5- antibiotic stewardship Flashcards

1
Q

what antibiotic is used to cover gram negatives?

A

gentamicin

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2
Q

what antibiotic is used to cover anaerobes?

A

metronidazole (good narrow spectrum)

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3
Q

what antibiotic is used to cover enterococcus?

A

amoxicillin

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4
Q

is allergic to amoxicillin what should you swap to to treta entyerococcus?

A

vancomycin

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5
Q

what are normal flora of mouth? (commensals there)

A
  • strep viridans
  • neisseria
  • anaerobes
  • candida
  • staphylococci
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6
Q

what are normal flora in stomach?

A
  • a few candida
  • a few staphylococci

= less as low pH

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7
Q

what are normal flora in jejunum?

A
  • small numbers of coliforms & anaerobes
    (more than stomach)
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8
Q

what is normal flora found in colon?

A
  • large numbers of coliforms (like e.coli and other commensals), anaerobes & enterococcus
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9
Q

what are normal flora in bile ducts?

A

normally sterile

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10
Q

what are the most important anaerobes to know about that live in the gut?

A
  • bacteroides = most important one
  • also clostridium and anaerobic cocci
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11
Q

what is primary peritonitis?

A

bacterial translocations like ascites translocating bacteria into sterile peritoneum (doesn’t involve a break in integrity of GI tract)→can be just 1 bacteria but also can be more = can do narrow spectrum antibiotic to treat once know bug

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12
Q

what is secondary peritonitis?

A

when some sort of leak of GI tract in peritoneum - will have all bugs as things from inside colon to outside colon = will need to cover big range (wider spectrum over antibiotics)
e.g. like if diverticulum perforated

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13
Q

what is tertiary peritonitis?

A

persistent or recurrent infection of peritoneum after treatment of secondary →less important

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14
Q

what is involved in treatment for secondary peritonitis - perforated gut?

A

the antibiotics discussed before (amoxicillin, metronidazole and gentamicin) alongside things like surgeons, radiologists, ICU etc = big range, not just antibiotics

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15
Q

is peritonitis infection, what is the step down after first 3 antibiotics (when get a bit better)?

A

move to oral co-trimoxazole & metronidazole

(swap amoxicillin & gentamicin to co-trimoxazole and from IV to oral)

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16
Q

what antibiotics should be given to treat c.difficile infection?

A

vancomycin

17
Q

what antibiotics should be given for acute gastroeneteritis?

A

none

18
Q

what antibiotics should be given for acute pancreatitis?

A

none

19
Q

what antibiotics should be given for proven spontaneous bacterial peritonitis? (for mild & severe)

A
  • mild = co-trimoxazole
  • severe = piperacillin or tazobactam IV then step down to co-trimoxazole
20
Q

what are some good practice points for good prescribing? (like what we aim for)

A
  • if pus = get pus out
  • take cultures before antibiotics
  • narrower spectrum the better
  • only certain circumstances use broad spectrum to start with e.g. neutropenic sepsis (start broad and then narrow) →everything else start narrow
  • each hospital has ALERT antibiotics which are some that can only be prescribed with speaking to specialists
  • if possible oral better than IV (as soon as ready, use oral over IV)
21
Q

what is antibiotic stewardship?

A

set of coordinated outcomes to enhance patient outcomes and reduce resistance

22
Q

do you give antibiotics for viral infections?

A

no

23
Q

what are the 4 C’s?

A
  1. co-amoxiclav
  2. clindamycin
  3. cephalosporin
  4. ciprofloxacin (any quinolones)
24
Q

what antibiotics have very good bioavailability?

A

metronidazole, quinolone (but don’t like), doxycycline, co-trimoxazole

25
Q

what is MALDI-TOF?

A
  • uses a database to distinguish between highly genetically similar organisms
  • amazing →many bugs we used to think were one but using this discovered it was 3 etc
  • but does have problems e.g. can’t tell between salmonella & shigella
26
Q

what is serotyping?

A

lab technique to specify microorganisms e.g good for salmonella, shigella, e.coli 0157 (where get 0157 from)

27
Q

what happens in antibiotic resistance?

A
  1. antibiotics are only able to kill some strains of bacteria
  2. bacteria with certain traits survive
  3. these bacteria now able to multiply & colonise

= resistance increases length of hospital stays & kills people

28
Q

what are mechanisms involved in antibiotic resistance? (i.e. what do bacteria do to make resistance) - 5

A
  • inactivating enzymes →some bacteria produce enzymes that inactivate antibiotics
  • alternative enzymes →some bacteria develop alternative metabolic pathways that bypass the target of the antibiotic
  • target alterations →some bacteria modify the target site of antibiotic
  • decreased uptake →bacteria may develop mechanisms to decrease uptake of antibiotics into their cells
  • efflux pumps →some bacteria have efflux pumps that actively pump out bacteria out of bacterial cell
29
Q

what are risk factors for c.difficile?

A

PPI, age, comorbidities, previous c.diff, 4C antibiotics

30
Q

what is treatment of c.difficile infection?

A

vancomycin, fidaxomicin, faecal transplant

1st episode = vancomycin

31
Q

what is life threatening c.diff infection and what’s treatment?

A

when admission to ICU, hypotension, ileus, significant abdominal distension, mental status changes

  • give vancomycin & metronidazole
32
Q

what antibiotics can give c.diff?

A

ANY antibiotic including ones used to treat it - 4C biggest ones though
= want to give narrowest for shortest time possible