abx question

[njac]

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This came up my last day of my MICU rotation and I didn't get a chance to ask the attending about it further.

Patient had GI funk - this was about 6 weeks ago so I don't remember specifics. I think we originally were worried about a cholecystitis but then an ERCP showed nothing, but he had a tense belly and was overall not doing well.

I was taught that for peritoneal-type stuff that Flagyl + ceftriaxone/Cipro/cefotaxime was more than adequate. The Cephalosporins have the advantage of not wasting Pseudomonas coverage.

However, the attending was adamant that cefepime is better for abdominal infxns. It has pseudomonas coverage that ceftriaxone/cefotaxime do not, but does anyone know of any further advantages in this setting? And is pseudomonas an issue looking at a community acquired (pt hadn't seen a Dr in >20 years) infection?

 

[prevacid]

as far as i can remember, flagyl + cefoxitin was the 2 drugs used to cover

to use cefepime? i guess the clinical guys would have to shed light on that
i dont think itd be necessary unless the pt is neutropenic, psuedomonas rates are high in the area, etc

 

[WVUPharm2007]

So...wtf...was it peritonitis...or...?

I'm thinking with something so indescript, it's hard to tell where the bug infiltrated from, so empirical therapy with a broad-ass spectrum drug like cefepime might be a good idea until you can isolate n' concentrate.

But what the hell do I know.

 

[njac]

in the end he died of pancreatic ca. he hadn't been to the dr in decades and it was pretty impressive on CT.

I was not privy to autopsy results.

 

[WVUPharm2007]

Well, right there's the problem...cefepime doesn't cover pancreatic cancer.

 

[bigpharmD]

we usually add pseudomonal cov. if they are at risk...ie in the hospital for a long time etc. but at that point why not just use zosyn instead of cefepime/flagyl...guess it just depends on you institution....we currently have a guy growing klebsiella pneu. from the peritoneal fluid that is hodge test positive, meaning it is resistant to carbapenems....😡

 

[StaviZFingerZ]

Zosyn 3.375g q6h costs 80 bucks. Cefepime 2g q12h and flagyl cost 30.

 

[Omegadramon]

Well, right there's the problem...cefepime doesn't cover pancreatic cancer.

Why did I laugh....for like 5 minutes.

 

[PharmDstudent]

we usually add pseudomonal cov. if they are at risk...ie in the hospital for a long time etc. but at that point why not just use zosyn instead of cefepime/flagyl...guess it just depends on you institution....we currently have a guy growing klebsiella pneu. from the peritoneal fluid that is hodge test positive, meaning it is resistant to carbapenems....😡

If only those "little attached garages" would stop caving...

 

[rxforlife2004]

if only those "little attached garages" would stop caving...

nerd!

Best choice in this case would be Flagyl+ maxipime...