Infection treatment Flashcards
Common infections and their treatment
Treatment of cellulitis
Oral or IV:
[1] Flucloxacillin
Pen allergy: clarithromycin, oral erythromycin (preg) or oral doxy
If infection near nose or eyes:
[1] Co-amoxiclav
Pen allergy: clarithromycin WITH metronidazole
Severe infection, oral or IV:
Co-amoxiclav, clindamycin, IV cefuroxime or IV ceftriaxone (ambulatory care only)
MRSA suspected: Add IV vancomycin/teicoplanin/linezolid (if teic and vanc can’t be used)
Treatment of animal/human bite
Oral:
[1] co-amoxiclav
Pen allergy - doxycycline WITH metronidazole
IV:
First line - co-amoxiclav
Pen allergy - cefuroxime or cetriaxone WITH metronidazole
Symptomatic: 5 days (treatment)
Non-symptomatic: 3 days (prophylaxis)
Treatment of endocarditis
Amoxicillin +/- low dose gentamicin
+ Vancomycin if MRSA suspected/pen allergy
Flucloxacillin in staphylococci
Benzylpenicillin in streptococci
Treatment of bacterial meningitis
Benzylpenicillin (IV or IM)
- Child <1 year 300mg
- Child 1-9: 600mg
- Adult/child 10+: 1.2g
Pen allergic - cefotaxime (or Chloramphenicol in immediate anaphylaxis reaction to penicillins)
Dexamethasone as adjuvant
Treatment of osteomyelitis
6 weeks for each treatment
[1] Flucloxacillin
If penicillin allergic: Clindamycin
If MRSA suspected: Vancomycin/Teicoplanin
Consider adding fusidic acid or rifampicin for initial 2 weeks (for all options)
Treatment for community acquired pneumonia (low, med and high severity)
5 days’ treatment duration for all
Low severity:
[1] Amoxicillin 500mg TDS
[2] Doxycycline, Clarithromycin or Erythromycin in pregnancy
Moderate severity:
[1] Amoxicillin (If atypicals suspected, add clarithromycin/erythromycin )
[2] Doxycycline, Clarithromycin or Erythromycin in pregnancy
High severity (oral or IV):
[1] Co-amoxiclav + clarithromycin/erythromycin
If penicillin allergic: Levofloxacin
What makes HAP early onset
Less than five days after admission to hospital
Treatment for early and late onset hospital acquired pneumonia?
Oral (if non-severe):
[1] Co-amoxiclav 500/125mg TDS
[2 - adult] Doxycycline or Cefalexin or Co-trimoxazole (unlicensed) or Levofloxacin (unlicensed)
[2 - children] Clarithromycin
IV (severe or high risk of resistance):
Piperacillin with tazobactam, Ceftazidime (+/- avibactam), ceftriaxone, levofloxacin (unlicensed) or meropenem
MRSA suspected: Add Vancomycin/Teicoplanin/Linezolid
Pseudomonas suspected: Add Aminoglycoside (Gentamicin, Amikacin)
Treatment for infective exacerbation of COPD
increased sputum/change in colour and SoB
Amoxicillin 500mg TDS OR
Doxycycline 200mg on day 1 then 100mg OD OR
Clarithromycin 500mg BD
For 5 days
(Avoid Clarithromycin if already taking Azithromycin prophylactically)
Pylenophritis (Upper UTI)
[1] Cefalexin 500mg BD - TDS for 7-10 days OR Ciprofloxacin (Cefalexin if pregnant)
If sensitivity known: co-amoxiclav or trimethoprim
IV (if severe or unable to swallow)
- Amikacin, gentamicin, ceftriazone, cefuroxime, ciprofloxacin
- Cefuroxime if pregnant
What is the treatment for meningococcal meningitis?
[1] Benzylpenicillin
[2] Cefotaxime
[3] Chloramphenicol for 7 days
What is the treatment for pneumococcal meningitis?
