Pneumonia/UTI
Preferred antibiotic treatment for asymptomatic bacteriuria in a non-pregnant female patient with a normal bladder
No antibiotics, Asymptomatic bacteriuria usually does not benefit from treatment and treating it can promote resistance and adverse drug effects; the main exceptions include pregnancy and certain urologic procedures.
Preferred antibiotic treatment for necrotizing pancreatitis and bowel necrosis
Zosyn, Piperacillin/tazobactam provides broad gram-negative and anaerobic coverage appropriate for severe intra-abdominal infection, including bowel necrosis.
The antibiotic that has fallen out of favor to treat MRSA SSTI infections due to a risk of Cdiff
Clindamycin is effective against many community-acquired MRSA strains, but its relatively high risk of C. difficile infection has made it less attractive when alternatives are available.
The most common etiology of COPD exacerbations
Respiratory viruses are the most common triggers of COPD exacerbations, with bacterial infections accounting for a smaller proportion.
A clinically stable patient has only 1 of 2 blood-culture sets positive for Staphylococcus epidermidis. The patient has no intravascular catheter, prosthetic device, or other hardware, and has no signs of systemic infection. What is the most appropriate management?
No antibiotic treatment, because this most likely represents blood-culture contamination?
The standard of care/antibiotics of choice for patients admitted with nonsevere CAP, with no risk factors for MRSA or Pseudomonas, per IDSA
Beta-lactam + macrolide or respiratory fluoroquinolone, For non-severe inpatient CAP without MRSA or Pseudomonas risk factors, guideline-based empiric therapy is a beta-lactam plus a macrolide or a respiratory fluoroquinolone alone.
The formulary antibiotic for the treatment of Cdiff and the dose, frequency and duration.
Oral vancomycin 125 mg four times daily for 10 days is a standard initial regimen for an initial non-fulminant C. difficile infection.
Organism that thrives in 'hot tubs'
Pseudomonas aeruginosa can colonize warm, poorly maintained water sources such as hot tubs and cause folliculitis after exposure.
This test can help to determine if antibiotics are appropriate during an acute exacerbation of COPD
Procalcitonin can provide supporting evidence about bacterial infection, although it should not be used alone to decide whether antibiotics are needed.
A patient has uncomplicated MSSA bacteremia with rapid clearance of blood cultures, no endocarditis, no prosthetic material, no metastatic infection, and adequate source control. How long should IV antibiotic therapy generally be continued?
At least 14 days of IV therapy from the first negative blood culture
Common medication used for empiric uncomplicated UTI treatment that we do not use for complicated UTI or pyelonephritis
Nitrofurantoin, Nitrofurantoin achieves high urine concentrations but inadequate renal tissue levels, so it should not be used for pyelonephritis or other infections requiring tissue penetration.
This IV antibiotic should be started in chirrotic patients with hematemesis
Ceftriaxone 1 gm IV daily for 7 days for primary prophylaxis, can de-escalate to Bactrim DS BID or Levaquin 250 mg daily
The antibiotic that is first line treatment for bite wounds, including dog, cat or human.
Amoxicillin/clavulanate 875/125mg PO q12h, Augmentin covers common oral flora, including streptococci, anaerobes, and Pasteurella, making it a preferred empiric choice for mammalian bite wounds.
This antibiotic has been studied for prophylaxis to delay COPD exacerbations, but the evidence is not clear for its use
Azithromycin has been studied as long-term prophylaxis in selected COPD patients, but potential benefits must be weighed against resistance, hearing effects, and QT prolongation.
A patient has MSSA bacteremia without evidence of endocarditis, implanted prosthetic material, or metastatic infection. Which IV antibiotic is preferred for definitive treatment?
Cefazolin or Oxacillin
Per IDSA, the minimum number of days for which CAP should be treated
5, A minimum 5-day course is generally recommended for CAP when the patient has achieved clinical stability, rather than automatically treating for longer.
Lily, a 5-year-old girl, presents with complaints of diarrhea, bloating, and fatigue after a camping trip near a lake. Her parents mention she had a history of drinking untreated water during the trip. Likely pathogen and treatment?
Pathogen: Giardia lamblia, a protozoan parasite that can be transmitted through contaminated water.
First-line Treatment: Oral metronidazole or tinidazole.Nitazoxanide may be an option if metronidazole is not tolerated or contraindicated.
Giardia is commonly acquired from untreated water and causes prolonged watery diarrhea, bloating, and malabsorption; metronidazole or tinidazole is effective therapy.
Procedure that is essential for clinical cure of purulent skin soft tissue infections
Incision/Drainage. Purulent collections require source control; incision and drainage removes the infected material and is often more important than antibiotics alone.
The most appropriate antibiotic for a patient with 3 or more hospitalizations per year, 1 prior hospitalization for an acute exacerbation of COPD and non-threatening respiratory failure (no patient allergies)
Augmentin, For frequent COPD exacerbations without Pseudomonas risk factors, amoxicillin/clavulanate is an appropriate antibiotic option when bacterial treatment is indicated.
A patient with ESBL-producing E. coli bacteremia is initially treated with IV meropenem. After 5 days, the patient is clinically improved, hemodynamically stable, and has adequate source control. Which oral step-down options are appropriate, and what is the typical total treatment duration for uncomplicated gram-negative bacteremia?
Levofloxacin or Bactrim, with approximately 7 days of total therapy
Patient presents with AMS, febrile to 39 C, and chills. He is a 79 yo M with an indwelling foley catheter with normal renal function. His previous urine culture susceptibilities grew ESBL E.coli R to ceftriaxone, cefepime, pip-tazo, levofloxacin, and nitrofurantoin. He is allergic to sulfa antibiotics (hives). Name the once-daily drug and dose you would recommend for this patient.
Ertapenem 1g q24h, Ertapenem is active against ESBL-producing Enterobacterales and can be given once daily, making it a convenient choice when there is no concern for Pseudomonas and the isolate is susceptible.
Patient with extreme bloating and low B12 and high folate, diagnosed with SIBO. What is the first line treatment?
Rifaximin 550 mg TID is commonly used for SIBO because it remains largely within the gut and has activity against a broad range of intestinal bacteria.
Common suspected organisms in non-purulent cellulitis
Beta hemloytic strep, including Strep A, B,C,G. Rare staph aureus (normally MSSA). Non-purulent cellulitis is most often caused by beta-hemolytic streptococci; Staphylococcus aureus is less common unless there is purulence or another specific risk factor.
This biologic is used as an add-on maintenance treatment for adults with uncontrolled COPD who have an eosinophilic phenotype and continue to experience exacerbations despite optimized inhaled therapy.
Dupilumab (Dupixent) targets IL-4 and IL-13 signaling and is used for COPD patients with an eosinophilic phenotype who remain uncontrolled despite appropriate inhaled treatment. It is not a rescue medication for acute exacerbations.
A patient is diagnosed with MRSA bacteremia. The patient has no evidence of endocarditis, metastatic infection, or an implanted prosthesis, and follow-up blood cultures obtained 48–72 hours later are negative. The patient’s fever resolves within 72 hours and the source of infection has been controlled.
What is the preferred antibiotic, dose, and minimum duration of therapy?
What is vancomycin 15 mg/kg IV every 12 hours for at least 14 days from the first negative blood culture?
Key teaching point:
For uncomplicated S. aureus bacteremia, treatment is for 14 days from negative blood cultures. Complicated bacteremia generally requires 28–42 days of IV therapy. Complicated: