SGU Antimicrobials
Complicated skin infection (polymicrobial including E.coli & P.aeruginosa) 1. Imipenem/cilastatin 2. PenicillinV 3. Cefazolin 4. Aztreonam 5. Erythromycin
** 1. Imipenem/cilastatin (broad spectrum& IV) 2. PenicillinV (oral only&mainly Gram+ve) 3. Cefazolin (mainly Gram+ve) 4. Aztreonam (only Gram-ve) 5. Erythromycin (mainly Gram+ve)
Osteomyelitis (Staph.aureus.) - Cultures show negative MRSA 1. Nafcillin 2. Aztreonam 3. Linezolid 4. Vancomycin 5. PenicillinV
** 1. Nafcillin (anti‐staphpenicillin) 2. Aztreonam (onlyGram-ve) 3. Linezolid (reserved for treatment of MDR infections) 4. Vancomycin (reserved for MDR infections, esp. MRSA) 5. Penicillin V (not resistant to‐lactamases)
Acute Sinusitis (pneumococci, H.influenzae, M.catarrhalis) 1. Amoxicillin 2. Vancomycin 3. Cefepime 4. Levofloxacin 5. Doxycycline
**1. Amoxicillin (DOC for mild‐moderate infections eg, sinusitis, otitis media) 2. Vancomycin (reserved for MDR infections) 3. Cefepime (IV only) 4. Levofloxacin (cannot use in children- amoxicillin is a better first choice) 5. Doxycycline (widespread resistance,cannot use in children)
UTI in pregnancy (39 weeks) 1. Amoxicillin 2. Ciprofloxacin 3. Nitrofurantoin 4. Trimethoprim 5. Doxycycline
**1. Amoxicillin (safe in pregnancy) 2. Ciprofloxacin (not used during pregnancy) 3. Nitrofurantoin (not used after 38 weeks) 4. Trimethoprim (not used during pregnancy) 5. Doxycycline (not used during pregnancy)
Surgical Prophylaxis (general) 1. Cefazolin 2. Cefaclor 3. Cefepime 4. Cefalexin 5. Cefixime
**1. Cefazolin (DOC) 2. Cefaclor 3. Cefepime 4. Cefalexin 5. Cefixime
Gonorrhea + Chlamydia 1. Ceftriaxone+doxycycline 2. Ceftriaxone+penicillin G 3. Penicillin G+doxycycline 4. Vancomycin 5. Cefepime+azithromycin
**1. Ceftriaxone (DOC for Gonorrhea)+ doxycycline (DOC for Chlamydia) 2. Ceftriaxone+penicillinG 3. PenicillinG+doxycycline 4. Vancomycin 5. Cefepime+azithromycin
Complicated UTI (antibiotic resistant Gram -ve bacilli, S.aureus or enterococci) 1. Ciprofloxacin 2. Penicillin V 3. Trimethoprim 4. Metronidazole 5. Penicillin G
**1. Ciprofloxacin 2. Penicillin V (narrow spectrum) 3. Trimethoprim (assume resistance) 4. Metronidazole (anaerobic bacteriaonly) 5. Penicillin G (mainly Gram+ve & IVonly)
Mild‐moderate diverticulitis (enteric Gram‐ve bacteria + enterococci & anaerobes) 1. Piperacillin/tazobactam 2. Vancomycin 3. Aztreonam 4. PenicillinG 5. Tigecycline
**1. Piperacillin/tazobactam (effective against many Gram -ve bacteria) 2. Vancomycin (only Gram+ve) 3. Aztreonam (only aerobic Gram-ve) 4. Penicillin G (mainly Gram +ve) 5. Tigecycline (reserved for life‐threatening MDR infections)
Community‐acquired pneumonia (Strep.pneumoniae - penicillin resistant) 1. Amoxicillin 2. Vancomycin 3. Cefazolin 4. Moxifloxacin 5. Penicillin G
1. Amoxicillin (not for penicillin‐resistant infection) 2. Vancomycin (reserved for MDR infections) 3. Cefazolin (mainly used for surgical prophylaxis) **4. Moxifloxacin (respiratory fluoroquinolone) 5. Penicillin G (not for penicillin‐resistant infection)
Acute Bronchitis in a patient with severe COPD (P.aeruginosa) 1. Amoxicillin/Clavulanic acid 2. Penicillin + Ciprofloxacin 3. Vancomycin + Ciprofloxacin 4. Piperacillin + Vancomycin 5. Piperacillin + Ciprofloxacin
1. Amoxicillin/clavulanic acid (not antipseudomonal) 2. Penicillin+ciprofloxacin (not antipseudomonal) 3. Vancomycin+ciprofloxacin (reserved for MDR infection) 4. Piperacillin+vancomycin(reserved for MDR infection) **5. Piperacillin+ciprofloxacin (DOC's)
Uncomplicated UTI (E.Coli, S.Saprophyticus) 1. Aztreonam 2. Cotrimoxazole 3. Daptomycin 4. Erythromycin 5. Penicillin G
1. Aztreonam (Gram-ve only) **2. Cotrimoxazole (DOC) 3. Daptomycin (MDR infections) 4. Erythromycin (onlyGram+ve) 5. Penicillin G (mainly Gram+ve & IV only)
Acute Otitis Media (Strep. pneumonia) 1. Aztreonam 2. Linezolid 3. Amoxicillin 4. Piperacillin 5. Meropenam
1. Aztreonam (only Gram-ve) 2. Linezolid (reserved for MDR infections) **3. Amoxicillin (DOC) 4. Piperacillin (antipseudomonal penicillin) 5. Meropenem (used for infections resistant to other drugs)
Uncomplicated skin infection (most likely caused by Staph or Strep) 1. Aztreonam 2. Vancomycin 3. Dicloxacillin 4. Metronidazole 5. Piperacillin
