Antimicrobial choice and limitations

Question 1

Co-amoxiclav in sepsis

Answer 1

Does not cover MRSA or Pseudomonas, and there is concern about an increase in the risk of necrotising
enterocolitis in neonates exposed to co-amoxiclav in utero

Question 2

Metronidazole in sepsis

Answer 2

Only covers anaerobes

Question 3

Clindamycin in sepsis

Answer 3

Covers most streptococci and staphylococci, including many MRSA, and switches off exotoxin production
with significantly decreased mortality. Not renally excreted or nephrotoxic

Question 4

Piperacillin–tazobactam (Tazocin) and carbapenems in sepsis

Answer 4

Covers all except MRSA and are renal sparing (in contrast to aminoglycosides

Question 5

Gentamicin (as a single dose of 3–5mg/kg) in sepsis

Answer 5

Poses no problem in normal renal function but if doses are to be given regularly serum levels must be monitored