Infectious Diseases- Prescribing Pathways

Question 1

BITES

Answer 1

1. Human bites:
   * First line: Co-Amoxiclav
   * Second line: Doxycycline and Metronidazole
   Prophylaxis: 3 days, Treatment: 5 days
2. Tick bites (Lyme disease)
   * First line: Doxycycline (100mg BD)
   * Second line: Amoxicillin (1,000mg TDS)
   Treatment: 21 days

Question 2

DIABETIC FOOT INFECTION

Answer 2

1. Mild (less than 2cm)
   * Flucloxacillin
   * Pen-allergic: Clarithromycin/ Erythromycin (in pregnancy)/ Doxycycline
2. Moderate/ Severe (abscess/ osteomyelitis)
   * First line: Flucloxacillin/ Co-Amoxicillin +/- Gentamicin
   * Pen-allergic: Co-Trimoxazole +/- Gentamicin

Question 3

C. DIFF

Answer 3

• First line: Vancomycin
• Second line: Fidaxomicin
• Life-threatening: Vancomycin + IV Metronidazole

Question 4

CELLULITIS

Answer 4

• Flucloxacillin
• Pen-allergic: Clarithromycin/ Erythromycin (in pregnancy)/ Doxycycline

Question 5

CAP

Answer 5

1. Low severity
   * First line: Amoxicillin
   * Second line: Doxycycline/ Clarithromycin^
2. Moderate severity
   * First line: Amoxicillin (+ Clarithromycin^ if atypical pathogens are suspected)
   * Second line: Doxycycline/ Clarithromycin^
3. High severity
   * First line: Co-Amoxiclav AND Clarithromycin^
   * Second line: Levofloxacin

^Erythromycin in pregnancy

Question 6

EAR INFECTIONS

Answer 6

1. Otitis Media
   * First line: Amoxicillin
   * Second line (if symptoms worsening despite 2-3 days treatment): Co-Amoxiclav
   * Pen-allergic: Clarithromycin (Erythromycin if pregnant)
2. Otitis Externa
   * First line: Topical acetic acid 2% (OTC)
   * If systemic treatment needed: Flucloxacillin

Question 7

H. PYLORI

Answer 7

Triple therapy

• PPI + 2 of the following antibiotics:
  Amoxicillin (1,000mg BD) OR Metronidazole (400mg BD) OR Clarithromycin (500mg BD)

Remember- CAMP

Question 8

HAP

Answer 8

• First line: Co-Amoxiclav
• Second line (adults): Doxycycline/ Co-Trimoxazole/ Levofloxacin
• Second line (children): Clarithromycin

Question 9

IMPETIGO

Answer 9

1. Localised non-bullous
   * First line: Hydrogen peroxide 1%
   * Second line: Fusidic acid (Mupirocin 2% if fusidic acid resistance suspected)
2. Widespread non-bullous
   * Second line: Fusidic acid (Mupirocin 2% if fusidic acid resistance suspected)
3. Bullous/ patient systemically unwell
   * First line: Flucloxacillin
   * Second line: Clarithromycin (Erythromycin if pregnant)

Question 10

LRTI

Answer 10

1. Men
   Nitrofurantoin or Trimethroprim
2. Non-pregnant women
   * First line: Nitrofurantoin or Trimethroprim
   * Second line: Pivmecillinam
3. Pregnant women:
   * First line: Nitrofurantoin
   * Second line: Cefalexin or Amoxicillin

TREATMENT DURATION:
7 days for men, pregnancy, catheter-associatied
3 days for uncomplicated

Question 11

STREP THROAT/ SCARLETT FEVER

Answer 11

First line: Phenoxymethylpenicillin
Second line: Clarithromycin (Erythromycin in pregnancy)

Question 12

What pathogen causes CAP?

Answer 12

Streptococcus pneumoniae

Question 13

What pathogen causes UTIs?

Answer 13

E. Coli

Question 14

What pathogen causes thrush?

Answer 14

Candida Albicans

Question 15

What pathogen causes cellulitis?

Answer 15

Staphylococcus aureus

Question 16

What pathogen causes meningitis?

Answer 16

Streptococcus pneumoniae