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Pre-reg > Chapter 5- Infection > Flashcards

Chapter 5- Infection Flashcards

1
Q

What are important bacteria considerations before starting therapy

A

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

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2
Q

Which antibiotics are the most suitable during pregnancy

A

Penicillins and cephalosporins

Nitrofurantoin may also be used

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3
Q

Which antibiotics should be avoided in the Renally impaired and why

A 
Tetracyclines 
Nitrofurantoin (eGFR<45)
Aminoglycosides 
Glycopeptide 
Amoxicillin

Theyre excreted by the kidneys so would accumulate with resultant toxicity

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4
Q

What antibiotics do aminoglycosides include

A 
Amikacin
Gentamicin 
Neomycin
Streptomycin
Tobramycin
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5
Q

What’s the mechanism of action of aminoglycosides

A

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

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6
Q

Indications for aminoglycosides

A

CNS infections, endocarditis, septicaemia, meningitis etc
Biliary tract infection, prostitis and pneumonia.

Streptomycin is active against TB

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7
Q

Side affects associated with aminoglycosides

A 
May Cause neuromuscular transmission 
Irreversible ototoxicity 
Nephrotoxicity
Nausea and vomiting 
Antibiotic associated colitis 
Peripheral neuropathy 
Electrolyte disturbance
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8
Q

Contraindications and cautions for aminoglycosides

A

Patients with clinical muscle weakness (eg: myasthenia gravis)

Avoid use with other ototoxic drugs (furosemide, ciaplatin)

Avoid use with nephrotoxic drugs (vancomycin and ciclosporin)

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9
Q

Why are aminoglycosides generally given parenterally for systemic infections

A

They are not absorbed from the gut

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10
Q

What’s the gentamicin dosing like in the Uk

A

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)

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11
Q

Warning signs for aminoglycosides

A

Nephrotoxicity
Ototoxicity (hearing impairment)
Dehydration

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12
Q

Whats the MHRA ALERT for streptomycin

A

Side effects increase after a cumulative dose of 100g (shouldnt need to be exceeded except in exceptional circumstances)

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13
Q

What are examples of carbapenem and what spectrum of activity do carbapenems have

A

Imipenam, meropenam and ertapenam

Broad spectrum which include many gram positive and gram negative bacteria and anaerobes

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14
Q

What’s the five generations of Cephalosporins

A
  1. Cefalexin and Cefradine
  2. Cefaclor and Cefuroxime
  3. Cefixime and Ceftriaxone
  4. Ceftaoline and Fosamil
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15
Q

Mechanism of action of Cephalosporins

A

They prevent cell wall synthesis by binding to enzymes called penicillin binding proteins. They are bacteriocidal to both gram positive and gram negative activity

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16
Q

When are cephalosporins indicated

A

Pneumonia
Meningitis
Gonorrhoea
UTIs

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17
Q

Caution with cephalosporins

A

Hypersensitivity- 0.5-6% of penicillin allergic patients will be allergic to cephalosporins

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18
Q

Examples of glycopeptide antibiotics

A

Vancomycin
Teicoplanin
Telavancin

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19
Q

Mechanism of action of glycopeptide antibiotics

A

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

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20
Q

Side-effects of glycopeptide antibiotics

A 
Nephrotoxicity 
Blood disorders 
Ototoxicity
Red man syndrome
Thrombophlebitis at injection site 
Nausea 
Chills 
Fever
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21
Q

Indication for glycopeptide antibiotics

A

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

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22
Q

Why is the loading dose required for vancomycin and what is the therapeutic range

A

Long half life

Therapeutic range: 10-15mg/L
15-20mg/ml for endocarditis and less sensitive MRSA strains

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23
Q

What are warning signs for patient taking glycopeptide antibiotics

A 
Ototoxicity 
Blood disorders
Red man syndrome (flushing of the upper part of the body)
Phlebitis 
Nephrotoxicity 
Skin disorders
Hypotension
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24
Q

Drug interactions with glycopeptide antibiotics

A

Increased risk of ototoxicity and nephrotoxicity when given with ciclosporin, aminoglycosides, anti fungal and loop diuretics (ototoxicity)

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25
Q

What’s the mechanism of action of Clindamycin

A

It binds to ribosomes inhibiting cell wall protein synthesis, it has bacteria static actions against gram positive aerobes and anaerobes

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26
Q

What’s the indication for clindamycin

A

Joint and bone infection, intraabdominal sepsis, cellulitis, skin and soft tissue infection

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27
Q

What’s an alarming symptom with clindamycin use?

