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Infection Flashcards

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1
Q

What antibiotics are not recommended in children?

A

Tetracyclines are CI in those under 12

Quinolones cause arthropathy

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2
Q

What antibiotics are not recommended in elderly?

A

The elderly are the most susceptible to C.difficile infections and have the greatest risk of developing it with Clindamycin

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3
Q

What antibiotics are not recommended in allergies?

A

Penicillin and Cephalosporins

Metronidazole for dental infections or macrolides

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4
Q

What antibiotics are not recommended in renal impairment?

A

Nephrotoxic - Aminoglycosides and Glycopeptide

Avoid tetracyclines except (Doxycycline and Minocycline) and Nitrofurantoin if eGFR <45mL/min

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5
Q

What antibiotics are not recommended in hepatic impairment?

A

RIP and teracyclines
Metronidazole if severe impairment
Co-amoxiclav and Flucloxacillin can cause cholestatic jaundice if used >14 days

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6
Q

What antibiotics are not recommended in pregancy?

A

Tetracyclines CI
Avoid MCAT (Metronidazole, Chloramphenicol, Aminoglycosides and Tetracyclines), Quinolones and Sulfonamides, and avoid Nitrofurantoin at term
Amoxicillin and Cephalosporins are safe

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7
Q

What side effects are associated with clindamycin?

A

Antibiotic associated colitis - can be fatal and must need to be reported

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8
Q

What side-effects are associated with trimethoprim and co-trimoxazole?

A

Trimethoprim - Blood dyscrasias, Hyperkalaemia and Anti-folate
Co-trimoxazole - SJS, toxic epidermalnecrolysis (similar to Lamotrigine)

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9
Q

What side effects are associated with chloramphenicol?

A

Blood dyscrasias and grey baby syndrome (avoid in pregnant women)

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10
Q

What indications can metronidazole be used in?

A

Metronidazole can be used in H.pylori, anaerobic dental infections, rosacea, antibiotic associated colitis, bacterial vaginosis and trichiomoniasis.

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11
Q

What side-effects can occur with metronidazole?

A

GI and taste disturbances, furred tongue and oral mucositis

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12
Q

What counselling should be given to patients taking metronidazole?

A

Take 1 tablet with or after food

Avoid alcohol for 48 hours after finishing the course

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13
Q

What side effects are associated with nitrofurantoin?

A

Nausea and peripheral neuropathy in those suffering from renal impairment

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14
Q

What counselling should be given to patients who take nitrofurantoin?

A

It should be taken with or after food

It may colour the urine yellow or brown

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15
Q

What are the indications for gentamicin?

A

Endocarditis, Complicated UTI, pyelonephritis and severe sepsis

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16
Q

Where are each of the 5 aminoglycosides indicated?

A

G-Gentamicin - for Psuedomonas aeruginosa
A- Amikacin - for gentamicin resistant Bacilli
N- Neomycin - parenterally toxic - for bowel cleanses
T- Tobramycin - inhaled for pseudomonas infections in CF
S- Streptomycin - reserved for mycobacterium for TB

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17
Q

Which two classes of antibiotics can gentamicin be given with as blind therapy?

A

Gentamicin + metronidazole or penicillin

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18
Q

When should gentamicin be avoided?

A

Gentamicin should be avoided in renal impairement <20ml/min and those suffering from gram positive endocarditis and HACEK bacteria

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19
Q

What is the peak concentration of gentamicin

a) For non-endocarditis
b) For endocarditis

A

a) 5-10mg/mL

b) 3-5mg/mL

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20
Q

What is the trough concentration of gentamicin

a) For non-endocarditis
b) For endocarditis

A

a) <2mg/mL

b) <1mg/mL

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21
Q

What are the side-effects of gentamicin?

A

Nephrotoxicity, neuromuscular transmission impairment, electrolyte disturbances (hypomagnesia, hypocalcaemia and hypokalaemia) and peripheral neuropathy

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22
Q

What drugs does gentamicin interact with?

