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Medicine block (Y3) > Week 2: Infectious diseases (1) (Antibiotics, fever in returned traveller, sepsis) > Flashcards

Week 2: Infectious diseases (1) (Antibiotics, fever in returned traveller, sepsis) Flashcards

1
Q

staphylococci (stap. aureus) skin/ soft tissue infection

A

flucloxacillin (narrowest spec and easy to give)

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2
Q

streptococci (e.g. group A strep) skin/ soft tissue infection

A

benzylpenicillin

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3
Q

if penicillin allergy skin/ soft tissue infection

A

doxycyline, levofloxacin

IV ceftriaxone, meropenem

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4
Q

coagulase negative staph skin/ soft tissue infection

A

is often fluclox/peniccilin resistant –> need to get micro advice

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5
Q

MRSA skin/ soft tissue infection

A

Vancomycin, teicoplanin, linezolid

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6
Q

musculoskeleteal infection antibiotics

A

same as skin/soft tissue

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7
Q

TB musculoskeletal infection

A

quadruple threapy (RIPE)

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8
Q

respiratory infections e.g. S.pneumonia, H.influenzae

A

amoxicillin

pencillin allergy- doxycline

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9
Q

atypical resp infection e.g. legionella, mycoplasma

A

doxycycline, clarithonmycin

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10
Q

respiratory infection e.g. influenza

A

oseltamivir- antiviral

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11
Q

viral GI infection e.g. diarrhoea/enetrocolitis

A

N/A- virus

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12
Q

GI infection by Enterobacteriacae: Campylobacter, shigella, E.coli

A

if severe: ciprofloxacin, azithromycin

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13
Q

GI infection with salmonella spp e.g. S.typhi/parathyphi

A

IV ceftriaxone/azithromycin

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14
Q

treatment for GI infection with C.difficile

A

PO (not IV) metronidazole/vanc

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15
Q

GI infection: visceral infection/peritonitis usually with enterobacteriacae

A

Co-amox or Cipro or gentamicin or tazocin

+- anaerobe cover–> metronidazole or tazocin

if pen allergy–> meropenem

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16
Q

lower GU tract infection e.g. E.coli, klebsiella sp, proteus sp

A

nitrofurantoin/ trimethoprim

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17
Q

if UTI resistant to first line antibitoics

A

ciprofloxain or co-amox

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18
Q

GU tract infections : pseudomonas aerogenosis

A

ciprofloxcin, gen, tazocin

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19
Q

ESBL (Extended Spectrum Beta Lactamase) / resistant GU infections

A

carbapenem

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20
Q

GU infectio- gonorrhoea

A

For uncomplicated gonococcal infections:

  • A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
  • A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
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21
Q

GU infection- chlamydia

A

uncomplicated- doxycyline for 7 days

azithromycin (if preggo)

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22
Q

CNS ifnection e.g. meningitis (S. pneumoniae, N. meningitidis, H. influenzae

A

IV cephalosporin ( ceftrixone)

–> give dexamethasone with 1st dose in bacterial meningitis

*if in GP practice give peniciilin IM STATT–> reduce risk of deafness

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23
Q
A
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24
Q

CNS infection caused by listeria in >55/ imm.comp

A

amoxiciilin/ meropenem

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25
Q

CNS infection : TB

A

RIPE

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26
Q

CNS infection: Herpes simplex virus (encephalitis)

A

IV aciclovir

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27
Q

endocarditis : streptococci e.g. S. viridans

A

(may vary for prostethic vakve ednocarditiis vs native valve)

benzylpenicillin +- Gent

28
Q

endocarditis : enterococci (E. faecalis)

A

amoxicillin

29
Q

endocarditis: S. auerus e.g. IV drug users

A

flucloxacillin

30
Q

“culture negative” endocarditis

A

ceeftriazone

31
Q

MRSA/ pen allergy, pen resistant endocarditis

A

vancomycin

32
Q

line infection

A

same as skin and soft tissue infection e.g. fluxclox

if MRSA- vancomycin

33
Q

hospital acquired infection e.g. ENTEROBACTERIACAE (E.COLI, KLEBSIELLA)

A

Co-am/ Taz

34
Q

hospital acquired infection e.g. pseudomonas

A

cipro, gent, tax, mero

35
Q

hospital acquired infection e.g. C.difficile

A

metronidazole/ vancomycin

36
Q

multi drug resistant HAI

A

meropenem

37
Q

Principles of antibiotic use

A
  • Simplest to use
    • IV, PO
    • Low frequency as possible
  • Narrowest spectrum
  • Drug drug interaction
  • C.diff risk
  • Cheapest
  • Lowest conc as poss
38
Q

common antibiotics

A
  • beta lactam
  • macrolides
  • fluorquinolones
  • tetracyclines
  • nitroimidazoles
  • aminoglycosides
  • lincomycin
  • glucopeptides
39
Q

types of beta lactam

A

penicillin e.g. benzylpenicillin, fluxlocacillin

cephalosporins e.g. ceftriaxone

carbapenems e.g. meropenem

40
Q

meropenem is very

A

broad spectrum and used for sepsis but does not cover meropenem MRSA

41
Q

macrolides

A

erythromycin, clarithromycin, azithromycin

42
Q

fluoroquinolones

A

ciprofloxacin, levofloxacin

43
Q

tetracyclines

A

doxycycline

44
Q

nitroimidazoles

A

metronidazole

→ can cause peripheral neuropathy on long term courses

→ disulfiram affect with alcohol

45
Q

aminoglycosides

A

gentamicin

46
Q

lincomycin

A

clindamycin

47
Q

glycopeptides

A

vancomycin, teicoplanin

48
Q

SEPSIS

A

“life-threatening organ dysfunction caused by a dysregulated host response to infection”

