Chapter 5: Infection Part 1

Question 1

What are the safest classes of antibiotics to use in pregnancy?

Answer 1

Penicillins, erythromycin and Cephalosporins (cefalexin (1st gen cefalexin, 2nd gen ceftriaxone, 1st gen cefadroxil)- all but Cefopime a 4th generation cephalosporin

Question 2

What antibiotic treatment is indicated for septicaemia (community)?

Answer 2

Community-Acquired Septicaemia:

Broad-spectrum antipseudomonal penicillin: (e.g. piperacillin with tazobactam, ticarcillin with clavulanic acid) or a broad-spectrum cephalosporin (e.g. cefuroxime).
If MRSA is suspected: Add vancomycin (or teicoplanin).
If anaerobic infection is suspected: Add metronidazole to broad-spectrum cephalosporin.
If other resistant organisms are suspected: Use a more broad-spectrum beta-lactam antibacterial (e.g. meropenem).

Question 3

What antibiotic treatment is indicated for septicaemia (hospital acquired)?

Answer 3

Hospital-Acquired Septicaemia:

Broad-spectrum antipseudomonal beta-lactam: antibacterial (e.g. piperacillin with tazobactam, ticarcillin with clavulanic acid, ceftazidime, imipenem with cilastatin, or meropenem).

If MRSA is suspected: Add vancomycin (or teicoplanin).

If anaerobic infection is suspected: Add metronidazole to broad-spectrum cephalosporin.

Question 4

How to manage Meningococcal Septicaemia (community or hospital acquired?)

also what to do after initial treatment is completed and why?

Answer 4

Meningococcal Septicaemia:
Suspected Meningococcal Disease: Benzylpenicillin (before Urgent transfer to the hospital)
Penicillin Allergy: Cefotaxime
Immediate Hypersensitivity to penicilins and cephalosporins: Chloramphenicol

After treatment
To Eliminate Nasopharyngeal Carriage: Ciprofloxacin, Rifampicin, or Ceftriaxone
Ceftriaxone

Question 5

What antibiotic Is very good against anaerobic bacteria so usually infections of the colon?

Answer 5

Metronidazole - V high anaerobic activity, narrow spectrum
Very high anaerobic activity: Effective against bacteria in low-oxygen environments.
Narrow spectrum: Targets anaerobes specifically, unlike broad-spectrum antibiotics.
Used for:

Gut infections (e.g., H. pylori, Crohn’s disease)
Bacterial vaginosis
Leg ulcers or other anaerobic infections like abscesses.

Question 6

How is bacterial meningitis empirically treated?
Pre-Hospital?
In-Hospital?
when to avoid dexamethasone?
Unknown Aetiology?
Treatment Duration?

Answer 6

In a nut shell:
1) BENZYPENICILLIN- can be given before transfer to hospital (emergency situation in community)
2) If penicillin allergy- CEFOTAXIME (a cephalosporin)

If hypersensitivity to penicillin & cephalosporins: CHLORAMPHENICOL

4) Can consider addition of Dexamethasone
5) Consider Vancomycin if multiple use of antibiotics in previous 3 months

expand:

Meningitis: Initial Empirical Therapy

Pre-Hospital
Urgent transfer: Immediate transfer to hospital is critical.
Suspected Meningococcal Disease (non-blanching rash or septicaemia): Give Benzylpenicillin Sodium before transfer if it doesn’t delay transport.

Suspected Bacterial Meningitis without non-blanching rash: Give Benzylpenicillin Sodium if transfer is delayed.

Alternative treatments for penicillin allergy:
Cefotaxime if penicillin allergy.
Chloramphenicol if hypersensitivity to both penicillins and cephalosporins.

In-Hospital
Adjunctive Dexamethasone:
For suspected pneumococcal meningitis, start before or with the first antibiotic dose. but no later than 12 hours after starting antibacterial
Avoid if: septic shock, meningococcal septicaemia, immunocompromised, or post-surgery meningitis.

Unknown Aetiology:
Adults & children (3 months to 59 years): Cefotaxime or Ceftriaxone (consider vancomycin if recent multiple antibiotic use or foreign travel).
Adults ≥60 years: Cefotaxime or Ceftriaxone + Amoxicillin (consider vancomycin under the same conditions).
Treatment Duration: Minimum 10 days for all.

Question 7

What is the treatment for meningococcal meningitis?

Answer 7

Benzylpenicillin or cefotaxime
2nd line: Chloramphenicol For 7 days

Question 8

What is the treatment for pneumococcal meningitis?

duration of treatment?

Answer 8

First-line treatment: Cefotaxime or Ceftriaxone.

Adjunctive dexamethasone: Consider starting before or with the first dose of antibacterial, but no later than 12 hours after starting. Note: may reduce vancomycin penetration into cerebrospinal fluid.

If organism is known to be penicillin-sensitive: Switch to benzylpenicillin sodium.

If highly penicillin- and cephalosporin-resistant: Add vancomycin and, if necessary, rifampicin.

Duration of antibacterial treatment: 14 days.

if penicilin allergic give vancomycin with moxifloxacin or meropenem

Question 9

What is the treatment for meningitis caused by haemophilus influenza?
Duratoion of treatment?

Answer 9

Haemophilus Influenzae Meningitis Treatment
First-line treatment: Cefotaxime or Ceftriaxone.

Adjunctive dexamethasone: Consider starting before or with the first dose of antibacterial, but no later than 12 hours after starting treatment.

Duration of antibacterial treatment: 10 days.

H. influenzae type b (before discharge): Give rifampicin for 4 days to:
Children under 10 years.
Household contacts with vulnerable individuals.

If penicillin or cephalosporin allergy or resistance: Use chloramphenicol.

Consider adding dexamethasone, preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial.

Question 10

What is the treatment for meningitis caused by Listeria?

Treatment duration?

Answer 10

first line: Amoxicillin (or ampicillin) + gentamicin
Suggested duration of treatment 21 days.
Consider stopping gentamicin after 7 days.

second line: If history of immediate hypersensitivity reaction to penicillin, co-trimoxazole only alone
Suggested duration of treatment 21 days.

Question 11

What antibiotics are used in endocarditis (infection of the heart) initial blind therapy?

Answer 11

Native valve endocarditis: Amoxicillin (or ampicillin).

Consider adding: low-dose gentamicin.
If penicillin-allergic, MRSA suspected, or severe sepsis: Use vancomycin + low-dose gentamicin.

If severe sepsis with risk factors for Gram-negative infection: Use vancomycin + meropenem.

Prosthetic valve endocarditis: Use vancomycin + rifampicin + low-dose gentamicin.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Question 12

approach for Staphylococcal Endocarditis:?
Duration of treatment for each scenario?

Answer 12

Staphylococcal Endocarditis (Native Valve)
First-line treatment: Flucloxacillin.
Duration: 4 weeks (extend to 6 weeks if secondary lung abscess or osteomyelitis is present).
If penicillin-allergic or MRSA suspected: Use vancomycin + rifampicin.
Duration: Same as above—4 weeks, extend to 6 weeks if needed.

Staphylococcal Endocarditis (Prosthetic Valve)
First-line treatment: Flucloxacillin + rifampicin + low-dose gentamicin.
Duration: At least 6 weeks. Review gentamicin at 2 weeks (specialist advice required if continuation is necessary).
If penicillin-allergic or MRSA suspected: Use vancomycin + rifampicin + low-dose gentamicin.
Duration: Same as above—6 weeks, review gentamicin at 2 weeks.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Question 13

approach for Enterococcal Endocarditis:

Answer 13

First-line: Amoxicillin (or ampicillin) + low-dose gentamicin (or benzylpenicillin sodium + low-dose gentamicin)
Duration: 4-6 weeks (6 weeks for prosthetic valves)
Review gentamicin: at 2 weeks, specialist advice if needed beyond 2 weeks
Penicillin-allergic or resistant: Vancomycin (or teicoplanin) + low-dose gentamicin
Gentamicin-resistant: Amoxicillin (or ampicillin) + streptomycin (if susceptible)
Duration: At least 6 weeks.

Question 14

approach for Streptococcal Endocarditis:?

Answer 14

Streptococcal Endocarditis (Fully Sensitive)
First-line treatment: Benzylpenicillin sodium.
Duration: 4–6 weeks (Use 6 weeks for prosthetic valve endocarditis).
If penicillin-allergic or resistant: Use vancomycin (or teicoplanin) + low-dose gentamicin.
Duration: 4–6 weeks (Stop gentamicin after 2 weeks).

Endocarditis: Less-Sensitive Streptococci
First-line treatment: Benzylpenicillin sodium + low-dose gentamicin.
Duration: 4–6 weeks (Use 6 weeks for prosthetic valve endocarditis).
Review gentamicin: Stop after 2 weeks if microorganisms are moderately sensitive to penicillin. Seek specialist advice if continuation is necessary beyond 2 weeks.
If penicillin-allergic or highly penicillin-resistant: Use vancomycin (or teicoplanin) + low-dose gentamicin.
Duration: Same as above—4–6 weeks, review gentamicin at 2 weeks.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Question 15

approach for Enterococcal Endocarditis?

Duration of treatment?

Answer 15

First-line treatment:

Amoxicillin (or ampicillin) + low-dose gentamicin or
Benzylpenicillin sodium + low-dose gentamicin.
Duration: 4–6 weeks (Use 6 weeks for prosthetic valve endocarditis).
Review gentamicin at 2 weeks—seek specialist advice if continuation is necessary beyond 2 weeks.
If penicillin-allergic or penicillin-resistant: Use vancomycin (or teicoplanin) + low-dose gentamicin.

Duration: Same as above—4–6 weeks (6 weeks for prosthetic valve endocarditis).
If gentamicin-resistant: Use amoxicillin (or ampicillin) and add streptomycin (if susceptible) for 2 weeks.

Duration: At least 6 weeks.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Question 16

approach for Endocarditis caused by Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella species (‘HACEK’ micro-organisms)?

Answer 16

(Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)

First-line treatment: Amoxicillin (or ampicillin) + low-dose gentamicin.

Duration: 4 weeks (Use 6 weeks for prosthetic valve endocarditis).
Stop gentamicin: After 2 weeks.
If amoxicillin-resistant: Use Ceftriaxone (or cefotaxime) + low-dose gentamicin.

Duration: Same as above—4 weeks (6 weeks for prosthetic valve endocarditis).

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Note: Gentamicin dosing targets: trough <1, peak 3-5.

Question 17

What antibiotic is indicated for gastro-enteritis?

Answer 17

This is usually self-limiting and an antibiotic not indicated

Question 18

What is the antibiotic indicated for C. diff?

Answer 18

Here’s a condensed version for your flashcard:

C. difficile Infection Treatment:

First Episode:
- Oral 1st line: Vancomycin
- Oral 2nd line: Fidaxomicin
- If ineffective: Seek specialist advice

Further Episodes:
- Relapse (≤12 weeks): Fidaxomicin
- Recurrence (>12 weeks): Vancomycin or Fidaxomicin

Life-Threatening Infection:
- Treatment: Oral Vancomycin + IV Metronidazole (specialist care)

Question 19

Which antibiotics are commonly used for GU infections?

Answer 19

GU Infections: Commonly Used Antibiotics
1. Urinary Tract Infections (UTIs)
First-line:
Nitrofurantoin (Avoid in renal impairment)
Trimethoprim (Not used in pregnancy unless resistant)
Fosfomycin (Single dose for uncomplicated UTIs)
Alternatives:
Cefalexin
Amoxicillin (if sensitive)
Ciprofloxacin (reserved for complicated cases)
2. Pyelonephritis
First-line:
Ciprofloxacin
Co-amoxiclav (Amoxicillin/clavulanate)
Alternatives:
Cefalexin
Trimethoprim (if susceptible)
3. Sexually Transmitted Infections (STIs)
Chlamydia:
Azithromycin (Single-dose) or Doxycycline (7-day course)
Gonorrhea:
Ceftriaxone (IM) with Azithromycin (Due to resistance)
Pelvic Inflammatory Disease (PID):
Ceftriaxone (IM) + Doxycycline + Metronidazole
4. Prostatitis
First-line:
Ciprofloxacin
Trimethoprim
Doxycycline

Question 20

What class of AB’s is Amikacin? When is amikacin usually indicated?

Answer 20

Class: Aminoglycoside antibiotic.

Indications:
Serious Gram-negative infections (e.g., Pseudomonas aeruginosa).
Used for sepsis, pneumonia, intra-abdominal infections, and UTIs.
Often reserved for infections resistant to other aminoglycosides (gentamicin) or multidrug-resistant organisms.
Common in hospital-acquired infections.
Usage: Typically combined with other antibiotics for broad coverage.

An aminoglycoside usually indicated for gentamicin resistant infections as amikacin is more stable than gentamicin to enzyme inactivation.

Question 21

What is the target One hour peak concentration of gentamicin? (multiple daily dosing)

Answer 21

5 - 10 mg/L (3-5mg/L For multiple daily dose regimen in endocarditis)

Question 22

What is the target pre-dose trough concentration of gentamicin? (multiple daily dosing)

Answer 22

under 2 mg/L (<1mg/L For multiple daily dose regimen in endocarditis)

Question 23

What is the target One hour peak conc of gentamicin in treatment of ENDOCARDITIS? and target trough level?

Answer 23

Peak: 3 - 5 mg/L Trough: <1mg/L

Question 24

Which aminoglycoside is too toxic to be administered parenterally, therefore is taken by mouth?

Answer 24

NEOMYCIN - used for bowel sterilisation before surgery as its so strong it will wipe the bowel clean of bacteria

Question 25

Etrapenem, Imipenem and Meropenem are all examples of what kind of antibiotics?

Answer 25

The carbapenems. These are beta-lactam antibacterials NB: imipenem is administered with cilastatin which is a specific enzyme inhibitor that stops it being renally metabolised

Question 26

Which two cephalosporins are suitable for infections of the CNS?

Answer 26

Cefotaxime + Ceftriaxone (TAX AND TRAX) (Hint: these are the two we see used in meningitis, a CNS infection!)

Question 27

Talk me through treatment of UTI's in pregnancy?

Answer 27

Here's the information condensed into a flashcard format: **UTI Treatment in Pregnancy:** - **Nitrofurantoin:** Safe during pregnancy but **avoid at term** (risk of neonatal hemolysis). - **Trimethoprim:** **Avoid in the first trimester** (teratogenic risk as a folate antagonist). - **Cefalexin:** Safe for use throughout pregnancy. - **Cranberry products:** **Not recommended** (no evidence to support use). | term pregnancy is any pregnancy from 37 weeks and beyond until delivery ## Footnote This summary aligns with current NICE guidelines for treating UTIs during pregnancy【15†source】【16†source】【17†source】. : term pregnancy is any pregnancy from 37 weeks and beyond until delivery

Question 28

What classes, other than penicillins, do we have to be wary of with penicillin allergic patients?

