbation
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14
Q

Investigation for influenza

A
  • nasophargyngeal swab for flu PCR in 2ndry care

- none in primary

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15
Q

Prevention of influenza

A

Vaccination

HCW

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16
Q

Common pharyngitis viruses

A 
Rhinovirus
Influenza/parainfluenza
Coronavirus
Adenovirus
RSV
Coxsackie
Enterovirus
EBV
CMV
HSC
Measles
HIV
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17
Q

Common pharyngitis bacteriae

A

Group a,b,c streptococci
Mycoplasma pneumoniae
Neisseria gonorrhoea
Corynebacterium diptheriae

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18
Q

Pharyngitis presentation

A 
Sore throat
Fever
Felt ill
Tonsillar exudate
Tender cervical nodes
Scarlet fever
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19
Q

Treatment for pharyngitis

A

Penicillin V for 10 days

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20
Q

Investigations for pharyngitis

A

Throat swab

Moderate group of Group A Strep sensitive to penicillin and erythromycin

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21
Q

Centor criteria

A 
- aid diagnosis of Group A Strep
Point
- tonsillar exudate = 1
- tender cervical LN = 1
- absence of cough = 1
- history of fever = 1

1-2 points = 20% chance = no treatment
3-4 points = 50% chance = treatment advised

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22
Q

Pharyngitis treatment if penicillin allergy

A

Erythromycin

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23
Q

Pencillin treatment for pharyngitis dose

A

Penicillin V 500mg QDS
OR
1g BD for 5-10 days

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24
Q

Clarithromycin Treatment for pharyngitis dose

A

500mg BD for 5 days

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25
Complications of pharyngitis
Rheumatic fever | Glomerulonephritis
26
Why shouldn't you give amoxicillin if sore throat in pharyngitis?
- causes rash if patient has EBV = infectious mononucleosis | - not an allergy to amoxicillin
27
Advantages of amoxicillin
- better absorbed than pen V and clarithromycin - easier to take - BUT STILL DON'T GIVE IN EBV
28
Viruses causing acute otitis media
``` Rhinovirus Influenza/parainfluenza Coronavirus Adenovirus RSV Coxsackie Enterovirus ```
29
Bacteria causing acute otitis media
``` Strep pneumoniae Haem influenza Moraxella catarrhalis Mycoplasma pneumonia Streptococus pyogenes ```
30
What do the 7 main URTI viruses most commonly cause?
Rhinitis Sinusitis Otitis media Pharyngitis
31
Treatment or otitis media in children?
- no AB usually | - if need to = amoxicillin 5-7 days OR clarithromycin 5-7 days
32
Indications for AB in acute otitis media children?
- <2 years - symptoms >48 hours - high fevers - bilateral - otorrhea
33
Treatment for acute otitis media adults?
- amoxicillin or co-amoxiclav | - OR clarithromycin
34
Complications of otitis media in adults
Decreased hearing Mastoiditis Brain abscess
35
Organisms causing sinusitis
- 7 common viruses - strep pneumoniae - haemo influenza - Moraxella catarrhalis
36
Treatment for sinusitis
- pen V or clarithromycin | - co-amoxiclav if systemically unwell
37
LRTIs
- bronchiolitis - pleurisy - bronchitis - pneumonia - bronchiectasis and CF - empyema
38
Types of pneumonia
- CAP = typical and atypical - HAP - Aspiration
39
Organisms causing typical CAP
- strep pneumoniae - Haem Inf - staph aureus - M TB
40
Organisms causing atypical CAP
- mycoplasma pneumoiae - legionella - chlamydia pneumoniae - chlamydia psittaci
41
RF for pneumococcal pneumonia
- influenza - alcohol - smoking/COPD - HIV
42
First line treatment for Strep Pneumonia?
Antibiotic resistance increasing - first = amoxicillin - doxycycline - levofloxacin Some strains amxocillin resistant = take travel history!
43
Second Line treatment for Strep Pneumonia
- ceftriaxone - teicoplanin - vancomycin
44
Atypical pneumonia species
Mycoplasma pneumoniae | Legionella species
45
Mycoplasma features
- no cell wall - small - gram stain not visible - cell AB don't affect them
46
M pneumonia features
- dry cough - epidemics - winter - with pharnygitis, rhinorrhea, otalgia, hepatitis, meningitis
47
Treatment for mycoplasma pneumonia
- macrolides = clarithromycin - quinolones = levofloxacin - tetracyclines = doxycycline
48
Legionella features
- gram negative rods - growth needs special media - slow growth 3-5 days
49
Treatment for legionella
