Medical guidelines for ICU cases

Medical guidelines for ICU cases You have to be up-to-date for ever

08/03/2026

اكتر antibiotic بيحصله misuse عندك ف المستشفى ايه ؟

07/03/2026

متوفر up to date app باسعار منخفضه يا دكاتره لو حد حابب يتواصل معانا

حاله Pneumonia ..كان فى حاله ٥٥ سنه DM, HTN, HF as EF 39 % ✅✅المهم داخله ب ADHF and lower limb edema المهم المريض خد las...
04/03/2026

حاله Pneumonia ..

كان فى حاله ٥٥ سنه
DM, HTN, HF as EF 39 % ✅

✅المهم داخله ب ADHF and lower limb edema

المهم المريض خد lasix لمده ٣ ايام و الدنيا بدات تتظبط و الاعراض اتحسنت جدا

بعد ٤ ايام من دخوله المستشفى بدأ يحصل حاجة غريبه
Feverish
Sputum cough
CRP 230
Procal 11.7

Diagnosed as HAP✅

سحبنا Sputum culture و بدانا
Linezolid and meropenem ✅

المهم المريض بيتدهور اكتر و اذ بعد يومين ال
Culture shows VRSA
Resistant to
Vancomycin
Linezolid
Teicoplanin

Sensitive to Daptomycin

الاستشارى قرر يدى Daptomycin و هذا كان اخطر قرار للمريض
و المريض لو خذه كان هيموت

احنا رفضنا الكلام دا و بدانا Ceftaroline و دا فعلا Anti VRSA

و جاب نتيجة رهيبه و بعد اسبوع المريض اتحسن فعلا و خرج

Discussion:
1️⃣VRSA is Vancomycin resistant staph aureus
2️⃣VRSA in resistant to Vancomycin
3️⃣VRSA may be also resistant to linezolid
4️⃣Daptomycin is Anti MRSA but should not be used in pneumonia as it is degraded in the lungs
5️⃣The best option was Zinforo( Ceftaroline) an anti MRSA can be used here

So even Daptomycin is sensitive in the culture but should not be used ✅

لو محتاج معلومات اكتر عن ال Culture interpretation البوست دا هيفيدك

https://www.facebook.com/share/17H3AafNAf/?mibextid=wwXIfr

تخيل مريضCKD ,DM داخل ب Pneumonia و أدت إلى Septic shock Mechanical Ventilation was initiated due to respiratory failure...
28/02/2026

تخيل مريضCKD ,DM داخل ب Pneumonia و أدت إلى Septic shock

Mechanical Ventilation was initiated due to respiratory failure 😞

المهم سحبنا sputum - blood culture
و بدانا Linezolid and meropenem

Also on fentanyl infusion

CRP= 228
Procal= 12
Feverish
TLC shift to left

المهم بعد يومين الدنيا بدات تتحسن
CRP= 112
Procal= 6
Normal TLC 👍🏻✅

Culture after 4 days showed
Sputum= MRSA sen to Linezolid, Vanco and Daptomycin 👏

Blood= showed no Growth ✅

We stopped meropenem and maintain Linezolid

After 2 days, hyperthermia, Tremors and mental status changes have occurred. 🔥

The reason most probably was serotonin syndrome so we have discontinued Linezolid and add ceftaroline instead. 🌺

After 2 days
The symptoms was subsided. And the patient is extubated and fentanyl was DC also 💥

Discussion:
Linezolid in anti MRSA but also is a MAOI ✅
Fentanyl also increase serotonin ✅
Concurrent use may cause serotonin syndrome
Concurrent use is not recommended ‼️

لو محتاج معلومات اكتر عن ال antibiotic stewardship البوست دا هيفيدك

https://www.facebook.com/share/1Bm9uUNh9K/?mibextid=wwXIfr

من اكتر الحاجات اللى بننساها ف ال practice هو ال SPICE organisms يعنى مثلا مريض داخل ب severe UTI Procal 3CRP 178 Fever...
27/02/2026

