Chapter 5: Infection Flashcards Preview

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Flashcards in Chapter 5: Infection Deck (326)
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1
Q

Name the antibiotics in the aminoglycoside class

A
Amikacin
Gentamicin
Neomycin
Streptomycin
Tobramycin
2
Q

What aminoglycosides are active against Pseudomonas and what one is the treatment of choice?

A

Gentamicin - treatment of choice

Amikacin
Tobramycin - usually via inhalation in CF

3
Q

What aminoglycoside is active against TB?

A

Streptomycin

mainly reserved for this indication

4
Q

Can aminoglycosides be given orally?

A

No- destroyed by the gut so must be given via injection

5
Q

Is gentamicin a broad or narrow antibiotic?

What strains does it have poor activity against?

A

Broad but it is inactive against anaerobes and poor activity against haemolytic streptococci and pneumococci

Very good for gram negative organisms

6
Q

Which aminoglycoside is used for encocarditis?

If it is resistant to this, what is an alternative aminoglycoside?

A

Gentamicin plus another antibiotic

Streptomycin is an alternative if resistant to gentamicin

7
Q

Are aminoglycosides more active against gram positive or gram negative?

A

Gram negative but are broad

8
Q

Can neomycin be given IV?

A

No
too toxic

Can only be used for skin/mucous membrane infections… However BNF states the cream is less suitable for prescribing

(Can also be used to reduce the bacterial population of the colon prior to bowel surgery or in hepatic impairment)

9
Q

What is the problem with using aminoglycosides in myasthenia gravis?

A

Contraindicated

May impair neuromuscular transmission

10
Q

What antibiotics can be used for prophylaxis in rheumatic fever?

A

Pen V or sulfadiazine

11
Q

What anitbiotics can be used for prevention of secondary case of menincoccal meningitis?

A

Ciprofloxacin or rifampicin

Or IM ceftriaxone (unlicensed)

12
Q

What antibiotic can be used for prevention of secondary infection for Group A strep?

A

Pen V

13
Q

What antibiotic can be used for prevention of secondary infection in Influenza Type B?

A

Rifampicin

14
Q

What antibiotic can be used for prevention of secondary cases of diphtheria in non-immune patients?

A

Erythromycin

15
Q

What is pertussis?

A

Whooping cough

16
Q

What antibiotic is used for prophylaxis of pertussis (whooping cough)?

A

Clarithromycin

17
Q

What antibiotic is used post splenectomy or in patients with sickle cell disease for prevention of pneumococcal infection?

A

Pen V

Erythromycin is penicillin allergic

18
Q

What antibacterial prophylaxis/treatment is used in animal and human bites?

If the patient is penicillin allergic, what should be used instead?

A

Co-amox

If penicillin allergic: Doxycycline and metronidazole

Up to 5 days and give tetanus jab

19
Q

What antibacterial prophylaxis do you use in hip and knee replacement?

A

Single dose IV cefuroxime/flucloxacillin

Add in gent

20
Q

What antibacterial prophylaxis do you use in high lower limb amputation?

A

Use i/v co-amoxiclav alone or i/v cefuroxime + i/v metronidazole

21
Q

What antibacterial prophylaxis do you use in caesarean section?

A

Single dose cefuroxime

22
Q

What is 1st line for aspergillosis?

What is 2nd line if this cannot be used?

A

Voriconazole

Liposomal amphotericin

23
Q

If a patient with aspergillosis is intolerant/refractory to voriconazole and liposomal amphotericin, what other antifungals can be used?

A

Caspofungin

Itraconazole

24
Q

What systemic antifungal is used in vaginal candidiasis?

For resistant organisms, what can be used?

A

Fluconazole

Itraconazole as an alternative

25
Q

What is micafungin licensed for?

A

Invasive candidiasis
Oesophageal candidiasis
Prophylaxis of candidiasis in patients undergoing haematopoietic stem cell transplantation

26
Q

Cryptococcal meningitis, a fungal infection, is especially common in which group of immunocompromised patients?

How is this treated?

A

HIV positive

IV amphotericin followed by PO fluconazole

27
Q

What is tinea capitis?

A

Fungal infection (ringworm) of scalp

28
Q

What is tinea pedis?

A

Athlete’s foot

29
Q

How do you treat tinea captis?

A

Systemically
Griseofulvin

Can also used an additional topical application

30
Q

True or false:

In fungal nail infections, topical therapy is more effective than systemic

A

False

Systemic is more effective

31
Q

Is fluconazole active against Aspergillus?

A

No

32
Q

Is caspofungin effective against CNS fungal infections?

A

No

33
Q

What is the advantage of lipid amphotericin formulations over conventional amphotericin?

A

Significantly less toxic and are recommended when the conventional formulation of amphotericin is contra-indicated because of toxicity, especially nephrotoxicity or when response to conventional amphotericin is inadequate

However, more expensive

34
Q

What are echinocandin antifungals active against? (Caspofungin, micafungin)

A

Aspergillus and Candida

Not active against CNS fungal infections

35
Q

What can be used for MRSA?

A

Glycopeptides mainly:
Teicoplanin
Vancomycin

Alternatives:
Tigecyline
Daptomycin
Linezolid (if glycopeptide unsuitable)

Tetracyclines can be used for skin or soft tissue infections or UTI caused by MRSA

Clindamycin can be used for bone and joint MRSA infections

36
Q

Are carbapenems useful against MRSA?

A

No

37
Q

Do carbapenems have good activity against pseudomonas? What is the exception to this?

A

Yes apart from ertapenem

38
Q

Why does imipenem have to be administered with cilastatin?

A

Imipenem is partially inactivated in the kidney by enzymatic activity and is therefore administered in combination with cilastatin, a specific enzyme inhibitor, which blocks its renal metabolism

39
Q

If meningitis is suspected, what antibiotic should be given before being transferred to hospital (as long as this doesn’t delay treatment)?

What would be an alternative?

A

IV benpen

Cefotaxime if penicillin allergic / chloramphenicol if history of immediate hypersensitivity to penicillin and cephalosporins

40
Q

When would you use dexamethasone in meningitis?

In what situations would you avoid this?

A

Particularly in pneumococcal meningitis in adults, either before starting antibacterial therapy or within 12 hours of starting

Avoid using dex in septic shock, meningococcal septicaemia, immunocompromised, or meningitis following surgery

41
Q

What is the recommended antibiotic therapy for children 3 months - adults 50 years in meningitis if the cause is unknown?

