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Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
A GP is called to see a 2-year-old child at home. He has a feverand has been vomiting since the morning. On examination, he isfebrile with a temperature of 39 °C, has cold peripheries and issleeping. He has a non-blanching spot on his ankle. What is thefirst thing that you would do? Set up intravenous access for fluid resuscitation.Prescribe an antipyretic.Refer to the on-call paediatric team.Prescribe an oral antibiotic.Administer intramuscular benzylpenicillin.
The administration of medicines to children
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
A seventeen month old boy was admitted to hospital with suspected meningitis. A junior doctor prepared and administered 300mg benzylpenicillin by the intrathecal route. The correct dose of benzylpenicillin for a 9 kg child of his age is less than 1 mg, although intrathecal treatment is generally discouraged. The boy started to have seizures just minutes after the injection and died a short time later, despite full resuscitation procedures.
Invasive Group A Streptococcal Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Treatment consists of intravenous benzylpenicillin. All GAS strains isolated from invasive infections produce toxins, and antibiotic treatment should also include an antibiotic that inhibits toxin production. Clindamycin or linezolid are often added to intravenous benzylpenicillin. Intravenous immunoglobulin (IVIG) may be considered in toxic shock syndrome.
Chlamydophila psittaci pneumonia associated to exposure to fulmar birds (Fulmaris glacialis) in the Faroe Islands
Published in Infectious Diseases, 2018
Marian Elsubeth Fossádal, Mansour Grand, Shahin Gaini
The first patient was a 75 years old man with chronic obstructive lung disease (COPD). He was hospitalized 18 September 2016 due to high fever with temperature of 40°C, impaired general condition, shortness of breath and elevated infection parameters including a CRP of 239 mg/l. He was initially treated with iv. cefuroxime at a local hospital. Chest X-ray showed bilateral diffuse infiltrative and interstitial changes (Figure 1). Cultures of blood and urine were negative. The antibiotic treatment was changed to iv. benzylpenicillin. The patient's respiratory condition deteriorated during the following 4 days. The antibiotic treatment was changed again to iv. piperacillin/tazobactam. After 8 days of hospitalization, the patient had increasing oxygen demands and was transferred to the intensive care unit at the National Hospital Faroe Islands. The patient was now treated with continuous positive airway pressure (CPAP) and iv. piperacillin/tazobactam and iv. ciprofloxacin. After another 2 days without significant clinical improvement, CP was identified in pleural fluid by PCR (Danish Reference Laboratory of Clinical Microbiology, Statens Serum Institut, SSI, Copenhagen, Denmark), (SSI). Treatment was now supplemented with oral doxycycline. The patient improved and was discharged the 3 October 2016 after 15 days of hospitalization with oral doxycycline planned for a total duration of 14 days. A control chest X-ray was taken 6 weeks after discharge and showed normalized conditions. The patient had been in contact with fulmar birds for 5 consecutive days in late August 2016.
A synthetic consortium of 100 gut commensals modulates the composition and function in a colon model of the microbiome of elderly subjects
Published in Gut Microbes, 2021
Marta Perez, Alexandra Ntemiri, Huizi Tan, Hugh M. B. Harris, Henrik M. Roager, Céline Ribière, Paul W. O’Toole
To evaluate the safety of the selected strains for eventual administration to humans, we determined their MIC values for a panel of seven antibiotics and interpreted the resistance based on EUCAST cutoff values. The Methanobrevibacter smithii MCC662 isolate could not be tested due to its inability to grow on plates. The bacterial susceptibility data are presented in Figure 2 and Supplementary Table S5a. Benzylpenicillin had the lowest inhibition activity with 35 resistant strains. However, the combination of a penicillin and a beta-lactamase inhibitor was very effective since amoxicillin-clavulanate inhibited the growth of all 99 bacterial strains. Imipenem inhibited 98 strains, with Faecalibacterium prausnitzii MCC585 showing intermediate resistance, but this strain was only tested on YCFA plates due to the lack of growth in the EUCAST-recommended testing medium. Moreover, 93 strains were sensitive to chloramphenicol, 86 to clindamycin, 83 to metronidazole and 63 out of 68 to vancomycin. Nevertheless, resistance to some antibiotics has been reported to be intrinsic in specific bacterial groups (Supplementary Table S5a, MIC values colored in blue). Indeed, while 48 strains had no resistance to any antimicrobial tested, 31 strains had endogenous resistance to up to 4 antibiotics. All 99 bacterial strains could be inhibited by using amoxicillin-clavulanate or combinations of imipenem with any of the other antibiotics tested, or metronidazole with chloramphenicol (Supplementary Table S5b). The aerobic strains were susceptible to the additional antimicrobials tested by disk diffusion method (Supplementary Table S5c).
Intratonsillar abscess in patients with COVID-19: Two case reports
Published in Acta Oto-Laryngologica Case Reports, 2021
Ivan Segerhammar, Erik Jans, Anders Eriksson, Fredrik Landström
The initial clinical assessment was that the patient had developed a PTA. However, despite several needle aspirations in the peritonsillar area, no pus was detected. The patient was admitted and administration of intravenous benzylpenicillin (three grams, three times daily) was initiated. Computed tomography revealed a right-sided intratonsillar lesion indicating an abscess (Figure 2). Intratonsillar needle aspiration of the lesion was performed but was again negative for pus. The patient was scheduled for a subacute tonsillectomy.