Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
108 Cards in this Set
- Front
- Back
|
What are the common causative pathogens in bacterial infections of the skin, soft tissue & muscle?
|
Streptococcus pyogenes
Staphylococcus aureus |
|
|
What is folliculitis?
When is it more common? What is a common causative pathogen? |
Inflammation of hair follicles due to infection, injury or irritation.
Tender, swollen areas that form around hair follicles, often on neck, breasts, buttocks & face. More common in hot weather, macerated areas (e.g. under wet dressings), or assoc. with shaving. Commonly due to Staph.aureus. |
|
|
What is the treatment for folliculitis?
|
If due to maceration (obesity, sweating, shaving):
• Attend to underlying problem • Antiseptic washes (e.g. chlorhexidine) If due to S. aureus: • Saline topically tds for 7 days to remove crusts PLUS • Mupirocin ointment/cream topically tds for 7 days If more severe, treat as impetigo: Severe/widespread infection: • Di/flucloxacillin 500mg qid for 10 days Penicillin hypersensitivity: • Cephalexin 1g bd for 10 days Immediate penicillin hypersensitivity: • Roxithromycin 300mg daily for 10 days |
|
|
When is treatment for boils and carbuncles required?
What antibiotics are used? |
ABs required for large lesions, spreading cellulitis or presence of systemic SMx.
Tx similar to folliculitis (but 5 days instead of 10): • Di/flucloxacillin 500mg qid for 5 days Penicillin hypersensitivity: • Cephalexin 1g bd for 5 days Immediate penicillin hypersensitivity: • Clindamycin 450mg tds for 5 days |
|
|
What is impetigo?
What are they also called? What are the common pathogens? What are the 2 distinct presentations? |
Contagious superficial infection of epidermis.
Also called school sores. Affluent community (commonly S.aureus) Remote/indigenous (commonly Strep.pyogenes) Crusted/non-bullous • Superficial vesicular lesions that later become pustular then crusted (honey coloured) Bullous: • Small vesicles or pustules that develop into bullae which rupture easily |
|
|
What is the treatment for impetigo?
|
Same as for folliculitis
Mild infection: • Saline topically tds for 7 days to remove crusts, PLUS • Mupirocin 2% ointment or cream tds for 7 days Severe/widespread: • Di/flucloxacillin 500mg qid for 7 days Penicillin hypersensitivity: • Cephalexin 1g bd for 10 days Immediate penicillin hypersensitivity: • Roxithromycin 300mg daily for 10 days |
|
|
What is erysipelas, and what are the common symptoms & signs?
What is the causative pathogen? |
Form of cellulitis, a bacterial infection affecting the dermal layer of skin.
SMx incl. characteristic butterfly distribution on cheeks & bridge of nose. Also fever, chills, shivering. Distinguished from other forms of cellulitis by its well-defined, raised border. Streptococcus pyogenes. |
|
|
What is cellulitis and what are the clinical features?
What are the common pathogens? |
Bacterial infection of the skin - often unilateral.
SMx: Redness, swelling, increased warmth, tenderness, blistering as rash progresses. May have systemic SMx e.g. fever, chills. Pathogens: • Streptococcus pyogenes (2/3) • Staphylococcus aureus (1/3) |
|
|
What are predisposing factors for cellulitis?
|
• Problems with venous or lymphatic drainage
• Previous injury to limb • Diabetes • Fissured dermatitis • Alcoholism • Obesity • Swelling of legs • Pregnancy • Tinea pedis |
|
|
What is the treatment for MILD EARLY cellulitis & erysipelas?
(they have the same treatment) |
To cover S.aureus & Strep.pyogenes:
• Di/flucloxacillin 500mg qid for 7-10 days If Strep.pyogenes confirmed: • Phenoxymethylpenicillin 500mg qid for 10 days, OR • Procaine penicillin 1.5g IM daily for at least 3 days Penicillin hypersensitivity: • Cephalexin 500mg qid for 7-10 days Immediate penicillin hypersensitivity: • Clindamycin 450mg tds for 7-10 days |
|
|
What is the treatment for SEVERE cellulitis?
|
• Rest & elevation of limb
• Surgery, debridement • Drainage of abscesses • Remove clots & foreign bodies IV therapy should continue until pt is afebrile & rash has cleared (3 days - 2 weeks). To treat Strep. or Staph.: • Di/flucloxacillin IV Penicillin hypersensitivity: • Cephalothin IV, OR • Cephazolin IV Immediate hypersensitivity: • Clindamycin IV, OR • Lincomycin IV |
|
|
What treatment would you use for a mild-moderately infected post-operative wound?
|
• Di/flucloxacillin 500mg qid for at least 5 days
OR • Cephalexin 500mg qid for at least 5 days If G-ve organisms suspected: • Amoxycillin + clavulanate 875+125mg bd for 5 days |
|
|
What treatment would you use for a severely infected post-operative wound (particularly where systemic SMx are present)?