What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone

Consider adding vancomycin

10 days

42
Q

What is the recommended antibiotic therapy for adults over 50 years in meningitis if the cause is unknown?

What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone

AND amoxicillin or ampicillin

Consider adding vanc

10 days

43
Q

What is the recommended antibacterial therapy for meningitis caused by meningococci (neisseria)?

What would be an alternative if not suitable?

What is the suggested duration of treatment?

A

Benpen

Or cefotaxime/ceftriaxone

Chloramphenicol is an alternative if history of immediate hypersensitivity to penicillins or cephalosporins

7 days

44
Q

What bacteria can be the cause of meningitis?

A

Meningococcal (neisseria)
Pneumococcal
Haemophilus influenzae
Listeria

45
Q

What is the recommended antibacterial therapy for meningitis caused by pneumococcal?

If the organism if penicillin and cephalosporin resistant, what can be added?

What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone

Consider adding dex before first dose or within 12 hours of starting antibacterial therapy

If penicillin sensitive, change to benpen

If penicillin and cephalosporin resistant, vancomycin and rifampicin can be added

14 days

46
Q

What is the recommended antibacterial therapy for meningitis caused by Haemophilus influenzae?

What is the suggested duration of treatment?

A

Cefotaxime or ceftriaxone

Consider adding dex before first dose or within 12 hours of starting antibacterial therapy

10 days

47
Q

What is the recommended antibacterial therapy for meningitis caused by Listeria?

What is the suggested duration of treatment?

If history of immediate penicillin hypersensitivity, what could be an alternative?

A

Amoxicillin/ampicillin

AND gentamicin

21 days - can consider stopping gentamicin after 7 days

Alternative- co-trimoxazole for 21 days

48
Q

How should the following be managed:

Patients presenting with sinusitis symptoms of 10 days or less

A

Paracetamol, ibuprofen, nasal saline

Antibiotics not usually required

49
Q

How should the following be managed:

Patients presenting with sinusitis symptoms of 10 days or more

A

Could be considered for treatment with a high-dose nasal corticosteroid, such as mometasone furoate [unlicensed use] or fluticasone [unlicensed use] for 14 days. Supply of a back-up antibiotic prescription could be considered and used if symptoms do not improve within 7 days, or if they worsen rapidly or significantly.

50
Q

In what situations would you offer antibiotics for sinusitis?

A

Should only be offered to patients with acute sinusitis who are systemically very unwell, have signs and symptoms of a more serious illness

Or if bacterial sinusitis is suspected

51
Q

How should the following be managed:

Patients presenting with sinusitis symptoms of 10 days or more

A

Could be considered for treatment with a high-dose nasal corticosteroid, such as mometasone furoate [unlicensed use] or fluticasone [unlicensed use] for 14 days. Supply of a back-up antibiotic prescription could be considered and used if symptoms do not improve within 7 days, or if they worsen rapidly or significantly.

52
Q

What is 1st and 2nd line in a non-penicillin allergic sinusitis patient if antibiotics are indicated?

A

1st line- Pen V

2nd line- Co-amox
especially if more serious illness

53
Q

What is 1st line in a penicillin allergic sinusitis patient if antibiotics are indicated?

A

Doxycycline or clarithyromycin

54
Q

What is 1st line in a penicillin allergic sinusitis PREGNANT patient if antibiotics are indicated?

A

Erythromycin

55
Q

What antibiotic can be used in a pregnant UTI patient?

A

Cefalexin

56
Q

If antibiotics are clinically appropriate, what would be used for otitis externa?

What if the patient is penicillin allergic?

A

Flucloxacillin

Clarithromycin

57
Q

If antibiotics are clinically appropriate, what would be used for otitis media?

What if the patient is penicillin allergic?

A

Amoxicillin (or co-amox as second line)

Clarithromycin

58
Q

Otitis media is most common in which age group?

A

Children

59
Q

What antibiotics are likely to cause C.Diff?

A

Clindamycin
Penicillins
Cephalosporins
Fluoroquinolones

60
Q

What 3 antibiotics can be used in C.Diff?

A

Vancomycin
Metronidazole
Fidaxomicin

61
Q

For first episode of mild-moderate C.Diff, what should be used and for how long?

A

Oral metronidazole for 10-14 days

62
Q

For second/subsequent C.Diff infection not responding to metronidazole, what can be used and for how long?

A

Oral vancomycin

Fidaxomicin can be used for severe infection

10-14 days

63
Q

What antibiotic is used for bacterial vaginosis and how long for?

A

Metronidazole 5-7 days

64
Q

What antibiotics cover chlamydia?

A

Azithromycin (single dose)
Doxycycline
Erythromycin

65
Q

What would you use to treat gonorrhoea?

If the IM route is not possible, what would you use instead?

A

Single dose
Azithromycin and IM ceftriaxone

Cefixime instead (unlicensed)

66
Q

What is the recommended length of treatment for osteomyelitis?

A

6 weeks

67
Q

Osteomyelitis and septic arthritis antibiotic choice:

  1. First line
  2. If penicillin allergic
  3. If MRSA suspected
A
  1. Flucloxacillin
  2. Clindamycin
  3. Vancomycin or teicoplanin
68
Q

What penicillins can you use for oral infections e.g. dental?

A

Pen V
Amoxicillin

However these are not effective against bacteria that produces beta lactamases

Co-amox can be used in severe cases

69
Q

What is the drug of choice for acute ulcerative gingivitis?

A

Metronidazole

70
Q

Is haemophilus influenzae a bacteria or a virus?

A

Bacteria

71
Q

What is the recommended therapy for Haemophilus influenzae?

A

Cefotaxime or ceftriaxone

72
Q

What antibiotics do you use to treat an acute exacerbation of chronic bronchitis and how long for?

A

Amoxicillin or a tetracycline for 5 days

73
Q

What antibiotic therapy is recommended in low severity CAP and how long for?

What would be alternatives?

A

Amoxicillin

Alternatives= doxycycline, clarithromycin

7 days (if infection caused by staph, it would be 14-21 days)

74
Q

What antibiotic therapy is recommended in moderate severity CAP and how long for?

A

Amoxicillin AND clarithromycin

Or doxycycline alone

7 days

75
Q

What antibiotic therapy is recommended in high severity CAP and how long for?

