Infection Flashcards
What drug works against anaerobic infections and protozoa?
metronidazole
If meningococcal septicaemia is suspected, a single stat dose of what should be given?
benzylpenicillin
(ceftaxime in penicillin allergy)
(chloramphenicol if both not suitable)
What are the treatment options for C.Diff infections?
Vancomycin
Fidaxomicin
What would be the treatment choice for bacterial vaginosis?
Metronidazole 5-7 days or single high dose stat
What would be the treatment choice for chlamydia?
Azithromycin or doxycycline
What is the treatment choice for pelvic inflammatory disease?
Doxy + Metro + single dose of IM ceftriaxone
What would be the treatment choice for an acute cough?
Doxycycline
What would be the first line choice for impetigo?
Hydrogen peroxide 1% cream
Treatment of cellulitis?
Fluclox
(clari if not suitable)
Prophylaxis of infection following animal or human bite?
Co-amox
(doxy with metro if unsuitable)
Treatment with aminoglycosides should not last longer than how many day?
7
What is the MHRA alert for aminoglycosides?
Ototoxicity
What condition are aminoglycosides contra-indicated in?
myasthenia gravis
What type of organisms do aminoglycosides work against?
gram negative
How would you manage obese patients taking aminoglycosides?
Use IBW
What is the therapeutic range of gentamicin for multiple daily dosing?
Peak: 5-10mg/L
Trough: <2mg/L
What is the peak and trough range for gentamicin when treating endocarditis with multiple daily dosing?
Peak: 3-5mg/L
Trough: <1mg/L
What specific bacteria is aminoglycosides active against?
pseudomonas aeruginosa
What are the treatment uses of aminoglycosides?
severe sepsis, pyelonephritis, complicated UTI, endocarditis
With once daily dosing, what is the renal cut off for gentamicin?
<20ml/min
With multiple daily dosing of gentamicin, after how many doses should a serum level be measured?
3-4 doses or after dose change
Which other drugs given alongside gentamicin, would be concerning for risk of ototoxicity?
Loop diuretics and cisplatin
What specific bacteria are carbapenems active against?
They are beta-lactam antibacterials having activity against pseudomonas aeruginosa
Why does imipenem have to be given alongside cilastatin?
Cilastatin is an enzyme inhibitor which prevents the renal enzymes from inactivating the imipenem
Name the carbapenems and what do they treat?
ertapenem - gynae infections, diabetic foot infections
meropenem - meningitis, endocarditis, chronic LRTI in CF
What is the only medication that interacts with meropenem?
sodium valproate
(decreases concentration of valproate)
Which cephalosporins are suitable against CNS infections?
ceftriaxone and cefotaxime
Cephalosporins have cross sensitivity with which other group of antibacterials?
penicillins
What is the treatment options and duration of treatment for bronchiectasis?
amox, doxy, clari
7-14 days
What is the treatment options and duration of treatment for COPD?
amox, doxy, clari
5 days
What is the treatment options and duration of treatment for acute bronchitis?
1st Doxy
amox, clari
5 days
What is the treatment options and duration of treatment for lower UTIs in women?
nitro or trimeth
fosfomycin
pivmecillinam
amox (only with susceptible)
3 days
What is the treatment options and duration of treatment for lower UTIs in men?
nitro or trimeth
fosfomycin
pivmecillinam
amox (only with susceptible)
7 days
What is the treatment options and duration of treatment for lower UTI in pregnant women?
1st Nitro
Amox or cefalexin
7-14 days
What is the treatment options and duration of treatment for acute prostatitis?
1st Ciprofloxacin
2nd Ofloxacin
14 days
What is the treatment options and duration of treatment for pyelonephritis?
1st cefalexin
ciprofloxacin
14 days
What is the treatment options and duration of treatment for C.Diff infections?
1st vancomycin
2nd fidaxomicin
10 days
What is the treatment options and duration of treatment for campylobacter?
clari or azithro
Cipro (high resistance)
5-7 days
What is the treatment options and duration of treatment for diverticulitis?
1st co-amox
cefalexin + metro
trimethoprim + metro
5 days
What is the treatment options and duration of treatment for cellulitis?
Fluclox
Clari
Erythro (pregnancy)
Doxy
7 days
What is the treatment options and duration of treatment for animal bites?
co-amox
Doxy + metro
Prophylaxis: 3 days
treatment: 5 days
What is the treatment options and duration of treatment for localised non-bullous impetigo?
Hydrogen peroxide 1%
fusidic acid 2%
5 days
What is the treatment options and duration of treatment for widespread non-bullous impetigo?
fusidic acid 2%
Oral fluclox
5 days
What is the treatment options and duration of treatment for acute otitis media?
1st amox
2nd co-amox
clari if unsuitable
5-7 days
What is the treatment options and duration of treatment for acute otitis externa?
