ABX specific Flashcards
1
Q
1st gen cephalosporins
name 2 of them
A
Cephalexin
Cephazolin
2
Q
what class
Cephalexin
Cephazolin
A
1st gen cephalosporins
3
Q
what are 1st gen cephalosporins used in
Cephalexin
Cephazolin
A
Skin and UTI
Prophylaxis to prevent infections from surgical repair
4
Q
specific organisms 1st gen cephalosporins treat
A
Gram + (skin)
-Streptococci
-Staphylococci that are not B lactamase
Gram - (UTI)
-Proteus Mirabelis
-E.Coli
-Klebsiella pneumoniae
5
Q
Name 4 of the 2nd gen cephalosporins
A
Cefuroxime
Cefotetan
Cefoxitin
Cefaclor
6
Q
what drug class?
Cefuroxime
Cefotetan
Cefoxitin
Cefaclor
A
2nd gen cephalosporins
7
Q
What do 2nd gen Cephalosporins treat
A
Increased resistance to B lactamase as opposed to 1st gen
These have better gram - coverage than 1st gen
Also 2 in this class have anaerobic coverage
Cefotetan and Cefoxitin
Gram -
H. Influenzae
Serratia Marcescens
Enterobacter aerogenes
Some Neisseria
Only Cefotetan and Cefoxitin can treat anaerobic (Bacteroides Fragilis ->Peritonitis)
8
Q
what 2nd gen Cephalosporins can treat the anaerobic bacteria seen in Peritonitis (Bacteroides Fragilis)
A
Cefotetan
Cefoxitin
9
Q
what 3 generations of cephalosporins are considered Broad Spectrum
A
3rd generation
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime
4th Gen
-Cefepime
5th gen
Ceftaroline
10
Q
what 2 generations of cephalosporins can cross the BBB
A
3rd generation
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime
4th Gen
-Cefepime
11
Q
what antibiotics are 3rd gen cephalosporins
A
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime
12
Q
what med class
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime
A
3rd gen cephalosporins
13
Q
As you get further into the generations of cephalosporins, how does the coverage change
A
1st gen has the most gram + coverage
least amount of gram -
3rd and 4th are broad spectrum, however 4th has less coverage against gram + and increased coverage for gram -
however 4th gen is broader than 3rd gen
14
Q
What does 3 rd gen cephalosporins treat and organisms
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime
A
Less gram + and better gram - coverage
Also Ceftazidime covers Pseudomonas
Bacterial Meningitis
-H.Influenzae
-Pneumococci
-Meningococci
-Neisseria
PCN resistant Neisseria Gonorrhoeae
Ceftazidime - covers Pseudomonas Aeruginosa
Ceftriaxone - covers Borrelia Burdorferi - Lyme disease
15
Q
what 3rd gen cephalosporin covers for Pseudomonas Aeruginosa
A
Ceftazidime
16
Q
What 3rd gen cephalosporin covers for Borrelia Burdorferi seen in Lyme disease
A
Ceftriaxone
17
Q
what is the 4th generation cephalosporin
A
Cefepime
18
Q
what class is Cefepime
A
4th gen cephalosporin
19
Q
What is 4th gen Cephalosporin (cefepime) affective against
A
Gram + and - and pseudomonas
-Pseudomonas aeruginosa
-Bacterial meningitis
-Nosocomial infections - does not treat MRSA
20
Q
What class
Ceftaroline
A
5th gen cephalosporin
21
Q
what is the 5th gen cephalosporin
A
Ceftaroline
22
Q
what medications are effective against MRSA
A
Vancomycin
Ceftaroline
23
Q
If a pt has a _____ allergy, they cannot have cephalosporins
A
PCN - cross reactivity
24
Q
Adverse reactions for Cephalosporins
A
Diarrhea
Nausea
Rash
Disulfiram like reaction
-mixing with alcohol causes
-nausea
-Flushing
-rapid heartbeat
25
Vancomycin treats what?
is this gram + or gram -
MRSA
gram +
26
On the antibiotic ladder,
what is the top gun for gram + and for gram -
gram + - Linezolid (Zyvox)
gram - - Carbopenems - merapenem
27
Gram - coverage - lowest on abx ladder
IV and PO option
IV - Ampicillin
PO - Amoxicillin
28
Broad spectrum on abx ladder that covers for B lactamase bacteria .....just above Amp and amox
IV - Ampicillin/sulbactam - Unasyn
PO - Amoxicillin/Clavulanate - Augmentin
29
up the Antibiotic ladder on the Gram - side above Unasyn and augmentin
Covers for Pseudomonas
Broad spectrum
+ and -
and anaerobes
does not cover for MRSA or fungals
Pipercillin/Tazo (Zosyn)
30
-floxacin
fluoroquinolones
31
what routes do fluoroquinolones come in
Broad spectrum
They all come PO and IV,
Ciprofloxacin and Ofloxacin come in otic solutions
Moxifloxacin comes in ophthalmic
32
what are fluoroquinolones effective against
Gram negative bacteria
-Enterobacteriaceae
-Haemophilus
-Legionella
-Neisseria
-Moraxella
-Pseudomonas
Effective against certain mycobacteria
-used to treat TB
Bacterial resistance starting to see for Ciprofloxacin
33
fluoroquinolone base analogy on abx ladder
1st base - Ciprofloxacin
2nd base - Levofloxacin
3rd base - Moxifloxacin
1st base and 2nd base are gram neg coverage.
