Antibiotic Man (2018) - Hospital and Primary Care

Question 1

Meningitis

Answer 1

Ceftriaxone (IV) + Dexamethasone (IV)

Aciclovir (IV)- if encephalitis suspected
Amoxicillin (IV)- if immunocompromised

Question 2

Epiglottitis

Answer 2

Ceftriaxone (IV)

Question 3

Community Acquired Pneumonia (CAP)

Answer 3

Mild: Amoxicillin (IV)
Severe: Co-amoxiclav (IV) + Doxycycline (PO)
ICU/HDU: Co-amoxiclav (IV) + Clarithromycin (IV)

Penicillin allergic:
Switch Amoxicillin for Doxycycline (PO)
Switch Co-amociclav for Levofloxacin (IV)

Question 4

Hospital Acquired Pneumonia (HAP)

Answer 4

Non-severe: Amoxicillin (IV) + Metronidazole (IV)
Severe: Amoxicillin (IV) + Metronidazole (IV) + Gentamicin (IV)

Penicillin allergic:
Switch Amoxicillin for Co-trimoxazole

Question 5

Acute exacerbation of COPD

Answer 5

1. Amoxicillin
2. Doxycycline

Only give if:

• increased sputum purulence
• consolidations on CXR
• signs of pneumonia

Question 6

Acute cough/ bronchitis

Answer 6

N/A, unless elderly and frail:

1. Amoxicillin
2. Doxycycline

Question 7

Native Valve Endocarditis

Answer 7

Take blood cultures
Start empirical therapy

Subacute/ indolent: Amoxicillin (IV) + Gentamicin (IV)
Acute/ severe: Flucloxicillin (IV)
Severe + potential resisetant pathogens: Vancomycin (IV) + Meropenem (IV)

Question 8

Prosthetic Valve Endocarditis

Answer 8

Vancomycin (IV) + Rifampicin (PO) + Gentimicin (IV)

Question 9

C. difficile Infection

Answer 9

Non-severe: Metronidazole (PO)

Severe: Vancomycin (PO) + Metronidazole (PO)

Question 10

Peritonitis / Biliary tract infection / Intra-abdominal infection

Answer 10

Amoxicillin (IV) + Gentamicin (IV) + Metronidazole (IV)

Penicillin allergic: Switch Amoxicillin with Vancomycin

Step down to: Co-trimoxazole + Metronidazole

Question 11

Acute Gastroenteritis

Answer 11

N/A

Question 12

Acute pancreatitis

Answer 12

N/A, unlikely to help

Question 13

Proven Spontaneous Bacterial Peritonitis

Answer 13

Mild: Co-trimoxazole (PO)
Severe: Piperacillin (IV) / Tazobactam (IV)

Question 14

Infection of catheterised adult

Answer 14

Do not treat unless signs and symptoms of infection.
Do not use urinalysis.
If you must: treat as complicated UTI

Question 15

Complicated UTI

Answer 15

Amoxicillin (IV) + Gentamicin (IV)

Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)

Step down to: Co-trimaxazole (IV)

Question 16

Pylonephritis (Hopsital)

Pyelonephritis is a kidney infection that occurs when bacteria from a urinary tract infection spreads to the kidney.

Answer 16

Amoxicillin (IV) + Gentamicin (IV)

Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)

Step down to: Co-trimaxazole (IV)

Question 17

Uncomplicated Female UTI

Answer 17

Nitrofurantoin or Trimethoprim

Question 18

Urosepsis

Urosepsis is sepsis with a source localised to the urinary tract (or male genital tract, e.g. prostate)

Answer 18

Amoxicillin (IV) + Gentamicin (IV)

Penicillin allergic: Switch Amoxicillin with Co-trimaxazole (IV)

Step down to: Co-trimaxazole (IV)

Question 19

Uncatheterised Male UTI

Answer 19

Nitrofurantoin or Trimethoprim

Question 20

Cellulitis

Answer 20

Flucloxacillin
Penicillin allergic: Doxycycline (PO)

If risk of MRSA: Doxycycline

Question 21

Acute Septic Arthritis

Answer 21

Flucloxacillin (IV)

Question 22

Osteomyelitis

Answer 22

Flucloxacillin (IV)

