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Infection Flashcards

1
Q

What antibiotics are not recommended in children?

A

Tetracyclines are CI in those under 12

Quinolones cause arthropathy

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2
Q

What antibiotics are not recommended in elderly?

A

The elderly are the most susceptible to C.difficile infections and have the greatest risk of developing it with Clindamycin

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3
Q

What antibiotics are not recommended in allergies?

A

Penicillin and Cephalosporins

Metronidazole for dental infections or macrolides

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4
Q

What antibiotics are not recommended in renal impairment?

A

Nephrotoxic - Aminoglycosides and Glycopeptide

Avoid tetracyclines except (Doxycycline and Minocycline) and Nitrofurantoin if eGFR <45mL/min

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5
Q

What antibiotics are not recommended in hepatic impairment?

A

RIP and teracyclines
Metronidazole if severe impairment
Co-amoxiclav and Flucloxacillin can cause cholestatic jaundice if used >14 days

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6
Q

What antibiotics are not recommended in pregancy?

A

Tetracyclines CI
Avoid MCAT (Metronidazole, Chloramphenicol, Aminoglycosides and Tetracyclines), Quinolones and Sulfonamides, and avoid Nitrofurantoin at term
Amoxicillin and Cephalosporins are safe

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7
Q

What side effects are associated with clindamycin?

A

Antibiotic associated colitis - can be fatal and must need to be reported

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8
Q

What side-effects are associated with trimethoprim and co-trimoxazole?

A

Trimethoprim - Blood dyscrasias, Hyperkalaemia and Anti-folate
Co-trimoxazole - SJS, toxic epidermalnecrolysis (similar to Lamotrigine)

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9
Q

What side effects are associated with chloramphenicol?

A

Blood dyscrasias and grey baby syndrome (avoid in pregnant women)

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10
Q

What indications can metronidazole be used in?

A

Metronidazole can be used in H.pylori, anaerobic dental infections, rosacea, antibiotic associated colitis, bacterial vaginosis and trichiomoniasis.

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11
Q

What side-effects can occur with metronidazole?

A

GI and taste disturbances, furred tongue and oral mucositis

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12
Q

What counselling should be given to patients taking metronidazole?

A

Take 1 tablet with or after food

Avoid alcohol for 48 hours after finishing the course

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13
Q

What side effects are associated with nitrofurantoin?

A

Nausea and peripheral neuropathy in those suffering from renal impairment

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14
Q

What counselling should be given to patients who take nitrofurantoin?

A

It should be taken with or after food

It may colour the urine yellow or brown

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15
Q

What are the indications for gentamicin?

A

Endocarditis, Complicated UTI, pyelonephritis and severe sepsis

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16
Q

Where are each of the 5 aminoglycosides indicated?

A

G-Gentamicin - for Psuedomonas aeruginosa
A- Amikacin - for gentamicin resistant Bacilli
N- Neomycin - parenterally toxic - for bowel cleanses
T- Tobramycin - inhaled for pseudomonas infections in CF
S- Streptomycin - reserved for mycobacterium for TB

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17
Q

Which two classes of antibiotics can gentamicin be given with as blind therapy?

A

Gentamicin + metronidazole or penicillin

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18
Q

When should gentamicin be avoided?

A

Gentamicin should be avoided in renal impairement <20ml/min and those suffering from gram positive endocarditis and HACEK bacteria

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19
Q

What is the peak concentration of gentamicin

a) For non-endocarditis
b) For endocarditis

A

a) 5-10mg/mL

b) 3-5mg/mL

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20
Q

What is the trough concentration of gentamicin

a) For non-endocarditis
b) For endocarditis

A

a) <2mg/mL

b) <1mg/mL

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21
Q

What are the side-effects of gentamicin?

A

Nephrotoxicity, neuromuscular transmission impairment, electrolyte disturbances (hypomagnesia, hypocalcaemia and hypokalaemia) and peripheral neuropathy

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22
Q

What drugs does gentamicin interact with?

A

Gentamicin can cause permanent ototoxicity with:
cisplatin and loop diuretics
It can also cause nephrotoxicity with ciclosporin, tacrolimus and vancomycin

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23
Q

What is vancomycin indicated for?

