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Chapter 5: Infection Flashcards

1
Q

Signs and symptoms of infection?

A
  • fever or malaise, aches and pains
  • pus, swelling or inflammation
  • drowsiness in children
  • confusion in the elderly
  • worsening renal function
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2
Q

Clinical markers for infection?

A
  • low blood pressure
  • raised blood glucose
  • high ESR, C-reactive protein, temperature, respiratory rate, pulse
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3
Q

What is antimicrobial stewardship and its principles?

A

“An organisation or healthcare system wide approach to promoting and monitoring the judicious use of antimicrobials to preserve future effectiveness”

  • do not treat viral infections with antibiotics
  • avoid blind prescribing
  • narrow-spectrum antibiotics are preferred except for serious infections where broad spectrum is needed
  • avoid prolonged therapy and complete courses
  • follow national and local guidelines
  • dose varies according to patient factors
  • prescribed for oral infections on basis of defined need
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4
Q

What does the choice of antibiotic depend on?

A
  1. patient

2. causative agent

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5
Q

When prescribing for children what are some things to know?

A
  • tetracyclines contraindicated in <12 yrs

- quinolones cause arthropathy (joint disease); avoid

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6
Q

When prescribing for the elderly what are some things to know?

A
  • increased risk of c.diff infection; clindamycin has highest risk
  • renal/liver impairment and drug interactions
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7
Q

Prescribing in patients who have allergies?

A
  • penicillin-allergic = cross sensitivity with cephalosporins and other B-lactam antibiotics
  • alternatives in penicillin-allergic patients
    • macrolides
    • metronidazole in dental infection
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8
Q

Prescribing in renal impairment ?

A
  • nephrotoxicity: aminoglycoside, glycopeptide
    AVOID:
  • tetracyclines (except minocycline/doxycycline)
  • nitrofurantoin (eGFR<45)
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9
Q

Prescribing in hepatic impairment ?

A
  • hepatotoxicity = rifampicin, tetracyclines
  • reduce metronidazole dose if severely impaired
  • cholestatic jaundice:
    • co-amoxiclav
    • flucloxacillin
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10
Q

Prescribing in pregnancy?

A
  • c/i = tetracyclines, trimethoprim
  • nitrofurantoin causes nausea; avoid at term
  • AVOID: MCAT (metronidazole, chloramphenicol, aminoglycosides, tetracyclines), Quinolones and Sulphonamides
  • safest antibiotics = penicillin/cephalosporin
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11
Q

Antibiotic cautionary and advisory label?

A

“space the doses evenly throughout the day and keep taking this medicine until the course is finished, unless you are told to stop.”

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12
Q

GI side effects of antibiotics ?

A
  • nausea, vomiting, diarrhoea and abdominal pain
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13
Q

What is superinfection?

A

Clindamycin and broad-spectrum antibiotics kill normal flora and allow selective organisms to thrive; causing antibiotic-associated coitis (c.difficile) and thrush (candida) e.g. vaginal thrush

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14
Q

How many people experience allergic reactions?

A

Around 1 in 15 people experience hypersensitivity reactions to antibiotics, especially penicillins and cephalosporins

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15
Q

What antibiotic is generally used for staphylococci?

A

Flucloxacillin

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16
Q

What antibiotic is generally used for MRSA?

A

Vancomycin

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17
Q

What is generally used to treat Streptococci?

A

Benzylpenicillin or Phenoxymethylpenicillin

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18
Q

What is generally used to treat anaerobic bacteria ?

A

Metronidazole

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19
Q

What is generally used to treat pseudomonas aeruginosa?

A

Gentamycin

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20
Q

Clindamycin MOA and spectrum?

A

Inhibits protein synthesis

Narrow spectrum + bacteriostatic ( a biological or chemical agent that stops bacteria from reproducing)

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21
Q

Clindamycin side effects?

A
  • antibiotic associated colitis
  • most frequently with clindamycin - can be fatal
  • most common in middle-aged, elderly women, especially after operations
  • counselling: if diarrhoea develops; STOP and see GP
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22
Q

Linezolid MOA and spectrum?

A

Inhibits protein synthesis. Only active against gram-positive bacteria e.g. MRSA and anaerobes

(narrow-spectrum + bacteriostatic)

Alternative to vancomycin in MRSA infection

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23
Q

Linezolid side effects?

