Chapter 5: Infection part 2 Flashcards by Izy Mal

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

Confusion - mental test 8 or less Urea > 7 mmol/LResp rate 30 breaths/min or moreBlood pressure systolic < 90 or diastolic 60 or less65 years and older1 point for eachLow risk 0-1Moderate 2High risk 3-5

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What is the dose of nitrofurantoin for a UTI?

50mg QDS

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When would you add flucloxacillin to pneumonia treatment?

If staphylococcus is suspected

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How would you manage someone with mild facial cellulitis?What if the patient was penicillin allergic?

Co-amoxiclav Clarithromycin for people with a penicillin allergy

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How do you treat Scarlet fever?

Pen V

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

48 hours

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Within what time should you notify PHE of a patient with a notifiable disease?What about if it is urgent?

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

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What are the treatment options for recurrent thrush?

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

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

Manage acute UTI first
i) If trigger known, 1st choice = trimethoprim 200mg single dose after trigger exposure
Nitrofurantoin 100mg single dose after trigger exposure
Alternatives- amoxicillin 500mg or cefalexin 500mg

ii) If trigger NOT known, 1st choice = trimethoprim 100mg ON, Nitrofurantoin 50-100mg ON
Alternatives: Amoxicillin 250mg ON or cefalexin 125mg ON

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Is Fluconazole or Itraconazole more readily absorbed?

Fluconazole

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What is amphotericin B used for?

Aspergillosis, blastomycosis, candidiasis, cryptococcosis

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Does amphotericin B need to be prescribed by brand?

Yes

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Name 7 antifungal drugs?

Fluconazole
Ketoconazole
Itraconazole
Amphotericin B
Nystatin
Voriconazole
Miconazole

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What is the mechanism of action of antifungal drugs?

Fungal cells contain ergosterol (not found in human/animal cells), antifungals bind to ergosterol creating pores as well as inhibiting ergosterol synthesis.

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What are the main side effects of fluconazole? (3)

1) Prolonged QT interval
2) Hepatotoxicity
3) Renal impairment

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What patient groups should avoid fluconazole? (2)

1) liver disease
2) pregnancy (teratogenic)

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Which antifungal’s are CYP450 inhibitors?

FluconazoleKetoconazoleItraconazole

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What drugs do antifungals interact with?

1) CYP450 substrates
2) QT prolonging drugs e.g amiodarone, antipsychotics, quinolones etc

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What are the main side effects of Voriconazole?

Hepatotoxicity
Photosensitivity (check for malignancy and seek medical attention if sunburnt)

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What must you carry if you are taking voriconazole?

An alert card

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What is nystatin normally used for? what are the typical dosage instructions?

Oral thrush-100,000 units QD for 7 days

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What age group can fluconazole 150mg be sold to the public OTC?

16-60 for candidiasis

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What must you monitor in patients taking LT treatment of fluconazole?

Liver enzymes before and during treatment

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What must you monitor when taking LT treatment of voriconazole?

Renal + hepatic function before starting ==> then at least weekly for 1 month ==> then monthly.

Check for malignancy + avoid sunlight.

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Hepatotoxicity is also associated with another antifungal, please name it?

Ketoconazole

What are the general monitoring requirements for antifungals?

1) ECG 2) Adrenal function (can cause adrenal insufficiency) 3) Hepatic function

What is the most common cause of fungal meningitis?

Cryptococcal meningitis

Can you use Itraconazole in heart failure or history of heart failure?

AVOID

How would you treat fungal meningitis?

IV amphotericin followed by oral fluconazole

What are the 1st and 2nd line treatments for aspergillosis?

1) Voriconazole 2) Liposomal amphotericin (alternatives = itraconazole or caspofungin)

What antifungal can you use to treat tinea capitis?

Griseofulvin

Is topical or systemic therapy more effective for fungal nail infections?

Systemic

What is a helminth infection?

Parasitic infection

What are the symptoms of thread worm?

itching around the anus and vagina, weight loss

What are the symptoms of whip worm?

Gi disturbance, colitis, bloody diarrhoea

What are the symptoms of hookworm?

Very few symptoms except weight loss and anemia (rare)

What are the symptoms of round worm?

