i) Most episodes of pharyngitis are viral. However, if it is a bacterial infection, what is the most common bacterial aetiology?

• Streptococcus pyogenes 

  
  

ii) Which antibiotic group is the first line (primary) antibiotic treatment for this condition recommended by the current guidelines? Name three antibiotic options. State the dose and frequency of the treatment. 

Antibiotic group: Beta-lactam (penicillin)

• Phenoxymethylpenicillin (Pen V) : 500mg PO q6h

• Amoxicillin : 500mg PO q8h 

• Benzanthine Penicllin 1.2MU IM, one single dose

  
  

iii) What is the recommended duration of the treatment?

• 5-10 days

  
  

iv) If the patient is allergic to the above antibiotic group, what are the other alternative antibiotics? Name two antibiotic options. (Include the dose and frequency).

• Cephalexin 25-50mg/kg/day PO in 2 divided doses for 10 days

• Erythromycin Ethylsuccinate 800mg q12h for 5-10 days 

  
  

References used: (please fill in)

National antimicrobial guideline 2019

Exercise 2

i) Urinary tract infection (UTI) is common in the primary care setting. How do you define uncomplicated UTI?

• Uncomplicated infection refers to a UTI in an otherwise healthy non-pregnant woman with a functionally normal urinary tract and will rarely result in serious kidney damage.

  
  

ii) What is the commonest bacterial aetiology for UTI?

• Escherichia coli 

  
  

iii) State two first-line antibiotic therapies for uncomplicated UTI? Give the dose and frequency. Are the antibiotics available at the primary healthcare clinics you are being posted to?

Preferred:

• Nitrofurantoin 50-100 mg PO QID (macrocrystals) or 100 mg PO ON (monohydrate/macrocrystals) 6 hourly for 5 days 

• Cephalexin 500mg PO BID 12 hourly 3-5 days

Alternatives:

• Amoxicillin/ Clavulanate 625mg PO every 8 hours 3-5 days

• Cefuroxime 250mg PO every 12 hours for 3-5 days

  
  

iv) What is the recommended duration of the treatment? Is there any difference for men and women?

Men 

• For 14 days 

  • Trimethoprim 300 mg daily 

  • Cephalexin 500 mg daily 

Women 

• Non-pregnant woman 

  • trimethoprim/ sulfamethoxazole 160 mg PO BID for 3 days

  • nitrofurantoin monohydrate 100 mg PO BID for 5 - 7 days 

  • ciprofloxacin 500 mg PO BID for 7-14 days

• Pregnant 

  • Cephalexin 500 mg for 5 days 

  • Nitrofurantoin 100mg for 5 days 

References used: ( please fill in)

1. National Antimicrobial Guideline, 3rd edition. (2019). 

2. Consensus guidelines on the management of urinary tract infection, 2021

3. Bono, M.J., Leslie, S.W. and Reygaert, W.C. (2022). Urinary Tract Infection. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470195/#:~:text=An%20uncomplicated%20urinary%20tract%20infection.

4. https://emedicine.medscape.com/article/233101-treatment#d8 

5. Kumar and Clark’s Clinical Medicine 7th Edition 

Exercise 3

i) There are several causes of conjunctivitis. If it is bacterial conjunctivitis, list down the bacterial aetiologies of this condition.

Bacterial causes

1. Staphylococcus aureus

2. Streptococcus pneumonia

3. Pseudomonas aeruginosa

4. Haemophilus influenzae 

5. Neisseria gonococcal

6. Chlamydia trachomatis

7. Moraxella catarrhalis

   
   

ii)  What are the eye-drops and eye ointments available at the health centres? How do you prescribe these medications? 

Eye-drops or eye ointments + prescription

1. Antibiotics

• Preferred: chloramphenicol 0.5% eye drop q6h 

• Alternative : moxifloxacin 0.5% eye drop q6h or ciprofloxacin 0.3% eye drop q6h or levofloxacin 0.5% eye drop q6h

  
  

2. Eye- ointments 

• Chloramphenicol 1% every night 

• If pseudomonas and other coliform, use topical gentamicin and tobramycin

  
  

3. Local anaesthetics: Proparacaine 

   
   

4. Dilator eye drops: Tropicamide (cholinergic blocker) and Phenylephrine (adrenergic stimulator)

   
   

5. If Pseudomonas and other coliform, use topical gentamicin and tobramycin

   
   

6. If Neisseria gonorrhoeae, use specific systemic antibiotic

   
   

References used: ( please fill in)

1. National Antimicrobial Guideline. Ministry of Health 2019

2. John Murtagh’s general practice  sixth edition. 2015

Exercise 4

i)Acute otitis media commonly occurs in children. If it is bacterial infection, name two types of bacteria which commonly cause this condition.