Answer 28

For penicillin-allergic patients, the main classes of antibiotics to be cautious with are **cephalosporins** and **carbapenems** due to their beta-lactam structure, which can potentially trigger cross-reactivity. The cross-sensitivity between penicillins and first-generation cephalosporins is reported to be higher (about 10%), while it is lower (around 2-3%) for third-generation cephalosporins like ceftriaxone【24†source】【25†source】. Here's a condensed version for your flashcard: **Penicillin Allergy:** - **Cephalosporins (e.g., cefalexin, ceftriaxone):** 0.5-10% cross-sensitivity - **Carbapenems:** Potential cross-reactivity, though lower than cephalosporins **Other Considerations:** - **Monobactams (e.g., aztreonam):** Generally safe in penicillin-allergic patients.

Question 29

What is Co-trimoxazole? What is it used for?

Answer 29

**Co-trimoxazole Use:** - **Contains:** Sulfamethoxazole and Trimethoprim - **Limited Use Due to Resistance** - **Indicated for:** - **Pneumocystis jirovecii (P. carinii) pneumonia** - **Toxoplasmosis** - **Nocardiasis** - **Restricted Use in children:** - Only in bronchitis exacerbations, UTIs, and otitis media **in children** when **culture and sensitivities** are evident. - **Important:** Only use when there is **strong evidence** to justify the combination therapy over a single agent due to increasing resistance ## Footnote 【32†source】【33†source】.

Question 30

What antibiotics require reporting on blood disorders/ rash?

Answer 30

**Co-trimoxazole (contains trimethoprim and sulfamethoxazole)**- discontinue immediately if: signs of a blood disorder such as **anaemia, thrombocytopenia or rash: stevens johnsons syndrome, photosensitivity** **Trimethoprim:** Blood disorders: fever, sore throat, ulcers, bruising, bleeds **Penicillamine:** not really an anti-bacterial: used as a disease-modifying anti-rheumatic drug Same as above: fever, sore throat, ulcers, bruising **Amoxicillin**: Report if rash (especially in glandular fever) or blood disorders (e.g., eosinophilia, anemia) develop. **Vancomycin**: Monitor for neutropenia and other blood dyscrasias. **Linezolid**: Requires reporting for thrombocytopenia or other blood disorders during prolonged use.

Question 31

What do you see fusidic acid commonly used for?

Answer 31

Staphylococcal infection of the SKIN e.g. impetigo & also EYES comes as tablet, cream, eye drops Fusidic Acid **What is it?**: Fusidic acid is a narrow-spectrum antibacterial that is primarily used topically. **Indications**: **Non-bullous impetigo** (first-choice topical antibiotic). **Secondary bacterial infections of eczema** or **other localized skin infections caused by Staphylococcus aureus.** **Conjunctivitis** (topical fusidic acid in the form of eye drops). **Usage Instructions**: Applied 2–3 times daily for 5-7 days. Avoid prolonged use due to risk of antimicrobial resistance. **Important Considerations**: Should not be used extensively or recurrently to prevent the development of resistance. Only use for localized infections and when systemic infection is not suspected. ## Footnote not check from here but i presume correct

Question 32

What happens if a patient on clindamycin develops diarrhoea?

Answer 32

Clindamycin and Diarrhoea Management **Diarrhoea on clindamycin?**: May indicate C. difficile infection. **First step**: Stop clindamycin immediately. **Test**: Send stool sample to test for C. difficile toxin. **Treatment**: If confirmed, treat with oral vancomycin or fidaxomicin. Use metronidazole if severe or other options unavailable. ## Footnote Antibiotic associated colitis with clindamycin can be fatal- discontinue immediately + start vancomycin if c.diff is confimed

Question 33

What antibiotic has been associated with Myopathy/ Muscle effects? **What to monitor?**

Answer 33

Antibiotics and Myopathy/Muscle Effects **Daptomycin**: Can cause myopathy and rhabdomyolysis. Monitor CK levels. **Action**: Stop the antibiotic and check CK if muscle pain or weakness develops. **additional info for muscle effects other than myophathy:** **Fluoroquinolones**: Associated with tendonitis **(not myopathy)** and tendon rupture (especially Achilles). **just a muscle effect not myopathy** | CK levels means: creatine kinase (CK). the main one is **Daptomycin**

Question 34

Which antibiotics can cause cholestatic jaundice?

Answer 34

**Flucloxacillin ( even upto 2 months after)**: Can also cause cholestatic hepatitis and jaundice, often presenting weeks after stopping the medication. **this is the main one** Others: **Co-amoxiclav:** Commonly associated with cholestatic jaundice and liver dysfunction, particularly in older adults or after prolonged use. **Nitrofurantoin**: May cause cholestatic jaundice with prolonged use, especially in elderly patients. Liver function should be monitored. **Erythromycin and other macrolides:** These are associated with cholestasis and liver toxicity. ## Footnote Be careful in liver patients and regularly monitor liver function

Question 35

What is the important safety information associated with Flucloxacillin?

Answer 35

**Hepatic disorders:** Cholestatic Jaundice and HEPATITIS have been reported in patients even up to 2 months after the drug has been stopped. **to expand:** **Hypersensitivity**: Flucloxacillin can cause severe allergic reactions, including anaphylaxis, particularly in patients with a history of penicillin allergy. **Cholestatic Jaundice and Hepatitis**: Cholestatic jaundice or hepatitis may occur during treatment or up to 2 months after stopping flucloxacillin. Risk is higher in older adults and after prolonged use (greater than 2 weeks). **Renal Impairment**: Dose adjustments are required in patients with severe renal impairment (eGFR less than 10 mL/min) to avoid toxicity. **Other cautions**: Use with caution in people with hepatic dysfunction or serious underlying disease. Should not be prescribed to people with a history of flucloxacillin-associated jaundice or hepatic dysfunction. ## Footnote Use flucloxacillin with caution in patients with **liver impairment!!**

Question 36

A few antibiotics have been associated with visual problems. Can you think of any?

Answer 36

**LINEZOLID**- optic nephropathy **QUINOLONES** (Ciprfloxacin, Levofloxacin)- **Fluoroquinolones** Can cause blurred vision, photophobia, and in rare cases, retinal detachment. **Ethambutol** (used for TB)- ocular toxicity **Rifampicin**- colours tears/ contacts red **Rifabutin**- Uveitis (eye inflammation) **Doxycycline**: May lead to visual disturbances and photosensitivity.

Question 37

What two things need to be looked out for with Linezolid treatment?

Answer 37

**Optic neuropathy (visual problems)**- report any visual disturbance IMMEDIATELY **Blood disorders:**Aneamia, thrombocytopenia FBC monitored WEEKLY, monitor especially for treatment of 10-14 days or more

Question 38

What are the three very important safety warnings with QUINOLONES (ciprofloxacin, levofloxacin)?

Answer 38

**Fluoroquinolones: Important Safety Information** **Convulsions**: May induce seizures, especially when taken with NSAIDs. Caution is advised for patients with epilepsy or those taking theophylline, as both increase the risk of convulsions. **Tendon Damage**: Can cause tendonitis or tendon rupture, especially in the Achilles tendon. The risk is increased when combined with corticosteroids. **QT Prolongation**: Fluoroquinolones can prolong the QT interval, increasing the risk of heart arrhythmias. Caution is needed in patients with existing risk factors like electrolyte imbalances. **MHRA Warning**: Fluoroquinolones have been associated with rare but potentially irreversible side effects, affecting the musculoskeletal and nervous systems, and should not be used for non-severe infections unless other treatments are inappropriate.

Question 39

When should patients discontinue treatment with Quinolones?

Answer 39

When to Discontinue Fluoroquinolones **Stop immediately if**: **Tendon pain or swelling** (signs of tendonitis or rupture). **Muscle pain, weakness**, or **joint pain and swelling**. **Peripheral neuropathy** (numbness, tingling, burning sensations) . **Central nervous system effects** (e.g., depression, psychosis, or seizures). **Seek immediate medical advice** if these symptoms develop to avoid long-term or irreversible side effects.

Question 40

WHAT ANTIOBIOTICS CAN CAUSE QT PROLONGATION??!

Answer 40

**Macrolides**: **Erythromycin** and **Clarithromycin** are commonly associated with QT interval prolongation. They can increase the risk of ventricular arrhythmias like torsades de pointes, particularly in patients with underlying heart conditions or electrolyte imbalances (e.g., low potassium). **Fluoroquinolones**: **Ciprofloxacin**,**Levofloxacin** and **especially Moxifloxacin** can prolong the QT interval and lead to arrhythmias, especially in patients also taking other QT-prolonging drugs. **Antifungal Azoles**: While not antibiotics, **Fluconazole** is often grouped with antimicrobial agents that prolong QT intervals. **Other Considerations**: **Caution** is advised when combining any of these antibiotics with other medications known to prolong QT or in patients with pre-existing heart conditions.

Question 41

Linezolid is an antibacterial used in pneumonia. It also had Monoamine oxidase inhibition activity (part of MAOI family). What should patients be advised to avoid?

Answer 41

Avoid consuming large amounts of **Tyramine** rich foods (mature cheese, , wine, beer) **Avoid foods high in tyramine**: Aged cheese, smoked meats, soybean, red wine, tap beer. **Avoid serotonergic drugs**: SSRIs, tricyclic antidepressants (to prevent serotonin syndrome). ## Footnote **Remember: Linezolid will still have interactions/ tyramine effects 2 weeks after discontinuation!!**

Question 42

What can happen if VANCOMYCIN is infused too rapidly?

Answer 42

Vancomycin: Rapid Infusion Risks **Red Man Syndrome**: Rapid infusion can cause flushing, rash, itching, and redness, particularly of the upper body. This reaction is due to histamine release. **Severe Hypotension and Cardiac Events**: Rapid infusion may lead to severe hypotension, shock, or even cardiac arrest. Wheezing Pruritis Pain/ muscle spasm in back **What to do?**: Slow the infusion rate (at least 60 minutes for doses under 1g). Premedicate with an antihistamine to reduce the risk of reactions. ## Footnote Flushing of upper body= **RED MAN SYNDROME**

Question 43

After how many doses should Vancomycin plasma levels be measured?

Answer 43

Before 3 or 4 doses if renal function is normal (earlier if its impaired!) expanded: Vancomycin: Plasma Level Monitoring **Measure trough plasma levels**: Before the 3rd or 4th dose to ensure therapeutic levels are reached. **Target trough levels**: Between 10–20 mg/L. **Ongoing monitoring**: Recheck levels regularly (e.g., twice weekly) if the treatment continues, especially in patients with renal impairment. ## Footnote Before 3 or 4 doses if renal function is normal (earlier if its impaired!)

Question 44

What side effects do Vancomycin and Gentamicin both have in common? What drugs should be avoided with these?

Answer 44

Vancomycin and Gentamicin: Common Side Effects **Ototoxicity**: Both drugs can cause hearing loss, tinnitus (ringing in the ears), and vertigo due to damage to the auditory nerves. **Nephrotoxicity**: Both can lead to kidney damage, especially when used together or with other nephrotoxic drugs. Drugs to Avoid Obviously avoid use of **vancomycin and gentamicin** together! **Other nephrotoxic agents**: Such as NSAIDs, diuretics, or other aminoglycosides, CICLOSPORINPlatinum chemotherapy. **Other ototoxic agents**: Such as loop diuretics (e.g., furosemide).

Question 45

Treatment with Vancomycin required Full Blood count monitoring. Why is this?

Answer 45

Risk or neutropenia- monitor neutrophils and platelets

Question 46

Which antibiotics could cause CHOLESTATIC JAUNDICE (a liver disorder where bile builds up in the blood stream as it gets blocker from being excreted)?

Answer 46

**FLUCLOXACILLIN** - may even occur up to **TWO MONTHS** after flucloxacillin stopped, more likely after TWO WEEKS of treatment and older age **Co-fluampicil** (contains amoxicillin and flucloxacillin) **Co-amoxiclav**:Often associated with cholestatic jaundice and liver dysfunction, particularly after prolonged use or in elderly patients. **Nitrofurantoin** - Use these with caution in those with liver dysfunction!! **Erythromycin** (Macrolide antibiotics): Known to cause cholestatic liver injury in some cases.

Question 47

Which antibiotics are commonly used to treat acne??

Answer 47

Antibiotics for Acne Treatment **Oral antibiotics**: **Lymecycline** and **Doxycycline**: First-line oral antibiotics for moderate to severe acne. They are typically used alongside topical treatments. **Erythromycin** (Macrolide): Used if tetracyclines are not suitable (e.g., during pregnancy). **Topical antibiotics**: **Clindamycin** and **Erythromycin**: Usually combined with benzoyl peroxide to reduce resistance.Tetracyclines most common: tetracycline, doxycycline, oxytetracycline, lymecycline (trimethoprim for resistant acne) Erythromycin (a macrolide) sometimes used ## Footnote Erythromycin (a macrolide) sometimes used

Question 48

What conditions can Tetracyclines exacerbate?

Answer 48

**Renal Impairment**: Tetracyclines can worsen kidney function due to their renal excretion. Caution is advised in patients with pre-existing renal failure. **Hepatic Impairment**: Tetracyclines can increase the risk of liver toxicity, especially when combined with other hepatotoxic drugs. **Myasthenia Gravis**: Tetracyclines can exacerbate muscle weakness in patients with this condition. **Systemic Lupus Erythematosus (SLE)**: Tetracyclines may worsen symptoms of lupus.

Question 49

Which antibiotics can cause photosensitivity?

Answer 49

**Tetracyclines**: Especially doxycycline and Demeclocycline. tetracycline, which are commonly used for acne and can cause severe sunburn-like reactions. **Fluoroquinolones**: Such as ciprofloxacin and levofloxacin, which increase the risk of phototoxic reactions with sun exposure. **Sulfonamides**: Includes sulfamethoxazole (part of co-trimoxazole), which can cause photosensitivity, especially in combination therapies. **Other drugs**: Griseofulvin (antifungal) and dapsone can also trigger photosensitive reactions. ## Footnote doxycycline is the main one

Question 50

Which antibiotics are not recommended in children and adolescences under 18 years old? And why?

Answer 50

**Fluoroquinolones**: Such as ciprofloxacin and levofloxacin, are generally not recommended in patients under 18 years old due to the risk of tendonitis and tendon rupture. **Tetracyclines**: Such as doxycycline and tetracycline, are avoided in children under **12 years old** because they can cause permanent tooth discoloration and affect bone growth. **Chloramphenicol**: Not used in **neonates and infants** due to the risk of Gray Baby Syndrome, a serious condition due to underdeveloped liver function.Quinolones: Ciprofloxacin, levofloxacin, moxifloxacin This is because of the risk of TENDON DAMAGE/ JOINT DISEASE (Aropathy) Tetracyclines - 12+: dental

Question 51

What is an important monitoring parameter with Linezolid?