A

MRSA

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24
Q

Name three examples of glycopeptides

A

Vancomycin, teicoplanin and televancin (for HAP)

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25
Q

How often are patients required to be monitored on vancomycin?

A

Patients are required to be monitored after every 3-4 doses or after a dose change

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26
Q

What are some of the indications for tetracyclines?

A

LRTIs, rosacea, acne, malaria and chlamydia

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27
Q

Which tetracycline can be used for both malaria and chlamydia?

A

Doxycycline

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28
Q

What side-effect is associated with tetracyclines and what should be done if this occurs?

A

Intercranial hypertension- the medication should be stopped

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29
Q

What are the counselling points for tetracyclines?

A

DOT- NO milk
DLM- milk
DD- avoid sunlight
DMT- take whilst upright with a full glass of water

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30
Q

What are the indications for quinolones?

A

LRTIs and UTIs

31
Q

What are the SEs of quinolones?

A

STAQ

32
Q

What interactions occur with quinolones?

A

Seizure threshold - MAST QT
NSAIDs+ Quinolones -> can cause seizures
QT inerval prolongation -MASTAQ

33
Q

What counselling needs to be given to patients on quinolones?

A

Ciprofloxacin + Norfloxacin -> avoid milk and indigestion remedies
Ofloxacin -> Avoid sunlight
Others -> Avoid antacids
Potential impaired driving

34
Q

What are the indications for macrolides?

A

H.pylori, RTIs and skin and soft tissue infection

35
Q

What are the side effects of macrolides?

A

G- GI
H- Hepatotoxicity
O- Ototoxicity at high doses
Q- QT interval prolongation

36
Q

What interactions occur with macrolides?

A

Warfarin- bleeding risk
Statins - myopathy
Digoxin - CRASED

37
Q

What are examples of narrow spectrum Beta-lactamase sensitive antibiotics?

A

Phenoxymethylpenicillin or Benzylpenicillin

38
Q

What are examples of broad spectrum Beta-lactamase sensitive antibiotics?

A

Ampicillin

Amoxicillin

39
Q

What are examples of Penicillinase resistant antibiotics?

A

Flucloxacillin

40
Q

What are examples of antipseudomonal antibiotics?

A

Piperacillin + Tazobactam or Ticaricillin + Clavulinic acid

41
Q

What are the possible outcomes for a possible penicillin allergy?

A

1) True allergy - anaphylaxis, urticaria -> do not give any cephalosporins, carbapenems, penicillins or cephalosporins
2) Mild rash - may take up to 72 hours for it to appear

42
Q

Which route should penicillin not be administered and why?

A

Intrathecal route- can cause encephalopathy and may be fatal

43
Q

What are the complication(s) that may arise from broad-spectrum antibiotics such as ampicillin and amoxicillin?

A

Can cause a maculopapular rash in glandular fever and can also cause antibiotic-associated colitis

44
Q

Where are narrow spectrum lactam sensitive antibiotics used?

A

Benzylpenicillin -> Meningitis (IV only as not gastrostable)
Phenoxymethylpenicillin -> Streptococci induced sore throat

45
Q

Where are penicillinase-resistant antibiotics used?

A

Penicillinase-resistant antibiotics such as flucloxacillin are used in skin conditions such as impetigo and cellulitis for pathogens that are penicillin resistant

46
Q

What is the dose of flucloxacillin? What side-effect can it cause?

A

xmg QDS before food. It can cause cholestatic jaundice if used for more than 14 days

47
Q

What are the treatments for psuedomonal bacteria?

A

Piperacillin and Tazobactam or Ticaricillin with Clavulanic acid

48
Q

When are cephalosporins not used?

A

Cephalosporins should not be used if a patient has immediate penicillin hypersensitivity

49
Q

Which antibiotics cause C.difficile colitis?

A

Ampicillin, Amoxicillin, Co-amoxiclav, 2nd and 3rd gen cephalosporins, quinolones, and clindamycin

50
Q

What can be used to treat C.difficile colitis?

A

Metronidazole for 10-14 days.

If this does not help then oral vancomycin or fidaxomicin

51
Q

What can be used to treat endocarditis?

