selection of antibiotics for empiric therapy in clinical practice linda l. van etta, md, facp
TRANSCRIPT
![Page 1: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/1.jpg)
Selection of Antibiotics forSelection of Antibiotics for Empiric Therapy in Clinical Practice Empiric Therapy in Clinical Practice
Linda L. Van Etta, MD, FACP
![Page 2: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/2.jpg)
Clinical presentation
Usual pathogens
Sensitivity of pathogen(s) to antibiotics
Drug/host interactions(allergies, renal & liver function,distribution in body, route, cost,duration of therapy)
![Page 3: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/3.jpg)
Please remember:Please remember:
the antibiotic choices listed for each diagnosis are represenative. Different hospitals and clinics may use other agents based on their antibiograms of their organisms or based on their purchasing group
All choices are for empiric therapy. Antibiotic therapy is altered based on culture results
![Page 4: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/4.jpg)
Central Nervous SystemCentral Nervous System
![Page 5: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/5.jpg)
Bacterial Meningitis - Neonate Bacterial Meningitis - Neonate or Infantsor Infants
Clinical presentation: poor feeding, irritability, fever, lethargy
May not have nuchal rigidity
![Page 6: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/6.jpg)
Bacterial Meningitis - Neonate Bacterial Meningitis - Neonate or Infantsor Infants
Strep, group B or D
Enterobacteriaceae
H. influenzae
Listeria
Meningococci
Pneumococci
![Page 7: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/7.jpg)
Bacterial Meningitis - Neonate Bacterial Meningitis - Neonate or Infantsor Infants
Cefotaxime
+ Ampicillin
+ Dexamethasone
![Page 8: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/8.jpg)
Bacterial Meningitis - AdultBacterial Meningitis - Adult
Clinical presentation- headache, fever, confusion
Nuchal rigidity
![Page 9: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/9.jpg)
Bacterial Meningitis - AdultBacterial Meningitis - Adult
Meningococci
Pneumococci
Listeria
![Page 10: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/10.jpg)
Bacterial Meningitis - AdultBacterial Meningitis - Adult
Ceftriaxone or cefotaxime
+ Vancomycin
+ Dexamethasone
![Page 11: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/11.jpg)
Brain AbscessBrain Abscess
Clinical presentation- often stroke like picture with focal neurological deficits, headache
May not be febrile!
![Page 12: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/12.jpg)
Brain AbscessBrain Abscess
Streptococci (60-70%)
Bacteroides (20-40%)
Enterobacteriaceae (25-33%)
Staph aureus (10-15%)
HIV (+) = toxoplasmosis
![Page 13: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/13.jpg)
Brain AbscessBrain Abscess
Ceftriaxone or cefotaxime
+ Metronidazole
![Page 14: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/14.jpg)
EncephalitisEncephalitis
Clinical presentation- confusion, headache, may have fever
Exposure history, season of year
![Page 15: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/15.jpg)
EncephalitisEncephalitis
Herpes simplex arboviruses rabies parasitic
![Page 16: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/16.jpg)
EncephalitisEncephalitis
Acyclovir (HSV) Others- symptomatic treatment only
![Page 17: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/17.jpg)
Respiratory TractRespiratory Tract
![Page 18: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/18.jpg)
Otitis MediaOtitis Media
Clinical presentation- ear pain, may have fever
Tympanic membrane-red, cloudy fluid behind
![Page 19: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/19.jpg)
Otitis MediaOtitis Media
Pneumococci (25-50%)
H. influenzae (15-30%)
B. catarrhalis (3-30%)
Staph aureus (1%)
Group A strep (2%)
“Sterile” (35%, viral)
![Page 20: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/20.jpg)
Otitis Media (choose one)Otitis Media (choose one)
Amoxicillin Erythromycin Trimethoprim/Sulfamethoxazole Amoxicillin/Clavulanic acid Cefuroxime azithromycin 3rd generation oral cephalosporins (Cefaclor)
![Page 21: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/21.jpg)