Answer 51

**Monitor for Thrombocytopenia**: Regular blood counts (especially platelets) should be monitored weekly during linezolid treatment to detect thrombocytopenia (low platelet count). **Optic and Peripheral Neuropathy**: Monitor for any signs of vision changes or nerve damage during prolonged treatment (over 28 days). ## Footnote WEEKLY Full Blood Counts due to risk of blood disorder/ anaemia

Question 52

# C Which antibiotics may cause a false positive result on urinary GLUCOSE tests- i.e. be careful when testing for diabetes?

Answer 52

**Cephalosporins**: Can interfere with glucose tests, leading to false positive results when using methods like the Clinitest. **Penicillins**: Such as amoxicillin may also cause false positives in certain glucose test methods. **Other antibiotics**: Levofloxacin and Ofloxacin (fluoroquinolones) can also interfere with some glucose urine tests.

Question 53

Which antibiotic is a FOLATE SYNTHESIS INHIBITORS and is therefore teratogenic?

Answer 53

**Trimethoprim**: Inhibits folate synthesis, which is essential for fetal development. It is teratogenic and should be avoided in pregnancy, particularly during the first trimester because it increases the risk of neural tube defects. Co-trimoxazole (contains sulfamethoxazole and trimethoprim) Therefore AVOID in pregnancy- especially first trimester when folate is needed

Question 54

What frequency of administration is Vancomycin given?

Answer 54

Vancomycin: Frequency of Administration **Intermittent infusion**: Typically administered every 12 hours, depending on kidney function and infection severity. **Continuous infusion**: In certain cases (e.g., severe infections like endocarditis), a continuous infusion is preferred, with doses adjusted based on creatinine clearance and regular monitoring. **Monitoring**: Regular plasma level monitoring is crucial, particularly in cases of continuous infusion. Teicoplanin: even longer acting: OD dosing after loading dose

Question 55

Name 2 Glycopeptide antibiotics?

Answer 55

Glycopeptide Antibiotics **Vancomycin**: Commonly used for serious infections like MRSA and C. difficile. **Teicoplanin**: Another glycopeptide used similarly for Gram-positive bacterial infections, including endocarditis. | Teicoplanin (less nephrotoxic than vancomycin)

Question 56

What are the target pre-dose TROUGH levels for vancomycin?? (only trough levels are used with Vancomycin)

Answer 56

Target Pre-Dose Trough Levels: Vancomycin: Target Pre-Dose Trough Levels **Standard infections**: 10–15 mg/L. **Severe or deep-seated infections** (e.g., MRSA, endocarditis): 15–20 mg/L. **Continuous Infusion**: Target range typically 20–25 mg/L. **Monitoring**: Regular trough level measurements are critical to avoid toxicity and ensure efficacy, especially in renal impairment cases. | 15-20 for endocarditis

Question 57

First line antibiotic for Cellulitis?

Answer 57

Flucloxacillin (250-500mg QDS) If penicillin allergic: Alternative in penicillin allergy or flucloxacillin unsuitable: clarithromycin, oral erythromycin (in pregnancy), or oral  doxycycline.

Question 58

Which antibiotics/ antifungals may cause STEVENS JOHNSON SYNDROME (skin rash)?

Answer 58

Antibiotics/Antifungals Associated with Stevens-Johnson Syndrome (SJS) **Sulfonamides**: Includes sulfamethoxazole (in co-trimoxazole), which has been widely associated with SJS. **Penicillins**: Such as amoxicillin and ampicillin. **Cephalosporins**: Includes ceftriaxone and cefixime. **Fluoroquinolones**: Such as ciprofloxacin and levofloxacin. **Antifungals**: Such as fluconazole and itraconazole.

Question 59

What are some of the more common side effects experienced with Metronidazole (its quite an unpleasant antibiotic)?

Answer 59

Common Side Effects of Metronidazole **Unpleasant metallic taste**: A sharp, metallic taste is very common. **Nausea and vomiting**: Often experienced, especially with oral forms. **Dry mouth and loss of appetite**. **Gastrointestinal discomfort**: Includes stomach cramps and diarrhea. **Dizziness or headaches**. **Dark urine**: May cause the urine to appear darker. **Disulfiram-like reaction with alcohol**: Severe nausea, flushing, and palpitations when taken with alcohol.

Question 60

What is fusidic acid used for?

Answer 60

Narrow spectrum antibiotic used for STAPHYLOCOCCAL SKIN infections Used for impetigo (topical) Fucidin cream Staph eye infections (topical)

Question 61

Which antibiotic is cautioned in problems to do with: Lungs, Liver, and Neurones

Answer 61

**Nitrofurantoin**: **Lungs:** Can cause pulmonary toxicity and Pulmonary Fibrosis, particularly in long-term use. **Liver:** May induce** hepatitis** or** cholestatic jaundice.** **Neurons:** Rarely, it can cause **peripheral neuropathy**, especially in patients with **renal impairment** or long-term use. also can cause Vit B/ Folate deficiency

Question 62

# F Which antifungal medication can cause QT prolongation?

Answer 62

Antifungal Medications That Can Cause QT Prolongation **Fluconazole**: Known to cause **QT interval prolongation** and increase the risk of torsades de pointes (a type of life-threatening arrhythmia). **Itraconazole**: Another azole antifungal associated with **QT prolongation**, particularly when used with other QT-prolonging medications or in patients with pre-existing heart conditions. **Voriconazole**: Also carries a risk of **QT prolongation**, especially in higher doses.

Question 63

What antibiotics/ antifungals should be stopped if signs of dark urine, vomiting, fatigue, anorexia occur?

Answer 63

This indicated LIVER FAILURE Discontinue drugs that are hepatotoxic: **Terbinafine** **Rifampicin** **Isoniazid** **Pyrizinamide** (R.I.P liver: TB drugs) **Nitrofurantoin**: Can cause liver toxicity leading to dark urine, vomiting, and fatigue. Stop immediately if these symptoms develop. **Itraconazole, Fluconazole and Ketoconazole (no longer available oral)!**: Known to cause liver dysfunction, which may present with dark urine, fatigue, and anorexia. Stop treatment and seek medical advice.

Question 64

Which antifungal is cautioned in patients at a high risk of heart failure?

Answer 64

Antifungal Cautioned in High-Risk Heart Failure **Itraconazole**: This antifungal is cautioned in patients at high risk of heart failure due to its potential to cause negative inotropic effects, which can worsen existing heart conditions or lead to heart failure. **Monitoring**: Close monitoring of cardiac function is essential when using itraconazole, especially in patients with pre-existing cardiac issues. | More at risk if on negatively ionotropic drug e.g. CCB

Question 65

What skin condition may Terbinafine (antifungal) exacerbate?

Answer 65

Terbinafine: Skin Condition Exacerbation **Psoriasis**: Terbinafine may exacerbate psoriasis in some patients. Close monitoring is advised in individuals with a history of this condition.

Question 66

Which antifungal can cause renal toxicity?

Answer 66

Antifungal That Can Cause Renal Toxicity **Amphotericin B**: Known for its potential to cause renal toxicity, particularly when used in high doses or for prolonged periods. It can lead to **acute kidney injury (AKI)**and requires close monitoring of renal function. Can also cause electrolyte disturbance: Hypokaleamia and hypomagneseamia

Question 67

Which antimalarials are unsuitable in patients with epilepsy/ has a history of epilepsy?

Answer 67

Antimalarials Unsuitable in Epilepsy **Chloroquine**: Can lower the seizure threshold, making it unsuitable for patients with a history of epilepsy. **Mefloquine**: Should be avoided due to its association with neuropsychiatric effects and increased risk of seizures in patients with epilepsy.

Question 68

A woman, 4 weeks pregnant, comes and asks you what she can do to avoid malaria when she goes to Bolivia next month. Which antimalarials are ok to use in pregnancy?

Answer 68

**Chloroquine** and **Proguanil**: These are considered safe for malaria prevention in pregnancy, especially in early pregnancy as benefit of malaria prophylaxis outweighs any risk BUT recommend FOLIC ACID 5mg to be taken with proguanil | Doxy - last resort and must complete full course before 15 weeks gestati

Question 69

What does the antimalarial malarone contain?

Answer 69

Proguanil & Atovaquone This is fine to use in epilepsy; does not contain chloroquine or mefloquine

Question 70

What is the most common causative bacteria of a UTI?

Answer 70

**Escherichia coli (E. coli)**: The most common bacterial cause of urinary tract infections (UTIs). E. coli originates from the gastrointestinal tract and is responsible for the majority of both uncomplicated and complicated UTIs.

