Antibiotic prescription

Question 1

How would you treat a dental abscess?

Answer 1

1st line: amoxicillin (500mg q8hr, x5 days)

Question 2

How would you treat conjunctivitis?

Answer 2

1st line: self-care
2nd line: chloramphenicol 0.5% eye drop (q2hr, x2 days, reduce freq)
3rd line: fusidic acid (q12hr, x2 days)

Question 3

What should be prescribed for viral CAP?

Answer 3

Oseltamivir (75mg BD x 5 days)

Question 4

How would you treat hepatitis?

Answer 4

Post-exposure prophylaxis: HBV vaccine + Hep IgG (Recombivax-Hb)

Fulminant hepatitis: Iamivudine

Chronic hepatitis: Tenofavir + Interferon a

Question 5

How would you treat Streptococcal endocarditis?

Answer 5

Penicillin-sensitive (usually): penicillin

Question 6

How would you treat PID?

Answer 6

Metronidazole (400mg q12hr, x14 days) 
PLUS oloxacin (400mg q12hr, x14 days)

Question 7

How would you treat Bordetella Pertussis?

Answer 7

First line:
Azithromycin (10mg/kg PO, x5 days) if < 6/12

Second line:
Clarithromycin (7.5mg/kg up to 500mg, q12hr, x7 days)

Third line: (must be >2/12)
Trimethoprim + Sulfamethoxazole (4+20mg/kg up to 160+800mg, q12hr, x7 days)

Question 8

What should be prescribed for HAP?

Answer 8

Broad spectrum anti-pseudomonal coverage (2 different classes):
1) Penicillin: Tazobactam, meropenem, cefepime, azteonam (only for beta lactam allaergy)
2) Flouroquinolones: Levofloxacin, ciprofloxacin, tobramycin
MRSA coverage: vancomycin

Question 9

When do you treat varicellar zoster infection? What do you prescribe?

Answer 9

Rx if: onset < 24hrs, >14yo, severe pain, dense/oral rash, steroid Rx, smoker

Aciclovir (800mg 5 times daily, x7 days)

Question 10

How do you treat oral candidiasis?

Answer 10

Mild: Miconazole gel

Severe: Fluconazole (50mg OD, x7 days)

Immunocompromised: Fluconazole (100mg OD, x7 days)

Question 11

How would you treat cholecystitis?

Answer 11

Cefazolin, cefuroxime, or ceftriaxone

Question 12

What should be prescribed for bacterial CAP?

Answer 12

Mild:
Amoxycillin OR doxycycline OR clarithromycin

Severe:
Azithromycin (500mg x 1 day, then 250mg x4 days)
PLUS ceftriaxone

Question 13

How would you treat genital herpes?

Answer 13

Aciclovir (400mg q8hr, x5 days)

Question 14

How would you treat impetigo?

Answer 14

Topical fusidic acid (thinly, q8hr, x5 days)

MRSA: topical mupirocin (2% ointment q8hr, x5 days)

Question 15

How would you treat meningitis causes by group B strep, E coli or Listeria monocytogenes?

Answer 15

Ampicillin (50mg/kg, q4hrs) PLUS cefotaxime (50mg/kg, q6hrs)

Note: ceftriaxone contraindicated in newborns

Question 16

How would you treat severe pyelonephritis?

Answer 16

Gentamicin (IV 5mg/kg) PLUS Amoxicillin (IV 2g) q6hr

Same Rx in pregnancy

Question 17

How would you treat mild pyelonephritis?

Answer 17

Amoxicillin (875mg) + clavulanic acid (125mg) q12hr, x10 days PO

Question 18

How would you treat a chlamydia trachomatis infection?

Answer 18

Azithromycin (1g stat) 
OR doxycycline (100mg q12hr, x7 days)

Question 19

How do you treat infectious diarrhoea where campylobacter is the suspected organism?

Answer 19

Clarithromycin (250mg q12hr, x7 days)

Question 20

How would you treat Enterococcal endocarditis?

Answer 20

Penicillin PLUS gentamicin

Question 21

How would you treat a Staph aureus lung abscess?

Answer 21

Flucloxacillin

AND Vancomycin

Question 22

How would you treat osteomyelitis?

Answer 22

Gram-negative:

Cefotaxime OR ceftriaxone

Question 23

How would you treat a Clostridium difficile infection?

Answer 23

First episode: Metronidazole (400 q8hr, x14 days)

Severe/recurrent: Vancomycin (PO 125mg q6hr, x14 days)

Recurrent/2nd line:
Fidaxomicin (200mg q12hr, x10 days)

Question 24

How do you treat an H. pylori infection?

Answer 24

Triple therapy:

1. PPI (1g q12hr)- omeprazole
2. PLUS amoxicillin (500mg q12hr)
3. PLUS clarithromycin (400mg q12hr), x14 days

Question 25

How would you treat meningitis caused by Neisseria meningitides (meningococcus) and Haemophilus influenzae?

Answer 25

Cefotaxime (50mg/kg, q6hrs) or ceftriaxone (50mg/kg, q12hrs)

Question 26

What should be prescribed for ventilator-associated pneumonia?

Answer 26

Broad spectrum anti-pseudomonal coverage (2 different classes):
1) Penicillin: Tazobactam, meropenem, cefepime, azteonam (only for beta lactam allaergy)
2) Flouroquinolones: Levofloxacin, ciprofloxacin, tobramycin
MRSA coverage: vancomycin

Question 27

How would you treat a leg ulcer?

Answer 27

Flucloxacillin (500mg q6hr, x7 days)

Question 28

How would you treat traveller’s diarrhoea?

Answer 28

High risk severe illness:
Azithromycin (500mg q24hr, x3 days)

Prophylaxis: 
Bismuth subsalicylate (2 tablets q6hr, x2 days)

Question 29

When would you treat a shingles (herpes zoster) infection? What would you prescribe?

Answer 29

Rx if: <72 hrs of rash, >50yo, non-truncal involvement, severe pain, severe rash

Aciclovir (800mg 5 times daily, x7 days)

Question 30

How would you treat cellulitis?

Answer 30

Flucloxacillin (500mg q6hr, x7 days)

Question 31

How would you treat vaginal candidiasis?

Answer 31

First line: Fluconazole (150mg stat)
Recurrent: Fluconazole (150mg every 72hrs, then weekly)

Pregnancy: intravainal Rx, x7 days

Question 32

How would you treat a cystitis UTI?

Answer 32

Uncomplicated:
Cefalexin (PO 500mg q12hr, x5 days)

Complicated:
Trimethoprim (PO 300mg q24hr, x7 days)

During pregnancy:
Cefalexin (PO 500mg q12hr, x5 days)

Question 33

How would you treat gonorrhoea?

Answer 33

Ceftriaxone (500mg IM stat)
PLUS azithromycin (PO 1g stat)

Question 34

How would you treat syphilis?

Answer 34

Metronidazole (400mg q12hr, x7 days)

Pregnancy: clotrimazole (100mg pessary, x6 days)

Question 35

How would you treat bacterial vaginosis?

Answer 35

Metronidazole (400mg q12hr, x7 days)