First Line Treatments

Question 1

C. difficile

Answer 1

Stop Abx and PPIs, if nil improvement within 48 hours after antibiotic cessation then start:

Metronidazole 400mg BD for 7 days (10mg/kg children)

70% cure rate, if not improving discuss w ID ? vancomycin

Question 2

hepatic encephalopathy

Answer 2

lactulose
titrating to 2 to 3 loose bowel motions a day

Question 3

Ascites

Answer 3

Spirolactone +/- frusemide
Limit sodium intake

Question 4

Spontaneous bacterial peritonitis prophylaxis

Answer 4

co-trimoxazole 480mg OD

Question 5

whooping cough

Answer 5

if within 3 weeks

azithromycin 500mg day one , then 250mg PO OD day 2- 5 days
(10mg/kg/dose)

• cotrimox if macrolide allergy

Question 6

Vitamin treatment for alcohol use disorder

Answer 6

Thiamine 50 mg four times a day or 100 mg twice a day (for prophylaxis against Wernicke encephalopathy), until six weeks after the patient stops drinking (or indefinitely if drinking continues).

Mvite or Bplex BD

Folic acid to treat folate deficiency.

Question 7

first line mild-moderate etoh withdrawal

Answer 7

Diazepam - weaning doses

Question 8

PID in a non pregnant women

Answer 8

Ceftriaxone 500 mg IM or IV STAT

PLUS

Doxycycline 100 mg PO BD for 2 weeks

PLUS

Metronidazole 400 mg PO BD for 2 weeks

severe PID/unwell should be acutely referred into hosp

Question 9

PID in a pregnant woman

emperic treatment for contacts

Answer 9

Same but use azithromycin 1g STAT then repeat in a week ( instead of doxycycline)

all contacts should be treated with doxycycline 100 mg PO BD for 1 week

Question 10

Treatment of mastitis

Answer 10

All should continue gentle massage, warm compress and ongoing breast emptying/expressing

If no improvment in 12 – 24 hours or systemically unwell
- flucloxacillin 500mg QID or
- Augmentin TDS or
- Cephalexin 500mg QID

Question 11

uncomplicated UTI

Answer 11

1st. Nitrofuratoin (MR 100g BD 5 days or 50mg QID 5 days)
- avoid if CrCl <60 or pregnant >36 weeks
- treat for 7 days in pregnant women or males

2nd: Cephalexin 500mg BD for 5 days

3rd: trimethoprim 300mg OD for 3 days
- avoid in first trimester

Question 12

UTI in a pregnant women

Answer 12

Treat for 7 days

Cephalexin 500mg BD
Nitro (up to 36 weeks)
trimethorim (avoid in the first trimester)
Amoxicillin 250mg TDS *use only if culture shows (S)

do a test of cure post treatment

Question 13

mild pyelonephritis

Answer 13

Cefalexin 1 g 3-4x daily for 10 days

Alternatives
- cotrimoxazole 960mg BD for 10 days
- Augmentin 625mg TDS for 10 days
- Ciprofloxacin (only if resistent or Pseudomonas suspected/confirmed) 500mg BD for 10 days

Question 14

first choice for a child with UTI

Answer 14

cephalexin 25mg/kg/dose TDS for 3 days

Question 15

Urethritis with discharge (presumed gonococcal)

Urethritis without discharge

Urethritis with known Gon/chlamy co-infection

Answer 15

1. ceftriaxone 500mg IM stat + azithromycin 1g
2. Doxycycline 100mg BD 7 days OR azithromcyin 1g STAT
3. ceftriaxone 500mg IM stat + 100mg doxycycline 7 days

Question 16

First line for smoking cessation/reduction

Answer 16

Behavioural support (quitline, aukati kaipaipa, pasifika support) and

NRT or
Bupropion (also used for depression) or
Nortriptyline

2nd Line: Varenicline
- due to neuropsych SEs and cost

Question 17

subsidised medication to treat etoh use disorder

Answer 17

Disulfiram: reacts w etoh, can be dangerous. fully subsidised med. Doesn’t reduce cravings or relapse. Limits the frequency of drinking and the amount consumed if relapse occurs.

naltrexone: reduces cravings
Acamprosate: reduces cravings, $$$

Question 18

Emergency contraception

Answer 18

Copper IUD (1st line)
Levonergestrol 1.5mg (take x2 if >70kgs, use up to 72hrs)

Question 19

Shingles

Answer 19

Valaciclovir 1g TDS (7 days)

2nd line: Aciclovir 800 mg, five times daily, for seven days

Question 20

Triple therapy for h.pylori

Answer 20

14 days
omeprazole 20mg BD
clarithromycin 500mg BD
amoxicillin 1g BD

(if prev macrolide exposure then metronidazole 400mg BD)

Question 21

2nd line for resistent h.pylori

Answer 21

14 days

Omeprazole, 20 mg twice daily; and
Tripotassium dicitratobismuthate (bismuth)*, 120 mg four times daily; and
Tetracycline†, 500 mg four times daily; and
Metronidazole, 400 mg three times daily

Question 22

bronchiectasis exacerbation (emperic tx)

Answer 22

Augmentin TDS for 14 days

Question 23

IECOPD or CAP
1st and 2nd line

Answer 23

1st: amoxicillin 1g TDS for 5-7 days

2nd (if penicillin allergy): Doxycycline 200mg BD on day 1, then 100mg BD for days 2-5

• if concern for atypical CAP add a macrolide (azithromycin 500mg OD for 3 days)

Question 24

child with CAP
1st and second

Answer 24

1st: amoxicillin 15-30mg/kg TDS for 5-7 days

2nd: erythromycin (10mg/kg) or azithromycin (10mg/kg)

Question 25

GAS - RF prophylaxis

Answer 25

Amoxicillin: 1g or 50mg/kg OD for ten days
Penicillin V: 500mg BD (or 250mg BD if <25kgs) for 10 days

Question 26

dental abscess

Answer 26

amoxicillin 15-30mg/kg or 1g PO TDS for 3-5 days

or

Erythromycin 7.5mg/kg or 400mg TDS for 5 days

Question 27

Abx prophylaxis for higher risk dental procedures

Answer 27

Amoxicillin
50 mg/kg (maximum 2 g), single dose, oral, IV or IM
2 g, single dose, oral, IV or IM

PO: one hour prior
IM: 30 minutes prior
IV: immediately before

Question 28

suspected meningitis

Answer 28

Ceftriaxone
< 30kg: 100 mg/kg stat dose IV/IM
>30kgs: 2 g, stat dose IV/IM

benzyl penicillin (penicillin G)
Child: 50 mg/kg (maximum 2 g/dose), stat IV/IM
Adult: 2.4 g, stat IV/IM

Question 29

Croup (mild, moderate, severe)

Answer 29

Mild/moderate: dexamethasone 0.15mg/kg + review in 2 hrs
Severe: dexamethasone 0.6 mg/kg + nebulised adrenaline + hospital admission