High temperature, dry cough, worms in the stools

What is the main treatment for helminth infection? and what are the criteria for sale OTC?What are the side effects?

Mebendazole, can be sold OTC to >2 years old if package is labelled 100mg as a single dose.Side effects: GI effects, SJS (rare)

What is the treatment duration for malarone in malaria prophylaxis?

Start 1-2 days before and 1 week after

What is the treatment duration for doxycyline in malaria prophylaxis?

Start 1-2 days before and for 4 weeks after

What is the treatment duration for mefloquine in malaria prophylaxis?

Start 2-3 weeks before and for 4 weeks after

What is the treatment duration for chloroquine and quinine and proguanil in malaria prophylaxis?

Start 1 week before and for 4 weeks after

Which antimalarials cannot be used in epilepsy? (2)

Chloroquine and mefloquine

Which antimalarials cannot be used in renal impairment? (2)

Proguanil (AVOID) Malarone (AVOID in eGFR <30)

Which antimalarials should you avoid in pregnancy? (3)

Doxycycline Malarone Proguanil (must take folic acid until 1st trimester)

Which antimalarial is associated with occular toxicity?

Chloroquine

What is the safest antimalarial in pregnancy?

Quinine

Which antimalarial is CI in patients with history of psychiatric disorders?

Mefloquine (Stop seek medical attention if experience insomnia, depression, anxiety etc)

Name 2 antiviral drugs used for influenza?

Oseltamivir & zanamivir

Which antiviral drug is licensed for use within 48 hours of influenza onset?

Oseltamivir

Which antiviral drug is licensed for use within 36 hours of influenza onset?

Zanamivir

What is tinea cruris?

Fungal groin infection, itchy inflammation with a visible patch of dry scaly skin

What is impetigo?

Red sores that quickly burst leaving a thick golden crust typically around 2cm across

What are the symptoms of measles/rubella?

rash for 3 days and cold-like symptoms with red blotchy rash and kopilks spots in the mouth

What are the symptoms of molloscum contagiousum?

small, firm, raised dome-shaped flesh coloured spots on the skin; thick yellowy-white substance released if popped

What are the symptoms of tinea corporis?

(ring worm)- affects arms & legs, round silvery patch of skin that may be scaly inflamed and itchy.

What are the symptoms of scarlet fever?

Sore throat, headache, swollen glands, red rash that feels like sandpaper, red cheeks, white or red tongue

What are the symptoms of mumps?

Swollen, salivary glands, fever, headache and joint pain (in adults)

What are the symptoms of scabies?

Intense itching, rashes with tiny red spots, burrow marks can be seen as silvery coloured lines on the skin

What are the symptoms of hand, foot and mouth disease?

Mouth ulcers after one or two days, soon after a rash made up of small raised red spots on the skin appear, the spots may turn in to grey blisters

What are the symptoms of slapped cheek syndrome?

Bright red rash on the cheeks, temperature, sore throat, runny nose and headache

What is the treatment for ACUTE non-complicated falciparum malaria?

Artemether with lumefantime

Which aminoglycoside is used for endocarditis?If it is resistant to this, what is an alternative aminoglycoside?

Gentamicin plus another antibiotic Streptomycin = alternative if resistant to gentamicin

What would you treat gonorrhoea with?

1st line: If susceptibility unknown: IM ceftriaxone. If micro-organism sensitive to ciprofloxacin: oral ciprofloxacin. Alternatives due to allergy, needle phobia or contra-indications: IM gentamicin + oral azithromycin.If parenteral administration not possible: oral cefixime [unlicensed] + oral azithromycin.(Only way left to FIX it Aha)

What would you use to treat gonorrhoea?If the IM route is not possible, what would you use instead?

1. If unknown species IM 1g ceftriaxone 2. If sensitive to cipro, oral ciprfloxacin 500mg 3. Alternative for allergy, contraindication or needle phobia IM Gentamicin + oral Azithromycin 4. If IM route not possible oral Cefixime+ Azithromycin

Which antibiotic(s) can be used in a patient who has had an anaphylactic reaction to penicillin? a) Cefuroxime b)Meropenem c) Gentamicin d) Ciprofloxacin e) Clarithromycin f) All of the above

Ciprofloxacin Gentamicin Clarithromycin

Which of the following is NOT a current example of clinically important antibiotic resistance? a. Meticillin resistant Staphylococcus aureusb. b. Penicillin resistant Streptococcus pyogenes (Group A Strep) c. Fluoroquinolone resistant P. aeruginosad. d. Vancomycin resistant Enterococci

BThe producer Streptomyces species, despite being Gram-positive, = highly resistant to penicillins, which is due to either overproduction of PBPs or synthesis of low-affinity PBPs. Naturally resistant.

