INFECTION Flashcards
1
Q
What is a super infection
A
An infection on top another infection eg cephalosporin eg fungal infections or abx associated colitis
2
Q
Examples of broad spectrum abx
A
Aminoglycosides
Macrolides
Carbapenems
Cephalosporin
Tetracycline
Quinolones
Ampicillin
Amoxicillin
Chloramphenicol
3
Q
Examples of narrow spectrum Abx
A
Vancomycin, Teicoplanin
Penicillin G
Clindamycin
Mnemonic
Narrow TV and PC
4
Q
What is sepsis
A
A life threatening medical emergency, affects body reaction to severe infection, affects whole body
5
Q
What is septicemia
A
Infection of the blood caused by bacteria, fungi or virus
6
Q
Symptoms of sepsis in adults
A
Shivering
Extreme pain or general discomfort (worst ever)
Pale or discoloured skin
Sleepy, lethargic
I feel like I might die”
Shortness of breath
7
Q
Mnemonic of sepsis
A
SEPSIS
8
Q
Signs of sepsis to watch out for in children/ babies
A
Very high or low temperature ( feels hot or cold to touch)
No urine in last 12hours
Vomiting
Breathing fast ( breathlessness)
Non- blanching rash- like meningitis
Blue/ pale skin or lips
Babies ( High pitch cry and lethargic)
9
Q
Call 999 or go to A and E if a baby or young child has any of the following symptoms
A
See photo
10
Q
How to treat sepsis
A
Give broad spectrum antibiotics at max recommended dose ideally within 1hour to reduce risk od severe illness or death for pat at high risk
11
Q
Give example of abx offered to pt with meningcocal sepsis in a community setting
A
Parental benzylpenicillin
12
Q
What broad spectrum abx is offered to pt with meningococcal sepsis in hospital setting
A
IV ceftraxone
13
Q
Parameters to monitor in high risk patients every 30 mins with sepsis
A
High resp. Rate, regularly no less than every 30mins
14
Q
What are notifiable disease
A
Disease where there could be a public health risk
Doctors must notify the proper officer, the local authority
Eg anthrax, whooping cough, small pox, TB , typhoid
15
Q
Which abx needs to be taken before food/empty stomach?
A
DROPFAT
Label 23 and 22
Demecyclocycline
Rifampicin
Oxytetracycline
Phenoxymethyl penicillin
Flucloxacillin
Ampicillin
Tetracycline
An hour before food or two hours after food
30-60mins before food
16
Q
List of abx to be taken with food or just after food
A
Label 21
MPN
Metronidazole
Nitrofurantoin
Pvmecillinam
17
Q
Which abx can be taken with milk
A
Label 6
DOX Like Milk
Doxycycline
Lymecycline
Minocycline
18
Q
Abx you cannot take with milk
A
C.DOT
Label 7
Ciprofloxacin
Demeclocycline
Oxytetracycline
Tetracycline
19
Q
Abx that require protection against sunlight (photosensitivity)
A
Doxycycline
Demeclocycline - most sensitive to sunlight
Tetracyclines
20
Q
Abx to avoid in pregnancy
A
Tetracycline
Aminoglycoside
Macrolides
Co-trimaxole
Rifampicin
Metronidazole
Quinolones
Nitrofurantoin
21
Q
Important safety information and advice for flucloxacillin
A
Cholestatic jaundice and hepatitis
22
Q
Contraindication of co-amoxiclav
A
History of co-amoxiclav-associated jaundice or hepatic dysfunction; history of penicillin-associated jaundice or hepatic dysfunction
23
Q
Important safety information for linezolid
A
Blood disorder and optc neuropathy
24
Q
Safety warning for Co-trimoxazole
A
Discontinue if ( severe allergic rxn and blood disorder occur
25
Safety warning for Quinolones
Tendon damage, arthropathy( joint problems) in children and convulsions with NSAIDs
See Bnf
26
What abx color urine and what color?