• Streptococcus pneumoniae  

• Haemophilus influenzae

ii)  What is the first-line antibiotic therapy for acute otitis media? How do you prescribe the antibiotic? (dose, frequency, route and duration).

Adult:

• Non-severe AOM: Amoxicillin 500 mg PO q8h (8 hourly) for 5 days

*If symptoms not improved in 48-72 hours, treat as severe AOM 

• Severe AOM or perforated tympanic membrane: Amoxicillin/Clavulanate 625mg PO q8h for 5 days

• Penicillin Allergy; Azithromycin 500mg PO on day 1 followed by 250 mg PO q24h until day 5

  Children:

• Amoxicillin 80-90mg/kg/day in 2 divided doses

     <2 years old: 10 days

      2-5 years old: 7 days

     >5 years old: 5 days

• For clinical failure, history of using amoxicillin in the last 30 days & has concurrent purulent conjunctivitis:

• Amoxicillin/clavulanate 45 mg/kg/day PO in 2 divided doses

• If penicillin allergy (either one): 

• Erythromycin Ethylsuccinate 15-20 mg/kg/dose PO q12h

• Clarithromycin 7.5mg/kg/dose PO q12h

• Azithromycin 10 mg/kg/dose on Day 1 (max 500 mg/day), followed by 5 mg/kg/dose PO q24 on Day 2-5 (max 250 mg/day)

• Azithromycin 10 mg/kg/dose PO q24h for 3 days

  
  

References used: (please fill in)

1. https://emedicine.medscape.com/article/994656-medication

2. National Antimicrobial Guideline. Ministry of Health 2019

i) Most episodes of pharyngitis are viral. However, if it is a bacterial infection, what is the most common bacterial aetiology?

·       Group A beta haemolytic streptococcus

ii) Which antibiotic group is the first line (primary) antibiotic treatment for this condition recommended by the current guidelines? Name three antibiotic options. State the dose and frequency of the treatment. 

Antibiotic group: Penicillin

1. Amoxicillin: 500 mg (PO) TDS (every 8 hours)

2. Benzathine penicillin: 1.2 MU (IM) single dose

3. Phenoxy Methyl penicillin: 500 mg (PO)

   QDS (every 6 hours) OR 1mg BD (every 12 hours)

iii) What is the recommended duration of the treatment?

5-10 days

iv) If the patient is allergic to the above antibiotic group, what are the other alternative antibiotics? Name two antibiotic options. (Include the dose and frequency).

·       Erythromycin ethylsuccinate (800mg, every 12 hours, 5-10 days)

·       Clindamycin (20-30 mg, TDS, 10 days)

References used:

1.       National Antimicrobial Guideline 2019

2.       https://www.healthline.com/health/medicine-for-urinary-tract-infection#oral-antibiotics

3.       https://journals.asm.org/doi/10.1128/aac.4.5.514

Exercise 2

i) Urinary tract infection (UTI) is common in the primary care setting. How do you define uncomplicated UTI?

Uncomplicated UTI is defined as infection in healthy, non-pregnant, pre-menopausal women, with anatomically and functionally normal urinary tract.

ii) What is the commonest bacterial aetiology for UTI?

Escherichia coli

iii) State two first-line antibiotic therapies for uncomplicated UTI. Give the dose and frequency. Are the antibiotics available at the primary healthcare clinics you are being posted to?

1. Cephalexin: 500 mg (PO) BD (every 12 hours)

2. Nitrofurantoin: 50-100 mg (PO) QDS (every 6 hours)

iv) What is the recommended duration of the treatment? Is there any difference between men and women?

For women, usually 3-5 days.

For men, 5-7 days in view of them having a longer urethra, which was supposed to put them at lower risk for UTI as compared to women. Hence, when a man has a UTI, they have a higher likelihood of having complicating factors, such as underlying STI (sexually transmitted illness), which should be further investigated.

References used: National Antimicrobial Guideline 2019

EXERCISE 3

i) There are several causes of conjunctivitis. If it is bacterial conjunctivitis, list down the bacterial etiologies of this condition.

·       Staphylococcus aureus

·       Streptococcus pneumoniae

·       Hemophilus influenza

·       Neisseria gonorrhoea

ii) What is the eye drops and eye ointments available at the health centers? How do you prescribe these medications? 

