Podcast
Questions and Answers
In cases where empiric antibiotic therapy is deemed necessary for prosthetic joint infections (PJIs), which of the following antibiotic combinations is most appropriate for initial broad-spectrum coverage?
In cases where empiric antibiotic therapy is deemed necessary for prosthetic joint infections (PJIs), which of the following antibiotic combinations is most appropriate for initial broad-spectrum coverage?
- Clindamycin and ciprofloxacin.
- Vancomycin and cefepime. (correct)
- Nafcillin and gentamicin.
- Ceftriaxone and metronidazole.
What is the standard duration of parenteral antimicrobial therapy recommended for patients undergoing a two-stage surgery for prosthetic joint infection (PJI)?
What is the standard duration of parenteral antimicrobial therapy recommended for patients undergoing a two-stage surgery for prosthetic joint infection (PJI)?
- 2 to 3 weeks.
- 10 to 12 weeks.
- 7 to 9 weeks.
- 4 to 6 weeks. (correct)
Which antibiotic is the MOST suitable alternative for treating methicillin-sensitive S. aureus (MSSA) infections in patients with a Type I penicillin allergy (anaphylaxis)?
Which antibiotic is the MOST suitable alternative for treating methicillin-sensitive S. aureus (MSSA) infections in patients with a Type I penicillin allergy (anaphylaxis)?
- Cefazolin.
- Clindamycin. (correct)
- Oxacillin.
- Nafcillin.
In treating prosthetic joint infections (PJIs) caused by coagulase-negative staphylococci (CoNS), what is a crucial consideration regarding antibiotic selection, especially for the strains causing the PJI?
In treating prosthetic joint infections (PJIs) caused by coagulase-negative staphylococci (CoNS), what is a crucial consideration regarding antibiotic selection, especially for the strains causing the PJI?
For a patient with a prosthetic joint infection (PJI) undergoing debridement and retention of the prosthesis, when is the use of rifampin in combination therapy most appropriate?
For a patient with a prosthetic joint infection (PJI) undergoing debridement and retention of the prosthesis, when is the use of rifampin in combination therapy most appropriate?
In managing prosthetic joint infections (PJIs) caused by P. aeruginosa, which intravenous antibiotic regimen is generally preferred?
In managing prosthetic joint infections (PJIs) caused by P. aeruginosa, which intravenous antibiotic regimen is generally preferred?
Which of the following is the MOST appropriate treatment option for prosthetic joint infections (PJIs) caused by Propionibacterium acnes?
Which of the following is the MOST appropriate treatment option for prosthetic joint infections (PJIs) caused by Propionibacterium acnes?
In cases of culture-negative prosthetic joint infections (PJIs), which antibiotic regimen is MOST appropriate?
In cases of culture-negative prosthetic joint infections (PJIs), which antibiotic regimen is MOST appropriate?
For acute septic arthritis in infants ≤ 2 months, what specific precaution should be observed when administering ceftriaxone?
For acute septic arthritis in infants ≤ 2 months, what specific precaution should be observed when administering ceftriaxone?
What is the recommended initial intravenous antibiotic treatment for acute osteomyelitis/septic arthritis in adults at the hospital level?
What is the recommended initial intravenous antibiotic treatment for acute osteomyelitis/septic arthritis in adults at the hospital level?
In the treatment of gonococcal arthritis, which combination of antibiotics is recommended?
In the treatment of gonococcal arthritis, which combination of antibiotics is recommended?
What is the initial antibiotic treatment regimen for acute hematogenous osteomyelitis (hospital level)?
What is the initial antibiotic treatment regimen for acute hematogenous osteomyelitis (hospital level)?
In treating acute septic arthritis in children older than 3 months with Gram-negative organisms present, what is the appropriate intravenous antibiotic combination?
In treating acute septic arthritis in children older than 3 months with Gram-negative organisms present, what is the appropriate intravenous antibiotic combination?
In cases of MRSA infections causing acute septic arthritis in children, which antibiotic is used to replace cloxacillin?
In cases of MRSA infections causing acute septic arthritis in children, which antibiotic is used to replace cloxacillin?
What are the initial empiric therapy options for chronic osteomyelitis, effectively targeting both anaerobic organisms and gram-positive and gram-negative aerobes?
What are the initial empiric therapy options for chronic osteomyelitis, effectively targeting both anaerobic organisms and gram-positive and gram-negative aerobes?
In chronic osteomyelitis treatment, when should vancomycin be added to the regimen?
In chronic osteomyelitis treatment, when should vancomycin be added to the regimen?
Following parenteral antibiotic administration for pyogenic septic arthritis and acute osteomyelitis in an improving neonate, what is the MOST appropriate oral follow-up therapy in the absence of penicillin allergy?
