Infections Flashcards
(193 cards)
1
Q
Symptoms of a UTI
A
Dysuria
Frequency
Urgency
Burning
Nocturia
2
Q
Symptoms of an upper UTI such as pyelonephritis?
A
Symptoms of a UTI plus sudden onset of:
- fever
- nausea and vomiting
- unilateral flank pain
3
Q
First line empirical treatment for pyelonephritis:
A
Cefalexin 500mg BD-TDS for 7-10 days.
4
Q
Alternative antibiotics for pyelonephritis:
A
- Ciprofloxacin 500mg BD, 7 days.
If indicated by C&S:
- Co-amoxiclav 500/125mg TDS, 7-10 days.
- Trimethoprim 200mg BD, 14 days.
5
Q
MHRA warning for fluoroquinolones?
A
Risk of tendinitis or muscle rupture. Report any signs of muscle aches, weakness, or joint pain and swelling. May also cause peripheral neuropathy and CNS effects.
6
Q
First line empiric UTI treatment:
A
Nitrofurantoin 100mg MR BD, 3 days
or
Trimethoprim 200mg BD, 3 days.
7
Q
Second-line empiric UTI treatment:
A
- Nitrofurantoin 100 mg MR BD, 3 days (if not used first-line).
- Pivmecillinam 400 mg, then 200 mg TDS, total 3 days.
- Fosfomycin 3 g single dose sachet.
8
Q
Red flag UTI symptom
A
Haematuria which persists or recurs following successful treatment of UTI - may indicate urological cancer.
9
Q
Recurrent UTI treatment
A
1st line: Trimethoprim 100mg ON or Nitrofurantoin 50-100mg ON.
2nd line: Amoxicillin 250mg ON or Cefalexin 125mg ON.
Can also consider methenamine hippurate (urinary antiseptic)
10
Q
Treatment of catheter associated UTI
A
First-line:
- Nitrofurantoin 100 mg MR BD, 7 days
or
Trimethoprim 200 mg BD for 7 days
or
Amoxicillin 500 mg TDS, 7 days (only if urine culture results show susceptibility).
Second-line:
Pivmecillinam 400 mg initial dose, then 200 mg TDS for a total of 7 days.
11
Q
Which antibiotics for UTI can be used in pregnancy?
A
1st: Nitrofurantoin (not in 3rd trimester)
2nd: Amoxicillin or Cefalexin.
12
Q
Meningitis red flag symptoms
A
- Fever
- Headache
- Neck stiffness
- Altered consciousness and cognition
- Non-blanching rash
- Pale mottled skin or cyanosis
- photophobia
In babies:
- bulging fontanelle
- irritability
- lethargy
- grunting
- weak, high-pitched continuous cry
13
Q
First line treatment of meningitis:
A
IV or IM benzylpenicillin
- 1-11 months: 300mg
- 1-9 years: 600mg
- >9 1200mg
+
IV or IM ceftriaxone
- 1 month -11 years (<50kg) 80mg/kg IM
- >9 years (>50kg): 2g
Amoxicillin if listeria monocytogenes found as causative agent.
14
Q
Name some notifiable diseases in the UK?
A
Encephalitis
Ifectious hepatitis
Meningitis
Poliomyelitis
Anthrax
Botulism
Cholera
COVID-19
Diptheria
Typhoid
Infectious bloody diarrhoea
Group A strep
Leprosy
Malaria
Measles
Meningitis
Mpox/monkey pox
Mumps
Plague
Rabies
Rubella
SARS
Scarlet fever
Smallpox
Tetanus
TB
Typhus
Whooping cough
Yellow fever
15
Q
Treatment of active TB
A
Initial phase (2 months):
- Rifampicin
- Isoniazid (with pyridoxine)
- Pyrazinamide
-Ethambutol
Continuation phase (6 months total):
- Rifampicin
- Isoniazid (with pyridoxine)
16
Q
Treatment of latent TB
A
3 months Isoniazid (with pyridoxine) and rifampicin.
If high risk of drug interactions or hepatotoxicity: Isoniazid alone for 6 months
17
Q
Treatment of cellulitis
A
1st line:
- Flucloxacillin 0.5-1g 5-7 days
Penicillin allergy:
- Clarithromycin 500mg BD 5-7 days
OR
- Doxycyline 200mg, then 100mg OD, 5-7 days
Pen allergy + Pregnancy:
- Erythromycin 500mg QDS 5-7 days
18
Q
Treatment of cellulitis near the eyes or nose:
A
1st line:
- Co-amoxiclav 625mg TDS 3 days
Penicillin allergy:
- Clarithromycin 500mg BD 7 days + Metronidazole 400mg TDS 7 days
19
Q
Endocarditis empiric treatment
A
Native valve: Amoxicillin or vancomycin (+ low-dose gentamicin)
Prosthetic valve: vancomycin + rifampicin + low-dose gentamicin
20
Q
Gastroenteritis symptoms
A
- Sudden onset diarrhoea
- Nausea and vomiting
- Fever
- Abdominal pain and cramps
21
Q
Gastroenteritis treatment
A
Generally, encourage hydration and general hygeine, and advise against use of anti-diarrhoeal agents, anti-emetics, probiotics, or fatty spicy diet. Avoid swimming for 2 weeks.
