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Published byRebecca Chase Modified over 8 years ago
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common infections Dr Arlo Upton Microbiologist Medical Director Labtests Professor Bruce Arroll Department of General Practice and Primary Health Care
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goodfellowunit.org
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UTI need for MSU resistance issues antibiotics when to avoid specific abs pyelonephritis
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vaginal discharge self swab± internal exam which swabs high vaginal vs cervix Rx for candida, trichomonas Rx gonorrhoea, bacterial vaginosis
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PID gonorrhea + chlamydia + anaerobes how easy is diagnosis swabs then empirical Rx Rx options partner?
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epididymitis Enterobacteriaciaes older men STIs younger men gonorrhea suspected or cultured Rx options repeat sexual health screen 3/12
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urethitis men painful micturition women sterile pyuria organisms Rx
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common cold Abs no use secondary bacterial infection myth nasal or oral decongestants ipratropium nasal spray NSAID paracetamol ? vicks in children
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acute bronchitis
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acute bronchitis 4 weeks of cough sputum value pertussis ?? check if patients want abs –passive voice
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acute sinus symptoms facial pain, nasal discharge, dental pain, nasal congestion mainly viral decongestant analgesic intranasal steroids 80% USA get abs most unnecessary
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acute sinus symptoms second sickening > 10 days or if very toxic antibiotics if symptoms last >10 d severe symptoms last for >3 days consecutive days, or worsening symptoms last after 3 consecutive days
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acute sinus symptoms which Abs duration- unclear ? 10 days if no improvement after 5 days change ab
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overview of respiratory antibiotics discretionary other than strep pharyngitis, pneumonia, severe symptoms most abs given for symptoms not bacterial diagnoses if give then short duration except if clear bacterial sinusitis
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acute otitis media antibiotics if < 6 months if 6 to 24 months severe pain or temp>39 o unilateral OM & not severe, watch –Pediatrics 2013;131:e964–e999
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acute otitis media amoxil 90mg/kg/day duration?? < 2yrs ? 10 days 2 to 6yrs 7 days > 6yr 5 to 7 days if recent amox then augmentin clavulanate 6.4 mg/kg per day
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antibiotic stewardship 50% kiwis get abs each year rising resistance delayed abs offer reassessment public campaign C difficile gut bacteria probiotics
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ear canal pus otitis externa Abs + steroids steroids alone ?? acetic acid < Abs + steroids
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ear canal pus with perforation swabs? quinolones other Abs + steroids ear toxicity?? role of oral antibiotics
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ear canal pus - complications necrotizing otitis externa –immune status? cholesteatoma mastoiditis
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COPD exacerbations 2 symptoms out of 3: increasing dyspnoea increase in sputum volume decrease in lung function
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COPD exacerbations which abs when to use augmentin role of steroids
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pneumonia –curb 65 Confusion of new onset Blood Urea nitrogen greater than 7 mmol/l Respiratory rate > 30/min Blood pressure <90 mmHg systolic DBP < 60 mmHg Age 65 or older
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pneumonia –curb 65 0 to 1 ok at home (2%) 2 admit of watch closely (7%) >2 admit (death 14 to 28%)
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boils staph drainage vs abs which abs MRSA – which abs topical abs recurrent boils
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impetigo ? swab topical hydrogen peroxide topical vs oral abs which abs recurrent impetigo
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cellulitis
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questions write in text box >>
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