Antibiotics

[jarjar5606]

Can Zosyn iv and Flagyl iv be used together? Is there any need for double anaerobes coverage? PO Flagyl is for C.diff, i don't think the patient has C.diff. Do you use Zosyn IV plus Flagy IV for aspiration pneumonia? What about Rocephin with Merrem? Any need for two beta-lactam abx? Or they should never be used together? I always thought they should never be used, why are people writing them?

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[jdh71]

Can Zosyn and Flagyl be used together? Is there any need for double anaerobes coverage? What about Rocephin with Merrem? Any need for two beta-lactam abx? Or they should never be used together? I always thought they should never be used, why are people writing them?

There is the rare B. frag isolate that is resistant to flagyl so you'll need the other (or is it that other way around), but generally, it's pretty stupid, UNLESS you're treating C. diff plus something else somewhere else - the last recommendations I saw say flagyl IV and Vanco PO for bad C. diff in the ICU.

Now Rocephin plus Merrem is plain stupid. The ONLY reason you might use two beta-lactams might be for empiric double coverage of PsA in an immunocompromised patient who can't have other classes of antibiotic for one reason or another.

 

[mrdowntoearth]

Completely agree with jdh71! Please choose your antibiotics judiciously because more and more bugs getting resistant due to antibiotics overuse.

jdh71, r u a critical care fellow? wish all intensivists know how to manage antibiotics in ICU

 

[jdh71]

Completely agree with jdh71! Please choose your antibiotics judiciously because more and more bugs getting resistant due to antibiotics overuse.

jdh71, r u a critical care fellow? wish all intensivists know how to manage antibiotics in ICU

I am a pulm/crit guy, yes. Antibiotics have always been a bit of an interest of mine, an "armchair" infectious disease guy if you will.

 

[Hernandez]

Do you use Zosyn IV plus Flagy IV for aspiration pneumonia?

No. I know what up to date says about anaerobes and aspiration pna, but the incidence of anaerobes is highly overstated. Even then, zosyn is going to cover what you need, c diff isn't the anaerobes you worry about for aspiration pna. Zosyn will cover the anaerobes you need covered.