Assignment on pharmacology (Case study)

Course title: Pharmacology-2

Course code: BPH 313

Submitted to:
Md. Anamul Haque
Assistant professor
Department of Pharmacy
Daffodil International University

Submitted by:
Fazle Rabbi ID: 173-29-1103
Shafiul Islam ID: 173-29-1105
Department of Pharmacy
Daffodil International University

Date of submission: 20/11/2019

Question: A patient with degenerative joint disease is to undergo insertion of hip prosthesis. To
avoid complications due to postoperative infection the surgeon will pretreat this patient with
an antibiotic. The hospital has a significant problem with MRSA. Which is following antibiotic
should the surgeon select?
A. Ampicillin.
B. Imipenem/cilastatin.
C. Gentamicin/piperacillin.
D. Vancomycin.
E. Cefazolin.

Answer:
At first top of the three options of antibiotics do not use in joint disease or prevent any type of
joint infection. They are normally use for post treatment. Beside that the hospital has a
problem with MRSA or methicillin-resistance Staphylococcus aureus. Ampicillin, piperacillin and
Gentamicin are in the group of penicillin so they should not use in the treatment with
methicillin-resistance Staphylococcus aureus (MRSA).
In general without MRSA Cefazolin is the first choice for above case. Cefazolin is very useful for
staph infection and often use to treat joint disease before or after surgery. Cefazolin has been
shown to be effective in treating methicillin-susceptible Staphylococcus aureus (MSSA) but in
sometimes it does not work in cases of methicillin-resistance staphylococcus aureus (MRSA).
Vancomycin is the preferred drug for prophylaxis against methicillin-resistance S. aureus
(MRSA). Hence, vancomycin should substitute with first generation cephalosporin in patients
with remote or recent history of MRSA infections. The latter includes institutionalized patients
such as those staying at intensive care unit, regular visitor of hemodialysis units or patients
whose hospital stay extended beyond 5 days. It should also be used in patients who are a
carrier of MRSA or have a remote or recent history with MRSA infections as reported by
hospital. However vancomycin usually uses when other antibiotics fail to resolve an infection.
To conclude vancomycin is the best choice from above antibiotic in this case. So the surgeon
should select vancomycin for pretreatment to avoid complication due to postoperative
infection during hip prosthesis.
 Aminoglycosides
Dosage: The daily dose is 2-5 mg/kg in divided doses every 8 hours. The standard adult dose is
100 ml to be administered over 20 minutes, 8 hourly or as prescribed by the physician.
Whenever possible treatment should not exceed 7 days. Higher doses are occasionally
indicated for serious infections, especially in the neonates or the compromised hosts. The
interval between doses and even the dose itself may be modified if there is impairment of renal
function or high pre-dose plasma concentration (pre-dose 'trough' concentration should be less
than 2 mg/L).
Child:
 Up to 2 weeks: 3 mg/kg every 12 hours
 2 weeks-12 years: 2 mg/kg every 8 hours

Indications
 Septicemia and neonatal sepsis
 Meningitis and other CNS infections
 Serious bacterial infections of Urinary tract, Respiratory tract, Gastrointestinal tract
(including peritonitis), Skin, Bone & Soft tissue (including Burns)
 Biliary tract infections
 Acute pyelonephritis or prostatitis
 Endocarditis caused by Strep. viridans or Strep. faecalis
 Adjunct in listerial meningitis
 Prophylaxis of surgical infections and the treatment of immunocompromised patients
and those in intensive care

Adverse effects:
Vestibular and auditory damage, nephrotoxicity, rarely hypomagnesaemia on prolonged
therapy, pseudomembranous colitis, neuromuscular blockade, blood dyscrasia.

Drug Interaction:
Aminoglycosides should not be given with potentially ototoxic diuretics (e.g. frusemide and
ethacrynic acid). Concurrent use of other nephrotoxic drugs including other aminoglycosides,
vancomycin and some of the cephalosporin may increase the risk of toxicity. Care is also
required if other drugs with a neuromuscular blocking action are given concomitantly.

Contraindications
Hypersensitivity to Aminoglycosides, pregnancy, myasthenia gravis.