Infections Flashcards
Acute Sore Throat
1st line: Phenoxymethylpenicillin
Penicillin allergy: Clarithromycin
Pregnant: Erythromycin
Influenza Treatment
Oseltamavir (Tamiflu) and Zanamavir (Relenza)
Scarlett Fever Treatment
1st Line: Phenyoxymethylpenicillin
(Pen V)
Penicillin allergy: Clarithromycin
Acute Otitis Media Treatment
1st line: Amoxicillin
2nd: Co-amoxiclav
Penicillin allergy: Clarithromycin
Pregnant: Erythromycin
(?)Acute Otitis Externa Treatment
1st line: Analgesia and apply localised heat.
2nd: Topical Acetic acid-2% (Ear Calm) and Topical Antibiotics/steroids
If cellulitis: Flucloxacillin
Sinusitis Treatment
1st line/Non-life-threatening: Phenoxymethylpenicillin
Penicillin allergy: Doxycycline or Clarithromycin
Pregnancy: Erythromycin
2nd line/Life Threatening: Co-amoxiclav
Treatment for Acute exacerbation of COPD (mild and severe)
Mild: Amoxicillin or Doxycycline or Clarithromycin
Severe: Co-amoxiclav or Co-trimoxazole or Levofloxacin
Acute exacerbation of Bronchiectasis
1st Line: Amoxicillin (preferred in pregnancy) or Doxycycline (not for <12 years old)
In risk of treatment failure: Co-amoxiclav, levofloxacin, ciprofloxacin.
Acute Cough infection treatment (LRTI)
Adults: Doxycycline/Amoxicillin/Clarithromycin
If pregnant: Erythromycin
Children: Amoxicillin/Clarithromycin/ Erythromycin/Doxycycline (Not <12 years old)
Community Acquired Pneumonia Treatment: All severities
Low: Amoxicillin, can also use Clarithromycin/Doxycycline (not under 12)/Erythromycin (pregnancy) CURB65- 0-1
Medium: Amoxicillin and another antibiotic (atypical pathogens suspected!) Clarithromycin and Erythromycin (pregnancy). Penicillin allergy: Doxycycline or Clarithromycin. CURB65 score -2
Severe: Co-amoxiclav + clarithromycin/Erythromycin (pregnancy). Penicillin allergy: Levofloxacin (consider patient safety issues e.g. age, kidney function etc.) CURB65 score- 3-5
Treatment for Community Acquired Pneumonia Treatment in children. All severities
Non-severe :Amoxicillin
Penicillin allergy: Clarithromycin (1month to 17 years) or Doxycycline (12 years-17 years) or erythromycin (8 years to 17 years)
Severe: Co-amoxiclav and* clarithromycin or erythromycin.
*only if atypical pathogen suspected.
Hospital Acquired Pneumonia treatment: all severities
Non-severe: Co-amoxiclav
Alternatives: Doxycycline or Cefalexin or Co-trimoxazole or Levofloxacin
(Co-trimoxazole and Levofloxacin aren’t licensed for this use)
Severe: Specialist Advice required; options include: Piperacillin with tazobactam, ceftriaxone, cefuroxime, ceftazidime, ceftazidime with avibactam, meropenem, Levofloxacin.
Severe HAP and suspected/confirmed MRSA INFECTION. What therapy should be added?
Vancomycin and Teicoplanin along with the IV antibiotics treating the HAP.
Linezolid (if vancomycin can’t be used and specialist advice only)
HAP Treatment (microbial) in children- All severities
Non-severe- Co-amoxiclav
Penicillin allergy: Clarithromycin
Severe- IV antibiotics by specialist options include: Piperacillin with Tazobactam, Ceftazidime, Ceftriaxone.
Urinary tract infection treatment in women
1st line: Nitrofuratoin (if eGFR >45) or trimethoprim.
2nd: Nitrofuratoin, pivmecillinam or fosfomycin (3 days)
Pregnancy: Nitrofuratoin (avoid at term due to risk of neonatal haemolysis)
2nd line: amoxicillin and cefalexin for 7 days.
