Primary Care Adult Empirical Treatment Flashcards
Meningitis (Primary Care)
Benzylpenicillin (IM/IV) 1.2g
If known anaphylaxis - Cefotaxime
Conjunctivitis
Treat only if severe, most cases are viral or self limiting.
1st line: clean eyelids to remove crusting
2nd line: chloramphenicol 0.5% eyedrops and chloramphenicol 1% ointment
3rd line: send swabs prior to treatment. Fusidic acid 1% eye drops
Ophthalmic Shingles
Aciclovir 800mg 5 times daily or valaciclovir 1g tds (7 days) + lubricating eye drops if lesions near eyelid.
Tonsilitis >4 on FeverPAIN score
1st line: Peniclin V 1g bd or 500mg qds (5 days)
2nd line penicillin allergy: Clarithromycin 500mg bd (5 days)
Sinusitis
<10 days symptoms: no treatment
> 10 days multiple or worsening symptoms -
1st line: Penicillin V 500mg qds or 1g bd (5 days)
2nd line: Doxycycline 200mg day 1 then 100mg daily (5 days total)
Otitis Media with otorrhoea
1st line: Amoxicillin 500mg tds
2nd line: Clarithromycin 500mg bd (5 days)
Otitis Externa
Provide information on aural care.
Mild: do not swab, Acetic acid 2% tds (EarCalm) continuing for 2 days after resolution.
Moderate: do not swab. Sofradex or Otomize tds
Oral Candidiasis
1st line: Miconazole gel qds or Nystatin 1ml qds
2nd line: Fluconazole 50mg (Immunocompromised 100mg) (7 days)
Acute Exacerbation of COPD with increased sputum purulence or pneumonia/consolidation on CXR
1st line: Amoxicllin 500mg tds
2nd line: Doxycycline 200mg day 1 then 100mg daily (5 days total)
Acute cough/acute bronchitis in the elderly (with consideration, no significant clinical benefit)
1st line: Amoxicllin 500mg tds
2nd line: Doxycycline 200mg day 1 then 100mg daily (5 days total)
Pneumonia
CURB65 score 0 or 1
No prognostic features
Home Therapy 5 days antibiotics
1st line: Amoxicillin 1g TDS oral
2nd line Penicillin allergy: Doxycycline 200mg on day 1 then 100mg daily
Pneumonia
CURB65 score 0 or 1
With prognostic features:
- co-exisiting chronic illness
- pulse oximetry <92% or PaO2 <8.0kPa on any FiO2
- bi-lateral or multi-lobar changes on CXR
- change suggestive of empyema or cavitation
- acidosis
Patient in Hospital 5 days antibiotics
1st line: Amoxicillin 1g TDS oral
2nd line Penicillin allergy: Doxycycline 200mg on day 1 then 100mg daily
IF Penicillin allergy and IV required: Clarithromycin 500mg BD
C.difficile Infection
Vancomycin 125mg qds oral
total 10 days treatment
Diverticulitis where antibiotics are indicated
Metronidazole 400mg tds plus Co-trimoxazole 960mg bd for 5 days
Uncomplicated Female UTI
For 3 days
1st line: Nitrofurantoin 100mg MR bd
2nd line: Trimethoprim 200mg bd
Pyelonephritis (male or female)
Co-trimoxazole 960mg bd or Co-amoxiclav 645mg tds (7 days)
Uncatheterised Male UTI
For 7 days
1st line: Nitrofurantoin 100mg MR bd or 50mg qds
2nd line: Trimethoprim 200mg bd
UTI in Older Catheterised Patients WITH clinical signs/symptoms of infection
Co-trimoxazole 960mg bd or Co-amoxiclav 625mg tds (7 days). Change catheter as soon as possible
Prostatitis
Ofloxacin 200mg bd or Ciprofloxacin 500mg bd.
