COMON INFECTION OF THE BLOOD

Terms

Septicemia-a disease caused by toxic microorganisms in the bloodstream

 Bacteremia-presence of bacteria in the blood

Septicemia is a medical emergency and blood cultures should be taken b4 starting antimicrobial therapy

When septicemia follows GI or genital tract surgery, E coli or other gram –ve bacteria, anaerobes eg Bacteroides, Streptococci or Enterococci are likely pathogens.

Drug regimens:

Cefuroxime + metronidazole

OR

Gentamycin + amoxycillin + metronidazole

When related to urinary tract infns, it involves E coli or other gram –ve, enterococci

Regimen:

Gentamycin + amoxycillin or gentamycin + ceftazidime where P aeruginosa is suspected.

Neonetal septicemia is due to Streptococci or P aeruginosa

Give cefotaxime or with netilmicin

When there is abcess, it may be due to Staphylococci….flucloxacillin is DOC

NB. Give vancomycin to MRSA

Cardiovascular system

Infective endocarditis (IE)- a microbial infection of the heart valves or other endocardial tissue

Common microbes are staphylococci, streptococci, enterococci or fungal

Initial ‘blind’ therapy

Flucloxacillin (or pen G if symptoms less severe) + gentamicin

Substitute flucloxacillin (or pen G) with vancomycin + rifampicin if cardiac prostheses present, or if penicillin-allergic, or if meticillin-resistant Staphylococcus aureus suspected

Endocarditis caused by streptococci

Pen G (or vancomycin if penicillin- allergic or highly penicillin-resistant) + gentamicin

Treat more resistant organisms for 4–6 weeks (stopping gentamicin after 2 weeks for organisms moderately sensitive to penicillin.

Treat prosthetic valve endocarditis for at least 6 weeks (stopping gentamicin after 2 weeks if organisms fully sensitive to penicillin

Endocarditis caused by enterococci (e.g. Enterococcus faecalis)

Amoxicillin (or vancomycin if penicillin-allergic or penicillin-resistant) + gentamicin

Treat for at least 4 weeks (at least 6 weeks for prosthetic valve endocarditis); if gentamicin-resistant, substitute gentamicin with streptomycin

CNC

Meningitis

Infection causing inflammation of the membranes covering the brain and spinal cord.

Headache, fever, stiff neck, photophobia, drowsiness, myalgias, malaise, chills, sore throat, abdominal pain, nausea, and vomiting

                                                 

Meningitis caused by meningococci

Pen G or cefotaxime

Treat for at least 5 days; substitute chloramphenicol if history of anaphylaxis to penicillin or to cephalosporins.

 To eliminate nasopharyngeal carriage give rifampicin for 2 days

Meningitis caused by pneumococci

Cefotaxime

Treat for 10–14 days; substitute benzylpenicillin if organism penicillin-sensitive; if organism highly penicillin- and cephalosporin-resistant, add vancomycin and if necessary rifampicin.

Consider adjunctive treatment with dexamethasone starting before or with first dose of antibacterial (but may reduce penetration of vancomycin into cerebrospinal fluid)

Meningitis caused by Haemophilus influenzae

Cefotaxime

Treat for at least 10 days; substitute chloramphenicol if history of anaphylaxis to penicillin or to cephalosporins or if organism resistant to cefotaxime.

Consider adjunctive treatment with dexamethasone For

H. influenzae type b give rifampicin for 4 days before hospital discharge

Meningitis caused by Listeria

Ampicillin or Amoxicillin + gentamicin

Treat for 10–14 days

Urinary tract

Common pathogens are E coli, Proteus spp, K pneumoniae, P aeruginosa, Enterobacteriae, S saprophyticus

Acute pyelonephritis

A broad-spectrum cephalosporin or a quinolone

Treat for 14 days;

longer treatment may be necessary in complicated pyelonephritis

Acute prostatitis

A quinolone or trimethoprim

Treat for 28 days; in severe infection, start treatment with a high dose broad-spectrum cephalosporin (e.g. cefuroxime or cefotaxime) + gentamicin

‘Lower’ urinary-tract infection

Trimethoprim or nitrofurantoin or amoxicillin or oral cephalosporin

Treat for 7 days but a short course (e.g. 3 days) of trimethoprim or nitrofurantoin is usually adequate for uncomplicated urinary-tract infections in women

Genital system

Syphilis by Treponema pallidum

Procaine benzylpenicillin or doxycycline or erythromycin

Treat early syphilis for 14 days (10 days with procaine benzylpenicillin).

Treat late latent syphilis with procaine benzylpenicillin for 17 days (or with doxycycline for 28 days).

 Treat asymptomatic contacts of patients with infectious syphilis with doxycycline for 14 days.

Uncomplicated gonorrhoea (Neisseria donorrhoeae)

Cefixime or ciprofloxacin

Single-dose treatment in uncomplicated infection.

Choice depends on locality where infection acquired.

 Pharyngeal infection requires treatment with ceftriaxone.

 Use ciprofloxacin only if organism sensitive.

Uncomplicated genital chlamydial infection, non-gonococcal urethritis and non-specific genital infection

Doxycycline or azithromycin

Treat with doxycycline for 7 days or with azithromycin as a single dose;

alternatively, treat with erythromycin for 14 days.

Pelvic inflammatory disease(N gonorrhoeae, C trachomatis, M hominis)

Doxycycline + metronidazole + i/m ceftriaxone or ofloxacin + metronidazole

Treat for at least 14 days (use i/m ceftriaxone as a single dose).

 In severely ill patients initial treatment with doxycycline + i/v ceftriaxone (as a single dose) + i/v metronidazole, then switch to oral treatment with doxycycline + metronidazole to complete 14 days' treatment.

Bacterial vaginosis

Oral or topical metronidazole or topical clindamycin

Oral treatment for 5–7 days (or with high-dose metronidazole as a single dose); topical treatment for 5 days (7 days with clindamycin)

Chancroid-Haemophillus ducrey

Erythromycin for 7 days or single dose of Rocephin™ or azithromycin

Granuloma inguinale-by Calymmatobacterium granulomatis

Ampicillin or CTX or tetracycline for 2 weeks