Only use abx treatment if stool sample indicates:
- Campylobacter (severe): clarithromycin 250-500mg BD 5-7 days.
- Amoebas: Metronidazole + diloxanide.
- E. coli: N/A monitor for HUS.
- Giardia: metronidazole 2g OD for 3 days or 400mg TDS for 5 days.
- Salmonella: N/A
22
Q
Impetigo symptoms
A
Non-bullous: thin pustules that rupture and form a golden brown crust.
Bullous: fluid-filled blisters which rupture to leave a thin, flat, yellow-brown crust.
23
Q
Treatment of uncomplicated or localised non-bullous impetigo:
A
First line: Hydrogen peroxide 1% cream
Second line: Fusidic acid cream
Third line: Mupirocin
24
Q
Treatment of bullous impetigo, or complicated/widespread non-bullous impetigo:
A
Widespread non-bullousbullous topical: fusidic acid or mupirocin 2%
Bullous/widespread non-bulous oral:
1st line: PO flucloxacillin
2nd line: PO clarithromycin
Pregnancy: PO erythromycin
25
Severe cellulitis treatment
Any of:
- PO/IV co-amoxiclav
- PO/IV clindamycin
- IV cefuroxime
- IV ceftriaxone
If MRSA suspected, add IV vancomycin, teicoplanin, or po linezolid.
26
Prophylaxis or treatment of an infected animal or human bite:
Oral:
- 1st line: co-amoxiclav
- 2nd line: doxycycline + metronidazole.
IV:
- 1st line: co-amoxiclav
- 2nd line: metronidazole + either ceftriaxone or cefuroxime.
27
Infected eczema treatment
1st line: fusidic acid cream.
2nd line: po flucloxacillin.
3rd line: po clarithromycin or erythromycin in pregnancy.
28
Mastitis treatment:
Continue to breast-feed/express milk. If mastitis severe, systemically unwell, or do not improve after 12-24h:
1st line Flucloxacillin 10-14 days.
2nd line: Erythromycin 10-14 days.
29
Otitis media treatment:
1st line: amoxicillin
2nd line (after 2-3 days): co-amoxiclav
Penicillin allergy:
Clarithromycin or erythromycin in pregnancy.
30
Bronchiectasis symptoms
Bronchiectasis is a persistent or progressive condition caused by chronic inflammatory damage to the airways and is characterised by thick-walled, dilated bronchi.
Symptoms: intermittent expectoration and infection, to chronic cough, persistent daily production of sputum, bacterial colonisation, and recurrent infections.
Acute exacerbation: worsening local symptpoms, wheeze, SOB, fever.
31
IE of bronchiectasis treatment:
Mild-moderate (oral):
1. Amoxicillin, clarithromycin, or doxycyline.
2. Co-amoxiclav or levofloxacin.
Severe (IV):
Co-amoxiclav, Pip/taz, or levofloxacin.
32
IECOPD treatment:
Mild-moderate (oral):
1. Amoxicillin, clarithromycin, or doxycyline.
2. Co-amoxiclav, co-trimoxazole, or levofloxacin.
Severe (IV):
Amoxicillin, co-amoxiclav, clarithromycin, Pip/taz, or co-trimoxaxole.
Specialist
33
CAP treatment:
CURB65 low-moderate severity:
1. Amoxicillin po
2. Clarithromycin, doxycycline, or erythromycin po.
CURB65 high severity:
1. IV/PO co-amoxiclav + either clarithromycin or po erythromycin
2. Levofloxacin IV
34
Pneumonia symptoms
Cough
Chest pain
Dyspnoea
Fever
Crackles (sound)
Shadows on CXR
35
CAP vs HAP
Pneumonia is classified as hospital-acquired when it develops 48 hours or more after hospital admission.
36
HAP treatment
Non-severe signs or symptoms and not at higher risk of resistance (oral):
1. Co-amoxiclav.
2. doxycycline, cefalexin, co-trimoxazole [unlicensed use], or levofloxacin.