|
• Di/flucloxacillin IV
OR • Cephalothin IV OR • Cephazolin IV If G-ve organisms suspected: • Gentamicin IV 4-6 mg/kg daily |
|
|
What are the likely pathogens in post-traumatic wounds (e.g. stab wounds, crush injuries)?
|
• Staphylococcus aureus
• Streptococcus pyogenes • Clostridium perfringens • Aerobic G-ve bacilli |
|
|
What treatment would you use in a clean post-traumatic wound?
|
ABs seldom necessary but if management delayed or debridement difficult:
• Di/flucloxacillin 500mg qid 5 days PLUS • Metronidazole 400mg bd for 5 days Or alternatively, • Amoxycillin + clavulanate 875+125mg bd for 5 days |
|
|
What treatment would you use in a contaminated post-traumatic wound?
|
• Di/flucloxacillin IV
PLUS • Gentamicin IV PLUS • Metronidazole IV |
|
|
What are the organisms usually involved in human & animal bites and clenched fist injuries?
|
Human bites & clenched fist:
• Staphylococcus aureus • Elkenella corrodens • Streptococcus species • Beta-lactamase producing anaerobes Animal bites: • Pasteurella species • Staphylococcus aureus • Capnocytophaga canimorsus • Streptococcus species • Anaerobes |
|
|
What is the recommended management of human/animal bites & clenched fist injuries?
|
Through cleaning, debridement, irrigation, elevation, immobilisation.
Severe & penetrating injuries - antibiotic Tx should be modified according to gram stain & culture. Empirical Tx: • Metronidazole 400mg bd PLUS EITHER • Ceftriaxone IV OR • Cefotaxime IV |
|
|
What type of organisms are found in diabetic foot ulcers?
|
Anaerobic organisms are almost always involved.
Often with mixed G+ve and G-ve aerobic organisms. |
|
|
What antibiotic therapy is used in mild-moderate diabetic foot infections?
|
• Amoxycillin + clavulanate 875+125mg bd for at least 5 days
OR • Cephalexin 500mg qid for at least 5 days PLUS • Metronidazole 400mg bd for at least 5 days Penicillin hypersensitivity: • Ciprofloxacin 500mg bd for at least 5 days PLUS • Clindamycin 600mg tds for at least 5 days |
|
|
What antibiotic therapy is used in severe diabetic foot infections?
|
• Piperacillin + tazobactam IV
OR • Ticarcillin + clavulanate IV OR • Meropenem IV Duration of treatment depends on response |
|
|
What is necrotising fasciitis?
What are the 2 types and the pathogens involved in each? |
Very serious bacterial infection of the soft tissue & fascia (sheath of tissue covering muscle).
The bacteria multiply & release toxins & enzymes resulting in thrombosis in blood vessels - leads to soft tissue & fascia destruction. Type I (monomicrobial): • Streptococcus pyogenes • Clostridium perfringens • Staphylococcus aureus • Vibrio species (G-ve) • Aeromonas hydrophilia (G-ve) Type II (polymicrobial): • E.coli • Bacteroides fragilis • Streptococci & Staphylococci |
|
|
What are the signs and symptoms of necrotising fasciitis?
|
Within 24 hrs:
• Pain in general area • Flu-like SMx • Intense thirst Within 3-4 days: • Area swells & may show purple rash • Large dark marks filled with dark fluid form • Wound starts to die & becomes blackened • Severe pain Day 4-5: • Very ill - dangerously low BP & high temp • Infection spreads to bloodstream - body goes into toxic shock, renal failure • Unconsciousness |
|
|
What is the empirical treatment for necrotising fasciitis?
|
• Meropenem IV
PLUS EITHER • Clindamycin IV OR • Lincomycin IV |
|
|
What is the treatment for necrotising fasciitis proven to be due to Streptococcus pyogenes?
|
• Benzylpenicillin IV
PLUS EITHER • Clindamycin IV OR • Lincomycin IV Penicillin hypersensitivity: Substitute benzylpenicillin for • Cephalothin IV OR • Cephazolin IV If polymicrobial, use meropenem IV. |
|
|
What is gas gangrene?
What is the most common pathogen? What are the signs and symptoms? |
Occurs as result of infection with Clostridium bacteria (usually Clostridium perfringens) that under anaerobic conditions produce gas as a result of fermentation, & toxins that cause tissue death & assoc. SMx.