A

Amoxicillin +/- low dose gentamicin
Strep = Benzylpenicillin
Staph = Flucloxacillin
MRSA = Vancomycin

52
Q

What can be used to treat CAP?

A

Mild CAP - Amox/Clarithro/Doxy
Moderate CAP - Amox + Clarithro or Doxy
Severe - Benzylpenicillin + Doxy or Clarithro
Add fluclox or vanco

53
Q

What can be used to treat HAP?

A

<5 days or early onset HAP - Cefuroxime or Co-amoxiclav
>5 days or severe - broad spectrum cephalo or antipseudomonal penicillin or quinolone
Add vanco or genta

54
Q

What can be used to treat meningitis?

A

Treatment for meningitis includes-
Benzylpenicillin
If penicillin allergic, then cefotaxime
If immediate penicillin allergy then chloramphenicol

55
Q

What can be used to treat osteomyelitis?

A

Flucloxacillin or Clindamycin if penicillin allergic

56
Q

What can be used to treat impetigo?

A

If a small area, fusidic acid. If it is a large area, it is flucloxacillin

57
Q

What can be used to treat cellulitis?

A

Flucloxacillin

58
Q

What can be used to treat animal bites?

A

Co-amoxiclav or Doxycycline and Metronidazole

59
Q

What can be used to treat MRSA?

A

Tetracycline, Clindamycin or Vancomycin or Linazolid if very severe

60
Q

What is Linezolid, indications, SEs and interactions?

A

Linezolid is a MAOi, an alternative option for MRSA. It can cause blood dyscrasias and occular neuropathy if used for more than 28 days. It interacts with sympathomimetics causing a hypertensive crisis

61
Q

What can be used for streptococcal sore throats?

A

Pen V or if severe, then initiate with Benzylpenicillin

62
Q

What can be used for sinusitis?

A

Amox/Clarithro/Doxy

63
Q

What can be used for otitis externa?

A

Fluclox or Clarithromycin if penicillin allergic

64
Q

What can be used for otitis media?

A

Amox or Clarithromycin if penicillin allergic

65
Q

Name some antifungals

A

Voriconazole
Itraconazole
Ketoconazole
Amphoterecin B

66
Q

Name some side-effects associated with these antifungals

A

Voriconazole - can cause skin cancer - avoid direct sunlight or lamps . Patients should carry an alert card Itraconazole - interaction with antacids. It can cause heart failure and is hepatotoxic
Ketoconazole - fatal hepatotoxicity
Amphoterecin B - must be given by brand as bioavailability differs

67
Q

What can be used to treat:
Oral thrush?
Vaginal thrush?

A

Oral thrush - nystatin or miconazole

Vaginal thrush - clotrimazole or fluconazole

68
Q

What can be used for tinea infections?

A

Miconazole, Clotrimazole or Terbinafine

69
Q

What can be used for nail infections?

A

Amorolfine nail lacquer

70
Q

What can be done to prevent mosquito bites?

A

DEET - after sunscreen
Permethrin coated nets
Cover up with long sleeve clothing after dusk

71
Q

What can be used for malaria prophylaxis?

A 
Doxycycline
Atovaquone and Proguanil
Chloroquine and Proguanil
Chloroquine 
Mefloquine
72
Q 
Which malaria prophylaxis should be given in:
Epilepsy
Renal Impairment
Pregnancy
Warfarin
A

Epilepsy - avoid mefloquine and chloroquine
Renal Impairment - Doxycycline and Mefloquine
Pregnancy - Chloroquine and proguanil - give 5mg folic acid with proguanil
Warfarin - take prophylaxis 2-3 weeks before, have INR stabilised prior departure

73
Q 
What is the treatment regime for:
Doxycycline
Malarone
Chloroquine and proguanil
Mefloquine
Chloroquine
A

Doxycycline - 1-2 days before, 4 weeks after - daily
Malarone - 1-2 days before, 1 week after - daily
Chloroquine and proguanil - 1 week before, 4 weeks after
Mefloquine - 2-3 weeks before, 4 weeks after - weekly
Chloroquine - 1 week before, 4 weeks after - weekly

74
Q

What is the standby treatment for malaria?

A

Quinine

Errors (6 decks)

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