Empirical antibiotic guidelines

Question 1

Name some broad spectrum antimicrobial agents that also have anaerobic activity

Answer 1

Tazocin

Augmentin

Meropenem

Question 2

What is the first line treatment for Infective exacerbation of COPD or asthma?

Answer 2

Amoxicillin (oral) for 5 days

Question 3

What is the penicillin allergy alternative for infective exacerbation of COPD/Asthma?

Answer 3

Doxyclycline (oral) for 5 days

Question 4

CAP-low risk of progression/fit for discharge/admitted for other reasons (CURB-65 of 0 or 1)

Answer 4

Amoxicillin (oral) for 7 days

Question 5

CAP - moderate severity/high risk fo progression (CURB-65 of 2)

Answer 5

Amoxicillin (oral/IV) for 7 days

Consider addition of doxycline (oral) on post-take ward-round

Question 6

What is the penicillin alternative for low risk/moderate severity CAP?

Answer 6

Doxycycline (oral) for 7 days

Question 7

CAP-high severity or systemic sepsis (CURB-65 of >3)

Answer 7

Amoxicillin (IV) and Doxycycline (oral) - give Clarith if oral route not available

Give Gent STAT if g-ve cover required

Review at 48hours - switch to oral Amox/Doxy

Question 8

What is the penicillin allergy alternative for CAP high severity/systemic sepsis?

Answer 8

Ceftriaxone (IV) and Doxy (oral)

review at 48 hours then 7d then oral switch to doxy

In IgE mediated allergy only give Levofloxacin (IV) then oral switch to doxy

Question 9

Community acquired aspiration pneumonia?

< 5 days post admission AND no risk factors for MDR

Answer 9

Amoxicillin (IV) tds

and

Metronidazole IV tds

for 3 days

Question 10

What is the penicillin allergy alternative for community acquired aspiration pneumonia?

Answer 10

Doxy oral od

if oral route unavailable give clarith IV bd

AND

Metronidazole IV tds

for

3 days

Question 11

Early onset HAP (less than 5 days post admission and no risk factors for MDR)

Answer 11

Treat as CAP

Question 12

Late onset HAP (>5 days post admission/risk factors)

Hospital stay within previous 4 weeks of +2 days duration

Dialysis

Immunosuppression

Answer 12

Tazocin (IV) tds

Review at 48 hours

Question 13

Penicllin allergy alternative for late onset HAP?

Answer 13

Levofloxacin (IV)

Review at 48 hours

Question 14

First line treatment for UTI

Answer 14

Nitrofurantoin qds or Trimethoprim bd (oral)

3 days female

7 days male

Question 15

Complex UTI/Urosepsis

failiure after 1st line

recent urological surgery

structural abnormalities

oral route unviable

1st lien drugs contraindicated

Answer 15

Gentamicin (IV) for 2 doses then review

If CrCl < 20ml/min use Augmentin IV stat

or Ciprofloxacin IV if pen allergy

Check winpath for ESBL producers in the past-check with micro for advice

Question 16

Pyelonephritis

Answer 16

Augmentin IV for 7 days

(add Gentamicin if severe sepsis/septic shock)

Question 17

Penicillin allergy alternative for Pyelonephritis?

Answer 17

Gentamicin IV for 7 days

If CrCl <20ml/min use Cipro IV od

oral switch to cipro bd

7d

Question 18

Intra-abdominal sepsis

Peritonitis

Cholecystitis (biliary sepsis)

Cholangitis

Diverticulitis

COMMUNITY ACQUIRED

Answer 18

Augmentin IV for 5 days

oral switch to oral Augmentin tds

Question 19

Intra-abdominal sepsis

Peritonitis

Cholecystitis

Cholangitis

Diverticulitis

HOSPITAL ACQUIRED

Answer 19

Tazocin IV for 5 days

oral switch to Augmenin tds unless cultures indicate resistance

Question 20

Penicillin allergy for intra-abdominal infections?

Answer 20

Gentamicin IV for 2 doses

Metronidazole IV tds

oral switch to Cipro bd and Met tds 5 days

Question 21

Digestive disease-

Variceal bleeding

Spontaneous bacterial peritonitis

Answer 21

Tazocin IV for 5 days

oral switch to Cipro bd 5d

Question 22

Digestive diseases: non-IgE mediated allergy

Answer 22

Ceftazidime IV tds

review after 48 hours and switch to oral ciprofloxacin to complete 5 days if clinically appropriate

Question 23

Mild cellulitis (no signs of systemic toxicity)

Answer 23

Flucloxacillin (oral) for 7 days qds

Question 24

Mild cellulitis - penicilling allergy alternative

Answer 24

Clarithromycin oral for 7 days

Question 25

Moderate/Severe Cellulitis Sepsis syndrome complicating co-morbidities

Answer 25

Flucloxacillin IV, switch to oral for OPAT if suitbale for 7-14 days

Question 26

Moderate/Severe Cellulitis - Penicllin allergy

Answer 26

Teicoplanin IV 12 hourly for 3 doses then od (also for MRSA colonisation) - IgE mediated non IgE Ceftriaxone oral Non-IgE: ceftriaxone IV until resolved oral switch clindamycin qds