A

Benpen AND clarithromycin/doxycycline

7-10 days

If MRSA suspected, add teic/vanc

76
Q

For life-threatening CAP, what would be the recommended treatment and how long for?

If the patient was penicillin allergic, what would be the alternative?

A

Co-amox + clarithromycin

7-10 days

Alternative to co-amox would be cefuroxime or ceftriaxone

77
Q

In CAP, the usual treatment duration is 7-10 days. When would you extend this to 14-21 days?

A

If staphylococci suspected

78
Q

If MSRA was suspected in CAP, what would you add on to the treatment?

A

Teic/vanc

79
Q

What are the main organisms that cause pneumonia?

A
Streptococcus pneumoniae
Haemophilus influenzae
Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumophila
80
Q

What would you use to treat pneumonia caused by chlamydial/mycoplasma?

A

Doxycycline

81
Q

What is the difference between early onset vs late onset HAP (in terms of days in hospital)?

A

Early onset = less than 5 days admission to hospital

Late onset = more than 5 days after admission to hospital

82
Q

How do you treat early onset HAP?

A

Co-amox or cefuroxime

83
Q

How do you treat late onset HAP?

A

Antipseudomonal penicillin e.g. Pip Taz

OR

Broad spectrum cephalosporin e.g. ceftazidime

OR

Quinolone e.g. ciprofloxacin

MRSA- add vanc

84
Q

What would you use to treat a small area of impetigo?

A

Fusidic acid

85
Q

What would you use to treat a widespread infection of impetigo?

If penicillin allergic, what would be an alternative?

A

Oral flucloxacillin

Clarithromycin

86
Q

What would you use to treat cellulitis?

If penicillin allergic, what can be used?

A

High dose flucloxacillin

Clindamycin/clarithromycin

87
Q

What antibiotic would you use for mastitis during breastfeeding?

What if penicillin allergic?

A

Flucloxacillin

Erythromycin

10-14 days

88
Q

What are the side effects of aminoglycosides?

A

Hearing impairment (ototoxicity - patients should report tinnitus, hearing loss, vertigo)
Nephrotoxicity
May impair muscle transmission-c/i in myasthenia gravis

89
Q

What is the risk of aminoglycosides to the infant in pregnancy?

A

Risk of auditory or vestibular nerve damage

90
Q

What is a possible problem with carbapenems that means it is cautioned in CNS disorders?

A

Seizure inducing potential

Also increased risk of seizures if renal impairment is present

91
Q

Should you give carbapenems if there is a history of immediate hypersensitivity to penicillins?

A

No

92
Q

True or false:

Cephalosporins penetrate the meninges poorly unless they are inflamed

A

True

93
Q

What are some common side effects of cephalosporins?

A

Abdo pain
Eosoniphilia
Thrombocytopenia

94
Q

Should you give cephalosporins if there is a history of penicillin allergy?

A

Used in caution

But should not be given if there is immediate hypersensitivity

95
Q

What are the glycopeptide antibiotics?

A

Dalbavancin
Teicoplanin
Telavancin
Vancomycin

96
Q

Which of the following antibiotics has a lower incidence of nephrotoxicity:
Teicoplanin
Vancomycin

A

Teicoplanin

97
Q

What drugs are associated with red man syndrome?

A

Glycopeptides
Teicoplanin
Vancomycin

98
Q

What is the main advice to give to patients on clindamycin and should stop taking if this happens?

A

Diarrhoea

Stop and contact doctor

99
Q

What are the cautions in macrolides?

A

QT prolongation

and electrolyte disturbances

100
Q

Amoxicillin can cause an increased risk of erythematous rash in what conditions?

A

Acute lymphocytic leukaemia
Chronic lymphocytic leukaemia
CMV
Glandular fever

101
Q

Why should you maintain adequate hydration with high doses of IV amoxicillin?

A

Risk of crystalluria

Especially in renal impairment

102
Q

What is the dose of amoxicillin in susceptible infection for a child 1-11 months?

A

125mg TDS

increased up to 30mg/kg TDS if needed

103
Q

What is the dose of amoxicillin in susceptible infection for a child 1-4 years?

A

250mg TDS

increased up to 30mg/kg TDS if needed

104
Q

What is the dose of amoxicillin in susceptible infection for a child 5-11 years?

A

500mg TDS

increased up to 30mg/kg TDS if needed

105
Q

What is the dose of amoxicillin in susceptible infection for a child 12-17 years?

A

500mg TDS

Increased up to 1g TDS if needed

106
Q

What is the dose of amoxicillin in susceptible infection for an adult?

A

500mg TDS

107
Q

What is the MHRA warning surrounding flucloxacillin?

A

Cholestatic jaundice and hepatitis

108
Q

What is a side effect of oral amoxicillin and co-amox in terms of colouring the patient’s tongue?

A

Black hairy tongue

109
Q

Ciprofloxacin is a type of what antibiotic?

A

Quinolone

110
Q

What is the important safety information regarding fluoroquinolones?

A

May induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.

Tendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment

Small increased risk of aortic aneurysm and dissection

111
Q

Should quinolones be used in MRSA?

A

No

112
Q

What quinolone is active against pseudomonas?

A

Ciprofloxacin

113
Q

What are some common side effects of quinolones?

A

QT prolongation
Hearing impairment
Decreased appetite
Rhabdomylosis

Drug should be discontinued if psychiatric, neurological reactions occur

Cautioned in young adults and children- risk of arthropathy

114
Q

What antibiotic would you use for PCP prophylaxis and treatment?

A

Co-trimoxazole

115
Q

What is a rare but serious side effect of co-trimoxazole?

A

Blood disorders

Rash - steven johnson’s syndrome

116
Q

What age group are tetracyclines contraindicated in?

A

Children < 12 due to deposition in growing bones and teeth

Staining of teeth can occur

117
Q

What are the common side effects of tetracyclines?

A

Angiodema
Henoch Schonlein purpura (spotty rash)
Photosensitivity reaction

Headaches and visual disturbances- may indicate benign intercranial hypertension - discontinue if intercranial pressure increases

118
Q

Is there any special patient advice with doxycycline?

A

Should be taken with meals

Avoid exposure to sunlight and sun lamps

Do not take zinc, indigestion remedies 2 hours before or after

119
Q

What is a serious side effect of chloramphenicol when given systemically?

