Infectious Diseases - Empirical Treatment (Antibiotic Man)

Question 1

Meningitis treatment is with _______

Answer 1

Ceftriaxone IV 2g twice daily + dexamethasone IV 10mg QDS for 4days

Question 2

Ceftriaxone is what type of antibiotic?

Answer 2

Cephalosporins

Question 3

How do cephalosporins work?

Answer 3

Bacteriocidal. Targets the cell wall. interferes with the polymerisation of muramic acid to render the cell susceptible to osmotic lysis.

Question 4

What type of antibiotic is a cephalosporin?

Answer 4

Beta-lactam

Question 5

Name other examples of cephalosporins

Answer 5

Cephalexin
Cefuroxime
Cefixime

Question 6

What should you add to ceftriaxone when treating for meningitis, if encephalitis is suspected?

Answer 6

Add aciclovir IV (10mg/kg 3xdaily)

Question 7

What should you add to ceftriaxone in an immunocompromised or over 60 patient with meningitis?

Answer 7

Amoxicillin 2g IV 4hrly

Question 8

What is the treatment for epiglottitis/supraglottitis?

Answer 8

Ceftriaxone IV 2g once daily

Question 9

What is the CURB-65 score used for? What does it predict?

Answer 9

Used to decide treatment of pneumonia. Predicts mortality.

Question 10

Empirical treatment for a CURB 0-2 CA pneumonia?

Answer 10

Amoxicillin 1g 3xdaily IV or PO for 5 days

Question 11

If the patient is pen allergic, what should the treatment for a CURB 0-2 CA pneumonia be?

Answer 11

Doxycycline PO 200mg on day 1 then 100mg once daily.

Question 12

CURB 3-5 CAP should be treated with…

Answer 12

IV co-amoxiclav 1.2g 3xdaily and doxycycline PO 100mg 2xdaily

Question 13

In a pen-allergic patient CURB 3-5 CAP should be treated with…

Answer 13

IV levofloxacin 500mg 2xdaily

Question 14

If the patient is nil by mouth what can you replace doxycycline with?

Answer 14

IV clarithromycin

Question 15

What type of antibiotic is amoxicillin? How does it work?

Answer 15

It is a penicillin. Works similarly to cephalosporins. Prevents murmuric acid polymerisation to interfere with cell wall and cause osmotic lysis.

Question 16

What is the difference between amoxicillin and co-amoxiclav?

Answer 16

Combination of amoxicillin and clavulanic acid; beta-lactamase inhibitor to overcome beta-lactamase resistance

Question 17

What type of antibiotic is levofloxacin? Give an example of another drug in this class

Answer 17

Quinolones

Ciprofloxacin

Question 18

How do quinolones work?

Answer 18

They affect DNA-gyrase to impair bacterial replication

Question 19

What type of antibiotic is doxycycline?

Answer 19

Tetracyclines

Question 20

How do tetracyclines work?

Answer 20

Inhibit protein synthesis.

Question 21

What type of antibiotic is clarithromycin? Give examples of others in this class

Answer 21

Azithromycin

Erythromycin

Question 22

How do macrolides work?

Answer 22

Inhibit protein synthesis by blocking peptidyltransferase and also ribosomal translation

Question 23

How should a severe hospital acquired pneumonia be treated?

Answer 23

IV amoxicillin, metronidazole and gentamicin.

Step down to oral amoxicillin and metronidazole. Total of 7days IV/PO.

Question 24

If pen allergic how should a severe HAP be treated?

Answer 24

IV co-trimoxazole + metronidazole + gentamicin. Step down to oral co-tromoxazole and metronidazole. Total of 7days IV/PO.

Question 25

How should a non-severe hospital acquired pneumonia be treated?

Answer 25

Oral penicillin and metronidazole for 5days

Question 26

If pen allergic how should a non-severe hospital acquired pneumonia be treated?

Answer 26

Oral co-trimoxazole and metronidazole for 5days

Question 27

What is co-trimoxazole?

Answer 27

Combination of trimethoprim and sulfamethoxazole

Question 28

What are the indications for ABx in COPD?

Answer 28

1 of: - Increased sputum - Consolidation on CXR - features of pneumonia

Question 29

What is the first line ABx therapy for acute exacerbation of COPD?

Answer 29

Amoxicillin 500mg 3x daily

Question 30

What is the 2nd line therapy for acute exacerbation of COPD?

Answer 30

Doxycycline 200mg on day 1 then 100mg/day. 5 days total.

Question 31

antibiotic therapy in acute cough/bronchitis shows a lot/little clinical benefit

Answer 31

Little clinical benefit

Question 32

When might antibiotic therapy be of benefit in acute cough/bronchitis?

Answer 32

Frail elderly

Question 33

Antibiotic therapy for acute cough or bronchitis is...

Answer 33

Same as COPD; amoxicillin 500mg tds or doxycycline 200mg on day 1 and 100mg for 4 days.

Question 34

Non-severe C.diff infection should be treated with...

Answer 34

metronidazole PO 400mg 3xdaily

Question 35

How does metronidazole work?

Answer 35

Inhibits nucleic acid synthesis by disrupting DNA of microbial cells.

Question 36

How should severe C.diff be treated?

Answer 36

Vancomycin 125mg QDS for 10days +/- metronidazole.

Question 37

How should peritonitis/biliary tract infection/intra-abdominal infections be treated?

Answer 37

IV amoxicillin metronidazole + gentamicin. Step down to PO Co-trimoxazole. If pen allergic, vanc, met, gent.

Question 38

Acute gastroenteritis should be treated with which antibiotics?

Answer 38

Trick question. Shouldn't be unless very severe and then, seek advice.

Question 39

Catheterised patients should be treated for UTI based on urinalysis. true/false

Answer 39

False- use clinical signs of infection.

Question 40

An uncomplicated female uti should be treated with...

Answer 40

Nitrofurantoin 500mg QDS or | trimethoprim 200mg BD (3days)

Question 41

Uncatheterised male UTI should be treated with...

Answer 41

Nitrofurantoin 500mg QDS or | trimethoprim 200mg BD (3days)

Question 42

Complicated UTI/Pyelonephritis/urosepsis should be treated with...

Answer 42

IV amoxicillin + gentamicin | Co-trimox and gent if pen allergic

Question 43

Cellulitis is treated with...

Answer 43

Flucloxacillin 1g QDS or doxycycline 100mg BD PO if allergic | 7 days total.

Question 44

Septic arthritis or osteomyelitis should be treated with...

Answer 44

IV flucloxacillin 2g QDS and seek ID help.

Question 45

Sepsis of unknown origin is treated with

Answer 45

IV Amoxicillin + metronidazole + gentamicin Consider adding vancomycin or flucloxacillin if concern RE staphylococci. Allergy: vanc, met, gent.