Following parenteral antibiotic administration for pyogenic septic arthritis and acute osteomyelitis in an improving neonate, what is the MOST appropriate oral follow-up therapy in the absence of penicillin allergy?
What is the MOST critical aspect for healthcare providers to consider when using ceftriaxone in neonates?
What is the MOST critical aspect for healthcare providers to consider when using ceftriaxone in neonates?
In a patient undergoing empiric antibiotic therapy for a suspected prosthetic joint infection, which diagnostic step is MOST critical before initiating antibiotics, when clinically feasible?
In a patient undergoing empiric antibiotic therapy for a suspected prosthetic joint infection, which diagnostic step is MOST critical before initiating antibiotics, when clinically feasible?
Following debridement and retention of a prosthesis due to a staphylococcal infection, when is the addition of rifampin to the antibiotic regimen MOST crucial?
Following debridement and retention of a prosthesis due to a staphylococcal infection, when is the addition of rifampin to the antibiotic regimen MOST crucial?
When treating prosthetic joint infections caused by Enterococci, which approach is MOST suited?
When treating prosthetic joint infections caused by Enterococci, which approach is MOST suited?
Which of the following is MOST important to review regarding the antibiotic treatment options discussed?
Which of the following is MOST important to review regarding the antibiotic treatment options discussed?
What are the intravenous options for acute septic arthritis in adults, who are severely allergic to penicillin, needing an alternative treatment?
What are the intravenous options for acute septic arthritis in adults, who are severely allergic to penicillin, needing an alternative treatment?
When is oral therapy initiated for osteomyelitis/septic arthritis in adults after initial treatment?
When is oral therapy initiated for osteomyelitis/septic arthritis in adults after initial treatment?
What is the duration of intravenous therapy for acute septic arthritis (pyogenic) and acute osteitis osteomyelitis in children?
What is the duration of intravenous therapy for acute septic arthritis (pyogenic) and acute osteitis osteomyelitis in children?
Which antibiotics can be used for neonates who have pyogenic septic arthritis and acute osteitis osteomyelitis?
Which antibiotics can be used for neonates who have pyogenic septic arthritis and acute osteitis osteomyelitis?
Beyond just knowing which drugs to prescribe, what deeper level of understanding regarding these drugs is MOST crucial?
Beyond just knowing which drugs to prescribe, what deeper level of understanding regarding these drugs is MOST crucial?
Which specific factor is MOST directly pertinent when selecting an oral agent from the fluoroquinolone class of antibiotics?
Which specific factor is MOST directly pertinent when selecting an oral agent from the fluoroquinolone class of antibiotics?
In managing septic arthritis in a 40-year old patient, what additional testing must be considered if there is urethritis or pelvic inflammatory disease?
In managing septic arthritis in a 40-year old patient, what additional testing must be considered if there is urethritis or pelvic inflammatory disease?
In a patient with a prosthetic joint infection diagnosed as culture-negative, what is the MOST plausible explanation for the absence of identifiable pathogens?
In a patient with a prosthetic joint infection diagnosed as culture-negative, what is the MOST plausible explanation for the absence of identifiable pathogens?
What is the recommended approach for a patient with beta-hemolytic streptococci septic arthritis who is allergic to penicillin?
What is the recommended approach for a patient with beta-hemolytic streptococci septic arthritis who is allergic to penicillin?
When managing an infection caused by gram-negative bacilli, what is the key therapeutic decision point in selecting the appropriate antibiotic regimen?
When managing an infection caused by gram-negative bacilli, what is the key therapeutic decision point in selecting the appropriate antibiotic regimen?
For infants over 3 months, what is the role of cloxacillin in managing acute septic arthritis, particularly in regions where MRSA prevalence is substantial?
For infants over 3 months, what is the role of cloxacillin in managing acute septic arthritis, particularly in regions where MRSA prevalence is substantial?
What is the recommended therapy for treating acute septic arthritis caused by N. gonorrhoeae?
What is the recommended therapy for treating acute septic arthritis caused by N. gonorrhoeae?
When is it MOST appropriate to switch from intravenous to oral antibiotics in the treatment of acute osteomyelitis/septic arthritis in adults?
When is it MOST appropriate to switch from intravenous to oral antibiotics in the treatment of acute osteomyelitis/septic arthritis in adults?
In the management of culture-negative prosthetic joint infections (PJIs) where prior antibiotic usage is suspected, what is the MOST critical modification to empiric antibiotic therapy?
In the management of culture-negative prosthetic joint infections (PJIs) where prior antibiotic usage is suspected, what is the MOST critical modification to empiric antibiotic therapy?
What is the significance of considering beta-lactamase sensitivity when selecting antibiotics for infections, especially when the provided examples of cephalosporins and penicillins are not exhaustive?
