management of infections

Question 1

pharyngitis

Answer 1

• majority viral
• <20% bacterial
• streptococcus pyogenes
  treatment:
• narrow spectrum penicillin
• macrolide

Question 2

otitis media

Answer 2

• usually viral/self limiting
• haemophilus influenzae
  treatment:
• penicillin
• macrolide

Question 3

exacerbation of COPD

Answer 3

diagnostic criteria: increased wheeze, shortness of breath, sputum volume/purulence
- strep pneumoniae
- haemophilus influenzae
- moraxella catarrhalis
treatment:
- penicillin
- tetracycline
- macrolide
- IV if severe

Question 4

community acquired pneumonia (CAP)

Answer 4

• strep pneumoniae
• haemophilus influenzae

Question 5

non-severe cap (CURB-65 0-1) treatment

Answer 5

• penicillin
• tetracycline
• macrolide

Question 6

moderate CAP (CURB-65 = 2 and no sepsis)

Answer 6

• possibly legionella
• penicillin (amoxicillin)
• tetracycline
• macrolide

Question 7

severe CAP (CURB-65 > 3/ any CURB-65 +s sepsis)

Answer 7

• consider legionella
• macrolide (oral/IV) with either:
• penicillin or penicillin with beta lactamase inhibitor
• quinolone may be used in patient with penicillin allergy

Question 8

urinary tract infections

Answer 8

• e. coli
• enterococci
• proteus spp
  uncomplicated UTI in men + non-pregnant women:
• trimethoprim
• nitrofurantoin
  pregnant women:
• nitrofurantoin
• penicillin

Question 9

upper UTI without sepsis

Answer 9

women:
- trimethoprim
- nitrofurantoin
men:
- trimethoprim
- penicillin with beta lactamase inhibitor
pregnant women:
- penicillin with beta lactamase inhibitor
- trimethoprim (depending on what trimester)

Question 10

upper UTI with sepsis

Answer 10

women + men + pregnant women:
- penicillin with beta lactamase inhibitor + aminoglycosides

Question 11

cellulitis

Answer 11

• staph aureus
• strep pyogenes
  mild cellulitis:
• narrow spectrum penicillin
• tetracycline
• macrolides
  moderate cellulitis:
• narrow spectrum penicillin
• glycopeptide IV

Question 12

human/animal bite treatment

Answer 12

• penicillin with beta lactamase inhibitor
• tetracycline + metronidazole

Question 13

necrotising fasciitis (flesh eating bacteria)

Answer 13

• strep pyogenes
• benzylpenicillin 2.4g every 6 hrs
• flucloxacillin 2g every 4-6 hrs
• gentamicin IV + clindamycin IV 600mg every 6 hrs
• metronidazole IV 500mg every 8 hrs

Question 14

pyrexia of unknown source

Answer 14

• sepsis or severe sepsis
  broad spectrum cover required:
• penicillin + aminoglycoside IV
• glycopeptide IV + aminoglycoside IV

Question 15

clostridium difficile

Answer 15

• antibiotic associated diarrhoea
• related to broad spectrum antibacterial therapy
  non-severe:
• metronidazole 400mg every 8 hrs
• vancomycin 125mg every 6 hrs
  severe:
• vancomycin 125mg every 6 hrs
  severe/complicated:
• vancomycin 125mg every 6 hrs + metronidazole 400mg every 8 hrs

Question 16

herpes (cold sores)

Answer 16

• viral infection
• aciclovir topically

Question 17

herpes zoster (chickenpox, shingles)

Answer 17

• viral infection
• aciclovir 800mg 5 times daily
• valaciclovir 1g every 8 hrs-

Question 18

tinea

Answer 18

• fungal infection
  athletes foot:
• antifungal powders/ointment
  ringworm (body/scalp/groin)
• topical antifungal

Question 19

candida

Answer 19

• oral infections (thrush)
• vaginal infections (thrush)
• azole antifungals - usually orally