Infection Flashcards
Tetracycline can be used in children under 12 years old - TRUE/FALSE
FALSE - C/I in Children under 12 years (deposition in growing bone and teeth, by binding to calcium, causes staining and occasionally dental hypoplasia)
Abx broad spectrum and has resistance to strains in pneumonia
Co-amoxiclav
Treatment C.Diff
mild-moderate: PO Metronidazole 400-500mg TDS for 10-14 days.
Severe: PO Vancomycin 500mg QDS 10-14 days.
Drugs that can cause Diarrhoea
Abx Acarbose Biguanides Bile salts Colchicine Cytotoxics Dipyridamole Iron preparations Laxataives Leflunomide magnesium preparations Metoclopramide Misoprostol NSAIDs Olsalazine Orlistat PPI Ticlopinide
Treatment UTI - non-pregnant pt
Ibuprofen and paracetamol for pain
1st line:
- Nitrofurantoin 50mg QDS or 100mg M/R BD for 3 days if eGFR above 45
- OR Trimethoprim 200mg BD for 3 days
2nd line: No improvement after 48 hrs or unavailable 1st line
- Nitrofurantoin 100mg M/R BD (or 50mg QDS) for 3 days if eGFR above 45
- Pivmecillinam 400mg STAT then 200mg BD for 3 days
- Fosfomycin 3g STAT
Treatment UTI - pregnant pt
1st line:
- Nitrofurantoin 100mg M/R BD (or 50 mg QDS) for 7 days if eGFR above 45 - avoid at term
2nd line: failure 1st line after 48 hrs or unavailable
- Amoxicillin 500mg TDS for 7 days (only if culture av and susceptible)
- Cefalexin 500mg BD for 7 days
treatment oral candidiasis
- miconazole oral gel 2.5ml QDS 7 days then 7 days after resolved
- Nystatin suspension 1ml 7 days, continue 2 days after resolved
- fluconazole capsule 50/100 mg OD 7-14 days
isoniazid in renal impairment
increased risk of ototoxicity and peripheral neuropathy - pyridoxine hydrochloride (B6) recommended
Notifiable diseases
Antrax Cholera Diarrhoea (infectious bloody) Diphteria encephalitis (acute) food poisonning hepatitis viral legionnaire's disease leprosy malaria measles meningitis meningococcal speticaemia mumps paratyphoid fever plague rabies rubella SARS scarlet fever smallpox streptococcal disease (grp A invasive) tetanus tuberculosis typhoid fever typhus whooping cough yellow fever
Mefloquine BNF
for treatment/prophylaxis of malaria
AVOID if hx of psychiatric disorder - associated with potential serious psychiatric disorders(inc suicidal ideation and suicide) - continues for month after cessation due to long half-life - if s+s DISCONTINUE IMMEDIATELY
S/E: psychiatric and GI upset
X in pt allergic to quinine
avoid mosquito bites, take regularly, visit dr if ill within 1 year or 3 mths of coming back from country with malaria
causative agent for community-acquired pneumonia
s. pneumoniae
h. influenza are 2 most common
treatment CAP
1st: amoxicillin 500mg TDS 5 days
2nd: doxycycline, clarithromycin, erythromycin
Upper resp Infections
1 - phenoxymethylpenicillin 500mg QDS or 1000 mg BD for 5-10 days
2- PEN ALL: Clarithromycin 250mg to 500mg BD 5 days
OR
PREGOS: Erythromycin 250mg to 500mg QDS or 500mg to 1000 mg BD 5 days
Scarlet fever
1- phenoxymethylpenicillin 500mg QDS 10 days
2- PEN ALL: Clarithromycin 250-500mg BD
Optimise analgesia + safety netting advice
Acute otitis media
IF SYSTEMICALLY UNWELL -give according to age, for 18+:
1- Amoxicillin 500mg TDS 5-7 DAYS
PEN ALL: CLARITHROMYCIN 250-500MG BD 5-7 days
PREGO: Erythromycin 250-500mg QDS or 500-1000mg BD 5-7 days
2nd line if first line after 2-3 days of no improvement:
Co-amoxiclav: 625mg TDS 5-7 days
GIVE APPROPRIATE ANALGESIA
Acute otitis externa
1st: Analgesia and apply localised heat (hot flannel)
2nd: topical acetic acid 2% 1 spray TDS 7 days
OR
Topical neomycin suplhate with corticosteroids 3 drops TDS 7-14 days
