Primary Care Adult Empirical Treatment

Question 1

Meningitis (Primary Care)

Answer 1

Benzylpenicillin (IM/IV) 1.2g

If known anaphylaxis - Cefotaxime

Question 2

Conjunctivitis

Answer 2

Treat only if severe, most cases are viral or self limiting.

1st line: clean eyelids to remove crusting
2nd line: chloramphenicol 0.5% eyedrops and chloramphenicol 1% ointment
3rd line: send swabs prior to treatment. Fusidic acid 1% eye drops

Question 3

Ophthalmic Shingles

Answer 3

Aciclovir 800mg 5 times daily or valaciclovir 1g tds (7 days) + lubricating eye drops if lesions near eyelid.

Question 4

Tonsilitis >4 on FeverPAIN score

Answer 4

1st line: Peniclin V 1g bd or 500mg qds (5 days)

2nd line penicillin allergy: Clarithromycin 500mg bd (5 days)

Question 5

Sinusitis

Answer 5

<10 days symptoms: no treatment

> 10 days multiple or worsening symptoms -
1st line: Penicillin V 500mg qds or 1g bd (5 days)

2nd line: Doxycycline 200mg day 1 then 100mg daily (5 days total)

Question 6

Otitis Media with otorrhoea

Answer 6

1st line: Amoxicillin 500mg tds

2nd line: Clarithromycin 500mg bd (5 days)

Question 7

Otitis Externa

Answer 7

Provide information on aural care.
Mild: do not swab, Acetic acid 2% tds (EarCalm) continuing for 2 days after resolution.
Moderate: do not swab. Sofradex or Otomize tds

Question 8

Oral Candidiasis

Answer 8

1st line: Miconazole gel qds or Nystatin 1ml qds

2nd line: Fluconazole 50mg (Immunocompromised 100mg) (7 days)

Question 9

Acute Exacerbation of COPD with increased sputum purulence or pneumonia/consolidation on CXR

Answer 9

1st line: Amoxicllin 500mg tds

2nd line: Doxycycline 200mg day 1 then 100mg daily (5 days total)

Question 10

Acute cough/acute bronchitis in the elderly (with consideration, no significant clinical benefit)

Answer 10

1st line: Amoxicllin 500mg tds

2nd line: Doxycycline 200mg day 1 then 100mg daily (5 days total)

Question 11

Pneumonia
CURB65 score 0 or 1
No prognostic features

Answer 11

Home Therapy 5 days antibiotics
1st line: Amoxicillin 1g TDS oral

2nd line Penicillin allergy: Doxycycline 200mg on day 1 then 100mg daily

Question 12

Pneumonia
CURB65 score 0 or 1

With prognostic features:

• co-exisiting chronic illness
• pulse oximetry <92% or PaO2 <8.0kPa on any FiO2
• bi-lateral or multi-lobar changes on CXR
• change suggestive of empyema or cavitation
• acidosis

Answer 12

Patient in Hospital 5 days antibiotics

1st line: Amoxicillin 1g TDS oral

2nd line Penicillin allergy: Doxycycline 200mg on day 1 then 100mg daily

IF Penicillin allergy and IV required: Clarithromycin 500mg BD

Question 13

C.difficile Infection

Answer 13

Vancomycin 125mg qds oral

total 10 days treatment

Question 14

Diverticulitis where antibiotics are indicated

Answer 14

Metronidazole 400mg tds plus Co-trimoxazole 960mg bd for 5 days

Question 15

Uncomplicated Female UTI

Answer 15

For 3 days

1st line: Nitrofurantoin 100mg MR bd

2nd line: Trimethoprim 200mg bd

Question 16

Pyelonephritis (male or female)

Answer 16

Co-trimoxazole 960mg bd or Co-amoxiclav 645mg tds (7 days)

Question 17

Uncatheterised Male UTI

Answer 17

For 7 days

1st line: Nitrofurantoin 100mg MR bd or 50mg qds

2nd line: Trimethoprim 200mg bd

Question 18

UTI in Older Catheterised Patients WITH clinical signs/symptoms of infection

Answer 18

Co-trimoxazole 960mg bd or Co-amoxiclav 625mg tds (7 days). Change catheter as soon as possible

Question 19

Prostatitis

Answer 19

Ofloxacin 200mg bd or Ciprofloxacin 500mg bd.

