NRNP6566 week 9 Knowledge check

NRNP6566 week 9 Knowledge check The factors considered when prescribing antibiotics empirically include the site of infection and the organism most likely colonizing the site, prior knowledge of microorganism that is known to colonize the patient, and local bacterial resistance patterns or antibiograms of important pathogens that are available in most hospitals (Leekha et al., 2011). For a patient suspected with otitis media, the most common bacterial pathogens in the middle ear are Streptococcus pneumoniae and Haemophilus influenzae, with Moraxella catarrhalis as the third most common bacterial etiology. For adults with suspected uncomplicated otitis media, Amoxicillin is the preferred drug of choice, 875 mg PO BID or 500 mg PO TID for 5-7 days, as the said microorganisms are susceptible to it. For patients with recurrent otitis media or uncomplicated otitis media for immunicompromised patients, Amoxicillin-clavulanate 875/125 mg PO BID for 7-10 days or 10-14 days respectively. If the patient received an antibiotic in the past month, a second line of antibiotics can be used. These include cefdinir or cefuroxime which are cephalosphorins which are sensitive against gram negative bacteria. Reference Leekha, S., Terrell, C. L., & Edson, R. S. (2011). General Principles of Antimicrobial Therapy. Mayo Clinic Proceedings, 86(2), 156- 167. The patient with a positive rapid strep test should be treated with amoxicillin. However, Type 1 allergy to a cephalosphorin (Cefaclor) resulting to anaphylactic reaction means a penicillin should not be used. The patient can be given a macrolide like azithromycin or can be given clindamycin as an alternative. QUESTION 3 The patient is exhibiting symptoms of pyelonephritis and sepsis. The patient needs to be admitted to the hospital and receive IV fluids and antibiotics. The Surviving Sepsis Campaign recommends obtaining lactic acid level, obtaining blood culture (and culture from site of infection, in this case, urine culture), fluid resuscitation with a bolus of 30ml/kg started by one hour of identification of sepsis and completed by 3 hours, and empiric antibiotic therapy targeting the suspected organism and site of infection be administered within the first hour. Vasopressors can be given during or after fluid resuscitation to maintain a MAP of equal or greater than 65mmHg. Broad spectrum antibiotics should be given. Initial antibiotics can be ceftriaxone or ciprofloxacin PLUS gentamycin or ampicillin/sulbactam. The antibiotics that are given to patients with pelvic inflammatory disease should be effective against the most common bacteria which are N. gonorrhoeae and C. trachomatis. Empiric treatment in the hospital setting includes Cefotetan 2gm IV q12 PLUS doxycycline 100 mg PO q12; or Cefoxitin 2gm IV q6 PLUS doxycycline 100 mg PO q 12; OR Clindamycin 900 mg IV q8 PLUS gentamycin 3-5mgkg IV once daily. If patient is treated in an outpatient setting, Doxycycline 100 mg PO BID x 14 days PLUS ceftriaxone 250 mg IM for one dose or cefoxitin 2 gm with probenecid 1 gm PO x 1 dose or another IV third-generation cephalosphorin PLUS Doxycycine 100 mg PO BID x 14 days. Reference Centers for Disease Control and Prevention. (2019). Pelvic inflammatory disease (PID). The Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children that was released by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America in 2017 recommend either vancomycin (125 mg PO 4 times a day) or fidaxomicin (200 mg PO BID x 10 days) over metronidazole for an initial episode of C. diff. (McDonald et al., 2018). Reference McDonald, L. C., Gerding, D. N., Johnson, S., Bakken, J. S., Carroll, K. C., Coffin, S. E., Dubberke, E. R., Garey, K. W., Gould, C. V., Kelly, C., Loo, V., Sammons, J. S., Sandora, T. J., & Wilcox, M. H. (2018). Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical Infectious Diseases, 66(7), e1– e48. MedCram (2016) explained clearly the difference of the five generation of cephalosporins: 1. The first generation cephalosporins have excellent coverage against gram positive cocci (staphylocci and streptococci); hence can be used for skin and soft tissue infections. Examples are cefazolin and cephalexin. They have no anaerobic coverage. It has some coverage of gram-negative pathogens like Klebsiella, Proteus, and E. coli, 2. Second generation cephalosporins have anaerobic bacteria coverage. They are active against gram-positive cocci and certain gram negative bacilli. They are slightly less active against gram + cocci than the first generation cephalosporins bbut better gram- negative