Question 71

Lonely frail old linda sat in her smelly flat

Answer 71

``` Lonely linda= Clindamycin (class of its own) Frail= bones - clindamycin used for osteomyelitis as it concentrates in the bones Smelly= diarrhoea= discontinue immediately ```

Question 72

Daktocort cream (containing Miconazole and Hydrocortisone) needs to be stored where?? Why??Where is the ointment stored?

Answer 72

Daktocort CREAM stored in fridge- creams are more water based so more liable to bacterial growth Ointment on shelf- more stable, less water less bacteria Similar to chloramphenicol eye drops/ ointment- DROPS in FRIDGE as more water based ointment on shelf

Question 73

What drugs are used to treat Bacterial Vaginosis?

Answer 73

Metronidazole vaginal gel | Clindamycin cream

Question 74

Which antifungal requires an Alert card as it is so Hepato-toxic?

Answer 74

Voriconazole

Question 75

What two toxicities may Voriconazole cause?

Answer 75

Hepatotoxicity | Phototoxcity- avoid sunlight!

Question 76

When should a penicillin be discontinued? Describe the affects.

Answer 76

Individuals with a history of anaphylaxis, urticaria, or rash immediately after a penicillin should discontinue and not receive penicillins as these are at risk of immediate hypersensitivity. The rash would come up straight away, be wide spread, all over body, confluent, raised and itchy (urticaria= hives like rash). Those with history of a minor rash (non-confluent, localised to one area, non-itchy) that occurred more than 72 hours after starting the penicillin are probably not truly allergic, and if a penicillin is absolutely needed they may receive it.

Question 77

What antibiotics are commonly seen prescribed for chest infections?

Answer 77

Penicillins- Amoxicillin or Ampicillin Or if not: A Macrolide - Azithromycin, Clarithromycin or Erythromycin Co-amoxiclav used for more serious chest infections as it has broader action over the typical bacteria (e.g. H. influenzae) ## Footnote Co-amoxiclav used for more serious chest infections as it has broader action over the typical bacteria (e.g. H. influenzae)

Question 78

How is oral thrush managed?

Answer 78

Initially TOPICAL treatment with either **Miconazole oromucosal gel** or **NYSTATIN oral suspension** (use pipette provided, hold in mouth, used after food) If these don't work or patient has a dry mouth can use **Oral fluconazole capsule**

Question 79

Which anti-epileptic does Meropenem reduce the levels of?

Answer 79

**Sodium Valproate** **Meropenem Interaction:** Sodium Valproate **Effect:** Meropenem significantly reduces sodium valproate levels, which can lead to a loss of seizure control. This interaction can result in a drop of valproate levels by up to 100% within 24 hours. **Management:** Sodium valproate should not be stopped, but adjunct therapy with levetiracetam is often recommended during meropenem treatment

Question 80

What is the usual organism (Not atypical) causing Lower respiratory tract infections?

Answer 80

**Streptococcus pneumoniae** - major cause of pneumonia S. pneumoniae is also one of the major causes of meningitis (pneumonococcal) along with Neisseria meningitidis (meningococcal)

Question 81

What antibiotic should be used for resistant strains of pneumonia? **AT WHAT DOSE?** **WHAT IS AN ALTERNATIVE?**

Answer 81

**Co-amoxiclav**.This contains amoxicillin plus clavulanic acid which is a beta lactamase inhibitor- this makes this antibiotic very effective against more resistant strains. (500/125 mg three times a day or 1.2 g intravenously three times a day). **Alternative:** Levofloxacin (500 mg twice a day orally or intravenously), particularly if penicillin allergy is present. This is often used when fluoroquinolones are needed due to their broader spectrum, but they come with risks like tendinopathy and should be used cautiously.

Question 82

Aside from antibiotics like clindamycin etc, what can cause C.diff?

Answer 82

PPI's

Question 83

What is the difference between the discharge in bacterial vaginosis and Trichomoniasis Vaginalis?

Answer 83

**Bacterial Vaginosis Discharge:** Greyish-white, thin and watery discharge Often has a strong fishy odor, especially after sex Usually no itching or soreness. **Trichomoniasis Vaginalis Discharge:** Frothy, yellow-green discharge Can have a fishy smell and may cause itching, soreness, and irritation around the vagina

Question 84

Pink and frothy sputum=?

Answer 84

Heart Failure: the pulmonary oedema (fluid on lungs) can result in coughing up blood and requiring more pillows to sleep on to take weight off the chest

Question 85

What are the most common causative organisms of Community Aquired pneumonia? (4)

Answer 85

**Streptococcus pneumoniae:** The most common bacterial cause of CAP in adults. **Haemophilus influenzae:** Frequently seen in individuals with underlying lung diseases, such as COPD. **Mycoplasma pneumoniae:** Often responsible for milder, atypical cases of pneumonia, especially in younger adults. **Legionella pneumophila:** Causes more severe pneumonia, often linked to contaminated water sources

Question 86

What antibiotics are suitable in pregnancy?

Answer 86

Penicillins and Cephalosporins + erythromycin

Question 87

What are the indications for aminoglycosides?

Answer 87

**Indications for Aminoglycosides** **Severe Gram-negative infections**(e.g., sepsis, pneumonia, urinary tract infections (pyelonephritis)) Endocarditis (in combination with other antibiotics) Plague and tularemia Tuberculosis (drug-resistant cases, alongside other antibiotics)

Question 88

What is the therapeutic range for gentamicin?

Answer 88

5-10mg/L

Question 89

Which aminoglycoside is given orally? and why?

Answer 89

Neomycin- too toxic for IV use **Reason for Oral Use:** Neomycin is given orally to prepare the bowel before surgery and to treat hepatic encephalopathy. It works by reducing bacteria in the intestines, which can help prevent infection during surgery or reduce the production of toxins in liver disease

Question 90

What are the side effects of aminoglycosides? (3)

Answer 90

1) Nephrotoxicity 2) Ototoxicity 3) Peripheral neuropathy

Question 91

Aminoglycosides shouldn't be used in...? (2)

Answer 91

1) Myasthenia gravis (impairs neuromuscular transmission | 2) Pregnancy (ear damage)

Question 92

Aminoglycosides interact with what drugs?

Answer 92

1) Loop diuretics and Vancomycin (ototoxicity) | 2) Cisplatin, Ciclosporin and vancomycin (nephrotoxicity)

Question 93

IV treatment with aminoglycosides should not exceed how many days?

Answer 93

7 days Treatment should not exceed 7 days in most cases. Prolonged treatment increases the risk of renal and ototoxicity. Gentamicin and other aminoglycosides are often reviewed after 48-72 hours, with doses adjusted based on serum levels and patient response​

Question 94

Monitoring requirements for aminoglycosides? (3)

Answer 94

**Monitoring Requirements for Aminoglycosides:** 1. **Serum concentration monitoring:** Measure levels **12–18 hours**after the first dose and every 3 days, or after dose adjustments. 2. **Renal function:** Monitor serum creatinine and creatinine clearance 3. **Auditory and vestibular function:**Check for ototoxicity, especially in patients with prolonged therapy or at high risk

Question 95

Common bacteria in meningitis? (3)

Answer 95

**Common Bacteria in Meningitis** 1. Neisseria meningitidis (meningococcus) 2. Streptococcus pneumoniae (pneumococcus) 3. Haemophilus influenzae type b (Hib) (now rare due to vaccination)

Question 96

Antibiotics used in meningitis?

Answer 96

**Antibiotics for Meningitis** Cefotaxime (first-line treatment) ceftriaxone(alternative if Cefotaxime is contraindicated) Benzylpenicillin sodium if organism is sensitive eg (Streptococcus pneumoniae) Chloramphenicol (for severe penicillin or cephalosporin allergies) | Amoxicillin or Ampicillin (for Listeria monocytogenes infections)

Question 97

Name THE NON C cephalosporins?

Answer 97

1) Cefalexin 2) Cetrotide 3) Cefaclor 4) Cefuroxime 5) Cefixime 6) Ceftriaxone 7) Ceftaroline 8) Fosamil

Question 98

Are cephalosporins broad spectrum?

Answer 98

Yes

Question 99

Indications for cephalosporins?

Answer 99

**Indications for Cephalosporins:** **Respiratory infections:** Including pneumonia and bronchitis **Meningitis:** Effective against Neisseria meningitidis and Streptococcus pneumoniae **Septicemia:** Often used in serious bloodstream infections **Urinary tract infections**(UTIs) **Biliary-tract infections** **Peritonitis** 2nd or 3rd line treatment for UTI and RTI IV for severe resistant organisms Pneumonia, meningitis, gonorrhoea

Question 100

Side effects of cephalosporins? (2)

Answer 100

1) GI effects | 2) Penicillin hypersensitivity (avoid in known allergy)

Question 101

Do IV cephalosporins require approval by a microbiologist?

Answer 101

YES and are now mainly restricted to antibiotic associated colitis

Question 102

Does warfarin interact with cephalosporins? if so, how?

Answer 102

YES, cephalosporins kill the gut flora responsible for synthesizing **vitamin K** this results in a reduction in the production of **vitamin K dependent blood clotting factors-results** in increased **anticoagulant effect** of warfarin. It is important to monitor **INR levels** closely and adjust the warfarin dose if needed during concurrent use​

Question 103

What is the first line antibiotic group for MRSA?

Answer 103

Glycopeptides e.g vancomycin, Teicloplanin etc

Question 104

What indications are glycopeptides generally used for?

Answer 104

**Indications for Glycopeptides** **Serious Gram-positive infections**, especially MRSA (methicillin-resistant Staphylococcus aureus) **Endocarditis caused by Staphylococcus or Enterococcus species** **Clostridium difficile infections (oral vancomycin)** **Bone and joint infections** when Gram-positive bacteria are involved

Question 105

What are the main side effects of glycopeptides? (5)

Answer 105

1) Nephrotoxicity 2) Blood disorders 3) Ototoxicity 4) 'Red man syndrome 5) Thrombophlebitis (IV)

Question 106

When would you avoid using glycopeptides? 4

Answer 106

elderly, history of deafness, renal impairment, pregnancy (ear damage)

Question 107

What are the monitoring requirements for glycopeptides? (5)

Answer 107

1) FBC 2) WCC 3) Hepatic and renal function 4) Urinalysis 5) Auditory function in elderly

Question 108

What drugs do glycopeptides interact with?

Answer 108

Ciclosporin, cisplatin, aminoglycosides, loop diuretics Suxamethonium- (Increases vancomycin conc)

Question 109

What are the indications for clindamycin? (3) what medicine class?

Answer 109

it is a lincosamide indications 1) Staphylococcal joint and bone infections 2) Intra abdominal sepsis 3) Cellulitis and skin and soft tissue infections (effective against penicillin resistant streptococci)

Question 110

Important side effects of clindamycin? (4)

Answer 110

1) Antibiotic associated colitis-REPORT diarrhoea 2) Esophageal disorders 3) Jaundice 4) SJS, rash

Question 111

In what patient groups is clindamycin CI?

Answer 111

Existing diarrhoea Caution in middle aged/ elderly women after an operation

Question 112

What are the indications for macrolides?

Answer 112

Respiratory infections (in addition to penicillin), Lyme disease, severe pneumonia (added to penicillin), skin and soft tissue infections (alternative to penicillin)

Question 113

Important side effects of macrolides? (4)

Answer 113

1) Antibiotic associated colitis 2) QT prolongation 3) Ototoxicity 4) Cholestatic jaundice

Question 114

Why would you avoid using macrolides in myasthenia gravis?

Answer 114

Macrolides cause electrolyte abnormalities which can aggravate myasthenia gravis

Question 115

Main CI for macrolides?

Answer 115

1) Hepatic impairment (cholestatic jaundice) 2) Arrhythmia (QT prolongation)

Question 116

What drugs interact with macrolides?

Answer 116

1) CYP450 substrates 2) Drugs that prolong QT interval

Question 117

What are the main indications of metronidazole? and appropriate doses? (3)

Answer 117

1) Antibiotic associated colitis (400mg TD 5 days) 2) Oral infections (200mg TD 3 days for gingivitis) 3) Gynecological infections e.g trichomonas vaginal infection

Question 118

Main side effects associated with metronidazole? (3)

Answer 118

1) Neurological effects e.g peripheral and optic neuropathy 2) Mouth-Taste disturbance, furred tongue and mucositis 3) Hearing loss

Question 119

Is metronidazole a CYP450 inhibitor?

Answer 119

NO, it is a substrate of CYP450

Question 120

What happens if you drink alcohol while taking metronidazole?

Answer 120

'di-sulfram like' reaction will occur. Metronidazole inhibits the clearing of acetylaldehyde (intermediary metabolite)- this causes flushing, headache, tachycardia

Question 121

How long after stopping metronidazole should you avoid alcohol?

Answer 121

2 days

Question 122

What drugs does metronidazole interact with? (4)

Answer 122

1) CYP450 inhibitors 2) CYP450 inducers 3) CYP450 substrates 4) Lithium (reduces clearance of lithium resulting in toxicity)

Question 123

What effect will ketoconazole have on metronidazole?

Answer 123

Ketoconazole is a CYP450 inhibitor, metronidazole is a substrate of CYP450 therefore ketoconazole will reduce the metabolism of metronidazole. Metronidazole is a pro-drug so this will reduce the efficacy of metronidazole.

Question 124

What duration of treatment with metronidazole requires FBC and hepatic monitoring?

Answer 124

10 days

Question 125

Are penicillins broad spectrum?

Answer 125

Yes

Question 126

What are the main indications for penicillins? (7)

Answer 126

1) Tonsillitis (streptococcal) 2) Otitis media 3) Cellulitis 4) respiratory tract infections 5) Meningitis 6) Tetanus (C.diff) 7) Skin and soft tissue infections

Question 127

Main side effects of penicillin's? (2)

Answer 127

1) Penicillin allergy 2) CNS toxicity (convulsions, coma)-do not give intrathecal injection

Question 128

Main drug interaction of penicillin's?

Answer 128

Methotrexate- reduced renal excretion and increased toxicity

Question 129

What are the main indications for co-amoxiclav? (3)Main side effect of co-amoxiclav?

Answer 129

1) Pneumonia 2) UTI (250-500mg 8hrly) 3) H.pylori (combo therapy)Same as penicillin's + Cholestatic jaundice (no more than 14 days treatment)

Question 130

What are the main indications for flucloxacillin? (3)Main side effect of flucloxacillin?

Answer 130

1) Skin and soft tissue infections e.g cellulitis 2) Osteomyelitis/septic arthritis 3) Endocarditis Same as penicillin's +Cholestatic jaundice

Question 131

Name two diaminopyrimidine antibiotics

Answer 131

1) Trimethoprim 2) Co-trimoxazole

Question 132

How do diaminopyrimidines work?

Answer 132

Bacteriostatic-inhibit folate synthesis

Question 133

Main indications of diaminopyrimidines?

Answer 133

Uncomplicated UTI (200mg 12 hourly) trimethoprim RTI, pneumocystis pneumonia (co-trimoxazole)

Question 134

What are the main side effects associated with diaminopyrimidines? (Trimethoprim) (2)

Answer 134

1) Blood disorders (look out for bruising, bleeding, ulcers etc) 2) SJS

Question 135

What are the main contra indication for diaminopyrimidines? (2)

Answer 135

1) Pregnancy (Teratogenic-especially in first trimester) 2) Caution in folate deficiency

Question 136

Drugs that interact with diaminopyrimidines?

Answer 136

K+ elevating drugs e.g ACE inhibitors, ARB's Folate antagonists e.g methotrexate Phenytoin, warfarin (reduced clearance)

Question 137

Name five Quinolone antibiotics?

Answer 137

1) Ciproflaxacin 2) Monoflaxacin 3) Levofloxacin 4) Ofloxacin 5) Norfloxacin

Question 138

Why are quinolones typically 2nd and 3rd line drugs?

Answer 138

Rapid resistance developing Safety Concerns: Tendinopathy, QT interval prolongation,Neurotoxicity,

Question 139

Main indications that quinolones are used for? (4)

Answer 139

1) Complicated UTIs and pyelonephritis 2) severe GI infections including travelers diarrhoea - (e.g., salmonella, shigella) 3) LRTI -lower respiratory tract infection - Pneumonia (only when other first-line antibiotics are inappropriate) 4) Gonorrhoea (when other options are unsuitable) 5) Prostatitis (acute bacterial)

Question 140

What are the main side effects associated with quinolones? (6)

Answer 140

