Basic AB rules - PASSMED

Question 1

Exacerbations of chronic bronchitis

Answer 1

Amoxicillin or tetracycline or clarithromycin

Question 2

Uncomplicated community-acquired pneumonia

Answer 2

Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)

Question 3

Pneumonia possibly caused by atypical pathogens

Answer 3

Clarithromycin

Question 4

Hospital-acquired pneumonia

Answer 4

Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with tazobactam
OR a broad-spectrum cephalosporin (e.g. ceftazidime)
OR a quinolone (e.g. ciprofloxacin)

Question 5

Lower urinary tract infection

Answer 5

Trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin

Question 6

Acute pyelonephritis

Answer 6

Broad-spectrum cephalosporin or quinolone

Question 7

Acute prostatitis

Answer 7

Quinolone or trimethoprim

Question 8

Impetigo

Answer 8

Topical hydrogen peroxide, oral flucloxacillin or erythromycin if widespread

Question 9

Cellulitis

Answer 9

Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

Question 10

Cellulitis (near the eyes or nose)

Answer 10

Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)

Question 11

Erysipelas treatment

Answer 11

Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

Question 12

Animal or human bite

Answer 12

Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)

Question 13

Mastitis during breast-feeding

Answer 13

Flucloxacillin

Question 14

Throat infections

Answer 14

Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)

Question 15

Sinusitis

Answer 15

Phenoxymethylpenicillin

Question 16

Otitis media

Answer 16

Amoxicillin (erythromycin if penicillin-allergic)

Question 17

Otitis externa**

Answer 17

Flucloxacillin (erythromycin if penicillin-allergic)

**a combined topical antibiotic and corticosteroid is generally used for mild/moderate cases of otitis externa

Question 18

Periapical or periodontal abscess

Answer 18

Amoxicillin

Question 19

Gingivitis: acute necrotising ulcerative

Answer 19

Metronidazole

Question 20

Gonorrhoea

Answer 20

Intramuscular ceftriaxone

Question 21

Chlamydia

Answer 21

Doxycycline or azithromycin

Question 22

Pelvic inflammatory disease

Answer 22

Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

Question 23

Syphilis

Answer 23

Benzathine benzylpenicillin or doxycycline or erythromycin

Question 24

Bacterial vaginosis

Answer 24

Oral or topical metronidazole or topical clindamycin

Question 25

Clostridium difficile

Answer 25

First episode: oral vancomycin

Second or subsequent episode of infection: oral fidaxomicin

Question 26

Campylobacter enteritis treatment

Answer 26

Clarithromycin

Question 27

Salmonella (non-typhoid)

Answer 27

Ciprofloxacin (quinolone)

Question 28

Shigellosis

Answer 28

Ciprofloxacin

Question 29

What are general rules for giving peri-op AB (quesbook)

Answer 29

Any surgery where a prosthesis is implanted (e.g. hip replacement)
Contaminated or dirty procedures
Thoracic procedures
Most upper, lower GI and hepatobiliary operations (except laparoscopic cholecystectomy).
Urological procedures
Open fracture repairs
Vascular surgery

Antibiotics should be given intravenously within 1 hour before the incision.

Question 30

A 67-yr man has a 3-day hx of productive cough + shortness of breath. X-ray imaging - LLL consolidation. Prescribed co-amoxiclav 1.2g IV and clarithromycin 500mg BD.

Which one of the following of his regular medications needs to be temporarily stopped?

Metformin
statin
levothyroixne 
indapamide 
Dapagliflozin

Answer 30

statin must be stopped when macrolide AB is started

Metformin only if renal function declined