Paeds Vivas · infectious-diseases
Antimicrobial pharmacology, selection, dosing and stewardship in children — branching viva
A branching structured oral following one child from empiric antimicrobial selection through developmental dosing, therapeutic drug monitoring, de-escalation, IV-to-oral switch, duration review, and penicillin allergy delabeling, with evidence and regional boundaries tested throughout.
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Study tools
Target exams
RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
A five-year-old child is admitted with a complicated skin and soft tissue infection. The examiner releases information in stages. The candidate must select empiric therapy using WHO AWaRe principles, justify weight-based and age-adjusted dosing, apply vancomycin and aminoglycoside monitoring, de-escalate when cultures return, perform an IV-to-oral switch, and resolve a reported penicillin allergy.
Station status
This is one MedVellum formative branching structured oral. The prompts and performance descriptions are educational feedback tools; they are not an official college examination format, mark allocation, pass score or reproduced station. The viva assesses empiric drug selection, developmental dosing, therapeutic drug monitoring, de-escalation, IV-to-oral switch, and penicillin allergy delabeling. [1] [2]
References9ShowHide
- [1]Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016.PMID 27080992
- [2]Moja L, Zanichelli V, Mertz D, et al. WHO's essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2024.PMID 38342438
- [3]Rybak MJ, Le J, Lodise TP, et al. Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020.PMID 32658968
- [5]Contopoulos-Ioannidis DG, Giotis ND, Baliatsa DV, et al. Extended-interval aminoglycoside administration for children: a meta-analysis. Pediatrics, 2004.PMID 15231982
- [8]Bielicki J, Lundin R, Patel S, et al. Antimicrobial stewardship for neonates and children: a global approach. The Pediatric infectious disease journal, 2015.PMID 25584443
- [10]Vyles D, Antoon JW, Norton A, et al. Children with reported penicillin allergy: Public health impact and safety of delabeling. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2020.PMID 32224207
- [11]Copaescu AM, Vogrin S, James F, et al. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA internal medicine, 2023.PMID 37459086
- [13]Hersh AL, Beekmann SE, Polgreen PM, et al. Antimicrobial stewardship programs in pediatrics. Infection control and hospital epidemiology, 2009.PMID 19852666
- [15]Pineda LC, Watt KM New antibiotic dosing in infants. Clinics in perinatology, 2015.PMID 25678003