Antimicrobial Prescribing and Infection Management

This module covers the pharmacology that underpins safe antimicrobial prescribing: the major antibiotic classes with their spectra, key toxicities and interactions, aminoglycoside dosing and monitoring, how to assess a penicillin allergy label, and stewardship principles including Clostridioides difficile risk. It prepares learners for the prescribing scenarios that follow.

1. The major antibiotic classes: spectra, key toxicities and clinically important interactionsPreview

   This lesson maps the antibiotic classes you will meet most often on UK wards: penicillins, cephalosporins, macrolides, tetracyclines, fluoroquinolones, glycopeptides, nitroimidazoles and trimethoprim-based agents. For each, it covers what the drug reliably treats, where it fails, and its characteristic harms, from penicillin hypersensitivity and cephalosporin cross-reactivity to fluoroquinolone tendon and aortic risk, tetracycline dental staining, macrolide QT prolongation and glycopeptide infusion reactions. Interactions are treated as prescribing safety problems: macrolides with statins, tetracyclines with calcium or iron, fluoroquinolones with cations, trimethoprim with methotrexate or potassium. It closes on collateral damage: how broad-spectrum pressure selects for Clostridioides difficile when choosing and reviewing an antimicrobial. Doses quoted are teaching examples; local formularies and current prescribing information decide what is safe.

   10 min
2. The penicillin allergy label and antimicrobial stewardship: history taking, risk assessment and safe antibiotic choice

   An unverified penicillin allergy label follows a patient for life, pushing prescribers towards broader-spectrum agents and increasing resistance, treatment failure and Clostridioides difficile infection. This lesson shows how to take a structured allergy history, separate predictable intolerance and benign delayed rashes from immediate hypersensitivity, and judge the genuine extent of cross-reactivity with cephalosporins and carbapenems. It then applies stewardship to the prescription itself: right drug, right dose, right route and right duration, IV to oral switch, documented review and stop dates, and practical steps that lower C. difficile risk. Dosing examples follow the BNF; local formularies and protocols vary and take precedence.

   10 min
3. Aminoglycosides in practice: gentamicin dosing, therapeutic drug monitoring and toxicity

   Gentamicin remains a first-line option for serious Gram-negative infection and a synergistic agent in Gram-positive endocarditis, but its narrow therapeutic window makes it one of the most error-prone drugs on an inpatient chart. This lesson covers once-daily dosing, dose calculation by weight and renal function, the timing and interpretation of aminoglycoside levels, and the recognition and management of nephrotoxicity and ototoxicity. It identifies the patients who need adjusted doses, extended intervals and closer monitoring, and it rehearses the practical steps of writing, charting and reviewing a safe gentamicin prescription in UK practice.

   10 min
4. Prescribing: First episode of Clostridioides difficile infection after co-amoxiclav
   15 min
5. Prescribing: H. pylori positive dyspepsia in a patient on simvastatin
   15 min
6. OSCE station: Inpatient Prescribing in a Patient with Penicillin Allergy
   11 min
7. OSCE station: Gentamicin Dose Calculation and Monitoring
   11 min
8. Quiz: Antibiotic Pharmacology and Stewardship: Choosing, Reviewing and Monitoring Antimicrobials Safely
   9 min

This module covers the acute respiratory presentations that drive most hospital antimicrobial prescribing. It teaches recognition and first-hour management of sepsis and septic shock, severity assessment and antibiotic choice in community-acquired pneumonia and infective exacerbations of COPD, and the recognition, investigation and initial treatment of tuberculosis. Sessions are written for UK practice, using BNF dosing and NICE-style guidance, with a note where local formularies and practice differ.

1. Recognising Sepsis and Septic Shock: Screening, the First Hour and Empiric Antibiotics

   Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is sepsis with persistent hypotension requiring vasopressors to maintain a mean arterial pressure of at least 65 mmHg, plus a serum lactate above 2 mmol/L, despite adequate fluid resuscitation. This lesson covers structured recognition of the deteriorating patient using NEWS2, red-flag criteria and lactate, then works through the first-hour priorities: taking blood cultures before antibiotics without delaying treatment in shock, choosing empiric antibiotics by suspected source with reference to BNF dosing and the local formulary, fluid resuscitation with crystalloid, oxygen targets including the 88 to 92 per cent range for patients at risk of hypercapnia, early source control, and escalation to critical care. Doses are teaching examples and defer to local guidance.

