Clindamycin + linezolid + metronidazole + chloramphenicol + nitrofurantoin + trimethoprim

Question 1

What is the MOA of clindamycin?

Answer 1

Active against anaerobes + gram +ve cocci (streptococci, penicillin resistant eg. MRSA)

Bacteriostatic (prevents protein synthesis)

Narrow spec

Question 2

Clindamycin: What is the indication?

Answer 2

MRSA

Staphylococcal bone + joint

Question 3

Clindamycin: What are the side effects?

Answer 3

Antibiotic associated colitis
- Counsel: Stop, report severe, prolonged or bloody diarrhoea

Question 4

What is the MOA of linezolid?

Answer 4

Active against gram +ve bacteria

Bacteriostatic

Narrow spec

Question 5

Linezolid: Indication

Answer 5

Complicated skin + tissue infections

Pneumonia

MRSA (used as an alternative)

Question 6

Linezolid: Side effect

Answer 6

Blood disorders: Monitor: FBC (esp Tx >10-14 days, severe RI, drugs)

Optic neuropathy
- Monitor: visual functions >28 days
- Counsel: report visual impairment, visual defects, eyesight changes

Question 7

Linezolid: Interaction

Answer 7

INC hypertensive crises
- Tyramine rich food
- MAOI (wait 2 weeks)
- Beta2 agonists
- Sympathomimetics (adrenaline)

Question 8

Chloramphenicol: MOA

Answer 8

Prevent protein synthesis (bacteriostatic)

Broad spec

Question 9

Chloramphenicol: Indication

Answer 9

Reserved for life threatening infections: Typhoid fever

Eye drops: conjunctivitis

Question 10

Chloramphenicol: Side effect

Answer 10

Blood disorders

Question 11

Chloramphenicol: Pregnancy

Answer 11

Grey baby syndrome (when given during 3rd trimester)

Question 12

Metronidazole: MOA

Answer 12

Active against anaerobic bacteria + protozoa

Prevent DNA synthesis (bactericidal)

Narrow spec

Question 13

Metronidazole: Indication

Answer 13

Anaerobic infections
- Oral
- H pylori
- Rosacea

Protozoal infections

Question 14

Metronidazole: Dose

Answer 14

400mg/500mg TDS

Question 15

Metronidazole: How to take

Answer 15

After food
- Label: take with or just after food, or a meal
- Label: warning: do not drink alcohol

Question 16

Metronidazole: Side effect

Answer 16

GI disturbances

Metallic taste

Oral mucositis

Furry tongue

Question 17

Nitrofurantoin: MOA

Answer 17

Only active against urinary pathogens

Bactericidal (damages bacterial DNA)

Broad spec

Question 18

Nitrofurantoin: how to take

Answer 18

Take with or just after food or meal

Question 19

Nitrofurantoin: Renal impairment

Answer 19

Avoid if eGFR <45

Question 20

Nitrofurantoin: Side effect

Answer 20

Yellow-brown urine

Nausea

Hepatotoxicity
- Monitor: liver function (LT Tx)

Pulmonary reactions
- Monitor: pulmonary symptoms (LT Tx)

Peripheral neuropathy

Question 21

Nitrofurantoin: Pregnancy

Answer 21

Avoid at term
- CI: infants <3M

Question 22

Trimethoprim: MOA

Answer 22

Bactericidal
Narrow spectrum

Question 23

Trimethoprim: Indication

Answer 23

Lower UTI

Co-trimoxazole contains trimethoprim + sulfamethoxazole: pneumocystitis jirovecil pneumonia (Causes SJS)

Question 24

Trimethoprim: Dose

Answer 24

200mg BD

Question 25

Trimethoprim: Side effect

Answer 25

Blood disorder
- Counsel: report signs of infection or blood disorder: sore throat, fever, mouth ulcers, bleeding

Hyperkalaemia

Question 26

Trimethoprim: Pregnancy

Answer 26

Teratogenic (antifolate)