Antimicrobials 3 - Specific Therapy Flashcards
What is the only pathogen to cause bacterial meningitis in the young and old that is not covered by cefotaxime?
Listeria monocytogenes
What is given alongside cefotaxime in bacterial meningitis to cover listeria infection?
Amoxicillin
What do cephalosporins have limited activity against? How do we combat this?
Anaerobes e.g. In an abdominal infection
Give concurrent metronidazole
What are all enterococci resistant to?
Cephalosporins
Which is the only antibiotic that pseudomonas is sensitive to? (Oral)
Ciprofloxacin
If clinically and/or microbiologically indicated which antibiotic should be given first line for an acute sore throat?
Phenoxymethylpenicillin (pen V)
If clinically indicated, what antibiotic should be given first line for acute OM?
Amoxicillin
Alternatives to penicillin for URTIs?
Macrolides - clarithromycin for sore throat, erythromycin for OM
Antibiotic choice for acute COPD exacerbation?
Amoxicillin, doxycycline or clarithromycin
Co-amoxyclav if severe
What antibiotic for CAP with CURB65
Amoxicillin, doxycycline or clarithromycin
What should be done for a severe CAP with CURB65 > 1?
Admit to hospital, oral amox + clarithromycin
What is first line for uncomplicated UTIs? Stipulations?
Trimethoprim
Not in kids or pregnant/breastfeeding women
What steps should be taken if first line treatment fails for UTI? Alternative Abs?
Re-culture urine
Nitrofurantoin
First line treatment for uncomplicated UTI in pregnancy?
Cefalexin
First and second line treatments for acute pyelonephritis?
Ciprofloxacin
Co-amoxyclav
What can be given for multi-cause or highly resistant UTIs?
Tazocin
What drug can be given if necessary for C Diff first line? Second line?
Metronidazole
Vancomycin
What gen of cephalosporin is cefotaxime and what is it specifically indicated for?
3rd gen to treat bacterial meningitis
Recommended treatment for gonorrhoea?
Ceftriaxone IM and azithromycin single dose
What is the daily alternative to ceftriaxone/azithromycin for gonorrhoea?
Ciprofloxacin/ofloxacin daily
What is the one-off PO alternative to ceftriaxone IM in gonorrhoea?
Cefixime
Recommended treatment for chlamydia?
Doxycycline for 7 days
What is the one-off alternative to doxycycline for chlamydia?
Azithromycin
What is the treatment (if required) for BV?
Metronidazole
Treatment options for candidiasis?
Clotrimazole pessary
Single dose fluconazole
Treatment for trichomonas infection?
Metronidazole
Treatment option if necessary for HSV genital ulcer infection?
Aciclovir
Treatment for Syphillis?
Benzathine penicillin injection
Alternative to benzathine penicillin for Syphillis?
Doxycycline
What is the home treatment for genital warts?
Podophyllotoxin
Empirical Rx for acute IE of unknown cause?
Vancomycin plus gentamicin (to cover s. Aureus)
What can be given for common causes of IE that are proven to be susceptible to penicillin?
Amoxicillin plus gentamicin
Generally what needs to be given alongside a cell wall disrupter in IE?
Gentamicin - protein synthesis inhibitor
Rx for atypical pneumonia?
Amoxicillin or a macrolide
Rx for acute mastoiditis?
Co-amoxyclav or 3rd gen cephalosporin
Rx for cellulitis/erysipelas?
Flucloxacillin (covers BHS A (strep pyogenes) and in theory s. Aureus)
Medical Rx for nec fasc?
Meropenem + clindamycin
What antibiotic is used in MRSA infection and what class is it?
Vancomycin - a glycopeptide
Rx for acute osteomyelitis?
Usually s aureus, GAS, s pneumoniae so use flucloxacillin +/- rifampicin
What can be given for pneumococcal meningitis if penicillin resistant strain or penicillin allergy?
Vancomycin
Rx for bacterial meningitis if B lactam allergy?
IV chloramphenicol
Risk of giving IV chloramphenicol for bacterial meningitis (B lactam allergy)?
Agranulocytosis - grey baby syndrome
What is the specific treatment for HSV encephalitis?
IV aciclovir
What can be given for aggressive CMV meningitis in an immunocompromised patient?
Ganciclovir
Prophylaxis for close contacts of bacterial meningitis?
Ciprofloxacin or Rifampicin
Antibiotic Rx for acute osteomyelitis?
Usually s aureus, GAS or s pneumoniae
So flucloxacillin and Rifampicin
Recommended Rx for septic arthritis?
Flucloxacillin + Rifampicin
What is the general treatment for an infection likely to be caused by s aureus or strep?
Flucloxacillin + Rifampicin
General principles of management for infective endocarditis?
Wait for culture and sensitivity before commencing specific treatment - can usually wait
Rx for epiglottitis in relation to its most likely causes?
Ceftriaxone (GAS or haemophilus influenzae b)
Chloramphenicol IV if true penicillin allergy
Rx for quinsy?
Co-amoxyclav
What is the Rx for otitis media if required?
Amoxicillin
Rx for oral candidiasis?
Nystatin suspension
Rx for gastroenteritis?
Normally viral. Non-campylobacter only treated if systemic illness -> ciprofloxacin
If severe campylobacter infection give erythromycin
Rx for biliary tract infections?
Co-amoxiclav +/- gentamicin single dose
Is co-amoxiclav effective against anaerobes?
YES - suitable for many GI infections where anaerobes likely to be implicated
Rx for peritonitis or abdominal abscess?
Co-amoxiclav + stat Gentamicin
What is gentamicin used to cover?
Infection by gram negative bacteria
Rx for infection in neutropenic patients?
Tazocin +/- gentamicin
Alternatively ciprofloxacin + teicoplanin ; metronidazole if anaerobics
Rx for GBS bacteruria in pregnant women not in labour?
Pen V (phenoxymethylpenicillin) oral
