General principles

Question 1

What are the general symptoms of infections?

Answer 1

• Inflammation, swelling + pus
• Confusion in elderly
• Worsening renal function
• Breathing difficulties
• Bio markers: INC CRP, ESR, temp, resp, glucose, DEC bp

Question 2

What are the side effects of antibiotics?

Answer 2

Gastrointestinal: N, V + D (Taken after food (erythromycin))

Superinfection:
- Candidiasis
- Colitis: Most seen in clindamycin + broad spec (amoxicillin, 3rd + 4th generation cephalosporins and quinolones)

Question 3

Give examples of narrow spectrum abx

Answer 3

selected: less resistance
- Clindamycin
- Metronidazole
- Nitrofurantoin
- Phenoxymethylpenicillin
- Linezolid

Question 4

Give examples of broad spec abx

Answer 4

variety: serious infections
- Aminoglycosides
- Amoxicillin
- Quinolones
- Tetracyclines
- Cephalosporins
- Carbapenems
- Chloramphenicol

Question 5

Penicillin allergy

Answer 5

• Cross sensitive: cephalosporins + beta lactams
• Alt: Macrolides + Metronidazole (dental infection)

Question 6

Tetracyclines and children

Answer 6

• Avoid tetracyclines under 12 years old
• Discolours teeth + deposit in growing bones
• Except: doxycycline + lymecycline

Question 7

Quinolones in children/pregnancy

Answer 7

Causes joint diseases (arthritis in weight bearing joints)

Question 8

What are elderly at higher risk of when using abx?

Answer 8

• Abx associated colitis
• Renal + liver impairment
• Drug interactions

Question 9

Which abx are nephrotoxic?

Answer 9

• Aminoglycoside + glycopeptide
• Avoid tetracyclines in RI as they accumulate (except minocycline + doxycycline)
• Caution: nitrofurantoin (relies on renal clearance -need certain GFR, also risk of peripheral neuropathy in RI

Question 10

Which abx are hepatotoxic?

Answer 10

tetracyclines + rifampicin

Question 11

Which abx causes cholestatic jaundice?

Answer 11

co-amoxiclav + flucoxacillin

Question 12

Pregnancy and abx

Answer 12

• Can give: penicillins + cephalosporins
• Avoid: tetracyclines (discolour teeth + deposit in growing bones), trimethoprim (teratogenic) + nitrofurantoin (at term)
• Avoid Q-CAM: quinolones (arthropathy), chloramphenicol (grey baby), aminoglycosides (injection) + metronidazole

Question 13

Bacteria: Staphylococci

Answer 13

• Impetigo + cellulitis
• Abx: Flucoxacillin

Question 14

Bacteria: MRSA

Answer 14

• Abx: Vancomycin (OR teicoplanin) (OR linezolid - certain infections)

Question 15

Bacteria: Streptococci

Answer 15

• Sore throat
• Abx: Benzylpenicillin (for serious infections, phenoxymethylpenicillin

Question 16

Bacteria: Anaerobic bacteria (dental infections)

Answer 16

Abx: Metronidazole

Question 17

Bacteria: Pseudomonas aeruginosa

Answer 17

Abx: Gentamicin, antipseudomonal penicillin