Chapter 5 Infection

Question 1

What antibiotic should be given for the prevention of infection from animal and human bites?

Answer 1

Co-amoxiclav (or doxycycline and metronidazole if penicillin allergic)

Question 2

What antibiotic should be given if meningitis is suspected? What other medicines might the patient also receive?

Answer 2

Benzylpenicillin

Dexamethasone should be considered (Avoid in septic shock, septicaemia, immunocompromised or following surgery)

Question 3

Antibacterial therapy for native-valve endocarditis caused by staphylocci

Answer 3

Flucloxacillin - 4 weeks

Question 4

Antibacterial therapy for prosthetic valve endocarditis caused by staphylocci

Answer 4

Flucoxacillin + rifampicin + low dose gentamicin

6 weeks

Question 5

Antibacterial therapy for endocarditis caused by sensitive streptococci

Answer 5

Benzylpenicillin

Question 6

Antibacterial therapy for endocarditis caused by enterococci

Answer 6

Amoxicillin + low dose gentamicin

4-6 weeks

Question 7

Antibacterial therapy for otitis externa

Answer 7

Consider systemic Abx if spreading cellulitis or patient systemically unwell with flucloxacillin

Question 8

Antibacterial therapy for otitis media - when do you start treatment? How long is the recommended duration of treatment?

Answer 8

Start if no improvement after 72 hours or if patient is systemically unwell.
Amoxicillin first line
Consider co-amoxiclav if no improvement after 48 hours
Suggested duration of treatment is 5 days

Question 9

What is the suggested duration of treatment for C.diff?

Answer 9

10-14 days

Question 10

Suggested antibacterial therapy for biliary-tract infection?

Answer 10

Ciprofloxacin or gent

Question 11

Antibacterial therapy for bacterial vaginosis?

Answer 11

Oral metronidazole

Question 12

Antibacterial therapy for uncomplicated chalmydia?

Answer 12

Azithromycin single dose or doxycycline 7 days

Question 13

Antibacterial therapy for osteomyelitis?

Answer 13

Flucloxacillin - 6 weeks

Question 14

Abx for low severity CAP?

Answer 14

Amoxicillin

If atypical pathogens are suspected, add clarithromycin or azithromycin

Question 15

Abx for HAP?

Answer 15

Co-amoxiclav or cefuroxime

Question 16

Impetigo treatment - small areas of skin infected

Answer 16

Topical fusidic acid for 7 days (max 10 days)

Question 17

Impetigo treatment when the infection is widespread? What is the patient is penicillin allergic?

Answer 17

Oral flucloxacillin

If penicillin allergic - clarithromycin or clindamycin

Question 18

Antibacterial therapy for cellulitis? What is the patient is penicillin allergic?

Answer 18

Flucloxacillin (high dose)

If penicillin allergic - clindamycin or clarithromycin

Question 19

Antibacterial therapy for mastitis during breast feeding?

Answer 19

Treat if severe, systemically unwell, if symptoms do not improve after 12-24 hours of effective milk removal. Flucloxacillin and erythromycin

Question 20

Aminoglycosides - bacteriostatic or bactericidal?

Answer 20

Bactericidal

Question 21

What cover do aminoglycosides have?

Answer 21

Mainly gram negative
Some gram positive cover
Inactive against anaerobes

Question 22

Contra-indication to aminoglycosides

Answer 22

Myasthenia gravis

Question 23

To avoid excessive dosing in obese patients, gentamicin doses should be based on what?

Answer 23

Use IBW

Question 24

Target peak level of gentamicin for multiple daily dose regimen?

Answer 24

5-10mg/l

lower for endocarditis 3-5mg/l

Question 25

What is the important safety information regarding streptomycin dosing?

Answer 25

Side-effects increase after a cumulative dose of 100g which should only be exceeded in exceptional circumstances.

Question 26

Carbapenems bacterial cover

Answer 26

The carbapenems are beta-lactam antibacterials with a broad-spectrum of activity which includes many gram positive and gram negative bacteria and anaerobes

Question 27

Which cephalosporin has good activity against pseudomonas?

Answer 27

Ceftazadime

Question 28

The calcium salt of cetriaxone can potentially cause what complication?

