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Infections Flashcards

1
Q

Safest antibiotics in pregnancy?

A

Penicillins and Cephalosporins

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2
Q

Animal Bites?

A

Co-amoxiclav or metronidazole + doxycycline if penicillin allergic. Give within 48-72 hours and for up to 5 days.

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3
Q 
Staphylococci
MRSA
Streptococci
Anaerobic
Pseudomonas Aeruginosa
A 
Flucloxacillin
Vancomycin
Benzylpenicillin or Phenoxymethylpenicillin
Metronidazole
Gentamicin
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4
Q

Septicaemia (community-acquired)?

A

A broad-spectrum antipseudomonal penicillin (e.g. piperacillin with tazobactam, ticarcillin with clavulanic acid) or a broad-spectrum cephalosporin (e.g. cefuroxime)

MRSA add vanc
Anaerobic add metro

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5
Q

Septicaemia (hospital-acquired)?

A

A broad-spectrum antipseudomonal beta-lactam antibacterial (e.g. piperacillin with tazobactam, ticarcillin with clavulanic acid, ceftazidime, imipenem with cilastatin, or meropenem)

MRSA add vanc
Anaerobic add metro

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6
Q

Septicaemia related to vascular catheter?

A

Vancomycin (or teicoplanin)

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7
Q

Meningococcal septicaemia?

A

Benzylpenicillin sodium or cefotaxime (or ceftriaxone)
If history of immediate hypersensitivity reaction to penicillin or to cephalosporins, chloramphenicol.

BCC

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8
Q

Endocarditis?

A

Amoxicillin (Vanc. if pen allergy) +/- Low Dose Gentamicin

MRSA OR PEN ALLERGY - ADD VANC
STAPH - ADD FLUCLOX
STREPT - ADD BENZYLPEN

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9
Q

Otitis Externa?

A

Flucloxacillin

If pen allergic - Clarithromycin

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10
Q

Otitis Media?

A

No penicillin allergy:
1st Line: Amoxicillin
If worsening: Co-amoxiclav

Pen allergy:
Clarithromycin or Erythromcyin (pref pregnancy).

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11
Q

Clostridium Difficile?

A

Caused by: ampicillin, amoxicillin, co-amoxiclav, second and third gen-cephalosporins, clindamycin and quinolones.

Treatment: 10-14 days.
Mild to moderate - oral metronidazole

Second episode/unresponsive/severe/CI metro:
Vancomycin, alternative Fidoxomicin.

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12
Q

Bacterial Vaginosis?

A

Metronidazole (5-7 days or high dose as single dose)

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13
Q

Chlamydia?

A

Azithromycin Stat or Doxycycline 7 days.

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14
Q

Osteomyelitis?

A

Flucloxacillin
Pen allergy: Clindamycin
MRSA: Vancomycin

Consider adding fusidic acid or rifampicin for initial 2 weeks.

Treatment duration 6 weeks.

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15
Q

Sinusitis? Prescribed after 10 days of symptoms.

A

Phenoxymethylpenicillin
Worsening symptoms/serious infection: Co-amoxiclav

Pen allergy:
Doxycyline or Clarithromycin (Erythromycin in pregnancy)

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16
Q

Oral Infections?

A

Penicillin (or macrolide) + Metronidazole

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17
Q

Bronchiesctasis or COPD exacerbation?

A

First line: Amoxicillin, clarithromycin or doxycycline
Alt. if high risk - co-amoxiclav or levofloxacin

IV severely unwell:
Amoxicillin, co-amoxiclav, clarithromycin, co-trimoxazole, or piperacillin with tazobactam.

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18
Q

Cough?

A

Doxycycline, amoxicillin, clarithromycin, erythromycin.

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19
Q

CAP low severity?

A

Amoxicillin

Clarithromycin or Doxycycline alternatives

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20
Q

CAP moderate severity?

A

Amoxicillin + Clarithromycin OR

Doxycyline alone

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21
Q

CAP high severity?

A

Benzylpenicillin + Clarithromycin/Doxycycline

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22
Q

HAP early onset less than 5 days after admission?

A

Co-amoxiclav or cefuroxime

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23
Q

HAP late onset more than 5 days after admission?

A

Antipseudomonal penicillin (piperacillin with tazobactam), or broad spectrum cephalosporin (ceftazadime) or another antipseudomonal beta lactam or a quinolone (e.g. ciprofloxacin)

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24
Q

Impetigo small areas?

A

Topical fusidic acid
if MRSA topical mupirocin
7 days, max 10 days.