[1] Cefotaxime (OR ceftriaxone)
- If pen sensitive: replace with Benzylpenicillin
- If resistant: vancomycin/rifampicin
For 14 days
Consider adding dexamethasone (started no later than 14 hours after staring antibiotic)
What is the treatment for meningitis caused by haemophilus influenza?
[1] Cefotaxime (OR ceftriaxone)
For 10 days
Consider adding dexamethasone
What is the treatment for meningitis caused by listeria?
- Amoxicillin [or ampicillin] + gentamicin
- Co-trimoxazole [ if pen allergic]
Symptoms suggestive of meningitis
stiff neck, non-blanching rash, fever, sensitivity to light
Treatment for diabetic foot infection
Mild infection (less than 2cm) [1] Flucloxacillin If pen allergy: clarithromycin, doxycycline or erythromycin in pregnancy
Moderate/severe infection (abscess, osteomyelitis)
[1] Flucloxacillin or Co-amoxiclav +/- Gentamicin
Penicillin allergy: Co-trimoxazole +/- Gentamicin
min. 7 days treatment and up to 6 weeks for osteomyelitis.
IV treatment - at least 48 hours
Treatment for diabetic foot infection
MILD INFECTION (LESS THAN 2CM): [1] Flucloxacillin 500mg to 1g QDS for 7 days If pen allergy: clarithromycin, doxycycline or erythromycin in pregnancy
MODERATE/SEVERE INFECTION (ABSCESS, OSTEOMYELITIS):
[1] Flucloxacillin or Co-amoxiclav +/- Gentamicin
Penicilllin allergy: Co-trimoxazole +/- Gentamicin
Min. 7 days treatment and up to 6 weeks for osteomyelitis.
IV treatment - at least 48 hours
Treatment for H. pylori
PPI + Amoxicillin 1000mg BD + Metronidazole 400mg BD OR Clarithromycin 500mg BD
For 7 days
Amoxicillin tends to be included in triple therapy unless patient has a penicillin allergy (then it’s PPI + Metronidazole + Clarithromycin)
Talk me through treatment of UTI’s in pregnancy?
[1] Nitrofurantoin
[2] Cefalexin or Amoxicillin
Nitrofurantoin: okay to use but avoid at term (after 36 weeks), if eGFR <45 and if have asthma/COPD
Trimethoprim: Teratogenic risk in first trimester as it is a folate antagonist
Cefalexin: a cephalosporin, these are safe in pregnancy
Cranberry juice or other cranberry products are not recommended as no evidence to support their use
Treatment for lower urinary tract infections
Non-pregnant women (3 days):
[1] Nitrofurantoin or Trimethoprim
[2] Pivmecillinam, fosfomycin
Pregnancy (7 days):
[1] Nitrofurantoin
[2] Cefalexin or Amoxicillin
Men (7 days):
[1] Nitrofurantoin or Trimethoprim
Catheter associated (7 days):
If no upper UTI symptoms:
[1] Nitrofurantoin, Amoxicillin (if susceptible culture) or Trimethoprim (low resistance)
[2] Pivmecillinam
If upper UTI symptoms:
[1] Cefalexin, ciprofloxacin, co-amoxiclav (if culture susciptible), trimethoprim
Severe or unable to take oral:
- Amikacin, ceftriaxone, cipro, cefuroxime, gentamicin (or co-amoxiclav but only in combo)
Co-amoxiclav usual dosing in pneumonia
500/125mg TDS (5 days total)
Doxycycline usual dosing in pneumonia
200mg on day 1 then 100mg OD (5 days total)
Macrolide usual dosing
Clarithromycin 500mg BD
Erythromycin 500mg QDS
Treatment for sepsis
Consult local guidelines but typically empirical treatment:
- Broad-spectrum β-lactam (e.g. piperacillin/tazobactam, cefepime, meropenem) and antibiotic for MRSA coverage (e.g. vancomycin/teicoplanin)
