Treatment Regimens & Chemoprophylaxis Flashcards by Tim Resch

Describe the three most common regimens for Malaria chemoprophylaxis

Chlorouqine +/- Proguanil
Mefloquine
Doxycycline + Atovaquone (Malarone = Proguanil + Ataovaquone)

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How long must malaria prophylaxis be maintained?

Continued for 4 weeks after leaving malarious area (1 wk for Malarone)

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What antibiotics are given as chemoprophylaxis for invasive Group A Strep infections?

Oral penicillin (Erthyromycin or Azithromycin)

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How many cases of group A strep are required in a household for chemoprophylaxis?

2 or more cases in 30 days

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Describe chemoprophylaxis for Group B strep

Penicillin/Clindamycin given during labour to high risk pregnancies:
Pre-term labour
Prolonged membrane rupture
History of group B strep in prev pregnancy
Known carrier of group B strep

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Describe the chemoprophylaxis for Rheumatic fever

Penicillin prophylaxis (Sulfadiazine) 250mg bd until >16 y/o

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What is the chemoprophylaxis regimen for bacterial meningitis/meningococcal disease?

Chemoprophylaxis for close contacts (+/- immunisation)
Rifampicin 600mg p.o. b.d. for 2 days (ADR w/ pill and contact lenses)
Ciprofloxacin 500mg p.o. stat
Ceftriaxone IM for pregnancy

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What is the relevant chemoprophylaxis for Hib meningitis?

Rifampicin 600mg p.o. o.d. for 4 days (for all household contacts)

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What three antibiotics can be given as chemoprophylaxis for UTIs?

Trimethoprim
Nitrofurantoin
Cephalexin

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What chemoprophylaxis is appropriate for splenectomy patients?

Penicillin (to prevent pneumococcal infections)

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What drug can be given as chemoprophylaxis after HIV infection?

Co-trimoxazole (to prevent PCP following 1st infection or when CD4 <200)

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What is the chemoprophylaxis for neutropenia?

Ciprofloxacin (to prevent Gram-ve infections)

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What is the chemoprophylaxis for Bone Marrow Transplant?

Ciprofloxacin + Aciclovir + Fluconazole

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What three actions are appropriate following trauma/bites?

Surgical debridement (+/- delayed closure)
Antibiotic prophylaxis (co-amoxiclav, metronidazole, doxycycline)
Tetanus booster (+/- tetatnus Ig)

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Is antibiotic prophylaxis appropriate for endocarditis?

No (generally)

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Describe the five most common UK surgical chemoprophylaxis regimens

Appendectomy (Metronidazole)
Elective colorectal surgery (Co-amoxiclav/Cefuroxime+Metronidazole/Genatmicin+Metronidazole)
Breast implant (Co-amoxiclav)
Cardiac surgery (Cefuroxime/Glycopeptide)
Orthopaedic implants (Cefradine+Cefuroxime)

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Describe the chemoprophylaxis regimen for Influenza A

Ideally <48 hours of exposure

Oseltamivir/Zanamivir

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Describe Post Exposure Prophylaxis for HIV

Ideally given <1h (offered up to 2 wks after exposure)
Combination of anti-retrovirals (AZT/DDI + Protease Inhibitors)
Taken for 4 wks

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What is the treatment regimen for a low severity CAP score (0-1)?

Amoxicillin 500mg q.d. for 7 days OR
Doxycyline 200mg (LD) then 100 mg o.d.
If unable to take oral therapy can give i.v. Amoxicillin

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What is the treatment regimen for a moderate severity CAP score (2)?

Amoxicillin 500mg q.d. for 7 days + Clarithromycin 500mg b.d. for 7 days OR Doxycyline 200mg (LD) then 100 mg o.d.
If unable to take oral therapy can give i.v. Benzyplenicillin

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If patients are allergic to penicillin what antibiotics can be prescribed instead? - CAP Score <2

Mild - i.v. Cefuroxime 1.5g t.d. (+ i.v. Clarithromycin 500mg b.d.)
Moderate - Ciprofloxacin 400mg b.d. + Vancomycin

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What is the treatment regimen for a severe CAP score (3)?

Co-amoxiclav 1.2g t.d. + Clarithromycin 500mg b.d. for 10 days

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If patients are allergic to penicillin what antibiotics can be prescribed? - CAP Score >3

Levofloxacin 500mg b.d. + Vancomycin 1g b.d. for 10 days

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If MRSA is likely what antibiotics should be prescribed?

