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SDCEP guidance > bacterial infections > Flashcards

bacterial infections Flashcards

1
Q

what is the use of broad spectrum ABs associated with?

A

increased c difficile associated disease

so care if prescribing to elderly, GIT disease inc PPIs

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2
Q

dental abscess local measures

A

achieve drainage of pus - ext/through RCs, drain any ST pus by incision (don’t drain a cellulitis-type swelling)
remove cause where possible

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3
Q

NUG local measures

A

remove supra and subgingival deposits, OH advice

due to pain may only be able to tolerate limited debridement in acute phase

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4
Q

local measures for pericoronitis

A

irrigation and debridement

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5
Q

sinusitis local measures

A

advise steam inhalation (not children)

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6
Q

indications for ABs

A

evidence of spreading infection: cellulitis, LN involvement, swelling
evidence of systemic involvement: fever, malaise
local measures have failed

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7
Q

indications for ABs - NUG/pericoronitis

A

systemic involvement or persistent swelling despite local tx

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8
Q

indications for ABs - sinusitis

A

persistent symptoms and/or purulent discharge lasting at least 7 days or where symptoms are severe

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9
Q

what should ABs be used in conjunction with?

A

local measures

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10
Q

pts who have taken AB course in prev 6 weeks

A

increased risk of harbouring bacteria resistant to that drug and should therefore be prescribed an alternative

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11
Q

emergency transfer to hospital

A

significant trismus
FOM swelling
difficulty breathing

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12
Q

don’t prescribe antibiotics to:

A

treat pulpitis
prevent dry socket in non-surgical ext

= these are inflammatory causes of pain

prophylaxis to prevent infections after a routine dental surgical procedure

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13
Q

before prescribing ABs what should you do?

A

refer to BNF and BNFC for drug interactions
advise pts to space out doses as much as possible throughout the day
review within 2-7days (whether or not ABs were prescribed)

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14
Q

contraception - recent change to guidelines

A

additional precautions no longer required when antibacterials that do not induce liver enzymes are taken with

  • combined oral contraceptives (unless diarrhoea/vomiting)
  • contraceptive patches or vaginal rings

ABs in this document don’t induce liver enzymes

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15
Q

IE 2008 NICE

A

ABP against IE not recommended for people undergoing dental tx

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16
Q

IE 2015 review

A

no evidence it is of benefit (inc in prosthetic joints)

unacceptable to expose pts to the potential adverse effects of ABs in these circumstances

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17
Q

what MOs are usually responsible for dental abscesses?

A

viridians streptococcus spp or gram - organisms

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18
Q

dental abscess - why are ABs not indicated where infection localised to PR tissues?

A

indicates infection being adequately managed by immune system
abscess mostly isolated from circulation - v little AB penetration

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19
Q

dental abscess - when are ABs required?

A 
immediate drainage not achieved using local measures
spreading infection (swelling, cellulitis, LN involvement)
systemic involvement (fever, malaise)

suggest immune response alone not able to adequately manage infection

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20
Q

what is it good practice to measure in a dental abscess pt?

A

temp - <36 or >38 degrees indicative of systemic involvement

but absence of pyrexia does not preclude ABs if other S+S of spreading infection or systemic involvement are present

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21
Q

dental abscess - compare amoxicillin and phenoxymethylpenicillin (penicillin V)

A

amoxicillin usually as effective as phenoxymethylpenicillin but better absorbed

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22
Q

dental abscess - what does the amoxicillin/phenoxymethylpenicillin duration depend on?

A

severity and clinical response, usually 5 days

don’t prolong courses unduly - can encourage development of resistance

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23
Q

dental abscess - if severe infection how should the AB dose be adjusted?

A

double dose

e.g. EO swelling, eye closing, trismus

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24
Q

dental abscess - what should you do if pt doesn’t respond to the prescribed AB?

