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infectious disease > antibiotic treatment pathways > Flashcards

antibiotic treatment pathways Flashcards

1
Q

describe the treatment for sinusitis bacterial infection

A
  • first line: phenoxymethylpenicillin
  • if severe/ high risk of complications: co-amoxiclav

if allergic to penicillins: doxycycline or clarithromycin (erythromycin in pregnancy).

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2
Q

describe the treatment for oral bacterial infections

A
  • first line: co-amoxiclav/ amoxicillin/phenoxymethylpenicillin
  • penicillin allergy: metronidazole/ macrolides (clarithromycin, erythromycin). erythromycin can be used in pregnancy)
  • anaerobic infections: metronidazole or doxycycline
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3
Q

what is the only treatment for conjunctivitis

A

chloramphenicol

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4
Q

describe the treatment for otitis EXTERNA

A
  • first line: flucloxacillin
  • allergic to pencillins: Clarithromycin/ azithromycin/ erythromycin (erythromycin can be used in pregnancy)
  • note Otitis externa is inflammation of the external ear canal triggered by bacterial infection*
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5
Q

what is the treatment for otitis MEDIA

A
  • first line: amoxicillin
    if symptoms worsening despite antibiotic: co-amoxiclav
  • penicillin allergy: clarithromycin or erythromycin (erythromycin can be used in pregnancy)
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6
Q

describe the treatment for initial “blind” therapy for endocarditis (cardiovascular system infection)

A

initial “blind” therapy:

  • amoxicillin (or ampicillin). consider adding low dose gentamicin
  • penicillin allergy/MRSA suspected/sepsis: use vancomycin + low-dose gentamicin
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7
Q

how do you treat endocarditis (cardiovascular system infection) caused by STAPHYLOCOCCI

A
  • first line: flucloxacillin

- if penicillin allergy or MRSA: vancomycin + rifampicin

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8
Q

how do you treat endocarditis (cardiovascular system infection) caused by STREPTOCOCCI

A
  • first line: Benzylpenicillin sodium

- if penicillin allergy or MRSA: vancomycin (or teicoplanin) + low-dose gentamicin

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9
Q

describe the treatment for septicaemia (hospital + community acquired)

A
  • first line treatment: piperacillin with tazobactam / ticarcillin with clavulanic acid / a broad-spectrum cephalosporin (e.g. cefuroxime)
  • if MRSA suspected: add vancomycin/ teicoplanin
  • anaerobic infection: add metronidazole to broad-spectrum cephalosporin
  • other resistant microorganisms suspected: meropenem
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10
Q

how do you treat Campylobacter enteritis (gastro-intestinal infection)

A
  • first line: Clarithromycin (or azithromycin or erythromycin)
    alternative: ciprofloxacin
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11
Q

how do you treat: Salmonella, Shigellosis, Biliary-tract infection, Typhoid fever

A

first line: ciprofloxacin

alternatives: azithromycin, cefotaxime, gentamicin

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12
Q

what is the treatment for clostridium difficile (c.diff) infection

A

first line: vancomycin
2nd line: Fidaxomicin

*note: if life-threatening infection of c.diff, specialist may offer oral vancomycin with intravenous metronidazole)

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13
Q

what is the treatment for bacterial vaginosis

A

first line: metronidazole (oral or topical)

2nd line: clindamycin (topical)

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14
Q

what is the treatment for chlamydia

A

first line: Azithromycin or doxycycline

alternative: erythromycin

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15
Q

what is the treatment for Gonorrhoea

A

first line: I.M ceftriaxone or oral ciprofloxacin

alternatives: oral azithromycin,

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16
Q

what is the treatment for syphilis

A

first line: Benzathine benzylpenicillin

Alternatively: doxycycline (also used in asymptomatic) or erythromycin

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17
Q

what is the treatment for Lower urinary-tract infection in NON-PREGNANT women

A

first line non-pregnant: Nitrofurantoin, or trimethoprim

if no improvement: Nitrofurantoin (if not used first line), fosfomycin, pivmecillinam

18
Q

what is the treatment for Lower urinary-tract infection in PREGNANT women

A

first line: Nitrofurantoin

if no improvement or pregnant at full term: Amoxicillin or cefalexin

catheter-pregnant: Cefalexin

Note: Nitrofurantoin is contraindicated in women is pregnant at full term so can only use it for UTI, if pregnancy is not at full term

19
Q

what is the treatment for Lower urinary-tract infection in men

A

First line: Nitrofurantoin, or trimethoprim

20
Q

describe the treatment for diabetic foot infection

A
  • Oral first line: Flucloxacillin
  • Alternative in penicillin allergy/ flucloxacillin unsuitable: clarithromycin, doxycycline, or erythromycin (in pregnancy).
21
Q

what is the treatment for the Musculoskeletal system infections: Osteomyelitis + Septic arthritis