A
  • blood disorders
  • optic neuropathy if >28 days use
  • patient counselling: report visual symptoms; blurred vision, visual field defects and changes in visual acuity and colour vision
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24
Q

Linezolid intercations?

A
  • hypertensive: SSRIs, TCAs, MAOIs (wait 2 weeks after stopping), sympathomimetics, dopaminergics, opioids, 5-HT1 agonists, buspirone, and pethidine (raises blood pressure)
  • linezolid is a reversible MAOI
  • avoid consuming large amount of tyramine-rich food
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25
Q

Trimethoprim MOA and spectrum?

A

Inhibits DNA synthesis

Narrow spectrum + bactericidal (kills bacteria)

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26
Q

Trimethoprim use and dose?

A

UTIs 200mg BD

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27
Q

Trimethoprim side effects?

A
  • anti-folate: teratogenic in first trimester
  • blood dycrasias; with long term use
  • counselling: report fever, sore throat, rash, mouth ulcers, purpura, bruising, bleeding
  • hyperkalaemia
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28
Q

What is co-trimoxaxole?

A

(trimethoprim/sulfamethoxazole)

  • use: prophylaxis and treatment of pneumocytis jrovecii pneumonia.
  • side effects; rashes; SJS toxic epidermal necrolysis, photosensivity
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29
Q

Chloramphenicol MOA and spectrum?

A

Inhibits protein synthesis

Broad spectrum + bacteriostatic

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30
Q

Chloramphenicol use and side effects?

A

Use: reserved for life threatening infections (also topical use in superficial eye infections)
Side effects
- blood dyscasias
- grey baby syndrome: avoid in pregnant women

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31
Q

Metronidazole MOA and spectrum?

A

Inhibits DNA synthesis. High activity against anaerobic bacteria and protozoa.

Narrow spectrum + bactericidal

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32
Q

Metronidazole use?

A
  • anaerobic infections e.g. dental infections, antibiotic-associated colitis, h.pylori, rosacea, bacterial vaginosis
  • protozoal infections e.g. vaginal trichomoniasis, giadiasis
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33
Q

Metronidazole common side effects and counselling?

A

Side effects

  • GI disturbances
  • taste disturbance
  • oral mucositis
  • furred tongue

Counselling:

  • take with or after food
  • avoid alcohol; causes disulfram-like reaction
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34
Q

Nitrofurantoin MOA and spectrum?

A

Damages bacterial DNA
Only active urinary pathogens

(Narrow spectrum + bactericidal)

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35
Q

Nitrofurantoil use and side effects?

A

Sole use: UTIs

Side effects: nausea, risk of peipheral neuropathy in renal impairment

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36
Q

Nitrofurantoin and pregnancy?

A

Avoid at term (neonatal haemolysis)

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37
Q

Nitrofurantoin c/i and counselling?

A

c/i in infants less than 3 months

Counselling:

  • take with or after food
  • colours urine yellow or brown
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38
Q

Aminoglycosides MOA and spectrum?

A

Bind irreversibly to bacterial ribosomes. Active against gram-negative aerobe; pseudomonas aeruginosa

Broad spectrum + bactericidal

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39
Q

Aminoglycoside use and administration?

A

Use: severe sepsis, pyelonephritis and complicated UTI and endocarditis

Given via parenteral injection; not absorbed by gut

  • gentamicin
  • tobramycin
  • streptomycin
  • neomycin
  • amikacin
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40
Q

Tobramycin?

A

Aminoglycoside

via inhaler for pseudomonal infection in cystic fibrosis

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41
Q

Streptomycin?

A

Aminoglycoside

active against mycobacteria reserved for TB

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42
Q

Neomycin?

A

Aminoglycoside

parenterally toxic. Use in bowel sterilization

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43
Q

Amikacin ?

A

Aminoglycoside

gentamicin-resistant gram negative baciili

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44
Q

Gentamicin use?

A

Active against psuedomonas aeruginosa.

Blind therapy in serious infection: with metronidazole/penicillin

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45
Q

What needs to be monitored with gentamicin?

A

Plasma concentrations –> NARROW THERAPEUTIC INDEX

  • must monitor serum levels in parenteral aminoglycosides
  • must be determined in:
  • elderlu
  • obesity
  • cystic fibrosis
  • high doses
  • renal impairment
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46
Q

Gentamicin once daily regimen?

A
  • avoid in renal impairment <20ml/min, HACEK or gram positive endocarditis, burns covering >20% of body
  • consult local guidelines for serum monitoring
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47
Q

Gentamicin multiple dose regimens?

