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CR3 > Antibiotics in Cardio-Respiatory Infections > Flashcards

Antibiotics in Cardio-Respiatory Infections Flashcards

1
Q

Infections of the respiratory tract

A
  • sinusitis
  • tonsillitis
  • pharyngitis
  • tracheitis
  • laryngitis
  • pleurisy
  • bronchioloitis
  • bronchitis
  • pneumonia
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2
Q

Types of organisms in the URT

A
  • normal flora
  • temporary colonisers
  • pathogens
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3
Q

Examples of organisms in the URT

A
  • strep pneumonie
  • viridians streptococci
  • staph aureus
  • candida
  • Corynebacterium diptheria
  • haemophilus influenzae
  • Group A Strep
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4
Q

Example of normal flora in URT

A

Viridans Streptococci

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5
Q

Example of temporary colonisers in URT

A

Staph aureus

Candida

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6
Q

Example of pathogens in URT

A
  • group A strep

- Corynebacterium diptheria

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7
Q

URTI Bacteria Common

A

Strep pyogenes = group A
Strep pneumonia
Haemophilus influenzae

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8
Q

Uncommon causes of URTI

A

Cornebacterium diphtheriae

Nesisseria meningitidis

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9
Q

URTI Viruses Common

A 
Rhinovirus
Influenza/parainfluenza
Coronavirus
Adenovirus
RSV
Coxsackie
Enterovirus
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10
Q

Influenza Presentation

A 
Fever
Headache
Malaise
Myalgia
Arthralgia
GI Symptoms
Coryza
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11
Q

Treatment for uncomplicated influenza

A
  • if previously healthy = none

- if at risk = oseltamivir 75mg PO within 48 hours of onset

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12
Q

Treatment for complicated influenza

A
  • oseltamivir PO/NG 1st line, zanamivir INH, NEB or IV 2nd line
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13
Q

Define complicated influenza

A

Requires hospital admission AND OR

  • pneumonia/hypoxaemia
  • CNS = meningitis
  • co-morbidity exacerbation
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14
Q

Investigation for influenza

A
  • nasophargyngeal swab for flu PCR in 2ndry care

- none in primary

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15
Q

Prevention of influenza

A

Vaccination

HCW

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16
Q

Common pharyngitis viruses

A 
Rhinovirus
Influenza/parainfluenza
Coronavirus
Adenovirus
RSV
Coxsackie
Enterovirus
EBV
CMV
HSC
Measles
HIV
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17
Q

Common pharyngitis bacteriae

A

Group a,b,c streptococci
Mycoplasma pneumoniae
Neisseria gonorrhoea
Corynebacterium diptheriae

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18
Q

Pharyngitis presentation

A 
Sore throat
Fever
Felt ill
Tonsillar exudate
Tender cervical nodes
Scarlet fever
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19
Q

Treatment for pharyngitis

A

Penicillin V for 10 days

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20
Q

Investigations for pharyngitis

A

Throat swab

Moderate group of Group A Strep sensitive to penicillin and erythromycin

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21
Q

Centor criteria

A 
- aid diagnosis of Group A Strep
Point
- tonsillar exudate = 1
- tender cervical LN = 1
- absence of cough = 1
- history of fever = 1

1-2 points = 20% chance = no treatment
3-4 points = 50% chance = treatment advised

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22
Q

Pharyngitis treatment if penicillin allergy

A

Erythromycin

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23
Q

Pencillin treatment for pharyngitis dose

A

Penicillin V 500mg QDS
OR
1g BD for 5-10 days

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24
Q

Clarithromycin Treatment for pharyngitis dose

A

500mg BD for 5 days

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25
Q

Complications of pharyngitis

A

Rheumatic fever

Glomerulonephritis

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26
Q

Why shouldn’t you give amoxicillin if sore throat in pharyngitis?

A
  • causes rash if patient has EBV = infectious mononucleosis

- not an allergy to amoxicillin

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27
Q

Advantages of amoxicillin

A
  • better absorbed than pen V and clarithromycin
  • easier to take
  • BUT STILL DON’T GIVE IN EBV
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28
Q

Viruses causing acute otitis media

A 
Rhinovirus
Influenza/parainfluenza
Coronavirus
Adenovirus
RSV
Coxsackie
Enterovirus
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29
Q

Bacteria causing acute otitis media

A 
Strep pneumoniae
Haem influenza
Moraxella catarrhalis
Mycoplasma pneumonia
Streptococus pyogenes
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30
Q

What do the 7 main URTI viruses most commonly cause?

