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Medicine > Anti-bacterial therapy > Flashcards

Anti-bacterial therapy Flashcards

1
Q

what is a bactericidal?

A

eradicates the bacteria

  • dependent on concentration
  • critical to use the appropriate dose
  • preferred for meningitis and UTI (immune system is not able to resolve these cases on their own)
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2
Q

what is a bacteriostatic?

A

inhibits bacterial replication and allows host to eradicate it
-dependent on time

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3
Q

what are common causative agents of UTI?

A

E. coli (90%), other gram neg bacilli (may be MDR), staph. saprophyticus,group B strep

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4
Q

what info should you get when treating for UTI?

A

prior UTIs
prior antimicrobials
exposure to or symptoms of STDs

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5
Q

what are the empiric treatments for UTIs?

A

TMP-SMX (3 dys-bacteriostatic)
Fluoroquinolone (3 dys)

Less preferred bc they take longer
Nitrofurantoin (7 dys)
Amox/Clav (7 dys)

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6
Q

what are common causative agents of cellulitis?

A

S. aureus
group A strep
group B strep

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7
Q

what info should you get when treating for cellulitis?

A

prior infections
MRSA risk profile
human/animal bite
comorbidities

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8
Q

what are the empiric treatments for cellulitis?

A 
dicloxacillin (MRSA gap)
TMP-SMX (GAS gap)
Clindamycin (MRSA gap)
doxycycline (less MRSA experience)
linezolid (cost, side effect profile)
fluoroquinolone and rifampin (less exp, drug interactions, resistance)
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9
Q

what info should you getn when treating URI?

A 
prior episodes/treatment
recent travel
sick contacts
animal exposures
TB risk/HIV risk
Occupation
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10
Q

what would you use to treat URI?

A 
most are viral
bacterial pathogen likelihood increases with more severe symptoms
-beta-lactam (penicillin/cephalosporin)
-macrolid
-lincomycin
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11
Q

what would you use to treat LRI?

A

empirical recommendations are more evidence based

  • Health pts
  • –doxycycline
  • –macrolide (not if high local resistance)
  • co morbidities/recent antibiotic use
  • –“respiratory” fluoroquinolone
  • –Amox/clav combination
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12
Q

what separates penicillin and cephalosporins?

A

penicillin is 5 member ring whereas the other is 6 member ring

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13
Q

what is the MOA of penicillin?

A

bactericidal-need the right concentration

inhibits bacterial cell wall synthesis

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14
Q

what do you use penicillin for?

A

Staph (coagulase-negative)
strep pyrogenes
other gram positives (enterococcus)

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15
Q

what would you use for uncomplicated otitis media?

A

amoxicillin

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16
Q

what would you use for pre-partum GBS prophylaxis?

A

ampicillin

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17
Q

what would you use for S bacterial endocarditis prophylaxis?

A

Penicillin V

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18
Q

what would you use for H. pylori treatment?

A

amoxicillin

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19
Q

when would you use anti-staph penicillin?

A

coagulase-negative staph
MSSA
beta-lactamase producing strep
***bacterial endocarditis

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20
Q

what are the broadened spectrum penicillin?

A

amox/clavulanate (augmentin)
ampicillin/sulbactam (unasyn)
piperacillin/tazobactam (zosyn)

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21
Q

what are the extended spectrum penicillins?

A 
ticarcillin
mezlocillin
azlocillin
piperacillin (only one that is mostly used today)
***only given in the hospital
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22
Q

why are cephalosporins better than penicillin?

A

more dosage options

better bio availability

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23
Q

what is the MOA of cephalosporins?

A

bactericidal

inhibit bacterial dihydropeptidase

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24
Q

what are the 1st generation cephs?

A

cefazolin
cephalexin
cefadroxil

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25
Q

what are the 2nd gen cephs?

A

cefoxitin

cefuroxime

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26
Q

what are the 3rd gen cephs?

A

ceftriaxone

cefpodoxime

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27
Q

what are teh 4th gen cephs?

A

cefipime

ceftaroline (pseuod)

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28
Q

which ceph will cover MRSA in vitro?

A

ceftaroline

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29
Q

what do 1st gen cephs work against?

A

non-beta lactamase producing gram positive, no anaerobes

-same coverage as penicillin but better bio availability

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30
Q

what do 2nd gen cephs work against?

A

non-BL producing organism, more gram N, less gram P, more anaerobes
-indicated in clean-contaminated surgical procedures

31
Q

what do 3rd gen cephs work against?

A

more resistance to BL producing organisms

more gram P, more gram N, no anaerobes

32
Q

what indications does ceftriaxone have?

A

OM with effusion
CAP
meningitis (accumulates well in the brain)
NOT recommended for surgical prophylaxis

33
Q

what do 4th gen cephs work against?

A

similar to 3rd gen, but have better resistance to BL producing organisms, no anaerobes
***mostly used to limit serious infections in the inpt setting

34
Q

what are the MOA of fluoroquinolones?

A

bactericidal

inhibits bacterial DNA synthesis

35
Q

what are indications for fluor?