A
  • monitor after 3 or 4 doses and after a dose change but in renal impairment requires more frequent and earlier monitoring
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48
Q

What to do in gentamicin therapy if the post dose peak level after 1 hour is too high?

A

Reduce dose 5-10mg/ml (3-5mg/ml for endocarditis)

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49
Q

What to do in gentamicin therapy if the pre dose trough level before the next dose is too high?

A

Increase interval <2mg/ml (<1mg/ml for endocarditis)

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50
Q

What to do in renal impairment when prescribed gentamicin?

A

Increase dosing interval

*in severe renal impairment (<30ml/min) = reduce DOSE

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51
Q

Gentamicin and pregnancy?

A
  • can give gentamicin but avoid unless essential

- must monitor serum concentrations

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52
Q

Gentamicin side effects?

A
  • dose-related; do not exceed 7 days
  • commonly occur in elderly and in renal failure; renally cleared
  • irreversible ototoxicity: monitor auditory and vestibular function before treatment (counselling: report tinnitis, hearing loss or vertigoO
  • nephrotoxicity:
    • aminoglycosides excreted by kidnet
    • assess renal function before treatment and correct any dehydration
    • signs: low urine output/creatinine clearance, high serum creatinine/urea
      Other
  • peripheral neruoapthy
  • impaired neuromuscular transmission (c/i in mysathenia gravis)
  • electrolytes HYPO K, Ca and Mg
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53
Q

Gentamicin interactions?

A
  • increased risk of nephrotoxicity: ciclosporin, tacolimus, vancomycin (avoid concomitant nephrotoxic drugs)
  • increased risk of ototoxicity: loop diuretics, cisplatin (avoid concomitiant ototoxic drug)

*concomitant ototoxic loop diuretics: separate by long period as possible

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54
Q

Glycopeptides MOA and spectrum?

A

Inhibits cell wall synthesis
Only active against gram-positive bacteria including MRSA

Narrow spectrum and bactericidal

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55
Q

Glycopeptides?

A
  • vancomycin (active against MRSA)
  • teicoplanin
  • televancin (only in HAP when other antibiotics are unsuitable)

*vancomycin and teicoplanin must not be given by mouth for systemic infections

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56
Q

Vancomycin use?

A

Uses; antibiotic-associated colitis, MRSA infections

Given parenterally for serious infections

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57
Q

What needs to be monitored with vancomycin?

A

Plasma concentrations (NARROW THERAPEUTIC INDEX)

  • must monitor serum concs for all patients
  • monitor after 3 or 4 doses and after a dose change
  • renal impairment requires earlier and regular monitoring = reduce dose
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58
Q

Vancomycin pre dose trough level?

A

10-15mg/ml

(15-20mg/ml for endocarditis, less sensitive MRSA strains OR complicated S. aureus infections) - vancomycin

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59
Q

Vancomycin and pregnancy?

A
  • avoid vancomycin unless essential

- must monitor serum concentrations

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60
Q

Vancomycin side effects? (parenteral)

A
  • nephrotoxicity: measure renal function, glycopeptides are renally excreted. low urine output/CrCl, high serum creatinine/urea
  • ototoxicity: measure auditory function in elderly - look for signs of hearing damage etc. discontinue in signs of tinnitus
  • red man syndrome: flushing of upper body caused by rapid infusion and can be associated with hypotension and bronchospasms
  • blood dyscasias: monitor FBC. (neutropenia and rarely thrombocytopenia, agranulocytosis
  • skin disorders: SJS, itching, rashes, toxic epidermal necrolysis
  • thrombophlebitis
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61
Q

Vancomycin interactions?

A
  • ciclosporin (avoid concomitant nephrotoxic drugs etc)

- loop diuretics (avoid concomitant ototoxic drugs)

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62
Q

Tetracyclines MOA and spectrum ?

A

Inhibits bacterial protein synthesis; binds to ribosomal 30S subunit

Broad spectrum + bacteriostatic

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63
Q

Tetracyclines use?

A

Uses: lower RTIs, acne, rosacea, malaria, chlamydia

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64
Q

Tetracyclines?

A
  • demeclocycline
  • doxycycline (used in malaria and chlamydia: OD)
  • lymecycline
  • minocycline (broader spec but rarely used)
  • oxytetracycline
  • tetracycline
  • tigecycline (antibiotic structurally related to tetracyclines)
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65
Q

Tetracycline side effects?