Rifampicin
Nitrofurantoin
Orange/brown
27
Signs of blood disorder caused by abx
Sore throat
Fever
Malaise
Rash
Mouth ulcers
Bruising or bleeding
28
Which Abx cause blood disorder
Trimethoprim
Co-trimoxazole
Linezolid
Gentamicin
Vancomycin
29
Contraindications with penicillin
Penicillin allergy
30
Contraindications with tetracyclines
Children less than 12 and pregnant
31
Contraindications with Quinolones
Hx of tendon disorders related to Quinolones use
32
Contraindications with Aminoglycoside
Myasthenia gravis
33
First line tx c.diff
Vancomycin
34
Whats the second line tx for c diff
Fidaxomicin
35
Relapse less than 12 weeks for c diff
Give fidaxomicin
36
Relapse greater than 12 weeks
Give fidaxomicin or Vancomycin
37
If first and 2nd line not effective for c diff
Use IV Metronidazole initiated by Specialist
38
Tx for acute pyelonephritis in non pregnant women and men
Oral first line
Cefalexin or ciprofloxacin
First line IV: Amikacin , gentamicin, ceftrixone and ciprofloxacin
39
First line tx for pyelonephritis in pregnant women
Oral - cefalexin
IV: cefuroxime
40
What abx do you give for animal/ human bite?
Co-amoxiclav
Allergy- Doxycycline plus Metronidazole
41
What to give a pt with cellulitis who is allergic to penicillin( flucloxacillin)?
Clarithromycin, dox or erythromycin
42
Causative organism for UTI
E.coli
43
Causative organism for whooping cough
Bordetella pertusis
44
Causative organism for gonorrhea
Neisseria gonorrhoea
45
Causative organism for colitis
Clostridium difficle
46
Causative organism for TB
Mycobacteria tuberculosis
47
Causative organism for food poisoning
Salmonella, shigella, E.coli, norovirus
48
Abx to tx anaerobic infections
Metronidazole
49
Abx to tx streptococci infection
Phenoxymethypenicillin
50
Abx to tx staphylococcal infections
Flucloxacillin
51
Abx to tx MRSA
Vancomycin
52
Abx to tx pseudonyms aeruginosa
Gentamicin
53
Abx used to tx hospital acquired pneumonia ( Non severe signs and symptoms)
Oral co-amoxiclav alternatively Dox or co- trimoxazole( unlicensed)
54
Abx used to tx CAP
Amoxicillin alternatively dox or erythromycin or clarithromycin
High Severity- Co-amoxiclav with clarithromycin
55
What is CURB65 score?
It is used to assess the Severity of pneumonia
C- confusion
U- Urea
R- Respiratory rate
B- blood pressure
65 = Age greater or equal to 65
56
Contraindications of Aminoglycoside
Myasthenia gravis
57
Common side effects of Aminoglycoside eg Gentamicin
Ototoxicity
Nephrotoxicity( occurs mostly in patients with Renal impairment)
Risk in pregnancy ( auditory nerve damage in infant)
58
Signs of Ototoxicity
Tinnitus or ringing in the ear
Hearing loss
Dizziness
Uncoordination in movement
59
Signs of nephrotoxicity
Decreased urine output
SOB
Fluid retention ( swelling in legs, ankles and feet)
Fatigue
60
Dose adjustment in renal impairment in pt taken Aminoglycoside
If renal impairment, increase dose interval
Reduce dose in severe impairment
61
Monitoring requirements with Aminoglycoside
Plasma concentration
Renal function
Auditory and vestibular function
62
Side effects of Gentamicin
Abx associated colitis
Blood disorder
Depression
Neurotoxicity
Vestibular damage
Skin reactions
Tinnitus N and V
Neurotoxicity
Deafness
Increased infection
63
CHM/ MHRA warning for Aminoglycoside
Increase risk of deafness(Ototoxicity) in pts with mitochondrial mutation
Potential for histamine related adrs with some batches , caution with patients on drugs which release histamine eg opiods
64
What bacteria is Gentamicin used against
It is used to tx pseudomonas aeroginosa, other E.coli , klebsiella , staph aureus etc
65
What are some examples of carbapenems
Imipenem, meropenem, ertapenem and doripenem
66
Side effects of carbapenems
Diarrhoea, N and V
Headache
Allergy and cross sensitivity
67
MOA of cephalosporin
Attach to penicillin binding proteins to interrupt cell wall biosynthesis leading to Bacterial cell lysis or death
68
Indication of cephalosporin
Septicaemia, pneumonia, meningitis billary tract infections, peritonitis and urinary tract infection
69
How's cephalosporin excreted?