A

Gentamicin can cause permanent ototoxicity with:
cisplatin and loop diuretics
It can also cause nephrotoxicity with ciclosporin, tacrolimus and vancomycin

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23
Q

What is vancomycin indicated for?

A

MRSA

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24
Q

Name three examples of glycopeptides

A

Vancomycin, teicoplanin and televancin (for HAP)

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25
How often are patients required to be monitored on vancomycin?
Patients are required to be monitored after every 3-4 doses or after a dose change
26
What are some of the indications for tetracyclines?
LRTIs, rosacea, acne, malaria and chlamydia
27
Which tetracycline can be used for both malaria and chlamydia?
Doxycycline
28
What side-effect is associated with tetracyclines and what should be done if this occurs?
Intercranial hypertension- the medication should be stopped
29
What are the counselling points for tetracyclines?
DOT- NO milk DLM- milk DD- avoid sunlight DMT- take whilst upright with a full glass of water
30
What are the indications for quinolones?
LRTIs and UTIs
31
What are the SEs of quinolones?
STAQ
32
What interactions occur with quinolones?
Seizure threshold - MAST QT NSAIDs+ Quinolones -> can cause seizures QT inerval prolongation -MASTAQ
33
What counselling needs to be given to patients on quinolones?
Ciprofloxacin + Norfloxacin -> avoid milk and indigestion remedies Ofloxacin -> Avoid sunlight Others -> Avoid antacids Potential impaired driving
34
What are the indications for macrolides?
H.pylori, RTIs and skin and soft tissue infection
35
What are the side effects of macrolides?
G- GI H- Hepatotoxicity O- Ototoxicity at high doses Q- QT interval prolongation
36
What interactions occur with macrolides?
Warfarin- bleeding risk Statins - myopathy Digoxin - CRASED
37
What are examples of narrow spectrum Beta-lactamase sensitive antibiotics?
Phenoxymethylpenicillin or Benzylpenicillin
38
What are examples of broad spectrum Beta-lactamase sensitive antibiotics?
Ampicillin | Amoxicillin
39
What are examples of Penicillinase resistant antibiotics?
Flucloxacillin
40
What are examples of antipseudomonal antibiotics?
Piperacillin + Tazobactam or Ticaricillin + Clavulinic acid
41
What are the possible outcomes for a possible penicillin allergy?
1) True allergy - anaphylaxis, urticaria -> do not give any cephalosporins, carbapenems, penicillins or cephalosporins 2) Mild rash - may take up to 72 hours for it to appear
42
Which route should penicillin not be administered and why?
Intrathecal route- can cause encephalopathy and may be fatal
43
What are the complication(s) that may arise from broad-spectrum antibiotics such as ampicillin and amoxicillin?
Can cause a maculopapular rash in glandular fever and can also cause antibiotic-associated colitis
44
Where are narrow spectrum lactam sensitive antibiotics used?
Benzylpenicillin -> Meningitis (IV only as not gastrostable) Phenoxymethylpenicillin -> Streptococci induced sore throat
45
Where are penicillinase-resistant antibiotics used?
Penicillinase-resistant antibiotics such as flucloxacillin are used in skin conditions such as impetigo and cellulitis for pathogens that are penicillin resistant
46
What is the dose of flucloxacillin? What side-effect can it cause?
xmg QDS before food. It can cause cholestatic jaundice if used for more than 14 days
47
What are the treatments for psuedomonal bacteria?
Piperacillin and Tazobactam or Ticaricillin with Clavulanic acid
48
When are cephalosporins not used?
Cephalosporins should not be used if a patient has immediate penicillin hypersensitivity
49
Which antibiotics cause C.difficile colitis?
Ampicillin, Amoxicillin, Co-amoxiclav, 2nd and 3rd gen cephalosporins, quinolones, and clindamycin
