Clinical Cases Beta-Lactam Answers

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Clinical CasesBeta-Lactam Answers
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Case 1

• What antibiotic would you recommend for
  intravenous therapy in a 40yo BM with a
  Staphylococcus aureus (MSSA) bacteremia?
  Nafcillin or oxacillin
• What if the patient had a penicillin allergy
  (rash)? cefazolin
• What if the patient had a penicillin allergy
  (anaphylaxis)? vancomycin
• What if the bacteria instead was MRSA? NKDA
• vancomycin or linezolid (others possible)

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Case 2

• A 22yo WF presents with a cellulitis.
• What would you recommend for an oral antibiotic
  to cover MSSA and Streptococcal species? NKDA
• dicloxacillin or cephalexin or cefadroxil

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Case 3

• A 55yo WM develops an Enterococcus faecalis
  endocarditis. What IV antibiotics would you
  recommend? NKDA
• Penicillin G Potassium (or Sodium) (
  aminoglycoside) or Ampicillin ( aminoglycoside)

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Case 4

• CC is a 65yo WM develops an intrabdominal
  infection s/p surgery for colon cancer. You would
  like broad coverage (gram , gram -, anaerobes).
  What would you recommend? NKDA
• Carbapenem or beta-lactam/beta-lactamase
  inhibitor combo or cefoxitin or cefotetan

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Case 5

• A 70yo WF is admitted to the hospital for CHF.
  After being in the hospital for 5 days, you now
  suspect a superimposed hospital-acquired
  pneumonia. What would you recommend for gram
  negative coverage including Pseudomonas
  aeruginosa?
• Drugs of choice Cefepime or ceftazidime or
  piperacillin/tazobactam or ticarcillin/clavulanate
  
• Others could use Aztreonam or carbapenem
  (except ertapenem)

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Case 6

• A 2yo WM presents to the pediatrician with fever
  and bilateral ear pain for 5 days. Otitis media
  is diagnosed. You would like to treat for for
  possible resistant Streptococcus pnemoniae. What
  do you recommend? NKDA
• Amoxicillin 90mg/kg/day
• What if the patient had a penicillin allergy
  (rash)?
• Cephalopsorin (generally for Steptococcus
  pneumoniae, a 2nd or 3rd generation would be used
  over a 1st generation because of resistance) such
  as cefdinir, cefpodoxime, cefprozil, cefuroxime
  axetil)

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Case 7

• A 25yo BF is seen by the PA for a 5 day history
  of fever and sore throat. A rapid strept test is
  positive. What antibiotic would you recommend?
  NKDA
• Strept throat caused by Group A Streptococcus
• Drug of choice Penicillin VK
• Others amoxicillin or ampicillin
• Should this antibiotic be taken with or without
  food? (penicillins except amoxicillin can be
  bound by food proteins and inactivated by acid)
• Penicillin VK and ampicillin on empty stomach (1h
  before or 2 h after eating)
• Amoxicillinwith or without food

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Case 8

• A 70yo WM with a history of COPD is admitted to
  the hospital for a COPD exacerbation. Sputum
  cultures reveal beta-lactamase positive
  hemophilus influenzae. What would you recommend?
  NKDA
• Name the penicillin/beta-lactamase inhibitor
  combinations.
• Amoxicillin/clavulanic acid (Augmentin) PO
• Ampicillin/sulbactam (Unasyn) IV
• Ticarcillin/clavulanic acid (Timentin) IV
• Piperacillin/tazobactam (Zosyn) IV
• What other bacteria produce a beta-lactamase?
  Beta lactamase producing organisms
• Haemophilus influenza, Proteus, Klebsiella, E.
  Coli, Moraxella catarrhalis, N. gonnorrhea
• Staphylococcus aureus
• Bacteroides