I have been to a number of meetings and had numerous discussions with colleagues, who lament the loss of the practical component of the Fellowship of the Royal College of Pathologists (FRCPath) exam. With a tear in their eye they talk about the “good old days”, that the exam was “character building” and how “trainees today have it so easy”… but is this really true? Was the practical exam such an essential element of the examination, were we made better for completing it; were those days really all rosy and wonderful as they say? And if so why has it been changed?
 
Back in the dim distant past when I took my FRCPath exam it was very different to what it is now. In 2003 the FRCPath consisted of two parts, and was sat after 1-3 years in a Registrar post. You needed to “lose some sense of reality” my wife says in order to submerge yourself enough to pass!

The patient was admitted 3 days after arriving in the UK from Nigeria. He had felt unwell with a fever and generalise aches and pains the day before he travelled. On the morning of admission he had noticed a rash on his left leg as well as tender enlarged lymph nodes in his groin.
 
The admitting Consultant Physician spoke to infection control before the patient arrived and it was decided to admit the patient directly to a negative pressure side-room in the infectious diseases unit without bringing the patient into the main hospital in case this might be a viral haemorrhagic fever. The patient met a diagnosis of low possibility of viral haemorrhagic fever; temperature ≥ 37.5 oC PLUS been in endemic area within 21 days of onset of illness.

The Practice Nurse was getting a bit bored, sitting in the travel clinic listening to all of these people wanting advice for their various holiday destinations. There was only so much advice she could give for beach holidays to Ibiza and Magaluf. So when she opened the next patient record and saw it was a couple about to go on a wildlife spotting trip to Madagascar, she said out loud… “ooh that’s a bit more like it!” and called them in…

​One of the most common bacterial infections we see in the hospital setting is cellulitis; an infection of the skin and subcutaneous tissues. Most of these are caused by Gram-positive bacteria such as Staphylococcus aureus and the Beta-haemolytic streptococci. First line antibiotic treatment is usually Flucloxacillin, or Teicoplanin or Vancomycin (if the patient is allergic to beta-lactams such as Flucloxacillin). I have recently got to thinking about new antibiotics that might be useful in the treatment of cellulitis and in particular a new cephalosporin called Ceftaroline, which is supposedly active against all S. aureus including MRSA and the Beta-haemolytic streptococci.
 
So what have I found out about Ceftaroline? How does it work? Why is it active against MRSA? Read on to discover the answers to these questions and many more about this new antibiotic…