Question 23

Diabetic Foot Infection

Answer 23

Mild: Flucloxacillin or Doxycycline
Moderate: Flucloxacillin + Metronidazole or Doxycycline + Metronidazole

Question 24

Open Fracture Prophylaxis

Answer 24

Co-amoxiclav (IV) + Metronidazole or
Co-trimoxazole (IV) + Metronidazole

Start within 3 hours

Question 25

Unknown source

Answer 25

Amoxicillin (IV) + Gentamicin (IV) + Metronidazole (IV) Penicillin allergy: Switch Amoxicillin with Vancomycin If Staphlococci: Add Flucloxacillin + Vancomycin

Question 26

Conjunctivitis

Answer 26

Usually self-limiting. Chloramphenicol

Question 27

Ophthalmic shingles

Answer 27

Aciclovir

Question 28

Tonsillitis

Answer 28

Most are viral. If Fever PAIN score is >4 and severe then treat with: Penicillin Penicillin allergy: Clarithromycin

Question 29

Pharyngitis

Answer 29

Most are viral. If Fever PAIN score is >4 and severe then treat with: Penicillin Penicillin allergy: Clarithromycin

Question 30

Sore throat

Answer 30

Most are viral. If Fever PAIN score is >4 and severe then treat with: Penicillin V Penicillin allergy: Clarithromycin

Question 31

Sinusitis

Answer 31

If >7 days 1. Penicillin V 2. Doxycycline

Question 32

Otitis Media

Answer 32

Most cases will resolve without antibiotics. Consider antibiotics if otorrhoea (discharge) is present: 1. Amoxicillin 2. Clarithromycin

Question 33

Otitis Externa

Answer 33

Mild: Acetic acid Moderate: Sofradex or Otomize. Basically Dexamethasone and an antibiotic. Severe: ENT referral Sofradex: Dexamethasone (corticosteroid), framycetin and gramicidin (antibiotics). Otomize: Dexamethasone, neomycin (antibiotic) and acetic acid.

Question 34

Oral thrush

Answer 34

1. Miconazole gel | 2. Fluconazole

Question 35

Diverticulitis

Answer 35

Uncomplicated acute diverticulitis may respond to analgesia and dietary modification. If needed use: Metronidazole 400mg + Co-trimoxazole

Question 36

UTI or bacteriuria in pregnancy

Answer 36

1st-2nd trimester: Nitrofurantoin 3rd trimester: Trimethoprim 2nd line: Cefalexin

Question 37

Prostatitis

Answer 37

Ofloxacin or Ciprofloxacin | High risk of C. difficile: Trimethoprim

Question 38

Epididymo-orchitis

Answer 38

Send MSSU, gonorrhoea & chlamydia tests. If STI likely (<35 or new partner in last 3mth): Doxycycline If UTI likely (>35 and no new partner): Ofloxacin or Ciprofloxacin

Question 39

Uncomplicated Chlamydia

Answer 39

Azithromycin or Doxycycline

Question 40

Pelvic Inflammatory Disease

Answer 40

Metronidazole + Ofloxacin

Question 41

Trichomoniasis Trichomoniasis (or “trich”) is a very common sexually transmitted disease (STD). It is caused by infection with a protozoan parasite called Trichomonas vaginalis.

Answer 41

Metronidazole

Question 42

Bacterial vaginosis

Answer 42

Metronidazole

Question 43

Tinea pedis

Answer 43

Topical 1% Terbinafine

Question 44

Dermatophyte nail infection

Answer 44

Confirm with nail clippings Terbinafine Fingers: 6-12 weeks Toes: 3-6 months

Question 45

Diabetic Foot Infection

Answer 45

Mild: Flucloxacillin or Doxycycline Moderate: Flucloxacillin + Metronidazole or Doxycycline + Metronidazole

Question 46

Impetigo

Answer 46

Localised lesions: Topical Fusidic Acid Non localised: 1. Flucloxacillin 2. Clarithromycin

Question 47

Chickenpox

Answer 47

Aciclovir

Question 48

Shingles

Answer 48

Aciclovir or Valaciclovir

Question 49

Bites (assuming from animals etc)

Answer 49

1. Co-amoxiclav | 2. Metronidazole + Doxycycline