Which of the following conditions should generally be treated with antibiotic therapy in patients who are not immunosuppressed and not pregnant? a. Acute bronchitisb. b. Asymptomatic urinary tract infection c. Cellulitis d. All of the above

C cellulitis

Which of the following is NOT a way that a bacterium can acquire antibiotic resistance ?. Acquiring resistance gene from its host’s cellsb. On its own through evolutionc. From its parent celld. Scavenging resistance genes from the environmente. Exchanging DNA with another bacterium

A. Acquiring resistance gene from its host’s cells

Which of these antibiotics have useful clinical activity against Pseudomonas? a. Ciprofloxacin b. Co-amoxiclav c. Ceftazidime d. Cefotaxime

A and c

Which of these would be suitable to treat Gram positive cocci isolated from a blood culture? a. Flucloxacillin b. Vancomycin c. Ciprofloxacin d. Trimethoprim

A and b

Which of these conditions needing IV antibiotics could be referred to an out-patient parenteral antibiotic therapy (OPAT) team? a. Resolving cellulitis needing a further 7 days therapy b. An ESBL positive urinary tract infection c. Meningitis – from day 2 of therapy d. Osteomyelitis needing a further 6 weeks of treatment e. All of the above

ABD

Gentamicin dosing is based on actual body weight so obese patients will need a significantly higher dose than lean patientsT or F

False - based on ideal body weight

IV Flucloxacillin plus IV vancomycin is a useful combination to treat a patient with MRSA bacteraemiaT or F?

False – flucloxacillin = no purpose as by definition MRSA resistant to flucloxacillin

If a Pseudomonas infection is resistant to ciprofloxacin, parenteral treatment with an alternative drug is the only optionT or F

True – All other groups of antibiotics with activity against Pseudomonas species = only available parenterally. Treatment may involve 1 or more of following types of antibiotics: ceftazidime ciprofloxacin (Cipro) or levofloxacin gentamicin cefepime aztreonam carbapenem sticarcillin ureido penicillins

Clostridium difficile infection is sometimes treated with more than one antibiotic at the same timeT or F

Metronidazole Vancomycin Fidamoxacin True – Metronidazole plus vancomycin is a useful combination for serious cases

Extended spectrum beta-lactamase producing organisms (ESBLs) may be resistant to common antibiotics including those without with a beta-lactam ringed structureT or F

True

Trimethoprim x Methotrexate interaction can be fatalT or F

T even in low doses, can result in serious systemic toxicity characterized by pancytopenia, oral mucositis, and nephrotoxicity.

A concentration dependant kill is associated with penicillins T or F

False – Penicillin = time-dependent ABX & exerts optimal bactericidal effect when drug concentrations maintained above minimum inhibitory concentration (MIC) of the organism.

Out-patient parenteral antibiotic therapy (OPAT) using IV teicoplanin could be useful for treatment of some cases of osteomyelitis T or F Bonus: what is treatment for osteomyelitis

True – Where organism susceptible to teicoplanin, = useful for OPAT as it can be given once daily (or even three times a week) Osteomyelitis - OnlyFans fuR Cleaned Vaginas 1st line flucloxacillin Pen allergy: clindamycinMRSA: vancomycin+ consider adding fusidic acid OR rifampicin

Mr jones is a 54 year old man . He is one of your regular patients. He calls the pharmacy to request a delivery as his calves are swollen, red, warm to touch and very painful. His doctor has confirmed he has cellulitis and has sent his prescription to the pharmacy electronically. Mr Jones is allergic to penicillin. What antibiotic would be the most appropriate to treat his cellulitis? A. Flucloxacillin B. Clindamycin C. Vancomycin D. Phenoxymethylpenicillin E. Nitrofurantoin

B Clindamycin