WBR1094
| Author | PageAuthor::Chetan Lokhande |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Infectious Disease |
| Prompt | [[Prompt::A 18-year-old female presents to you with chief complaints of fever, headache, running nose, nasal congestion. After careful examination you make a diagnosis of bacterial sinusitis. You decide to start her on oral Amoxicillin as that is the recommended treatment. The patient comes to you after a week and says that her symptoms have not improved. You suspect drug resistance micro-organism. Which of these antibiotics should be prescribed considering the fact that the organism has amoxicillin resistance?]] |
| Answer A | AnswerA::Macrolide |
| Answer A Explanation | [[AnswerAExp::Incorrect: Following no response to amoxicillin in a patient of sinusitis if failure of treatment even after 7 days of diagnosis the start treatment with :
1.Amoxicillin-Clavalunate 2.Levofloxacin 3.Moxifloxacin]] |
| Answer B | AnswerB::Cephalosporin |
| Answer B Explanation | [[AnswerBExp::Incorrect: Following no response to amoxicillin in a patient of sinusitis if failure of treatment even after 7 days of diagnosis the start treatment with
1.Amoxicillin-Clavalunate 2.Levofloxacin 3.Moxifloxacin]] |
| Answer C | AnswerC::Fluoroquinolone |
| Answer C Explanation | [[AnswerCExp::Correct: Following no response to amoxicillin in a patient of sinusitis if failure of treatment even after 7 days of diagnosis the start treatment with
1.Amoxicillin-Clavalunate 2.Levofloxacin 3.Moxifloxacin]] |
| Answer D | AnswerD::Tetracyclines |
| Answer D Explanation | [[AnswerDExp::Incorrect: Following no response to amoxicillin in a patient of sinusitis if failure of treatment even after 7 days of diagnosis the start treatment with
1.Amoxicillin-Clavalunate 2.Levofloxacin 3.Moxifloxacin]] |
| Answer E | AnswerE::Aminoglycosides |
| Answer E Explanation | [[AnswerEExp::Incorrect: Following no response to amoxicillin in a patient of sinusitis if failure of treatment even after 7 days of diagnosis the start treatment with
1.Amoxicillin-Clavalunate 2.Levofloxacin 3.Moxifloxacin]] |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::The vast majority of cases of sinusitis are caused by viruses and will therefore resolve without antibiotics. However, if symptoms do not resolve within 10 days, amoxicillin is a reasonable antibiotic to use first for treatment with amoxicillin/clavulanate being indicated when the person's symptoms do not improve after 7 days on amoxicillin alone. Antibiotics are specifically not recommended in those with mild / moderate disease during the first week of infection due to risk of adverse effects, antibiotic resistance, and cost. Due to increasing resistance to amoxicillin the Infectious Diseases Society of America recommends amoxicillin-clavulanate as the treatment of choice for acute sinusitis.[38] They also recommend against other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim/sulfamethoxazole, because of growing drug resistance.
Fluoroquinolones, and a newer macrolide antibiotic such as clarithromycin or a tetracycline like doxycycline, are used in those who have severe allergies to penicillins. Because of increasing resistance to amoxicillin the 2012 guideline of the Infectious Diseases Society of America recommends amoxicillin-clavulanate as the initial treatment of choice for bacterial sinusitis. The guidelines also recommend against other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim/sulfamethoxazole, because of growing drug resistance. A short-course (3–7 days) of antibiotics seems to be just as effective as the typical longer-course (10–14 days) of antibiotics for those with clinically diagnosed acute-bacterial sinusitis without any other severe disease or complicating factors. The IDSA guideline suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The guidelines still recommend children receive antibiotic treatment for ten days to two weeks. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Amoxocillin resistance, WBRKeyword::Sinusitis |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |