Prescribing pathways

Question 1

what should be prescribed for a bite?

Answer 1

-human or animal
first line: co-amoxiclav
second line: doxycycline AND metronidazole
-prophylaxis: 3 days treatment (can see puss, read swollen) : 5 days

scratches: flucloxacillin

tick bites (can cause Lyme disease)
first line: doxycycline 100mg BD
second line: amoxicillin 1000mg TDS TREATMENT FOR 21 DAYS

Question 2

what is the treatment for diabetic foot infection?

Answer 2

mild (less than 2cm)
first line: flucloxacillin
penicillin allergy: clarithromycin, erythromycin, doxycycline

moderate/severe (abscess, osteomyelitis): first line: flucloxacillin or co-amoxiclav + or - gentamicin
penicilin allergy: co-trimoxazole + or - gentamicin

Question 3

what I the treatment for cellulitis?

Answer 3

first line: flucloxacillin
penicillin allergy or if flucloxacillin unsuitable give: clarithromycin or erythromycin (in pregnancy), doxycycline or co-amox

if infection near ey es or nose
-co-amox
penicillin allergy: clarithroycin AND metronidazole

Question 4

what is the treatment for CAP?

Answer 4

Low- first line: amoxicillin
second line: doxycycline or clarithromycin (erythromycin in preganancy

moderate: amoxicillin AND clarithromycin
second line: doxycycline or clarithromycin (erythromycin in preganancy

high: co-amox AND clarithromycin
second line: levofloxacin

Question 5

what is treatment for diarrhoea?

Answer 5

C.Diff (10 days treatment)
first line vancomycin
second: fidaxomicin
life threatening: vancomycin and IV metronidazole

travellers diarrhoea
standby: azithromycin
prophylaxis/treatment: bismuth subsalicylate

Question 6

what is the treatment for ear infections?

Answer 6

otitis media (inside ear)
first line: amoxicillin
second line:(worsening symptoms despite 2-3 days treatment : co-amoxiclav
penicillin: clarithromycin (erythromycin in pregnancy)

otitis externa (outside)
first line: topical acetic acid 2%
second line: topical neomycin sulphate with hydrocortisone
if systmetreatment needed: flucox

Question 7

how do you test for H.pylori

Answer 7

-test someone for it through urea 13 breath test
-cant do this test if on PPI, have to wait 2 weeks
-OR been treated with previously with antibiotics , have to wait 4 weeks
then can take breath test
-if test is positive you start triple therapy

Question 8

what is the treatment for H.pylori?

Answer 8

what is triple therapy?
-PPI
-Then 2 of either amoxicillin (1000mg BD) or metronidazole (400MG BD) or clarithromycin (500mg BD)

Question 9

what is the treatment for HAP?

Answer 9

-NON-SEVERE
first line: co-amoxiclav
second adults: doxycycline or cefalexin or co-trimoxazole or levofloxacin
second children: clarithromycin

Question 10

why shouldn’t you use doxycycline in children?

Answer 10

-decolouration of teeth and affects bones

Question 11

what is the treatment for lower UTI? in men and pregnant women?

Answer 11

first line: nitrofurantoin (or trimethoprim in men but not pregnancy)
second: in pregnancy cefalexin or amoxicillin

Question 12

what is the treatment for impetigo?

Answer 12

-localised non-bulbous
first: hydrogen peroxide 1%
second: fusidic acid (mupirocin 2% if fusidic acid resistance suspected)

-widespread non-bullous
first line: fusidic acid (mupirocin 2% if fusidic acid resistance suspected

-bullous or patients who are systemically unwell
first line: flucloxacilin
second line: clarithromycicn (erythromycin in pregnancy)

Question 13

why dont you use trimethoprim in pregnancy?

Answer 13

antifolate

Question 14

what is the treatment for non-pregnant women?

Answer 14

first: nitrofurantoin
second: pivmecillinam or fosfomycin

Question 15

what is the length treatment for patients on nitrofurantoin?

Answer 15

men 7 days
pregnancy 7 days
uncomplicated 3 days
catheter associated 7 days

Question 16

what is the eGFR limit for nitrofurantoin?

Answer 16

> or more than 45ml/min

Question 17

what bacteria family are strep throat and Scarlett fever both from?

Answer 17

streptococcus bacteria family

Question 18

what is the treatment for both strep throat or Scarlett fever?

Answer 18

first: phenoxymethylpenicillin
second: clarithromycin or erythromycin in pregnancy

Question 19

what are the symptoms for Scarlett symptoms?

Answer 19

flu like symptoms, high temp, swollen neck glands
a red rash with small raised bumps, rough feeling like sandpaper
white coating on tongue

Question 20

what is the first line treatment for acne vulgaris?

Answer 20

adapalene, clindamycin, benzoyl peroxide, lymecycline

Question 21

what is the first line treatment for bacterial vaginosis and trichomoniasis?

Answer 21

metronidazole

Question 22

what is the first line treatment for chlamydia?

Answer 22

doxycycline

Question 23

what is the first line treatment for conjunctivitis and blepharitis? who not to use

Answer 23

chloramphenicol
over 2 only and not to pregnant women OTC

Question 24

what is the first line treatment for dental abscess?

Answer 24

amoxicillin or metronidazole

Question 25

what is the first line treatment for gonorrhoea?

Answer 25

ceftriaxone or ciprofloxacin

Question 26

what is the first line treatment for meningitis?

Answer 26

benzylpenicillin

Question 27

what is the first line treatment for scabies? + counselling

Answer 27

permethrin
apply to neck down all over the body

Question 28

what is the first line treatment for sinusitis?

Answer 28

phenoxymethylpenicillin
penicillin allergy: docycycline

Question 29

what is the first line treatment for threadworms? who not to use?

Answer 29

mebendazole
under two

Question 30

WHAT IS THE MOST COMMON PATHOGENS IN cap?

Answer 30

streptococcus pneumoniae

Question 31

what is the most common pathogen in A UTI?

Answer 31

escherichia coli

Question 32

what is the most common pathogen in thrush?

Answer 32

candia albicans

Question 33

what is the most common pathogen in cellulitis?

Answer 33

strophylococcus aures

Question 34

what is the most common pathogen in meningitis?

Answer 34

streptococcus pneumoniae