SMx: • Mod-severe pain • Swelling • Mod-high fever • Skin color goes from pale to dark red or purple • Vesicle formation • Foul-smelling fluid filled blisterse • Air under the skin If untreated, shock-like SMx develop. |
|
|
What is the treatment for gas gangrene (Clostridial infection)?
|
Basis of Tx is surgical debridement of necrotic tissue, resuscitation & AB Tx:
• Benzylpenicillin IV Penicillin hypersensitivity: • Metronidazole IV |
|
|
Which parts of the body do the following affect:
• Tinea barbae • Tinea capitis • Tinea corporis • Tinea cruris • Tinea faciei • Tinea mannum • Tinea pedis • Tinea unguium |
• Tinea barbae (beard)
• Tinea capitis (head) • Tinea corporis (body) • Tinea cruris (groin) • Tinea faciei (face) • Tinea mannum (hand) • Tinea pedis (foot) • Tinea unguium (nail) |
|
|
What antifungals are given when oral therapy is indicated for tinea?
|
• Terbinafine 250mg daily
OR • Fluconazole 150mg weekly OR • Itraconazole 200mg bd for one week (feet & hands) or 200mg daily for one week (elsewhere on body) |
|
|
What treatment is available for nail tinea?
|
First line:
• Terbinafine 250mg daily for 6 weeks (fingernails) or 12 weeks (toenails) OR • Itraconazole 200mg bd for 7 days every month for 2 months (fingernails) and 3-4 months (toenails) OR • Fluconazole 150-300mg once weekly for 12-24 weeks (fingernails) and 52 weeks (toenails) Topical nail lacquers also available OTC e.g. amorolfine 5% nail lacquer topically, weekly for up to 12 months. |
|
|
How do you treat candida infections of:
a) Skin folds b) Nappy rash |
a) Immunocompetent pts:
• Imidazole cream OR • Nystatin cream, 2-3 times daily Continue Tx for 2 weeks after symptoms resolve. Add hydrocortisone 1% cream if necessary for inflammation. b) As above if caused by candida. Also, • Mild detergent to wash nappies • Breathable nappy liners or change to disposable nappes • Allow nappy free periods • Avoid baby wipes which can irritate skin (or use hypoallergenic) • Apply barrier cream e.g. zinc with each nappy change |
|
|
What is scabies and how is it acquired?
What are the signs and symptoms? |
Itchy rash caused by a little mite that burrows into the skin surface.
Almost always acquired by skin-to-skin contact with someone with scabies. Occasionally via bedding or furnishings. SMx: • Itch • Burrows (appear as tiny grey irregular tracks) • Generalised rash (tiny red intensely itchy bumps) • +/- Nodules • Blisters & pustules on palms & soles in infants • Secondary infections e.g. impetigo |
|
|
What is the treatment and management for scabies?
|
• Permethrin 5% (stronger than lice one) cream topically to skin from neck down, leave for min 8 hrs
Better success rate if used on 2 occasions, 1 week apart. • Wash clothes, towels, bedding or subject to heat from iron or dryer (or store for a week as mites only survive max 36 hrs away from host) • Treat family & close contacts simultaneously even if no SMx • Treatment of classmates in children not required |
|
|
What is the treatment for herpes simplex type I (coldsores)?
|
• Aciclovir 5% cream 5 times a day (every 4 hrs while awake) for 5 days at first sign of recurrence
OR • Penciclovir 1% cream at least 6 times a day (every 2 hrs while awake) for 4 days Oral Tx recommended in severe HSV infections on any part of skin or mucosa: • Aciclovir 400mg tds for 5 days OR • Famciclovir 125mg bd for 5 days • Valaciclovir 500mg bd for 5 days |
|
|
What is Herpes Zoster (shingles)?
|
Painful blistering caused by reactivation of varicella (the chickenpox virus).
After initial infection with chickenpox, the virus remains dormant in nerve cells for years before it is reactivated & grows down the nerves to the skin to produce shingles. Infective in the vesicular stage & exposure may result in varicella in nonimmune contacts. |
|
|
What are the clinical features of shingles?
|
• Pain in one spot or spread out
• Blistering rash in the painful area • Starts as crop of closely grouped red bumps in a continuous band on area of skin supplied by spinal nerves • Chest, neck, forehead & lumbar sensory nerve supply regions are most commonly affected • New lesions appear for several days, blistering then becoming pustular then crusting over • Pain & general SMx subside as the eruption disappears • Recovery is complete in 2-3 weeks in children/young adults and 3-4 weeks in older pts • Some pts left with postherpetic neuralgia |
|
|
What is the treatment and management of shingles?
|
Antivirals for pts seen within 72 hrs of onset of vesicles, pts with opthalmic herpes zoster & in immunocompromised pts:
• Famciclovir 250mg tds for 7 days • Valaciclovir 1g tds for 7 days • Aciclovir 800mg 5 times a day for 7 days Management: • Bathe lesions w/ saline tds • Cover lesions w/ light non-adherent dressing to reduce infectivity • Analgesia • Ice packs/cold compressions |
|
|
What is chickenpox and what are the signs and symptoms?
|
Highly contagious disease caused by the varicella virus and spread by breathing in airborne respiratory droplets or through direct contact with fluid from open sores.