Severe signs or symptoms or at higher risk of resistance (IV):
1. Pip/taz, ceftazidime, ceftazidime with avibactam, ceftriaxone, cefuroxime, meropenem, or levofloxacin.
2. MRSA: + vancomycin, teicoplanin, or linezolid.
37
Sepsis symptoms
CRUSHT:
Confusion
RR >25bpm
(No) Urine output in 12-18h
Skin mottled or cyanosed
HR > 140
Temp >38 or <36
38
Sepsis 6 rapid response to suspected sepsis:
BUFALO:
Blood cultures
Urine output (hourly)
Full blood count and other bloods
Antibiotics (IV broad spectrum)
Lactate measurment
Oxygen therapy (maintain >94%)
39
Duration of human/animal bite prophylactic abx
3 days
40
Duration of human/animal bite abx treatment
5 days
41
Abx treatment of animal scratch
Flucloxacillin
42
Antibiotic treatment pathway for tick bite / Lyme Disease
1. Doxycycline 100mg BD or 200mg OD
2. Amoxicillin 1g TDS
21 day course
43
Classification of diabetic foot infections
Mild: <2cm
Moderate/severe: >2cm or presence of abscess or osteomyelitis
44
First line treatment of mild diabetic foot infection.
1. Flucloxacillin
2. Penicillin allergy: clarithrimycin or doxycyline
3. Pregnancy; Erythromycin
45
Antibiotic treatment of moderate or severe diabetic foot infection
1. Flucloxacillin +/-gentamicin +/- metronidazole OR Co-amoxiclav +/- gentamicin
2. (allergy) Co-trimoxazole +/-gentamicin +/- metronidazole
46
Treatment of C. diff
10 days:
1. Vancomycin
2. Fidaxomicin
* Severe/life threatening: Vancomycin + IV metronidazole
47
Relief of traveller's diarrhoea
Loperamide and bismuth subsalicylate (pepto-bismol) can be used for relief of mild-to-moderate diarrhoea for max 2 days.
High risk travellers should carry standby ciprofloxacin treatment.
48
Treatment of otitis media
* First line: amoxicillin
* If symptoms worsen despite 2-3 days treatment: co-amoxiclav
* Penicillin allergic: Clarithromycin
* Pen allergic + pregnancy: Erythromycin
Or: phenazone + lidocaine ear drops
49
Treatment of otitis externa
1. Topical acetic acid 2%
2. Topical neomycin sulphate with corticosteroid (e.g., hydrocortisone)
3. Po flucloxacillin
If pseudomonas suspected: ciprofloxacin or aminoglycoside
50
When can't a Urea 13C breath test or stool antigen test be performed?
* Within 2 weeks of using a PPI
* Within 4 weeks of using antibiotics.
51
Treatment of H. pylori infection
Triple therapy:
1 PPI e.g., omeprazole, lansoprazole
PLUS 2 of:
* Amoxicillin 1g BD (1st choice unless allergic)
* Metronidazole 400mg BD
* Clarithromycin 500mg BD
52
Treatment of HAP in children
Non-severe signs or symptoms and not at higher risk of resistance (oral):
1. Co-amoxiclav.
2. Clarithromycin
Severe signs or symptoms or at higher risk of resistance (IV):
1. Pip/taz, ceftazidime, ceftazidime with avibactam, ceftriaxone.
2. MRSA: + vancomycin, teicoplanin, or linezolid.
53
What is the treatment duration of UTI antibiotics?
Uncomplicated UTI in women: 3 days
Men/Pregnancy/Catheter-associated: 7 days
54
What is the causative organism of scarlet fever and strep throat?
Streptococcus
55
Treatment of strep throat
1. Phenoxymethylpenicillin
2. Clarithromycin / erythromycin (pregnancy)
56
Treatment of scarlet fever
1. Phenoxymethylpenicillin
2. Amoxicillin or Azithromycin
57
Symptoms of scarlet fever
* Fever and flu-like symptoms
* Swollen neck glands
* Red rash with small raised bumps which feels rough/like sandpaper
* White coating on tongue/strawberry tongue
58
Treatment of acne vulgaris
Mild-moderate:
* Topical benzoyl peroxide + clindamycin
Moderate-severe:
* Topical Adapalene (a retinoid) + Benzoyl peroxide (antiseptic) + po lymecycline or doxycyline
* Topical azelaic acid + lymecycline or doxycyline
Any severity:
- Topical Adapalene (a retinoid) + Benzoyl peroxide (antiseptic)
- Topical tretinoin + po clindamycin
59
Treatment of bacterial vaginosis and trichomoniasis
Metronidazole
60
Treatment of chlamydia
Doxycycline
61
Treatment of conjuncitivitis
Chloramphenicol 0.5% drops (1 drop 2hrly for 48h then 3-4x/24h) or 1% ointment (3-4x/24h)
Fusidic acid 1% eye drops: 1 BD
To be used until 48h after infection has cleared
62
Treatment of blepharitis
Chloramphenicol 0.5% drops (1 drop 2hrly for 48h then 3-4x/24h) or 1% ointment (3-4x/24h)
63
Exclusions for OTC chloramphenicol
* <2
* Pregnancy
64
Treatment of dental abscess
1. Amoxicillin or phenoxymethylpenicillin
2. Metronidazole or clarithromcyin
+ paracetamol / NSAIDs
65
Treatment of gonorrhoea
1st line options:
* Ceftriaxone
* Ciprofloxacin
66
Treatment of scabies
Permethrin 5% cream
67
How to apply permethrin?