A

Antibiotic associated colitis so if diarrhoea develops stop and contact GP

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28
Q

Examples of macrolides

A

Erythromycin
Azithromycin
Clarithromycin

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29
Q

Mechanism of action of macrolides

A

Binds to ribosomes inhibiting cell wall protein synthesis, similar activity to penicillin thus are an alternative in allergic patients

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30
Q

Indications for macrolides

A

Respiratory infection

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31
Q

Interactions of macrolides

A

Other drugs that prolong the QT interval
Statins
Calcium channel blockers
Warfarin (increasing their concentration)

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32
Q

Mechanism of action of metronidazole

A

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

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33
Q

When is metronidazole indicated

A

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

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34
Q

Side effects of metronidazole

A 
GI disturbances 
Taste disturbances (metallic)
Furred tongue 
Anorexia 
Oral mucositis
Discoloured urine (dark)
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35
Q

How should metronidazole be taken

A

With it after food

Avoid alcohol

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36
Q

Penicillins mechanism of action

A

Inhibit bacterial wall synthesis by preventing peptoglycan cross linking. Cover both gram positive and negative

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37
Q

How should penicillin be taken?

A

On an empty stomach an hour before food or 2 hours after

Amoxicillin not affected by food

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38
Q

Side effects of penicillins

A

Hypersensitivity
Anaphylaxis
Diarrhoea
CNS toxicity (encephalopathy)

Jaundice with co-amoxiclav
Hepatic disorders with flucloxacillin

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39
Q

Which penicillins are beta-lactamase sensitive

A

Penicillin G and V and amoxicillin

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40
Q

Which penicillin is penicillinase resistant

A

Flucloxacillin

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41
Q

MHRA alert for specific penicillins

A

Jaundice with co-amoxiclav

Hepatic disorders with flucloxacillin

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42
Q

Quinolone examples

A 
Ciprofloxacin 
Levofloxacin 
Moxifloxacin 
Norfloxacin 
Ofloxacin
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43
Q

Mechanism of action of quinolone

A

Inhibits enzyme necessary for bacterial DNA replication

Active against gram positive and gram negative

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44
Q

Quinolone indications

A

Respiratory tract infections
Anthrax
Gonorrhoea
UTI

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45
Q

What important interaction or side effects are important to note with quinolone

A

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

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46
Q

Example of diaminopyramides and it’s mechanism of action

A

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

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47
Q

Tetracycline examples and mechanism of action

A

Tetracycline
Doxycycline
Minocycline

Taken up into bacterial cells and inhibit protein synthesis and hence cell growth

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48
Q

Tetracycline side effects

A 
GI disturbances 
Hepatotoxicity 
Photosensitivity 
Hypersensitivity 
Headache and visual disturbances (indicate increased intracranial pressure)
Oesophageal irritation
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49
Q

Contraindications and cautions on tetracycline

A

Hepatic and renal impairment

Avoid in children, pregnant women and breast feeding (affects growing bones and stain teeth)

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50
Q

Counselling points with tetracyclines

A

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

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51
Q

What would you need to measure if you experience unexplained muscle weakness tenderness or cramps while taking Daptomycin

A

Creatinine kinase levels

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52
Q

Which MAOI medication can be given for bacterial infection and covers MRSA and vancomycin-resistant cocci

A

Linezolid

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53
Q

What needs to be monitored and what are MHRA alerts for linezolid

A

Full weekly blood count

Severe optic neuropathy may occur if used for longer than 28 days

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54
Q

What does the initial stage of the management of tuberculosis consist of and what’s the aim (clue: RIPE)

A 
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

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55
Q

What does the continuous phase of tuberculosis treatment consist of
(Clue: RI)

A

Consists of 2 drugs:
- Isoniazid
- Rifampicin
Lasting 4 months

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56
Q

What do you monitor for antituberculosis drugs

A 
Drug levels 
Visual activity 
Blood counts 
Renal function 
Hepatic function 
Urinalysis 
Plasma levels 
Auditory function in elderly
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57
Q

What is nitrofurantoin used for and how does it work

A

Broad spectrum antibacterial active against the majority of urinary pathogens. (Mainly E. coli)
It’s bactericidal in renal tissue and throughout the urinary tract

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58
Q

When should culture and sensitivity testing be carried out for the use of nirtofurantoin

A 
In men 
In pregnant women 
In children under 3
In patients with upper UTI, complicated UTI or recurrent UTI
If resistant organism suspected
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59
Q

What is co-amoxiclav

A

Amoxicillin with a beta-lactamase inhibitor called clavulanic acid

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60
Q

What does Tazocin contain and what is it used against?

