Infectious Diseases And Anti-Infectives Flashcards

1
Q

Tx for necrotising fasciitis (ALL)

A

M-eropenem
V-ancomycin
C-lindamycin

Strep pyogenes confirmed
B-enzylpenicillin
C-lindamycin
PLUS
normal immunoglobulin
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2
Q
Endocarditis Tx 
Native valve Empirical Tx
Prostatic valve and MRSA Empirical Tx
Hypersensitivity to penicillin 
Directed enterococcus Tx
A

Native Valve Empirical Tx
Gentamicin +
Benzylpenicillin +
Flucloxicillin

MRSA Empirical Tx & Prosthetic Valve Empirical Tx
Gentamicin +
Vancomycin +
Flucloxicillin

If immediate sensitivity to penicillins:
Gentamicin +
Vancomycin

Directed- enterococcal
Gentamicin
PLUS EITHER
Benzylpenicillin 
OR
Amoxicillin/ampicillin
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3
Q

What does TB Tx consist of?

A

Combination and prolonged therapy

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4
Q

TB Tx and duration

A

Isoniazid 6 months
Rifampicin 6 months
Ethambutol 2 months
Pyrazinamide 2 months

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5
Q

Bacterial gastroenteritis empirical Tx

A

Ciprofloxacin
OR
Norfloxicin 400mg 12-hourly 3 days

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6
Q

Campylobacter enteritis Tx

A
Azithromycin
OR
ciproflox
OR 
norflox
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7
Q

Cholera tx

A

Azithromycin AS A SINGLE DOSE
OR
ciproflox AS A SINGLE DOSE

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8
Q

Salmonella Tx

A

If AB are required:
Azith
OR
ciproflox

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9
Q

Shigellosis Tx

A
Ciproflox
OR
Norflox
OR
Co-trimoxazole
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10
Q

Travellers diarrhoea Tx

A
Mild: no AB just rehydration, +/- anti motility drugs, usually self limiting
Moderate or severe: rehydration 2-3L/day
azithromycin 
OR
norfloxacin
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11
Q

What are the two parasitic infections of the GIT?

A

Amoebiasis

Giardia

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12
Q

Ameobasis Tx

A
Tindazole
OR
2. Metronidazole
Then administration of a luminal agent to eradicate cysts and prevent relapse 
Paromomycin
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13
Q

Giardia Tx

A

Water borne

  1. Tindazole OR
  2. Metronidazole
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14
Q

Empirical Tx for bacterial meningitis

Hypersensitivity incl

A
Dexamethasone
PLUS EITHER
Ceftriaxone
OR
cefotaxime

If listeria is suspected or immunocompromised, pregnant, >50 years etc. ADD
Benzylpenicillin to the above regimen

Hypersensitive immediate
Vanc
PLUS
Ciproflox

OR
2. Moxiflox as monotherapy

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15
Q

Direct therapy neisseria minigitidis

A

Benzylpenicillin

Immediately hypersensivity
Ciproflox

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16
Q

Strep pneumoniae meningitis

A

Benzylpenicillin for strains susceptible to penicillin
OR
Ceftriaxone or cefotaxime for strains susceptible

17
Q

Haemophilus influenzae type b (Hib)

A

Ceftriaxone or cefotaxime

Allergy: ciproflox

18
Q

Listeria Tx

A

Benzylpenicillin

Allergy: co-trimoxazole

19
Q

Tx of herpes simplex encaphalitis

A

Aciclovir

20
Q

Mild early and erysipelas Cellulitis Tx empirical

A

Staph & strep: Difluclox 500mg orally 6-hourly for 5-10 days

Strep confirmed: phenoxy 500mg orally 6-hourly for 5-10 days OR procaine penicillin IM for 3 days

Allergy 2: Cefalexin 500mg 6-hourly 5-10 days
Allergy 1: clindamycin 450mg 8-hourly 5-10 days

21
Q

Severe cellulitis Tx

A

Flucloxicillin IV
Allergy: cefazolin IV
Immediate allergy: 1. Vancomycin IV 2. Clindamycin IV

22
Q

MIND ME- antimicrobial stewardship

A

Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum therapy required
Dosage individualised to the patient and appropriate to the site and type of infection
Minimise duration of therapy
Ensure oral therapy is used where clinically appropriate

23
Q

Pyelonephritis Tx mild

A
Cefalexin 500mg orally 6-hourly
OR
amoxicillin/clav 875+125mg orally 12-hourly 
OR
trimethoprim 300,g orally daily

10-14 Tx

Follow up urine culture 1-2 weeks after the conclusion of therapy.

24
Q

Pyelonephritis Tx acute severe

A
Sepsis or vomiting
Empirical
IV amoxicillin/ampicillin 
PLUS
IV gentamicin 

THEN
Further Tx is guided by urine or blood MCS results and clinical response
Change to oral therapy as soon as patient is clinically well enough

IF SUSCEPTIBILITY RESULTS NOT AVAILABLE BY 72HRS SWITCH TO
IV Ceftriaxone or cefotaxime

Total 10-14 days Tx

Repeat urine culture 1-2 weeks after conclusion of therapy

25
Q

Mild CAP Tx

A

Amoxicillin 1g orally 8-hourly 5-7 days
OR
doxycycline 100mg orally 12-hourly 5-7 days

If not improved in 48 hours combine both

26
Q

Moderate CAP tropical and non tropical

A

IV benzylpenicillin until significant improvement, THEN
amoxicillin 1g orally 8-hourly
Total 7 days
PLUS doxycycline 100mg orally 12-hourly 7 days

Hypersensivity:
Replace penicillin with either Ceftriaxone or Cefotaxime IV and follow with Cefuroxime 500mg 12-hourly.
Total 7 days

Immediately hypersensivity:
Moxifloxacin 400mg orally daily for 7 days as monotherapy

Tropical
IV Ceftriaxone PLUS IV gentamicin
If atypical pathogen suspected ADD doxy

27
Q

Severe CAP Tx

A

Ceftriaxone 1g IV daily OR
Cefotaxime 1g IV 8-hourly
PLUS
Azithromycin 500mg IV daily

Immediate hypersensivity
Moxifloxacin 400 IV daily

Tropical
Meropenem 1g IV 8-hourly (wet season) OR
piperacillin+tazobactam 4+0.5g IV 8-hourly (dry season)
PLUS
azithromycin 500mg IV daily

Tx is for 7 days total usually but depends on patient’s clinical condition/response and MCS results

28
Q

What is the aim of anti microbial stewardship?

A
  • Promote appropriate and optimal use of AM using a systematic approach.
  • Improve patient care and health outcomes
  • Reduce adverse effects associated with AM use
  • Reduce costs
  • Reduce the development of AM resistance
29
Q

What does the AMS team consist of?

A

Infectious diseases physician
Clinical microbiologist or nominated clinician
Clinical pharmacist
Some have an infectious control nurse too