If high risk CDI: Trimethoprim 200mg bd (all 28 days)

Question 20

Epididimo-orchitis

<35 or new partner in last 3 months

Answer 20

Send MSSU, gonorrhoea and chlamydia tests.

Doxycycline 100mg
bd (14 days)

Question 21

Epididimo-orchitis

> 35 and no new partner

Answer 21

Ofloxacin 200mg bd or Ciprofloxacin 500mg bd (14 days).

Question 22

Uncomplicated Chlamydia

Answer 22

Doxycycline 100mg bd (7 days). If intolerant: Azithromycin 1g od day 1 then 500mg od for 2 days

Question 23

PID Outpatient Treatment

Answer 23

For 14 days

Ofloxacin 400mg twice daily + Metronidazole 400mg twice daily

OR patients < 18 or if patient at high risk of GC (partner with gonorrhoea, sexual contact abroad, or gram negative diplococci
on microscopy of endocervical swab):

IM Ceftriaxone 1g single dose + Doxycycline 100mg twice daily + Metronidazole 400mg twice daily

Question 24

Bacterial Vaginosis

Answer 24

Metronidazole 400mg bd (5 days) or 2g single dose

Question 25

Vulvovaginal Candidiasis

Answer 25

Fluconazole 150mg single dose or Clotrimazole 500mg Pessary Single dose

Question 26

Cellulitis

Answer 26

Total IV/PO 5 days (extend to 7 days if clinically indicated) Flucloxacillin 1g qds or doxycycline 100mg bd If history or risk of MRSA doxycycline 100mg bd

Question 27

Sinus/dental/Mandibular cellulitis

Answer 27

Co-amoxiclav 625mg tds (7 days) or clindamycin – weight based dosing (7 days)

Question 28

Diabetic foot infection

Answer 28

MILD: flucloxacillin 1g qds or doxycycline 100mg bd (7 days) MODERATE: flucloxacillin 1g qds + metronidazole 400mg tds or doxycycline 100mg bd + metronidazole 400mg tds (7 days) SEVERE: follow guidance

Question 29

Scabies

Answer 29

Permethrin 5% cream - apply over whole body including face, neck and ears. Wash off after 8-12 hours and repeat treatment after 7 days. If hands are washed with soap and water within 8 hours of application, re-apply cream. Malathion 0.5% in aqueous basis - apply to all parts of the body for 12 hours or overnight and repeat treatment after 7 days. Note all members of household/close contacts should be treated once only

Question 30

Crab Lice

Answer 30

Permethrin 5% cream - apply over whole body including face, neck and ears and wash off after 8-12 hours and repeat treatment after 7 days. If hands are washed with soap and water within 8 hours of application, cream should be re-applied Malathion 0.5% in aqueous basis (may be more suitable for treating crab lice in hair bearing areas or for use on eyelashes). Apply to all parts of the body for 12 hours or overnight and repeat treatment after 7 days

Question 31

Head lice

Answer 31

Dimeticone 4% lotion - Apply into dry hair and scalp, shampoo after a minimum of 8 hours or overnight and repeat application after 7 days Malathion 0.5% in aqueous basis - rub into dry hair and scalp, shampoo after 12 hours and repeat treatment after 7 days

Question 32

Athlete's Foot (Tinea Pedis)

Answer 32

Terbinafine cream

Question 33

Fungal Scalp Infection

Answer 33

use oral terbinafine 250mg od for 2-4 weeks + ketoconazole shampoo twice weekly for first 2 weeks.

Question 34

Bites (Dog/cat/human)

Answer 34

Prophylaxis for uninfected bite: 3 days Treatment for infected bite: 5 days 1ST LINE: co-amoxiclav 625mg tds 2ND LINE: metronidazole 400mg tds + doxycycline 100mg bd

Question 35

Chickenpox Consider treatment if patient presents <24 hours after onset of rash or if immunocompromised

Answer 35

Aciclovir 800mg 5 times daily (7 days)

Question 36

Shingles

Answer 36

Must present within 72 hours of onset of rash Aciclovir 800mg 5 times daily or valaciclovir 1g tds (7 days)

Question 37

Impetigo

Answer 37

Localised lesions: topical hydrogen peroxide 1% cream or topical fusidic acid 2% cream tds (5 days) If lesions are extensive or severe: 1st LINE - flucloxacillin 500mg qds (5 days) 2nd LINE - clarithromycin 500mg bd (5 days)