Preferred: Chloramphenicol 0.5% eye drop every 6 hours

Alternative:

·       Moxifloxacin 0.5% eye drop every 6 hours

·       Ciprofloxacin 0.3% eye drop every 6 hours

·       Levofloxacin 0.5% eye drop every 6 hours

*if the aetiological organism is Neisseria gonorrhoea, then the treatment should be systemic antibiotic

References used: National Antimicrobial Guideline 2019

Exercise 4

i)                    Acute otitis media commonly occurs in children. If it is a bacterial infection, name two types of bacteria which commonly cause this condition.

·       Streptococcus pneumoniae

·       Haemophilus influenzae

·       + Moraxella catarrhalis

ii)                  What is the first-line antibiotic therapy for acute otitis media? How do you prescribe the antibiotic? (dose, frequency, route and duration).

if Severe AOM or perforated TM

Amoxicillin OR Clavulanate: 625 mg QDS, PO, 5 days

if Non-severe AOM: Amoxicillin 500 mg QDS, PO 5 days

References used: National Antimicrobial Guideline 2019

i) Most episodes of pharyngitis are viral. However, if it is bacterial infection, what is the most common bacterial aetiology?

• Streptococcus pyogenes. 

  
  

ii) Which antibiotic group is the first line (primary) antibiotic treatment for this condition recommended by the current guidelines? Name three antibiotic options. State the dose and frequency of the treatment.  

1. Amoxicillin 500mg PO TDS (5 to 10 days)

2. Penicilin G – 1.2mu IM, 1 single dose 

3. Penicilin V – 500mg PO TDS (5 to 10 days)

   
   

iii) What is the recommended duration of the treatment?

5 to 10 days

iv) If the patient is allergic to the above antibiotic group, what are the other alternative antibiotics? Name two antibiotic options. (Include the dose and frequency).

1. Erythromycin Ethylsuccinate 800mg (5-10 days)

2. Clindamycin 300mg PO QID 

references: National Antimicrobial guideline 2019

Exercise 2

i) Urinary tract infection (UTI) is common in the primary care setting. How do you define uncomplicated UTI?

Uncomplicated UTIs are infections that develop in healthy men or women with completely normal genitourinary systems.

ii) What is the commonest bacterial aetiology for UTI?

E. coli

iii) State two first-line antibiotic therapies for uncomplicated UTI? Give the dose and frequency. Are the antibiotics available at the primary healthcare clinics you are being posted to?

Uncomplicated cystitis  

1. Nitrofurantoin 50-100mg QID -6-hourly 

2. Cephalexin 500mg BD-12hourly

Uncomplicated Pyelonephritis 

1. amoxicilin/ clavulanate 625mg TDS -8-hourly 

2. Ampicilin / sulbactam 375-750mg BD -12hourly

iv) What is the recommended duration of the treatment? Is there any difference for men and women?

The recommended duration for treatment is 5-7 days for uncomplicated cystitis. Recommended duration for uncomplicated pyelonephritis treatment is for 14 days.

References used: National Antimicrobial Guideline 2019

EXERCISE 3

1. There are several causes of conjunctivitis. If it is bacterial conjunctivitis, list down the bacterial aetiologies of this condition.

1. Staphylococcus aureus

2. Streptococcus pneumoniae

3. Haemophilus influenzae

4. Neisseria gonorrhoea

5. Chlamydia trachomatis

2. What are the eye-drops and eye ointments available at the health centres? How do you prescribe these medications?  

Treatment for bacterial conjunctivitis

Preferred: Chloramphenicol 0.5% eye-drops QID 

Alternative:

-Moxifloxacin 0.5% eye-drops QID

-Ciprofloxacin 0.3% eye-drops QID

-Levofloxacin 0.5% eye-drops QID

Eye ointments:

Chloramphenicol 1% ON

References used: 

National Antimicrobial Guideline 

Murtagh 7th Edition 

Exercise 4

1. Acute otitis media commonly occurs in children. If it is bacterial infection, name two types of bacteria which commonly cause this condition.

• Streptococcus Pneumonia

• Haemophilus Influenza 

• Moraxella catarrhalis 

2. What is the first-line antibiotic therapy for acute otitis media? How do you prescribe the antibiotic? (dose, frequency, route and duration).

• For non-severe  : Amoxicilin 500mg PO TDS for 5 days 

• If not improved in 48-72hrs, treat as severe AOM 

• For severe or perforated ™ : Amoxicilin/ clavulanate 625mg PO TDS for 5 days

References used: 

National Antimicrobial Guideline