Antibiotics Dosing Guidelines

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Questions and Answers

What combination of antibiotics is recommended for children with a specific condition, assuming first-line antibiotics are not available?

Clindamycin + ciprofloxacin

Ceftriaxone

Ampicillin + gentamicin (correct)

Cloxacillin + amikacin

Which of the following is NOT a risk factor for MRSA?

Recent hospitalization

Chronic allergies (correct)

Recurrent skin infection

Invasive device

Which antibiotic combination should be used for adult patients at risk for pseudomonas?

Cloxacillin + amikacin

Ceftriaxone

Ceftriaxone + amikacin (correct)

Clindamycin + ciprofloxacin

For which reason should clindamycin + ciprofloxacin be used in adults?

If first-line antibiotics are unavailable Signup and view all the answers

Which statement is true regarding patients with severe beta-lactam allergies?

They should not be administered certain antibiotics. Signup and view all the answers

What is the recommended daily maximum dose of morphine for patients needing continuous infusion?

600 mg Signup and view all the answers

How should the morphine dose be adjusted for elderly patients?

Reduce the dose by half Signup and view all the answers

When initiating treatment with sustained release morphine (MSR), what is the correct starting dose?

30 mg every 12 hours Signup and view all the answers

What should be added to morphine treatment if it exceeds 48 hours?

A laxative Signup and view all the answers

What adjustment should be made for patients with renal or hepatic impairment when prescribing morphine?

Reduce the dose by half Signup and view all the answers

Which of the following is a sign of hypotension in patients suspected of shock?

Weak pulse Signup and view all the answers

In children, which sign is considered a late indicator of shock?

Hypotension Signup and view all the answers

What is the significance of a capillary refill time (CRT) of ≥ 3 seconds in the context of shock?

Suggests shock or tissue hypoperfusion Signup and view all the answers

Which symptom is not associated with tissue hypoperfusion in shock?

Increased urine output Signup and view all the answers

What is the primary risk factor in anaphylaxis-related shock?

Recent exposure to an allergen Signup and view all the answers

What does severe gastrointestinal symptoms indicate in the context of distributive shock?

Potential for severe vasodilation Signup and view all the answers

In patients with shock, which condition is characterized by a high mortality rate without early diagnosis and treatment?

Prolonged shock Signup and view all the answers

Which of the following clinical features is NOT typical for the compensatory mechanisms in shock?

Hypotension Signup and view all the answers

What is the maximum daily dose of amikacin for adults?

1.5 g Signup and view all the answers

How frequently should ampicillin be administered to children over 1 month?

Every 8 hours Signup and view all the answers

What is the dosing interval for ciprofloxacin IV infusion in children?

Every 12 hours Signup and view all the answers

When treating meningitis in adults, what is the dosage schedule for ceftriaxone?

2 g every 12 hours Signup and view all the answers

What is the maximum dosage of metronidazole for children when administered by NGT every 8 hours?

500 mg Signup and view all the answers

What is the initial dose of doxycycline for adults on the first day of treatment?

200 mg Signup and view all the answers

What rate should intravenous gentamicin be administered to children?

7.5 mg/kg once daily Signup and view all the answers

What is the appropriate volume for fluid administration in adults experiencing cardiogenic shock?

100 to 250 ml Signup and view all the answers

What characterizes pulsus paradoxus?

Decrease of > 10 mmHg in SBP during inspiration Signup and view all the answers

Which initial management step should be taken for a patient in shock?

Monitor urine output hourly Signup and view all the answers

What is the primary objective of shock management?

Restore adequate tissue perfusion Signup and view all the answers

What should be the minimum mean arterial pressure (MAP) maintained in adults?

65 mmHg Signup and view all the answers

In case of suspected anaphylaxis, what is the preferred position for the patient?

Sitting position Signup and view all the answers

To manage a patient's airway and breathing, how should the patient be positioned?

On their back Signup and view all the answers

What is a key monitoring parameter in the ongoing care of a patient in shock?

Mental status and consciousness levels Signup and view all the answers

When assessing for dehydration in a shock patient, what is critical to manage?