A

Rhinitis
Sinusitis
Otitis media
Pharyngitis

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31
Q

Treatment or otitis media in children?

A
  • no AB usually

- if need to = amoxicillin 5-7 days OR clarithromycin 5-7 days

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32
Q

Indications for AB in acute otitis media children?

A
  • <2 years
  • symptoms >48 hours
  • high fevers
  • bilateral
  • otorrhea
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33
Q

Treatment for acute otitis media adults?

A
  • amoxicillin or co-amoxiclav

- OR clarithromycin

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34
Q

Complications of otitis media in adults

A

Decreased hearing
Mastoiditis
Brain abscess

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35
Q

Organisms causing sinusitis

A
  • 7 common viruses
  • strep pneumoniae
  • haemo influenza
  • Moraxella catarrhalis
36
Q

Treatment for sinusitis

A
  • pen V or clarithromycin

- co-amoxiclav if systemically unwell

37
Q

LRTIs

A
  • bronchiolitis
  • pleurisy
  • bronchitis
  • pneumonia
  • bronchiectasis and CF
  • empyema
38
Q

Types of pneumonia

A
  • CAP = typical and atypical
  • HAP
  • Aspiration
39
Q

Organisms causing typical CAP

A
  • strep pneumoniae
  • Haem Inf
  • staph aureus
  • M TB
40
Q

Organisms causing atypical CAP

A
  • mycoplasma pneumoiae
  • legionella
  • chlamydia pneumoniae
  • chlamydia psittaci
41
Q

RF for pneumococcal pneumonia

A
  • influenza
  • alcohol
  • smoking/COPD
  • HIV
42
Q

First line treatment for Strep Pneumonia?

A

Antibiotic resistance increasing

  • first = amoxicillin
  • doxycycline
  • levofloxacin

Some strains amxocillin resistant = take travel history!

43
Q

Second Line treatment for Strep Pneumonia

A
  • ceftriaxone
  • teicoplanin
  • vancomycin
44
Q

Atypical pneumonia species

A

Mycoplasma pneumoniae

Legionella species

45
Q

Mycoplasma features

A
  • no cell wall
  • small
  • gram stain not visible
  • cell AB don’t affect them
46
Q

M pneumonia features

A
  • dry cough
  • epidemics
  • winter
  • with pharnygitis, rhinorrhea, otalgia, hepatitis, meningitis
47
Q

Treatment for mycoplasma pneumonia

A
  • macrolides = clarithromycin
  • quinolones = levofloxacin
  • tetracyclines = doxycycline
48
Q

Legionella features

A
  • gram negative rods
  • growth needs special media
  • slow growth 3-5 days
49
Q

Treatment for legionella

A
  • cell wall AB not effective

- quinolones>macrolides>tetracyclines

50
Q

RF of S aureus pneumonia

A
  • viral URTI

- colonisation of URTI

51
Q

What can S aureus pneumonia cause?

A
  • necrotising/abscess formation

- severe disease

52
Q

CAP Diagnosis

A 
CURB65
Confusion
Urea>7mmol/l
RR>30min
BP = systolic <90 or diastolic <60
Age >65
0-1 = low severity, outpatient
2 = moderate, admit, Ix microbiology, IV Tx
3-5 = high, urgent admission
53
Q

Treatment for 0-1 score of CURB65

A

Oral amoxicillin 500mg TDS
OR
Doxycycline 100mg OD

54
Q

Treatment for 2 score CURB65

A

IV benzylpnecillin 1.2g QDS AND Doxycycline 100mg BD

55
Q

> 2 treatment score CURB65

A

IV co-amoxiclav 1.2g TDS AND doxycycline 100mg BD
OR
IV ceftriaxone 2g OD AND doxycycline 100mg BD if history of travel

