Adverse Effects

Colistin and polymyxin B can cause extreme nephro-toxicity when used parenterally, and any preexisting renal insufficiency will potentiate the nephrotoxicity caused by these antibiotics.

Neurotoxicity is a rare adverse reaction that can be recognized by perioral paresthesia, numbness, weakness, ataxia, and blurred vision. These drugs may precipitate respiratory arrest both in patients given muscle relaxants during anesthesia and in persons with myas-thenia gravis.

^Study Questions

1. A pediatric nurse is found to be colonized with MRSA in her nares during an outbreak investigation in the pediatric intensive care unit. The best strategies to eradicate her nasal carriage could be

(A) Parenteral therapy with IV vancomycin

(B) Oral vancomycin

(C) Bacitracin ointment application to her nasal passages

(D) Polymyxins

(E) A month-long furlough from patient care

2. In the treatment of uncomplicated urinary tract infection caused by gram-negative bacteria, the therapy of choice would be

(A) Teicoplanin

(B) Bacitracin

(C) IV vancomycin

(D) IV polymyxin B

(E) Trimethoprim-sulfamethoxazole

3. Effective interventions for treating a minor surgical suture site infection should definitely include one of the following choices:

(A) Polymyxins

(B) Bacitracin

(C) Triple antibiotics ( bacitracin, Polymyxin B, and neomycin) ointment

(D) IV vancomycin

(E) Observation

4. A urine culture in an asymptomatic female patient with an indwelling Foley catheter comes back with more than 50,000 colonies of enterococci. The uri-nalysis is unremarkable. The best course of action would be to

(A) Start IV vancomycin to cover enterococci

(B) Seek the newly approved drug linezolid for possibility of vancomycin-resistant enterococci (VRE)

(C) Initiate a quinolone like levofloxacin with broad-spectrum coverage for UTIs

(D) Discontinue use of the Foley catheter if possible and obtain follow-up cultures if she develops symptoms

(E) Watchful waiting

5. Which glycopeptide or polypeptide antibiotic is still investigational and not used in the United States for parenteral therapy?

(A) Polymyxins

(B) Vancomycin

(C) Teicoplanin

(D) Bacitracin

(E) Linezolid

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