European Journal of Neurology 2011, 18: 1115–1121 Treatment of medication overuse headache – guideline of theEFNS headache panel S. Eversa and R. JensenbaDepartment of Neurology, University of Mu¨nster, Mu¨nster, Germany; and bDanish Headache Center, Department of Neurology, GlostrupHospital, University of Copenhagen, Copenhagen, Denmark Background: Medication overuse headache is a common condition with a population-
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Antibiotics - an aide-memoire
Antibiotics "Aide-Memoire" (adult doses unless otherwise stated)
oxy(tetracycline) 500mg BD 3/12 doxycycline 100mg OD for 3/12 or lymecycline caps If mild to moderate consider topical treatment. Not minocycline due to side effects Acute cough, bronchitis,
amoxicillin 500mg TDS 5/7 doxycycline 200mg stat then 100mg OD 5/7 Cough/bronchitis - antibiotic little benefit if no co-morbidity. Symptom resolution can take 3 exacerbations of COPD
weeks. Consider 7day delayed antibiotic with symptomatic advice/leaflet. Consider immediate
antibiotics if >80yr and ONE of: hospitalisation in past year, oral steroids, diabetic, congestive
heart failure OR>65 yrs with 2 of above.
COPD - treat promptly if purulent sputum and increased SOB and/or increased sputum volume.
Acute Otitis externa
EarCalm® spray (acetic acid 2%) 1 spray TDS Neomycin sulphate + corticosteroid 3 drops TDS 7- Cure rates similar at 7 days for topical acetic acid or antibiotic +/- steroid 7/7, prescribe by brand name.
Acute Otitis Media
(<1mth) amoxicillin 30mg/kg tds 5/7 erythromycin if need liquid clarithromycin if can
Optimise analgesia. 60% resolve in 24hrs without antibiotics which only reduce pain at 2 days and (1mth to 1yr) amoxicillin 125mg tds 5/7 do not prevent deafness. (1-5yrs) amoxicillin 250mg tds 5/7 (1mth to 2yrs) 125mg qds 5/7 (5-18yrs) amoxicillin 500mg tds 5/7 (2-8yrs) 250mg qds 5/7 Consider 2 or 3-day delayed or immediate antibiotics for pain relief if: <2 years AND bilateral or
(adult) amoxicillin 500mg TDS 5/7 (8-18yrs) 250-500mg qds 5/7 bulging membrane, all ages with otorrhoea.
(Adult) Clarithromycin 500mg BD 5/7 amoxicillin 500mg TDS 7/7.
doxycycline 200mg stat then 100mg OD 7/7. For Avoid antibiotics as 80% resolve in 14 days without, and they only offer marginal benefit after 7
For persistent symptoms: add metronidazole persistent symptoms: add metronidazole 400mg BD days. Use adequate analgesia
400mg BD 7/7 Consider 7-day delayed or immediate antibiotic when purulent nasal discharge Acute sore throat
phenoxymethylpenicillin 500mg QDS 10/7 Penicillin allergy - clarithromycin 500mg BD 10/7 Avoid antibiotics as 90% resolve in 7 days without, and pain only reduced by 16 hours with antibiotic. If Centor * score 3 or 4 consider 2 or 3-day delayed or immediate antibiotics Bites - Human & Animal
co-amoxiclav 625mg TDS 7/7 Penicillin allergy : (cat/dog) - metronidazole 400mg Human: thorough irrigation is important. Assess risk of, HIV, hepatitis B&C. Antibiotic prophylaxis TDS plus doxycycline 100mg BD both 7/7, (human bite) - ciprofloxacin 500mg BD + clindamycin 300mg Cat or dog: assess risk of tetanus and rabies. Give prophylaxis if cat bite/puncture wound; bite to QDS both 7/7 hand, foot, face, joint, tendon, ligament; or if immunocompromised /diabetic/asplenic/ cirrhotic.
flucloxacillin 500mg QDS 7/7 Penicillin allergy - clarithromycin 500mg BD 7/7 If slow response continue for a further 7 days. (if afebrile and healthy other than cellulitis, use If febrile and ill, consider IV treatment by community team. If river or sea water exposure, discuss Chloramphenicol 0.5% drops Fusidic acid 1% gel BD Treat only if severe, as most viral or self-limiting. 2 hourly for 2 days and then 4 hourly (whilst Bacterial conjunctivitis is also self-limiting; 65% resolve on placebo by day five awake); and 1% ointment at night
Continue treatment for 48 hours after resolution co-amoxiclav 625mg TDS 7/7 If penicillin allergic, ciprofloxacin 500mg BD PLUS Assess the need for admission. metronidazole 400mgTDS both 7/7 If treated at home, use broad spectrum antibiotics Eczema (where visible signs
If no visible signs of infection, use of antibiotics (alone or with steroids) encourages resistance and does not improve healing In eczema with visible signs of infection, use treatment as in impetigo Eradication of Helicobacter
Always use PPI (lansoprazole 30mg or
If previous clarithromycin use and not had Eradication is beneficial in known DU, GU or low grade MALToma.
