Infection Prescribing Pathways

Question 1

CURB65 parameters

Answer 1

Confusion
Blood Urea nitrogen levels (>7 mmol/L)
Respiratory rate (>20 BPM)
Low Blood pressure (<60/90)
Age (65+)

Question 2

Tx low severity CAP

Answer 2

CURB: 0-1
1st: amoxicillin
2nd: Doxycycline or clarithromycin

Question 3

Tx moderate severity CAP

Answer 3

CURB: 2
1st: amoxicillin
+ clairthromycin IF aptypical pathogens present
2nd: doxycycline or clarithromycin

Question 4

Tx high severity CAP

Answer 4

CURB: 3-5
1st: Co-amoxiclav
+ Clarithromycin if atypical pathogens present
2nd: Levofloxacin

Question 5

Which macrolide is preferred in pregnancy?

Answer 5

Erythromycin

Question 6

Tx non-severe HAP

Answer 6

1st: co-amoxiclav
2nd (adults): doxycycline, cefelexin, co-trimoxazole or levofloxacin
Second line (children): clarithromycin

Question 7

TX severe HAP

Answer 7

1st: depends on local guidelines
+ vancomycin OR teicoplanin if MRSA suspected

Question 8

Tx TB initial phase
- how long?

Answer 8

RIPE
Rifampicin
Isoniazid (given with pyridoxine (VIT B6) to stop peripheral neuropathy)
Pyrazinamide
Ethambutol

2 months

Question 9

Tx TB continuation phase
- how long

Answer 9

Rifampicin
Isoniazid

4 months (After 2 months initial phase)

Question 10

Tx latent TB
- how long

Answer 10

Rifampicin + isoniazid (3 months) OR Isoniazid (with pyridoxine) (6 months)

Question 11

Tx human and animal bites
- how long for prophylaxis and treatment?

Answer 11

1st: co-amoxiclav
2nd: doxycycline + metronidazole
- prophylaxis: 3 days
- treatment: 5 days

Question 12

Tx Lyme disease
- how long?

Answer 12

1st: doxycycline
2nd line: amoxicillin
- for 21 days!

Question 13

Tx cellulitis

Answer 13

1st: flucloxacillin
- clari/doxy of pen allergic
- erythro if preg

Question 14

Tx cellulitis near eyes or nose

Answer 14

Co-amoxiclav
- Clarithromycin + metronidazole if penicillin allergic

Question 15

Tx diabetic foot infection if ulcer is <2cm

Answer 15

Flucloxacillin
- pen allergic: doxy/ clary/eryth

Question 16

Tx diabetic foot infection if ulcer is >2cm (abscess or osteomyelitis)

Answer 16

Fluclox +/- gent +/- metronidazole
Co-amox +/- gent
- pen allergic: Co-trimoxazole +/- gent +/- metronidazole

Question 17

Tx localised non-bolus impetigo

Answer 17

1st: hydrogen peroxide 1%
2nd: fusidic acid

Question 18

Tx wide spread, non-bolus impetigo

Answer 18

Topical: fusidic acid
Oral: flucloxacillin

Question 19

Tx in bullous or if pt is systemically unwell

Answer 19

1st: Oral flucloxacillin
2nd: clarithromycin

Question 20

Tx severe qacne vulgaris
- age restriction
- MHRA warnings

Answer 20

Oral isotretinoin
- 12 years +
- resistant to standard therapy

MHRA: under 18 = two prescribers agree
MHRA: PPP in place for child bearing potential
- contraception used 1 months before and 1 month after treatment

Prescription is only valid for 7 DAYS and is 30 DAYS SUPPLY

Question 21

Tx scabies

Answer 21

Permethrin TWICE- 1 week apart to the whole body
- treat all family members
- avoid physical contact with others

Question 22

Tx C.diff
- how long?

Answer 22

1st: ORAL vancomycin
2nd: fidaxomicin
- 10 days

Question 23

Tx travellers diarrhoea
- standby, given to those at high risk

Answer 23

Ciprofloxacin

Question 24

Tx H.pylori

Answer 24

Triple therpay
1. PPI
With 2 of:
- amoxicillin
- clarithromycin
- metronidazole

Question 25

Diagnostic test for H.pylori - when what should be stopped before doing this test?

Answer 25

Urea (13c) breath test OR stool antigen test Should not be performed: - within 2 weeks of taking PPI - within 4 weeks of taking ABX

Question 26

Tx UTI Treatment length in: - uncomplicated - men - pregnant women - catheter associated

Answer 26

Nitrofurantoin or trimethoprim - Uncomplicated: 3 days - Men: 7 days - Pregnant: 7 days - Catheter associated: 7 days

Question 27

Tx BV

Answer 27

Metronidazole

Question 28

Tx chlamydia

Answer 28

1st: doxy 2nd: Azithromycin

Question 29

Tx gonorrhoea

Answer 29

Ceftriaxone ciprofloxacin

Question 30

Most common pathogens - CAP - UTI - Thrush - cellulitis - meningitis

Answer 30

- CAP: Streptococcus pneumonia - UTI: E.coli - Thrush: candida Albican - cellulitis: Straphylococcus aureus - meningitis: Streptococcus pneumoniae

Question 31

Tx otitis media

Answer 31

1st: amoxicillin - pen allergy: clarithromycin Worsening after 2-3 days: co-amoxiclav

Question 32

Tx Otitis externa

Question 33

Tx Step throat

Answer 33

1st: Phenoxymethylpenicillin 2nd: clarithromycin

Question 34

Tx Scarlett fever

Answer 34

1st line: Phenoxymethylpenicillin 2nd: azithromycin

Question 35

Tx Dental abscess

Answer 35

1st line: amoxicillin or Phenoxymethylpenicillin 2nd: metronidazole or clarithromycin

Question 36

Tx Conjunctivitis

Answer 36

Chloramphenicol ointment/ drops - give until 48 hours after infection has cleared - REFER pregnant, PGD under 2

Question 37

Tx meningitis - before hospital - suspected bacterial - listeria monocytogenes

Answer 37

Before hospital: ceftriaxone or benzylpenicillin Suspected bacterial: ceftriaxone Listeria monocytogens: amoxicillin