NRNP6566 week 9 Knowledge check
QUESTION 1
1. What factors are considered when making empiric antibiotic decisions? Apply those
factors to a patient with suspected acute otitis media.
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. https://doi.org/10.4065/mcp.2010.0639
QUESTION 2
1. A 32 year old preschool teacher complains of difficulty swallowing, sore throat, and
chills. She is febrile with a temperature of 101.6 along with white patches on her
tonsils. Her rapid strep test is positive. Her past medical history is positive for an
anaphylactic reaction to cefaclor two years ago. What antibiotic could be safely
utilized in this patient?
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
, 1. A 20-year old woman was seen by her primary care provider last week and diagnosed
with a lower track UTI. Her complaints at that time included burning on urination,
frequent urination of a small amount, and superpubic pain. She was prescribed a 3
day course of Bactrim which she completed. She is admitted to the step down unit
today with complaints of fever (102.6 and above) for the past 24 hours and CVA
tenderness. She appears very ill and is somewhat confused today. Her BP is 100/62.
Her family indicates that she has been vomiting for the last 24 hours and been
unable to keep food or fluids down.
What would your initial plan for this patient include?
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.
QUESTION 4
1. A 19 year old female presents with complaints of crampy abdominal pain. The pain
has been present for about 7 days. She verifies unprotected sexual activity with
multiple partners over the past 6 months. The pain is worse with movement and
exercise. She has purulent vaginal discharge and a low grade temperature (99.6). PID
is suspected and cultures have been sent off.
What are the most common bacteria in this patient and how are they treated?
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). https://www.cdc.gov/std/tg2015/pid.htm
QUESTION 1
1. What factors are considered when making empiric antibiotic decisions? Apply those
factors to a patient with suspected acute otitis media.
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. https://doi.org/10.4065/mcp.2010.0639
QUESTION 2
1. A 32 year old preschool teacher complains of difficulty swallowing, sore throat, and
chills. She is febrile with a temperature of 101.6 along with white patches on her
tonsils. Her rapid strep test is positive. Her past medical history is positive for an
anaphylactic reaction to cefaclor two years ago. What antibiotic could be safely
utilized in this patient?
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
, 1. A 20-year old woman was seen by her primary care provider last week and diagnosed
with a lower track UTI. Her complaints at that time included burning on urination,
frequent urination of a small amount, and superpubic pain. She was prescribed a 3
day course of Bactrim which she completed. She is admitted to the step down unit
today with complaints of fever (102.6 and above) for the past 24 hours and CVA
tenderness. She appears very ill and is somewhat confused today. Her BP is 100/62.
Her family indicates that she has been vomiting for the last 24 hours and been
unable to keep food or fluids down.
What would your initial plan for this patient include?
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.
QUESTION 4
1. A 19 year old female presents with complaints of crampy abdominal pain. The pain
has been present for about 7 days. She verifies unprotected sexual activity with
multiple partners over the past 6 months. The pain is worse with movement and
exercise. She has purulent vaginal discharge and a low grade temperature (99.6). PID
is suspected and cultures have been sent off.
What are the most common bacteria in this patient and how are they treated?
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). https://www.cdc.gov/std/tg2015/pid.htm