1) Gastrointestinal upset: Nausea, vomiting, and diarrhea are common, or C. diff 2)Central nervous system effects:-seizures and hallucinations 3)Inflammation and rupture of tendons-STOP 4) Prolong QT interval-arrhythmia 5) Photosensitivity 6) Peripheral neuropathy: Causes abnormal sensations like tingling, numbness, and weakness.

Question 141

What is an important side effect of monoflaxacin?

Answer 141

Life threatening hepatotoxicity

Question 142

In what conditions should quinolones be use with caution?

Answer 142

1) Epilepsy 2) GPD6 deficiency 3) Joint disorders e.g myasthenia gravis 4) Children and adolescents (disease of joints)

Question 143

What drugs do quinolones interact with?

Answer 143

1) Calcium and antacids (reduce absorption) 2) Theophylline (quinolones inhibit CYP450) 3) NSAIDS 4) Prednisolone (tendon rupture) 5) QT prolonging drugs e.g amiodarone, antipsychotics etc

Question 144

What is the last resort antibiotic for MRSA?

Answer 144

Linezolid (vancomycin resistant cocci)

Question 145

What types of infections is Linezolid used for?

Answer 145

Complicated skin and soft tissue infections and pneumonia 1. **Infections Treated with Linezolid** 2. **Pneumonia:**Especially when caused by Gram-positive bacteria and when other antibacterials like vancomycin cannot be used. 3. **Complicated skin and soft-tissue infections:** Particularly those caused by resistant Gram-positive organisms like MRSA (Methicillin-resistant Staphylococcus aureus). 4. **Vancomycin-resistant Enterococcus (VRE) infections**

Question 146

What type of drug is linezolid?

Answer 146

a monoamine oxidase inhibitor (MAOI) in addition to being an oxazolidinone antibiotic.

Question 147

What are the main side effects associated with Linezolid?

Answer 147

1) Bipolar and confusional states 2) History of seizures 3) Uncontrolled hypertension 4) Elderly (increased risk of eosinophilia)

Question 148

What foods should be avoided while taking linezolid?

Answer 148

Tyramine rich foods

Question 149

What monitoring is required for Linezolid if the treatment exceeds 14 days?

Answer 149

FBC monitoring unless patient has existing myelosuppression, taking blood drugs and renal impairment (check for eosinophilia)

Question 150

What monitoring is required for Linezolid if treatment exceeds 28 days?

Answer 150

Check for optic neuropathy

Question 151

What drugs does Linezolid interact with and why?

Answer 151

SSRIs, triptans, tricylic antidepressants, sympathomimetics, buspirone, opioids, pethidine, antipsychotics (MAOI inhibitor)

Question 152

Which TWO drugs cause peripheral neuropathy?

Answer 152

**Antibiotics Causing Peripheral Neuropathy:** **Fluoroquinolones**(e.g., ciprofloxacin, levofloxacin): Commonly associated with peripheral neuropathy, particularly with prolonged use. **Chloramphenicol:** Rarely causes peripheral neuropathy, especially with prolonged or high-dose therapy. **Ethambutol:** Known to cause sensory peripheral neuropathy, especially with long-term use. **Dapsone:** Can cause a motor axonal neuropathy, particularly with high doses or long-term treatment **Metronidazole** and **nitrofurantoin**

Question 153

What type of infection is nitrofurantoin used for and what are the typical doses?

Answer 153

1st line for UTI (100mcg m/r BD for 3 days) and as prophylaxis for UTI (50-100mg nightly for max 6 months)

Question 154

What are the main side effects associated with nitrofurantoin? (4)

Answer 154

1) Dark yellow/ brown urine 2) Pulmonary reactions 3) Peripheral neuropathy 4) Hepatitis

Question 155

In what patient groups would nitrofurantoin be an inappropriate choice? (4)

Answer 155

**Patient Groups Where Nitrofurantoin is Inappropriate:** **Patients with Renal Impairment:** Contraindicated in those with an eGFR of less than 45 ml/min/1.73m², as its efficacy decreases, and the risk of side effects increases. **Pregnant Women at Term (38-42 weeks):** Risk of haemolytic anaemia in newborns. **Patients with G6PD Deficiency:** Risk of haemolysis. **Severe Hepatic Impairment:** Risk of liver damage

Question 156

What are the TWO monitoring requirements for Long term nitrofurantoin use?

Answer 156

Hepatic and pulmonary function

Question 157

In what patient groups would a specimen and culture be collected before treatment for UTI?

Answer 157

**Men**, **pregnant women,** **children <3,** **Upper UTI** **Recurrent UTIs**: reresistant organism suspected e.g Klebsiella suspected

Question 158

What are the treatment options for an uncomplicated UTI in a child >3mo?

Answer 158

Trimethoprim, Nitrofurantoin, Cefalexin, amoxicillin

Question 159

What are the treatment options for an uncomplicated UTI in a child <3mo?

Answer 159

IV ampicillin with gentamicin or cefotaxime in hospital, then oral treatment

Question 160

What are the antibiotic treatment options for recurrent UTI's in children?

Answer 160

Trimethoprim or nitrofurantoin

Question 161

Name FIVE tetracyclines?

Answer 161

Tetracyline, doxycycline, minocycline, lymecyline, oxytetracyline

Question 162

What are the main indications for tetracylines? (6)

Answer 162

1) Chlamydia and PID 2) Acne 3) LRTI (including COPD) 4) Malaria, 5) lyme disease, 6) rickettsia

Question 163

Main side effects associated with tetracylines? (5)

Answer 163

1) Photosensitivity 2) Esophageal irritation 3) Hepatotoxicity 4) benign intracranial pressure- headache and visual disturbances-STOP 5) Discoloration of tooth enamel

Question 164

In what patient groups would you want to avoid tetracylines?

Answer 164

1) Children <12 (binds to teeth) 2) Pregnancy and breastfeeding

Question 165

Name TWO conditions that require prolonged courses of antibiotics?

Answer 165

TB osteomyelitis

Question 166

Antibiotic used to prevent pneumococcal infection in sickle cell disease?

Answer 166

Phenoxymethylpenicillin, If contra indicated then erythromycin

Question 167

Antibiotic used as prevention for early onset neonatal infection?

Answer 167

IV : **Benzylpenicillin** or **ampicillin** in combination with **gentamicin**, which provides broad coverage against Gram-positive bacteria like Group B Streptococcus and Gram-negative bacteria like Escherichia coli.

Question 168

Name FOUR beta lactam antibiotics?

Answer 168

1) Penicillins 2) Cephalosporins 3) Carbapenems 4) Monobactams

Question 169

What is the main use for fusidic acid?

Answer 169

narrow spectrum for staph infections, topically on the skin or eye or IV/oral for osteomyelitis and endocarditis

Question 170

What is the first line treatment for C.diff?

Answer 170

vancomycin or fidoxamicin

Question 171

What can a tobramycin dry powder inhaler be used for?

Answer 171

**Pseudomonas aeruginosa** lung infection in **cystic fibrosis.**

Question 172

Name TWO carbapenems?

Answer 172

Imipenem and Meropenem

Question 173

Name TWO cephalosporins that can be used for CNS infections?

Answer 173

1) Cefotaxime 2) Ceftriaxone

Question 174

Which cephalosporin has good activity against haemophillus influenza?

Answer 174

Cefotaxime (or ceftriaxone)

Question 175

Which cephalosporin should be used in history of hypercalciuria (history of renal stones)?

Answer 175

Ceftriaxone

Question 176

What is the maximum duration of treatment for fusidic acid?

Answer 176

10 days

Question 177

What are the specific monitoring requirements for minocycline if the treatment is longer than 6 months?

Answer 177

Monitor every 3 months for hepatotoxicity, pigmentation of the skin and systemic lupus erythromtosus

Question 178

Name TWO antimycobacterials?

Answer 178

1. Isoniazid Use: First-line treatment for TB. 2. Rifampicin Use: Essential in TB therapy and other mycobacterial infections. 3. Ethambutol Use: Commonly used in combination therapy for TB. 4. Pyrazinamide Use: Key part of short-course TB treatment. 5. Rifabutin Use: For TB, especially in patients intolerant to rifampicin, and for mycobacterium avium complex (MAC). 6. Rifapentine Use: Similar to rifampicin, often used for latent TB. 7. Clofazimine Use: Primarily for leprosy, has anti-inflammatory effects. 8. Dapsone Use: A key drug for leprosy, used in multidrug therapy

Question 179

Name the three antibiotics that can be used in lyme disease?

Answer 179

1) doxycycline 2) amoxicillin 3) azithromycin | Should be used in this order unless <9 years (avoid doxycycline)

Question 180

Name SEVEN bacteria that can cause UTI?

Answer 180

1) E coli 2) Staph saprophyticus 3) Proteus 4) Klebsiella 5) Pseudomonas aeruginosa 6) Staph epidermidus 7) Enterococcus Faecalis

Question 181

What is the antibacterial prophylaxis and treatment of choice for animal bites?

Answer 181

Co-amoxiclav (if penicillin allergic- doxycyline + metronidazole for up to 5 days) and give the tetanus jab

Question 182

What is the treatment for a >50 year old with meningitis?

Answer 182

First-line treatment Ceftriaxone (2g IV every 12 hours) Add Amoxicillin or Ampicillin (2g IV every 4 hours) to cover (Listeria monocytogenes). Duration: Usually 10-14 days, depending on the clinical response. ## Footnote Cefotaxime or ceftriaxone AND Amoxicillin or Ampicillin Consider adding vancomycin (10 days)

Question 183

How long is the initial phase of TB treatment?

Answer 183

Duration: 2 months Regimen: Four-drug therapy (Rifampicin, Isoniazid with Pyridoxine, Pyrazinamide, Ethambutol). This phase is followed by a continuation phase of 4 months with Rifampicin and Isoniazid

Question 184

How long is the second phase of TB treatment?

Answer 184

4 months Rifampicin and Isoniazid

Question 185

What drugs are used in the initial phase of treatment for TB?

Answer 185

Isonazid (300mg OD) Rifampicin (<50kg=450mg OD, >50kg=600mg OD) Pyrazinamide (<50kg=1.5g, >50kg=2g OD) Ethambutol (15mg/kg OD)

Question 186

What drugs are used in the second phase of treatment for TB?

Answer 186

Isonazid (300mg OD) Rifampicin (<50kg=450mg OD, >50kg=600mg OD)

Question 187

Which TB drugs cause liver toxicity?

Answer 187

Isonazid Rifampacin Pyrazinamide

Question 188

Which TB drugs cause peripheral neuropathy?

Answer 188

Isonazid

Question 189

Which TB drugs cause occular toxicity?

Answer 189

Ethambutol

Question 190

What are the monitoring requirements for TB treatment?

Answer 190

Plasma levels e.g ethambutol Urinalysis Visual acuity testing Blood counts Liver and hepatic function Auditory function in the elderly

Question 191

What is the duration of treatment for extrapulmonary TB?

Answer 191

CNS Tuberculosis Treatment **Duration:** 12 months (2 months initial, 10 months continuation). **Drugs:** Rifampicin, Isoniazid, Pyrazinamide, Ethambutol. **Steroids:** Dexamethasone or Prednisolone tapered over 4–8 weeks. **Surgery:** If raised intracranial pressure or spinal instability

Question 192

What is a specific Contra indication of pyrazinamide?

Answer 192

Acute attack of gout

Question 193

Name the antibiotics in the aminoglycoside class

Answer 193

Amikacin Gentamicin Neomycin Streptomycin Tobramycin

Question 194

What aminoglycosides are active against Pseudomonas and what one is the treatment of choice?

Answer 194

For aminoglycosides that are active against Pseudomonas aeruginosa, the following are commonly used: **Gentamicin** **Tobramycin** **Amikacin** Among these, **Tobramycin** is often considered the treatment of choice for infections caused by **Pseudomonas aeruginosa** due to its effectiveness, particularly in respiratory infections like **cystic fibrosis**.

Question 195

What aminoglycoside is active against TB?

Answer 195

Aminoglycoside active against TB **Streptomycin:**Commonly used in TB treatment, particularly for multidrug-resistant TB. **Alternatives:** Amikacin, Kanamycin (used in drug-resistant TB). | Streptomycin(mainly reserved for this indication)

Question 196

Can aminoglycosides be given orally?

Answer 196

No- destroyed by the gut so must be given via injection except neomycin which can be given orally

Question 197

Is gentamicin a broad or narrow antibiotic?What strains does it have poor activity against?

Answer 197

Broad but it is inactive against anaerobes and poor activity against haemolytic streptococci and pneumococci, but Very good for gram negative organisms

Question 198

Which aminoglycoside is used for encocarditis?If it is resistant to this, what is an alternative aminoglycoside?

Answer 198

Which aminoglycoside is used for endocarditis? **Gentamicin:** Used in combination with other antibiotics for **gram-positive endocarditis (e.g., with penicillin or teicoplanin).** **Alternative:** If resistant or high-level aminoglycoside resistance occurs, **Streptomycin** or **Amikacin** may be considered as alternatives

Question 199

Are aminoglycosides more active against gram positive or gram negative?

Answer 199

More Active Against: **Gram-negative bacteria.** Examples: **Pseudomonas aeruginosa, Escherichia coli.** Use in Gram-positive infections: **Often combined with other antibiotics** (e.g., gentamicin with penicillin for endocarditis) for synergy | Gram negative but are broad

Question 200

Can neomycin be given IV?

Answer 200

**No**, Neomycin cannot be administered intravenously. **Forms:** It is used orally or topically. **Uses:** For reducing gut bacteria before surgery or treating hepatic coma (oral), and for skin, eye, or ear infections (topical). **Reason:** It is highly toxic systemically, making IV use inappropriate ## Footnote No too toxic Can only be used for skin/mucous membrane infections... However BNF states the cream is less suitable for prescribing(Can also be used to reduce the bacterial population of the colon prior to bowel surgery or in hepatic impairment)

Question 201

What is the problem with using aminoglycosides in myasthenia gravis?

Answer 201

**Problem:**Aminoglycosides (e.g., gentamicin) can impair **neuromuscular transmission**, worsening muscle weakness in myasthenia gravis. **Risk:** This may lead to severe symptoms such as respiratory failure or even a myasthenic crisis. **Caution:** Aminoglycosides should be avoided unless no alternative exists | **Contraindicated May impair neuromuscular transmission**

Question 202

What antibiotics can be used for prophylaxis in rheumatic fever?

Answer 202

Pen V or sulfadiazine

Question 203

What anitbiotics can be used for prevention of secondary case of menincoccal meningitis?

Answer 203

Ciprofloxacin or rifampicin Or IM ceftriaxone (unlicensed)

Question 204

What antibiotic can be used for prevention of secondary infection for Group A strep?

Answer 204

Pen V

Question 205

What antibiotic can be used for prevention of secondary infection in Influenza Type B?

Answer 205

Rifampicin

Question 206

What antibiotic can be used for prevention of secondary cases of diphtheria in non-immune patients?

Answer 206

Erythromycin

Question 207

What is pertussis?

Answer 207

Whooping cough

Question 208

What antibiotic is used for prophylaxis of pertussis (whooping cough)?

Answer 208

Clarithromycin

Question 209

What antibiotic is used post splenectomy or in patients with sickle cell disease for prevention of pneumococcal infection?

Answer 209

Pen V(Erythromycin if penicillin allergic)

Question 210

What antibacterial prophylaxis/treatment is used in animal and human bites?If the patient is penicillin allergic, what should be used instead?

Answer 210

Co-amoxIf penicillin allergic: Doxycycline and metronidazoleUp to 5 days and give tetanus jab

Question 211

What antibacterial prophylaxis do you use in hip and knee replacement?

Answer 211

Single dose IV cefuroxime/flucloxacillinAdd in gent

Question 212

What antibacterial prophylaxis do you use in high lower limb amputation?

Answer 212

Use i/v co-amoxiclav alone or i/v cefuroxime + i/v metronidazole

Question 213

What antibacterial prophylaxis do you use in caesarean section?

Answer 213

Single dose cefuroxime

Question 214

What is 1st line for aspergillosis?What is 2nd line if this cannot be used?

Answer 214

Voriconazole Liposomal amphotericin

Question 215

If a patient with aspergillosis is intolerant/refractory to voriconazole and liposomal amphotericin, what other antifungals can be used?

Answer 215

CaspofunginItraconazole

Question 216

What systemic antifungal is used in vaginal candidiasis?For resistant organisms, what can be used?

Answer 216

FluconazoleItraconazole as an alternative

Question 217

What is micafungin licensed for?

Answer 217

Invasive candidiasisOesophageal candidiasisProphylaxis of candidiasis in patients undergoing haematopoietic stem cell transplantation

Question 218