1. Aztreonam (only Gram-ve) 2. Vancomycin (only for MDR infections) ** 3. Dicloxacillin (anti‐staph penicillin) 4. Metronidazole (only anaerobic bacteria) 5. Piperacillin (antipseudomonal penicillin, mainly used for Gram-ve infections)
Severe Febrile Neutropenia 1. Cefipime 2. PenicillinG 3. Amoxicillin/ClavulanicAcid 4. Vancomycin 5. Metronidazole
1. Cefipime (broad spectrum IV drug) 2. PenicillinG(mainlyGram+ve) 3. Amoxicillin/Clavulanic Acid (oral only) 4. Vancomycin (only Gram+ve, only used if it is known to be MRSA) 5. Metronidazole (only anaerobes)
Suppurative skin infection (likely MRSA 1. Ciprofloxacin 2. Penicillin G 3. Vancomycin 4. Ceftriaxone 5. Gentamicin
1. Ciprofloxacin 2. Penicillin G MRSA) ** 3. Vancomycin (only option available that MRSA is susceptible to) 4. Ceftriaxone 5. Gentamicin
Acute Pharyngitis (Group A Strep) 1. Ciprofloxacin 2. Metronidazole 3. Penicillin V 4. Aztreonam 5. Linezolid
1. Ciprofloxacin (cannot use in children - only some Gram +ve activity) 2. Metronidazole (only anaerobic bacteria) **3. Penicillin V (DOC) 4. Aztreonam(Gram-veonly) 5. Linezolid (reserved for multi drug resistant bacteria)
UTI in pregnancy (22 weeks) 1. Cotrimoxazole 2. Ciprofloxacin 3. Nitrofurantoin 4. Trimethoprim 5. Vancomycin
1. Cotrimoxazole (not used during pregnancy) 2. Ciprofloxacin(not used during pregnancy) **3. Nitrofurantoin (can used up to 38 weeks) 4. Trimethoprim (not used during pregnancy) 5. Vancomycin (only Gram+ve bacteria)
Severe Acne 1. Penicillin G 2. Doxycycline 3. Daptomycin 4. Cefazolin 5. Linezolid
1. Penicillin G (IV only & mainly Gram+ve) **2. Doxycycline (DOC) 3. Daptomycin (reserved for MDR infections) 4. Cefazolin (mainly Gram +ve) 5. Linezolid (reserved for MDR infections)
Prostatitis (enteric Gram -ve bacteria) 1. Penicillin V 2. Vancomycin 3. Cefazolin 4. Levofloxacin 5. Amoxicillin
1. Penicillin V (mainly Gram+ve & does not reach sufficient levels in prostate) 2. Vancomycin (Gram+ve only) 3. Cefazolin (mainly Gram +ve) **4. Levofloxacin (DOC) 5. Amoxicillin (does not reach sufficient levels in prostate)
Life-threatening Sepsis 1. Penicillin V 2. Vancomycin 3. Cefepime 4. Cefepime + vancomycin 5. Penicillin G + vancomycin
1. Penicillin V (oral only) 2. Vancomycin (only Gram+ve) 3. Cefepime (noteffectiveagainstMRSA) **4. Cefepime+vancomycin (empiric therapy for life‐threatening infections - IV, broad spectrum & effective against MDR bacteria) 5. Penicillin G + vancomycin (onlyGram+ve)
Community acquired (H.influenzae) 1. Vancomycin 2. Penicillin V 3. Ceftriaxone 4. Cefazolin 5. Daptomycin
1. Vancomycin (only Gram +ve; H.influenzae is Gram -ve) 2. Penicillin V (mainly Gram+ve) **3. Ceftriaxone 4. Cefazolin (mainly Gram +ve) 5. Daptomycin (reserved for MDR infections)
A 1-year-old child presents to her family doctor with symptoms including fever nasal discharge cough lack of symptoms including fever, nasal discharge, cough, lack of appetite and pain in her right ear. The patient is diagnosed with otitis media. Which of the following is the most media. Which of the following is the most appropriate choice of drug to treat this patient? A. Amoxicillin B. Vancomycin C. Nafcillin D. Doxycycline E. Ceftaroline
A. Amoxicillin
A 24 year-old pregnant woman has returned from her vacation suffering from traveler from traveler's diarrhea and her problem has not responded diarrhea, and her problem has not responded to antidiarrheal drugs. A pathogenic Gram-negative bacillus is suspected. Which is the most appropriate drug for the suspected. Which is the most appropriate drug for the treatment of this patient? A. Azithromycin B. Ciprofloxacin C. Doxycline D. Co-trimoxazole E. Metronidazole
A. Azithromycin
A 34-year-old woman presents to her family doctor with symptoms of an uncomplicated UTI. This is a first time occurrence. Which of the following is the drug of choice? A. Co-trimoxazole B. Doxycycline C. Vancomycin D. Methicillin E. Amoxicillin
A. Co-trimoxazole
