Infections - key infections Flashcards
What is 1st and 2nd line for c.diff? (1st episode of mild-moderate or severe)
Vancomycin 125mg QDS 10 days
2nd line: Fidaxomicin 200mg BD 10 days
If c.diff recurs within 12 weeks of treatment, what is used?
what if this is >12 weeks?
Fidaxomicin 200mg BD 10 days
> 12 weeks= Vanc 125mg QDS 10 days
What medications need to be reviewed in a patient with C.diff?
PPIs
Laxatives
loperamide
NSAIDS (may cause issues if patient gets dehydrated)
Who is most at risk of c diff?
Elderly >65
Women
Which antibiotics cause cdiff?
broad spect
- clindamycin
- ampicillin, amoxicillin
- 2/3 gen cephalosporins
- quinolones
What pneumonic is used to remember drugs associated with C.diff?
Crazy chimps buy fluorescent poo -
- clindamycin
- cephalosporin
- broad spectrum abx
- fluoroquinolones
- ppis
What are the CURB65 scores?
Confusion Urea >7mmol/L Resp rate >30bpm Blood pressure - low, <90 systolic, <60 diastolic 65 = age 65 or more
What are the classifications for severity of CAP using CURB65?
0=low risk
1-2 = interermediate
3-4 = high
what is used for low severity cap?
amoxicillin 500 mg three times a day for 5 days
Alternatively, if there is a penicillin allergy, or amoxicillin is unsuitable (for example atypical pathogens are suspected) options are:
- oral doxycycline 200 mg on the first day then 100 mg once a day for 4 days (total course of 5 days)
- oral clarithromycin 500 mg twice a day for 5 days, or oral erythromycin (in pregnancy) 500 mg four times a day for 5 days.
What is the treatment for moderate severity CAP?
oral amoxicillin 500 mg three times a day for 5 days
and (if atypical pathogens suspected) oral clarithromycin 500 mg twice a day for 5 days, or oral erythromycin (in pregnancy) 500 mg four times a day for 5 days.
Pen allergy: Doxycycline 200mg day 1 then 100mg day for 4 days OR oral clarithromycin 500 mg twice a day for 5 days.
Main abx for CAP?
- amoxicillin
- clarithromycin
- doxycycline
In CAP, for young people aged 12–17 years, if symptoms or signs are non-severe-what is treatment?
Amoxicillin PO 500mg TDS 5 days
Alternatives:
- clarithromcyin 250-500mg BD 5 days
- erythromycin in prengnacy 250-500mg QDS 5 days
- doxycycline 200mg day 1 then 100mg BD 4 days
Generally if using IV abx, when should they be reviewed with aims to step down to oral?
48hrs
What is the treatment for high severity CAP?
Co-amoxiclav 500/125mg TDS PO (or 1.2g IV TDS) 5 days
WITH
Clarithromycin 500mg BD PO/IV for 5 days
OR erythromycin if pregnancy - 500mg TDS 5 days
pen allergy: Levofloxacin 500mg BD PO /IV 5 days
What is Hospital acquired pneumonia and when to treat?
Develops 48hrs or more after admission
Treat within 4hrs
send samples
What is the treatment for early onset HAP <5 days? / non severe
Co-amoxiclav TDS 5 days
Pen allergy:
- doxycycline 200mg day 1 then 100mg 4 days
- Cefalexin (but caution pen allergy) - 500mg BD or TDS 5 days
- co-trimoxazole 960mg BD 5 days
- Levofloxacin 500mg OD or BD 5 days
what is treatment for severe HAP / >5 days onset
Antipseudomonal - Tazocin 4.5g TDS Ceftazidime 2g TDS Ceftriaxone 2g OD Cefuroxime meropenem
What abx would you add if confirmed MRSA in HAP?
Vancomycin
Teicoplanin
Linezolid
What abx would you add if pseudomonas suspected in HAP?
Aminoglycoside e.g. gent
What colour phlegm indicates TB
dark red
What is treatment regimen for TB
2 months - RIPE (rifampicin, isoniazid, pyrazinamide, ethambutol + pyridoxine)
4months - rifampicin, isoniazid (+ pyridoxine)
what are symptoms indicative of TB
Cough >3weeks night sweats, fever coloured phlegm/dark red weight loss neck swelling
what is a side effect of ethambutol
visual changes
what TB drugs are hepatotoxic
All except for ethambutol
rif, ison, pyrazinamide