- cell wall AB not effective | - quinolones>macrolides>tetracyclines
50
RF of S aureus pneumonia
- viral URTI | - colonisation of URTI
51
What can S aureus pneumonia cause?
- necrotising/abscess formation | - severe disease
52
CAP Diagnosis
``` CURB65 Confusion Urea>7mmol/l RR>30min BP = systolic <90 or diastolic <60 Age >65 ``` ``` 0-1 = low severity, outpatient 2 = moderate, admit, Ix microbiology, IV Tx 3-5 = high, urgent admission ```
53
Treatment for 0-1 score of CURB65
Oral amoxicillin 500mg TDS OR Doxycycline 100mg OD
54
Treatment for 2 score CURB65
IV benzylpnecillin 1.2g QDS AND Doxycycline 100mg BD
55
>2 treatment score CURB65
IV co-amoxiclav 1.2g TDS AND doxycycline 100mg BD OR IV ceftriaxone 2g OD AND doxycycline 100mg BD if history of travel
56
HAP define
>48 hour after admission or within 2 weeks of admission
57
Predisposing factors to HAP
- abnormal conscious state/intubation and ventilation | - immunosuppression
58
Organisms causing HAP
- same as CAP | - also E coli, klebsiella, pseudomonas
59
Treatment for mild/moderate HAP
doxycycline
60
Treatment for severe HAP
early onset <5 days = coamoxiclav | late onset >5 days = piperacillin-tazobactam
61
Cause of aspiration pneumonia
- bacteria from URT/stomach
62
Treatment for aspiration pneumonia
``` 1 = amoxicillin and metronidazole 2 = levofloxacin and metronidazole 3 = co-amoxiclav 4 = piperacillin-tazobactam ```
63
triggers for COPD exacerbation
- virus - bacteria - pollution - CCF - VTE - aspiration
64
When are AB effective in COPD exacerbation?
- increased dyspnoea - increased sputum purulence - increased sputum volume
65
Treatment for COPD exacerbation
- doxycycline or clarithromycin - guided by sputum results - 5 day treatment - if recurrence within 3 months = use alternative agent - if consolidation on CXR = treat as CAP/HAP
66
Features of bronchiectasis
- abnormal dilatation of major bronchi and bronchioles - chronic daily cough with sputum - CT = bronchial wall thickening and luminal dilatation
67
CF features
- congenital | - abnormal secretions = chronic infections and bronchiectasis
68
treatment for bronchiectasis and CF
- guided by sputum culture - if no pseudomonas = clarithromycin or doxy or co-amoxiclav - if psueodmonas = ciprofloxacin or IV pip0taz
69
Prophylaxis of bronchiectasis and CF
- chest physio - postural drainage - oral azithromycin - inhaled AB = nebulised gentamicin, tobramycin, colistin
70
Define empyema
- complicated parapneumonic effusion - effusion into pleural space adjacent to bacterial pneumonia - treat pneumonia to treat normally unless complicated
71
treatment of empyema
- drainage | - AB 2-4 weeks until CXR resolution
72
Prevention of resp infections
VACCINES - influenza - pneumococca - haemo influenzae - pertussis - diptheria
73
RF of infective endocarditis
- iatrogenic = infected cannulae - IVDA = right sided often - staph aureus, strep pneum, yeast infection
74
Causes of abnormal valve
- rheumatic fever - Degen calcific disease - congenital defects - mitral valve prolapse!!
75
Antibiotic sensitivity testing
- disc diffusion tests (qualitiative - sensitive or resistant) - MIC tests (E-test) (quantitiative, how sensitive/resistant)
76
Define MIC
Minimum Inhibitory concentration | Lowest conc of an antimicrobial that will inhibit the visible growth of a micro-organism after overnight incubation
77
Define MBC
Minimum bactericidal concentration | Lowest conc of antimicrobial that will prevent the growth of an organism after subculture on to antibiotic-free media
78
Empirical Therapy for endocarditis when?
- only if severe sepsis
79
Native valve infective endocarditis therapy
- vanco and genta - OR - vanco and meropenem (gram negative risk)
80
Prosthetic valve infective endocarditis therapy
vanco and genta and rifampicin 6 weeks - rifampicin treats biofilm
81
Directed therapy infective endocarditis for staphylococcous
Staphylococcus – flucloxacillin 4 hourly  MRSA – vancomycin
82
Directed therapy infective endocarditis for streptococci
Streptococci – benzyl penicillin 4 hourly  Penicillin resistance – vancomycin & gentamicin
83
Directed therapy infective endocarditis for enterococci
Enterococci – amoxicillin 4 hourly & gentamicin
84
Define biofilm
cluster of bacteria in extracellular matrix attached to surface
85
What is required in directed therapy for infective endocarditis
- guidance of microbiology/infectious diseases team

CR3 (30 decks)

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