Urinary Tract Infection treatments for Men
1st line: Trimethoprim
2nd line: Nitrofuratoin for 7 days
Urinary tract infections for children over 3 months
1st line: Nitrofuratoin, Trimethoprim
2nd line: Nitrofuratoin, amoxicillin, cefalexin
Acute Prostatis Treatment
1st line: Ciprofloxacin, ofloxacin, trimethoprim
2nd line: Levofloxacin, Co-trimoxazole
Acute Pyelonephritis (Upper UTI)
1st line in Women: cefalexin, trimethoprim, ciprofloxacin, Co-amoxiclav
1st line in Men: IV Antibiotics (specialist)
Pregnancy: Cefalexin
Children over 3 months: Co-amoxiclav
Prophylactic Recurrent UTI Treatment
Prophylaxis:
1st line: Nitrofuratoin or Trimethoprim
2nd line: amoxicillin or cefalexin
Catheter associated UTI
1st line with no upper UTI symptoms: Nitrofuratoin, Trimethoprim, amoxicillin.
2nd line with no upper UTI symptoms:
Cefalexin, Co-amoxiclav, trimethoprim, ciprofloxacin.
Pregnancy: Cefalexin
Children over 3 months: Trimethoprim, amoxicillin, Co-amoxiclav, Cefalexin
Bacterial Meningococcal Meningitis treatment
IV/IM Benzylpenicillin, cefotaxime, ceftriaxone.
Penicillin allergy: Chloramphenicol
Oral candidiasis treatment
Miconazole gel if not tolerated use Nystatin oral solution.
Fluconazole can be used if severe.
Infectious diarrhoea treatment
If campylobacter suspected: clarithromycin
If giardia suspected: tinidazole
Traveller’s Diarrhoea treatment
Azithromycin
Prophylaxis: Bismuth subsalicylate
Threadworms treatment
Adults and children >6 months: Mebendazole
Children <6 months and pregnancy: only hygiene measures.
C. Difficile infection treatment
1st line: Vancomycin
2nd line: Fidaxomicin
Relapse infection within 12 weeks: Fidaxomicin
Relapse infection after 12 weeks: Vancomycin (and Fidaxomicin if it’s severe)
Helicobacter Pylori treatment
Triple therapy: 2 antibiotics and a PPI
Amoxicillin, clarithromycin and metronidazole are normally considered first line.
H. Pylori treatment 2nd line
PML -(PPI +metronidazole+levofloxacin)
To be used if levo/clarithromycin is unsuccessful: PBMT -(PPI + Bismuth+ metronidazole+tetracycline)
Acute diverticulitis Treatment
1st line: Co-amoxiclav
2nd line/penicillin allergy:
Cefalexin and metronidazole, OR trimethoprim and metronidazole, OR ciprofloxacin and metronidazole.
Conjunctivitis treatment
Chloramphenicol
Chlamydia Trachomata/Urethritis Treatment
1st line: Doxycycline
2nd line/allergy/breastfeeding/intolerance: Azithromycin
Epididymitis gram negative bacteria
Doxycycline or ofloxacin or ciprofloxacin
Vaginal Candidiasis Treatment
Clotrimazole or fenticonazole or oral fluconazole.
If recurrent, then oral fluconazole 150mg every 72 hours then 150mg once weekly
Bacterial Vaginitis
Oral or topical Metronidazole gel
Or clindamycin 2% cream
Genital Herpes Treatment
Oral Aciclovir or
Valaciclovir or famciclovir
Gonorrhoea treatment (Susceptibility known and unknown)
Known: Ciprofloxacin 500mg single oral dose
Unknown/Pregnancy : Ceftriaxone 1g IM
Alternatively: Azithromycin 2g single dose oral + (gentamicin 240mg IM/cefixime 400mg oral)
Trichomoniasis Treatment
Metronidazole or Clotrimazole
Pelvic Inflammatory Disease Treatment
1st line: Ceftriaxone+metronidazole+ doxycycline
2nd line: (metronidazole+ofloxacin) or moxifoxacin alone
Cold sores Treatment
Aciclovir 400mg BD
Eczema bacterial infection treatment
Topical antibiotics
1st line: Fusidic acid 2%
Oral antibiotics
1st line: Flucloxacillin
Penicillin allergy: Clarithromycin or Erythromycin (pregnant)
Impetigo Treatment
Topical antiseptic: Hydrogen peroxide 1%
Topical antibiotics:
1st line: fusidic acid 2%
Resistance option: mupirocin 2%
Oral antibiotics:
Flucloxacillin (clarithromycin or erythromycin in pregnancy)
Mastitis treatment
1st line: Flucloxacillin
Penicillin allergy/pregnancy: Clarithromycin or Erythromycin (in pregnancy)
Leg Ulcer infection treatment
1st line: Flucloxacillin