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25
Impetigo widespread?
Flucloxacillin If strep in severe add phenoxymethylpenicillin If penicillin allergic - clarithromycin or erythromycin 7 days
26
Cellulitis?
Flucloxacillin If strep replace fluclox with Pen V or Pen V If penicillin allergic: clindamycin or clarithromycin, or vancomycin.
27
Erysipelas?
Pen V or Pen G if severe replace with high dose flucloxacillin Pen allergy: clindamycin or clarithromycin.
28
Mastitis during breastfeeding?
Flucloxacillin | Pen allergy: Erythromycin.
29
High peak concentration and high trough concentration? what to do?
High peak: reduce dose | High trough: increase dosing interval
30
Cephalosporins, Generations?
``` 1st Gen: Cefa Cefalexin, Cefadroxil, Cefradine 2nd Gen: 2 Foxes For Tea Cefuroxime, Cefaclor 3rd Gen: Cefixime, Ceftazadime, Ceftriaxone, Cefotaxime (3rd Gen or Cefuroxime can be given in pen allergy) Collitis 2nd and 3rd Gen 5th Gen: Ceftaroline ```
31
Quinolones safety information?
Seizures - with or without history, concomitant NSAIDs also increases risk. Tendon Damage - within 48 hours to months later. CI in history of tendon disorders, over 60 more prone, increased risk by concomitant corticosteroids, if tendinitis suspected discontinue immediately. Aortic aneurysm. QT prolongation. Disabling severe life long side effects, musculoskeletal and nervous system. DISCONTINUE IF NEUROLOGICAL, PSYCHIATRIC, TENDON DAMAGE OR HYPERSENSITIVITY OCCUR.
32
Co-Trimoxazole?
Trimethoprim and Sulfamethoxazole (1:5 parts) Treatment and prophylaxis of Pneumocystis jirovecii (pneumocystis carinii) pneumonia and nocardiasis Stenotrophomonas maltophilia and toxoplasmosis. Blood disorders, Rash, Steven Johnson Syndrome, Toxic Epidermal Necrolysis.
33
Tetracyclines?
Benign intracranial hypertension, report headache. Minocycline - irreversible pigmentation, greatest risk of lupus-eryth. CI under 12, Pregnancy and Breastfeeding - (1st trimester skeletal development effects) 2nd and 3rd tri - tooth discolouration and dental hypoplasia child. Safe in renal impairment - Doxy, Mino Avoid in hepatic impairment. Photosensitivity - DD, doxy, demec. Do not take antacid, zinc, iron, aluminium, magnesium, calcium products 2 hours before or after. Avoid milk - demec, oxytet, tetra. Oesophageal Irritation - DMT, doxy, mino, tetra. Swallow whole plenty of fluid during meals. Photosensitivity doxy.
34
Chloramphenicol
Life threatening infections - Blood dyscrasias - Grey baby syndrome - avoid in pregnancy.
35
Linezolid
``` Alternative to VANC in MRSA Blood Disorders Optic Neuropathy with >28 days use Hypertensive crisis Reversible MAOi Avoid tyramine rich foods ```
36
Trimethoprim
Anti-folate - teratogenic 1st trimester Blood dyscrasias with long term use Hyperkalaemia Fungal overgrowth
37
Aminoglycosides?
``` Pregnancy - avoid unless essential Nephrotoxic - excreted by kidneys Irreversible ototoxicity Increased risk with loop diuretics Peripheral neuropathy Impaired neuromuscular transmission CI in myaesthenia gravis Hypo K Ca Mg Potential for histamine related adverse reactions with some batches ```
38
Vancomycin
``` Monitor serum concentration - after 3/4 doses or dose change Renal impairment Pre-dose trough = 10-20 15-20 if endocarditis Pregnancy - avoid unless essential Nephrotoxicity Ototoxicity Red Man Syndrome - flushing of entire body Blood dyscrasias Skin disorders Thrombophlebitis ```
39
Lyme Disease?
Caused by tick bites Non-focal symptoms: fever, swollen glands, fatigue, neck pain. Focal: neurological (cranial nerves, peripheral nervous system, central nervous system), lyme arthritis, lyme carditis. Non-focal: oral doxycyline, amoxicillin alt. azithromycin if both CI. Focal (cranial, PNS): doxycyline, amoxicillin alt. Focal (CNS): IV ceftriaxone, oral doxy alt. Lyme arthritis: oral doxy, amox alt. then IV ceftriaxone alt. ``` Lyme carditis (haemo stable): Oral doxy, IV ceft. alt. (haemo unstable): IV ceftr. oral doxy when switching to oral. ```
40
TB?
RIPE 2 months Rifampicin, Isoniazid (pyridoxine for prophylaxis of Isoniazid induced neuropathy), Pyrazinamide, Ethambutol RI 4 months Rifampicin, Isoniazid (pyridoxine) CNS involvement, continue treatment to 12 months total Resistant to rifampicin - 6 drug treatment.
41
Rifampicin
Enzyme Inducer (contraceptives? use IUD) Rifampicin intermittent therapy: influenza-like, abdominal, respiratory, shock, renal failure, and thrombocytopenic purpura. Orange-Red Urine and Soft Contact Lenses HEPATOTOXICITY LFTs weekly for two weeks then two weekly for six weeks Blood counts
