Infections Flashcards
What antibiotics are contraindicated in children?
tetracyclines: must be over 12 years
- deposition in growing bone and teeth, by binding to calcium, causes staining and occasionally dental hypoplasia)
quinolones
- caution due to arthopathy in children
What is treatment for c.difficile infection?
1st line - vancomycin
2nd line - fidaxomicin
further episodes
- less than 12 weeks: fidaxomicin
- more than 12 weeks: vancomycin or fidaxomicin
severe c.difficile
- vancomycin + metronidazole
What is treatment for osteomyelitis?
flucloxacillin
- rifampicin and fusidic acid for 2 weeks
clindamycin if penicillin allergic
in MRSA
- add vancomycin or teicoplanin
What is treatment for community acquired pneumonia?
low
- amoxicillin
- penicillin allergy: clarithromycin, doxycycline, or erythromycin (in pregnancy)
moderate
- amoxicillin
- penicillin allergy: clarithromycin, or doxycycline
severe (IV or oral)
- co-amoxiclav WITH clarithromycin or oral erythromycin (in pregnancy)
- penicillin allergy: levofloxacin
What is the treatment for hospital acquired pneumonia?
non-severe
- co-amoxiclav
- penicillin allergy: doxycycline, cefalexin, co-trimoxazole, or levofloxacin
severe
- piperacillin with tazobactam, ceftazidime, ceftriaxone, cefuroxime, meropenem, or levofloxacin
if MRSA: add vancomycin, or teicoplanin, or linezolid
What is the treatment for cellulitis?
for 5-7 days
1st line - flucloxacillin or in penicillin allergy: clarithromycin, erythromycin, doxycycline
if the infection is near the eyes or nose - co-amoxiclav or in penicillin allergy: clarithromycin with metronidazole.
severe infections
- co-amoxiclav, cefuroxime, clindamycin
if MRSA: add vancomycin, or teicoplanin, or linezolid
What is the treatment for animal bites?
1st line - co-amoxiclav or in penicillin allergy: doxycycline with metronidazole
prophylaxis - 3 days
treatment - 5-7 days
What is the treatment for pneumocystis pneumonia?
co-trimoxazole
- 2nd line: atovaquone
What is treatment for influenza?
oseltamivir
- must be started within 48 hours of symptom onset
zanamivir
- must be started within 48 hours (36 hours for children) of symptom onset
What is the treatment for respiratory syncytial virus?
ribavirin (infants)
palivizumab (children)
What is NEWS2 score?
clinical tool used to anticipate patient deterioration, assesses degree of illness
looks at
- respiration rate
- oxygen saturation
- on air or oxygen
- systolic blood pressure
- pulse
- consciousness
- temperature
What are some physical symptoms of sepsis?
mottled or ashen appearance
cyanosis
non-blanching or petechial rash
breach of skin integrity
What is the sepsis six?
IV antibiotics
IV fluids
give oxygen (if needed)
monitor urine output
monitor lactate - >2mmol/L
take blood cultures
BUFALO
blood cultures, urine output, fluids, antibiotics, lactate, oxygen
give 3 take 3
iv abx, oxygen, fluids
blood cultures, urine output, lactate
What is sepsis?
life-threatening organ dysfunction from a dysregulated host response to infection
sepsis — severe sepsis — septic shock
What is treatment for meningococcal septicaemia?
ceftriaxone or benzylpenicillin sodium
dexamethasone if confirmed
What are red flags for sepsis?
altered mental state
heart rate >130bpm
respiratory >24bpm
systolic blood pressure <90 mmHg
urine output: not passed urine in the previous 18 hours, or less than 0.5 ml/kg of urine per hour in catheterised patients.
skin: mottled appearance or cyanosis or non-blanching rash.
What is the treatment for diabetic foot infection?
1st line - flucloxacillin
2nd line - clarithromycin or doxycycline
erythromycin in pregnancy
moderate to severe
- flucloxacillin +/- gentamicin, metronidazole
- co-amoxiclav +/- gentamicin
- ceftriaxone + metronidazole
What is the treatment for UTI in non-pregnant women, >16 years?
1st line - nitrofurantoin 100mg BD 3 days or trimethoprim 200mg BD 3 days
2nd line - pivmecillinam or fosfomycin
What is the treatment for UTI in children <16 years?
1st line - trimethoprim or nitrofurantoin for 3 days
2nd line - nitrofurantoin, amoxicillin or cefalexin for 3 days
What is the treatment for UTI in pregnant women, >12 years?
1st line - nitrofurantoin 100mg BD 7 days
- avoid at TERM: neonatal haemolysis
2nd line - amoxicillin or cefalexin for 7 days
What is the treatment for UTI in men?
1st line - trimethoprim or nitrofurantoin for 7 days
