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45 Cards in this Set

  • Front
  • Back
What antibiotic would you recommend for IV therapy for a Staphylococcus aureus (MSSA) bacteremia?
nafcillin or oxacillin
What if the patient had a penicillin allergy (rash)?
1st gen ceph (cefazolin)

Others: clindamycin, linezolid, daptomycin, Synercid, tigecycline
What if the patient had a penicillin allergy (anaphylaxis)?

Others: clindamycin, linezolid, daptomycin, Synercid, tigecycline
What if the bacteria instead was MRSA?

Others: clindamycin, linezolid, daptomycin, Synercid, tigecycline
A 22yo WF presents with a cellulitis. What oral antibiotic would you recommend to cover MSSA and Streptococcal species?
dicloxacillin, cloxacillin, 1st gen ceph (cephlalexin)
What if community-acquired MRSA was expected?
Bactrim + diclox
Bactrim + clox
Bactrim + cephalexin

minocycline, doxycycline, clindamycin
A 55yo WM develops an Enterococcus faecalis endocarditis. What IV antibiotics would you recommend?
Amp or Pen G + Gent or Streptomycin
What gentamicin peak/trough would you target?
Peak ~3
Trough <1
What if the patient had a penicillin allergy (rash)?
Vancomycin + Gent or Strep
10 days later, the patient develops diarrhea. A stool sample reveals Clostridium difficile. What would you recommend?
Metronidazole po

Others: Metronidazole IV or vancomycin po
CC is a 65yo WM develops an intrabdominal infection s/p surgery for colon cancer. The physician wants broad coverage (gram +, gram -, anaerobes). What would you recommend?
Beta lactam/BLI combo
Amp + Gent + Metronidazole
Levofloxacin or Cipro + Metronidazole
The patient develops an Enterococcus faecium bacteremia after being in the hospital for 10 days following abdominal surgery. What antibiotic would you recommend?
Linezolid or Syndercid
Daptomycin, tigecycline
What if the patient has thrombocytopenia?
Don't use linezolid
A 70yo WF is admitted for a community-acquired pneumonia. The physician suspects Streptococcus pneumoniae and also wants to cover atypical pathogens. What would you recommend?
Ceftriazone or cefotaxime+ Azithromycin
Levofloxin or Moxifloxacin
After being in the hospital for 5 days, the physician now expects a superimposed hospital-acquired pneumonia. He would like you to recommend better gram negative coverage including Pseudomonas aeruginosa. What would you recommend?
Extended spectrum penicillin: Piperacillin/tazobactam, Ticarcillin/clavulanate

Carbapenem (not ertapenem)


Cipro or Levofloxacin

Gentamicin or tobramycin
A 2yo WM presents to the pediatrician with fever and bilateral ear pain for 5 days. Otitis media is diagnosed. The pediatrician asks for a recommendation for possible resistant Streptococcus pnemoniae.
Amoxicillin 80-90mg/kg/day
What if the patient had a penicillin allergy (rash)?
3rd gen ceph (cefdinir, cefpodxime, cefixime)
A 25yo BF is seen by the family practitioner for a 5 day history of fever and sore throat. A rapid strep test is positive. What antibiotic would you recommend?
Pen VK
Should this antibiotic be taken with or without food?
A 22yo WF presents with a 3 day history of dysuria and frequency. A urinary tract infection is suspected. The physician wants you to choose an antibiotic to cover Escherichia coli. What would you recommend?
Bactrim x3 days
What if the patient had a sulfa allergy?
Nitrofurantoin, fosfomycin, quinolones (not moxi- or gemi-)
Name the penicillin/BLI combos.
What bacteria can produce a beta-lactamase? (Gram positives, gram negatives, andanaerobes?)
Gram +: Staph aureus
Gram -: H. flu, Proteus, Klebsiella, E. coli
Anaerobes: B. fragilis
How does the antibacterial coverage of clindamycin and metronidazole differ?
Clindamycin: gram + and anaerobes

Metronidazole: anaerobes and parasites
Why is penicillin G IV often given as a continuous infusion?
Time-dependent killing (above MIC)
Short-half life
Which cephalosporins contain the MTT side chain?
Cefamandole, cefoperazone, cefotetan, cefmetazole
What are cephalosporins inactive against?
How does coverage of cephs change with generations?
Gram positive coverage best with 1st gen and decreases as go up in gen class.
Gram negative coverage increases as go up in ceph class.
What is the major difference in antibacterial coverage among the carbapenems?
Ertapenem: no Pseudomonas, Enterococcus, or Acinetobacter
What adverse effect of the carbapenems can occur if not modified for renal function?
What is the general antibacterial coverage of aztreonam?
Gram negatives
Can aztreonam be used in patients allergic to other beta lactams?
What is the spectrum of antibacterial activity of the macrolides?
Some gram positives, atypicals, chlamydia, mycobacterim avium, some gram negatives (Bordetella pertussis, legionella pneumophilia, clarithromycin and azithromycin with improved activity vs. hemophilus influenzae and moraxella catarrhalis, Helicobacter pylori)
What is the spectrum of antibacterial activity of the ketolides?
Enhanced strep. pneumo coverage, atypicals, some gram negatives (H. flu, moraxella, legionella)
What are common drug-drug interactions of erythromycin, clarithromycin, and telithromycin?
All are potent inhibitors of CYP-3A4. Thus interact with some benzos, theophylline, statins, carbamazepine, cyclosporine, tacrolimus, etc.
What is the spectrum of antibacterial activity of the tetracyclines?
Some gram positives, atypicals, some gram negatives (H. flu, moraxella), mycoplasma, rickettsia, borrelia, plasmodium, treponema
Why should tetracyclines not be prescribed for children?
Bind to calcium in teeth and bones and result in damage.
Know common drug-drug interactions of the tetracyclines.
Di and trivalent cations.
Know the spectrum of antibacterial activity of tigecycline.
Very broad: gram positives including MRSA, gram negatives but not Pseudomonas, anaerobes
What ABX should be avoided with warfarin?
Bactrim, Metronidazole
ADR’s of chloramphenicol?
Bone marrow suppression and the gray baby syndrome
What is the dose of TMP and SMX in a SS tab? DS tab?
SS tab 80mg TMP/400mg SMX
DS tab 160mg TMP/800mg SMX
Know the difference in spectrum of antibacterial coverage based on fluoroquinolone generation.
3rd gen quinolones (levofloxacin, trovofloxacin, gemifloxacin, moxifloxacin) considered respiratory quinolones (cover Streptococcus pneumoniae) Do not use other quinolones for Streptococus pneumoniae coverage.
Know common drug-drug interactions of the fluoroquinolones.
Di and trivalent cations inhibit absorption significantly
Can increase INR with warfarin
Possible concomitant QT prolongation with antiarrhythmics
Antibiotics just used for UTIs?
nitrofurantoin, fosfomycin, methenamine