What is first-line for Community-Acquired Pneumonia (CAP)?
Co-amoxiclav + Doxycycline
Route: IV or PO (depending on severity)
Co-amox: 1.2 g IV TDS or 625 mg PO TDS
Doxy: 100 mg PO/IV OD
Load: No
Level: No
Max: Co-amox 1.2 g QDS; Doxy 200 mg/day
Notes: If penicillin-allergic → Levofloxacin. Adjust for renal impairment.
What is first-line for Aspiration Pneumonia?
Tazocin (Piperacillin-Tazobactam)
Route: IV
Dose: 4.5 g IV every 8 h (renally adjust: eGFR < 40 → 4.5 g q12h)
Load: No
Level: No
Max: 4.5 g QDS
Notes: Broad Gram-neg & anaerobic cover. Avoid if severe penicillin allergy.
What is first-line for Sepsis of Unknown Origin (ICU empiric)?
Tazocin ± Gentamicin ± Vancomycin (if MRSA risk)
Route: IV
Tazocin: 4.5 g q8h
Gent: 5–7 mg/kg IV OD
Vanc: 15–20 mg/kg IV → adjust per level
Load: Gent/Vanc both need loading
Level: ✅ Both monitored (trough 15–20 mg/L for vanc; <1 mg/L trough for gent)
Max: Gent 7 mg/kg; Vanc ≤2 g/dose
Notes: Renal adjust both; Vanc nephrotoxic + red-man if too fast.
What is first-line for Meningitis (adult)?
Ceftriaxone + Dexamethasone (± Amoxicillin if >60 y or immunocompromised)
Route: IV
Ceftriaxone: 2 g IV q12h
Amox: 2 g IV q4h
Dex: 10 mg IV q6h for 4 days
Load: No
Level: No
Max: Ceftriaxone 4 g/day
Notes: Cover N. meningitidis, S. pneumoniae, Listeria. Avoid ceftriaxone with calcium infusions.
What is first-line for Infective Endocarditis (native valve)?
Amoxicillin + Gentamicin
Route: IV
Amox: 2 g IV q4h
Gent: 1 mg/kg IV q8h (or OD dosing)
Load: Gent load if OD protocol
Level: ✅ Gent trough <1 mg/L, peak 3–5 mg/L
Max: Gent 7 mg/kg/day
Notes: If penicillin-allergic → Vancomycin + Gent. Adjust for renal function.
What is first-line for Spontaneous Bacterial Peritonitis (SBP)?
Cefotaxime
Route: IV
Dose: 2 g IV q8h
Load: No
Level: No
Max: 6 g/24h
Notes: If pen-allergic → Ciprofloxacin 400 mg IV BD.
Also give albumin (1.5 g/kg day 1, then 1 g/kg day 3).
What is first-line for Necrotising Fasciitis?
Meropenem + Clindamycin + Vancomycin
Route: IV
Mero: 1 g IV q8h (up to 2 g q8h severe)
Clinda: 600–900 mg IV q6–8h
Vanc: 15–20 mg/kg IV → monitor level
Load: Vanc needs load
Level: ✅ Vanc levels
Max: Meropenem 6 g/day
Notes: Early surgical debridement is key; renal adjust all.
What is first-line for Fungal Infection (Candidaemia)?
Fluconazole (stable) or Anidulafungin (critically ill)
Route: IV
Fluconazole: 400 mg IV/PO load → 200–400 mg OD
Anidulafungin: 200 mg load → 100 mg IV OD
Level: No
Max: Fluconazole 800 mg/day
Notes: Avoid fluconazole if on interacting drugs or resistant Candida.
Echinocandins preferred in ICU.
What is first-line for MRSA infection?
Vancomycin
Route: IV
Load: 25–30 mg/kg
Maintenance: 15–20 mg/kg IV q8–12h
Level: ✅ Trough 15–20 mg/L
Max: Usually ≤2 g/dose
Notes: Red-man if infused <1 h per g; renal adjust.
What is first-line for Pancreatitis (infected or necrotising)?
⚠️ Note: Antibiotics are not routinely indicated in uncomplicated acute pancreatitis!
