Other

Question 1

Endocarditis

Answer 1

Amoxicillin - consider adding low dose gentamicin.
MRSA/penicillin allergy = vancomycin
Staphylococci = flucloxacillin
Streptococci = benzylpenicillin

Question 2

Meningitis - causative organism

Answer 2

Neisseria meningitis

Question 3

Meningitis - Initial emperical treatment

Answer 3

Benzylpenicillin
- Cefotaxime if penicillin allergy
- Chloramphenicol if IMMEDIATE penicillin allergy

Question 4

Meningitis - Hospital (3 months to 59 years)

Answer 4

Cefotaxime (or ceftriaxone)
Add vancomycin if:
- prolonged/multiple use of Abx in last 3 months
- travelled outside UK in last 3 months

Question 5

Meningitis - Hospital (60+)

Answer 5

Cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
Add vancomycin under same conditions mentioned before

Question 6

Osteomyelitis

Answer 6

Flucloxacillin - 6 week treatment
- Penicillin allergic = clindamycin
- MRSA suspected = vancomycin
- Consider adding fusidic acid or rifampicin for initial 2 weeks

Question 7

Sore throat

Answer 7

i.e. strep throat
Phenoxymethylpenicillin
Penicillin = clarithromycin OR erythromycin (pregnancy)
Severe = benzylpenicillin

Question 8

Sinusitis

Answer 8

1. Paracetamol/ibuprofen
2. Saline (limited evidence)
3. High dose corticosteroid nasal spray e.g. mometasone furoate or fluticasone for 14 days
4. Abx:
   Abx typically given as ‘back-up’
   Non life-threatening = phenoxymethylpenicillin
   Life-threatening = co-amoxiclav
   Penicillin allergy = doxycycline or clarithromycin/erythromycin (pregnancy)

Question 9

Otitis externa

Answer 9

Only treat if systemically unwell
Flucloxacillin
Alternative = ciprofloxacin or erythromycin
Pseudomonas suspected = ciprofloxacin

Question 10

Otitis media

Answer 10

1st line = Amoxicillin (clarithromycin/erythromycin)
2nd line = Co-amoxiclav

Question 11

Otitis media - when is treatment given?

Answer 11

No improvement after 3 days
Systemic symptoms or severely unwell
Mastoiditis
Bilateral otitis media <2 years