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General > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

Sore throat

A

Centor 3-4, or Fever pain 4-5

1st Phenoxymethylpenicillin 5 -10 days

Pen allergy, not pregnant
Clarithromycin 5 days

Pen allergy, pregnant
Erythromycin 5 days

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2
Q

Acute otitis media

A

Abx indicated:
Child <2 with BL AOM
Any child with otorrhoea
No improvement after 3 days
Systemically unwell / immunocompromised

  1. Amoxicillin
    1b. Clarithromycin (or erythromycin if preggo)
  2. Co-Amoxiclav
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3
Q

Acute otitis externa

A
  1. Top Abx and steroid 7-14 days
  2. Consider PO Abx if infection beyond canal, immunocompromised, severe infection, no improvement with topical
    • Fluclox (maybe quinolone depending on local guidelines)
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4
Q

Scarlet Fever

A
  1. Phenoxymethylpenicillin 10 days

1b. Clarithromycin age <6M. For 10 days
Clari or Azithro otherwise. 10 days
Erythromycin in pregnancy. 10 days

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5
Q

Sinusitis

A

Symptoms 10 days- no Abx
Symptoms w no improvement >10 days, offer nasal steroid, consider Abx
Systemically unwell, or risks of complications, Abx

  1. Phenoxymethylpenicillin 5 days
    1b. Doxycycline (age >12). 5 days
    1b. Clarithromycin. 5 days
    1b. Erythromycin if preggo. 5 days
  2. Co-Amox 5 days- if systemically v unwell or high risk complications
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6
Q

Exacerbation COPD

A
  1. Amox 500 TDS. 5 days
  2. Doxy 200 –> 100 OD. 5 days
  3. Clari 500 BD. 5 days

If at higher risk, alternatives:
2. Co-amox 625 TDS. 5 days
2. Co-trimox 960 BD. 5 days
2. Levofloxacin (d/w specialist)

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7
Q

Acute exacerbation bronchiectasis

A

Similar to COPD. Similar in child and adult (except doses and levo vs cipro)

  • Amox
  • Dox
  • Clari
  • Co-Amox
  • Levoflox (for adults, d/w specialist)
  • Ciproflox (for children, d/w specialist)
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8
Q

Acute cough

A

Adults:
- Doxy
- Amox preferred if pregnant
- Clarithromycin (if not pregnant)
- Erythromycin (if pregnant)

Kids:
- Amox
- Clari
- Erythro
- (Doxycycline but not in under 12s)

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9
Q

HAP

A

HAP if symptoms / signs pneumonia within 48 hours of hospital admission

  1. Co-Amox 625 TDS. 5 days then review
  2. Doxy
  3. Cefalexin
  4. Co-trimoxazole

Child
1. Co-Amox
1. Clari

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10
Q

CAP

A

Assess CRB65
0 = low severity
1-2 = mod severity
3-4 = high severity

Low severity
Amox, or Doxy, or Clari, or Erythro (preggo)

Mod
1. Amox + clari (if ?atypical pathogens, or erythro if preggo)
1. Doxy, or Clari

Sev
1. Co-Amox + Clari (or Erythro)
1. Levofloxacin

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11
Q

UTI, female, non pregnant

A
  1. Nitrofurantoin (eGFR >45), 100 BD. 3 days
  2. Trimethoprim 200 BD. 3 days
  3. Pivmecillinam or fosfomycin
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12
Q

UTI, female, pregnancy

A

Pregnant women, men, young people, offer immediate Abx
Same meds for asymptomatic bacteriuria in pregnancy.

  1. Nitrofurantoin (if eGFR >45, and avoid at term), 100m/r BD (or 50 QDS). 7 days
  2. Amoxicillin (if sensitivities available) 500 TDS. 7 days
  3. Cefalexin 500 BD. 7 days
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13
Q

UTI, men

A
  1. Trimethoprim 200 BD. 7 days
  2. Nitrofurantoin (eGFR >45) 100m/r BD. 7 days
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14
Q

UTI, children

A
  1. Trimethoprim
  2. Nitrofurantoin (eGFR >45)
  3. Amoxicillin (only if culture available)
  4. Cefalexin
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15
Q

Pyelonephritis

A

Women, men, children:
1. Cefalexin 7-10 days
1. Co-Amox (if susceptibilities available)

Non-pregnant women and men, consider trimethoprim if sensitivities available, or ciprofloxacin