PharyngitisPharyngitis
Clinical presentation- sore throat, may have fever
![Page 22: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/22.jpg)
PharyngitisPharyngitis
Group A, C, G strep
“Viral”
EBV
![Page 23: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/23.jpg)
Pharyngitis- for lab proven Pharyngitis- for lab proven streptococcal infection (choose streptococcal infection (choose one)one)
Penicillin
Erythromycin
Clindamycin
Treat for 10 days
![Page 24: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/24.jpg)
Pneumonia: Community-acquiredPneumonia: Community-acquired
Clinical presentation- cough, fever, sputum production, occ. dyspnea
Infiltrate on CXR
![Page 25: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/25.jpg)
Pneumonia: Community-acquiredPneumonia: Community-acquired
Pneumococci H. influenzae Mycoplasma pneumoniae Legionella Viral:
Hanta influenza others
![Page 26: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/26.jpg)
Pneumonia: Community-acquired Pneumonia: Community-acquired (choose one)(choose one)
Doxycycline Respiratory fluoroquinolone:
moxifloxacin,gatifloxacin,levofloxacin
Ceftriaxone or Cefotaxime + azithromycin
Piperacillin / tazobactam combined with a resp. fluoroquinolone for severe cases
Influenza-rimantadine or oseltamivir
![Page 27: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/27.jpg)
Pneumonia: Hospital-acquiredPneumonia: Hospital-acquired
Clinical presentation- cough, fever, sputum production developing after >72 hours in the hospital
![Page 28: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/28.jpg)
Pneumonia: Hospital-acquiredPneumonia: Hospital-acquired
Pseudomonas sp.
Klebsiella sp.
Enterobacter sp.
![Page 29: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/29.jpg)
Pneumonia: Hospital-acquiredPneumonia: Hospital-acquired
Cephalosporin, 3rd generation or anti-pseudomonal penicillin
Combined with
Cipro or aminoglycoside
![Page 30: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/30.jpg)
Cystic FibrosisCystic Fibrosis
Pseudomonas aeruginosa*
Staph aureus
Burkholdia (Pseudomonas) cepacia
![Page 31: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/31.jpg)
Cystic FibrosisCystic Fibrosis
Tobramycin- inhaled
AP penicillin or ceftazidime
Ciprofloxacin
(always use 2 drugs)
TMP/sulfa (for Burkholdia)
![Page 32: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/32.jpg)
HIV / AIDS PatientsHIV / AIDS Patients
Clinical presentation
Organisms
Antimicrobial agents
![Page 33: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/33.jpg)
HIV / AIDS PatientsHIV / AIDS Patients
Pneumocystis
(R/O TB)
![Page 34: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/34.jpg)
HIV / AIDS PatientsHIV / AIDS Patients
TMP/sulfa or
Clindamycin + primaquine or
Atovaquone or
Dapsone + trimethoprim
Always use steroids
![Page 35: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/35.jpg)
Genitourinary TractGenitourinary Tract
![Page 36: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/36.jpg)
CystitisCystitis
Clinical presentation- urinary frequency, dysuria, hematuria, urgency
![Page 37: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/37.jpg)
CystitisCystitis
Enterobacteriaceae (E. coli)
Staph saprophyticus
Enterococcus
![Page 38: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/38.jpg)
Cystitis (choose one)Cystitis (choose one)
TMP/SMX
TMP
Ciprofloxacin
3 day treatment course
![Page 39: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/39.jpg)
PyelonephritisPyelonephritis
Clinical presentation- fever, flank or back pain, hematuria
![Page 40: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/40.jpg)
PyelonephritisPyelonephritis
Enterobacteriaceae
Enterococci
![Page 41: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/41.jpg)
Pyelonephritis (choose one)Pyelonephritis (choose one)
TMP/SMX
Cephalosporin (3rd) or AP Pen
Gentamicin
Ciprofloxacin
Treat for 2 weeks
![Page 42: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/42.jpg)
ProstatitisProstatitis
Clinical presentation- perineal pain, low back pain, dysuria, frequency, may have fever and chills
Prostatic tenderness on rectal exam
![Page 43: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/43.jpg)
ProstatitisProstatitis
Enterobacteriaceae
Pseudomonas sp.
