NBME 22 Azithromycin (NBME Answers)

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NBME 22 Answers

nbme22/Block 1/Question#49 (reveal difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...
Azithromycin 🔍 / 📺 / 🌳 / 📖
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submitted by elephantbuddy(8)

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In addition to all the great points already made, FA also says that Azithromycin is first-line and favored in general because it's a one-time treatment. You would use doxy though to treat lymphogranuloma venereum (FA 2019 and 2020, pg 148-149).

Neisseria gonorrhea - ceftriaxone

chlamydia coinfection: +azithromycin or doxycycline

Chlamydia - azithromycin (1st line); doxycycline (2nd line, or for LGV)

gonorrhea coinfection: +ceftriaxone

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anjum It's probably simpler to just memorize treatment as: chlamydia: azithromycin gonorrhea: ceftriaxone It's correct and won't trip you up on pregnant women questions +1

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submitted by ∗adong(144)

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the patient is pregnant so not doxy. azithro is alternative (see sketchy vid)

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submitted by medstudied(0)

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Why is it azithromycin not doxycycline? According to sketchy, you treat chlamydia with macrolides/doxy +ceftriaxone. You treat neisseria gonorrhea with ceftriaxone+azithromycin+doxycycline.

Not sure what this question is testing -- is it wanting us to know that gonorrhea has to be treated as well? In that case, doxy would work for both according to sketchy ... Any other reasonings appreciated!

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dr_salface The patient in the stem is pregnant! The question wants to see if you know that doxy is a teratogen. Tetracyclines in general like to bind to fetal bone/teeth which can impair development. +36

dr_salface As a side note, treating chlamydia alone only requires macrolides or doxy. Treating gonorrhea alone only requires ceftriaxone or macrolides. The reason sketchy includes all three is because you usually treat one infection and co-treat the other. +6

yotsubato Theres a crow in the chlamydia sketchy. You can use Macrolides, OR Ceftriaxone, OR Doxycycline. Most doctors in real life just give the azithromycin z pack (which kicks ass cause its one drug 5 doses thats it) +3

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