Which antibiotic for this infected burn?

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

I choose E, since they are good/perhaps the best choice anti psuedomonals on the list.

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

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.

Seetal said:

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.

Click to expand...

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.

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.