NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

For severely ill inpatients with pyelonephritis, which antibiotic combination is NOT recommended?

1. CTX, pip/tazo

2. quinolone, carbapenem

3. cipro x7, levo x5

4. amino glycoside x1, then cipro/levo for 5-7 days

The correct answer is: cipro x7, levo x5

For severely ill inpatients with pyelonephritis, aggressive antibiotic therapy is essential to target the causative pathogens effectively. The combination of ciprofloxacin for 7 days and levofloxacin for 5 days is not recommended for this scenario. This is because the combination of ciprofloxacin and levofloxacin belongs to the same class of antibiotics, fluoroquinolones. Using two antibiotics from the same class without a specific indication for dual therapy does not provide additional benefits and increases the risk of resistance development without improving clinical outcomes. On the other hand, options A, B, and D all suggest appropriate antibiotic combinations for treating severely ill inpatients with pyelonephritis. Option A suggests the use of ceftriaxone and piperacillin/tazobactam, option B suggests a quinolone and a carbapenem, and option D suggests an aminoglycoside followed by ciprofloxacin/levofloxacin for 5-7 days. These combinations cover a broad spectrum of pathogens commonly involved in pyelonephritis and provide synergistic effects to improve treatment efficacy.