Respiratory Hospital Adult Empirical Treatment

Question 1

If NEWS is >/ = 5, think _____

Answer 1

Sepsis

Question 2

possible vital signs in sepsis

Answer 2

temperature = >38 degrees or <36 degrees
pulse = > or = 90
respiratory rate = >20 
altered mental state
known or suspected neutropenia
WCC <4 or > 12

Question 3

how often should antibiotic therapy be reviewed?

Answer 3

daily

Think if antibiotics can be stopped/ switched/ simplified

Question 4

indications for IV use

Answer 4

• 2 or more criteria out of range (temperature, rr, pulse, WCC)
• febrile with neutropenia or immunosuppression
• specific infections e.g. endocarditis, septic arthritis, abscess, meningitis, osteomyelitis
• oral route compromised
• post-surgery: unable to tolerate 1 litre of oral fluids
• no oral formulation available

Question 5

for CAP, CURB65 should be assessed. Which antibiotics should be given if score = 0-2 (mild/ moderate) and dose?

Answer 5

amoxicillin (5 days)

Dose: 1g tds (three times a day) IV/ PO

Question 6

for CAP, CURB65 should be assessed. If patient is PENICILLIN ALLERGIC, which antibiotics should be given if score = 0-2 (mild/ moderate) and dose?

Answer 6

doxycycline PO 200mg on day 1, then 100mg od (once a day)

or IV clarithromycin if NBM - nil by mouth

Question 7

For CAP, CURB65 should be assessed. Which antibiotics should be given if score = 3-5 (severe) and dose?

Answer 7

co-amoxiclav IV 1.2g tds (three times a day) + doxycycline PO 100mg bd (twice a day)

Question 8

For CAP, CURB65 should be assessed. If penicillin allergic, which antibiotics should be given if score = 3-5 (severe) and dose?

Answer 8

IV levofloxacin 500mg bd (twice a day)

Question 9

For CAP, CURB65 should be assessed. Which antibiotics should be given if score = 3-5 (severe), and the patient is in ICU/ HDU or NBM? dose?

Answer 9

co-amoxiclav IV tds (three times a day) and clarithromycin IV 500mg bd

Question 10

For CAP, CURB65 should be assessed. If patient is PENICILLIN ALLERGIC, which antibiotics should be given if score = 3-5 (severe), and the patient is in ICU/ HDU or NBM? dose?

Answer 10

IV levofloxacin 500mg bd

Question 11

How many days should a total IV/ PO last?

Answer 11

7 days

Question 12

ALL patients with severe CAP should be stepped down to 100mg bd of which antibiotic?

Answer 12

doxycycline

Question 13

For severe HAP and aspiration pneumonia, which antibiotics should be given?

Answer 13

IV amoxicillin and metronidazole and gentamicin

Question 14

For severe HAP and aspiration pneumonia, which antibiotics should be given to a PENICILLIN ALLERGIC patient?

Answer 14

IV co-trimoxazole and metronidazole (and possible also gentamicin)

Question 15

For patients with severe HAP or aspiration pneumonia, their treatment should be stepped down to which antibiotics (and which route)?

Answer 15

PO co-trimoxazole and metronidazole

Question 16

How many days should the total antibiotic treatment for severe HAP or aspiration pneumonia be?

Answer 16

7 days (IV/ PO)

Question 17

For non-severe HAP or aspiration pneumonia, which antibiotics should be given?

Answer 17

PO amoxicillin and metronidazole (5 days)

Question 18

For non-severe HAP or aspiration pneumonia, which antibiotics should be given if the patient is PENICILLIN ALLERGIC?

Answer 18

PO co-trimoxazole and metronidazole

Question 19

If HAP or aspiration pneumonia patient has previous ICU admission or history of MRSA, you should ____ _____

Answer 19

seek advice

Question 20

For an acute exacerbation of COPD, antibiotics should be given if there is increased sputum purulence. True/ False?

Answer 20

True.

Question 21

For an acute exacerbation of COPD, where there is NO increase in sputum purulence, should antibiotics be given?

Answer 21

Antibiotics should not be given UNLESS there is consolidation on CXR or signs of pneumonia

Question 22

For acute exacerbation of COPD, what is the 1st line antibiotic (and dose)?

Answer 22

amoxicillin 500mg tds (three times a day) for 5 days

Question 23

For acute exacerbation of COPD, what is the 2nd line antibiotic (and dose)?

Answer 23

doxycycline 200mg on day 1 then 100mg daily

5 days

Question 24

For acute cough/ acute bronchitis, should antibiotics be given?

Answer 24

For acute cough/ acute bronchitis, antibiotics give no significant benefit in clinical improvement, but may be considered in the elderly.

Question 25

When it has been decided that antibiotics are to be prescribed to patient with acute cough/ acute bronchitis, which antibiotics (and dose) are 1st line?

Answer 25

amoxicillin 500mg tds

5 days

Question 26

When it has been decided that antibiotics are to be prescribed to patient with acute cough/ acute bronchitis, which antibiotics (and dose) are 2nd line?

Answer 26

doxycycline 200mg on day 1 then 100mg daily

5 days