Anti-bacterial therapy Flashcards by Faith Hislop

what is a bactericidal?

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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what is a bacteriostatic?

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

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what are common causative agents of UTI?

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

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what info should you get when treating for UTI?

prior UTIs
prior antimicrobials
exposure to or symptoms of STDs

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what are the empiric treatments for UTIs?

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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what are common causative agents of cellulitis?

S. aureus
group A strep
group B strep

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what info should you get when treating for cellulitis?

prior infections
MRSA risk profile
human/animal bite
comorbidities

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what are the empiric treatments for cellulitis?

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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what info should you getn when treating URI?

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

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what would you use to treat URI?

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

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what would you use to treat LRI?

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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what separates penicillin and cephalosporins?

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

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what is the MOA of penicillin?

bactericidal-need the right concentration

inhibits bacterial cell wall synthesis

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what do you use penicillin for?

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

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what would you use for uncomplicated otitis media?

amoxicillin

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what would you use for pre-partum GBS prophylaxis?

ampicillin

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what would you use for S bacterial endocarditis prophylaxis?

Penicillin V

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what would you use for H. pylori treatment?

amoxicillin

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when would you use anti-staph penicillin?

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

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what are the broadened spectrum penicillin?

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

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what are the extended spectrum penicillins?

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

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why are cephalosporins better than penicillin?

more dosage options

better bio availability

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what is the MOA of cephalosporins?

bactericidal

inhibit bacterial dihydropeptidase

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what are the 1st generation cephs?

cefazolin
cephalexin
cefadroxil

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what are the 2nd gen cephs?

cefoxitin | cefuroxime

what are the 3rd gen cephs?

ceftriaxone | cefpodoxime

what are teh 4th gen cephs?

cefipime | ceftaroline (pseuod)

which ceph will cover MRSA in vitro?

ceftaroline

what do 1st gen cephs work against?

non-beta lactamase producing gram positive, no anaerobes | -same coverage as penicillin but better bio availability

what do 2nd gen cephs work against?

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

what do 3rd gen cephs work against?

more resistance to BL producing organisms | more gram P, more gram N, no anaerobes

what indications does ceftriaxone have?

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

what do 4th gen cephs work against?

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

what are the MOA of fluoroquinolones?

bactericidal | inhibits bacterial DNA synthesis

what are indications for fluor?

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

which fluor are good agents against strep?

levofloxicin | moxifloxacin

which fluor is a good agent against anaerobes?

moxifloxacin

what should you use for uncomplicated uTI?

cipro

what are benefits of fluors?

broad spectrum once a day all orally available

why would you not use fluor for meningitis?

it does not penetrate BBB

which antibiotic requires renal adjustment?

fluoro penicillin cephs

would you use fluor for URI?

no, not evidence based

which are the macrolides?

erythromycin azithromycin clarithromycin

what is the MOA of macrolides?

bacteriostatic | inhibits bacterial protein synthesis which prevents replication

what do macrolides work against?

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

what are clinical indications of macrolides?

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

which antibiotics are the worst for GI flora?

macrolides

what are the tetracycline agents?

tetracycline doxycycline minocycline tigecycline (glycylcycline)

what is the MOA of tetras?

bacteriostatic | inhibits bacterial protein synthesis

what are drawbacks of tetras?

rapid development of resistance and toxicities

what are clinical indications of tetras?

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

who is contraindicated for tetras?

children (staining of bone and teeth), expecting mothers

what is the agent for lincomycin?

clindomycin

what is the MOA of lincomycin?

bacteriostatic | inhibits protein synthesis

what are the clinical uses of lincomycin?

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

what are clinical side effects of lincomycin?

``` severe enterocolitis (1-2% pseudomembranous colitis) sig resistance among gram P ```

what are agents of sulfonamides?

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

what is the MOA of sulfonamides?

bacteriostatic | inhibits bacterial folic acid synthesis

what are the clinical indications for sulfonamides?

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

what are drawbacks for using sulfonamides?

rash/exfoliation folic acid deficiency allergy

what are agents of nitrofurantoin?

macrodantin | macrobid

what are clinical indications of nitrofurantoin?

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

who is contraindicated for nitrofurantoin?

CrCl of less than 50 - have to be secreted from kidneys into the blood - won't be absorbed w/o good kidney function

what are clinical indications of metronidazole?

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

what are clinical indications of rifampin?

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

what are drawbacks of using rifampin?

hepatotoxic numerous drug interactions lost of resistance has limited uses

what is the MOA of aminoglycosides?

bacteriostatic | inhibits protein synthesis

what are drawbacks of using aminoglycosides?

have to adjust to renal function | ototoxic with long term use

what is the MOA of vancomycin?

bactericide | must be given IV (large molecule)

what are clinical indications of vanc?

* ****effective against MRSA but resistance is rising | * ***used to treat c. diff if metronidazole isn't working

what are drawbacks of using vanc?

renal and ototoxic

what is linezolid used for?

MRSA,!! VRE!!!

what is a drawback of using linezolid?

food-drug interactions effects metabolism of serotonin and catecholamines

what is daptomycin used for?

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