So Many Samples, So Little Time
Nurse Practitioner Case Study Series
Authored by Margaret A. Fitzgerald, MS, RN, CS, FNP

Match the available sample with the most appropriate patient.

You see Peg, a 22 year old woman with acute otitis media. She is febrile, in pain, and has a bulging, immobile right TM. She uses Depo Provera for contraception with her last injection 6 weeks ago. She has a penicillin allergy: "A rash according to my mother." She does not recall any difficulty breathing with the penicillin. She is self pay and has no money right now but will get paid in 5 days. (Rent due this week, entire check gone. Welcome to the real world!)

At the same time, you see Marc, a teen with impetigo who has extensive facial involvement. His parents have no money and he needs medication.

Finally, to top it off, you see Maddy, a 28 year old who just completed a round of amoxicillin for the treatment of sinusitis. She continues to have a purulent dischage, maxillary "toothache", foul breath and facial tenderness. Your assessment is sinusitis, apparently an amoxicillin failure.

You have the following in the sample closet and can give each patient enough for a full course of treatment. Which of these antibiotics represents the best therapeutic choice for each patient?

Click on the selections below for the correct answer.
Cefixime Peg Marc Maddy  
Ceprozil Peg Marc Maddy  
Cefalexin Peg Marc Maddy  


Cefixime (Suprax): Third generation cephalosporin.


Ceprozil (Cefzil): Second generation cephalosporin.


Cefalexin (Keflex): First generation cephalosporin.


Right you are! Ceprozil is a second generation cephalosporin. It has strong Streptococcus pneumoniae and Hemophilus influenzae coverage, two major organisms in otitis media.


Right you are! Cefalexin, a first generation product with great gram positive coverage, for bugs such as Staphylococcus aureus.


Right you are! Cefixime is a third generation cephalosporin with strong gram negative coverage for Hemophilus influenzae and Moraxella catarrhalis. It has poorer gram positive coverage (Streptococcus pneumoniae). In this case consider that Streptococcus pneumoniae would have likely been eradicated by an adequate amoxicillin dose.

Oops, wrong choice try again.

Last updated:  Aug 14, 1998