Hospital Adult Empirical Treatment

Question 1

Meningitis Empirical Treatment

Answer 1

Ceftriaxone IV 2g bd
(Penicillin allergy: Chloramphenicol IV 25mg/kg qds)
+
Dexamethasone IV 10mg qds for 4 days only
(3ml of 3.3mg/ml dexamethsone base injection)

Question 2

Meningitis

Meningococcus organism identified

Answer 2

5 days ceftriaxone (if patient not
recovered by 5 days extend course to 7 days initially
and review) + stop dexamethasone

Question 3

Meningitis

Pneumococcus

Answer 3

10 days ceftriaxone (if patient taking
longer to respond extend course up to 14 days) + 4
days dexamethasone

Question 4

Meningitis

Haemophillus influenzae

Answer 4

10 days of ceftriaxone

+ stop dexamethasone

Question 5

Brain abscess

Answer 5

IV ceftriaxone 2g 12 hourly
+
IV metronidazole 500mg 8 hourly

Question 6

viral encephalitis

Answer 6

IV aciclovir 10mg/kg 8 hourly

14 days (21 if immunocompromised) then repeat LP.

Question 7

epiglottis/supraglottitis

Answer 7

IV ceftriaxone 2g od

Question 8

Pneumonia with a CURB65 score 3 or more (severe)

Answer 8

IV CO-AMOXICLAV 1.2g TDS
+
DOXYCYCLINE 100mg BD

HDU/ ICU:
IV CO-AMOXICLAV 1.2g TDS
\+
IV/ PO Clarithromycin 
500mg BD

PENICILLIN ALLERGY:
IV Levofloxacin 500mg BD

Question 9

Hospital Acquired Pneumonia

Non-severe

Answer 9

Non severe: PO Amoxicillin

(If penicillin allergic: Doxycycline 100mg bd)

TOTAL 5 days

Question 10

Hospital Acquired Pneumonia

Severe

Answer 10

IV Amoxicillin + Gentamicin

(If penicillin allergic:IV Co-trimoxazole + Gentamicin)

Step down: PO Co-trimoxazole TOTAL IV/PO 7 days

Question 11

Aspiration Pneumonia

Non-severe

Answer 11

PO Amoxicillin + Metronidazole

(If penicillin allergic: PO Doxycycline 100mg bd + Metronidazole)

TOTAL 5 days

Question 12

aspiration Pneumonia

severe

Answer 12

IV Amoxicillin + Metronidazole + Gentamicin

(If penicillin allergic: replace amoxicillin with PO Doxycycline or IV Clarithromycin*)

Step down: PO Amoxicillin + Metronidazole

(If penicillin allergic: Doxycycline 100mg bd + Metronidazole) TOTAL IV/PO 7 days

Question 13

Endocarditis

Native Valve Indolent (subacute)

Answer 13

Amoxicillin IV 2g 4 hourly + Gentamicin

Question 14

Endocarditis

Native Valve severe sepsis
acute

Answer 14

Flucloxacillin IV 2g 6 hourly (4 hourly if >85kg)

Question 15

Endocarditis

Prosthetic valve or Suspected MRSA

Answer 15

Vancomycin IV + Gentamicin

+ when therapeutic vancomycin levels reached add Rifampicin PO 600mg bd

Question 16

Peritonitis/Biliary Tract/Intra-abdominal

Answer 16

Total IV/PO 7 days

IV Amoxicillin + Metronidazole + Gentamicin

Step down: PO Co-trimoxazole + Metronidazole

(If penicillin allergic: IV Vancomycin + Metronidazole + Gentamicin

Question 17

Diabetic Foot Infection

Answer 17

7 days

Mild: Flucloxacillin 1g qds or Doxycycline 100mg bd

Moderate: Flucloxacillin 1g qds + Metronidazole 400mg tds
or doxycycline 100mg bd + Metronidazole 400mg tds

Question 18

Open Fracture Prophylaxis

Answer 18

Cefuroxime 1.5g IV every 8 hours

Start within 3 hours for max 72 hours

Question 19

Acute Septic Arthritis/Osteomyelitis

Answer 19

IV Flucloxacillin 2g qds

Question 20

PID Inpatient Treatment

normal

Answer 20

IV ceftriaxone 2g daily + IV metronidazole 500mg three times daily + PO Doxycycline 100mg twice daily

Step down to oral doxycycline 100mg twice daily + metronidazole 400mg twice daily to complete 14 days

Question 21

PID Inpatient Treatment

severe penicillin allergy

Answer 21

IV Clindamycin 900mg tds + IV Gentamicin

Step down to oral doxycycline and metronidazole as above

Question 22

PID Inpatient Treatment

pregnancy

Answer 22

IV Ceftriaxone 2g daily + IV Erythromycin 500mg four times daily + IV Metronidazole 500mg three times daily

Step down to oral erythromycin 500mg qds + oral metronidazole 400mg tds
to complete 14 days