Renally
70
Cephalosporin is structurally similar to...
Penicillin
71
List examples of cephalosporin suitable for infections of CNS eg meningitis
Cefotaxime and ceftriaxone
72
Main side effect cephalosporin
Allergy and anaphylaxis
73
What is the therapeutic class of vancomycin
Glycopeptide antibacterials
74
Drug action of Vancomycin
Bactericidal activity against aerobic and anaerobic Gram positive Bacteria
75
Indication of Vancomycin
C.difficile
76
What is the side effect of Vancomycin
Agranulocytosis, dizziness, drug fever hypersensitivity, neutropenia, skin rxns, RED man syndrome ( Infusion related rxn)
77
State when to withdraw Vancomycin
Discontinue if Tinnitus occurs
78
Monitoring with Vancomycin
Trough conc range 10-20mg/L
Monitor FBC , renal and hepatic function
Vestibular and auditory function
79
Drug action of Clindamycin
Against Gram positive bacteria
80
Indication of Clindamycin
Bone and joint infections eg osteomyelitis, potential bone and joint infection
Alternative to Macrolides esp in penicillin sensitive patients
81
Clindamycin is contraindicated in
Diarrhoea state
82
Side effects of Clindamycin
Abx associated colitis( fatal) occurs most frequently with Clindamycin than other abx
83
State when to discontinue Clindamycin
Discontinue if diarrhoea occur and Contact Dr.
Discontinue if c.difficile suspected or confirmed ( diarrhoea and watery stool
84
Monitoring with Clindamycin
Liver and renal function if tx exceed 10days
85
Examples of Macrolides
Erythromycin, clarithromycin, Azithromycin
86
MOA of Macrolides
Bacteriostatic, they stop bacteria cell growth
87
Facts about Macrolides
Broad spectrum abx
Similar to penicillin
Active against many penicillin resistant staphylococcus
Alternative for penicillin allergic pts
88
Common indication of Macrolides
Respiratory/skin /soft tissue infection
Severe pneumonia
Eradication of H.pylori with PPI and amoxicillin
89
Interaction of Macrolides
Clarithromycin and erythromycin are enzyme inhibitors
Increase plasma concentration of drugs eg warfarin and simvastatin- muscles pain
90
Indication of erythromycin
Respiratory tract infection, legionella, skin and oral infection, campylobacter enteritis, early syphilis
91
Side effects of Erythromycin
N,V and diarrhoea ( give lower dose to avoid in mild infection
92
Cautionary labels for Erythromycin
Label 9
Swallow this medicine whole
Space dose evenly via out the day
93
Is erythromycin safe in pregnancy and bf?
Use only if potential benefit outweighs risk
94
Erythromycin might cause what kind of impairment
May cause hepatoxicity
Cerebral impairment,
AV block
can cause Ototoxicity in adults and children at high doses
95
Facts about Azithromycin
Less active than erythromycin over Gram positive but enhanced activity over some Gram negative and H influenza
96
Half life of Azithromycin
Long tissue half life and Once daily dosage recommended
97
Pregnancy and Breastfeeding with Azithromycin
Use only if no other alternative
98
Cautionary label for Azithromycin
Label 5, 9 for other medicinal forms and 23 for capsules
Label 23 -"take this medicine when your stomach is empty or 2hrs before or after food
99
What is Azithromycin used to tx OTC?
Confirmed asymptomatic Chlamydia infection in age greater than 16 old and sexual partner ( needs a doctors prescription)
100
Dose of Azithromycin used to tx Chlamydia
Max single dose of 1g , max daily dose 1g and a pack size of 1g
101
First line tx for Chlamydia
Doxycycline
102
Alternative treatment for uncomplicated chlamydial infection
Azithromycin
103
Facts about Clarithromycin
Erythromycin derivative with slightly greater activity
Most commonly prescribed Macrolides, more stable and causes less side effect
Tissue conc higher than with Erythromycin
Given twice daily
104
Indication of clarithromycin
See bnf
105
Is clarithromycin safe in pregnancy?