Chlamydia and gonoccocus in younger patients
![Page 44: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/44.jpg)
ProstatitisProstatitis
Tetracycline
TMP/SMX
Ciprofloxacin
Ofloxacin
![Page 45: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/45.jpg)
UrethritisUrethritis
Clinical presentation-dysuria, frequency
![Page 46: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/46.jpg)
UrethritisUrethritis
Chlamydia trachomatis
![Page 47: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/47.jpg)
Urethritis (choose one)Urethritis (choose one)
Tetracycline / Doxycycline
Ofloxacin
Azithromycin
![Page 48: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/48.jpg)
Salpingitis (PID)Salpingitis (PID)
Clinical presentation-pelvic or lower abdominal pain, fever
Tenderness and possible mass on pelvic exam
![Page 49: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/49.jpg)
Salpingitis (PID)Salpingitis (PID)
Gonococcus
Chlamydia
Bacteroides
Enterobacteriaceae
Streptococci
![Page 50: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/50.jpg)
Salpingitis (PID)Salpingitis (PID)
Doxycycline + Ceftriaxone + Metronidazole
or Cefoxitin + doxycycline
or
Ofloxacin + metronidazole
![Page 51: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/51.jpg)
Gastrointestinal TractGastrointestinal Tract
![Page 52: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/52.jpg)
Cholecystitis / CholangitisCholecystitis / Cholangitis
Clinical presentation- RUQ pain, fever, nausea
Tenderness in RUQ on exam
![Page 53: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/53.jpg)
Cholecystitis / CholangitisCholecystitis / Cholangitis
Enterobacteriaceae (68%)
Enterococci (14%)
Cl. perfringens (7%)
Bacteroides (10%)
![Page 54: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/54.jpg)
Cholecystitis / CholangitisCholecystitis / Cholangitis
Ceftriaxone + Metronidazole
AP Pen Metronidazole
![Page 55: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/55.jpg)
DiverticulitisDiverticulitis
Clinical presentation-left, lower abdominal pain with fever and diarrhea or bloody stools
Tenderness over LLQ on abdominal exam
![Page 56: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/56.jpg)
DiverticulitisDiverticulitis
Enterobacteriaceae
Bacteroides sp.
Enterococci
![Page 57: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/57.jpg)
Diverticulitis (choose one combo)Diverticulitis (choose one combo)
Gentamicin + Clindamycin
Ceftriaxone + metronidazole
AP Pen + Metronidazole
Amoxacillin/clavulanate
Ciprofloxacin + metronidazole
TMP/SMX + metronidazole
![Page 58: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/58.jpg)
Dysentery / DiarrheaDysentery / DiarrheaSevere, fever, or bloodySevere, fever, or bloody
Clinical presentation- diarrhea, may be bloody, may have fever
![Page 59: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/59.jpg)
Dysentery / DiarrheaDysentery / DiarrheaSevere, fever, or bloodySevere, fever, or bloody
Shigella sp.
