GP ABs Flashcards
URTI
-influenza-
Treat at risk eg preg, over 65, chronic resp dis, sig CVS dis, imm comprom, DM, chronic neuro/liver/renal dis, BMI over 40.
5d oseltamivir 1st line. Zanamivir if resis or sev imm supp.
-acute sore throat- rarely treat. Use feverPAIN score.
10d phenoxymethylpenicillin 1st line. 5d clarithromycin if pen allergic.
-acute otitis media- delayed or immed AB if under 2yo AND bilat or bulging mem AND at least 4 marked symps. Tx all ages with ottorhoea.
5d amoxicillin 1st line. 5d Erythromycin if pen allergic.
-acute otitis externa-
1st line acetic acid 2% 1 spray TDS for 7d. 2nd line neomycin sulphate plus CS 3 drops TDS. If cellulitis or dis extending out of ear canal then start oral AB and refer.
-acute rhinosinusitis- self resolve in 14d us. Do use analgesia. AB when purulent nasal disch or persis infec.
7d Amoxicillin 1st line, or doxycycline, or penV. Co amox for persis symps.
LRTI
-acute cough bronchitis-
AB if over 80 AND one of hosp in last year, oral setroid, DM, CHF. OR over 65 with 2 of above. Consider CRP test.
5d amoxicillin or doxycycline.
-acute exacerbation COPD-
AB fast if purulent sputum AND incr SOB AND/OR incr sputum vol.
5d amoxicillin/ doxy/ clarithromycin 1st line. Co amox if resis.
-CAP-
CURB65 score for admiss req.
CURB65 0- amxoicillin/clarithromycin/doxy for 5d init.
CURB65 1/2- can treat at home. 7-10d amox PLUS clarithromycin or doxy.
UTI
Nitrofurantoin now 1st line as trimethoprim resis incr.
-lower UTI in adults-
Tx women with sev or at least 3 symps. Tx for 3d.
Nitrofurantoin 1st line for all if eGFR over 45.
If GFR lower then pivmecillinam.
If high risk resis then fosfomycin.
If organism susceptible then amox.
For mild infec in women then consid delayed or back up AB.
In men do dip to confirm. Tx for 7d.
In over 65s tx if fever over 38 AND dysuria or 2 other symps.
Always culture if tx fail.
If catheter then only tx if systemic ill or pyelonephritis likely. Take sample if new delerium or at least 2 symps.
-acute prostatitis-
Send culture and start 4 wk AB.
Ciprofloxacin or ofloxacin 1st line for 28d. Trimethoprim 2nd line.
-UTI in preg-
Culture. AB if sig bacteruria. Avoid trimehtorpim if low folate. Tx for 7d.
1st line nitrofurantoin 7d. Amox if suscep.
2nd line trimethoprim with folate if 1st trimester.
3rd line cephalexin.
-UTI in kids-
Under 3mnth urgent ref. Over 3 mnth tx if pos nitrite.
If lower UTI then 3d nitro or trimeth. Amox if suscep. Cefalexin 2nd line.
If upper UTI- 7-10d co amox. Cefixime 2nd line.
-acute pyelonephritis-
Culture and suscep testing.
7d co amox or ciprofloxacin 1st line.
If sensitive then 14d trimeth.
-recurr in NON preg (2 in 6mnth or at least 3 in 1yr)-
1st line hydrat and analgesia. 2nd line stand by or post coital AB. 3rd line AB prophylaxis.
1st line nitro 3-6 mnth.
2nd pivmecillinam or trimeth if sensit. Also 3-6mnth.
6mnth methenamine if no renal or hepatic impair.
Meningitis
-suspected meningococcal dis-
ADMIT. If time before, and non blanching rash, give IV benzylpen or cefotaxime unless definate hypersensit.
So IV/IM benxylpen or cefotaxime. IM if no vein.
-preven of secondary case-
On advise of PH dr only.
GI
-oral candidiasis-
Consid imm comprom as rare in adults.
7d miconazole gel 1st line. Nystatin susp if miconazole not tol.
7d oral fluconazole if sev, and high dose if imm comprom.
-H pylori-
Tx if test pos and known ulcer/MALToma/dispepsia. Dont tx for GORD.
Triple therapy- PPI WITH amox AND clarithromycin or metronidazole. For 7d (14 of MALToma).
For pen allergic- PPI, clarithromycin, metronidzole.
-infective diarr-
Tx if systemic ill.
Clarithromycin for susp campylobacter.
-C diff-
Stop PPI and AB. Tx for 10-14d.
Metronidazole 1st line for 1st episode.
Vancomycin if sev or recurr. (Sev if temp over 38.5, WCC over 15, rising Cr, sev colitis).
-travellers diarr-
Standby AB if high risk. 3d Ciprofloxacin.
-threadworm-
Hyg and treat all family.
For all pts over 6 mnths mebendazole stat dose, rep in 2wk if persis.
If under 6mnth then mebendazole off license or hyg alone for 6wk.
GU
-chlamydia trachomatis/urethritis-
Tx partners. Ref to GUM. Test for cure on preg.
Stat azithromycin or doxy 7d.
If preg or breastfeed- azithromycin or erythromycin or amox 7d.
-epididymitis-
Low risk STI and over 35- 14d ofloxacin or doxy.
High risk GUM ref.
-vaginal candidiasis-
Topical stat clotrimazole or stat oral fluconazole.
If preg avoid oral azoles and use intravag tx for 7d- clotrimazole or miconazole 2% cream for 1wk.
-BV-
Oral metronidazole stat (not in preg) or 7d.
Or metronidazole 0.75% gel 7d
Or clindamycin 2% cream 7d.
-gonorrhoea-
Lot resis. Stat IM ceftriaxone PLUS stat azithromycin.
-trichomoniasis-
Metronidazole stat or 7d.
Clotrimazole pessary 6d.
-PID-
Cult for NG and CT. ref to GUM and contacts.
14d metronidazole PLUS ofloxacin.
Or doxy.
If high risk NG, add ceftriaxone stat.
Skin
-impetigo-
Oral AB for sev or bullous. Topical for loc.
7d oral fluclox 1st line.
Oral clarithromycin for pen allergic.
5d topical fusidic acid.
5d mupirocin for MRSA ONLY.
-eczema-
As for impetigo only if signs of infec.
-cellultis-
7d oral flucloxacillin 1st line. Clarithromycin if pen allrgic. Doxy if on statins. Clindamycin if unresolving. Co amox if facial.
IV if febrile and ill or comorb.
-leg ulcer- tx dep on culture.
If active infec (cellul, pain, pyrex, purul exudate, odour) then fluclox or clarithromycin.
-scabies-
Tx whole body face down. Incl face if under 2 or eld. Tx family.
Permethrin 5% cream 2 applics 1 wk apart.
If allergic, malathion 0.5% aq liq.
-dermatophyte skin-
Topical Terbinafine or imidazole for 1-2wk.
Topical mycota for athletes foot.
-dermatophyte nail-
Oral terbinafine 1st line up to 6mtnh.
2nd line itraconazole.
-VZV chicken pox-
7d aciclovir if fast onset, over 14, sev pain or dense oral rash, 2nd household case, steroids, smoker.
-herpes zoster shingles-
7d aciclovir if over 50, opthalmic or eczema.
2nd line valaciclovir.
Eye
-conjunctivitis-
Tx if sev.
Chloramphenicol 0.5% drop (2hourly) and 1% ointment (4 hourly) for 48hr after resol.
2nd line fusidic gel 1% twice daily for 48hr after resol.
