Lippincott Chapter 38: Cell Wall Inhibitors Flashcards
38.1 A 45-year-old male presented to the hospital 3 days
ago with severe cellulitis and a large abscess on his
left leg. Incision and drainage were performed on the
abscess, and cultures revealed methicillin-resistant
Staphylococcus aureus. Which of the following would
be the most appropriate treatment option for once-
daily outpatient intravenous therapy?
A. Ertapenem.
B. Ceftaroline.
C. Daptomycin.
D. Piperacillin/tazobactam.
Correct answer = C. Daptomycin is approved for skin and
skin structure infections caused by MRSA and is given
once daily. A and D are incorrect because they do not cover
MRSA. Ceftaroline covers MRSA, but it must be given twice
daily.
38.2 Which of the following adverse effects is associated
with daptomycin?
A. Ototoxicity.
B. Red man syndrome.
C. QTc
prolongation.
D. Rhabdomyolysis.
Correct answer = D. Ototoxicity and red man syndrome are
associated with vancomycin. QTc prolongation is associ-
ated with telavancin. Myalgias and rhabdomyolysis have
been reported with daptomycin therapy and require patient
education and monitoring.
38.3 A 72-year-old male is admitted to the hospital from
a nursing home with severe pneumonia. He was
recently discharged from the hospital 1 week ago
after open heart surgery. The patient has no known
allergies. Which of the following regimens is most
appropriate for empiric coverage of methicillin-
resistant Staphylococcus aureus and Pseudomonas
aeruginosa in this patient?
A. Vancomycin + cefepime + ciprofloxacin.
B. Vancomycin + cefazolin + ciprofloxacin.
C. Telavancin + cefepime + ciprofloxacin.
D. Daptomycin + cefepime + ciprofloxacin.
Correct answer = A. Vancomycin provides adequate
coverage against MRSA, and cefepime and ciprofloxacin
provide adequate empiric coverage of Pseudomonas. B is
incorrect because cefazolin does not have activity against
Pseudomonas. C is incorrect because telavancin should be
avoided if possible with drugs that prolong the QTc interval,
in this case ciprofloxacin. Daptomycin is inactivated by pul-
monary surfactant and should not be used for pneumonia.
38.4 A 23-year-old male presents with acute appendicitis
that ruptures shortly after admission. He is taken to
the operating room for surgery, and postsurgical
cultures reveal Escherichia coli and Bacteroides
fragilis, susceptibilities pending. Which of the following
provides adequate empiric coverage of these two
pathogens?
A. Cefepime.
B. Piperacillin/tazobactam.
C. Aztreonam.
D. Ceftaroline.
Correct answer = B. While all of these agents cover most
strains of E. coli, piperacillin/tazobactam is the only drug on
this list that provides coverage against Bacteroides species.
38.5 A 68-year-old male presents from a nursing home with
fever, increased urinary frequency and urgency, and
mental status changes. He has a penicillin allergy of
anaphylaxis. Which of the following β-lactams is the
most appropriate choice for gram-negative coverage
of this patient’s urinary tract infection?
A. Cefepime.
B. Ertapenem.
C. Aztreonam.
D. Ceftaroline.
Correct answer = C. Based on the severity of the allergic
reaction, aztreonam is the choice of all the β-lactams.
Although cross-reactivity with cephalosporins and car-
bapenems is low, the risk rarely outweighs the benefit in
these cases.
38.6 A 25-year-old male presents to the urgent care center
with a painless sore on his genitals that started 1 to
2 weeks ago. He reports unprotected sex with a new
partner about a month ago. A blood test confirms
the patient has Treponema pallidum. Which of the
following is the drug of choice for the treatment of this
patient’s infection as a single dose?
A. Benzathine penicillin G.
B. Ceftriaxone.
C. Aztreonam.
D. Vancomycin.
Correct answer = A. A single treatment with penicillin is
curative for primary and secondary syphilis. No antibiotic
resistance has been reported, and it remains the drug of
choice unless the patient has a severe allergic reaction.
38.7 A 20-year-old female presents to the emergency room
with headache, stiff neck, and fever for 2 days and
is diagnosed with meningitis. Which of the following
agents is the best choice for the treatment of meningitis
in this patient?
A. Cefazolin.
B. Cefdinir.
C. Cefotaxime.
D. Cefuroxime axetil.
Correct answer = C. Cefotaxime is the only drug on this list
with adequate CSF penetration to treat meningitis. Cefdinir
and cefuroxime axetil are only available orally, and cefazo-
lin CSF penetration and spectrum of coverage against
S. pneumoniae are not likely adequate to treat meningitis.
38.9 In which of the following cases would it be appropriate
to use telavancin?
A. A 29-year-old pregnant female with ventilator-
associated pneumonia.
B. A 76-year-old male with hospital-acquired
pneumonia also receiving amiodarone for atrial
fibrillation.
C. A 36-year-old male with cellulitis and abscess
growing MRSA.
D. A 72-year-old female with a diabetic foot
infection growing MRSA who has moderate renal
dysfunction.
Correct answer = C. A is not a good option due to the
potential of telavancin harming the fetus. Option B is not
a good choice because the patient is on amiodarone, and
telavancin can cause QTc
prolongation. Option D is not an
appropriate choice because the patient has baseline renal
dysfunction and telavancin should be avoided unless ben-
efit outweighs the risk. Option C is the best choice in this
case since it is approved for skin and skin structure infec-
tions, and the patient has no appa
38.10 An 18-year-old female presents to the urgent care
clinic with urinary frequency, urgency, and fever for the
past 3 days. Based on symptoms and a urinalysis, she
is diagnosed with a urinary tract infection. Cultures
reveal Enterococcus faecalis that is pan sensitive.
Which of the following is an appropriate oral option to
treat the urinary tract infection in this patient?
A. Cephalexin.
B. Vancomycin.
C. Cefdinir.
D. Amoxicillin.
Correct answer = D. Option A and C are incorrect because
enterococci are inherently resistant to all cephalospo-
rins. Option B is incorrect because oral vancomycin is not
absorbed and would not reach the urinary tract in suffi-
cient quantities to treat a urinary tract infection. Option D is
the best choice, as amoxicillin is well absorbed orally and
concentrates in the urine.
