Antibiotics _ Jan2018

60 yr old male, diagnosis-perforated appendix, empirically started on Piperacillin-Tazobactam + Metronidazole. C/S report on day 2 shows Klebsiella (ESBL) resistant to Piperacillin-Tazobactam and sensitive to all carbapenems. What is the most appropriate next step?

Change to Imipenem 500mg qid + Metronidazole

Change to Ertapenem 1gm OD + Metronidazole

Increase the dose of Pip/Tazo and add Ertapenem

Monotherapy with Ertapenem 1gm OD

Which of the following about Antibiotic stewardship is Most correct option?

It incorporates Local data, Risk stratification and De-escalation

ID Physician, Clinical microbiologist, Pharmacist are integral parts of ABS team

Antimicrobial stewardship includes fungal infection management also

All are True, No statement is false

Which of the following is not an example of complicated UTI?

UTI due to Stone/Stricture

UTI due to Catheter/BPH

UTI in Neutropenic / UTI in chronic renal failure

Cystitis in 26 year old, newly married female

C and d

Which of the following statements about beta lactamases is false?

Amp C and OXA strains are mostly resistant to BL + BLIs

SHV-15 is most common ESBL variant in India

Metallo-beta-lactamases are usually resistant to carbapenems

CTX-M variant of ESBL is common even in community

In which of the following cases BL + BLIs should be avoided?

Which of the following is not an example of complicated IAI?

Which is/are the common pathogens responsible for cIAI?

E.coli

S.Aureus

B.fragilis

All of the above

What does MIC stand for?

Minimum Inhibitory Calculation

Making Initial Choice

Minimum Inhibitory Concentration

Maximum inhibitory Concentration

The MIC is the lowest concentration of an antibiotic that inhibits the visible growth of bacteria and can be determined by the Etest or broth dilution tests

True

False

Which of the following are risk factors for ESBL infection?

Which of the following is NOT a common mechanism of resistance in gram negative bacteria?

Target site modification

Beta lactamase production

Efflux pumps

Porin loss

The phase 3 clinical trials of Zerbaxa were

Randomized Retrospective Non inferiority

Non fandomized Retrospective non inferiority

Randomized Prospective non inferiority

Randomized Prospective superiority

What was the comparator drug used in ASPECT cIAI trial?

Meropenem

Ampicillin

Vancomycin

What was the primary endpoint of ASPECT cIAI clinical trial?

Clinical cure rates at the test-of-cure visit

Composite cure rates at the test-of-cure visit

Microbiological eradication rates at the test-of-cure visit

Safety endpoints including adverse events

What was the primary endpoint of ASPECT c-UTI clinical trial?

Clinical cure in the microbiological modified intention-to-treat (MITT) population

Composite cure in the microbiological modified intention-to-treat (MITT) population

Microbiological eradication in the microbiological modified intention-to-treat (MITT) population

Safety endpoints including adverse events

Zerbaxa is active against which of the following:

Ceftolozane/Tazobactam is indicated for which of the following infections in adults:

Which of the following types of bacteria is Zerbaxa not active against in vitro:

Enterococcus faecalis

Enterococcus faecium

Staphylococcus aureus

All of the above

Which of the following is not an adverse event occurring in >3% of patients administered Zerbaxa in clinical trials:

Clostridium difficile colitis

Headache

Nausea

Diarhhoea

Ertapenem has activity against:

Gram negative aerobe

Gram positive aerobe

Anaerobes

All of the above

Ertapenem do not have stability to hydrolysis against

Penicillinases

Cephalosporinases

ESBL

Metallo beta lactamases

No dose adjustment of Ertapenem is necessary for patients with creatinine clearance more than

100 mL/min/1.73m2

50 mL/min/1.73m2

30 mL/min/1.73m2

10 mL/min/1.73m2

Which of the following statements about Ertapenem is true ?

It belongs to group 2 carbapenem

Enterococcus is covered in ertapenem's spectrum

The normal dose of Ertapenem by I/M injection is 500mg

The dose of Ertapenem in children is 15mg/kg BD

Following are the advantages of Ertapenem over BL+BLIs except ?

BL+BLIs undergo more inoculum effect than Ertapenem

Ertapenem can be given in Amp C but BL+BLIs cant

Ertapenem can be given for Mixed infections but not Pip/Tazo

Ertapenem causes lesser collateral damage than Pip/Tazo

Both c and d

Ertapenem has activity against which organisms

Streptococcus pneumonia

H.influenzae

E.coli

All of the above

Ertapenem acts by binding to

30s ribosome

50s ribosome

Penicillin binding protein

None of the above

Which of the following statements about Ertapenem is False ?

It is the only Gp 1 carbapenem in the market

Amp C are covered by ertapenem

UTI and DFI are most appropriate indications for OPAT with Ertapenem

Ertapenem cannot be given for patients with renal failure

Ertapenem has activity against following organisms

1)Streptococcus pneumonia

2) Pseudomonas aeuroginosa

3) Bacteroides fragalis

4) Klebsiella pneumonia

1,2,3

1,3,4

2.3.4

1,2,4

Ertapenem should NOT be diluted with

Sterile water

0.9% Sodium chloride

Dextrose containing solution

None

Clinical trials on Ertapenam are .

ASPECT cIAI and cUTI

OASIS I and II

PACTS

None of the above

Antibiotics _ Jan2018

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