Infections

Question 1

What is antimicrobial stewardship

Answer 1

• To only provide the amount necessary for the specific conditions. Following local and national prescribing protocols.
• A political commitment to prioritise AMR;
• Monitoring antimicrobial use and resistance in microbes;
• Development of new drugs, treatments, and diagnostics;
• Individuals’ behaviour relating to infection prevention and control, antimicrobial use, and AMR;
• Healthcare professionals’ prescribing decisions.

Question 2

First-choice oral antibiotic for human and animal bites, 12+ and dosage

Answer 2

Co-amoxiclav: 250/125 mg or 500/125 mg three times a day

Question 3

Alternative first-choice oral antibiotic for human and animal bites 12+ and dosages

Answer 3

Doxycycline: 200 mg on first day, then 100 mg or 200 mg daily With Metronidazole: 400 mg three times a day

Question 4

First-choice oral antibiotic for human and animal bites, under 12 and dosage

Answer 4

Co-amoxiclav: 1-11 months: 0.25mL/kg og 125/31 mg suspension three times a day
1-5 yearsl 5mL of 125/31 mg suspension three times a day
6-11 years: 5 mL of 250/62 mg suspension three times a day

Question 5

Alternative choice oral antibiotic for human and animal bites, under 12 and dosage

Answer 5

Co-Trimoxazole: 6 weeks - 5 months: 120 mg BD
6 months - 5 years, 240 mg or BD
6 - 11 years 480 mg BD

Question 6

First choice antibiotic for cellulitis and erysipelas 18+

Answer 6

Flucloxacillin: 500 mg to 1 g four times a day orally. 5 to 7 days.

Question 7

Alternate antibiotic for cellulitis and erysipelas 18+ (3 listed)

Answer 7

Clarithromycin: 500 mg BD orally for 5 to 7 days
Erythromycin (in pregnancy) 500 mg QDS orally for 5 to 7 days
Doxycycline 200 mg on first day, then 100 mg OD orally for 5 to 7 days in total

Question 8

First choice antibiotic for cellulitis and erysipelas under 18

Answer 8

Clarithromycin
Co-amoxiclav (not in penicillin allergy):
1 to 11 months, 0.25 ml/kg of 125/31 suspension TDS
1 - 5 years: 5 ml of 125/31 suspension TDS
6 - 11 years: 5 ml of 250/62 suspension TDS
All for 5 to 7 days
12 - 17 years: 250/125 or 500/125 mg TDS for 5 to 7 days

Question 9

First choice: Antibiotics for pneumonia in adults 18+

Answer 9

Amoxicillin 500 mg three times a day for 5 days

Question 10

Alternate choice: Antibiotics for pneumonia in adults 18+

Answer 10

Doxycycline: 200 mg on first day, then 100 mg OD for 4 days
Clarithromycin 500 mg BD for 5 days
Erythromycin 500 mg QDS for 5 days

Question 11

First choice: Antibiotics for pneumonia under 18

Answer 11

Amoxicillin: 1 - 11 months - 125 mg TDS for 5 days
1 - 4 years - 250 mg TDS for 5 days
5 - 17 years, 500 mg TDS for 5 days
Clarithromycin
Doxycycline

Question 12

1st Choice antibiotics for H Pylori 18+

Answer 12

PPI, plus amoxicillin, and either clarithromycin or metronidazole (take into account previous treatment with clarithromycin or metronidazole).

Question 13

1st Choice antibiotics for otitis externa infections 18+

Answer 13

Flucloxacillin,
Clarithromycin (or azithromycin or erythromycin).

Question 14

1st Choice antibiotics for otitis media infections 18+

Answer 14

First line: amoxicillin.
Second line (worsening symptoms despite 2 to 3 days of antibacterial treatment): co-amoxiclav.
In penicillin allergy: clarithromycin or erythromycin

Question 15

1st Choice antibiotics for strep throat infections 12+

Answer 15

Phenoxymethylpenicillin: 500 mg QDS or 1000 mg BD for 5 to 10 days

Question 16

Alternative choice strep throat in penicillin allergy and pregnancy 12+

Answer 16

Clarithromycin: 250 mg to 500 mg BD for 5 days
Pregnancy:
Erythromycin: 250 mg to 500 mg QDS, or 500 mg to 1000 mg BD for 5 days

Question 17

First choice for strep throat in under 12

Answer 17

Phenoxymethylpenicillin:
1 - 11 months: 62.5 mg QDS, or 125 mg BD for 5 to 10 days
1 - 5 years: 125 mg QDS, or 250 mg BD for 5 to 10 days
6 - 11 years: 250 mg QDS, or 500 mg BD for 5 to 10 days

Question 18

Alternatives for under 12 strep throat

Answer 18

Clarithromycin
Erythromycin (ONLY FOR 8+)

Question 19

First choice for scarlet fever in 12+ (What is the increase in adult dose 18+ if needed?)

Answer 19

Phenoxymethylpenicillin: 500 mg four times daily, or 1000 mg twice daily (increased in adults if necessary up to 1000 mg four times daily) for 10 days.

Question 20

Choice for scarlet fever in pregnancy

Answer 20

Erythromycin
For women who are pregnant or postpartum (within 28 days of childbirth), prescribe 250 mg to 500 mg four times daily or 500 mg to 1,000 mg twice daily for 10 days.

Question 21

Choice for scarlet fever in penicillin allergy

Answer 21

Clarithromycin
In 12+, prescribe 250 to 500 mg twice daily for 10 days.
In children aged 1 month to 11 years weighing:
Up to 8 kg, prescribe 7.5 mg/kg twice daily for 10 days.
8-11 kg, prescribe 62.5 mg twice daily for 10 days.
12-19 kg, prescribe 125 mg twice daily for 10 days.
20-29 kg, prescribe 187.5 mg twice daily for 10 days.
30-40 kg, prescribe 250 mg twice daily for 10 days.

Question 22

First and alternate antibiotics for HOSPITAL ACQUIRED non severe pneumonia in adults 18+

Answer 22

1st: Co-amoxiclav 500/125 mg TDS for 5 days then review
Alternate:
Doxycycline 200 mg on first day, then 100 mg once a day for 4 days
Cephalexin: 500 mg twice or three times a day (can be increased to 1 to 1.5 g three or four times a day) for 5 days then review
Co-trimoxazole: 960 mg twice a day for 5 days then review

Question 23

First and alternate antibiotics for HOSPITAL ACQUIRED SEVERE pneumonia in adults 18+

Answer 23

Piperacillin with tazobactam 4.5 g three times a day (increased to 4.5 g four times a day if severe infection) Ceftazidime 2 g three times a day Ceftriaxone 2 g once a day

Question 24

Impetigo antimicrobials adults aged 18 years and over

Answer 24

Question 25

Impetigo antimicrobials adults aged 18 years and over

Answer 25

Question 26

What are aminoglycosides? Give examples

Answer 26

Broad spectrum ABx: The aminoglycosides include gentamicin, amikacin, tobramycin, neomycin, and streptomycin

Question 27

What are cephalosporins

Answer 27

A class of β-lactam antibiotics: cefazolin and cephalexin

Question 28

What are macrolides

Answer 28

The macrolides have an antibacterial spectrum that is similar but not identical to that of penicillin; they are thus an alternative in penicillin-allergic patients: examples are Erythromycin, roxithromycin, azithromycin and clarithromycin

Question 29

What are glycopeptide Abxs?

Answer 29

POWERFUL treatments for Gram-positive infections
Examples: teicoplanin and vancomycin