A

Haemotological side effects (agranulocytosos, bone marrow disorder)
Aplastic anaemia- reports of leukaemia

Should only be reserved for life-threatening conditions e.g. typhoid fever

120
Q

What muscle side effect can daptomycin cause?

A

Myopathy
Report any muscle weakness and monitor creatine kinase if necessary
Need to monitor CK twice a week whilst on it

121
Q

What monitoring requirements are needed for systemic fusidic acid?

A

Elevated liver enzymes, hyperbilirubinaemia and jaundice can occur with systemic use

Manufacturer advises monitor liver function with high doses or on prolonged therapy

122
Q

What is the important safety information regarding linezolid?

A

Severe optic neuropathy- patients should report visual impairment

Blood disorders - thrombocytopenia, anaemia,

123
Q

What food does linezolid interact with and why?

A

Tyramine-rich foods (such as mature cheese, salami)

Avoid consuming large amounts

Also is a reversible MAOI

124
Q

Is linezolid active against gram-ve, gram+ve or both?

A

Gram +ve

125
Q

What would be the dose of trimethoprim in an adult for UTI?

A

200mg BD

126
Q

Can you use trimethoprim in renal impairment?

A

Yes- monitor

May need to half normal dose

127
Q

What is the patient advice surrounding rifampicin?

A

May stain contact lenses red
Report signs of liver disorder
May colour urine red - harmless

128
Q

How does rifampicin interact with hormonal contraceptives?

A

Effectiveness of hormonal contraceptives are reduced - alternative method needed

129
Q

What antibiotics are used in the initial phase of TB treatment?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

Streptomycin- hardly used but may be useful if resistant to isoniazid

130
Q

How many antibacterials are used in the initial phase of TB treatment and how long for?

A

4

2 months

131
Q

How many antibacterials are used in the continuous phase of TB treatment and how long for?

A

2

4 months

132
Q

If someone is isoniazid, what else must be prescribed and why?

A

Pyridoxine (vitamin B6)

Prophylaxis of isoniazid-induced neuropathy

133
Q

Generally speaking, after 2 months of RIPE treatment for TB, what antibiotics are continued for a further 4 months?

A

Rifampicin and isoniazid (needs to be on pyridoxine for prevention of neuropathy)

134
Q

What treatment for TB should be given in pregnancy and breastfeeding?

A

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 4 months

Should NOT be given streptomycin

135
Q

DOT TB therapy should be offered to which groups of people?

A

Directly observed therapy should be offered to patients who:

-Have a history of non-adherence;
-Have previously been treated for tuberculosis;
-Are in denial of the tuberculosis diagnosis;
have multidrug-resistant tuberculosis;
have a major psychiatric or cognitive disorder;
-Have a history of homelessness, drug or alcohol misuse;
-Are in prison, or have been in the past 5 years;
-Are too ill to self-administer treatment;
-Request directly observed therapy.

136
Q

In a patient with HIV and TB, starting antiretrovirals in the first 2 months of TB treatment can increase the risk of what?

A

Immune reconstitution syndrome

137
Q

In patients with HIV and TB, how long should the TB treatment be for?

What is the exception to this?

A

6 months

However if the TB has CNS involvement, 12 months max

138
Q

What is the general TB treatment regimen?

A

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 4 months

139
Q

What is the general CNS TB treatment?

A

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 10 months

Initial high dose of dexamethasone or prednisolone should be started at the same time and slowly withdrawn over 4-8 weeks

140
Q

What would be the treatment regimen for latent TB?

A

Isoniazid for 6 months - recommended if interactions with rifampicin a concern

OR rifampicin and isoniazid for 3 months - recommended if hepatotoxicity a concern

141
Q

A break in TB treatment of how many weeks is classed as a treatment interruption?

A

2 weeks

142
Q

What are the 6 toxicity syndromes associated with intermittent TB treatment?

A

Influenza-like, abdominal, and respiratory symptoms, shock, renal failure, and thrombocytopenic purpura

143
Q

What is the brand name of the medicine that contains RIPE for TB?

A

Voractiv

144
Q

What is the brand name of medicine that contains RI (rifampicin and isoniazid) for TB?

A

Rifinah

145
Q

Why is ethambutol cautioned in young children?

A

Can cause visual impairment

Ethambutol should be used with caution in children until they are at least 5 years old and capable of reporting symptomatic visual changes accurately.

146
Q

What kind of toxcity can ethambutol cause?

A

Ocular - report any visual disturbances
Nephrotoxicity

Other side effects include red-green colour blindness, hepatotoxicity

147
Q

What are the main side effects to look out for in a patient on isoniazid?

A

Peripheral neuropathy
Hepatic disorders
Ototoxicity

148
Q

What are the main side effects to look out for in a patient on pyrazinamide?

A

Hepatoxicity

Aggravates gout

149
Q

What antibiotics respond to a lower UTI?

A

Trimethoprim
Nitrofurantoin

Amoxicillin
Ampicillin
Cefalexin

150
Q

What is the recommended duration of treatment for uncomplicated UTI in women?

A

3 days

151
Q

What antibiotics for a UTI should be used in pregnancy?

A

Penicillins and cephalosporins are the best choices

152
Q

At what EGFR should you avoid prescribing nitrofurantoin in?

A

<45

153
Q

Does does caspofungin interact with and what should be done about the dose?

A

Some enzyme inducers e.g. rifampicin, carbamazepine, phenytoin

increase dose to 70mg daily (if not already on it)

154
Q

What is the risk of giving an infusion of amphotericin?

A

Risk of arrhythmias if given too rapidly

Anaphylaxis- test dose is needed and close observation is needed for first 30 mins after this test dose

155
Q

What are some side effects of amphotericin?

A
  • Abnormal hepatic function (discontinue)
  • Renal impairment
  • Agranulocytosis
  • Arrhythmias
  • Anaemia
  • Chills
156
Q

Are different preparations of amphotericin interchangeable?

A

No
Vary in PD, PK
Should preferably prescribe by brand to avoid confusion

157
Q

What are some side effects of fluconazole?

A
  • QT prolongation
  • Oedema
  • If rash occurs, discontinue - could be SCARSs (severe cutaneous reaction)
158
Q

What is a specific side effect with IV isavuconazole?

