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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
Q

what are the protein synthesis inhibitor abxs

A
  1. aminoglycosides–> gentamicin, tobramycin, amikacin, streptomycin
  2. macrolides–> erythromycin, clarithromycin, azithromycin
  3. other–> clinda, linezolid, tetracyclines (doxy)
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26
Q

what are the RNA or DNA synthesis inhibitor abxs

A
  1. RNA transcription inhibitor –> rifampin
  2. DNA synthesis inhibitors–> fluoroquinolones (cipro and levofloxacin)
  3. nucleotide synthesis inhibitors–> TMP-SXT
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27
Q

how does metronidazole work

A

toxic free radical production

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28
Q

what are bacteriostatic abxs

A

inhibit bacterial cell growth

need INTACT IMMUNE SYSTEM to fight infection

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29
Q

what are bacteriocidal abxs

A

kill bacteria directly

do not rely on immune system of patient

(therefore okay in immunocompromised)

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30
Q

empiric therapy for septicemia in younger than 6 weeks

A

amp + (gent or cefotaxime) + acyclovir

31
Q

empiric therapy for septicemia in older than 6 weeks

A

cefotaxime + (cloxacillin or vanco)

32
Q

empiric therapy for meningitis in less than 6 weeks

A

amp + (gent or cefotaxime) + acyclovir

33
Q

empiric therapy for meningitis in older than 6 weeks

A

cefotaxime + vanco with or without acyclovir with or without steroids

34
Q

empiric therapy for strep pharyngitis/tosillitis

A

penicillin V or amoxicillin or penicillin G

35
Q

empiric therapy for acute otitis media

A

amoxicillin or amox clav

36
Q

empiric therapy for mastoiditis

A

cefotaxime + (cloxacillin or vanco) with or without metronidazole

37
Q

empiric therapy for sinusitis

A

amox clav or (treat as mastoiditis if IV therapy needed)

38
Q

empiric therapy for cervical lymphadenitis

A

cephalexin or clinda or (cefazolin plus or minus vanco)

39
Q

empiric therapy for preseptal cellulitis

A

cephalexin or clinda or (cefazolin with or without vanco)

40
Q

empiric therapy for orbital cellulitis

A

cefotaxime + (cloxacillin or vanco) plus or minus metro

41
Q

empiric therapy for dental abscess

A

amox clav or (penicillin G + metro)

42
Q

empiric therapy for pneumonia older than 3 months mild

A

amoxicillin and/or clarithromycin

43
Q

empiric therapy for older than 3 months severe

A

cefotaxime + (clox or vanco) plus or minus clarithro plus or minus oseltamivir

44
Q

empiric therapy for hospital acquired pna

A

(cefotaxime or pip-tazo) + (clox or vanco) plus or minus genta

45
Q

empiric therapy for UTI mild

A

amox clav or cefixime

46
Q

empiric therapy for UTI severe

A

(cefotaxime with or without gent) or pip tazo

47
Q

empiric therapy for secondary peritonitis

A

pip tazo or (amp + gent + metro)

48
Q

empiric therapy for mild cellulitis

A

cephalexin with or without TMP-SXT

49
Q

empiric therapy for severe cellulitis

A

(clox or vanco) with or without clinda

50
Q

empiric therapy for dog/cat/human bites

A

mile–> amox clav

severe–> pip tazo

51
Q

empiric therapy for nec fasc/bacterial myositis

A

penicillin + clinda with or without vanco

52
Q

empiric therapy for bone and/or joint infection

A

cefazolin with or without vanco

53
Q

what is the number one indication for abx use in kids

A

otitis media

80% of kids have 1 or more episodes (30% have three or more)

milder disease often resolves spontaneously

54
Q

how is otitis media usually treated

A

empirically

amox clav or high dose amoxicillin

55
Q

what does amoxicillin (with or without clav) cover?

A

respiratory tract flora (s pneumo, h influenzae, m catarrhalis)

  • -> high dose overcomes pneumococcus insensitivity
  • -> clav inhibits beta lactamases in haemophilus and moraxella
56
Q

side effect of clavulanic acid

57
Q

what bugs are most commonly causes of sepsis/meningitis in kids

A

respiratory colonizers

pneumococcus, menongococci, Hib, GAS

58
Q

what abx offers good CSF penetration

A

cefotaxime

59
Q

what do the first generation cephalosporins cover

A

more gram + than gran -

60
Q

what do the third generation cephalosporins cover

A

gram - more than gram +

61
Q

what do the fourth generation cephalosporins cover

A

extended spectrum

beta lactamase stable

62
Q

what is first line for pertussis

63
Q

what does clinda cover

A

anaerobic coverage –> but bacteriostatic

covers some strains of MRSA

64
Q

what are the common coliforms

A

ecoli
klebsiella
enterobacter

65
Q

how do you treat “bowel spills” (i.e ruptured appendix)

A

requires multidrug empiric coverage

ampicillin + cefotaxime + metro

ampicillin + genta + metro

pip tazo

66
Q

is gentamicin avail orally

A

no only IV

67
Q

what are the side effects of gentamicin

A

nephrotoxic
ototoxic (vestibular and cochlear)
–monitor renal function, potassium, audiometry

68
Q

what does gentamicin cover

A

gram negativ orgs

69
Q

what does metronidazole cover

A

excellent anaerobic coverage

70
Q

side effects of metronidazole

A

metallic taste

peripheral neuropathy

disulfiram reaction

71
Q

when do you use TMP SMX

A

skin and soft tissue infection
empiric option for UTI

**caution in those with G6PD

72
Q

most common organisms causing neonatal sepsis

A

coliforms
GBS
listeria

73
Q

top 10 pediatric abx

A 
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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