SMx: • Itchy rash of red papules progressing to blisters which are very itchy & uncomfortable • Fever, headache, cold-like SMx, vomiting, diarrhoea |
|
|
What is the treatment for chickenpox?
|
In healthy patients, antivirals not recommended b/c benefits are only marginal. Only need symptomatic Tx:
• Analgesics • Calamine lotion & antihistamines for itch In immunocompromised pts with severe disease or normal pts with complications of varicella use: • Aciclovir 10 mg/kg tds for 7-10 days Less severe disease: • Use oral therapy as for herpes zoster |
|
|
What is measles and the clinical features of it?
What is the treatment? |
Highly contagious acute viral infection caused by a paramyxovirus & spread by respiratory droplets.
SMx incl. fever, cough, inflamed nasal passages, conjunctivitis, Koplik's spots on buccal or labial mucosa, spreading maculopapular cutaneous rash. No specific Tx therefore immunisation is important. Supportive Tx: • Paracetamol for fever • Maintain fluid intake • Provide nutritional support if necessary • Severe cases usually require hospitalisation • ABs for secondary bacterial infections |
|
|
Which pathogens are usually involved in UTIs in the community, and in the hospital?
|
G-ve cause most bacterial UTIs.
Community: • E.coli (80%) Hospital: • E.coli (50%) • Other G-ve and G+ve bacteria |
|
|
What are the signs and symptoms of acute cystitis?
|
• +/- Fever
• Frequency, urgency • Burning or painful voiding of small amounts of urine • Nocturia • Turbid urine • Gross hematuria |
|
|
What counselling would you give to someone with acute cystitis?
|
• Take ABs at night to maximise urinary concentration
• Drink lots of water to flush it out & give bacteria less time to sit there & multiply • Empty the bladder completely when going to the toilet • Go to the toilet after intercourse b/c it will flush out the area • Cranberry juice |
|
|
What is the treatment for acute cystitis in non-pregnant women?
|
• Trimethoprim 300mg daily for 3 days
OR • Cephalexin 500mg bd for 5 days OR • Amoxycillin + clavulanate 500+125mg bd for 5 days OR • Nitrofurantoin 50mg qid for 5 days |
|
|
What is the treatment for acute cystitis in pregnant women?
|
• Cephalexin 500mg bd for 10 days
OR • Nitrofurantoin 50mg qid for 10 days OR • Amoxycillin + clavulanate 500+125 mg bd for 10 days |
|
|
What is the treatment of acute cystitis in men?
|
• Trimethoprim 300mg daily for 14 days
OR • Cephalexin 500mg bd for 14 days OR • Amoxycillin + clavulanate 500+125 mg bd for 14 days OR • Nitrofurantoin 50mg qid for 14 days |
|
|
What are the signs & symptoms of pyelonephritis?
|
Systemic as well as localised urinary tract SMx:
• Rapid onset • Flank & loin pain • Lumbar tenderness present on infected side • Fever, rigors • N+V • Urinary frequency, urgency, dysuria • Enlarged kidney sometimes palpable |
|
|
What is the treatment of mild-moderate pyelonephritis?
|
May be treated by oral Tx alone:
• Cephalexin 500mg qid for 10 days OR • Amoxycillin + clavulanate 875+125 mg bd for 10 days OR • Trimethoprim 300mg daily for 10 days If resistant or causative organism is Pseudomonas aeruginosa use: • Ciprofloxacin 500mg bd (or norfloxacin) for 10 days |
|
|
What is the treatment of severe pyelonephritis?
|
• Amoxy/ampicillin IV
PLUS • Gentamicin IV 4-6 mg/kg daily Total treatment should be for 10-14 days incl. oral therapy. |
|
|
What is the prophylaxis for recurrent UTIs?
What can be done to prevent recurrent UTIs? |
Prophylaxis:
• Nitrofurantoin 50mg at night, or in adult females within 2 hrs of sexual intercourse OR • Cephalexin 250mg at night OR • Trimethoprim 150mg at night Prevention: • Perineal hygiene • Micturition after intercourse • Intravaginal oestrogen in postmenopausal women |
|
|
What is epididymo-orchitis and how is it acquired?
|
Inflammation of the epididymis & testis & can be caused by infection.
Acquired: • Sexually (esp. in younger men) as complication of a urethral infection by sexually transmitted pathogens • Non-sexually (from the bladder or prostate as a complication of UTI with prostatitis or urethritis). • Complication of prostate surgery • Result of infection secondary to indwelling catheter • Caused by G-ve coliform bacteria |
|
|
What are the signs and symptoms of epididymo-orchitis?
|
• Pain, swelling & tenderness of the scrotum with only one side affected
• Pain at first more intense at back of one testicle but quickly spreads to entire testicle, the overlying scrotum & sometimes the groin • Redness & heat in the painful area • Inability to walk w/out limping b/c of pain • Dysuria • Fever, chills • Clear, white or yellow abnormal discharge similar to pus from the tip of the penis that may stain underwear |
|
|
What is the symptomatic treatment for epididymo-orchitis?
|
• Bed rest
• Scrotal elevation • Scrotal ice packs • Analgesics • Antimicrobial Tx for 14 days |
|
|
What is the treatment for epididymo-orchitis acquired from a urinary tract source?
|
Mild-moderate:
• Trimethoprim 300mg daily for 14 days OR • Cephalexin 500mg bd for 14 days If resistant: • Norfloxacin 400mg bd for 14 days Severe infection: • Amoxy/ampicillin IV PLUS • Gentamicin IV 4-6 mg/kg daily |
|
|
What is the treatment for epididymo-orchitis that is sexually acquired?
