Infection prescribing pathways Flashcards
for human and animal bites whats the first line tx?
co-amoxiclav
useful due to it being harder for bacteria (B lactamase) to break down abx
for human and animal bites whats the second line tx? why, how do they work
doxycycline and metronidazole
e.g. due to pen allergy
doxycycline: also broad spec, tackles most infection AND
metronidazole: tackle anaerobic bacteria
-> ensures whole infection treated
for human and animal bites whats the prophylaxis timeframe? and treatment timeframe?
prophylaxis 3 days i.e. bitten by dog and no sign of infection
treatment: 5 days eg bitten by cat and signs of infection
first line tx for tick bites (lyme disease) and dose?
doxycycline 100mg BD
second line tx for tick bites (lyme disease) and dose?
amoxicillin 1g TDS
how long to treat lyme disease tick bites
21 days
DIABETIC FOOT INFECTION- TREATMENT
MILD (<2cm) 1st line?
If penicillin allergy..?
1st line? Flucloxacillin
If penicillin allergy.. Clarithromycin/ Erythromycin/ Doxycycline
DIABETIC FOOT INFECTION- TREATMENT
MODERATE/SEVERE (abscess, osteomyelitis)
1st line?
2nd line?
1st line? FLUCLOXACILLIN or CO-AMOXICLAV with/without GENTAMICIN
2nd line? (Penicillin allergy) CO-TRIMOXAZOLE with/without GENTAMICIN
CELLULITIS tx
first line?
pen allergy?
first line? flucloxacillin
pen allergy? Clarithromycin OR
Erythromycin (in pregnancy)
Doxycycline
CELLULITIS- TREATMENT
INFECTION NEAR EYES/NOSE
1st LINE?
PENICILLIN ALLERGY? CAM
1st LINE? Co-amoxiclav
PENICILLIN ALLERGY? Clarithromycin & Metronidazole
3 types of CAP community acquired pneumonia
LOW SEVERITY
MODERATE SEVERITY
HIGH SEVERITY
for low severity CAP, whats the first line tx, and second line tx?
1st line? Amoxicillin
2nd line? Doxycycline OR Clarithromycin OR Erythromycin (in pregnancy)
for moderate severity CAP, whats the first line tx, and second line tx?
1st line? Amoxicillin OR Erythromycin in pregnancy
2nd line? Doxycycline OR Clarithromycin
in mod severity CAP, when would you prescribe clarithromycin with amoxicillin as first line?
if atypical pathogens present
for high severity CAP, whats the first line tx, and second line tx?
1st line? Co-amoxiclav w/ Clarithromycin (OR Erythromycin in pregnancy)
2nd line? Levofloxacin
whats the CURB65 score stand for
CONFUSION
UREA >7mmol/L
RAISED RESP. RATE>/= 30breaths/min
low BP systolic <90, diastolic </= 60
>65 years
1 point for each
what is CURB65 score used to categorise
CAP
what CURB65 = low severity
0-1
low risk, consider home tx
what CURB65 = moderate severity
2
possible admin vs close outpatient management
what CURB65 = high severity
3-5
admission manage as serious
how long does diarrhoea tx last for targeting C Diff?
10 days
(C. Difficile = 10 letters)
C Diff diarrhoea tx first and second line?
- oral vancomycin
- fidaxomicin
tx for life threatening C diff diarrhoea
vancomycin + IV metronidazole
what drug class should pt stop if they have C. Diff?
PPIs
standby tx for travellers diarrhoea
azithromycin
prophylaxis/ tx for travellers diarrhoea
Bismuth Subsalicylate
(pepto bismol otc)
Ear infections
otitis media (inner, need systemix tx)
first and second line (worsened symptoms after 2-3 days treatment)
Penicillin allergy?
Can resolve itself if it’s not bad!
so standard paracetamol, ibu, first initially, 3days-1week
1st LINE? Amoxicillin
2nd LINE? Co-amoxiclav
Penicillin allergy? Clarithromycin (Erythromycin in pregnancy)
Ear infections
otitis externa
first and second line?
1st LINE? Topical Acetic Acid 2% (OTC earcalm 12+ yrs)
2nd LINE? Topical Neomycin Sulphate w/ Corticosteroid (eg hydrocortisone)
for otitis externa if systemic tx needed, what abx given?
flucloxacillin
triple therapy for H.Pylori infection
PPI: omeprazole/ esomeprazole/ lansoprazole if pt on clopidogrel
PLUS 2 of what?
Amoxicillin 1000mg BD
OR
Metronidazole 400mg BD
OR
Clarithromycin 500mg BD
(always amox first in combination therapy unless pen allergy)
H.Pylori is diagnosed by Urea (13C) breath test.
when SHOULDNT this be performed
within 2 weeks of taking PPIs- wait
within 4 weeks of taking abx - wait
can also do stool antigen
for non severe HAP (hospital acquired pneumonia) what is
1st LINE?