A

Infusion related reactions:
Hypotension, SOB, paraesthesia
Nausea, headache

Discontinue if these occur

159
Q

What is the important safety information regarding itraconazole?

A

Reports of heart failure, especially in high risk patients:

  • High dose and long courses
  • Patients on negative ionotropic drugs- CCBs
  • Elderly
  • Chronic heart disease

Should be avoided in those with a history of heart failure unless the infection is serious

Also, hepatotoxicity that can be life-threatening can occur. Patient should be aware of liver disorder signs

160
Q

What are the specific side effects for voriconazole that requires patient counselling?

A

Hepatotoxicity- patients should be aware of liver disorder signs

Phototoxicity- patients should avoid intense or prolonged exposure to direct sunlight, avoid sunbeds
If they get sunburnt, seek medical attention

It is the antifungal that is most associated with hallucinations

Keep an alert card on them

161
Q

What is the contraception and conception advice for both men and women who are on griseofulvin (antifungal for dermatophyte infections of the skin)?

A

Women:
Should continue effective contraception at least 1 month after administration. The effectiveness of the pill may reduce so use an additional barrier method

Men:
Avoid fathering a child during and for at least 6 months after administration

162
Q

What adjunctive therapy is recommended in PCP treatment in patients with HIV?

A

For moderate to severe infections, prednisolone for 21 days

163
Q

True or false:

All members in a household must be treated if one person in the house has threadworm

A

True

164
Q

What is the drug of choice for threadworm?

A

Mebendazole

165
Q

For malaria prophylaxis, what are mosquito nets usually impregnated with?

A

Permethrin (insecticide)

166
Q

Can DEET spray be used during pregnancy and breastfeeding?

A

Yes

167
Q

When applying DEET and suncream, what should be applied first?

A

Suncream

Then DEET

168
Q

How does DEET spray affect the SPF of suncream?

A

Lowers it so a factor 30-50 should be used

169
Q

Generally speaking, how much time before travelling should malaria prophylaxis be started?

What are the exceptions to this?

A

1-2 weeks before

Mefloquine is 2-3 weeks before

Malarone and doxycycline is 1-2 days before

In warfarin patients- 2-3 weeks before

170
Q

How much time before travelling should malaria prophylaxis with Malarone be started?

A

1-2 days before

171
Q

How much time before travelling should malaria prophylaxis with doxycycline be started?

A

1-2 days before

172
Q

How much time before travelling should malaria prophylaxis with mefloquine be started?

A

2-3 weeks before

173
Q

How long can Malarone be used for in malaria prophylaxis?

A

Up to 1 year

174
Q

How long can doxycycline be used for in malaria prophylaxis?

A

Up to 2 years

175
Q

How long can mefloquine be used for in malaria prophylaxis?

A

Up to 1 year

176
Q

What antimalarials are unsuitable for those with epilsepy?

What would be alternatives?

A

Chloroquine
Mefloquine

Proguanil is recommended in areas with chloroquine resistance

Doxycyline or Malarone is recommended in areas without chloroquine resistance

177
Q

Which group of patients are at a particularly high risk of severe malaria?

A

Those without a spleen

178
Q

What antimalarials can be given at their usual dose during pregnancy?

A

Chloroquine
Proguanil

However, resistance exists so may have to look at other options, only if benefit outweighs risk and travel is unavoidable

179
Q

If a pregnant lady is on proguanil during malaria prophylaxis, what else must she be on?

A

Folic acid at high dose (5mg) for at least the first trimester

180
Q

How long should malaria prophylaxis continue after leaving the at risk country?

What is the exception to this?

A

Continue for 4 weeks after

Except for Malarone which is 1 week

181
Q

In warfarin patients, when should malaria prophylaxis begin?

A

2-3 weeks before travelling

INR should be stable before departure

182
Q

When should INR be checked in warfarin patients on malaria prophylaxis?

A

Before starting the course
7 days after starting the course
After completing the course

For prolonged stays, INR needs to be checked at regular intervals

183
Q

What is standby malaria treatment?

A

Travellers visiting remote, malarious areas for prolonged periods should carry standby treatment if they are likely to be more than 24 hours away from medical care. Self-medication should be avoided if medical help is accessible.

In order to avoid excessive self-medication, the traveller should be provided with written instructions that urgent medical attention should be sought if fever (38°C or more) develops 7 days (or more) after arriving in a malarious area and that self-treatment is indicated if medical help is not available within 24 hours of fever onset.

184
Q

When travelling to different places that require 2 different malaria prophylaxis regimens, what do you do?

A

The regimen for the higher risk area should be used for the whole journey

185
Q

What combination of antimalarials is in Malarone/Maloff?

A

Atovaquone and proguanil

186
Q

For the treatment of malaria, is the infective species is unknown/mixed, what are the options?

A

Malarone
Riamet
Quinine

187
Q

What is P. Falciparum resistant to?

A

Chloroquine

188
Q

What are the treatment options for malaria caused by P.Falciparum?

A

Quinine (with doxycycline or clindamycin)
Malarone
Riamet

189
Q

What are the treatment options for malaria caused by P.Falciparum in pregnancy?

A

Quinine followed by clindamycin

cannot use doxycycline

190
Q

What are the treatment options for non-falciparum malaria?

A

Chloroquine

However, if resistant- Malarone or Riamet

191
Q

What are the treatment options for non-falciparum malaria in pregnancy?

A

Chloroquine

192
Q

What antimalarials does Riamet contain?

A

Artemether and lumefantrine

193
Q

What is the important safety information with chloroquine?

A

Occular toxicity

Very toxic in overdose

194
Q

What are some side effects of chloroquine?

A
  • QT prolongation
  • Seizures
  • Hypoglycaemia- cautioned in diabetes
195
Q

What is a main neurological side effect of mefloquine?

A

Mefloquine is associated with potentially serious neuropsychiatric reactions. Abnormal dreams, insomnia, anxiety, and depression occur commonly.

Therefore, contraindicated in those with history of psychiatric disorders including depression

Has a long half life so can persist up to several months after discontinuation

196
Q

What screening should be done before a patient starts taking primaquine and why?

A

G6PD as if deficient, can cause haemolysis

197
Q

What is the difference between quinine sulphate and quinine bisulphate?

A

Bisulphate has less quinine in

Should not be used for malaria, only quinine sulphate

198
Q

What is the important safety information regarding quinine?