omeprazole 20mg) bd with: exposure to a quinolone:(all for 7/7) Consider test and treat in persistent uninvestigated dyspepsia. amoxicillin 1g BD plus either clarithromycin
Do not offer eradication for GORD. 500mg BD or metronidazole 400mg BD – all
metronidazole 400mg BD Do not use clarithromycin or metronidazole if used in past yr for any infection. If pen allergic – use PPI plus clarithromycin Levofloxacin 250mg bd In relapse see NICE 500mg BD and metronidazole 400mg BD – all 7/7 Impetigo
flucloxacillin 500mg QDS 7/7 Penicillin allergy - clarithromycin 500mg BD 7/7 For extensive, severe, or bullous impetigo, use oral antibiotics
Reserve topical antibiotics for very localised lesions topical fusidic acid 2% tds 5/7
Updated October 15 Review date: Jan 2017 or sooner if updated evidence
Antibiotics "Aide-Memoire" (adult doses unless otherwise stated)
Leg Ulcers & Pressure Sores
Ulcers are always colonized. Antibiotics do not Flucloxacillin 500mg QDS or clarithromycin 500mg Only treat if cellulitic. If slow response continue for a further 7 days.
improve healing unless active infection Meningococcal Disease
IV or IM benzylpenicillin: IV or IM cefotaxime: Transfer all patients to hospital immediately. IF time before admission, give IV benzylpenicillin or
Age 10+ years: 1200 mg Age 12+ years: 1gram cefotaxime unless clear history of anaphylaxis. (IM if cannot find vein) Children 1 - 9 yr: 600 mg Child < 12 yrs: 50mg/kg Prevention of secondary case of meningitis: Only prescribe following advice from Public Health.
Children <1 yr: 300 mg Contact local HPA on 0845 894 2944; out of hours 0844 967 0069 Pelvic Inflammatory Disease
metronidazole 400mg BD 5/7 plus If high risk of G/C : Ceftriaxone 500mg IM stat plus Refer woman & contacts to GUM service. Always culture for gonorrhoea (G) & chlamydia (C). If ofloxacin 400mg BD 14/7 metronidazole 400mg BD 5/7 plus doxycycline gonorrhoea likely (partner has it, severe symptoms, sex abroad) use ceftriaxone regimen or refer to GUM. If pregnant, do not prescribe, refer to GUM If CRB65*=0, amoxicillin 500mg TDS 7/7, if 2nd line if CRB65*=0, doxycycline 200mg stat then Use CRB65* score to help guide and review – Score 0 – suitable for home Pneumonia – treatment in
CRB65=1 and patient at home, doxycycline 100mg OD for 7/7.
treatment. Score 1-2 – hospital assessment or admission. Score 3-4 – urgent hospital admission.
200mg stat then 100mg OD 7/7 Urinary Tract Infection
nitrofurantoin 100mg M/R BD if egfr>45 (use Perform culture (i.e. send MSU) in all treatment
N.B. in people >65yrs: do not treat asymptomatic bacteruria; it is common but is not associated
with caution if between 30 and 45) failures. If increased resistance risk, send culture
with increased morbidity. If catheter in situ: Antibiotics will not eradicate asymptomatic
men and women
for susceptibility testing and give safety net advice.
bacteriuria; only treat if systemically unwell or pyelonephritis likely. Do not use prophylactic
Or trimethoprim 200mg bd if eGFR >30 antibiotics for catheter changes unless history of catheter-change-associated UTI. See Microbiology recommendation only – fosfomycin All ages - Treat for 3/7 females, 7/7 males (3g stat in women plus 2nd 3g dose in men on day 3 (microbiology 01273 696955 ext 4619) N.B. URINARY SYMPTOMS IN ADULT WOMEN <65 DO NOT CULTURE ROUTINELY. In sexually
active young men and women with urinary symptoms consider trachomatis
Women <65yrs - with severe/3 or more symptoms – TREAT
Choose Nitrofurantoin as first
Women <65yrs - with mild/2or less symptoms – use dipstick to guide treatment. See
choice for UTI's because of lower
Men under 65yrs – consider prostatitis and send pre-treatment MSU, or, if symptoms
mild/non-specific, use negative dip-stick to exclude UTI
Also, See for the management of UTI in children and in pregnancy, and management of recurrent UTI (3 or more episodes per year). ciprofloxacin 500 mg BD 28/7 Trimethoprim 200mg bd 28/7 Send MSU for culture and start antibiotics
4-wk course may prevent chronic prostatitis
co-amoxiclav 625mg TDS 10/7 ciprofloxacin 500mg BD 7/7 If admission not needed, send MSU for culture & sensitivities and start antibiotics If no response within 24 hours, admit Adapted from Brighton and Hove CCG and High Weald Lewes Havens CCG ‘antibiotics in primary care 2014 update', which is based on the HPA "Management of infection guidance for primary care for consultation and local adaptation" Aug 2010, revised Aug 15, available at *Centor Criteria: each parameter scores 1: History of fever; absence of cough; tender anterior cervical lymphadenopathy and tonsillar exudates *CRB65 score: each parameter scores1: Confusion (AMT<8); Respiratory rate >30/min; BP systolic <90 or diastolic ≤60; Age >65; Updated October 15 Review date: Jan 2017 or sooner if updated evidence
The Perinatal Gazette Newsletter of the Regional Perinatal Center Maria Fareri Children's Hospital at Westchester Medical Center Volume 16, Issue 1 Paracetamol Treatment for Bioethics of Fetal Surgery PDA Closure in Preterm Infants Maintenance of the fetal Patent Ductus Arteriosus (PDA) is critical for Fetal surgery represents a broad spectrum of techniques that are used