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.
