Microman and antibiotic man.

Question 1

When should we automatically think sepsis and start a sepsis 6 bundle?

Answer 1

If we have a sews of four or over and clinical suspicion of an infection.

Question 2

What are the 6 criteria that we should initiate a sepsis 6 bundle with if two or more are present and their is a suspicion of infection? E.g. Temperature etc.

Answer 2

Temp over 38 or under 36.
Pulse rate of 90 or over
Altered mental state
RR of over 20
WCC under 4 or over 12.
Known or suspected neutropenia.

Question 3

What are the 6 indications for the use of IV antibiotics?

Answer 3

2 or more of the sepsis 6 criteria.
Febrile with neutropenia or immunosuppression.
Specific serious infections e.g. Endocarditis.
Oral route is compromised.
Post surgery and unable to tolerate 1 litre of fluid.
No oral formulation available.

Question 4

What should we check when administering normal doses of antibiotics?

Answer 4

There is Normal renal and hepatic function.

Question 5

What should we consider when prescribing clarithromycin in terms of side effects and interactions?

Answer 5

That there is a risk of long QT interval and interactions e.g. With statins.

Question 6

What three things should we do if gentamicin therapy is still indicated after 72 hours or 24 hours of there is poor or deteriorating renal function?

Answer 6

Check microbiology results and sensitivities.
Consider a switch to aztreonam.
Ask microbio or infectious diseases for advice if required.

Question 7

What do we use Aztreonam for?

Answer 7

For certain patients only as an alternative to gent.

Question 8

What antibiotics can we give in case of a penicillin allergy?

Answer 8

IV vancomycin
Metronidazole
Gentamicin.
Doxycycline

Question 9

What antibiotics should we give for an infection of an unknown source?

Answer 9

IV amoxicillin, metronidazole and gent.

If there is concern of staphylococci consider adding: flucloxacillin/vancomycin.

Question 10

What antibiotic do we give for epiglotitis or supraglotitis?

Answer 10

Ceftriaxone

Question 11

What antibiotic do we give for CAP with a CURB score of 0-2?

What do we give instead if there is a penicillin allergy?

Answer 11

Amoxicillin

If allergy:
Doxycycline (Or IV clarithromycin).

Question 12

What antibiotic do we give for CAP with a CURB score of 3-5?
What do we give instead if there is a penicillin allergy?
What do we step down to?

Answer 12

Co-amoxiclav IV and either clarythromycin IV or doxycycline PO.

If penicillin allergy: IV levoflaxacin

Step down to doxycycline 100mg bd.

Question 13

What antibiotic do we give for severe hospital acquired/aspiration pneumonia?
What do we give instead if there is a penicillin allergy?
What do we step down to for both?

Answer 13

IV amoxicillin + metronidazole + gentamicin.

If penicillin allergy: IV co-trimoxazole + metronidazole +/- gentamicin.

Step down to PO co-trimoxazole + metronidazole for both.

Question 14

What antibiotic do we give for non severe hospital acquired/aspiration pneumonia?
What do we give instead if there is a penicillin allergy?

Answer 14

PO amoxicillin + metronidazole.

If penicillin allergy: PO co-trimoxazole + metronidazole.

Question 15

When do we give antibiotic for COPD exacerbations?

Answer 15

If there is increased sputum purulence.

If there is none then no antibiotics unless there is consolidation on CXR or signs of pneumonia.

Question 16

What are the first line antibiotics given for COPD exacerbations?

Answer 16

Amoxicillin.

Question 17

What are the second line antibiotics given for COPD exacerbations?

Answer 17

Doxycycline.

Question 18

What antibiotics do we give for non pneumonic LTRI?

Answer 18

Consider it the same as COPD flare ups and follow the same rules.

Question 19

What are the sepsis 6? And when should they be started in a patient suspected of sepsis?

Answer 19

Within an hour.
High flow oxygen
Blood cultures
Broad spectrum antibiotics
IV fluid challenge
Measure serum lactate and Hb
Measure accurate hourly urine output.

Question 20

What actions should we take if we suspect endocarditis?

Answer 20

Take blood cultures.

Start empirical treatment.

Question 21

What is the antibiotic treatment for native valve indolent endocarditis?

Answer 21

Amoxicillin IV and gentamicin.

Question 22

What is the antibiotic treatment for severe native valve endocarditis?

Answer 22

Flucloxacillin IV.

Question 23

What antibiotics do we give for prosthetic valve or suspected MRSA endocarditis?

