Chapter 5- Infection Flashcards
What are important bacteria considerations before starting therapy
Viral infections should not be treated with antibacterial
Samples should be taken for culture to avoid blind antibacterial prescribing
Narrow spectrum are preferred unless there’s a clear clinical indication
Knowledge in the prevalent organism helps chose an antibacterial
The dose is dependent on many factors (age, weight, renal, hepatic function)
The route often depends on the severity of the infection
Duration of therapy depends on the nature of the infection and response to treatment and complete course
Follow national and local prescribing guidelines
Which antibiotics are the most suitable during pregnancy
Penicillins and cephalosporins
Nitrofurantoin may also be used
Which antibiotics should be avoided in the Renally impaired and why
Tetracyclines Nitrofurantoin (eGFR<45) Aminoglycosides Glycopeptide Amoxicillin
Theyre excreted by the kidneys so would accumulate with resultant toxicity
What antibiotics do aminoglycosides include
Amikacin Gentamicin Neomycin Streptomycin Tobramycin
What’s the mechanism of action of aminoglycosides
They are bacteriocidal by irreversibly binding to ribosome to inhibit protein synthesis
Causes the cell to leak and the antibiotic to be taken up
Effective in gram +ive and -ive but mainly negative
Not effective in anaerobes
Indications for aminoglycosides
CNS infections, endocarditis, septicaemia, meningitis etc
Biliary tract infection, prostitis and pneumonia.
Streptomycin is active against TB
Side affects associated with aminoglycosides
May Cause neuromuscular transmission Irreversible ototoxicity Nephrotoxicity Nausea and vomiting Antibiotic associated colitis Peripheral neuropathy Electrolyte disturbance
Contraindications and cautions for aminoglycosides
Patients with clinical muscle weakness (eg: myasthenia gravis)
Avoid use with other ototoxic drugs (furosemide, ciaplatin)
Avoid use with nephrotoxic drugs (vancomycin and ciclosporin)
Why are aminoglycosides generally given parenterally for systemic infections
They are not absorbed from the gut
What’s the gentamicin dosing like in the Uk
Requires a loading dose as it has a narrow therapeutic index
Multiple daily dose regime:
One hour serum concentration (peak) should be 5-10mg/L (3-5 for endocarditis)
Pre-dose trough concentration should be <2mg/L (<1mg/L for endocarditis)
Warning signs for aminoglycosides
Nephrotoxicity
Ototoxicity (hearing impairment)
Dehydration
Whats the MHRA ALERT for streptomycin
Side effects increase after a cumulative dose of 100g (shouldnt need to be exceeded except in exceptional circumstances)
What are examples of carbapenem and what spectrum of activity do carbapenems have
Imipenam, meropenam and ertapenam
Broad spectrum which include many gram positive and gram negative bacteria and anaerobes
What’s the five generations of Cephalosporins
- Cefalexin and Cefradine
- Cefaclor and Cefuroxime
- Cefixime and Ceftriaxone
- Ceftaoline and Fosamil
Mechanism of action of Cephalosporins
They prevent cell wall synthesis by binding to enzymes called penicillin binding proteins. They are bacteriocidal to both gram positive and gram negative activity
When are cephalosporins indicated
Pneumonia
Meningitis
Gonorrhoea
UTIs
Caution with cephalosporins
Hypersensitivity- 0.5-6% of penicillin allergic patients will be allergic to cephalosporins
Examples of glycopeptide antibiotics
Vancomycin
Teicoplanin
Telavancin
Mechanism of action of glycopeptide antibiotics
They inhibit cell wall synthesis by binding to the cell wall precursor components, this leads to interference of the penicillin binding protein enzymes preventing Cell wall synthesis.
