Hospital Prescribing

Question 1

Which drug can be used as an alternative to Gentamicin in certain patients?

Answer 1

Aztreonam

Question 2

What is the standard dose of Amoxicillin? (Assuming normal renal & hepatic function)

Answer 2

Oral: 1g TDS
IV: 1g TDS

Question 3

What is the standard dose of Co-trimoxazole? (Assuming normal renal & hepatic function)

Answer 3

Oral: 960mg BD
IV: 960mg BD

Question 4

What is the standard dose of Co-amoxiclav? (Assuming normal renal & hepatic function)

Answer 4

Oral: 625mg TDS
IV: 1.2g TDS

Question 5

What is the standard dose of Clarithromycin? (Assuming normal renal & hepatic function)

Answer 5

Oral: 500mg BD
IV: 500mg BD

Question 6

What is the standard dose of Metronidazole? (Assuming normal renal & hepatic function)

Answer 6

Oral: 400mg TDS
IV: 500mg TDS

Question 7

What is the standard dose of Flucloxacillin? (Assuming normal renal & hepatic function)

Answer 7

Oral: 1g QDS
IV: 1g QDS

Question 8

Which antibiotic carries a risk of prolonged QT and interacts with statin?

Answer 8

Clarithromycin

Question 9

ABx: Meningitis

Answer 9

Ceftriaxone IV 2g BD + Dexamethosone IV 10mg QDS

Question 10

What is the guidance for Dexamethosone prescription for meningitis?

Answer 10

Start with or just before ABx and continue for 4 days

Question 11

In meningitis, which antibiotic should be added if >60y/o or immunocompromised?

Answer 11

Amoxicillin IV 2g 4hrly

Question 12

What is the management of encephalitis and is oral treatment an option?

Answer 12

Aciclovir IV (10mg/kg TDS); No

Question 13

ABx: Epiglottitis/Supraglottitis

Answer 13

Ceftriaxone IV 2g OD (see guidelines for step down)

Question 14

ABx: CAP (CURB65 = 2)

Answer 14

Amoxicillin 1g TDS; If PA give Doxycycline PO 200mg BD on day 1 then 100mg OD or Clarithromycin IV if NBM

Total 5 days

Question 15

ABx: CAP (CURB65 = 4) + step down therapy

Answer 15

Co-amoxiclav IV 1.2g TDS + Doxycycline PO 100mg BD; If PA Levofloxacin IV 500mg BD. Step down to Doxycycline 100mg BD.

Total IV/PO 7 days

Question 16

ABx: CAP (ICU/HUD +/- NBM)

Answer 16

IV Co-amoxiclav 1.2g TDS + Clarithromycin 500mg BD; If PA Levofloxacin IV 500mg BD. Step down to Doxycycline 100mg BD.

Total IV/PO 7 days

Question 17

ABx: Non-severe HAP

Answer 17

Amoxicillin PO; If PA Doxycycline PO 100mg BD.

Total 5 days

Question 18

ABx: Severe HAP

Answer 18

IV Amoxicillin + Gentamicin; If PA IV Co-trimoxazole + Gentamicin. Step down to Co-trimoxazole PO.

Total IV/PO 7 days; seek advice if ICU admission or MRSA Hx.

Question 19

ABx: Non-severe aspiration pneumonia

Answer 19

PO Amoxicillin + Metronidazole; If PA PO Doxycycline 100mg BD + Metronidazole.

Total 5 days.

Question 20

ABx: Severe aspiration pneumonia

Answer 20

IV Amoxicillin + Metronidazole + Gentamicin; If PA replace Amoxicillin with Doxycycline PO or Clarithromycin IV.

Step down as for non-severe aspiration pneumonia.

Total IV/PO 7 days.

Question 21

What are the indications for ABx for an acute exacerbation of COPD?

Answer 21

• Increased sputum purulence
• Consolidation on CXR
• Signs of pneumonia

Question 22

ABx: Acute exacerbation of COPD

Answer 22

1st Line: Amoxicillin 500mg TDS

2nd Line: Doxycycline 200mg on day 1 then 100mg OD (total 5 days)

Question 23

ABx: Native valve indolent (subacute) endocarditis

Answer 23

Amoxicillin IV 2g 4hrly + Gentamicin 1mg/kg BD (max. 120mg/dose)

Question 24

ABx: Native valve severe sepsis (acute) endocarditis

Answer 24

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

Question 25

ABx: Prosthetic valve or suspected MRSA endocarditis

Answer 25

Vancomycin IV + Gentamicin IV 1mg/kg BD (max. dose of 120mg/dose).

Once therapeutic levels of Vanc. reached then add Rifampicin PO 600mg (checking for interactions).

Question 26

ABx: Non-severe C.diff

Answer 26

Metronidazole PO 400mg TDS

Total 10 days

Question 27

ABx: Severe C.diff

Answer 27

Vancomycin 125mg QDS PO/NG +/- Metronidazole IV

Total 10 days

Question 28

ABx: Peritonitis/Biliary Tract/Intra-Abdominal

Answer 28

IV Amoxicillin + Metronidazole + Gentamicin

Step down to PO Co-trimoxazole + Metronidazole

Total IV/PO 7 days

Question 29

ABx:Peritonitis/Biliary Tract/Intra-Abdominal (PA!)

Answer 29

IV Vancomycin + Metronidazole + Gentamicin

Step down to PO Co-trimoxazole + Metronidazole

Total IV/PO 7 days

Question 30

ABx: Complicated UTI/Pyelonephritis/Urosepsis

Answer 30

IV Amoxicillin (Co-trimoxazole if PA) + Gentamicin

Step down PO Co-trimoxazole (or as per sensitivities)

Total IV/PO 7 days

Question 31

ABx: Uncomplicated Female Lower UTI

Answer 31

Nitrofurantoin 100mg MR BD or 50mg QDS
OR
Trimethoprim 200mg BD

Total 3 days

Question 32

ABx: Uncatheterised Male UTI

Answer 32

Nitrofurantoin 100mg MR BD or 50mg QDS
OR
Trimethoprim 200mg BD

Total 7 days

Question 33

ABx: Cellulitis

Answer 33

Flucloxacillin 1g QDS; If PA then Doxycycline 100mg BD PO

Total IV/PO 7 days

Question 34

ABx: Open Fracture Prophylaxis

Answer 34

IV Co-amoxiclav 1.2g TDS or IV Co-trimoxazole 960mg BD + Metronidazole 500mg TDS

Start within 3hrs for max of 72hrs

Question 35

ABx: Mild Diabetic Foot Infection

Answer 35

Flucloxacillin 1g TDS or Doxycycline 100mg BD

Total 7 days

Question 36

ABx: Moderate Diabetic Foot Infection

Answer 36

Flucloxacillin 1g QDS + Metronidazole 400mg TDS
OR
Doxycycline 100mg BD + Metronidazole 400mg TDS

Total 7 days

Question 37

ABx: Acute Septic Arthritis/Osteomyelitis

Answer 37

IV Flucloxacillin 2g QDS

Seek ID advice!

Question 38

ABx: Severe systemic infection of unknown source!

Answer 38

IV Amox (if PA use Vanc) + Met + Gent!

PWID: + IV Flucloxacillin 2g QDS