Management Of Common Bacterial Infections

Question 1

What do we use to treat c-diff infections (mild, moderate or severe)

Answer 1

1st episode - vancomycin
2nd episode - Fidaxomicin - seek specialist advice if not appropriate

Relapse - Less than 12 weeks =Fidaxomicin
More than 12 weeks =vancomycin or Fidaxomicin

Life threatening = Specialist - IV metronidazole or oral vancomycin

Question 2

Diabetic
foot

Answer 2

Flucloxacillin [1] [Mild infection]
If pen allergy or fluclox unsuitable [ clarithro/
Doxy/erythro [preg]] [2

Question 3

MSK

Answer 3

Osteomyelitis
Flucloxacillin
If penicillin allergic : Clindamycin [2

Question 4

Skin

Answer 4

Impetigo
Topical [Hydrogen peroxide 1% cream] [1] ,
fusidic acid [2],
Impetigo
Oral ; Flucloxacillin [1], [clarithro, erythro for pen
allergy]
Cellulitis
Flucloxacillin [1] [clari, ery, dox pen allergy], co-
amoxiclav, clindamycin[2]
Leg ulcer
Fluclox[1] [clar, ery, dox pen allergy], co-
trimoxazole [pen allergy] 2
Animal & human bite
Co-amoxiclav [1], [pen allergic, Doxycycline
+ Metronidazole]
Mastitis during breastfeeding:
Flucloxacillin [pen allergic, erythromycin]

Question 5

Respiratory

Answer 5

Epiglottitis
Cefotaxime or cefriaxone [1],Chloramphenicol [2] -
pen allergic
COPD
Amoxicillin/clar/dox [1], co-amoxiclav, levofloxacin
or co-trimoxazole [2]
Cough,acute
Doxycycline [1] or amox, Clar or erythro.
Pregnancy [ amox or erythro] [1]
Pneumonia [community]
Amox [1] , [erythro/dox,clar pen aller

Question 6

Genitals

Answer 6

Bacterial Vaginosis à Metronidazole [oral/topical]
[1], Clindamycin [topical] [2]
Chlamydia à Azithromycin or Doxycycline[1],
Erythromycin
Gonorrhoea à Azithromycin +[I.m
ceftriaxone/cefixime/ ciprofloxacin
Syphillis àBenzylpenicillin , Erythro, Doxycycline
[asymptom

Question 7

UTI

Answer 7

Lower urinary tract infections [non pregnant women]
Nitrofurantoin or Trimethoprim [1]
Fosfomycin/ Pivmecillinam [2]
Pregnant women
Nitrofurantoin [1]
Amoxicillin or cefalexin Catheter-pregnant : Cefalexin

Question 8

GIT

Answer 8

Campylobacter enteritis à Clar/azithro/Erythro -
ciprofloxacin
Salmonella/shigellosis/Typhoid/Biliary infection
- Ciprofloxacin, Azithromycin , cefotaxime, gentamicin
Clostridium difficile à- Metronidazole - Vancomycin
Diverticulitis à Co-amoxi

Question 9

Blood

Answer 9

Piperacillin with Tazobactam/ Ticarcillin with clavulanic
acid/ Cephalosporin broad spec [ e.g Cefuroxime]
- Add Vancomycin or teicoplanin [MRSA]
- Add Metronidazole to cephalosporin [anaerobic
infection] [If other infection] use broad spec e.g
Meropenem

Question 10

Heart

Answer 10

Endocarditis: Initial ‘blind’ therapy
- Amoxicillin/ampicillin
- Add low dose Gentamicin
- Low dose Gentamicin + Vancomycin [ If penicillin
allergic/MRSA suspected or severe sepsis]
Endocarditis: caused by staphylococci
- Flucloxacillin
- If pen allergy or MRSA [ Vancomycin + rifampicin]
Endocarditis : caused by streptococci
Benzylpenicillin sodium. If pen allergy [ vancomycin + low
dose gentamicin]

Question 11

Oral

Answer 11

Broad spec penicillins [Co amox, Amox, Phenoxy]
- Cephalosporins : Cefalexin & cefradine
- Metronidazole/Tinidazole [Pen allergy/anaerobe] -
Macrolides [ Clar, erythro] [ pen allergic patients
- Doxycycline [oral anaerobes]

Question 12

Ears

Answer 12

Otitis externa
- Flucloxacillin [counselling?]
- Clarithro/Azithro/Erythro -pen allergy
- Ciprofloxacin/ aminoglycoside [pseudomonas]
Otitis media
- Amoxicillin
- Co-amoxiclav [worsening symptoms]
- Clarithro/Erythro [Pen allergy]

Question 13

Nose

Answer 13

Sinusitis [ viral/bacterial[very unwell & high risk]
- Phenoxymethylpenicillin [non-life-threatening]
- Co- amoxiclav [life threatening/severe]
- Dox/Clar/Erythro [preg

Question 14

Eyes

Answer 14

Conjunctivitis- Chloramphenicol

Question 15

CNS

Answer 15

Meningitis caused by meningococci
- Benzylpenicillin or cefotaxime - Chloramphenicol
Meningitis caused by pneumococci
- Cefotaxime [add Dexamethasone]
- Benzylpen [ cephalosporin + vancomycin if pen allergic]
Meningitis caused by Listeria
- Amoxicillin [or ampicillin] + gentamicin
- Co-trimoxazole [ if pen allergic]
Meningitis caused by Haemophilus influenzae
- Cefotaxime [or cefriaxone]

Question 16

Acute Pyleonephritis

Answer 16

Non pregnant women and men:

• oral first line = cefalexin or ciprofloxicin
• IV first line - Amikacin, Gentamicin,ceftriazone and ciprofloxicin

Pregnant women - Oral first line - Cefalexin
IV 1st line - Cefuroxime

Question 17

Animal, Human bites and scratches

Answer 17

Co- amoxiclav 1st line

Penicillin allergy - Doxycycline and metronidazole

Question 18

Causative organisms

Answer 18

Food poisoning (GI upset)= Salmonella, shingella, Ecoli, Nora virus
Tuberculosis - Mycobacterium tuberculosis
MRSA - Methicllin - resistant staphylococcus aureus
Colitis - Clostidium difficile
Pneumonia - Streptococcus pneumonia,
Gonorrhoea- Neisseria gonorrhoea
Whooping cough - Bordetella Pertusis
UTI- Ecoli

Question 19

CELLULITIS with penicillin allergy

Answer 19

Clarithromycin, Erythromycin or doxycycline

Question 20

Common infections and treatments

Answer 20

Anaerobic infections = metronidazole
Streptoccocci infection = phenoxymethylpenicllin
Staphylococci infection = Flucloxacillin
MRSA- Vancomycin
Pseudomonas aeruginosa - Gentamicin

Question 21

Hospital acquired pneumonia - low severity

Answer 21

Co-amoxiclav
Alternative - doxycycline
Or
Co- trimazole

Question 22

What is the CURB 65 score

Answer 22

It is used to access the severity of pneumonia

C - onfusion
U- Urea
Respiratory
Blood pressure
Age over 65 y/o

0-1 =-1 treat as an outpatient
2= consider a short hospital start or watch closely as out patient
3-5=-2 requires hospitalisation with consideration as to whether they need to be in an intensive unit or not