Infectious Disease Flashcards
Antibiotic for animal bites
Co-amox
Doxy and metronidazole if pen allergic
Antibiotic for human bites
Co-amox
Antibiotic for exacerbations of chronic bronchitis
Amox, tetracycline, or clarithromycin
Antibiotic for uncomplicated CAP
Amox
Doxy or clarithro in pen allergic, add fluclox if staph suspected e.g. in influenza
Antibiotic for ?atypical pneumonia
Clarithromycin
Antibiotic for HAP
If within 5 days of admission - co-amox or cefuroxime
If more than 5 days after admission - taz or broad spectrum ceph, e.g. ceftazidime, or quinolone e.g. cipro
Antibiotic UTI
Trimethoprim or nitro
Alternative: amox or cephalosporin
Antibiotic acute pyelonephritis
Broad spectrum cephalosporin or quinolone
Antibiotic acute prostatitis
Quinolone or trimethoprim
Antibiotic impetigo
Topical hydrogen peroxide
Oral fluclox or erythromycin if widespread
Antibiotic cellulitis
Fluclox
Clarithromycin, erythromycin, or doxycycline if pen allergic
Antibiotic cellulitis near the eyes or nose
Co-amox
Clarithromycin and metronidazole if pen allergic
Antibiotic erysipelas
Fluclox
Clarithromycin, erythromycin, or doxy if pen allergic
Antibiotics mastitis
Fluclox
Antibiotics throat infections
Phenoxymethylpenicillin
Erythromycin if pen allergic
Antibiotic sinusitis
Phenoxymethylpenicillin
Antibiotic otitis media
Amoxicillin
Erythromycin if pen allergic
Antibiotics otitis externa
Fluclox
Erythromycin if pen allergic
Antibiotics periapical or periodontal abscess
Amox
Antibiotics acute necrotising ulcerative gingivitis
Metronidazole
Antibiotics gonorrhoea
IM ceftriaxone
Antibiotics Chlamydia
Doxycycline or azithromycin
Antibiotics pelvic inflammatory disease
Oral ofloxacin and oral metronidazole
or
IM ceftriaxone and oral doxy and oral metronidazole
Antibiotics syphilis
Benzathine benzylpenicillin
or
Doxycycline and erythromycin
Antibiotics bacterial vaginosis
Oral or topical metronidazole
or
Topical clindamycinA
Antibiotics C. diff
First episode: oral vancomycin
Second/subsequent episode: oral fidaxomicin
Antibiotics campylobacter enteritis
Clarithromycin
Antibiotics salmonella (non-typhoid)
Ciprofloxacin
Antibiotics shigellosis
Ciprofloxacin
Adverse effects aminoglycosides
- Nephrotoxicity
- Ototoxicity
Adverse effects tetracyclines
- Discolouration of teeth
- Photosensitivity
Adverse effects chloramphenicol
Aplasia anaemia
Adverse effects clindamycin
C. Diff
Adverse effects macrolides
Nausea (esp erythromycin)
P450 inhibitor
Prolonged QT
Adverse effects azoles
P450 inhibition
Liver toxicity
Adverse effects amphotericin B
Nephrotoxicity
Flu like symptoms
Hypokalaemia
Hypomagnasaemia
Adverse effects griseofulvin
Induces P450 system
Teratogenic
Adverse effects flucytosine
Vomiting
Adverse effects caspofungin
Flushing
Contraindications BCG vaccine
- Previous BCG vaccine
- Past history TB
- HIV
- Pregnancy
- Positive tuberculin test
- Over 35 (no evidence it works)
Most common bacterial cause of infectious intestinal disease in UK
Campylobacter
Features of campylobacter
Prodrome of headache and malaise
Often bloody diarrhoea
Abdo pain
Most common protozoal cause of diarrhoea in UK
Cryptosporidiosis
Features of cryptosporidial diarrhoea
- More common in immunocompromised and young children
- Watery diarrhoea
- Abdominal cramps
- Fever
Complication of cryptosporidial diarrhoea in immunocompromised
Entire GI tract may be affected resulting in sclerosing cholangitis and pancreatitis
Management of cryptosporidial diarrhoea -
- Supportive if immunocompetent
- Nitazoxanide or rifaximin for immunocompromised
Features of diptheria
Diptheric membrane on tonsils - grey, pseudomembrane on posterior pharyngeal wall
Bulky cervical lymphadenopathy