Levofloxacin 500mg b.d. + Vancomycin 1g b.d. for 10 days

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In what cases should the time course of CAP treatment be extended?

``` Infection with: Legionella Staphylococcal Gram-ve Pneumonia Extend to 14-21 days ```

How should CAP caused by S. aureus be treated?

Flucloxacillin 2g i.v. q.d. ADDED to standard regimen

How should Legionellosis be treated?

High dose macrolide (up to 4mg Erythromycin per day) + Rifampicin 600mg b.d.

What is the standard antituberculous regimen in the UK?

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol for 2 months THEN Rifampicin + Isoniazid for 4 months Otherwise patient is RIPE for infection

What is the initial management of MDR TB?

>4 drugs to which the organism is likely to be sensitive | Treatment continuing until 3-6 mo AFTER sputum is culture negative

What is the long term management of MDR TB?

After initial treatment therapy should be continued with 3> drugs for 15-18 months Surgery may be necessary

What are the three main treatments for C. diff?

PO Vancomycin - Main treatment, oral, better efficacy in severely ill PO Metroidazole - Similar efficac as Vanc. i.v. an option PO Fidaxomicin - Lower relapse rate, consider for severe disease/recurrence (more expensive)

What are three emerging treatments for C. diff?

Rifaximin - Chaser therapy post Vanc. reduces relapse IV Immunoglobulins - Treatment if life threatening, prevents relapse Faecal Microbiotia Transplants - to replace IVIG

How should Traveller's diarrhoea caused by bacteria (80%) be treated?

Ciprofloxacin | 500mg stat OR 500mg b.d. for 5 days

How should Traveller's diarrhoea caused by parasites be treated?

Metronidazole (Giardia, Entaemoeba histolytica) | Nitazoxanide (Cryptosprodium)

What are the five main steps in general management of chronic diarrhoea?

``` Rehydration (oral/i.v.) Analgesia Antiemetics Avoid antidiarrhoeal agents Isolation ```

What is the ideal HAART regimen?

Two NRTIs + NNRTI/PI/INSTI | Tenofovir + Abacavir + Rilpiravirine/Darunavir/Raltegravir

What antifungals are used to treat invasive candidasis?

AmB Fluconazole Caspofungin Micafungin

What antifungals are used to treat aspergillosis?

AmB Itraconazole Voriconazole Caspofungin

What antifungals are used to treat cryptococcus?

AmB +/- 5-Flucytosine

What antifungals are used to treat endemic mycoses?

AmB | Itraconazole

What is the antibiotic treatment for P. falciparum?

Quinine + Doxycycline/Clindamycin Atovaquone/Proguanil (mild) Artemisinin Derivatives -Lumefantrine/Amodiaquine/Piperaquine

What is the antibiotic treatment for benign species of Malaria?

Chloroquine + Primaquine (hypnozoites)

Describe the treatment for African Trypanosmomiasis

Treatments are toxic, given i.v. Stage 1 - Suramin, Pentamidine Stage 2 - Melarsoprol, Eflornithine + Nifurtimox

Describe the treatment for S. American Trypanosmoiasis

Oral treatment | Benznidazole + Nifurtimox

Describe the treatment for Leishmaniasis

Sodium Stibogluconate (i.m.) AmB (i.v.) Miltefosine (oral)

What is the treatment for Toxoplasmosis?

Pyrimethamine Sulphadiazine Folinic acid

What three luminal protozoa can be treated with Metronidazole/Albendazole?

Entamoeba histolytica Giardia Trichomonas

What luminal protozoa can be treated with Co-trimoxazole?

Cyclospora

What luminal protozoa can be treated with Nitazoxanide?

Cryptosporidiosis

What antibiotics are used to treat intestinal nematodes?

Mebendazole/Albendazole

What is the treatment for Strongyloides?

Ivermectin

What is the treatment for Onchocerciasis?

Two doses of Ivermectin 6m apart (every 3 years) | Occasionally combined with nodulectomy

What is the management of asymptomatic UTIs?

If culture is positive repeat and watch for development of symptoms IF PREGNANT NEEDS TREATING

Describe non-specific therapy for UTIs

Fluid re-hydration Lowering urinary pH Analgesia not recommended

What two antibiotics are most commonly prescribed in UTIs?

Trimethoprim | Nitrofurantoin

What i.v. antibiotics are useful in treating UTIs?

i. v Tazocin | i. v. Gentamicin

What is the time course of treatment for UTIs?

Cystitis - 3 days (10-14 in young men) | Pyelonephritis - 10-14 days

What is the management of Herpes Simplex 2?