Active against aerobic and anaerobic gram +ive bacteria including MRSA
Side-effects of glycopeptide antibiotics
Nephrotoxicity Blood disorders Ototoxicity Red man syndrome Thrombophlebitis at injection site Nausea Chills Fever
Indication for glycopeptide antibiotics
More serious infections
C. Diff
Endocarditis
Surgical prophylaxis when high risk of MRSA
Should not be given orally except for c. Diff as it’s not significantly absorbed
Why is the loading dose required for vancomycin and what is the therapeutic range
Long half life
Therapeutic range: 10-15mg/L
15-20mg/ml for endocarditis and less sensitive MRSA strains
What are warning signs for patient taking glycopeptide antibiotics
Ototoxicity Blood disorders Red man syndrome (flushing of the upper part of the body) Phlebitis Nephrotoxicity Skin disorders Hypotension
Drug interactions with glycopeptide antibiotics
Increased risk of ototoxicity and nephrotoxicity when given with ciclosporin, aminoglycosides, anti fungal and loop diuretics (ototoxicity)
What’s the mechanism of action of Clindamycin
It binds to ribosomes inhibiting cell wall protein synthesis, it has bacteria static actions against gram positive aerobes and anaerobes
What’s the indication for clindamycin
Joint and bone infection, intraabdominal sepsis, cellulitis, skin and soft tissue infection
What’s an alarming symptom with clindamycin use?
Antibiotic associated colitis so if diarrhoea develops stop and contact GP
Examples of macrolides
Erythromycin
Azithromycin
Clarithromycin
Mechanism of action of macrolides
Binds to ribosomes inhibiting cell wall protein synthesis, similar activity to penicillin thus are an alternative in allergic patients
Indications for macrolides
Respiratory infection
Interactions of macrolides
Other drugs that prolong the QT interval
Statins
Calcium channel blockers
Warfarin (increasing their concentration)
Mechanism of action of metronidazole
A prodrug that it’s active form binds to DNA to distrust its helical structure, inhibiting bacterial synthesis
It has high activity against anaerobic bacteria and Protozoa
When is metronidazole indicated
An alternative to penicillin treatment for many awful infections where anaerobes are either resistant to penicillin or patients are allergic
H. Pylori
Oral infections
Ulcers
Pressure sores
Side effects of metronidazole
GI disturbances Taste disturbances (metallic) Furred tongue Anorexia Oral mucositis Discoloured urine (dark)
How should metronidazole be taken
With it after food
Avoid alcohol
Penicillins mechanism of action
Inhibit bacterial wall synthesis by preventing peptoglycan cross linking. Cover both gram positive and negative
How should penicillin be taken?
On an empty stomach an hour before food or 2 hours after
Amoxicillin not affected by food
Side effects of penicillins
Hypersensitivity
Anaphylaxis
Diarrhoea
CNS toxicity (encephalopathy)
Jaundice with co-amoxiclav
Hepatic disorders with flucloxacillin
Which penicillins are beta-lactamase sensitive
Penicillin G and V and amoxicillin
Which penicillin is penicillinase resistant
Flucloxacillin
MHRA alert for specific penicillins
Jaundice with co-amoxiclav
Hepatic disorders with flucloxacillin
Quinolone examples
Ciprofloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin
Mechanism of action of quinolone
Inhibits enzyme necessary for bacterial DNA replication
Active against gram positive and gram negative
Quinolone indications
Respiratory tract infections
Anthrax
Gonorrhoea
UTI
What important interaction or side effects are important to note with quinolone
QT interval prolongation
Quinolone may induce convulsion and taking NSAID at the same time increases the risk
Rare risk of tendon damage within 48 hours of starting (risk increased if used with a steroid, history of tendon disorder or patient over 60)
Reduce exposure to light to avoid photosensitivity reaction
Less suitable in children due to risk of arthropathy
Example of diaminopyramides and it’s mechanism of action
Co-trimoxazole and trimethoprim
They both block different steps in the synthesis of nucleic acids essential to many bacteria
Effective against a wide range of gram positive and negative bacteria
Tetracycline examples and mechanism of action
Tetracycline
Doxycycline
Minocycline
Taken up into bacterial cells and inhibit protein synthesis and hence cell growth
Tetracycline side effects
GI disturbances Hepatotoxicity Photosensitivity Hypersensitivity Headache and visual disturbances (indicate increased intracranial pressure) Oesophageal irritation
Contraindications and cautions on tetracycline
Hepatic and renal impairment
Avoid in children, pregnant women and breast feeding (affects growing bones and stain teeth)