من اكتر الحاجات اللى بننساها ف ال practice هو ال SPICE organisms

يعنى مثلا مريض داخل ب severe UTI

Procal 3
CRP 178
Feverish

المهم ادينا Ceftriaxone as empiric therapy

بعديها ب يومين بس المزرعه طلعت و كانت
Citrobacter sensitive to Ceftriaxone

اكبر غلط اننا نكمل ع Ceftriaxone ليه ؟

Citrobacter is one of SPICE organisms

يعنى ايه ؟ يعنى هتطلع AmpC gene

يعنى حتى لو المزرعه مطلعه انها sensitive to Ceftriaxone

ف هى In Vivo هتطلع ال AmpC gene

ف هتلاقى المريض بيتحسن ف الاول و بعد ٤ ايام مثلا تبدا تلاقى الاعراض ظهرت تانى

و دا شوفناه كتير جدا جدا جدا

طيب الحل ايه ؟
Cephalosporin is not an option towards SPICE

We may update to carbapenem
We may use FQ instead

لو محتاج معلومات اكتر عن Antibiotic stewardship
البوست دا هيفيدك

https://www.facebook.com/share/1HiQH85bcz/?mibextid=wwXIfr

تخيل معايا Pseudomoans طالعه Resistance to carbapebem but piperacillin sensitive ! 😘كنا فى المرور فى الرعايه و حاله CKD ...
20/02/2026

تخيل معايا Pseudomoans طالعه Resistance to carbapebem but piperacillin sensitive ! 😘

كنا فى المرور فى الرعايه و حاله CKD داخله ب Severe UTI

المهم Feverish
Procal: 23
CRP 383

Urine analysis shows pus 100💚

We have loaded meropenem after taking urine culture

After 2 days
Procal increasing
Fever increasing
CRP increasing 🔥

Urine culture showed Pseudomonas that was sensitive only to colostin and piperacillin only

Imagine. ? Resistant to carbapenem but piperacillin sensitive!!! 🙄

لو انت مكانى فالمرور و استشارى الرعايه بيسالك ؟ هتعمل ايه

هتدى Colistin ؟ مع ان المريض عندك CKD
ولا هتدى piperacillin ؟
طيب المزرعه غلط ؟؟
😢ازاى أصلا تطلع كدا !!؟

القرار صعب بس مش محتاج تاخير اكتر من كذا لازم نبدا و دلوقتى ؟
🤩
Our clinical pharmacy team Confidently has started piperacillin only adjusted to patient’s GFR infused over 3 hours 👏👏

After 4 days
Procal 11
CRP 112
No feverish
Patient has been discharged. 😉

Discussion:
Is the culture wrong.?
Does it make sense to be meropenem and imipenem resistant but piperacillin sensitive

Yes it makes sense 💚😘

Pseudomonas has OprD gene that is responsible for imipenem influx so any mutations will lead to imipenem resistance 🔥

MPM gene also has the ability for meropenem influx so any mutation exhibits MPM mutation will shows Meropenem resistance ✊

MexAB-OprM has the ability for carbepenem efflux 😭

So here the microorganism shows all these 3 genes 😀
OprD. So imipenem resistance 😍
MPM so meropenem resistance 😋
MexAB-OprM so carbapenem resistance 🤪

Piperacillin is not inhibited by these 3 genes 😌

لو محتاج case studies اكتر و تبقى اشطر فى ال antibiotic stewardship
البوست دا هيفيدك

https://www.facebook.com/share/16Q9bf3WzU/?mibextid=wwXIfr

Tygacil doesn’t cover Proteus even it was sensitive in the culture ✅Tygacil doesn’t cover pseudomonans ✅Tygacil has high...
15/02/2026

Tygacil doesn’t cover Proteus even it was sensitive in the culture ✅

Tygacil doesn’t cover pseudomonans ✅

Tygacil has high volume of distribution so it should not be used in bacteremia ✅

Colistin has low volume of distribution so it is not good choice for tissue infection ✅