49
Q

SEPTIC SHOCK:

A

“a subset of sepsis with profound circulatory, cellular and metabolic abnormalities, associated with greater risk of mortality than sepsis alone” (Mortality: Sepsis 10%, Septic shock >40%)

50
Q

adult sepsis screening and immediate action tool

A
51
Q

Much of travel-related illness will manifest as

A
  • febrile illness,
  • GI symptoms (diarrhoea +/- vomiting),
  • jaundice,
  • reticuloendothelial change (lymphadenopathy /hepatosplenomegaly),
  • respiratory symptoms (cough, shortness of breath), or rash.
52
Q

The most common tropical infections we diagnose in the unit are:

A
  • malaria,
  • dengue fever, and
  • typhoid (enteric) fever.
53
Q

Incubation period

A

Knowing when potential exposures occurred allows the determination of an incubation period. Most of the severe, rapidly progressive infections (such as falciparum malaria and haemorrhagic fevers) acquired in tropical or developing countries become apparent within one to two months after return.

54
Q

useful time-frames when thinking about incubation period

A
  • 0-10 days: Dengue, rickettsia, viral (including infectious mononucleosis), gastrointestinal (bacteria / amoeba)
  • 10-21 days: Malaria, typhoid, primary HIV infection
  • >21 days: Malaria, chronic bacterial infections (e.g. brucella, coxiella, endocarditis, bone and joint infections); TB; parasitic infections (helminths/protozoa)
55
Q

which hepatitis has vaccines

A

against hepatitis A, hepatitis B,

56
Q

common vaccinations for travellers

A

against hepatitis A, hepatitis B, typhoid, tetanus, childhood vaccinations (e.g. MMR) + yellow fever and rabies when appropriate

57
Q

prophylaxis for malarious areas

A

drugs: Atovaquone/proguanil (Malarone), doxycycline, and mefloquine

non-drugs:

nets and DEET spray

58
Q

history: fever in a returning traveller

A
  • Geographic region of travel within the last 12 months (especially tropics)
  • Dates of travel and duration of stay (helps identify incubation periods of infection)
  • Careful documentation of time of onset and nature of various signs and symptoms
  • Types of accommodations + rural vs urban stays.
    • Modern hotels generally have fewer exposures than backpackers or volunteer workers who spend significant time in rural areas.
    • Persons who visit family and friends while abroad may also be at risk of illness (especially if rural areas)
  • Recreational activities and exposures – e.g. insects (malaria, rickettsia), animals (bites/ticks), freshwater lakes and streams (schistosomiasis), well/canal water (leptospirosis)
  • Type of food and water consumed (bottled, hotel, street food). Helps asses risk for food-borne illnesses (faeco-oral route)
  • Sexual history, including sexual exposure while abroad (include condom use, sex with commercial sex worker, MSM). Helps to assess risk of HIV, Hep B/C and other STI acquisition
  • Past medical history and predisposition to infection (e.g. diabetes, on immunosuppressive therapy)
  • Vaccinations and preventative measure
59
Q

clinical examination for fever in the returned traveller

A
  • vital signs
  • skin
  • eyes
  • spleen
  • neuro
60
Q

vtial signs to look out for in returned traveller

A

a pulse rate that is slow for the degree of fever e.g. typhoid

61
Q

skin signs to look out for in the returned traveller

A
  • A maculopapular rash (dengue fever, leptospirosis, rickettsia, infectious mononucleosis (EBV, CMV), childhood viruses (rubella, parvovirus B19), primary HIV infection
  • Rose spots (pink macules, 2 to 3 mm in diameter) on chest or abdomen (typhoid fever).
  • Black necrotic ulcer with erythematous margins – rickettsia (tick exposure)
  • Petechiae, ecchymoses, or hemorrhagic lesions - dengue fever, meningococcemia and viral hemorrhagic fever
62
Q

eye signs to look out for in the returned traveller

A

The eyes should be examined for evidence of conjunctival suffusion - leptospirosis.

63
Q

spleen signs to look out for int he returned traveller

A

splenomegaly: mononucleosis, malaria, visceral leishmaniasis, typhoid fever, brucellosis.

64
Q

neurologic systems to look out for in the returned traveller

A

Fever and altered mental status in the returned traveler may represent meningo-encephalitis and is a medical emergency. E.g. cerebral malaria, Japanese encephalitis and West Nile Virus encephalitis. Do not forget common infective causes (N. meningitis, Strep. Pneumonia, Herpes simplex virus (HSV)).

65
Q

bacterial vaginosis

A

metronidazole

66
Q

thrush

A

fluconazole

67
Q

general management of STI

A
  • Co-infections are common
  • May be asymptomatic
    • Consider screening for others
  • Start with presenting complaint

STIs

  • Chlamydia
    * doxycyline
    * azithromycin if preggo
  • Gonorrhoea
    * IM ceftriaxone
  • Syphillis
  • benzylpenicillin IM

Medicine block (Y3) (38 decks)

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