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Antimicrobials > Empirical antibiotic guidelines > Flashcards

Empirical antibiotic guidelines Flashcards

1
Q

Name some broad spectrum antimicrobial agents that also have anaerobic activity

A

Tazocin

Augmentin

Meropenem

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2
Q

What is the first line treatment for Infective exacerbation of COPD or asthma?

A

Amoxicillin (oral) for 5 days

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3
Q

What is the penicillin allergy alternative for infective exacerbation of COPD/Asthma?

A

Doxyclycline (oral) for 5 days

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4
Q

CAP-low risk of progression/fit for discharge/admitted for other reasons (CURB-65 of 0 or 1)

A

Amoxicillin (oral) for 7 days

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5
Q

CAP - moderate severity/high risk fo progression (CURB-65 of 2)

A

Amoxicillin (oral/IV) for 7 days

Consider addition of doxycline (oral) on post-take ward-round

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6
Q

What is the penicillin alternative for low risk/moderate severity CAP?

A

Doxycycline (oral) for 7 days

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7
Q

CAP-high severity or systemic sepsis (CURB-65 of >3)

A

Amoxicillin (IV) and Doxycycline (oral) - give Clarith if oral route not available

Give Gent STAT if g-ve cover required

Review at 48hours - switch to oral Amox/Doxy

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8
Q

What is the penicillin allergy alternative for CAP high severity/systemic sepsis?

A

Ceftriaxone (IV) and Doxy (oral)

review at 48 hours then 7d then oral switch to doxy

In IgE mediated allergy only give Levofloxacin (IV) then oral switch to doxy

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9
Q

Community acquired aspiration pneumonia?

< 5 days post admission AND no risk factors for MDR

A

Amoxicillin (IV) tds

and

Metronidazole IV tds

for 3 days

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10
Q

What is the penicillin allergy alternative for community acquired aspiration pneumonia?

A

Doxy oral od

if oral route unavailable give clarith IV bd

AND

Metronidazole IV tds

for

3 days

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11
Q

Early onset HAP (less than 5 days post admission and no risk factors for MDR)

A

Treat as CAP

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12
Q

Late onset HAP (>5 days post admission/risk factors)

Hospital stay within previous 4 weeks of +2 days duration

Dialysis

Immunosuppression

A

Tazocin (IV) tds

Review at 48 hours

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13
Q

Penicllin allergy alternative for late onset HAP?

A

Levofloxacin (IV)

Review at 48 hours

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14
Q

First line treatment for UTI

A

Nitrofurantoin qds or Trimethoprim bd (oral)

3 days female

7 days male

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15
Q

Complex UTI/Urosepsis

failiure after 1st line

recent urological surgery

structural abnormalities

oral route unviable

1st lien drugs contraindicated

A

Gentamicin (IV) for 2 doses then review

If CrCl < 20ml/min use Augmentin IV stat

or Ciprofloxacin IV if pen allergy

Check winpath for ESBL producers in the past-check with micro for advice

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16
Q

Pyelonephritis

A

Augmentin IV for 7 days

(add Gentamicin if severe sepsis/septic shock)

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17
Q

Penicillin allergy alternative for Pyelonephritis?

A

Gentamicin IV for 7 days

If CrCl <20ml/min use Cipro IV od

oral switch to cipro bd

7d

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18
Q

Intra-abdominal sepsis

Peritonitis

Cholecystitis (biliary sepsis)

Cholangitis

Diverticulitis

COMMUNITY ACQUIRED

A

Augmentin IV for 5 days

oral switch to oral Augmentin tds

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19
Q

Intra-abdominal sepsis

Peritonitis

Cholecystitis

Cholangitis

Diverticulitis

HOSPITAL ACQUIRED

A

Tazocin IV for 5 days

oral switch to Augmenin tds unless cultures indicate resistance

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20
Q

Penicillin allergy for intra-abdominal infections?

A

Gentamicin IV for 2 doses

Metronidazole IV tds

oral switch to Cipro bd and Met tds 5 days

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21
Q

Digestive disease-

Variceal bleeding

Spontaneous bacterial peritonitis

A

Tazocin IV for 5 days

oral switch to Cipro bd 5d

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22
Q

Digestive diseases: non-IgE mediated allergy

A

Ceftazidime IV tds

review after 48 hours and switch to oral ciprofloxacin to complete 5 days if clinically appropriate

23
Q

Mild cellulitis (no signs of systemic toxicity)

