Lecture 6 - Oct 28

Question 1

Menti link

Answer 1

https://www.menti.com/altnh5otjjng

Question 2

Common Indications for Antibiotics, Antifungals, Anti-infectives if Midwifery Care:

Answer 2

-uti
-abnormal vaginal discharge
-BV
-STI
-yeast infection
-Group B streptococcus
-wound infection
-nipple pain
-mastitis

Question 3

Mastitis

Answer 3

-infectious mastitis is a bacterial disease
-inflammation of breast tissue
-main cause = milk stasis and infection
-changes in the microbiome of the mammary gland, allowing for the formation of biofilms by mastitis-causing bacteria
-incidence varies, but condition is common - between 2-33% of lactating people
-most common in the first 6 weeks postpartum
-usually treated empirical with oral antibiotics
-culture and sensitivity test can be done but not very common (unless symptoms don’t get better with antibiotics)

Question 4

mastitis risk factors

Answer 4

-mastitis with previous child
-cracked/sore nipples - from incorrect feeding practices
-peripartum antibiotic therapy
-compromised immune status (or extreme fatigue)
-almost always caused by:
-staphylococcus aureus (or other gram + organisms such as streptococcus)
-untreated - may lead to abscess that needs to be surgically drained
-infections that don’t resolve with antibiotics within 24 h may be candida albicans (thrush, not mastitis)

Question 5

slide 7 - differential diagnosis of symptoms

Question 6

Treating Mastitis:

Answer 6

-is like treating engorgement only more urgent - heat, massage, rest, empty breast
1. Rest: replenishes immune system
2.Alternate warm/cold compress on breast: cold relieves pain, warm increases circulation and infection fighters
3.Gentle massage to increase circulation, helps loose plugged ducts
4.Breastfeed frequently on affected side or pump: lessens milk stasis
5.Vary baby’s positions
6.Taken analgesics for fever and pain
7.Drink fluids
8.Boost immune system with good nutrition
9.Sleep without bra to decrease pressure on affected area
10.Baby may refuse to nurse on affected side as inflammation increase sodium content of milk
11. Antibiotics

Question 7

Staphylococcus aureus:

Answer 7

-almost always the causative agent of mastitis
-ubiquitous normal flora of humans
-part of normal flora of nasopharynx in 30% of population (usually transiently)
-part of normal flora of skin 20% if population (higher in hospitalised patients and hospital employees)

Question 8

Commonly treatment algorithm for mastitis slide

Question 9

slide 11

Question 10

Antibiotics for mastitis:

Answer 10

-dicloxacillin (not on 188/24)
-flucloxacillin (not on 188/24)
-cloxacillin
-cephalexin
-clindamycin
-sulfamethoxazole-trimethoprim
-historically, amoxicillin-clavulanic acid has ben used

Question 11

1st line cell wall synthesis for mastitis - cloaxcillin

Answer 11

cloaxacillin (cephalexin is other choice)
-beta lactam antibiotic, peniciilin class
-limited data, probably compatible with human lactation (no infant concern, pencillin widely used in pregnancy)
-has good oral bioavailabilty
-narrow sprectrum (only treasts staphylococcus) so less gi upset
-use amoxicillin-clavulanic acid if you want to kill staph and strep at the same time

Question 12

1st line cell wall synthesis for mastitis - cephalexin

Answer 12

cephalexin (cloaxicillin is other)
-beta lactam antibiotic, cephalosporin class
-limited data, proablu compatible with lactation
-structurally similar to pencillin class, but has a 6 member ring and large group stuck to beta lactam ring
-same antimicrobial acitivity as penicillin (gram + and good coverage of gram -)
-advantages: resistant to beta-lactamse, acceptable for cleints with mild penicillin allergy

Question 13

Cloxacillin side 13 - what’s in book Medications and Mother’s Milk in course outline

Question 14

2nd line therapies for mastits slide 15

Question 15

slide 18

Question 16

G6PD

Answer 16

genetic variation making people more prone to hyperbilirubinemia, check this

Question 17

Urinary Tract Infections UTIs:

Answer 17

-female anatomy increases risk of UTI over males because:
-female urethra is shorter and easier access from bacteria to bladder
-warm moist vulva and rectum are in close proximity
-really common in pregnancy (up to 10%)
-prevalence increased in pregnancy:
-significant urethral dilation leading to urinary stasis in 2nd and 3rd trimesters
-relaxing effects of progesterone and mechanical compressions of ureters by the uterus at the pelvic brim lead to incomplete bladder emptying
-80% cases caused by e.coli - also, streptocooi (including gbs), staphyloccci (epideris and saprophyticus) and enterococci

Question 18

UTIs

Answer 18

-in pregnancy should be treated whether symptomatic or not because they are associated with PPROM, premature labour/birth, pyelonephritis, chorioamnionitis
-appropriate treatment of UTIs in pregnancy depends on gestational age (avoid ciprofloxacin, sulfamethoxazole, and trimethoprim in 1st trimester cause of teratogenicity)

Question 19

Common treatment algorithms for UTI slide:

Question 20

-antibiotics for uncomplicated bacteriuria in pregnancy:

Answer 20

-nitrofurantoin
-cephalexin
-sulfamethoxazole-trimethoprim
-fosfomycin (not on 188/24)
-amoxicillin
-amoxicillin-clavulanic acid

Question 21

188/24 antibiotics for treating utis slide

Question 22

Nitrofurantoin:

Question 23

Cephalexin:

Question 24

Sulfamethoxazole-trimethoprim:

Question 25

Trimethoprim:

Question 26

Ciprofloxacin:

Question 27

Special Case: GBS Bacteriuria:

Answer 27

-while vaginal-rectal colonisation with GBS is common 6-36% of pregnant people, GBS in urine is rare 0/4-5%
-bacteria caused by GBS should be treated regardless of colony count (indicative of greater than average colonisation)
-person is then considered positive for GBS for labour and birth and are not re-screened in 3rd trimester
-treatment of choice is penicillin

Question 28

penicillin v

Question 29

Abnormal Vaginal Secretions:

Answer 29

-either due to imbalance of microflora or infection
-3 most common causes:
1.Bacterial vaginosis BV (prokaryotic)
2.Vulvovaginal candidiasis (yeast, eukaryotic)
3.Trichomonas vaginalis (protozoa, eukaryotic)
-1 and 3 are both normal bacteria but just get to be aboral amounts

Question 30

Abnormal Vaginal Secretions chart

Question 31

Vulvovaginal Candidiasis:

Answer 31

-approximately 90% of cases caused by candida albicans
-remainder caused by other candid species (c. glabrata, c. parapsilosis, c. tropicalis, s. cerevisiae)
-recommended treatment in pregnancy = OTC treatments
-longest possible courses
-ex. Mositat 7d

Question 32

Bacterial Vaginosis:

Answer 32

-most common cause of vaginal discharge
-characterised by overgrowth of genital tract organisms
-usually gardnerella (gram variable coccobacilli;ic anaraboe_
-mobiluncus species
-other anaerobic bacteria with a depletion of lactobacilli
-BV often gets lumped with STIs but it is not an STI

Question 33

BV treatment

Question 34

Metronidazole (FLAGYL):

Question 35

FINISH