Antimicrobials

Question 1

Clinical Vignette:
A 55-year-old male patient is undergoing removal of an external urinary catheter. He has no identified risk factors. Which antimicrobial prophylaxis is indicated for him?

A) Fluoroquinolone
B) TMP-SMX
C) Aminoglycoside ± ampicillin
D) None

Answer 1

Correct Answer: D) None
Explanation: According to the American Urological Association Best Practice Guidelines, antimicrobial prophylaxis is indicated only if risk factors are present during the removal of an external urinary catheter. In this case, the patient has no identified risk factors.
Memory Tool: “Risk-Free, Med-Free”—No risk factors, no meds needed for urinary catheter removal.
Reference Citation: Paragraph 1, American Urological Association Best Practice Guidelines.
Rationale: Understanding when to administer antimicrobial prophylaxis is crucial for patient safety and antibiotic stewardship.

Question 2

Clinical Vignette:
A patient is allergic to fluoroquinolones and is about to undergo removal of an external urinary catheter. The patient has identified risk factors. What is the alternative antimicrobial of choice?

A) TMP-SMX
B) Aminoglycoside ± ampicillin
C) First- or second-generation cephalosporin
D) Amoxicillin/clavulanate

Answer 2

Correct Answer: B) Aminoglycoside ± ampicillin
Explanation: The guidelines suggest using Aminoglycoside ± ampicillin as an alternative antimicrobial for patients undergoing removal of an external urinary catheter when risk factors are present.
Memory Tool: “Allergic to Fluoro? Amp it up!”—Aminoglycoside ± ampicillin is your go-to alternative.
Reference Citation: Paragraph 1, American Urological Association Best Practice Guidelines.
Rationale: Knowledge of alternative antimicrobials is essential for treating patients with allergies or contraindications to first-line choices.

Question 3

Question 1:
A 58-year-old male with diabetes is scheduled to have his external urinary catheter removed. Which of the following is the recommended antimicrobial of choice for prophylaxis?

A) First-generation cephalosporin
B) Fluoroquinolone
C) Clindamycin
D) Vancomycin

Answer 3

Correct Answer:
B) Fluoroquinolone

Explanation:
For removal of an external urinary catheter, the antimicrobial of choice is Fluoroquinolone when risk factors are present. This recommendation is particularly important when managing high-risk patients such as diabetics.

Memory Tool:
Think of “Fluoroquinolone” for “Foley (external catheter) Farewell.”

Reference Citation:
Modified from Wolf JS Jr, Bennett CJ, Dmochowski RR, et al.; Table 8.5, Paragraph 1

Rationale:
Understanding prophylactic guidelines is crucial for preventing post-operative complications, especially in high-risk patients.

Question 4

Question 2:
A patient is scheduled for prostate cryotherapy. What is the antimicrobial of choice?

A) First-generation cephalosporin
B) Clindamycin
C) Fluoroquinolone
D) Second- or third-generation cephalosporin

Answer 4

Correct Answer:
A) First-generation cephalosporin

Explanation:
For prostate brachytherapy or cryotherapy, the antimicrobial of choice is a First-generation cephalosporin. There is some uncertainty regarding the necessity of prophylaxis for these procedures.

Memory Tool:
“Cryotherapy” and “Cephalosporin” both start with a “C”.

Reference Citation:
Modified from Wolf JS Jr, Bennett CJ, Dmochowski RR, et al.; Table 8.5, Paragraph 4

Rationale:
Proper antimicrobial selection for specialized urological procedures helps in reducing complications.

Question 5

Question 3:
What is the duration for administering prophylactic antimicrobials in percutaneous renal surgery?

A) ≤24 hr
B) ≤48 hr
C) Single dose
D) ≤72 hr

Answer 5

Correct Answer:
A) ≤24 hr

Explanation:
For percutaneous renal surgery, the recommended duration for administering prophylactic antimicrobials is ≤24 hr.

Memory Tool:
“Percu24neous renal surgery” helps you remember the 24-hour duration.

Reference Citation:
Modified from Wolf JS Jr, Bennett CJ, Dmochowski RR, et al.; Table 8.5, Paragraph 7

Rationale:
Correct duration of antibiotic prophylaxis is vital to minimize the risk of resistance and side effects.

Question 6

Question 4:
What is the antimicrobial of choice for prophylaxis in a patient undergoing shock wave lithotripsy?

A) Amoxicillin/clavulanate
B) Fluoroquinolone
C) Clindamycin
D) Vancomycin

Answer 6

Correct Answer:
B) Fluoroquinolone

Explanation:
For patients undergoing shock wave lithotripsy, the antimicrobial of choice is Fluoroquinolone, as indicated for all cases.

Memory Tool:
“Shock waves? Feel safe with Fluoroquinolone.”

Reference Citation:
Modified from Wolf JS Jr, Bennett CJ, Dmochowski RR, et al.; Table 8.5, Paragraph 8

Rationale:
Shock wave lithotripsy involves manipulation of the urinary tract; thus, correct antimicrobial prophylaxis is key to reducing infection rates.

Question 7

Question 5:
In open or laparoscopic surgery without entering the genitourinary tract, what is the alternative antimicrobial to be used if risk factors are present?

A) Clindamycin
B) Second- or third-generation cephalosporin
C) Aminoglycoside
D) Fluoroquinolone

Answer 7

Correct Answer:
A) Clindamycin

Explanation:
Clindamycin is the alternative antimicrobial for open or laparoscopic surgery without entering the genitourinary tract when risk factors are present.

Memory Tool:
“No GU entry, choose Clindamycin.”

Reference Citation:
Modified from Wolf JS Jr, Bennett CJ, Dmochowski RR, et al.; Table 8.5, Paragraph 13

Rationale:
Knowing alternatives for antimicrobial prophylaxis is crucial for patient management, especially for those with allergies or resistance to first-line medications.

Question 8

Question 6:
Which among the following is NOT recommended as an antimicrobial of choice in urological intestinal surgeries?

A) Ticarcillin/clavulanate
B) Aminoglycoside + metronidazole or clindamycin
C) Amoxicillin/clavulanate
D) Second- or third-generation cephalosporin

Answer 8

Correct Answer:
C) Amoxicillin/clavulanate

Explanation:
Amoxicillin/clavulanate is not listed among the antimicrobials of choice for intestinal surgeries in urology.

Memory Tool:
“In intesti-not, Amoxicillin/clavulanate is not the one.”

Reference Citation:
Modified from Wolf JS Jr, Bennett CJ, Dmochowski RR, et al.; Table 8.5, Paragraph 14

Rationale:
Antimicrobial selection is especially critical in intestinal surgeries due to the wide range of flora that might be encountered.