infection Flashcards
patient group most at risk of c.diff?
women and elderly
which antibiotics cause c.diff the most
clindamycin most
penicillins and quinolones can
treatment of c.diff
1st: oral metronidazole
2nd: oral vancomycin/ oral fidoxamicin
10-14 days
what is contraindicated in c.diff?
no, loperamide is contraindicated as we want to get rid of the bacteria
how to treat endocarditis
amoxicillin, flucloxacillin (staphylococcus), benzylpenicillin (strep), vancomycin if MRSA
can add low dose gentamicin
treatment of mild CAP?
7 days:
amoxicillin
pen allergy: clarithromycin or doxycycline
treatment of moderate CAP?
amoxicillin+ clarithromycin or doxycycline
7 days
treatment of HAP?
7 days
early: <5 days
co-amox or cefurox
severe/ >5 days : piperacillin or broad spectrum quinolone
what would you add into the treatment of HAP if you suspected pseudomonas aeruginosa?
aminoglycoside
meningitis treatment?
empirical benzylpenicillin or cefotaxime
pen allergy: chloramphenicol
meningococcal: 7 days
pneumococcal: 14 days
h. influenzae: 10 days
osteomyelitis treatment
clindamycin: concentrates in the bones
flucloxicillin
if MRSA: +Vancomycin
conjunctivitis drops/ ointment dose?
chloramphenicol: 1 drop every 2 hours for the first day then 1 drop every 4 hours till day 5
Oint: TDS-QDS for 5 days
refer if no improvement in >48 hours
impetigo treatment?
Fusidic acid for 7 days
Flucloxicillin oral for 7 days if wide spread
cellulitis treatment?
Flucloxicillin 250-500mg QDS
Clindamycin
animal bites treatment:
co-amoxiclav 1-2 TDS for 7 days
doxycycline+ metro
MRSA treatment
Glycopeptide (vancomycin or teicoplanin which is better on the kidneys)
can give a tetracycline or linezolid as well
oral infection treatment and dose? and alternative
metronidazole 200mg TDS for 3 days
amoxicillin or doxy if allergic
can combine pen/ macrolide with metronidazole if needed
what should you do if theres no response to treatment of dental infection within 48 hours
switch to an alternative
sore throat treatment?
treatment if severe?
phenoxymethylpenicillin
benzylpenicillin
clarithromycin if pen allergic
what are sore throats caused by commonly
strep
otitis externa treatment and why
fluclox or clarithromycin as usually caused by staph
if youre going to treat otitis media what would you give treatment
when wouldn’t you treat it?
amoxicillin or Clari if allergic
only treat if it doesnt improve after 3 days or there are systemic symptoms
when should you not give amoxicillin?
in glandular fever: mapupapular rash
TB treatment:
initial phase for 2 months: Rifampicin Isonazid Pyrazinamide Ethambutol
continuous phase for 4 months:
RI
Cautions of TB treatment
all hepatotoxic
what should you report with ethambutol
visual changes
two things to monitor with linezolid
report any visual changes: ocular neuropathy
monitor bloods every week especially with treatment over 10-14 days
anaemia and thrombocyopenia
antibiotics effecting vision
linezolid: optic neuropathy
quinolones
ethambutol
Rifampicin can colour contacts red
which anti fungal should be avoided in HF
Itraconazole can cause HF
increased risk if with CCB
hepatotoxic antibiotics/ antifungals
itraconazole, ketoconazole fluconazole terbinafine voriconazole: supply with alert card
co-amox flucloxacillin erythromycin co-trimoxazole RI
drugs causing cholestatic jaundice
flucloxicillin
co-amoxiclav
nitrofurantoin
MHRA Ketoconazole
fatal hepatotoxity: do not use for anything except cushings
send back Rx if you see it
Voriconazole side effects
hepatotoxic and phototoxic
alert card for liver
SPF and avoid the sun
amphotericin side effects
nephrotoxicity
how to administer amphotericin
IV but monitor for 30 minutes as can cause anaphylaxis
not brand interchangeable
oral thrush treatment
POM nystatin
OTC metronidazole gel
if severe can give oral fluconazole
vulvovaginal thrush treatment
oral fluconazole
topical imidazole
what is tinea capatis
scalp ringworm
what is tinea cruris
jock itch
what is tinea pedis
athletes foot
what is terbinafine
treatment for athletes food ONLY
tinea pedis
treatment of tineas?
