Tayside Hospital Antibiotic Man

Question 1

Meningitis

Answer 1

Ceftriaxone IV 2g BD + Dexamethasone IV 10mg QDS for 4 days started with or just before first dose of antibiotics

Question 2

Meningitis + suspected encephalitis

Answer 2

Aciclovir IV (10mg/kg) TDS

Question 3

Meningitis of over 60yrs or immunocompromised

Answer 3

Ceftriaxone IV 2g BD + Dexamethasone IV 10mg QDS for 4 days started with or just before first dose of antibiotics

PLUS

Amoxicillin IV 2g 4hourly

Question 4

Epiglottitis/Supraglottitis

Answer 4

Ceftriaxone IV 2g OD

Question 5

CAP 0-2

Answer 5

Amoxicillin 1g TDS IV/PO

5 days

Question 6

CAP 0-2 Penicillin Allergic

Answer 6

Doxycycline PO 200mg on day 1 then 100mg OD

Or IV Clarithryomycin if NBM

Question 7

CAP 3-5

Answer 7

Co-Amoxiclav IV 1.2g TDS
PLUS
Doxycycline PO 100mg BD

STEP DOWN
Doxycycline 100mg BD for all patients with severe CAP

TOTAL IV/PO 7 days

Question 8

CAP 3-5 Penicillin allergy

Answer 8

IV Levofloxacin 500mg BD

Question 9

CAP 3-5 ICU/HDU/NBM

Answer 9

Co-amoxiclav IV 1.2g TDS
PLUS
Clarithromycin IV 500mg BD

STEP DOWN
Doxycycline 100mg BD for all patients with severe CAP

Total IV/PO 7 days

Question 10

HAP Severe

Answer 10

IV Amoxicillin + Metronidazole + Gentamycin

STEP DOWN
PO Co-trimoxazole + Metronidazole

TOTAL IV/PO 7 days

Question 11

HAP Severe + Penicillin allergy

Answer 11

IV Co-trimoxazole + Metronidazole +/- Gentamycin

Question 12

HAP Non severe

Answer 12

PO Amoxicillin + Metronidazole

TOTAL 5days

Question 13

HAP non severe + penicillin allergy

Answer 13

PO Co-trimoxazole + Metronidazole

Question 14

HAP + previous ICU admission or history of MRSA

Answer 14

Seek advice

Question 15

Acute exacerbation of COPD

Answer 15

Increased sputum purulence
Antibiotics

No increased sputum purulence then no antibiotics UNLESS consolidation CXR or signs or pneumonia

1st line Amoxicillin 500mg TDS
2nd line Doxycycline 200mg on day 1 then 100mg daily
5 DAYS

Question 16

Acute Cough/Acute Bronchitis

Answer 16

Antibiotics give no significant benefit in clinical improvement but may be considered in the frail elderly

1st line Amoxicillin 500mg TDS
2nd line Doxycycline 200mg on day 1 then 100mg daily
5 days

Question 17

Endocarditis General Management

Answer 17

Take blood cultures
Start empirical therapy and refer to ID/Microbiology
Check full endocarditis guidance for gentamicin/vancomycin dosing especially in reduced renal function
Do not use gentamicin chart

Question 18

Endocarditis

Native valve indolent (subacute)

Answer 18

Amoxicillin IV 2g 4hourly + Gentamicin 1mg/kg BD (use actual body weight - max 120mg/dose)

Question 19

Endocarditis

Native valve severe sepsis (acute)

Answer 19

Flucloxacillin IV 2g 6hourly

4 hourly if >85kg

Question 20

Endocarditis

Prosthetic valve or suspected MRSA

Answer 20

Vancomycin IV + Rifampicin PO 600mg BD + Gentamicin IV 1mg/kg BD (use actual body weight - max 120mg/dose)

Question 21

Endocarditis

Native severe sepsis + risk factors for resistant pathogens

Answer 21

See full guidance

Vancomycin IV + Meropenem IV 2g TDS (requires ID/Micro approval)

Question 22

Acute gastroenteritis

Answer 22

No antibiotics. Seek advice if severe

Question 23

C Diff Non severe

Answer 23

Metronidazole PO 400mg TDS

10days

Question 24

C Diff Severe

Answer 24

Vancomycin 125mg QDS PO/NG
+/-
IV Metronidazole

10days

Question 25

C Diff Recurrent

Answer 25

Positive CDI in previous 8 weeks- see guidance

Question 26

Acute Pancreatitis

Answer 26

Antibiotics unlikely to affect outcome. Seek advice

Question 27

Peritonitis/Biliary Tract/Inta-Abdominal

Answer 27

IV Amoxicillin + Metronidazole + Gentamicin STEP DOWN PO Co-trimoxazole + Metronidazole TOTAL IV/PO 7-10days

Question 28

Peritonitis/Biliary Tract/Inta-Abdominal + Penicillin Allergy

Answer 28

IV Vancomycin + Metronidazole + Gentamicin STEP DOWN PO Co-trimoxazole + Metronidazole TOTAL IV/PO 7-10days

Question 29

Proven spontaneous bacterial peritonitis - Severe

Answer 29

Piperacillin/Tazobactam IV 4.5g TDS STEP DOWN PO Co- trimoxazole 5-7days

Question 30

Proven spontaneous bacterial peritonitis - mild disease (incidental diagnosis on routine tap)

Answer 30

PO Co-trimoxazole 5-7days

Question 31

Catheterised patients

Answer 31

Do not use urinalysis Do not treat unless clinical signs/symptoms of infection If definite infection treat as per complicated UTI

Question 32

Uncomplicated Female Lower UTI

Answer 32

Nitrofurantoin 50mg QDS OR Trimethoprim 200mg BD 3days

Question 33

Uncatheterised Male UTI

Answer 33

Nitrofurantoin 50mg QDS OR Trimethoprim 200mg BD 7mg

Question 34

Complicated UTI/Pyelonephritis/Urosepsis

Answer 34

IV Amoxicillin + Gentamicin Step down to co-trimoxazole or as per sensitivities Total IV/PO 7 days

Question 35

Complicated UTI/Pyelonephritis/Urosepsis + Penicillin allergy

Answer 35

IV Co-trimoxazole + Gentamicin Step down to co-trimoxazole or as per sensitivities Total IV/PO 7 days

Question 36

Cellulitis

Answer 36

Flucloxacillin 1g QDS TOTAL IV/PO 7 days

Question 37

Cellulitis + Penicillin allergy

Answer 37

Doxycycline 100mg BD PO TOTAL IV/PO 7 days

Question 38

Diabetic Foot Infection Mild

Answer 38

Flucloxacillin 1g QDS OR Doxycycline 100mg BD TOTAL 7 days

Question 39

Diabetic Foot Infection Moderate

Answer 39

Flucloxacillin 1g QDS + Metronidazole 400mg TDS OR Doxycycline 100mg BD + Metronidazole 400mg TDS TOTAL 7 days

Question 40

Acute septic arthritis/Osteomyelitis

Answer 40

Seek ID advice IV Flucloxacillin 2g QDS

Question 41

Open fracture prophylaxis

Answer 41

IV Co-amoxiclav 1.2 TDS (or IV Co-trimoxazole 960mg BD + Metronidazole 500mg TDS) Start within 3 hours for max 72hours

Question 42

Unknown source

Answer 42

IV Amoxicillin + Metronidazole + Gentamicin (consider adding Flucloxacillin/Vancomycin if concerns re staphylococci)

Question 43

Unknown source + penicillin allergy

Answer 43

IV Vancomycin + Metronidazole + Gentamicin