Colistin doesn’t cover serratia even it was sensitive in the culture✅

Colistin doesn’t cover proteus ✅

Some organisms ( pseudomonans) may be susceptible to meropenem but not imipenem✅

Some organisms may be susceptible to imipenem but not meropenem ✅

Some organisms may be susceptible to piperacillin tazobactam but not carbapenem ✅

لو محتاج معلومات اكتر عن ال Antibiotic stewardship
البوست دا هيفيدك

https://www.facebook.com/share/17sLRNMMqb/?mibextid=wwXIfr

تخيل حاله تموت بسبب معلومة بسيطه فال Antibiotic stewardship انت مش عارفها 🥹 ؟ حاله داخله ب severe hypoxia - Bilateral ef...
12/02/2026

تخيل حاله تموت بسبب معلومة بسيطه فال Antibiotic stewardship انت مش عارفها 🥹 ؟

حاله داخله ب severe hypoxia - Bilateral effusion
بسبب انها Heart failure

المهم بدانا Loop diuretics و حطيناها على Vent

المهم بعد ٣ ايام بدأ يكون فيه fever
CRP 220🔴
Prcal 12🔴
TLC high 🔴
Neutrophiles shift to left 🔴

🛑المهم اتشخصت VAP
حطينا Linezolid and meronem as empiric therapy

و سحبنا sputum c/s
Blood c/s

طلعوا الاتنين Klebsiella XDR sensitive to tygacil and colistin🉐

طبعا Cr كان عالى بسبب ال lasix ف مش هينفع نحط Colistin
ف الاستشارى قرر يحط
Tygacil 200 then 100 bid

بعد يومين بدا ال Urea تزيد
Bilirubin ⛔️
ALT ⛔️

كمان ال CRP بيزيد و ال procal و فعلا البيشنت توفى ب cardiac arrest⛔️

Discussion:
Never 👎 use tygacil for VAP it is not approved ☀️
Never use tygacil for Bactermia ☀️

Black box warning ⛔️ to use tygacil in these circumstances! ❗️

The best option was to think out of the box how?

Give combine therapy of Aztreonam plus zavicefta ✅
Even each antibiotic was resistant in the c/s ✅

The combined therapy decrease MIC dramatically ✅
Also we may use inhalation colistin as a synergism ✅

Also note that Tigecycline increases urea and cause hepatotoxicity 🚱

لو محتاج معلومات اكتر ف ال antibiotic stewardship البوست دا هيفيدك

https://www.facebook.com/share/1S3GkzFMUX/?mibextid=wwXIfr

Remember that NSAIDs, trimethoprim found in co-trimoxazole and heparin increase potassium level. Also ACEI increase pota...
07/02/2026

Remember that NSAIDs, trimethoprim found in co-trimoxazole and heparin increase potassium level.

Also ACEI increase potassium lvl so it’s not preferred to give co-trimoxazole nor NSAIDs concurrently with ACEI.

For heparin with ACEI check k lvl first.🥰

07/02/2026

نعلن عن توافر اكونتات ل up to date app اونلاين + اوفلاين بسعر مناسب للجميع

✅One of the most important information is the difference between diarrhea due to Macrolides and B-lactam.✅It's well-know...
04/02/2026

✅One of the most important information is the difference between diarrhea due to Macrolides and B-lactam.

✅It's well-known that macrolides stimulate motility of GIT by the binding of motilin receptors. That is the reason why very common adverse drug reaction associated with macrolides is diarrhea.

✅But difference of diarrhea associated with Beta-lactam diarrhea is mostly due to alteration of bacteria flora causing C.difficle infection which requires stop therapy.

✅Macrolides do not affect bacterial flora in GIT, but they just increase motility. Mild diarrhea associated with macrolide doesn't require to stop the therapy and change the antibiotics.

لو محتاج معلومات زياده فى ال antibiotic stewardship البوست دا هيفيدك

https://www.facebook.com/share/1CuAzfqfd4/?mibextid=wwXIfr

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