Counselling points with tetracyclines
Take with food but avoid antacids, aluminium, calcium, iron, magnesium and zinc salts as these decrease absorption
Swallow whole with plenty of fluid and sit up for Atleast 30 minutes to avoid oesophageal irritation
Wear spf and avoid direct sunlight
What would you need to measure if you experience unexplained muscle weakness tenderness or cramps while taking Daptomycin
Creatinine kinase levels
Which MAOI medication can be given for bacterial infection and covers MRSA and vancomycin-resistant cocci
Linezolid
What needs to be monitored and what are MHRA alerts for linezolid
Full weekly blood count
Severe optic neuropathy may occur if used for longer than 28 days
What does the initial stage of the management of tuberculosis consist of and what’s the aim (clue: RIPE)
Consists of 4 drugs - Rifampicin - Isoniazid - Pyrazinamide - Ethambutol It lasts for 2 months
Aim is to rapidly reduce the population of M. Tuberculosis to minimise bacterial resistance
What does the continuous phase of tuberculosis treatment consist of
(Clue: RI)
Consists of 2 drugs:
- Isoniazid
- Rifampicin
Lasting 4 months
What do you monitor for antituberculosis drugs
Drug levels Visual activity Blood counts Renal function Hepatic function Urinalysis Plasma levels Auditory function in elderly
What is nitrofurantoin used for and how does it work
Broad spectrum antibacterial active against the majority of urinary pathogens. (Mainly E. coli)
It’s bactericidal in renal tissue and throughout the urinary tract
When should culture and sensitivity testing be carried out for the use of nirtofurantoin
In men In pregnant women In children under 3 In patients with upper UTI, complicated UTI or recurrent UTI If resistant organism suspected
What is co-amoxiclav
Amoxicillin with a beta-lactamase inhibitor called clavulanic acid
What does Tazocin contain and what is it used against?
Piperacillin and tazobactam
It is a broad spectrum antibiotics effective against anaerobes
What needs to be counselled with nitrofurantoin
Should be taken with food and may colour the urine yellow or brown
Side effects of the TB antibiotics used
RIFAMPICIN:
Liver toxicity (jaundice)
Induces hepatic enzymes that accelerates metabolism (COC ineffective)
Tears urine and sweat become orange/ red
ISONIAZID:
Peripheral neuropathy
Vitamin B6 deficiency
Hepatotoxicity
ETHAMBUTOL:
Visual problems
Flatulence
What common antibiotics are used to treat C. Diff and for how long
First line: metronidazole
Oral vancomycin
10-14 days
Which antibiotics or acute exacerbation of chronic bronchitis treated with
Amoxicillin or a tetracycline
What is community-acquired pneumonia typically treated with
Amoxicillin and clarithromycin
What is hospital-acquired pneumonia and usually treated with
Co-amoxiclav or cefuroxime
What are urinary tract infections usually treated with
Trimethoprim or nitrofurantoin families
What is gonorrhoea and chlamydia usually treated with
Azithromycin
What is sepsis usually treated with
Tazocin or cefuroxime
Which macrolides can be sold OTC for patients over 16 with confirmed chlamydia
Azithromycin
For which antibiotics are oral contraceptives not effective and must use additional contraception
Penicillins and tetracyclines
Which antibiotics do you take on an empty stomach and a full glass of water
Macrolides
Tetracyclines
Quinolone
Which antibiotics should you avoid sun due to risk of burns from increased photosensitivity
Quinolone
Tetracycline
Sulfa drugs (trimethoprim)
Major side effect of cephalosporins
Bleeding so monitor platelet count
C. Diff
Which 2 antibiotics classes shouldn’t be mixed
Penicillin
Cephalosporins
Which are the most ototoxic and nephrotoxic drugs
Glycopeptide- vancomycin
Aminoglycosides- tobramycin, gentamicin, neomycin
What’s the best way to administer vancomycin
Slow over 60 minutes to avoid red man syndrome
While monitoring BP
Which metronidazole symptom is a red flag
Skin peeling
What group of patients might receive antifungal drugs prophylactically and why
Immunocompromised patients as they’re at risk of fungal infections
Name the main antifungals drug classes
Triazole
Imidazole
Polyene
Echinocandin
What role do triazole antifungals have
They have a role in the prevention and systemic treatment of fungal infections
Name antifungals in the triazole class
Fluconazole
Itraconazole
Posaconazole
Voriconazole
What drugs does the Imidazole antifungals class include
Clotrimazole Econazole Ketoconazole Tioconazole Miconazole
What are Imodazole antifungals used for
Local treatment of vaginal candidiasis and for dermatophyte infections
Miconazole for oral infections
