Infection: General Flashcards
Why should rifampicin or fusidic acid alone NOT be used to treat MRSA?
Resistance may rapidly develop.
A tetracycline alone or a combination of rifampicin and fusidic acid can be used for skin and soft-tissue infections caused by MRSA; clindamycin alone is an alternative.
A glycopeptide (such as Vanc) can be used for severe skin and soft-tissue infections associated with MRSA; if not a glycopeptide then linezolid on specialist advice BUT linezolid is not active against Gram-negative organisms.
What can be used for monotherapy of MRSA skin and soft-tissue infections? (4)
A tetracycline
A glycopeptide (severe)
Clindamycin
Linezolid if glyco not approp (severe) but not if Gram-neg
Linezolid is not active against what organisms?
Gram-negative. It must be given with other antibacterials if the infection also involves Gram-negative organisms.
Linezolid can be used as an alternative to a glycopeptide in severe MRSA of skin and soft-tissue.
What two drugs are licensed for the treatment of complicated skin and soft-tissue infections involving MRSA?
Tigecycline: a glycylcycline antibacterial structurally related to the tetracyclines
Daptomycin:a lipopeptide antibacterial with a spectrum of activity similar to vancomycin but its efficacy against enterococci has not been established.
A tetracycline or _________ can be used for bronchiectasis caused by MRSA.
A tetracycline or clindamycin can be used for bronchiectasis caused by MRSA. A glycopeptide can be used for pneumonia associated with MRSA; if a glycopeptide is unsuitable, linezolid can be used on expert advice. Linezolid must be given with other antibacterials if the infection also involves Gram-negative organisms.
A _________ can be used for pneumonia associated with MRSA; if a glycopeptide is unsuitable, ______ can be used on expert advice.
A tetracycline or clindamycin can be used for bronchiectasis caused by MRSA. A glycopeptide can be used for pneumonia associated with MRSA; if a glycopeptide is unsuitable, linezolid can be used on expert advice. Linezolid must be given with other antibacterials if the infection also involves Gram-negative organisms.
A tetracycline can be used for UTI caused by MRSA: _________ or __________ are alternatives.
A tetracycline can be used for urinary-tract infections caused by MRSA; trimethoprim or nitrofurantoin are alternatives. A glycopeptide can be used for urinary-tract infections that are severe or resistant to other antibacterials.
What can be used for speticaemia associated with MRSA? How would it need to be given?
A glycopeptide can be used for septicaemia associated with MRSA.
Vancomycin would need to be given IV not orally for systemic infections.
Prophylaxis against MRSA in patients undergoing surgery who are at risk can be achieved with:
Prophylaxis with vancomycin or teicoplanin (alone or in combination with another antibacterial active against other pathogens) is appropriate for patients undergoing surgery if:
there is a history of MRSA colonisation or infection without documented eradication;
there is a risk that the patient’s MRSA carriage has recurred;
the patient comes from an area with a high prevalence of MRSA.
See eradication of nasal carriage of MRSA in Nose.
What important safety information is there regarding linezolid use?
Optic neuropathy.
Haematopoietic disorders (thrombocytopenia, anaemia, leucopenia, and pancytopenia).
Close monitoring if 10-14 days or more treatment etc.
What is first-line treatment of osteomyelitis? (3)
What is the suggested duration of treatment?
Flucloxacillin:
Consider adding fusidic acid or rifampacin for initial 2 weeks.
Suggested duration is 6 weeks for acute infection.
Pen-allergic: clindamycin instead of flucloxacillin.
MRSA suspected: Vancomycin/teicoplanin instead of fluclox.
What is the treatment of osteomyelitis in pen-allergic patients?
Flucloxacillin:
Consider adding fusidic acid or rifampacin for initial 2 weeks.
Suggested duration is 6 weeks for acute infection.
Pen-allergic: clindamycin instead of flucloxacillin.
MRSA suspected: Vancomycin/teicoplanin instead of fluclox.
What is the treatment of suspected MRSA osteomyelitis?
Flucloxacillin:
Consider adding fusidic acid or rifampacin for initial 2 weeks.
Suggested duration is 6 weeks for acute infection.
Pen-allergic: clindamycin instead of flucloxacillin.
MRSA suspected: Vancomycin/teicoplanin instead of fluclox.
What is the treatment of suspected gonococcal arthritis or Gram-negative infection?
Flucloxacillin
Suggested duration of treatment 4–6 weeks (longer if infection complicated).
If penicillin-allergic, clindamycin
Suggested duration of treatment 4–6 weeks (longer if infection complicated).
If meticillin-resistantStaphylococcus aureussuspected, vancomycin (or teicoplanin)
Suggested duration of treatment 4–6 weeks (longer if infection complicated).
If gonococcal arthritis or Gram-negative infection suspected, cefotaxime (or ceftriaxone)
Suggested duration of treatment 4–6 weeks (longer if infection complicated; treat gonococcal infection for 2 weeks).