   10 min
2. Community-Acquired Pneumonia and Infective Exacerbations of COPD: Severity Assessment and Antibiotic Choice

   This lesson covers severity assessment in community-acquired pneumonia using CURB-65 alongside clinical judgement to decide place of care, then matches empiric antibiotic choice to severity and setting using BNF doses, noting where local formulary and resistance patterns change the choice. It then addresses antibiotic indications in infective exacerbations of COPD, the role of sputum culture, and the risk of type 2 respiratory failure with controlled oxygen targets. Teaching doses are examples only; always check the current BNF and local guidance.

   10 min
3. Tuberculosis: Recognising the Presentation, Confirming the Diagnosis and Starting Treatment

   Tuberculosis often presents insidiously, with weeks of cough, haemoptysis, weight loss, fever and night sweats, and it can affect almost any organ. This lesson covers how to recognise pulmonary and extrapulmonary disease, how the differential differs from community-acquired pneumonia or an infective exacerbation of COPD, and how to act on suspicion. It then works through infection control and isolation, the investigations that confirm diagnosis and drug susceptibility, and the standard initial multi-drug regimen with British National Formulary dosing, monitoring and adherence support. Referral to specialist tuberculosis services and contact tracing are also covered. Drug doses are teaching examples only, and local protocols, formularies and specialist advice vary by region.

   10 min
4. Case: Septic Shock from Community-Acquired Pneumonia
   20 min
5. Case: Severe Community-Acquired Pneumonia: A 55-Year-Old Smoker
   20 min
6. Case: A 34-year-old man with six weeks of cough and haemoptysis
   20 min
7. Prescribing: Community-Acquired Pneumonia: Initial Prescribing
   15 min
8. Prescribing: Infective exacerbation of COPD with type 2 respiratory failure risk
   15 min
9. Quiz: Sepsis and Respiratory Infection: Recognition, Severity Assessment and Initial Prescribing
   9 min

This module covers common and serious bacterial infections of the urinary tract, skin and soft tissues. It teaches recognition, sampling, empirical antibiotic choice and review for lower urinary tract infection, acute pyelonephritis, urosepsis, cellulitis, necrotising fasciitis and diabetic foot infection, including gentamicin dosing in obesity and renal impairment. Doses are teaching examples; local guidance and the BNF govern practice.

1. Lower Urinary Tract Infection and Acute Pyelonephritis: Recognition, Sampling and Empirical Antibiotic Choice

   This lesson covers the recognition and management of lower urinary tract infection (uncomplicated cystitis) and acute pyelonephritis in UK practice. It explains how to take urine samples correctly, when to send cultures, and how to choose empirical antibiotics using the British National Formulary and local guidance. It outlines treatment durations, safety-netting advice for community care, and the decision to admit. The lesson also describes the features that suggest progression from upper urinary tract infection to urosepsis. Doses are teaching examples only; always check local formularies and prescribing information.

   10 min
2. Urosepsis and Gentamicin Prescribing: Dose Selection in Obesity and Renal Impairment

   This lesson covers the recognition and early management of urosepsis in adults, with a specific focus on gentamicin prescribing. It follows the septic patient with a urinary source from sepsis screening and resuscitation through blood and urine culture collection and empirical intravenous antibiotics. The main teaching focus is gentamicin dose selection: once-daily dosing, the weight used in obesity, adjustment in renal impairment, and what levels and duration monitoring should look like in practice. Doses quoted are teaching examples only; local guidelines and current prescribing information take precedence.