What drugs does the polyene antifungals include
Amphotericin
Nystatin
How should polyene antifungals not be given
Orally as they’re not absorbed (local application or intravenous infusion)
What are cautions when prescribing Itraconazole
Heart failure and hepatotoxicity
What should be monitored with itraconazole
Liver function if high doses or longe term
Which triazole antifungals should not be given in pregnancy
Fluconazole
What’s important about the prescribing and administration of amphotericin
Prescribed by brand as not interchangeable
Needs to be given intravenously but toxic (anaphylaxis can occur) via this route so side effects are common
A test dose must be given and monitored for half an hour
What is the Antifungal of choice for prophylactic treatment
Oral Triazole antifungals
What’s the MHRA alert for ketoconazole
Restriction of ketoconazole use due to associated fatal hepatotoxicity
Monitoring requirements for Ketoconazole
ECG
Adrenal function
Hepatic function
When should systemic antifungal treatment be used
It topical treatment fails
If many areas are affected
If the site of infection is difficult to treat (eg nail)
What may fluconazole interact with
Statins Warfarin Diazepam Phenytoin Theophylline
What’s the drug of choice for helminth infections (eg: thread worm) and what’s the dosing
Mebendazole
One dose then another after 2 weeks to avoid reinfection (age > 6months)
What amphotericin B used for and what’s the adverse effects
Severe fungal infections
Renal injury
What’s nystatin used for
Fungal infection (candidiasis) of the mouth, GI, nail, skin and the vagina
Give a few malaria preventative measures against bites
Long sleeves
Trousers after dusk
Mosquito nets
DEET (diethyltoluamide) anyone over 2 months
Length of malarial prophylaxis
Generally one week before travel and 4 weeks after leaving
2-3 weeks before leaving for mefloquine
1-2 days before leaving for malarone and Stopped 1 weeks after return
1-2 days before leaving for doxycycline
What should the patient travelling from a high malaria endemic area look out for once returning
Any illness within 1 year of return especially within 3 months
What anti-malarial are not suitable for patients with epilepsy
Chloroquine and mefloquine due to neuropsychiatric reactions
What anti-malarial are not suitable for patients with renal impairment
Proguanil should be avoided
malarone and chloroquine should not be used if eGFR < 30
(Doxycycline or mefloquine choice of drug)
Anti malarial advice during pregnancy
Avoid travelling to malarious areas as a whole
Quinine can be taken
If taking proguanil, folic acid should be given for the first trimester
Doxycycline is contraindicated in pregnancy (can be used after 15 weeks gestation)
Malarone should be avoided in pregnancy
Advice for anti-malarial for patients on anticoagulation
Travellers taking warfarin should begin chemoprophylaxis 2 to 3 weeks before departure
INR should be stable before departure and should be measured before starting chemoprophylaxis, Seven days after starting and after completing the course
What do you treat malaria with if the infective species is not known
Quinine
Malarone (atovaquone with proguanil)
Riamet
How is uncomplicated malaria usually treated
Chloroquine
What antimalarials are available OTC for prophylaxis
Chloroquine and proguanil
Atovaquone and proguanil (malarone)
Prophylaxis regimes against malaria
(1) Chloroquine only
(2) Chloroquine with proguanil
(3) Atovaquone with proguanil
OR doxycycline
OR mefloquine
That’s the treatment options for malaria
Quinine
Malarone (atovaquone with proguanil)
Riamet
Choloquine (non- falciparum malaria)
What group of drugs are used for HIV and what’s the treatment aims?
Antiretroviral
Aim is to prevent mortality and morbidity associated with chronic HIV infection whilst minimising drug toxicity
Which antivirals are licensed for influenza and how do they work
Osteltamivir and zanamivir
They reduce the replication of influenza A and B by inhibiting viral neuraminidase
(Licensed for use up to 48hrs into a flu)
Why may oseltamivir be ineffective in neonates
They’re unable to metabolise it to its active form
What causes herpes simplex and where does it affect
HSV 1- mouth, lips and eyes
HSV 2 and HSV 1- genital infections
What is chicken pox caused by and when is treatment usually required
Varicella zoster
Neonates should be treated with parenteral antiviral
Antiviral may be needed in adolescents and adults
What’s shingles caused by and how is it treated
Herpes Zoster
Treated with systemic antiviral within 72hrs of rash and contributed for 7-10 days
What’s the treatment of choice for herpes virus?
