Important Infections - 1

?
  • Created by: LBCW0502
  • Created on: 29-11-19 09:50
The NICE guidelines on antimicrobial prescribing covers which infections?
Sinusitis, sore throat, otitis media, prostatitis, recurrent UTI, pyelonephritis, COPD, urinary tract infection (catheter associated), lower UTI, bronchiectasis, cough, pneumonia (hospital), pneumonia (community), cellulitis, diabetic foot infection
1 of 38
Describe features of the NICE guidelines for pneumonia in adults (1)
Covers diagnosis (signs/symptoms, tests - point of care, microbiology, X-ray, severity assessment (mortality), primary/secondary care). Management with new antibiotic prescribing guidelines
2 of 38
Describe features of the NICE guidelines for pneumonia in adults (2)
CRB65 (primary), CURB65 (secondary). Score 0-5 (higher score, severity increases, increased mortality risk). Score of 5 (40% mortality rate)
3 of 38
Describe features of the NICE guidelines for pneumonia in adults (3)
Determine score (points for) – aged over 65, confusion (new onset), urea (measured in the blood, level of renal function, high urea level/poor renal function, co-morbidity, disease severity), RR(>30 bpm), BP (diastolic <90, systolic <60)
4 of 38
What is the difference between CRB65 and CURB65?
Difference is the measurement of urea level (used in secondary care rather than primary care) - may influence choice of antibiotics to treat pneumonia
5 of 38
What other factors need to be considered when prescribing antimicrobials for community acquired pneumonia? (1)
Consider patient’s co-morbidities, elderly patients may not always show signs/symptom of pneumonia. Pneumonia might affect control of other co-morbidities e.g. diabetes. Personal antibiotic resistance data
6 of 38
What other factors need to be considered when prescribing antimicrobials for community acquired pneumonia? (2)
Consider past infections/organisms the patient had, recent antibiotics the patient had – drives choice of antibiotic used (e.g. amoxicillin not used despite being first line treatment due to not being effective in the patient in previous cases)
7 of 38
What is the time frame for the administration of antibiotics to a patient with community acquired pneumonia?
Within 4 hours - improves outcomes (oral antibiotics suitable for most patients)
8 of 38
When would IV antibiotics be appropriate for the treatment of pneumonia? (1)
Severe pneumonia – admitted to hospital, moderate pneumonia where patient has underlying GI tract disease not controlled (e.g. episode of infection leads to flare in the symptoms of IBD)
9 of 38
When would IV antibiotics be appropriate for the treatment of pneumonia? (2)
Use IV if patient cannot tolerate oral formulation (vomiting, diarrhoea/reduced absorption/efficacy)
10 of 38
When would IV antibiotics be appropriate for the treatment of pneumonia? (3)
IV used if patient cannot swallow, no oral equivalent for some IV antibiotics (e.g. piperacillin/bactam), patient is not improving
11 of 38
Why is it better to switch IV antibiotics to oral? (1)
Consider switching to oral when assessing response to treatment, reduce cross-infection when IV is changed to oral (remove catheter as early as possible), patient can be discharged with oral antibiotics
12 of 38
Why is it better to switch IV antibiotics to oral? (2)
Easier to administer oral antibiotic, IV (preparation required), oral formulation used if patient is clinically improving
13 of 38
What are the monitoring requirements for a patient with pneumonia?
Monitor FBC, CRP, WCC, BP etc. Reassess patient quickly and appropriately
14 of 38
Why is the blood pressure reduced in severe infections?
Due to release of lipid A from organisms into circulation, stimulate cytokines, ILs, make circulation leaky (endothelium junctions wider), fluid leads out, circulating volume is reduced, BP decreases, HR increases for compensation
15 of 38
Give examples of conditions which require long term use of antibiotics
Endocarditis, bone/joint infections, abscess
16 of 38
Why is it important to consider other possible causes of infection?
E.g. cause could be a non-bacterial infection (flu), inflammation - influences choice of antibiotic
17 of 38
Which antibiotics are used to treat mild pneumonia? (1)
Amoxicillin (or doxycycline, clarithromycin), erythromycin (used in pregnancy)
18 of 38
Which antibiotics are used to treat mild pneumonia? (2)
Amoxicillin – narrow spectrum, active against strep pneumoniae (+), haemophilus pneumoniae (-) – most common causes of pneumonia regardless of disease severity, beta lactam, easy to dose, can be given as IV as well
19 of 38
Which antibiotics are used to treat mild pneumonia? (3)
Doxycycline – better coverage than macrolides (not used in pregnancy – affects teeth/bone development). Clarithromycin – anti-inflammatory/antimicrobial effects, useful in respiratory tract infections (not licensed for use in pregnancy)
20 of 38
Which antibiotics are used to treat moderate pneumonia?
Patient may have unstable co-morbidities (e.g. diabetes, HF, respiratory tract conditions), use IV antibiotics, doxycycline (alternative), can be amoxicillin/clarithromycin/erythromycin
