Infections

Question 1

What does CURB-65 stand for and when is it used?

Answer 1

For CAP assessment of severity:
Confusion
Urea (>7mmol/L)
Respiratory rate (>30)
BP ( systolic <90 diastolic <60)
65 years or older

Question 2

What is the 1st line antibiotic with a CURB65 score of 0?

Answer 2

Amoxicillin 500mg TDS for 5 days

Allergy:
Doxycycline 200mg OD for 1 day then 100mg OD for 4 days
Or
Clarithromycin 500mg BD for 5 days

Question 3

What is 1st line treatment for CAP with a CURB65 score of 1 or 2?

Answer 3

Amoxicillin 500mg TDS plus clarithromycin 500mg BD for 5 days

Question 4

Which macrolide is contraindicated in pregnancy?

Answer 4

Clarithromycin

Question 5

What is the main contraindication for clarithromycin?

Answer 5

QT prolongation:
History of QT or other ventricular cardiac arrhythmias
Concurrent use of other QT prolonging drugs
Hypokalaemia (increased risk of QT prolongation)

Question 6

Which antibiotic is associated with photosensitivity?

Answer 6

Doxycycline

Question 7

Which drug class can affect absorption of doxycycline?

Answer 7

Antacids and other iron, zinc or bismuth containing medications

Question 8

Why is doxycycline contraindicated in pregnancy?

Answer 8

Can be deposited in growing bone and teeth leading to discolouration