A

QT prolongation

199
Q

What are the initial treatment options for chronic Hep B?

A

Peginterferon alpha
Interferon alpha
Treatment with the above should be stopped if no improvement after 4 months

Entecavir
Tenofovir
Treatment should be changed to other antivirals if no improvement after 6-9 months

200
Q

What determines treatment route for chronic Hep C?

A

Before starting treatment, the genotype of the infecting hepatitis C virus should be determined and the viral load measured as this may affect the choice and duration of treatment.

201
Q

What is used for the initial treatment of chronic Hep C?

A

Combination of ribavirin and peginterferon alpha

Ribavirin monotherapy=ineffective

202
Q

What is the MRHA warning regarding direct-acting antivirals to treat chronic Hep C?

A

Risk of interaction with Vitamin K antagonists and changes in INR.
INR needs to be monitored closely

Risk of Hep B reactivation (if patient has both B and C)
Need to be screened for Hep B before starting treatment

203
Q

What is herpes labialis?

A

Cold sore

204
Q

What is herpes zoster?

A

Shingles

205
Q

What is varicella?

A

Chicken pox

206
Q

In shingles, within how many hours of rash onset should antivirals be started?

How long is it continued for?

A

Within 72 hours

Continued for 7-10 days

207
Q

In adults with chickenpox, within how many hours of rash onset should antivirals be started to reduce duration and severity of symptoms?

A

Within 24 hours

208
Q

What kind of drug is foscarnet?

A

Antiviral

209
Q

What antivirals are used for CMV?

A

Ganciclovir IV
Valganciclovir PO
Foscaret - toxic and causes renal impairment

210
Q

During CMV treatment, what does ganciclovir cause if given with zidovudine (for HIV)?

A

Myelosuppression

211
Q

Initial treatment of HIV-1 includes what combination types of antiretroviral drugs?

A

Triple therapy

2 nucleoside reverse transcriptase inhibitors and ONE of the following;

  • Boosted protease inhibitor
  • Non-nucleoside reverse transcriptase inhibitor
  • Integrase inhibitor
212
Q

What is used for HIV pre-exposure prophylaxis?

A

Emtricitabine with tenofovir

213
Q

Why are some HIV medicines used in combination with cobicistat?

A

It is a pharmacokinetic enhancer that boosts the concentrations of other antiretrovirals, but it has no antiretroviral activity itself.

214
Q

Name the nucleoside reverse transciptase inhibitors for HIV

A
Zidovudine
Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Tenofovir disoproxil.
215
Q

Name the protease inhibitors used for HIV

A
Atazanavir
Darunavir
Fosamprenavir
Ritonavir
Saquinavir
Tipranavir

Metabolised by cytochrome P450 enzyme systems

216
Q

Name the integrase inhibitors used for HIV

A

Dolutegravir, elvitegravir and raltegravir

217
Q

Name the non-nucleoside reverse transcriptase inhibitors used for HIV

A

Efavirenz, etravirine, nevirapine, and rilpivirine

218
Q

What is Maraviroc?

A

Antagonist of the CCR5 chemokine receptor. It is licensed for patients exclusively infected with CCR5-tropic HIV.

219
Q

What has been reported in patients with advanced HIV disease or following long-term exposure to antiretroviral treatment?

A

Osteonecrosis

220
Q

What is the MHRA advice regarding preparations containing dolutegravir (integrase inhibitor used for HIV)?

A

Increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

221
Q

What CNS effects can efavirenz cause and how can this be reduced?

A

Depression, psychosis, confusion, hallucination, abnormal behaviour, suicidal ideations

Take the dose at bedtime, especially during the first 2-4 weeks of treatment

222
Q

What reaction can occur with HIV medicines?

A

Hypersensitivity e.g. Rash, lesions, oedema, SOB

223
Q

Which HIV medicine is associated with a high incidence of rash including Stevens-Johnson syndrome?

A

Nevirapine

224
Q

What is the important information that requires patient counselling for patients on nevirapine for HIV?

A
  • Hepatotoxicity can occur so patients need to be made aware of symptoms
  • Rash, hypersensitivity reaction
225
Q

Efavirenz for HIV is associated with an increase in plasma concentration of what substance?

A

Cholesterol

226
Q

What are the long term effects of HIV treatment?

A

1.Immune reconstitution syndrome: as the immune system stands up on its feet again due to antiretroviral treatment, marked inflammatory reactions happen against opportunistic organisms

  1. Lipodystrophy syndrome: this is made up of insulin resistance, fat redistribution and dyslipidaemia
    Blood lipids and sugars should be measured before, 3-6 months after and yearly after HIV treatment.
  2. Osteonecrosis: following long-term exposure to treatment.
227
Q

Protease inhibitors are mainly associated with what side effects?

A

Lipodystrophy and metabolic effects.

228
Q

What can be used for the treatment of influenza and within how many hours of symptom onset should it be started?

A

Oseltamivir (Tamiflu) first line and zanamivir is reserved for those who are immunocompromised or when oseltamivir cannot be used
Within 48 hours

229
Q

What can be used for post-exposure prophylaxis of influenza and within how many hours of exposure?

A

Oseltamivir (Tamiflu) within 48 hours of exposure and zanamivir within 36 hours of exposure

230
Q

How long should influenza treatment be for?

A

Twice daily dosing for 5 days

231
Q

How long should post-exposure prophylaxis for influenza be for?

A

Once daily dosing for 10 days

232
Q

What is a particular caution with co-amoxiclav in in terms of side effects?

A

Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav.

233
Q

What is a rare but potentially fatal side effect of ketoconazole?

A

Associated with fatal hepatotoxicity. The CSM advise that prescribers should
weigh the potential benefits of ketoconazole treatment against the risk of liver damage and should
carefully monitor patients both clinically and biochemically.

234
Q

What penicillin based antibiotics must you take on an empty stomach (1 hour before food or 2 hours after food)?

A

Flucloxacillin
Ampicillin
Penicillin V

235
Q

What shouldn’t a patient take at the same time as tetracycline antibiotics?

A

Do not take milk, indigestion remedies, or medicines
containing iron or zinc at the same time of day as this medicine (prevents absorption of the antibiotic
and should be taken 2-3 hours apart)

Oxytetracycline and tetracycline should be taken on an empty stomach

236
Q

Which tetracycyline antibiotics should be taken on an empty stomach?

