Makindo Medical Notes

🩺 UK-SPECIFIC ORGAN-SPECIFIC INFECTIONS & TREATMENT GUIDELINES 🏥

Based on NICE (NG250 for pneumonia, NG109/113 for UTI, NG141 for SSTI, NG240 for meningitis, NG199 for C. diff), BASHH for STIs, BSAC for endocarditis, and other UK sources like PHE/UKHSA. Always consult local guidelines, BNF, and specialists. Dates reflect latest updates as of 2025.

• 1. RESPIRATORY TRACT INFECTIONS 🌬️

  • 1.1 Community-Acquired Pneumonia (CAP) 🫁

    • Most Common Pathogens:
      • 🟢 S. pneumoniae (mainstay)
      • 🟣 Mycoplasma pneumoniae, Legionella, C. pneumoniae (atypicals)
      • 🟠 H. influenzae (esp. in COPD)
    • Assessment: Use CRB-65 score (NICE NG250). Score 0-1: Outpatient; 2: Hospital; ≥3: Urgent hospital.
    • Treatment (NICE NG250):
      • 🚶‍♂️ Low severity (outpatient): Amoxicillin 500mg TDS x 5 days (first-line). If atypical suspected or penicillin allergy: Doxycycline 200mg day 1, then 100mg OD x 4 days OR Clarithromycin 500mg BD x 5 days.
      • 🏥 High severity (hospital, non-ICU): Co-amoxiclav 1g TDS IV/PO + Clarithromycin 500mg BD. Switch to oral when stable.
      • 💉 Severe/ICU: Co-amoxiclav + Clarithromycin + consider adding Levofloxacin if Legionella risk. Add Corticosteroids (e.g., hydrocortisone) for high-severity.
    • Duration: 5 days; extend if not improving.

  • 1.2 Hospital-Acquired Pneumonia (HAP) 🎗️

    • Pathogens: Gram-negatives (Pseudomonas), MRSA.
    • Treatment (NICE NG139): Pip/taz 4.5g TDS IV OR Cefuroxime 1.5g TDS + Metronidazole if anaerobic risk. Add MRSA cover if needed (Vancomycin). Start within 1-4 hours.

  • 1.3 Pharyngitis/Tonsillitis 🤒

    • Group A Strep (Centor score ≥3): Phenoxymethylpenicillin (Pen V) 500mg QDS x 10 days (NICE). Allergy: Clarithromycin 250mg BD x 5 days.

    2. URINARY TRACT INFECTIONS (UTI) 🚽

    2.1 Uncomplicated Lower UTI (Cystitis) 💧

    • #1 Pathogen: 🟣 E. coli.
    • Treatment (NICE NG109): Non-pregnant women: Nitrofurantoin 100mg BD x 3 days (first-line). Alternatives: Trimethoprim 200mg BD x 3 days (if resistance <20%). Pregnant women: Nitrofurantoin x 7 days (avoid 3rd trimester). Men: x 7 days.
    • Delay if mild: Back-up prescription with self-care advice.

    2.2 Acute Pyelonephritis 🩸

    • Treatment (NICE NG109): Ciprofloxacin 500mg BD x 7 days (avoid if resistance high; MHRA warnings). Alternatives: Co-amoxiclav 500/125mg TDS x 7-10 days OR Cefalexin 500mg QDS x 7-10 days.

    2.3 Catheter-Associated UTI 🩹

    • Treatment (NICE NG113): Only treat symptomatic. Ciprofloxacin 500mg BD x 7 days OR Co-amoxiclav. Remove/replace catheter.

• 3. SKIN & SOFT TISSUE INFECTIONS 🩹

  • 3.1 Cellulitis/Erysipelas 🟡

    • Pathogens: 🟡 S. aureus, 🔴 S. pyogenes.
    • Treatment (NICE NG141): Flucloxacillin 500mg QDS x 5-7 days (PO). Severe: IV 1-2g QDS. Allergy: Clarithromycin 500mg BD OR Clindamycin 300mg QDS.
    • MRSA risk: Clindamycin or Doxycycline.