Avoid especially in the first trimester. Only use if benefit outweigh risk
106
Clarithromycin in hepatic and renal impairment
Avoid
107
Cautionary labels for clarithromycin
9
Space dose evenly throughout the day
108
Side effects of penicillin
Hypersensitivity
Diarrhoea
Encephalopathy when given intrathecal injection
109
Higher risk of anaphylaxis occur in which patient group taking penicillin?
Asthma
Eczema
Hayfever
110
Facts about benzylpenicillin
Pen G, inactivated by beta lactamases
Inactivated by gastric acid and absorption from GI Tract is low, therefore must be given by injection
111
Indication of Benzylpenicillin
Throat infections, otitis media, cellulitis, pneumonia, anthrax and streptococcal infection, meningitis
112
Important safety information for Pen G
Intrathecal injection not recommended
113
Caution with Pen G
Accumulation of sodium from injection can occur with high doses especially in renal failure
114
Side effects of PEN G
Fever
115
Is PenG harmful in pregnancy and BF?
Not known to be harmful
116
Benzylpenicillin and renal Impairment
High doses may cause neurotoxicity ( cerebral irritation, convulsion or coma
117
All penicillin safe in pregnancy. True/false
True
118
Facts about PEN V( phenoxymethypenicillin)
Similar activity to pen G
Gastric acid stable , so suitable for oral administration
119
Indication for Pen V
Indicated principally for respiratory infections in children, oral infections, tonsillitis, otitis media, cellulitis, streptococcal infections and acute sinusitis
120
Side effects of PenV
Coagulation disorder, increased risk of infection , neurotoxicity, oral disorder, paraesthesia
121
Cautionary label for pen V
9 and 23
Take this medicine when your tummy is empty. An hour before food or two hrs after food
Space dose evenly via out the day
Drop fat
122
Facts about ampicillin
Active against certain Gram positive and Gram negative organism
Can be given orally but less than half absorbed
Absorption further decreased by presence of food in gut( take before food)
123
Main indication of Ampicillin
Chronic bronchitis
Middle ear infection and UTI
124
Side effects of penicillin
Maculopapular rash( Ampicillin and amoxicillin)
Colitis haemorrhagic
125
Cautionary label for Ampicillin
9 and 23
126
Facts about amoxicillin
Derivative of Ampicillin with similar antibacterial spectrum
Better absorbed by mouth than Ampicillin which produces higher plasma and tissue concentration
Absorption not affected by food
127
Indication of amoxicillin
UTI, otitis media sinusitis, uncomplicated CAP, salmonellosis, oral infections, Lyme disease anthrax, dental assessment, H.pylori
128
Cautionary label for amoxicillin
9
Space dose evenly through out the day
129
State how to differentiate between a severe and minor side effect of pen (allergy)
Immediate rash indicate severe
Rash after 3days, small rash non itchy- minor side effect. Continue taking penicillin
130
Major Interaction of amoxicillin
Allopurinol- increase risk of skin rash
Methotrexate- increase risk of toxicity
Warfarin- Alters Anticoagulant effect of Warfarin
W.A.M
131
Facts about Co- amoxiclav
Betalactamase inhibitor
Amoxicillin with clavulanic acid
132
What infection is Co-amoxiclav used for?
Reserved for infections caused by amoxicillin resistant beta lactamase producing strain
133
Is Co-amoxiclav safe in pregnancy?