Aciclovir- active against HSV topically or systemically varicella-zoster (chicken pox)
Famiciclovir- used in herpes zoster (shingles) and genital herpes
Valciclovir- used in herpes zoster (shingles) and herpes simplex (HSV)
What’s the drug treatment of choice for chronic hepatitis B and when should it be contraindicated
Peginterferon alfa
Contraindicated in liver disease
What’s the drug treatment of choice in chronic hepatitis C
A combination of ribavirin and peginterferon Alfa is used
Peg Alfa can be used alone but ribavirin mono therapy is ineffective
Why should alcohol be avoided with metronidazole
Cause disulfiram like reaction
Severe nausea and vomiting
Aminoglycosides must be monitored on everyone but mainly what groups of people
Elderly Obese Cystic fibrosis High doses Renally impaired
When should once daily regime of gentamicin be avoided
Crcl <20ml/min
Burns covering >20%
Endocarditis caused by HÁČEK or gram positive
What do you do if the gentamicin post dose peak is too high (above 5-10)
Reduce dose
What do you do if the pre dose trough level of gentamicin is too high (>2)
Increase interval
What’s the general rule of thumb for common bacterial infections
Staphylococci- flucloxacillin MRSA- vancomycin Streptococci- benzylpenicillin or phenoxymethylpenicillin Anaerobic bacteria- metronidazole Pseudomonas aeruginosa- aminoglycosides
What’s endocarditis treated with
Amoxicillin
+/-
Gentamicin
What’s the initial treatment for meningitis
Benzylpenicillin
Common eye infection and treatment
Conjunctivitis
Chlorophenicol
What’s dental infections usually treated with?
Metronidazole 200mg TDS 3 times a day
Which antifungal causes phototoxicity and an alert card should be carried
Voriconazole
What do you give for thrush
Oral thrush:
Nystatin or miconazole
Vaginal thrush:
Fluconazole or clotrimazole (imidiazole)
What do you give for fungal nail infection and when do you refer
Amorolfine
When more than 2 nails is infected
What’s the standby treatment for malaria?
Quinine
Take 1 if you cannot access medical care in 24hours of fever onset
What are the long term malaria prophylaxis
> 5 years chloroquine and proguanil
2 years doxycycline
1 year mefloquine, malarone
If Gentamicin and ciprofloxacin are the only suitable antibiotics for a specific treatment, which one would you go for and why?
Ciprofloxacin as it’s oral
Gentamicin is IV so patient would have to remain an inpatient
Oral> IV
What’s the interaction between erythromycin and theophylline
Erithromycin increases theophylline conc
What’s the scoring system for CAP and HAP
CAP- crb65
HAP- curb65
Signs and symptoms of an infection
Fever, malaise, aches and pains Pus, swelling or inflammation Drowsiness in children Confusion in elderly Worsening renal function
Clinical markers of an infection
Low blood pressure
Raised blood glucose
High ESR, CRP, temperature, RR and pulse
What’s a superinfection
Clindamycin and broad spec antibiotics kill normal flora and allow selective organism to thrive
Causing antibiotic associated colitis (c. Diff) and thrush (candida)
Side effect of trimethoprim
Anti folate (teratogenic)
Blood dysrasias
Hyperkalaemia
What’s chloramphenicol reserved for
Reserved for life threatening infections
Why should broad spectrum-antibiotics not be given blindly for sore throats
Causes maculopapular rash in Glandular fever
Give examples of narrow spectrum, broad spectrum, penicillinase resistant and anti pseudomonal penicillins
Narrow spec:
Benzylpenicillin (pen G)
Phenoxymethylpenicillin (pen V)
Broad spec:
Ampicillin
Amoxicillin
Penicillinase resistant:
Flucloxicillin
Antipseudomonas (extended spectrum):
Piperacillin (tazobactam)
Ticaricillin (with clauvic acid)
When should you monitor multiple dose regimes of aminoglycoside and vancomycin
After 3 or 4 doses and after a dose change
Antibiotics most likely to cause c. Diff
Clindamycin
Ampicillin/ amoxicillin
2nd 3rd gen cephalosporin
Quinolone
Treatment for c. Diff
Metronidazole 10-14 days
Then try oral vancomycin
Loperamide is contraindicated
Treatment for CAP
Mild= Amoxicillin (alternative: clarithromycin or doxycycline) for 7 days
Moderate= amoxicillin + clarithromycin
Severe= benzylpenicillin + Clari/doxy
Add fluclox if staph suspected
Add vancomycin if MRSA suspected
Treatment for HAP
