Infection Flashcards
What are the notifiable diseases?
Anthrax, botulism, brucellosis, cholera, infectious bloody diarrhoea, diphtheria, acute encephalitis, food poisoning, hemolytic uraemic syndrome, haemorrhagic fever, viral hepatitis, legionnaires disease, leprosy, malaria, measles, meningitis, meningococcal septicemia, mumps, paratyphoid fever, plaque, poliomyelitis, rabies, rubella, SARS, scarlet fever, smallpox, streptococcal disease group a, tetanus, tuberculosis, typhoid, typhus, whopping cough, yellow fever
What are the safest antibacterials in preganancy?
Cephalosporins and penicillins
What is given in septicemia?
Broad spectrum antipseudomonal penicillin (beta lactam if hospital aquired) or cephalosporin in community
Add metronidazole if anaerobic
What is generally added to therapy if MRSA is suspected?
Vancomycin or teicoplanin
Tetracyclines, glycopeptides.
Linezolid with expert advice.
Trimethiprim/nitrofurantoin alternatives in UTI
What drug is used against staphylococcus?
Flucloxacillin
What drug is used against streptococci?
Benzyl penicillin
What drug is given against haemophillus influenza?
Cefotaxime
What is given for gastroenteritis?
Antibacterial not usually indicated.
What is given in campylobacter?
Clarithromycin or ciprofloxacin if Severe
What is given with salmonella?
Ciprofloxacin or cefotaxime if indicated
What is indicated for shigellosis?
Ciprofloxacin or azithromycin or amoxicillin or trimethoprim if not mild
What is given for typhoid?
Cefotaxime, azithromycin or ciprofloxacin
What is given in c diff?
Metronidazole or vancomycin or fidaxomicin
Which drugs have c diff as particular hazard?
Ampicillin, amoxicillin, Co amoxiclav, second and third gen cephalosporins, clindamycin, quinolones.
What is given in bacterial vaginosis?
Metronidazole or topical clindamycin
What is given in chlamydia?
Azithromycin or doxycycline or erythromycin
What is the benefit of using Co amoxiclav over a penicillin?
Active against beta lactamase producing bacteria
Are cephalosporins used in dental infections?
Little advantage over penicillins as usually resistant to both and less active against anaerobes. Cefalexin and cefradine have been used
Is metronidazole used in oral infections?
Yes. First choice in necrotising ulcerative gingivitis and pericoronitis.
What drugs are used in pneumonia?
Amoxicillin
Add clarithromycin if moderate
Replace amoxicillin with benzyl penicillin if Severe
Co amoxiclav or cefuroxime if hospital
Antipseudomonal penicillin, cephalosporins or quinolone if over 5 days since admission
What is given in impetigo if not widespread
Fusidic acid topical
What are amino glycosides effective against?
Bactericidal to some Gram positive and many gram negative.
Psuedomonas aeruginosa
Streptomycin - mycobacyerium tuberculosis
Not absorbed from gut. IV except neomycin as too toxic
When should amino glycosides NOT be given once daily?
Endocarditis (gram positive)
HACEK
Burns of more than 20% of body
Creatinine clearance less than 20.
Serum amino glycoside concentrations should be monitored but when must they?
Elderly, obesity, cystic fibrosis, high doses, renal impairment
What cautions and side effects are associated with amino glycosides?
Care with dosage, parenteral no more than 7 days. Nephrotoxicity and ototoxicity with renal impairment. Auditory and vestibular function should be monitored and may be effected in baby in pregnancy. Monitor Serum concentrations after 3 or 4 doses of multiple dose regime.
What are carbapenems active against?
Beta lactam Broad spectrum antibacterials including gram positive and gram negative and anaerobes. Not MRSA
Which antibacterials should also be avoided if someone has a penicillin allergy?
Cephalosporins especially cefaclor, cefadroxil, cefalexin, cefradine and ceftaroline
Which class of antibacterial may be effected by obesity and what should be done?
