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A2 ME3031 INFECTION > W07 - Clinical 3 - Abx, Imm & Prophylaxis, Travel Infection > Flashcards

W07 - Clinical 3 - Abx, Imm & Prophylaxis, Travel Infection Flashcards

1
Q

Describe those factors important in deciding when to use intravenous or oral antimicrobials.

A

Iv more serious

oral switch after prescribing (FOCUS after starting SMART)

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2
Q

Describe the spectrum of action of different antimicrobial groups and the ad- vantages/disadvantages of broad and narrow spectrum antibacterials used singly or in combination.

A

BACTEROCIDAL
penicillin, gentamicin, vancomycin, ciproflox., metronidazole

BACTERIOSTATIC
doxycycline, clarithromycin, azithromycin, linezolid

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3
Q

Explain the place of monitoring drug levels in antibacterial usage.

A

Red Man Syndrome - activation of mast cell = histamine therefore Vancomycin dose needs to be monitored

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4
Q

Explain the role of the laboratory in influencing antimicrobial choice.

A

Testing for susceptibility / resistance via disc or gradient diffusion = MINIMUM INHIBITORY CONCENTRATION

CULTURES before prescribing abx unless severe sepsis or LT infection

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5
Q

Describe the use of antiviral and antifungal agents in contemporary infection practice.

A

a

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6
Q

CELL WALL INHIBITION

A

BETA LACTAMS bind PBP and inhibit wall formation
penicillins - wide spectrum
cephalosporins - broad
carbapenems - broad, IV only, Valporate interactions
*MEROPENEM: broad, severe, CF infections

!rash, fever, anaphylaxis

GYCOPEPTIDES: gram +, inhibit peptoglycans in cell wall, poor oral abs.
vancomycin - MRSA, 1st line for pencillin allergy, Inf.Endo.

!Red Man Syndrome - activation of mast cell = histamine therefore Vancomycin dose needs to be monitored

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7
Q

Carbapenem significant interaction

A

interacts with Sodium Valporate (epilepsy, migraine) = decreased valporate levels

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8
Q

Significance of Co-amox

A

Combo of beta-lactam and beta lactamase inhibitor

  • MSSA
  • Klebsiella spp.
  • Proteus spp.
  • Anaerobes
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9
Q

PROTEIN SYNTHESIS INHIBITION

A

AMINIGLYCOSIDES = GENTAMICIN

  • binds 30S rRNA = bacteriostatic
  • depolarise cell membrane = bactericidal

•sepsis

!nephrotox., ototox., neuromuscular blockade

TETRACYCLINES = DOXYCYCLINE
*broad, oral, inhibit protein synth

• SSTI, genito-urinary infection, malaria

!pregnancy - crosses placenta, tooth staining.

MACROLIDES = CLARITHROMYCIN, AZITHROMYCIN

  • typhoid fever, CAP, skin/soft tissue infections, atypical pneumonia, STI
  • H pylori
  • T gondii

!jaundice, ototox., prolonged QT syndrome, GI disturbance
!prego - avoid clari and azi, (erythro not known to be harmful)

LINCOSAMIODES = CLINDAMYCIN

OXAZOLIDINONES = LINEZOLID

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10
Q

Metronidazole

A

Inhibit DNA synth

  • anaerobic organisms: C difficile, Helicobacter,
  • parasite: giardia, entameoba

*do not take with alcohol

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11
Q

Co-trimoxazole

A

Trimethoprim and sulfonamides
* inhibit folic acid synth.

  • Pneumocystis jiroveci pneumonia
  • Toxoplasmosis
  • multidrug resistant organisms

!renal impairment, BM suppression

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12
Q

MRSA sensitive Abx

A

VANCOMYCIN

CLINDAMYACIN

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13
Q

List the situations for which immunisations are currently recommended.

A

Childhood schedules
2months = 6in1 + pneumococcal + rotavirus + Men B

3months = 6-in-1 + rotavirus

4 months = 6-in-1 + pneumococcal + Men. B

Special patient groups

Occupational
BCG, influenza, pneumococcal, hep B, varicella-zoster, herpes-zoster

Traveler’s

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14
Q

Outline the characteristics of the vaccines used.

