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A13AMC @ UoN > Treatment Regimens & Chemoprophylaxis > Flashcards

Treatment Regimens & Chemoprophylaxis Flashcards

1
Q

Describe the three most common regimens for Malaria chemoprophylaxis

A

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

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2
Q

How long must malaria prophylaxis be maintained?

A

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

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3
Q

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

A

Oral penicillin (Erthyromycin or Azithromycin)

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4
Q

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

A

2 or more cases in 30 days

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5
Q

Describe chemoprophylaxis for Group B strep

A

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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6
Q

Describe the chemoprophylaxis for Rheumatic fever

A

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

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7
Q

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

A

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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8
Q

What is the relevant chemoprophylaxis for Hib meningitis?

A

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

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9
Q

What three antibiotics can be given as chemoprophylaxis for UTIs?

A

Trimethoprim
Nitrofurantoin
Cephalexin

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10
Q

What chemoprophylaxis is appropriate for splenectomy patients?

A

Penicillin (to prevent pneumococcal infections)

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11
Q

What drug can be given as chemoprophylaxis after HIV infection?

A

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

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12
Q

What is the chemoprophylaxis for neutropenia?

A

Ciprofloxacin (to prevent Gram-ve infections)

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13
Q

What is the chemoprophylaxis for Bone Marrow Transplant?

A

Ciprofloxacin + Aciclovir + Fluconazole

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14
Q

What three actions are appropriate following trauma/bites?

A 
Surgical debridement (+/- delayed closure)
Antibiotic prophylaxis (co-amoxiclav, metronidazole, doxycycline)
Tetanus booster (+/- tetatnus Ig)
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15
Q

Is antibiotic prophylaxis appropriate for endocarditis?

A

No (generally)

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16
Q

Describe the five most common UK surgical chemoprophylaxis regimens

A

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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17
Q

Describe the chemoprophylaxis regimen for Influenza A

A

Ideally <48 hours of exposure

Oseltamivir/Zanamivir

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18
Q

Describe Post Exposure Prophylaxis for HIV

A

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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19
Q

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

A

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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20
Q

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

A

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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21
Q

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

A

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

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22
Q

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

A

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

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23
Q

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

A

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

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24
Q

If MRSA is likely what antibiotics should be prescribed?

A

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

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25
Q

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

A 
Infection with:
Legionella
Staphylococcal
Gram-ve Pneumonia
Extend to 14-21 days
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26
Q

How should CAP caused by S. aureus be treated?

A

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

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27
Q

How should Legionellosis be treated?

A

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

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28
Q

What is the standard antituberculous regimen in the UK?

A

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

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29
Q

What is the initial management of MDR TB?

A

> 4 drugs to which the organism is likely to be sensitive

Treatment continuing until 3-6 mo AFTER sputum is culture negative

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30
Q

What is the long term management of MDR TB?

A

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

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31
Q

What are the three main treatments for C. diff?

A

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)

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32
Q

What are three emerging treatments for C. diff?

A

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

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33
Q

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

A

Ciprofloxacin

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

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34
Q

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

A

Metronidazole (Giardia, Entaemoeba histolytica)

Nitazoxanide (Cryptosprodium)

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35
Q

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

A 
Rehydration (oral/i.v.)
Analgesia
Antiemetics
Avoid antidiarrhoeal agents
Isolation
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36
Q

What is the ideal HAART regimen?

A

Two NRTIs + NNRTI/PI/INSTI

Tenofovir + Abacavir + Rilpiravirine/Darunavir/Raltegravir

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37
Q

What antifungals are used to treat invasive candidasis?

A

AmB
Fluconazole
Caspofungin
Micafungin

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38
Q

What antifungals are used to treat aspergillosis?

A

AmB
Itraconazole
Voriconazole
Caspofungin

39
Q

What antifungals are used to treat cryptococcus?

A

AmB +/- 5-Flucytosine

40
Q

What antifungals are used to treat endemic mycoses?

A

AmB

Itraconazole

41
Q

What is the antibiotic treatment for P. falciparum?

A

Quinine + Doxycycline/Clindamycin

Atovaquone/Proguanil (mild)

Artemisinin Derivatives -Lumefantrine/Amodiaquine/Piperaquine

42
Q

What is the antibiotic treatment for benign species of Malaria?

A

Chloroquine + Primaquine (hypnozoites)

43
Q

Describe the treatment for African Trypanosmomiasis

A

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

44
Q

Describe the treatment for S. American Trypanosmoiasis

A

Oral treatment

Benznidazole + Nifurtimox

45
Q

Describe the treatment for Leishmaniasis

A

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

46
Q

What is the treatment for Toxoplasmosis?

A

Pyrimethamine
Sulphadiazine
Folinic acid

47
Q

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

A

Entamoeba histolytica
Giardia
Trichomonas

48
Q

What luminal protozoa can be treated with Co-trimoxazole?

