5/8 Antibiotics Review Flashcards
Pt with foreign body in place, and coag-neg staph growing?
normally we would dismiss coag-neg staph as a contaminant, but a foreign body makes us think it is something growing on the surface.
Assume it is MRSA; treat with Vanco
Neisseria?
Ceftriaxone (3rd gen)
(3rd generation; Neisseria has 3 letters that are repeated!)
C Diff: one sigle drug?
Metronidazole
If suspect Listeria in meningitis, add what to cover it?
Ampicillin
for staph, which is better: PCN or Ampicillin?
PCN
MSSA bacteremia?
Nafcillin
Piperacillin: good against what?
SPACEK
esp pseudomonas
Zosyn covers everything except what?
except MRSA
the devil drug
(=Pip + Tazobactam)
Anaerobic gram neg rods: name 3?
what are they likely to have?
Prevotella, Fusobacterium, Bacteriodes
likely to have beta-lactamase
UTI from E Coli?
Ampicilin
Diverticular abscess (ie below the diaphragm)?
Unisyn (Amp + Sulbactam)
Combination PCN + beta-lactamase inh.
Prophy for someone about to have abd surg?
Cefazolin (1st)
Cellulitis w PCN allergy?
Cefazolin (1st)
CA Pneumonia?
Ceftriaxone (3rd)
Pyelonephritis?
Ceftriaxone (3rd)
Why can’t we use just Ceftazadime (3rd - IV) for VAP?
it covers SPACEKs but not other causes of HAP (S pneumo, S aureus, MRSA, MSSA)
Add vanco.
2 equivalent regimens for VAP/HAP?
Vanco/Ceftazadime
Vanco/Piperacillin/Tazobactam
(need to cover SPACEK and anaerobes)
Why does he think that Cefapime is the devil?
Covers very widely.
Covers Staph, strep, E Coli, SPACEK…..
Your roommate (who has smelly socks) develops a cellulitis of the right foot, but is otherwise healthy and clinically stable.
What organisms cause this?
What drugs kill them?
What organisms cause this? Group A Strep
What drugs kill them? Penicillins
A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.
Why isn’t penicillin adequate therapy for a UTI?
Because it doesn’t kill Enterococcus.
Because it is oral.
Because it kills most Nocardia.
Because it doesn’t kill most E. coli.
Because you don’t treat UTI’s.
A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.
Why isn’t penicillin adequate therapy for a UTI?
Because it doesn’t kill Enterococcus.
Because it is oral.
Because it kills most Nocardia.
Because it doesn’t kill most E. coli.
Because you don’t treat UTI’s.
A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.
Why is ceftazidime overkill for an uncomplicated UTI?
Because it doesn’t kill Enterococcus.
Because it is oral.
Because it kills the SPACE bugs.
Because it doesn’t kill most E. coli.
Because it kills M. tuberculosis.
A sexually active mother of three complains of dysuria, urinary frequency, and incomplete voiding. She’s otherwise healthy and her examination including her vitals are normal. You diagnose uncomplicated cystitis, a.k.a. a UTI.
Why is ceftazidime overkill for an uncomplicated UTI?
Because it doesn’t kill Enterococcus.
Because it is oral.
Because it kills the SPACE bugs.
Because it doesn’t kill most E. coli.
Because it kills M. tuberculosis.
What is the equivalent of Ceftazadime for pts who are allergic to PCN?
Azeotreonam
Your first patient of third year has febrile neutropenia without a clear source. Your resident says she remembers resistant Gram negative rods are potential pathogens in this crowd, so she wants to start empiric antibiotic therapy to cover them.
Which of these do not cover resistant GNRs?
Ceftriaxone
Meropenem
Aminoglycosides
Ciprofloxacin
Piperacillin / tazobactam
Ceftazidime
Cefepime
Your first patient of third year has febrile neutropenia without a clear source. Your resident says she remembers resistant Gram negative rods are potential pathogens in this crowd, so she wants to start empiric antibiotic therapy to cover them.
Which of these do not cover resistant GNRs?
Ceftriaxone
Meropenem
Aminoglycosides
Ciprofloxacin
Piperacillin / tazobactam
Ceftazidime
Cefepime
When would you use Cipro (quinolone) for a UTI?
If there is resistance to Bactim
Bactirm is cheaper
Why are moxyfloxacin and levofloxacin good against pneumonia?
Cover strep pneumo
Why might we give Vanco in a meningitis situation but not in pneumonia, if we suspect that each may be caused by MRSA?
Meningitis far more dangerous - cannot take the chance on MRSA.
Pneumonia - if they don’t get well on first-line they can come back in for Vanco.
1: FYI: you should get a chest x-ray.
31 year old medical student vomits while taking his final exam. Three days later, he develops a fever, cough and dyspnea. You’re worried about pneumonia.
What is the first-line, assuming he is well enough to remain home (not in hosp)?
Azithromycin
Why are ceftriaxone plus azithromycin the standard treatment for patients hospitalized with pneumonia?
(why not only azithromycin?)
If patient is in hospital, add Ceftraixone covers resistant pneumo.
If very concerned/sick, add Vanco.
Pneumonia: Azithro –> Ceftriaxone –> Vanco
His post-test pre-pneumonia emesis makes aspiration a concern. Which bugs might be important?
Pseudomonas aeruginosa
MRSA
Bacteroides fragilis
M. tuberculosis
Haemophilus influenzae
His post-test pre-pneumonia emesis makes aspiration a concern. Which bugs might be important?
Pseudomonas aeruginosa
MRSA
Bacteroides fragilis
M. tuberculosis
Haemophilus influenzae
31 year old medical student vomits while taking his final exam. Three days later, he develops a fever, cough and dyspnea. You’re worried about pneumonia.
His post-test pre-pneumonia emesis makes aspiration a concern. Which of the following drugs DOES NOT KILL ANAEROBES?
Clindamycin
Ceftriaxone
Metronidazole
Beta-lactams paired with a beta-lactamase inhibitor
31 year old medical student vomits while taking his final exam. Three days later, he develops a fever, cough and dyspnea. You’re worried about pneumonia.
His post-test pre-pneumonia emesis makes aspiration a concern. Which of the following drugs DOES NOT KILL ANAEROBES?
Clindamycin
Ceftriaxone
Metronidazole
Beta-lactams paired with a beta-lactamase inhibitor
Dental abscess -> what drug?
Clindamycin (for peptostreptococcus)
Bacterial abscess in abd: what drug?
amp/sulbactam (Unisyn) + metronidazole (for C diff)
A college student comes in, embarrassed: “there’s something on my butt, and it hurts.” You diagnose a boil, likely from Staph. aureus. You are worried about MRSA.
What drugs are inactive against MRSA?
Linezolid
Ceftriaxone
Vancomycin
Daptomycin
Trimethroprim-sulfamethoxazole
A college student comes in, embarrassed: “there’s something on my butt, and it hurts.” You diagnose a boil, likely from Staph. aureus. You are worried about MRSA.
What drugs are inactive against MRSA?
Linezolid
Ceftriaxone (remember ceftaroline is the only cephalosporin that covers MRSA)
Vancomycin
Daptomycin
Trimethroprim-sulfamethoxazole
