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45 Cards in this Set
- Front
- Back
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What antibiotic would you recommend for IV therapy for a Staphylococcus aureus (MSSA) bacteremia?
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nafcillin or oxacillin
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What if the patient had a penicillin allergy (rash)?
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1st gen ceph (cefazolin)
Others: clindamycin, linezolid, daptomycin, Synercid, tigecycline |
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What if the patient had a penicillin allergy (anaphylaxis)?
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Vancomycin
Others: clindamycin, linezolid, daptomycin, Synercid, tigecycline |
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What if the bacteria instead was MRSA?
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Vancomycin
Others: clindamycin, linezolid, daptomycin, Synercid, tigecycline |
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A 22yo WF presents with a cellulitis. What oral antibiotic would you recommend to cover MSSA and Streptococcal species?
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dicloxacillin, cloxacillin, 1st gen ceph (cephlalexin)
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What if community-acquired MRSA was expected?
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Bactrim + diclox
Bactrim + clox Bactrim + cephalexin minocycline, doxycycline, clindamycin |
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A 55yo WM develops an Enterococcus faecalis endocarditis. What IV antibiotics would you recommend?
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Amp or Pen G + Gent or Streptomycin
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What gentamicin peak/trough would you target?
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Peak ~3
Trough <1 |
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What if the patient had a penicillin allergy (rash)?
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Vancomycin + Gent or Strep
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10 days later, the patient develops diarrhea. A stool sample reveals Clostridium difficile. What would you recommend?
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Metronidazole po
Others: Metronidazole IV or vancomycin po |
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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?
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Carbapenem
Beta lactam/BLI combo Amp + Gent + Metronidazole Levofloxacin or Cipro + Metronidazole Tigecycline |
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The patient develops an Enterococcus faecium bacteremia after being in the hospital for 10 days following abdominal surgery. What antibiotic would you recommend?
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Linezolid or Syndercid
Daptomycin, tigecycline |
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What if the patient has thrombocytopenia?
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Don't use linezolid
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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?
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Ceftriazone or cefotaxime+ Azithromycin
or Levofloxin or Moxifloxacin |
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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?
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Extended spectrum penicillin: Piperacillin/tazobactam, Ticarcillin/clavulanate
Carbapenem (not ertapenem) Aztreonam Cipro or Levofloxacin Gentamicin or tobramycin |
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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.
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Amoxicillin 80-90mg/kg/day
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What if the patient had a penicillin allergy (rash)?
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3rd gen ceph (cefdinir, cefpodxime, cefixime)
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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?
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Pen VK
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Should this antibiotic be taken with or without food?
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Without
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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?
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Bactrim x3 days
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What if the patient had a sulfa allergy?
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Nitrofurantoin, fosfomycin, quinolones (not moxi- or gemi-)
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Name the penicillin/BLI combos.
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Augmentin
Unasyn Timentin Zosyn |
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What bacteria can produce a beta-lactamase? (Gram positives, gram negatives, andanaerobes?)
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Gram +: Staph aureus
Gram -: H. flu, Proteus, Klebsiella, E. coli Anaerobes: B. fragilis |
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How does the antibacterial coverage of clindamycin and metronidazole differ?
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Clindamycin: gram + and anaerobes
Metronidazole: anaerobes and parasites |
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Why is penicillin G IV often given as a continuous infusion?
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Time-dependent killing (above MIC)
Short-half life |
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Which cephalosporins contain the MTT side chain?
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Cefamandole, cefoperazone, cefotetan, cefmetazole
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What are cephalosporins inactive against?
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Listeria
Enterococcus |
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How does coverage of cephs change with generations?
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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. |
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What is the major difference in antibacterial coverage among the carbapenems?
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Ertapenem: no Pseudomonas, Enterococcus, or Acinetobacter
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What adverse effect of the carbapenems can occur if not modified for renal function?
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Seizures
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What is the general antibacterial coverage of aztreonam?
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Gram negatives
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Can aztreonam be used in patients allergic to other beta lactams?
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Yes
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What is the spectrum of antibacterial activity of the macrolides?
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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)
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What is the spectrum of antibacterial activity of the ketolides?
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Enhanced strep. pneumo coverage, atypicals, some gram negatives (H. flu, moraxella, legionella)
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What are common drug-drug interactions of erythromycin, clarithromycin, and telithromycin?
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All are potent inhibitors of CYP-3A4. Thus interact with some benzos, theophylline, statins, carbamazepine, cyclosporine, tacrolimus, etc.
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What is the spectrum of antibacterial activity of the tetracyclines?
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Some gram positives, atypicals, some gram negatives (H. flu, moraxella), mycoplasma, rickettsia, borrelia, plasmodium, treponema
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Why should tetracyclines not be prescribed for children?
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Bind to calcium in teeth and bones and result in damage.
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Know common drug-drug interactions of the tetracyclines.
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Di and trivalent cations.
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Know the spectrum of antibacterial activity of tigecycline.
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Very broad: gram positives including MRSA, gram negatives but not Pseudomonas, anaerobes
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What ABX should be avoided with warfarin?
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Bactrim, Metronidazole
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ADR’s of chloramphenicol?
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Bone marrow suppression and the gray baby syndrome
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What is the dose of TMP and SMX in a SS tab? DS tab?
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SS tab 80mg TMP/400mg SMX
DS tab 160mg TMP/800mg SMX |
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Know the difference in spectrum of antibacterial coverage based on fluoroquinolone generation.
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3rd gen quinolones (levofloxacin, trovofloxacin, gemifloxacin, moxifloxacin) considered respiratory quinolones (cover Streptococcus pneumoniae) Do not use other quinolones for Streptococus pneumoniae coverage.
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Know common drug-drug interactions of the fluoroquinolones.
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Di and trivalent cations inhibit absorption significantly
Can increase INR with warfarin Possible concomitant QT prolongation with antiarrhythmics |
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Antibiotics just used for UTIs?
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nitrofurantoin, fosfomycin, methenamine
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