Microman and antibiotic man. Flashcards
When should we automatically think sepsis and start a sepsis 6 bundle?
If we have a sews of four or over and clinical suspicion of an infection.
What are the 6 criteria that we should initiate a sepsis 6 bundle with if two or more are present and their is a suspicion of infection? E.g. Temperature etc.
Temp over 38 or under 36. Pulse rate of 90 or over Altered mental state RR of over 20 WCC under 4 or over 12. Known or suspected neutropenia.
What are the 6 indications for the use of IV antibiotics?
2 or more of the sepsis 6 criteria.
Febrile with neutropenia or immunosuppression.
Specific serious infections e.g. Endocarditis.
Oral route is compromised.
Post surgery and unable to tolerate 1 litre of fluid.
No oral formulation available.
What should we check when administering normal doses of antibiotics?
There is Normal renal and hepatic function.
What should we consider when prescribing clarithromycin in terms of side effects and interactions?
That there is a risk of long QT interval and interactions e.g. With statins.
What three things should we do if gentamicin therapy is still indicated after 72 hours or 24 hours of there is poor or deteriorating renal function?
Check microbiology results and sensitivities.
Consider a switch to aztreonam.
Ask microbio or infectious diseases for advice if required.
What do we use Aztreonam for?
For certain patients only as an alternative to gent.
What antibiotics can we give in case of a penicillin allergy?
IV vancomycin
Metronidazole
Gentamicin.
Doxycycline
What antibiotics should we give for an infection of an unknown source?
IV amoxicillin, metronidazole and gent.
If there is concern of staphylococci consider adding: flucloxacillin/vancomycin.
What antibiotic do we give for epiglotitis or supraglotitis?
Ceftriaxone
What antibiotic do we give for CAP with a CURB score of 0-2?
What do we give instead if there is a penicillin allergy?
Amoxicillin
If allergy:
Doxycycline (Or IV clarithromycin).
What antibiotic do we give for CAP with a CURB score of 3-5?
What do we give instead if there is a penicillin allergy?
What do we step down to?
Co-amoxiclav IV and either clarythromycin IV or doxycycline PO.
If penicillin allergy: IV levoflaxacin
Step down to doxycycline 100mg bd.
What antibiotic do we give for severe hospital acquired/aspiration pneumonia?
What do we give instead if there is a penicillin allergy?
What do we step down to for both?
IV amoxicillin + metronidazole + gentamicin.
If penicillin allergy: IV co-trimoxazole + metronidazole +/- gentamicin.
Step down to PO co-trimoxazole + metronidazole for both.
What antibiotic do we give for non severe hospital acquired/aspiration pneumonia?
What do we give instead if there is a penicillin allergy?
PO amoxicillin + metronidazole.
If penicillin allergy: PO co-trimoxazole + metronidazole.
When do we give antibiotic for COPD exacerbations?
If there is increased sputum purulence.
If there is none then no antibiotics unless there is consolidation on CXR or signs of pneumonia.
What are the first line antibiotics given for COPD exacerbations?
Amoxicillin.
What are the second line antibiotics given for COPD exacerbations?
Doxycycline.
What antibiotics do we give for non pneumonic LTRI?
Consider it the same as COPD flare ups and follow the same rules.
What are the sepsis 6? And when should they be started in a patient suspected of sepsis?
Within an hour. High flow oxygen Blood cultures Broad spectrum antibiotics IV fluid challenge Measure serum lactate and Hb Measure accurate hourly urine output.
What actions should we take if we suspect endocarditis?
Take blood cultures.
Start empirical treatment.
What is the antibiotic treatment for native valve indolent endocarditis?
Amoxicillin IV and gentamicin.
What is the antibiotic treatment for severe native valve endocarditis?
Flucloxacillin IV.
What antibiotics do we give for prosthetic valve or suspected MRSA endocarditis?
Vancomycin IV and rifampicin PO + gentamicin IV.
What is the antibiotic treatment for native valve severe sepsis endocarditis, if the patient had risk factors foe resistant pathogens?
Vancomycin IV and meropenem IV.
What antibiotics do we give for a non severe C diff infection?
How long do we give it for?
Metronidazole PO.
What antibiotics do we give for a severe C diff infection?
How long do we give it for?
Vancomycin.
+/- IV metronidazole.
What antibiotics do we give for acute gastroenteritis?
None unless it is very severe and then we should seek advice.
What antibiotics do we give for acute pancreatitis?
None, they are unlikely to affect the outcome so we should seek advice.
What antibiotic do we give for peritonitis / biliary tract or intra abdominal infection?
What do we give instead if there is a penicillin allergy?
What do we step down to for both?
IV amoxicillin + metronidazole + gentamicin.
Penicillin allergy: IV vancomycin + metronidazole and gentamicin.
Step down to co-trimoxazole and metronidazole for both.
What antibiotics should we give for proven spontaneous bacterial peritonitis?
Answer for both severe and mild disease.
What do we step down to?
Severe - piperacillin/tazobactam IV
Mild disease - co-trimoxazole PO.
Step down to co-trimoxazole PO.
How do we normally spot mild spontaneous bacterial peritonitis?
Incidental diagnosis on a routine tap.
What two antibiotics is therapeutic drug monitoring required for?
Gentamicin and vancomycin.
What antibiotics are gram negative coliforms and pseudomonas aeruginosa sensitive to?
Gentamicin and most to aztreonam.
What is the problem with only giving amoxicillin for E. coli?
Is only covers around 40%
What is the problem with only giving co-trimoxazole for E. coli?
It only covers around 65%
What are ESBL’s and what are they resistant to?
Extended spectrum beta lactamases.
Resistant to all penicillins including Coamoxiclav, piperacillin-tazobactam and aztreonam.
What are ESBL’s and what are they sensitive to?
Extended spectrum beta lactamases.
Temocillin and meropenem.
What two antibiotics have anaerobic cover so metronidazole is not needed?
Pip-tazobactam and meropenem.
What kind of cover do remocillin and aztreonam not have?
Aerobic or gram positive cover.
What are all anaerobes sensitive to?
Metronidazole and pip-tazobactam and meropenem.
What are gram positives sensitive to?
Vancomycin.
What is MRSA resistant to?
All beta lactams.
What are VRE’s resistant to?
Vancomycin and meropenem.
What are beta haemolytic streps sensitive to?
Penicillin and flucloxacillin.
What organisms cause epiglottitis?
Haemophilus influenzae and streptococci.
What organisms cause tonsillitis?
Group A streptococci.
What organisms cause sinusitis?
Pneumococcus.
What organisms cause pneumococcus?
Pneumococcus and haemophilus influenzae.
What bacteria commonly cause mild CAP?
Pneumococcus and haemophillus influenzae.
What can cause acute exacerbations of COPD?
Pneumococcus and haemophillus influenzae.
What organisms can cause severe CAP?
Pneumococcus and haemophillus influenzae.
Legionella, mycoplasma, chlamydia pneumoniae and coxiella.
What is a common cause of pneumonia post influenza?
Staph aureus.
What organisms can cause hospital acquired pneumonia?
Pneumococcus, haemophillus influenzae, coliforms and legionella.
What tends to cause acute native valve endocarditis?
Staph aureus.
What tends to cause subacute native valve endocarditis?
Viridans streptococci and enterococci.
