a****9
发帖数: 773 | 1 上周五，我OB的attending安慰了我两句有关申请的形势，还问我写下全名给他。
让我觉得非常激动。
今天他忽然问我cefepime和ceftriaxone的区别。我对英文名字实在不敏感，愣了下才
说cefepime对G- move coverage,他继续问，具体是哪个呢？我就说pseudomonas,他才
不问了。吓死我了，还好没有答错，不然就杯具了。其实这个是step 1, 2里面有的，
但才过了几个月，每看书竟然就记不清楚了。。。55555。我难道是老了，记忆力好烂
。。。
现在觉得考试考个好分数和实践还是很不一样的，看到病房里面轮转的medical
student看得和我们都是完全不一样的书。比如说Step up to medicine,MKSP,Case
files, Pocket Medicine什么的。不知道大家现在有人看这些书吗？ |
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L*****r
发帖数: 722 | 2
Aztreonam 的一个主要特色，是anti-pseudomonas 作用比levaquin强，且耐药性低。
当前抗生素应用的一个最常见的难点，是anti-pseudomonas，因为越来越多的multi-
drug resistance出现. Anti-pseudomonas antibiotics 如下:
1.Antipseudomonal penicillins (ticarcillin, piperacillin) , usually
plus beta-lactamase inhibitor (ticarcillin-clavulanate, piperacillin-tazobactam)
2.Third generation cephalosporins (ceftazidime, cefoperazone [not available in the United States])
3.Fourth generation cephalosporins (cefepime)
4.Monobactam (aztreonam)
... 阅读全帖 |
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f****o
发帖数: 2770 | 3 1. 1g Q12h or 500mg Q6h都没关系吧。。。keflex应该是time dependent killing
当然q6h compliance会有影响
而且这个case是uncomplicated UTI还是complicated uti?
2. penicillin allergy cross-reaction with cephalosporins and
carbapenem----概率不是很高啦，只要病人对pcn不是anaphylaxis，试一下cefepime也
无妨啊，如果allergic反正在医院可以抢救。aztreonam超贵的，而且只cover gram
negative,现在为了省钱自然就不用啦
cefepime coverage和zosyn差不多啊，除了anaerobes少了很多，你要cover anaerobe
可以加flagyl |
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j******e
发帖数: 50 | 4 so from first generation to third generation cephalosporin, decrease in
activity against gram positive, but increase in activity against gram
negative,
only ceftazidime and cefepime have activity against pseudomonas
ceftaroline: SSSI MRSA
Anaerobic coverage: cefepime?
trial |
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a*****8
发帖数: 2115 | 5 anaerobic coverage: cefoxitin and cefotetan. However, resistance towards
cefotetan had increased through out the years. So usually cefoxitin would be
preferred over cefotetan.
Pseodomonas coverage: ceftazidime and cefepime.
Another important thing to remember about cephalosporin is they DO NOT have
enterococcus coverage (like VRE). But if you want to go into more depth that
ceftriaxone have been used as synergistic agent with ampicillin or dapto in
treating enterococcus bacteremia or endocarditi... 阅读全帖 |
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b******a
发帖数: 704 | 6 Case 12-2013 — An 18-Year-Old Woman with Pulmonary Infiltrates and
Respiratory Failure
N Engl J Med 2013; 368:1537-1545
Presentation of Case
Dr. James Sawalla Guseh (Medicine): An 18-year-old woman was admitted to
this hospital because of pulmonary infiltrates and respiratory failure.
