USMLE Step 2 Review 19 02 Drugs of Choice Osteomyelitis

USMLE Step 2 Review 19 02 Drugs of Choice Osteomyelitis

 

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Play USMLE Audio MP3 19 02 Drugs of Choice Osteomyelitis Below

 

Begin 19 02 Drugs of Choice Osteomyelitis Transcription

What is the most common organism in osteomyelitis in any age group, except for puncture wounds and diabetes?

  • Staph aureus.

Two drugs of choice used together for osteomyelitis in children?

  • A PRSP and a 3rd generation Cephalosporin.

What is the generic name of the PRSP used IV usually for osteomyelitis?

  • Oxacillin.

Trade name for Oxacillin?

  • Bactocill.

What is a 3rd generation cephalosporin commonly used IV in hospitals, including osteomyelitls?

  • Ceftriaxone.

Trade name for Ceftriaxone?

  • Rocephin.

Let’s look at PRSPs for just a second. In addition to Oxacillin, which is Bactocill, which is a PRSP used both PO and IV, What are 2 other PRSPs which are used only PO?

  • Cloxacillin and Nafcillin.

What’s the trade name for Cloxacillin?

  • Cloxapin.

And the trade name for Nafcillin?

  • Unipen.

Student doctor, please review for me the 3 PRSPs. Oxacillin, Cloxacillin, and Nafcillin.

What is the drug of choice for allergies, for blocking histamine release in the skin and mucous membranes when drowsiness is acceptable, or even desirable?

  • Diphenhydramine.

And what’s the trade name for the common preparation of Diphenhydramine?

  • Benadryl.

However, in cases where drowsiness must be avoided, what is the drug of choice for seasonal allergic rhinitis for blocking histamine release in the skin and mucous membranes?

  • Terfenadine.

And the trade name for Terfenadine?

  • Seldane.

What is the organism in crabs?

  • Phthirus pubis.

And what is the topical drug of choice for crabs?

  • Permethrin liquid.

And the trade name for Permethrin liquid?

  • Nix.

What is the additional strategy to prevent spread of infection?

  • Also treat the sexual partners.

The treatment of meningitis is too complicated to try to memorize all the different regimens. We’ll concentrate here on a few points. In neonates less than 1 month old, what are the 2 drugs of choice used together for meningitis?

  • Ampicillin plus Gentamycin.

Three trade names for Ampicillin?

  • Omnipen, Principen, Unasyn.

And trade name for Garamycin?

  • Garamycin.

What 3 organisms are the most likely in meningitis in neonates less than 1 month old?

  • Strep BD, Enterobacter, Listeria.

Now, which of these bugs is the Gentamycin/Garamycin specifically for?

  • Enterobacter.

And what class of drug is Gentamycin/Garamycin?

  • Aminoglycoside.

Which bug is the Ampicillin for?

  • Both the Strep BD and the Listeria.

What class of drug is Ampicillin/Omnipen/Principen/Unasyn?

  • It is an Amino-penicillin.

With infants 1-3 months, what are the 2 drugs of choice used together for meningitis?

  • Ampicillin plus Dexamethasone.

What class of drug is Dexamethasone?

  • Steroid.

And what is the purpose of Dexamethasone in meningitis?

  • To reduce swelling.

The organisms most likely to cause meningitis in infants 1-3 months include the same bugs for neonates, plus 3 more. Again, what were the 3 for neonates that are also possible for infants 1-3 months old, although not as likely?

  • Strep BD, Enterobacter, Listeria.

However, there are 3 organisms much more likely for meningitis in infants 1-3 months old. What are they?

  • Strep pneumo, Meningococci, H. influenzae.

Now, all 6 of the organisms we’ve mentioned for meningitis in infants 1-3 months old are covered to varying degrees by Ampicillin, except 1. Which is the exception?

  • Enterobacter.

And what is the recommended class of drug to add to the Ampicillin regimen if Enterobacter is suspected?

  • Third generation Cephalosporins.

Two 3rd generation Cephalosporins that are used in meningitis?

  • Cephaltaxime or Ceftriaxone IV.

And the trade name for Cefotaxime?

  • Claforan.

And the trade name for Ceftriaxone?

  • Rocephin.

Now, 1 of the 5 bugs which are covered by Ampicillin may not be covered all that well, but it is much less common currently in the US due to more widespread vaccination. Which one is it?

  • H. influenzae.

And if you suspect H. influenzae, what class of drugs is probably better than Ampicillin?

  • Again, the 3rd generation Cephalosporins.

Now, there is another antibiotic which is highly effective for H. flu meningitis, but which many physicians are reluctant to use due to a very rare but fatal side effect in infants, and a more common and fatal side effect in neonates. What is the drug?

  • Chloramphenicol.

What is the very rare but fatal side effect in infants?

  • Irreversible aplastic anemia.

What is the more frequent and fatal side effect in neonates?

  • Gray baby syndrome with circulatory collapse.

What enzyme system has not yet matured in the neonate liver that makes them susceptible to Gray Baby Syndrome with circulatory collapse due to administration of Chloramphenicol?

  • The glucuronyl transferase system has not yet developed in the neonate liver.

****END OF TRANSCRIPTION****

 

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