First Line Treatments Flashcards
C. difficile
Stop Abx and PPIs, if nil improvement within 48 hours after antibiotic cessation then start:
Metronidazole 400mg BD for 7 days (10mg/kg children)
70% cure rate, if not improving discuss w ID ? vancomycin
hepatic encephalopathy
lactulose
titrating to 2 to 3 loose bowel motions a day
Ascites
Spirolactone +/- frusemide
Limit sodium intake
Spontaneous bacterial peritonitis prophylaxis
co-trimoxazole 480mg OD
whooping cough
if within 3 weeks
azithromycin 500mg day one , then 250mg PO OD day 2- 5 days
(10mg/kg/dose)
- cotrimox if macrolide allergy
Vitamin treatment for alcohol use disorder
Thiamine 50 mg four times a day or 100 mg twice a day (for prophylaxis against Wernicke encephalopathy), until six weeks after the patient stops drinking (or indefinitely if drinking continues).
Mvite or Bplex BD
Folic acid to treat folate deficiency.
first line mild-moderate etoh withdrawal
Diazepam - weaning doses
PID in a non pregnant women
Ceftriaxone 500 mg IM or IV STAT
PLUS
Doxycycline 100 mg PO BD for 2 weeks
PLUS
Metronidazole 400 mg PO BD for 2 weeks
severe PID/unwell should be acutely referred into hosp
PID in a pregnant woman
emperic treatment for contacts
Same but use azithromycin 1g STAT then repeat in a week ( instead of doxycycline)
all contacts should be treated with doxycycline 100 mg PO BD for 1 week
Treatment of mastitis
All should continue gentle massage, warm compress and ongoing breast emptying/expressing
If no improvment in 12 – 24 hours or systemically unwell
- flucloxacillin 500mg QID or
- Augmentin TDS or
- Cephalexin 500mg QID
uncomplicated UTI
1st. Nitrofuratoin (MR 100g BD 5 days or 50mg QID 5 days)
- avoid if CrCl <60 or pregnant >36 weeks
- treat for 7 days in pregnant women or males
2nd: Cephalexin 500mg BD for 5 days
3rd: trimethoprim 300mg OD for 3 days
- avoid in first trimester
UTI in a pregnant women
Treat for 7 days
Cephalexin 500mg BD
Nitro (up to 36 weeks)
trimethorim (avoid in the first trimester)
Amoxicillin 250mg TDS *use only if culture shows (S)
do a test of cure post treatment
mild pyelonephritis
Cefalexin 1 g 3-4x daily for 10 days
Alternatives
- cotrimoxazole 960mg BD for 10 days
- Augmentin 625mg TDS for 10 days
- Ciprofloxacin (only if resistent or Pseudomonas suspected/confirmed) 500mg BD for 10 days
child with UTI
cephalexin 25mg/kg/dose TDS for 3 days
or
cotrimox
augmentin
nitrofuration
7 days if severe
Urethritis with discharge (presumed gonococcal)
Urethritis without discharge
Urethritis with known Gon/chlamy co-infection
- ceftriaxone 500mg IM stat + azithromycin 1g
- Doxycycline 100mg BD 7 days OR azithromcyin 1g STAT
- ceftriaxone 500mg IM stat + 100mg doxycycline 7 days
First line for smoking cessation/reduction
Behavioural support (quitline, aukati kaipaipa, pasifika support) and
NRT or
Bupropion (also used for depression) or
Nortriptyline
2nd Line: Varenicline
- due to neuropsych SEs and cost
subsidised medication to treat etoh use disorder
Disulfiram: reacts w etoh, can be dangerous. fully subsidised med. Doesn’t reduce cravings or relapse. Limits the frequency of drinking and the amount consumed if relapse occurs.
naltrexone: reduces cravings
Acamprosate: reduces cravings, $$$
Emergency contraception
Copper IUD (1st line)
Levonergestrol 1.5mg (take x2 if >70kgs, use up to 72hrs)
Shingles
Valaciclovir 1g TDS (7 days)
2nd line: Aciclovir 800 mg, five times daily, for seven days
Triple therapy for h.pylori
14 days
omeprazole 20mg BD
clarithromycin 500mg BD
amoxicillin 1g BD
(if prev macrolide exposure then metronidazole 400mg BD)
2nd line for resistent h.pylori
14 days
Omeprazole, 20 mg twice daily; and
Tripotassium dicitratobismuthate (bismuth)*, 120 mg four times daily; and
Tetracycline†, 500 mg four times daily; and
Metronidazole, 400 mg three times daily
bronchiectasis exacerbation (emperic tx)
Augmentin TDS for 14 days
IECOPD or CAP
1st and 2nd line
1st: amoxicillin 1g TDS for 5-7 days
2nd (if penicillin allergy): Doxycycline 200mg BD on day 1, then 100mg BD for days 2-5
- if concern for atypical CAP add a macrolide (azithromycin 500mg OD for 3 days or roxithro 300mg for 5 days)
child with CAP
1st and second
1st: amoxicillin 15-30mg/kg TDS for 5-7 days
2nd: erythromycin (10mg/kg) or azithromycin (10mg/kg)
GAS - RF prophylaxis
Amoxicillin: 1g or 50mg/kg OD for ten days
Penicillin V: 500mg BD (or 250mg BD if <25kgs) for 10 days
dental abscess
amoxicillin 15-30mg/kg or 1g PO TDS for 3-5 days
or
Erythromycin 7.5mg/kg or 400mg TDS for 5 days
Abx prophylaxis for higher risk dental procedures
Amoxicillin
50 mg/kg (maximum 2 g), single dose, oral, IV or IM
2 g, single dose, oral, IV or IM
PO: one hour prior
IM: 30 minutes prior
IV: immediately before
suspected meningitis
Ceftriaxone
< 30kg: 100 mg/kg stat dose IV/IM
>30kgs: 2 g, stat dose IV/IM
benzyl penicillin (penicillin G)
Child: 50 mg/kg (maximum 2 g/dose), stat IV/IM
Adult: 2.4 g, stat IV/IM
Croup (mild, moderate, severe)
Mild/moderate: dexamethasone 0.15mg/kg + review in 2 hrs
Severe: dexamethasone 0.6 mg/kg + nebulised adrenaline + hospital admission
