Infectious Diseases - Empirical Treatment (Antibiotic Man) Flashcards
Meningitis treatment is with _______
Ceftriaxone IV 2g twice daily + dexamethasone IV 10mg QDS for 4days
Ceftriaxone is what type of antibiotic?
Cephalosporins
How do cephalosporins work?
Bacteriocidal. Targets the cell wall. interferes with the polymerisation of muramic acid to render the cell susceptible to osmotic lysis.
What type of antibiotic is a cephalosporin?
Beta-lactam
Name other examples of cephalosporins
Cephalexin
Cefuroxime
Cefixime
What should you add to ceftriaxone when treating for meningitis, if encephalitis is suspected?
Add aciclovir IV (10mg/kg 3xdaily)
What should you add to ceftriaxone in an immunocompromised or over 60 patient with meningitis?
Amoxicillin 2g IV 4hrly
What is the treatment for epiglottitis/supraglottitis?
Ceftriaxone IV 2g once daily
What is the CURB-65 score used for? What does it predict?
Used to decide treatment of pneumonia. Predicts mortality.
Empirical treatment for a CURB 0-2 CA pneumonia?
Amoxicillin 1g 3xdaily IV or PO for 5 days
If the patient is pen allergic, what should the treatment for a CURB 0-2 CA pneumonia be?
Doxycycline PO 200mg on day 1 then 100mg once daily.
CURB 3-5 CAP should be treated with…
IV co-amoxiclav 1.2g 3xdaily and doxycycline PO 100mg 2xdaily
In a pen-allergic patient CURB 3-5 CAP should be treated with…
IV levofloxacin 500mg 2xdaily
If the patient is nil by mouth what can you replace doxycycline with?
IV clarithromycin
What type of antibiotic is amoxicillin? How does it work?
It is a penicillin. Works similarly to cephalosporins. Prevents murmuric acid polymerisation to interfere with cell wall and cause osmotic lysis.
What is the difference between amoxicillin and co-amoxiclav?
Combination of amoxicillin and clavulanic acid; beta-lactamase inhibitor to overcome beta-lactamase resistance
What type of antibiotic is levofloxacin? Give an example of another drug in this class
Quinolones
Ciprofloxacin
How do quinolones work?
They affect DNA-gyrase to impair bacterial replication
What type of antibiotic is doxycycline?
Tetracyclines
How do tetracyclines work?
Inhibit protein synthesis.
What type of antibiotic is clarithromycin? Give examples of others in this class
Azithromycin
Erythromycin
How do macrolides work?
Inhibit protein synthesis by blocking peptidyltransferase and also ribosomal translation
How should a severe hospital acquired pneumonia be treated?
IV amoxicillin, metronidazole and gentamicin.
Step down to oral amoxicillin and metronidazole. Total of 7days IV/PO.
If pen allergic how should a severe HAP be treated?
IV co-trimoxazole + metronidazole + gentamicin. Step down to oral co-tromoxazole and metronidazole. Total of 7days IV/PO.
How should a non-severe hospital acquired pneumonia be treated?
Oral penicillin and metronidazole for 5days
If pen allergic how should a non-severe hospital acquired pneumonia be treated?
Oral co-trimoxazole and metronidazole for 5days
What is co-trimoxazole?
Combination of trimethoprim and sulfamethoxazole
What are the indications for ABx in COPD?
1 of:
- Increased sputum
- Consolidation on CXR
- features of pneumonia
What is the first line ABx therapy for acute exacerbation of COPD?
Amoxicillin 500mg 3x daily
What is the 2nd line therapy for acute exacerbation of COPD?
Doxycycline 200mg on day 1 then 100mg/day. 5 days total.
antibiotic therapy in acute cough/bronchitis shows a lot/little clinical benefit
Little clinical benefit
When might antibiotic therapy be of benefit in acute cough/bronchitis?
Frail elderly
Antibiotic therapy for acute cough or bronchitis is…
Same as COPD; amoxicillin 500mg tds or doxycycline 200mg on day 1 and 100mg for 4 days.
Non-severe C.diff infection should be treated with…
metronidazole PO 400mg 3xdaily
How does metronidazole work?
Inhibits nucleic acid synthesis by disrupting DNA of microbial cells.
How should severe C.diff be treated?
Vancomycin 125mg QDS for 10days +/- metronidazole.
How should peritonitis/biliary tract infection/intra-abdominal infections be treated?
IV amoxicillin metronidazole + gentamicin. Step down to PO Co-trimoxazole. If pen allergic, vanc, met, gent.
Acute gastroenteritis should be treated with which antibiotics?
Trick question. Shouldn’t be unless very severe and then, seek advice.
Catheterised patients should be treated for UTI based on urinalysis. true/false
False- use clinical signs of infection.
An uncomplicated female uti should be treated with…
Nitrofurantoin 500mg QDS or
trimethoprim 200mg BD (3days)
Uncatheterised male UTI should be treated with…
Nitrofurantoin 500mg QDS or
trimethoprim 200mg BD (3days)
Complicated UTI/Pyelonephritis/urosepsis should be treated with…
IV amoxicillin + gentamicin
Co-trimox and gent if pen allergic
Cellulitis is treated with…
Flucloxacillin 1g QDS or doxycycline 100mg BD PO if allergic
7 days total.
Septic arthritis or osteomyelitis should be treated with…
IV flucloxacillin 2g QDS and seek ID help.
Sepsis of unknown origin is treated with
IV Amoxicillin + metronidazole + gentamicin
Consider adding vancomycin or flucloxacillin if concern RE staphylococci.
Allergy: vanc, met, gent.