If pseudomonas suspected:
Ciprofloxacin
Or else:
Penicillin
Clari if not suitable
7-14 days
Which drugs are risk factors for developing C.Diff?
clindamycin
Cephalosporins
Broad spec penicillins
Fluoroquinolones
PPIs
What are CRB65 and CURB65 used to assess?
Severity of CAP
What dose CURB65 stand for?
Confusion
Urea > 7
Resp rate > 30
BP < 90/60
65 years or older
(0-1 low risk)
(2 intermediate risk)
(3-5 high risk)
Which of the following medications does not interact with methotrexate?
-amoxicillin
-cefalexin
-ciprofloxacin
-trimethoprim
cefalexin
What gram bacteria are glycopeptides active against?
gram positive
Which of the following can be used for MRSA infections?
-aminoglycosides
-glycopeptides
-penicillins
glycopeptides (vancomycin)
Which two glycopeptide medications must not be given orally when used for systemic infections?
Vancomycin and teicoplanin
What is the benefit to using teicoplanin over vancomycin?
teicoplanin has zero order kinetics, vancomycin has first
What is the drawback to using teicoplanin vs vancomycin?
does not cross the BBB
what is the target trough level for vancomycin for general infections vs endocarditis?
10-15 mg/mL for general
15-20 mg/mL for endo
What are side effects of vancomycin?
-nephrotoxicity
-ototoxicity
-red man syndrome
-blood dyscrasias
-skin disorders (SJS)
-thrombophlebitis (pain/ inflammation of veins at infusion site)
What symptoms can occur when vancomycin is given too quickly?
Red man syndrome (flushing of upper body)
hypotension
bronchospasms
What indications are clindamycin a treatment option for?
Bone and joint infections
What major side effect is clindamycin associated with?
antibiotic associated colitis
What counselling points should be made to patient taking clindamycin?
If diarrhoea develops, stop medication and see GP
which antibiotic is used against amoebic infections?
mepacrine
Name the macrolides?
erythromycin
clarithromycin
azithromycin
What would you need to monitor on an ECG for macrolides?
QT prolongation
What indications are macrolides for?
campylobacter enteritis, resp, skin infections, h.pylori eradication
Is clarithromycin an CYP450 enzyme inducer or inhibitor?
Inhibitor
Which of the macrolides are CYP450 inhibitors?
Erythromycin and clarithromycin
what are the counselling points for azithromycin, erythromycin and clarithromycin?
azithromycin - before food/ indigestion remedies (2 hrs)
erythromycin - before indigestion remedies (2 hrs)
clarithromycin - taste disturbance
What are common side effects of macrolides?
GI upset
QT prolongation
Hepatotoxicity
Ototoxicity at high doses
Can you give aminoglycosides during pregnancy? which ones are safer?
yes, but not routinely unless no other choice
gent and tobra safe
What effect does clarithromycin have on warfarin?
Increased risk of bleeding
What effect does clarithromycin have on a statin?
Increased risk of myopathy
Which of the following medication does not interact with clarithromycin?
-colchicine
-carbamazepine
-ramipril
-ondansetron
-colchicine - increased colchicine toxicity
-carbamazepine - carb is enzyme inducer
-ramipril
-ondansetron - QT prolongation
which of the macrolides should not be taken during pregnancy? and which is safest?
Clarithromycin unsafe in pregnancy
Erythromycin preferred
What are the MHRA alerts for erythromycin?
- increased cardiac risks (QT prolongation) and risk of interaction with rivaroxaban
-risk of infantile hypertrophic pyloric stenosis
How do the following drugs interact with aminoglycosides?
-bisphosphonates
-loop diuretics
-digoxin
-bisphosphonates - hypocalcaemia
-loop diuretics - risk of ototoxicity and nephrotoxicity
-digoxin - dig toxicity
Which DOAC interacts with erythromycin?
rivaroxaban
What type of antibiotic is aztreonam?
Monobactam
What 3 things do you need to monitor with aminoglycosides?
-renal
-hearing
-levels
What is an example of an anaerobic infection?
Dental infections and bacterial vaginosis
What is an example of a protozoal infection?
vaginal trichomoniasis
What are the common side effects of metronidazole?
GI upset
Taste disturbance
oral mucositis
furred tongue
Important counselling points for metronidazole?
Take with or after food
Avoid alcohol during and for 48 hours after - disulfuram-like reaction (flushing, tachycardia and hypotension)
may discolour urine (dark urine)
taste disturbances
Which of the following does not interact with metronidazole?
-ciclosporin
-digoxin
-warfarin
-phenobarbital
-lithium
Digoxin
-ciclosporin - increases levels
-warfarin - increases INR
-phenobarbital - metronidazole metabolism increased
-lithium - increased levels
What is the formulation of choice for benpen and why?
By injection - inactivated by gastric acid
Which two of the penicillins are considered narrow spectrum?
benpen and penv
What is the antibiotic of choice for pneumoccocal meningitis?
Ceftriaxone/ cefotaxime