3rd base is both
34
Avoid Clarithromycin and Erythromycin in neonates due to what potential complication
Hypertrophic pyloric stenosis
35
Antibiotics for Community acquired pneumonia
Azithromycin PO
or
Ceftriaxone and Azithromycin IV
or
Moxifloxacin IV or PO
36
Antibiotics for Hospital acquired pneumonia
Vancomycin
and
Zosyn
37
Abx for Meningitis
Ceftriaxone
Vancomycin
+/- steroids
+/- Ampicillin - for immune compromised
38
ABX for UTI
Amoxicillin - pregnant
or
Nitrofurantoin - women
or
Bactrim - if no renal failure
or
Ceftriaxone - IV inpatient for pylo
or
Cipro - Outpatient for Pylo
39
abx for Cellulitis
Vancomycin - covers MRSA
or
Clindamycin
or
Bactrim
40
is e.coli gram neg or gram pos
gram neg
41
is PJP gram neg or pos
gram neg
42
Macrolides can cause what big side effect?
Long QT syndrome
azithromycin -infants
clarithromycin
Erythromycin - Everyone
43
PCN covers gram ___
+
44
Amox and Amp covers gram
+ and -
45
Augmentin and Unasyn cover
+ - and anaerobes
46
Methicillin and Oxacillin cover gram
+
47
Zosyn (piperacillin-tazobactam) and Timentin (Ticarcillin/Clavulanate) cover
+
-
Pseudomonas
Anaerobes
48
5th generation cephalosporin (Ceftaroline) covers for ____ but not _____
Covers for MRSA
Does not cover for Pseudomonas
49
Carbapenems cover
Gram +, -, pseudomonas, Anaerobes
*except ertapenem will not cover pseudomonas
50
Aztreonam covers
Gram - and pseudomonas
51
Quinolones cover
some gram +
gram -
Pseudomonas
Also Moxifloxacin will cover Anaerobes and Atypicals
52
Aminoglycosides cover
Gram -
Pseudomonas
53
Bactrim covers
MRSA
Gram +
Gram -
54
Macrolides cover
Gram +
Gram -
Atypicals
55
Tetracyclines (Doxycycline) cover
Gram +
Gram -
MRSA
Atypicals
56
Tigecycline covers
Everything except Pseudomonas
57
Clindamycin covers
MRSA
Gram +
Anaerobes
58
Vancomycin covers
MRSA
Gram +
59
Daptomycin covers
MRSA
Gram +
60
Daptomycin covers
MRSA
Gram +
61
Linezolid covers
MRSA
Gram +
62
How is CNS penetration with Cefazolin
poor
63
How is CNS penetration with Clindamycin
Poor
64
How is CNS penetration with Gentamicin
only 10-30% penetration with inflamed meninges
65
which drugs concentrate high in the urine
Penicillin
Cephalosporins
Aminoglycosides
66
Gram + or -
E. Coli
Gram -
67
Gram + or -
Staphylococcus
-MRSA
-MSSA
-Staph Epidermidis
Gram+
68
Most common organisms in CLABSI
Coagulase-negative Staphylococcus (CoNS)
S. aureus
GNR
Candida
69
After diagnosing a CLABSI, when would you considering removing the central line?
-Severe Sepsis
-Endocarditis
-Persistently + cultures after 72 hours of therapy
-S. aureus, GNR including Pseudomonas, Bacillus, Enterococcus
-Mycobacteria/fungi
-Tunnel site infection
-Suppurative thrombophlebitis
70
Gram + or -
Streptococcus
-Agalactiae (Group B Strep)
-Anginosus
- Constellatus
-Intermedius
-Pneumoniae
-Pyogenes (Group A strep)
Gram +
71
Gram positive cocci in clusters
Staph
72
Vancomycin covers
All Staph aureus including MRSA
73
You have a pt who you start on Vancomycin for MRSA coverage.
After your culture comes back, continue only if MRSA AND ???
