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M1 Microbiology > Anti-bacterials > Flashcards

Anti-bacterials Flashcards

1
Q

ESBL treatment

A

Imipenem + Cilastatin
(cilastatin inhibit DHP → prevent hydrolysis of imipenem @ brush border of PCT)

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2
Q

Bacteriostatic vs Bacteriocidal

A

Bacteriostatic
1) 30s: Tetracyclines, Glycylcycline
2) 50s: Macrolides, Clindamycin, Linezolid
3) Anti-TB: Ethambutol
4) Folate Acid Synthesis: Sulfonamide, Trimethoprim, Cotrimoxazole

Everything else bactericidal

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3
Q

Oral only

A

1) Penicillin V
2) 1st and 2nd Gen cephalosporin: cephalexin, cefuroxime (except cefazolin)
3) Aztreonam (monobactam)
4) Neomycin (Aminoglycosides)

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4
Q

IV/IM only

A

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)

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5
Q

Both Renal and Hepatic
(req. mostly only renal adjustment)

A

1) Linezolid
2) Pyrazinamide
3) Folate synthesis inhibitors: Sulfonamide, Trimethoprim, Cotrimoxazole

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6
Q

Hepatic/Unchanged vs Renal

A

1) Ceftriaxone
2) Tetracyclines: Doxy and Minocycline
3) Tigecycline
4) 50s: Macrolides, Clindamycin (except Linezolid)
5) Anti-TB: Rifampicin, Isoniazid
6) Fluoroquinolone: Moxifloxacin

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7
Q

Hepatic adjustments

A

1) Ceftriaxone
2) Tigecycline
3) Moxifloxacin

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8
Q

Renal adjustments

A

1) All cell wall (except penicillinase R & Ceftriaxone)
2) Tetracycline
3) Aminoglycosides
4) Fluroquinolones (except moxifloxacin)
5) Folate acid synthesis inhibitors
6) Pyrazinamide

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9
Q

Unsafe in pregnancy

A

1) 30s: Tetracycline, Glycylcycline, Aminoglycosides
2) Nucleic acid: Fluoroquinolones, Sulfonamide, Cotrimoxazole (except trimethoprim)
3) Nitrofurantoin

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10
Q

CYP inducer

A

Rifampicin

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11
Q

CYP inhibitor

A

1) Macrolides (except Azithromycin)
2) Isoniazid
3) Ciprofloxacin
4) Sulfonamide
5) Cotrimoxazole

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12
Q

Nephrotoxicity

A

1) Vancomycin
2) Aminoglycosides

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13
Q

Hepatotoxicity

A

1) Co-amoxiclav
2) Tigecycline
3) Macrolides
4) Nitrofurantoin
5) Isoniazid
6) Pyrazinamide

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14
Q

Ototoxicity

A

1) Vancomycin
2) Aminoglycosides
3) Macrolides

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15
Q

Neurotoxicity

A

1) Penicillins
2) Carbapenems
3) Metronidazole

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16
Q

Peripheral neuropathy

A

1) Linezolid
2) Fluroquinolones
3) Nitrofurantoin
4) Isoniazid (give pyridoxine)
5) Ethambutol
6) Metronidazole

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17
Q

CDAD

A

1) Aminopenicillins
2) Cephalosporins
3) Tetracyclines
4) Tigecycline
5) Clindamycin
6) Ciprofloxacin

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18
Q

Hypersensitivity (Anaphylaxis, SJS, TEN)

A

1) Penicillin
2) Cephalosporins
3) Carbapenems
4) Neomycin
5) Co-trimoxazole

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19
Q

Prolonged QT interval

A

Macrolides, fluroquinolones

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20
Q

Thrombophlebitis

A

1) Cephalosporins
2) Vancomycin

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21
Q

Serotonin syndrome

A

1) Linezolid
2) Isoniazid

22
Q

Colour changes

A

1) Nitrofurantoin (Brown urine)
2) Rifampicin (Orange tears and sweat)
3) Metronidazole (Dark/rust coloured urine)

23
Q

Bone marrow suppression

A

1) Linezolid
2) Cotrimoxazole

24
Q

Generally what to use against no R bacteria?

A

Penicillin

25
Q

Generally what to use against penicillinase producing strains?

