Antimicrobial Chemotherapy Guidelines

Question 1

What does empirical treatment mean?

Answer 1

“Treatment decision based on experience and observation, rather than logic or reason”

Good example in infectious disese is treating before microbiology labs have identified organism

Question 2

What are the types of antimicrobial prophylaxis?

Answer 2

• Primary - e.g. antimalarial drugs; pre-operative; post-exposure
• Secondary - prevent a second episode

Question 3

What are important patient characteristics to assess when determining which type of antimicrobial to use?

Answer 3

• Age
• Renal function
• Liver function
• Immunocompromised
• Pregnancy
• Known allergies

Question 4

How often should you review IV treatment for continution/downgrading?

Answer 4

Daily

Question 5

What criteria could you use to determine if someone needs to be downgraded to oral antibiotics?

Answer 5

• Oral route compromisation
• Sepsis status
• Special indications - endocarditis, meningitis, S. aureus bacteraemia, immunosuppression, bone/joint infection, deep abscess, CF, prosthetic infection
• Febrile neutropenia
• Hypotension/Shock

Question 7

How long after starting IV antibiotics should you consider downgrading to oral antibiotics?

Answer 7

48 hrs, provided that they meet the IV-Oral switch criteria

Question 8

What treatment is used to treat non-severe community acquired pneumonia (CURB65)?

Answer 8

Amoxicillin or Clarythromycin/Doxycycline

Question 9

What medications are used in the treatment of severe community acquired pneumonia (CURB65 >/= 3)?

Answer 9

1. Co-amoxiclav + Clarythromycin (IV)
2. Co-amoxiclav +/- Clarythromycin/Doxycycline (Oral)

Question 10

If someone was penicillin allergic and had severe CAP, what medications would you use?

Answer 10

• Levofloxacin/Co-trimoxazole (IV)
• Doxycycline/Co-trimoxazole (Oral)

Question 11

How would you treat someone with staphylococcal pneumonia?

Answer 11

Add Flucloxacillin to normal CAP treatment

Question 12

How would you treat someone with aspiration pneumonia?

Answer 12

• Benzylpenicillin + Metranidazole (IV)
• Amoxicillin + Metranidazole (oral)

Question 13

What is the first line antibiotic used for exacerbation of COPD?

Answer 13

Amoxicillin

Question 14

What is the 2nd line treatment for COPD exacerbation?

Answer 14

Clarythromycin/Doxycycline

Question 15

Under what circumstances would you use second line antibiotics for Exacerbation of COPD?

Answer 15

• Recent hospitalisation
• Recent 1st line antibiotic use

Question 16

How would you treat severe infective exacerbation of COPD?

Answer 16

1. Co-trimoxazole (IV)
2. Co-trimoxazole/Doxycycline (Oral)

Question 17

How would you treat someone who developed pneumonia within 4 days of admission?

Answer 17

As for CAP

Question 18

How would you treat someone who developed non-severe pneumonia after 5 days of being admitted to hospital?

Answer 18

Amoxicillin

Question 19

How would you treat someone who had developed a moderate/severe pneumonia after 5 days in hospital?

Answer 19

Co-amoxiclav + Gentamicin (IV)

Question 20

If nosocomial MRSA pneumonia is suspected, what would you add to your treatment?

Answer 20

Co-amoxiclav + Gentamicin PLUS VANCOMYCIN

Question 21

How would you treat someone with osteomyelitis?

Answer 21

1. Flucloxacillin +/- Rifampicin (IV)
2. Flucloxacillin +/- Rifampicin (oral)

Question 22

If someone developed osteomyelitis and was penicillin allergic, what treatment would you use?

Answer 22

1. Vancomycin (IV)
2. Clindamycin (Oral)

Question 23

What treatment would you use if you suspected MRSA osteomyelitis?

Answer 23

• Vancomycin (IV)
• Clindamycin (IV)

Question 24

How would you treat someone with Septic Arthritis?

Answer 24

• Flucloxacillin +/- Rifampicin (IV)
• Flucloxacillin +/- Rifampicin (oral)

Question 25

What antibiotics would you use if a female presented with a lower UTI?

Answer 25

• Trimethoprim
• Nitrofurantoin

Question 26

How would treat a man with a lower UTI differ from that of a woman?

Answer 26

Same antibiotics - longer duration

7 days

Question 27

How would be your first line treatment choice for a pregnant woman with a UTI?

Answer 27

• Trimethoprim
• Nitrofurantoin - except 3rd trimester and renal impairment

Question 28

What would you use as a second line treatment for UTI in pregnancy?

Answer 28

Cefalexin

Question 29

How would you treat complicated UTI?

(1st and 2nd line Abx…?)

Answer 29

• 1st line - Co-amoxiclav or Co-trimoxazole
• 2nd line - Ciprofloxacin

Question 30

When would you not treat a UTI?

Answer 30

When the patient is asymptomatic - try to avoid resistance

ONLY TREAT IF SYMPTOMS + POSITIVE URINALYSIS!!!!

Question 31

What antibiotics would you use to treat gastro-enteritis?

Answer 31

No antibiotics usually required

Question 32

What antibiotics would you use to treat someone with non-severe C. diff infection?

Answer 32

Oral metranidazole

Question 35

How long would you treat a C. diff infection with antibiotics?

Answer 35

10 days

Question 57

What antibiotics would you use to treat someone with pyelonephritis?

Answer 57

Gentamicin + Amoxicillin

Question 60

How would you treat someone with severe C. diff infection?

Answer 60

Oral Vancomycin

Question 61

How would you treat someone with C. diff infection who showed no improvement after 5 days of Oral Metranidazole?

Answer 61

Oral Vancomycin