Can increase dosage if obese. So use ideal weight to calculate dose.
What penicillin must be given by injection and why
Benzyl penicillin (G) as inactivated by gastric acid
Phenoxymethylpenicillin is reserved for more serious infections. True or false.
False. Should not be used as absorption is unpredictable and concentrations variable.
Which drug would be used if staphylococcus found to be resistant to benzyl penicillin?
Flucloxacillin
What drugs can commonly cause maculopapular rash and what condition does the patient likely have?
Ampicillin and amoxicillin. Glandular fever (also increased risk of rash in lymphocytic leukemia or cytomegalovirus)
Which of the 2 Antipseudomonal combinations is active against the most range of bacteria?
Piperacillin with tazobactam > ticarcillin with clavulanic acid
Which class is commonly combined with Antipseudomonal penicillins and why
Aminoglycosides as synergistic for severe infections
Which antibacterial preperations have high sodium content?
Antipseudomonal and iv penicillins
Why is it even more important with Co amoxiclav that the duration of treatment is appropriate? What other drugs is this for?
Clavulanic acid is possible associated with cholestatic jaundice. Also with Antipseudomonal combination and flucloxacillin.
How should pivmecillinam be administered?
Swallowed whole with plenty of fluid during meals while sitting or standing
Which antibacterials effect driving and skilled tasks
Polymyxin, quinolones
When should quinolones be discontinued?
If tendinitis suspected, psychiatric, neurological or hypersensitivity occurs.
Which tetracycline differs the most microbiologically from others in the class and how?
Monocycline
Broader spectrum
Dizziness,vertigo limit use.
Greater lupus erythematsus like syndrome risk
Irreversible pigmentation
Monitor every 3 months if treated longer than 6 months.
Which antibiotics are most dangerous in children and pregnancy? When might it be used exceptionally?
Tetracyclines cause deposition in growing bone and teeth so not used in under 12s. Effect skeletal development of babies.
May be used in pregnancy for malaria prophylaxis if completed by 15 weeks.
What advice should be given with tetracyclines and which is most commonly associated with this side effect?
Avoid exposure to sunlight or sun lamps. More common with demeclocycline.
Doxycycline and tetracycline should be swallowed with plenty of fluid sitting or standing with meals.
What dangers does systemic chloramphenicol pose?
Haematological side effects. Grey baby syndrome, bone marrow toxicity in bf infants. Plasma concentrations monitored in elderly and under 4s.
When should daptomycin be discontinued?
Unexplained muscle pain, tenderness, weakness or cramps and elevated creatine markedly
A patient taking warfarin is put on a course of daptomycin. What should be done differently with his warfarin?
Take INR immediately before daptomycin doses
What is the maximum duration of fusidic acid or mupirocin to avoid resistance?
10 days
What should be monitored with fusidic acid systemic use?
Elevated liver enzymes, hyperbilirubinaemia and jaundice can occur. Monitor liver function.
When should linezolid be avoided?
Uncontrolled hypertension, phaeochromocytoma, carcinoid tumor, thyrotoxicosis, bipolar depression, Schizophrenia or acute confusional state
What advice should be given with trimethoprim therapy?
Recognise symptoms of blood disorder (seek attention with fever, sore throat, rash, mouth ulcer, bruising, bleeding)
What antibacterials are used in anthrax?
Ciprofloxacin or doxycycline
Combined with 1-2 others eg amoxicillin, benzyl penicillin, chloramphenicol, clarithromycin, clindamycin, imipenem, rifampicin and vancomycin (if inhalation or GI)
Switch to single antibacterial (amoxicillin if susceptible) once strain known (after 10 - 14 days in prophylaxis) . Continue for 60 days as germination may be delayed.
What regimes are given in leprosy?
Multibacilliary - rifampicin, dapsone and clofazimine for at least 2 years.
Paucibacillary - rifampicin and dapsone for 6 months
Ofloxacin, minocycline and clarithromycin second line.
What drugs are used in tuberculosis?
