Antibiotic Man

Question 1

What is the antibiotic alternative to Gentamicin?

Answer 1

Aztreonam

Question 2

What are the 2 antibiotics requiring therapeutic monitoring?

Answer 2

Gentamicin and Vancomycin

Question 3

Non-severe C.Diff

Answer 3

PO Metronidazole 400mg tds x 10/7

Question 4

Severe C.Diff

Answer 4

PO/NG Vancomycin 125mg qds

+/- IV Metronidazole x 10/7

Question 5

Acute Gastroenteritis

Answer 5

Not required (Seek advice if severe)

Question 6

Acute Pancreatitis

Answer 6

(Seek advice)

Unlikely to affect outcome

Question 7

Peritonitis/Biliary Tract/ Intra-abdominal infection

Answer 7

IV Amoxicillin 1g tds + Metronidazole 500mg tds + Gentamicin
(Vancomycin if penicillin allergy)
Step down: PO Co-trimoxazole 960mg bd + Metronidazole 400mg tds

IV/PO x 1/52

Question 8

Proven SBP (Incidental; mild)

Answer 8

PO Co-trimoxazole 960mg bd x 5-7/7

Question 9

Proven SBP

Answer 9

IV Piperacillin-Tazobactam 4.5g tds
Step down: PO Co-trimoxazole 960mg bd

x 5-7/7

Question 10

Severe systemic infection of unknown source

Answer 10

IV Amoxicillin 1g tds + Gentamicin + Metronidazole 500mg tds
*Add IV flucloxacillin 2g qds if PWID for S.Aureus cover

(Vancomycin if penicllin allergy)

Question 11

Native valve subacute endocarditis

Answer 11

IV Amoxicillin 2g 4hourly + Gentamicin 1mg/kg bd (Use ABW; max 120mg/dose)

Question 12

Native valve acute with severe sepsis

Answer 12

IV Flucloxacillin 2g 6hourly (4hourly if >85kg)

Question 13

Prosthetic valve or suspected MRSA

Answer 13

IV Vancomycin + Gentamicin 1mg/kg bd (Use ABW; max 120mg/dose)
- Add PO Rifampicin 600mg bd when therapeutic level of vancomycin reached (Check for interaction)

Question 14

CAP with CURB65 0-2 (Mild-mod)

Answer 14

IV/PO Amoxicllin 1g tds x 5/7

(PO Doxycycline 200mg Day 1 then 100mg od OR IV Clarithromycin 500mg bd if NBM) - if penicllin allergy

Question 15

CAP with CURB65 3-5 (Severe)

Answer 15

IV Co-Amoxiclav 1.2g tds + IV Clarithromycin 500mg bd
(IV Levofloxacin 500mg bd monotherapy if penicillin allergy)

Step down: Doxycycline 100mg bd

Question 16

CAP with CURB65 3-5 (Severe) (ICU/HDU or NBM)

Answer 16

IV Co-Amoxiclav 1.2g tds + IV Clarithromycin 500mg bd
(IV Levofloxacin 500mg bd monotherapy if penicillin allergy)

Step down: Doxycycline 100mg bd

x 1/52

Question 17

HAP (Non-severe)

Answer 17

PO Amoxicillin 1g tds (Doxycycline 100mg bd if penicillin allergy) x 5/7

Question 18

HAP (Severe)

Answer 18

IV Amoxicillin 1g tds + Gentamicin
(IV Co-trimoxazole 960mg bd + Gentamicin if pencillin allergy)

Step down: PO Co-trimoxazole 960mg bd

x 1/52

Question 19

HAP (with previous ICU admission or Hx of MRSA)

Answer 19

Seek advice

Question 20

Aspiration pneumonia (Non-severe)

Answer 20

PO Amoxicillin 1g tds + Gentamicin
(PO Doxycycline 100mg bd + Metronidazole 400mg tds if penicillin allergy)

x 5/7

Question 21

Aspiration pneumonia (Severe)

Answer 21

IV Amoxicillin 1g tds + Gentamicin + Metronidazole 500mg tds
(PO Doxycycline or IV Clarithromycin 500mg bd if penicillin allergy)

Step down: PO Amoxicillin 1g tds + Gentamicin
(PO Doxycycline 100mg bd + Metronidazole 400mg tds if penicillin allergy)

x 1/52

Question 22

When to give Abx for Acute exacerbation of COPD?

Answer 22

Only if increased sputum purulence.
If not, look for consolidation on CXR or signs of pneumonia.

Otherwise, no abx.

Question 23

Abx for Acute exacerbation of COPD (1st and 2nd line)

Answer 23

1st line: Amoxicillin 500mg tds

2nd line: Doxycycline 200mg day 1 then 100mg od (x 5/7)

Question 24

When to consider Abx for Acute cough/ Acute bronchitis?

Answer 24

Frail elderly

Otherwise, no significant benefit

Question 25

Abx for Acute cough/ Acute bronchitis (1st and 2nd line)

Answer 25

1st line: Amoxicillin 500mg tds

2nd line: Doxycycline 200mg day 1 then 100mg od (x 5/7)

Question 26

What to consider when giving clarithromycin?

Answer 26

Prolonged QT interval and interactions (Statin)