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Abx in children Flashcards

1
Q

what host factors should be taken into account when picking abx for kids

A

age, pregnancy, immune status

site of infection

renal/hepatic fxn

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2
Q

what are the elements of pharmacokinetics?

A

drughost

ADME
absorption
distribution
metabolism
excretion
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3
Q

what abx have 100% oral bioavailability

A

clinda
flagyll
fluoroguinolones

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4
Q

what abx distributions completely to the tissues (has NO blood level)

A

azithro

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5
Q

what are the elements of pharmacodynamics

A

effects
time course of activity
toxicity

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6
Q

what is the MIC

A

minimum inhibitory concentration

minimum amount of an abx necessary to inhibit the growth of an organism

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7
Q

what is the MBC

A

minimum bactericidal concentration

the minimum amount of an abx necessary to kill 99% of an organism

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8
Q

what is the attainable drug level

A

concentration of the drug in tissues (blood, uring, CSF) which will result when it is administered according to a standard dose

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9
Q

what does it mean to say an organism is susceptible to an abx

A

organism will be inhibited or killed by the average attainable drug level in the body

MIC

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10
Q

what does it mean to say an organism is resistant to an abx

A

organism will not be killed by average attainable drug level in the body

MIC>attainable drug level

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11
Q

what are the major parameters of efficacy of abx

A

time/MIC

peak/MIC

24 hour AUC/MIC

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12
Q

in what drugs do we look at peak/MIC

A

animoglycosides

daptomycin

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13
Q

in what drugs do we look at AUC/MIC (area under concentration and time curve for the abx)

A

fluoroquinoloes
macrolides
tetracycline
vancomycin

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14
Q

in what drugs do we look at time > MIC

A

beta lactams

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15
Q

what are the mechanisms by which drugs achieve resistance to abx

A
  1. diminished intracellular drug concentration–> either by increased efflux or by decreased membrane permability
  2. drug inactivation–> usually by enzymes possessed by organism
  3. target modification
  4. target bypass
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16
Q

which drugs are affected by increased efflux resistance

A

tetracyclin (tetA)

quinolones (norA)

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17
Q

which drugs are affected by decreased membrane permeability resistance

A

beta lactams (ompF, oprD)

quinoloes (ompF)

aminoglycosides (decreased energy)

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18
Q

which drugs are affected by drug inactivation resistance

A

beta lactams (lactamase)

aminoglycosides (modifying enzyme)

ampC–cephalosporinase in Klebsiella

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19
Q

which drugs are affected by target modification resistance

A

quinolones (gyrase)

rifampin (DNApol)

beta lactams (PBP)

macrolides (rRNA methylation)

streptomycin (rDNA genes)

macrolides (methylation)

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20
Q

which drugs are affected by target bypass resistance

A

glycopeptides

bactrim

trimethoprim resistance

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21
Q

what is induction verus selection with regard to resistance

A
  1. selection is a problem on a population level over time–> statistically 1/1x10e6 is resistant to a drug
  2. induction is a problem for the individual during therapy–> AmpC cephalosporinase–> ESSCAPPPEM
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22
Q

what are the ESSCAPPPEM organisms and why do we care

A

care because have AmpC cephalosporinace activity

enterobacter

stenostrophomonas

serratia

cirtobacter

acinetobacter

pseudomonas

providencia

proteus

morganella

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23
Q

what are the two reasons/theories behind dual therapy of abx

A

either synergistic or combination

synergistic–> two drugs have an effect greater than the sum of their treatments–> increases rate and killing for example
–> i.e amp/gent for enterococcus

combination–> invovles using drugs with different MOAs to decrease the chance of resistance to break through

