Domain – Infectious diseases (Guiding topics)

• Assess and manage a patient presenting with fever of unknown origin.
• Assess and manage a patient presenting with fever with rash.
• Formulate a differential diagnosis list in a patient presenting with lymphadenitis and painful lymph node swelling.
• Assess and manage a patient with a suspected COVID-19 infection.
• Take a focused history, clinically examine and manage a patient presenting with an infection affecting the following systems:
  • eye
  • upper respiratory tract
  • lower respiratory tract
  • urinary tract
  • intra-abdomen
  • central nervous system
  • gastrointestinal system
  • bones and joints
  • sexually transmitted and genital tract
  • liver
  • skin and soft tissues
  • heart
  • blood-borne infections such as hepatitis C.
• Recognise and investigate a patient presenting with clinical features suggestive of sepsis-like fever, tachycardia and low blood pressure.
• Describe common infections and their prevention in high-risk populations:
  • people in contact with the criminal justice system
  • refugees and migrants
  • Aboriginal and Torres Strait Islander peoples
  • individuals living in overcrowded housing
  • immunocompromised patients
  • pregnant women
  • LGBTIQ₊ people
  • high-risk occupations, such as working with livestock.
• Identify infections that a patient can acquire while visiting a general practice (eg influenza, COVID-19).
• Identify and manage a patient presenting with a notifiable disease (eg pertussis).
• Manage a patient presenting with a needle stick injury, including notification, investigation, review of infection control procedures and addressing medico-legal aspects.
• Take a focused history, clinically examine and manage patients presenting with vaccine-preventable diseases:
  • measles
  • mumps
  • rubella
  • chicken pox
  • meningococcal infections
  • zoster and varicella
  • pertussis
  • pneumococcal disease
  • Q fever
  • rota virus
  • haemophilus
  • tuberculosis
  • monkeypox.

Disease	Clinical Signs/Symptoms	Examination Findings	Management
Measles	High fever, cough, coryza, conjunctivitis, Koplik spots, maculopapular rash	Koplik spots on buccal mucosa, maculopapular rash starting at hairline and spreading downward	Supportive care, Vitamin A, isolation, MMR vaccine
Mumps	Parotitis, orchitis, fever, headache, malaise	Swollen, tender parotid glands	Supportive care, analgesics, MMR vaccine
Rubella	Low-grade fever, lymphadenopathy, maculopapular rash, arthralgia	Forchheimer spots on soft palate, maculopapular rash starting on face and spreading downward	Supportive care, isolation, MMR vaccine
Chickenpox (Varicella)	Fever, malaise, vesicular rash in crops	Vesicles on erythematous base, various stages of lesions	Supportive care, antiviral (acyclovir) if severe or high-risk, Varicella vaccine
Meningococcal Infection	Fever, headache, stiff neck, photophobia, petechial rash	Petechial or purpuric rash, meningismus	IV antibiotics (ceftriaxone or penicillin G), supportive care, close contacts prophylaxis
Zoster (Shingles)	Painful, unilateral vesicular rash along a dermatome	Vesicles in a dermatomal distribution	Antivirals (acyclovir, valacyclovir), pain management, Zoster vaccine
Pertussis (Whooping Cough)	Paroxysmal cough, inspiratory “whoop,” post-tussive vomiting	Prolonged cough, inspiratory whoop sound	Macrolide antibiotics (azithromycin, erythromycin), supportive care, DTaP/Tdap vaccine
Pneumococcal Disease	Fever, cough, dyspnea, chest pain, meningitis symptoms	Crackles, dullness to percussion (pneumonia), nuchal rigidity (meningitis)	IV antibiotics (penicillin, cephalosporins), supportive care, Pneumococcal vaccine
Q Fever	Fever, headache, myalgia, atypical pneumonia	Hepatomegaly, splenomegaly	Doxycycline, supportive care
Rotavirus	Vomiting, watery diarrhea, fever	Dehydration signs (dry mucous membranes, sunken eyes)	Oral rehydration therapy, supportive care, Rotavirus vaccine
Haemophilus influenzae	Fever, cough, dyspnea, meningitis symptoms	Crackles, dullness to percussion (pneumonia), nuchal rigidity (meningitis)	IV antibiotics (cephalosporins), supportive care, Hib vaccine
Tuberculosis	Chronic cough, hemoptysis, weight loss, night sweats	Positive PPD test, chest X-ray showing cavitary lesions	RIPE therapy (rifampin, isoniazid, pyrazinamide, ethambutol), DOT for compliance
Monkeypox	Fever, headache, lymphadenopathy, vesicular/pustular rash	Vesicular/pustular lesions, lymphadenopathy	Supportive care, antiviral (tecovirimat), isolation

• Perform the following procedures:
  • blood culture
  • nasopharyngeal swab
  • high vaginal and cervical swabs
  • urethral swab
  • wound swab
  • urine dipstick and interpretation.
• Perform vaccinations:
  • Be familiar with current vaccination schedules.
  • Be familiar with routes of administering different vaccinations.
  • Counsel patients about vaccine reactions.
  • Manage vaccine reactions.
  • Document vaccinations in the electronic records.
  • Update vaccination records in the Australian childhood immunisation register.
  • Arrange recalls for further vaccination.
  • Understand (or be familiar with) cold chain requirements.
• Be familiar with antimicrobial stewardship in a general practice setting.
• Be familiar with infection control procedures and protocols in a general practice setting and any context in which a GP works, such as, residential aged care facility or hospital.
• Be familiar with good hand-washing technique.

Antimicrobial Stewardship in a General Practice Setting

Definition: program that promotes the

• appropriate use of antimicrobials (including antibiotics) to improve patient outcomes
• reduce microbial resistance
• decrease the spread of infections caused by multidrug-resistant organisms

Goals of Antimicrobial Stewardship:

1. Optimize Clinical Outcomes: Ensure patients receive the most appropriate antimicrobial therapy, including the correct dose, duration, and route of administration.
2. Minimize Adverse Effects: Reduce the risk of side effects and adverse reactions to antimicrobial treatments.
3. Reduce Resistance: Decrease the incidence of antimicrobial resistance through judicious use of antibiotics.
4. Cost-Effective Therapy: Promote the use of cost-effective treatments without compromising the quality of care.

Key Strategies in General Practice:

1. Education and Training:
   • Educate healthcare providers about antimicrobial resistance and appropriate prescribing practices.
   • Provide resources and guidelines for the appropriate use of antibiotics.
2. Guidelines and Protocols:
   • Implement evidence-based guidelines for common infections (e.g., respiratory, urinary tract, skin infections).
   • Use clinical decision support tools to guide appropriate antimicrobial prescribing.
3. Diagnosis and Testing:
   • Encourage accurate diagnosis through appropriate use of diagnostic tests (e.g., rapid antigen tests, cultures).
   • Avoid empirical treatment without clear indications of bacterial infection.
4. Antibiotic Selection:
   • Prefer narrow-spectrum antibiotics over broad-spectrum agents when appropriate.
   • Consider local resistance patterns when selecting antibiotics.
5. Dose and Duration:
   • Prescribe the correct dose and duration based on current guidelines and individual patient factors.
   • Avoid unnecessarily prolonged antibiotic courses.
6. Review and Feedback:
   • Regularly review antibiotic prescriptions and provide feedback to prescribers.
   • Conduct audits of antibiotic use and resistance patterns within the practice.
7. Patient Education:
   • Educate patients about the importance of taking antibiotics as prescribed.
   • Discuss the risks of antibiotic resistance and the importance of not demanding antibiotics for viral infections.
8. Vaccination:
   • Promote vaccination to prevent infections that might otherwise require antibiotic treatment (e.g., influenza, pneumococcal vaccines).
9. Infection Prevention and Control:
   • Implement standard infection control practices to reduce the spread of infections.
   • Promote hand hygiene and other preventive measures among patients and staff.

Monitoring and Evaluation:

• Continuously monitor antibiotic prescribing patterns and resistance trends.
• Evaluate the impact of stewardship interventions on prescribing behavior and patient outcomes.

Challenges in General Practice:

• Balancing patient expectations with appropriate prescribing.
• Limited time and resources for detailed patient education and follow-up.
• Keeping up-to-date with evolving guidelines and resistance patterns.

Benefits of Effective Antimicrobial Stewardship:

• Improved patient outcomes through more targeted and effective treatments.
• Reduced incidence of adverse drug reactions and antibiotic-associated complications.
• Lower rates of antimicrobial resistance, benefiting the broader community.
• Cost savings from reduced unnecessary antibiotic use and shorter duration of treatments.

By implementing these strategies, general practices can contribute significantly to the global effort to combat antimicrobial resistance and ensure effective treatments for future generations.

Learning resources