A

Cloxacillin/Zosyn

26
Q

Generally what to use against penicillin R Gram negs?

A

Aminopenicillins
→ Antipseudomonal
→ Monobactam / carbapenem

27
Q

Generally what to use against beta lactamase producing strains?
eg. Pseudomonas, Klebsiella

A

Co-amoxiclav / Zosyn + Anti-pseudomonal (piptazo)

28
Q

Generally what to use against ESBL strains?
eg. Acinetobacter

A

1) Carbapenems (Mero and Imi)
2) Tigecycline

29
Q

Generally what to use against altered PBP strains?
eg. MRSA, Neisseria gonorrhoeae

A

MRSA: Vancomycin, Linezolid

N. gonorrhoeae: Protein synthesis inhibitors (eg. Aminoglycosides, tetracyclines, macrolides, clindamycin, linezolid)

30
Q

What to give in place of penicillin (allergy)?

A

1) Monobactam (Aztreonam)
2) Glycopeptides (Vancomycin)
3) anything else

31
Q

What are aminoglycosides mainly used for?

A

G- coverage
(6 NOs)

32
Q

What are tetracyclines mainly used for?

A

Atypicals
+ Doxycyclin for soft tissue MRSA
+ Tigecycline for MRSA and VRE

33
Q

What are macrolides mainly used for?

A

In place of penicillins (braod spec + atypicals)

34
Q

What is clindamycin mainly used for?

A

1) Anerobic everywhere expect GUT and GU
2) Anti-toxin properties

35
Q

What is linezolid mainly used for?

A

Last resort against MRSA and VRE

36
Q

What are Fluoroquinolones mainly used for?

A

1) Ciprofloxacin: G-
2) Levofloxacin: G-, G+, Atypical, Anaerobe
3) Moxifloxacin: G+, Atypical, Anaerobe - Pseudomonas

37
Q

What is cotrimoxazole mainly used for?

A

1) G+ including MRSA
2) G- except pseudomonas
3) UTI (non pregnant)
4) Pneumocystis jirovecii and toxoplasmosis

38
Q

What is nitrofurantoin mainly used for?

A

1) uncomplicated UTIs
2) 2nd line complicated UTIs

39
Q

What is metronidazole mainly used for?

A

GIT/other Anaerobe coverage
1) Anaerobes
2) CDAD
3) H. pylori

40
Q

What can be used against anaerobes?

A

1) Metronidazole
2) Clindamycin (except GIT)
3) Cloxacillin, Zosyn, Piptazo
4) Carbapenems
5) Moxifloxacin

41
Q

What can be used against atypicals?

A

1) Tetracyclines
2) Macrolides
3) Moxifloxacin
4) Penicillin G for Treponema pallidum

42
Q

Empirical treatment for CAP

A

Coamoxiclav/ Ceftriaxone

Atypical → Azithromycin + Doxycycline

Worsen → Levo/Moxifloxacin + ↑ BL dose

43
Q

Empirical treatment for HAP

A

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

44
Q

Adult meningitis empirical treatment

A

1) Ceftriaxone + Vancomycin
- Ceft: N. meningitidis, Misc G- bacilli
- Vanco: MRSA

2) Ceftazidime/gentamicin + Vanco

45
Q

Neonate/Child/Immunocompromised meningitis empirical treatment

A

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)

46
Q

Uncomplicated UTI/cystitis empirical treatment
(E. coli, S. saprophyticus)

A

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)

47
Q

Complicated UTI/pyelonephritis empirical treatment
(stones, catheters, ESBL, E.coli, Kleb, Proteus, Enterococci)

A

Non-pregnant
1) Ciprofloxacin / Cotrimoxazole
2) Carbapenems / Aminoglycosides

Pregnant
1) Piptazo + Meropenem

48
Q

H-pylori treatment

A

CAO
1) Clarithromycin
2) Amoxicillin / Metronidazole
3) Omeprazole

2nd line: BMTO
1) Bismuth
2) Metronidazole
3) Tetracyclines
4) Omeprazole

49
Q

TB treatment

A

1) Rifampicin
2) Isoniazide
3) Pyrazinamide
4) Ethambutol / Streptomycin (if R)

RIPE for 2 mths daily
RI for 4 mths 3x/week

50
Q
A

M1 Microbiology (7 decks)

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