Infection Flashcards
What is the first line tx for human and animal bites?
co-amoxiclav
tx - 5dy
prophylaxis - 3dy
What is the second line tx for human and animal bites?
doxycyclinr + metronidazole
tx - 5dy
prophylaxis - 3dy
what do you use to tx human and animal scratches?
flucloxacillin
what is 1st line for tick bites (lyme disease)
doxycycline 100mg BD 21dy
what is 2nd line for tick bites (lyme disease)
amoxicillin 1g TDS 21dy
1st line for diabetic foot infection less than 2cm
flucloxacillin
2nd line or penicilin allergy for diabetic foot infection less than 2cm
clarithyromycin, erythromycin or doxycycline
1st line for diabetic foot infection - severe abscess or oestomyelitis
flucloxacillin or co-amox +/- gentamicin
2nd line or pen allergy for diabetic foot infection - severe abscess or oestomyelitis
co-trimoxazole +/- gentamicin
1st line for cellulitis
flucloxacillin
tx for cellulitis if pen allergy or if flucloxacillin unsuitable
clarithyromycin, erythromycin
doxycycline
co-amox
tx if infection near nose/eyes
co-amox
tx if infection near nose/eyes + pen allergy
clarithromycin + metronidazole
tx for low severity community acquired pneumonia
1st - amox
2nd doxy / clarithy / erytho
tx for moderate severity community acquired pneumonia
1st amox + clarith
2nd doxy or clarith
tx for high severity community acquired pneumonia
1st co-amox + clarith
2nd levofloxacin
c.diff tx
1st vancomycin
2nd fidaxomicin
life threat - vanco + iv metronidazole
travellers diarrhoea tx
Aithromycin
prophylaxis/tx - bismuth subsalicylate
otitis media
1st amox
2nd co-amox
or clarith/erytho if allergy
otitis externa
1st acetic acid 2%
2nd topical neomycin + corticosteriod
if systemic = fluclox
h.plyori tx
-triple therapy
-PPI (x omeprazole if clopidogrel) with amox 1g BD or metronidazole 400mg BD or clarithromycin 500mg BD
how do you diagnose h.pylori
urea 13C breath test x 2WK after PPI or 4WK after antibiotics
non-severe hospital acquired pneumonia tx
-1st co-amox
-2nd (adults) doxycl or cefalexin or co-trimox or levofloxacin
-2nd (child) clarithromycin
impetigo localised non-bullous
1st hydrogen peroxide
2nd fusidic acid or mupirocin 2%
impetigo wide spread non-bullous
fusidic acid or mupirocin
impetigo bullous or systemically unwell
1st flucloxacillin
2nd clarithy
lower uti men
1st nitrofurantoin or trimethoprim for 7DY
lower uti non preg
1st nitrofurantoin or trimethoprim
2nd pivmecillinam or fosfomycin
if uncomplicated 3DY
lower uti pregn
1st nitrofurantoin (if egfr >45)
2nd cefalexin or amox
7DY tx
what causes strep throat and scarlet fever and what is the tx?
-streptococcus
-1st phenoxymethylpenicillin
-2nd clarithromycin
scarlet fever symptoms
- flu like symp - high temp, swollen neck glands
-red rash small raised bumps rough feeling = sandpaper
-white coating on tongue
tx of acne vulgaris
adapalene, clindamycin, benzoyl peroxide, lymecycline
tx of bacterial vaginosis _ trichomoniasis
metronidazole
tx of chlamydia
doxy
tx of conjunctivitis b+ blepharitis
choramphenicol x under 2 (POM) or pregn
tx of dental absess
amox or metronidazole
tx of gonorrhoea
ceftriaxone or ciprofloxacin
tx of meningtisis
benzylpenicillin
tx of scabies
permethrin ( whole body)
tx of sinusitis
phenoxymethylpencillin or doxycl
tx of threatworm
mebendazole x under 2 or pregn
what pathogen causes community acquired pnuem
streptococcus pneumoniae
what pathogen causes uti
e.coli
what pathogen causes thrush
candida albicans
what pathogen causes cellulitis
staphylococcus aures
what pathogen causes meningitis
steptococcus pneumoniae
what are aminoglycosides
amikacin, gentamicin, neomycin, streptomycin, tobramycin
when does serum aminoglycosides conc need to be measured
all pt with parental
obesity, high doses, cystic fibrosis and elderly
measure after 3-4 doses then every 3DY and after dose change
what is peak concentration
level after 1hr after dose - if high lower dose.