A
  • benign intracranial hypertension
  • counselling: stop if headache and visual disturbances.
  • minocycline (rarely used): causes vertigo, dizziness, irreversible pigmentation, has greatest risk of lupus-erythematosus-like syndrome
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66
Q

Tetracycline c/i’s?

A
  • children under 12
  • pregnancy and breastfeeding: deposit in growing bone and teetch and causes teeth discoloration and dental (enamel) hypoplasia
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67
Q

Tetracyclines in renal impairment?

A

Avoid except doxycycline and minocycline

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68
Q

Tetracycline in hepatic impairment ?

A

Avoid or use with caution, especially with concomitant hepatotoxic drugs (tetracyclines are hepatotoxic)

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69
Q

Tetracycline counselling points:

A

PHOTOSENSITIVITY (DD)
- avoid exposure to sunlight
- spf
(doxycycline and demeclocycline)

DECREASED ABSORPTION (DOT): avoid milk!
- do not take antacid, Al, Ca, iron, Mg, Zinc salts 2 hours before/after taking 
(demeclocycline, oxytetracycline and tetracycline)
OESOPHAGEAL IRRITATION (DMT)
- swallow whole with plenty of fluid during meals sitting or standing 
(doxycycline caps, minocycline caps/tabs. tetracycline tabs)
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70
Q

Quinolones MOA and spectrum ?

A

Inhibits DNA synthesis

Broad spectrum + bactericidal

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71
Q

Quinolones uses?

A

Uses: lower RTIs. UTIs,

Avoid in MRSA infections (innate resistance)

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72
Q

Quinolones?

A
  • ciprofloxacin
  • levofloxacin
  • moxifloxacin (QT prolongation, life threatening hepatotoxicity)
  • nalidixic acid (1st gen; uncomplicated UTI. Avoid in eGFR<20)
  • norfloxacin
  • ofloxacin
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73
Q

Quinolones side effects?-

A
  • seizures (lower seizure threshold): with or without previous history
  • tendon damage: stop if tendonitis is suspected
  • QT prolongation: leads to ventricular arrhythmias (especially moxifloxacin: c/i in risk factors for QT prolongation)
  • arthropathy: avoid in pregnancy, children, adolescent

Discontinue if psychiatric, neurological and hypersensitvity reactions occur

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74
Q

Quinolones interactions?

A
  • increased risk of QT prolongation; ventricular arrythmia: SSRI, quinine, amiodarone, macrolide, antipsychotics
  • increased risk of seizures: ciprofloxacin and theophylline: pk and pd interaction: ciprofloxacin is an enzyme inhibitor and causes theophylline toxicity: theophylline side effect is convulsions
  • NSAIDs induce convulsions
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75
Q

Quinolones counselling points ?

A

DRIVING: quinolones can impair the performance of skilled tasks; its effect is enhanced by alcohol

ANTACID AND ZINC/IRON: leave 2 hours before or after taking a quinolone. Also avoid milk with ciprofolxacin and norfloxacin

PROTECT SKIN FROM SUNLIGHT, AVOID SUNBEDS
Oflaxacin

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76
Q

Macrolides MOA?

A

(Penicillin alternative)
Inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome

Broad spectrum + bacteriostatic

77
Q

Macrolide use?

A
  • h. pylori
  • RTIs
  • skin and soft tissue infections
78
Q

Macrolides?

A
  • azithromycin OD
  • clarithromycin BD
  • erythromycin QDS/BD
  • telithromycin
  • spiramycin
79
Q

Azithromycin dosage regime and how to take?

A

OD

- before food/indigestion remedies: 2 hour gap

80
Q

Clarithromycin dosage regime and side effect?

A

BD

- can cause taste disturbance

81
Q

Erythromycin dosage regimen and how to take?

A

QDS/BD

- before indigestion remedies: 2 hour gap

82
Q

Telithromycin indication and side effects?

A

For B-lactam resistant infections

Causes visual disturbancs, hepatotoxicty and transient loss of consciousness - driving!

83
Q

Spriamycin use?

A

toxoplasmosis (disease that results from infection with the Toxoplasma gondii parasite, one of the world’s most common parasites. Infection usually occurs by eating undercooked contaminated meat, exposure from infected cat feces, or mother-to-child transmission during pregnancy.)

84
Q

Macrolides side effects?