Apply twice, 1 week apart. Ensure entire family is treated, and avoid physical contact with others.
>2 years: apply to entire body from the neck down, particularly between fingers/toes, under nails, to wrists, armpits, genitalia, breasts, and buttocks.
2 months-2 years AND elderly: also include neck, face, ears, and scalp, avoiding sensitive skin around the eyes.
Wash off after 8-12 hours. If hands are washed in this time, reapply cream.
Ensure skin is cool and dry before applying, and wait for cream to dry before dressing.
68
Treatment of sinusitis
* Phenoxymethylpenicillin
* Allergy: doxycyline
69
Treatment of threadworm
Mebendazole, 1 tablet then another 2 weeks later.
70
Most common causative pathogen for CAP
Streptococcus pneumoniae
71
Most common causative pathogen of a UTI
Escherichia coli
72
Most common causative pathogen of thrush
Candida Albicans
73
Most common causative pathogen of cellulitis
Staphylococcus aureus
74
Most common causative pathogen of meningitis
Streptococcus pneumoniae
75
Name 5 aminoglycosides
* Amikacin
* Gentamicin
* Neomycin
* Streptomycin
* Tobramycin
76
When are once-daily dosing regimens of aminoglycosides not preferred?
* Endocarditis
* Burns covering >20% of body
* CrCl <20ml/min
* Pregnancy
77
Monitoring for multiple-daily dose regimen of aminoglycosides
After 3-4 doses, then every 3 days or after a dose change. Take a trough (pre-dose) and peak (1 hour post dose) level:
* Peak: 5-10mg/L (3-5mg/L in endocarditis)
* Trough: <2mg/L (<1mg/L in endocarditis)
Lower peak levels for endocarditis as it is often used with other abx.
78
How do you adjust aminoglycoside regimen if trough level is too high?
Increase dose interval
79
How do you adjust aminoglycoside regimen if peak level is too high?
Reduce dose
80
Aminoglycoside interactions
Ototoxicity
- Cisplatin
* Loop diuretics
* Vancomycin
* Vinca alkaloids
Nephrotoxicty
* NSAIDs
* ACEis
81
Aminoglycosides considerations
* Myasthenia Gravism - contraindicated
* Pregnancy - risk of auditory or vestibular nerve damage - monitor serum concentrations closely.
* Obesity - use IBW to calculate parenteral dose
82
Name the 3 1st gen cephalosporins
Cefadroxil
Cefalezin
Cefradine
| Fad Fal Frad
83
Name the 3 2nd gen cephalosporins
Cefuroxime
Cefoxitin
Cefaclor
| Furry Fox Face
84
What is the only oral cephalosporin from the later generations (3rd-5th)
Cefixime
85
OTC age for chloramphenicol
2+
86
Considerations for chloramphenicol
Avoid in pregnancy due to risk of "grey-baby syndrome" if used in 3rd trimester.
87
Considerations for clindamycin
* Antibiotic-associated colitis (can be fatal) - contact if severe/prolonged/bloody
* C. diff
In both cases, discontinue immediately and more common in elderly patients.
88
Name 4 glycopeptides
* Vancomycin
* Teicoplanin
* Telavancin
* Dalbavancin
89
Glycopeptides adverse effects
* Ototoxicity
* Nephrotoxicity
* Red-man syndrome
* Severe skin reactions - Steven Johnson Syndrome
* Blood dyscrasias e.g., neutropenia, agranulocytosis
* Cardiogenic / hypotensive shock on rapid IV injection
* Risk of anaphylactoid reactions at infusion site e.g., pain, thrombophlebitis - avoid rapid infusion and rotate site.
90
Linezolid adverse effects
* Peripheral and optic neuropathy - report visual impairment or numbness/tingling. Monitored regularly if treatment >28 days.
* Blood disorders/myelosuppression - monitor FBC baseline and weekly. Monitored regularly if treatment >10-14 days or in renal impairment.
* Interacts with tyramine-rich foods e.g., mature cheese, marmite.
* Can cause serotonin syndrome - avoid interactions.
91
Name 3 macrolides
Azithromycin
Clarithromycin
Erythromycin
92
Macrolides adverse effects
* Hepatotoxicity
* Ototoxicity
* QT prolongation and hypokalaemia
* High risk of GI disturbance
* Exacerbation of myasthenia gravis
93
Metronidazole adverse effects
* Taste disturbance - mettalic taste and furry tongue
* Nausea and vomiting - take with food.
* Diarrhoea
* Disulfiram-like reactin if taken with alcohol - avoid until 48h course finished.
94
Nitrofurantoin considerations
* Avoid in 3rd trimester of pregnancy (neonatal haemolysis)
* Avoid if eGFR <45
* Take with food to reduce nausea and vomiting
* May discolour urine yellow or brown.