Providing nutritional support Signup and view all the answers

Study Notes

Antibiotic Dosages

Amikacin:
- Children: 15 mg/kg (max 1.5 g) once daily via IM or slow IV
- Adults: 15 mg/kg once daily via slow IV over 3 mins.
Ampicillin:
- Children: 50 mg/kg (max 2 g) every 8 hours via IV infusion over 30 mins
- Adults: 2 g every 6-8 hours (2 g every 4 hours for meningitis).
Azithromycin:
- Children: 10-20 mg/kg (max 500 mg) once daily via PO or NGT
- Adults: 500 mg to 1 g once daily.
Cefazolin:
- Children: 25 mg/kg (max 3 g) every 12 hours via slow IV or IV infusion
- Adults: 2 g every 8 hours.
Ceftriaxone:
- Children: 80 mg/kg (max 4 g) once daily (100 mg/kg max for meningitis)
- Adults: 2 g once daily (2 g every 12 hours for meningitis).
Ciprofloxacin:
- Children: 15-20 mg/kg (max 750 mg) every 12 hours via PO or NGT
- Adults: 500-750 mg every 12 hours via PO or 400 mg every 8-12 hours IV.
Clindamycin:
- Children: 10 mg/kg (max 600 mg) every 8 hours via IV infusion
- Adults: 600-900 mg every 8 hours.
Cloxacillin:
- Children: 25-50 mg/kg (max 2 g) every 6 hours via IV infusion
- Adults: 2 g every 6 hours.
Doxycycline:
- Children: 4.4 mg/kg (max 200 mg) on day 1, then 2.2 mg/kg (max 100 mg) every 12 hours via PO or NGT
- Adults: 200 mg on day 1, then 100 mg every 12 hours.
Gentamicin:
- Children: 7.5 mg/kg once daily via IM or slow IV
- Adults: 5 mg/kg once daily.
Meropenem:
- Children: 20 mg/kg (max 2 g) every 8 hours via IV infusion
- Adults: 2 g every 8 hours.
Metronidazole:
- Children: 10 mg/kg (max 500 mg) every 8 hours via PO or IV infusion
- Adults: 500 mg every 8 hours.
Vancomycin:
- Children: 15 mg/kg (max 500 mg) every 6 hours via IV infusion over 60-240 minutes
- Adults: 15-20 mg/kg (max 2 g) every 12 hours.

Cardiogenic Shock Management

Fluid Administration:
- Administer RL cautiously, monitor for fluid overload.
- Adults: 100-250 ml over 30 mins; adjustments based on assessment (urinary output, mental status, SpO2).
Clinical Features of Shock:
- Hypotension: weak pulse, low BP, narrow pulse pressure.
- Tissue hypoperfusion signs:
 - Skin: pallor, cold extremities, CRT ≥ 3 seconds.
 - Lungs: tachypnea, dyspnea.
 - Heart: tachycardia precedes BP drop.
 - Kidney: oliguria (< 0.5 to 1 ml/kg/hour) or anuria.
 - Brain: altered mental states, anxiety, thirst.
Shock in Children:
- Hypotension is a late sign; treat if presenting with: lower limb temperature gradient, CRT ≥ 3 seconds, weak radial pulse, or severe tachycardia.

Specific Shock Types

Anaphylaxis:
- Recent allergen exposure; skin/mucous membrane involvement along with respiratory symptoms or low BP.
Distributive Shock:
- Severe vasodilation, increased capillary permeability with risk factors like recent allergen exposure, or infections.

Basic Life Support Steps

Manage airways and breathing; position the patient appropriately.
If anaphylaxis is suspected, immediately address it.
Monitor vital signs, including urine output, HR, RR, BP, and SpO2.

Antibiotic Administration Guidelines

First-line treatments specified, including combinations for children (ampicillin + gentamicin, ceftriaxone).
Alternative regimens for adults based on risk factors and antibiotic availability.

Morphine Dosing

Immediate Release (MIR):
- Children > 6 months: 0.15 mg/kg every 4 hours.
- Adults: 10 mg every 4 hours, adjust based on pain intensity.
Sustained Release (MSR):
- Daily doses for elderly and those with renal/hepatic impairment should be halved.

Additional Considerations

Administer a laxative if morphine treatment exceeds 48 hours.
Attention to changes in condition; re-evaluate every 10 minutes until stability is achieved.

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Description

This quiz focuses on the dosing guidelines for antibiotics in children over one month and adults. It includes specific dosage recommendations for amikacin, ampicillin, and azithromycin, ensuring safe and effective treatment. Test your knowledge on these critical medication protocols.