A
  • GI side effects: nausea, vomiting, abdominal discomfort and diarrhoea and diarrhoea (most with erythromycin)
  • QT interval prolongation risk factors: bradycardia, heart disease, hypoK, hypoMg, concomitant QT prolongation drugs
  • Hepatoxicity
  • Ototoxicity at high doses
85
Q

How to take macrolides?

A

Take with or after food

86
Q

Macrolides interactions?

A

Erythromycin and clarithromycin are potent enzyme inhibitors

  • warfarin = increased risk of bleeding
  • statins = increased risk of myopathy
87
Q

Penicillin MOA and spectrum?

A

Intefere with bacterial cell wall synthesis.
Not useful in CNS infections except meningitis

Broad spectrum + bactericidal

BETA LACTAM ANTIBIOTICS

88
Q

Narrow spectrum penicillins (beta-lactamase sensitive)

A
  • benzylpenicillin “pen G”

- phenoxymethylpenicillin “pen V”

89
Q

Broad spectrim penicillins (inactivated by beta-lactamases)

A
  • ampicillin

- amoxicillin

90
Q

Penicillinase-resistant penicillins?

A

Flucloxacillin

91
Q

Antipsuedomonal penicillins (extended spectrum)

A
  • piperacillin (with tazobactam)

- ticaricillin (with clavulanic acid)

92
Q

Penicillins side effects?

A
  • Penicillin allergy: rashes or anaphylaxis. Atopic allergies: higher risk of anaphylactic reactions
  • True allergy = immediate rash, anaphylaxis, hives. Do not use any beta-lactam antibiotic: cephalosporins, carbapenems, monobactams
  • May not be allergic: minor rash; small, not itchy and non-confluent or rash after 72hr, do not withold penicilin for serious infections
93
Q

Why should you not give penicillin antibiotic as intrathecal injection (the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord)?

A

ENCEPHALOPATHY - cerebral irritation and can be fatal

94
Q

When should you not give Broad spectrum penicillins ?

A

(ampicillin and amoxicillin)

- do not give blindly for sore throats: causes maculopapular rash in glandular fever

95
Q

What can broad spectrum antibiotics cause ?

A

Antibiotic-associated colitis

96
Q

Ampicillin uses and how to take?

A
  • HIGH RESISTANCE; consider before blindly prescribing
  • Uses: UTIs, Otitis media, acute COPD exacerbations
  • Take before food

BROAD

97
Q

Amoxicillin use and side effects?

A
  • commonly rxed with clavulanic acid (Co-amoxiclav)
  • active against beta-lactamse producing strains
  • side effects: cholestatic jaundice: do not exceed 14 days

BROAD

98
Q

Benzylpenicillin “pen G” uses?

A

NARROW

  • Use: meningitis (meningococcal infections)
  • parenteral use only = not gastric acid stable
99
Q

Phenoxymethylpenicillin “pen V” uses

A
  • uses: RTIs in children e.g. streptococcal throat, tonsilitis
  • oral use = gastric acid stable
100
Q

Pencillinase-resistant: Flucloxacillin uses?

A

Uses: penicillin-resistant staphylococcal infections except MRSA e.g. skin infections, impetigo, cellulitis

Take BEFORE food

101
Q

Flucloxacillin side effects?

A
  • cholestatic jaundice and hepatitis
  • up to 2 months after treatment
  • increasing age and >14 days treatment increases risk
102
Q

Antipseudomonal penicillin uses?

A

(piperacillin with tazobactam and ticaricillin with clavulanic acid)

Use: serious infections e.g. septicaemia, complicated UTI, hospital-acquired pneumonia.
Effective against psuedomonas aeruginosa

103
Q

Temocillin use?

A

Reserved for beta-lactamase producing strains of gram negative bacteria

104
Q

Cephalosporins MOA and spectrum?

A

Inteferes with bacterial cell wall synthesis.
They have similar spectrum of activity to penicillins

(broad spectrum and bactericidal)

105
Q

Cephalosporins uses?

A

Orally active

Uses: UTI (pregnancy or second line), sinusitis, otitis media

106
Q

1st generation cephalosporins? (CEFA)

A
  • cefalexin
  • cefadroxil (BD)
  • cefradine
107
Q

2nd generation cephalosporins? (2 foxes for tea)

A
  • cefuroxamine

- cefaclor (protected skin reactions, especially in children)

108
Q

Parenteral cephalosporins 3rd generation? (“contains t except cefixime”)

A
  • cefixime (orally active)
  • ceftriaxone (OD, treats meningitis)
  • cefotaxime (treats meningitis)
  • ceftazidime
109
Q

Parenteral cephalosporins 5th gen? (extended spectrum)

A
  • ceftaroline use in CAP and complicated skin and soft tissue infections
110
Q

Cephalosporin side effects?