* MHRA warning: risk of acute pulmonary reactions and in first week of treatment and respiratory failure. Risk of hepatic dysfinction with long-term therapy.
95
Name the 3 narrow spectrum penicillins
* Penicillin G aka Benzylpenicillin
* Penicillin V aka Phenoxymethylpenicillin
* Flucloxacillin
96
Name 4 broad spectrum penicillins
Ampicillin
Amoxicillin (+/- clavulanic acid)
Piperacillin (+tazobactam)
Ticarcillin (+ clavulanic acid)
97
Why should broad-spectrum antibiotics not be given blindly for a sore throat?
If the symptoms are caused by glandular fever, taking penicillin may cause a maculopapular rash in these patients which mimics a penicillin allergy, but is not a sign of a true penicillin allergy.
98
Flucloxacillin considerations
* Take on an empty stomach
* Can cause cholestatic jaundice and hepatitis upto 2 months after treatment - avoid administration >2 weeks.
99
Name 2 antipseudomonal penicillins
* Piperacillin (only available with tazobactam)
* Ticarcillin (only available clavulanic acid)
100
Why should penicillins not be given intrathecally?
Can cause fatal encephalopathy
101
What is the difference between a true penicillin allergy and a minor reaction?
* True allergy - immediate rash followed by anaphylaxis.
* May not be allergy - minor, small, non-itchy rash, or one which appears after 72h.
102
Name 5 quinolones
* Ciprofloxacin
* Delafloxacin
* Levofloxacin
* Moxifloxacin
* Ofloxacin
103
Considerations for quinolones
* Should not be used unless there is no other option
* Lower seziure threshold - avoid in epilepsy and do not concurrently use NSAIDs
* Psychiatric disordes and suicidal thoughts
* Tendonitis!!!!!!! - stop and report muscle aches or weakness - irreversible damage. can occur in first 48h.
* Hypersensitivity
* Photosensitivity
* QT prolongation
* Can exacerbate myasthenia gravis
* Risk of heart valve regurgitation - seek attention if experiences SOB, heart palpitations, oedema.
* RIsk of aortic aneurysm and dissection - seek attention if sudden onset severe abdo, chest, or back pain.
* Reduced absorption if taken with dairy products, mineral-fortified drinks, Iron, zinc, or antacids (Ca, Al, Mg).
* CI in pregnancy - arthopathy (joint diseases e.g., arthritis)
* CI in breastfeeding - articular damage
* Can affect blood glucose so avoid in diabetes
104
Cautions for use of quinolones
* QT prolongation
* Myasthenia gravis
* Arthropathy in <18s
* Perforated tympanic membrane (if used topically to ear)
105
Name 7 tetracycines
* Doxycyline
* Demeclocycline
* Lymecycline
* Minocycline
* Oxytetracycline
* Tetracycline
* Tigecycline
106
How to take tetracyclines? What's the exception to this?
Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2h before or after these medicines.
Doxycycline, Lymecycline, and Minocycline (DLM - does like milk) can be taken with milk.
107
Adverse effects of tetracyclines
* Teeth discolouration and bone deposit - contraindicated in children <12 or pregnancy
* Hepatotoxic - avoid in liver failure
* Photosensitivity
* Dysphagia - have a whole glass of water and don't take lying down.
* Benign intracranial hypertension - headache and visual disturbance stop and report.
* Lupus-erythematosis-like syndrome and irreversible pigmentation - highest risk with minocycline.
* Can exacerbate myasthenia gravis
108
Trimethoprim considerations
* Antifolate - avoid in pregnancy and with concurrent use with other antifolates e.g., MTX, phenytoin.
* Can cause blood dyscrasias - with long-term treatment, measure FBC and report fever, sore throat, rash, mouth ulcers, bruising, bleeding.
* Can cause hyperkalaemia & hyponatraemia
* Can cause renal impairment
109
Are glycopeptides narrow or broad spectrum?
Narrow spectrum
110
Is trimethoprim narrow or broad spectrum?
Narrow spectrum
111
Is linezolid narrow or broad spectrum?
Narrow spectrum
112
Is clindamycin narrow or broad spectrum?
Narrow spectrum
113
Is chloramphenicol narrow or broad spectrum?
Broad spectrum
114
Is amoxicillin narrow or broad spectrum?
Broad spectrum
115
Is ampicillin narrow or broad spectrum?
Broad spectrum
116
Is nitrofurantoin narrow or broad spectrum?
Broad spectrum
117
Are aminoglycosides narrow or broad spectrum?
Broad spectrum
118
Are tetracyclines narrow or broad spectrum?
Broad spectrum
119
Are cephalosporins narrow or broad spectrum?
Broad spectrum
120
Are quinolones narrow or broad spectrum?
Broad spectrum
121
Which antibiotics are narrow spectrum?
