Anti-bacterials Flashcards
ESBL treatment
Imipenem + Cilastatin
(cilastatin inhibit DHP → prevent hydrolysis of imipenem @ brush border of PCT)
Bacteriostatic vs Bacteriocidal
Bacteriostatic
1) 30s: Tetracyclines, Glycylcycline
2) 50s: Macrolides, Clindamycin, Linezolid
3) Anti-TB: Ethambutol
4) Folate Acid Synthesis: Sulfonamide, Trimethoprim, Cotrimoxazole
Everything else bactericidal
Oral only
1) Penicillin V
2) 1st and 2nd Gen cephalosporin: cephalexin, cefuroxime (except cefazolin)
3) Aztreonam (monobactam)
4) Neomycin (Aminoglycosides)
IV/IM only
1) Penicillin G
2) Sulbactam (the one to take with ampicillin)
3) Piptazo
4) 3-5th Gen Cephs + Cefazolin
5) Carbapenems (Imi, Mero, Erta)
6) Tigecycline (Glycylcycline)
7) Aminoglycosides (except neomycin)
Both Renal and Hepatic
(req. mostly only renal adjustment)
1) Linezolid
2) Pyrazinamide
3) Folate synthesis inhibitors: Sulfonamide, Trimethoprim, Cotrimoxazole
Hepatic/Unchanged vs Renal
1) Ceftriaxone
2) Tetracyclines: Doxy and Minocycline
3) Tigecycline
4) 50s: Macrolides, Clindamycin (except Linezolid)
5) Anti-TB: Rifampicin, Isoniazid
6) Fluoroquinolone: Moxifloxacin
Hepatic adjustments
1) Ceftriaxone
2) Tigecycline
3) Moxifloxacin
Renal adjustments
1) All cell wall (except penicillinase R & Ceftriaxone)
2) Tetracycline
3) Aminoglycosides
4) Fluroquinolones (except moxifloxacin)
5) Folate acid synthesis inhibitors
6) Pyrazinamide
Unsafe in pregnancy
1) 30s: Tetracycline, Glycylcycline, Aminoglycosides
2) Nucleic acid: Fluoroquinolones, Sulfonamide, Cotrimoxazole (except trimethoprim)
3) Nitrofurantoin
CYP inducer
Rifampicin
CYP inhibitor
1) Macrolides (except Azithromycin)
2) Isoniazid
3) Ciprofloxacin
4) Sulfonamide
5) Cotrimoxazole
Nephrotoxicity
1) Vancomycin
2) Aminoglycosides
Hepatotoxicity
1) Co-amoxiclav
2) Tigecycline
3) Macrolides
4) Nitrofurantoin
5) Isoniazid
6) Pyrazinamide
Ototoxicity
1) Vancomycin
2) Aminoglycosides
3) Macrolides
Neurotoxicity
1) Penicillins
2) Carbapenems
3) Metronidazole
Peripheral neuropathy
1) Linezolid
2) Fluroquinolones
3) Nitrofurantoin
4) Isoniazid (give pyridoxine)
5) Ethambutol
6) Metronidazole
CDAD
1) Aminopenicillins
2) Cephalosporins
3) Tetracyclines
4) Tigecycline
5) Clindamycin
6) Ciprofloxacin
Hypersensitivity (Anaphylaxis, SJS, TEN)
1) Penicillin
2) Cephalosporins
3) Carbapenems
4) Neomycin
5) Co-trimoxazole
Prolonged QT interval
Macrolides, fluroquinolones
Thrombophlebitis
1) Cephalosporins
2) Vancomycin
Serotonin syndrome
1) Linezolid
2) Isoniazid
Colour changes
1) Nitrofurantoin (Brown urine)
2) Rifampicin (Orange tears and sweat)
3) Metronidazole (Dark/rust coloured urine)
Bone marrow suppression
1) Linezolid
2) Cotrimoxazole
Generally what to use against no R bacteria?
Penicillin
Generally what to use against penicillinase producing strains?
Cloxacillin/Zosyn
Generally what to use against penicillin R Gram negs?
Aminopenicillins
→ Antipseudomonal
→ Monobactam / carbapenem
Generally what to use against beta lactamase producing strains?
eg. Pseudomonas, Klebsiella
Co-amoxiclav / Zosyn + Anti-pseudomonal (piptazo)
Generally what to use against ESBL strains?
eg. Acinetobacter
1) Carbapenems (Mero and Imi)
2) Tigecycline
Generally what to use against altered PBP strains?
eg. MRSA, Neisseria gonorrhoeae
MRSA: Vancomycin, Linezolid
N. gonorrhoeae: Protein synthesis inhibitors (eg. Aminoglycosides, tetracyclines, macrolides, clindamycin, linezolid)
What to give in place of penicillin (allergy)?
