To be or not to be
CAP: Calculate CURB-65 score for the following patient and where to treat them-
Pt is a 62 year old female, she denies confusion.
Vitals / Labs - BUN: 24, RR: 16, BP: 110/50
CURB-65: 2, treat inpatient
CAP: What would lead us to choose doxycycline over a macrolide for treatment?
QTc Prolongation
UTI: a patient had anaphylaxis when treated with penicillin. What beta-lactam antibiotic can they use if any?
Aztreonam
UTI: This carbapenem does not have coverage against pseudomonas
Ertepenem
UTI: What is a risk factor for having a complicated UTI?
Indwelling catheter, UTIs in men, pregnancy, Type II DM, poor hygiene
UTI: Bactrim to treat bacterial prostatitis is used for what duration?
4 - 6 weeks
CAP:
What is the shortest duration of treatment for community-acquired pneumonia?
5 days
UTI:Nocturia and dysuria are typical symptoms of
Simple cystitis
CAP:
Your fellow pharmacist asks you what antibiotic can they use for MRSA coverage. You reply:
Vancomycin, daptomycin, linezolid, doxycycline, telavancin
UTI:
What is the generic name of Zyvox?
Linezolid
CAP: On the spot
A doctor calls you and tells you about his patient that is on Zinacef for CAP, he wants to discharge the patient but does not remember if there is an oral equivalent. What do you tell him?
The oral version of cefuroxime is Ceftin
A patient with uncontrolled type 2 diabetes should try to avoid what class of antibiotics?
Fluoroquinolones
Nitrofurantoin is contraindicated in a CrCl of:
< 60 ml/min
CAP: What do you do
You are rounding with the medical staff when you come across a patient who is receiving azithromycin alongside ceftriaxone for their CAP. The cultures have come back with Pseudomonas as the cause. The attending asks if the patient is currently receiving adequate coverage for that bug and if not what would you recommend
UTI: Bactrim and nitrofurantoin are NOT safe in which trimesters of pregnancy
1st and 3rd
CAP: Decide where the patient can be treated
72 year old male presents to the hospital stating he has pneumonia. He mentions in passing that he just recently got over the flu.
He denies confusion, low blood pressure, or rapid respiratory rate
Past medical history: HTN, BPH, DM
CURB-65 score: 1
He can be treated outpatient, but he does have risk factors for MRSA and DSRP
UTI: Diarrhea from augmentin is dependent on
Clavulanate dosing
UTI:
Create a regimen for simple cystitis using nitrofurantoin?
100mg PO BID x 5 days
UTI:
39 year old female was admitted into the hospital with a uncomplicated UTI. Her culture results came back with E. Coli and susceptibility was pending, she was started on nitrofurantoin. Microbiology just sent in the susceptibility and the E. Coli was found to be resistant to nitrofurantoin and amoxicillin. What would you switch the patient to?
Bactrim , ciprofloxacin, levofloxacin
CAP:
The doctor decides to start a diabetic patient on methylprednisolone for adjunctive treatment of their community-acquired pneumonia. What would you caution the doctor on?
Fluctuation of glucose levels. Typically glucocorticoids and insulin levels will be titrated up and down together.
UTI: Name some risk factors for multi-drug resistant gram-negative infection
83 year old female presents to the hospital from a long-term care facility with burning upon urination and flank pain. She was recently treated for CAP last month with levofloxacin.
Inpatient stay at healthcare facility and use of fluoroquinolone use in the past 3 months
CAP:
What antibiotics used for the treatment of CAP DO NOT require renal dose adjusting?
Doxycycline, azithromycin, moxifloxacin, cefpodoxime, ceftriaxone
UTI: Decide if you would treat the following patient:
34 year old female has a urinalysis done in the hospital that is + for bacteria. She denies pain or burning with urination, and no flank pain. She is in her 2nd trimester of pregnancy.
Yes you would treat.
CAP:
What drug class would you recommend for coverage against atypical bacteria in a patient with known QTc prolongation?
Doxycycline
CAP: How would you treat the patient -
Patient has been admitted to the inpatient ward for CAP. You see in their medical chart that they have a penicillin allergy, upon questioning they tell you that their reaction was severe diarrhea. Does this change your recommendation of a beta-lactam and if so, how?No, they are able to use cephalosporins due to low cross-reactivity.