PG TLC
* Penicillins (benzyl and phenoxymethyl)
* Glycopeptides
* Trimethoprim
* Linezolid
* Clindamycin
| Less side effects - more PG and just requires TLC
122
Which antibiotics are broad spectrum?
CAPTN MCQ
* Chloramphenicol
* Aminoglycosides
* Penicillins (amoxicillin + ampicillin)
* Tetracycline
* Nitrofurantoin
* Macrolides
* Cephalosporins
* Quinolones
| So many, they require a captain/leader.
123
Which antibiotics must be taken with/after food?
Metronidazole
Erythromycin
Nitrofurantoin
Clatirhromycin MR
Pivemecillinam
Trimethoprim
Co-amoxiclav
Doxycyline
| Must Eat Now, Clara's Pad Thai Can Do
124
Which antibiotics need to be taken on an empty stomach?
DROPFAT
- Demeclocycline
- Rifampicin
- Oxytetracycline
- Phenoxymethylpenicillin
- Flucloxacillin
- Ampicillin (+Azithromycin caps)
- Tetracycline
125
Which antibiotics should be avoided in myasthenia gravis?
* Quinolones
* Aminoglycosides
* Macrolides
* Tetracyclines
126
Which antibiotics are nephrotoxic?
* Nitrofurantoin
* Aminoglycosides
* Glycopeptides
* Tetracyclines
* Trimethoprim
127
Which antibiotics are hepatotoxic?
* Macrolides
* Flucloxacillin
* Co-amoxiclav
* Chloramphenicol
* Nitrofurantoin
* Tetracyclines
* Rifampicin, Isoniazid, Pyrazinamide (3/4 TB meds)
128
Considerations for TB treatment
* Pts aged 35-65 should be checked for hepatoxicity before (rifampicin, isoniazid, pyrazinamde can be hepatotoxic)
* Rifampicin colours body fluids and contact lenses orange/red colour.
* Isoniazid can cause peripheral neuropathy so vit B6 (pyridoxine) is given alongside prophylactically.
* Ethambutol can cause visual impairment and ocular toxicity.
* Avoid CYP450 substrates - rifampicin = inducer, isoniazid - inhibitor.
129
Advise on anti-malaria bite protection
* Use mosquito nets impregnated with permethrin
* Use bug spray containing 20-50% DEET in anyone over 2 months (safe in pregnancy and breastfeeding (wash nipple before)).
* Apply DEET after sunscreen as DEET can reduce SPF of sunscreen.
130
How to take Atovaquone with Proguanil for malaria prophylaxis?
* 1-2 days before travel
* 1 daily throughout travel
* Take for 1 week after travel
* Maximum duration: 1 year
131
How to take Doxycycline for malaria prophylaxis?
* 1-2 days before travel
* 1 daily throughout travel
* Take for 4 weeks after travel
* Maximum duration: 2 years
132
How to take Mefloquine for malaria prophylaxis?
* Take for 2-3 weeks before travel
* Take once weekly throughout trip.
* Take for 4 weeks after trip.
* Maximum duration = 1 year
133
How to take Chloroquine for malaria prophylaxis?
* Take for a 1 week before travel
* Take once weekly throughout trip.
* Take for 4 weeks after trip.
* No maximum duration.
134
How to take Proguanil for malaria prophylaxis?
* Take for a 1 week before travel
* Take once a day throughout trip.
* Take for 4 weeks after trip.
* No maximum duration.
135
How long might malaria symptoms occur after exposure?
1 year, but especially within 3 months.
136
Which anti-malarials are licensed in pregnancy for prophylaxis?
Chloroquine
(Mefloquin can be given in 2nd or 3rd trimester in high risk areas)
| Ensure taking 5mg folic acid due to risk of neural tube defects
137
In which patient group must anti-malarials be taken 2-3 weeks before departure?
Patients taking warfarin:
- Measure INR before anti-malarial, 7 days after starting, and after completing course.
- INR should be stable before departure.
- If prolonged stay, check INR while away regularly.
138
Which anti-malarials should be avoided in epilepsy?
Chloroquine
Mefloquine
(reduced seizure threshold)
139
What is standby treatment?
In the case that a patient develops symptoms of malaria, and they cannot reach medical care within 24h of fever onset, they can self-medicate with standby emergency treatment.
Provide patients with the following written instructions:
"Seek urgent medical attention if fever 38C+ develops &+ days after arriving in malarious area. Self treat if medical help is not available within 24h of fever onset".
140
Treatment of aspergillosis
Voriconazole
141
Treatment of cryptococcosis
Amphotericin B
142
Treatment of vaginal thrush
Topical clotrimazole or oral fluconazole
Resistant: itraconazole
143
Treatment of oral thrush
* Nystatin, Miconazole, or Fluconazole
* Resistant: Itraconazole
144
What is tinea capitis?
Ringworm of the head
145
What is tinea corporis?
Ringworm of the body
146
What is tinea cruris?
