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Victor BNF Notes > Infections Part 1 > Flashcards

Infections Part 1 Flashcards

1
Q

Principles of Antimicrobial Stewardship

A
  • Do not treat viral infection with antibiotics
  • avoid blind prescribing
  • narrow spectrum antibiotics preferred, unless serious infection
  • avoid long course and complete course
  • follow prescribing guidelines
  • dose varies according to patient factors
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2
Q

Patient factors that need attention when prescribing antibiotics

A
  • Age
  • Allergies
  • Renal Impairment
  • Hepatic Impairment
  • Pregnancy
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3
Q

Patient needs in Antibiotic prescribing:
Children

A
  • Tetracyclines contraindicated in under 12
  • Quinolones cause arthropathy, so avoid
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4
Q

Patient needs in Antibiotic prescribing:
Elderly

A
  • Increased risk of Clostridium Difficile infection; Clindamycin has highest risk
  • Be aware of renal/liver impairment and drug interactions
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5
Q

Patient needs in Antibiotic prescribing:
Allergies

A

Penicillin-allergic = cross sensitivity with Cephalosporins and other B-lactam antibiotics

Alternatives to penicillin:
- Macrolides
- Metronidazole (dental)

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6
Q

Patient needs in Antibiotic prescribing:
Renal Impairment

A
  • avoid tetracyclines
  • avoid Nitrofurantoin if eGFR <45
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7
Q

Patient needs in Antibiotic prescribing:
Hepatic Impairment

A

Rifampicin and Tetracyclines

  • reduce metronidazole dose if severely impaired

Cholestatic jaundice:
- co-amoxiclav
- flucloxacillin

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8
Q

Patient needs in Antibiotic prescribing:
Pregnancy

A

Tetracyclines and Trimethoprim contraindicated

Nitrofurantoin causes nausea and vomiting (avoid at term)

Avoid Quinolones, Sulphonamides and MCAT:
- Metronidazole
- Chloramphenicol
- Aminoglycosides
- Tetracyclines

(safest antibiotic is Penicillin/Cephalosporin)

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9
Q

What is the antibiotic cautionary and advisory label

A

Space the doses evenly through the day and finish the course unless told to stop

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10
Q

Antibiotic gastro-intestinal side effects

A
  • Nausea
  • Vomiting
  • Diarrhoea
  • Abdominal pain
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11
Q

What is superinfection

A

Broad spectrum antibiotics and Clindamycin kills all flora. This allows selective organisms to thrive: causing antibiotic associated colitis and thrush

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12
Q

What medication manages Staphylococci

A

Flucloxacillin

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13
Q

What medication manages MRSA

A

Vancomycin

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14
Q

What medication manages Streptococci

A

Benzylpenicillin or phenoxymethylpenicillin

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15
Q

What medication manages Anaerobic bacteria

A

Metronidazole

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16
Q

What medication manages Pseudomoans Aaeruginosa

A

Gentamicin

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17
Q

Clindamycin mode of action

A

Inhibits protein synthesis

(narrow spectrum)
(bacteriostatic)

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18
Q

Side Effects of Clindamycin

A
  • antibiotic associated colitis
  • especially after operation

Counselling:
if diarrhoea develops: stop and see GP

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19
Q

Linezolid mode of action

A

Inhibits protein synthesis. Only effective on gram-positive bacteria

(Narrow-spectrum)
(bacteriostatic)

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20
Q

What antibiotic is an alternative to vancomycin in MRSA infection

A

Linezolid

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21
Q

Side Effects of Linezolids

A
  • Blood disorders
  • optic neuropathy (above 28 day use)

Counselling:
- report visual symptoms
(blurred vision, visual field defects and changes in visual activity)

avoid foods with high tyramine levels

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22
Q

What drugs react with Linezolids to increase hypertensive crisis

A
  • SSRIs
  • TCAs
  • MAOIs
  • Dopaminergics
  • Opioids
  • 5-HT agonists
  • Buspirone
  • Pethidine
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23
Q

Trimethoprim mode of action

A

Inhibits DNA synthesis

(narrow spectrum)
(bacteriostatic)