A

First line: Flucloxacillin

If penicillin-allergic, clindamycin

22
Q

what is the treatment for Meningitis caused by MENINGOCOCCI

A
  • first line: Benzylpenicillin sodium/ cefotaxime (or ceftriaxone)
  • If history of immediate hypersensitivity reaction to penicillin or to cephalosporins, chloramphenicol
23
Q

what is the treatment for Meningitis caused by PNEUMOCOCCI

A

first line: Cefotaxime or ceftriaxone (consider adding dexamethasone)

2nd line: benzylpenicillin sodium. if penicillin allergy (cephalosporin + vancomycin)

24
Q

what is the treatment for Meningitis caused by HAEMOPHILUS INFLUENZAE

A

first line: Cefotaxime or ceftriaxone (consider adding dexamethasone)

if allergy to penicillin/ cephalosporins, or if microorganism resistant to cefotaxime: chloramphenicol

25
Q

what is the treatment for Meningitis caused by LISTERIA

A

first line: Amoxicillin (or ampicillin) + gentamicin

penicillin allergy: co-trimoxazole

26
Q

what is the treatment for Epiglottitis (Haemophilus influenzae)

A

first line: Cefotaxime (or ceftriaxone)

penicillin/cephalosporin allergy: chloramphenicol

27
Q

what is the treatment for COPD infection

A

Oral first line: Amoxicillin, clarithromycin, or doxycycline

alternatives: co-amoxiclav, or levofloxacin.

28
Q

what is the treatment for an acute cough infection

A

First line: Doxycycline. (Alternative first line choices: amoxicillin, clarithromycin, or erythromycin)

  • Choice during pregnancy:
    Amoxicillin or erythromycin.
29
Q

what is the treatment for Pneumonia (community-acquired)

A

Oral first line: Amoxicillin

Alternative in penicillin allergy or amoxicillin unsuitable: clarithromycin, doxycycline, or erythromycin (in pregnancy)

30
Q

what is the treatment for impetigo

A

Topical first line: hydrogen peroxide 1% cream (alternative fusidic acid)

Oral first line: Flucloxacillin
penicillin allergy: clarithromycin or erythromycin (in pregnancy).

31
Q

what is the treatment for cellulitis, leg ulcers

A

Oral or Intravenous first line: Flucloxacillin

Alternative in penicillin allergy or flucloxacillin unsuitable: clarithromycin, oral erythromycin (in pregnancy), or oral doxycycline

32
Q

what is the treatment for a skin infection due to Human and animal bites

A

Oral + I.V first line: Co-amoxiclav

Alternative in penicillin allergy or co-amoxiclav unsuitable: doxycycline with metronidazole

note: seek specialist advice in pregnancy

33
Q

what is the treatment for Mastitis during breast-feeding

A

first line: Flucloxacillin

If penicillin-allergic: erythromycin

34
Q

what are the 2 stages of tuberculosis treatment

A
  1. initial stage: a combination of 4 drugs are used to reduce population of Mycobacterium tuberculosis bacteria. usually taken for two months
  2. continuous phase: once initial phase finished, 2 drugs are taken for four months
35
Q

which 4 drugs are used during the “initial stage” of tuberculosis treatment

acronym: RIPE

A

Rifampicin, Isoniazid, Pyrazinamide and Ethambutol – (RIPE)

These are taken daily for 2 months

36
Q

name the 2 drugs used during the “continuous phase” of tuberculosis treatment

A

Isoniazid and Rifampicin

these are taken daily for 4 months

37
Q

what are the side effects of the drugs used on tuberculosis treatment:

Rifampicin, Isoniazid, Pyrazinamide and Ethambutol – (RIPE)

A
  • Rifampicin, Isoniazid, Pyrazinamide : liver toxicity
  • Isoniazid: peripheral neuropathy
  • ethambutol: ocular toxicity (visual disturbances)
  • rifampicin: orange/red discolouration of body secretions
38
Q

what monitoring should occur during tuberculosis treatment

A
  • drug levels (e.g ethambutol peak and trough levels)
  • visual acuity testing
  • blood counts
  • liver and kidney function
  • urinalysis
  • plasma levels
  • auditory function in elderly
39
Q

why is pyridoxine often given in tuberculosis treatment

A

to prevent peripheral neuropathy caused by Isoniazid

40
Q

why should patients taking rifampicin not wear soft contact lenses

A

rifampicin discolours soft contact lenses

41
Q

what are the signs of liver toxicity/disorder you can advise patients to look out for

(e.g when taking RIPE treatment for tuberculosis)

A

seek immediate medical attention if symptoms such as:

  • persistent nausea/ vomiting
  • malaise
  • jaundice develop

infectious disease (5 decks)

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