A

Killed Vaccines = produce stronger immune responses with more doses

  • polio
  • Hep A.
  • Rabies
  • Influenza

whereas
LIVE Vaccines = immune response develops over time but plateaus
- MMR. BCG, Varicella-zoster, smallpox

DETOXIFIED EXOTOXIN = treated with formalin becoming a TOXOID
- diptheria, tetanus

SUBUNIT VACCINES

  • pertussis
  • typhoid
  • anthrax
  • Hep B

RECOMBINANT VACCINES = DNA (HBsAg) recreated by yeast (via plasmid)
-Hep B. (all new born recieve from 2018 onwards)

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15
Q

Discuss the prevention of disease in the traveller.

A

GENERAL MEASURES

IMMS
-tetanus, polio, typhoid, hep a., yellow fever, cholera

CHEMOPROPHYLAXIS

  • malaria
  • post-exposure chemproph. for meningococcal disease
  • HIV
  • Surgical abx proph.
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16
Q

Significance of Passive Imm

A

Human normal immunoglobulin

  • against Hep A, rubella, measles
  • Ig deficiencies
  • AuIm disorder tx = Myasthenia gravis

+Post exposure Ig: Hep B, Rabies, Tetanus (anti-toxin) etc.

17
Q

Chemoroph against malaria

A

MALARONE

doxycycline (daily)

MEFLOQUINE
sfx = psychosis, epilepsy

CHLOROQUINE + PROQUANIL

18
Q

Recognise the common features of the most important travel-related infections and how they can be diagnosed and treated.

A

MALARIA

  • fever, rigors, aching bones, abdo pain, headache
  • splenomeg., hepatomeg, mild jaundice

=> cerebral malaria, blackwater fever (profound haemolysis and anaemia), pulm oedema, jaundice

-blood films, Ag test, quantitative buffy coat

> Riamet (uncomplicated) or Quinine 7 days
QUININE (IV for complicated) + doxycycline
Chloroquine for other species

TYPHOID FEVER
*salmonella typhi / paratyphi

progresses thru weeks: fever, headache, abdo discomfort, constipation, dry cough

complication = intestinal bleeding, perofration, peritonism, metastatic infection

*culture, bloods, BM culture

> AZITHROMYCIN (oral - uncomplicated)
IV CEFTRIAXONE (complicated)

DENGUE FEVER
*commonest human arbovirus

-suden fever, headache, retro-orbital pain, myalgia/arthralgia
+ macular rash, petichial rash

*thrombocytopenia, leucopenia, ⇧transaminases

> supportive; fresh frozen plasma, platelets

!dengue haemorrhagic fever, shock syndrome

SHISTOSOMIASIS- freshwater snails,

  • swimmer itch, invasive (cough, abdo discomfort, splenomegaly, eosinophilia)
  • Katayama Fever

*Antibody tests, ova in stools/urine, rectal snip

> PRAZIQUANTEL
+PREDNISOLONE

19
Q

Understand in principle how to manage the patient returning from a tropical country with a febrile illness - with particular reference to taking a travel history and the indications for patient isolation or early best-guess treatment.

A

Water exposure and water-related infections

*Shistosomiasis, Liver flukes, hookworms

20
Q

Signs of Rickettsiosis

A

(tick typhus) SA, Med, Arabian Gulf

abrupt swinging fever, headache, confusion, endovasculitis, rash (macular, petechial),

> TETRACYCLINE

21
Q

Viral Haemorrhagic Fever

A

Ebola, Congo-Crimea, Lassa Fever

ZIKA: flavivirus

  • prego = microcephaly
  • guillain-barre syndrome
22
Q

Signs on examination

A

rash - typhoid, typhus, dengue

jaundice - hepatitis, malaria, Yellow fever

lymph nodes - leishmania, trypanosomiasis

liver - malaria, typhoid, amoebic abscess

spleen – visceral leishmaniasis, typhoid, malaria

A2 ME3031 INFECTION (4 decks)

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