Antibiotics

Question 1

Meningitis prophylaxis for close contacts? (7 days)

Answer 1

Ciprofloxacin (single dose)

Question 2

Chlamydia (and in pregnancy)

Answer 2

Doxycycline (7 days)

(azithyromycin in pregnancy)

Question 3

Gonorrhoea

Answer 3

IM ceftriaxone (single dose)
(If sensitivities are known = ciprofloxacin

Question 4

Meningitis? (3mnths and above)

Answer 4

<3mnths - cefotaxime (sheff accept for all)
>3mnths - ceftriaxone

Question 5

UTI (complicated)

Answer 5

All males + pregnant females + catheterised.
=> Cefalexin (7 days)

Question 6

UTI (uncomplicated)

Answer 6

All females (not pregnant)
=> Nitrofurantoin / trimethoprim (3 days)

Question 7

Contraindication for nitrofurantoin?

Answer 7

Avoid inthird trimester- risk ofneonatal haemolysis.

Question 8

Contraindication for trimethoprim?

Answer 8

Avoid in first trimester -folate antagonist.
It is not known to be harmful later in pregnancy but is generally avoided unless necessary.

Question 9

Treatment for upper UTI?

Answer 9

Cefalexinandco-amoxiclav - for 7-10 days

Inpregnant women, cefalexin is the first-line oral antibiotic, and cefuroxime is the first-line IV antibiotic.

Question 10

Sepsis 6?

Answer 10

Serum lactate, blood cultures, urine output monitoring, oxygen, empirical broad-spectrum antibiotics & IV fluids

Question 11

H.pylori

Answer 11

Amoxicillin, clarithromycin + PPI (omeprazole)

Change amoxicillin to metronidazole if there is a penicillin/B lactam allergy

Question 12

Treatment for Impetigo

Answer 12

Flucloxacillin

(or clarithromycin in penicillin allergy)

Caused by S.aureus

Question 13

C.difficile?

Answer 13

• oral vancomycin
• IV metronidazole

Question 14

Cellulitis?

Answer 14

Flucloxacillin (S.pyogenes)

Question 15

MRSA (S.aureus)

Answer 15

Resistant to methicillin/flucloxacillin

=> use VANCOMYCIN

Question 16

Mild CAP treatment?

Answer 16

(SCORE 0-1 ON CURB-65)

5 days of oral antibiotics:
- Amoxicillin
(clarithromycin - in penicillin allergy)

• Doxycycline

Question 17

Moderate CAP treatment?

Answer 17

(SCORE 2 ON CURB-65)

Amoxicillin plus clarithromycin

IV antibioticsand stepped down to oral antibiotics as the condition improves.

Respiratory support(oxygen or intubation and ventilation)

Question 18

PCP in HIV patients?

Answer 18

Pneumocystis jiroveciipneumonia (PCP), afungal pneumonia, occurs inimmunocompromisedpatients
- DRY COUGH WITHOUT SPUTUM PRODUCTION
- SOB
- NIGHT SWEATS

=> Co-trimoxazole(trimethoprim/sulfamethoxazole) treats PCP

Patients with a low CD4 count are prescribedprophylactic co-trimoxazole to protect against PCP

Question 19

Giardiasis?

Answer 19

Metronidazole 5-7 days

infection caused by the protozoan Giardia lamblia

Question 20

UNITS OF ALCOHOL equation

Answer 20

(% strength) x (amount of liquid in L)

Question 21

How many grams of pure alcohol are in 1 UNIT OF ALCOHOL?

Answer 21

1 unit = 8g pure alcohol

Question 22

How many calories in alcohol?

Answer 22

7 CALORIES (per gram)

Question 23

Acute otitis media?

Answer 23

Amoxicillinfor 5-7 days (first-line)

Co-amoxiclavis a second-line option if the infection is not responding to amoxicillin.

• Clarithromycin(if penicillin allergic)
• Erythromycin(in pregnant women allergic to penicillin)

Question 24

Treatment for strep throat (group A strep - S pyogenes)

Answer 24

Amoxicillin (or clarithromycin in penicillin allergy)

Question 25

Whooping cough treatment

Answer 25

Clarithromycin
(bordatella pertussis)

Question 26

Treatment of atypical pneumonia? i.e. legionella

Answer 26

Macrolide –> clarithromycin

Question 27

Treatment for PCP pneumonia? (HIV - pneumocystis jirovecii)

Answer 27

Co-trimoxazole

(combination of trimethoprim and sulphamethoxazole which have anti-fungal activity against P. jirovecii in addition to antibacterial action

Question 28

Moderate vs SEVERE CAP treatment?

Answer 28

MODERATE:
IV or PO - Amoxicillin, plus clarithromycin

SEVERE:
IV co-amoxiclav, plus clarithromycin
(broad spectrum cover!!)

Question 29

Treatment of atypical pneumonia? (general options)

Answer 29

The so called ‘atypical’ pathogens that can cause pneumonia are not sensitive to amoxicillin and must be treated with macrolides (erythromycin, clarythromicin), fluoroquinolones (ciprofloxacin, levofloxacin) or tetracyclines (doxycycline). In the case of Legionella the first line is clarythromycin.

Question 30

Severe CAP treatment?

Answer 30

3+ score on CURB-65

Co-axoxiclav, plus clarithromycin