Cryptococcal meningitis, a fungal infection, is especially common in which group of immunocompromised patients?How is this treated?

Answer 218

HIV positive IV amphotericin followed by PO fluconazole

Question 219

What is tinea capitis?

Answer 219

Fungal infection (ringworm) of scalp

Question 220

What is tinea pedis?

Answer 220

Athlete's foot

Question 221

How do you treat tinea captis?

Answer 221

SystemicallyGriseofulvin Can also used an additional topical application

Question 222

True or false:In fungal nail infections, topical therapy is more effective than systemic

Answer 222

FalseSystemic is more effective

Question 223

Is fluconazole active against Aspergillus?

Answer 223

No

Question 224

Is caspofungin effective against CNS fungal infections?

Answer 224

No

Question 225

What is the advantage of lipid amphotericin formulations over conventional amphotericin?

Answer 225

Significantly less toxic and are recommended when the conventional formulation of amphotericin is contra-indicated because of toxicity, especially nephrotoxicity or when response to conventional amphotericin is inadequateHowever, more expensive

Question 226

What are echinocandin antifungals active against? (Caspofungin, micafungin)

Answer 226

Aspergillus and CandidaNot active against CNS fungal infections

Question 227

What can be used for MRSA?

Answer 227

Glycopeptides mainly: Teicoplanin Vancomycin Alternatives: Tigecyline, Daptomycin Linezolid (if glycopeptide unsuitable) Tetracyclines can be used for skin or soft tissue infections or UTI caused by MRSA Clindamycin can be used for bone and joint MRSA infections

Question 228

Are carbapenems useful against MRSA?

Answer 228

No

Question 229

Do carbapenems have good activity against pseudomonas? What is the exception to this?

Answer 229

Yes apart from ertapenem

Question 230

Why does imipenem have to be administered with cilastatin?

Answer 230

Imipenem is partially inactivated in the kidney by enzymatic activity and is therefore administered in combination with cilastatin, a specific enzyme inhibitor, which blocks its renal metabolism

Question 231

If meningitis is suspected, what antibiotic should be given before being transferred to hospital (as long as this doesn't delay treatment)?What would be an alternative?

Answer 231

IV benpenCefotaxime if penicillin allergic / chloramphenicol if history of immediate hypersensitivity to penicillin and cephalosporins

Question 232

When would you use dexamethasone in meningitis?In what situations would you avoid this?

Answer 232

Particularly in pneumococcal meningitis in adults, either before starting antibacterial therapy or within 12 hours of startingAvoid using dex in septic shock, meningococcal septicaemia, immunocompromised, or meningitis following surgery

Question 233

What is the recommended antibiotic therapy for children 3 months - adults 50 years in meningitis if the cause is unknown?What is the suggested duration of treatment?

Answer 233

Cefotaxime or ceftriaxoneConsider adding vancomycin10 days

Question 234

What is the recommended antibiotic therapy for adults over 50 years in meningitis if the cause is unknown?What is the suggested duration of treatment?

Answer 234

Cefotaxime or ceftriaxone AND amoxicillin or ampicillinConsider adding vanc10 days

Question 235

What is the recommended antibacterial therapy for meningitis caused by meningococci (neisseria)?What would be an alternative if not suitable?What is the suggested duration of treatment?

Answer 235

Benpen Or cefotaxime/ceftriaxoneChloramphenicol is an alternative if history of immediate hypersensitivity to penicillins or cephalosporins 7 days

Question 236

What bacteria can be the cause of meningitis?

Answer 236

Meningococcal (neisseria)PneumococcalHaemophilus influenzaeListeria

Question 237

What is the recommended antibacterial therapy for meningitis caused by pneumococcal?If the organism if penicillin and cephalosporin resistant, what can be added?What is the suggested duration of treatment?

Answer 237

Cefotaxime or ceftriaxone Consider adding dex before first dose or within 12 hours of starting antibacterial therapy If penicillin sensitive, change to benpenIf penicillin and cephalosporin resistant, vancomycin and rifampicin can be added14 days

Question 238

What is the recommended antibacterial therapy for meningitis caused by Haemophilus influenzae?What is the suggested duration of treatment?

Answer 238

Cefotaxime or ceftriaxone Consider adding dex before first dose or within 12 hours of starting antibacterial therapy 10 days

Question 239

What is the recommended antibacterial therapy for meningitis caused by Listeria?What is the suggested duration of treatment?If history of immediate penicillin hypersensitivity, what could be an alternative?

Answer 239

Amoxicillin/ampicillin AND gentamicin 21 days - can consider stopping gentamicin after 7 daysAlternative- co-trimoxazole for 21 days

Question 240

How should the following be managed:Patients presenting with sinusitis symptoms of 10 days or less

Answer 240

Paracetamol, ibuprofen, nasal salineAntibiotics not usually required

Question 241

How should the following be managed:Patients presenting with sinusitis symptoms of 10 days or more

Answer 241

Could be considered for treatment with a high-dose nasal corticosteroid, such as mometasone furoate [unlicensed use] or fluticasone [unlicensed use] for 14 days. Supply of a back-up antibiotic prescription could be considered and used if symptoms do not improve within 7 days, or if they worsen rapidly or significantly.

Question 242

In what situations would you offer antibiotics for sinusitis?

Answer 242

Should only be offered to patients with acute sinusitis who are systemically very unwell, have signs and symptoms of a more serious illnessOr if bacterial sinusitis is suspected

Question 243

What is 1st and 2nd line in a non-penicillin allergic sinusitis patient if antibiotics are indicated?

Answer 243

1st line- Pen V2nd line- Co-amox (especially if more serious illness)

Question 244

What is 1st line in a penicillin allergic sinusitis patient if antibiotics are indicated?

Answer 244

Doxycycline or clarithyromycin

Question 245

What is 1st line in a penicillin allergic sinusitis PREGNANT patient if antibiotics are indicated?

Answer 245

Erythromycin

Question 246

What antibiotic can be used in a pregnant UTI patient?

Answer 246

Cefalexin

Question 247

If antibiotics are clinically appropriate, what would be used for otitis externa?What if the patient is penicillin allergic?

Answer 247

FlucloxacillinClarithromycin

Question 248

If antibiotics are clinically appropriate, what would be used for otitis media?What if the patient is penicillin allergic?

Answer 248

Amoxicillin (or co-amox as second line)Clarithromycin

Question 249

Otitis media is most common in which age group?

Answer 249

Children

Question 250

What antibiotics are likely to cause C.Diff?

Answer 250

ClindamycinPenicillinsCephalosporinsFluoroquinolones

Question 251

What 3 antibiotics can be used in C.Diff?

Answer 251

VancomycinMetronidazoleFidaxomicin

Question 252

For first episode of mild-moderate C.Diff, what should be used and for how long?

Answer 252

Oral vancomycin for 10 days

Question 253

For second/subsequent C.Diff infection not responding to metronidazole, what can be used and for how long?

Answer 253

Oral vancomycin Fidaxomicin can be used for severe infection 10 days

Question 254

What antibiotic is used for bacterial vaginosis and how long for?

Answer 254

Metronidazole 5-7 days

Question 255

What antibiotics cover chlamydia?

Answer 255

Azithromycin (single dose)DoxycyclineErythromycin

Question 256

What is the recommended length of treatment for osteomyelitis?

Answer 256

6 weeks

Question 257

Osteomyelitis and septic arthritis antibiotic choice: 1. First line 2. If penicillin allergic 3. If MRSA suspected

Answer 257

1. Flucloxacillin 2. Clindamycin 3. Vancomycin or teicoplanin

Question 258

What penicillins can you use for oral infections e.g. dental?

Answer 258

Pen VAmoxicillinHowever these are not effective against bacteria that produces beta lactamasesCo-amox can be used in severe cases

Question 259

What is the drug of choice for acute ulcerative gingivitis?

Answer 259

Metronidazole

Question 260

Is haemophilus influenzae a bacteria or a virus?

Answer 260

Bacteria

Question 261

What is the recommended therapy for Haemophilus influenzae?

Answer 261

Cefotaxime or ceftriaxone

Question 262

What antibiotics do you use to treat an acute exacerbation of chronic bronchitis and how long for?

Answer 262

Amoxicillin or a tetracycline for 5 days

Question 263

What antibiotic therapy is recommended in low severity CAP and how long for?What would be alternatives?

Answer 263

AmoxicillinAlternatives= doxycycline, clarithromycin7 days (if infection caused by staph (MRSA), it would be 14-21 days)

Question 264

What antibiotic therapy is recommended in moderate severity CAP and how long for?

Answer 264

Amoxicillin AND clarithromycinOr doxycycline alone 7 days

Question 265

What antibiotic therapy is recommended in high severity CAP and how long for?

Answer 265

Co-amoxiclav with clarithromycin or oral erythromycin (in pregnancy). Alternative in penicillin allergy: levofloxacin (consult local microbiologist if fluoroquinolone not appropriate).

Question 266

For life-threatening CAP, what would be the recommended treatment and how long for?If the patient was penicillin allergic, what would be the alternative?

Answer 266

Co-amoxiclav with clarithromycin or oral erythromycin (in pregnancy). Alternative in penicillin allergy: levofloxacin (consult local microbiologist if fluoroquinolone not appropriate).

Question 267

In CAP, the usual treatment duration is 5 days. When would you extend this to 7-21 days?

Answer 267

If staphylococci suspected

Question 268

If MSRA was suspected in CAP, what would you add on to the treatment?

Answer 268

Teic/vanc

Question 269

What are the main organisms that cause pneumonia?

Answer 269

Streptococcus pneumoniaeHaemophilus influenzaeChlamydia pneumoniaeMycoplasma pneumoniaeLegionella pneumophila

Question 270

What would you use to treat pneumonia caused by chlamydial/mycoplasma?

Answer 270

Doxycycline

Question 271

What is the difference between early onset vs late onset HAP (in terms of days in hospital)?

Answer 271

Early onset = less than 5 days admission to hospitalLate onset = more than 5 days after admission to hospital

Question 272

How do you treat early onset HAP?

Answer 272

Co-amox or cefuroxime

Question 273

How do you treat late onset HAP?

Answer 273

Antipseudomonal penicillin e.g. Pip TazORBroad spectrum cephalosporin e.g. ceftazidimeORQuinolone e.g. ciprofloxacinMRSA- add vanc

Question 274

What would you use to treat a small area of impetigo?

Answer 274

Fusidic acid

Question 275

What would you use to treat a widespread infection of impetigo?If penicillin allergic, what would be an alternative?

Answer 275

Oral flucloxacillin Clarithromycin

Question 276

What would you use to treat cellulitis?If penicillin allergic, what can be used?

Answer 276

High dose flucloxacillin Clindamycin/clarithromycin

Question 277

What antibiotic would you use for mastitis during breastfeeding?What if penicillin allergic?

Answer 277

FlucloxacillinErythromycin10-14 days

Question 278

What are the side effects of aminoglycosides?

Answer 278

Hearing impairment (ototoxicity - patients should report tinnitus, hearing loss, vertigo)NephrotoxicityMay impair muscle transmission-c/i in myasthenia gravis

Question 279

What is the risk of aminoglycosides to the infant in pregnancy?

Answer 279

Risk of auditory or vestibular nerve damage

Question 280

What is a possible problem with carbapenems that means it is cautioned in CNS disorders?

Answer 280

Seizure inducing potential Also increased risk of seizures if renal impairment is present

Question 281

Should you give carbapenems if there is a history of immediate hypersensitivity to penicillins?

Answer 281

No

Question 282

True or false:Cephalosporins penetrate the meninges poorly unless they are inflamed

Answer 282

TRUE

Question 283

What are some common side effects of cephalosporins?

Answer 283

Abdo painEosoniphiliaThrombocytopenia

Question 284

Should you give cephalosporins if there is a history of penicillin allergy?

Answer 284

Used in cautionBut should not be given if there is immediate hypersensitivity

Question 285

What are the glycopeptide antibiotics?

Answer 285

DalbavancinTeicoplaninTelavancinVancomycin

Question 286

Which of the following antibiotics has a lower incidence of nephrotoxicity:TeicoplaninVancomycin

Answer 286

Teicoplanin

Question 287

What drugs are associated with red man syndrome?

Answer 287

GlycopeptidesTeicoplaninVancomycin

Question 288

What is the main advice to give to patients on clindamycin and should stop taking if this happens?

Answer 288

Diarrhoea Stop and contact doctor

Question 289

What are the cautions in macrolides?

Answer 289

QT prolongationand electrolyte disturbances

Question 290

Amoxicillin can cause an increased risk of erythematous rash in what conditions?

Answer 290

Acute lymphocytic leukaemiaChronic lymphocytic leukaemiaCMVGlandular fever

Question 291

Why should you maintain adequate hydration with high doses of IV amoxicillin?

Answer 291

Risk of crystalluria Especially in renal impairment

Question 292

What is the dose of amoxicillin in susceptible infection for a child 1-11 months?

Answer 292

125mg TDS (increased up to 30mg/kg TDS if needed)

Question 293

What is the dose of amoxicillin in susceptible infection for a child 1-4 years?

Answer 293

250mg TDS(increased up to 30mg/kg TDS if needed)

Question 294

What is the dose of amoxicillin in susceptible infection for a child 5-11 years?

Answer 294

500mg TDS(increased up to 30mg/kg TDS if needed)

Question 295

What is the dose of amoxicillin in susceptible infection for a child 12-17 years?

Answer 295

500mg TDSIncreased up to 1g TDS if needed

Question 296

What is the dose of amoxicillin in susceptible infection for an adult?

Answer 296

500mg TDS

Question 297

What is the MHRA warning surrounding flucloxacillin?

Answer 297

Cholestatic jaundice and hepatitis

Question 298

What is a side effect of oral amoxicillin and co-amox in terms of colouring the patient's tongue?

Answer 298

Black hairy tongue

Question 299

Ciprofloxacin is a type of what antibiotic?

Answer 299

Quinolone

Question 300

What is the important safety information regarding fluoroquinolones?

Answer 300

May induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.Tendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatmentSmall increased risk of aortic aneurysm and dissection

Question 301

Should quinolones be used in MRSA?

Answer 301

No

Question 302

What quinolone is active against pseudomonas?

Answer 302

Ciprofloxacin

Question 303

What are some common side effects of quinolones?

Answer 303

QT prolongationHearing impairmentDecreased appetiteRhabdomylosisDrug should be discontinued if psychiatric, neurological reactions occurCautioned in young adults and children- risk of arthropathy

Question 304

What antibiotic would you use for PCP prophylaxis and treatment?

Answer 304

Co-trimoxazole

Question 305

What is a rare but serious side effect of co-trimoxazole?

Answer 305

Blood disorders Rash - steven johnson's syndrome

Question 306

What age group are tetracyclines contraindicated in?

Answer 306

Children < 12 due to deposition in growing bones and teeth Staining of teeth can occur

Question 307

What are the common side effects of tetracyclines?

Answer 307

Angiodema Henoch Schonlein purpura (spotty rash) Photosensitivity reaction Headaches and visual disturbances- may indicate benign intercranial hypertension - discontinue if intercranial pressure increases

Question 308

Is there any special patient advice with doxycycline?

Answer 308

Should be taken with mealsAvoid exposure to sunlight and sun lamps Do not take zinc, indigestion remedies 2 hours before or after

Question 309

What is a serious side effect of chloramphenicol when given systemically?

Answer 309

Haemotological side effects (agranulocytosos, bone marrow disorder) Aplastic anaemia- reports of leukaemiaShould only be reserved for life-threatening conditions e.g. typhoid fever

Question 310

What muscle side effect can daptomycin cause?

Answer 310