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16
Q

Acute prostatitis

A
  1. Ciprofloxacin 500 BD. 14 days then review
  2. Ofloxacin
  3. Trimethoprim 200BD. 14 days then review
  4. Levofloxacin (after specialist discussion)
  5. Co-trimoxazole 960 BD. 14 days then review
17
Q

Recurrent UTI

A

Behavioural and hygiene measures
Self care with D-mannose or cranberry products

Consider vaginal oestrogen in post-menopausal women

  • Single dose Abx on exposure to a trigger
  • Or consider daily prophylaxis with specialist advice

Prophylactic Abx advice:
1. Trimethoprim (avoid in pregnancy)
- 200mg STAT with trigger, or
- 100mg ON
1. Nitrofurantoin (avoid at term)
-100mg STAT with trigger, or
- 50-100 ON

  1. Amoxicillin
    • 500mg STAT, or
    • 250mg ON
  2. Cefalexin
    • 500mg STAT, or
    • 125mg ON
18
Q

CAUTI

A
  • Asymptomatic bacteriuria not need Abx
  • Remove if possible, or change if in for >7 days

Abx options, uncomplicated CAUTI, non pregnant:
1. Nitrofurantoin (if eGFR >45). 7 days
1. Trimethoprim 7 days
1. Amoxicillin (if susceptibilities available). 7 days
2. Pivmecillinam 400 –> 200mg TDS. 7 days
Upper UTI symptoms
1. Cefalexin. 7-10 days
1. Co-Amox (MSU). 7-10 days
1. Trimethoprim (MSU). 14 days
1. Cipro. 7 days

Pregnant:
1. Cefalexin. 7-10 days

Children:
1. Trimethoprim
1. Amox (MSU)
1. Cefalexin
1. Co-Amox (MSU)

19
Q

Chemoprophylaxis for meningococcal disease

A

Ciprofloxacin 1st line

Discuss other option if contraindicated, as in case of:
- Allergy
- G6PD deficiency
- Epilepsy
(may be recommended Rifampicin

Dose:
Age 12+ = 500mg STAT
Age 5-11= 250mg STAT
Child <5 = 30mg/kg max 125mg STAT

20
Q

When is meningococcal vaccine recommended for close contacts of meningococcal disease?

A

Offer single dose Man WACY to contact if not vaccinated within the previous year

21
Q

Community management of suspected meningococcal septicaemia?

A

Suspected meningococcal septicaemia with non-blanching rash- ABX
Suspected meningitis with no rash- do not give Abx unless urgent hospital transfer not possible

Meningococcal septicaemia:
- Emergency hospital admission
- BenPen IM/IV
- Child <1 = 300 mg
- Age 1-9 = 600 mg
- Age 10+ = 1200 mg

Withhold Benpen if Hx of penicillin anaphylaxis (rash only is not a contraindication)

22
Q

Oral candidiasis

A

Children: From 4 months +
- Oral miconazole gel 2 weeks
- Alternatively nystatin

Adults, not immunocompromised:
- Oral miconazole gel 2 weeks
- Alternatively nystatin
- If extensive / severe infection, PO fluconazole 50mg OD 2 weeks, & seek specialist advice

Adults, immunocompromised:
- Seek specialist advice if person receiving ciclospirin / tacrolimus / chemotherapy
- If on steroids / DMARDs
- TOP miconazole gel
- TOP nystatin
- PO Fluconazole 50-100 OD 2 weeks

23
Q

Treatment of Shiga toxin-producing E Coli (STEC)?

A
  • No Abx indicated
  • Need monitoring for HUS
  • Need 2x negative stool C&S 24 hours apart, and symptom free for 48 hours until can return to school…
24
Q

Management of Giardiasis?

A

D/W ID
- Tinidazole may be indicated

  • No swimming for 2 weeks
25
Q

Abx for Shigella?

A

Usually not required
If severe symptoms d/w ID for Abx choice

26
Q

Abx for Dysenteric Amoebiasis (Entamoeba histolytica)?

A

Normally requires Abx
- D/W ID / micro
- Metronidazole

27
Q

Abx for Campylobacter?

A

Commonest cause of infective diarrhoea in UK, and one of the commonest causes of traveller’s diarrhoea in UK
- Usually self limiting
- May require Abx if severe- Azithro / Cipro

28
Q

Abx for crypotosporidium?

A

No licensed Rx in the UK
Seek advice if severely immunocompromised

  • No swimming for 2 weeks
29
Q

Management of threadworm?

