5- antibiotic stewardship Flashcards
what antibiotic is used to cover gram negatives?
gentamicin
what antibiotic is used to cover anaerobes?
metronidazole (good narrow spectrum)
what antibiotic is used to cover enterococcus?
amoxicillin
is allergic to amoxicillin what should you swap to to treta entyerococcus?
vancomycin
what are normal flora of mouth? (commensals there)
- strep viridans
- neisseria
- anaerobes
- candida
- staphylococci
what are normal flora in stomach?
- a few candida
- a few staphylococci
= less as low pH
what are normal flora in jejunum?
- small numbers of coliforms & anaerobes
(more than stomach)
what is normal flora found in colon?
- large numbers of coliforms (like e.coli and other commensals), anaerobes & enterococcus
what are normal flora in bile ducts?
normally sterile
what are the most important anaerobes to know about that live in the gut?
- bacteroides = most important one
- also clostridium and anaerobic cocci
what is primary peritonitis?
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
what is secondary peritonitis?
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
what is tertiary peritonitis?
persistent or recurrent infection of peritoneum after treatment of secondary →less important
what is involved in treatment for secondary peritonitis - perforated gut?
the antibiotics discussed before (amoxicillin, metronidazole and gentamicin) alongside things like surgeons, radiologists, ICU etc = big range, not just antibiotics
is peritonitis infection, what is the step down after first 3 antibiotics (when get a bit better)?
move to oral co-trimoxazole & metronidazole
(swap amoxicillin & gentamicin to co-trimoxazole and from IV to oral)