Antibiotic Indications

Question 1

Narrow Spectrum PCNs

Answer 1

Strep Pharyngitis DOC
Strep Pneumoniae infections (if sensitive)
Endocarditis due to Strep viridans and Endocarditis Px
Meningitis due to Neisseria meningitidis
Syphilis DOC
Lyme disease

Question 2

Penicillinase-Resistant PCNs

Answer 2

Skin infections due to Staph aureus (MSSA or MSSE)
Osteomyelitis due to MSSA or MSSE
Infection of prosthetic joint due to MSSA or MSSE
Line infections due to Staph

Question 3

Amino PCNs

Answer 3

Upper resp infections
Otitis Media DOC
Strep Pharyngitis
Enterococcus infection (combo with Aminoglycoside)
UTI
Meningitis due to Listeria monocytogenes
H. pylori (with PPI + other antibiotic)
Lyme disease

Question 4

Amino PCN + Beta-Lactamase Inhibitors

Answer 4

Otitis Media
Sinusitis
Aspiration Pneumonia
Bites
UTI
Anaerobic infections (abscess)

Question 5

Anti-Pseudomonal PCN + Beta-Lactamase Inhibitors

Answer 5

Empiric broad spectrum coverage +/- other antimicrobials. GI organisms - ruptured appy, GI surgery, diverticulitis, nosocomial pneumonia (hosp acquired).
Pseudomonas infection (w/aminoglycoside)
Febrile neutropenia

Question 6

1st Gen Cephalosporins

Answer 6

Skin infections
Bone infections (osteomyelitis)
Surgical prophylaxis
Uncomplicated UTI

Question 7

2nd Gen Cephalosporins

Answer 7

Community Acquired Pneumonia
Sinusitis
AECB
Otitis Media
UTI
Cystitis
Pyelonephritis
Cefoxitin/Cefotetan - surgical px (GI, GU, GYN procedures) and Tx for PID with Doxy

Question 8

3rd/4th Gen Cephalosporins

Answer 8

PO Agents - Resp Tract Infections; UTI - cystitis, pyelonephritis
IV Agents - empiric tx of serious infections; Meningitis (DOC + Vanco); w/Aminoglycoside for Pseudomonas (Ceftazidime, Cefipime), Febrile neutropenia.

Question 9

Carbapenems

Answer 9

Serious nosocomial infections such as pneumonia, bacteremia and urosepsis
Serious polymicrobial infections (diabetic infections)
Nosocomial intra-abdominal infections
Pseudomonas infections (w/aminoglycoside)
Febrile neutropenia

Question 10

Ertapenem

Answer 10

Intra-abdominal infections
Skin infections
UTI - pyelonephritis

Question 11

Monobactams

Answer 11

Gram (-) sepsis - pneumonia, osteomyelititis
UTI
Intra-abdominal infections (w/anti-anaerobe)
CF (inhaled)

Question 12

Vancomycin

Answer 12

Serious infections caused by HCA-MRSA (DOC), MRSE, and Enterococci (option for PCN allergic)
Serious infections caused by S. aureus, Enterococcus, or Strep in pts intolerant of Beta-Lactams
Infections caused by resistant Gram (+) organisms
C. difficile colitis (PO) only if Metronidazole fails
Endocarditis Px - for selected GU/GI procedures

Question 13

Oxazolidinone

Answer 13

Strictly reserved for serious infections due to resistant organisms

Question 14

Streptogramin

Answer 14

Strictly reserved for serious infections due to resistant organisms

Question 15

Cyclic Lipopeptide

Answer 15

MRSA skin infections, bacteremia, right sided infective endocarditis - do not use for pneumonia

Question 16

Lipoglycopeptide

Answer 16

Strictly reserved for serious infections due to resistant organisms

Question 17

Glycylcycline

Answer 17

MRSA and VRE. Avoid using for serious infections - not as effective. Risk of death and tx failure higher than with other options.

Question 18

Fluoroquinolones

Answer 18

UTI - pyelonephritis, uncomplicated cystitis, prostatitis
Osteomyelitis due to Gram (-) like pseudomonas
CAP
M. tb alternative
Complicated Gram (-) and anaerobic abd and gyn infections

Question 19

Trimethoprim-Sulfamethoxazole

Answer 19

Resp Tract Infections - pneumocystic pneumonia (DOC), Actute exacerbations of Chronic Bronchitis, Acute Sinusitis
UTI - uncomplicated cystitis (DOC when E. coli sen), Prostatitis, Orchitis, Epididymitis
GI infections - Travelers diarrhea (enterotoxic E. coli), Shigellosis
Others - B. cepacia, S. maltophelia, Serratia, Nocardia, Typhoid Fever

Question 20

Aminoglycosides

Answer 20

Serious hosp acquired infections caused by Enterobacteriaceae and Pseudomonas aeruginosa
Enterococcal endocarditis (with amp, pen or vanco)
Serious Staph infections (for synergy w/ other agents)
Usually used in combo with Beta-Lactam

Question 21

Tetracyclines

Answer 21

Resp Infections - CA-Pneumonia; Atypical Pneumonia; AECB; Legionella (alt to Erythromycin)
Genital Infections - Chlamydia trachomatis, NGU, PID, epididymitis, prostatitis, lymphogranuloma venereum, Granuloma inguinale, Syphilis (alt to PCN)
Systemic Infections - Rickettsiae, Brucellosis, Lyme disease, Ehrlichiosis, Vibrio cholera, Tularemia (alt)
Other - Pasteurella multocida (alt to Amox/Clav), H. pylori (with Bismuth, Metronidazole or Clarithromycin), Propionibacterium acnes

Question 22

Macrolides - Erythromycin

Answer 22

DOC for Diphtheria and Bordetella Pertussis

Question 23

Macrolides - Clarithromycin

Answer 23

Similar to Erythromycin

Question 24

Macrolides - Azithromycin (pediatrics)

Answer 24

Pharyngitis/Tonsillitis (alt to PCN and Erythro)

Acute Otitis Media (not DOC)

Question 25

Macrolides - Azithromycin (adults)

Answer 25

STIs - Urethritis/Cervicitis/Proctitis (tx with Ceftriaxone)
Upper Resp Infect - Sinusitis, Pharyngitis
Lower Resp Infect - CA-Pneumonia

Question 26

Clindamycin

Answer 26

Tx of Staph and Strep in PCN allergic - good for retropharyngeal abscess and Staph osteomyelitis
Anaerobic infections (used with Amp, Gent, Clinda)
Topical Tx of Acne
Topical (vaginal) tx of Gardnerella Vaginosis
Toxoplasmosis in pts with AIDS (alt to Sulfonamides)
PID (Chlamydia) in combo with Gent

Question 27

Metronidazole

Answer 27

Tx of serious anaerobic infections in peritoneum, liver, skin, CNS, bone and joints, lower resp tact (Bacteroides)
Px prior to abd, gyn or colorectal surgery
C. difficile colitis DOC
Bacterial vaginosis (Trichomonas, Gardnerella)
Hepatic encephalopathy
Crohns disease - rectal disease only
PUD due to H. pylori