2nd LINE? (adults) DCCL
2nd LINE? (children)
1st LINE? Co-amoxiclav
2nd LINE? (adults): Doxycycline/ Cefalexin/ Co-trimoxazole/ Levofloxacin
2nd LINE? (children): Clarithromycin
Why do we avoid doxycycline in children<12?
Deposition in growing bone & teeth
Binding to calcium
Causes staining
Dental hypoplasia
also possible rash - allergy
IMPETIGO TREATMENT
LOCALISED NON-BULLOUS
1st LINE?
2nd LINE?
1st LINE? Hydrogen Peroxide 1%
2nd LINE? Fusidic Acid (Mupirocin 2% if fusidic acid resistance suspected)
IMPETIGO TREATMENT
WIDESPREAD NON-BULLOUS
1st LINE?
1st LINE? Fusidic Acid (Mupirocin 2% if fusidic acid resistance suspected)
when it spreads to upper lip, near nose and down to chin
IMPETIGO TREATMENT
BULLOUS or SYSTEMICALLY UNWELL
1st LINE?
2nd LINE?
1st LINE? Flucloxacillin 5 days
2nd LINE? Clarithromycin (OR Erythromycin in pregnancy)
LOWER UTI TREATMENT
1st line tx for men and non-pregnant women
Nitrofurantoin (eGFR > 45) OR Trimethoprim
lower UTI in men, if no improvement after 48hrs, what other conditions to consider?
pyelonephritis/ prostatis
lower UTI in men worsens -> prostatitis, whats the first and second line tx options?
- ciprofloxacin, ofloxacin, trimethoprim
- levofloxacin, co-trimoxazole
LOWER UTI TREATMENT
2nd line tx for non-pregnant women
Pivmecillinam OR Fosfomycin
why is trimethoprim AVOIDED in pregnancy
antifolate + teratogenic
what 3 does trimethoprim interact with
mtx
phenytoin
warfarin
LOWER UTI TREATMENT
first and second line for pregnant women
NCA
- nitrofurantoin
- cefalexin/ amoxicillin
Nitrofurantoin should only be used if eGFR is…?
≥ 45 mL/min
why should nitrofurantoin be avoided at term in preg women
neonatal haemolysis
how is pyelonephritis treated in
men and non-preg women?
preg women?
cefalexin, ciprofloxacin
cefalexin
LOWER UTI TREATMENT - No. of days
MEN?
PREGNANCY?
UNCOMPLICATED?
CATHETER-ASSOCIATED?
MEN? 7 days
PREGNANCY? 7 days
UNCOMPLICATED? 3 days
CATHETER-ASSOCIATED? 7 days
STREP THROAT and SCARLETT FEVER both caused by which bacteria?
Streptococcus
STREP THROAT/SCARLETT FEVER
1st LINE?
2nd LINE?
1st LINE? Phenoxymethylpenicillin
2nd LINE? Clarithromycin OR Erythromycin (in pregnancy)
SYMPTOMS OF SCARLETT FEVER?
- Flu-like: high temp, swollen neck glands
- Red rash w/ small, raised bumps, rough feeling like sandpaper
- White coating on tongue - strawberry-like
TREATMENT - ACNE VULGARIS?
Adapalene (Differin)/ Clindamycin/Benozyl Peroxide (Duac once daily) /Lymecycline
TREATMENT - BACTERIAL VAGINOSIS/TRICHOMONIASIS? (anaerobic)
Metronidazole 400mg BD 5-7 days
TREATMENT - CHLAMYDIA?
Doxycycline 100mg BD 14 days
TREATMENT - CONJUNCTIVITIS/BLEPHARITIS?
Chloramphenicol
not suitable for <2yrs or pregnant OTC
max tx 5 days
TREATMENT - DENTAL ABSCESS?
phenoxym OR Amoxicillin OR Metronidazole
PAM
TREATMENT - GONORRHOEA?
Ceftriaxone/Ciprofloxacin
(IM gent + azithromycin if allergy)
TREATMENT - MENINGITIS?
Benzylpenicillin
TREATMENT - SCABIES?
Permethrin - apply over whole body, including face, neck, scalp & ears and wash off
after 8-12 hrs, if hands washed w soap then retreat
TREATMENT - SINUSITIS?
Phenoxymethylpenicillin
Very unwell? Co-amoxiclav
(pen allergy? Doxycycline/Clarithromycin/Ery in pregnancy)
TREATMENT - THREADWORM?
OTC sale?
Mebendazole (ovex/ vermox)
2 YEARS+
MAX. SINGLE DOSE 100mg
MAX. PACK SIZE 800mg
what pathogen causes CAP and meningitis?
Streptococcus Pneumoniae
what pathogen causes uti
e coli
what pathogen causes thrush
Candida Albicans
what pathogen causes cellulitis
Staphylococcus Aureus
which abx to prescribe for pt with CAP and pen allergy?
doxy/ clarithro/ erythro
