Micro and Antibiotic man Flashcards
what are gram -ve coliforms sensitive to
gentamicin and aztreonam
what is 47% of e. coli resistent to
amoxicillin
what covers 65% of e coli
co-trimoxazole
what are ESBL resistant to
most penicillins- co- amoxiclav, piperacillin/tazobactam and aztreonam
what covers ESBLs
temocillin, pivmecillinam
would you give metronidazole with pip-tazobactam/ co-amoxiclav
no as they both have anaerobic cover
do temocillin and ertapenem cover pseudomonas
no
do temocillin and aztreonam have aerobic or gram +ve cover
no have neither
what aee CPEs resistant to
pencillins, cephalosporins, pip-tazobactam, aztreonam, temocillin, carbapenems & often
other classes of antibiotics – gentamicin, ciprofloxacin, co-trimoxazole
what are anaerobes sesnitive to
metronidazole
also- co-amoxiclav, clindamycin, pip-tazobactam and meropenem
gram +ves like staph aureus (MSSA, MRSA), streps and enterococci are sensitive to what when there is a penicillin allergy
vancomycin (except VREs)
what is MRSA resistant to
all beta lactams (penicillins, flucloxacillin, piptazobactam, cephalosporins, meropenam)
what is VRE resistant to
vancomycin and meropenam
what are beta haemolytic streps (groups A, C and G) sensitive to
penicillin and flucloxacillin
what causes meningitis
pneumococcus, meningococcus
if >/= to 60 y/o then listeria
what causes encephalitis
herpes simplex
what are pneumococci and meningococci sensitive to
penicillin
what are the indications for IV anitbiotics
Specif ic inf ections e.g. endocarditis, septic arthritis, abscess, meningitis, osteomy elitis
• 2 or more criteria as abov e out with range (temperature, respiratory rate, pulse, WCC)
• Febrile with neutropenia or immunosuppression
• Oral route compromised
• Post surgery – unable to tolerate 1 litre of oral f luids
• No oral f ormulation av ailable
what must you consider in clarithromycin
interactions (e.g. with statins)
risk of OT interval prolongation
what should you do if IV therapy is still indicated after 72 hrs of gentamicin (or 24hrs with poor renal function)
- CHECK MICROBIOLOGY RESULTS & SENSITIVITIES
- CONSIDER SWITCH TO AZTREONAM
- IF REQUIRED ASK ID OR MICRO FOR ADVICE
when should aztreonam be used
only for certain patients as alternative to gentamicin
Tx for meningitis
ceftriaxone IV + dexamethasone IV
aciclovir IV if encephalitis suspected
add amoxicillin IV if >/= 60 / immunocompromised (to cover listeria)
what is herpes simplex sensitive to
IV aciclovir
what causes epiglotitis
H. influenzae, streptococci
what are all beta haemolytic strep (groups A, B, C and G) sensitive to
penicillin
what causes tonsilitis
group A strep
what causes sinusitis
pneumococcus
what cause AOM
pneumococcus, H. influenzae
what is the Tx for epiglottitis/ supraglottitis
ceftriaxone IV
what is h influenza sensitive to
amoxillin, doxycycline,
what are pneumococci and meningococci sensitive to
penicillin but amoxicillin better oral absorption
what causes mild/ mod CAP
pneumococcus (strep pneumonae), H influenzae
what causes mild/mod CAP
pneumococcus (strep pneumonae), H influenzae
coliforms and atypicals: legionella, mycoplasma, chlamydia pneumoniae, coxiella
S. aureus post influenza (PVL producing forms V severe in children/ YA)
what causes an acute exacerbation of COPD
pneumococcus, H. influenzae
Tx for mild/mod CAP
amoxicillin IV/PO (5 days)
if penicillin allergic doxycycline PO or clarithromycin IV
Tx for severe CAP
co-amoxiclav IV + doxycyline PO
if penicillin allergic IV levofloxacin
if ICU/HDU/NBM then Co-amoxiclav IV + clarithromycin IV
step down to doxycycline for all
(total 7 days)
what is H influenza sensitive to
amoxicillin
doxycycline
why do you give co-amoxiclav in severe CAP
as covers both H influenae and coliforms
why do you give doxycycline in severe CAP
atypical cover
pneumococci sensitive to it
what does levofloxacin cover in CAP
legionella
aslo covers MSSA, h infleunzae, pneumococci and coliforms
what has better atypical cover in severe CAP: clarithromycin or doxycyline
doxycycline
clarithromycin used in penicillin allergies
what causes HAP
pneumococcus, H influenzae and coliforms
legionella
what tests should you do in pneumonia
if mild/ mod can rely on clinical picture
bood cultures, clotted blood for atyptical bacteria, throat swab in viral transport medium,
sputum for bacterial culture, BAL or tracheal aspirates as indicated clinically (suitable for PCR for Legionella and PCR for
PCP if induced sputum cannot be done), urine (white topped sterile universal) for Legionella antigen serogroup 1
Tx for non severe hospital acquired pneumonia
PO amoxicillin (doxycyline if penicillin allergic) (5 days)
Tx for severe HAP
IV amoxicillin + gentamicin
(if penicillin allergic IV co trimoxazole + gentamicin)
step down PO co-trimoxazole
(total 7 days)
Tx for non severe aspiration pneumonia
PO amoxicillin + metronidazole
(if penicillin allergic PO doxycyline and metronidazole)
(total 5 days)
Tx for severe aspiration pneumonia
IV amox + met + gent
(if penicillin allergic replace amox with PO doxycycline or IV clarithromycin)
step down PO amoxicillin + metronidazole (allergic replace amox with doxycycline)
total 7 days
Tx for exacerbation of COPD
only antibiotics in increased sputum purulence/ consolidation on CXR/ signs of pneumonia
1st line amoxicillin
2nd line doxycycline
5 days