Not known to be harmful
134
Contraindication of co-amoxiclav
History of co-amoxiclav-associated jaundice or hepatic dysfunction; history of penicillin-associated jaundice or hepatic dysfunction
135
Facts about flucloxacillin
Effective against infections caused by penicillin resistant staphylococcus ( impetigo, otitis external, cellulitis, pneumonia
Acid stable
Give orally or injection
136
Safety info for flucloxacillin
Hepatic disorders such as cholestatic jaundice and hepatitis may occur rarely up to 2months after flucloxacillin had been stopped
Admin for greater 2wks and increasing age are risk factors
137
Advice for flucloxacillin
Don't use in pt with hx of hepatic dysfunction associated with flucloxacillin
Caution in pt with hepatic impairment
Carefu enquiry should be made about hypersensitivity reactions to beta lactam antibiotics
138
Alternative for penicillin allergy
Macrolides/tetracycline
DEC
Doxycycline, erythromycin and clarithromycin
139
Egs of Quinolones
Nalidixic acid, norfloxacin, ciprofloxacin, ofloxacin
140
Indication of Quinolones
Uncomplicated UTI
Respiratory infections
Bone and joints infections
Gonorrhoea
GI infections
Avoid in MRSA infections (not effective)
141
Safety info for Quinolones
May induce convulsions in pts with or without hx of seizure
Taking NSAIDs at the same may induce convulsions
Tendon damage in pts within 48hrs of starting tx
Patient > 60yrs higher risk of tendon damage
Concomitant use with corticosteroid can increase the risk of tendon damage
142
State when to discontinue Quinolones
If tendinitis occur
143
Contraindications of Quinolones
Hx of tendon damage associated with Quinolones use
144
Caution with Quinolones
QT prolongation
Increase risk of Arrhythmia
Pts with hx of epilepsy or seizure
Avoid exposure to excessive sunlight
Discontinue if photosensitivity occur
145
Is Quinolones safe in children and growing adults?
Not recommended
Can cause athripathy ( joint diseases eg arthritis
146
State when to discontinue Quinolones
If psychiatric, neurological ( hallucination) or hypersensitivity reactions occur
147
Quinolones causes athropathy in pregnancy. True or false?
True
148
Cautionary label for Quinolones
7, 9 and 25
149
Are tetracycline broad or narrow spectrum abx?
Broad ( value decrease due to resistance)
150
Common indication of tetracycline
Acne, pneumonia, Chlamydia and rickettsia
MRSA infections
151
Eg of tetracycline that is different from the rest
MINOCYCLINE
152
Facts about Minocycline
Broader spectrum
Greater risk if lupus- like syndrome ( photosensitive rash, swelling, unexplained fever etc)
Sometime cause irreversible pigmentation
153
Caution for tetracycline
Can increase muscle weakness in pts with myasthenia gravis
Antacids and aluminium, Ca, Fe, Mg and Zn salts decrease absorption of Tetracycline and milk
9,7, 6,11
See bnf
154
State when to discontinue tetracycline
If intracranial hypertension ( headache and visual disturbance occur)
155
Side effects of tetracycline
Headache
N and V ,D
Photosensitivity rxn
Skin reactions
Discolouration of tooth enamel in children
Dysphagia and oesophageal irritation esp with DMT - advice pt to swallow whole with plenty of fluid during meals while standing or sitting upright ( label 27)
156
Important interactions of tetracycline
Do not give within 2hrs before or after food
Photosensitivity esp dox and demeclocycline
Binds to diavalent cations preventing absorption of Cations such as , Fe , Ca and antacids
157
Contraindications of tetracycline
Avoid in under 12's, pregnant and Breastfeeding
Binds to growing teeth and bones
Leads to discontinuation of child's teeth in 2nd and 3rd trimester
158
When to avoid tetracycline/ caution
Pts with hepatic impairment
159
What's Trimethoprim indicated for?
UTI and respiratory tract infections( chronic bronchitis, pneumonia
160
Mode of action of Trimethoprim
Bacteriostatic
Folate antagonist, therefore Teratogenic and can cause blood disorder( broad spectrum abx)
161
Trimethoprim is contraindicated in
Blood disorders
162
Side effects of Trimethoprim
Diarrhoea, electrolytes imbalance, fungal overgrowth, headache, nausea, skin reactions, vomiting and blood disorder
163
When to avoid Trimethoprim in pregnancy
Avoid in first trimester (Teratogenic) causes fetal abnormalities
164
Monitoring while on Trimethoprim
Full blood counts on long term therapy
Renal function
Electrolyte- due to risk of hyperkalaemia
Plasma - trimethoprim concentration
165
Patient and carer's advice
Long term tx patient how to recognise signs of blood disorder
166
State the symptoms of blood disorder to watch out for patients on Trimethoprim
Fever, sore throat, rash, mouth ulcers, purpura , bruising or bleeding develops
167
Cautionary label for Trimethoprim
Label 9
168
The only abx that is a MAOI is called
LINEZOLID
169
MHRA/CHM warning for Linezolid
Severe optic neuropathy particularly if used longer than 28days
Warn pt to report signs of impairment
Blood disorders
Can cause Hypertensive crisis, avoid eating tyramine rich food
170
Signs of visual impairment for pt on Linezolid
Blurred vision, visual field defect, changes in colour and visual acuity immediately
171
How often should you monitor blood count/ platelet count in patient taken Linezolid?
