CCFP priority topic 5 of 105
Antibiotics on the CCFP exam
5 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 5 key features for Antibiotics. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 5
Choosing the drug
When an antibiotic is needed, pick it for this germ, this patient and this place.
CFPC skill Clinical reasoning, selectivityPhase TreatmentSources Choosing Wisely Canada / national participating organizations, Choosing Wisely Canada
On the exam
A preschooler with pneumonia goes home, and the parents want something stronger. Expect one best answer from a list.
Pick the drug.
Common mistakes
A macrolide (such as azithromycin) or amoxicillin-clavulanate because the parents ask, or because of a course months ago. For a child with pneumonia at home, amoxicillin is the drug.
Approach
- Child with pneumonia treated at home: amoxicillin. Preschoolers often need no antibiotic at all, since most of their pneumonia is viral.
- Ask what the penicillin reaction really was. A mild reaction is no reason to skip a beta-lactam (penicillins and cephalosporins) when it is the first choice.
- If the patient can swallow, give the oral form of a well-absorbed drug. The IV form is rarely needed, and the line brings its own risks.
- Keep the course short. The table gives course lengths the listed sources set.
| Infection | Course | Know this |
|---|---|---|
| Bladder infection, uncomplicated | 3 to 5 days | Depends on the drug |
| Bladder infection in a man, with a catheter, or with an abnormal urinary tract | 7 days | Counts as complicated |
| Kidney infection (pyelonephritis) | 7 days, in general | In long-term care, a pharmacist checks any course over 7 days |
| Dental abscess with fever, facial swelling or weak immunity | 5 days | Dental care, not the antibiotic, is the treatment |
Key feature 2 of 5
Viral illness
When the illness looks viral, leave the antibiotic out.
CFPC skill Clinical reasoningPhase TreatmentSources Choosing Wisely Canada
On the exam
Day 5 of amoxicillin, started for a red eardrum that was not bulging. The fever is gone, a rash has appeared, and the ears are normal. Expect one best answer from a list.
Decide whether any antibiotic is needed.
Common mistakes
Finishing the course or switching to a macrolide. Each keeps treating a virus. The question is whether any antibiotic is needed, and none is: stop it.
Approach
- Colds, flu and most sinus infections are viral. Do not treat a sinus infection that is under 7 days old.
- Adults with bronchitis and children with bronchiolitis get no antibiotic.
- Sore throat: an antibiotic needs two things. An intermediate or high Centor or FeverPAIN score (a sore-throat checklist), and a positive throat culture or rapid test.
- A child with a sore throat and clear viral signs needs no strep swab. Many children carry strep without being infected by it.
- Uncomplicated ear infection in a well child over 6 months, with fever under 39°C: give pain relief and watch 48 to 72 hours. Or give a delayed prescription.
- If an illness you treated turns out viral, stop the antibiotic. Tell the family why.
| Illness | The advice | When an antibiotic may help |
|---|---|---|
| Sinus infection | No antibiotic under 7 days. Nearly all are viral. | Signs of bacterial infection after 7 days or more |
| Sore throat | No routine antibiotic | Intermediate or high Centor or FeverPAIN score, plus a positive test |
| Ear infection | Well child over 6 months: watch 48 to 72 hours, or a delayed prescription | Not better after watching, both ears under 24 months, or ear discharge |
| Bronchitis (adult), bronchiolitis (child) | No antibiotic | Rarely: most are not bacterial |
Key feature 3 of 5
Allergy labels
Before you accept a reported drug allergy, check that it was not something else.
CFPC skill Clinical reasoningPhase Hypothesis generation, historySources Choosing Wisely Canada
On the exam
A child labelled allergic to amoxicillin after a walk-in visit. Expect a short menu: you pick several answers from a list.
Pick the history that tells you what happened.
Common mistakes
Asking about family allergies, eczema, egg allergy or vaccine reactions. The answer is in the story of the reaction itself.
Approach
- Get the story: which drug, when the reaction began, what it looked like, how it was treated, and whether the drug was taken since.
- Vomiting or diarrhea on a drug is a side effect, not an allergy. A rash during a viral illness is often the virus, not the drug: weigh both before you record an allergy.
- Between 6% and 25% of patients report a penicillin allergy. Most of them can take it.
- A label has a cost: broader drugs such as vancomycin, quinolones and clindamycin, longer hospital stays, and more infections such as MRSA, VRE (resistant enterococcus) and C. difficile.
- After a mild past reaction, give the beta-lactam when it is the first choice.
- If the story is unclear, refer for skin testing or a graded oral challenge (doses given step by step, under watch).
Key feature 4 of 5
When to culture
Send a culture before antibiotics only when the result will change what you do.
