Question #6 explained:
BB is a 64 year-old male at ABC Hospital who came in with fever plus urinary symptoms, which led to a diagnosis of acute prostatatis. He has a past medical history of dyslipidemia, hypertension, and anemia. His current medications include: metoprolol succinate, simvastatin, ferrous sulfate, and a multivitamin. He has an allergy label for penicillin (rash as a 5 year-old). His urine culture is pending final sensitivities, but is showing Gram negative rods.The prescribing physician asks you to select a medication for him and tells you she doesn’t want any of his current medications stopped. Which one of the following could be an acceptable option?
A. Oral ciprofloxacin
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- While this could be an option, the ferrous sulfate the patient is taking (which is usually TID) can bind to the fluoroquinolone and prevent it’s absorption. It can be worked around, but to illustrate this point this is labeled as an incorrect answer.
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B. IV levofloxacin CORRECT
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- Fluoroquinolone are generally considered the drugs of choice for prostatitis. The IV route would get around the issue of binding to the ferrous sulfate (answer A).
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C. Oral nitrofurantoin
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- Nitrofurantoin achieves poor concentrations in the prostate and is not able to be used for prostatitis.
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D. IV vancomycin
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- Vancomycin has activity against Gram positive bacteria only. Prostatitis is most commonly caused by E. coli (a Gram negative bacteria) and the patient has GNRs in his urine culture. This would be a bug-drug mismatch.
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