Only if infection or necrosis is confirmed/suspected.
Meropenem
Route: IV
Starting dose: 1 g IV q8h (severe: 2 g q8h)
Load: No
Level: No
Max dose: 6 g/24 h
Notes:
Excellent pancreatic tissue penetration.
Renal adjust if eGFR <50.
Add antifungal (fluconazole) if prolonged antibiotics or necrosis.
If penicillin allergy → Ciprofloxacin 400 mg IV BD + Metronidazole 500 mg IV TDS.
What is first-line for Urinary Tract Infection (UTI)?
Nitrofurantoin
Route: PO
Starting dose: 100 mg MR BD (or 50 mg QDS)
Load: No
Level: No
Max dose: 400 mg/day (divided doses)
Notes:
Avoid if eGFR <45 (ineffective).
Covers E. coli, Enterococcus.
Course: 3 days (women), 7 days (men).
What is first-line for Severe / Complicated / Catheter-Associated UTI (ICU)?
Tazocin (Piperacillin–Tazobactam)
Route: IV
Dose: 4.5 g q8h (renal adjust: eGFR <40 → q12h)
Load: No
Level: No
Max: 4.5 g QDS
Notes:
Broad Gram-negative and Pseudomonas cover.
If ESBL suspected → Meropenem 1 g IV q8h.
Catheter change is key step in management.
What is first-line for Cellulitis / Skin & Soft Tissue Infection?
Flucloxacillin
Route: IV or PO
Starting dose:
IV: 1–2 g q6h
PO: 500 mg–1 g q6h
Load: No
Level: No
Max dose: 8 g/day
Notes:
Covers Staph aureus (MSSA) and Strep.
If penicillin allergy → Clarithromycin 500 mg BD or Doxycycline 100 mg BD.
If severe or systemic → Tazocin or Vancomycin (if MRSA suspected).
Elevate limb, mark border, and reassess at 24–48 h.
What is first-line for Clostridioides difficile infection (C. diff)?
Vancomycin (oral)
Route: PO (or NG if unable to swallow)
Starting dose: 125 mg PO QID
Load: No
Level: No
Max dose: 500 mg PO QID (severe cases)
Notes:
10-day course.
Fidaxomicin 200 mg BD x10 days → 2nd line (recurrent cases).
Metronidazole 400 mg TDS only if mild & vancomycin unavailable.
Avoid anti-motility drugs (e.g. loperamide).
Use enteric isolation and stop precipitating antibiotics.
What is first-line for Biliary Sepsis / Cholangitis?
Tazocin (Piperacillin–Tazobactam)
Route: IV
Starting dose: 4.5 g IV q8h
Load: No
Level: No
Max dose: 4.5 g QDS
Notes:
Broad Gram-neg & anaerobic cover (esp. E. coli, Klebsiella, Enterococcus).
If penicillin allergy → Ciprofloxacin 400 mg IV BD + Metronidazole 500 mg IV TDS.
Always seek source control → ERCP or drainage.
Renal adjust if eGFR <40.
What is first-line for Hospital-Acquired Pneumonia (HAP)?
Tazocin (Piperacillin–Tazobactam)
Route: IV
Starting dose: 4.5 g IV q8h
Load: No
Level: No
Max dose: 4.5 g QDS
Notes:
Covers Pseudomonas, Klebsiella, Staph aureus.
If MRSA risk → add Vancomycin (15–20 mg/kg IV, monitor levels).
If pen-allergic → Ciprofloxacin 400 mg IV BD + Metronidazole 500 mg TDS.
Renal adjust; duration 5–7 days (shorter if improving).
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Resp Physiology 150
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Resp Physiology 229
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Resp Physiology Part 3 - ABG60
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NAGMA AGMA HAGMA18
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Renal Physiology76
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Endo Physiology111
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IV Fluids57
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Haem75
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GI Physiology 141
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GI Liver Function Tests12
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Burns20
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Cardiovascular Physiology45
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NMP Hx Taking70
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Meds23
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Abx16
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Viva Prep: Neuro118
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Viva Prep: Endo121
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Viva Prep: GI42
