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Victor BNF Notes > Infections Part 1 > Flashcards

Infections Part 1 Flashcards

1
Q

Principles of Antimicrobial Stewardship

A
  • Do not treat viral infection with antibiotics
  • avoid blind prescribing
  • narrow spectrum antibiotics preferred, unless serious infection
  • avoid long course and complete course
  • follow prescribing guidelines
  • dose varies according to patient factors
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2
Q

Patient factors that need attention when prescribing antibiotics

A
  • Age
  • Allergies
  • Renal Impairment
  • Hepatic Impairment
  • Pregnancy
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3
Q

Patient needs in Antibiotic prescribing:
Children

A
  • Tetracyclines contraindicated in under 12
  • Quinolones cause arthropathy, so avoid
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4
Q

Patient needs in Antibiotic prescribing:
Elderly

A
  • Increased risk of Clostridium Difficile infection; Clindamycin has highest risk
  • Be aware of renal/liver impairment and drug interactions
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5
Q

Patient needs in Antibiotic prescribing:
Allergies

A

Penicillin-allergic = cross sensitivity with Cephalosporins and other B-lactam antibiotics

Alternatives to penicillin:
- Macrolides
- Metronidazole (dental)

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6
Q

Patient needs in Antibiotic prescribing:
Renal Impairment

A
  • avoid tetracyclines
  • avoid Nitrofurantoin if eGFR <45
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7
Q

Patient needs in Antibiotic prescribing:
Hepatic Impairment

A

Rifampicin and Tetracyclines

  • reduce metronidazole dose if severely impaired

Cholestatic jaundice:
- co-amoxiclav
- flucloxacillin

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8
Q

Patient needs in Antibiotic prescribing:
Pregnancy

A

Tetracyclines and Trimethoprim contraindicated

Nitrofurantoin causes nausea and vomiting (avoid at term)

Avoid Quinolones, Sulphonamides and MCAT:
- Metronidazole
- Chloramphenicol
- Aminoglycosides
- Tetracyclines

(safest antibiotic is Penicillin/Cephalosporin)

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9
Q

What is the antibiotic cautionary and advisory label

A

Space the doses evenly through the day and finish the course unless told to stop

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10
Q

Antibiotic gastro-intestinal side effects

A
  • Nausea
  • Vomiting
  • Diarrhoea
  • Abdominal pain
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11
Q

What is superinfection

A

Broad spectrum antibiotics and Clindamycin kills all flora. This allows selective organisms to thrive: causing antibiotic associated colitis and thrush

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12
Q

What medication manages Staphylococci

A

Flucloxacillin

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13
Q

What medication manages MRSA

A

Vancomycin

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14
Q

What medication manages Streptococci

A

Benzylpenicillin or phenoxymethylpenicillin

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15
Q

What medication manages Anaerobic bacteria

A

Metronidazole

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16
Q

What medication manages Pseudomoans Aaeruginosa

A

Gentamicin

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17
Q

Clindamycin mode of action

A

Inhibits protein synthesis

(narrow spectrum)
(bacteriostatic)

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18
Q

Side Effects of Clindamycin

A
  • antibiotic associated colitis
  • especially after operation

Counselling:
if diarrhoea develops: stop and see GP

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19
Q

Linezolid mode of action

A

Inhibits protein synthesis. Only effective on gram-positive bacteria

(Narrow-spectrum)
(bacteriostatic)

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20
Q

What antibiotic is an alternative to vancomycin in MRSA infection

A

Linezolid

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21
Q

Side Effects of Linezolids

A
  • Blood disorders
  • optic neuropathy (above 28 day use)

Counselling:
- report visual symptoms
(blurred vision, visual field defects and changes in visual activity)

avoid foods with high tyramine levels

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22
Q

What drugs react with Linezolids to increase hypertensive crisis

A
  • SSRIs
  • TCAs
  • MAOIs
  • Dopaminergics
  • Opioids
  • 5-HT agonists
  • Buspirone
  • Pethidine
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23
Q

Trimethoprim mode of action

A

Inhibits DNA synthesis

(narrow spectrum)
(bacteriostatic)

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24
Q

Trimethoprim side effects

A
  • Anti-folate (teratogenic in first trimester)
  • Blood dyscrasias (long term use)
  • Hyperkalaemia
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25
Q

What is Co-Trimoxaxole

A

Trimethoprim and Sulfamethoxazole

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26
Q

Indication of Co-Trimoxaxole

A

Prophylaxis and treatment of pneumocystis jirovecii pneumonia.

27
Q

Side effects of Co-Trimoxaxole

A
  • Steven Johnson Syndrome toxic toxic epidermal necrolysis
  • Photosensitivity
28
Q

Chloramphenicol mode of action

A

inhibits protein synthesis

(broad-spectrum)
(bacteriostatic)

29
Q

Chloramphenicol indication

A

reserved for life-threatening infections

  • Blood dyscrasias
  • Grey baby syndrome (avoid in pregnant women)
30
Q

Metronidazole mode of action

A

Inhibits DNA synthesis. High activity against anaerobic bacteria and protozoa

(narrow-spectrum)
(bactericidal)

31
Q

Metronidazole indications

A
  • Anaerobic infections
    (dental, antibiotic colitis, h.pylori, rosacea, bacterial vaginosis)
  • Protozoal Infections
    (vaginal trichomoniasis, giardiasis)
32
Q

