Prescribing Pathways Flashcards
(26 cards)
What is the treatment plan for human and animal bites
First line: co-amoxiclav broad spectrum
If can’t use co-amoxiclav because of penicillin allergy
Second line: doxycycline (broad spectrum) and metronidazole (anaerobic infections)
Prophylaxis: 3 days
Treatment: 5 days
What is the treatment plan for tick bites (Lyme disease)
First line: Doxycycline (100mg BD) treatment is for 21 days
Second line: amoxicillin (1000mg 3x a day) treatment for 21 days
What is the treatment pathway for human or animal scratches
Flucloxacillin
What is the treatment pathway for diabetic foot infection- mild less than 2cm
Flucloxacillin
Penicillin allergy: clarithromycin/ erythromycin / doxycycline
What is the treatment plan for diabetic foot infection- moderate/ severe (abscess, osteomyelitis)
Flucloxacillin +/- gentamicin +/- metrondiazole
Co-amoxiclav +/- gentamicin
Penicillin allergy: co-trimoxazole +/- gentamicin +/- metrondiazole
What is the treatment pathway for cellulitis
First line: Flucloxacillin
Penicillin allergy or if Flucloxacillin is unsuitable
clarithromycin or erythromycin (in pregnancy)
Doxycycline
Co-amoxiclav
What is the treatment pathway if cellulitis is near the eyes or the nose
Co-amoxiclav
Penicillin allergy: clarithromycin and metronidazole
What is the treatment plan for community acquired pneumonia
Low severity
First line: amoxicillin
Second line: doxycycline or clarithromycin (erythromycin in pregnancy)
Moderate severity
First line: amoxicillin and clarithromycin (erythromycin in pregnancy)
Second line doxycycline or clarithromycin
High severity
First line: co-amoxiclav and clarithromycin (erythromycin in pregnancy
Second line levofloxacin
What is the treatment plan for diarrhoea
If you have confirmed c.diffe (10 day treatment)
1st line: ORAL vancomycin
Second line: fidaxomicin
Life threatening: vancomycin and iv metronidazole
Travellers diarrhoea
Standby: ciprofloxacin
Prophylaxis/ treatment: bismuth subsalicylate /loperamide
Ciprofloxacin can be used as a prophylaxis but not routinely recommended
What is the treatment pathway for otitis media
First line: amoxicillin
Second line (worsening symptoms despite 2-3 days treatment: co-amoxiclav
Penicillin allergy: clarithromycin (erythromycin in pregnancy)
Earsdrops can be given if antibiotic prescription isn’t:
Phenazone + lidocaine
What is the treatment pathway for otitis externa
First line: topical acetic acid 2%
Second line: topical neomycin sulphate with corticosteroid
If systemic treatment needed: Flucloxacillin
Chronic:
Fungal: clotrimazole solution, clioquinol and corticosteroid drops, acetic acid 2%
Bacterial: gentamicin or Ciprofloxacin eardrops (systemic: flucloxacillin) 
No bacteria of infection: prednisolone ear drops
What is the treatment pathway for h.pylori
Triple therapy:
PPI: Omeprazole, esomeprazole etc
Might not be prescribed if on clopidogrel would be prescribed lansoprazole instead
+
Two of the following antibiotics:
amoxicillin (100mg BD) OR
Metronidazole 400mg BD) OR
Clarithromycin (500mg BD)
Amoxicillin tends to be included in triple therapy unless patient has penicillin allergy
Diagnosed with urea (13c) breath test
Shouldn’t be performed within 2 weeks of taking PPIs
Shouldn’t be performed within 4 weeks of taking antibiotics
What should you take into consideration when taking Omeprazole
Give Omeprazole 1-2 a day depending on the risk of the patient developing ulcers due to being on other medications such as ssris, older blood thinners
What is the treatment pathway for hospital acquired pneumonia
Non severe:
First line: co-amoxiclav for both adults and children
Second line (adults): doxycycline or cefalexin or co-trimoxazole or levofloxacin
Second line (children): clarithromycin
Severe :
First line: piperacillin + tazobactam, ceftazidime, ceftriaxone, cefuroximine meropenem or ceftazidime + avibactam
Add vancomycin OR teicoplanin if MRSA suspected (linezolid if vanc can’t be used
Why wouldn’t our use doxycycline in children
Discolouration of teeth’s in children
Avoid tetracyclines in children aged 12 and below
What is the prescribing pathway for impetigo
Localise non-bulbous
First line: hydrogen peroxide 1%
Second line: fusidic acid (mupirocin 2% if fusidic acid resistance is suspected )
Wide spread non-bulbous
First line: fusidic acid (mupirocin 2% if fusidic acid resistance is suspected )
Oral: Flucloxacillin (2L:: clarithromycin or erythromycin in pregnancy )
Bulbous or patients who are systemically unwell
First line: Flucloxacillin
Second line: clarithromycin (erythromycin in pregnancy)
What is the treatment pathway for lower UTI
Treatment in men:
First line: nitrofurantoin or trimethoprim
Treatment in non-pregnant women first choice
First line: nitrofurantoin or trimethoprim
Second line: pivmecillinam or fosfomycin
Treatment in pregnant women
First line nitrofurantoin
Second line: cefalexin or amoxicillin
When should nitrofurantoin be used
Should only be used for eGFR is > or equal to 45ml/min
What is the length of time for lower UTIs
Men: 7 days
Pregnancy: 7 days
Uncomplicated: 3 days
Catheter associated: 7 days
Why wouldn’t you give trimethoprim in pregnancy
Teratogenic
Or methotrexate as antifolate
Phenytoin as antifolate
What is the treatment pathway for strep throat and Scarlett fever
Both infections are part of the streptococcus bacteria family
First line: phenoxymethylpenicillin
Second line: clarithromycin (strep) or erythromycin (in pregnancy), amoxicillin/ azithromycin (Scarlett)
Scarlett fever:
Flu like symptoms, high temperature, swollen neck glands
A red rash with small raised bumps, rough feeling like sandpaper
White coating on tongue
What are the treatment pathways of other infections
Acne vulgaris: adapalene, clindamycin, benzoyl peroxide and lymecycline (acne side)
Bacterial vaginosis and trichomoniasis: metrondiazole
Clamydia: doxycycline
2L: azithromycin
Conjunctivitis and blepharitis: chloramphenicol not for under 2 or pregnant can’t be sold otc
Chloramphenicol 0.5%: 1 drop every 2 hours for the first 48 hrs then 3-4 times daily
1% ointment: 3-4 times a day
Fusidic acid 1% eye drops: 1 drop twice daily
Until 48 hrs after infection has cleared
Dental abscess: amoxicillin or phenoxyphenoxymethylpenicillin
2L: metronidazole or clarithromycin
Offer paracetamol or NSAIDs
Gonorrhoea: ceftriaxone or ciprofloxacin
Meningitis: benzylpenicillin
Scabies: permethrin- give advice of apply all over the body from neck down
Sinusitis: phenoxymethylpenicillin ( if penicillin allergy- doxycycline )
Threadworms: mebendazole not for pregnant women and under 2
What are the most common pathogens
Community acquired pneumonia : streptococcus pneumoniae
UTI: escherichia coli
Thrush: Candida albicans
Cellulitis: staphylococcus aureus
Meningitis: streptococcus pneumoniae
Treatment for acne vulgaris
Mild- moderate:
Topical benzoyl peroxide + clindamycin
Moderate-severe:
Topical adapalene +benzoyl peroxide
Topical Azelaic acid
Both options should have oral lymecycline or doxycycline
Any severity
Topical adapting impulse benzoyl peroxide
Topical renal plus clindamycin