56
Q

HAP define

A

> 48 hour after admission or within 2 weeks of admission

57
Q

Predisposing factors to HAP

A
  • abnormal conscious state/intubation and ventilation

- immunosuppression

58
Q

Organisms causing HAP

A
  • same as CAP

- also E coli, klebsiella, pseudomonas

59
Q

Treatment for mild/moderate HAP

A

doxycycline

60
Q

Treatment for severe HAP

A

early onset <5 days = coamoxiclav

late onset >5 days = piperacillin-tazobactam

61
Q

Cause of aspiration pneumonia

A
  • bacteria from URT/stomach
62
Q

Treatment for aspiration pneumonia

A 
1 = amoxicillin and metronidazole
2 = levofloxacin and metronidazole
3 = co-amoxiclav
4 = piperacillin-tazobactam
63
Q

triggers for COPD exacerbation

A
  • virus
  • bacteria
  • pollution
  • CCF
  • VTE
  • aspiration
64
Q

When are AB effective in COPD exacerbation?

A
  • increased dyspnoea
  • increased sputum purulence
  • increased sputum volume
65
Q

Treatment for COPD exacerbation

A
  • doxycycline or clarithromycin
  • guided by sputum results
  • 5 day treatment
  • if recurrence within 3 months = use alternative agent
  • if consolidation on CXR = treat as CAP/HAP
66
Q

Features of bronchiectasis

A
  • abnormal dilatation of major bronchi and bronchioles
  • chronic daily cough with sputum
  • CT = bronchial wall thickening and luminal dilatation
67
Q

CF features

A
  • congenital

- abnormal secretions = chronic infections and bronchiectasis

68
Q

treatment for bronchiectasis and CF

A
  • guided by sputum culture
  • if no pseudomonas = clarithromycin or doxy or co-amoxiclav
  • if psueodmonas = ciprofloxacin or IV pip0taz
69
Q

Prophylaxis of bronchiectasis and CF

A
  • chest physio
  • postural drainage
  • oral azithromycin
  • inhaled AB = nebulised gentamicin, tobramycin, colistin
70
Q

Define empyema

A
  • complicated parapneumonic effusion
  • effusion into pleural space adjacent to bacterial pneumonia
  • treat pneumonia to treat normally unless complicated
71
Q

treatment of empyema

A
  • drainage

- AB 2-4 weeks until CXR resolution

72
Q

Prevention of resp infections

A

VACCINES

  • influenza
  • pneumococca
  • haemo influenzae
  • pertussis
  • diptheria
73
Q

RF of infective endocarditis

A
  • iatrogenic = infected cannulae
  • IVDA = right sided often
  • staph aureus, strep pneum, yeast infection
74
Q

Causes of abnormal valve

A
  • rheumatic fever
  • Degen calcific disease
  • congenital defects
  • mitral valve prolapse!!
75
Q

Antibiotic sensitivity testing

A
  • disc diffusion tests (qualitiative - sensitive or resistant)
  • MIC tests (E-test) (quantitiative, how sensitive/resistant)
76
Q

Define MIC

A

Minimum Inhibitory concentration

Lowest conc of an antimicrobial that will inhibit the visible growth of a micro-organism after overnight incubation

77
Q

Define MBC

A

Minimum bactericidal concentration

Lowest conc of antimicrobial that will prevent the growth of an organism after subculture on to antibiotic-free media

78
Q

Empirical Therapy for endocarditis when?

A
  • only if severe sepsis
79
Q

Native valve infective endocarditis therapy

A
  • vanco and genta
  • OR
  • vanco and meropenem (gram negative risk)
80
Q

Prosthetic valve infective endocarditis therapy

A

vanco and genta and rifampicin
6 weeks
- rifampicin treats biofilm

81
Q

Directed therapy infective endocarditis for staphylococcous

A

Staphylococcus – flucloxacillin 4 hourly  MRSA – vancomycin

82
Q

Directed therapy infective endocarditis for streptococci

A

Streptococci – benzyl penicillin 4 hourly  Penicillin resistance – vancomycin & gentamicin

83
Q

Directed therapy infective endocarditis for enterococci

A

Enterococci – amoxicillin 4 hourly & gentamicin

84
Q

Define biofilm

A

cluster of bacteria in extracellular matrix attached to surface

85
Q

What is required in directed therapy for infective endocarditis

A
  • guidance of microbiology/infectious diseases team

CR3 (30 decks)

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