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  #1  
Old 06-02-2012
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Lungs what is emperic treatment in lung abscess ?

A 45-year-old woman is evaluated for fever, diminished appetite, weight loss, and cough productive of foul-smelling
sputum of 2 weeks' duration. She has a history of chronic alcoholism and frequent hospital admissions for alcohol withdrawal seizures, with the most recent episode occurring 3 weeks ago.
On physical examination, temperature is 38.3 C (101.0 F), blood pressure is 130/84 mm Hg, pulse rate is 80/min, and
respiration rate is 18/min. Her breath is foul smelling and dentition is poor. Pulmonary examination reveals crackles and
rhonchi in the right anterior chest.
Laboratory studies indicate a leukocyte count of 12,500/μL (12.5
109/L) with 8% band forms. The chest radiograph shows cavitary lesion.
Sputum Gram stain results indicate gram-positive cocci in
chains, gram-negative bacilli, and gram-positive bacilli.

Which of the following empiric antimicrobial regimens should be initiated?

(A) Ampicillin-sulbactam
(B) Aztreonam
(C) Ceftriaxone
(D) Levofloxacin
(E) Metronidazole
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Old 06-02-2012
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sputum culture is always misleading as it will always show organisms.

H/O seizures favors aspiration and high possibility of ANAEROBIC infection
(plus poor dentition/ foul smelling sputum etc)

anaerobes are treated with either PENICILLINs / clindamycin if above diaphragm
and metro if below diaphragm

so in this case answer shud be
AMPICILLIN - SULBACTAM
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Old 06-02-2012
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Levo might work ?
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  #4  
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Quote:
Originally Posted by mbbs2010 View Post
sputum culture is always misleading as it will always show organisms.

H/O seizures favors aspiration and high possibility of ANAEROBIC infection
(plus poor dentition/ foul smelling sputum etc)

anaerobes are treated with either PENICILLINs / clindamycin if above diaphragm
and metro if below diaphragm

so in this case answer shud be
AMPICILLIN - SULBACTAM
ya thats correct. awesome expln dude.

never knw that amp-sulbactam can be good cover for anerobes. do you know more anerobic coverage..or it ends with these 3 drugs...amp-sulbactam.clinda.metro ?

btw, metro is not ans because it does not cover anerobic microaerophillic strep which is part of organism causing lung abscess.
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Quote:
Originally Posted by tyagee View Post
ya thats correct. awesome expln dude.

never knw that amp-sulbactam can be good cover for anerobes. do you know more anerobic coverage..or it ends with these 3 drugs...amp-sulbactam.clinda.metro ?

btw, metro is not ans because it does not cover anerobic microaerophillic strep which is part of organism causing lung abscess.
page 8 MTB for CK

anaerobes :

oral(above diaphragm)
penicillin (g, ampicillin, amoxicillin, V)
clindamycin

abdominal/git
Metronidazole
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Quote:
Originally Posted by tyagee View Post
ya thats correct. awesome expln dude.

never knw that amp-sulbactam can be good cover for anerobes. do you know more anerobic coverage..or it ends with these 3 drugs...amp-sulbactam.clinda.metro ?

btw, metro is not ans because it does not cover anerobic microaerophillic strep which is part of organism causing lung abscess.
In general all Penicillins are good for anaerobes.

MTB 3 Page 4:

Anaerobes:

GIT (Bacteroides):

1. Metro is the best for GI anaerobes.
2. Carbipenams, Ticarcillin and pipracillin are equal in efficacy to Metro for abd anaerobes.
3. Cefoxitin & Cefotetan are the ONLY cephalosporins which covers anaerobes.

Respiratory Anaerobes( Anaerobic strep):

1. Clindamycin is the best against anaerobic strep.
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  #7  
Old 06-04-2012
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,

B-Lactam/B-Lactamse inhibitor combinations have strong anaerobic coverage comparable to Metronidazole

Piperacillin/Tazobactam
Amoxicillin/Clavulanate
Ampicillin/Sulbactum
Ticarcillin/Clavulanate
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  #8  
Old 06-05-2012
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e
Quote:
page 8 MTB for CK

anaerobes :

oral(above diaphragm)
penicillin (g, ampicillin, amoxicillin, V)
clindamycin

abdominal/git
Metronidazole
Quote:
MTB 3 Page 4:

Anaerobes:

GIT (Bacteroides):

1. Metro is the best for GI anaerobes.
2. Carbipenams, Ticarcillin and pipracillin are equal in efficacy to Metro for abd anaerobes.
3. Cefoxitin & Cefotetan are the ONLY cephalosporins which covers anaerobes.

Respiratory Anaerobes( Anaerobic strep):

1. Clindamycin is the best against anaerobic strep.

B-Lactam/B-Lactamse inhibitor combinations have strong anaerobic coverage comparable to Metronidazole

anything else for anerobes ? or this is complete
  • clinda.metro
  • penicilins [ampicillin-sulbactam,cefoxitin,cefotetan]
  • antipseudomonals [Carbipenams, Ticarcillin and pipracillin]
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