MSK Infection treatment

Question 1

Gram + bacterial organisms?

Answer 1

MRSA
Staph
Strep

Question 2

Gram - bacterial organism?

Answer 2

Pseudomonas
E. coli
ESBL

Question 3

Anaerobes?

Answer 3

Streptococci (+)
Clostridia (+)
Bacteroides (-)

Question 4

Problematic resistant organisms?

Answer 4

MRSA (+)
VRE (+)
ESBL (-)

Question 5

Beta-Lactams: Penicillin

Answer 5

Amoxicillin
Oxacillin
Penicillin G

Question 6

Penicillin/Beta-Lactamase

Answer 6

Amoxicillin/clavulanate
Piperacillin/tazobactam

Question 7

First gen cephalosporin

Answer 7

Cephalexin*
cefazolin
cefadroxil

Question 8

Second gen cephalosporin

Answer 8

Cefaclor
Cefoxitin
Cefotetan

Question 9

Third gen cephalosporin

Answer 9

Ceftriaxone*
cefotaxime

Question 10

Fourth gen cephalosporin

Answer 10

Cefepime*

Question 11

Carbapenems

Answer 11

Ertapenem*
Meropenem

Question 12

Aminoglycosides

Answer 12

gentamicin
tobramycin
Amikacin

Question 13

Quinolones

Answer 13

Ciprofloxacin*
Levofloxacin
Moxifloxacin

Question 14

Macrolides

Answer 14

Erythromycin
Clarithromycin
Azithromycin*

Question 15

Glycopeptides

Answer 15

Vancomycin*

Question 16

Sulfonamides

Answer 16

Sulfamethoxazole/trimethoprim *

Question 17

Inhibition of cell wall synthesis

Answer 17

PCN, Cephalosporins, Imipenem, Meropenem, Aztreonam, Vancomycin

Question 18

Inhibition of bacterial protein synthesis

Answer 18

Aminoglycosides
Macrolides

Question 19

Mechanisms of resistance

Answer 19

Enzymatic inactivation of target site or antimicrobial
Alteration of target site
Decreased permeability

Question 20

Bacteriostatic

Answer 20

Clindamycin
Erythromycin
Sulfamethoxazole
Tetracycline
Trimethoprim

Question 21

Bactericidal

Answer 21

Cephalosporin
Fluoroquinolones
Metronidazole
Penicillin
Vancomycin

Question 22

Majority have what side effects

Answer 22

N/V/D
Rash
Thrush

Question 23

ASE Penicillin

Answer 23

Hypersensitivity
Skin reactions

Question 24

Cephalosporin ASE

Answer 24

C. diff

Question 25

Macrolides ASE

Answer 25

QT interval prolongation

Question 26

Quinolone ASE

Answer 26

QT prolongation

Question 27

Aminoglycosides ASE

Answer 27

Nephrotoxicity
Ototoxicity

Question 28

Vancomycin ASE

Answer 28

“Red man syndrome”

Question 29

Clindamycin ASE

Answer 29

C. Diff

Question 30

Sulfonamides ASE

Answer 30

SJS
Blood dyscrasias

Question 31

Drugs that do not need renal adjustment

Answer 31

Oxacillin
Ceftriaxone
Clindamycin
Azithromycin
Doxycycline
Rifampin

Question 32

What should be done prior to administering AB for SA

Answer 32

Synovial fluid
2 sets of blood cultures
Radiographs

Question 33

What is an important part of SA treatment

Answer 33

Joint drainage

Question 34

SA treatment is MSSA

Answer 34

Cefazolin 2g IV q8hrs
Oxacillin 2g IV q4hrs
If penicillin allergy, keep Vanco

Question 34

SA treatment for MRSA

Answer 34

Vancomycin
Alternatives: Daptomycin or Linezolid

Question 35

Gram + cocci SA

Answer 35

Empiric Vancomycin

Question 36

Gram - Bacilli SA

Answer 36

Cephalosporin:
Ceftriaxone
Cefotaxime
Cefepime

Question 37

Pseudomonas Aeruginosa (IVDU concern)

Answer 37

Initial therapy - 2 antipseudomonal drugs
Cephalosporin + Ciprofloxacin
Aztreonam is alternative to cephalosporin

Question 38

Staph aureus infection with bacteremia but no endocariditis

Answer 38

IV ABx for 4 weeks

Question 39

Staph aureus no bacteremia or endocarditis

Answer 39

IV 14 days the oral 7-14 days

Question 40

Septic arthritis + osteomyelitis

Answer 40

4-6 week course of antibiotics

Question 41

SA monitoring protocol

Answer 41

1. Culture/sensitivity of synovial fluid and blood at initiation of treatment
2. WBC weekly until within normal range
3. Daily monitoring - evaluate clinical signs
4. Reinforcement of compliance

Question 42

OM empiric therapy

Answer 42

Vancomycin + agent with activity against gram negative organisms

Question 43

OM MSSA

Answer 43

Oxacillin
Cefazolin

Question 44

OM MRSA

Answer 44

Vancomycin
Linezolid with allergy

Question 45

OM anaerobes

Answer 45

Clindamycin

Question 46

OM Enterobacteriaceae (E. coli - quinolone resistant)

Answer 46

E. coli - quinolone resistant
Piperacillin/tazobactam (Zosyn)

Question 47

OM Enterobacteriaceae (E. coli - quinolone sensitive)

Answer 47

Ciprofloxacin

Question 48

OM Pseudomonas

Answer 48

Cefepime + Ciprofloxacin
Piperacillin/Tazobactam

Question 49

OM Streptococcus

Answer 49

Penicillin G 2-4 million units IV every 4 hours

Question 50

Chronic OM

Answer 50

Ciprofloxacin
Linezolid
Sulfamethoxazole/Trimethoprim

Question 51

OM duration

Answer 51

generally 4-8 weeks
prosthetic joint replacement: 3-6 months or longer