(consolidating everything) spectrum of activity table / treatment / adverse effects

Question 1

use what against beta hemolytic strep (Grp A-C,G)

Answer 1

Pen G
Pen V
Amoxicillin

Question 2

use what against MSSA

Answer 2

Cloxacillin
Cephalexin

(mild allergy) cefuroxime
(severe allergy) Clindamycin

Question 3

When is Ceftazidime used?

Answer 3

Burkholderia and Pseudomonas
Inpatient severe CAP (CURB-65, 3 onwards)

Question 4

When is Ceftriaxone used in STI?

Answer 4

1) First line for gonorrhea (IM 500mg single dose)
2) Neurosyphilis (if pt has pen allergy, IV / IM 2g daily x 10-14 days

Question 5

Difference between Cephalexin / Cefazolin VS Cefuroxime

Answer 5

Cefuroxime can cover Strep Pneumo, Cephalexin and Cefazolin cannot

Hence Cefuroxime is used in CAP

Question 6

When are Macrolides used?

Answer 6

Usually Azithromycin and Clarithromycin

1) 2nd line for bacterial pharyngitis

2) Can cover atypicals also -> used in Outpatient CAP w co-morbs onwards

Azithromycin only
1) Chlamydia 2nd line (PO 1g single dose)
2) 2nd line for Gonorrhea (PO 2g single dose, taken with Gentamicin)

Question 7

When is Azithromycin used in STI?

Answer 7

1) Chlamydia 2nd line (PO 1g single dose)
2) 2nd line for Gonorrhea (PO 2g single dose, taken with Gentamicin)

Question 8

IC9 Counselling points for Macrolides (Azithromycin, Clarithromycin)

Answer 8

Gastric distress (low)
Hepatotixicity
Ototoxicity
Prolong QTc interval

Question 9

When is Doxycycline used for STI?

Answer 9

1) 1st line for Chlamydia

2) Syphilis, if patient has penicillin allergy, for primary / secondary / early latent or late latent / unknown duration / tertiary (basically not neurosyphilis can alr)

Question 10

What is Doxycycline used for? (across all ICs)

Answer 10

1) Atypical coverage for CAP

2) 1st line for Chlamydia

3) Syphilis, if patient has penicillin allergy, for primary / secondary / early latent or late latent / unknown duration / tertiary (basically not neurosyphilis can alr)

4) MRSA oral option for SSTI

Question 11

What are aminoglycosides used for?

Answer 11

Amikacin, Gentamicin
cover ESBL producing

Gentamicin
1) Pyelonephritis patients who are seriously ill
2) Gonorrhea (2nd line, 240mg IM single dose and taken with Azithromycin)

Amikacin (more broad than Genta)
1) HA-UTI, CA-UTI
2) Anti-pseudomonal for HAP, VAP

Question 12

What is Ciprofloxacin not good for

Answer 12

1. MSSA, hence cannot be single antipseudomonal in HAP / VAP

Question 12

Which fluoroquinolone is used for STI? Which drug and which condition?

Answer 12

Levofloxacin, for Chlamydia

PO 500mg OD for 7 days

Question 13

Adverse effects of Fluoroquinolones

Answer 13

1. C.diff associated diarrhea
2. Phototoxicity
3. Tendinitis, Tendon rupture
4. Arthropathy
5. Prolong QTc interval
6. Peripheral Neuropathy

Question 14

What is Co-trimoxazole not good for

Answer 14

Beta hemolytic (Grp A-C, G) strep
Dont use in mild diabetic foot infection

Question 15

Antibiotics with atypical coverage

Answer 15

Macrolides
Doxycycline
Levofloxacin and Moxifloxacin

Question 16

CrCl EQUATION

Answer 16

(140 - age) x weight x 0.85 if female
/
72 x (SCr in umol/L / 88.4)