Patient factors and patient needs

Question 1

Which antibiotics need extra consideration when used inpatients with renal impairment

Answer 1

Avoid nitrofurantoin if eGFR is under 45ml/min
avoid tetracyclines unless it is doxycycline or minocycline
Monitor for nephrotoxicity in drugs that are aminoglycosides: gentamicin, neomycin, amikacin, streptomycin, tobramycin and glycopeptides : vancomycin. teicoplanin

Question 2

What are the safest antibiotics to give in pregnancy?

Answer 2

Penicillin’s and cephalosporins

Question 3

Which medications should be avoided in pregnancy, when and why

Answer 3

tetracyclines and trimethoprim are contraindicated
Nitrofurantoin should be avoided at term- causes nausea
Avoid MCAT- metronidazole, chloramphenicol, aminoglycosides, tetracyclines
Avoid quinolones and sulphonamides

Question 4

Which drugs cause hepatotoxicity/cholestatic jaundice therefore should be avoided

Answer 4

Metronidazole- one third of the daily dose given once a day if pt has hepatic encephalopathy (normal dose is 400-500mg- depending on the indication- tds
Rifampicin, tetracyclines
co-amoxiclav and flucloxacillin cause cholestatic jaundice

Question 5

which Abx are contra-indicated in children

Answer 5

tetracyclines in under 12

quinolones- causes arthropathy- joint disease

Question 6

which ABx should be used with caution in elderly

Answer 6

hepatic and renal abx

Increased risk of C. diff with Clindamycin use

Question 7

If a patient has a penicillin allergy which drugs might they also not be able to tolerate

Answer 7

beta lactams
and cephalosporins
carbapenems
macrolides