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Antibiotic Cases

Antibiotic Cases. Nathan P. Samsa, Pharm.D., R.Ph. Case 1. A 59yo female presents to the ER with community acquired pneumonia. PMH: DM-2, HTN, CRF Labs: WBC: 14,500 CrCl: 4.6 BUN: 71. Case 1 Question. What empiric antibiotic(s) would you start this patient on? Cetriaxone Levofloxacin

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Antibiotic Cases

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  1. Antibiotic Cases Nathan P. Samsa,Pharm.D., R.Ph.

  2. Case 1 • A 59yo female presents to the ER with community acquired pneumonia. • PMH: DM-2, HTN, CRF • Labs: • WBC: 14,500 • CrCl: 4.6 • BUN: 71

  3. Case 1 Question • What empiric antibiotic(s) would you start this patient on? • Cetriaxone • Levofloxacin • Azithromycin • Cetfriaxone + Levofloxacin • Ceftriaxone + Azithromycin

  4. Case 1 Answer • Ceftriaxone + Azithromycin • Key concept here is the CRF. Fluoroquinolones (levofloxacin) are renally eliminated. • Ceftriaxone + Azithromycin are hepatically eliminated. • Both are standard of care, but it comes down to liver & kidney status.

  5. Case 1 Discussion • Shortcut for CrCl: • (140-Age)/SrCr (x0.85 for female) • <50mL/min, drugs need to be adjusted • Patient’s is 15 • Azithromycin covers all bugs for pneumonia (atypicals & typicals) except for Strep pneumo, so that is why ceftriaxone is added.

  6. Case 2 • A 13 day old neonate has suspected meningitis.

  7. Case 2 Question • What empiric antibiotic(s) would you start this patient on? • Cetriaxone • Cefotaxime • Cefotaxime + Ceftriaxone • Cefotaxime + Ampicillin • Ceftriaxone + Ampicillin

  8. Case 2 Answer • Cefotaxime + Ampicillin • Ampicillin is added for Listeria monocytogenes coverage • Cefotaxime covers the other bugs • Why cefotaxime over ceftriaxone? • Ceftriaxone can cause kernicterus in a neonate

  9. Case 3 • A woman has a diagnosed case of Pseudomebranous Colitis.

  10. Case 3 Question 1 • What antibiotic is the most common cause? • Clindamycin • Vancomycin • Erythromycin • Gentamicin • Penicillin

  11. Case 3 Answer 1 • Clindamycin

  12. Case 3 Question 2 • Which antibiotic would you treat the above patient first line (with Pseduemembranous Colitis)? • Vancomycin • Clindamycin • Metronidazole • Pipercillin/tazobactam • Fluconazole

  13. Case 3 Answer 2 • Metronidazole • Both vancomycin and metronidazole are treatments, but metronidazole is 1st line because: • It’s cheaper • You don’t want to start out with your biggest guns

  14. Case 4 • Which agent is safe to give to a neonate? • Sulfamexthoxazole/trimethoprim • Penicillin • Ciprofloxacin • Minocycline • Chloramphenicol

  15. Case 4 Answer • Penicillin • SMX/TMP can cause kernicterus • Ciprofloxacin can cause tendon rupture • Minocycline can cause tooth malformation • Chloramphenicol can cause Grey Baby Syndrome

  16. The End

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