for aminoglycosides conc = 5-10mg/l endocarditis - 3-5mg/l
what is trough concentration
level before next dose - if high increase interval
for aminoglycosides conc = <2 mg/l endocarditis -<1mg/l
renal impairment and aminoglycosides
increase dose interval if severe decrease dose
avoid co-comitant use of nephrotoxic drugs
what is the MHRA warning with aminoglycosides
use of aminoglycosides assoc with ototoxicity
- interactions with cisplatin, loop diuretics (furosemide, bumentide, torsemide), vancomycin, vinca alkaloids (vinblastine, vinasitine, vindesine, vinflusline)
CI with aminoglycosides
myarthesria gravis
pregn - risk of auditory or vestibular nerve damage
obesity - ideal body weight for parental dose
1st gen of cephalosporins
cefadroxil, cefalexin, cefradine
2nd gen of cephalosporins
cefuroxime, cefoxitin, cefaclor
3rd + 5th gen of cephalosporins
all parental apart from oral cefixime
is cephalosporins okay in penicillin allergy?
if hypersensitivity to penicillin or other beta-lactams there is cross sensitivity so NO
s/e of clindamycin
-antibiotic assoc-colitis can be fatal high risk in elderly contact doc if severe, prolonged or bloody diarrhoea
-in c.diff if suspected discontinue
what are glycopeptides
dalbavancin, teicoplanin, tstevancin + vancomycin
caution with glycopeptides
-for systemic infections use parental route with vancomycin due to low absorption with oral route
-avoid in pregn (benefit vs risk)
-initial dose based on weight then adjust based on vanco conc = trough = 15-20
-can cause ototoxicity and nephrotoxicity
glycopeptides s/e
-red man syndrome
-severe cutaneous adverse steven-johnson syndrome
-blood dyserasis - agranulocytosis, eosinophilia + neutropenia
-cardiogenic shock on rapid IV inj
-risk of anphylactoid reactions at infusion site avoid rapid infusion and rotate site
linezolid caution
-risk of severe optic neuropathy - report visual impairment + monitor reg if tx more than 28DY
-risk of blood disorders - weekly monitor FBC regular if tx more than 10-14DY
linezolid interactions
-tyramine rich foods - mature cheese, marmite, yeast extract, fermented soya bean extract, beers and wine
linezolid + serotonin syndrome
- SSRI, dipaminergics, 5-HT1 agonists, TCAs, lithium + MOAIs
what are macrolides
azithromycin (OD), clarithromycin (BD), erythromycin (QDS)
macrolides caution
-myasthenia gravis
-pregn only erytho
macrolides s/e
-hepatoxity
-ototoxicity (hearing loss in high dose)
- high GI s.e N+V+D
-QT prolongation
macrolides interactions
- cyp450 inhibitors - statins inc myopathy, warfarin inc bleeding
-hypokalaemia - loop diureitcs/thiazides, steroids, salbutamol, theophylline,
-QT prolongation - amiadrone, domperidone, fluconazole, lithium, methadone, ondansetron, quinine, quinolones, SSRIs, sotalol
metronidazole s/e
-taste disturbance, metallic taste, furred tongue
-n+v
- x alcohol (48hr after)
nitrofurantoin caution
-x pregn
-renal impairment avoid if egfr <45
-may discolour urine yellow/brown
-with/after food
narrow spectrum penicillin (beta lactamase sensitive)
-penicilin G benzylpenicillin
–>x gastric acid safe so only parental
-penicillin V phenoxymethylpenicillin
–> gastric safe
broad spectrum penicillin (beta lactamase sensitive)
-amox
-amox + clavulanic acid (co-amox) –> beta lactamase resistant
broad spectrum penicillin side effects
-diarrhoea
-maculopapular rashes commonly occur in pt = glandular fever x use broad spec in sore throats blindly
penicillinase resistant penicillin