  • 3.2 Abscess/Boil 🩸

    • I&D primary. Antibiotics if systemic symptoms: Flucloxacillin + Clindamycin for MRSA cover.

  • 3.3 Necrotizing Fasciitis ⚠️

    • Treatment: Urgent surgery + Clindamycin 600-900mg IV TDS (toxin suppression) + broad-spectrum (e.g., Pip/taz 4.5g TDS).

• 4. CENTRAL NERVOUS SYSTEM 🧠

  • 4.1 Bacterial Meningitis (Age-Based) 💉

    • Empiric (NICE NG240/UK JSSG): Give IV antibiotics ASAP (within 1 hour if sepsis). Ceftriaxone 2g BD (adults) + Dexamethasone 10mg IV QDS (before/with first dose, if pneumococcal suspected).
    • Neonates: Cefotaxime + Ampicillin (Listeria cover).
    • Children/Young Adults: Ceftriaxone (meningococcus/pneumococcus).
    • Adults >50/Elderly: Add Ampicillin 2g QDS for Listeria.
    • Duration: 7-14 days depending on organism.

  • 4.2 Brain Abscess 🩸

    • Treatment: Ceftriaxone 2g BD + Metronidazole 400mg TDS + consider Flucloxacillin. Surgery if needed.

• 5. GASTROINTESTINAL INFECTIONS 🤢

  • 5.1 Bacterial Diarrhea 🦠

    Pathogen	Treatment (NICE/PHE)
    🟣 Salmonella (non-typhi)	Supportive (avoid abx unless severe)
    🟣 Shigella	Ciprofloxacin 500mg BD x 3 days
    🟤 C. difficile	Vancomycin 125mg QDS PO x 10 days (first-line, NICE NG199). Severe/recurrent: Fidaxomicin 200mg BD x 10 days. Stop offending abx.
    🟣 Campylobacter	Supportive; Azithromycin if severe

    5.2 Intra-abdominal Infections 🫀

    • Treatment: Pip/taz 4.5g TDS IV OR Ceftriaxone 2g OD + Metronidazole 400mg TDS.

• 6. SEXUALLY TRANSMITTED INFECTIONS 🍆

  Disease	Pathogen	Treatment (BASHH 2023/2024)
  🦠 Gonorrhoea	N. gonorrhoeae	Ceftriaxone 1g IM single dose + Azithromycin 2g PO single dose (or Doxycycline 100mg BD x 7d if macrolide allergy)
  🔴 Chlamydia	C. trachomatis	Doxycycline 100mg BD x 7 days (first-line) OR Azithromycin 1g single dose
  🟣 Syphilis	T. pallidum	Benzathine penicillin 2.4g IM (early); 3 doses weekly (late). Alternative: Doxycycline 100mg BD x 14/28 days
  🦠 Trichomoniasis	T. vaginalis	Metronidazole 400mg BD x 5-7 days OR 2g single dose

7. BONE & JOINT INFECTIONS 🦴

7.1 Osteomyelitis 🦴

• Empiric: Flucloxacillin 1-2g QDS IV (S. aureus cover). Add Clindamycin if MRSA.
• Duration: 4-6 weeks total (IV 1-2 weeks, then oral switch if stable, per BSAC/BOA).
• Children: Early OPAT consideration (BOAST).

• 7.2 Septic Arthritis 💧

  • Treatment: Urgent aspiration/drainage + Flucloxacillin IV. Gonococcal: Ceftriaxone.
  • Duration: 2-4 weeks IV/PO.

**🩺 KEY TAKEAWAYS FOR UK EXAMS (PLAB/MRCP):** - **NICE emphasis: Antimicrobial stewardship, short courses, local resistance data. - **MRSA/Pseudomonas: Risk assess (hospitalisation, ICU). - **Sepsis: Within 1 hour antibiotics (NICE NG51). - **Prophylaxis: No routine for IE (NICE CG64); focus on hygiene. - **Always: Source control + de-escalate based on cultures. Consult BNF for doses.