STI, PID, maternal infections = antibiotic man Flashcards
Antibiotics recommended for PROM?
Erythromycin for max 10 days or until labour established
Antibiotics recommended for UTI or asymptomatic bacteriuria?
1st or 2nd trim; nitrofurantoin
3rd trim; trimethoprim
Antibiotics recommended for pyelonephritis?
Consider hospital admission
Co-amoxiclav for 7 days then review
Antibiotics recommended for chlamydia in pregnancy?
Azithromycin 1g as single dose then 500mg for 2 days
Test of cure at least 3 weeks after
Rescreen in 3rd trim
Antibiotics recommended for thrush in pregnancy?
Clotrimazole pessary + clotrimazole 1% cream
Antibiotics recommended for bacterial vaginosis in pregnancy?
Metronidazole PO or gel
Or
Clindamycin vaginal cream
Antibiotics recommended for trichomoniasis in pregnancy?
Metronidazole 400 mg bd for 5-7 days
Antibiotics recommended for genital herpes in pregnancy?
If first episode in 3rd trim - urgent referral to sexual health
Aciclovir
Who should be suspected for sepsis in postpartum period?
In all women who have recently delivered who feel unwell, have pyrexia or hypothermia
Antibiotics recommended for endometritis?
Co-amoxiclav + metronidazole for 7 days
Antibiotics recommended for post c/s wound infection?
Flucloxacillin + metronidazole or clindamycin
Antibiotics recommended for mastitis?
Ensure complete drainage of breast at each feed by baby +/- expressing
Symptom relief with NSAIDs and warm compresses
Consider antibiotics if symptoms not improving within 12-14 hours
Flucloxacillin
Antibiotics recommended for breast abscess?
Send pus for culture
Flucloxacillin or clindamycin if penicillin allergic
Antibiotics recommended for thrush at the breast?
Ensure good attachment of baby and treat mother and baby simultaneously
Mother; miconazole 2% cream applied to niple and areola after each feed for 7 days
If pain severe or deep; fluconazole for 10 days
Infant; miconazole oral gel for at least 7 days
Nystatin oral suspension 1 ml qds after feeds for 48 hours after symptoms cleared
Antibiotics recommended for nipple fissure?
Only treat if signs of infection; yellow discharge or crusts around fissures
If isolated use topical fusidic acid sparingly 3 or 4 times a day
Caution surrounding co-trimoxazole in breastfeeding?
Monitor baby for hyperbilirubinemia and kernicterus due to small amounts in breast milk
If baby premature, or jaundice avoid
Antibiotics recommended for maternal sepsis?
IV co-amoxiclav +/- gentamicin
Antibiotics recommended for maternal septic shock?
IV piperacillin/ tazobactam + IV clindamycin + IV gentamicin
Antibiotics recommended for prophylaxis in c/s or instrumental delivery?
BMI <30; IV co-amoxiclav
BMI >30; IV co-amoxiclav + IV amoxicillin
Antibiotics recommended for group B strep intrapartum prophylaxis?
IV benzylpenicillin 3g followed by 1.5g every 4 hours until delivery
Antibiotics recommended for 3rd and 4th degree tears involving the anal sphincter/ rectal mucosa?
Prior to suturing; one off dose of IV co-amoxiclav
Followed by PO co-amoxiclav for 7 days
Antibiotics recommended for termination of pregnancy prophylaxis (medial or surgical)?
7-days 100mg doxycycline BD* OR 1 g oral azithromycin +500 mg daily for 2 days
What is PID?
Presence of inflammation and infection in the upper genital tract and usually results from ascending infection from the vagina resulting in a spectrum of disease including endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis
What are the causative organisms of PID?
N. gonorrhoea Chlamydia trachomatis Gardnerella Vaginalis Anaerobes Coliforms
DDx for PID?
Ectopic pregnancy Endometriosis Functional pain UTI IBS Acute appendicitis Ovarian complications Postnatal endometritis
Symptoms of PID?
Lower abdo pain (bilateral) Lower abdominal tenderness Abdominal vaginal or cervical discharge Temp >38 degrees Abnormal vaginal bleeding including post coital or intermenstrual bleeding Deep dyspareunia Adnexal tenderness
Outpatient treatment for PID?
Ofloxacin + metronidazole
If high risk of GC; IM ceftriaxone + doxycycline + metronidazole
Investigations outpatient for PID?
Full sexual health screen including HIV and syphilis
MSSU for culture and sensitivity
Urine pregnancy test
Urinalysis
FBC, CRP
Vulvovaginal swab for chlamydia and gonorrhoea (PCR essential)
Inpatient tx for PID?
IV ceftriaxone + IV metronidazole + PO doxy
Antibiotic recommendations for chlamydia?
Doxycycline 100mg 7 days
Antibiotic recommendations for gonorrhoea?
IM ceftriaxone
Fungal recommendations for vulvovaginal candidiasis?
Fluconazole 150mg + clotrimazole 1% cream or pessary
Antibiotic recommendations for bacterial vaginosis?
Metronidazole
2nd line; clindamycin vaginal cream
Antibiotic recommendations for trichomoniasis?
Metronidazole
Viral recommendations for genital herpes?
1st; aciclovir 400 mg tds for 5 days
Recurrent; aciclovir 400mg bd for 12 months
Management of genital warts (HPV)?
30% resolve in 6 months
Podophyllotoxin 0.5% solution or 0.15% screm
Imiquimoid 5% cream
Cryotherapy