Initial phase - rifampicin, ethambutol, pyrazinamide and isoniazid for 2 months or until susceptibility confirmed. 3 - 6 rifater daily plus 15mg/kg of ethambutol. Voractiv has all 4.
Streptomycin may replace isoniazid in resistance
Continuation phase - rifampicin and isoniazid for further 4 months (10 months if cns plus dexamethasone or prednisolone from start and withdrawn over 4 - 8 weeks).
Rifinah 2 x 300/150 daily if over 50kg.
Isoniazid is combined with pyridoxine to prevent neuropathy
Can pregnant and breastfeeding women be given tuberculosis regimes?
Yes. Not Streptomycin in pregnancy. Unsupervised.
What changes are thhere with supervised tuberculosis treatment rather than unsupervised?
Three times weekly dosing may be considered instead of daily.
15mg/kg isoniazid, 600 - 900mg rifampicin, 2.5g pyrazinamide and 30mg/kg ethambutol
All patients with latent tuberculosis should be treated. True or false. What is the treatment?
False. Only if Hepatitoxicity is not a concern between 35 - 65yo. Not at all over 65yo.
Isoniazid alone for 6 months or rifampicin with it for 3 months.
How can compliance with tuberculosis medication be checked in unsupervised patients?
Monthly tablet counts or urine examination
What length break in tuberculosis treatment is considered interruption?
2 weeks or missing more than 20% of doses.
Does disturbance of liver function with elevated Serum transaminasses require interruption of rifampicin treatment?
Generally not
How many drugs are given in multidrug resistance tuberculosis and which second line drugs may be used?
- If resistance to rifampicin (and/or isoniazid)
Amino salicylic acid, amikacin, capreomycin, cycloserine, newer macrolides, moxifloxacin, bedaquiline, delamanid
Which drug replaces isoniazid in Continuation phase if resistance is present?
Ethambutol for 7 months.
How long is the Continuation phase if pyrazinamide or ethambutol cannot be included in the initial?
7 months if no pyrazinamide
4 months if no ethambutol
What advice should be given to patients taking rifampicin?
May cause influenza like symptoms, shortness of breath, collapse, shock, hemolytic anaemia, thrombocytopenia and acute renal failure. Shouldhave renal and hepatic function checked before treatment and if symptoms develop (seek attention with jaundice, malaise, vomiting) or alcohol dependant - same with pyrazinamide . May colour contact lenses, tears, sweat and urine.
What issues are there with ethambutol treatment?
Discontinue treatment immediately if deterioration in vision. Caution in children until at least 5 years old due to capability of reporting these symptoms.
What are the risk factors of peripheral neuropathy with isoniazid treatment?
Diabetes, alcohol dependance, chronic renal failure, pregnancy, malnutrition and HIV.
Which anti tuberculosis drug does not have patient advice regarding hepatic disorder symptoms?
Ethambutol
What bacteria causes urinary tract infections?
E coli most common.
Staph saprophyticus
Proteus, klebsiella
Psuedomonas aeruginosa
Specimens of urine should be collected for culture and sensitivity testing in urinary tract infections. True or false.
In men, pregnant women, under 3yo, upper uti, resttistance
What drugs are used in urinary tract infections?
Trimethoprim, Amoxicillin, ampicillin - resistance
Co amoxiclav, Cephalosporin, nitrofurantoin (not renal failure), pivmecillinam, quinolone
Trimethiprim (not pregnancy) , Nitrofurantoin or cefalexin for long term.
Compare the triazole antifungals
Fluconazole - well absorbed and penetrates CSF
Itraconazole - effective against more incl aspergillus. Require acid stomach. Hepatoxicity
Posaconazole - for invasive infections
Voriconazole - life threatening infections
What problems occur with amphotericin administration?
Protein bound, toxic. Lipid formulations avoid these, good for nephrotoxicity risk.
Anaphylaxis can occur so test dose advisable and use prophylactic antipyretocs or hydrocortisone if previous reaction.