Campylobacter jejuni
Salmonella
E. coli 0157:H7
![Page 60: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/60.jpg)
Dysentery / DiarrheaDysentery / DiarrheaSevere, fever, or bloodySevere, fever, or bloody
Ciprofloxacin
TMP/sulfa, erythromycin
Do not treat E coli 0157-increases risk of complications
![Page 61: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/61.jpg)
Dysentery / DiarrheaDysentery / DiarrheaMild or moderateMild or moderate
Clinical presentation – diarrhea, no fever usually, no bloody stools
![Page 62: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/62.jpg)
Dysentery / DiarrheaDysentery / DiarrheaMild or moderateMild or moderate
Enteropathogenic E. coli
Rotaviruses
Norwalk agent
![Page 63: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/63.jpg)
Dysentery / DiarrheaDysentery / DiarrheaMild or moderateMild or moderate
(fluids)
(antimotility agents)
![Page 64: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/64.jpg)
Pseudomembranous enterocolitisPseudomembranous enterocolitis
Clinical presentation-diarrhea, may be bloody
Tenderness on abdominal exam Risk of developing toxic megacolon May develop without antibiotic
exposure, but usually associated
![Page 65: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/65.jpg)
Pseudomembranous enterocolitisPseudomembranous enterocolitis
Clostridium difficile
![Page 66: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/66.jpg)
Pseudomembranous enterocolitisPseudomembranous enterocolitis
Metronidazole
or
Vancomycin (oral)
![Page 67: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/67.jpg)
Bone and Soft Tissue InfectionsBone and Soft Tissue Infections
![Page 68: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/68.jpg)
CellulitisCellulitis
Clinical presentation- swelling, redness, painful soft tissue area, may have fever
![Page 69: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/69.jpg)
CellulitisCellulitis
Group A strep
Staph aureus
![Page 70: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/70.jpg)
Cellulitis (choose one)Cellulitis (choose one)
Clindamycin
Nafcillin or Oxacillin
Cefazolin / Cephalothin
Penicillin G
![Page 71: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/71.jpg)
Septic Arthritis - AdultSeptic Arthritis - Adult
Clinical presentation- painful, swollen, warm joint
![Page 72: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/72.jpg)
Septic Arthritis - AdultSeptic Arthritis - Adult
Staph aureus
Group A strep
Gonococci
Pneumococci
Borrelia burgdorferi (Lyme)
![Page 73: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/73.jpg)
Septic Arthritis - AdultSeptic Arthritis - Adult
Nafcillin or Oxacillin
or
Ceftriaxone (neg. rods) or Cefotaxime
Treat for 4 weeks
Consider Vancomycin if MRSA problem locally
![Page 74: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/74.jpg)
Osteomyelitis (adults)Osteomyelitis (adults)
Clinical presentation- bone pain, may have chronic, draining wound or sinus over the site
Often history of trauma or previous surgery at site
![Page 75: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/75.jpg)
Osteomyelitis (adults)Osteomyelitis (adults)
Staph aureus
![Page 76: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/76.jpg)
Osteomyelitis (adults)-choose oneOsteomyelitis (adults)-choose one
Nafcillin or Oxacillin
Vancomycin (for MRSA concern)
Cephalothin (1st generation)
Clindamycin
![Page 77: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/77.jpg)
Puncture FootPuncture Foot
Pseudomonas aeruginosa
![Page 78: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/78.jpg)
Puncture FootPuncture Foot
AP Pen or Ceftazidime +
APAG or FQ
![Page 79: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/79.jpg)
Bacterial EndocarditisBacterial Endocarditis
![Page 80: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/80.jpg)
Bacterial Endocarditis - AcuteBacterial Endocarditis - Acute
Clinical presentation- fever, night sweats
Heart murmur on exam
![Page 81: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/81.jpg)
Bacterial Endocarditis - AcuteBacterial Endocarditis - Acute
Viridans strep (30-40%)
Staph aureus (20-35%)
Group D strep (5-18%)
![Page 82: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/82.jpg)
Bacterial Endocarditis - AcuteBacterial Endocarditis - Acute
Penicillin G or Ampicillin +gentamicin
Nafcillin +rifampin
Vancomycin
![Page 83: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/83.jpg)
Case studiesCase studies
![Page 84: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/84.jpg)
7 y.o. Girl7 y.o. Girl
Chief Complaint Dysuria and urinary frequency x 2 days No fever, flank pain, trauma, hematuria (gross),
or emesis
Physical Exam Mild suprapubic tenderness T-37.0, P-71
![Page 85: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/85.jpg)
7 yr old girl7 yr old girl
Dx?