What is the significance of considering beta-lactamase sensitivity when selecting antibiotics for infections, especially when the provided examples of cephalosporins and penicillins are not exhaustive?
How does the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) impact the empiric treatment strategies for acute septic arthritis in children over 3 months, especially when initiating antibiotic therapy at the hospital level?
How does the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) impact the empiric treatment strategies for acute septic arthritis in children over 3 months, especially when initiating antibiotic therapy at the hospital level?
What is the MOST appropriate strategy in treating a confirmed Enterococci prosthetic joint infection (PJI), given the organism's intrinsic resistance mechanisms and the need for sustained bactericidal activity?
What is the MOST appropriate strategy in treating a confirmed Enterococci prosthetic joint infection (PJI), given the organism's intrinsic resistance mechanisms and the need for sustained bactericidal activity?
In the context of acute septic arthritis management, what critical step differentiates the treatment approach for adults with suspected N. gonorrhoeae infection from the standard empiric therapy?
In the context of acute septic arthritis management, what critical step differentiates the treatment approach for adults with suspected N. gonorrhoeae infection from the standard empiric therapy?
Flashcards
Empiric antibiotic therapy
Empiric antibiotic therapy
Delaying antibiotic therapy until the causative organism is identified to guide the therapy process.
Antibiotic therapy for specific pathogens
Antibiotic therapy for specific pathogens
A 4 to 6-week course of antimicrobial therapy after surgery for patients with one- or two-stage surgery, debridement surgery, or resection arthroplasty without delayed re-implantation.
Antibiotics for methicillin-sensitive S. aureus (MSSA)
Antibiotics for methicillin-sensitive S. aureus (MSSA)
Nafcillin or oxacillin (IV every 4-6 hours), ceftriaxone (IV every 24 hours) or cefazolin (IV every 8 hours) are effective.
Antibiotics for Methicillin-resistant S. aureus (MRSA)
Antibiotics for Methicillin-resistant S. aureus (MRSA)
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Treating staphylococci infections after debridement
Treating staphylococci infections after debridement
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Treatment for beta-hemolytic Streptococci
Treatment for beta-hemolytic Streptococci
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Treatment of Enterococci infections
Treatment of Enterococci infections
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Treatment for gram-negative bacilli
Treatment for gram-negative bacilli
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Treatment for Anaerobes (Propionibacterium acnes)
Treatment for Anaerobes (Propionibacterium acnes)
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Treatment for Culture-negative PJIs
Treatment for Culture-negative PJIs
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Treatment for acute septic arthritis (primary level)
Treatment for acute septic arthritis (primary level)
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Treatment for acute osteomyelitis/septic arthritis (adults, hospital level)
Treatment for acute osteomyelitis/septic arthritis (adults, hospital level)
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Treatment for acute hematogenous osteomyelitis
Treatment for acute hematogenous osteomyelitis
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Treating MRSA in children
Treating MRSA in children
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Treatment for chronic osteomyelitis
Treatment for chronic osteomyelitis
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Study Notes
Overview
- This document serves as a revision of antimicrobial lectures given during the BCMH block
BCMH Antibiotic Notes
- Review cell wall synthesis inhibitors I & II from lectures 2 & 3
- Review nucleic acid synthesis inhibitors from lecture 4
- Review protein synthesis inhibitors from lectures 6 & 7
Prosthetic Joint Infections (PJI)
- Antibiotic treatment for PJI aims to cure or control the infection
Empiric Antibiotic Therapy
- Delay antibiotic therapy until the causative organism is identified
- If empiric therapy is needed, cover staphylococci (including MRSA) and aerobic gram-negative bacilli
- Vancomycin and cefepime can be used as empiric therapy
- Adjust subsequent therapy based on culture and susceptibility data
Antibiotic Therapy for Specific Pathogens
- A 4 to 6-week course of parenteral antimicrobial therapy is needed after surgery for one- or two-stage surgery, debridement, or resection arthroplasty without delayed re-implantation
- If possible, a long-term course of oral antimicrobial treatment is used for patients with debridement and retention after initial parenteral treatment
Staphylococci Treatment
- For methicillin-sensitive S. aureus (MSSA), nafcillin or oxacillin IV every 4-6 hours is most effective