Which antifungals effects driving and skilled tasks?
Posaconazole, isavuconazols, griseofulvin
What patient advice is given with Voriconazole?
Hepatitoxicity and phototoxicity can occur. Seek medical attention with liver disorder symptoms and avoid exposure to direct sunlight. Keep alert card.
What advice is given to patients with griseofulvin?
Effective contraception required during and at least 1 month after admin. Additional barrier methods required as contraceptives effectiveness reduced. Men should also avoid fathering during and for at least 6 months after administration
What advice should be given for threadworm prevention alongside what drug of choice for treatment?
Wash hands and scrub nails before each meal and after each visit to the toilet. Take a bath immediately after rising. Supply mebendazole. Reinfection is common so give second dose after 2 weeks.
Patients already taking hydroxy chloroquine and needing malaria prophylaxis for which chloroquine would be suitable, may remain on hydroxy chloroquine. True or false.
True
Which drugs can be used in prophylaxis of malaria but are rarely used for treatment, and why?
Chloroquine, mefloquine.
Resistance.
What should mosquito nets be impregnated with?
Permethrin
DEET can be used in children of all ages, pregnant and breastfeeding women. True or false.
Yes, except not for under 2 months.
Should DEET be applied before or after sunscreen and how do they interact?
After. DEET reduces SPF.
How long before entering endemic area should all malaria prophylaxis be started?
Mefloquine 2 - 3 weeks before
Malarone/doxycycline 1- 2 days before
Rest 1 week
How long after leaving endemic area must malaria prophylaxis be continued?
4 weeks. 1 week for Malarone.
How long after returning should illness be considered for malaria?
1 year, especially within 3 months.
An epileptic patient travelling to an area without chloroquine resistance should be given which antimalarial?
Proguanil
Breast fed infants by protected mothers are also protected. True or false.
False.
A patient is travelling between 2 malaria areas that both have different recommendations, what should be recommended?
The regime for the higher risk area should be used for the whole journey
What is given for falciparum malaria?
Quinine with or followed by doxycycline or clindamycin (quinine plus clindamycin in pregnancy)
Malarone
Riamet
What particular reactions occur with mefloquine treatment?
Neuropsychiatric - abnormal dreams, insomnia, anxiety, depression, suicidal ideation. Long half life so may persist several months after.
What monitoring requirements are there for nucleoside analogues?
Liver function every 3 months, viral markers every 3 to 6 months. For at least 1 year after discontinuation
What requirements are often needed by women in antiviral treatment? When does it apply to men?
Contraception
Foscarnet - men should avoid fathering a child during and up to 6 months after
Neonates should be treated for chicken pox with a parenteral drug. True or false. E
True. From 1m to 12y treatment not usually required.
Ganciclovir
Zidovudine
What is the issue with a prescription for both
Profound myelosuppression together
Which antivirals should have caution with handling?
Ganciclovir and valganciclovir
What class is included in every HIV treatment regime?
Two Nucleoside reverse transcriptase inhibitors (with one other)
What side effects are associated with protease inhibitors?
Lipodystrophy and metabolic effects
Rash usually within 3/4 weeks
Pancreatitis signs
Hepatoxicity
What side effects are associated with efavirenz?
Psychiatric band increased plasma cholesterol. Rash usually in first 2 weeks is most common but discontinue if Severe with blistering
What side effects can occur with HIV antivirals?
Hypersensitivity (vomiting chills rigors low blood pressure) and osteonecrosis
Can HIV antivirals be used with hepatitis?
Used in caution as greater risk of hepatic side effects
What various side effects occur with nucleoside reverse transcriptase inhibitors?
Mitochondrial dysfunction if exposed in utero.
Pancreatitis
Lipodystrophy
Lactic acidosis and hepatic stenosis
What neuraminidase inhibitor side effects more commonly occur in children and adolescents?
Neurological/psychiatric
Which of the risk factors of influenza is also a caution for the treatment?
Asthma/COPD as risk of bronchospams with zanamivir