Tests?
![Page 86: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/86.jpg)
7 y.o. Girl7 y.o. Girl
UA 100-200 WBC/hpf 5-10 RBC/hpf
Urine Gram Stain 15-25 gram negative rods/hpf
Specimen sent for culture
RX: ____________________
![Page 87: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/87.jpg)
7 y.o. Girl7 y.o. Girl
Culture Grew
>100,000 ml E. coli sensitive to amoxicillin, sulfa, cefazolin, ciprofloxacin
![Page 88: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/88.jpg)
7 y.o. Girl7 y.o. Girl
Recommended
IVP
Voiding cystogram
Cystoscopy
![Page 89: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/89.jpg)
27 y.o. Male Pediatric Resident27 y.o. Male Pediatric Resident
Chief Complaint Cough, chest pain, fever x 2 days, headache
History of Present Illness “URI” symptoms for several days Developed nonproductive cough and fever Day before admission noted right-sided
pleuritic pain and cough productive of blood-tinged sputum
![Page 90: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/90.jpg)
27 y.o. Male Pediatric Resident27 y.o. Male Pediatric Resident
Physical Exam
Moderately ill
VSS, Temp - 103ºF
Chest - fine, moist rales RLL posteriorly
![Page 91: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/91.jpg)
27 yr old male pediatric resident27 yr old male pediatric resident
Dx? Tests?
![Page 92: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/92.jpg)
![Page 93: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/93.jpg)
27 yr old pediatric resident27 yr old pediatric resident
WBC-8,700/ul Legionella urinary antigen-neg Pneumococal urinary antigen-neg C-reactive protein-4.5 mg/dL
![Page 94: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/94.jpg)
27 y.o. Male Pediatric Resident27 y.o. Male Pediatric Resident
Gram Stain (sputum) Many PMNs Few (+) cocci Occasional (-) rod
RX: ___________________
![Page 95: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/95.jpg)
27 y.o. Male Pediatric Resident27 y.o. Male Pediatric Resident
Sputum culture - grew normal flora
![Page 96: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/96.jpg)
54 y.o. Female54 y.o. Female
Chief Complaint Pain in right leg, chills and fever
History of Present Illness Hx of phlebitis, now has chronic edema, especially
right leg 18 hours prior to admission noted pain in leg that
became progressively worse Few hours later noted redness, swelling & blisters;
then chills and fever developed
![Page 97: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/97.jpg)
54 y.o. Female54 y.o. Female
Physical Exam VSS, Temp 102.6ºF Right leg indurated, erythematous, swollen,
large bullae from ankle to knee
![Page 98: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/98.jpg)
![Page 99: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/99.jpg)
54 yr old female54 yr old female
Dx? Tests?
![Page 100: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/100.jpg)
54 yr old female54 yr old female
WBC-14,600 CRP-18.2 Blood cultures x 2-results pending Wound culture-moderate WBC, moderate
Gram + cocci
Rx_____________
![Page 101: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/101.jpg)
54 y.o. Female54 y.o. Female
Blood culture and culture of skin lesions grew Group A beta hemolytic streptococci
Patient improved with parenteral clindamycin and warm packs
![Page 102: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/102.jpg)
69 y.o. Male69 y.o. Male
Chief Complaint Fever, cough, pain in left leg
History of Present Illness 10 days PTA fever and cough productive
of purulent sputum 8 days PTA severe pain left knee 7 days PTA knee swollen, very hot and
tender
![Page 103: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/103.jpg)
69 y.o. Male69 y.o. Male
Physical Exam
Acutely ill, dyspneic
VSS, Temp – 103.6ºF
Chest - rales left mid lung field, posteriorly
Left knee - swollen, tender, erythematous, hot
![Page 104: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/104.jpg)
69 yr old male69 yr old male
Dx? Tests?
