antibiotics

Question 1

what is the interaction between trimethoprim + methotrexate

Answer 1

increased risk of nephrotoxicity and methotrexates side effects

Question 2

which antibiotic has high activity against anaerobic bacteria

Answer 2

metronidazole

Question 3

what is the interaction between ciprofloxacin + theophylline

Answer 3

Ciprofloxacin interacts with theophylline- increases exposure by altering the rate of metabolism of theophylline.

Moderate interaction -manufacture advises monitor + adjust dose

Question 4

should phenoxymethylpenicillin be taken with food or without

Answer 4

Phenoxymethylpenicillin- take on an empty stomach

Question 5

what should be avoided 2 hours before/after taking doxycycline

Answer 5

indigestion remedies/iron/zinc 2 hours before or after

Question 6

what are the counselling points for doxycycline

Answer 6

• full glass of water
• protect skin from sunlight
• no indigestion remedies/iron/zinc 2 hours before or after

Question 7

should flucloxacillin be taken with food or without food

Answer 7

Flucloxacillin should be taken on an empty stomach

Question 8

which antibiotic should not be routinely used in children under 12 due to deposition in growing bones + teeth

Answer 8

doxycycline

Question 9

which antibiotic may impair the performance of skilled tasks e.g driving

Answer 9

ciprofloxacin

Question 10

which antibiotic is used for antibiotic-associated colitis (pseudomembranous colitis)

Answer 10

vancomycin

Question 11

which antibiotic class is associated with tendon rupture

Answer 11

quinolones e.g ciprofloxacin, ofloxacin, levofloxacin

Question 12

why should you avoid using Gentamicin in patients with renal impairment

Answer 12

because gentamicin is excreted by the kidneys. Renal impairment can cause accumulation- increased risk of nephrotoxicity + ototoxicity

note: if you must use it, reduce or increase the dose according to impairment

Question 13

what colour can rifamipicin change your urine to

Answer 13

urine colour can be change anywhere from:

yellow - reddish/orange - reddish/brown

Question 14

what colour can nitrofurantoin change your urine to

Answer 14

dark yellow to brownish

Question 15

what symptoms should patients taking Trimethoprim recognise + report

Answer 15

seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop

note: these are signs of blood disorders

Question 16

which medication interact with quinolones + increase the risk of seizures

quinolones e.g ciprofloxacin, ofloxacin, levofloxacin

Answer 16

• ibuprofen
• naproxen
• indometacin
• theophylline

Question 17

which antibiotics are most likely to cause a c.difficile infection

Answer 17

• Clindamycin
• cephalosporins (cefalexin, cefradine, cefadroxil, cefaclor)
• fluoroquinolones (Ciprofloxacin, Moxifloxacin, Levofloxacin, Ofloxacin)
• broad-spectrum penicillins

Question 18

what is the first line treatment for c.difficle

Answer 18

first line: vancomycin

second line: Fidaxomicin

Question 19

which antibiotic class is not suitable to children and why

Answer 19

tetrayclines: e.g doxycycline, tetracyline, Tigecycline

it causes deposits in growing bone and teeth, by binding to calcium, causes staining and occasionally dental hypoplasia

Question 20

which antibiotic is contraindicated in patients with jaundice or hepatic dysfunction

Answer 20

co-amoxiclav

co-amoxiclav can cause jaundice + reduce hepatic function

Question 21

describe the monitoring around vancomycin

Answer 21

• All patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment—consult product literature)
• The next vancomycin dose should not be withheld whilst awaiting results unless toxicity is suspected
• Administration rate should not exceed 10mg/min to reduce the risk of red-man’s syndrome.

Question 22

what is the interaction between amoxicillin + methotrexate

Answer 22

Amoxicillin is predicted to increase the risk of toxicity when given with methotrexate. Manufacturer advises
monitor.