The patient had been well until 3 weeks before admission, when fever and a
cough productive of white, nonbloody sputum developed. During the next week,
night sweats, extremely painful pharyngitis, pleuritic chest ... 阅读全帖 |
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l******k
发帖数: 27533 | 7 第一，病人可能得的是hospital acquired pneumonia（HAP）
Acinetobactor species是常引起late onset HAP的细菌。
问问医院有没有查pseudomonas和MRSA，这也是常引起HAP的病菌，在治疗方案中也常常
对用上抗pseudomonas的抗生素。pseudomonas或者MRSA感染后果可能会比较严重，而且
只有某些抗生素才能抑制这些细菌。一定要问医院有没有查这两个细菌感染的可能性。
非常震撼！医院居然把病人直接送回家让自己康复？ HAP的死亡率是20-50%，如果
empiric antibiotics 没选对，死亡率对增加2-3倍！只听你说病史，还有细菌的确认
结果，多半就是HAP。病人有其他的症状吗？发热？白细胞数量变化？氧饱和率？是确
诊了还是怀疑HAP感染？
第二，用药问题。你问这个药不是推荐治疗HAP的用药。美国传染病学最权威的
guideline在
IDSA上。
对HAP治疗的guideline地址如下：
http://www.idsociety.org/uploadedFiles/IDSA/Guidelin... 阅读全帖 |
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L*****r
发帖数: 722 | 8
Aztreonam 的一个主要特色，就是很好的anti-pseudomonas 作用，而且可用在青霉素
过敏的病人。
当前抗生素应用的一个最常见的难点，是anti-pseudomonas，因为越来越多的multi-
drug resistance.
anti-pseudomonas antibiotics 如下:
1.Antipseudomonal penicillins (ticarcillin, piperacillin) , usually plus
beta-lactamase inhibitor (ticarcillin-clavulanate, piperacillin-tazobactam)
2.Third generation cephalosporins (ceftazidime, cefoperazone [not
available in the United States])
3.Fourth generation cephalosporins (cefepime)
4.Monobactam (aztreonam)
|
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r*****1
发帖数: 805 | 9 还有部分Abx总结，以前有经验贴分享USMLEforum的经典贴。但自己总结的东西容易记
住。希望给大家一点帮助。
P.S.: 顺着iamreallybad&斑竹思路，旁注中文为mnemonics.
Menigitis: G- use Ceftriaxone; bacilli use Gentamycin; DXM- in S. pneumonia
& unknown microb infection
G+ cocci: Vancomycin+Ceftriaxon
G+ bacilli (Listeria): Ampicillin + Gentamycin +
dexamethasone
G- cocci: Ceftriaxon
G- bacilli: Ceftriaxon+ Gentamycin
Fungus: Amphotericin+ Flucytosin IV-> Flucona... 阅读全帖 |
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z******8
发帖数: 844 | 10 ☆─────────────────────────────────────☆
rhcrc11 (Rebel) 于 (Thu May 15 00:13:42 2014, 美东) 提到:
Step3考场壮烈回来。第一天挺累人，最后一个block甚至做到有心无力状，看着题反应
不过来，导致来不及做完。非常没有信心能否通过。所以match之前先考Step3的童鞋，
需要考前调整生物钟，坚持锻炼，提高耐力。
MCQ没有资格说，CCS有一点小感受，拿出来分享下。大家请轻拍砖。
复习资料：
UW 52 online cases : 基础。最好复习早起找高手一起过一遍，尽快摸熟软件，进入
状态。第二遍找一位水平相近童鞋过一遍，不断总结protocol. 考前迅速做一遍，熟练
运用protocol.
UW 41 offline cases: 我当时和partner每个case仔细做一遍，虽然不像online有反馈
，但对练临床思维，补充protocol非常有帮助。最后考试与41 case有异曲同工之处，
遇到复杂case也不慌神。
CD 6 cases： 最后再熟悉下考试软件。与UW相近，但... 阅读全帖 |
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a*****8
发帖数: 2115 | 11 Things cover pseudomonas:
beta-lactam: zosyn, cefepime and ceftazidime (for ceph), carbapenem (except
ertapenem), monobactam (azetreonam)
FQN: except for moxi
aminoglycoside
colistin
--Cephalosporin does not cover entercoccus
--Cipro does not cover strep (that's why not a respiratory FQN)
--MRSA: vancomycin, dapto, linezolid, bactrim, clindamycin, doxycycline
--FQN very broad spectrum cover most gram +, gram - and anaerobes (except B.
Frag)
先看是gram+ 还是 gram -，再想药。
比如说： UTI，主要是gram -，所以3rd gener... 阅读全帖 |
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l******k
发帖数: 27533 | 12 师姐有空来教教呀～
1. UTI: 如果culture sensitive to cefazolin, 决定给keflex，是 500 mg BID 还是
TID OR QID for 7 days or 5 days？今天一个PA说她学的是QID. 但uptodate 和
micromedex都是BID,快速看了idsa uti guideline，没提到keflex dosing，只有
提到证据不充分，也不知道是resistance problem 还是 lack of efficacy...
