Treatments Flashcards
Simple CAP
Amoxicillin 500mg-1gTDS (alt. Clarithromycin)
Severe CAP
IV Co-amoxiclav+ IV erythromycin/clarithromycin (if micro undefined 10 days Tx but if you culture Legionella, staph or gm -ve bac then extend to 14-21 days)Ch
Chlamydia
one dose oral Azithromycin 1g// or Doxycycline 100mg bd 7 days alt. erythromycin
Avoid sex till finish Tx or 7 days after Azithro
Gonnorhoea
Ceftriaxone 250mg IM (OR single cipro oral dose)- can also give single dose azithromycin alongside to cover chlamydia
Vulvovaginal Candidiasis
Topical and oral Azole (not oral if preg)
Appendicitis
IV cefuroxime+ metronidazole. Remove appendix.
Ascending cholangitis (Charcot’s triad- fever with rigors, Abdo pain+ Jaundice). U/S shows dilated intrahepatic ducts+ gallstones in CBD,
Cefuroxime and Metronidazole IV. If anaphylaxis to penicillin in past then Ciprofloxacin. ERCP. If septic too- add gentamicin
Pyogenic Liver abscess
Disprop increase ALP. U/S- large gas containing mass on liver U/S
Radiologically guided drain abscess. Tx Cefuroxime+ Metronidazole (Cont 4wks-3m)
Spontaneous bacterial peritonitis
Ascitic tap on admx to see of SBP. (Clot screen 1st)- WCC>250cm3- consistent so Tx even if no org (Cefuroxime) - if ESBL prod E.coli then add Meropenem IV
Acute pancreatitis (Blood amylase Increased)- - central dull abdo pain relived by sitting forwards. Tachy. Flank discol
Usually sterile process but infec of inflammed pancreas can occcur- so if >30% necrosis- meropenem+ fluconazole
Abx prophylaxis for surgery
Cefuroxime+ Metronidazole IV 1 dose (within 30 min of inducing anaesthesia). - unless blood loss> 1500ml, haemodialysis or surgery prolonged (then add dose)
What do you do if a patient is MRSA +ve coming in for an op?
Operate on them at the end of the theatre list+ add teicoplanin to standard prophylaxis
Bacterial Vaginosis
Oral metronidazole/ clindamycin (if breastfeeding- intravag metronidazole gel)
Pelvic Inflammatory Disease
IV ceftriaxone, Doxycycline, Metronidazole Combo
Herpes Simplex
Saline baths; Analgesia; Topical anaesthetics when peeing- lidocaine; Aciclovir or famiciclovir, or valaciclovir- shortens and reduces severity )oral) -if recurrence can use chronic supressive Tx or episodic Tx
Secondary Syphillis (VDRL blood test)
Penicillin IM (1 if 2 years)
Genital warts
No specific Tx (use condoms)- Can try imiquimod, cryotherapy, laser therapy
Molluscum contagiosum
Usually resolves. May do cutterage/ cryotherapy
Falciparum Malaria (No dormant liver stage- so no recurrence except within that year)
Oral quinine+ Doxycycline (+/-cefuroxime/ metronidazole if added bac infec/ septicaemia). If severe–> ICU- IV quinine
Vivax +Ovale Malaria- more benign but have dormant types so recur if not killed by Tx
Primaquine (14 days) kills hypnozoites
Malariae malaria (benign + no hypnozoites) - but if not Tx- can recrudesce from blood + recurrent fevers ~50 yrs. Fevers every 3 days
Chloroquine
Typhoid- Gm-ve rods.
Ceftriaxone
Schistosomiasis (Bilharzia)- fresh water esp. lake malawi Cercaria- become worms + lay eggs in bowel/rectum–> liver (+ shed in stools). Serology at 6+ 12wk post exposure. Risk= transverse myelitis
Can Tx without test if v. worried- but no point in first 3 wks. Praziquantel- single dose
Malaria prophylaxis
Mefloquine (vivid dreams/ neuropsych effects)- 1 a wk- start 3 wks before. Malarone (during and 1-2d before)/ Doxycycline- nausea + photosensitivity- daily- 1-2 before
HIV Testing
HIV ab+ ag. Window is 6 wks- 3months
Classes of ART
NRTI (Phosp inhibit HIV RT so can’t replicate in CD4 cells); NNRTIs- act on another part of RT don’t need phosp. PI- proteins produced by translation can’t be spliced
Predom meningococcal septicaemia
Don’t attempt LP- IV cefotaxime or ceftriaxone
If predom meningitis
If no signs increased ICP - LP unless will delay IV cefotaxime/ ceftriaxone by >30 mins (consider streroids)
If increased LP signs- Defer LP, give the abx+ steroids
Notifying public health
Meningococcal or Hib meningitis (rifampicin)
Organisms on stain. Strep p; Staph; N. meningitidis; H. influenzae. L. monocytogenes
Strep p. Gm+ve cocci in pairs Staph- Gm+ve cocci in clusters Gm -ve diplococci- N.meningitidis H. influenzae- Gm -ve bacilli Gm+ve bacilli- L.monocytogenes
Duration meningitis Tx
7day in meningococcal septicaemia+ meningitis if N. men or H. influenzae
10-14d- Strep pneumoniae
21d- Aerobic gm-ve bacilli/ L.monocytogenes.
Cellulitis
Afebrile+ healthy look- Oral Flucloxacillin outpatient
(if allergic- clindamycin)
If febrile+ ill look but no other co-morb- short stay/outpatient IV Ceftriaxone–> Fluclox PO
Toxic app/ 1 co-morb/limb threatening infec- IV fluclox–>Fluclox PO
Necrotizing fasciitis (Clostridium perfringens; Strep pyogenes)
Meropenem+ clindamycin immed+ fluids–> urgent surgical debridement
Animal bites (risk with dog-pastuerella)
Augmentin; Irrigate+ clean wound; Give tetanus jab if need
Venflon ass. infections. Commonest HAI- Use aseptic technique+ change every 3d
Flucloxacillin (if MRSA in wound- vancomycin, teicoplanin, linezolid)
UTI (lower, uncomplicated, cystitis)
Trimethoprim/ Nitrofurantoin for 3d
Upper UTI
Meropenem or whatever hosp policy is- 7-14d IV if complicated+ bacteraemia
Bacteruria in preg
7 day Amoxicillin if asymp. Trimethoprim 7d if symp
UTI in males
Quinolone (or trimethoprim,)- 2 wks
Catheter UTI
Don’t give abx if asymp bacteruria
Sepsis 6
- Give 100% O2 via non-rebreathable bag
- Take blood cultures
- Give IV abx (co-amoxiclav+ gentamicin)
- Start IV fluid rescuscitation
- Check lactate
- Monitor urine output
Endocarditis
Benzyl+ gentamicin if natural valve
Vancomycin IV and gent if prosthetic
Patient remains hypotensive despite adequate fluid
Insert CVP, IV adrenaline, IV noradrenaline (1st choice as vasopressor as increases BP by increasing CO whereas IV adrenaline does it by increasing TPVR)
Aspergillosis (invasive)- halo sign of consolidation on CXR (mass surrounded by ground glass)
Bronchoalveolar lavage+ serum ag. IV voriconazole.