Question 23

what is the first line treatment for community acquired pneumonia

Answer 23

first line= amoxicillin

alternative if penicillin allergic: clarithromycin, doxycycline, or erythromycin (in pregnancy)

note: this is for both low + moderate severity

Question 24

which antibiotic is commonly used as an alternative for penicillin allergy in pregnant/breastfeeding women

Answer 24

erythromycin

Question 25

what is the antibiotic regimen for a h-pylori infection

Answer 25

``` Oral first line for 7 days: - A proton pump inhibitor (twice daily) - amoxicillin (1 g twice daily) and either - clarithromycin (500 mg twice daily) or - metronidazole (400 mg twice daily) ``` *note: if penicillin allergy: just give PPI + Clarithromycin + Metronidazole*

Question 26

what is the interaction between clarithromycin + atorvastatin

Answer 26

Clarithromycin increases the exposure to Atorvastatin - severe

Question 27

what is the interaction between clarithromycin + amlodipine

Answer 27

Clarithromycin increases the exposure to Amlodipine

Question 28

which food should not be taken with ciprofloxacin

Answer 28

avoid dairy products and mineral-fortified drinks with oral ciprofloxacin- reduces exposure of ciprofloxacin

Question 29

which antibiotic is used to treat meningitis

Answer 29

Benzylpenicillin

Question 30

what is the treatment for acute sinusitis

Answer 30

first line: phenoxymethylpenicillin, if severe or high risk co-amoxiclav - if penicillin allergy: doxycycline or clarithromycin (erythromycin in pregnancy) * note: acute sinusitis is usually viral + self limiting. antibiotics only used if the patient has had no improvement in symptoms after trying nasal corticosteroids*

Question 31

which antibiotic do you give to a pregnant woman if she has a UTI but is it at term in her pregnancy

Answer 31

cefalexin *note: nitrofurantoin is given if pregnant but not at term. nitrofurantoin should avoid at term (36-42 week)—may produce neonatal haemolysis. once the pregnant woman is at term, can only give cefalexin*

Question 32

when should you avoid giving nitrofurantoin in pregnant women

Answer 32

can give nitrofurantoin in pregnancy but at term (36-42 weeks in pregnancy)

Question 33

which antibiotic is contraindicated in patients with G6PD deficiency

Answer 33

nitrofurantoin *note: G6PD is an enzyme that supports the functioning of red blood cells. Individuals with this deficiency are susceptible to haemolytic anaemia*

Question 34

which class of antibiotics are potent enzyme inhibitors

Answer 34

Macrolides e.g Clarithromycin, erythromycin, azithromycin

Question 35

which antibiotic is used to treat meningitis if the person is allergic to penicillin

Answer 35

cefotaxime *note: first line is normally benzylpenicllin*

Question 36

can chloramphenicol eye drops containing borax or boric acid buffers be used in children younger than 2 years

Answer 36

yes- it is safe to use them

Question 37

which antibiotic can cause ‘neonatal grey-baby syndrome’

Answer 37

chloramphenicol

Question 38

why should pregnant women avoid chloramphenicol in the 3rd trimester

Answer 38

because it can cause ‘neonatal grey-baby syndrome’ *note: this is chloramphenicol drops/ iv + oral use*

Question 39

what is the treatment for otitis externa

Answer 39

first line: Flucloxacillin - penicillin allergy: Clarithromycin (or azithromycin or erythromycin). If pseudomonas suspected: Ciprofloxacin

Question 40

what is the treatment for otitis media

Answer 40

first line: amoxicillin. if worsening: co-amoxiclav penicillin allergy: clarithromycin or erythromycin *note otitis media can be viral, bacterial or both*

Question 41

which antibiotics are used in the "initial blind therapy" of endocarditis

Answer 41

- amoxicillin/ ampicillin + low dose gentamicin penicillin allergy/sepsis: vancomycin + dose dose gentamicin *note: in endocarditis, gentamicin (‘peak’) serum concentration should be 3–5 mg/litre; pre-dose (‘trough’) concentration should be less than 1 mg/litre*

Question 42

which antibiotics should be used for Patients with a human or an animal bite

Answer 42

first line: co-amoxiclav penicillin allergy: doxycycline + metronidazole

Question 43

which tablets, when taken with quinolones, further increase the risk of tendon damage

Answer 43

- the risk of tendon damage is increased by the concomitant use of corticosteroids quionolones e.g ciprofloxacin, Ofloxacin, Levofloxacin, Moxifloxacin