- fluclox
-empty acid 1hr before food / 2hr after food - cholestastic jaundice + hepatitis = v rare but up to 2 MT POST TX
-if more than 2wk inc s.e with age
antipseudomonal penicillin
-piperacillin + tazobactam
- ticarcillin + clavulanic acid
s/e of penicillin
- x intrathecathy - encephalopathy = fatal
- true penc allergy ; rashes or anaphylactic
- x allergy ; minor rashes, small, hot, itchy + con-confluent or rash after 72hr
-cross sens - x give cephlasporins
quinolones
ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin
quinolones caution + s/e
-lower seizure threshold avoid in epilepsy
- psychotic disorders
- tendon disorders
-hypersen reactions
- sunlight + uv radiation lower exposure
- impair driving
quinolones MHRA
-tendinitis - higher in 60+, stop and seek advice if suspected
- small risk of aneurysm + dissection (sudden onset, severe abdominal chest back pain)
-small heart valve regurgitation (SoB, peripheral, new heart palpations, odema)
quinolones caution
-qt prolongation
-myasthenia gravis
-arthropathy in children and teens
-perforated tympanic membrane (ear)
quinolones interaction
food, water - avoid dairy products, mineral fortified drinks, lower absorption of drugs - qt prolongation
-seizure threshold + NSAIDs (ibuprofen)
tetracyclines
doxycycline, demeclocycline, lymecycline, minocycline, oxytetracycline, tetracycline + tigecycline
-x milk, indigestion remedies (iron, zinc) 2hr before or after
tetracyclines + milk
DOES LIKE MILK
doxy, lymcy, minocycl
tetracyclines s/e
-benign intracranial hypertension - stop if headache + visual impairment
-lupus -erythematosus like syndrome + irreversible pigmentation - more in minocyc
-teeth discolouration + bone deposits x under 12 or preg
tetracyclines counselling points
-hepatotoxic - avoid liver failure
-photosensitivity - avoid exposure to sunlight or sunlamps
- dysphagia - swallowed whole while standing
-caution myasthenia gravis
trimethoprim interactions
-may cause blood dyscrasis - long tx look for blood disorder signs (fever, sore throat, rash, mouth ulcers, bruising, or bleeding)
-antifolate x pregn interaction with methotrexate + phenytoin
-renal impairment
-hyperkalaemia
narrow spectrum antibiotics
-less stomach s/e
- penicillin V + G
-glycopeptides
-trimethoprim
-linezolid
-clindamycin
broad spectrum antibiotics
-chloramphenicol
-aminoglycosides
-penicillin (amox _ ampicillin)
-tetracycline
-nitrofurantoin
-macrolides
-cephalosporins
-quinolones
anaerobic antibiotic
metronidazole
bacteriostatic antibiotics
prevents bacterial growth
-chloramphenicol
-linezolid
-tetracycline
-macrolides
-clindamycin
bactericidal antibiotics
kills bacteria
-cephalosporins
-aminoglycosides
-nitrofurantoin
-trimethoprim
-quinolones
-metronidazole
-glycopeptides
-penicillin
antibiotics with/after food
-metronidazole
-nitrofu
-clarith MR
- pivermecilinam
antibiotics empty stomach 30-60mins before/2hr after
-fluclox
-phenoxymeth
-azithro caps
-tetracy + oxytetracycline
caution in myasthenia gravis
-quinolones
-aminoglycosides
-macrolides
-tetracyc
nephrotoxic antibiotics
-nitrofur
-aminoglycosides
-gylcopepides
-tetracycl
-trimetho
heptotoxic antibiotics
-macrolides
-flucloxacillin
-co-amox
-chloramphenicol
-nitrofur
-tetracycli
-rifampicin + isoniazid + pyrazinamide
TB initial phase tx
TWO MONTHS
-rifampicin
-isoniazid
-pyrazinamide
-ethambutol
TB continuous phase tx
FOUR MONTHS
-rifampicin
-isoniazid
latent TB tx
3 MONTHS of rifampicin + isoniazid or 6 MONTHS of isoniazid