Unsuitable/pregnancy: doxycycline or clarithromycin, erythromycin (in pregnancy)
2nd line: Co-amoxiclav or
Co-trimoxazole (penicillin allergy)
Cellulitis and/or erysipelas treatment (away from face)
1st line: Flucloxacillin
Penicillin allergy/unsuitable: clarithromycin, Co-amoxiclav, doxycycline (adults only)
Pregnancy: Erythromycin
Cellulitis and/or erysipelas treatment (near eyes and nose)
1st line: Co-amoxiclav
Penicillin allergy: clarithromycin and metronidazole (only add metronidazole in children if anaerobes are present)
Mild Diabetic foot infection treatment
1st line: Flucloxacillin
Penicillin allergy: Clarithromycin or Doxycycline
Pregnancy: Erythromycin
Mild Acne Vulgaris treatment
Benzoyl peroxide or topical clindamycin (not in under 12)
Scabies treatment
Permethrin
Penicillin allergy: malathion (6 months over)
Insect bite treatment
Chlorophenamine
Human animal Bite treatment
1st line: Co-amoxiclav
Penicillin allergy: doxycycline and metronidazole
Dermatophyte skin infection treatment
Topical terbafine/imidazole
Dermatophyte nail treatment
1st line: Terbafine
2nd line: Itraconazole
Varicella Zoster/Chickenpox/Shingles treatment
1st line: Aciclovir
2nd line: famiciclovir or valaciclovir
Conjunctivitis treatment
1st line: Bath/clean eyelid with cotton wool dipped in sterile saline or boiled cooled water to remove crusting
2nd line: Chloramphenicol eye drops or ointment
3rd line: fusidic acid 1%
Blepharitis treatment
1st line: Lid Hygiene for symptoms
2nd line: Topical Chloramphenicol
3rd line: Oral oxytetracycline or doxycycline
Mucosal ulceration and inflammation treatment (simple gingivitis)
Chlorhexidine 0.1-0.12% or
Hydrogen peroxide 6%
Acute necrotising ulcerative gingivitis treatment
Chlorhexidine 0.1-0.12% or hydrogen peroxide or metronidazole
Pericoronitis treatment
Metronidazole/amoxicillin+ Chlorhexidine/hydrogen peroxide
Dental abscess treatment
Amoxicillin or Phenoxymethylpenicillin
Penicillin allergy: metronidazole or clarithromycin
Osteomyelitis treatment for 6 weeks
Flucloxacillin
Penicillin allergy: Clindamycin
consider adding fusidic acid and rifampicin for initial 2 weeks
Epiglottis treatment
1st line: Cefotaxime or ceftriaxone
Penicillin allergy: Chloramphenicol
Syphillis treatment
Benzylpenicillin or procaine penicillin
Treating Septicaemia
Anti-pseudomonal beta lactam e.g. Piperacillin with tazobactam, Ticarcillin with clavulanic acid, or broad spec cephalosporin (Cefuroxime).
Add metronidazole if anaerobic infection
Initial Blind Endocarditis treatment
1st line: Amoxicillin (maybe add low dose gentamicin)
Penicillin allergy/MRSA suspected: Vancomycin and low dose gentamicin
If severe sepsis with risk factors for gram negative: Vancomycin +Meropenem
Prosthetic valve endocarditis
Vancomycin+ Rifampicin+ low-dose gentamicin
Staphylococcal endocarditis treatment
1st line: Flucloxacillin for 4 weeks
Penicillin allergy/MRSA: Vancomycin+ rifampicin for 4 weeks
( 6 weeks if secondary lung abscess or osteomyelitis is also there)
Staphylococcal endocarditis with prosthetic valve treatment
1st line: Flucloxacillin+rifampicin+low dose gentamicin
Penicillin allergy/MRSA: Vancomycin+ rifampicin+low dose gentamicin
Both plans for 6 weeks
Fully sensitive streptococcal endocarditis treatment
1st line: Benzylpenicillin
Penicillin allergy: Vancomycin (or teicoplanin) + low dose gentamicin
Duration: 4-6 weeks (Stop gentamicin after 2 weeks)
Less-sensitive streptococcal endocarditis treatment
Benzylpenicillin+ low dose gentamicin
Enterococcal endocarditis treatment
1st line: Amoxicillin or Benzylpenicillin +low dose gentamicin
Penicillin allergy/resistance: Vancomycin (or teicoplanin)+ low dose gentamicin
HACEK Endocarditis treatment
1st line: Amoxicillin +low dose gentamicin
Penicillin allergy/resistance: Ceftriaxone (or cefotaxime) + low dose gentamicin