Answer 28

the calcium salt can form a precipitate in the gall bladder which may rarely cause symptoms but these usually resolve when the antibiotic is stopped. Caution in patients with a history of hypercalcuria, history of kidney stones

Question 29

What generation are cefaclor and cefuroxime?

Answer 29

Second gen

Question 30

What generation are cefixime, cefotaxime, ceftazidime, ceftriaxone?

Answer 30

Third gen

Question 31

Antibacterial cover of glycopeptides

Answer 31

Aerobic and anaerobic gram positive bacteria

Question 32

How does the duration of action of teichoplanin differ from vancomycin?

Answer 32

Has a significantly longer duration of action, allowing once daily administration after the loading dose. Vancomycin can be given every 12 hours

Question 33

Common side effects of vancomycin with IV use (5 points)

Answer 33

``` Blood disorders - inc. neutropenia, usually occurs after 1 week, or if cumulative dose reaches 25g Interstitial nephritis Nephrotoxicity Ototoxicity Renal failure ```

Question 34

Which glycopeptide is associated with a higher incidence of nephrotoxicity?

Answer 34

Vancomycin is associated with a higher risk of nephrotoxicity than teichoplanin

Question 35

Clindamycin should be used with caution in what patients?

Answer 35

Middle age-elderly women as higher risk of antibiotic associated colitis

Question 36

Macrolides should be used with caution in what patients?

Answer 36

Patients with electrolyte disturbances - predisposes to QT interval prolongation May aggravate myasthenia gravis Patients with predisposition to QT interval prolongation

Question 37

Gastro-intestinal side effects are less frequent with which macrolides?

Answer 37

Less frequent with azithromycin and clarithromycin than with erythromycin

Question 38

5 common side effects of clarithromycin

Answer 38

Dyspepsia, headache hyperhidrosis, insomnia, taste disturbances

Question 39

True or false - Piptaz is active against Pseudomonas and MRSA?

Answer 39

False Piptaz is effective in the treatment of pesudeomonas BUT is not active against MRSA

Question 40

Why must penicillins NOT be given by intrathecal injection?

Answer 40

The penicillins should not be given by intrathecal injection because they can cause encepthalopathy due to cerebral irritation which may be fatal.

Question 41

Main side effect with piptaz?

Answer 41

Nausea and vomiting

Question 42

Co-amoxiclav is associated with a risk of cholestatic jaundice, who is more at risk of this?

Answer 42

More common in patients over the age of 65 years and in men These reactions have rarely been reported in children The duration of treatment should be appropriate and should generally not exceed 14 days.

Question 43

Co-amoxiclav common side effects =

Answer 43

cholestatic jaundice, hepatitis, nausea and vomiting

Question 44

Discuss the risk of cholestatic jaundice with flucloxacillin

Answer 44

Cholestatic jaundice and hepatitis may occur very rarely, up to two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing age are risk factors. Healthcare professionals are reminded that: flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin and used with caution in those with hepatic impairment

Question 45

Bacterial cover of ciprofloxacin

Answer 45

Cipro is active against both gram positive and gram negative bacteria. It is particularly active against gram neg

Question 46

Quinolones may induce convulsions with or without a history of convulsions, what medication prescribed at the same time increases this risk further?

Answer 46

NSAIDS

Question 47

When is moxifloxacin contraindicated?

Answer 47

Acute myocardial infarction (risk factor for QT prolongation), bradycardia, heart failure with reduced LV ejection fraction,

Question 48

What is the drug of choice in the treatment and prophylaxis of PCP?

Answer 48

co-trimoxazole

Question 49

Tetracyclines are contraindicated in what patients?

Answer 49

Patients under 12 years. Should not be given to pregnant women. Caution in myasthenia gravis

Question 50

Unusual side effect of tetracyclines

Answer 50

Benign intracranial hypertension - headache and visual disturbances may indicate this, should discontinue treatment

Question 51

Daptomycin monitoring

Answer 51

Monitor creatine kinase before treatment and then weekly during treatment - monitor more frequently if CK elevated more than 5 times the upper limit of normal before treatment

Question 52

What important safety information is there regarding linezolid?

Answer 52

Severe optic neuropathy may occur rarely, particularly if used for longer than 28 days. Patients should be warned to report symptoms of visual impairment. Haematopoietic disorders inc. thrombocytopenia, anaemia, leucopenia. FBC monitoring weekly.