Infections Flashcards by Eilidh Pottinger

What are the indications of Quinine?

Nocturnal leg cramps
Non-falciparum malaria
Falciparum malaria (in adults and children)

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What is the main safety information of quinine?

Dose dependant QT Prolongation
Caution in patients with an increased risk of QT Prolongation and Atrioventricular Block

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What are the contraindications of Quinine?

Remember: TOM Hiddleston

Tinnitus
Optic Neuritis,
Myasthenia Gravis,
Haemoglobinemia

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What drugs cause a definite risk of haemolysis in G6PD-deficient patients?

Mnemonic: MNOPQRS (Alphabetical)

Methylthioninium Chloride
Nitrofurantoin
dapsone and Other sulfones
Primaquine
Quinolones (ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin)
Rasburicase
Sulfonamides (including co-trimoxazole)

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What’s drugs cause a possible risk of haemolysis in some G6PD-Deficient patients?

Aspirin
Chloroquine
Menadione, water soluble derivatives (eg. Menadiol sodium phosphate)
Quinine (may be acceptable in acute malaria)
sulfonylureas
naphthalene in mothballs

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What are the drugs which cause C. Diff?

The 4 C’s

Cephalosporins
Clindamycin
Ciprofloxacin
Co-amoxiclav

Also
Other broad spec Penicillins
PPIs

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What are the main side effects of Nitrofurantoin?

Mnemonic: Bob Can Pee Alright

Blood Disorders
Acute Pulmonary Reactions
Peripheral Neuropathy
Cholestatic Jaundice

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A patient has an eGFR of 38 and the doctor wishes to put them onto nitrofurantoin.

What advice would you give the prescriber with regarding their treatment?

Give them a short course only

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A patient has an eGFR of 27 and the doctor wishes to start them on nitrofurantoin?

What advice would you give the prescriber regarding their treatment?

Nitrofurantoin should be avoid in eGFR <30

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What counselling advice would you give patients regarding nitrofurantoin?

Report any signs of new or worsening respiratory symptoms
Report any signs of hepatic dysfunction (abdo pain, swelling legs, jaundice etc)
Take with or after food
This tablet may discolour the urine, it is of no concern

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Can you give chloramphenicol to someone who is pregnant? Yes or no, and if no, why?

No - Avoid

Risk of neonatal ‘Grey-Baby syndrome’

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What are the antibiotic choices for Lower UTI?

Mnemonic: Can Not Avoid the Treatment For Peeing

Cefalexin
Nitrofurantoin
Amoxicillin
Trimethoprim
Fosfomycin
Pivemecillinam

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What are the side effects of Amoxicillin?

Nausea
Diarrhoea
Antibiotic-Associated Colitis
Skin Rash

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What are the main interactions of Amoxicillin?

Methotrexate: Reduced clearance
Allopurinol: Increased Risk of Rash

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What are the main side effects of Trimethoprim?

Remember: ‘HACk SiR’
- Hyperkalaemia
- Agranulocytosis
- Cholestatic Jaundice
- Skin rashes
- Raised serum Creatinine

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What are the contra-indications of Trimethoprim?

Severe Hepatic or Renal Impairment
Blood Dyscrasias

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What are the side effects of Pivmecillinam?

Diarrhoea
Vulvovaginal Fungal Infection

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What are the contra-indications of Pivmecillinam?

Carnitine Deficiency
GI Obstruction

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What are the main interactions with Pivmecillinam?

Methotrexate: Reduced clearance
Valproate - Increased risk of Carnitine Depletion

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What are the main interactions with penicillins?

Methotrexate: may reduce MTX clearance and increase risk of toxicity
Allopurinol: Increased risk of rash with Amoxicillin
Warfarin: May increase INR Levels

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What are the main interactions with Quinolones (-floxacins)?

Drugs that prolong QT Interval
NSAIDs: Increase risk of seizures
Theophylline: Plasma levels increased
Corticosteroids: Increased risk of tendon damage
Ciclosporin: Risk of nephrotoxicity and increased conc.
Phenytoin: Increase or decrease levels
Methotrexate: may increase plasma levels of MTX

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What are the main interactions with Trimethoprim?

Methotrexate: Increased risk of bone marrow suppression
Phenytoin: Reduced risk of Phenytoin toxicity
Digoxin: Increased Digoxin levels
Azathioprine: Risk of haematological toxicity increased
Warfarin: May increase levels

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What are the main interactions with Macrolides?

Erythromycin and Clarithromycin are enzyme inhibitors.
Mnemonic: Clarithromycin Will Treat Super Tb.

Carbamazepine
Warfarin
Theophylline
Simvastatin
Ticagrelor
Drugs prolonging QT interval
Statins (Simvastatin, Atorvastatin)
Colchicine

What are the side effects of Chloramphenicol?

Irritation
Burning
Stinging

What is the treatment duration of Lower Urinary Tract Infections for each of the following: - Women - Men - Pregnant Women? There is one more group you should be remembering, which is it?

Women: 3 days Men: 7 days Pregnant Women: 7 days Catheter-associated LUTI: 7 days

What antibiotics can be used to treat a Lower Urinary Tract Infection? List 6.