What if the culture shows MSSA
CNS infection OR
Endovascular infection (ie: endocarditis)
otherwise switch to another agent like clindamycin - like for a bone infection
for MSSA
-for parenteral therapy: can use nafcillin or cefazolin
74
Gram + or -
Enterococcus
-Faecalis
-Faecium
Gram +
75
Gram + or -
Enterobacter
-Aerogenes
-Cloacae
Gram -
76
Drugs that offer MRSA coverage (can be limited by resistance)
-Vancomycin
-Clindamycin
-Bactrim
-Doxycycline
-Linezolid
-Ceftaroline
77
Gram + or -
Klebsiella
-Oxytoca
-Pneumoniae
Gram -
78
Gram + or -
Morganella Morganii
Gram -
79
In treating MRSA
What would be a smaller gun for treating MRSA rather than Vancomycin
Bactrim - In 2020 only 5% of cases were resistant
Clindamycin - 25% MRSA and 16% MSSA were resistant
Vancomycin - 100% susceptible - so best choice for initial therapy...
80
CoNS is frequently a blood culture contaminate but can be a real pathogen in what settings
-Preterm neonates
-CLABSI
-VP Shunt infections
-Hardware infections
-S. saprophyticus can cause UTIs in adolescents
81
Gram + or -
Proteus Mirabilis
Gram -
82
Gram + or -
Pseudomonas Aeruginosa
Gram -
83
Gram + or -
Salmonella species Not Typhi
Gram -
84
Enterococcus are inherently resistant to what drugs
Cephalosporins
85
Drug options for Enterococcus
Depends on susceptibility
-Ampicillin
-Zosyn
-Vancomycin
In abdominal infections:
-Carbapenems (Meropenem) will cover Ampicillin susceptible Enterococci
In VRE (Vancomycin resistant Enterococcus)
-Linezolid
-Daptomycin
86
Treatment for VRE (Vancomycin resistant Enterococcus)
-Linezolid
-Daptomycin
87
Gram + or -
Serratia Marcescens
Gram -
88
Gram + or -
Stenotrophomonas Maltophilia
Gram -
89
Cystic fibrosis isolates in Gram neg
Pseudomonas Aeruginosa (CF)
Pseudomonas Aeruginosa, Mucoid (CF)
Stenotrophomonas Maltophilia (CF)
90
Cystic fibrosis isolates in Gram Pos
MRSA (CF)
MSSA (CF)
91
treatment for Strep. pneumoniae
1st line
-PCN
-Ampicillin
-Amoxicillin (high dose so overcome resistance)
2nd line
-3rd gen cephalosporins
-Ceftriaxone and cefotaxime
-oral: Cefdinir, cefixime, Cefpodoxime
-Clindamycin
Do not use
-Azithromycin
-Bactrim
For multi-drug resistant:
-Vancomycin
-Levofloxacin
-Linezolid
92
Gram neg rod
pink stain
E. coli
93
Gram neg drugs
-Beta-Lactams
-Aminoglycosides (Gentamicin, tobramycin)
(Nephrotoxic, Ototoxic)
-Bactrim
-Fluoroquinolones (Levofloxacin, Ciprofloxacin)
(Black box warning: damage cartilage in growing children)
-Carbapenems (meropenem, imipenem)
-Others (Tigecycline, colistin)
94
When do you consider pseudomonas?
-Fever and neutropenia
-Ventilator Associated pneumonia
-Cystic Fibrosis
-Burns
-Chronic otitis/mastoiditis
-Osteomyelitis after nail puncture through tennis shoes
95
Anti-pseudomonal drugs
Beta-lactams
-Piperacillin, Ticarcillin
-Cefepime, Ceftazidime
-Carbapenems
Aminoglycosides
Fluoroquinolones
Aztreonam
96
When do you consider anaerobes
-Dental infections
-Deep neck infections
-Bran abscesses
-Abdominal process
97
Drugs with anaerobic coverage
-PCN (unless Beta lactamase positive)
-Augmentin, Bactrim
-Clindamycin
-Flagyl
-Ticarcillin-Clavulanate, Zosyn
-Meropenem/Carbapenems
98
What antibiotics cover osteomyelitis from S. Aureus
-Nafcillin
-Cefazolin
-Clindamycin
-Vancomycin
*4 week min
* if uncomplicated, can transition to oral therapy
99
What antibiotics cover osteomyelitis from Streptococci?