21 of 38
When would a combination of antibiotics be used?
In the presence of atypical organisms e.g. other organisms which may cause community acquired pneumonia (strepneumonia, haemophilus pneumoniae), chlamydia, legionella – conditions covered (use combination of antibiotics)
22 of 38
Which antibiotics are used to treat severe pneumonia?
Cover all causes of pneumonia, consider potential of resistance, use co-amoxiclav or erythromycin, levofloxacin (quinolone, association with MRSA, C. difficile infections)
23 of 38
What are the other aspects of antimicrobial prescribing for community acquired pneumonia?
Mycoplasma pneumoniae – occurs as epidemic (useful as diagnostic tool). Avoid use of quinolones in children – toxicity issues
24 of 38
Describe features of the NICE guideline for antimicrobial prescribing in lower UTIs (1)
Lower UTI – could be self-limiting (delayed prescription for new onset, mild symptoms). Send urine sample and offer antibiotic – check urine sample result (not usually checked due to short treatment for UTI - 3 days)
25 of 38
Describe features of the NICE guideline for antimicrobial prescribing in lower UTIs (2)
Always send a urine sample of pregnant women, men, children under 16 years – suspected UTI (influences drug choice e.g. effects on foetus). Self-care- good hydration/fluid management, rest, analgesia for pain
26 of 38
Which antibiotics are used in non-pregnant women for lower UTI?
Nitrofurantoin (1st choice), trimethoprim (2nd choice, used if low risk of resistance, or susceptible)
27 of 38
Why is nitrofurantoin not used in moderate renal impairment?
Not used in moderate renal impairment (eGFR <45 mL/min), drug doesn’t enter urinary tract very well (not effective), not excreted well (accumulation, increases risk of toxicity)
28 of 38
What are the alternative antimicrobial choices for UTIs?
Pivmecillinam, Fosfomycin – alternative choices (increase in demand of narrow spectrum antibiotics). Fosfomycin – single dose sachet
29 of 38
How long is the treatment course for UTI in men?
7 days - consider other potential diagnoses
30 of 38
Why is the use of nitrofurantoin in children not cost effective?
Nitrofurantoin for children – sold in large bottles but only small doses used for children (not cost effective) – usually avoid
31 of 38
Describe features of the NICE guideline for antimicrobial prescribing in cellulitis and erysipelas (1)
Exclude other causes of skin redness (inflammatory reactions or non-infectious causes such as chronic venous insufficiency). When choosing antibiotics, consider - severity of symptoms, site of infection, risk of uncommon pathogens
32 of 38
Describe features of the NICE guideline for antimicrobial prescribing in cellulitis and erysipelas (2)
Microbiological results/MRSA status. Oral antibiotics (1st line), review IV antibiotics by 48h and consider switching to oral. Antibiotics not routinely used for recurrence.
33 of 38
Describe features of the NICE guideline for antimicrobial prescribing in cellulitis and erysipelas (3)
Phenoxymethylpenicillin 250 mg BD or erythromycin 250 mg BD for penicillin allergy - review at least every 6 months
34 of 38
What other factors are considered when prescribing antimicrobials for cellulitis and erysipelas? (1)
Manage underlying conditions (diabetes, venous insufficiency, eczema, oedema). Skin will take time to return to normal after finishing antibiotics. Reassess if symptoms are worse in 2-3 days
35 of 38
What other factors are considered when prescribing antimicrobials for cellulitis and erysipelas? (2)
Referral - severely unwell, infection of eyes/nose, uncommon pathogens, spreading infection not responsive to oral antibiotics, cannot take oral antibiotics (may need to give IV)
36 of 38
Which antibiotics are prescribed for cellulitis and erysipelas in adults? (1)
Flucloxacillin (alternatives - clarithromycin, erythromycin/pregnancy, doxycycline). Infection near eyes/nose - co-amoxiclav (alternative - clarithromycin with metronidazole). Severe (co-amoxiclav, cefuroxime clindamycin, or ceftriaxone)
37 of 38
Which antibiotics are prescribed for cellulitis and erysipelas in adults? (2)
MRSA infection - vancomycin, teicoplanin, linezolid (similar prescribing guidelines for children)
38 of 38

Other cards in this set

Card 2

Front

Describe features of the NICE guidelines for pneumonia in adults (1)

Back

Covers diagnosis (signs/symptoms, tests - point of care, microbiology, X-ray, severity assessment (mortality), primary/secondary care). Management with new antibiotic prescribing guidelines

Card 3

Front

Describe features of the NICE guidelines for pneumonia in adults (2)

Back

Preview of the front of card 3

Card 4

Front

Describe features of the NICE guidelines for pneumonia in adults (3)

Back

Preview of the front of card 4

Card 5

Front

What is the difference between CRB65 and CURB65?

Back

Preview of the front of card 5
View more cards

Comments

No comments have yet been made

Similar Pharmacy resources:

See all Pharmacy resources »See all Important Infections - 2 resources »