Principles of Antibiotic Selection

Question 1

“Often times our diagnosis of a bacterial infection is solely based on our clinical judgement and understanding of their history and physical” is called what

Answer 1

Empiric Therapy

Question 2

T/F Empiric Therapy is standard of care for many conditions

Answer 2

T

Question 3

Most common pathogens for Acute Otitis Media

Answer 3

Streptococcus pneumoniae (most common, 49%)
Haemophilus influenzae (29%)
Moraxella catarrhalis
Streptococcus pyogenes

Question 4

Antibiotic Treatment for AOM

Answer 4

Amoxicillin is DOC if no antibiotic in prior month
Alternatives:
Amoxicillin-Clavulanate (Augmentin)
Cefdinir (Omnicef) 3rd Generation
Ceftriaxone (Rocephin) IM QD x 3d- if prior ABX used
Azithromycin (Z-pak)- Only if beta-lactms cannot be used.

Question 4

Antibiotic Treatment for Streptococcal Pharyngitis

Answer 4

Penicillin VK is the DOC. (PCN G IM for compliance)
Alternatives:
Cephalexin for 10 days
In cases of PCN/Ceph allergies:
Clindamycin
Azithromycin (Z-pak) for 5 days

Question 5

Most common pathogens in Community Acquired Pneumonia

Answer 5

Streptococcus pneumoniae (nearly ⅔ of isolates in most adults)
Haemophilus influenzae
Mycoplasma pneumonia
- Healthy teens and young adults
- “Walking pneumonia”

Question 6

Bacterial Sinusitis common pathogens

Answer 6

Strep pneumoniae (1) and Haemophilus influenzae (2)
Others: Staph aureus, Strep pyogenes, Moraxella

Question 6

Antibiotic treatment for CAP Pneumona

Answer 6

For previously healthy person and no Abx in last 90 days
Amoxicillin 1 gm PO TID
OR
Doxycycline 100 mg PO BID for 5-7 days
Alternative: Azithromycin or Clarithromycin

Question 6

Urinary Tract Infection Most common pathogens

Answer 6

Escherichia coli (about 75-95% of isolates)
Others:
Klebsiella species
Staphylococcus saprophyticus
Proteus species-catheters

Question 6

Urinary Tract Infection (Uncomplicated Cystitis) Antibiotic Treatment

Answer 6

Nitrofurantoin
Alternatives include:
Fosfomycin
Fluoroquinolone (Ciprofloxacin or Levofloxacin) x 3 days
Amoxicillin-Clavulanate (Augmentin) 5-7 days
Cephalexin (Keflex)- 5-7 days

Question 7

Bacterial Sinusitis Antibiotic treatment

Answer 7

Pediatric Patient-
Amoxicillin
Augmentin ES
Alternative: Consider Cefdinir (3rd) for 10-14 days OR Clindamycin

Adult Patient-
Augmentin XR
Alternatives: Doxy, Levofloxacin