Bugs and drugs

Pregunta	Respuesta
Upper respiratory tract common infecting organisms and gram stain results:	Strep. pneumoniae positive Moraxella catarrhalis negative Haemophilus influenzae negative
ENT common infecting organisms and gram stain results:	As above + Strep. Pyogenes (=GABHS) positive
Lower respiratory tract common infecting organisms and gram stain results:	Strep. pneumoniae positive H.’flu negative Mycoplasma pneumoniae Neither-no cell wall
Urinary tract common infecting organisms and gram stain results:	E.coli Negative (anaerobe) Staph. saprophyticus positive Klebsiella sp. Negative (anaerobe) Proteus mirabilis Negative (anaerobe)
Genital tract common infecting organisms and gram stain results:	Chlamydia trachomatis negative Neisseria gonorrhoeae negative Gardnerella vaginalis Variable (anaerobe) Trichomonas vaginalis Neither-protozoa (anaerobe)
GI tract common infecting organisms and gram stain results:	Campylobacter jejuni negative Giardia lamblia Neither-protozoa (anaerobe)
Skin common infecting organisms and gram stain results:	Staph. aureus positive Strep. pyogenes positive
CNS common infecting organisms and gram stain results:	Neisseria meningitidis negative S. Pneumoniae positive
Beta lactams:	Beta lactams: Mechanism of action: Interfere with cell wall synthesis Examples: Penicillin, flucloxacillin, amoxycillin (can be combined with clavulanic acid to increase range of cover but can knock out gut anaerobes, use only when necessary).
Cephalosporins:	Cephalosporins: Examples: Cefalexin, cefaclor, cefuroxime, ceftriaxone (move from G+ to G-, ceftriaxone not available in oral form and cefuroxime only subsidised in certain situations).
Macrolides:	Macrolides: Mechanism of action: Inhibit bacterial protein synthesis. Examples: Erythromycin, roxithromycin, azithromycin, clarithromycin (only subsidised in certain situations, wide spectrum of activity including mycoplasma which doesn’t have a cell wall, not so good against H. ‘flu).
Quinolones:	Quinolones: Mechanism of action: Inhibit bacterial DNA replication Examples: Norfloxacin, ciprofloxacin, moxifloxacin (active against G- anaerobes and S.aureus but little other G+ cover, do NOT use for S.pneumoniae)
Sulphonamides:	Sulphonamides: Mechanism of action: Inhibit bacterial folic acid synthesis Examples: Co-trimoxazole= Trimethoprim+Sulfamethoxazole (useful for resp, ENT and UTI, trimethoprim alone also for uncomplicated UTI).
Tetracyclines:	Tetracyclines: Examples: Tetracycline, doxycycline (very broad range of activity including some anaerobes, chlamydia and mycoplasma, also used for malaria prophylaxis)
Imidazoles:	Imidazoles: Examples: Metronidazole, ornidazole, tinidazole (treatment of anaerobic and protozoa).
Topical agents: Examples:	Topical agents: Examples: Mupirocin, fusidic acid + a few others for ears and eyes.
Streptococcal infection Site of pain Severity Radiation Appearance of tonsils Time course Temperature Voice Halitosis Lymph nodes Liver and spleen Lab investigations	Pharynx, tonsils Cannot eat Sometimes to ear Large red pockets of pus in crypts Abrupt onset; starts and stays in throat Not discriminatory Normal or muffled (“hot potato voice) May be present Jugulo-digastric - Can do bacterial swab. FBC may show neutrophilia
EBV Site of pain Severity Radiation Appearance of tonsils Time course Temperature Voice Halitosis Lymph nodes Liver and spleen Lab investigations	Pharynx, tonsils Cannot eat Sometimes to ear May be same as in strep infection; may have pseudomembrane, or be very enlarged meeting in midline and obstruct airway Varies- may be preceded with malaise with more gradual onset of sore throat Not discriminatory Normal or muffled May be present Large, rubbery, non-tender posterior triangle nodes. May also have nodes elsewhere on body. One of both enlarged and/or tender. Rarely be jaundiced. FBC shows absolute or relative lymphocytosis, with atypical lymphocytes. EBV serology will be positive in due course. Throat swab may show coexisting strep.
Other viral infection Site of pain Severity Radiation Appearance of tonsils Time course Temperature Voice Halitosis Lymph nodes Liver and spleen Lab investigations	Trachea Still eat despite pain Usually none Normal Early part of progression. Symptoms involve and migrate from nose and throat to chest. Not discriminatory Hoarse if larynx affected Not present Anterior triangle,may include jugulo-digastric. Sometimes liver may be tender but not usually enlarged. Very often normal.
Questions to ask yourself when prescribing antibiotics:	Does this patient need antibiotics for this illness? Consider: Is this bacterial? Will it get better on its own? Likely organism? Appropriate antibiotic? Any reasons why not appropriate antibiotic? Age (tetracyclines not for <12, prescribing for v. young and old). Allergies Other medical conditions (renal/hepatic impairment, long QT syndrome) Other medications (warfarin, digoxin, statins (with macrolides), ergot derivatives (macrolides) Side effects (diarrhoea in those with limited mobility) Cost (subsidised or not?) Taste (children) Mode of delivery (patient’s preference) Pregnancy/lactation What do I need to tell this patient about this medication?
Tetracyclines avoid in: Sulfonamides avoid in: Azoles avoid in: Macrolides avoid with:	Tetracyclines should not be used in <12 and pregnancy (stains teeth and teratogenic). Sulfonamides should not be used in <6 month babies and elderly; folate antagonist. Azoles should not be given with 24 hrs of alcohol. Macrolides interact with statins.

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	Creado por Ashutosh Kumar hace casi 8 años