A

check diagnosis and consider referral to a specialist

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25
Q

dental abscess - first line ABs

A

amoxicillin
phenoxymethylpenicillin
(metronidazole)

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26
Q

dental abscess - amoxicillin

A

500mg capsules
15 capsules
x3 daily
double in severe infection in adults and children aged 12-17 years

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27
Q

dental abscess - amoxicillin cautions/contraindications

A

can cause hypersensitivity reactions, inc rashes and anaphylaxis, can cause diarrhoea
- don’t prescribe to pts with history of anaphylaxis, urticaria or rash immediately after penicillin administration - at risk of immediate hypersensitivity

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28
Q

dental abscess - phenoxymethylpenicillin

A

250mg tablets
40 tablets
2 tablets x4 daily
severe infection in adults - double dose

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29
Q

dental abscess - phenoxymethylpenicillin cautions/contraindications

A

can cause hypersensitivity reactions, inc rashes and anaphylaxis, can cause diarrhoea
- don’t prescribe to pts with history of anaphylaxis, urticaria or rash immediately after penicillin administration - at risk of immediate hypersensitivity

30
Q

dental abscess - when is metronidazole indicated?

A

pts allergic to penicillin

can be used as an adjunct to amoxicillin in pts with spreading infection or pyrexia

31
Q

dental abscess - what is metronidazole effective against?

A

anaerobic bacteria

32
Q

dental abscess - metronidazole

A

tablets 200mg
15 tablets
x3 daily
for severe infection double dose in adults and children 12-17yrs

33
Q

dental abscess - metronidazole cautions/contraindications

A 
avoid alcohol (disulfiram-like reaction with alcohol)
don't prescribe to pts on warfarin
34
Q

dental abscess - why shouldn’t 2nd line ABs be prescribed first?

A

no advantage over 1st line drugs for most pts, could contribute to antimicrobial resistance
use of broad-spectrum ABs associated with increase in clostridium difficile infection

35
Q

dental abscess - if pt hasn’t responded to 1st line AB prescribed, what should you do?

A

check diagnosis

either refer pt or consider speaking to a specialist before prescribing clindamycin, co-amoxiclav or clarithromycin

36
Q

dental abscess - what is clindamycin active against?

A

gram + cocci, inc streptococci and penicillin-resistant staphylococci

37
Q

dental abscess - when can clindamycin be used?

A

if pt has not responded to amoxicillin/metronidazole

38
Q

dental abscess - risk of clindamycin

A

can cause the serious adverse effect of antibiotic-associated colitis more frequently than other ABs

39
Q

dental abscess - what is co-amoxiclav active against?

A

B-lactamase producing bacteria that are resistant to amoxicillin

40
Q

dental abscess - when can co-amoxiclav be used?

A

to tx severe dental infection with spreading cellulitis or dental infection that has not responded to 1st line antibacterial tx

41
Q

dental abscess - what is clarithromycin active against

A

B-lactamase producing bacteria

42
Q

dental abscess - which broad-spectrum ABs are especially high risk of resultant c difficile infection?

A

coamoxiclav and clindamycin

43
Q

dental abscess - what should the use of broad-spectrum ABs be restricted to and why?

A

2nd line tx of severe infections or in cases of severe infection with spreading cellulitis
risk of c difficile infection

44
Q

dental abscess - clindamycin

A

150mg capsules
20 capsules
x4 daily, swallowed with water
same for 12-17 yr olds

45
Q

dental abscess - clindamycin cautions

A

don’t prescribe to pts with diarrhoea states
advise pt to discontinue use immediately if diarrhoea or colitis develops as clindamycin can cause the SE of antibiotic-associated colitis

46
Q

dental abscess - coamoxiclav

A 
250/125 tablets
15 tablets
x3 daily
same for 12-17 yr olds
amoxicillin 250mg as trihydrate and clavulanic acid 125mg as potassium salt
47
Q

dental abscess - coamoxiclav cautions

A

cholestatic jaundice can occur either during or shortly after use, more common in >65s and in men
- don’t prescribe to pts who have a history of co-amoxiclav-associated or penicillin-associated jaundice or hepatic dysfct
can result in hypersensitivity reactions inc rashes and anaphylaxis, can cause diarrhoea
- don’t prescribe to pts with history of anaphylaxis, urticaria or rash immediately after penicillin administration as these pts are at risk of immediate hypersensitivity