A

Oxytetracycline and tetracycyline

237
Q

What is the patient advice surrounding trimethoprim?

A

On long-term treatment, patients and their carers should be told how to recognise signs of blood disorders and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop.

238
Q

True or false:

Rifampicin should be taken on an empty stomach

A

True

239
Q

True or false:

Metronidazole should be taken on an empty stomach

A

False

Take with or just after food

240
Q

What shouldn’t a patient take at the same time as ciprofloxacin?

A

Do not take milk, indigestion remedies, or medicines containing iron or
zinc at the same time of day as this medicine.

241
Q

What specific monitoring should you do with daptomycin?

A

Creatine kinase twice a week

242
Q

What is the CHMP advice regarding the use of oral ketoconazole to treat fungal infections?

A

Marketing authorisation for oral ketoconazole to treat fungal infections should be suspended. The CHMP concluded that the risk of hepatotoxicity associated with oral ketoconazole is greater than the benefit in treating fungal infection

People with a prescription for oral ketoconazole should be referred back to their doctors

243
Q

How does calcium carbonate interact with doxycycline? What do you recommend the patient does if the patient is normally on calcium carbonate e.g. Adcal and is prescribed doxycycline?

A

Calcium carbonate is predicted to decrease the absorption of doxycycline

Separate administration by 2-3 hours

244
Q

What CD4 count is classed as AIDs?

A

<200

245
Q

Which of the following is active against pseudomonas:

  • Benpen
  • Flucloxacillin
  • Ampicillin
  • Piperacillin
A

Piperacillin (Pip taz)

246
Q

Which antibacterial drug increases the risk of serotonin syndrome?

Linezolid
Vancomycin
Telvancin
Septrin

A

Linezolid as it is a weak MAOI

Serotonin syndrome risk increases with:
SSRIs
TCAs
Macrolides
Amiodarone
Fluoroquinolones
Antipsychotics
Quinine

Risk of hypertensive crisis

247
Q
Which drug class is most associated with lipodystrophy?
Antiretroviral drugs
Alkylating agents
TCAs
ARBs
A

Antiretroviral drugs can cause redistribution of fat around the body

248
Q

Quinine can be very toxic - what are the signs of toxicity?

A

Life-threatening features include arrhythmias (which can have a very rapid onset) and convulsions (which can be intractable).

249
Q

What are adverse effects of quinine?

A
Tinnitus
Deafness
Blindness
QT prolongation
Hypoglycaemia
GI upset
Hypersensitivity reactions
250
Q

What advice should you give to a patient on metronidazole regarding their urine?

A

May darken urine (brown)

251
Q

Which of these is used to boost the effects of protease inhibitors?

Elvitegravir
Maraviroc
Ritonavir
Etravirine

A

Ritonavir - it is a protease inhibitor itself but it inhibits CYP enzymes that would otherwise metabolise other protease inhibitors

252
Q

What are the side effects of trimethoprim?

A
Megaloblastic anaemia
GI effects
Taste disturbance
Elevated creatinine levels
Skin rash
Hyperkalaemia
253
Q

Trimethoprim can cause high levels of what electrolyte?

A

Potassium

254
Q

What is the advice surrounding ribavirin and contraception?

A

Effective contraception essential during treatment and for 4 months after treatment in females and for 7 months after treatment in males of childbearing age.

255
Q

What is the standard dose of oseltamivir in:

i) Treatment of flu
ii) Prevention of flu

A

i) 75mg BD for 5 days for treatment

ii) 75mg OD for 10 days for prophylaxis

256
Q

Is vancomycin good for treating gram negative or positive organisms?

A

Gram positive

257
Q

Is teicoplanin good for treating gram negative or positive organisms?

A

Gram positive

258
Q

Allopurinol and what antibiotic can result in a skin rash?

A

Amoxicillin

259
Q

True or false:

NSAIDs and fluoroquinolones together increase seizure risk

A

True

260
Q

Can macrolides cause QT prolongation?

A

Yes

261
Q

What tetracyclines can you take with milk?

A

Does Like Milk acronym

Doxycline
Lymecycline
Minocycline

262
Q

What is 1st line treatment for chlamydia (both the patient and partner)?

If this is not suitable, what regimes can be used instead?

A

Doxycycline 100 mg BD for 7 days

Alternatives:
Azithromycin 1 g orally for one day, then 500mg orally once daily for two days

Erythromycin 500 mg BD for 10–14 days

263
Q

How you manage a pregnant lady with chlamydia?

A

Azithromycin 1 g orally for one day, then 500mg orally once daily for two days

Erythromycin 500 mg BD for 10–14 days

264
Q

If a patient is thought to have chlamydia and presents in a primary care setting, where should you refer to?

A

GUM clinic

265
Q

When should you do an STI screen in a patient with chlamydia?

A

1 week after completing treatment

266
Q

If a patient and their partner are being treated for chlamydia, how long should they abstain from sexual intercourse?

With what antibiotic is this different?

A

Until they have both finished treatment

With azithromycin, you need to wait 7 days after

267
Q

Does a partner of someone of chlamydia need to be treated if their screen result is negative?

A

Yes

268
Q

How many weeks after the start of treatment do you do a test of cure treatment for chlamydia?

A

5 weeks

269
Q

What age should you offer repeat testing of chlamydia in 3-6 months after treatment?

A

<25 years

270
Q

What can a high ESR indicate?

A

Inflammation, infection

271
Q

Is ESR usually low or raised in infection?

A

Raised

272
Q

Why aren’t quinolones e.g. ciprofloxacin, ofloxacin generally used in children?

A

Quinolones cause arthropathy and therefore are not recommended in children and growing adolescents.

273
Q

What is the cut off eGFR for nitrofurantoin?

A

45

274
Q

Can you use tetracyclines in renal impairment?

A

No - should not be given at all in renal impairment

Apart from doxycycline and minocycline (but these should be used with caution)

275
Q

Can tetracyclines cause hepatotoxicity?

A

Yes

276
Q

True or false:

Tetracyclines can be used during pregnancy

A

False

277
Q

True or false:

Trimethoprim can be used during pregnancy

A

False - teratogenic in first trimester

278
Q

True or false:

Nitrofurantoin can be used during pregnancy

A

True

But avoid at term

279
Q

Can metronidazole be used during pregnancy?