Answer 23

Vancomycin IV and rifampicin PO + gentamicin IV.

Question 24

What is the antibiotic treatment for native valve severe sepsis endocarditis, if the patient had risk factors foe resistant pathogens?

Answer 24

Vancomycin IV and meropenem IV.

Question 25

What antibiotics do we give for a non severe C diff infection? How long do we give it for?

Answer 25

Metronidazole PO.

Question 26

What antibiotics do we give for a severe C diff infection? | How long do we give it for?

Answer 26

Vancomycin. | +/- IV metronidazole.

Question 27

What antibiotics do we give for acute gastroenteritis?

Answer 27

None unless it is very severe and then we should seek advice.

Question 28

What antibiotics do we give for acute pancreatitis?

Answer 28

None, they are unlikely to affect the outcome so we should seek advice.

Question 29

What antibiotic do we give for peritonitis / biliary tract or intra abdominal infection? What do we give instead if there is a penicillin allergy? What do we step down to for both?

Answer 29

IV amoxicillin + metronidazole + gentamicin. Penicillin allergy: IV vancomycin + metronidazole and gentamicin. Step down to co-trimoxazole and metronidazole for both.

Question 30

What antibiotics should we give for proven spontaneous bacterial peritonitis? Answer for both severe and mild disease. What do we step down to?

Answer 30

Severe - piperacillin/tazobactam IV Mild disease - co-trimoxazole PO. Step down to co-trimoxazole PO.

Question 31

How do we normally spot mild spontaneous bacterial peritonitis?

Answer 31

Incidental diagnosis on a routine tap.

Question 32

What two antibiotics is therapeutic drug monitoring required for?

Answer 32

Gentamicin and vancomycin.

Question 33

What antibiotics are gram negative coliforms and pseudomonas aeruginosa sensitive to?

Answer 33

Gentamicin and most to aztreonam.

Question 34

What is the problem with only giving amoxicillin for E. coli?

Answer 34

Is only covers around 40%

Question 35

What is the problem with only giving co-trimoxazole for E. coli?

Answer 35

It only covers around 65%

Question 36

What are ESBL's and what are they resistant to?

Answer 36

Extended spectrum beta lactamases. | Resistant to all penicillins including Coamoxiclav, piperacillin-tazobactam and aztreonam.

Question 37

What are ESBL's and what are they sensitive to?

Answer 37

Extended spectrum beta lactamases. | Temocillin and meropenem.

Question 38

What two antibiotics have anaerobic cover so metronidazole is not needed?

Answer 38

Pip-tazobactam and meropenem.

Question 39

What kind of cover do remocillin and aztreonam not have?

Answer 39

Aerobic or gram positive cover.

Question 40

What are all anaerobes sensitive to?

Answer 40

Metronidazole and pip-tazobactam and meropenem.

Question 41

What are gram positives sensitive to?

Answer 41

Vancomycin.

Question 42

What is MRSA resistant to?

Answer 42

All beta lactams.

Question 43

What are VRE's resistant to?

Answer 43

Vancomycin and meropenem.

Question 44

What are beta haemolytic streps sensitive to?

Answer 44

Penicillin and flucloxacillin.

Question 45

What organisms cause epiglottitis?

Answer 45

Haemophilus influenzae and streptococci.

Question 46

What organisms cause tonsillitis?

Answer 46

Group A streptococci.

Question 47

What organisms cause sinusitis?

Answer 47

Pneumococcus.

Question 48

What organisms cause pneumococcus?

Answer 48

Pneumococcus and haemophilus influenzae.

Question 49

What bacteria commonly cause mild CAP?

Answer 49

Pneumococcus and haemophillus influenzae.

Question 50

What can cause acute exacerbations of COPD?

Answer 50

Pneumococcus and haemophillus influenzae.

Question 51

What organisms can cause severe CAP?

Answer 51

Pneumococcus and haemophillus influenzae. | Legionella, mycoplasma, chlamydia pneumoniae and coxiella.

Question 52

What is a common cause of pneumonia post influenza?

Answer 52

Staph aureus.

Question 53

What organisms can cause hospital acquired pneumonia?

Answer 53

Pneumococcus, haemophillus influenzae, coliforms and legionella.

Question 54

What tends to cause acute native valve endocarditis?

Answer 54

Staph aureus.

Question 55

What tends to cause subacute native valve endocarditis?

Answer 55

Viridans streptococci and enterococci.