A

Piperacillin and tazobactam

It is a broad spectrum antibiotics effective against anaerobes

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61
Q

What needs to be counselled with nitrofurantoin

A

Should be taken with food and may colour the urine yellow or brown

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62
Q

Side effects of the TB antibiotics used

A

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

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63
Q

What common antibiotics are used to treat C. Diff and for how long

A

First line: metronidazole
Oral vancomycin

10-14 days

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64
Q

Which antibiotics or acute exacerbation of chronic bronchitis treated with

A

Amoxicillin or a tetracycline

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65
Q

What is community-acquired pneumonia typically treated with

A

Amoxicillin and clarithromycin

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66
Q

What is hospital-acquired pneumonia and usually treated with

A

Co-amoxiclav or cefuroxime

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67
Q

What are urinary tract infections usually treated with

A

Trimethoprim or nitrofurantoin families

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68
Q

What is gonorrhoea and chlamydia usually treated with

A

Azithromycin

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69
Q

What is sepsis usually treated with

A

Tazocin or cefuroxime

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70
Q

Which macrolides can be sold OTC for patients over 16 with confirmed chlamydia

A

Azithromycin

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71
Q

For which antibiotics are oral contraceptives not effective and must use additional contraception

A

Penicillins and tetracyclines

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72
Q

Which antibiotics do you take on an empty stomach and a full glass of water

A

Macrolides
Tetracyclines
Quinolone

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73
Q

Which antibiotics should you avoid sun due to risk of burns from increased photosensitivity

A

Quinolone
Tetracycline
Sulfa drugs (trimethoprim)

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74
Q

Major side effect of cephalosporins

A

Bleeding so monitor platelet count

C. Diff

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75
Q

Which 2 antibiotics classes shouldn’t be mixed

A

Penicillin

Cephalosporins

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76
Q

Which are the most ototoxic and nephrotoxic drugs

A

Glycopeptide- vancomycin

Aminoglycosides- tobramycin, gentamicin, neomycin

77
Q

What’s the best way to administer vancomycin

A

Slow over 60 minutes to avoid red man syndrome

While monitoring BP

78
Q

Which metronidazole symptom is a red flag

A

Skin peeling

79
Q

What group of patients might receive antifungal drugs prophylactically and why

A

Immunocompromised patients as they’re at risk of fungal infections

80
Q

Name the main antifungals drug classes

A

Triazole
Imidazole
Polyene
Echinocandin

81
Q

What role do triazole antifungals have

A

They have a role in the prevention and systemic treatment of fungal infections

82
Q

Name antifungals in the triazole class

A

Fluconazole
Itraconazole
Posaconazole
Voriconazole

83
Q

What drugs does the Imidazole antifungals class include

A 
Clotrimazole 
Econazole 
Ketoconazole 
Tioconazole
Miconazole
84
Q

What are Imodazole antifungals used for

A

Local treatment of vaginal candidiasis and for dermatophyte infections

Miconazole for oral infections

85
Q

What drugs does the polyene antifungals include

A

Amphotericin

Nystatin

86
Q

How should polyene antifungals not be given

A

Orally as they’re not absorbed (local application or intravenous infusion)

87
Q

What are cautions when prescribing Itraconazole

A

Heart failure and hepatotoxicity

88
Q

What should be monitored with itraconazole

A

Liver function if high doses or longe term

89
Q

Which triazole antifungals should not be given in pregnancy

A

Fluconazole

90
Q

What’s important about the prescribing and administration of amphotericin

A

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

91
Q

What is the Antifungal of choice for prophylactic treatment

A

Oral Triazole antifungals

92
Q

What’s the MHRA alert for ketoconazole

A

Restriction of ketoconazole use due to associated fatal hepatotoxicity

93
Q

Monitoring requirements for Ketoconazole

A

ECG
Adrenal function
Hepatic function

94
Q

When should systemic antifungal treatment be used

A

It topical treatment fails
If many areas are affected
If the site of infection is difficult to treat (eg nail)