topical imidazoles: miconazole, clotrimazole
daktacort 10+ BD for 7 days
daktacort age restriction OTC
10+
DAKTACORT dose regimen for tinea treatment
BD for 7 days
OTC treatment of herpes simplex? +dose
aciclovir 5 times a day for 4 days with 4 hour intervals
Penciclovir: 12+ 8 times daily for 4 days with 2 hour intervals
what can be used as influenza prophylaxis? who would use this?
oseltamivir
> 65
diabetes
immunocompromised
ABCD acronym in malaria?
aware of risk
bite prevention
chemoprophylaxis
Diagnose promptly
strength of DEET?
age restriction
what must you wear with it
20-50%
>2 months old
suncream 35-40 SPF put on before DEET. DEET reduces the SPF of suncream
macaroni contains?
atorvaquone and proguanil
different regimens for malaria chemoprophylaxis?
- Malarone
- Chloroquine only
- Chloroquine and proguanil
- Mefloquine
- Doxycycline
before giving chloroquine what should be checked
the area for chloroquine resistance
doxycycline for malaria treatment regimen
1-2 days before and 4 weeks after
doxycycline CA labels
not to be given with CA, FE, ZN antacids 2 h before or after
photosensitivity
with a whole glass of water
if someone wants a quick get away holiday which malaria regimen should they take
doxycycline or macaroni as only 1-2 days before
MHRA for mefloquine
+ a counselling point
C/I if history of psychiatric disorders or convulsions
care when driving as can cause dizziness
stop and seek immediate medical attention if neuropsychiatric effects occur- replace with alternative anti-malarial
when can the side effects of mefloquine occur
months after stopping as long half life
Flucloxicillin safety?
hepatitis and liver toxicity
can occur 2weeks-2 months after stopping
length of treatment for chemoprophylaxis on malaria before and after travel
Usually 1 week before EXCEPT:
Mefloquine is 2-3 weeks to see if they tolerate
malarone and doxycycline are 1-2 days
after: usually 4 weeks
EXCEPT: Malarone which is 1 week after
malaria long term prophylaxis?
> 5 years: chloroquine and proguanil
2 years: doxy
1 year: mefloquine and malarone but if tolerated mefloquine can be used for up to 3 years
which malaria prophylaxis can be used for up to 5 years
chloroquine and proquanil
which malaria prophylaxis can be used for up to 2 years
doxycycline
which malaria prophylaxis can be used for up to 1 years
malarone and mefloquine but mefloquine can be used for up to 3 years
which anti malarials should be avoided in epilepsy
mefloquine and chloroquine
can give malarone
which anti malarials should be given in renal impairment
which should be avoided
give doxycycline or mefloquine
avoid: proguanil, malarone and chloroquine (if eGFR <30)
which anti malarials can be given in pregnancy
which cannot be given
chloroquine and proguanil
give proguanil with folic acid 5mg
mefloquine in the second/ third trimester if no alternative
dont give doxycycline or mefloquine
which patient group require different malaria chemoprophylaxis?
warfarin patients- start 1-2 weeks before to stabilise INR before
malaria treatment?
- falciparum: quinine, malarone, raiment
2. non-falciparum: chloroquine
what can be given as malaria stand by treatment. when would this be provided?
quinine if cant reach medical care within 24 hours
treatment of chlamydia and dose
alternative?
doxycycline 100mg BD 7 days
azithromycin if pregnant, allergies or breast feeding
when would you give azithromycin instead of doxycycline for treatment of chlamydia
pregnant, allergies or breast feeding
