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?
More than one type of ESBLs present
ESBL + Amp C
When the inoculum is high
Both b and c
All the above
Which of the following is not an example of complicated IAI?
Acute Cholecystitis with rupture
Acute appendicitis with perforation
Intra-abdominal abscess
Generalized peritonitis
None of the above
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 antibiotic is NOT a Beta lactam antibiotic?
Piperacillin
Aztreonam
Meropenem
Cefepime
Azithromycin
Which of the following are risk factors for ESBL infection?
Past history of hospital admission
Past history of 2nd and 3rd gen cephalosporins
Comorbidities like Diabetes
None of the above
All of the above
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
Which of the following is NOT a common mechanism of Resistance in Pseudomonas?
KPC
OXA
Efflux Pumps
Porin loss
Amp C
A and b
D and e
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
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:
ESBL producing strains of E. coli
ESBL producing strains of K. pneumoniae
MDR P. aeruginosa
All of the above
None of the above
Ceftolozane/Tazobactam is indicated for which of the following infections in adults:
Complicated IAI
Complicated UTI
Acute pyelonephritis
All of the above
None of the above
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
Ertapenem can be administered as
Intravenous infusion
Intramuscular injection
Subcutaneous injection
Both a) and b)
All of the above
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
Ertapenem needs dose adjustment in
Hepatic Insufficiency
Renal Insuffciency
None
Both
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