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Chapter 20. Antimicrobial Regimen Selection

Select the antimicrobial that may cause collateral damage by selecting for a nontargeted organism (ie, Clostridioides difficile) leading to a colitis infection. Select all that apply.

a. Clindamycin

b. Levofloxacin

c. Ciprofloxacin

d. Ceftriaxone

Clostridioides difficile (also known as Clostridium difficile or C. difficile) is a species of gram-positive bacteria of the genus Clostridium. Clostridia are anaerobic, spore-forming rods (bacillus). C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. The C. difficile bacteria, which naturally reside in the body, become overpopulated. The overpopulation is harmful because the bacterium releases toxins that can cause bloating, constipation, and diarrhea with abdominal pain, which may become severe. Discontinuation of causative antibiotic treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice. Relapses of C. difficile AAD have been reported in up to 20% of cases.

Answer a is correct. Clindamycin may cause/select for a C. difficile infection.

Answer b is correct. Levofloxacin may cause/select for a C. difficile infection.

Answer c is correct. Ciprofloxacin may cause/select for a C. difficile infection.

Answer d is correct. Ceftriaxone may cause/ select for a C. difficile infection.

Select the correct dose of cefepime (Maxipime) for a patient with normal renal function and empirically treated for an infection (at this time the site or source of infection has not been identified). Select all that apply.

a. 1 g IV every 12 hours

b. 2 g IV every 12 hours

c. 2 g IV every 8 hours

d. 4.5 g every 6 hours

Answer a is correct. Cefepime 1 g every 12 hours may be utilized for patients with community-acquired pneumonia and urinary tract infection (UTIs).

Answer b is correct. Cefepime 2 g every 12 hours may be utilized for patients with intra-abdominal infections, skin and skin structure infections, and UTIs.

Answer c is correct. Cefepime 2 g every 8 hours may be utilized for patients with febrile neutropenia and suspected-resistant pathogens (ie, Pseudomonas aeruginosa infections)

All of the above doses of cefepime may be utilized, depending upon the site of infection and the potential for bacterial resistance. High doses of cefepime are often utilized empirically, especially when ...

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