Skin - Bites

Question 1

First line treatment for human and animal bites (include duration)

Answer 1

Co-amoxiclav

Prophylaxis; 3 days
Treatment; 5 days

Question 2

When is a 3 day prophylaxis duration recommended for human and animal bites?

Answer 2

When the patient has been bitten but does not have signs of infection

Question 3

When is a 5 day treatment duration recommended for human and animal bites?

Answer 3

Where there are signs of infection

Question 4

Second line treatment for human and animal bites

Answer 4

Doxycycline AND metronidazole

Prophylaxis; 3 days
Treatment; 5 days

Question 5

Why is co-amoxiclav first line?

Answer 5

It is more difficult for beta-lactamases to break down co-amoxiclav

Question 6

Treatment of human and animal scratches

Answer 6

Flucloxacillin

Question 7

First line treatment for Lyme disease (include duration)

Answer 7

Doxycycline 100mg BD for 21 days

Question 8

Second line treatment for Lyme disease

Answer 8

Amoxicillin 1000mg TDS for 21 days

Question 9

Co-amoxiclav spectrum of activity

Answer 9

Broad spectrum (and good in terms of resistance)

Question 10

Doxycyline spectrum of activity

Answer 10

Broad spectrum

Question 11

Metronidazole spectrum of activity

Answer 11

Anaerobic cover

Question 12

Side effects of metronidazole

Answer 12

Taste disturbance: metallic taste, furred tongue
Nausea and vomiting (take with or after food)
Darkened urine

Question 13

Metronidazole counselling

Answer 13

Avoid alcohol during and 48 hours after treatment
Disulfiram like side-effects (nausea and vomiting, flushing)

Question 14

Tetracycline interactions

Answer 14

Milk
Indigestion remedies
Iron or zinc

Can take the above if >2 hours before or after taking tetracycline

Question 15

Which tetracyclines can you drink milk with?

Answer 15

Does Like Milk

Doxycycline
Lymecycline
Minocycline

Question 16

Side effects of tetracyclines

Answer 16

Benign intracranial hypertension - Stop and report on headache and visual disturbances

Lupus-erythematosus-like syndrome and irreversible pigmentation - Highest risk with minocycline

Teeth discolouration and bone deposit - Do not give to children under the age of 12 years or pregnancy women

Question 17

Tetracycline counselling points

Answer 17

Take on an empty stomach (avoid the interactions)

Hepatotoxic – avoid in liver failure

Nephrotoxic - cautioned in renal impairment

Can cause photosensitivity – avoid sunlight or sun lamps

Can cause dysphagia – tablets should be swallowed whole with plenty of fluid, while sitting or standing

Caution in myasthenia gravis

Question 18

Are tetracyclines bacteriostatic or bactericidal?

Answer 18

Prevent bacterial growth - bacteriostatic

Question 19

Is metronidazole bacteriostatic or bactericidal?

Answer 19

Kills bacteria - bactericidal

Question 20

What does take on an empty stomach mean (in terms of timeframe)?

Answer 20

30 to 60 minutes before a meal or snack or at least 2 hours after a meal or snack