A

Pregnant, breastfeeding, or child under 6 months
- Traet with hygiene measures alone for 6 weeks (handwashing, cut fingernails, shower each morning especially perianal area, change bedsheets and clothes daily, dust and vacuum

Otherwise:
- Mebendazole 100mg STAT, can be repeated after 2 weeks

Treat all household contacts unless contraindicated (as above) as highly transmissable

30
Q

C Diff

A

Stop Abx if possible or switch from Abx causing high risk of C Diff (clindamycin, cephalosporins, quinolones, Co-Amox)

1st episode
1 - Vancomycin 125mg QDS. 10 days
2 - Fidaxomicin 200mg BD. 10 days

2nd episode, within 12 weeks of last (relapse)
1 - Fidaxomicin

2nd episode >12 weeks later (recurrence)
- Vancomycin, or
- Fidaxomicin

If severe, in hosp Vancomycin can be increased to 500mg QDS with Metronidazole IV

31
Q

H pylori

A

Avoid using Abx previously used, resistance

  1. PPI + Amox + Clari / Metronidazole
  2. PPI + Amox + Clari / Metronidazole
  3. PPI + Amox + Tetracycline or levofloxacin

Pen allergic

  1. PPI + Clari + Metronidazole
  2. PPI + Bismuth + metronidazole + tetracycline
  3. PPI + Metronidazole + levofloxacin
32
Q

Acute diverticulitis

A
  1. Co-Amox
  2. Pen allergic - Cef + Met
    - Trimethoprim + Met
33
Q

Epididymo-orchitis

A

If thought secondary to STI
1. IM Ceftriaxone 1g & Doxy 100mg BD for 14 days

If thought gonorrhoea / chlamydia / enteric organisms
1. IM ceftriaxone 1g & ofloxacin 200mg BD

If thought due to enteric pathogens
1. Ofloxacin 200 mg BD (or levofloxacin 500 mg OD) 14 days

If ?mycoplasma genitalium- Moxifloxacin

34
Q

Chlamydia

A

Female- VV swab send for NAAT
Male- FPU

  1. Doxycycline 100 mg BD. 7 days (avoid in pregnancy)
  2. Azithromycin 1g STAT, then 500 mg OD for 2 days
  3. Erythrmoycin 500 mg BD 10 - 14 days
  4. Ofloxacin 200 mg BD 7 days
35
Q

Vaginal candidiasis (VVC)

A

Microscopy is the primary investigation for acute VVC (not practical in primary care?)
- Culture indicated for sensitivities in recurrent VVC (4 or more symptomatic episodes in 1 year)

  1. Fluconazole 150 mg PO STAT
  2. Clotrimazole 500 mg PV ON STAT (safe in pregnancy)
36
Q

BV

A
  1. Metronidazole 400mg PO BD 5-7 days
  2. Metronidazole 2g STAT
  3. Metronidazole vaginal gel 0.75% for 5 days
  4. Clindamycin cream 7 days
  5. Tinidazole 2g STAT
  6. Clindamycin 300 mg BD 7 days
37
Q

Genital herpes

A

Saline bathing
Petroleum jelly
Analgesia
Topical anaesthetic agents (5% lidocaine ointment)

Antivirals indicated if:
- Within 5 days of start of episode
- New lesions still forming
- Systemic symptoms (fever, myalgia)

  1. Aciclovir 400 mg TDS (or 200 5 times per day) 5 days
  2. Valaciclovir 500 mg BD 5 days

If recurrent episodes consider short-course therapies:
1. Aciclovir 800 mg TDS for 2 days
1. Famciclovir 1 g BD 1 day

?Suppressive therapy, consider if having 6 episodes in 1 year
- Aciclovir 400 mg BD (or 200 mg QDS)

38
Q

Gonorrhoea

A

Send VV swab
Repeat test if negative and taken within 2 weeks of new sexual partner

Treat if:
- intracellular Gram- siplococci on microscopy
- Positive gonorrhoea culture
- Positive NAAT gonorrhoea
- Sexual partner of confirmed case of gonorrhoea

  1. Ceftriaxone 1g IM STAT
    If sensitivities known
  2. Ciprofloxacin 500mg PO STAT (resistance to cipro is high so only use if confirmed susceptible)
  3. Cefixime 400 mg PO STAT, plus azithromycin 2 g PO (only really if IM refused by patient)

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