IF CELLULITIS: REFER + Flucloxacillin 250mg QDS 7 days or 500 mg QDS if severe
Sinusitis
Symptoms 10 days or less: no ABX
No improvement >10 days: consider use of high doss nasal corticosteroids (X IN UNDER 12)
IF SYSTEMICALLY V.UNWELL:
1- Phenoxymethylpenicillin 500mg QDS 5 days
2nd line: co-amox 625mg TDS 5 days
PEN ALL: DOXYCYCLINE 200mg STAT then 100mg OD next day for 5 days (X UNDER 12)
OR
Clarithromycin 500mg BD 5 DAYS
or
PREGGO: Erythromycin 250-500mg QDS or 500-1000mg BD 5 days
Acute exacerbation COPD
1st choice:
1- Amoxicillin 500mg TDS for 5 days
2- Doxycycline 200mg STAT then 100mg OD thereafter 5 days
3- Clarithromycin 500mg BD 5 days
If treatment failure swap to diff 1st line abx
2nd choice: IF PERSON AT HIGHER RISK OF TREATMENT FAILURE
1- Co-amoxicalv 625mg TDS 5 days
2- Co-trimaxozole 960mg BD
3- Levofloxacin (NEED SPE ADVICE) 500 mg OD
IF V.SEVERE - IV ABX
acute exacerbation of bronchiectasis
1st choice empirical treatment:
1- Amoxicillin 500 mg TDS 7-14 days (1st IF PREGGO)
2- Doxycycline 200 mg STAT and 100mg OD thereafter for 7-14 days (NOT IN UNDER 12)
3- Clarithromycin 500mg BD 7-14 days
2nd choice empirical treatment for pt at higher risk of severity:
1- co-amox 625mg TDS 7-14 days
2nd line:
ADULTS ONLY: Levofloxacin 500 mg OD or BD 7-14 days
CHILDREN ONLY: Ciprofloxacin 7-14 days
POSSIBILITY IV ABX
Acute cough higher risk pop factors
people with pre-existing co-morbidity premature babies and babies born premie Aged >65+ with 2 of OR aged >80+ with 1 of: - hospitalisation in previous year - T1DM OR T2DM - Hx congestive HF - current use of oral corticosteroids
Acute cough treatment
For pt at high risk or pt that are systemically unwell:
ADULTS:
1- Doxycycline 200mg STAT then 100mg OD for 5 days
2 - Amoxicillin 500 mg TDS 5 days (PREF IF PREGGO)
OR
Clarithromycin 250-500 mg BD 5 days
OR
Erythromycin 250-500mg QDS or 500-1000 mg BD for 5 days (PREF IF PREGGO)
CHILDREN: 1- AMOXICILLIN 5 days OR Clarithromycin 5 days OR Erythromycin 5 days OR Doxycycline 5 days (X UNDER 12s)
CAP low severity (non-severe in kids)
CURB 0-1 - START TREATMENT WITHIN 4 HRS
1st: Amoxicillin 500mg TDS 5 days
IF PEN ALL: Doxycycline 200mg STAT then 100mg OD thereafter 5 days (NOT IN UNDER 12s) OR Clarithromycin 500 mg BD 5 days OR 2ND IF PREGGO: 500 mg QDS 5 days
CAP moderate severity
CURB 2 - START TREATMENT WITHIN 4 HOURS
1st: Amoxicillin 500 mg TDS 5 days
AND (IF ATYPICAL PATHOGEN)
Clarithromycin 500mg BD 5 days
OR Erythromycin (PREF IF PREGGO) 500 mg QDS 5 days
alternative choice 1st line:
PEN ALL:
1ST: Doxycycline 200mg STAT then 100 mg OD thereafter 5 days
2nd: Clarithromycin 500mg BD 5 days (give with erythromycin if atypical suspected)
CAP severe
CURB 3-5 - TREAT WITHIN 4 HOUSR DIAGNOSIS
1st: Co-amoxiclav 625mg TDS 5 days
AND (IF ATYPICAL PATHOGEN):
Clarithromcin 500 mg BD 5 days
OR (PREF IF PREGGO) Erythromycin 500mg QDS 5 days
Alternative 1st line:
Levofloxacin (consider safety issues) 500 mg BD 5 days
CURB SCORE
1 pt per parameter: Confusion Urea (> 7 mmol) Reps rate (30+ breath/min) Blood Pressure: Low systolic (<90 mmHg) OR diastolic (<60 mmHg) Age 65+
HAP
Start within 48 hours of hospital admin
TREAT WITHIN 4 HOURS OF DIAGNOSIS
Non-SEVERE and NOT HIGH RISK RESISTANCE:
1st - Co-amox 625 mg TDS 5 days then R/W
PEN ALL:
1- Doxyxycline 200 mg STAT then 100mg OD thereafter 5 days then R/W
2- Cefalexin (care in pen allergy) 500 mg BD or TDS (can increase to 1g to 1.5g TDS or QDS) 5 days then r/w
3- Co-trimaxozole 960 mg BD 5 days then R/W
4- Levofloxacin (only if switching from IV) 500 mg OD or BD for 5 days then R/W
CHILDREN ALTERNATIVE:
Clarithromycin
IF SEVER OR RESISTANCE: IV Abx + micro input
