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)
what antibiotics should be given to treat c.difficile infection?
vancomycin
what antibiotics should be given for acute gastroeneteritis?
none
what antibiotics should be given for acute pancreatitis?
none
what antibiotics should be given for proven spontaneous bacterial peritonitis? (for mild & severe)
- mild = co-trimoxazole
- severe = piperacillin or tazobactam IV then step down to co-trimoxazole
what are some good practice points for good prescribing? (like what we aim for)
- 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)
what is antibiotic stewardship?
set of coordinated outcomes to enhance patient outcomes and reduce resistance
do you give antibiotics for viral infections?
no
what are the 4 C’s?
- co-amoxiclav
- clindamycin
- cephalosporin
- ciprofloxacin (any quinolones)
what antibiotics have very good bioavailability?
metronidazole, quinolone (but don’t like), doxycycline, co-trimoxazole
what is MALDI-TOF?
- 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
what is serotyping?
lab technique to specify microorganisms e.g good for salmonella, shigella, e.coli 0157 (where get 0157 from)
what happens in antibiotic resistance?
- antibiotics are only able to kill some strains of bacteria
- bacteria with certain traits survive
- these bacteria now able to multiply & colonise
= resistance increases length of hospital stays & kills people
what are mechanisms involved in antibiotic resistance? (i.e. what do bacteria do to make resistance) - 5
- 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
what are risk factors for c.difficile?
PPI, age, comorbidities, previous c.diff, 4C antibiotics
what is treatment of c.difficile infection?
vancomycin, fidaxomicin, faecal transplant
1st episode = vancomycin
what is life threatening c.diff infection and what’s treatment?
when admission to ICU, hypotension, ileus, significant abdominal distension, mental status changes
- give vancomycin & metronidazole
what antibiotics can give c.diff?
ANY antibiotic including ones used to treat it - 4C biggest ones though
= want to give narrowest for shortest time possible
