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Announcements on Recent Management Guidelines Updates

In addition to editing the ordinary chapters, we will also be posting any new updates on
management guidelines here to keep all candidates updated with the most up-to-date
changes. Thus, besides us being working on it, we encourage you to inform us of any new
updates that contradict with the information provided in the other chapters
Contact us at → info@plab1keys.com

Recent Guidelines for the management of Cervicitis (Published in September 2019)

 
Chlamydia cervicitis
◙ 1st line → Doxycycline 100 mg BID for 7 Days.
◙ Another line:
Azithromycin 1-gram PO
Followed by 500 mg PO OD for 2 days.

Neisseria gonorrhoea cervicitis

◙ Ceftriaxone 1 gm IM (single dose). Or:
◙ Ciprofloxacin 500 mg PO (Single dose).

There have been some modifications on Tetanus Prophylaxis after an injury

(Published late in 2019).

Let’s firstly remember the usual guidelines:

 
Tetanus Prophylaxis (after injury)
 
♦ Is the wound high risk; dirty/ contaminated/ compound fracture?
√ If Yes → Give IM human Tetanus Immunoglobulins “Regardless of the immunisation status”.
(This is not the case now, see below).
√ If No → no need for Tetanus Immunoglobulin.
 
♦ What is the person’s immunisation status?
√ If Fully immunised/up-to-date (completed 5 doses of tetanus vaccine) → Do not give tetanus
vaccine.
√ If Unknown or Incomplete → Give Complete course of tetanus vaccine (5 doses) Or Full course
of DTP if never been immunised (Diphtheria, Tetanus, Pertussis)
 
♦ Important, sometimes we also give antibiotics as prophylaxis for wound infection if the wound
is high risk.
 
The new update, in short, is that people who have completed the full course of the tetanus
vaccine (including the booster doses) if injured with a deep or contaminated wound will no
longer receive Tetanus Immunoglobulin. Instead, cleaning the Wound, reassurance & maybe an
Antibiotic as prophylaxis.

In the past, people with contaminated wounds would receive tetanus immunoglobulin whether
they had completed the doses or not. Now, if they have been given the full course, they won't
be given tetanus immunoglobulin (the Hx of immunisation makes a difference now).

♦ Example: If deep penetrating wound in an adult with full course of tetanus vaccine?
→ According to the Sept 2019 update, nothing is needed as he has completed the full
course of tetanus vaccine. Clean the wound + Reassure ± Give prophylactic Antibiotic if the
wound is contaminated.