What pathogens are usually involved? |
Chlamydia trachomatis & Neisseria gonorrhoeae usually involved, although can also be caused by E.coli among men who practice anal intercourse.
• Ceftriaxone 250mg IM as ONE dose (covers Gonorrhoea + E.coli) PLUS • Doxycycline 100mg bd for 14 days (covers Chlamydia) OR • Roxithromycin 300mg daily for 14 days |
|
|
What type of pathogens are involved in prostatitis?
What are the signs and symptoms? |
The typical urinary tract pathogens, although sometimes sexually transmitted pathogens can be the cause.
• Prostate gland is tender, swollen, hard & warm • Chills, high fever • Urinary frequency & urgency • Perineal & lower back pain • Obstructed voiding • Dysuria or burning on urination • Nocturia • Sometimes gross haematuria • Arthralgia, myalgia |
|
|
What is the treatment for prostatitis?
|
Mild-moderate:
• Use one of the regimens for acute cystitis in men Severe: • Amoxy/ampicillin IV PLUS • Gentamicin IV 4-6 mg/kg daily General support: • Bed rest • Analgesics • Hydration • If constipation assoc. then stool softeners |
|
|
What are the signs and symptoms of genital herpes?
|
• Recurrent painful blisters on genital area that rapidly erode to leave ulcers which heal spontaneously over 2 weeks
• Lesions may also occur on surrounding skin • Feeling unwell • Headaches • Pain in back & legs |
|
|
What is the treatment for genital herpes?
|
Not curative but may shorten episode if commenced within 72 hrs of SMxs:
• Valaciclovir 500mg bd for 5 days OR • Aciclovir 400mg tds for 5 days OR • Famciclovir 125mg bd for 5 days |
|
|
What is syphilis and what is the treatment for it?
|
STI transmitted by close personal contact, pregnancy, or blood transfusions.
Early syphilis: • Benzathine penicillin IM as 1 dose OR • Procaine penicillin IM daily for 10 days Penicillin hypersensitivity: • Doxycycline 100mg bd for 14 days Late latent syphilis - Tx is same but longer. Tertiary syphilis - Benzylpenicillin IV for 15 days Sexual contacts within last 3 months should have same Tx even if serology is -ve. |
|
|
What is vulvovaginitis?
What are the different types? |
Inflammation of vulva & vaginal mucosa and may have an infectious or non-infectious cause, or combination of both.
Types: • Bacterial vaginosis • Candidiasis • Trichomoniasis vaginalis |
|
|
What are the signs and symptoms of bacterial vaginosis?
|
• Malodourous vaginal discharge usually w/out redness or soreness
• Amine (fishy) odour often becomes stronger after coitus or menses when the discharge is more alkaline • Can cause itching & irritation |
|
|
What is the treatment for bacterial vaginosis?
|
• Metronidazole 400mg bd for 7 days
OR • Clindamycin 2% vaginal cream, 1 applicatorful intravaginally for 7 nights Treatment of sexual partners is not indicated. |
|
|
What is vulvovaginal candidiasis and what are the signs and symptoms?
|
Yeast infection of the vulva & vagina commonly called 'thrush'.
• Vaginal pruritus • With or w/out vulvular itching, burning, or irritation • Thick, white vaginal discharge that clings to vaginal walls • Erythema, oedema & excoriation • SMxs increase the week before menses |
|
|
What is trichomoniasis and what are the signs and symptoms?
|
STI caused by Trichomoniasis vaginalis which causes vaginitis.
50% of women and almost all men are asymptomatic. • Profuse vaginal discharge (may be frothy, yellowish green) • Dysuria • Painful sexual intercourse • Vaginal erythema • Fishy odor discharge |
|
|
What is the treatment for trichomoniasis?
|
• Metronidazole 2g orally as 1 dose
OR • Tinidazole 2g orally as 1 dose Relapsing cases: • Metronidazole 400mg bd for 5 days Empirical Tx of sexual partners at the same time is indicated to prevent re-infection. |
|
|
What is urethritis & cervicitis?
|
Urethritis is the inflammation of the urethra which can occur in both sexes.
