Brief AB summary

Question 1

amoxicillin: gm+

Answer 1

streptococcus

non beta-lactamase producing Staphylococcus aureus, Listeria, Enterococcus

Question 2

amoxicillin: gm -

Answer 2

fair coverage

Shigella (ampicillin)
E. Coli, H. flu (non beta-lactamase)
proteus mirabilis
N. gonorrhea
Pasteurella multocida

rash, diarrhea

DIs: methotrexate, oral corticosteroids

Question 3

beta lactam / beta lactamase inhibitor: coverage

Answer 3

b lactamase-producing bugs
and
B. fragilis, Haemophilus influenza, Proteus, Klebsiella, E. coli, Moraxella catarrhalis, N. gonorrhea, S. aureus

Bacteroides frag. (anaerobic)

Question 4

clindamycin: coverage

Answer 4

Gm+ Streptococcus sp, Staphylococcus sp (MSSA only), acnes, anaerobes, atypicals

rash, diarrhea, pseudomembranous colitis, inc AST/ALT, thrombocytopenia, granulocytopenia

Question 5

clinda: black box warning

Answer 5

can cause severe and possibly fatal colitis

reserve for serious infections where less toxic antimicrobial agents are inappropriate

Question 6

antibiotic tx for C. diff: initial episode

Answer 6

vanc 125mg po 4x daily for 10 days

or

fixamoxicin 200mg orally twice daily for 10 days

not responding:
metronidazole 500mg orally TID for 10 days

Question 7

antibiotic tx for C. diff: second or subsequent recurrence

Answer 7

vanc followed by rifaximin (400mg three times daily for 20 days)

fecal microbiota transplantation

Question 8

antibiotic tx for C. diff: severe disease
WBC >15,000 cells/mL or serum creatinine >1.5mg/dL

Answer 8

vanc 125 mg PO 4x daily for 10 days

or

fidamoxicin 200mg orally twice daily for 10 days

Question 9

fulminant disease

Answer 9

severe, complicated C. diff infection (hypotension or shock, ileus, megacolon)

enteric vanc plus parental metronidazole:
vanc 500mg orally or via nasogastric tube 4x daily
AND
metronidazole 500mg IV q8h

Question 10

antimicrobial agents that may induce C. difficile diarrhea and colitis: frequently associated

Answer 10

-fluoroquinolones
-clindamycin
-cephalosporins (broad spectrum)
-penicillins (broad spectrum)

Question 11

antimicrobial agents that may induce C. difficile diarrhea and colitis: occasionally associated

Answer 11

-macrolides
-trimethoprim-sulfamethoxazole

Question 12

antimicrobial agents that may induce C. difficile diarrhea and colitis: rarely associated

Answer 12

aminoglycosides
tetracyclines
metronidazole
vanc

Question 13

tetracyclines: coverage

Answer 13

inc doxy

wide range of Gm+ (CA-MRSA) and Gm- coverage w/ high degree of resistance, anaerobic coverage, Atypical coverage

GI, photosensitivity, tooth discoloration (peds), dizziness
DIs: r/t binding (chelation) w/ multi-valent cations- admin 2 hrs before or after

Question 14

quinolones: coverage

Answer 14

Gm+, Gm-, and anaerobic

GI, rash, photosensitivity, QT prolongation (levo/gemi/ moxi-floxacin), arthropathy, tendon rupture (peds/elderly)

DIs: chelation w/ multi-valent cations, alter [theophylline, digoxin] + warfarin = increased bleeding

Question 15

macrolide: coverage

Answer 15

can be thought as an alternative to PCNs

Gm+: S. pneumoniae, S. pyogenes; staphyloccoi (S. aureus) NOT MRSA, Clostridium perfringens

Gm-: poor; some H. influenxae

misc: mycoplasma, liogenella, chlamydia

GI, cholestasis, QT prolongation

Question 16

sulfonamides

Answer 16

Gm+ streptococci, staphylococci inc MRSA, CA-MRSA
Gm- E. coli, Haemophilus, Klebsiella, Proteus, Shigella
Others: nocardia, chlamydia trachomatis, pneumocystis carinii

rash, fever, n/v/d, hemolytic disturbances, crystalluria, bone marrow suppression

caution in late pregnancy and newborns