95
Q

What may fluconazole interact with

A 
Statins 
Warfarin 
Diazepam 
Phenytoin 
Theophylline
96
Q

What’s the drug of choice for helminth infections (eg: thread worm) and what’s the dosing

A

Mebendazole

One dose then another after 2 weeks to avoid reinfection (age > 6months)

97
Q

What amphotericin B used for and what’s the adverse effects

A

Severe fungal infections

Renal injury

98
Q

What’s nystatin used for

A

Fungal infection (candidiasis) of the mouth, GI, nail, skin and the vagina

99
Q

Give a few malaria preventative measures against bites

A

Long sleeves
Trousers after dusk
Mosquito nets
DEET (diethyltoluamide) anyone over 2 months

100
Q

Length of malarial prophylaxis

A

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

101
Q

What should the patient travelling from a high malaria endemic area look out for once returning

A

Any illness within 1 year of return especially within 3 months

102
Q

What anti-malarial are not suitable for patients with epilepsy

A

Chloroquine and mefloquine due to neuropsychiatric reactions

103
Q

What anti-malarial are not suitable for patients with renal impairment

A

Proguanil should be avoided

malarone and chloroquine should not be used if eGFR < 30

(Doxycycline or mefloquine choice of drug)

104
Q

Anti malarial advice during pregnancy

A

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

105
Q

Advice for anti-malarial for patients on anticoagulation

A

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

106
Q

What do you treat malaria with if the infective species is not known

A

Quinine
Malarone (atovaquone with proguanil)
Riamet

107
Q

How is uncomplicated malaria usually treated

A

Chloroquine

108
Q

What antimalarials are available OTC for prophylaxis

A

Chloroquine and proguanil

Atovaquone and proguanil (malarone)

109
Q

Prophylaxis regimes against malaria

A

(1) Chloroquine only
(2) Chloroquine with proguanil

(3) Atovaquone with proguanil
OR doxycycline
OR mefloquine

110
Q

That’s the treatment options for malaria

A

Quinine
Malarone (atovaquone with proguanil)
Riamet

Choloquine (non- falciparum malaria)

111
Q

What group of drugs are used for HIV and what’s the treatment aims?

A

Antiretroviral

Aim is to prevent mortality and morbidity associated with chronic HIV infection whilst minimising drug toxicity

112
Q

Which antivirals are licensed for influenza and how do they work

A

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)

113
Q

Why may oseltamivir be ineffective in neonates

A

They’re unable to metabolise it to its active form

114
Q

What causes herpes simplex and where does it affect

A

HSV 1- mouth, lips and eyes

HSV 2 and HSV 1- genital infections

115
Q

What is chicken pox caused by and when is treatment usually required

A

Varicella zoster

Neonates should be treated with parenteral antiviral
Antiviral may be needed in adolescents and adults

116
Q

What’s shingles caused by and how is it treated

A

Herpes Zoster

Treated with systemic antiviral within 72hrs of rash and contributed for 7-10 days

117
Q

What’s the treatment of choice for herpes virus?

A

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)

118
Q

What’s the drug treatment of choice for chronic hepatitis B and when should it be contraindicated

A

Peginterferon alfa

Contraindicated in liver disease

119
Q

What’s the drug treatment of choice in chronic hepatitis C

A

A combination of ribavirin and peginterferon Alfa is used

Peg Alfa can be used alone but ribavirin mono therapy is ineffective

120
Q

Why should alcohol be avoided with metronidazole

A

Cause disulfiram like reaction

Severe nausea and vomiting

121
Q

Aminoglycosides must be monitored on everyone but mainly what groups of people

A 
Elderly 
Obese 
Cystic fibrosis 
High doses 
Renally impaired
122
Q

When should once daily regime of gentamicin be avoided

A

Crcl <20ml/min
Burns covering >20%
Endocarditis caused by HÁČEK or gram positive

123
Q

What do you do if the gentamicin post dose peak is too high (above 5-10)

A

Reduce dose

124
Q

What do you do if the pre dose trough level of gentamicin is too high (>2)

A

Increase interval

125
Q

What’s the general rule of thumb for common bacterial infections

A 
Staphylococci- flucloxacillin 
MRSA- vancomycin
Streptococci- benzylpenicillin or phenoxymethylpenicillin 
Anaerobic bacteria- metronidazole 
Pseudomonas aeruginosa- aminoglycosides
126
Q

What’s endocarditis treated with

A

Amoxicillin
+/-
Gentamicin

127
Q

What’s the initial treatment for meningitis

A

Benzylpenicillin

128
Q

Common eye infection and treatment

A

Conjunctivitis

Chlorophenicol

129
Q

What’s dental infections usually treated with?