48
Q

dental abscess - clarithromycin

A

tablets 250mg
14 tablets
x2 daily
same for 12-17 yr olds

49
Q

dental abscess - clarithromycin cautions/contraindications

A

use with caution in pts who are predisposed to QT interval prolongation inc electrolyte disturbances, and those with hepatic/renal impairment
don’t prescribe:
- pregnant/breastfeeding
- taking warfarin/statins

50
Q

NUG

A

painful, superficial infection of the gingival margins associated with anaerobic fuse-spirochaetal bacteria

51
Q

what groups is NUG more common in?

A

smokers
immunosuppressed
poor OH

52
Q

pericoronitis

A

superficial infection of operculum, with occasional local spread, that is often associated with anaerobic bacteria

53
Q

NUG and pericoronitis first line tx

A

local measures

54
Q

when should ABs be used for NUG and pericoronitis?

A

severe/systemic involvement/persistent swelling despite local measures

55
Q

ABs for NUG/pericoronitis

A

metronidazole first choice

alternative - amoxicillin

56
Q

NUG and pericoronitis - metronidazole

A

400mg tablets
9 tablets
x3 daily

57
Q

NUG and pericoronitis - metronidazole cautions/contraindications

A 
avoid alcohol (disulfiram-type reaction)
don't prescribe to pts taking warfarin
58
Q

NUG and pericoronitis - amoxicillin

A

capsules 500mg
9 capsules
x3 daily
double in severe infection in adults and children aged 12-17yrs

59
Q

NUG and pericoronitis - amoxicillin cautions

A

can cause hypersensitivity reactions inc rashes and anaphylaxis, can cause diarrhoea
- do not prescribe to pts with history of anaphylaxis, urticaria or rash immediately after penicillin administration - at risk of immediate hypersensitivity

60
Q

sinusitis course of illness

A

generally self-limiting, av duration 2 and a half weeks

61
Q

sinusitis local measures

A

advise pt to use steam inhalation (not recommended for children)

62
Q

sinusitis - indications for ABs

A

persistent symptoms and/or purulent discharge lasting at least 7 days or if symptoms are severe

63
Q

sinusitis - ephedrine

A

nasal drops 0.5%
10 ml
1 drop into each nostril up to 3 times daily when required
same for 12-17 yr olds
advise pt to use for max 7 days
dose can be increased to 2 drops 3 or 4 times daily if required

64
Q

sinusitis - ephedrine contraindication

A

don’t use in pts with high bp

65
Q

sinusitis - AB choices

A

Phenoxymethylpenicillin

doxycycline

66
Q

sinusitis - amoxicillin

A

capsules 500mg
21 capsules
x3 daily
double in severe infection in adults and children aged 12-17 years

67
Q

sinusitis - amoxicillin cautions/contraindications

A

can result in hypersensitivity reactions, inc rashes and anaphylaxis, can cause diarrhoea. Don’t prescribe to pts with history of anaphylaxis, urticaria or rash immediately after penicillin administration as these pts are at risk of immediate hypersensitivity

68
Q

sinusitis - doxycycline

A

capsules 100mg (/dispersible tablets)
8 capsules
2 capsules on 1st day, followed by 1 capsule daily
swallow whole with plenty of fluid during meals, while sitting or standing
severe infection in adults and >12yrs - 2 capsules daily

69
Q

sinusitis - doxycycline cautions/contraindications

A

use with caution in pts with hepatic impairment or those receiving potentially hepatotoxic drugs
do not prescribe
- pregnant/breastfeeding/<12yrs - can deposit on growing bone and teeth (by binding to calcium) and cause staining and occasional dental hypoplasia
- pts taking warfarin

70
Q

sinusitis - doxycycline SEs

A 
nausea
vomiting
diarrhoea
dysphagia
oesophageal irritation and photosensitivity

SDCEP guidance (7 decks)

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