tayside empirical treatment

Question 1

CNS infections

Answer 1

meningitis= IV ceftriaxone and IV dexamethasone

• if encephalitis suspected add in IV acyclovir
• add in IV amoxicillin if 60 or over or immunocompromised

Question 2

ENT infections

Answer 2

epiglottis= IV ceftriaxone

Question 3

community acquired pneumonia

Answer 3

access CURB 65 score
- 0-2= oral amoxicillin (doxycycline if penicillin allergic)
- 3-5= IV co-amoxical and oral doxycycline (if penicillin allergic IV levofloxacin)
EXCEPT in HDU/ICU or nill by mouth IV co-amoxiclan and IV clarithromycin
- step down to doxycycline for all patients with severe community acquired pneumonia

Question 4

hospital acquired pneumonia

Answer 4

• non-severe= oral amoxicillin and metronidazole ( if penicillin allergic co-trimoxazole)
• severe= IV amoxicillin, metronidazole and gentamicin ( if penicillin allergic IV co-trimoxazole) for all patients with severe hospital acquired pneumonia step down to oral co-trimoxazole and metronidazole

Question 5

acute exacerbation of COPD

Answer 5

give antibiotics if increased purulent sputum, if no increase in purulent sputum do not give antibiotics unless consolidation seen on chest X-ray or signs of pneumonia
1st line= amoxicillin
2nd line= doxycycline

Question 6

acute cough/ bronchitis

Answer 6

antibiotics make no significant benefit in clinical improvement but may be considered in frail elderly
1st line= amoxicillin
2nd line= doxycycline

Question 7

cardiac infection

Answer 7

endocaridits= take 3 sets of blood cultures and then start empirical therapy while you await the results

• native valve indolenet (subacute)= IV amoxicillin and gentamicin
• native valve sepsis (acute)= IV flucloxacillin
• prosthetic valve/ MRSA= IV vancomycin, gentamicin and rifampicin

Question 8

After the results come back for infective endocaridits

Answer 8

alter treatment accordingly

• strep viridans= IV benzylpenicillin and gentamicin
• staph aures= IV flucloxacillin
• enterococcus= IV amoxicillin/ vancomycin and gentamicin
• staph epidermis/ MRSA= IV vancomycin and gentamicin and rifampicin

Question 9

4 C’s of c. difficile

Answer 9

• Clindamycin
• Cephalosporins
• Co-trimoxazole
• Ciprofloxacin (BUT ALL QUINOLONES)

Question 10

C. dificilie treatment

Answer 10

• non-severe= oral metronidazole

- severe= oral vancomycin

Question 11

Peritonitis/ billiary tract infection. intra-abdominal infections

Answer 11

IV amoxicillin, metronidazole and gentamicin and then step down to oral co-trimoxazole and metronidazole

Question 12

proven spontaneous bacterial peritonitis

Answer 12

• mild disease (incidental diagnosis on routine tap)= oral co-trimoxazole
• severe disease= IV piperacillin/ Tazobactam

Question 13

genitourinary infections

Answer 13

• catheterised patients= do NOT use urinalysis, do NOT treat unless there is clinical signs of symptoms of infection= IV amoxicillin and gentamicin
• UTI in older adults= do NOT use urinalysis, do not treat unless there is clinical signs or symptoms of infections, treat as per guidance below
• uncomplicated female lower UTI= nitrofurantoin or trimethoprim
• uncatheterised male UTI= nitrofurantoin or trimethoprim
• complicated UTI/ pyelonephritis/ urosepsis= IV amoxicillin and gentamicin

Question 14

cellulitis

Answer 14

flucloxacillin

Question 15

acute septic arthritis/ osteomyeltis

Answer 15

IV flucloxacillin

Question 16

diabetic foot infection

Answer 16

mild= flucloxacillin 
moderate= flucloxacilin and metronidazole

Question 17

open fracture prophylaxis

Answer 17

IV co- amoxiclav