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24
Q

what are the cell wall synthesis inhibitor abxs

A
  1. beta lactams–> penicillins, cephalosporins, carbapenems
    (beta lactamase inhibs in organisms can mess with these)
  2. glycopeptides–>vanco
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25
what are the protein synthesis inhibitor abxs
1. aminoglycosides--> gentamicin, tobramycin, amikacin, streptomycin 2. macrolides--> erythromycin, clarithromycin, azithromycin 3. other--> clinda, linezolid, tetracyclines (doxy)
26
what are the RNA or DNA synthesis inhibitor abxs
1. RNA transcription inhibitor --> rifampin 2. DNA synthesis inhibitors--> fluoroquinolones (cipro and levofloxacin) 3. nucleotide synthesis inhibitors--> TMP-SXT
27
how does metronidazole work
toxic free radical production
28
what are bacteriostatic abxs
inhibit bacterial cell growth need INTACT IMMUNE SYSTEM to fight infection
29
what are bacteriocidal abxs
kill bacteria directly do not rely on immune system of patient (therefore okay in immunocompromised)
30
empiric therapy for septicemia in younger than 6 weeks
amp + (gent or cefotaxime) + acyclovir
31
empiric therapy for septicemia in older than 6 weeks
cefotaxime + (cloxacillin or vanco)
32
empiric therapy for meningitis in less than 6 weeks
amp + (gent or cefotaxime) + acyclovir
33
empiric therapy for meningitis in older than 6 weeks
cefotaxime + vanco with or without acyclovir with or without steroids
34
empiric therapy for strep pharyngitis/tosillitis
penicillin V or amoxicillin or penicillin G
35
empiric therapy for acute otitis media
amoxicillin or amox clav
36
empiric therapy for mastoiditis
cefotaxime + (cloxacillin or vanco) with or without metronidazole
37
empiric therapy for sinusitis
amox clav or (treat as mastoiditis if IV therapy needed)
38
empiric therapy for cervical lymphadenitis
cephalexin or clinda or (cefazolin plus or minus vanco)
39
empiric therapy for preseptal cellulitis
cephalexin or clinda or (cefazolin with or without vanco)
40
empiric therapy for orbital cellulitis
cefotaxime + (cloxacillin or vanco) plus or minus metro
41
empiric therapy for dental abscess
amox clav or (penicillin G + metro)
42
empiric therapy for pneumonia older than 3 months mild
amoxicillin and/or clarithromycin
43
empiric therapy for older than 3 months severe
cefotaxime + (clox or vanco) plus or minus clarithro plus or minus oseltamivir
44
empiric therapy for hospital acquired pna
(cefotaxime or pip-tazo) + (clox or vanco) plus or minus genta
45
empiric therapy for UTI mild
amox clav or cefixime
46
empiric therapy for UTI severe
(cefotaxime with or without gent) or pip tazo
47
empiric therapy for secondary peritonitis
pip tazo or (amp + gent + metro)
48
empiric therapy for mild cellulitis
cephalexin with or without TMP-SXT
49
empiric therapy for severe cellulitis
(clox or vanco) with or without clinda
50
empiric therapy for dog/cat/human bites
mile--> amox clav severe--> pip tazo
51
empiric therapy for nec fasc/bacterial myositis
penicillin + clinda with or without vanco
52
empiric therapy for bone and/or joint infection
cefazolin with or without vanco
53
what is the number one indication for abx use in kids
otitis media 80% of kids have 1 or more episodes (30% have three or more) milder disease often resolves spontaneously
54
how is otitis media usually treated
empirically amox clav or high dose amoxicillin
55
what does amoxicillin (with or without clav) cover?
respiratory tract flora (s pneumo, h influenzae, m catarrhalis) - -> high dose overcomes pneumococcus insensitivity - -> clav inhibits beta lactamases in haemophilus and moraxella
56
side effect of clavulanic acid
diarrhea
57
what bugs are most commonly causes of sepsis/meningitis in kids
respiratory colonizers pneumococcus, menongococci, Hib, GAS
58
what abx offers good CSF penetration
cefotaxime
59
what do the first generation cephalosporins cover
more gram + than gran -
60
what do the third generation cephalosporins cover
gram - more than gram +
61
what do the fourth generation cephalosporins cover
extended spectrum beta lactamase stable
62
what is first line for pertussis
azithro
63
what does clinda cover
anaerobic coverage --> but bacteriostatic covers some strains of MRSA
64
what are the common coliforms
ecoli klebsiella enterobacter
65
how do you treat "bowel spills" (i.e ruptured appendix)
requires multidrug empiric coverage ampicillin + cefotaxime + metro ampicillin + genta + metro pip tazo
66
is gentamicin avail orally
no only IV
67
what are the side effects of gentamicin
nephrotoxic ototoxic (vestibular and cochlear) --monitor renal function, potassium, audiometry
68
what does gentamicin cover
gram negativ orgs
69
what does metronidazole cover
excellent anaerobic coverage
70
side effects of metronidazole
metallic taste peripheral neuropathy disulfiram reaction
71
when do you use TMP SMX
skin and soft tissue infection empiric option for UTI **caution in those with G6PD
72
most common organisms causing neonatal sepsis
coliforms GBS listeria
73
top 10 pediatric abx
``` amox/amoxclav cloxacillin (IV) vanco cefotaxime (IV) azithro gentamicin (IV) metronidazole clinda penicillin V TMP SMX ``` cephalexin

Pediatrics 2 (19 decks)

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