Treatments Flashcards
Community acquired septicaemia
1) a broad spectrum antipseduomonal penicillin (e.g. piperacillin with tazibactam) or Broad spectrum cephalosporin (e.g. cefuroxime)
2) if MRSA- Add vancomicin
3) if anaerobic- add metronidazole
4) if other resistance- more broad spectrum beta lactate (meropenem)
Hospital acquired septicaemia
1) broad spectrum antispedomonal
2) if MRSA- add vancomicin or teicoplanin
3) if anaerobic- add metronidazole
Septicaemia related to vascular catheter
1) vancomicin (or teicoplanin)
2) if gram neg- add broad spectrum antipseudomonal beta lactate
3) consider removal of catheter
Meningococcal septicaemia
Single dose benzylpenicillin ( or cefotaxime in PA/ chloramphenicol in hypersensitivity) before hospital
Then, ciprofloxacin/ rifampicin/ ceftriaxone to eliminate nasal carriage
Endocarditis initial (blind) therapy if native valve
Amoxicillin
Consider adding low dose gentamicin
If MRSA/ severe sepsis- use vancomicin and low dose gentamicin
If severe sepsis with risk factors for gram neg- vancomicin and meropenem
Initial blind therapy for endocarditis with prosthetic heart valve
Vancomicin+ rifampicin+ low dose gentamicin
Endocarditis that is caused by staphylococci (native)
Flucloxacillin for 4-6 weeks
If PA/MRSA- vancomicin + rifampicin
Endocarditis caused by staphylococci (prosthetic)
Flucloxacillin+ rifampicin + low dose gentamicin
For 6 weeks (review gent at 2 weeks)
In PA or MRSA- vancomicin + rifampicin + low dose gentamicin
For 6 weeks (review gent at 2 weeks)
Endocarditis is strep and fully sensitive
Benzypenicillin 4-6 weeks
In PA- vancomicin + low dose gentamicin
Endocarditis caused by less sensitive steptococci
Benzylpenicillin + low dose gentamicin 4-6 weeks
If PA or MRSA- vancomicin + gentamicin
Endocarditis caused by enterococci
Amoxicillin + low dose gentamicin
or
benzylpenicillin + low dose gentamicin
Or if PA or MRSA
Vancomicin + low dose gent
or if gentamicin resistance
Amoxicillin with streptomicin (if susc- for 2 weeks)
Endocarditis caused by HACEK organisms
Amoxicillin (4 weeks) + low dose gentamicin (2 weeks)
Or
If amoxicllin resistant- ceftiaxone + low dose gentamicin
Hacek organisms
Haemophilus, actinobacillus,cardiobacterium, eikenella, kingella
Meningitis blind therapy first step
Benzylpenicillin ASAP (cefoxamine/ chloramphenicol if PA or hypersensitivity)
Dexamethosone within 12 hours (unless shock/ septic/ immunocompromised)
Blind hospital treatment of meningitis if 3months- 50 years old
Cefotaxime
+/- vanxomicin
10 days
Blind hospital treatment of meningitis if >50 years old
Cefotaxime + amoxicillin
+/- vancomicin
10 days
Meningitis caused by meningococci
Benzylpenicillin or cefotaxime (or chloramphenicol if hypersensitivity)
7 days
Meningitis caused by pneumonococci
Cefotaxime
Or benzylpenicillin if susc
If very resistant- + vancomicin +/- rifampicin
14 days
Meningitis caused by haemophilus influenzae
1)Cefotaxime
2) chloramphenicol if resistant
10 days
If Hib- give rifampicin for 4 days before discharge
Meningitis caused by listeria
Amoxicillin (21 days) + gentamicin (7 days)
If hypersensitivity- co-trimoxazole (21 days)
Mild diabetic foot infection (no pen allergy)
Oral flucloxacillin
Moderate to severe diabetic foot infection (no pen allergy)
Flucloxacillin +/- iv gentamicin +/- metronidazole
Or
Co-amoxiclav +/- iv gentamicin
Or
Iv ceftriaxone + metronidazole
Moderate to severe diabetic foot infection (pen allergy)
Co-trimoxazole +/- iv gentamicin +/- metronidazole
Mild diabetic foot infection (pen allergy)
clarithromicin/ doxycycline/ erythromycin (preg)
Otitis externa is caused by which 2 bacteria
Psedomonas aureginosa
Staphylococcus aureus
Otitis externa if psedomonas suspected
Ciprofloxacin
Otitis externa if no pen allergy
Flucloxacillin
Otitis externa if pen allergy
Clarithromycin
Otitis media caused by which bacteria
Haemophilus influenza, streptococcus pneumonia, streptococcus pyrogenes, moraxella catarrhalis
Otitis media in children
Amoxicillin
If worsening after 2-3 days- co-amoxiclav
Otitis media with pen allergy
Clarithromycin or erythromycin in preg
Conjunctivitis
Chloramphenicol eye drops
Campylobacter enteritis if immonucompromised or severe
Clarithromycin
Or
Ciprofloxacin
Acute uncomplicated diverticulitis
Oral co-amoxiclav
Or if PA cefalexin + metronidazole / trimethoprim + metronidazole/ ciprofloxacin + metronidazole
Complicated acute diverticulitis
Iv co-amoxiclav / cefuroxime + metronidazole /
Or
amoxicillin + gentamicin + metronidazole
Complicated acute diverticulitis with PA