2. 今天进来那个巨臭的人，在床上躺了半年没人管，背上ulcer流得稀里哗啦，一想到
就噁心。。。anyway，admitted for hyperkalemia, renal failure, sepsis,
hyponatremia. 然后呢，allergic to penicillin, cipro. 病人无法说话，不知道具
体是啥allergic reactions. 在ED就得上ABX了，preceptor就问我啦，该用啥呢，我觉
得vanco加aztreonam不错呀，但prec... 阅读全帖 |
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a*****8
发帖数: 2115 | 13 for your second questions:
Lets put aside the fast kill or slow kill issue.
1. we are treating potential sepsis right, but where is the source, is it
skin-soft tissue or osteo, or bacteremia or pneumonia, cause the organisms
you want to cover may be different.
2. I am assuming pt has been in the hospital or LTCF for a long time, in
that case we do want to cover broadly
3. If we are treating skin and soft tissue infection due to his ulcer, it
usually gram positive directed, but if he is at a hig... 阅读全帖 |
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l******k
发帖数: 27533 | 14 The pt is treated by clindamycin, vanco, and cefepime now. May I assume that
the concomitant use of clindamycin and vanco is for the slow killing
affects from vanco?
antibiotics
★ 发自iPhone App: ChineseWeb 8.6 |
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j******e
发帖数: 50 | 15 目前就做了这些和大家分享一下，还没有写到ceftaroline，大家有没有补充的呀
First Generation Cephalosporins
• best activity against gram positive aerobes, with limited
activity against gram negative aerobes
• Gram-positive: MSSA, penicillin susceptible, S.pneumoniae, group
streptococci, viridan streptococci
• Gram-netagive: E.coli, K.pneumoniae, p.mirabilis
Second Generation Cephalosporins
• slightly less active against gram-positive aerobes, but more
active against gram negative aerobe... 阅读全帖 |
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j******e
发帖数: 50 | 16 师姐好强哦。我自己都写下来了还是不记得。。
cefotetan and cefoxitin are the only two has anaerobic coverage
cefepime is the only one has pseudomonas coverage... |
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a*****8
发帖数: 2115 | 17 I would not necessary call this as IV to PO. IV to PO is used in drugs that
have 100% bioavailability like levofloxacin, ciproflaxin, flagyl, linezolid
and metronidazole.
This list you have here is potential possible PO options for similar
coverage.
--cefazolin to cephalexin: really have to depend on what are you treating.
if just skin soft tissue infection, maybe. But if it is MSSA bacteremia or
endocarditis, I would never change to cephalexin.
--Depending on your hospital antibiogram, you can ... 阅读全帖 |
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b******a
发帖数: 704 | 18 Common Causes of Pneumonia
In a young patient without coexisting illnesses, there are many potential
infectious causes of pneumonia.1 The patient's history gives us several
clues that help in reducing the list of possible pathogens. This patient
underwent bronchoscopy and bronchoalveolar lavage. Negative bacterial
cultures argue against common, easy-to-culture bacterial pathogens.
Furthermore, the patient did not have a response to multiple, broad-spectrum
antibacterial therapy including erythro... 阅读全帖 |
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h*********t
发帖数: 116 | 19 美国"类似三甲"医院用vanco, zosyn, ceftriaxone, cefepime, meropenem 太太太多
了。经常都是一股脑上来就"联合用药"。penicillin用得比前面那几种少多了 不知道
你是哪一科的医生？
, |
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A*******s
发帖数: 9638 | 20 下面这个case是一个医生俱乐部贴出来的，我给了他们一个建议，结果今天看到LZ回帖
证实了我的诊断，并且根据诊断治疗有效，病人出院了！
网上咨询看来确实有它的实际效果。
大家讨论一下，第一个答对的请版主发奖。
??? ANY IDEAS REGARDING HYPOTHERMIA????
68 year old family with no past medical history except basal cell carcinoma
of face who has no primary care physician and is on no chronic medications
presents with altered mentation. She has difficulty speaking, hearing,
ambulating and seems "catatonic" per family who admits she has been severely
withdrawn and depressed since the death of her 98 year ... 阅读全帖 |
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