TB medication
-clear hepatotoxicity 35-65
-rifampicin - discolour soft contact lesnes + bodily fluids orangey red. enzyme inducer
-isoniazid - neuropathy - prophylactic pyridoxine HCL (vit b6) given - cyp450 inhibitor
-pyrazinamide = heptatotoxic
-ethambutol = visual impairment + ocular toxicity
tx of aspergillons
voriconazole
tx of cryptococlosis
amphotericin B
tx of thrush
-vaginal - clotrimazole / fluconazole or itraconazole
- oral - nystatin/miconazole/fluconazole/ itraconazole
tx of skin + nail infections
topical therapy -> systemic therapy itraconazole, terbinafine
tinea (ringworm)
tinea capitis - head
tinea corporis - body
tinea crusis - groin
tinea pedis - feet
tinea uriguium/longchontosis - nails
tinea (ringworm) tx
topical antifungal cream or terbinafine
duration of nail region terbinafine or amorofine nail laquer
OW for 1 yr
refer to gp if l<18, 2+ nails, diabetic, pregnant/BF
antifungal medications
fluconazole, itraconazole, ketoconazole, voriconazole
qt prolongation + heptatotoxicity (less in flucon,ketocon,voricom,itracon)
amphotericin B
-caution in renal failure,
-anaphylaxiss risk in IV - 30 min observation
-maintain same formulation between conventional, liposomal, lipid-complex formulation
Itraconazole
carbonated drinks inc bioavailability
ketoconazole
life threatening hepatotoxicity - oral tx suspended
voriconazole
photosensitivity occurs uncommonly - avoid sunlight exposure
terbinafine
hepatotoxicity
tx of varicella zoster, chickenox, herpes zoster, shingles
Aciclovir, valaclovir (prodrug)
chickenpox
-pt 14+ = antiviral 24hr onset
herpes/shingles
-tingling sensation, burning, fluid filled blisters,
-shingles follow pattern of individual nerve on one side of body looks like blet/half belt around ribcage/torso
malaria bite protection
-not absolute
-mosquito net impregnated permethrin
-diethyltoluamide (DEET) 20-50% (50% longer protection)
–>suitable for 2+ MT
–>avoid ingestion - wash hands
–>suitable pregn + BF
–>apply SPF then DEET
malaria prophylaxis tx
malarone, chloroquine, proguanil, mefloquine, doxycycline
IF ILLNESS OCCURS IN 1 YR ESP 3MT AFTER RETURN = MALARIA
malarone + atorvaquone + proguanil
-before travel - 1-2DY
-dosage - 1OD
-after travel - 1WK
-max use - 1YR
chloroquine
-before travel -1WK
-dosage - OW
-after travel -4WK
-max use -LONG TERM
progunanil
-before travel -1WK
-dosage -1OD
-after travel -4WK
-max use -LONG TERM
mefloquine
-before travel -2-3WK
-dosage -OW
-after travel -4WK
-max use -1YR
doxycycline
-before travel -1-2DY
-dosage -1OD
-after travel -4WK
-max use -2YR
malaria pt groups
-asplenia - high risk of malaria
-pregn - avoid travelling to regions with malaria. can give chloroquine + proguanil + 5mg folic acid (neural tube defect risk)
malaria medication groups
-epilepsy avoid chloroquine + mefoloquine
- warfarin - start tx 2-3wk before travel
–> INR stable before travel
–>INR measured before antimalarials, 7DY after starting + after completing
–>prolonged stay check INR regularly
antimalarial caution
-mefloquine - psychiatric disorders develops stop. convulsions
-chloroquine - convulsions, retinotoxic
-proguanil - renal impairment lower dose
- doxyc avoid sunlight exposure
malaria standby tx
-travelling = emergency standby tx if 24+HR away from medical care
-avoid self medication if access available
-written instructions provided - seek urgent if fever (38+) develops 7DY after arriving
-self tx if no help available within 24hr of fever onset
