#7523 - Infections And Antibiotics - Medical Finals & OSCEs Notes

Infections and Antibiotics

Infection	Microorganism	Antibiotic first-line	If allergic	If severe
Cellulitis	Strep pyogenes, staph aureus	Flucloxacillin	Ceftriaxone Clarithromycin	Ceftriazone, clarithromycin
Scalded skin syndrome	Staph aureus toxins	Erythromycin		cephalosporin
	Herpes simplex	Topical acyclovir
	Herpes zoster	Oral acyclovir
Wart	HPV	Imiquimod cream
Tinea		Imidazole
Thrush	Candida	Nystatin in mouth Imidazole in vagina
Scabies	Sarcoptes mite	Permethrin
COPD Exacerbation		Coamoxiclav	doxycycline	Coamoxiclav + ceftriaxone or moxifloxacin
Pneumonia		Amoxicillin	Doxycycline or clarithromycin	Coamoxiclav + clarithromycin
Septic shock, not neutropaenic		IV coamoxiclav + gentamicin	Ceftriaxone or ciproflaxin + gentamicin
Septic shock, neutropaenic	IV tazocin + gentamicin	IV tazocin + gentamicin	Meropenem	Amphotericin and ganciclovir
Meningitis (Meningococcus, pneumococcus, haemophilus influenza B, Listeria, TB, Lyme disease, syphilis, viral (mups, EBV, HIV), Cryptococcus)		IV ceftriaxone Add amoxicillin if Listeria. Give dexamethasone with the first dose of antibiotics
Meningitis suspected		IM/IV benzypenicillin one-off
Sickle cell crisis	Infection suspected	Cephalosporins + macrolides until cultures known
Plain UTI		Nitrofurantoin
Pyelonephritis		Co-amoxiclav		Gentamicin
In pregnancy		Nitrofurantoin in first trimester	Trimethoprim in second and third trimesters
Open fractures/dirty wounds		Co-amoxiclav
Osteomyelitis or septic arthritis		Co-amoxiclav
Necrotising fasciitis		Coamoxiclav + clindamycin + debridement	Ciprofloxacin + clindamycin
If high risk of MRSA carriage in many different infections		Add vancomycin IV
Diabetic foot infection		Coamoxiclav + metronidazole
Sepsis	Unknown organism	Co-amoxiclav	Ciprofloxacin + vancomycin	ceftriaxone
Severe sepsis or septic shock	Unknown organism	Add gentamicin in addition to those above
Surgery wounds – clean		flucloxacillin
Surgery wounds – dirty		Metronidazole + coamoxiclav
H pylori	Omeprazole 20mg po bd + amoxicillin 1g po bd + clarithromycin 500mg po bd		Clarithromycin + metronidazole
Cholecystitis and ascending cholangitis		Ceftriaxone + metronidazole
Acute severe pancreatitis	No evidence of infection	No antibiotics
Spontaneous bacterial peritonitis		Ceftriaxone	Ciprofloxacin
Intra-abdo sepsis	High risk e.g. diverticulitis	Coamoxiclav + metronidazole	Ciprofloxacin
Intra-abdo sepsis	High risk e.g. post-op	Tazocin (piperacillin + tazobactam) + metronidazole
Any infection	Risk of gut Gram negatives	Metronidazole
CAP		Amoxicillin	Doxycycline or clarithromycin
CAP severe		Amoxicillin + clarithromycin
HAP	Coamoxiclav	Moxifloxacin
Typhoid		Ciprofloxacin
Malaria prophylaxis		Doxycycline		Consider proguanil + chloroquine
Malaria uncomplicated	Falciparum	Po co-artemether
Malaria uncomplicated	Vivax/ovale	PO quinine + doxycycline
Severe malaria		IV artesunate		Exchange transfusion
Infective endocarditis, initial blind treatment (Strep viridians, strep bovis. Staph aureus. HACEK organisms. Enterococci.)		Flucloxacillin + gentamicin	Vancomycin + rifampicin
Staph endocarditis		Flucloxacillin for 4 weeks
Staph endocarditis with prosthetic valves		Flucloxacillin + rifampicin for 6 weeks
Strep endocarditis		Benzylpenicillin + gentamicin	Vancomycin + gentamicin
TB	Rifampicin, isoniazid, pyrazinamide, ethambutol for 2 months. Then just isoniazid and pyridoxine for 4 months to continue. Give pyridozine with isoniazid.			Streptomycin is rarely in the UK but is used for isoniazid resistance
HIV HAART	1 nucleoside reverse transcriptase inhibitor OR 1 protease inhibitor; with 2 non-nucleoside reverse transcriptase inhibitor.
Pneumocystis pneumonia	Pneumocystic jirovecii	High dose IV cotrimoxazole (trimethoprim and sulfamethoxazole), each dose preceded by prednisolone
Pneumocystic pneumonia prophylaxis		Cotrimoxazole
C difficile, mild to moderate		oral metronidazole
C difficile, severe		Oral vancomycin	>6cm colon dilatation (toxic megacolon)/perforation/sepsit shock colectomy (total colectomy with end ileostomy)

#7523 - Infections And Antibiotics - Medical Finals & OSCEs Notes

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