General antibiotic quiz Flashcards
Counselling for doxycycline
Don’t take indigestion remedies or medicines containing iron or zinc for 2 hours before/after
Protect skin from sunlight and don’t use sunbeds
Take with a full glass of water
Why don’t we give doxyxyline to children
deposition of tetracyclines in bones and teeth of under 12
Antibiotics that interact with statins & action to take
Clarithromycin & erythromycin - increase Increased risk of mypoathy - simv should be withheld during treament
Daptomycin, fusidic acid and telithromycin
Avoid all statins and for 7 days after fusidic acid dose
What diuretics interact with aminogylcosides and vanc?
Loop - increase risk of ototoxicity
Diuretic interaction with trimethoprim?
Increased risk of hyperglycemia with spironolactone - increase monitoring
2 CSM warnings for quinolones
and one other drug that increases the likelihood of this occuring
Convulsions - even in pt with no history. Increase likelihood with NSAIDs
Tendon damage
Who is more prone to tendon damage as a result of taking a particular class of antibiotcs
Quinolones:
- over 60
- history of tendon disorders
- corticosteroids
If suspected stop quinolone immediately
Anti-infectives that can prolong the QT interval (5)
Erythromycin
Clarithromycin
Moxifloxacin
Fluconazole
Ketoconazole
Other medicines that can prolong the QT interval (5)
Some: Antiarrhymics (amiodarone) Antipsychotics Antidepressants Antiemetics (domepridone/ondansetron) Methadone
Does ciprofloxacin interact with much? (2)
Yes - it’s a CYP inhibitor (e.g. theophylline)
Also NSAIDs with cipro increases risk of convulstions
Interactions with co-amoxiclav
Nothing significant
Caution with co-amoxiclav
limits treatment course to ……. days
14 days
Cholestatic jaundice - liver tox risk 6x greater than with just amox. Greater risk in over 65. Can occur shortly after use.
Usually self limiting.
Rare but serious potential side-effect of penicillins
CNS toxicity (high doses and renal failure increase risk)
Therefore penicillin should not be given intrathcally
Patients with history of …… more at risk of penicillin anyphalaxis
atopic allergy - asthma, eczema, hayfever
Compare a rash likely to be penicillin allergy and one that isn’t
anaphylaxis, urticaria or rash immediately after administration = likely
Minor rash (non-confluent, non-pruritic, small) occuring 72 hours after admin = less likely
What classes of antibiotic should penicillin allergic patients not recieve
cephlasporins or beta-lactams
Interaction of methotrexate and an antibiotic
Trimethoprim - bone marrow suppression and other blood things
Restrictions in the use of co-trimoxazole
Should only be used for exacerbations of bronchitis/UTI/otitis media when there is evidence of sensitivity and good reason to prefer this to single antibacterial
Rare serous side-effect of co-trimoxazole
blood disorders or rash (e.g. steven-johnsons syndrome) - discontinue immediately
Effect of tetracyclines on warfarin
increase anticoagulant effect
Rare serious side effect of tetracyclines and a class of drugs that increases the risk
Benign intracranial hypertension - report headache and visual disturbance.
