CICM SAQ 2010.1 Q13
Questions
13.1. Apart from vancomycin, list three antibiotics that have activity against hospital acquired methicillin resistant staphylococcus aureus (MRSA).
13.2 List an example of each of the three main classes of systemic antifungal agents.
13.3. Briefly outline the dosing adjustment and the monitoring necessary in patients with septic shock for each of the following drug groups in patients with moderate to severe renal dysfunction (without dialysis)
- a) Aminoglycosides
- b) Fluoroquinolones
- c) Beta Lactams
- d) Carbapenems
- e) Glycopeptides
Answers
Answer and interpretation
13.1. Apart from vancomycin, list three antibiotics that have activity against hospital acquired methicillin resistant staphylococcus aureus (MRSA).
- Linezolid
- Talavancin
- Streptogramins (not currently available in Australia)
- Tigecycline
13.2 List an example of each of the three main classes of systemic antifungal agents.
- Polyenes e.g. Amphotericin B
- Azoles e.g. Fluconazole
- Echinocandins e.g. caspofungin, andulafungin, micafungin
13.3. Briefly outline the dosing adjustment and the monitoring necessary in patients with septic shock for each of the following drug groups in patients with moderate to severe renal dysfunction (without dialysis)
- a) Aminoglycosides
- b) Fluoroquinolones
- c) BetaLactams
- d) Carbapenems
- e) Glycopeptides
a) Aminoglycosides
- High initial dose and monitor trough concentrations. Extend interval. May be necessary to decrease dose and monitor with MIC data
b) Fluoroquinolones
- Reduce frequency but maintain dose.
- Monitor QT interval
c) BetaLactams
- Can reduce dose OR frequency
- Monitoring unnecessary
d) Carbapenems
- As for Beta Lactams
e) Glycopeptides
- High dosing on day one
- dose adjustments according to Cmin and dependent on degree of renal dysfunction
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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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