A

Metronidazole 200mg TDS 3 times a day

130
Q

Which antifungal causes phototoxicity and an alert card should be carried

A

Voriconazole

131
Q

What do you give for thrush

A

Oral thrush:
Nystatin or miconazole

Vaginal thrush:
Fluconazole or clotrimazole (imidiazole)

132
Q

What do you give for fungal nail infection and when do you refer

A

Amorolfine

When more than 2 nails is infected

133
Q

What’s the standby treatment for malaria?

A

Quinine

Take 1 if you cannot access medical care in 24hours of fever onset

134
Q

What are the long term malaria prophylaxis

A

> 5 years chloroquine and proguanil

2 years doxycycline

1 year mefloquine, malarone

135
Q

If Gentamicin and ciprofloxacin are the only suitable antibiotics for a specific treatment, which one would you go for and why?

A

Ciprofloxacin as it’s oral
Gentamicin is IV so patient would have to remain an inpatient

Oral> IV

136
Q

What’s the interaction between erythromycin and theophylline

A

Erithromycin increases theophylline conc

137
Q

What’s the scoring system for CAP and HAP

A

CAP- crb65

HAP- curb65

138
Q

Signs and symptoms of an infection

A 
Fever, malaise, aches and pains 
Pus, swelling or inflammation 
Drowsiness in children 
Confusion in elderly 
Worsening renal function
139
Q

Clinical markers of an infection

A

Low blood pressure
Raised blood glucose
High ESR, CRP, temperature, RR and pulse

140
Q

What’s a superinfection

A

Clindamycin and broad spec antibiotics kill normal flora and allow selective organism to thrive
Causing antibiotic associated colitis (c. Diff) and thrush (candida)

141
Q

Side effect of trimethoprim

A

Anti folate (teratogenic)
Blood dysrasias
Hyperkalaemia

142
Q

What’s chloramphenicol reserved for

A

Reserved for life threatening infections

143
Q

Why should broad spectrum-antibiotics not be given blindly for sore throats

A

Causes maculopapular rash in Glandular fever

144
Q

Give examples of narrow spectrum, broad spectrum, penicillinase resistant and anti pseudomonal penicillins

A

Narrow spec:
Benzylpenicillin (pen G)
Phenoxymethylpenicillin (pen V)

Broad spec:
Ampicillin
Amoxicillin

Penicillinase resistant:
Flucloxicillin

Antipseudomonas (extended spectrum):
Piperacillin (tazobactam)
Ticaricillin (with clauvic acid)

145
Q

When should you monitor multiple dose regimes of aminoglycoside and vancomycin

A

After 3 or 4 doses and after a dose change

146
Q

Antibiotics most likely to cause c. Diff

A

Clindamycin
Ampicillin/ amoxicillin
2nd 3rd gen cephalosporin
Quinolone

147
Q

Treatment for c. Diff

A

Metronidazole 10-14 days

Then try oral vancomycin

Loperamide is contraindicated

148
Q

Treatment for CAP

A

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

149
Q

Treatment for HAP

A

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

150
Q

Causative agent for meningitis and treatment

A

Neisseria meningitidis

Benzylpenicillin

151
Q

Treatment for osteomyelitis

A

Flucloxacillin

Clindamycin of penicillin allergic

Add vancomycin if MRSA suspected

152
Q

How long should aninoglycoside treatment generally not exceed

A

7 days

153
Q

Drugs to avoid in hepatic impairment

A

Chloramphenicol
Co wmoxiclav
Tetracycline
Co trimoxazole

154
Q

Treatment for impetigo and what is it

A

Bacterial skin infection mainly in children

First line fusidic acid

155
Q

What macrolide can you give in pregnancy

A

Erythromycin

156
Q

What varies with increasing generation of cephalosporins

A

It cover more gram negative as it goes from from 1 to 5

157
Q

Which antibiotic is least likely to cause c diff or the best treatment for c diff

