STI, PID, maternal infections = antibiotic man

Question 1

Antibiotics recommended for PROM?

Answer 1

Erythromycin for max 10 days or until labour established

Question 2

Antibiotics recommended for UTI or asymptomatic bacteriuria?

Answer 2

1st or 2nd trim; nitrofurantoin

3rd trim; trimethoprim

Question 3

Antibiotics recommended for pyelonephritis?

Answer 3

Consider hospital admission

Co-amoxiclav for 7 days then review

Question 4

Antibiotics recommended for chlamydia in pregnancy?

Answer 4

Azithromycin 1g as single dose then 500mg for 2 days
Test of cure at least 3 weeks after
Rescreen in 3rd trim

Question 5

Antibiotics recommended for thrush in pregnancy?

Answer 5

Clotrimazole pessary + clotrimazole 1% cream

Question 6

Antibiotics recommended for bacterial vaginosis in pregnancy?

Answer 6

Metronidazole PO or gel
Or
Clindamycin vaginal cream

Question 7

Antibiotics recommended for trichomoniasis in pregnancy?

Answer 7

Metronidazole 400 mg bd for 5-7 days

Question 8

Antibiotics recommended for genital herpes in pregnancy?

Answer 8

If first episode in 3rd trim - urgent referral to sexual health
Aciclovir

Question 9

Who should be suspected for sepsis in postpartum period?

Answer 9

In all women who have recently delivered who feel unwell, have pyrexia or hypothermia

Question 10

Antibiotics recommended for endometritis?

Answer 10

Co-amoxiclav + metronidazole for 7 days

Question 11

Antibiotics recommended for post c/s wound infection?

Answer 11

Flucloxacillin + metronidazole or clindamycin

Question 12

Antibiotics recommended for mastitis?

Answer 12

Ensure complete drainage of breast at each feed by baby +/- expressing
Symptom relief with NSAIDs and warm compresses
Consider antibiotics if symptoms not improving within 12-14 hours
Flucloxacillin

Question 13

Antibiotics recommended for breast abscess?

Answer 13

Send pus for culture

Flucloxacillin or clindamycin if penicillin allergic

Question 14

Antibiotics recommended for thrush at the breast?

Answer 14

Ensure good attachment of baby and treat mother and baby simultaneously
Mother; miconazole 2% cream applied to niple and areola after each feed for 7 days
If pain severe or deep; fluconazole for 10 days
Infant; miconazole oral gel for at least 7 days
Nystatin oral suspension 1 ml qds after feeds for 48 hours after symptoms cleared

Question 15

Antibiotics recommended for nipple fissure?

Answer 15

Only treat if signs of infection; yellow discharge or crusts around fissures
If isolated use topical fusidic acid sparingly 3 or 4 times a day

Question 16

Caution surrounding co-trimoxazole in breastfeeding?

Answer 16

Monitor baby for hyperbilirubinemia and kernicterus due to small amounts in breast milk
If baby premature, or jaundice avoid

Question 17

Antibiotics recommended for maternal sepsis?

Answer 17

IV co-amoxiclav +/- gentamicin

Question 18

Antibiotics recommended for maternal septic shock?

Answer 18

IV piperacillin/ tazobactam + IV clindamycin + IV gentamicin

Question 19

Antibiotics recommended for prophylaxis in c/s or instrumental delivery?

Answer 19

BMI <30; IV co-amoxiclav

BMI >30; IV co-amoxiclav + IV amoxicillin

Question 20

Antibiotics recommended for group B strep intrapartum prophylaxis?

Answer 20

IV benzylpenicillin 3g followed by 1.5g every 4 hours until delivery

Question 21

Antibiotics recommended for 3rd and 4th degree tears involving the anal sphincter/ rectal mucosa?

Answer 21

Prior to suturing; one off dose of IV co-amoxiclav

Followed by PO co-amoxiclav for 7 days

Question 22

Antibiotics recommended for termination of pregnancy prophylaxis (medial or surgical)?

Answer 22

7-days 100mg doxycycline BD* OR 1 g oral azithromycin +500 mg daily for 2 days

Question 23

What is PID?

Answer 23

Presence of inflammation and infection in the upper genital tract and usually results from ascending infection from the vagina resulting in a spectrum of disease including endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis

Question 24

What are the causative organisms of PID?

Answer 24

N. gonorrhoea 
Chlamydia trachomatis
Gardnerella Vaginalis
Anaerobes 
Coliforms

Question 25

DDx for PID?

Answer 25

Ectopic pregnancy 
Endometriosis 
Functional pain
UTI
IBS
Acute appendicitis 
Ovarian complications 
Postnatal endometritis

Question 26

Symptoms of PID?

Answer 26

Lower abdo pain (bilateral) 
Lower abdominal tenderness 
Abdominal vaginal or cervical discharge 
Temp >38 degrees 
Abnormal vaginal bleeding including post coital or intermenstrual bleeding 
Deep dyspareunia 
Adnexal tenderness

Question 27

Outpatient treatment for PID?

Answer 27

Ofloxacin + metronidazole

If high risk of GC; IM ceftriaxone + doxycycline + metronidazole

Question 28

Investigations outpatient for PID?

Answer 28

Full sexual health screen including HIV and syphilis
MSSU for culture and sensitivity
Urine pregnancy test
Urinalysis
FBC, CRP
Vulvovaginal swab for chlamydia and gonorrhoea (PCR essential)

Question 29

Inpatient tx for PID?

Answer 29

IV ceftriaxone + IV metronidazole + PO doxy

Question 30

Antibiotic recommendations for chlamydia?

Answer 30

Doxycycline 100mg 7 days

Question 31

Antibiotic recommendations for gonorrhoea?

Answer 31

IM ceftriaxone

Question 32

Fungal recommendations for vulvovaginal candidiasis?

Answer 32

Fluconazole 150mg + clotrimazole 1% cream or pessary

Question 33

Antibiotic recommendations for bacterial vaginosis?

Answer 33

Metronidazole

2nd line; clindamycin vaginal cream

Question 34

Antibiotic recommendations for trichomoniasis?

Answer 34

Metronidazole

Question 35

Viral recommendations for genital herpes?

Answer 35

1st; aciclovir 400 mg tds for 5 days

Recurrent; aciclovir 400mg bd for 12 months

Question 36

Management of genital warts (HPV)?

Answer 36

30% resolve in 6 months
Podophyllotoxin 0.5% solution or 0.15% screm
Imiquimoid 5% cream
Cryotherapy