Cipro, ertapenem or beta-lactam +macrolide?

[minette]

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Hey, I know you are watching the super bowl, but please help me!!

Pt has CAP and admitted to the ER
Allergies: PCN (rash), norfloxacin (gait unsteadiness)
Acoording to the CDC guidelines, inpatient non-ICU treatment is: a respiratory fluoroquinolone
or a beta-lactam+macrolide (preferred beta lactam agents include cefotaxime, ceftriaxone, and ampicillin; with doxycycline[level 3 evidence] as an alternative to the macrolide. Respiratory fluoroquinolone should be used for PCN-allergic pts.

My Q: Pt is allergic to norfloxacin, so i don't think i could give him Cipro (might be a cross reactivity of unknown severity according to micromedex)
Pt is allergic to PCN, so beta lactam is not good; but it was only a rash...do u think i could still recommend b-lactam + macrolide?

 

[cycloketocaine]

Hey, I know you are watching the super bowl, but please help me!!

Pt has CAP and admitted to the ER
Allergies: PCN (rash), norfloxacin (gait unsteadiness)
Acoording to the CDC guidelines, inpatient non-ICU treatment is: a respiratory fluoroquinolone
or a beta-lactam+macrolide (preferred beta lactam agents include cefotaxime, ceftriaxone, and ampicillin; ertapenem for selected patients; with doxycycline[level 3 evidence] as an alternative to the macrolide. Respiratory fluoroquinolone should be used for PCN-allergic pts.

My Q: Pt is allergic to norfloxacin, so i don't think i could give him Cipro (might be a cross reactivity of unknown severity according to micromedex)
Pt is allergic to PCN, so beta lactam is not good; but it was only a rash...do u think i could still recommend b-lactam + macrolide? or should i go with ertapenem?

🙂

 

[VA Hopeful Dr]

Hey, I know you are watching the super bowl, but please help me!!

Pt has CAP and admitted to the ER
Allergies: PCN (rash), norfloxacin (gait unsteadiness)
Acoording to the CDC guidelines, inpatient non-ICU treatment is: a respiratory fluoroquinolone
or a beta-lactam+macrolide (preferred beta lactam agents include cefotaxime, ceftriaxone, and ampicillin; ertapenem for selected patients; with doxycycline[level 3 evidence] as an alternative to the macrolide. Respiratory fluoroquinolone should be used for PCN-allergic pts.

My Q: Pt is allergic to norfloxacin, so i don't think i could give him Cipro (might be a cross reactivity of unknown severity according to micromedex)
Pt is allergic to PCN, so beta lactam is not good; but it was only a rash...do u think i could still recommend b-lactam + macrolide? or should i go with ertapenem?

Ertapenem is also a b-lactam.

If this were my patient, with only a rash to PCN, I'd go with rocephin and zithromax.

 

[deleted205891]

Is gait unsteadiness a true allergy? I don't really think so. Cipro isn't really a respiratory FQ. Why not try levaquin?

 

[njac]

If hes sick enough to get admitted I'm all about the ceftriaxone + azithro.

 

[njac]

Ertapenem is also a b-lactam.

If this were my patient, with only a rash to PCN, I'd go with rocephin and zithromax.

Is it? How is the cross reactivity between beta lactams and carbepenems?

 

[J ROD]

Is it? How is the cross reactivity between beta lactams and carbepenems?

yeah, but not that great....

 

[J ROD]

The cross reactivity is low for the PCN allergy....so I would give the Rocephin and Zithromax....

and monitor for rash......if rash occurs, then I would switch over to Avelox or Levaquin because the gait unsteadiness is not that bad of an adverse reaction to the medication to make me not give it in this case.

 

[ethyl]

Levaquin and a ceph (Cipro is not a respiratory FQ). Don't really mind if he walks 'unsteadily' if he's admitted. 😳

 

[nnguyenc]

man ... i was way off


i was thinking vicodin the whole time

 

[npage148]

Avelox and out the door.

 

[Praziquantel86]

Colistin + chloramphenicol. Can't rule out multiple MDR organisms.

 

[Sparda29]

Wats the offending bug here? Or are you looking for empirical treatment?

 

[Requiem]

Wats the offending bug here? Or are you looking for empirical treatment?

What do you think it is? It's a patient in the ER.

Think he mailed in a sputum sample two days before admission?

 

[VA Hopeful Dr]

Colistin + chloramphenicol. Can't rule out multiple MDR organisms.

True enough, but we usually don't worry too much about the more uncommon resistances at presentation. That'd be why we get cultures.

 

[Praziquantel86]

True enough, but we usually don't worry too much about the more uncommon resistances at presentation. That'd be why we get cultures.

I was kidding...

 

[VA Hopeful Dr]

I was kidding...

I was afraid of that, being on OB call makes a person stupid (ie. me). And after I called out someone in the other thread for that exact same mistake. My apologies.

Oddly enough, our hospital is using a concerning amount of colistin these days. Damn pseudomonas.

 

[sleazye]

The cross reactivity is low for the PCN allergy....so I would give the Rocephin and Zithromax....

and monitor for rash......if rash occurs, then I would switch over to Avelox or Levaquin because the gait unsteadiness is not that bad of an adverse reaction to the medication to make me not give it in this case.

Levaquin and a ceph (Cipro is not a respiratory FQ). Don't really mind if he walks 'unsteadily' if he's admitted. 😳

i may be missing something here but what is the rationale for empiric double coverage in this CAP patient?

 

[npage148]

i may be missing something here but what is the rationale for empiric double coverage in this CAP patient?

Here is my canned Z-pack fact finding answer.

"What are the common bugs that cause CAP and what are they sensitive to?"

 

[sleazye]

Here is my canned Z-pack fact finding answer.

"What are the common bugs that cause CAP and what are they sensitive to?"[/QUOTE

exactly, that's what I was getting at. almost always S. pneumo, followed by atypicals and h. flu. so why double cover? anyone for doxy?

 

[Rebel78]

Levaquin and a ceph (Cipro is not a respiratory FQ). Don't really mind if he walks 'unsteadily' if he's admitted. 😳

Winner chicken dinner!