A

No

Only use if benefit outweighs risk

280
Q

Is Ben Pen active against streptococci?

A

Yes

281
Q

Is linezolid active against MRSA?

A

Yes

282
Q

Can chloramphenicol be used in pregnancy?

A

No

283
Q

Should metronidazole be taken with or without food?

A

With or just after food

284
Q

What electrolyte disturbances can be caused by aminoglycosides?

A

Hypokalaemia
Hypo Mg
Hypo Ca

285
Q

What is the MHRA warning about gentamicin?

A

Potential for histamine-related adverse drug reactions with some batches

286
Q

Is gentamicin used for MRSA?

A

No

287
Q

Red man syndrome caused by vancomycin causes is associated with what other clinical features?

A

Hypotension
Bronchospasms

Caused by rapid infusion

288
Q

Which is associated with a higher incidence of nephrotoxicity?

Teicoplanin
Vancomycin

A

Vancomycin

289
Q

If a patient on a tetracycline develops a headache, what should they do?

A

Stop

Side effect of tetracyclines- benign intracranial hypertension

290
Q

What tetracyclines should you avoid milk in? (DOT)

A

Demeclocycline
Oxytetracycline
Tetracycline

291
Q

What tetracyclines can you have milk with? (DLM)

A

Doxycycline
Lymecycline
Minocycline

292
Q

What tetracyclines cause oesophageal irritation and is recommended to take with plenty of fluid?

A

Doxycycline
Minocycline
Tetracycline

293
Q

Can ciprofloxacin cause QT prolongation?

A

Yes

294
Q

Are quinolones active against MRSA?

A

No

295
Q

If a patient on a quinolone develops psychiatric disturbances, what should you recommend?

A

They should stop the drug

296
Q

What is the interaction between ciprofloxacin and theophylline?

A

Ciprofloxacin is an enzyme inhibitor and causes theophylline toxicity - convulsions risk

297
Q

Which quinolone should you protect yourself from sunlight if on it?

A

Ofloxacin

298
Q

Cholestatic jaundice risk is increased with amoxicillin/flucloxacillin if on it for more than how many days?

A

14 days

299
Q

What is the dosing regimen for Malarone for the prophylaxis of malaria?

A

1 tablet OD, started 1-2 days before, during, and 7 days after

Take with food/milky drink

300
Q

Should Malarone be taken on an empty stomach or with food?

A

Take with food/milky drink to maximise absorption

301
Q

What is the renal cut off for Malarone?

A

<30 mL/min

302
Q

What is the dosing regimen for doxycycline for the prophylaxis of malaria?

A

1 tablet OD, started 1-2 days before, during, and 4 weeks after

303
Q

How long do you continue malaria prophylaxis with doxycycline after leaving the area of risk?

A

4 weeks after

304
Q

What is the dosing regimen for chloroquine in the prophylaxis of malaria?

A

2 tablets once a week
Start 1 week before, during and 4 weeks after

Take just after food

305
Q

Should chloroquine be taken on an empty stomach?

A

No

Take just after food

306
Q

Should proguanil be taken on an empty stomach?

A

No

Take just after food

307
Q

What is the dosing regimen for proguanil in the prophylaxis of malaria?

A

2 tablets OD
Started 1 week before

Continue for 4 weeks after

Take just after food

308
Q

Should mefloquine be taken on an empty stomach?

A

No

Take just after food

309
Q

What are the side effects associated with glycopeptides?

A
  • Nephrotoxicity
  • Ototoxicity
  • Red man syndrome - associated with too rapid infusions and other symptoms are hypotension and bronchospasms
  • Phlebitis - rotate infusion sites
  • Neutropenia
  • Steven Johnsons
310
Q

What is the dose of trimethoprim for a UTI?

A

200mg BD

311
Q

What is the safest macrolide to use in pregnancy?

A

Erythromycin

312
Q

What is penicillin G?

A

Benzylpenicillin

313
Q

What is first line for acute infective exacerbation of COPD and how long for?

A

Amoxicilin, clarithromycin or doxycycline for 5 days

314
Q

What is first line for acute exacerbation of bronchietasis and how long for?

A

Amoxicilin, clarithromycin or doxycycline for 7-14 days

315
Q

What is low severity CAP in terms of CURB score?

A

0-1

316
Q

What is moderate severity CAP in terms of CURB score?

A

2

317
Q

What is high severity CAP in terms of CURB score?

A

3-5

318
Q

What is the CURB score and what does each marker mean?

A
Confusion - mental test 8 or less 
Urea > 7 mmol/L
Resp rate 30 breaths/min or more
Blood pressure systolic < 90 or diastolic 60 or less
65 years and older

1 point for each
Low risk 0-1
Moderate 2
High risk 3-5

319
Q

What is the dose of nitrofurantoin for a UTI?

A

50mg QDS

320
Q

When would you add flucloxacillin to pneumonia treatment?

A

If staphylococcus is suspected

321
Q

How would you manage someone with mild facial cellulitis?

What if the patient was penicillin allergic?

A

Co-amoxiclav

Clarithromycin for people with a penicillin allergy

322
Q

How do you treat Scarlet fever?

A

Pen V

323
Q

How long should you abstain from alcohol after a metronidazole course?

A

48 hours

324
Q

Within what time should you notify PHE of a patient with a notifiable disease?

What about if it is urgent?

A

Send the form to the proper officer within 3 days, or notify them verbally within 24 hours if the case is urgent by phone, letter, encrypted email or secure fax machine.

325
Q

What are the treatment options for recurrent thrush?

A

Initially:

3 doses of 150mg fluconazole ( 3 days apart)
or intravaginal antifungal for 10-14 days

After:

Maintenance of 6 months or oral fluconazole 150mg weekly or intravaginal clotrimazole 500mg weekly

326
Q

What are the treatment options for recurrent UTIs if trigger is not known and if trigger is known?

A

Manage acute UTI first

Then,

i) If trigger is known, 1st choice is trimethoprim 200mg single dose after trigger exposure

Nitrofurantoin 100mg single dose after trigger exposure

Alternatives- amoxicillin 500mg or cefalexin 500mg

ii) If trigger is NOT known, 1st choice trimethoprim 100mg ON

Nitrofurantoin 50-100mg ON

Alternatives: Amoxicillin 250mg ON or cefalexin 125mg ON

Decks in Pharmacy Pre-Registration 20/21 Class (82):