Know Your Antibiotic: Nitrofurantoin A patient is prescribed nitrofurantoin for an uncomplicated UTI in the ED and sent home. Two days later, the urine culture results with P. mirabilis. Should the antibiotic be changed? How did others respond? Reveal the answer Best Answer Yes Explanation: Nitrofurantoin is a preferred option for the management of UTIs …
β-lactam/β-lactamase Inhibitors for MSSA A patient is on empiric piperacillin-tazobactam and found to have MSSA bacteremia. Is de-escalating piperacillin-tazobactam to cefazolin urgent ? How did others respond? Reveal the answer Best Answer Yes Explanation: Beta-lactam/beta-lactamase inhibitors (BLBLIs) such as piperacillin-tazobactam are active against MSSA, but microbiological and observational clinical data suggest worse outcomes compared to …
Amoxicillin-Clavulanate for ESBL UTIs A patient is prescribed cephalexin for a UTI by her primary care doctor. Two days later an ESBL P. mirabilis grows in culture. The only susceptible oral antibiotic is amoxicillin-clavulanate. Should she be admitted for IV antibiotics? How did others respond? Reveal the answer Best Answer Maybe Explanation: The IDSA suggests …
Hemodialysis-only Antibiotic Dosing A patient with a history of chronic HD has been receiving treatment for complicated MSSA bacteremia and is clinically stable for discharge. Ok to complete treatment with thrice weekly cefazolin at the outpatient HD center? How did others respond? Reveal the answer Best Answer Yes Explanation: Cefazolin is primarily renally cleared, therefore …
Know Your Antibiotics: Silent Sodium An inpatient is diagnosed with heart failure exacerbation and pneumonia . They are on IV diuretics and IV antibiotics. What is a good way to lower sodium load to improve heart failure management? How did others respond? Reveal the answer Best Answer Switch to PO antibiotics Explanation: Sodium load in …
Pick Your Poison: Legionella Pneumonia A Legionella urine antigen returns positive in a patient on empiric ceftriaxone (CRO) and azithromycin for community-acquired pneumonia. How should antibiotics be adjusted? How did others respond? Reveal the answer Best Answer Stop ceftriaxone, continue azithromycin Explanation: Legionella is a common causative pathogen of community-acquired pneumonia (CAP) and is covered …
How Long for Legionella? A patient has finished 3 days of azithromycin 500 mg daily and has a positive Legionella urinary antigen. They are clinically stable. Should azithromycin be continued? How did others respond? Reveal the answer Best Answer No Explanation: Legionella is a common causative pathogen of community-acquired pneumonia (CAP) that is covered by …
Cefdinir PO for Bacteremic UTI A patient is being discharged on cefdinir 300 mg PO BID for E. coli bacteremia secondary to a cUTI. Is this an appropriate discharge plan? How did others respond? Reveal the answer Best Answer No Explanation: Cefdinir is unable to reach appropriate serum target attainment for typical MICs of …
Know your Antifungal: Echinocandins A patient has candida endophthalmitis . Which echinocandin should be used? How did others respond? Reveal the answer Best Answer Neither Explanation: Echinocandin antifungals should not be used in CNS, eye, or urine infections. They are similar in characteristics such as spectrum of activity, tolerability, and distribution. None of the echinocandins …
Cefuroxime PO for Bacteremic UTI The available pharmacokinetic-pharmacodynamic data supports cefuroxime as a PO step-down option in patients with complicated urinary tract infections with secondary bacteremia. True or False? How did others respond? Reveal the answer Best Answer False Explanation: At a dose of 500 mg BID, good pharmacokinetic-pharmacodynamic target attainment may be only achieved …