Abx and Antifungal Prescribing Pathway

Question 1

Human and animal bites

Answer 1

First Line: Co-Amoxiclav
Second Line: Doxycycline and Metronidazole

Prophylaxis: 3 days
Treatment: 5 days

Question 2

Tick bites (Lyme disease)

Answer 2

First Line: Doxycycline (100mg BD)
Second Line: Amoxicillin (1000mg TDS)

Treatment: 21 days

Question 3

Human and animal scratch

Answer 3

First Line: Flucloxacillin
Second Line:

Question 4

Diabetic food infection (mild, <2cm)

Answer 4

First Line: Flucloxacillin
Second Line: Clarithromycin/erythromycin/doxycycline

Question 5

Diabetic foot infection (moderate/severe - abscess, osteomyelitis)

Answer 5

First Line: Flucloxacillin/Co-Amoxiclav +/- Gentamicin
Second Line: Co-Trimoxazole +/- Gentamicin

Question 6

Cellulitis

Answer 6

First Line: Flucloxacillin
Second Line: Clarithromycin/erythromycin (in pregnancy)/doxycycline/Co-amoxiclav

Question 7

Cellulitis - infection near eyes or nose

Answer 7

First Line: Co-Amoxiclav
Second Line: Clarithromycin and metronidazole

Question 8

CAP (low severity)

Answer 8

First Line: Amoxicillin
Second Line: Clarithromycin/doxycycline (erythromycin if pregnancy)

Question 9

CAP (moderate severity)

Answer 9

First Line: Amoxicillin
Second Line: Clarithromycin (erythromycin if pregnancy)/doxycycline

Question 10

CAP (high severity)

Answer 10

First Line: Co-Amoxiclav and Clarithromycin
Second Line: Levofloxacin

Question 11

Diarrhoea (C.diff)

Answer 11

First Line: Vancomycin
Second Line: Fidaxomicin
Life threatening: Vancomycin and IV methronidazole

Treatment: 10 days

Question 12

Diarrhoea (traveller’s diarrhoea)

Answer 12

Standby: Azithromycin
Prophylaxis/treatment: Bismuth subsalicylate

Question 13

Otitis media

Answer 13

First Line: Amoxicillin
Second Line (worsening symptoms despite 2-3 days treatment): Co-Amoxiclav
Penicillin allergy: Clarithromycin (erythromycin if pregnancy)

Question 14

Otitis externa

Answer 14

First Line: Topical acetic acid 2%
Second Line: Topical neomycin sulphate with corticosteroid
Systemic treatment: Flucloxacillin

Question 15

H.pylori infection

Answer 15

Triple therapy:
- PPI
- Two of the three abx: Amoxicillin (tends to be included), Metronidazole, Clarithromycin

Question 16

H.pylori infection - Diagnosis?

Answer 16

Diagnosed by Urea 13C Breath Test

Shouldn’t be performed:
- within 2 weeks of taking PPI
- within 4 weeks of taking Abx

Question 17

HAP - non severe

Answer 17

First Line: Co-Amoxiclav
Second Line (adults): Doxycycline/Cefalexin, Co-tromidazole/Levofloxacin
Second Line (children): Clarithromycin

Question 18

Impetigo - localised non bollous

Answer 18

First Line: hydrogen peroxide 1%
Second Line: fusidic acid (mupirocin 2% if fusidic acid resistance suspected)

Question 19

Impetigo - widespread non bollous

Answer 19

First line: fusidic acid (mupirocin 2% if fusidic acid resistance suspected)

Question 20

Impetigo - bollous or patients who are systematically unwell

Answer 20

First Line: Flucloxacillin
Second Line: Clarithromycin (erythromycin if pregnancy)

Question 21

Lower UTI - Men

Answer 21

First Line: Nitrofurantoin/trimethoprim

Treatment: 7 days

Question 22

Lower UTI - non pregnant women

Answer 22

First Line: Nitrofurantoin/trimethoprim
Second Line: Pivmecillinam/Fosfomycin

Treatment: 3 days

Question 23

Lower UTI - pregnant women

Answer 23

First Line: Nitrofurantoin
Second Line: Cefalexin/Amoxicllin

Treatment: 7 days

Question 24

Strep Throat and Scarlet Fever

Answer 24

First Line: Phenoxymethylpenicillin
Second Line: Clarithromycin (erythromycin in pregnancy)

Question 25

Scarlett Fever Symptoms

Answer 25

Flu like symptoms Fever, swollen neck glands Red rash, rough feeling like sandpaper White coating on tongue

Question 26

Bacterial Vaginosis and Trichomoniasis

Answer 26

Metronidazole

Question 27

Threadworm

Answer 27

Mebendazole

Question 28

Meningitis

Answer 28

Benzylpenicillin

Question 29

Tuberculosis Treatment

Answer 29

Initial phase (2 months): ethambutol, rifampicin, isoniazid, pyrazinamide Continuation phase (4 months): rifampicin, isoniazid

Question 30

Latent tuberculosis

Answer 30

3 months of rifampicin + isoniazid OR 6 months of isoniazid

Question 31

Aspergillosis

Answer 31

Voriconazole

Question 32

Cryptococcosis

Answer 32

Amphotericin B

Question 33

Vaginal Thrush

Answer 33

Clotrimazole/Fluconazole Itraconazole if resistant

Question 34

Oral Thrush

Answer 34

Nystatin/Clotrimazole/Fluconazole Itraconazole if resistant

Question 35

Skin and nail infections

Answer 35

Topical therapy Systemic therapy (Itraconazole, terbinafine)

Question 36

Nail infection

Answer 36

Nail region terbinafine/Amorolfine nail lacquer - once weekly for up to one year - refer to GP if <18, more than 2 nails affected, patient is diabetic, pregnant/breastfeeding