MyopathyReport any muscle weakness and monitor creatine kinase if necessaryNeed to monitor CK twice a week whilst on it

Question 311

What monitoring requirements are needed for systemic fusidic acid?

Answer 311

Elevated liver enzymes, hyperbilirubinaemia and jaundice can occur with systemic useManufacturer advises monitor liver function with high doses or on prolonged therapy

Question 312

What is the important safety information regarding linezolid?

Answer 312

Severe optic neuropathy- patients should report visual impairment Blood disorders - thrombocytopenia, anaemia,

Question 313

What food does linezolid interact with and why?

Answer 313

Tyramine-rich foods (such as mature cheese, salami)Avoid consuming large amountsAlso is a reversible MAOI

Question 314

Is linezolid active against gram-ve, gram+ve or both?

Answer 314

Gram +ve

Question 315

What would be the dose of trimethoprim in an adult for UTI?

Answer 315

200mg BD

Question 316

Can you use trimethoprim in renal impairment?

Answer 316

Yes- monitorMay need to half normal dose

Question 317

What is the patient advice surrounding rifampicin?

Answer 317

May stain contact lenses red Report signs of liver disorder May colour urine red - harmless

Question 318

How does rifampicin interact with hormonal contraceptives?

Answer 318

Effectiveness of hormonal contraceptives are reduced - alternative method needed

Question 319

What antibiotics are used in the initial phase of TB treatment?

Answer 319

Rifampicin IsoniazidPyrazinamideEthambutolStreptomycin- hardly used but may be useful if resistant to isoniazid

Question 320

How many antibacterials are used in the initial phase of TB treatment and how long for?

Answer 320

4 FOR 2 months

Question 321

How many antibacterials are used in the continuous phase of TB treatment and how long for?

Answer 321

2 FOR 4 months

Question 322

If someone is isoniazid, what else must be prescribed and why?

Answer 322

Pyridoxine (vitamin B6)Prophylaxis of isoniazid-induced neuropathy

Question 323

Generally speaking, after 2 months of RIPE treatment for TB, what antibiotics are continued for a further 4 months?

Answer 323

Rifampicin and isoniazid (needs to be on pyridoxine for prevention of neuropathy)

Question 324

What treatment for TB should be given in pregnancy and breastfeeding?

Answer 324

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 4 monthsShould NOT be given streptomycin

Question 325

DOT TB therapy should be offered to which groups of people?

Answer 325

Directly observed therapy should be offered to patients who:-Have a history of non-adherence;-Have previously been treated for tuberculosis;-Are in denial of the tuberculosis diagnosis;have multidrug-resistant tuberculosis;have a major psychiatric or cognitive disorder;-Have a history of homelessness, drug or alcohol misuse;-Are in prison, or have been in the past 5 years;-Are too ill to self-administer treatment;-Request directly observed therapy.

Question 326

In a patient with HIV and TB, starting antiretrovirals in the first 2 months of TB treatment can increase the risk of what?

Answer 326

Immune reconstitution syndrome

Question 327

In patients with HIV and TB, how long should the TB treatment be for?What is the exception to this?

Answer 327

6 monthsHowever if the TB has CNS involvement, 12 months max

Question 328

What is the general TB treatment regimen?

Answer 328

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 4 months

Question 329

What is the general CNS TB treatment?

Answer 329

RIPE for 2 months and then RI (Rifampicin and isoniazid) for a further 10 monthsInitial high dose of dexamethasone or prednisolone should be started at the same time and slowly withdrawn over 4-8 weeks

Question 330

What would be the treatment regimen for latent TB?

Answer 330

Isoniazid for 6 months - recommended if interactions with rifampicin a concernOR rifampicin and isoniazid for 3 months - recommended if hepatotoxicity a concern

Question 331

A break in TB treatment of how many weeks is classed as a treatment interruption?

Answer 331

2 weeks

Question 332

What are the 6 toxicity syndromes associated with intermittent TB treatment?

Answer 332

Influenza-like, abdominal, and respiratory symptoms, shock, renal failure, and thrombocytopenic purpura

Question 333

What is the brand name of the medicine that contains RIPE for TB?

Answer 333

Voractiv

Question 334

What is the brand name of medicine that contains RI (rifampicin and isoniazid) for TB?

Answer 334

Rifinah

Question 335

Why is ethambutol cautioned in young children?

Answer 335

Can cause visual impairmentEthambutol should be used with caution in children until they are at least 5 years old and capable of reporting symptomatic visual changes accurately.

Question 336

What kind of toxcity can ethambutol cause?

Answer 336

Ocular - report any visual disturbancesNephrotoxicityOther side effects include red-green colour blindness, hepatotoxicity

Question 337

What are the main side effects to look out for in a patient on isoniazid?

Answer 337

Peripheral neuropathyHepatic disordersOtotoxicity

Question 338

What are the main side effects to look out for in a patient on pyrazinamide?

Answer 338

HepatoxicityAggravates gout

Question 339

What antibiotics respond to a lower UTI?

Answer 339

TrimethoprimNitrofurantoinAmoxicillinAmpicillinCefalexin

Question 340

What is the recommended duration of treatment for uncomplicated UTI in women?

Answer 340

3 days

Question 341

What antibiotics for a UTI should be used in pregnancy?

Answer 341

Penicillins and cephalosporins are the best choices

Question 342

At what EGFR should you avoid prescribing nitrofurantoin in?

Answer 342

<45

Question 343

Does does caspofungin interact with and what should be done about the dose?

Answer 343

Some enzyme inducers e.g. rifampicin, carbamazepine, phenytoin increase dose to 70mg daily (if not already on it)

Question 344

What is the risk of giving an infusion of amphotericin?

Answer 344

Risk of arrhythmias if given too rapidly Anaphylaxis- test dose is needed and close observation is needed for first 30 mins after this test dose

Question 345

What are some side effects of amphotericin?

Answer 345

#NAME?

Question 346

Are different preparations of amphotericin interchangeable?

Answer 346

No Vary in PD, PKShould preferably prescribe by brand to avoid confusion

Question 347

What are some side effects of fluconazole?

Answer 347

#NAME?

Question 348

What is a specific side effect with IV isavuconazole?

Answer 348

Infusion related reactions:Hypotension, SOB, paraesthesiaNausea, headacheDiscontinue if these occur

Question 349

What is the important safety information regarding itraconazole?

Answer 349

Reports of heart failure, especially in high risk patients:- High dose and long courses- Patients on negative ionotropic drugs- CCBs- Elderly - Chronic heart diseaseShould be avoided in those with a history of heart failure unless the infection is serious Also, hepatotoxicity that can be life-threatening can occur. Patient should be aware of liver disorder signs

Question 350

What are the specific side effects for voriconazole that requires patient counselling?

Answer 350

Hepatotoxicity- patients should be aware of liver disorder signsPhototoxicity- patients should avoid intense or prolonged exposure to direct sunlight, avoid sunbeds If they get sunburnt, seek medical attention It is the antifungal that is most associated with hallucinationsKeep an alert card on them

Question 351

What is the contraception and conception advice for both men and women who are on griseofulvin (antifungal for dermatophyte infections of the skin)?

Answer 351

Women:Should continue effective contraception at least 1 month after administration. The effectiveness of the pill may reduce so use an additional barrier methodMen: Avoid fathering a child during and for at least 6 months after administration

Question 352

What adjunctive therapy is recommended in PCP treatment in patients with HIV?

Answer 352

For moderate to severe infections, prednisolone for 21 days

Question 353

True or false:All members in a household must be treated if one person in the house has threadworm

Answer 353

TRUE

Question 354

What is the drug of choice for threadworm?

Answer 354

Mebendazole

Question 355

For malaria prophylaxis, what are mosquito nets usually impregnated with?

Answer 355

Permethrin (insecticide)

Question 356

Can DEET spray be used during pregnancy and breastfeeding?

Answer 356

Yes

Question 357

When applying DEET and suncream, what should be applied first?

Answer 357

Suncream Then DEET

Question 358

How does DEET spray affect the SPF of suncream?

Answer 358

Lowers it so a factor 30-50 should be used

Question 359

Generally speaking, how much time before travelling should malaria prophylaxis be started?What are the exceptions to this?

Answer 359

1-2 weeks before Mefloquine is 2-3 weeks beforeMalarone and doxycycline is 1-2 days beforeIn warfarin patients- 2-3 weeks before

Question 360

How much time before travelling should malaria prophylaxis with Malarone be started?

Answer 360

1-2 days before

Question 361

How much time before travelling should malaria prophylaxis with doxycycline be started?

Answer 361

1-2 days before

Question 362

How much time before travelling should malaria prophylaxis with mefloquine be started?

Answer 362

2-3 weeks before

Question 363

How long can Malarone be used for in malaria prophylaxis?

Answer 363

Up to 1 year

Question 364

How long can doxycycline be used for in malaria prophylaxis?

Answer 364

Up to 2 years

Question 365

How long can mefloquine be used for in malaria prophylaxis?

Answer 365

Up to 1 year

Question 366

What antimalarials are unsuitable for those with epilsepy?What would be alternatives?

Answer 366

ChloroquineMefloquineProguanil is recommended in areas with chloroquine resistanceDoxycyline or Malarone is recommended in areas without chloroquine resistance

Question 367

Which group of patients are at a particularly high risk of severe malaria?

Answer 367

Those without a spleen

Question 368

What antimalarials can be given at their usual dose during pregnancy?

Answer 368

ChloroquineProguanilHowever, resistance exists so may have to look at other options, only if benefit outweighs risk and travel is unavoidable

Question 369

If a pregnant lady is on proguanil during malaria prophylaxis, what else must she be on?

Answer 369

Folic acid at high dose (5mg) for at least the first trimester

Question 370

How long should malaria prophylaxis continue after leaving the at risk country?What is the exception to this?

Answer 370

Continue for 4 weeks afterExcept for Malarone which is 1 week

Question 371

In warfarin patients, when should malaria prophylaxis begin?

Answer 371

2-3 weeks before travellingINR should be stable before departure

Question 372

When should INR be checked in warfarin patients on malaria prophylaxis?

Answer 372

Before starting the course7 days after starting the course After completing the courseFor prolonged stays, INR needs to be checked at regular intervals

Question 373

What is standby malaria treatment?

Answer 373

Travellers visiting remote, malarious areas for prolonged periods should carry standby treatment if they are likely to be more than 24 hours away from medical care. Self-medication should be avoided if medical help is accessible.In order to avoid excessive self-medication, the traveller should be provided with written instructions that urgent medical attention should be sought if fever (38°C or more) develops 7 days (or more) after arriving in a malarious area and that self-treatment is indicated if medical help is not available within 24 hours of fever onset.

Question 374

When travelling to different places that require 2 different malaria prophylaxis regimens, what do you do?

Answer 374

The regimen for the higher risk area should be used for the whole journey

Question 375

What combination of antimalarials is in Malarone/Maloff?

Answer 375

Atovaquone and proguanil

Question 376

For the treatment of malaria, is the infective species is unknown/mixed, what are the options?

Answer 376

MalaroneRiametQuinine

Question 377

What is P. Falciparum resistant to?

Answer 377

Chloroquine

Question 378

What are the treatment options for malaria caused by P.Falciparum?

Answer 378

Quinine (with doxycycline or clindamycin)MalaroneRiamet

Question 379

What are the treatment options for malaria caused by P.Falciparum in pregnancy?

Answer 379

Quinine followed by clindamycin(cannot use doxycycline)

Question 380

What are the treatment options for non-falciparum malaria?

Answer 380

ChloroquineHowever, if resistant- Malarone or Riamet

Question 381

What are the treatment options for non-falciparum malaria in pregnancy?

Answer 381

Chloroquine

Question 382

What antimalarials does Riamet contain?

Answer 382

Artemether and lumefantrine

Question 383

What is the important safety information with chloroquine?

Answer 383

Occular toxicity Very toxic in overdose

Question 384

What are some side effects of chloroquine?

Answer 384

QT prolongation Agranulocytosis Side-effects which occur at doses used in the prophylaxis or treatment of malaria are generally not serious Arrhythmias and convulsions in overdose

Question 385

What is a main neurological side effect of mefloquine?

Answer 385

Mefloquine is associated with potentially serious neuropsychiatric reactions. Abnormal dreams, insomnia, anxiety, and depression occur commonly.Therefore, contraindicated in those with history of psychiatric disorders including depressionHas a long half life so can persist up to several months after discontinuation

Question 386

What screening should be done before a patient starts taking primaquine and why?

Answer 386

G6PD as if deficient, can cause haemolysis

Question 387

What is the difference between quinine sulphate and quinine bisulphate?

Answer 387

Bisulphate has less quinine inShould not be used for malaria, only quinine sulphate

Question 388

What is the important safety information regarding quinine?

Answer 388

QT prolongation

Question 389

What are the initial treatment options for chronic Hep B?

Answer 389

Peginterferon alphaInterferon alphaTreatment with the above should be stopped if no improvement after 4 monthsEntecavirTenofovirTreatment should be changed to other antivirals if no improvement after 6-9 months

Question 390

What determines treatment route for chronic Hep C?

Answer 390

Before starting treatment, the genotype of the infecting hepatitis C virus should be determined and the viral load measured as this may affect the choice and duration of treatment.

Question 391

What is used for the initial treatment of chronic Hep C?

Answer 391

Combination of ribavirin and peginterferon alphaRibavirin monotherapy=ineffective

Question 392

What is the MRHA warning regarding direct-acting antivirals to treat chronic Hep C?

Answer 392

Risk of interaction with Vitamin K antagonists and changes in INR. INR needs to be monitored closelyRisk of Hep B reactivation (if patient has both B and C)Need to be screened for Hep B before starting treatment

Question 393

What is herpes labialis?

Answer 393

Cold sore

Question 394

What is herpes zoster?

Answer 394

Shingles

Question 395

What is varicella?

Answer 395

Chicken pox

Question 396

In shingles, within how many hours of rash onset should antivirals be started?How long is it continued for?

Answer 396

Within 72 hoursContinued for 7-10 days

Question 397

In adults with chickenpox, within how many hours of rash onset should antivirals be started to reduce duration and severity of symptoms?

Answer 397

Within 24 hours

Question 398

What kind of drug is foscarnet?

Answer 398

Antiviral

Question 399

What antivirals are used for CMV?

Answer 399

Ganciclovir IVValganciclovir POFoscaret - toxic and causes renal impairment

Question 400

During CMV treatment, what does ganciclovir cause if given with zidovudine (for HIV)?

Answer 400

Myelosuppression

Question 401

Initial treatment of HIV-1 includes what combination types of antiretroviral drugs?

Answer 401

Triple therapy2 nucleoside reverse transcriptase inhibitors and ONE of the following;- Boosted protease inhibitor- Non-nucleoside reverse transcriptase inhibitor- Integrase inhibitor

Question 402

What is used for HIV pre-exposure prophylaxis?

Answer 402

Emtricitabine with tenofovir

Question 403