Question 27

Diabetic foot no systemic toxicity

Answer 27

First line: Flucloxacillin oral qds 7d Pen allergy: Clarith oral bd 7d

Question 28

Diabetic foot (systemic toxicity/comorbidities)

Answer 28

Teicoplanin IV for 3 doses then od and Tazocin IV untill clinically resolved

Question 29

Diabetic foot (systemic toxicity etc) - penicillin allergy

Answer 29

Teicoplanin for 3 doses then od and Metronidazole IV and Gentamicin IV for 2 doses then review

Question 30

Human bites

Answer 30

Augmentin oral for 7 days Asess risk of BBVs

Question 31

Animal bites

Answer 31

Augmentin oral tds 7d Pen allergy: Doxy oral od AND met oral tds 7d

Question 32

Meningitis - Community acquired

Answer 32

Ceftriaxone IV If \>55y/immunocompromised/alchoholic, add amoxicillin IV for 7-14 days and dexamethosone IV for 4 days unless septic shock, immunocompromised or post-neurosurgery

Question 33

Meningitis - community acquired, penicillin allergy

Answer 33

Chloramphenicol IV qds and reduce after 48hrs AND add Co-trimoxazole IV if \>55y/immunocompromised/alcoholic 7-14 days AND add aciclovir if signs of encephalitis e.g. seizures, alterterd mental staus or focal neurology

Question 34

Post neurosurgery meningitis/ventriculitis/infected EVD

Answer 34

Meropenem IV tds AND Linezolid IV bd add gent if g-ve cover required Pen allergy: chloramphenicol IV qds and if required gent intra ventricular od

Question 35

Neutropenic sepsis

Answer 35

Take blood culture first then Tazocin IV qds Add Gentamicin IV if hypotensive Add Teicoplanin IV for 3 doses then od (if central line infected or MRSA colonised)

Question 36

Neutropenic sepsis - non IgE mediated

Answer 36

Ceftazidime IV add Gentamicin IV if hypotensive add Teicolanin IV for 3 doses (if central line infected/MRSA colonised)

Question 37

Neutropenic sepsis - IgE mediated

Answer 37

Ciprofloxacin IV and Gentamicin IV for 2 doses Add Teicoplanin IV for 3 doses (if central line infected/MRSA colonised)

Question 38

Severe sepsis/septic shock no clear focus community assocaited

Answer 38

Augmentin IV and Gentamicin IV for a single dose

Question 39

Severe sepsis/septic shock - Penicllin allergy community assocaited

Answer 39

Vancomycin IV and Gentamicin IV and Metronidazole IV

Question 40

Severe sepsis/septic shock - risk factors for MDR

Answer 40

Tazocin IV stat AND Gent IV stat Penicillin allergy: Vanc IV AND Gent IV

Question 41

Endocarditis - severe sepsis - prosthetic valves - IVDU - MRSA colonised

Answer 41

Vancomycin IV and Gentamicin IV and Rifampicin oral

Question 42

Endocarditis -indolent presentation

Answer 42

Amoxicillin IV 4 hourly and Gentamicin IV bd

Question 43

Endocarditis - indolent presentation - penicillin allergy

Answer 43

Vancomycin IV and Gentamicin IV

Question 44

Osteomyelitis/septic arthritis

Answer 44

Flucloxacillin IV 4-6 weeks first line

Question 45

Osteomyelitis/septic arthritis - penicillin allergy/MRSA colonised

Answer 45

Teicoplanin IV for 12 hourly 3 doses then od

Question 46

Quinsy/tonsillar abscess

Answer 46

BenPen IV and Metronidazole IV for 10 days (can switch to PenV oral post incision and drainage)

Question 47

Quinsy/tonsillar abscess - penicillin allergy

Answer 47

Clarithromycin IV and Metronidazole IV for 10 days Can switch to clarithromycin oral post incision and drainage

Question 48

Epiglottitis

Answer 48

Ceftriaxone IV for 7 days

Question 49

Epiglottitis - penicillin allergy

Answer 49

Chloramphenicol IV qds and reduce dose after 48 hrs for 7 days

Question 50

Surgical site infection -localised signs

Answer 50

First line: Flucloxacillin oral qds 5days

Question 51

Surgical site infection localised signs penicillin allergy

Answer 51

Clarithromycin 500 mg oral 5days

Question 52

Surgical site infection - deep incisional - pus, abscess, fever and tenderness first line

Answer 52

Flucloxacillin IV qds OR Augmentin (Co-Amoxiclav) IV tds if gastrointesinal/gynaecogical/urological 5 days and review Oral switch to Flucloxacillin oral qds/Augmentin oral qds