A child is brought to her physician after complaining of a sore throat and fever for 1 day. On examination the physician observes the tonsils to be enlarged and a white exudate. A rapid streptococcal antigen test is performed in conjunction with a throat culture; results come back positive. The drug of choice for this condition is prescribed. Which of the following is the mechanism of action of the drug most likely prescribed. A. Inhibition of peptidoglycan synthesis B. Inhibition of RNA synthesis C. Inhibition of dihydrofolate reductase D. Inhibition of peptidoglycan polymerization E. Formation of cytotoxic products
A. Inhibition of peptidoglycan synthesis
A 19 year old college student presents to student health services with a dry cough, fever, and SOB. A chest X-ray shows multi focal interstitial opacities throughout the lung parenchyma whilst blood studies show a positive cold agglutination test. You make a diagnosis of Mycoplasma pneumonia. What is the most appropriate treatment? A. Acyclovir B. Azithromycin C. Penicillin G D. Ceftriaxone E. Metronidazole
B. Azithromycin
A 42 year old male who smokes is diagnosed with pneumonia. He claims that multiple people who work at his office have also had chest infections and someone mentioned it may have been due to the air conditioning. A sputum culture on blood agar medium did not yield any growth, but buffered charcoal yeast extract grew out a gram negative bacteria. An infection with legionella pneumophilia is suspected. What is the most appropriate treatment? A. Penicillin G B. Azithromycin C. Ceftaroline D. Mupirocin E. Metronidazole
B. Azithromycin
A 7-year-old boy presents to the ER with severe flu-like symptoms including fever chills and dry cough. Due to a recent outbreak at the child's school, Legionnaires' disease (Gram-ve) is suspected. Which of the following is the most appropriate treatment? A. Ciprofloxacin B. Azithromycin C. Penicillin G D. Doxycycline E. Vancomycin
B. Azithromycin
Which of the following options would be acceptable in treating an upper respiratory infection due to Streptococcus pneumoniae in a pregnant woman with a known history of penicillin allergy? A. Ampicillin B. Azithromycin C. Ciprofloxacin D. Metronidazole E. Tetracycline
B. Azithromycin
A 33-year-old woman presents to her family doctor complaining of a poorly healing painless ulcer on her labia complaining of a poorly healing painless ulcer on her labia. She first noticed the lesion a week or so ago, not long after having a sexual encounter with a man at a party. The lesion is identified as a chancre of primary syphilis. What is the most appropriate treatment for this patient? A. Amoxicillin B. Benzathine Penicillin G C. Ciprofloxacin D. Doxycycline E. Procaine Penicillin G
B. Benzathine Penicillin G
A 1-year-old child presents to her family doctor with symptoms including fever nasal discharge cough lack of symptoms including fever, nasal discharge, cough, lack of appetite and pain in her right ear. The patient is diagnosed with otitis media. Medical history indicates the patient has a mild penicillin allergy. Which of the following is the most appropriate choice of drug to treat this patient? A. Amoxicillin B. Ceftriaxone C. Vancomycin D. Doxycycline E. Dicloxacillin
B. Ceftriaxone
A 24-year-old man presents to his family doctor with a purulent urethral discharge dysuria for the past 2 days. Microscopic examination of a Gram stain of the urethral exudates shows Gram-negative intracellular diplococci. Which of the following is the most appropriate drug for the treatment of this patient? A. Penicillin G B. Ceftriaxone C. Cefazolin D. Imipenem E. Vancomycin
B. Ceftriaxone
A 24 year-old woman has returned from her vacation suffering from traveler from traveler's diarrhea and her problem has not responded diarrhea, and her problem has not responded to antidiarrheal drugs. A pathogenic Gram-negative bacillus is suspected. Which is the most appropriate drug for the suspected. Which is the most appropriate drug for the treatment of this patient? A. Penicillin G B. Ciprofloxacin C. Sulfacetamide D. Imipenem E. Mupirocin
B. Ciprofloxacin
A 5-year-old boy is brought to his pediatrician by his mother. She says that her son has had a persistent cough for 2 weeks. She describes the coughing as "occasional fits of coughing where he can't even breathe," often followed by an inspiratory 'whoop' sound. What is the most appropriate treatment? A. Gentamicin B. Doxycycline C. Azithromycin D. Linezolid E. Ciprofloxacin
C. Azithromycin
A 34-year-old woman presents to her family doctor with symptoms of an uncomplicated UTI This a first time symptoms of an uncomplicated UTI. This a first time occurrence. Medical history indicates she is 39 weeks pregnant and has a severe allergy to penicillin. What would be the most appropriate choice of treatment? A. Co-trimoxazole B. Doxycycline C. Aztreonam D. Nitrofurantoin E. Amoxicillin
C. Aztreonam
A 50-year-old male with Type I diabetes presents to his doctor with left ear pain and ear discharge. On examination, the patient has tenderness of his mastoid process and erythema and mucopurulent discharge in his ear canal. An infection with Pseudomonas aeruginosa is suspected. What is the appropriate treatment for this patient? A. Amoxicillin B. Erythromycin C. Ciprofloxacin D. Penicillin G E. Metronidazole
C. Ciprofloxacin
An 85 year old woman with COPD is admitted with a fever of 103 0F and an elevated WBC count. A chest X-ray shows an infiltrate in the lower left lobe. Cultures reveal a gram negative bacillus and IV antibiotics are started immediately. Later that day, the patient has a seizure that lasts 40s. A subsequent lumbar puncture is negative. The physician suspects a pharmacological cause for the seizure. Which of the following drugs was the most likely cause? A. Amoxicillin B. Cefepime C. Imipenem D. Daptomycin E. Aztreonam
C. Imipenem
A 50 year old man is hospitalized for the treatment of aspiration pneumonia. He is immediately started on an antibiotic. On day 5 of hospitalization, the patients breathing has improved and his chest X-ray is normal, but he has developed crampy, abdominal pain and multiple loose stools in a 24h period. Colonoscopy reveals a patchwork pattern of mucous and mucosal erosions. Which of the following is the site of action of the antibiotic that the patient was most likely initially treated with? A. 30S ribosomal subunit B. RNA polymerase C. DNA gyrase D. 50S ribosomal subunit E. Dihydrofolate reductase
D. 50S ribosomal subunit
A 48-year old male diagnosed with tuberculosis has been treated for 2 months with isoniazid and rifampin and is responding well. During a routine checkup the patient complains of numbness and paresthesias in the extremities. How should you alter his treatment? A. Stop isoniazid B. Stop rifampin C. Add vitamin E D. Add pyridoxine E. Replace isoniazid with ethambutol
D. Add pyridoxine
A 1-year-old child presents to her family doctor with symptoms including fever nasal discharge cough lack of symptoms including fever, nasal discharge, cough, lack of appetite and pain in her right ear. The patient is diagnosed with otitis media. The mother of the patient requests a drug with parenteral administration. Which of the following would be an appropriate choice of drug to fulfill this request? A. Amoxicillin B. Vancomycin C. Nafcillin D. Ceftriaxone E. Penicillin V
D. Ceftriaxone
A 34-year old woman presents to the clinic and explains that she has returned from vacation with traveler's diarrhea. She has not responded to loperamide. The physician decides to treat the patient with antibiotics. Bacterial resistance to the drug of choice for this condition most frequently occurs through which of the following mechanisms? A. Plasmid associated synthesis of enzymes that inactivate drug B. Modification of a ribosomal binding site C. Decreased cellular permeability D. Chromosomal mutations of DNA gyrase E. Production of esterase that hydrolyzes drug
D. Chromosomal mutations of DNA gyrase
A 16 year-old woman has returned from her vacation suffering from traveler's diarrhea and her problem has not responded to antidiarrheal drugs. A pathogenic Gram-negative bacillus is suspected. Which is the most appropriate drug for the treatment of this patient? A. Penicillin G B. Ciprofloxacin C. Nafcillin D. Co-trimoxazole E. Vancomycin
D. Co-trimoxazole
