Antibiotics in Pharyngitis and Rheumatic Fever Treatment

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10 Questions

Which of the following bacteria is commonly associated with meningitis?

Neisseria Meningitidis

Which cephalosporin is preferred in neonates for septicaemia caused by Gram-negative bacteria?


What is the most common adverse effect of cephalosporins?

Hypersensitivity reactions

Which of the following cephalosporins is associated with bleeding disorders?


What is the treatment of choice for gonococcal infections?


Which of the following cephalosporins is associated with diarrhea?


What is the treatment of choice for septicaemia caused by Gram-negative bacteria?

A cephalosporin + aminoglycoside

Which of the following is a common side effect of cephalosporins administration?

All of the above

What is the mechanism of action of cephalosporins?

Inhibition of cell wall synthesis

Which of the following bacteria is commonly associated with otitis media?

Staphylococcus aureus

Study Notes

Penicillin V

  • Administered orally, achieving lower levels than parenteral benzylpenicillin
  • Used primarily against Streptococcus pyogenes in the treatment of pharyngitis and the prevention of rheumatic fever
  • Often replaced by amoxycillin, which has more reliable oral absorption and is less dependent on an empty stomach

Antistaphylococcal Penicillins

  • Isoxazolyl penicillins:
    • Cloxacillin, Dicloxacillin, Flucloxacillin, and Oxacillin
    • Used for infections caused by beta-lactamase-producing staphylococci, streptococci, and pneumococci
  • Others:
    • Methicillin and Nafcillin
  • Isoxazolyl penicillins are suitable for mild to moderate localized staphylococcal infections
  • Flucloxacillin is equivalent to cloxacillin but has better oral absorption

Antipseudomonal Penicillins

  • Carboxypenicillins:
    • Carbenicillin and Ticarcillin
  • Ureidopenicillins:
    • Azlocillin, Mezlocillin, and Piperacillin
  • Piperacillin is effective against Pseudomonas and most Enterobacteriaceae
  • Carboxypenicillins and ureidopenicillins possess additional effects against Gram-negative organisms


  • B-Lactam antibiotics similar to penicillins
  • Broad-spectrum antibiotics acting by inhibition of cell wall synthesis
  • Bactericidal, but inactive against enterococci, MRSA, Legionella, Mycoplasma, and Chlamydia spp.
  • Widely used in surgical procedures to reduce the risk of post-operative infections

Classifications of Cephalosporins

  • First Generation:
    • Cephalexin, Cefazolin, Cephalothin, and Cephradine
    • Active against Gram-positive cocci, but not enterococci and MRSA
    • Indicated for streptococcal pharyngitis and used as prophylaxis in surgical procedures
  • Second Generation:
    • Cefoxitin, Cefuroxime, Cefaclor, and Cefprozil
    • Mainly effective against Gram-negative bacteria
    • Cefoxitin active against bowel anaerobes, Cefuroxime active against H. influenzae, M. catarrhalis, and S. pneumoniae
  • Third Generation:
    • Ceftriaxone, Cefotaxime, Ceftazidime, and Cefoperazone
    • Enhanced Gram-negative activity, effective against H. influenzae, N. meningitidis, N. gonorrhoeae, and P. aeruginosae
    • Ceftriaxone has a long half-life and is not advised in neonates
  • Fourth Generation:
    • Cefipime
    • Active against Gram-positive bacteria, with enhanced activity against Pseudomonas

Adverse Effects of Cephalosporins

  • Hypersensitivity reactions (anaphylaxis, bronchospasm, urticaria)
  • Nephrotoxicity (especially with Cephradine)
  • Thrombophlebitis (with i.v. administration)
  • Superinfections
  • Diarrhea (with oral cephalosporins, Cefoperazone, and Ceftriaxone)
  • Cefamandole, Moxalactam, and Cefoperazone may cause bleeding disorders and interactions with alcohol intake

This quiz is about the use of Penicillin V in treating pharyngitis and preventing rheumatic fever, particularly against Streptococcus pyogenes.

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