Ringworm of the groin (Jock itch)
147
What is tinea pedia?
Ringworm of the foot (athlete's foot)
148
What is tinea unguim / onchomyosis?
Fungal infection of the nails
149
How are fungal skin infections treated?
Topical antifungal cream or terbinafine
150
How are fungal nail infections treated?
Use terbinafine or amorolfine nail lacquer once weekly for upto a year.
151
Fungal nail infection referral points
Can be treated OTC unless:
* <18
* >2 nails affected
* Diabetic
* Pregnant
* Breastfeeding
152
Antifungals side effects
- QT prolongation - ketoconazole, fluconazole, itraconazole, voriconazole.
- Hepatotoxicity - KETOCONAZOLE, fluconazole, itraconazole, voriconazole, terbinafine.
- Photosensitivity - voriconazole.
Note that ketoconazole oral treatment has been suspended due to life-threatening hepatotoxicity.
153
Considerations with using Amphotericin B.
* Risk of anaphylaxis with IV use - test dose given with 30 mins observation prior to treatment. Prophylactic antipyretics or hydrocortisone can be given in patients with previous reactions.
* Maintain same formulation - available as conventional, liposomal, and lipid-complex formulations. Switching between has caused serious harm and fatal overdose.
* Caution in renal function.
154
What virus causes chickenpox?
Varicella-zoster
155
When is antiviral treatment required for chickenpox?
In individuals aged 14+ within 24h of onset
156
Which virus causes shingles?
Herpes-zoster
157
Symptoms of shingles
Tingling, itching,burning fluid-filled blisters on one side of the body, usually around the rib cage.
158
Treatment options for COVID-19
* Oxygen: from low-flow O2 to mechanical ventilation.
* Corticosteroids: dexamethasone, hydrocortisone, prednisolone.
* Antivirals: remdesivir, molnupiravir, or nirmatrelvir +R ritonavir.
* Monoclonal antibodies: toclizumab, sotrovimab, baricitinib.
* LMWH for prevention of VTE.
159
What are the 3 main COVID-19 vaccines?
* Spikevax (Moderna)
* Comirnaty (Pfizer)
* Vaxzevria (astrazeneca) - not currently available. rare rports of thrombocytopenia and thrombosis.
160
What is the goal of HIV treatment?
Reduce viral load to a level that can't be detected with blood tests.
161
HIV treatment options
Triple therapy.
2 NRTIs (nucleoside reverse transcriptase inhibitor): abacavir, emtricitabine, lamivudine, tenofovir.
+ 1 of:
* NNRTI (Non-nucloside reverse transcriptase inhibitor)
* Protease inhibitor
* Integrase inhibitor
* Entry inhibitor
162
How can HIV be prevented if someone is exposed?
Rapid initiation of treatment for 28 days, within 72h of exposure (e.g., via sex, needles, bite)
163
What does CRB65 scores stand for?
1 point for:
* Confusion
* RR 30+
* BP <90/60mmHg
* Age 65+
164
What does CURB65 score stand for?
1 point for:
* Confusion
* Blood urea nitrogen >7mmol/L
* RR 30+
* BP <90/60mmHg
* Age 65+
165
Treatment of CAP
Low severity (CRB65 0/CURB65 0-1)
* Amoxicillin
* Doxycyline / Clarithromycin / Erythromycin (pregnancy)
Moderate severity (CRB65 1-2/CURB65 2)
* Same as above but if atypical pathogens suspected, first line is Amoxicillin + Clarithromycin (or erythromycin in pregnancy)
High severity (CRB65 3-4/CURB65 3-5)
* Co-amoxiclav
* + Clarithromycin (or erythromycin in pregnancy) if atypical pathogens suspected
* 2nd line: levofloxacin
166
HAP antibiotic treatment pathway
Non-severe:
* Co-amoxiclav
* Adults 2nd line: doxycyline/cefalexinco-trimox/levofloxacin
* Children 2nd line: clarithromycin
Severe:
* Piperacillin + tazobactam/ ceftazidime/ ceftriaxone/ cefurozime/ meropenem / ceftazidime + avibactam
* MRSA: add vancomycin + teicoplanin, or linezolid
167
Elgibility for po isotretinoin
* >12
* Severe acne that is resistant to standard systemic and topical therapy
* If <18, must be approved by 2 independent prescribers that there is no alternative
* PPP: Take contraception for 1 month before and till 1 month after
* Patient must be counselled on risks and benefits, including risk of mental health and sexual dysfunction
* Prescriber must have expertise in systemic retinoids.
* Patients must be reviewed F2F 1 month after treatment initiation.
* Contra-indicated in patients with peanuts or soya (capsule filling contains soya-bean oil)
* Monitor hepatic function and serum lipids before, after 1 month, and every 3 months.
168
Prescription rules for isotretinoin
Valid for 7 days from date on prescription.
Maximum of 30 days supply.