42
Isoniazid
Enzyme Inhibitor HEPATOTOXIC Peripheral neuropathy overcome by concomitant pyridoxine.
43
Pyrazinamide
Hepatotoxic
44
Ethambutol
Optic neuritis, ocular toxicity More common if renal function impaired. Hyperuricaemia. Monitoring: Serum conc, renal function before treatment, visual acuity using Snellen chart before treatment.
45
UTIs
Lower UTIs: - trimethoprim, nitrofurantoin, alt. amox, amp, cephalo. Treatment 7 days but short course of 3 days adequate in uncomplicated UTIs in women. Prophylaxis - trimethoprim, nitrofurantoin, cefalexin. Upper UTIs: broad spectrum IV e.g. cephalosporins cefuroxime, or quinolone. 10-14 days. Prostatitis: quinolones or trimethoprim (28 days) Pregnancy: penicillin or cephalo. Nitrofurantoin should be avoided at term.
46
Nitrofurantoin
UTIs - Avoid eGFR < 45 Nausea side effect, peripheral neuropathy in RI Pregnancy avoid at term neonatal haemolysis CI under 3 months Take with or after food Colours urine yellow brown
47
Candidiasis
Oral fluconazole, | if resistant organisms give Itraconazole.
48
Skin and nail (tinea corporis, tinea cruris, tinea pedis, tinea capitis, onychomycosis)
Itraconazole or terbinafine.
49
Pityriasis versicolor
Itraconazole, if ineffective fluconazole by mouth. | Terbinafine IS NOT EFFECTIVE.
50
Amphotericin B
Serious fungal infections Specify BRAND - risk of fatal adverse reactions if formulations confused. IV avoid rapid infusion (arrythmias, toxicity) ANAPHYLAXIS (TEST DOSE AND MONITOR FOR 30 MINUTES) Nephrotoxicity.
51
Fluconazole
Enzyme Inhibitor, QT prolong susceptibility
52
Itraconazole
HEART FAILURE, HEPATOTOXICITY CCB CI Needs acidic pH, avoid antacids.
53
Voriconazole
HEPATOTOXICITY PHOTOTOXICITY - Pre-malignant lesions or skin cancer CARRY ALERT CARD avoid sunlight, SPF.
54
Antimalarials?
``` Malarone (Atovaquone and proguanil) POM Chloriquine (avloclor) P Larium (mefloquine) POM Palodrine (proguanil) P Chloroquine with proguanil P Doxycycline POM ```
55
Malaria Prophylaxis?
1 week before for chloroquine and proguanil, 2-3 weeks before for mefloquine, 1-2 days before for atovaquone & proguanil and doxycycline. Continue for 4 weeks after leaving except for atovaquone and proguanil which is one week.
56
Long term prophylaxis malaria?
Mefloquine 1 year Atovaquone & Proguanil 1 year Doxycycline 2 years
57
Malaria in asplenic and pregnancy?
travel should be avoided. Chloroquine and proguanil may be given in pregnancy 5mg folic acid given with proguanil for at least 1st tri. Mefloquine if high risk only in 2nd and 3rd trimester Doxy if others unsuitable and the entire course can be completed before 15 weeks gestation.
58
Antimalarias and anticoagulants?
If taking warfarin, begin chemoprophylaxis 2-3 weeks before departure and INR must be stable before. INR before, 7 days after starting and when completed.
59
Return from region and illness?
Any illness occurring within 1 year and especially 3 months of return might be malaria.
60
Antimalarials and epilepsy?
Avoid mefloquine and chloroquine.
61
Malaria Treatment?
Falciparum - Quinine, Malarone (A&P), or Riamet (artemether and lumefantrine) Non-falciparum - Chloroquine
62
Antimalarials and renal impairment?
Doxycycline and Mefloquine are okay. Avoid - proguanil. Avoid malarone and chloroquine if eGFR <30 (severe)
63
Chloroquine
Ocular toxicity - retinopathy. | Baseline eye exam and annual screening if taken for >1 year. Avoid in epilepsy. Lower seizure threshold.
64
Mefloquine
Neuropsychiatric reactions - PSYCHOSIS, SUICIDAL IDEATION AND SUICIDE. Prodromal symptoms for more serious event: insomnia, nightmares, anxiety, depression, restlessness, confusion. AVOID IF HISTORY OF PSYCHIATRIC DISORDERS INCLUDING DEPRESSION OR CONVULSIONS. Long Half Life - dizziness and disturbed sense of balance months after stopping.
65
Quinine
Standby treatment for malaria if cannot access medical care within 24 hours. Written instructions that urgent help required if fever >38, 7 days or more after entering area. QT PROLONGATION.
66
Herpes?
Varicella zoster - start antiviral within 24 hours Herpes zoster - start antiviral within 72 hours Aciclovir.
67
Influenza?
Oseltamavir start within 48 hours of symptoms or without symptoms on exposure. Prophylaxis Reduces symptoms by 1 day For at risk groups: 65+ diabetes immunocomp. Zanamivir within 36 hours of exposure.
68
Amoxicillin + methotrexate?
Amoxicillin is predicted to reduce excretion of methotrexate resulting in toxicity

Prereg (2 decks)

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