Cervicitis is inflammation of the cervix. |
|
|
What are the signs and symptoms of urethritis & cervicitis?
|
Urethritis (women):
• Some asymptomatic • Vaginal discharge • Dysuria, frequency • Pelvic pain • Painful sexual intercourse Urethritis (men): • Mild dysuria & discomfort • Clear to mucopurulent discharge from urethra • Urethra opening may be red & stuck together with dried secretions in the morning Cervicitis: • Yellow mucopurulent discharge • Red cervix which bleeds easily |
|
|
What are the causative pathogens of urethritis & cervicitis?
What is the treatment? |
Chlamydia trachomatis is the most common.
Neisseria gonorrhoea is the other important cause. • Azithromycin 1 g as one dose OR • Doxycycline 100mg bd for 7 days Penicillin-resistant N.gonorrhoea: • Ceftriaxone IM as 1 dose PLUS EITHER • Azithromycin 1g orally as 1 dose OR • Doxycycline 100mg bd for 7 days |
|
|
What is the treatment for acute diarrhoeal diseases caused by bacteria & viruses?
|
• Most cases are self-limiting
• Antibiotic therapy not required (particularly if there's no blood in the stool) unless there is suspicion of an outbreak • Aim of Tx is to achieve & maintain hydration (oral rehydration solutions) • +/- Anti-motility drugs • Hygiene, handwashing, disinfecting toilet areas If required: • Erythromycin 500mg qid 5-7 days OR • Norfloxacin 400mg bd for 5 days |
|
|
What is the treatment for cholera?
|
Rehydration is the basis of Tx.
ABs not necessary but reduces duration, volume of fluid loss & hastens clearance of the organism. • Doxycycline 100mg bd for 3 days OR • Ciprofloxacin 1g as a single dose Children & preganncy: • Amoxycillin 250mg qid for 5 days |
|
|
What is the treatment for salmonella enteritis?
|
Antibiotic Tx not generally advisable as it is not clinically beneficial & may prolong excretion of pathogenic organisms.
Severely ill or immunocompromised: • Ciprofloxacin 500mg bd for 5-7 days OR • Azithromycin 1g on 1st day followed by 500mg daily for next 6 days |
|
|
What is the treatment for shigellosis?
|
Antibiotic Tx is recommended in all cases for public health reasons as a very low inoculum causes infection.
• Norfloxacin 400mg bd for 5 days OR • Trimethoprim + sulfamethoxazole 160+800 mg bd for 5 days |
|
|
What is the most common pathogen for traveller's diarrhoea and what is it's treatment?
|
Enterotoxigenic E.coli
Mild: • No ABs • Rehydration • +/- Anti-motility drugs Mod-severe: • Azithromycin 1g or Norfloxacin 800mg as a single dose • Rehydration |
|
|
How are threadworms spread?
|
• Threadworm eggs swallowed
• Larvae hatch in intestine, then mature & mate • A few weeks later, female worms emerge at night to deposit eggs around anus causing itching & discomfort • Person scratches itch with hand • Contaminated hands placed in mouth & eggs ingested again |
|
|
How are threadworms detected, and what are the signs and symptoms?
|
Detection:
• Place piece of sticky tape over anus - eggs will stick to it • Visible worms on stools • Worms sometimes seen moving around outside of anus at night Signs and SMx: • Itching around anus or vagina esp. at night • Restless sleep • Increased irritability (lack fo sleep) • Reduced appetite • Stomachache |
|
|
What is the treatment and prevention for threadworms?
|
• Mebendazole 100mg as single dose for adults & children > 10kg
OR • Pyrantel 10mg/kg up to 750mg as a single dose Refer pregnant women or children < 10kg • Treat whole household • Shower night Tx given, again in morning to remove eggs laid overnight • Effective handwashing • Don't scratch bare anal area • Shower rather than bathe • Vacuum carpets, wash floors, clothes, bedding w/ hot water • Don't shake bed linen • Disinfect toilet regularly |
|
|
What can you do to reduce the spread of roundworm, hookworm, tapeworm & whipworm?
|
• Hygiene (esp. when handling food)
• Cooking meat well • Footwear (roundworm penetrates through feet/hands) • Handwashing • Improvement of sanitation facilities • Community worm treatment programs |
|
|
What is meningitis?
What are the common pathogens in bacterial meningitis? |
Inflammation of the meninges which cover/line the brain or spinal cord.
Neisseria meningitidis (G-ve) Streptococcus pneumoniae (G+ve) Haemophilus influenzae (G-ve) |
|
|
What are the signs and symptoms of bacterial meningitis?
|
• Acute onset of headache
• Neck stiffness • Photophobia • Fever • Vomiting • Weakness/paralysis • Positive Kernig syndrome • Haemorrhagic rash • Confusion, delirium • Visual field deficits • Dysphagia • If left untreated pts deteriorate rapidly - loss of consciousness & death |
|
|
What is the treatment for bacterial meningitidis?
|
Immediate dose of parenteral benzylpenicillin or ceftriaxone before transfer to hospital.