50
What can be used to treat C.difficile colitis?
Metronidazole for 10-14 days. | If this does not help then oral vancomycin or fidaxomicin
51
What can be used to treat endocarditis?
Amoxicillin +/- low dose gentamicin Strep = Benzylpenicillin Staph = Flucloxacillin MRSA = Vancomycin
52
What can be used to treat CAP?
Mild CAP - Amox/Clarithro/Doxy Moderate CAP - Amox + Clarithro or Doxy Severe - Benzylpenicillin + Doxy or Clarithro Add fluclox or vanco
53
What can be used to treat HAP?
<5 days or early onset HAP - Cefuroxime or Co-amoxiclav >5 days or severe - broad spectrum cephalo or antipseudomonal penicillin or quinolone Add vanco or genta
54
What can be used to treat meningitis?
Treatment for meningitis includes- Benzylpenicillin If penicillin allergic, then cefotaxime If immediate penicillin allergy then chloramphenicol
55
What can be used to treat osteomyelitis?
Flucloxacillin or Clindamycin if penicillin allergic
56
What can be used to treat impetigo?
If a small area, fusidic acid. If it is a large area, it is flucloxacillin
57
What can be used to treat cellulitis?
Flucloxacillin
58
What can be used to treat animal bites?
Co-amoxiclav or Doxycycline and Metronidazole
59
What can be used to treat MRSA?
Tetracycline, Clindamycin or Vancomycin or Linazolid if very severe
60
What is Linezolid, indications, SEs and interactions?
Linezolid is a MAOi, an alternative option for MRSA. It can cause blood dyscrasias and occular neuropathy if used for more than 28 days. It interacts with sympathomimetics causing a hypertensive crisis
61
What can be used for streptococcal sore throats?
Pen V or if severe, then initiate with Benzylpenicillin
62
What can be used for sinusitis?
Amox/Clarithro/Doxy
63
What can be used for otitis externa?
Fluclox or Clarithromycin if penicillin allergic
64
What can be used for otitis media?
Amox or Clarithromycin if penicillin allergic
65
Name some antifungals
Voriconazole Itraconazole Ketoconazole Amphoterecin B
66
Name some side-effects associated with these antifungals
Voriconazole - can cause skin cancer - avoid direct sunlight or lamps . Patients should carry an alert card Itraconazole - interaction with antacids. It can cause heart failure and is hepatotoxic Ketoconazole - fatal hepatotoxicity Amphoterecin B - must be given by brand as bioavailability differs
67
What can be used to treat: Oral thrush? Vaginal thrush?
Oral thrush - nystatin or miconazole | Vaginal thrush - clotrimazole or fluconazole
68
What can be used for tinea infections?
Miconazole, Clotrimazole or Terbinafine
69
What can be used for nail infections?
Amorolfine nail lacquer
70
What can be done to prevent mosquito bites?
DEET - after sunscreen Permethrin coated nets Cover up with long sleeve clothing after dusk
71
What can be used for malaria prophylaxis?
``` Doxycycline Atovaquone and Proguanil Chloroquine and Proguanil Chloroquine Mefloquine ```
72
``` Which malaria prophylaxis should be given in: Epilepsy Renal Impairment Pregnancy Warfarin ```
Epilepsy - avoid mefloquine and chloroquine Renal Impairment - Doxycycline and Mefloquine Pregnancy - Chloroquine and proguanil - give 5mg folic acid with proguanil Warfarin - take prophylaxis 2-3 weeks before, have INR stabilised prior departure
73
``` What is the treatment regime for: Doxycycline Malarone Chloroquine and proguanil Mefloquine Chloroquine ```
Doxycycline - 1-2 days before, 4 weeks after - daily Malarone - 1-2 days before, 1 week after - daily Chloroquine and proguanil - 1 week before, 4 weeks after Mefloquine - 2-3 weeks before, 4 weeks after - weekly Chloroquine - 1 week before, 4 weeks after - weekly
74
What is the standby treatment for malaria?
Quinine

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