GI + cardio + resp + CNS + MSK + Skin + dental - Infections

Question 1

Infections: gastro-enteritis

Answer 1

Causes diarrhoea + vomiting

Typically caused by: salmonella, e coli, rotavirus or noravirus

Question 2

Infections: C diff

Answer 2

Elderly (over 65), PPI, hospitals

Abx: Clindamycin, Quinolones, Ampicillin, amoxicillin, 3rd + 4th gen cephalosporins

Question 3

What is the treatment for C diff?

Answer 3

First episode
- First line: oral vancomycin
- Second line: fidaxomicin

Further episode
- <12w: fidoxamicin
- 12w: fidoxamicin or oral vancomycin

Life threatening (specialist)
- Oral vancomycin + IV metronidazole

Question 4

Infections: endocarditis

Answer 4

Cause:
- Staphylococci
- Streptococci
- Enterococci
- HACEK
Can be from dental procedures/infections

Question 5

Endocarditis treatment

Answer 5

Blind therapy:
Native valve

• Amoxicillin (or ampicillin) +/- low dose gentamicin
• Pen allergy/MRSA suspected, severe sepsis: vancomycin + low dose gentamicin

Prosthetic valve

• Vancomycin + rifampicin + low dose gentamicin

After test results
- MRSA → vancomycin
- Staphylococci → flucoxacillin
- Streptococci → benzylpenicillin

Question 6

Respiratory infections

Answer 6

Cough
Pneumonia

Cause: S pneumoniae + H influenzae

Question 7

Pneumonia treatment: Low severity

Answer 7

First line: amoxicillin 500mg -1g TDS 5 days

Pen allergy: clarithromycin OR doxy OR eryth (pregnant)

Question 8

Pneumonia treatment: moderate severity

Answer 8

First line: amoxicillin

If atypical pathogens: ADD clarith OR eryth (pregnant)

Pen allergy: clarith OR doxy

Question 9

Pneumonia treatment: High severity

Answer 9

High severity (oral/IV)

• First line: co-amox + clarith OR eryth (pregnant)
• Pen allergy: levofloxacin

Question 10

Pneumonia treatment: hospital non severe + not higher risk of resistance

Answer 10

First line: co-amox

Pen allergy: doxy OR cefalexin

Question 11

CNS infection

Answer 11

Meningitis
- Cause: N meningitidis
- Non-blanching rash
- Medical emergency

Question 12

What is the treatment for meningitis?

Answer 12

Blind therapy
- First line: benzylpenicillin
- Pen allergy: cefotaxime
- Immediate hypersensitivity: chloramphenicol

Question 13

Give examples of skin infections

Answer 13

Impetigo, cellulitis (Cause: staphylococci aureus)

Animal + human bite

Question 14

What is the treatment for impetigo?

Answer 14

Hydrogen peroxide cream
Fusidic acid (if unsuitable)
Resistance: muirocin

Wide spread non bullous

• First line: flucoxacillin OR fusidic acid

Bullous + non-bullous if systemic unwell or high risk

-First line: flucoxacillin

• Pen allergy: clarith OR eryth (pregnant)

Question 15

What is the treatment for cellulitis?

Answer 15

First line: flucox oral/IV

Pen allergy: clarith OR eryth (pregnant) OR doxy

Near eyes or nose

• First line: co-amox oral/IV
• Pen allergy: clarith + metronidazole

Question 16

What is the treatment for animal and human bites?

Answer 16

First line: co-amoxiclav oral/IV

Question 17

What are examples of dental infections?

Answer 17

cause: anaerobes

• Gingivitis (ANUG)
• Periacical abscess
• Periodontal abscess
• Periodontitis
• Pericoronitis

Question 18

What is the treatment for pericoronitis/anug?

Answer 18

3 days
- Metronidazole 400/500mg TDS
- Alt: amoxicillin

Question 19

What is the treatment for periapical periodontal abscess?

Answer 19

Upto 5 days

Phenoxymethylpenicillin OR amox

Pen allergy: clarithromycin

Signs of spreading infection: add metronidazole

Question 20

MSK infections

Answer 20

• Osteomyelitis - bone infection
• Septic arthritis - joint infection

Question 21

MSK treatment

Answer 21

First line: Flucoxacillin

Pen allergy: clindamycin

If MRSA suspected: vancomycin

Osteomyelitis - 6 w
- Consider + rifampicin or fusidic acid for 2 w

Septic arthritis - 4-6w
- Gonococcal (2w) or gram negative suspected: cefotaxime OR ceftriaxone