Antibiotics

Question 0

Primary drug used for gram positive? If allergic?

Answer 0

Penicillin

Second line - cephalozolin if minor allergy.

Question 1

What are the types of broad organisms?

Answer 1

Gram positive - staph aureus (difficult bug)
Gram negative - pseudomonas (difficult bug)
Anaerobes
Atypicals

Question 2

Staph aureus antibiotic? What if MRSA?

Answer 2

Flucloxacillin, or clavulanic acid

Vancomycin (risk of nephrotoxicity)

Question 3

Gram negative antibiotics?

Answer 3

Gentamicin (nephrotoxicity or ototoxicity) after first dose calculate next dose?
Second line - quinolones e.g ciprofloxacin
Or 2nd gen - cefuroxime
Or 3rd gen - ceftriaxone (very broad spectrum)

Question 4

Pseudomonas

Answer 4

Common hospital acquired
Develops resistance easily
Combine 2 antipseudomanal penicillins

Question 5

Anaerobes?

Answer 5

Metronidazole
Problem with immunosuppressant or warfarin pts need checking of INR
OR
CLAVULANIC ACID

Question 6

Atypical antibiotics?

Answer 6

Macrolide (azithromycin)

Question 7

What should you ask yourself prior to administering antibiotics?

Answer 7

What is the condition?
What is the likely organism?
What antibiotics are empirical?
What should be done before administering? (E.g testing)

Question 8

Antibiotics for CAP?

Answer 8

Likely organisms are strep pneumoniae, klebsiella or mycoplasma legionella

Benzyl penicillin + gentamicin + azithromycin

Question 9

Antibiotics for UTI?

Answer 9

Pathogen: proteus and ecoli (negative), enterrococcus (positive), pseudomonas (catheter)

Gentamicin, amoxicillin.

If renal impairment: ceftriaxone

Question 10

Bone or soft tissue infection? Septic or osteomyelitis?

Answer 10

Almost always gram positive.
Do joint aspirate.

Flucloxacillin

If allergy: cephalosporin, if major allergy: vancomycin

Question 11

Intra-abdominal infections?

Answer 11

Broad organisms in gut.

Gentamicin, amoxicillin, metronidazole

Question 12

Hospital acquired pneumonia antibiotics?

Answer 12

Pseudomonas plus others
Do sputum and blood cultures

Tazocin (tazobactam and clavulanic acid) and gentamicin

Question 13

Tx for H. Pylori?

Answer 13

PPI, amoxicillin and clarithomycin

Then do urease breath test one week later. If positive lifelong PPIs (for maintenance?)

Question 14

Testing for gentamicin toxicity?

Answer 14

Test for “peaks” and “troughs”. I.e 30 mins before administering gent and 30 mins after administering gent.