Infection: Antibacterials, use for prophylaxis

Question 1

What should be used for the prevention of recurrence of rheumatic fever? (2)

Answer 1

Phenoxymethylpenicillin or sulfadiazine

Question 2

What anitbiotics are used to prevent secondary cases of invasive group A streptococcal infection?

Answer 2

Phenoxymethylpenicillin.

For patients who are penicillin allergic: erythromycin or azithromycin [unlicensed use].

Question 3

Which antibitiotics are used to prevent secondary cases of invasive group A streptococcal infection in penicllin allergic patients?

Answer 3

For patients who are penicillin allergic: erythromycin or azithromycin [unlicensed use].

Question 4

What is used to prevent secondary cases of meningococcal meningitis? (3)

Answer 4

Ciprofloxacin 
OR
Rifampicin 
OR
IM Ceftriaxone [unlicensed indication]

Question 5

How are secondary cases of haemophilus influenza type b disease prevented?

Answer 5

Rifampicin
OR
IM/IV ceftriaxone if rifampicin cannot be used.

Question 6

How are secondary cases of diphtheria in non-immune patients prevented?

Answer 6

Erythromycin (or another macrolide e.g. azithromycin or clarithromycin).

Treat for further 10 days if nasopharyngeal swabs positive after first 7 days’ treatment.

Question 7

What prophylaxis is appropriate for pertussis?

Answer 7

Clarithromycin (or azithromycin or erythromycin).

Within 3 weeks of onset of cough in the index case, give antibacterial prophylaxis to all close contacts if amongst them there is at least one unimmunised or partially immunised child under 1 year of age, or if there is at least one individual who has not received a pertussis-containing vaccine more than 1 week and less than 5 years ago.

Question 8

What antibacterial prophylaxis is used for pneumonococcal infection in asplenia or in patients with sickle-cell disease?

Answer 8

Phenoxymethylpenicillin.

If pen allergic: erythromycin.

Question 9

What is the treatment of an animal or human bite?

Answer 9

Co-amoxiclav alone (or doxycycline + metronidazole if penicillin-allergic) for up to 5 days.

Question 10

Can chlorhexidine mouthwash be recommended for the prevention of infective endocarditis in at risk patients undergoing dental procedures?

Answer 10

NO

Question 11

Antibacterial prophylaxis is NOT recommended routinely for the prevention of infective endocarditis in patients undergoing what procedures?

Answer 11

1. Dental
2. URT + LRT
3. Genito-urinary tract
4. Upper and lower GI tract

Whilst these procedures can cause bacteraemia, there is no clear association with the development of infective endocarditis. Prophylaxis may expose patients to the adverse effects of antimicrobials when the evidence of benefit has not been proven.