Duplicate Anaerobic Activity

A is admitted to the with a new intra-abdominal fluid collection after a recent partial colectomy. Which empiric treatment needs the ADDITION of metronidazole for anaerobic coverage?

A. Cefepime
B. Meropenem
C. Piperacillin/tazobactam

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Best Answer

Cefepime

Explanation: IDSA cIAI guideline states cefepime is the only option here where the addition of metronidazole is required to treat anaerobes 🦠

Both meropenem and piperacillin/tazobactam have excellent anaerobic activity.

Duplicate anaerobic activity 👯 is a common issue, with one study reporting pip/tazo + metronidazole being the most commonly observed.

The CDC Core Elements of Antimicrobial Stewardship recommend avoiding duel coverage ❌ and specifically ask pharmacists to help.

Don't double up on anaerobic activity!