Empirical therapy: • Ceftriaxone IV If due to N.meningitidis: • Benzylpenicillin IV for 3-5 days Penicillin hypersensitivity: • Ceftriaxone IV for 3-5 days Immediate penicillin hypersensitivity: • Ciprofloxacin 400mg IV for 3-5 days |
|
|
What is used for chemoprophylaxis for Neisseria meningitidis?
|
Prophylaxis and/or immunisation essential for close contacts.
• Ceftriaxone IM as single dose (preferred for pregnancy) OR • Ciprofloxacin 500mg as single dose (preferred for women on OCP) OR • Rifampicin 600mg bd for 2 days (preferred for children) |
|
|
What is encephalitis?
What is the most common cause in Australia? |
Acute inflammatory disease of the brain substance (cortex, white matter, basal ganglia) that is usually caused by direct viral invasion or hypersensitivity initiated by a virus or foreign protein.
Most common cause in Australia is due to the Herpes Simplex Virus (HSV) |
|
|
What are the signs and symptoms of encephalitis?
|
• Progressive headache
• Fever • Alterations in cognitive state • Consciousness ranges from drowsy to coma • Seizures • Aphasia • Upper motor signs, but flaccid paralysis can occur if spinal cord is involved • Cerebral oedema |
|
|
What is the treatment for encephalitis?
|
• Specific antiviral, antifungal, antibiotic therapy should be initiated where appropriate
• Anticonvulsant for seizures • Antipyretics prn • Support in ICU often required • Fluid restriction • Intracranial pressure monitoring HSV encephalitis: • Aciclovir IV for at least 14 days |
|
|
Generally what combination of treatments do you use in the treatment of HIV?
|
• 1NNRTI + 2 NRTIs
• 1 PI + 2 NRTIs NNRTI (efavirenz or nevirapine) PI (lopinavir, atazanavir, fosamprenavir combination with ritonavir) NRTI (tenofovir plus either lamivudine or emtricitabine) |
|
|
Why is good adherence in HIV therapy important?
|
Missed doses lead to decreased blood levels of active drug.
Below a min. threshold drug conc, resistant strains of HIV will emerge - therefore you need to take at least 95% of the doses. Very hard as 95% is missing only 3 tabs a month (bd) or 4 a month (tds) |
|
|
What treatment would you recommend for pharyngitis/tonsilitis?
|
Acute sore throat usually due to viral pathogen (only small amount due to bacteria).
ABs recommended when: • Strep. pyogenes involved • Aged 3-14 yrs as more likely to be caused by Strep.pyogenes • Younger pts w/ sore throat in communities w/ high incidence of acute rheumatic fever • Scarlet fever • Peritonsillar cellulitis or abscess Phenoxymethylpenicillin 500mg bd for 10 days Penicillin hypersensitivity: Roxithromycin 300mg daily for 10 days |
|
|
When is antibacterial treatment for acute sinusitis indicated and what antibiotics are used?
|
At least 3 of the following features:
• Persistent mucopurulent nasal discharge • Facial pain • Poor response to decongestants • Tenderness over the sinuses • Tenderness on percussion of maxillary molar & premolar teeth that can't be attributed to a single tooth • Amoxycillin 500mg tds for 5-7 days Penicillin hypersensitivity: • Cefuroxime 500mg bd for 5-7 days Immediate penicillin hypersensitivity: • Doxycycline 100mg daily for 5-7 days |
|
|
What is otitis externa and what would be the treatment for it?
|
Inflammation of external auditory canal characterised by erythema & swelling of the canal.
• Dexamethasone + framycetine + gramicidin eardrops, 3 drops tds for 3-7 days OR • Flumethasone + clioquinol eardrops, 3 drops bd for 3-7 days - Keep ears dry - Earplugs when swimming - Don't insert foreign objects in ears |
|
|
What are the clinical features of otitis media?
|
• Severe ear pain
• Purulent discharge if ear drum perforates • Degree of hearing impairment • Fever, vomiting • Dystinct erythema of the tympanic membrane |
|
|
What is the treatment for otitis media without systemic features?
|
No systemic features - likely to have a good outcome, so no immediate ABs necessary.
Symptomatic Tx with analgesia. • Pts >2 yrs, symptomatic Tx for 48 hrs, then if SMx persist consider ABs • Pts 6m-2yrs, symptomatic Tx for 24 hrs, then consider ABs • Pts < 6m, treat with antibiotics |
|
|
What is the treatment for children with otitis media WITH systemic features?
|
Antibiotics should cover:
• Strep. pneumoniae (G+ve) • Haemophilus influenzae (G-ve) • Strep. pyogenes (G+ve) • Amoxycillin 15 mg/kg tds for 5 days OR • Amoxycillin 30 mg/kg up to 1g, bd for 5 days Penicillin hypersensitivity: • Cefuroxime 10 mg/kg up to 500mg bd for 5 days OR • Cefaclor 10 mg/kg up to 250mg tds for 5 days |
|
|
What is pneumonia?
What are the factors you will consider when accessing a patient with pneumonia? |
Inflammation of lung parenchyma incl. bronchioles, alveoli & interstitial tissue (infective origin).
• Age • Symptoms • Time course • Concomitant diseases • How sick is the patient? • Extrapulmonary involvement • Determine host defence mechanisms • Current/recent interventions • Past medical Hx |
|
|
What is the most common pathogen in CAP?
|
Streptococcus pneumoniae
|
|
|
What are the clinical features for CAP and HAP?
|
Systemic:
• Malaise • Anorexia • Myalgia, arthralgia • Chills • Rigor Respiratory: • Shortness of breath • Pleuritic chest pain • Cough • Sputum production |
|
|
How is HAP acquired and what are the likely pathogens?
|
Most HAP occurs by microaspiration of bacteria colonising upper GIT of pt. Intubation greatly increases risk b/c it interferes with first line patient defences.
Pts in low-risk ward or in high risk ward for < 5 days more likely to be due to Streptococcus pneumoniae & non-MDR G-ve bacteria. Pts > 5 days in high risk areas are more likely to have MDR infection. |
|
|
What is the treatment for patients with HAP in high risk wards for 5 days or longer?
|
• Cefepime IV
OR • Piperacillin + tazobactam IV OR • Ticarcillin + clavulanate IV In severe pneumonia, add gentamicin as it can reduce mortality for HAP due to MDR organisms in critically ill patients |
|
|
What is aspiration pneumonia?
What are the risk factors and treatment? |
Caused by inhalation of stomach contents contaminated by bacteria from the mouth.
Risk factors: • Alcohol • General anaesthesia • Hypnotic drugs Treatment: • Benzylpenicillin IV PLUS • Metronidazole IV or oral |
|
|
What are the signs and symptoms of pulmonary tuberculosis?
What diagnostic tests are done? |
• Insidious onset
• Persistent cough that becomes productive • Haemoptysis • Pleural pain not assoc. with acute illness • Spontaneous pneumothorax • Lethargy • Loss of weight Diagnosis: • Chest X-ray • Sputum examination • Positive tuberculin skin test (doesn't necessarily mean active infection) |
|
|
What are the side effects of the drugs commonly used for treatment of TB?
|
• Isoniazid - polyneuropathy (give pyridoxine to prevent this)
• Ethambutol - optic neuritis • Pyrizinamide - hepatitis, gout • Rifampicin - multiple drug interactions, staining of tears/urine/sweat red |
|
|
What is the daily treatment regimen for tuberculosis?
|
• Isoniazid daily for 6 months
PLUS • Rifampicin daily for 6 months PLUS • Ethambutol daily for 2 months PLUS • Pyrazinamide daily for 2 months |
|
|
What is the three-times-weekly treatment regimen for tuberculosis with directly-observed therapy?
|
• Isoniazid 3 times weekly for 6 months
PLUS • Rifampicin 3 times weekly for 6 months PLUS • Ethambutol 3 times weekly for 2 months PLUS • Pyrazinamide 3 times weekly for 2 months |
|
|
What happens to treatment for tuberculosis in pregnancy & breastfeeding?
|
Treatment should be initiated due to risk of TB to the fetus - isoniazid, rifampicin & ethambutol do not appear to have teratogenic effects.
Pyrazinamide not recommended due to insufficient data - if not included in Tx regimen, minimum duration of Tx is 9 months. Babies being breastfed by mothers taking isoniazid should be given pyridoxine 5mg on days the mother receives her isoniazid dose. |
|
|
What is the causative pathogen in malaria and what are the signs & symptoms?
|
Of the 4 species that infect humans, Plasmodium falciparum is the most pathogenic & most resistant to standard antimalarials.
Early symptoms: • Headache • Malaise • Fatigue • Nausea • Muscular pains • Slight diarrhoea • Slight increase in body temp Severe malaria: • Major signs of organ dysfunction • Altered consciousness • Jaundice • Severe anaemia |
|
|
Generally, what kind of therapy is used in treatment of malaria?
|
• IV quinine in severe malaria (use IV artesunate if available)
• Use hydroxychloroquine if chloroquine is unobtainable |
|
|
What can you do to prevent malaria?
|
• Chemoprophylaxis (e.g. doxycycline)
• Personal insect repellant • Insecticide for indoor use • Light-coloured clothing • Long sleeved shirts in evening • Mosquito nets • Avoid outside activities b/w dusk & dawn • Avoid perfume & aftershave |
|
|
What is the empirical treatment for infective endocarditis?
|
• Benzylpenicillin IV
PLUS • Di/flucloxacillin IV PLUS • Gentamicin IV |