Confirm diagnosis with PCR | Treat with aciclovir (5x daily)

What is the treatment for Syphilis? - Early (primary, secondary, early latent)

``` Benzathine penicillin G (2.4 mill units, single dose) Procaine penicllin (2.4 mill units + probenicid for 14 days) Doxycycline (100mg b.d. for 15 days) ```

What is the treatment for Syphilis? - Tertiary/Late latent

Benzathine penicillin G (2.4 mill units, 3x wk) Doxycycline (100mg b.d. for 28 days) Monitor serological response

What is the treatment for Chancroid?

Azithromycin/Ceftriaxone (single dose)

What is the treatment for Gonorrhoea?

Ceftriaxone (125mg i.m.) Azithromycin (2g o.d.) Quinolones

What is the treatment for Non Gonorrhoeal Urethritis?

Ceftriaxone Azithromycin Doxycycline

What is the treatment for genital warts?

Scraping, cryotherapy, keratolytics Podophyllin Imiquimod

How should meningitis be managed?

``` Antibiotics Oxygenation Prevention of hypoglycaemia/hyponatraemia Anticonvulsants Decrease ICP ```

What is the antimicrobial therapy for N. meningitidis?

Benzylpenicillin if sensitive | Cefotaxime/Ceftriaxone if not

What is the antimicrobial therapy for S. pneumoniae?

Benzylpenicillin if sensitive Cefotaxime/Ceftriaxone if not Add Vancomycin if strain may be resistant

What is the antimicrobial therapy for Hib?

Cefotaxime/Ceftriaxone

What is the antimicrobial therapy for an unknown organism? - Child >2mo and adults

Cefotaxime/Ceftriaxome | Add Amoxicillin if >50 or immunocompromised

What is the antimicrobial therapy for an unknown organism? - Child <2mo

Benzylpenicillin AND Gentamicin

What is the length of treatment for N. meningitidis?

7 days

What is the length of treatment for S. pneumoniae?

14 days

What is the length of treatment for Hib?

7 days

What is the length of treatment for L. monocytogenes?

>21 days

What is the length of treatment for unknown organisms?

7-14 days i.v. treatment

What antibiotic treatment is best if the source is likely dental/sinus/haematogenous? (brain abscess)

Ceftriaxone + Metronidazole | If streptococcal/anaerobic narrow to Benzylpenicillin + Metronidazole

What antibiotic treatment is best if the source is likely otogenic? (brain abscess)

Ceftazidime + Benzylpenicilin + Metronidazole OR | Meropenem

What antibiotic treatment is best for post-operative/post-traumatic treatment? (brain abscess)

Vancomycin + Meropenem

What is the general structure of antibiotic therapy? (brain abscess)

High dose 6-8 wks 3 wks i.v. then oral

How are carbuncles treated?

Draining of pus and antibiotic therapy

What is the surgical treatment for necrotising fasciitis?

Debridement, cutting away of soft tissue

What is the antibiotic therapy for S. aureus?

Flucloxacillin | Co-amoxiclav

What is the antibiotic therapy for S. pyogenes?

Penicillins | Flucloxacillin

What antibiotics are available for treating MRSA/resistant S. pyogenes?

Erythromycin Clindamycin Cefuroxime (not MRSA) Vancomycin

What topical antibiotics are used around the mouth? - What are they treating?

Nystatin (candida)

What topical antibiotics are used around the eyes? - What are they treating?

Chloramphenicol/Tetracycline (conjunctivitis)

What topical antibiotics are used around the nose? - What are they treating?

Mupirocin (S. aureus/MRSA)

What topical antibiotics are used on the skin? - What are they treating?

Fucidin (impetigo) Aciclovir (cold sores) Azoles (fungal infections)

What is the treatment for Septic Arthritis?

High dose of i.v. antibiotics >2wks | Followed by 4wks oral antibiotics

What is the treatment for osteomyelitis - Acute

High dose i.v. antibiotics >6wks | +/- surgical drainage

What is the treatment for osteomyelitis - Chronic

Formation of sequestrum (dead bone w/i tissue) Months of antibiotics + surgery Often relapses

What is the treatment for infective endocarditis?

High dose, targeted i.v. antibiotics | Surgery

What is the management of Sepsis?

``` ABC - Oxygen/Fluid resuscitation Mechanical ventilation, vasopressors Monitor hourly urine output (AKI) Antibiotic to cover likely organisms (w/i 1 hour admission) Source control ```

What is a good starting antibiotic for sepsis?

Tazocin (Piperacillin/Tazobactam)