Ciprofloxacin + metronidazole
Salmonella
Ciprofloxacin/ cefotaxime
Shigellosis
Ciprofloxacin/ azithromycin
Or is susc- amoxicillin / trimethoprim
Typhoid fever
Cefotaxime
Or if Mild/ moderate can use azithromycin
Or Ciprofloxacin if susc
Drugs increase the risk of c diff sec infection
Clindamyxin, cepgakosporins (especially 3rd and 4th gen), fluoroquinoloned, broad spec penicillins, ppis
First episode of c diff
1)Oral vancomycin
2) oral fidaximixin
C.diff recurrence within 12 weeks of resolution
Oral fidaxomicin
C.diff recurrence > 12 weeks after resolution
Oral vancomicin or fidaxomicin
Lifethreatening c diff
Specialist- oral vancomicin with iv meteonidazole
Biliary tract infection
Ciprofloxacin/ gentamicin/ cephalosporin
Peritonitis
Cephalosporin + metronidazole
Or
Gentamicin+ metronidazole
Or
Gentamicin + clindamicin
Or
Piperacillin with tazobactam alone
Bacterial vaginosis
Oral metronidazole 5-7 days
Or topical metronidazole 5 days
Or topical clindamycin 7 days
Genital infection (e.g. Chlamydia)
Azithromycin/ doxycycline 7 days
Or
Erythromycin 14 days
Uncomplicated gonorrhea within 14 days of exposure
1) IM ceftriaxone
If susc oral ciprofloxacin
2)IM gentamicin + azithromycin
3) oral only- oral cefixime + oral azithromycin
4) oral azithromycin
Pelvic inflammatory disease (non severe)
Doxycycline + metronidazole + single dose IM ceftiaxone
or Ofloxacin + metronidazole
14 days
Pelvic inflammatory disease (severely ill)
doxycycline + IV ceftisxone + IV metronidazole -> oral switch to doxycycline + metronidazole
Early syphillis ( less than 2 years)
Benzanthine benzylpenicillin (single dose + 1 dose 7 days after if third trimester)
Or doxycycline / erythromycin
14 days
late latent syphillis ( more than 2 years)
Benzanthine benzylpenicillin once a week for 2 weeks
or
doxycycline 28 days
asymptomatic contacts of syphillis
doxycycline 14 days
osteomyelitis no PA
flucloxacillin
consider +/- fucidic acid/ rifampicin for first 2 weeks
If MRSA- vancomycin
osteomyelitis PA
clindamycin
consider +/- fucidic acid/ rifampicin for first 2 weeks
septic arthritis
flucloxacillin 4-6 weeks
MRSA- vancomycin 4-6 weeks
if gonococcal- cefotaxime
septic arthritis with PA
clindamycin 4-6 weeks
sinusitis (non-life threatening)
phenoxymethylpenicillin
no improvement in 2-3 days- co-amoxiclav
sinusitis very unwell
co-amoxiclav
sinusitis PA
doxycycline/ clarithomycin/ erythromycin
epiglottitis
cefotaxime
hypersensitivity- chloramphenicol
Bronchiectasis non severe
oral co-amoxiclav
7-14 days
Bronchiectasis non severe PA
doxycycline/ cefalexin/ co-trimoxazole/ levofloxacin
Bronchiectasis severe / high resistance
IV piperacillin with tazobactam/ ceftazidime/ ceftriaxone/ cefuroxime/ levofloxacin/ meropenem
if MRSA- add vancomycin/ linezolid/ teicoplanin
Empitigo topical treatments
1) hydrogen peroxide
2) fucidic acid or mupirocin
Empitigo oral treatments
1) flucloxacillin
PA- clarithromycin/ erythromycin
Cellulitis and Erysipelas (not near eyes or nose)
Flucloxacillin
PA- clarithromycin. erythromycin/ doxycyline
Cellulitis and Erysipelas (near eyes or nose)
Co-amoxiclav
PA- clartithromycin + metronidazole
Severe infection of cellulitis or erysipelas
Co-amoxiclav/ clindamycin/ IV cefuroxime/ IV ceftriaine
If MRSA- add vancomycin/ teicoplanin/ linezolid
Leg ulcer- not severely unwell no PA
1) Flucloxacillin
2) Co-amoxiclav
Leg ulcer- not severely unwell- PA
1)doxycycline/ clarithromycin/ erythromycin
2) co-trimoxazole
Leg ulcer- severely unwell no PA
1) IV flucloxacillin +/- IV gentamicin +/- metronidazole
Or
IV co-amoxiclav +/- gentamicin
2) piperacillin with tazobactam
or
IV ceftiaxone +/- metronidazole
Leg ulcer- severely unwell- PA
IV co-trimoxazole +/- IV gentamicin +/- IV metronidazole
Human and animal bites- no PA
oral- co-amoxiclav
IV- coamoxiclav
Human and animal bites- PA
oral - doxycyline + metronidazole
IV- cefuroxime
or
ceftriaxone + metronidazole
Secondary infection of eczema
topical fucidic acid
oral flucloxacillin
PA- clarithromycin/ erythromycin
Mastitis during breast feeding
flucloxacillin 10-14 days
PA- erythromycin 10-14 days
UTI in non-preg women
1) Nitrofurantoin/ trimethoprim
2) nitrofurantoin/ fosfomycin
if susc- pivemecillinam/ amoxicillin
UTI in men
nitrofurantoin/ trimethorpim
then treat as pyelonephritis
UTI in preg women (or asymptomatic bactiriuria).
1) nitrofurantoin
2) amoxicillin or cefalexin
Acute prostatitis (oral tx)
1) ciprofloxacin/ ofloxacin
2) levofloxacin/ co-trimoxazole
acute prostatitis (IV tx)
amikacin/ ceftriaxone/ cefuroxime/ ciprofloxacin/ gentamicin/ levofloxacin