If high risk CDI: Trimethoprim 200mg bd (all 28 days)
Epididimo-orchitis
<35 or new partner in last 3 months
Send MSSU, gonorrhoea and chlamydia tests.
Doxycycline 100mg
bd (14 days)
Epididimo-orchitis
> 35 and no new partner
Ofloxacin 200mg bd or Ciprofloxacin 500mg bd (14 days).
Uncomplicated Chlamydia
Doxycycline 100mg bd (7 days). If intolerant: Azithromycin 1g od day 1 then 500mg od for 2 days
PID Outpatient Treatment
For 14 days
Ofloxacin 400mg twice daily + Metronidazole 400mg twice daily
OR patients < 18 or if patient at high risk of GC (partner with gonorrhoea, sexual contact abroad, or gram negative diplococci
on microscopy of endocervical swab):
IM Ceftriaxone 1g single dose + Doxycycline 100mg twice daily + Metronidazole 400mg twice daily
Bacterial Vaginosis
Metronidazole 400mg bd (5 days) or 2g single dose
Vulvovaginal Candidiasis
Fluconazole 150mg single dose or Clotrimazole 500mg Pessary Single dose
Cellulitis
Total IV/PO 5 days (extend to 7 days if clinically indicated)
Flucloxacillin 1g qds or doxycycline 100mg bd If history or risk of MRSA doxycycline 100mg bd
Sinus/dental/Mandibular cellulitis
Co-amoxiclav 625mg tds (7 days) or
clindamycin –
weight based dosing (7 days)
Diabetic foot infection
MILD: flucloxacillin 1g qds or doxycycline 100mg bd (7 days)
MODERATE: flucloxacillin 1g qds + metronidazole 400mg tds or doxycycline 100mg bd + metronidazole 400mg tds (7 days)
SEVERE: follow guidance
Scabies
Permethrin 5% cream - apply over whole body including face, neck and ears. Wash off after 8-12 hours and repeat treatment after 7 days. If hands are washed with soap and water within 8 hours of application, re-apply cream.
Malathion 0.5% in aqueous basis - apply to all parts of the body for 12 hours or overnight and repeat treatment after 7 days.
Note all members of household/close contacts should be treated once only
Crab Lice
Permethrin 5% cream - apply over whole body including face, neck and ears and wash off after 8-12 hours and repeat treatment after 7 days. If hands are washed with soap and water within 8 hours of application, cream should be re-applied
Malathion 0.5% in aqueous basis (may be more suitable for treating crab lice in hair bearing areas or for use on eyelashes). Apply to all parts of the body for 12 hours or overnight and repeat treatment after 7 days
Head lice
Dimeticone 4% lotion - Apply into dry hair and scalp, shampoo after a minimum of 8 hours or overnight and repeat application after 7 days
Malathion 0.5% in aqueous basis - rub into dry hair and scalp, shampoo after 12 hours and repeat treatment after 7 days
Athlete’s Foot (Tinea Pedis)
Terbinafine cream
Fungal Scalp Infection
use oral terbinafine 250mg od for 2-4 weeks + ketoconazole shampoo twice weekly for first 2 weeks.
Bites (Dog/cat/human)
Prophylaxis for uninfected bite: 3 days
Treatment for infected bite: 5 days
1ST LINE: co-amoxiclav 625mg tds
2ND LINE: metronidazole 400mg tds + doxycycline 100mg bd
Chickenpox
Consider treatment if patient presents <24 hours after onset of rash or if immunocompromised
Aciclovir 800mg 5 times daily (7 days)
Shingles
Must present within 72 hours of onset of rash
Aciclovir 800mg 5 times daily or valaciclovir 1g tds (7 days)
Impetigo
Localised lesions: topical hydrogen peroxide 1% cream or topical fusidic acid 2% cream tds (5 days)
If lesions are extensive or severe:
1st LINE - flucloxacillin 500mg qds (5 days)
2nd LINE - clarithromycin 500mg bd (5 days)
