Abx

Question 1

What abx target the cell wall

Answer 1

Beta-lactate abx
• Penicillins
• Cephalosporins
• Carbapenems
• Glycopeptides and Lipoglycopeptides

Question 2

What abx work by inhibiting protein production

Answer 2

Rifamycins
Aminoglycosides
Macrolides
Tetracyclines
Clindamycin
Nitrofurantoin

Question 3

Abx that inhibit replication

Answer 3

Bactrim
Quinolones
Metronidazole

Question 4

What are the four categories that bacteria are grouped into?

Answer 4

Gram-positive
Gram-negative
Anaerobic
Atypical

Question 5

Examples of gram positive bacteria

Answer 5

Staph aureus
Strep pneumo
Enterococcus
Listeria

Question 6

Examples of gram-negative bacteria

Answer 6

H. flu
Neisseria spp
Enterobacteriaceae
Pseudomonas

Question 7

Examples of anaerobic bacteria

Answer 7

Bacteroides fragilis

Clostridium spp

Question 8

Examples of atypical bacteria

Answer 8

Chlamydia spp
Mycoplasma spp
Legionella pneumophilia

Question 9

What are some common pathogens causing CAP?

Answer 9

Strep pneumo
H flu
Legionella
Mycoplasma pneumo
Chlamydia pneumo

Question 10

What is the primary treatment for uncomplicated CAP?

Answer 10

Oral macrolide

Or

Doxycycline

Question 11

If a patient’s CAP is severe enough to require hospitalization, how should you adjust their treatment regimen?

Answer 11

Add a ß-lactam (cefotaxime, ceftriaxone, high dose ampicillin)

Could use ß-lactam w/ a quinolone (ie moxifloxacin or levofloxacin)

Question 12

If your patient’s CAP blood culture comes back positive for Strep pneumo, how would you adjust treatment?

Answer 12

High-dose pen G (narrow the spectrum) or 2nd/3rd gen cephalosporin

Question 13

What is the first line treatment for uncomplicated acute cystitis?

Answer 13

Nitrofurantoin (Macrobid)

Bactrim if area is not high for resistant E. coli

Question 14

How would your treatment for acute cystitis change if patient is diabetic?

Answer 14

Consider them complicated

Switch to Cipro (broader coverage)

Question 15

How do you treat acute pyelonephritis if patient unable to maintain oral intake (2˚ to N/V)?

Answer 15

Inpatient treatment with IVF

Carbapenem if concern for resistant organism

Extended spectrum penicillin or beta lactam combo

Cipro or levofloxacin

Question 16

What is the spectrum for quinolones?

Answer 16

Broad spectrum, but resistance is becoming common

Question 17

What are the adverse reactions possible with quinolones (ie Cipro)?

Answer 17

Cartilage anormalities, including tendon rupture (avoid use in under 18 and pregnancy)

Can prolong QT interval —> TdP

Recent concern for increasing risk of aortic aneurism and dissection

Question 18

What pathogens usually cause PID?

Answer 18

N. gonorrhoeae

C. trachomatis

Question 19

How do you treat PID empirically?

Answer 19

Single IM dose of ceftriaxone or cefotaxime

PLUS

Oral doxycycline

Question 20

How would your PID treatment regimen change if she is found to have C. trachomatis?

Answer 20

Doxy or Azithromycin

Question 21

How would your PID treatment regimen change if she is found to have N. gonorrhoeae?

Answer 21

Ceftriaxone

Plus

Azithromycin

Question 22

How would your PID treatment regimen change if she is pregnant?

Answer 22

Just use the Azithromycin

Question 23

Which abx are your drug of choice during pregnancy?

Answer 23

Penicillins and cephalosporins

Question 24

What pregnancy Category are macrolides?

Answer 24

Erythromycin and Azithromycin are Category B

Clarithromycin is Category C

Question 25

Which abx should be avoided in pregnancy unless severe or life threatening infection

Answer 25

Quinolones
Tetracyclines
Metronidazole
Aminoglycosides

Exception example - doxy for Rocky Mountain Spotted Fever

Question 26

Avoid trimethroprim in _____ trimester because ______

Answer 26

First

It’s a folate agonist (—> NTD)

Question 27

Avoid sulfas and nitrofurantoin at what point in pregnancy and why?

Answer 27

At Term

Sulfas interfere with bile conjugation

Nitrofurantoin increases risk of neonatal hemolysis

Question 28

In general, avoid abx in _______ of pregnancy if possible and use shortest effective duration

Answer 28

First trimester

Question 29

What are the most common causative organisms for acute bacterial meningitis?

Answer 29

Strep pneumo

N. meningitides

Question 30

How do you treat acute bacterial meningitis?

Answer 30

Empiric 3rd gen cephalosporin with vancomycin to cover resistant strep strains

Tailor according to CSF analysis

Question 31

5-10% of those allergic to PCN will also react to …

Answer 31

Cephalosporins

Question 32

Most common pathogens for cellulitis?

Answer 32

Staph aureus

Strep spp

Question 33

How do you treat cellulitis empirically?

Answer 33

Clindamycin
Bactrim
Tetracyclines if purulent drainage

Clindamycin less frequently chosen b/c of risk of C. diff

Question 34

Pros and cons of clindamycin

Answer 34

Effective against toxin-mediated disease from staph and strep

Active against many MRSA strains

BUT kills healthy intestinal flora —> C. diff

Question 35

Why are tetracyclines contraindicated in pregnancy?

Answer 35

Hepatotoxic for mother and fetal bone/teeth development

Also contraindicated in children under 8

Question 36

SE specific to minocycline

Answer 36

Can cause blue-black hyperpigmentation (3-20%)

Question 37

Which abx is most commonly used against MRSA cellulitis?

Answer 37

Vancomycin

One of the few abx used against C. diff

Question 38

Adverse effects of vancomycin and friends

Answer 38

Nephrotoxicity and hearing loss (esp with aminoglycoside use)

Red man syndrome with rapid infusion