Infectious Diseases And Anti-Infectives

Question 1

Tx for necrotising fasciitis (ALL)

Answer 1

M-eropenem
V-ancomycin
C-lindamycin

Strep pyogenes confirmed
B-enzylpenicillin
C-lindamycin
PLUS
normal immunoglobulin

Question 2

Endocarditis Tx 
Native valve Empirical Tx
Prostatic valve and MRSA Empirical Tx
Hypersensitivity to penicillin 
Directed enterococcus Tx

Answer 2

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

Question 3

What does TB Tx consist of?

Answer 3

Combination and prolonged therapy

Question 4

TB Tx and duration

Answer 4

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

Question 5

Bacterial gastroenteritis empirical Tx

Answer 5

Ciprofloxacin
OR
Norfloxicin 400mg 12-hourly 3 days

Question 6

Campylobacter enteritis Tx

Answer 6

Azithromycin
OR
ciproflox
OR 
norflox

Question 7

Cholera tx

Answer 7

Azithromycin AS A SINGLE DOSE
OR
ciproflox AS A SINGLE DOSE

Question 8

Salmonella Tx

Answer 8

If AB are required:
Azith
OR
ciproflox

Question 9

Shigellosis Tx

Answer 9

Ciproflox
OR
Norflox
OR
Co-trimoxazole

Question 10

Travellers diarrhoea Tx

Answer 10

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

Question 11

What are the two parasitic infections of the GIT?

Answer 11

Amoebiasis

Giardia

Question 12

Ameobasis Tx

Answer 12

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

Question 13

Giardia Tx

Answer 13

Water borne

1. Tindazole OR
2. Metronidazole

Question 14

Empirical Tx for bacterial meningitis

Hypersensitivity incl

Answer 14

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

Question 15

Direct therapy neisseria minigitidis

Answer 15

Benzylpenicillin

Immediately hypersensivity
Ciproflox

Question 16

Strep pneumoniae meningitis

Answer 16

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

Question 17

Haemophilus influenzae type b (Hib)

Answer 17

Ceftriaxone or cefotaxime

Allergy: ciproflox

Question 18

Listeria Tx

Answer 18

Benzylpenicillin

Allergy: co-trimoxazole

Question 19

Tx of herpes simplex encaphalitis

Answer 19

Aciclovir

Question 20

Mild early and erysipelas Cellulitis Tx empirical

Answer 20

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

Question 21

Severe cellulitis Tx

Answer 21

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

Question 22

MIND ME- antimicrobial stewardship

Answer 22

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

Question 23

Pyelonephritis Tx mild

Answer 23

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.

Question 24

Pyelonephritis Tx acute severe

Answer 24

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

Question 25

Mild CAP Tx

Answer 25

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

Question 26

Moderate CAP tropical and non tropical

Answer 26

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

Question 27

Severe CAP Tx

Answer 27

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

Question 28

What is the aim of anti microbial stewardship?

Answer 28

• 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

Question 29

What does the AMS team consist of?

Answer 29

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