Tx for acute cough/ acute bronchitis
only in frail elderly
1st line amoxicillin
2nd line doxycycline
5 days
what causes acute native valve endocarditis
s aureus
what should you do in acute native valve endocarditis
2 sets of blood cultures and start antibiotics within the hour
what causes native valve subacute endocarditis
viridans strep, enterococci
what should you do in native valve subacute endocarditis
take 3 sets of blood cultures
6 hours apart if patient stable
what causes prosthetic valve endocarditis
MRSA, coagulase negative strep
Tx for native valve indolent (subacute) endocarditis
IV amoxicillin + gentamicin
Tx for native valve severe sepsis (acute)
IV flucloxacillin
Tx for prosthetic valve/ suspected MRSA endocarditis
IV vancomycin + IV gentamicin (can add rifampicin)
how you you need to give antibiotics to treat endocarditis
high doses, prolonged duration (4-6 weeks), bacteriocidal, IV, to eliminate bacteraemia, penetrate vegetations and reduce septic emboli risk
where should you take samples from CVC related infection
blood cultures from peripheral and line site, swab exit site
what causes peritonitis/ biliary tract sepsis/ intraabdominal infections
polymicrobial coliforms, anaerobes and eneterococci
tx for peritonitis/ biliary tract/ intra-abdominal infections
IV am + met + gent
step down PO co-trimoxazole + met
(if penicillin allergic IV vanc + met + gent- step down PO co-tri + met)
(total days)
Tx for non severe C diff
metronidazole PO 10 days
Tx for severe C diff
vancomycin PO/NG 10 days
what defines recurrent c diff
positive CDI in previous 8 weeks
Tx for acute gastroenteritis
none
Tx for acute pancreatitis
none
what causes spontaneous bacterial peritonitis
coliforms +/- anaerobes, sometimes strep pneumoniae
what should you do for an intra abdominal infection
send blood cultures, pus/ other intra abdominal samples
who gets HUS
people with ecoli 0157 infection
aged <5 or >65
most develop 6-8 days post onset of symptoms
more common in those with bloody diarrhoea/ who are unwell
why do you not give antibiotics for e coli 0157
might precipitate HUS
what should you do in e coli 0157
notify public heath
faeces fro culture
heamotolofy: FBC, film for HUS/ confimed 0157
biochem: U&E, LDH, CRP
what are coliforms sensitive to
getamicin and aztreonam
Tx for a mild proven spontaneous bacterial peritonitis
co-trimoxazole PO (5-7 days)
Tx for a severe proven spontaneous bacterial peritonitis
piperacillin/tazobactam IV
step down PO co-trimoxazole (5-7 days)
cause of female uncomplicated lower UTI
coliforms, enterococci
what causes a male UTI
coliforms, enterococci
what causes (complicated UTI) pyelonephritis, urosepsis
coliforms, pseudomonas aeruginosa, enterococci
what should you do for UTIs
blood cultures and urine cultures if complicated or male
females no culture unless recurrent
do not send catheter urine samples unless you thin this is a source of infection and they have signs of infection
Tx for catheterised UTI
do not treat unless signs/ symptoms of infection
same as complicated UTI
IV amox + gent
(if penicillin allergic IV com-trimoxazole + gent)
strep down PO co-trimoxazole
(total 7 days)
Tx for UTI in older patients
do not treat unless signs/ symptoms of infection
treat same as male/female Tx
Tx for complicated UTI/pyelonephritis/ urosepsis
IV amox + gent
(if penicillin allergic IV com-trimoxazole + gent)
strep down PO co-trimoxazole
(total 7 days)
Tx for uncomplicated female lower UTI
nitroflurantoin or trimethoprim (3 days)
Tx for uncatheterised male lower UTI
nitroflurantoin or trimethoprim (7 days)
when is nitrofurantion not excreted in the urine
in renal impairment (also has no kidney penetration so only ever used for uncomplicated lower UTIs in females and uncatheterised males)
cause of cellulitis
s aureus, group A strep and other beta haemolytic strep
Tx for cellulitis
flucloxacillin (in penicillin allergic doxycycline PO) total 7 days
cause of diabetic foot acute
staph aureus
cause of diabetic foot on acute on chronic polymicrobial
s aureus, coliforms and anaerobes
Tx for mild diabetic foot infection
flucloxacillin or doxycycline 7 days
Tx for moderate diabetic foot infection
flucloxacillin + metronidazole
or doxycycline + met
7 days
what should you do in skin or soft tissue infection
if severe/ systemic take blood cultures
swab wounds- these will not be able to distinguish infection for colonisation
previous antibiotics will select out coliforms and pseudomonas
does flucloxacillin cover beta haemolytic strep
yes
does co-trimoxazole cover MRSA
yes
Tx for open fracture prophylaxis
IV co-amoxiclav (or IC co-trimoxazole) + metronidazole
start within 3 hours for max 72 hours
Tx for acute septic arthritis/ osteomyelitis
IV flucloxacillin
Tx for severe systemic infection source unkown
Iv amox met and gent
(if PWID add IV flucloxacillin for s aureus)
if penicillin allergy Iv vanc + met + gent
cause of septic arthritis/ osteomyelitis
s aureus
what should you do in septic arthritis/ osteomyelitis
blood cultures before antibiotics, joint aspirates/ washouts and bone samples
consider distant focci of infection
how do you need to give antibiotics in septic arthritis/ ostepmyelitis
high doses IV, prolonged duration (4-6 weeks), bactericidal to penetrate joint and tissue, elimante bacteraemia and reduce septic emboli risk
