Would you have filled this?

[Its Z]

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Not necessarily. http://www.ncbi.nlm.nih.gov/pubmed/15620440 There are several studies like this one that have shown increasing FQ susceptibilities when they take them away and put them on ID restriction.

There is hope!

what are you... a FQ Crusader?

 

[Praziquantel86]

Cipro is a No No for CAP empiric treatment.

I know...the NP was going of of Davis' or some such thing that recommended a respiratory quinolone (good). She picked Cipro (not so good).

 

[Socrates25]

First off, I have to question the original diagnosis of an "ear infection" at 7 weeks old. Diagnosing otitis in that age group is unusual and its fairly hard to do considering how narrow the ear canals are. At any rate, assuming the kid had fevers he should have been admitted to a hospital for at LEAST blood and urine work, and probably should have gotten a lumbar puncture as well. Standard 48 hour sepsis work-up w/ IV antibiotics (ceftriaxone 100mg/kg q24h or amp/gent).

The rate of cross-allergenicity between later generation cephalosporins and penicillin is low enough that I would still prescribe it, provided that the mother was savvy enough to monitor for problems and take quick action if there was an issue. Yes, you can use azithromycin but IMHO thats clearly an inferior 2nd line agent for otitis.

I wouldnt use cipro for otitis, but I think the risk of tendon rupture cited in dog studies is way overblown; we can and do use fluoroquinolones in the pediatric world when there's not another good agent available. I've never seen any adverse reactions to it. The doses that result in tendon rupture are higher than anything we would use in kids anyways from the studies I've seen about it.

 

[kvl1027]

and if you see a community doc prescribing Cipro for CAP, let me in on that lawsuit...

What do you call a patient with community acquired pneumonia on Cipro?

dead patient.

I had a pt the other day tell me her doc put her on cipro for an URTI...tisk tisk.

 

[KARM12]

Cipro is a No No for CAP empiric treatment.

Is there a pharmacy student in the house that can tell us why?

 

[njac]

Is there a pharmacy student in the house that can tell us why?

pshhh! I already asked that!

 

[Jbuprepharm]

Is there a pharmacy student in the house that can tell us why?

well, I just graduated, but it's a coverage issue, Cipro is crummy for gram + bugs, which are the most likely cause of CAP

however, appropriately dosed IV Cipro, 400 BID I think, is fine for HCAP/VAP etc as it covers the gram - bugs that may be involved (edit: as a part of combo therapy obviously)