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A13AMC @ UoN > L07 - Chemoprophylaxis > Flashcards

L07 - Chemoprophylaxis Flashcards

1
Q

Define Chemoprophylaxis - Give an example

A

The use of an antimicrobial drug to prevent an infection - Use of antimalarials to prevent malaria in travellers

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2
Q

What six factors should be present when considering prophylaxis?

A 
Significant and predictable risk of infection
Serious consequences of infection
Period of higher risk is known
Microbial causes are predictable
Antimicrobial sensitivity is predictable
Cheap and safe antimicrobials available
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3
Q

Give five examples of potential disadvantages of chemoprophylaxis

A 
Cost
ADRs
Disturbance of the normal human flora
Colonisation with antibiotic-resistant bacteria
Selection of antibiotic resistance
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4
Q

What strain of Malaria is potentially fatal?

A

Falciparum malaria

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5
Q

What groups are particularly at risk of Malaria?

A

Pregnant women

Splenectomy patients

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6
Q

Describe the three most common regimens for Malaria chemoprophylaxis

A

Chlorouqine +/- Proguanil
Mefloquine
Doxycycline + Atovaquone (Malarone = Proguanil + Ataovaquone)

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7
Q

How long must malaria prophylaxis be maintained?

A

Continued for 4 weeks after leaving malarious area (1 wk for Malarone)

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8
Q

What antibiotics are given as chemoprophylaxis for invasive Group A Strep infections?

A

Oral penicillin (Erthyromycin or Azithromycin)

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9
Q

How many cases of group A strep are required in a household for chemoprophylaxis?

A

2 or more cases in 30 days

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10
Q

Describe Group B Strep infections

A

Part of normal vaginal flora
Can cause neonatal meningitis/septicaemia
Particular risk for pre-term, low birth weight infants

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11
Q

Describe chemoprophylaxis for Group B strep

A

Penicillin/Clindamycin given during labour to high risk pregnancies:
Pre-term labour
Prolonged membrane rupture
History of group B strep in prev pregnancy
Known carrier of group B strep

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12
Q

What is Rheumatic fever?

A

The immunological response to infection with Streptococcus pyogenes

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13
Q

Describe the chemoprophylaxis for Rheumatic fever

A

Penicillin prophylaxis (Sulfadiazine) 250mg bd until >16 y/o

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14
Q

What is the most common cause of meningitis?

A

Viral infection

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15
Q

What is the major bacterial cause of meningitis/meningococcal disease?

A 
Meningococcal meningitis (Septicaemia)
Invasive infection by Neisseria meningitidis
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16
Q

Describe the vaccination program for meningitis

A

Conjugated vaccine vs. serogroup C (infants)
Men B (infants)
ACWY (14-18 y/o and travel)

17
Q

What is the chemoprophylaxis regimen for bacterial meningitis/meningococcal disease?

A

Chemoprophylaxis for close contacts (+/- immunisation)
Rifampicin 600mg p.o. b.d. for 2 days (ADR w/ pill and contact lenses)
Ciprofloxacin 500mg p.o. stat
Ceftriaxone IM for pregnancy

18
Q

What is Hib meningitis?

A

Haemophilus influenzae capsular type B

Cause of meningitis <4

19
Q

What is the relevant chemoprophylaxis for Hib?

A

Rifampicin 600mg p.o. o.d. for 4 days (for all household contacts)

20
Q

What three groups are at risk of recurrent UTIs?

A

Children <5
Pregnant women
Females

21
Q

What is the major risk of recurrent UTIs?

A

Risk of repeated kidney damage

22
Q

What three antibiotics can be given as chemoprophylaxis for UTIs?

A

Trimethoprim
Nitrofurantoin
Cephalexin

23
Q

What is the most common problem with splenectomised patients?

A

Severe overwhelming infections
Capsulated bacteria (strep. p, meningococci, hib)
Malaria

24
Q

What chemoprophylaxis is appropriate for splenectomy patients?

A

Penicillin (to prevent pneumococcal infections)

25
Q

Give six examples of immunosuppression

A 
Primary IDS
HIV
Malignancy of immune system
Cancer chemotherapy
Drugs (steroids, azathoprine, cyclophosphamide)
Organ transplants
26
Q

What drug can be given as chemoprophylaxis after HIV infection?

A

Co-trimoxazole (to prevent PCP following 1st infection or when CD4 <200)

27
Q

What is the chemoprophylaxis for neutropenia?

A

Ciprofloxacin (to prevent Gram-ve infections)

28
Q

What is the chemoprophylaxis for Bone Marrow Transplant?

A

Ciprofloxacin + Aciclovir + Fluconazole

29
Q

What three actions are appropriate following trauma/bites?

A 
Surgical debridement (+/- delayed closure)
Antibiotic prophylaxis (co-amoxiclav, metronidazole, doxycycline)
Tetanus booster (+/- tetatnus Ig)
30
Q

Is antibiotic prophylaxis appropriate for endocarditis?

A

No (generally)

31
Q

In what four ways can surgical operations be described?

A

Clean
Clean w/ implant (req. prophylaxis)
Contaminated (req. prophylaxis)
Dirty (req. treatment)

32
Q

Describe the five most common UK surgical chemoprophylaxis regimens

A

Appendectomy (Metronidazole)
Elective colorectal surgery (Coamoxiclav/Cefuroxime+Metronidazole/Genatmicin+Metronidazole)
Breast implant (Coamoxiclav)
Cardiac surgery (Cefuroxime/Glycopeptide)
Orthopaedic implants (Cefradine+Cefuroxime)

33
Q

What are the three most common faults with surgical antibiotic prophylaxis?

A

Used for clean operations
Given for too long (max 24h)
Given w/o regard for prev. treatment

34
Q

Describe the chemoprophylaxis regimen for Influenza A

A

Ideally <48 hours of exposure

Oseltamivir/Zanamivir

35
Q

Who are the at risk groups for Influenza A?

A 
>65 y/o
Pregnant women
Chronic resp/cardiac/renal/liver/neurological disease
Immunosuppresive disease
Diabetes
36
Q

When should post-exposure prophylaxis for HIV be considered?

A

Penetrating needlestick injuries
Blood splashes to mucous membranes/non-intact skin
Sexual contact (rape)
When source is known/suspected to be HIV+ve

37
Q

Describe Post Exposure Prophylaxis for HIV

A

Ideally given <1h (offered up to 2 wks after exposure)
Combination of anti-retrovirals (AZT/DDI + Protease Inhibitors)
Taken for 4 wks

A13AMC @ UoN (20 decks)

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