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Prereg > Infections > Flashcards

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
Q

Impetigo widespread?

A

Flucloxacillin
If strep in severe add phenoxymethylpenicillin
If penicillin allergic - clarithromycin or erythromycin
7 days

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26
Q

Cellulitis?

A

Flucloxacillin
If strep replace fluclox with Pen V or Pen V
If penicillin allergic: clindamycin or clarithromycin, or vancomycin.

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27
Q

Erysipelas?

A

Pen V or Pen G if severe replace with high dose flucloxacillin
Pen allergy: clindamycin or clarithromycin.

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28
Q

Mastitis during breastfeeding?

A

Flucloxacillin

Pen allergy: Erythromycin.

29
Q

High peak concentration and high trough concentration? what to do?

A

High peak: reduce dose

High trough: increase dosing interval

30
Q

Cephalosporins, Generations?

A 
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
Q

Quinolones safety information?

A

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
Q

Co-Trimoxazole?

A

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
Q

Tetracyclines?

A

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
Q

Chloramphenicol

A

Life threatening infections

  • Blood dyscrasias
  • Grey baby syndrome - avoid in pregnancy.
35
Q

Linezolid

A 
Alternative to VANC in MRSA
Blood Disorders
Optic Neuropathy with >28 days use
Hypertensive crisis
Reversible MAOi
Avoid tyramine rich foods
36
Q

Trimethoprim

A

Anti-folate - teratogenic 1st trimester
Blood dyscrasias with long term use
Hyperkalaemia
Fungal overgrowth

37
Q

Aminoglycosides?

A 
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
Q

Vancomycin

A 
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
Q

Lyme Disease?

A

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
Q

TB?

A

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
Q

Rifampicin

A

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
Q

Isoniazid

A

Enzyme Inhibitor
HEPATOTOXIC
Peripheral neuropathy overcome by concomitant pyridoxine.

43
Q

Pyrazinamide

A

Hepatotoxic

44
Q

Ethambutol

A

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
Q

UTIs

A

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
Q

Nitrofurantoin

A

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
Q

Candidiasis

A

Oral fluconazole,

if resistant organisms give Itraconazole.

48
Q

Skin and nail (tinea corporis, tinea cruris, tinea pedis, tinea capitis, onychomycosis)

A

Itraconazole or terbinafine.

49
Q

Pityriasis versicolor

A

Itraconazole, if ineffective fluconazole by mouth.

Terbinafine IS NOT EFFECTIVE.

50
Q

Amphotericin B

A

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
Q

Fluconazole

A

Enzyme Inhibitor, QT prolong susceptibility

52
Q

Itraconazole

A

HEART FAILURE, HEPATOTOXICITY
CCB CI
Needs acidic pH, avoid antacids.

53
Q

Voriconazole

A

HEPATOTOXICITY
PHOTOTOXICITY - Pre-malignant lesions or skin cancer
CARRY ALERT CARD
avoid sunlight, SPF.

54
Q

Antimalarials?

A 
Malarone (Atovaquone and proguanil) POM
Chloriquine (avloclor) P
Larium (mefloquine) POM
Palodrine (proguanil) P
Chloroquine with proguanil P
Doxycycline POM
55
Q

Malaria Prophylaxis?

A

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
Q

Long term prophylaxis malaria?

A

Mefloquine 1 year
Atovaquone & Proguanil 1 year
Doxycycline 2 years

57
Q

Malaria in asplenic and pregnancy?

A

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
Q

Antimalarias and anticoagulants?

A

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
Q

Return from region and illness?

A

Any illness occurring within 1 year and especially 3 months of return might be malaria.

60
Q

Antimalarials and epilepsy?

A

Avoid mefloquine and chloroquine.

61
Q

Malaria Treatment?

A

Falciparum - Quinine, Malarone (A&P), or Riamet (artemether and lumefantrine)

Non-falciparum - Chloroquine

62
Q

Antimalarials and renal impairment?

A

Doxycycline and Mefloquine are okay.
Avoid - proguanil.
Avoid malarone and chloroquine if eGFR <30 (severe)

63
Q

Chloroquine

A

Ocular toxicity - retinopathy.

Baseline eye exam and annual screening if taken for >1 year. Avoid in epilepsy. Lower seizure threshold.

64
Q

Mefloquine

A

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
Q

Quinine

A

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
Q

Herpes?

A

Varicella zoster - start antiviral within 24 hours
Herpes zoster - start antiviral within 72 hours

Aciclovir.

67
Q

Influenza?

A

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
Q

Amoxicillin + methotrexate?

A

Amoxicillin is predicted to reduce excretion of methotrexate resulting in toxicity

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