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CCS Antibiotics -- broad coverage?

Discussion in 'Step III' started by rlwebb, Feb 14, 2012.

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  1. rlwebb

    rlwebb Member 5+ Year Member

    Dec 22, 2005
    Any thoughts on overcoverage with antibiotics... eg. will you be penalized for treating a cellulitis with zosyn + vanco... the ultimate combo!! of course this is an overstatement but I do plan on overtreating rather than undertreating as there is NO WAY I can remember all the proper therapies... and I'd rather the patient not die. Any broad sweeping mnemonics to help with proper coverage? Eg. go-to drugs that work for a lot of situations. Thanks!
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  3. drbluedevil401


    Dec 2, 2010
    Yes, you should use the 'lowest' or most specific antibiotic in most cases, because the CCS emphasizes the proper use of resources, just because you can order any antibiotic doesnt mean you can and you will get penalized, I dont know if the case will end though, so try and use something similar but I wouldnt start out with vancomycin for pharyngitis, you can always start the routine antibiotic and then switch after cultures show up.

    I think the coverages that you need to know are : learn for both adult/child, sometimes they are the same.
    Pneumonia - Inpatient vs. Outpatient
    AIDS/ HIV - PCP, TOXO, atypical myco, cryptococcus.
    UTI/ Cystitits - pregnancy vs. regular adult(complicated vs. uncomplicated)
    Bowel Coverage for Abdominal surgeries
    Otitis Media
    Lyme Disease

    I think that covers almost 80 % of ID related to antibiotic of choice, i wrote down some cards and went over them every night for a week and most of it stuck.
    Good luck
  4. haresh


    Oct 8, 2011
    We may not lose score if we use higher antibiotics. But we will definitely lose score if lower antibiotic than that indicated is used. Examples : There are very poor management and giuve zero score : Using ciprofloxacin in pneumonia, using moxifloxacin in UTI, not using double gram negatives like quinolone and zosyn in hospital acquired pneumonia, not using indicated regimen in complicated pelvic inflammatory disease. In these conditions, they are really testing appropriate use of antibiotic. Sub optimal or poor antibiotic gets very low score.

    Simple Guidelines for antibiotic management of Sepsis/ Infections on a CCS case

    1)Pseudomembranous colitis/ C.Difficle Diarrhea : Metronidazole p.o. If resistant, use vanco p.o ( do not use I.V vanco – not effective) c.difficle

    2) Meningtitis, empiric : Bugs are S.pneumonia, H.influenzae, N.meningitidis, E.coli. Choice : Vanco+Ceftriaxone. If listeria suspected, add Ampicillin. Give Dexametasone prior to antibiotics In ages < 1month or > 50 years - think of Listeria Meningitis

    3) Urinary tract infections : Bugs are E.coli, proteus Enterococci - use Quinolone, ceftriaxone, extended spectrum beta lactums, if enterococci is present - use ampicillin or vancomycin.

    4) Intra abdominal infections ( diverticulitis etc) : Enteric gram –ve rods ( E.coli), Anerobes (B.fragilis) - Use good anerobic coverage : Cipro+flagyl if uncomplicated, Pip/tazo, Ertapenem, Imipenem if complicated. Do not use cephalosporin alone ( add metronidazole if using it)

    5) Community acquired pneumonia : Bugs are S.pneumoniae, Legionella, mycoplasma, H.influenzae - Use Third generation cephalosporin + macrolide or Newer Quinolone for inpatient therapy. For OP therapy, quinolone newer or macrolide

    6) Early Hospital Acquired Pneumonia ( < 5 days) : Bugs : Gram negative rods – non resistant ( e.coli, proteus, klebsiella), S.pneumonia, H.influenzae, legionella - use PIP/TAZO, Unasyn, Cefepime or newer quinolone

    7) Late Hospital Acquired Pneumonia ( > 5days) - Bugs are Resistant gram –ves (ESBL), Pseudomonas, MRSA - Use anti-pseudomonal drugs – PIP/TAZO + quinolone, Cefepime, Imipenem, Vancomycin (if MRSA suspected)

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