Hospital adult Flashcards
how do you treat meningitis?
- Ceftriaxone IV 2g bd + Dexamethasone IV 10mg qds
- Aciclovir IV (10mg/kg tds) if encephalitis suspected
- Add Amoxicillin IV 2g 4 hourly if ≥ 60 years or immunocompromised
how do you treat epiglottitis/ supraglottitis?
Ceftriaxone IV 2g od
how do you treat community acquired pneumonia?
0-2 curb 65 score
0-2 Mild/Mod
Amoxicillin 1g tds IV/PO (5 days)
(If penicillin allergic:Doxycycline PO 200mg on day 1 then 100mg od or IV Clarithromycin* if NBM)
how do you manage hospital acquired pneumonia?
non severe
Non severe: PO Amoxicillin (If penicillin allergic: Doxycycline 100mg bd) TOTAL 5 days
how do you manage aspiration pneumonia?
non severe
Non severe:
PO Amoxicillin + Metronidazole (If penicillin allergic: PO Doxycycline 100mg bd + Metronidazole) TOTAL 5 days
how do you manage acute exacerbation of COPD?
1ST LINE Amoxicillin 500mg tds
2ND LINE Doxycycline 200mg on day 1 then 100mg od (5days)
how do you manage acute bronchitis?
1ST LINE Amoxicillin 500mg tds
2ND LINE Doxycycline 200mg on day 1 then 100mg od (5days)
how do you manage endocarditis?
Native valve indolent (Subacute): Amoxicillin IV 2g 4 hourly + Gentamicin
Native valve severe sepsis (Acute): Flucloxacillin IV 2g 6 hourly (4 hourly if >85kg)
Prosthetic valve or Suspected MRSA: Vancomycin IV + Gentamicin
how do you manage c.difficle infection?
Severe/Non severe: Vancomycin 125mg qds (10 days)
Recurrent: positive CDI in previous 12 weeks
how do you manage peritonitis/biliary tract/ intra-abdominal?
IV amoxicillin+ metronidazole+ gentamicin
step down: PO co-trimoxazole + metronidazole
if penicillin allergic : IV vancomycin + metronidazole + gentamicin
what must you consider when treating catherterised patients?
do not use urinalysis
do not treat unless clinical signs/ symptoms of infection
if confirmed treat as complicated UTI
how do you manage complicated UTI/ pyelonephritis/urosepsis?
IV amoxicillin + gentamicin ( penicillin allergic: IV Co-trimoxazole + Gentamicin)
Step down: PO Co-trimoxazole or as per sensitivities
how do you manage uncomplicated Female lower UTI?
Nitrofurantoin 100mg MR bd or 50mg qds or Trimethoprim 200mg bd
how do you manage uncatherterised male UTI?
Nitrofurantoin 100mg MR bd or 50mg qds or Trimethoprim 200mg bd
how do you manage cellulitis?
Flucloxacillin 1g qds (If penicillin allergic: Doxycycline 100mg bd PO)
how do you manage open fracture prophylaxis?
Cefuroxime 1.5g IV every 8 hours
how do you manage diabetic foot infection?
Mild: Flucloxacillin 1g qds or Doxycycline 100mg bd
Moderate: Flucloxacillin 1g qds + Metronidazole 400mg tds
how do you manage acute septic arthritis osteomyelitis?
IV flucloxacilin 2g qds
how do you manage severe systemic infection source unknown?
IV Amoxicillin + Metronidazole + Gentamicin (If PWID add S. aureus cover IV Flucloxacillin 2g qds or if penicillin allergic use regime below)
Penicillin allergy: IV Vancomycin + Metronidazole + Gentamicin
what causes meningitis?
pneumococcus
meningicoccus
if >60: listeria
what causes encephalitis?
herpes simplex
what causes epiglottis?
haemophilius influenzae
streptococci
what causes tonsilitis?
group A streptococci
what causes sinusitis?
pneumococcus
what causes acute otitis media?
pneumococcus
haemophilius influenzae
what causes mild/moderate Community acquired pneumonia?
pneumococcus
haemophilius influenzae
what causes severe CAP?
same as mild/moderate
as well as legionella
mycoplasma
chlamydia pneumoniae
coxiella
what are the causes of acute exacerbation of COPD?
pneumococcus
haemophilius influenzae
what are the causes of HAP?
pneumococcus
haemophilius influenzae
coliforms
what are the causes of endocarditis?
native valve acute: staph aureus
native valve sub acute: viridans streptococci ,enterococci
prosthetic valve: MRSA ( resistant to flucloxacillin and beta lactams, coagulase negative staphylococci
what are the causes of peritonitis/biliary tract sepsis?
polymicrobial coliforms, anaerobes and enterococci
what are the causes of spontaneous bacterial peritonitis?
coliforms
sometimes strep pneumonia
what are the causes of female uncomplicated UTIs?
coliforms
enterococci
what are the causes of male (no catheter) UTIs?
coliforms
enterococci
what are the causes of complicated infections such as pyelonephritis,urosepsis ?
coliforms
pseudomonas aeruginosa
enterococci
what are the causes of cellulitis?
staph aureus
group A & other beta haemolytic streptococci
what are the causes of diabetic foot acute infections?
staph aureus
what are the causes of septic arthritis/osteomyelitis?
staph aureus
what is the CURB 65 score?
C Confusion (abbreviated mental test score <= 8/10)
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years
CRB 65 for primary care
UREA ( >7mmol) for hospital
how do you manage CAP?
Curb 3-5 score (severe)
3-5 Severe
Co-amoxiclav IV 1.2g tds + Doxycycline PO 100mg bd (If penicillin allergic: IV Levofloxacin 500mg bd monotherapy)
Step down to Doxycycline 100mg bd for ALL patients with severe CAP TOTAL IV/PO 5 days
how do you treat CAP?
ICU
ICU/HDU or NBM
Co-amoxiclav IV 1.2g tds + Clarithromycin* IV 500mg bd (If penicillin allergic: IV Levofloxacin 500mg bd monotherapy)
how do you treat severe HAP?
Severe: IV Amoxicillin + Gentamicin
(If penicillin allergic:IV Co-trimoxazole + Gentamicin)
Step down: PO Co-trimoxazole TOTAL IV/PO 7 days
how do you manage severe aspiration pneumonia?
Severe:
IV Amoxicillin + Metronidazole + Gentamicin
(If penicillin allergic: replace amoxicillin with PO
Doxycycline or IV Clarithromycin*)
Step down: PO Amoxicillin + Metronidazole (If penicillin allergic: Doxycycline 100mg bd + Metronidazole) TOTAL IV/PO 7 days