Metronidazole side effects

A
  • gastro-intestinal disturbances, taste disturbances, oral mucositis, furred tounge
33
Q

Metronidazole patient counselling

A
  • take with or after food
  • avoid alcohol (causes disulfiram-like reaction)
34
Q

Nitrofurantoin mode of action

A

damages bacterial DNA. Only targets active urinary pathogens

(narrow spectrum)
(bactericidal)

35
Q

Side effects of Nitrofurantoin

A
  • Nausea
  • Risk of peripheral neuropathy in renal impairment
36
Q

Nitrofurantoin and pregnancy

A

Avoid at term (37 to 42 weeks) (causes neonatal haemolysis)

37
Q

Nitrofurantoin contraindications

A

Infants less than 3 months

38
Q

Nitrofurantoin patient counselling

A
  • take with or after food
  • colours urine yellow or brown
39
Q

Aminoglycosides

A

Binds irreversibly to bacteria ribosomes. Active against gram-negative aerobe; Pseudomonas aeruginosa

(Broad spectrum)
(Bactericidal)

40
Q

Examples of Aminoglycosides Part 1

A
  • Gentamicin (Pseudomonas aeruginosa)
  • Tobramycin (inhaled for Pseudomonas aeruginosa in cystic fibrosis)
  • Streptomycin (for mycobacterium for TB)
41
Q

Examples of Aminoglycosides Part 2

A
  • Neomycin (for bowel sterilisation, parenterally toxic)
  • Amikacin (for gentamicin resistant gram-negative bacilli)
42
Q

Gentamicin (Aminoglycosides) mode of action

A

Active against Pseudomonas Aeruginosa. Blind therapy in serious infection with metronidazole/penicillin

43
Q

What therapeutic index does Gentamicin have

A

Narrow

44
Q

Monitoring with Gentamicin and aminoglycoside use

A

Monitor serum levels in…
- parental ahminoglycosides use
- Elderly
- Obesity
- Cystic fibrosis
- High doses
- Renal Impairment

45
Q

Aminoglycoside once daily dose regimen, when to avoid

A
  • renal impairment (<20ml/min)
  • HACEK
  • Gram-positive endocarditis
  • Burns convering more than 20% of body
46
Q

When to increase dose interval of Gentamicin

A
  • when renal impairment
  • if serum levels pre-dose are too high
47
Q

When to reduce dose of Gentamicin

A
  • if post-dose serum level after 1 hour is too high
  • in severe renal impairment (<30ml/min)
48
Q

Pregnancy and Gentamicin

A
  • avoid unless essential
  • must monitor serum concentrations
49
Q

Aminoglycosdies and nephrotoxicity

A
  • Aminoglycosdies are excreted by kidney
  • Assess renal function before treatment and correct any dehydration

Signs of Nephrotoxicity:
- Low urine output/creatinine clearance
- High creatinine/urea serum conc

50
Q

Aminoglycosdies and Ototoxicity (hearing/balance loss)

A

monitor auditory and vestibular function before treatment

Patient counselling:
report hearing loss, tinnitus, vertigo

51
Q

What drugs interact with Aminoglycosdies to increase risk of nephrotoxicity

A
  • Ciclosporin
  • Tacrolimus
  • Vancomycin
52
Q

What drugs interact with Aminoglycosdies to increase risk of Ototoxicity

A
  • Loop diuretics
  • Cisplatin

(if taking loop diuretics is needed, separate use by long period)

53
Q

Other Side effects of Aminoglycosdies

A
  • Peripheral neuropathy
  • Impaired neuromuscular transmission
  • Electrolyte imbalance (too much: K, Ca, Mg)
54
Q

Glycopeptides mode of action

A

Inhibits cell wall synthesis. Only active against gram-positive bacteria including MRSA

(narrow spectrum)
(Bactericidal)

55
Q

What examples of Glycopeptides

A
  • Vancomycin (MRSA)
  • Teicoplanin
  • Televancin

Vancomycin and Teicoplanin not be given by mouth for systemic infections

56
Q

Vancomycin indications

A
  • Antibiotic-associated colitis
  • MRSA

(Paternally injected for serious infections)

57
Q

What is the therapeutic index for Vancomycin

A

Narrow

58
Q

Vancomycin Monitoring

A
  • serum conc for all patients (after 3 to 4 doses and dose change)
  • If in renal impairment (earlier and more regular monitoring) = reduce dose
  • Pre dose level= 10-15mg/ml
  • Pre dose level for endocarditis or MRSA= 15-20mg/ml)
59
Q

Pregnancy and Vancomycin

A

avoid in pregnancy unless essential

need to monitor serum conc

60
Q

Side Effects of Glycopeptides

A
  • Nephrotoxicity
  • Ototoxicity
  • Red mans syndrome
  • Blood dyscrasias
  • Skin disorders
  • Thrombophlebitis
61
Q

What is red mans syndrome

A

flushing of the upper body caused by rapid infusion and can be associated with hypotension and bronchospasm

62
Q

Examples of Blood Dyscasias

A
  • Netropoenia
  • Thrombocytopenia
  • Agranulocytis
63
Q

Examples of skin disorders with Glycopeptides

A
  • Steven-Johnson syndrome
  • Itching
  • Rashes
  • Toxic epidermal necrolysis
64
Q

what is Thrombophlebitis

A

pain and inflammation of veins

(usually at infusion lights)

Victor BNF Notes (25 decks)

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