Early onset or < 5 days
Co amoxiclav or cefuroxime
Severe or > 5 days
Antipseudomonal penicillin or broad spectrum cephalosporin or quinolone
Add fluclox if staph suspected
Add vancomycin if MRSA suspected
Causative agent for meningitis and treatment
Neisseria meningitidis
Benzylpenicillin
Treatment for osteomyelitis
Flucloxacillin
Clindamycin of penicillin allergic
Add vancomycin if MRSA suspected
How long should aninoglycoside treatment generally not exceed
7 days
Drugs to avoid in hepatic impairment
Chloramphenicol
Co wmoxiclav
Tetracycline
Co trimoxazole
Treatment for impetigo and what is it
Bacterial skin infection mainly in children
First line fusidic acid
What macrolide can you give in pregnancy
Erythromycin
What varies with increasing generation of cephalosporins
It cover more gram negative as it goes from from 1 to 5
Which antibiotic is least likely to cause c diff or the best treatment for c diff
Vancomycin
When should another dose be taken to treat lice
7 days
Why is pyridoxine given with isoniazid for TB treatment
Peripheral neuropathy
Which antibiotic is likely to cause sedation
Quinolones- ciprofloxacin
What type of infection is ringworms
Fungal
Which antibiotics are used for common GU infections like chlamydia, BV and pelvic inflammatory disease
Azithromycin- used in chlamydia And gonorrhoea
Doxycycline- alternative in chlamydia and pelvic inflammatory disease
Metronidazole- used in BV and pelvic inflammatory disease
What class is amikacin and when is it usually indicated
Aminoglycosides
Indicated for gentamicin resistant infections as amikacin is more stable to enzyme inactivation
Which aminoglycoside is too toxic to be administered parenteral
Therefore taken by mouth
Neomycin
Used for bowel sterilisation before surgery
What antibiotics require reporting on blood disorders/ rash
Co-trimoxazole (contains trimethoprim and sulfamethoxazole)
Trimethoprim
Penicillamine
Which antibiotic has been associated with myopathy/ muscle effects
Daptomycin
Monitor creatinine kinase every 2 days of muscle effects reported
Which antibiotics can cause choke static jaundice
Co amoxiclav
Nitrofurantoin
Fluoxacillin (even up to 2 months after)
Which antibiotics are associated with visual problems
Linezolid- optic nephropathy
Quinolones- retinol detachment
Ethambutol (used for tb)- ocular toxicity
Rifampicin- colours tears/ contacts red
Rifambutin- uveitis (eye inflammation)
What conditions can tetracyclines exacerbate
Systemic lupus Myasthenia gravis (increased muscle weakness)
Which antibiotics can cause a false positive on urinary glucose tests
Cephalosporin
Which antibiotics is a folate synthesis inhibitor and therefore teratogenic
Trimethoprim
Co trimoxazole
Which antibiotics/ anti fungal S can cause Steven Johnson’s syndrome
Cotrimoxazole
Clindamycin
Fluconazole
What skin condition may terbinafine (antifungal) exacerbate
Psoriasis
What antibiotic should be used for resistant strains of pneumonia
Co amoxiclav
What can chloremphenicol cause in babies
Grey baby syndrome
What’s an important side effect of tetracycline that would require you to stop
Benign intracranial hypertension
Stop if headache or visual disturbances occur
Tetracyclines should be avoided in renal impairment except which ones
Doxycyclines
Minocycline
Which tetracyclines need to counselled to avoid exposure to sunlight and wear spf
Doxycycline
Demeclocycline
Which tetracycline have decreased absorption when taken with antacids so need to be counselled to avoid taking antacid 2 hours before and after
Demeclocycline
Oxytetracycline
Tetracycline
Which tetracyclines can cause oesophageal irritation so need to be counselled to swallow tablet whole
Doxycycline
Minocycline
Tetracycline
What infections should quinolones be avoided in
MRSA
What’s clarithromycin commonly used to treat
Chest infections
What can azithromycin 1g as a single dose otc be used to treat
Chlamydia
Which macrolides should be taken 2 hours after ingestion remedies
Azithromycin
Erythromycin
Side effects of macrolides
GI effects
QT prolongation
Heptotoxicty
Otoxicity at high doses
What antibiotic is first line for treating animal bites
Co-amoxiclav
Can pregnant women take mebendazole
No
Treatment for scarlet fever
Phenoxymethylpenicillin (pen V)
Qds for 10 days