A

Vancomycin

158
Q

When should another dose be taken to treat lice

A

7 days

159
Q

Why is pyridoxine given with isoniazid for TB treatment

A

Peripheral neuropathy

160
Q

Which antibiotic is likely to cause sedation

A

Quinolones- ciprofloxacin

161
Q

What type of infection is ringworms

A

Fungal

162
Q

Which antibiotics are used for common GU infections like chlamydia, BV and pelvic inflammatory disease

A

Azithromycin- used in chlamydia And gonorrhoea

Doxycycline- alternative in chlamydia and pelvic inflammatory disease

Metronidazole- used in BV and pelvic inflammatory disease

163
Q

What class is amikacin and when is it usually indicated

A

Aminoglycosides

Indicated for gentamicin resistant infections as amikacin is more stable to enzyme inactivation

164
Q

Which aminoglycoside is too toxic to be administered parenteral
Therefore taken by mouth

A

Neomycin

Used for bowel sterilisation before surgery

165
Q

What antibiotics require reporting on blood disorders/ rash

A

Co-trimoxazole (contains trimethoprim and sulfamethoxazole)

Trimethoprim

Penicillamine

166
Q

Which antibiotic has been associated with myopathy/ muscle effects

A

Daptomycin

Monitor creatinine kinase every 2 days of muscle effects reported

167
Q

Which antibiotics can cause choke static jaundice

A

Co amoxiclav
Nitrofurantoin
Fluoxacillin (even up to 2 months after)

168
Q

Which antibiotics are associated with visual problems

A

Linezolid- optic nephropathy

Quinolones- retinol detachment

Ethambutol (used for tb)- ocular toxicity

Rifampicin- colours tears/ contacts red

Rifambutin- uveitis (eye inflammation)

169
Q

What conditions can tetracyclines exacerbate

A 
Systemic lupus 
Myasthenia gravis (increased muscle weakness)
170
Q

Which antibiotics can cause a false positive on urinary glucose tests

A

Cephalosporin

171
Q

Which antibiotics is a folate synthesis inhibitor and therefore teratogenic

A

Trimethoprim

Co trimoxazole

172
Q

Which antibiotics/ anti fungal S can cause Steven Johnson’s syndrome

A

Cotrimoxazole
Clindamycin
Fluconazole

173
Q

What skin condition may terbinafine (antifungal) exacerbate

A

Psoriasis

174
Q

What antibiotic should be used for resistant strains of pneumonia

A

Co amoxiclav

175
Q

What can chloremphenicol cause in babies

A

Grey baby syndrome

176
Q

What’s an important side effect of tetracycline that would require you to stop

A

Benign intracranial hypertension

Stop if headache or visual disturbances occur

177
Q

Tetracyclines should be avoided in renal impairment except which ones

A

Doxycyclines

Minocycline

178
Q

Which tetracyclines need to counselled to avoid exposure to sunlight and wear spf

A

Doxycycline

Demeclocycline

179
Q

Which tetracycline have decreased absorption when taken with antacids so need to be counselled to avoid taking antacid 2 hours before and after

A

Demeclocycline
Oxytetracycline
Tetracycline

180
Q

Which tetracyclines can cause oesophageal irritation so need to be counselled to swallow tablet whole

A

Doxycycline
Minocycline
Tetracycline

181
Q

What infections should quinolones be avoided in

A

MRSA

182
Q

What’s clarithromycin commonly used to treat

A

Chest infections

183
Q

What can azithromycin 1g as a single dose otc be used to treat

A

Chlamydia

184
Q

Which macrolides should be taken 2 hours after ingestion remedies

A

Azithromycin

Erythromycin

185
Q

Side effects of macrolides

A

GI effects
QT prolongation
Heptotoxicty
Otoxicity at high doses

186
Q

What antibiotic is first line for treating animal bites

A

Co-amoxiclav

187
Q

Can pregnant women take mebendazole

A

No

188
Q

Treatment for scarlet fever

A

Phenoxymethylpenicillin (pen V)

Qds for 10 days

Pre-reg (27 decks)

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