Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Aug 30 2020


  • Snapshot
    • A 45-year-old man presents to the emergency room for right lower extremity cellulitis. He reports feeling feverish and malaise for the past 2 days and noticed redness and swelling along his right leg. He reports having tripped a few days ago, sustaining a cut on his foot. He denies any recent surgeries or long trips. He has a history of methicillin-resistant Staphylococcus infections. A Doppler is negative for blood clot. On physical exam, he is febrile. He is started on broad-spectrum antibiotics. He requests an anti-histamine prior to infusions, as he has previously had a flushing reaction to this particular antibiotic in the past. (Cellulitis)
  • Introduction
    • Drugs
      • vancomycin
    • Mechanism of action
      • binds to D-Ala-D-Ala, a cell wall precursor, and prevents peptidoglycan formation
      • mainly bactericidal but bacteriostatic against Clostridium difficile
    • Mechanism of resistance
      • not susceptible to beta-lactamases
      • D-Ala-D-Ala mutation to D-Ala-D-Lac, preventing vancomycin from binding
    • Clinical use
      • gram-positive rods and cocci
        • especially methicillin-resistant Staphylococcus aureus (MRSA)
        • ampicillin-resistant Enterococcus
      • Clostridium difficile (oral dose)
      • often reserved for serious infections
    • Adverse effects
      • ROTN
        • Red man syndrome
          • pretreat with antihistamines and slow infusion rate
          • vancomycin directly causes degranulation of mast cells and histamine release
          • characterized by a pruritic, erythematous rash of the face, neck, and upper trunk within minutes to days of vancomycin exposure
        • Ototoxicity
        • Thrombophlebitis
        • Nephrotoxicity
          • must be renally dosed in patients with renal impairment
      • DRESS syndrome
        • Drug Reaction with Eosinophilia and Systemic Symptoms
1 of 0
1 of 3
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options