A

Cyclospora

49
Q

What luminal protozoa can be treated with Nitazoxanide?

A

Cryptosporidiosis

50
Q

What antibiotics are used to treat intestinal nematodes?

A

Mebendazole/Albendazole

51
Q

What is the treatment for Strongyloides?

A

Ivermectin

52
Q

What is the treatment for Onchocerciasis?

A

Two doses of Ivermectin 6m apart (every 3 years)

Occasionally combined with nodulectomy

53
Q

What is the management of asymptomatic UTIs?

A

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

54
Q

Describe non-specific therapy for UTIs

A

Fluid re-hydration
Lowering urinary pH
Analgesia not recommended

55
Q

What two antibiotics are most commonly prescribed in UTIs?

A

Trimethoprim

Nitrofurantoin

56
Q

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

A

i. v Tazocin

i. v. Gentamicin

57
Q

What is the time course of treatment for UTIs?

A

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

Pyelonephritis - 10-14 days

58
Q

What is the management of Herpes Simplex 2?

A

Confirm diagnosis with PCR

Treat with aciclovir (5x daily)

59
Q

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

A 
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)
60
Q

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

A

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

61
Q

What is the treatment for Chancroid?

A

Azithromycin/Ceftriaxone (single dose)

62
Q

What is the treatment for Gonorrhoea?

A

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

63
Q

What is the treatment for Non Gonorrhoeal Urethritis?

A

Ceftriaxone
Azithromycin
Doxycycline

64
Q

What is the treatment for genital warts?

A

Scraping, cryotherapy, keratolytics
Podophyllin
Imiquimod

65
Q

How should meningitis be managed?

A 
Antibiotics
Oxygenation
Prevention of hypoglycaemia/hyponatraemia
Anticonvulsants
Decrease ICP
66
Q

What is the antimicrobial therapy for N. meningitidis?

A

Benzylpenicillin if sensitive

Cefotaxime/Ceftriaxone if not

67
Q

What is the antimicrobial therapy for S. pneumoniae?

A

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

68
Q

What is the antimicrobial therapy for Hib?

A

Cefotaxime/Ceftriaxone

69
Q

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

A

Cefotaxime/Ceftriaxome

Add Amoxicillin if >50 or immunocompromised

70
Q

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

A

Benzylpenicillin AND Gentamicin

71
Q

What is the length of treatment for N. meningitidis?

A

7 days

72
Q

What is the length of treatment for S. pneumoniae?

A

14 days

73
Q

What is the length of treatment for Hib?

A

7 days

74
Q

What is the length of treatment for L. monocytogenes?

A

> 21 days

75
Q

What is the length of treatment for unknown organisms?

A

7-14 days i.v. treatment

76
Q

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

A

Ceftriaxone + Metronidazole

If streptococcal/anaerobic narrow to Benzylpenicillin + Metronidazole

77
Q

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

A

Ceftazidime + Benzylpenicilin + Metronidazole OR

Meropenem

78
Q

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

A

Vancomycin + Meropenem

79
Q

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

A

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

80
Q

How are carbuncles treated?

A

Draining of pus and antibiotic therapy

81
Q

What is the surgical treatment for necrotising fasciitis?

A

Debridement, cutting away of soft tissue

82
Q

What is the antibiotic therapy for S. aureus?

A

Flucloxacillin

Co-amoxiclav

83
Q

What is the antibiotic therapy for S. pyogenes?

A

Penicillins

Flucloxacillin

84
Q

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

A

Erythromycin
Clindamycin
Cefuroxime (not MRSA)
Vancomycin

85
Q

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

A

Nystatin (candida)

86
Q

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

A

Chloramphenicol/Tetracycline (conjunctivitis)

87
Q

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

A

Mupirocin (S. aureus/MRSA)

88
Q

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

A

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

89
Q

What is the treatment for Septic Arthritis?

A

High dose of i.v. antibiotics >2wks

Followed by 4wks oral antibiotics

90
Q

What is the treatment for osteomyelitis - Acute

A

High dose i.v. antibiotics >6wks

+/- surgical drainage

91
Q

What is the treatment for osteomyelitis - Chronic

A

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

92
Q

What is the treatment for infective endocarditis?

A

High dose, targeted i.v. antibiotics

Surgery

93
Q

What is the management of Sepsis?

A 
ABC - Oxygen/Fluid resuscitation
Mechanical ventilation, vasopressors
Monitor hourly urine output (AKI)
Antibiotic to cover likely organisms (w/i 1 hour admission)
Source control
94
Q

What is a good starting antibiotic for sepsis?

A

Tazocin (Piperacillin/Tazobactam)

A13AMC @ UoN (20 decks)

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