169
Oral isotretinoin side effects
* Teratogenic
* Neuropsychiatric reactions
* MHRA warning: low libido and ED
* Photosensitivity and epidermal stripping: avoid UV light, laser skin treatment during treatment, and dermabrasion and epilation during and for 6 months after.
* Visual disturbances
* Discontinue if skin peeling or bloody diarrhoea develops.
* Risk of pancreatitis if triglycerides >9mmol/l.
170
Treatment of bacterial vaginosis.
Oral or vaginal metronidazole
171
Treatment of chalmydia
1. Doxycyline
2. Azithromycin
172
Treatment of Gonorrhoea
Ceftriaxone or Ciprofloxacin
173
Treatment of chronic otitis externa
Fungal:
* clotrimazole 1% solution
* Clioquinol + corticosteroid drops
* Acetic acid 2% drops
Bacterial:
* Gentamicin or ciprofloxacin ear drops
* Systemic: flucloxacillin
Neither bacterial or fungal: prednisolone ear drops
174
Symptoms of malaria
* Fever
* Headache
* Fatigue
* D & V
* Abdo pain
* Sore throat and cough
* Confusion
175
Malaria medication cautions:
Mefloquine: risk of psychoatric disorders
Chloroquine: MHRA warning increased risk of CVD events when given with macrolides. And risk of psychiatric disorders.
Doxycyline: photosensitivity.
176
Aminoglycosides adverse effects
* Nephrotoxicity
* Ototoxicity
* Severe cutaneous adverse reactions (SCARs)
* Hypersensitivity: Stevens-Johnsons Syndrome
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Name 4 3rd generation cephalosporins
Cefotazidime
Cefixime
Ceftriaxone
Cefotaxime
| Taz Fixed Tria's tax
178
Name a 4th gen cephalosporin
Cefepime
179
Name 2 5th gen cephalosporins
Ceftaroline
Ceftobiprole
180
Systemic chloramphenicol adverse effects
Hypersensivity
Bone marrow depression
Avoid in pregnancy and breastfeeding: grey baby syndrome
181
Clindamycin adverse effects
* Hypersensitivity reactions e.g., Stevcen Johnson syndrome
* C. diff associated diarrhoea
Discontinue in both cases
182
Complications of severe C. diff
* Peritonitis - swelling and redness of peritoneum (lining of adbomen
* Shock
* Toxic megacolon (enlarged swollen colon which can perforate)
Can be fatal
183
Vancomycin monitoring
Measure serum levels on day 2 of treatment prior to dose.
Trough level: 15-20mg/L.
184
Which penicllins are sensitive and resistant to beta-lactamase?
Sensitive:
* Amoxicllin (alone)
* Ampicillin
* Benzylpenicillin (PenG)
* Phenoxymethylpenicillin (Pen V)
Resistant:
* Flucloxacillin
* Co-amoxiclav
* Piperacillin + taxobactam
* Ticarcillin + clavulanic acid
185
Which penicllins are sensitive and resistant to penicllinase?
Sensitive:
* Amoxicllin (+/- clavulanic acid)
* Ampicillin
* Benzylpenicillin (PenG)
* Phenoxymethylpenicillin (Pen V)
* Piperacillin + taxobactam
* Ticarcillin + clavulanic acid
Resistant:
* Flucloxacillin
186
General penicillins adverse effects
* GI - D &N &V
* May cause antibiotic-associated colitis (can be fatal) - contact if severe/prolonged/bloody
* Hypersensivity and skin reactions
187
Which penicillins can cause hepatitis and cholestatic jaundice?
Co-amoxiclav and flucloxacillin can cause these upto 2 months after treatment
188
General penicillin interactions
* Methotrexate (MTX) - reduced clearance leading to toxicity
* Warfarin - altered INR (monitor)
* Allopurinol - increased risk of allergic skin reactions
189
Which antibiotics are bacteriostatic?
Prevents bacterial growth:
Chloramphenicol
CLindamycin
Trimethoprim
Tetracyclines
Macrolides
Linezolid
| Can Cause Them To Multiply Less
190
Which antibiotics are bactericidal?
Kills bacteria:
Cephalosporins
Aminoglycosides
Metronidazole
Penicillins
Quinolones
Nitrofurantoin
Glycopeptides
| CAMPQuiNG - think rather die than go camping
191
Which antibiotics should be avoided in myasthenia gravis?
Contraindicated: aminoglycosides
Caution: quinolones, macrolides, tetracyclines
192
Nephrotoxic antibiotics
UTI meds: Nitrofurantoin & trimethoprim
Tetracyclines
Aminoglycosides
Glycopeptides
| UTAG
193
Hepatoxic antibitoics
Co-amoxiclav
Macrolide
Tetracyclines
TB Meds (3/4): rifampicin, isoniazid, pyrazinamide
Flucloxacillin
Nitrofurantoin
| Can't Metabolise The TB-meds Fully Now
