Common Infections (UTI, Pneumonia, Skin/Soft Tissue)

Question 1

What are the symptoms of a urinary tract infection?

Answer 1

Bloody/cloudy urine
Pelvic pain
Insufficient bowel emptying

Question 2

When do you refer if a patient presents UTI symptoms to you in a community pharmacy?

Answer 2

Pregnant
Child
Male
>65 years old

Question 3

Which people do you not treat for a UTI infection?

Answer 3

Asymptomatic non-pregnant women

Question 4

What are the 1st line treatment options for an uncomplicated UTI?

Answer 4

1. Nitrofurantoin 100mg M/R BD 3/7
2. Trimethoprim 200mg BD 3/7

Question 5

What should the patients eGFR be in order to give nitrofurantoin?

Answer 5

> 45ml/min

Question 6

What are the 2nd line treatment options for an uncomplicated UTI?

Answer 6

1. Pivmecillinam 400mg, then 200mg TDS 3/7
2. Fosfomycin 3mg single dose

Question 7

What is the 1st line treatment option for a pregnant woman with a UTI?

Answer 7

Nitrofurantoin 100mg M/R BD 7/7

Question 8

What are the 2nd line treatment options for a pregnant woman with a UTI?

Answer 8

1. Amoxicillin 500mg TDS 7/7
2. Cefalexin 500mg BD 7/7

Question 9

What is the 1st line treatment option for a man with a UTI?

Answer 9

1. Trimethoprim 200mg BD 7/7
2. Nitrofurantoin 100mg M/R BD 7/7

Question 10

When should you never give trimethoprim to a woman, and why?

Answer 10

During her 1st trimester of pregnancy as there is risk of teratogenicity

Question 11

What is the 1st line treatment option for a child (<16 yrs) with a UTI?

Answer 11

Trimethoprim 200mg BD 3/7
Nitrofurantoin 100mg M/R BD 3/7

Question 12

What age do you refer a patient with a suspected UTI in a community pharmacy setting?

Answer 12

<16 years old

Question 13

What are some non-pharmacological treatment options for a UTI?

Answer 13

Increase fluid intake
Manage any constipation symptoms
Urinate after sex

Question 14

What is pyelonephritis?

Answer 14

A type of UTI that travels to the kidneys

Question 15

What are the symptoms of pyelonephritis?

Answer 15

Fever
Middle-back pain (where kidneys are)
N+V

Question 16

What is the 1st line treatment option for pyelonephritis (men + women)?

Answer 16

Cefalexin 500mg BD 7-10 days

Question 17

What are some 2nd line treatment options for pyelonephritis?

Answer 17

1. Co-amoxiclav 500/125mg TDS 7-10 days
2. Trimethoprim 200mg BD 14 days

Question 18

What is cellulitis/erysipelas?

Answer 18

Cellulitis: infection of the deeper layers of the skin

Erysipelas: infection of the uppermost layers of the skin

Question 19

What are the symptoms of cellulitis/erysipelas?

Answer 19

Red, swollen skin
Oedema
Warmth
Skin appearing shiny
Systemic symptoms if severe

Question 20

What areas of the body can cellulitis/erysipelas occur?

Answer 20

Hands
Feet
Upper legs

Question 21

When do you refer a patient if you suspect cellulitis/erysipelas?

Answer 21

Diabetic
Immunocompromised
Appearing on the face
<1 yrs old
If infection appears severe

Question 22

What are some non-pharmacological interventions for cellulitis/erysipelas?

Answer 22

Painkillers for pain
Increase fluid intake
Avoid compression garments
Manage any skin breaks

Question 23

What is the 1st line treatment option for cellulitis/erysipelas?

Answer 23

Flucloxacillin 500mg QDS 5-7 days

Question 24

What are the 2nd line treatment options for cellulitis/erysipelas, or if the patient has a penicillin allergy?

Answer 24

1. Clarithromycin 500mg BD 5-7 days
2. Doxycyline 200mg STAT, then 100mg OD 5-7 days

Question 25

Which antibiotic do you give to a pregnant woman with cellulitis/erysipelas?

Answer 25

Erythromycin 500mg QDS 5-7 days

Question 26

What are the symptoms of a respiratory tract infection?

Answer 26

Cough SOB Systemic symptoms - fever/sweats/chills/aches

Question 27

What does CURB65 stand for?

Answer 27

Confusion Urea Respiratory rate Blood pressure Age >65 years old

Question 28

What is community acquired pneumonia?

Answer 28

Pneumonia acquired outside of a hospital setting

Question 29

When do you refer a patient who presents CAP?

Answer 29

If they have a CURB65 score of >1

Question 30

What is the 1st line treatment option if the CURB65 score of a CAP patient is <2?

Answer 30

Amoxicillin 500mg TDS 5/7

Question 31

What are the 2nd line treatment options if the CURB65 score of a CAP patient is <2?

Answer 31

1. Doxycyline 200mg STAT, then 100mg OD 5/7 2. Clarithromycin 500mg BD 5/7

Question 32

What is the 1st line treatment option if the CURB65 score of a CAP patient is >3

Answer 32

1. Co-amoxiclav 500/125mg TDS 5/7 2. Benzylpenicillin 1.2g IV 4 hourly + dox. 3. Clarithromycin 500mg BD 5/7

Question 33

What is the 2nd line treatment option if the CURB65 score of a CAP patient is >3?

Answer 33

Levofloxacin 500mg BD 5/7 IV/PO Can also use if penicillin allergy present

Question 34

What is hospital acquired pneumonia (HAP)?

Answer 34

A patient acquiring pneumonia >48h during a hospital setting

Question 35

What is the 1st line treatment option for HAP?

Answer 35

Co-amoxiclav 500/125mg TDS 5/7

Question 36

What are the 2nd line treatment options for HAP?

Answer 36

1. Doxycyline 200mg STAT then 100mg OD 5/7 2. Cefalexin 500mg BD 5/7 3. Co-trimoxazole 960mg BD 5/7 4. Levofloxacin 500mg OD/BD 5/7