L33- Antibiotic Clinical Uses

Question 1

discuss the general guidelines and treatment options for bacterial endocarditis

Answer 1

• IV antibiotics (prolonged course)
• valve debridement, repair, replacement

Note- usually give empiric therapy after cultures are taken (not before)

Question 2

Bacterial Endocarditis, empiric therapy:

• (1) choice therapy
• (2) possible adjunct, especially with (3) Pts
• (4) alternate therapy

Answer 2

1- vancomycin, gentamicin (aminoglycoside)

2- rifampin
3- prosthetic valve

4- linezolid, daptomycin

Question 3

α-hemolytic Streptococci Endocarditis:

• (1) choice treatment
• (2) alternatives

Answer 3

1- Penicillins (IV): penicillin G, ampicillin + Gentamicin (aminoglycoside, limit 5-7 days)

2:

• Vancomycin; penicillin allergy [+ Gentamicin]
• IV ceftriaxone (3rd gen. cephalosporin) + Gentamicin

Question 4

list the types of S. aureus Endocarditis and associated therapy

Answer 4

i) Oxacillin-sensitive strain: nafacillin or oxacillin +/- gentamicin
ii) Penicillin-allergic (nonanaphylactoid) Pt: cefazolin +/- gentamicin
iii) Oxacillin-resistant strain: vancomycin +/- gentamicin

Question 5

list the surgical conditions for which bacterial endocarditis prophylaxis is used

Answer 5

• **dental surgeries
• respiratory surgeries

-GI, GU, MSK surgeries involving area with established infections

Question 6

list the cardiac conditions for which bacterial endocarditis prophylaxis is used

Answer 6

• prosthetic cardiac valves
• previous infective endocarditis
• CHD
• cardiac transplant recipients with valvulopathy

Question 7

bacterial endocarditis prophylaxis:

• (1) choice therapy
• (2) alternatives

Answer 7

1) Oral: amoxicillin
2) penicillin allergy, Oral: (many options) clindamycin, cephalexin, azithromycin, clarithromycin

3) oral therapy not possible, IV/IM: ampicillin
4) no oral + penicillin allergy, IV: clindamycin, cefazolin

Question 8

bacterial pharyngitis, GAS Strep.:

• (1) choice therapy
• (2) alternatives

Answer 8

1- penicillin V (oral)

2:

• amoxicillin (oral)
• penicillin G benzathine (IV/IM)
• macrolide (penicillin-allergy)
• clindamycin
• 1st/2nd gen. cephalosporin

Question 9

bacterial sinusitis:

• (1) choice therapy
• (2) alternatives

Answer 9

1- amoxicillin (oral)

2:

• amoxicillin-clavulanic acid
• macrolide (penicillin allergy)
• co-trimoxazole
• 2nd/3rd gen. cephalosporin

Question 10

acute otitis media:

• (1) choice therapy
• (2) alternatives

Answer 10

1- amoxicillin (oral)

2:

• amoxicillin-clavulanic acid
• macrolide (penicillin allergy)
• co-trimoxazole
• 2nd/3rd gen. cephalosporin

Question 11

CA-pneumonia, out-patient empiric therapy: healthy + no antibiotics in last 3 mos

Answer 11

-macrolide (pregnancy and children)
OR
-doxycyclin (no pregnancy, children)

Question 12

CA-pneumonia, out-patient empiric therapy: indicate the therapy for complicated status (include criteria for complicated status)

Answer 12

-co-morbidities, immuno-suppressing conditions, immuno-suppression therapy, antimicrobials in last 3 mos

-respiratory fluoroquinolones
OR
-β-lactam (penicillin/cephalosporin) + macrolide

Question 13

CA-pneumonia, in-patient, no ICU empiric therapy

Answer 13

-respiratory fluoroquinolones
OR
-β-lactam (penicillin/cephalosporin) + macrolide

Question 14

CA-pneumonia, in-patient, in ICU empiric therapy

Answer 14

• β-lactam (penicillin/cephalosporin) + azithromycin / respiratory fluoroquinolones
• (penicillin allergy): respiratory fluoroquinolones + aztreonam (monobactam)

Question 15

aspiration pneumonia (anaerobes)

• (1) preferred agent
• (2) second line agent

Answer 15

1- clindamycin

2- metronidazole

Question 16

bordetella pertussis:

• (1) preferred agent
• (2) second line agent

Answer 16

(whooping cough)
1- macrolide
2- co-trimoxazole

Question 17

chlamydia pneumoniae:

• (1) preferred agent
• (2) second line agent

Answer 17

1- macrolide, doxycycline

2- 3rd/4th gen. fluoroquinolones

Question 18

H. influenzae, non-β-lactamase producing- otitis media, sinusitis:

• (1) preferred agent
• (2) second line agent

Answer 18

1- amoxicillin

2- 2nd/3rd gen. cephalosporin, co-trimoxazole

Question 19

H. influenzae, β-lactamase producing- otitis media, sinusitis:

• (1) preferred agent
• (2) second line agent

Answer 19

1- 2nd/3rd gen. cephalosporin OR amoxicillin-clavulanic acid

3- co-trimoxazole

Question 20

Klebsiella pneumoniae:

• (1) preferred agent
• (2) second line agent

Answer 20

1- ceftriaxone, cefotaxime

2- fluoroquinolones

Question 21

Legionella spp.:

• (1) preferred agent
• (2) second line agent

Answer 21

1- fluoroquinolone, azithromycin

2- doxycycline, co-trimoxazole

Question 22

Moraxella catarrhalis:

• (1) preferred agent
• (2) second line agent

Answer 22

(HEENT infections)
1- amoxicillin-clavulanic acid, 2nd/3rd gen. cephalosporins, co-trimoxazole

2- macrolides

Question 23

Mycoplasma pneumoniae:

• (1) preferred agent
• (2) second line agent

Answer 23

1- macrolide, doxycycline

2- 3rd/4th gen. fluoroquinolones

Question 24

Pseudomonas aeruginosa:

• (1) preferred agent
• (2) second line agent

Answer 24

1- anti-pseudomonal penicillin (ticarcillin, piperacillin)

2- levofloxacin, aztreonam (monobactam), aminoglycoside

Question 25

Staph. aureus (non-MRSA): - (1) preferred agent - (2) second line agent

Answer 25

1- anti-staphylococcal penicillin (nafcillin, oxacillin, dicloxacillin) 2- 2nd/3rd gen. cephalosporins, clindamycin, fluoroquinolones, imipenem

Question 26

MRSA: - (1) preferred agent - (2) second line agent

Answer 26

(methicillin resistant S. aureus) 1- vancomycin, linezolid 2- ceftaroline

Question 27

Strep. pneumoniae (non-penicillin resistant): - (1) preferred agent - (2) second line agent

Answer 27

1- penicillin G, amoxicillin 2- cephalosporin, clindamycin, fluoroquinolone, macrolide, co-trimoxazole

Question 28

Strep. pneumoniae, penicillin resistant: - (1) preferred agent - (2) second line agent

Answer 28

Note- depends on culture sensitivity testing 1- 2nd/3rd gen. cephalosporin, 3rd/4th gen. fluoroquinolones 2- vancoomycin, linezolid, streptogramins

Question 29

Tularemia: - (1) preferred agent - (2) second line agent

Answer 29

1- streptomycin | 2- gentamicin, chloramphenicol

Question 30

list the antibiotic that cause Clostridium difficile colitis: - (1) most common antibiotic - (2) frequently cause it - (3) occasionally cause it

Answer 30

1- Clindamycin 2- ampicillin/amoxicillin, cephalosporins, fluoroquinolones 3- penicillin, erythromycin, trimethoprim

Question 31

Clostridium difficile: - (1) preferred agent - (2) second line agent - (3) third line - (4) non-antibiotic treatment

Answer 31

1- vancomycin 2- fidaxomicin 3- metronidazole 4- fecal microbiota transplant

Question 32

Traveler's diarrhea (indicate organism): - (1) preferred agent - (2) second line agent

Answer 32

(ETEC) 1- ciprofloxacin 2- amoxicillin, azithromycin, doxycycline

Question 33

Bacterioides fragilis in suspected intra-abdominal infections: therapy options

Answer 33

Alone: metronidazole, carbapenems, clindamycin Combo: β-lactam + β-lactamase inhibitor

Question 34

Giardia therapy

Answer 34

metronidazole

Question 35

list the H.pylori therapies

Answer 35

1st: clarithromycin + amoxicillin + metronidazole + PPI 2nd (penicillin allergy): clarithromycin + metronidazole + PPI 3rd: clarithromycin + amoxicillin + PPI 4th: bismuth subsalicylate + metronidazole + tetracycline + PPI

Question 36

Uncomplicated UTI: - (1) preferred agent - (2) second line agent

Answer 36

(E. coli is majority cause) 1- co-trimoxazole 2- ciprofloxacin, nitrofurantoin, amoxicillin-clavulanic acid

Question 37

Uncomplicated UTI / Simple Cystitis in pregnancy therapy

Answer 37

- penicillins - cephalosporins - nitrofurantoin (not close to term- hemolytic anemia) - sulfonamides (not close to term- kernicterus)

Question 38

acute bacterial prostatitis therapy

Answer 38

- fluoroquinolones: ciprofloxacin, levofloxacin - co-trimoxazole - doxycycline

Question 39

Syphilis: - (1) preferred agent - (2) second line agent

Answer 39

1- penicillin G benzathine | 2- doxycycline, azithromycin

Question 40

Gonorrhea: - (1) preferred agent - (2) second line agent

Answer 40

1- ceftriaxone | 2- doxycycline, azithromycin

Question 41

Chlamydia (STI)

Answer 41

azithromycin, doxycycline

Question 42

Trichomoniasis: - (1) preferred agent - (2) second line agent

Answer 42

1- metronidazole | 2- tinidazole

Question 43

bacterial vaginosis: - (1) preferred agent - (2) second line agent

Answer 43

1- metronidazole | 2- clindamycin

Question 44

bacterial meningitis empirical therapy

Answer 44

vancomycin + ceftriaxone

Question 45

bacterial meningitis prophylaxis

Answer 45

rifampin ciprofloxacin ceftriaxone