CFPC skill SelectivityPhase InvestigationSources Choosing Wisely Canada / national participating organizations, Choosing Wisely Canada
On the exam
A long-term care resident is more confused, and her family wants a urine test. Expect a short menu of next steps.
Pick what to check before any test.
Common mistakes
Sending urine because she is confused, or treating a positive culture with no urinary signs. Look for other causes first; bacteria without symptoms need no antibiotic.
Approach
- A simple bladder infection can be treated on the history alone, with no urine test.
- After draining a simple skin abscess, give no antibiotic. The exceptions: cellulitis spreads widely, or the patient has weak immunity or is unwell all over (fever, fast pulse).
- In long-term care, no urine screening at admission, at routine exams or before a referral.
- A change in behaviour is not a urinary infection until other causes are ruled out: dehydration, constipation, skin breakdown, drug effects, other infections.
- Bacteria in the urine without symptoms need no antibiotic. Treating them does not help, even with confusion, and adds side effects.
- In a child in diapers, never send a bag urine culture. Skin germs often make a positive result false, and a positive must be confirmed by catheter or suprapubic sample.
| Resident | Culture if | Not enough on its own |
|---|---|---|
| No catheter | Sudden burning on passing urine. Or 2 or more of: fever, new or worse urgency or frequency, pain above the pubic bone, visible blood, flank pain, incontinence. | Confusion or a change in behaviour |
| Catheter | Any one of: fever, flank pain, shaking chills, new delirium, once other causes are ruled out. If the catheter has been in over 14 days, replace it before the sample. | A dipstick result |
| Fever means | Above 37.9°C, or 1.5°C over usual twice in 12 hours | Applies to both |
Key feature 5 of 5
No delay when urgent
In a life-threatening infection, start antibiotics at once, before tests confirm it.
CFPC skill SelectivityPhase TreatmentSources Choosing Wisely Canada / national participating organizations
On the exam
A long-term care resident with a catheter has low blood pressure and may have sepsis from the urine. Expect one best answer from a list.
Pick the next step now.
Common mistakes
Waiting for the urine sample or culture result before the first dose while the resident is unstable.
Approach
- In long-term care, a resident who is unstable (low blood pressure) does not wait for the urine sample or any result: give the first dose now. The long-term care urine rules do not apply to a resident who may have sepsis.
Flashcards
Answer it first, then check.
KF 1A 3-year-old with pneumonia is well enough to go home. Which antibiotic?
Amoxicillin. Preschoolers often need none, since most of their pneumonia is viral. Source: Choosing Wisely Canada
KF 1Uncomplicated bladder infection in a long-term care resident. How long do you treat?
3 to 5 days, depending on the drug. Complicated cystitis or kidney infection: 7 days. Source: Choosing Wisely Canada / national participating organizations
KF 2An adult has had sinus symptoms for 4 days. Does she need an antibiotic?
No. Nearly all sinus infections are viral. Bacterial ones usually show only after 7 days or more. Source: Choosing Wisely Canada
KF 3She vomited on amoxicillin years ago. Is she allergic to penicillin?
No. Vomiting is a side effect, not an allergy. Take the full story, then give the beta-lactam if it is first choice.
KF 3Which tests sort out an unclear penicillin allergy label?
Skin testing, or a graded oral challenge: doses given step by step, under watch. Source: Choosing Wisely Canada
KF 4A resident with a catheter has new delirium, other causes ruled out. Culture the urine?
Yes. With a catheter, one sign is enough. If the catheter has been in over 14 days, replace it before taking the sample. Source: Choosing Wisely Canada / national participating organizations
KF 4Why not send a bag urine culture in a febrile toddler?
Skin germs get into it. A positive bag culture cannot confirm a urinary infection. Source: Choosing Wisely Canada
KF 5A resident with a catheter is unstable and may have sepsis. Wait for a urine culture?
No. Start antibiotics now. The rules for waiting do not apply to an unstable resident. Source: Choosing Wisely Canada / national participating organizations
FAQ
Which antibiotic guideline does the exam follow?
The CFPC names none. Canadian sources include the Choosing Wisely Canada lists, provincial guides and your local lab report. Marks go to the reasoning: is it bacterial, which germ, which drug.
Is a delayed prescription a real answer on the exam?
Yes, for the right illness. For an uncomplicated ear infection, a prescription filled only if the child is not better is a Canadian option. It cuts antibiotic use safely.
What is a local lab's yearly report of resistance?
Often called an antibiogram. It shows how often each common germ was stopped by each drug in local lab tests. Use it when you pick a drug before culture results return.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Using antibiotics wisely in long-term careChoosing Wisely Canada / national participating organizations
- Choosing Wisely recommendationsChoosing Wisely Canada