PCN
Ceftriaxone
*4 weeks min
100
What antibiotics cover osteomyelitis from Pseudomonas
Ceftazidime
Zosyn
Fluoroquinolones
-Shorter course usually okay if proper debridement
101
What antibiotics cover osteomyelitis from Kingella
Ceftriaxone
102
What antibiotics cover osteomyelitis from Salmonella
Ceftriaxone (ampicillin if susceptible)
* 4 weeks min
103
For Osteomyelitis what would you cover with while waiting on Culture
Vancomycin - staph
Ceftriaxone -strep, kingella, salmonella
doesn't cover for pseudomonas
104
CSF analysis
OP < 20
WBC <5
Protein 15-45
Glucose 45-80
Stain/Cx Neg/Neg
Normal CSF
105
CSF analysis
OP elevated
WBC >1000
Protein >100
Glucose <40
Stain/Cx Pos/Pos
Bacterial
106
CSF analysis
OP WNL
WBC <300
Protein <150
Glucose WNL
Stain/Cx Neg/Pos
Viral
107
CSF analysis
OP Very elevated
WBC <500
Protein >100
Glucose <50
Stain/Cx Pos/Pos
TB
108
CSF analysis
OP elevated
WBC <200
Protein Elevated
Glucose WNL
Stain/Cx Neg/Neg
Abscess
109
meningitis etiology by age
< 1 mos
-GBS
-E.coli
-Listeria Monocytogenes
1-3 mo
-Neonatal pathogens
-S pneumoniae
-N. meningitis
-Hib
3-6 mos
-S. pneumoniae
-N. meningitis
-Hib
>7 mo - 21 yrs
-S. pneumoniae
-N. meningitis
110
abx to cover meningits
usually
Vancomycin + Ceftriaxone if > 1 month
Vanc (just in case strep pneumo that is resistant to Rocephin)
Ceftriaxone (strep pnemo and N. meningitis)
Neonates - Ampicillin and Ceftazidime (or gentamicin)
Infants and children: Vancomycin and 3rd gen cephalosporin (Ceftriaxone)
111
Most likely pathogens causing sepsis in normal infants and children with no other factors
Treat?
S. pneumoniae,
N. meningitidis,
Group A streptococcus
Vancomycin + Rocephin
112
Most likely pathogens causing sepsis in normal infants and children with
Skin lesion, bone or joint focus, trauma
Treat?
S. aureus
Group A streptococcus
Vancomycin +/- Rocephin
Add Nafcillin if suspecting Staph
113
Most likely pathogens causing sepsis in normal infants and children with burns
Pseudomonas
114
Most likely pathogens causing sepsis in normal infants and children with uropathy or UTI
Treat?
Gram - enterics
-Rocephin (if differential does not include pseudomonas)
-Zosyn
115
Most likely pathogens causing sepsis in normal infants and children with Gastrointestinal source
Gram - enterics
Anaerobes
-Zosyn
-Ampicillin or Rocephin + Clindamycin or Flagyl + aminoglycoside
116
Acute community-acquired pneumonia in normal children: infectious etiologies
Treatment:
Birth to 3 wks
-GBS, GNR, CMV, Listeria, HSV, syphilis
3 wks to 3 months
-Viruses, GBS, S. pneumoniae, pertussis, C. trachomatis (2 wks – 4 mo)
3 mo to 5 yrs
-Viruses, S. pneumoniae, Hib, NT H. flu, Moraxella, S. aureus, S. pyogenes, Mycoplasma, think about TB too!
Children > 5 yrs
-Mycoplasma pneumoniae
-S. pneumonia, S. aureus, S. pyogenes
Treatment:
-Ampicillin for fully immunized infant or school aged
-Ceftriaxone if not fully immunized
-Local epidemiology with PCN resistance
-Life threatening infection
-empyema
Add Vanc or clindamycin if you are concerned about S. Aureus
Add azithromycin if concerned for atypical
117
Outpatient pneumonia management
Amoxicillin (high dose)
-Add azithromycin if need atypical coverage
oral cephalosporins not recommended
118
parenteral treatment for UTI
Rocephin
Cefotaxime
Ceftazidime
Gentamicin
Tobramycin
Piperacillin
119
most common organism for Purulent/fluctuant lesions (abscess, furuncle, folliculitis)
Staph aureus
120
Most common organism for cellulitis, erysipelas
GAS and other beta-hemolytic strep or S. Aureus
121
Most common organism for impetigo
S. Aureus or GAS
122
Abx for skin and soft tissue
Bactrim
Clindamycin
or Doxycycline
123
Most common organisms for acute otitis media
Treatment?
Streptococcus pneumoniae, nontypeable H. influenzae, and Moraxella catarrhalis
If > 2 years and uncomplicated/ non-toxic – could observe x 48-72 hours after risk/ benefit discussion with family
Antibiotics:
Amoxicillin (90 mg/kg/DAY divided into 2 doses)
Amoxicillin-clavulanate if recent betalactam use or if no response to amoxcillin
124
Most common organism for sinusitis and treatment
Haemophilus influenzae (nontypeable)
Streptococcus pneumoniae
Moraxella catarrhalis
Treatment:
Amoxicillin-clavulanate
125
GAS pharyngitis treatment
Penicillin x 10 days
Amoxicillin x 10 days is a reasonable alternative
Cephalosporins, clindamycin, and macrolides are alternatives for patients who are allergic to penicillin or who cannot otherwise tolerate penicillin
