Antibiotic Prophylaxis And Management Of Common Conditions

Front 1

Which patients getting GI surgery don't get metronidazole (i.e. just recieve cephazolin or gent)

Back 1

Upper GI: normal gastric acidity, no obstruction, no bleeding, no prev GI surgery)
Biliary tract: <60, non-diabetic, for elective surgery unlikely to involve exploration of the common bile duct

Front 2

What endoscopic procedures require antibiotic prophylaxis?

Back 2

those likely to cause bacteraemia (i.e. not standard endoscopy): involving biliary tract, sclerotherapy, oesophageal dilatation, ERCP

Front 3

Standard antibiotic regime for endoscopic procedures?

Back 3

cephazolin or gent prophylaxis

if evidence of biliary stasis: 3d of oral amoxicillin/clavulanate

Front 4

Antibiotic prophylaxis for hernia repair?

Back 4

none if no prosthetic material used\
cephazolin if prosthetic material used

Front 5

Management of peritonitis due to a perforated viscus?

Back 5

amixicillin
gentamycin\
metronidazole

if therapy >72 hours use piperacillin-tazobactam

Front 6

Management of patients with SBP?

Back 6

ceftriaxone
cefotaxime
piperacillin-tazobactam
ticaracillin-clavulanate

If have been on TMP-SMX prophylaxis: enterococcal infection is more common so add amoxy/ampicillin.
Albumin 20% 100ml IV to reduce the risk of hepatorenal syndrome

Front 7

Antibiotic prophylaxis for SBP in cirrhotic patient

Back 7

oral norfolxacin/IV cipro for 2 days if GI bleed

If previous SBP/very low protein content in ascietes: use TMP-SMX first line or norflox

Front 8

Outpatient treatment of mild community-acquired pneumonia

Back 8

oral amoxicillin or doxy/clarythromycin if atypical org

Front 9

Inpatient treatment of non-severe community acquired pneumonia

Back 9

benpen + doxy/clartythromycin
if gram negs on stain/suspected: add gent or substitute cefriaxone/cefotaxime for the ben pen

Front 10

Management of severe community acquired pneumonia:

Back 10

IV ceftriaxone + azithro

instead of ceftriaxone use cefotaxime/benpen + gent

i.e. same as non-severe (moderate) CAP where gram negative bacilli are identified in sputum/blood

Front 11

Indications for in-patient treatment in community acquired pneumonia?

Back 11

ONE of above:
Clinical
respiratory rate greater than 30 breaths/min
systolic blood pressure less than 90 mm Hg
oxygen saturation less than 92%
acute onset confusion.
Investigations
arterial (or venous) pH less than 7.35
partial pressure of oxygen (PaO2) less than 60 mm Hg
multilobar involvement on chest X-ray.

Front 12

Define severe pneumonia?

Back 12

At least 2 of CORB:
C = acute confusion

O = oxygen saturation 90% or less

R = respiratory rate 30 breaths or more per minute

B = systolic blood pressure less than 90 mm Hg or diastolic blood pressure 60 mm Hg or less

Front 13

Antibiotic prophylaxis for cardiac surgery

Back 13

cephazolin
OR
di/fluclox + gent

Front 14

Indications for pre-operative vancomycin prophylaxis in any surgery?

Back 14

preoperative patients infected or colonised with a methicillin-resistant S. aureus (MRSA) strain (health care–associated or community-associated) currently or in the past
patients having major surgery who are at high risk for MRSA colonisation (eg those who have resided for longer than 5 days in a health care facility where MRSA is endemic)
patients undergoing prosthetic cardiac valve, joint or vascular surgery where the procedure is a re-operation (return to theatre or revision)
patients hypersensitive to penicillins and/or cephalosporins

Front 15

Indications for post-operative vancomycin?

Back 15

cardiac surgery and vascular surgery

Front 16

Antibiotic prophylaxis for head, neck, thoracic surgery?

Back 16

incision/prosthetic material\
use cephazolin- usually single dose is enough but if procedure is not completed within 3 hours of initiating prophylaxis a 2nd dose should be given

Front 17

Prophylaxis for lower limb amputation

Back 17

risk of clostridial infection
benpen + metro

Front 18

Prophylaxis before neurosurgery

Back 18

cephazolin or di/fluclox

Front 19

prophylaxis for termination of pregnancy

Back 19

cephazolin + metro

Front 20

Prophylaxis for c-section

Back 20

cephazolin

Front 21

Prophylaxis for orthopaedia surgery

Back 21

cephazolin or di/fluclox

Front 22

Prophylaxis for turp

Back 22

ciprofloxacin 1 hr before procedure

Front 23

prophylaxis before prostatectomy/ urological procedure with evidence of a UTI

Back 23

gentamycin

Front 24

Are prophylactic antibiotics used for surgery on the brachial/carotid arteries?

Back 24

no, unless prosthetic material is used

Front 25

Indications for antibiotic prophylaxis in vascular surgery?

Back 25

Arterial reconstructive surgery involving the abdominal aorta and/or the lower limb, particularly if a groin incision is involved or with the implantation of foreign material

Front 26

prophylactic antibiotics in vascular surgery

Back 26

cephazolin
OR
di/fluclox + vancomycin

if vancomycin indicated use vanc + gent

Front 27

Antibiotic cover for human bites/clenched fist injuries?

Back 27

amoxicillin + clavulanate
cover eikinella

Front 28

Common side effects of augmentin

Back 28

>10% GI (diarrhoea)
1-10% rash, vaginitis, mucositis
<1%: ALP rise, cholestatic jaundice, hepatitis, thrombocytosis

Front 29

How many dTPA doses should a kid have had by the age of 17?

Back 29

5

Front 30

How do you vaccinate an adult who has not had their primary course of tetanus vaccination?

Back 30

Give 3 doses dT at 4 weeks apart and a booster 10/20 years later

Front 31

Management of a tetanus prone wound?

Back 31

if no bouster in 5 years- give booster
if doubt adequacyy of immunization- give Ig + toxoid

Front 32

Antibiotic cover for human bites/clenched fist injuries?

Back 32

amoxicillin + clavulanate
cover eikinella

Front 33

Common side effects of augmentin

Back 33

>10% GI (diarrhoea)
1-10% rash, vaginitis, mucositis
<1%: ALP rise, cholestatic jaundice, hepatitis, thrombocytosis

Front 34

How many dTPA doses should a kid have had by the age of 17?

Back 34

5

Front 35

How do you vaccinate an adult who has not had their primary course of tetanus vaccination?

Back 35

Give 3 doses dT at 4 weeks apart and a booster 10/20 years later

Front 36

Management of a tetanus prone wound?

Back 36

if no bouster in 5 years- give booster
if doubt adequacyy of immunization- give Ig + toxoid

Front 37

Antibiotic cover for human bites/clenched fist injuries?

Back 37

amoxicillin + clavulanate
cover eikinella

Front 38

Common side effects of augmentin

Back 38

>10% GI (diarrhoea)
1-10% rash, vaginitis, mucositis
<1%: ALP rise, cholestatic jaundice, hepatitis, thrombocytosis

Front 39

How many dTPA doses should a kid have had by the age of 17?

Back 39

5

Front 40

How do you vaccinate an adult who has not had their primary course of tetanus vaccination?

Back 40

Give 3 doses dT at 4 weeks apart and a booster 10/20 years later

Front 41

Management of a tetanus prone wound?

Back 41

if no bouster in 5 years- give booster
if doubt adequacyy of immunization- give Ig + toxoid

Front 42

Are prophylactic antibiotics indicated in simple scalp lacerations?

Back 42

no