Increased with retinoids
Antibiotic colitis and diarrhoea is more common with broad or narrow spec
broad
Cholestatic jaundice is particular risk with which penicillin and what are the risk factors…? (3)
Fluclox
Over 2 weeks
Increasing age
Hepatic dusfunction
Can occur up to two months after treatment
effect of metronidazole on warfarin
increased anticoag effect
Long term s/e of nitrofuranitoin (2)
liver issues and pulmonary fibrosis (monitor)
Who should be notified about notifiable disease
Proper officer of the local authority
What are these examples of? Acute encephalitis Acute infectious hepatitis Acute meningitis Acute poliomyelitis Anthrax Botulism Brucellosis Cholera Diphtheria Enteric fever (typhoid or paratyphoid fever) Food poisoning Haemolytic uraemic syndrome (HUS) Infectious bloody diarrhoea Invasive group A streptococcal disease Legionnaires’ disease Leprosy Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough Yellow fever
Notifiable diseases
Empirical treatment for meningitis
Benzylpenicillin
OR cefotaximine or chloramphenicol in allergy
Dexamethasone as adjuvant
Preventative therapy for meningitis
Ciprofloxacin, Rifampicin or ceftriaxone
Healthcare workers don’t require unless direct exposure to mouth and nose droplets of patient treated for less than 24hours
Antibacterial therapy for otitis externa
Flucloxacillin or clarithromycin in allergy
Antibacterial therapy for otitis media
Usually viral - only start antibacterial soap after 72 hours (amoxicillin or clarithromycin)
Antibacterial therapy for c diff
Oral metronidazole
Then
Oral vancomycin
Are penicillins or cephalosporins preferred for dental infections
Penicillins - cephalosporin are less effective against anaerobes
Are organisms causing dental infections likely aerobic or anaerobic ?
Anaerobic
First line for dental infections
Phenoxymethyl penicillin or metronidazole
CAP treatment low,med and high severity
And treatment duration
Low severity pneumococci - amoxicillin (7 days)
Med severity - amoxicillin + clarithromycin or doxy (7-10days)
High severity - benpen or co-amoxicillin + clarithromycin or doxy (7-10 days)
What would make you treat someone with cap automatically with high severity treatment
Nursing home
Comorbidities
Cap treatment if staph suspected
For all With staphylococci add flucloxacillin - total 14-21 days
Treatment for pneumonia caused by atypical pathogens
Clarithromycin
What makes HAP early onset
Less than five days after admission to hospital
Treatment for early and late onset hap
Early - coamox
Late - tazocin
What to add to HAP if MRSA suspected
Vancomycin
What to add to hap in pseudomonas aeruginosa suspected
Aminoglycaside
Treatment for exacerbation of COPD and duration
Amox or tetracycline for five days
When do you treat and exacerbation of COPD?
Increased sputum purilence
Accompanied by increased sputum volume or sob
Treatment for cellulitis
Flucloxacillin
2 drugs that should not be used alone for MRSA s resistance rapidly develops
Rifampicin
Fusidic acid
Is MRSA gram positive or negative ?
Positive
First line for MRSA
… And what to treat with if severe?
A Tetracycline +/- Rifampicin & Fusidic acid
If severe use glycopeptide (e.g vancomycin )
Why do we not normally use Linezolid for mixed gram infections
Not active against gram negative
Duration and number of drugs used in the phases of TB
Initial - Four drugs for two months
Continuation - 2 drugs for four months
Drugs for the initial phase of TB
Iaoniazid
Rifampicin
Pyrazinamide
Ethambutol
Continuation phase of TB components
Isoniazid and Rifampicin
Colour that Rifampicin chafed urine?
Red orange
Difficult with treating tab in children?
Ethambutol can effect eyesight but it’s difficult to test in children and hard to get the, to report visual symptoms
Two most common organisms causing UTI
Ecoli
Then staphylococcus saprophyticus in young sexually active women
Treatment duration for UTI
7 days or 3 days if uncomplicated in women
First line for Utis
Trimethoprim or nitro
Alternatively Amox, ampicillin or oral cephalosporin
First line for upper UTI
Cephalosporin (cefuroxamine)
Duration of treatment for an upper UTI
10-14 days
UTI in pregnancy treatment (3)
Penicillins or cephalosporins
Nitrofurantoin but avoid this at term
Can nitrofurantoin be used in renal impairment
Should be avoided
Treatments for UTI in children
From 3 months - trimethoprim, cephalosporins or nitrofurantoin
Who does pneumocystis pneumonia occur in ?
Immunocompromised patients
What is first line for pneumocystis pneumonia ?
Co-trimoxazole (also used prophylactically until immune recovery daily or on alternate days)
May also give corticosteroids as a adjuvant in HIV
