Final Exam

Question 1

VAP

Answer 1

• Pick 2 diff classes IF RF for Pseudo Resistance: Zosyn, Cefepime, Imipenem, Meropenem OR Levoflox OR Tobra, Amikacin (cover Pseudo)
• AND Vanc or Linezolid (cover MRSA)
  7 days if clinically stable

Question 2

Outpt CAP - WITH comorbidities (chronic heart, lung, or renal disease, DM, alcoholism, malignancy, asplenia, immunocomped)

Answer 2

• MonoTx: Levo or Moxiflox
• ComboTx (DOC): Augmentin, Cefpodixime, or Cefuroxime AND Macrolide or Doxycycline
  Minimum 5 days and clinically stable

Question 3

Inpt CAP - Non-Severe

Answer 3

• MonoTx: Levo or Moxiflox
• ComboTx (DOC): Unasyn or Ceftriaxone AND Macrolide
  (Doxy can be swapped if FQ or MAC can’t be used)
  Minimum 5 days and clinically stable

Question 4

HAP - not at high risk for mortality (no vent support or septic shock)

Answer 4

• Zosyn, Cefepime, Imipenem, Meropenem, or Levofloxacin (cover MSSA + Pseudomonas)
• ADD Vanc or Linezolid if MRSA risk
  7 days if clinically stable

Question 5

Outpt CAP - Healthy Adult, NO comorbidities

Answer 5

• Amoxicillin (DOC)
• Doxycycline
• Azithromycin
  Minimum 5 days and clinically stable

Question 6

Inpt CAP - Severe

Answer 6

• Unasyn or Ceftriaxone AND Macrolide (DOC)
• Unasyn or Ceftriaxone AND Levo/Moxiflox
  Minimum 5 days and clinically stable

Question 7

CAP and HAP/VAP common pathogens

Answer 7

• CAP: Strep Pneumo, Staph A., Myco, Legion, H.Flu
• HAP/VAP: Pseudo, Staph A., Enterobacterales,

Question 8

Acute Bronchitis

Answer 8

Sx management (OTCs)
- NO antibiotics!! (viral infxn)

Question 9

Acute Pharyngitis

Answer 9

• Strep Pyogenes (group A), Respiratory virus
• Penicillin VK or Amoxicillin PO (DOC)
• IF PCN Ax: Cephalexin, Cefadroxil, Cefuroxime, or Cefpodoxime
• If PCN anaphylaxis: Azithro or Clindamycin
  10 days

Question 10

Acute Exacerbation of Chronic Bronchitis

Answer 10

• Augmentin (DOC), Cefuroxime, Cefpodoxime
• Alternatives: Doxy, Bactrim, azithromycin
• If Pseudo risk: Levofloxacin
  5-7 days

Question 11

Acute Bacterial Rhinosinusitis

Answer 11

• Augmentin (DOC)
• MRSA concern: ADD Doxy, Bactrim, Linezolid
• Pseudo Concern: ADD Levo 750mg QD

Question 12

UTI

Answer 12

• E. COLI
• Outpt: Nitro, Bactrim, FQ, Cephalex, Augmentin, Amox
• Inpt: Ceftriaxone (DOC) or Ampicillin + Gent
• Choose based on ANTIBIOGRAM!!

Question 13

Diabetic Foot Infxn

Answer 13

• Staph/Strep, Pseudo (WATER bug!!)
• Always cover MRSA if in INDY
• Mild: Dicloxacillin, Cephalex, Clinda
• Mod: Moxi, Aug, or Cipro/Levo+Clinda/Metro
  (Pseudo RF? Cipro/Levo + Clinda/Metro)
• Severe: Zosyn, Carbapenem, (Cefepime + Clinda/Metro)
• MRSA RF? ADD Doxy, Bactrim, Linez, Vanc, or Dapto

Question 14

Purulent SSTI

Answer 14

• Staph, Strep
• Mild: I&D
• Mod: Bactrim, Doxy (MRSA: Bactrim or Doxy // MSSA: Dicloxacillin or Cephalex)
• Severe: Vanc, Dapto, or Linezolid (if MSSA: Naf, Cefazolin, or Clinda)

Question 15

Non-Purulent SSTI

Answer 15

• Staph, Strep
• Mild: PO PCN VK, Cepha, Diclox, or Clinda
• Mod: IV PCN, Ceftriaxone, Cefazolin, or Clinda
• Severe: Vanc + Zosyn

Question 16

Nec Fas

Answer 16

• Vanc + Zosyn

Question 17

Peds Acute Otitis Media

Answer 17

• DOC: Amoxicillin 80-90mg/kg/day Q12H
• 2nd Line: Augmentin (same dose) (600mg/42.9 formulation)
• Don’t use Amoxicillin IF: Amox in last 30 days or CONCURRENT CONJUCTIVITIS

Question 18

Peds UTI

Answer 18

• E. COLI
• Cephalexin

Question 19

Osteomyelitis, Septic Arthritis, Prosthetic Joint Infxns - IV Tx

Answer 19

• STAPH AUREUS
• MSSA Coverage: Cefazolin *, Ceftriaxone *, Cefepime *, Zosyn, Unasyn, Meropenem, Ciproflox *, Levoflox * ( * =add Metronid if anaerobic coverage needed)
• PLUS MRSA Coverage: Vanc, Dapto, Linezolid