Antibiotic Cases Nathan P. Samsa, Pharm.D., R.Ph. Case 1 A 59yo female presents to the ER with community acquired pneumonia. PMH: DM-2, HTN, CRF Labs: WBC: 14,500 CrCl: 4.6 BUN: 71 Case 1 Question What empiric antibiotic(s) would you start this patient on? 1.Cetriaxone 2.Levofloxacin 3.Azithromycin 4.Cetfriaxone + Levofloxacin 5.Ceftriaxone + Azithromycin Case 1 Answer 5.Ceftriaxone + Azithromycin Key concept here is the CRF. Fluoroquinolones (levofloxacin) are renally eliminated. Ceftriaxone + Azithromycin are hepatically eliminated. Both are standard of care, but it comes down to liver & kidney status. Case 1 Discussion Shortcut for CrCl: (140-Age)/SrCr (x0.85 for female)