Which antibiotic for this infected burn? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 07-15-2010
doctorF's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 316
Threads: 68
Thanked 408 Times in 110 Posts
Reputation: 428
Drug Which antibiotic for this infected burn?

A 43-year-old electrician suffers third-degree burns over 40% of his body following an electric shock. One week following admission he is recovering uneventfully but develops a fever. Within 24 hours, he develops severe hypotension requiring pressors. The intensivist notes a sickly sweet odor and purulence on the patientís wounds. Which antibiotic regimen should be empirically initiated?
A. Vancomycin and ciprofloxacin
B. Vancomycin and amikacin
C. Ceftriaxone
D. Piperacillin and tazobactam
E. Cefepime and gentamicin
__________________
Why does Good luck often carries more weightage than hard work in successes???
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
dr-ahmed (07-15-2010)



  #2  
Old 07-15-2010
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 6
Threads: 3
Thanked 0 Times in 0 Posts
Reputation: 10
Default

staph.aureus is most common cause of infection in the 1st wk,and pseudomonas aeruginosa is the most common cause of infection in the 2nd wk in pts with burns,,so i will go for A
Reply With Quote Quick reply to this message
  #3  
Old 07-15-2010
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 68
Threads: 5
Thanked 47 Times in 29 Posts
Reputation: 57
Default

I choose E, since they are good/perhaps the best choice anti psuedomonals on the list.
Reply With Quote Quick reply to this message
 
  #4  
Old 07-15-2010
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 25
Threads: 2
Thanked 12 Times in 9 Posts
Reputation: 22
Post E. Cefipime and Gentamicin

Even though Piperacillin is an antipseudomonal, and works well with a B-Lactamase inhibitor Tazobactam against pseudomonas, and other B-lactamase producing strains as staph aureus, burns units usually have multi drug resistant Pseudomonas strains, and it is essential that an aminoglycoside is added to the treatment protocol.

E: Cefipime and Gentamicin are the best option here
Reply With Quote Quick reply to this message
  #5  
Old 07-15-2010
Seetal's Avatar
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 919
Threads: 134
Thanked 1,324 Times in 364 Posts
Reputation: 1347
Send a message via MSN to Seetal
Default

i strongly wanted to choose D (just because of piperacilin), but tmsid's explanation is pushing me towards E now, because the 2 combinations combats pseudomonas synergistically.
Reply With Quote Quick reply to this message
  #6  
Old 07-15-2010
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 68
Threads: 5
Thanked 47 Times in 29 Posts
Reputation: 57
Default

Quote:
Originally Posted by Seetal View Post
i strongly wanted to choose D (just because of piperacilin), but tmsid's explanation is pushing me towards E now, because the 2 combinations combats pseudomonas synergistically.
For all USMLE style questions, when Pseudomona is the potential culprit, always choose the option w/ two effective anti-pseudomonals. Yes, Piperacillin works most the time, but so does an aminoglycoside + a 4th gen cephalosporin (Cefepime). It's like in war; 2 tanks are better than 1, 2 battle cruisers > 1 and lastly, $100 is better than $50 dollars.
Reply With Quote Quick reply to this message
The above post was thanked by:
shaheer (08-12-2010)
  #7  
Old 07-15-2010
doctorF's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 316
Threads: 68
Thanked 408 Times in 110 Posts
Reputation: 428
Default

The correct answer is E.

In a burn patient, a sweet odor ("grape-like") with rapid onset of septic shock (fever, hypotension) is highly concerning for Pseudomonas infection. Pseudomonal infections should be managed with a combination of extended-beta lactam antibiotics plus aminoglycosides. This combination is synergistic, enhancing the activity of both antibiotics. It also decreases rates of resistance, which is a significant problem in managing nosocomial Pseudomonal infections.

Effective antipseudomonal beta lactams include: cefepime, ceftriaxone, and piperacillin-tazobactam. Examples of aminoglycosides are: gentamicin, amikacin, tobramycin. Vancomycin is not effective against Pseudomonas.
__________________
Why does Good luck often carries more weightage than hard work in successes???
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message



Reply

Tags
Pharmacology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
appropriate antibiotic? sam01 USMLE Step 1 Forum 9 05-01-2010 11:11 AM
Which factor deficiency after antibiotic courses? HouseWannabe USMLE Step 1 Forum 9 04-21-2010 09:21 AM
Infected Microbiology Experiment? sam01 USMLE Step 1 Forum 4 04-13-2010 04:44 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)