A

Flucloxacillin (oral) for 7 days qds

24
Q

Mild cellulitis - penicilling allergy alternative

A

Clarithromycin oral for 7 days

25
Q

Moderate/Severe Cellulitis

Sepsis syndrome

complicating co-morbidities

A

Flucloxacillin IV, switch to oral for OPAT if suitbale for 7-14 days

26
Q

Moderate/Severe Cellulitis - Penicllin allergy

A

Teicoplanin IV 12 hourly for 3 doses then od (also for MRSA colonisation) - IgE mediated

non IgE Ceftriaxone oral

Non-IgE: ceftriaxone IV until resolved oral switch clindamycin qds

27
Q

Diabetic foot

no systemic toxicity

A

First line: Flucloxacillin oral qds 7d

Pen allergy: Clarith oral bd 7d

28
Q

Diabetic foot (systemic toxicity/comorbidities)

A

Teicoplanin IV for 3 doses then od

and Tazocin IV

untill clinically resolved

29
Q

Diabetic foot (systemic toxicity etc) - penicillin allergy

A

Teicoplanin for 3 doses then od

and

Metronidazole IV

and

Gentamicin IV for 2 doses then review

30
Q

Human bites

A

Augmentin oral for 7 days

Asess risk of BBVs

31
Q

Animal bites

A

Augmentin oral tds 7d

Pen allergy: Doxy oral od AND met oral tds 7d

32
Q

Meningitis - Community acquired

A

Ceftriaxone IV

If >55y/immunocompromised/alchoholic, add amoxicillin IV for 7-14 days

and

dexamethosone IV for 4 days unless septic shock, immunocompromised or post-neurosurgery

33
Q

Meningitis - community acquired, penicillin allergy

A

Chloramphenicol IV qds and reduce after 48hrs

AND

add Co-trimoxazole IV if >55y/immunocompromised/alcoholic

7-14 days

AND

add aciclovir if signs of encephalitis e.g. seizures, alterterd mental staus or focal neurology

34
Q

Post neurosurgery meningitis/ventriculitis/infected EVD

A

Meropenem IV tds

AND

Linezolid IV bd

add gent if g-ve cover required

Pen allergy: chloramphenicol IV qds and if required gent intra ventricular od

35
Q

Neutropenic sepsis

A

Take blood culture first then

Tazocin IV qds

Add Gentamicin IV if hypotensive

Add Teicoplanin IV for 3 doses then od (if central line infected or MRSA colonised)

36
Q

Neutropenic sepsis - non IgE mediated

A

Ceftazidime IV

add Gentamicin IV if hypotensive

add Teicolanin IV for 3 doses (if central line infected/MRSA colonised)

37
Q

Neutropenic sepsis - IgE mediated

A

Ciprofloxacin IV

and

Gentamicin IV for 2 doses

Add Teicoplanin IV for 3 doses (if central line infected/MRSA colonised)

38
Q

Severe sepsis/septic shock

no clear focus

community assocaited

A

Augmentin IV and Gentamicin IV for a single dose

39
Q

Severe sepsis/septic shock - Penicllin allergy

community assocaited

A

Vancomycin IV and Gentamicin IV and Metronidazole IV

40
Q

Severe sepsis/septic shock - risk factors for MDR

A

Tazocin IV stat

AND

Gent IV stat

Penicillin allergy: Vanc IV AND Gent IV

41
Q

Endocarditis

  • severe sepsis
  • prosthetic valves
  • IVDU
  • MRSA colonised
A

Vancomycin IV and Gentamicin IV and Rifampicin oral

42
Q

Endocarditis

-indolent presentation

A

Amoxicillin IV 4 hourly and Gentamicin IV bd

43
Q

Endocarditis

  • indolent presentation
  • penicillin allergy
A

Vancomycin IV and Gentamicin IV

44
Q

Osteomyelitis/septic arthritis

A

Flucloxacillin IV 4-6 weeks first line

45
Q

Osteomyelitis/septic arthritis - penicillin allergy/MRSA colonised

A

Teicoplanin IV for 12 hourly 3 doses then od

46
Q

Quinsy/tonsillar abscess

A

BenPen IV and Metronidazole IV for 10 days

(can switch to PenV oral post incision and drainage)

47
Q

Quinsy/tonsillar abscess - penicillin allergy

A

Clarithromycin IV and Metronidazole IV for 10 days

Can switch to clarithromycin oral post incision and drainage

48
Q

Epiglottitis

A

Ceftriaxone IV for 7 days

49
Q

Epiglottitis - penicillin allergy

A

Chloramphenicol IV qds and reduce dose after 48 hrs for 7 days

50
Q

Surgical site infection

-localised signs

A

First line: Flucloxacillin oral qds 5days

51
Q

Surgical site infection

localised signs

penicillin allergy

A

Clarithromycin 500 mg oral 5days

52
Q

Surgical site infection - deep incisional - pus, abscess, fever and tenderness

first line

A

Flucloxacillin IV qds

OR

Augmentin (Co-Amoxiclav) IV tds if gastrointesinal/gynaecogical/urological

5 days and review

Oral switch to Flucloxacillin oral qds/Augmentin oral qds

53
Q
A

Antimicrobials (2 decks)

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