   10 min
3. Skin and Soft Tissue Infection: Cellulitis, Necrotising Fasciitis and Diabetic Foot Infection

   This lesson covers the assessment and empirical management of common skin and soft tissue infections in UK practice. It contrasts cellulitis with necrotising fasciitis, highlights red flags and the need for urgent surgical assessment, and explains how to grade diabetic foot infection severity. Learners consider empirical antibiotic choice, including alternatives in penicillin allergy and dose adjustment in renal impairment, and when to seek advice from microbiology, surgery and the diabetic foot team. Doses and regimens are teaching examples; local formularies and guidelines should always be checked.

   10 min
4. Case: Rapidly Spreading Leg Cellulitis or Necrotising Fasciitis?
   20 min
5. Case: Diabetic Foot Infection with Sepsis: A 60-Year-Old Man
   20 min
6. Prescribing: Prescribing for acute uncomplicated cystitis
   15 min
7. Prescribing: Outpatient Management of Acute Pyelonephritis
   15 min
8. Prescribing: Urinary sepsis: empirical intravenous antibiotics including gentamicin in an obese patient with renal impairment
   15 min
9. Prescribing: Prescribing for Uncomplicated Cellulitis of the Lower Leg
   15 min
10. Prescribing: Cellulitis in a penicillin-allergic patient with renal impairment
    15 min
11. Quiz: Urinary, Skin and Soft Tissue Infection: From Cystitis and Pyelonephritis to Urosepsis, Cellulitis and Diabetic Foot Infection
    9 min

This module covers central nervous system, tropical and immunocompromised infection for prescribers. It runs from bacterial meningitis and meningococcal sepsis, through falciparum malaria and dengue in returning travellers, to febrile neutropenia and the antifungal and antiviral drugs these patients need, with British National Formulary dosing and UK practice. Doses quoted are teaching examples and must be checked against local formulary and current prescribing information.

1. Bacterial Meningitis and Meningococcal Sepsis: Recognition, Immediate Antibiotics and Public Health Action

   Bacterial meningitis and meningococcal sepsis are time-critical emergencies: outcome depends on how quickly antibiotics are given, not on how certain the diagnosis is. This lesson covers recognition and red flags, the non-blanching rash, when to give empiric antibiotics before or after lumbar puncture, contraindications to immediate lumbar puncture, dexamethasone and supportive care, and the notification and chemoprophylaxis duties that follow a probable or confirmed case. Doses quoted are teaching examples for checking against your local formulary and current prescribing information.

   10 min
2. Falciparum Malaria and Dengue in Returning Travellers: Severity Assessment, Antimalarials and Critical Phase Fluids

   Fever in a returning traveller is a medical emergency until malaria is excluded. This lesson covers how exposure and incubation history narrow the differential, how thick and thin films and rapid diagnostic tests are used together, and how to separate uncomplicated from severe falciparum malaria. It sets out when parenteral artesunate is indicated and when oral artemisinin combination therapy is appropriate, then turns to dengue: warning signs, the critical phase, cautious fluid balance, and drugs such as NSAIDs that should be avoided. Dosing and first-line choices vary by region and formulary, so always check the current BNF, local guidance and specialist advice. Content is for education and training only.

   10 min
3. Febrile Neutropenia and the Immunocompromised Host: Empiric Therapy, Antifungal and Antiviral Prescribing

   Fever in a neutropenic patient is a medical emergency. This lesson covers recognition and risk stratification, blood cultures and prompt empiric antipseudomonal beta-lactam therapy, when to escalate or add a glycopeptide, and how to select and monitor antifungal agents. It also reviews antivirals used in immunocompromised patients, including aciclovir, ganciclovir and oseltamivir, with attention to renal dose adjustment and drug interactions. Doses given are teaching examples, and local protocols, resistance patterns and formularies vary by region.

   10 min
4. Case: A 19-year-old Student with Fever, Headache, Neck Stiffness and a Spreading Non-blanching Rash
   20 min
5. Case: Severe Falciparum Malaria in a Returning Traveller
   20 min
6. Case: Dengue Fever with Warning Signs: Critical Phase Management
   20 min
7. Case: Febrile Neutropenia in a Breast Cancer Patient: A Case Study
   20 min
8. Quiz: CNS, Tropical and Immunocompromised Infection: Meningitis, Malaria, Dengue and Febrile Neutropenia
   9 min