![Page 105: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/105.jpg)
![Page 106: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/106.jpg)
69 yr old male69 yr old male
WBC-17.600 CRP-25.6 Blood cultures x 2 –results pending Creatinine-1.1 Other tests?
![Page 107: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/107.jpg)
69 y.o. Male69 y.o. Male
Arthrocentesis Turbid fluid 70,000 WBC, 95% PMNs Sugar - 15 mg% Protein - 6 grams %
Gram Stain (+) cocci, in pairs
RX: __________________
![Page 108: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/108.jpg)
![Page 109: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/109.jpg)
69 y.o. Male69 y.o. Male
Blood cultures and synovial fluid grew
Streptococcus pneumoniae
Patient was treated with ceftriaxone 2 gms IV q 24 hrs for 4 weeks
![Page 110: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/110.jpg)
56 yr old male56 yr old male
Chief complaint : abdominal pain and fever
HPI: 3 days of increasing abdominal pain, mild diarrhea, and fever to 100.4
![Page 111: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/111.jpg)
56 yr old male56 yr old male
P.E: T-38, BP-130/72, P-96, R-19 Lungs-clear, CV- RR, no murmur Abdomen- tender with rebound diffusely,
absent bowel sounds
![Page 112: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/112.jpg)
56 yr old male56 yr old male
Dx? Tests?
![Page 113: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/113.jpg)
56 yr old male56 yr old male
WBC-18,600 with 92% neutrophils Creatinine-1.8, BUN-34 AST-24 Other tests?
![Page 114: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/114.jpg)
56 yr old male56 yr old male
CT abdomen/pelvis-diverticula of sigmoid colon with inflammatory changes, paracolonic inflammatory mass, and peritoneal fluid.
Rx:______________
![Page 115: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/115.jpg)
56 yr old male56 yr old male
Blood cultures were negative Peritoneal cultures grew-E coli, Bacteroides
species, Fusobacterium species, Enterococcus faecalis, and Enterobacter cloacae
![Page 116: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/116.jpg)
56 yr old male56 yr old male
Patient recovered after surgical resection of the sigmoid colon with formation of a colostomy and peritoneal irrigation combined with
Antibiotic therapy- metronidazole combined with ciprofloxacin and piperacillin/tazobactam for 10 days
![Page 117: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/117.jpg)
28 yr old female28 yr old female
Chief complaint: confusion HPI: lives alone, found by her friend in bed at
home this morning-confused, weak, unsteady on feet, speaking in nonsensical sentences
![Page 118: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/118.jpg)
28 yr old female28 yr old female
Physical exam: T-37, BP 122/63. P-73, R-16 Lungs-clear, CV-RR, no murmur, Abd-soft,
non-tender Neuro-neck supple, expressive aphasia,
DTRs-equal and reactive, toes down-going bilaterally
![Page 119: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/119.jpg)
28 yr old female28 yr old female
Dx? Tests?
![Page 120: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/120.jpg)
28 yr old female28 yr old female
CSF- WBC 34 with 72% mononuclear, RBC 75, glucose-64, protein-45
CSF- gram stain – few WBC, no bacteria seen
CT brain- normal Additional tests?
![Page 121: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/121.jpg)
28 yr old female28 yr old female
MRI brain- enhancement of the temporal region on the left
Rx:__________________
![Page 122: Selection of Antibiotics for Empiric Therapy in Clinical Practice Linda L. Van Etta, MD, FACP](https://reader034.vdocuments.net/reader034/viewer/2022051416/56649e165503460f94b01494/html5/thumbnails/122.jpg)
28 yr old female28 yr old female
CSF PCR was positive for herpes simplex
Patient recovered with intravenous acyclovir-10 mg/kg IV q 8 hrs for 21 days