- Trimethoprim - Nitrofurantoin - Fosfomycin - Pivemecillinam - Amoxicillin - Cefalexin

What dose recommended for treating Lower UTIs with nitrofurantoin, and when do you take it?

50mg four times a day (Immediate-release) 100mcg twice a day (modified-release) With or after food

What are the main side effects of Nitrofurantoin?

- Acute Pulmonary Reactions - Rash - Nausea - Peripheral Neuropathy

The doctor wishes to give a woman who is 12 weeks pregnant nitrofurantoin for a Lower Urinary Tract Infection. What advice would you give the prescriber?

It is not known to be harmful in the first few weeks of pregnancy but avoid when at term.

The doctor wishes to give nitrofurantoin to a man with an eGFR=36. What advice would you give the prescriber?

It is fine to use, but keep the course short.

What are the main side effects of Penicillins?

- Cholestatic Jaundice (Flucloxicillin) - Diarrhoea - Skin reactions - Clostridium Difficile - Black Hairy Tongue (Amoxicillin)

What are the side effects of Tetracyclines?

- Photosensitivity - Tooth Discolouration - Headaches - Irreversible Pigmentation (Minocycline) - GI Disorders

What are the main side effects of Quinolones?

Mnemonic: QTC HA - QT Prolongation - Tendon Damage (Increased risk with those on corticosteroids and over 60 years old) - Convulsions (Increased risk with those on NSAIDs) - Heart Valve Regurgitation - Aortic Aneurysm

What are the main side effects of Nitrofurantoin?

- Pulmonary Disorders (report any pulmonary symptoms) - Hepatic Disorders (monitor LFTs in long term use) - Urine Discolouration

What are the main side effects with Trimethoprim?

- Hyperkalaemia - Haematological Disorders - Skin Rashes - Fungal Overgrowth

How do you treat a Clostridium Difficile Infection?

1st Line: Vancomycin 125-500mg four times a day for 10 days 2nd Line: Fidaxomycin 200mcg twice a day for 10 days

What are the cautions with Quinolones?

- History of Epilepsy - Risk factors for QT Prolongation - Children or adolescents (Arthropathy risk)

A doctor wishes to give ciprofloxacin to a 28 year old female who is 24 weeks pregnant. What advice would you give the prescriber?

Avoid

What are the indications of Quinolones?

Mnemonic: DEAR P - Diverticulitis - Eye Infections - Acute Otitis Media - Respiratory Tract Infection - Prostatitis

What counselling advice would you give to a patient starting a quinolone?

Treatment with quinolones should be stopped at the first sign of serious adverse reactions, such as tendon pain or inflammation, CNS effects and peripheral neuropathy.

What are the indications for Trimethoprim?

- UTI - Acute Pyelonephritis - Acute Prostatitis - Acute Diverticulitis

What are the main side effects of Fluconazole?

4HQ - Headaches - Hyperlipidaemia - Hair loss - Hepatic Disorders - QT Prolongation

What are the main drugs which cause C. Diff?

The 4 C's - Clindamycin - Cephalosporins - Co-amoxiclav - Ciprofloxacin Also - Broad spec Penicillins - Other Fluoroquinolones (Moxifloxacin, Ofloxacin, Levofloxacin)

What are the main side effects of Nitrofurantoin?

- Blood Disorders - Cholestatic Jaundice - Acute Pulmonary Reactions - Peripheral Neuropathy

What are the main counselling points with Nitrofurantoin?

- Take with or after food - Report any new or worsening respiratory symptoms - Report any signs of hepatic dysfunction (vomiting, jaundice etc) - Nitrofurantoin may discolour the urine, this is harmless

What monitoring is required for Trimethoprim and when?

In long term treatment: monitor FBC and U+Es

A doctor wishes to start a patient with an eGFR of 12 on Trimethoprim. What is the advice you give to the prescriber?

Half the normal dose

A doctor wishes to start a patient with an eGFR of 28 on Trimethoprim. What is the advice you give to the prescriber?

Half the dose after 3 days.

A doctor wishes to start a 24 year old woman on trimethoprim. She is 12 weeks pregnant. What advice do you give the prescriber?

Avoid in the first trimester Risk of teratogenicity.

What are the main counselling points with Tetracyclines?

- Wear suncream and avoid direct sunlight while on treatment - avoid indigestion remedies, containing iron or zinc for 2 hours before and after dose (doxycycline, lymecycline, minocycline)

What are the main side effects of Tetracyclines?

Mnemonic: POST - Photosensitivity - Oesophageal Irritation - Severe headaches and/or visual disturbances - Tooth Discolouration Also: - Irreversible Pigmentation - GI Disorders

What are the indications for tetracyclines?

Mnemonic: PR CAR - Respiratory Infection - Periodontal Infections - Chlamydia - Acne - Rosacea

What are the main interactions with Tetracyclines?

- CYP3A Inducers - Lithium - Methotrexate - Retinoids

A doctor wishes to prescribe a 22 year old woman with doxycycline. She is 23 weeks pregnant. What advice do you give to the prescriber?

Avoid May cause discolouration of child teeth and affect skeletal development (affects calcium)

What is the main warning with minocycline?

Causes irreversible pigmentation (greater risk of lupus erythematosus like symptoms)