Neuritis, e.g. cranial nerve
Heart blocka
Management of diptheria
IM penicillin
Diptheria antitoxin
Features of enteric fever (typhoid/paratyphoid)
- Systemic features - fever, headache, arthralgia
- Relative bradycardia
- Abdominal pain and distention
- Constipation
- Rose spots (more common in paratyphoid)
Complications of enteric fever
Osteomyelitis
GI bleed/perforation
Meningitis
Cholecystitis
Chronic carriage
Most common cause of travellers diarrhoea
E coli
Most common causes of acute food poisioning
- Staphylococcus aureus
- Bacillus cereus
- Clostridium perfringens
Features of E coli gastroenteritis
Watery stools
Abdominal cramps and nauseaF
Features of giardiasis gastroenteritis
Prolonged, non-bloody diarrhoea
Foul smelling burps
Bloating
Steatorrhoea
Malabsorption and lactose intolerance
Features of cholera gastroenteritis
Profuse, watery diarrhoea
Severe dehydration resulting in weight loss
Not common in travellers
Features of shigella gastroenteritis
Bloody diarrhoea
Vomiting and abdominal pain
Features of S aureus gastroenteritis
Severe vomiting
Short incubation period
Features of campylobacter gastroenteritis
Flu-like prodrome usually followed by crampy abdominal pain, fever, and diarrhoea which may be bloody
Can mimic appendicitis
Features of bacillus cereus gastroenteritis
Vomiting within 6 hours
Diarrhoeal illness occurring after 6 hours
Features of amoebiasis gastroenteritis
Gradual onset bloody diarrhoea, abdominal pain, and tenderness which may last several weeks
Which pathogens causing gastroenteritis have incubation period of 1-6 hours
Staph aureus
Bacillus cereus
Which pathogens causing gastroenteritis have incubation period 12-48 hours
Salmonella
E coli
Which pathogens causing gastroenteritis have incubation period 48-72 hours
Shigella
Campylobacter
Which pathogens causing gastroenteritis have incubation period >7 days
Giardiasis
Amoebiasis
Virus causing genital herpes
HSV-1 and HSV-2 (more so HSV-2)
Management of HSV in pregnancy
Elective section at term if primary attack of herpes after 28 weeks
Recurrent herpes in pregnancy treated with suppressive therapy, risk of transmission to baby is low
Virus causing genital warts
HPV 6 and 11
Virus causing cervical cancer
HPV 16, 18, 33
First line treatment for genital wards
Topical podophyllum if multiple, non-keratinised warts
Cryotherapy if solitary keratinised warts
Second line treatment for genital warts
Imiquimod
Treatment for giardiasis
Metronidazole
Features of hepatitis A
Flu like prodrome
Abdominal pain, typically RUQ
Tender hepatomegaly
Jaundice
Deranged LFTs
Features of acute hepatitis B
Fever
Jaundice
Raised LFTs
Complications of hepatitis B
- Chronic hepatitis (5-10%)
- Fulminant liver failure (1%)
- Hepatocellular carcinoma
- Glomerulonephritis
- Polyarteritis nodosa
- Cryoglobulinaemia
Risk factors for non-response to hep B vaccine
- Age over 40
- Obesity
- Smoking
- Alcohol excess
- Immunosuppression
Criteria for testing anti-HBs to assess response to hep B vaccine
- Risk of occupational exposure
- CKD
What anti-HBs level indicates adequate response
> 100
What anti-HBs level indicates suboptimal response
10-100
Management of suboptimal response to hep B vaccine
One additional vaccine dose given. If immunocompetent, no further testing required
What anti-HBs level indicates non-responder
<10
Management of non-responder to hep B vaccine
Test for current or past infection
Give further vaccine course (3 doses again) and then testing
Management of non-responder to hep B vaccine after repeat course
HBIG for protection if exposed to virus
Management of hepatitis B infection
Pegylated interferon-alpha
Breastfeeding and hep C
Not contraindicated