Clinical Case Discussion of Antimicrobial Selection

Question 1

First step in AB selection?

Answer 1

• ID specific site - Localize the source, first step in defining spectra

Question 2

What determines the microbial spectrum?

Answer 2

The site of infection

Question 3

What should be considered when determining a microbial spectrum?

Answer 3

• Host comorbidity (HIV)
• Resistance

Question 4

Considerations when determining drug route?

Answer 4

• Severity
• Site
• Pharmacokinetics
• Host Immunity

Question 5

What should be considered when assessing drug benefit/toxicity?

Answer 5

• Host immunity
• Host PMHx
• Host comorbidity

Question 6

What are empirical AB selection principles driven by?

Answer 6

• Likelihood of resistance
• Severity of illness

Question 7

What drives definitive selection of AB?

Answer 7

• Culture results

Question 8

In a patient with adrenal insufficiency, why would a fever be observed?

Answer 8

Taking the patient off steroids results in fever

Question 9

What are the most likely bugs to cause infection of skin?

Answer 9

• Staphylococcus aureus
• Streptococcus

Question 10

When considering a possible staph infection, what important consideration should be made?

Answer 10

Is it methicillin resistant or not? (MRSA vs. MSSA)

Question 11

If staphylococcus aureus infection is ID’ed, what is the plan?

Answer 11

Use IV ABs because of the potential of endocarditis