A

good against staph, NOT strep, good against gram negative (non BL producing), NOT anaerobes

36
Q

which fluor are good agents against strep?

A

levofloxicin

moxifloxacin

37
Q

which fluor is a good agent against anaerobes?

A

moxifloxacin

38
Q

what should you use for uncomplicated uTI?

A

cipro

39
Q

what are benefits of fluors?

A

broad spectrum
once a day
all orally available

40
Q

why would you not use fluor for meningitis?

A

it does not penetrate BBB

41
Q

which antibiotic requires renal adjustment?

A

fluoro
penicillin
cephs

42
Q

would you use fluor for URI?

A

no, not evidence based

43
Q

which are the macrolides?

A

erythromycin
azithromycin
clarithromycin

44
Q

what is the MOA of macrolides?

A

bacteriostatic

inhibits bacterial protein synthesis which prevents replication

45
Q

what do macrolides work against?

A

gram P organisms (strep, listeria, clostridium), good atypical coverage **mycoplasma, legionella, chlamydia), NOT staph, NOT gram N, NOT anaerobic

46
Q

what are clinical indications of macrolides?

A

mono outpatient therapy for CAP, combo inpatient therapy w/ ceftriaxone for CAP
atypical pneumonia
GU infections cause by chlamydia
some URI

47
Q

which antibiotics are the worst for GI flora?

A

macrolides

48
Q

what are the tetracycline agents?

A

tetracycline
doxycycline
minocycline
tigecycline (glycylcycline)

49
Q

what is the MOA of tetras?

A

bacteriostatic

inhibits bacterial protein synthesis

50
Q

what are drawbacks of tetras?

A

rapid development of resistance and toxicities

51
Q

what are clinical indications of tetras?

A

rickettsial infections (Lymes, RMSF)
prophylaxis, intra-abdominal, gyn infections (Dox)
2a infections caused by acne (Mino)
serious infections by susceptible bacteria -hail mary (Tige)

52
Q

who is contraindicated for tetras?

A

children (staining of bone and teeth), expecting mothers

53
Q

what is the agent for lincomycin?

A

clindomycin

54
Q

what is the MOA of lincomycin?

A

bacteriostatic

inhibits protein synthesis

55
Q

what are the clinical uses of lincomycin?

A 
gram P infections by some strains of strep and staph (alt to beta lactam)
anaerobic infections (gut, pelvis)
56
Q

what are clinical side effects of lincomycin?

A 
severe enterocolitis (1-2% pseudomembranous colitis)
sig resistance among gram P
57
Q

what are agents of sulfonamides?

A

sulfamethoxazole
trimethoprim
TMP-SMX (bactrim)
sulfaisoxazole (gantrisin)

58
Q

what is the MOA of sulfonamides?

A

bacteriostatic

inhibits bacterial folic acid synthesis

59
Q

what are the clinical indications for sulfonamides?

A

peds URI
PCP pneumonia treatment
topical bacterial infections for burns (silvadine)
ocular infections

60
Q

what are drawbacks for using sulfonamides?

A

rash/exfoliation
folic acid deficiency
allergy

61
Q

what are agents of nitrofurantoin?

A

macrodantin

macrobid

62
Q

what are clinical indications of nitrofurantoin?

A

alt for uncomplicated UTI caused by gram N (E. coli, Klebsiella, Proteus)

63
Q

who is contraindicated for nitrofurantoin?

A

CrCl of less than 50

  • have to be secreted from kidneys into the blood
  • won’t be absorbed w/o good kidney function
64
Q

what are clinical indications of metronidazole?

A

excellent against bacteroids, clostridium, helicobacter, trichomonas,**drug of first choice for c. diff

65
Q

what are clinical indications of rifampin?

A

bactericidal
TP and
meningitis caused by gram P (pneumococcus) b/c of CNS penetration
good mycobacterial in combination with other agents (isoniazid, ethambutol)

66
Q

what are drawbacks of using rifampin?

A

hepatotoxic
numerous drug interactions
lost of resistance has limited uses

67
Q

what is the MOA of aminoglycosides?

A

bacteriostatic

inhibits protein synthesis

68
Q

what are drawbacks of using aminoglycosides?

A

have to adjust to renal function

ototoxic with long term use

69
Q

what is the MOA of vancomycin?

A

bactericide

must be given IV (large molecule)

70
Q

what are clinical indications of vanc?

A
  • **effective against MRSA but resistance is rising

* ***used to treat c. diff if metronidazole isn’t working

71
Q

what are drawbacks of using vanc?

A

renal and ototoxic

72
Q

what is linezolid used for?

A

MRSA,!! VRE!!!

73
Q

what is a drawback of using linezolid?

A

food-drug interactions effects metabolism of serotonin and catecholamines

74
Q

what is daptomycin used for?

A

bactericidal
**MRSA (skin/soft tissue), **MSSA, anti staph, maybe against VRE
IV only
***inpatient use against serious gram P infections

Medicine (146 decks)

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