Infection, Antimicrobials and Vaccines: GPhC Registration Assessment Content

Scope and time budget

The area combines pharmacology with community services. Pharmacy First, introduced on 31 January 2024, has made infection questions very practical: eligibility, red flags and treatment choice.

What is tested

• Stewardship. NICE and UKHSA guidance, narrow-spectrum choices and course length.
• Penicillin allergy. True allergy, intolerance and cross-sensitivity.
• Urinary tract infection. Treatment, with trimethoprim and nitrofurantoin precautions.
• Respiratory infection and sore throat. FeverPAIN and Centor scoring.
• Skin and soft tissue. Impetigo and cellulitis.
• ENT infections. Sinusitis and otitis media.
• Tuberculosis, HIV and hepatitis. Treatment principles.
• Antifungal, antiviral and antiparasitic therapy. Choice and interactions.
• Sexually transmitted infections. Chlamydia, gonorrhoea and syphilis.
• Clostridioides difficile. Healthcare-associated infection.
• Sepsis. Recognition and urgent referral.
• Antibiotic interactions. Macrolides, quinolones, rifampicin and metronidazole.
• Routine immunisation. The UK schedule from infancy to older age.
• Travel vaccines and malaria prophylaxis. Selective vaccines and advice.
• Pharmacy First. Seven clinical pathways.

UK guideline anchors

• Pharmacy First (checked). Acute otitis media 1 to 17 years, impetigo 1 year and over, infected insect bites 1 year and over, shingles 18 and over, sinusitis 12 and over, sore throat 5 and over and uncomplicated UTI in women aged 16 to 64.
• Immunisation (checked). 8, 12 and 16 weeks for the infant series, 18 months for 6-in-1 and MMRV in children born on or after 1 July 2024, HPV at 12 to 13 years, and flu, pneumococcal, shingles and RSV for older adults.
• Pregnancy vaccines (checked). Inactivated flu at any stage, pertussis from 16 weeks and RSV from 28 weeks.
• NICE and UKHSA. Antimicrobial prescribing guidance for each infection.
• BNF and BNFc. Doses, renal adjustments and child doses for antimicrobials.

Antimicrobial stewardship

Infection questions are rarely about naming a bug. They ask what the right first step is: whether an antibiotic is needed, which one, for how long and with what safety checks. Follow NICE antimicrobial prescribing guidance and UKHSA guidance, and apply stewardship principles: prescribe only when needed, choose narrow-spectrum agents where possible, keep courses as short as the evidence allows and review at 48 to 72 hours. Know the common patterns of penicillin allergy and the practical difference between a true allergy and an intolerance.

Interactions matter. Macrolides, quinolones, rifampicin and metronidazole all have well-known interactions, for example with warfarin, statins, antiepileptics and hormonal contraception. If a question lists the patient's medicines, read them all before choosing an antibiotic. Nitrofurantoin and trimethoprim have their own precautions in renal impairment and in pregnancy, so check the BNF.

Pharmacy First in the exam

Seven clinical pathways run in community pharmacy in England: acute otitis media (1 to 17 years), impetigo (1 year and over), infected insect bites (1 year and over), shingles (18 years and over), sinusitis (12 years and over), sore throat (5 years and over) and uncomplicated urinary tract infection (women aged 16 to 64). Know the eligibility, the red flags for referral and the treatment choice. Scoring tools such as FeverPAIN or Centor are used for sore throat. Distance-selling pharmacies do not complete acute otitis media consultations.

Vaccines

The UKHSA routine schedule was revised for 2026, so check it. Infant vaccines at 8, 12 and 16 weeks, the 18-month 6-in-1 and MMRV for children born on or after 1 July 2024, HPV at 12 to 13 years, Td/IPV and MenACWY at 14 years, and the older-adult programmes (pneumococcal at 65, annual flu from 65, shingles, and RSV at 75) are the main blocks. In pregnancy, inactivated flu, pertussis from 16 weeks and RSV from 28 weeks. The children's nasal flu vaccine contains porcine gelatine, so an inactivated vaccine is the alternative. Because the schedule changed, avoid notes from before 2026 for questions that turn on exact timing.

Counselling and referral

• Finish the course. Counsel on the prescribed course while stressing that antibiotics are not for viral illness.
• Red flags. Rapid heart rate, confusion, mottled skin, very high or very low temperature, or deterioration in a child mean urgent referral for possible sepsis.
• Pregnancy. Some antibiotics need avoiding or timing around trimester, so check the BNF.
• Hormonal contraception. Enzyme-inducing antibiotics such as rifampicin reduce contraceptive effect, and vomiting or severe diarrhoea can also affect absorption.

If you have only an hour

Spend 20 minutes on the seven Pharmacy First pathways, their eligibility and red flags. Spend 15 minutes on antibiotic interactions and penicillin allergy. Spend 15 minutes on the vaccine timeline. Spend 10 minutes on sepsis recognition and urgent referral. Then do fifteen questions, and check the Green Book for any timing you are unsure about.

Three typical traps

1. The old-schedule trap. The immunisation schedule was revised in 2025 to 2026, so older notes can give the wrong age or vaccine.
2. The interaction trap. An antibiotic that is correct in isolation may interact with warfarin, a statin, an antiepileptic or hormonal contraception.
3. The eligibility trap. A Pharmacy First pathway has age and sex limits. A patient outside them is not eligible, whatever the symptoms.

How to revise it

1. Make a table of the seven pathways. Eligibility, red flags, treatment and referral.
2. Learn stewardship rules. Delayed prescribing, narrow spectrum and course length.
3. Build a vaccine timeline. Birth to old age, with pregnancy and the risk groups.
4. Pair antibiotics with interactions. One interaction per class.
5. Check the Green Book. Confirm timings in the current chapter before the exam.

Continue with respiratory and genito-urinary. See UK law and guidelines for the checked schedules. Back to the hub.