Why are some HIV medicines used in combination with cobicistat?

Answer 403

It is a pharmacokinetic enhancer that boosts the concentrations of other antiretrovirals, but it has no antiretroviral activity itself.

Question 404

Name the nucleoside reverse transciptase inhibitors for HIV

Answer 404

ZidovudineAbacavirDidanosineEmtricitabineLamivudineStavudineTenofovir disoproxil.

Question 405

Name the protease inhibitors used for HIV

Answer 405

AtazanavirDarunavirFosamprenavirRitonavirSaquinavirTipranavir*Metabolised by cytochrome P450 enzyme systems*

Question 406

Name the integrase inhibitors used for HIV

Answer 406

Dolutegravir, elvitegravir and raltegravir

Question 407

Name the non-nucleoside reverse transcriptase inhibitors used for HIV

Answer 407

Efavirenz, etravirine, nevirapine, and rilpivirine

Question 408

What is Maraviroc?

Answer 408

Antagonist of the CCR5 chemokine receptor. It is licensed for patients exclusively infected with CCR5-tropic HIV.

Question 409

What has been reported in patients with advanced HIV disease or following long-term exposure to antiretroviral treatment?

Answer 409

Osteonecrosis

Question 410

What is the MHRA advice regarding preparations containing dolutegravir (integrase inhibitor used for HIV)?

Answer 410

Increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception

Question 411

What CNS effects can efavirenz cause and how can this be reduced?

Answer 411

Depression, psychosis, confusion, hallucination, abnormal behaviour, suicidal ideations Take the dose at bedtime, especially during the first 2-4 weeks of treatment

Question 412

What reaction can occur with HIV medicines?

Answer 412

Hypersensitivity e.g. Rash, lesions, oedema, SOB

Question 413

Which HIV medicine is associated with a high incidence of rash including Stevens-Johnson syndrome?

Answer 413

Nevirapine

Question 414

What is the important information that requires patient counselling for patients on nevirapine for HIV?

Answer 414

#NAME?

Question 415

Efavirenz for HIV is associated with an increase in plasma concentration of what substance?

Answer 415

Cholesterol

Question 416

What are the long term effects of HIV treatment?

Answer 416

1.Immune reconstitution syndrome: as the immune system stands up on its feet again due to antiretroviral treatment, marked inflammatory reactions happen against opportunistic organisms2. Lipodystrophy syndrome: this is made up of insulin resistance, fat redistribution and dyslipidaemiaBlood lipids and sugars should be measured before, 3-6 months after and yearly after HIV treatment.3. Osteonecrosis: following long-term exposure to treatment.

Question 417

Protease inhibitors are mainly associated with what side effects?

Answer 417

Lipodystrophy and metabolic effects.

Question 418

What can be used for the treatment of influenza and within how many hours of symptom onset should it be started?

Answer 418

Oseltamivir (Tamiflu) first line and zanamivir is reserved for those who are immunocompromised or when oseltamivir cannot be usedWithin 48 hours

Question 419

What can be used for post-exposure prophylaxis of influenza and within how many hours of exposure?

Answer 419

Oseltamivir (Tamiflu) within 48 hours of exposure and zanamivir within 36 hours of exposure

Question 420

How long should influenza treatment be for?

Answer 420

Twice daily dosing for 5 days

Question 421

How long should post-exposure prophylaxis for influenza be for?

Answer 421

Once daily dosing for 10 days

Question 422

What is a particular caution with co-amoxiclav in in terms of side effects?

Answer 422

Cholestatic jaundice can occur either during or shortly after the use of co-amoxiclav.

Question 423

What is a rare but potentially fatal side effect of ketoconazole?

Answer 423

Associated with fatal hepatotoxicity. The CSM advise that prescribers shouldweigh the potential benefits of ketoconazole treatment against the risk of liver damage and shouldcarefully monitor patients both clinically and biochemically.

Question 424

What penicillin based antibiotics must you take on an empty stomach (1 hour before food or 2 hours after food)?

Answer 424

FlucloxacillinAmpicillinPenicillin V

Question 425

What shouldn't a patient take at the same time as tetracycline antibiotics?

Answer 425

Do not take milk, indigestion remedies, or medicinescontaining iron or zinc at the same time of day as this medicine (prevents absorption of the antibioticand should be taken 2-3 hours apart)Oxytetracycline and tetracycline should be taken on an empty stomach

Question 426

Which tetracycyline antibiotics should be taken on an empty stomach?

Answer 426

Oxytetracycline and tetracycyline

Question 427

What is the patient advice surrounding trimethoprim?

Answer 427

On long-term treatment, patients and their carers should be told how to recognise signs of blood disorders and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop.

Question 428

True or false:Rifampicin should be taken on an empty stomach

Answer 428

TRUE

Question 429

True or false:Metronidazole should be taken on an empty stomach

Answer 429

FalseTake with or just after food

Question 430

What shouldn't a patient take at the same time as ciprofloxacin?

Answer 430

Do not take milk, indigestion remedies, or medicines containing iron orzinc at the same time of day as this medicine.

Question 431

What specific monitoring should you do with daptomycin?

Answer 431

Creatine kinase twice a week

Question 432

What is the CHMP advice regarding the use of oral ketoconazole to treat fungal infections?

Answer 432

Marketing authorisation for oral ketoconazole to treat fungal infections should be suspended. The CHMP concluded that the risk of hepatotoxicity associated with oral ketoconazole is greater than the benefit in treating fungal infectionPeople with a prescription for oral ketoconazole should be referred back to their doctors

Question 433

How does calcium carbonate interact with doxycycline? What do you recommend the patient does if the patient is normally on calcium carbonate e.g. Adcal and is prescribed doxycycline?

Answer 433

Calcium carbonate is predicted to decrease the absorption of doxycycline Separate administration by 2-3 hours

Question 434

What CD4 count is classed as AIDs?

Answer 434

<200

Question 435

Which of the following is active against pseudomonas:- Benpen- Flucloxacillin- Ampicillin- Piperacillin

Answer 435

Piperacillin (Pip taz)

Question 436

Which antibacterial drug increases the risk of serotonin syndrome?LinezolidVancomycinTelvancinSeptrin

Answer 436

Linezolid as it is a weak MAOI Serotonin syndrome risk increases with:SSRIsTCAsMacrolidesAmiodaroneFluoroquinolonesAntipsychoticsQuinineRisk of hypertensive crisis

Question 437

Which drug class is most associated with lipodystrophy?Antiretroviral drugsAlkylating agentsTCAsARBs

Answer 437

Antiretroviral drugs can cause redistribution of fat around the body

Question 438

Quinine can be very toxic - what are the signs of toxicity?

Answer 438

Life-threatening features include arrhythmias (which can have a very rapid onset) and convulsions (which can be intractable).

Question 439

What are adverse effects of quinine?

Answer 439

TinnitusDeafnessBlindnessQT prolongationHypoglycaemiaGI upsetHypersensitivity reactions

Question 440

What advice should you give to a patient on metronidazole regarding their urine?

Answer 440

May darken urine (brown)

Question 441

Which of these is used to boost the effects of protease inhibitors?ElvitegravirMaravirocRitonavirEtravirine

Answer 441

Ritonavir - it is a protease inhibitor itself but it inhibits CYP enzymes that would otherwise metabolise other protease inhibitors

Question 442

What are the side effects of trimethoprim?

Answer 442

Megaloblastic anaemiaGI effectsTaste disturbanceElevated creatinine levelsSkin rashHyperkalaemia

Question 443

Trimethoprim can cause high levels of what electrolyte?

Answer 443

Potassium

Question 444

What is the advice surrounding ribavirin and contraception?

Answer 444

Effective contraception essential during treatment and for 4 months after treatment in females and for 7 months after treatment in males of childbearing age.

Question 445

What is the standard dose of oseltamivir in:i) Treatment of fluii) Prevention of flu

Answer 445

i) 75mg BD for 5 days for treatmentii) 75mg OD for 10 days for prophylaxis

Question 446

Is vancomycin good for treating gram negative or positive organisms?

Answer 446

Gram positive

Question 447

Is teicoplanin good for treating gram negative or positive organisms?

Answer 447

Gram positive

Question 448

Allopurinol and what antibiotic can result in a skin rash?

Answer 448

Amoxicillin

Question 449

True or false:NSAIDs and fluoroquinolones together increase seizure risk

Answer 449

TRUE

Question 450

Can macrolides cause QT prolongation?

Answer 450

Yes

Question 451

What tetracyclines can you take with milk?

Answer 451

Does Like Milk acronymDoxyclineLymecyclineMinocycline

Question 452

What is 1st line treatment for chlamydia (both the patient and partner)?If this is not suitable, what regimes can be used instead?

Answer 452

Doxycycline 100 mg BD for 7 daysAlternatives:Azithromycin 1 g orally for one day, then 500mg orally once daily for two daysErythromycin 500 mg BD for 10–14 days

Question 453

How you manage a pregnant lady with chlamydia?

Answer 453

Azithromycin 1 g orally for one day, then 500mg orally once daily for two daysErythromycin 500 mg BD for 10–14 days

Question 454

If a patient is thought to have chlamydia and presents in a primary care setting, where should you refer to?

Answer 454

GUM clinic

Question 455

When should you do an STI screen in a patient with chlamydia?

Answer 455

1 week after completing treatment

Question 456

If a patient and their partner are being treated for chlamydia, how long should they abstain from sexual intercourse?With what antibiotic is this different?

Answer 456

Until they have both finished treatmentWith azithromycin, you need to wait 7 days after

Question 457

Does a partner of someone of chlamydia need to be treated if their screen result is negative?

Answer 457

Yes

Question 458

How many weeks after the start of treatment do you do a test of cure treatment for chlamydia?

Answer 458

5 weeks

Question 459

What age should you offer repeat testing of chlamydia in 3-6 months after treatment?

Answer 459

<25 years

Question 460

What can a high ESR indicate?

Answer 460

Inflammation, infection

Question 461

Is ESR usually low or raised in infection?

Answer 461

Raised

Question 462

Why aren't quinolones e.g. ciprofloxacin, ofloxacin generally used in children?

Answer 462

Quinolones cause arthropathy and therefore are not recommended in children and growing adolescents.

Question 463

What is the cut off eGFR for nitrofurantoin?

Answer 463

45

Question 464

Can you use tetracyclines in renal impairment?

Answer 464

No - should not be given at all in renal impairment Apart from doxycycline and minocycline (but these should be used with caution)

Question 465

Can tetracyclines cause hepatotoxicity?

Answer 465

Yes

Question 466

True or false:Tetracyclines can be used during pregnancy

Answer 466

FALSE

Question 467

True or false:Trimethoprim can be used during pregnancy

Answer 467

False - teratogenic in first trimester

Question 468

True or false:Nitrofurantoin can be used during pregnancy

Answer 468

True But avoid at term

Question 469

Can metronidazole be used during pregnancy?

Answer 469

No Only use if benefit outweighs risk

Question 470

Is Ben Pen active against streptococci?

Answer 470

Yes

Question 471

Is linezolid active against MRSA?

Answer 471

Yes

Question 472

Can chloramphenicol be used in pregnancy?

Answer 472

No

Question 473

Should metronidazole be taken with or without food?

Answer 473

With or just after food

Question 474

What electrolyte disturbances can be caused by aminoglycosides?

Answer 474

HypokalaemiaHypo MgHypo Ca

Question 475

What is the MHRA warning about gentamicin?

Answer 475

Potential for histamine-related adverse drug reactions with some batches

Question 476

Is gentamicin used for MRSA?

Answer 476

No

Question 477

Red man syndrome caused by vancomycin causes is associated with what other clinical features?

Answer 477

HypotensionBronchospasms Caused by rapid infusion

Question 478

Which is associated with a higher incidence of nephrotoxicity?TeicoplaninVancomycin

Answer 478

Vancomycin

Question 479

If a patient on a tetracycline develops a headache, what should they do?

Answer 479

Stop Side effect of tetracyclines- benign intracranial hypertension

Question 480

What tetracyclines should you avoid milk in? (DOT)

Answer 480

DemeclocyclineOxytetracyclineTetracycline

Question 481

What tetracyclines can you have milk with? (DLM)

Answer 481

Doxycycline LymecyclineMinocycline

Question 482

What tetracyclines cause oesophageal irritation and is recommended to take with plenty of fluid?

Answer 482

DoxycyclineMinocyclineTetracycline

Question 483

Can ciprofloxacin cause QT prolongation?

Answer 483

Yes

Question 484

Are quinolones active against MRSA?

Answer 484

No

Question 485

If a patient on a quinolone develops psychiatric disturbances, what should you recommend?

Answer 485

They should stop the drug

Question 486

What is the interaction between ciprofloxacin and theophylline?

Answer 486

Ciprofloxacin is an enzyme inhibitor and causes theophylline toxicity - convulsions risk

Question 487

Which quinolone should you protect yourself from sunlight if on it?

Answer 487

Ofloxacin

Question 488

Cholestatic jaundice risk is increased with amoxicillin/flucloxacillin if on it for more than how many days?

Answer 488

14 days

Question 489

What is the dosing regimen for Malarone for the prophylaxis of malaria?

Answer 489

1 tablet OD, started 1-2 days before, during, and 7 days afterTake with food/milky drink

Question 490

Should Malarone be taken on an empty stomach or with food?

Answer 490

Take with food/milky drink to maximise absorption

Question 491

What is the renal cut off for Malarone?

Answer 491

<30 mL/min

Question 492

What is the dosing regimen for doxycycline for the prophylaxis of malaria?

Answer 492

1 tablet OD, started 1-2 days before, during, and 4 weeks after

Question 493

How long do you continue malaria prophylaxis with doxycycline after leaving the area of risk?

Answer 493

4 weeks after

Question 494

What is the dosing regimen for chloroquine in the prophylaxis of malaria?

Answer 494

2 tablets once a weekStart 1 week before, during and 4 weeks afterTake just after food

Question 495

Should chloroquine be taken on an empty stomach?

Answer 495

No Take just after food

Question 496

Should proguanil be taken on an empty stomach?

Answer 496

No Take just after food

Question 497

What is the dosing regimen for proguanil in the prophylaxis of malaria?

Answer 497

2 tablets ODStarted 1 week beforeContinue for 4 weeks after Take just after food

Question 498

Should mefloquine be taken on an empty stomach?

Answer 498

No Take just after food

Question 499

What are the side effects associated with glycopeptides?

Answer 499

#NAME?

Question 500

What is the dose of trimethoprim for a UTI?

Answer 500

200mg BD

Question 501

What is the safest macrolide to use in pregnancy?

Answer 501

Erythromycin

Question 502

What is penicillin G?

Answer 502

Benzylpenicillin

Question 503

What is first line for acute infective exacerbation of COPD and how long for?

Answer 503

Amoxicilin, clarithromycin or doxycycline for 5 days

Question 504

What is first line for acute exacerbation of bronchietasis and how long for?

Answer 504

Amoxicilin, clarithromycin or doxycycline for 7-14 days

Question 505

What is low severity CAP in terms of CURB score?

Answer 505

0-1

Question 506

What is moderate severity CAP in terms of CURB score?

Answer 506

2

Question 507

What is high severity CAP in terms of CURB score?

Answer 507

03-May

Question 508

What is the CURB score and what does each marker mean?

Answer 508

Confusion - mental test 8 or less Urea > 7 mmol/LResp rate 30 breaths/min or moreBlood pressure systolic < 90 or diastolic 60 or less65 years and older1 point for eachLow risk 0-1Moderate 2High risk 3-5

Question 509

What monitoring is required for clindamycin?

Answer 509

Renal and liver function if more than 10 days of treatment