Antibotics

[jarjar5606]

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Can Zosyn iv and Flagyl iv be used together? Is there any need for double anaerobes coverage? PO Flagyl is for C.diff, why two ABX for anaerobes? What about Rocephin with Merrem? Any need for two beta-lactam abx? Or they should never be used together? I always thought they should never be used, why are MDs writing them?

 

[bacillus1]

I would say no to Rocephin and Merrem. I believe there are cases when Flagyl and Zosyn can be used together. I believe in intraabdominal infections you can use Flagyl and a beta lactam. Also if you have C. Diff and another infection for which Zosyn is warranted, you could use the combo.

 

[KARM12]

Are they treating c. diff? Anaerobe resistance is very rare, so double covering in the majority of cases does not make sense.

 

[rsrx74]

Basically, the only time it would be appropriate to use metronidazole and pip-tazo together is if you are using the metronidazole for C.diff coverage. Otherwise, double anaerobic coverage totally unnecessary. Pip-tazo gets fantastic anaerobic coverage.

As for ceftriaxone and meropenem, I don't see what you would be covering with ceftriaxone that meropenem does not cover. Either way, I hate carbapenems - that's all.

 

[Brunsizzle]

Can Zosyn iv and Flagyl iv be used together? Is there any need for double anaerobes coverage? PO Flagyl is for C.diff, why two ABX for anaerobes? What about Rocephin with Merrem? Any need for two beta-lactam abx? Or they should never be used together? I always thought they should never be used, why are MDs writing them?

Just going through this now. Current treatment guidelines for C diff is PO flagyl 500mg x10-14days for mild/moderate. Oral Vanco 125mg x10-14 days for severe. And combo oral vanco/enema vanco/IV flagyl for severe/complicated (toxic megacolon or ileus). Zosyn was probably treating another infection?

"As for ceftriaxone and meropenem, I don't see what you would be covering with ceftriaxone that meropenem does not cover. Either way, I hate carbapenems - that's all." -Agree, kinda stumped on this.

 

[njac]

Unsure as to why for the Meropenem/Ceftriaxone; it's not like Meropenem doesn't get in the CNS...

 

[xiphoid2010]

Unsure as to why for the Meropenem/Ceftriaxone; it's not like Meropenem doesn't get in the CNS...

Correct. I'm not aware of any reason for mero + rocephin. Rocephin is a first line for meningitis, but mero is also the only carbapenem approved for it.

Question for residents, and what Meropenem dosage should be used for meningitis?

Zosyn + flagyl makes sense for clostridum infections. Remember, Zosyn covers bacteroides, but not clostridum. Vanco only covers gram+ anaeobes, which is why PO vanc covers clostridum but not bacteroides. Flagyl covers only anaeobes because it works by producing radicals, which is inactivated by oxygen.

See, antibiotics makes sense. Can't say the same for oncology regimens why a lot is just based on clinical trial outcomes data.