Weekly
172
Facts about Linezolid used as abx
It's a reversible , non selective inhibitor of MAO, however it dose used as abx does not have any antidepressant effect
173
Indication of Nitrofurantoin
UTI
174
Treatment duration of Nitrofurantoin
Usually 3days
175
Nitrofurantoin tx duration in male and pregnant women
7days
176
Contraindication of Nitrofurantoin
Acute porphyria, G6PD deficiency, infant less than 3 months
177
Caution with Nitrofurantoin
Anaemia, diabetes, electrolytes imbalance, folate deficiency, pulmonary disease, Vit B deficiency
178
Is Nitrofurantoin safe in pregnancy?
Avoid at term, may produce neonatal haemolysis
179
Renal impairment with Nitrofurantoin
Avoid if EGFR is less than 45ml/mins
Use with caution if EGFR is 30-34 as a short course for 7days to tx uncomplicated UTI caused by suspected or proven multi drug resistant bacteria and if benefit outweighs risk
180
Monitoring with Nitrofurantoin
Liver function
Pulmonary function especially in elderly
Avoid if deterioration in lung function
181
Dose of Nitrofurantoin used to tx lower UTI
50mg QDS (IR)
100mg BD ( MR) for 3days
182
Tx dose for Nitrofurantoin in male and pregnant women
50mg QDS [ IR]
Or
100mg BD for 7days
183
Tx dose of Trimethoprim for lower UTI
200mg BD for 3days
184
Tx dose of Trimethoprim for lower UTI in male
200mg BD for 7days
185
How many drugs are used in the initial phase to tx TB
Four(4) drugs
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
(RIPE)
2months duration
186
How many drugs used in the continuous phase to tx tB and duration
Two(2) drugs
RIISON
Rifampicin and Isoniazid
4months
187
All tuberculosis drugs but one are hepatoxic . Name the one
Ethambutol
188
Monitoring requirements with TB drugs
Signs of hepatoxicity
Check renal and hepatic function before tx
189
What are the signs of liver toxicity to watch out for?
Fever, malaise, vomiting, jaundice, unexplained deterioration
190
How often should you monitor pts with preexisting liver disease and alcohol dependence taking TB drugs?
Frequent liver check in first two months
191
Facts about Rifampicin
It's an enzyme inducer
Can cause discolouration of urine( orange -red)
Colour soft contact lenses
192
Patient and carer advice for Rifampicin
Colour soft contact lenses
Discontinue medicine if signs of liver disorder occurs
Colour bodily fluid
193
Which of the TB drug causes causes peripheral neuropathy?
Isoniazid
Give vit B6( pyridoxine hcl from start of tx to prevent neuropathy
More likely to occur if there are pre existing risk factors such as diabetes, pregnancy, HIVv CRF, etoh deficiency
194
Pt and carer advice for Ethambutol
Causes visual side effects
Discontinue therapy immediately if any deterioration in vision, seek advice promptly
195
Monitoring for ethambutol
Renal function should be checked before treatment
Test visual acuity using Snellen chart before tx
196
Common side effects of ethambutol
Hyperuricaemia, nerve disorder, visual impairment
197
What is Metronidazole used to tx
Trichomonal vaginitis
Bacterial vaginitis
Vaginosis
C.dif
Oral infections in penicillin allergy
Topical- used to reduce microbial odours and rosacea
198
Route of administration of Metronidazole
IV, oral, rectal
199
What's the first choice of drug to tx gingivitis in penicillin allergy
Metronidazole ( 400mg TDS for 3days)
200
Caution with Metronidazole
Avoid alcohol as it causes disulfiram like rxn eg vomiting, flushing, throbbing headache, general hangover like symptoms
201
Side effects of Metronidazole
N and V
Taste disturbance - metallic
Anorexia
Dry mouth
Oral disorders
202