A
  • hypersensitivity: do not give in history of immediate penicillin hypersensitivity
  • if no alternative available and essential; give 3rd gen OR cefuroxime
  • antibiotic associated colitis: more common in 2nd and 3rd gen cephalosporins
111
Q

Other beta-lactam antibiotics?

A
  • carbapenems and monobactams
112
Q

Common GI infections?

A

C.difficile = DIARRHOEA (elderly and women most at risk

Antibiotic associated colitis

  • clindamycin (most)
  • ampicillin/amoxicillin
  • 2nd/3rd gen cephalosporins
  • quinolones
113
Q

Which antibiotics can cause antibiotic-associated colitis?

A
  • clindamycin (most)
  • ampicillin/amoxicillin
  • 2nd/3rd gen cephalosporin
  • quinolones
114
Q

Treatment of GI infections length?

A

10-14 days

115
Q

Treatment of first episode of mild to moderate GI infection?

A

Oral metronidazole

116
Q

Treatment of subsequent episodes/severe infections/unresponsive to metronidazole?

A

Oral vancomycin/ fidoxamicin

117
Q

What is contraindicated in GI infections?

A

Loperamide

118
Q

Common cardiovascular infection?

A

Endocarditis

119
Q

Endocarditis treatment ?

A

Amoxicillin +/- low dose gentamicin

  • vancomycin in MRSA/penicillin allergy
  • flucloxacillin in staphylococci
  • benzylpenicillin in streptococci
120
Q

Common respiratory infections?

A

Community acquired pneumonia (CAP)

Hospital acquired pneumonia (HAP)

121
Q

CAP treatment duration ?

A

7 days (14-21 days if staphylococci)

122
Q

Mild CAP treatment ?

A

Amoxicillin

Alternatives: clarithromycin or doxycycline

123
Q

Moderate CAP treatment?

A

Amoxicilin + clarithromycin OR doxycline alone

124
Q

High severity CAP treatment ?

A

Benzylpenicillin + clarithromycin/doxycyline

  • add flucloxacillin if staphy suspected
  • add vancomycin if MRSA suspected
125
Q

What can be added if staphylococci is suspected ?

A

Flucloxacillin

126
Q

What can be added if MRSA suspected ?

A

Vancomycin

127
Q

HAP treatment duration?

A

7 days

128
Q

Early onset <5 days HAP treatment?

A

Co-amoxiclav or cefuroxime

129
Q

Severe or >5days HAP treatment ?

A

Antipseudomonal penicillin OR broad spectrum cephalosporin or quinolone

  • add vancomycin for MRSA
  • add aminoglycoside for pseudomonas aeruginosa
130
Q

Antipseudomonal penicillin?

A

Piperacillin with tazobactam
Ticaricillin with clavulanic acid

*aminoglycoside also antipseudomonal)

131
Q

Common nervous system infections?

A

Meningitis/meningococcal septicaemia

non-blanching rash

132
Q

Meningitis/meningococcal septicaemia causative agent?

A

Neisseria meningitis

133
Q

Meningitis initial empiral treatment ?

A
  • Benzylpenicillin
  • cefotaxime if penicillin allergy
  • chloramphenicol if immediate penicillin allergy
134
Q

Common musculoskeletal infection?

A

Osteomyelitis (bone infection)

135
Q

Osteomyelitis treatment ?

A
  • Flucloxacillin
  • Clindamycin if penicillin allergy
  • Vancomycin if MRSA
136
Q

Common eye infection?

A

Conjunctivitis - chloramphenicol

137
Q

Common skin infections?

A

Impetigo
Cellulitis
Animal and human bites
MRSA

138
Q

Common skin infections causative agent?

A

Staphylococci aureus

139
Q

Impetigo treatment ?

A

Fusidic acid 7 days if small areas affected

Flucloxacillin for 7 days if widespread

140
Q

Cellulitis treatment?

A

Flucloxacillin

141
Q

Animal and human bites treatment ?

A

Co-amoxiclav OR

Doxycyline + metronidazole

142
Q

MRSA treatment (skin and soft tissue?

