Clinical uses of antibiotics

• common investigations for infection

  - blood tests (WBC/inflammatory markers)

  - blood cultures

  - local sites (chest x-ray, urine culture etc)

  
• assessing sore throats

  - most don't need antibiotics as often viral and recover in a week

  - drink fluids, ibuprofen+paracetamol, avoid hot drinks

  
• Group A Strep infection (GAS)

  - most common bacterial cause of sore throat

  - treat with antibiotics to prevent acute rheumatic fever, decrease severity and prevent transmission
• FeverPAIN score


  Fever (>38C)

  Purulence (pharyngeal/tonsillar exudate)

  Attend rapidly (within 3 days of onset)

  Inflamed tonsils

  No cough or cold symptoms

  
• What results of feverPAIN mean?

  - consider antibiotic if score 4-5 with severe symptoms or not improving

  - 0-1 probably doesn't need intervention

  - 2-3 requires monitoring

  
• antibiotics to treat GAS sore throat?

  - 1st line = phenoxymethylpenicillin

  - penicillin allergy = clarithromycin

  - pregnant = erythromycin
• What is epiglottitis?


  - inflammation of the epiglottis

  - immediately life-threatening so call 999 if seen

  - DO NOT examine throat as could make worse

  
• what are the symptoms of epiglottitis?

  - severe sore throat, stridor, high fever

  - 4 D's: 1. Dysphonia 2. Drooling 3. Dysphagia 4. Distress
• other potential cases

  1. glandular fever = suspect if more than a few days, adenopathy, splenomegaly

  2. scarlet fever = sandpaper rash, strawberry tongue

  3. quinsy = fever, neck pain, muffled voice, displaced uvula, enlarged tonsils

  
• what are the signs of sepsis?

  Slurred speech or confusion

  Extreme shivering or muscle pain

  Passing no urine (in a day)

  Severe breathlessness

  It feels like you're going to die

  Skin mottled or discoloured