Tayside Primary Care Antibiotic Man

Question 1

Dental abscess:

Answer 1

Penicillin V 500mg qds or Metronidazole 400mg tds (5 days)

Question 2

Tonsillitis / Pharyngitis / Sore Throat

Answer 2

Only consider antibiotic if severe (at least 4 on FeverPAIN score). most are viral.

1st LINE Penicillin V 1g bd or 500mg qds (5 days) 2nd LINE Clarithromycin 500mg bd (5 days, penicillin allergy only)

Question 3

Sinusitis:

Answer 3

If >10 days multiple or worsening symptoms consider back up antibiotic.

1st LINE Penicillin V 500mg qds or 1g bd (5days) 2nd LINE Doxycycline 200mg day 1 then 100mg daily (5 days total)

Question 4

Epiglottitis / Supraglottitis:

Answer 4

Medical emergency – transfer to hospital immediately

Question 5

Oral Candidiasis:

Answer 5

1ST LINE Miconazole gel qds or Nystatin 1ml qds
2ND LINE Fluconazole 50mg daily (Immunocompromised 100mg) (7 days)

Question 6

Acute exacerbation of COPD:

Answer 6

Treat if high sputum purulence. If no sputum purulence no antibiotics unless pneumonia or consolidation on CXR.

1st LINE Amoxicillin 500mg tds 2nd LINE Doxycycline 200mg day 1 then 100mg daily (5 days total)

Question 7

Acute cough / acute bronchitis:

Answer 7

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 day 1 then 100mg daily (5 days total)

Question 8

Community acquired pneumonia CURB65 score 0:

Answer 8

Usually treat at home.
Amoxicillin 1g tds or Doxycycline 200mg day 1 then 100mg daily (5 days)

Question 9

Community acquired pneumonia CURB65 score 1-2:

Answer 9

Usually treat at home.
Consider hospital referral (in particular if major co-morbidity)

Question 10

Community acquired pneumonia CURB65 score 3-4:

Answer 10

Urgent hospital admission

Give Amoxicillin 1g oral or Benzylpenicillin 1.2g IV before transfer (withhold if known anaphylaxis)

Question 11

C Difficile infection:

Answer 11

Oral Vancomycin (if unavailable: metronidazole)

Question 12

Recurrant C difficile infection in 12 weeks:

Answer 12

fidaxomycin

Question 13

Acute gastroenteritis:

Answer 13

No antibiotic required unless systemically unwell or post antibiotic

Question 14

Diverticulitis:

Answer 14

Uncomplicated acute diverticulitis may respond to analgesia and dietary modification.

If antibiotics are indicated use Metronidazole 400mg tds plus Co-trimoxazole 960mg bd 5 days

(or co-amoxiclav 625mg tds if unable to take cotrimoxazole)