- Ceftriaxone (IV every 24 hours) or cefazolin (IV every 8 hours) can be used alternatively
- For penicillin-allergic patients, clindamycin (IV every 8 hours) or vancomycin (IV every 8-12 hours) can be used
- Nafcillin and oxacillin are both beta-lactamase resistant penicillins
- Fusidic acid can be used as an alternative to beta-lactams
- For methicillin-resistant S. aureus (MRSA) infections, vancomycin, daptomycin, fusidic acid, or linezolid can be used
- For coagulase-negative staphylococci (CoNS), use the same antibiotics as for S. aureus
- Most CoNS strains causing PJI are methicillin resistant
- For patients with debridement/retention of prosthesis/one-stage arthroplasty, combination therapy with rifampin can treat staphylococci infections
Streptococci Treatment
- Penicillin G, ampicillin, or ceftriaxone (IV every 24 hours) is used
- Clindamycin (IV every 8 hours) or vancomycin (IV every 8-12 hours) can be used in penicillin-allergic patients
Enterococci Treatment
- These infections are rare
- Tailor antibiotic therapy to susceptibility results (ampicillin, penicillin G, or vancomycin)
- Combine one of those antibiotics with gentamicin or streptomycin for combination therapy
- Ampicillin can be combined with ceftriaxone
Gram-Negative Bacilli Treatment
- For fluoroquinolone-susceptible organisms, use oral ciprofloxacin (2x daily)
- For P. aeruginosa infections, consider these regimens:
- Cefepime (IV every 12 hours)
- Meropenem (IV every 8 hours)
- Ciprofloxacin (orally every 12 hours)
- Ceftazidime (IV every 8 hours)
Anaerobes Treatment
- Propionibacterium acnes is the most common form of anaerobic PJI
- Treatment options include penicillin G (IV every 24 hours or continuous infusion) or ceftriaxone (IV once daily)
- Vancomycin, clindamycin, and metronidazole can also be used for treatment
Culture-Negative Infections Treatment
- These occur in a small proportion of PJI patients
- About half had prior antibiotic use
- Give antibiotics effective against both gram-positive and gram-negative pathogens
- Suggested regimens include vancomycin with ciprofloxacin or cefazolin with ciprofloxacin
Osteomyelitis/Septic Arthritis
- Antibiotics effective against both gram-positive (S. aureus) and gram-negative organisms are given until culture results are available
Acute Septic Arthritis (Primary Level) Treatment
- Treat with immediate ceftriaxone (IM, single dose)
- For infants ≤ 2 months, give initial ceftriaxone dose and care while awaiting transfer, even for neonates/jaundiced infants
- Avoid concurrent administration of Ca2+-containing IV fluids, and use ceftriaxone with caution in neonates and children
Acute Osteomyelitis/Septic Arthritis (Adults, Hospital Level) Treatment
- Initiate with cefazolin (IV every 8 hours) for 4 weeks
- If a patient responds well after 2 weeks, start oral flucloxacillin (every 6 hours for 2 weeks)
- For severe penicillin allergy, use clindamycin (IV every 8 hours for 2 weeks) then oral clindamycin (every 8 hours for 2 weeks) if a patient responds well
- For Gonococcal Arthritis, use ceftriaxone (IV, daily for a week) and azithromycin (oral, single dose)
Acute Hematogenous Osteomyelitis (Hospital Level) Treatment
- Initiate with nafcillin or oxacillin (IV every 4 hours) or vancomycin (IV every 12 hours)
- Administer a 3rd- or 4th-generation cephalosporin like ceftazidime (IV every 8 hours) or cefepime (IV every 12 hours)
Acute Septic Arthritis (Pyogenic) and Acute Osteitis Osteomyelitis in Children (Hospital Level) Treatment
- Treat for 4-6 weeks
- Start with IV therapy, adjust based on culture results or if empiric therapy fails
- Start oral therapy upon improvement and when inflammatory markers normalize
- For neonates, use cloxacillin (IV every 6-12 hours, depending on weeks of age) and cefotaxime (IV every 6-12 hours, depending on weeks of age)
- For infants 1-3 months, use cloxacillin (IV every 6 hours) and ceftriaxone (IV every 12 hours)
- For infants over 3 months and children, administer cloxacillin (IV every 6 hours) and add ceftriaxone (IV every 12 hours) if gram-negative organisms are present
- For MRSA, replace cloxacillin with vancomycin (IV slowly over 1 hour, every 6 hours)
- Start oral clindamycin (for penicillin allergy) or flucloxacillin (every 6 hours) once there is sustained improvement
Chronic Osteomyelitis Treatment
- Must be effective against anaerobic organisms, gram-positive, and gram-negative aerobes
- Use ampicillin/sulbactam (IV every 6 hours) or piperacillin/tazobactam (IV every 6 hours)
- Add vancomycin (IV every 12 hours) for severe or MRSA infections
- Give antibiotics parenterally for 4-8 weeks and adjust based on culture results
Drug Information Review
- Mechanism of action
- Contraindications
- Safety during pregnancy/lactation
- Adverse effects
- Drug interactions
- Precautions for use
- Penicillins: beta-lactamase sensitivity
- Consult the list of penicillins and cephalosporins (1st, 2nd, 3rd, and 4th generations) available in South Africa
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