OUH trust antimicrobial guidelines Flashcards
What are the sepsis 6?
Give high flow oxygen Take blood cultures Give broad spectrum IV abx Give IV fluid resuscitation Measure serum lactate Monitor urine output
What are the criteria for SIRS?
Temperature >38.3 or 20
Pulse >90
WCC >12 or <4
Define sepsis
2 or more SIRS criteria when due to infection and is severe is there is also evidence of organ dysfunction and lactic acidosis.
Septic shock is persistent hypotension despite adequate fluid resuscitation.
Which antibiotics should be given first line when there is suspected sepsis?
Co-amoxiclav 1.2g IV TDS
Gentamicin 5mg/kg IV single dose
For patients at high risk of MRSA, add vancomycin
For patients where abdominal focus of infection is suspected, add metronidazole 400mg TDS PO.
How should neutropenic sepsis be managed?
Neutropenic sepsis is a MEDICAL EMERGENCY. it requires prompt treatment with effective antimicrobials. Antibiotics should be given within 1 hour of arrival in hospital.
First line treatment - Tazocin and gentamicin.
How should suspected community-acquired meningitis be managed?
Bacterial meningitis is a medical emergency. Cases should be discussed with ICU.
CSF should be sent for microscopy, culture and PCR. Also take blood cultures and consult ID.
Treatment: ceftriaxone 2g IV BD and dexamethaxone 10mg IV QDS for 4/7. For the older person, pregnant or immunocompromised, add amoxicillin. If viral encephalitis is suspected, add aciclovir.
How should H. pylori infection be treated?
7 days of:
Omeprazole, amoxicillin and clarithromycin or
Omeprazole, clarithryomycin and metronidazole
Which antibiotics should be given for cholecystitis and ascending cholangitis?
Co-amoxiclav and metronidazole
How is community acquired pneumonia diagnosed?
Symptoms consistent with LRTI and evidence of consolidation on CXR.
Which antibiotics are used for CAP?
CURB 65 scores:
0-1: amoxicillin
2-5: amoxicillin and clarithromycin
Which antibiotic is first line for IE COPD?
Amoxicillin.
Which wounds are considered tetanus-prone?
Wounds or burns that require surgical intervention that is delayed for >6 hours
Wounds or burns that show a significant degree of devitalised tissue or a puncture type injury, particularly where there has been contact with soil or manure
Wounds containing foreign bodies
Open fractures
Wounds or burns in patients with systemic sepsis
When should human tetanus immunoglobulin be given irrespective of the tetanus immunisation history of the patient?
If the wound is considered to be tetanus-prone and high risk (heavy contamination and/or extensive devitalised tissue).
Intravenous drug users may be at high risk of tetanus-contaminated illicit drugs, especially when they have sites of focal infection such as skin abscesses.
Immunocompromised patients
For those whose immunisation status is uncertain, and individuals born before 1961 who may not have been immunised in infancy, a full course of immunisation is likely to be required.
Which antibiotic should be used to treat UTI in pregnancy?
Nitrofurantoin (avoid trimethoprim in the first trimester)
Which antibiotics should be used to treat acute pyelonephritis?
Co-amoxiclav. For severe sepsis, use a single dose of gentamicin.