1) Monobactam (Aztreonam)
2) Glycopeptides (Vancomycin)
3) anything else
What are aminoglycosides mainly used for?
G- coverage
(6 NOs)
What are tetracyclines mainly used for?
Atypicals
+ Doxycyclin for soft tissue MRSA
+ Tigecycline for MRSA and VRE
What are macrolides mainly used for?
In place of penicillins (braod spec + atypicals)
What is clindamycin mainly used for?
1) Anerobic everywhere expect GUT and GU
2) Anti-toxin properties
What is linezolid mainly used for?
Last resort against MRSA and VRE
What are Fluoroquinolones mainly used for?
1) Ciprofloxacin: G-
2) Levofloxacin: G-, G+, Atypical, Anaerobe
3) Moxifloxacin: G+, Atypical, Anaerobe - Pseudomonas
What is cotrimoxazole mainly used for?
1) G+ including MRSA
2) G- except pseudomonas
3) UTI (non pregnant)
4) Pneumocystis jirovecii and toxoplasmosis
What is nitrofurantoin mainly used for?
1) uncomplicated UTIs
2) 2nd line complicated UTIs
What is metronidazole mainly used for?
GIT/other Anaerobe coverage
1) Anaerobes
2) CDAD
3) H. pylori
What can be used against anaerobes?
1) Metronidazole
2) Clindamycin (except GIT)
3) Cloxacillin, Zosyn, Piptazo
4) Carbapenems
5) Moxifloxacin
What can be used against atypicals?
1) Tetracyclines
2) Macrolides
3) Moxifloxacin
4) Penicillin G for Treponema pallidum
Empirical treatment for CAP
Coamoxiclav/ Ceftriaxone
Atypical → Azithromycin + Doxycycline
Worsen → Levo/Moxifloxacin + ↑ BL dose
Empirical treatment for HAP
1) Coamoxiclav / Ceftriaxone / Levo/moxifloxacin
- BL cover weaker G+/-
- Quinolone cover pseudomonas + atypicals
2) Piptazo / Ceftazidime/Cefepime / Imi/meropenem
- Stronger for nastier G- (eg. ventilator-associated pneumonia)
- ESBLs: Pseudomonas, Klebsiella, Acinetobacter
3) Linezolid/Vancomycin
- For MRSA
Adult meningitis empirical treatment
1) Ceftriaxone + Vancomycin
- Ceft: N. meningitidis, Misc G- bacilli
- Vanco: MRSA
2) Ceftazidime/gentamicin + Vanco
Neonate/Child/Immunocompromised meningitis empirical treatment
1) Ampicillin + Ceftriaxone / Vanco + Cotrimoxazole + Ciprofloxacin (penicillin allergy)
- Amp: Strep agalactiae, Listeria, Haemophilus
- Ceft: E. coli, meningitidis, Strep pneumo, misc. G- bacilli
2) Ceftazidime/gentamicin + Vanco/rifampicin (+ ampicillin)
Uncomplicated UTI/cystitis empirical treatment
(E. coli, S. saprophyticus)
Non-pregnant:
1) Nitrofurantoin / Cotrimoxazole
2) Ciprofloxacin / Coamoxiclav / 1-3 gen cephs / fosfomycin
Pregnant
1) Coamoxiclav / 1-3rd cephs
2) + Fosfomycin + Nitrofurantoin (if not at term)
Complicated UTI/pyelonephritis empirical treatment
(stones, catheters, ESBL, E.coli, Kleb, Proteus, Enterococci)
Non-pregnant
1) Ciprofloxacin / Cotrimoxazole
2) Carbapenems / Aminoglycosides
Pregnant
1) Piptazo + Meropenem
H-pylori treatment
CAO
1) Clarithromycin
2) Amoxicillin / Metronidazole
3) Omeprazole
2nd line: BMTO
1) Bismuth
2) Metronidazole
3) Tetracyclines
4) Omeprazole
TB treatment
1) Rifampicin
2) Isoniazide
3) Pyrazinamide
4) Ethambutol / Streptomycin (if R)
RIPE for 2 mths daily
RI for 4 mths 3x/week