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24
Q

Trimethoprim side effects

A
  • Anti-folate (teratogenic in first trimester)
  • Blood dyscrasias (long term use)
  • Hyperkalaemia
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25
What is Co-Trimoxaxole
Trimethoprim and Sulfamethoxazole
26
Indication of Co-Trimoxaxole
Prophylaxis and treatment of pneumocystis jirovecii pneumonia.
27
Side effects of Co-Trimoxaxole
- Steven Johnson Syndrome toxic toxic epidermal necrolysis - Photosensitivity
28
Chloramphenicol mode of action
inhibits protein synthesis (broad-spectrum) (bacteriostatic)
29
Chloramphenicol indication
reserved for life-threatening infections - Blood dyscrasias - Grey baby syndrome (avoid in pregnant women)
30
Metronidazole mode of action
Inhibits DNA synthesis. High activity against anaerobic bacteria and protozoa (narrow-spectrum) (bactericidal)
31
Metronidazole indications
- Anaerobic infections (dental, antibiotic colitis, h.pylori, rosacea, bacterial vaginosis) - Protozoal Infections (vaginal trichomoniasis, giardiasis)
32
Metronidazole side effects
- gastro-intestinal disturbances, taste disturbances, oral mucositis, furred tounge
33
Metronidazole patient counselling
- take with or after food - avoid alcohol (causes disulfiram-like reaction)
34
Nitrofurantoin mode of action
damages bacterial DNA. Only targets active urinary pathogens (narrow spectrum) (bactericidal)
35
Side effects of Nitrofurantoin
- Nausea - Risk of peripheral neuropathy in renal impairment
36
Nitrofurantoin and pregnancy
Avoid at term (37 to 42 weeks) (causes neonatal haemolysis)
37
Nitrofurantoin contraindications
Infants less than 3 months
38
Nitrofurantoin patient counselling
- take with or after food - colours urine yellow or brown
39
Aminoglycosides
Binds irreversibly to bacteria ribosomes. Active against gram-negative aerobe; Pseudomonas aeruginosa (Broad spectrum) (Bactericidal)
40
Examples of Aminoglycosides Part 1
- Gentamicin (Pseudomonas aeruginosa) - Tobramycin (inhaled for Pseudomonas aeruginosa in cystic fibrosis) - Streptomycin (for mycobacterium for TB)
41
Examples of Aminoglycosides Part 2
- Neomycin (for bowel sterilisation, parenterally toxic) - Amikacin (for gentamicin resistant gram-negative bacilli)
42
Gentamicin (Aminoglycosides) mode of action
Active against Pseudomonas Aeruginosa. Blind therapy in serious infection with metronidazole/penicillin
43
What therapeutic index does Gentamicin have
Narrow
44
Monitoring with Gentamicin and aminoglycoside use
Monitor serum levels in... - parental ahminoglycosides use - Elderly - Obesity - Cystic fibrosis - High doses - Renal Impairment
45
Aminoglycoside once daily dose regimen, when to avoid
- renal impairment (<20ml/min) - HACEK - Gram-positive endocarditis - Burns convering more than 20% of body
46
When to increase dose interval of Gentamicin
- when renal impairment - if serum levels pre-dose are too high
47
When to reduce dose of Gentamicin
- if post-dose serum level after 1 hour is too high - in severe renal impairment (<30ml/min)
48
Pregnancy and Gentamicin
- avoid unless essential - must monitor serum concentrations
49
Aminoglycosdies and nephrotoxicity
- Aminoglycosdies are excreted by kidney - Assess renal function before treatment and correct any dehydration Signs of Nephrotoxicity: - Low urine output/creatinine clearance - High creatinine/urea serum conc
50
Aminoglycosdies and Ototoxicity (hearing/balance loss)
monitor auditory and vestibular function before treatment Patient counselling: report hearing loss, tinnitus, vertigo
51
What drugs interact with Aminoglycosdies to increase risk of nephrotoxicity
- Ciclosporin - Tacrolimus - Vancomycin
52
What drugs interact with Aminoglycosdies to increase risk of Ototoxicity
- Loop diuretics - Cisplatin (if taking loop diuretics is needed, separate use by long period)
53
Other Side effects of Aminoglycosdies
- Peripheral neuropathy - Impaired neuromuscular transmission - Electrolyte imbalance (too much: K, Ca, Mg)
54
Glycopeptides mode of action
Inhibits cell wall synthesis. Only active against gram-positive bacteria including MRSA (narrow spectrum) (Bactericidal)
55
What examples of Glycopeptides
- Vancomycin (MRSA) - Teicoplanin - Televancin Vancomycin and Teicoplanin not be given by mouth for systemic infections
56
Vancomycin indications
- Antibiotic-associated colitis - MRSA (Paternally injected for serious infections)
57
What is the therapeutic index for Vancomycin
Narrow
58
Vancomycin Monitoring
- serum conc for all patients (after 3 to 4 doses and dose change) - If in renal impairment (earlier and more regular monitoring) = reduce dose - Pre dose level= 10-15mg/ml - Pre dose level for endocarditis or MRSA= 15-20mg/ml)
59
Pregnancy and Vancomycin
avoid in pregnancy unless essential need to monitor serum conc
60
Side Effects of Glycopeptides
- Nephrotoxicity - Ototoxicity - Red mans syndrome - Blood dyscrasias - Skin disorders - Thrombophlebitis
61
What is red mans syndrome
flushing of the upper body caused by rapid infusion and can be associated with hypotension and bronchospasm
62
Examples of Blood Dyscasias
- Netropoenia - Thrombocytopenia - Agranulocytis
63
Examples of skin disorders with Glycopeptides
- Steven-Johnson syndrome - Itching - Rashes - Toxic epidermal necrolysis
64
what is Thrombophlebitis
pain and inflammation of veins (usually at infusion lights)

Victor BNF Notes (25 decks)

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