Which of the following is a drug indicated for the treatment of Gram positive aerobes that are resistant to multiple of Gram positive aerobes that are resistant to multiple drugs (both MRSA + vancomycin-resistant organisms) that acts by causing depolarization of bacterial cell membranes? A. Gentamicin B. Cotrimoxazole C. Clindamycin D. Daptomycin E. Linezolid
D. Daptomycin
A 33-year-old woman presents to her family doctor complaining of a poorly healing painless ulcer on her labia complaining of a poorly healing painless ulcer on her labia. She first noticed the lesion a week or so ago, not long after having a sexual encounter with a man at a party. The lesion is identified as a chancre of primary syphilis. The patient states that she is severely allergic to penicillin. What is the most appropriate treatment for this patient? A. Amoxicillin B. Benzathine Penicillin G C. Ciprofloxacin D. Doxycycline E. Desensitization to Penicillin
D. Doxycycline
A week after clindamycin therapy, your patient develops signs of a potentially fatal infection of the colon. His tests reveal that his infection is due to C.difficile. What should he be treated with? A. A higher dose of clindamycin B. Gentamicin C. Linezolid D. Metronidazole E. Rifampin
D. Metronidazole
An elderly debilitated patient has a fever due to an infection. Cultures from his extensive skin lesions reveal large numbers of Gram-positive cocci. The best choice of drug to treat this patient with is? A. Amoxicillin B. Aztreonam C. Gentamicin D. Nafcillin E. Penicillin G
D. Nafcillin
A 34-year-old woman presents to her family doctor with symptoms of an uncomplicated UTI. This is a first time occurrence. Medical history indicates she is 19 weeks pregnant and has a severe allergy to penicillin. Which of the following would be the most appropriate choice of treatment? A. Co-trimoxazole B. Doxycycline C. Piperacillin D. Nitrofurantoin E. Amoxicillin
D. Nitrofurantoin
A 19 year old college student is brought to the ER because her boyfriend said she was difficult to arouse in the morning. She has had a flulike illness for the last 12 hours. Her temperature is 103.1 °F, BP 90/60, and RR 120. There is a diffuse petechia like rash over the extremities. She has a stiff neck that can not be flexed passively. Which of the following would be most appropriate choice of drugs for empiric treatment? A. Vancomycin + penicillin G B. Imipenem + cilastatin C. Vancomycin + ceftaroline D. Vancomycin + ceftriaxone E. Daptomycin + linezolid
D. Vancomycin + ceftriaxone
A 34-year-old woman presents to her family doctor with symptoms of an uncomplicated UTI. This is a first time occurrence. Medical history indicates she is 19 weeks pregnant. Which of the following would be the most appropriate choice of treatment? A. Co-trimoxazole B. Doxycycline C. Vancomycin D. Ciprofloxacin E. Amoxicillin
E. Amoxicillin
A 1-year-old child presents to her family doctor with symptoms including fever nasal discharge cough lack of symptoms including fever, nasal discharge, cough, lack of appetite and pain in her right ear. The patient is diagnosed with otitis media. Medical history indicates the patient has a severe penicillin allergy. Which of the following is the most appropriate choice of drug to treat this patient? A. Amoxicillin B. Ceftriaxone C. Vancomycin D. Imipenem E. Azithromycin
E. Azithromycin
A 33-year-old pregnant woman presents to her family doctor complaining of a poorly healing painless ulcer on her labia complaining of a poorly healing painless ulcer on her labia. She first noticed the lesion a week or so ago, not long after having a sexual encounter with a man at a party. The lesion is identified as a chancre of primary syphilis. The patient states that she is severely allergic to penicillin. What is the most appropriate treatment for this patient? A. Amoxicillin B. Benzathine Penicillin G C. Ciprofloxacin D. Doxycycline E. Desensitization to Penicillin
E. Desensitization to Penicillin
A 38-year-old male patient presents to the ER and is determined to be suffering from a bacteremia caused by an organism that is both MRSA and vancomycin-resistant. A drug of choice for treating this infection would be? A. Amoxicillin B. Nafcillin C. Metronidazole D. Penicillin G E. Quinupristin/dalfopristin
E. Quinupristin/dalfopristin