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WorksheetsRocK n RoLL
Total questions: 10
Worksheet time: 50mins
Cephalosporin (eg: Rocephine) usage is associated with promotion of ESBL infection.
The reason of increasing usage of rocephine being a great concern:
Rate of ESBL infection is increasing fast.
It is because rocephine has narrow spectrum of activity.
It is because of the toxicity profile of rocephine.
Rocephine is a very expensive antibiotic.
Augmentin/ Unasyn and rocephine have similar bacterial coverage for community acquired infections.
A 50 yo man presented with fever, cough and SOB. He was diagnosed to have CAP.
I will start antibiotic after culture result available.
I will start Augmentin/ Unasyn. They have good coverage for community organisms.
I will start rocephine first, then deescalate later when patient improve.
I will continue IV rocephine since casualty already given a stat dose.
According to our local antibiogram, sensitivity of augmentin/ unasyn towards common community organisms are higher than rocephine.
Which of the below are reasons that augmentin/unasyn are better than rocephine?
Augmentin & unasyn are showing higher sensitivity for E coli and klebsiella pneumoniae in our antibiogram.
Augmentin/unasyn do not induce ESBL infection.
Augmentin/ unasyn have addition anaerobe coverage.
Augmentin/ unasyn have oral option for easy conversion.
All of the above.
Increasing carbapenem resistant organisms need to be emphasized. We are losing our last bullet (carbapenem).
Which of the below are measures to prevent ESBL infection.
Improve hand hygiene compliance.
Avoid unnecessary usage of cephalosporins.
Promote catheter care bundle.
All of the above
Non of the above.
IV rocephine is the preferred empirical antibiotic for acute bacterial meningitis.
35 yo Nepalese presented with fever & altered behaviour for 1 week. IV rocephine was started for suspected acute bacterial meningitis. CT brain and LP were both normal.
Deescalate antibiotic and look for other source of infection.
Continue IV Rocephine for 2 weeks since clinically still suspicious of meningitis.
Reduce IV rocephine to OD dosing for 1 week.
Off antibiotic and discharge home. Most likely is malingering.
For community acquired sepsis when patients are very ill, IV piperacillin/tazobactam appear to be a reasonable alternative
A 45 yo lady with DM, admitted for one week fever and poor oral intake. She was in shock. There was no apparent source of infection was identified. No history of recent hospitalization or antibiotic exposure.
Start IV augmentin/ unasyn.
Start IV rocephine, my all time favourite.
Start IV piperacillin/tazobactam.
I will start IV meropenem.
IV rocephine is often used for RVD with suspicious salmonellosis. Negative blood culture is sufficient to exclude salmonellosis.
A 35 yo RVD patient with CD4 of 10 copies/ml, presented with one week fever and passing loose stool. His vitals are stable. He had no recent hospitalisation and no recent exposure to antibiotic.
I will start IV piperacillin/tazobactam.
I will start IV augmentin/ Unasyn.
I still prefer IV rocephine since it can be used to cover salmonellosis.
I will start antiTB.
Prescribing IV rocephine for dengue patient to cover for leptospirosis co-infection is very common in our practice.
Which of the below statement is incorrect.
If bacterial co-infection is suspected, I should use IV augmentin/ unasyn in patient with no recent admission.
If leptospirosisis is highly suspected, IV Benzylpenicillin appear to be the most appropriate antibiotic.
IV rocephine can prevent dengue mortality.
Physician should revise the indication of IV rocephine after reviewing results.
All of the below are the measures for RocK? (Rocephine Kurangkan) EXCEPT
if the use of IV rocephine is not avoidable, the indication should revise everyday.
In community acquired infection, use IV augmentin/ unasyn as preferred agent.
I will refer ID whenever I want to start rocephine.
Only use IV rocephine empirically in acute bacterial meningitis, and revise diagnosis as soon. If I am not confident in stopping the antibiotic, I should seek for expert opinion (ID/neuromedical).
In conclusion, we should try to avoid unneccessary usage of rocephine, it is because
Cephalosporins induce ESBL infection, which causing high morbidity and mortality.
IV rocephine is highly protein bound, its efficacy is questionable in patient with low serum protein.
carbapenem usage can be reduced when ESBL rate reduce.
ALL of the above.