A

Tetracycline OR
Sodium fusidate + rifampicin
Alt; clindamycin

If severe; glycopeptide or if unsuitable linezolid

143
Q

Common oral infections?

A
  • gingivitis: acute necrotising ulcerative

- periapical/periodontal abcess: periodontitis, pericoronitis

144
Q

Oral infections treatment ?

A

Dental infections are generally treated with metronidazole 200mg TDS for 3 days

Alternative: amoxicillin OR doxycycline for periodontitis

[change antibiotic if no response in 48 hours penicillin or macrolide with metronidazole]

145
Q

Common ear nose and oropharynx infections?

A
  • throat infection
  • sinusitis
  • otitis externa
  • otitis media
146
Q

Throat infection causative agent?

A

Steptococci

147
Q

Otitis externa causative agent?

A

Staphylococci aureus

148
Q

Throat infection treatment?

A

Phenoxymethylpenicillin

  • if severe benzylpenicillin
  • clarithromycin if penicillin allergic
149
Q

Sinusitis treatment ?

A

Amoxicillin OR clarithromycin OR doxycyline

150
Q

Otitis externa treatment?

A

Flucloxacillin

  • clarithromycin if penicillin allergic
151
Q

Otitis media treatment ?

A

Amoxicillin

  • clarithromycin if penicillin allergic
  • treat if systemically unwell
  • treatment is given if there is no improvement after 72 hours or earlier if systemic symptoms, mastoditis, bilateral otitis media in under 2 years
152
Q

Anti-tuberculosis drugs: initial phase?

A

(2 months)

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

(RIPE)

153
Q

Continuation phase anti-TB drugs?

A

4 months

Rifampicin
Isoniazid

154
Q

Rifampicin key points?

A
  • enzyme inducer (do not use oral contraceptives - insert IUD)
  • counselling: reports signs of hepatotoxicity
  • colours soft contact lenses and urine red/orange
155
Q

Isoniazid key points ?

A
  • enzyme inhibitor
  • counselling: report signs of hepatotoxicity
  • peripheral neuropathy; overcome by concomitant pyridoxine
156
Q

Pyrazinamide key points?

A

Hepatotoxitiy

157
Q

Ethambutol key points?

A

counselling: visual changes; report immediately

158
Q

Itraconazole side effects and interactions?

A
  • Anti-fungal
  • side effects: heart failure and hepatotoxicity
  • interactions: antacids, needs acidic pH for greater absorption
159
Q

Oral ketoconazole MHRA warning?

A

Risk of fatal hepatotoxicity is greater than the benefit of treating fungal infections. Refer back prescriptions

160
Q

Voriconazole side effects?

A

Photoxicity and hepatotoxicity (causes pre-malignant lesions or skin cancer - avoid direct sunlight and sunlamps. Use high factor spf, and carry alert card)

161
Q

What is amphoteracin B used for and what are its side effects?

A

SERIOUS FUNGAL INFECTIONS
Side effects: nephrotoxicity. Anaphylaxis with IV preps - do a test dose and monitor for 30 mins.
*specify brand: not interchangeable

162
Q

What is used to treat candidias (thrush)?

A

ORAL
- nystatin (POM) or miconazole (daktarin oral gel)

VULVAL OR VAGINAL
- oral fluconazole OR topical imidazole e.g. clotrimazole

163
Q

What is tinea and how is it treated?

A

Fungal infection on the skin

TINEA CAPATIS, CORPORIS (ring worm), CRUIS AND PEDIS
- miconazole or clotrimazole or terbinafine (for athletes foot)

FUNGAL NAIL INFECTION
- amorolfine

164
Q

What is used for viral infection herpes simplex?

A

ACICLOVIR

- herpes simplex can affect lips, mouth and eyes

165
Q

What is used for the prophylaxis of influenza (viral infection)?

A

OLSELTAMIVIR

  • prophylaxis, reduces symptoms by 1 day
  • for at risk groups: 65+, diabetes mellitus, immunocompromised etc start withun 48hours of symptoms or without symptoms on exposure
166
Q

What is used for bite prevention when in countries with malaria?

A
  • NETS impregnated with permethrin is most effective
  • DEET 20-50%
  • Applied to skin e.g. spray/lotion
  • safe and effective in adults and children above 2 months
  • apply suncream first and use at least spf 35-50; DEET reduces the spf
  • 50% provides longest protection
  • long sleeves and trousers after dusk
  • asplenic/pregnant women should avoid travel to malarious zones
167
Q

is chemopropylaxis absolute in antimalarials?

A

not absolute - breakthrough malaria can occur

168
Q

Antimalarial prophylaxis regimen?

A
  • malarone (atovaquone and proguanil)
  • chloroquine only
  • chloroquine + proguanil (proguanil occasionally used alone)
  • mefloquine
  • doxycycline
169
Q

Doxycline specific counselling for malaria prophylaxis?

A
  • take 1-2 days before entering endemic area and continued for 4 weeks after leaving
  • protect your skin from sunlight - even on a bright but cloudy day. do not use sunbeds
  • do not take indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine
  • capsules should be swallowed whole with plenty of fluid during meals while sitting or standing
170
Q

Mefloquine side effects?

A
  • SERIOUS NEUROPSYCHIATRIC REACTIONS
  • psychosis, suicidal ideation and suicide reported
  • prodromal symptoms for a serious event = abnormal dreams, insomnia, nightmares, depression, anxietym restlessness, confusion
  • counselling: stop and seek immediate medical attention to replace with alternative antimalarial, if neuropsychiatric effects occur
  • containdicated in patients with a history of psychiatric disorders (including depression) or convulsions
171
Q

Mefloquine and driving?

A
  • dizziness and disturbed sense of balance - can persist up to several months after stopping; mefloquine has a long half life
172
Q

Which antimalarial regimen?

A
  • Choose high risk regimen for whole journey

- settled immigrants in UK rapidly lose immunity acquired whilst previously living in malarious area

173
Q

Length of antimalarial prophylaxis ?

A

BEFORE TRAVEL

  • usually 1 week before
  • exceptions: mefloquine 2-3 weeks,
  • malarone and doxycline 1-2 days

AFTER TRAVEL

  • usually 4 weeks after
  • exceptions: 1 week after
174
Q

Long term antimalarial prophylaxis? (>5years)

A

> 5years chloroquine and proguanil

175
Q

Long term antimalarial prophylaxis? (2 years)

A

Doxycycline

176
Q

Long term antimalarial prophylaxis? (1 year)

A

Mefloquine, malarone

177
Q

What antimalarials prophylaxis should patients with epilepsy avoid?

A
  • chloroquine and mefloquine (affects seizure threshold)
178
Q

What antimalarials prophylaxis should patients with renal impairment avoid?

A
  • proguanil
  • malarone and chloroquine if eGFR <30ml/min (severe)
  • choose doxycycline or mefloquine
179
Q

What antimalarials prophylaxis can be given in pregnancy?

A
  • give cholorquine and proguanil
  • 5mg folic acid is given with proguanil
    • doxycycline is contra-indicated
    • avoid mefloquine (advised by manufacturer
    • avoid malarone (if there is no alternative may give in 2nd or 3rd trimester)
180
Q

When should antimalarial prophylaxis be started ? *on warfarin???

A
  • 2-3 weeks before
  • INR should be stable before departure
  • monitor INR before, 7 days after starting and after completing the course
  • for prolonged stays check INR regularly in visiting country
181
Q

What should you do with any illness that occurs within a year after being in malarial region?

A
  • see GP immediately and specifically mention malaria exposure
  • especially the first 3 months of return from malarial region
182
Q

Malaria treatment?

A
  • quinine
  • malarone
  • riamet (artemether and lumefantrine) (top 3: falciparum malaria)
  • chloroquine (non-falciparum malaria)
183
Q

How is quinine used ?

A
  • standby treatment of malaria
  • take only if you cannot access medical care in 24 hours of fever onset
  • given with written instructions that urgent help is required if fever >38, 7 days or more after arriving in malarious zone
184
Q

Which antibiotics should you avoid in MRSA infections?

A

QUINOLONES (innate resistance)

185
Q

Interaction between ciprofloxacin and theophylline?

A

Pk and Pd interaction: ciprofloxacin is an enzyme inhibitor and causes theophylline toxicity: theophylline side effects is convulsions

186
Q

What can NSAIDS induce?

A

convulsions

187
Q

Which antibiotics cause photosensitivity ?

A

Tetracyclines (demeclocycline and doxycycline)

* and others

188
Q

Which antibiotics are an alternative for penicillina)

A

Macrolides (azithromycin, clarithromycin, erythromycin, and roxithromycin)

189
Q

Which macrolide has the most GI side effects?

A

Erythromycin

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