Mini Case Chaos
A 34-year-old otherwise healthy woman presents to clinic with 24 hours of fever, myalgias, and a positive influenza A test. She requests medication to shorten her illness. Her renal function is normal, and she has no contraindications.
Which antiviral is recommended? Include dosing and duration.
What is oseltamivir 75 mg twice daily for 5 days?
This antibiotic combination in Zerbaxa targets both Pseudomonas aeruginosa and Enterobacteriaceae, making it effective against a variety of gram-negative pathogens.
What is Ceftolozane-tazobactam?
This bacterium, often a causative pathogen of hospital-acquired pneumonia (HAP), is notorious for its resistance to beta-lactams and is often treated with carbapenems or cephalosporins combined with beta-lactamase inhibitors.
What is Pseudomonas aeruginosa?
This is the oral first-line antiviral for influenza A and B and works best when started within 48 hours of symptom onset. (looking for the drug name and class)
What is the neuraminidase inhibitor oseltamivir (Tamiflu)?
This antibiotic class is notorious for causing photosensitivity, making patient counseling on sun protection essential.
What is tetracyclines?
A 68-year-old man is admitted with community-acquired pneumonia. CXR shows lobar consolidation. He has COPD and heart failure, but no MRSA or Pseudomonas risk factors.
Which inpatient antibiotic regimen is most appropriate?
What is ceftriaxone and azithromycin?
This beta-lactamase inhibitor in Avycaz enhances the activity of ceftazidime by inhibiting class A, C, and some class D beta-lactamases.
What is Avibactam?
In inpatient CAP, this atypical pathogen is treated by macrolides or fluoroquinolones and is known for causing relative bradycardia and hyponatremia
What is Legionella pneumophila?
This single-dose antiviral is a cap-dependent endonuclease inhibitor, making it a popular option for patients unlikely to adhere to multi-day regimens.
What is baloxavir marboxil (Xofluza)?
This aminoglycoside toxicity manifests as hearing loss, tinnitus, or balance problems due to damage to the vestibulocochlear nerve.
What is ototoxicity?
A 56-year-old man with obesity and diabetes is hospitalized with COVID-19 pneumonia. He requires 4 L/min nasal cannula oxygen but is not on high-flow or mechanical ventilation. Labs show elevated CRP.
Which medication has proven mortality benefit in this scenario?
What is dexamethasone?
While Zerbaxa is active against Pseudomonas, it is not effective against this drug-resistant gram-negative pathogen.
In COVID-19, the use of this antiviral agent, an RNA polymerase inhibitor, has been controversial due to mixed clinical trial results. It works by inhibiting the viral RNA-dependent RNA polymerase, but its benefit has been shown to be most significant in patients with severe disease and high viral loads.
What is remdesivir?
This inhaled antiviral must be used cautiously in patients with asthma or COPD due to the risk of bronchospasm.
What is zanamivir (Relenza)?
This lincosamide is strongly associated with Clostridioides difficile infection, making it one of the highest-risk antibiotics for CDI.
What is clindamycin?
A 75-year-old female with hypertension and chronic kidney disease presents with fever, chills, and difficulty breathing. Chest X-ray shows patchy infiltrates in both lower lobes. Blood cultures reveal Klebsiella pneumoniae, and her renal function is slightly impaired. What is the preferred empiric antibiotic regimen for Klebsiella pneumonia in this patient?
What is Ceftriaxone?
This antibiotic was recently approved in an IV formulation for adults with complicated urinary tract infections (cUTIs) caused by Escherichia coli and Klebsiella pneumoniae.
What is Contepo (IV fosfomycin)?
This pathogen, a common cause of both acute bacterial sinusitis and acute otitis media, is often treated with amoxicillin or amoxicillin-clavulanate, especially in cases with risk for beta-lactam resistance.
What is Streptococcus pneumoniae?
This intravenous neuraminidase inhibitor is often reserved for hospitalized or critically ill patients, especially when oral absorption is unreliable. Hint: we do NOT carry this at Essentia Health.
What is peramivir?
This beta-lactam can cause seizures, especially in patients with renal impairment or when dosed incorrectly at high levels.
What is imipenem-cilastatin?
A 72-year-old ICU patient develops pneumonia after being intubated for 5 days following ARDS. Comorbidities include COPD, hypertension, and ESRD on renal replacement therapy. What risk factors are present for multidrug-resistant (MDR) pathogens? What empiric treatment would you select?
1. What is acute renal replacement therapy prior to VAP onset, ≥5 days of hospitalization prior to the occurrence of VAP, Acute respiratory distress syndrome (ARDS) preceding VAP.
2. What is cefepime/piperacillin-tazobactam/meropenem + vancomycin?
This novel oral antibiotic was recently approved for treating uncomplicated urinary tract infections (uUTIs). Although the first oral option in its class, there are concerns of overuse leading to increased resistance.
What is Orlynvah (sulopenem etzadroxil/probenecid)?
This drug, used in both the treatment of active TB and as part of latent TB infection (LTBI) therapy, works by inhibiting bacterial DNA synthesis. It is particularly important in cases where drug-resistant Mycobacterium tuberculosis is suspected.
What is fluoroquinolone (e.g., levofloxacin or moxifloxacin)?
This antiviral is no longer recommended for routine influenza treatment due to widespread resistance, but it was once a mainstay for influenza A and also used in Parkinson’s disease.
What is amantadine? (Alternative: What is rimantadine?)
This antibiotic carries a severe adverse reaction for potentially fatal blood dyscrasias, including aplastic anemia, and is reserved for specific severe infections like VRE.
What is linezolid?