American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT a component of inpatient antimicrobial regimens for Acute Pyelonephritis?

1. Aminoglycosides

2. Extended-spectrum cephalosporins

3. Intravenous penicillin

4. Carbapenems

The correct answer is: Intravenous penicillin

In the context of treating acute pyelonephritis, the ideal antimicrobial regimen is typically guided by recommendations for managing severe urinary tract infections, particularly from organisms like Escherichia coli, which is the most common culprit. Aminoglycosides, extended-spectrum cephalosporins, and carbapenems are commonly utilized in inpatient settings due to their broad spectrum of activity against the pathogens that cause pyelonephritis, especially when dealing with more severe cases or when there is a risk of resistant organisms. Aminoglycosides, such as gentamicin, are effective against gram-negative bacteria, while extended-spectrum cephalosporins can target a wide variety of bacteria, including those producing beta-lactamase. Carbapenems are known for their efficacy against multi-drug resistant bacteria, making them a choice in complicated infections. Intravenous penicillin, on the other hand, is not typically used to treat acute pyelonephritis due to its limited spectrum against the common pathogens associated with this condition, particularly gram-negative organisms. While penicillin can be effective against certain infections, it does not cover the range of bacteria often implicated in acute pyelonephritis effectively, especially in a hospital setting where resistant organisms