Antibiotics

Question 1

Chronic bronchitis

Answer 1

Amoxicillin or Tetracycline

Clarithromycin

5d

Question 2

CAP

low, moderate and high severity

Answer 2

LOW

Amoxicillin 7d

Atypical: + Clarithromycin 14d

PENAL: Doxycycline or Clarithromycin

Staph suspected (post flu): Flucloxacillin

MOD

Amoxicillin + Clarithromycin or Doxycycline alone 7d

MRSA: + Vancomycin

HIGH

Benzylpenicillin + Clarithromycin

or Benzylpenicillin + Doxycycline 7d

Serious/ G+/ Home: Co-amoxiclav + Clarithromycin

MRSA: + Vancomycin

Question 3

HAP

Answer 3

<5d post-admission

• Co-amoxiclav
• or Cefuroxime 7d

>5d post-admission

• Piperacillin with Tazobactam
• or Cephalosporin broad (eg Ceftazidime)
• or Quinilone (eg Ciprofloxacin)

MRSA: +Vancomycin

Question 4

Lower UTI

Answer 4

Trimethoprim

or Nitrofurantoin 7d (3d in women)

2nd line: Co-amoxiclav

Question 5

Acute pyelonephritis

Answer 5

Cefuroxime

Quinolone (

Question 6

Acute prostatitis

Answer 6

Quinolone

or Trimethoprim

Question 7

Impetigo

Answer 7

Topical fusidic acid

Widespread;

• Flucloxacillin
• or Erythromycin

Question 8

Cellulitis

Answer 8

Flucloxacilline

PENAL: Clarithromycin or Clindomycin

Question 9

Erysipelas

Answer 9

Phenoxymethylpenicillin

PENAL: Erythromycin

Question 10

Animal or human bite

Answer 10

Co-Amoxiclav

PENAL: Doxycycline + Metronidazole

Question 11

Mastitis during breast feeding

Answer 11

Flucloxacillin

Question 12

Throat infections

Answer 12

Phenoxymethylpenicillin

PENAL: Erythromycin

Question 13

Sinusitis

Answer 13

Amoxicillin

or Doxycycline

or Erythromycin

Question 14

Otitis media

Answer 14

Amoxicillin

PENAL: Erythromycin

Question 15

Otitis externa

Answer 15

Flucloxacillin

PENAL: Erythromycin

Question 16

Periapical or Periodontal abscess

Answer 16

Amoxicillin

Question 17

Gingivitis: acute necrotising ulcerative

Answer 17

Metronidazole

Question 18

Genital herpes

Answer 18

Oral Aciclovir 5x5

Question 19

Genital warts

Condylomata accuminata

HPV 6+11

Answer 19

1. Topical podophyllum (4wk, multiple) or Cryrotherapy (single)
2. Imiquimod (16wk)

Question 20

Syphilis

Answer 20

Benzathine Benzylpenicillin stat (repeat in 6d if 3rd trimester)

or 14d Doxycyline

or 14d Erythromycin

Question 21

Donavanosis

Granuloma inguinale

Klebsiella granulomatis

Answer 21

Azithromycin or Doxycyline

Pregnant: Erythromycin

Question 22

Candidiasis (thrush)

Answer 22

PO Fluconazole stat

Topical/ pressary: Clotrimazole

Question 23

Trichomonas Vaginalis

Answer 23

Metronidazole 2g stat or 400mg/5d

Question 24

Bacterial Vaginosis

Answer 24

Metronidazole 2g stat or 400mg/5d

2. Topical Metronidazole or Clindamycin

Question 25

Chlamydia

Answer 25

**Azithromycin 1g stat** or **Doxycycline 7d** Pregnant: **Erythromycin 14d**

Question 26

Gonnorrhoea

Answer 26

**Azithromycin 1g PO stat** + **Ceftriazone 500mg IM**

Question 27

PID

Answer 27

**Ceftriazone 500mg IM stat + Doxycycline PO 7d** 2. **Ofloxacin + Metronidazole PO 14d** (not Gonorrhoea) Severe: **IV ceftriazone + metronidazole + doxycycline**

Question 28

Campylobacter enteritis

Answer 28

**Clarithromycin** Alternative **Ciprofloxacin**

Question 29

Salmonella (non-typhoid)

Answer 29

**Ciprofloxacin**

Question 30

Shigellosis

Answer 30

**Ciprofloxacin**

Question 31

H Pylori

Answer 31

**7d** 1. **PPI** 2. **Amoxicillin 1mg** 3. **Clarithromycin** 500mg bd po or **Metronidazole 400mg**

Question 32

C. difficile

Answer 32

All 10-14d, stop at 10d if asym. Fails move up. * Nurse in side room until 72hr symptom free Mild-mod * **Metronidazole 400mg PO 8hrly 10-14d** Severe [WCC\>15,Cr\>50%,temp\>38.5,COLITIS] * **Vancomycin 125mg PO 6hrly** Lifethreatening [hypotension, ilius/ megacolon, severe on CT] * **Vancomycin 500mg PO 6hrly** + **Metronidazole 500mg IV infusion 8hrly**

Question 33

MRSA * What is it * Screening protocol * Management

Answer 33

What * Methicillin-Resistant Staphylococcus Aureus (MRSA) * Resistant to Penicillins + Cephalosporins MRSA screen 2-4wks prior admission in ALL; * **+ MSSA** (Full Staph) screen: Implant/ high risk surgery * Swabs * **Anterior nares** (nasal) * **Any skin lesion** * Catheterised: **CSU** (Catheter Specimen of Urine) * Productive cough: **Sputum** * Staph screen/ patient tagged: **Perineum swab** Blind management * **\>65yrs+transferred from carehome/hospital** * **MRSA** Hx in past 6months **Management** **min _5days_** and rescreen d7 * Single room * Nasal: **Mupirocin 2% 8hrly** * Skin: **Chlorhexidine 0.1% + Neomycin 0.5%** * Wash body daily * Infection * Vancomycin, Teicoplanin, Linezolid ESBL, MGNB, CARB screen * **ALL patient** (unless hasnt been in hospital/ abroad for 1yr) * Rectal swab (stoma/ unable: stool sample) * Catheter: CSU * Management: Microbiologist **ESBL: E**xtended **S**pectrum **B**eta-**L**actamase-producing Bacilli **MGNB: M**ulti-resistant **G**ram-**N**egative **B**acilli **CARB: Carb**apenemase-producing Gram-negative Bacilli