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Infectious Disease 2 > Anti-Infectives for Gram-Negative Pathogens in Health Systems > Flashcards

Anti-Infectives for Gram-Negative Pathogens in Health Systems Flashcards

1
Q

What are the beta-lactam anti-infectives?

A
  • Penicillins
  • Cephalosporin (Cephamycins)
  • Carbapenems
  • Monobactams
  • Sulbactam-Durlobactam
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2
Q

Of the fluoroquinolones, which of them have Pseudomonas activity?

A
  • Ciprofloxacin
  • Levofloxacin
  • Delafloxacin
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3
Q

What are the aminoglycosides?

A
  • Gentamicin
  • Tobramycin
  • Amikacin
  • Plazomicin
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4
Q

What gram-positive activity do aminopenicillins have?

A
  • Streptococci
  • Enterococcus (especially faecalis species)
  • PCN-susceptible Staphylococci
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5
Q

What is the spectrum of activity of gram-negatives for aminopenicillins?

A
  • Limited Enterobacterales
  • NO Pseudomonas
  • NO Acinetobacter
  • NO Stenotrophomonas
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6
Q

What is the DOC for Acinetobacter baumannii including CRAB?

A

Ampicillin/Sulbactam

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7
Q

What are the beta-lactamase inhibitors?

A
  • Sulbactam & Clavulanate
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8
Q

What is the spectrum of activity of aminopenicillin/beta-lactamase inhibitors?

A
  • SOME Enterobacterales
  • Acinetobacter
  • NO Pseudomonas
  • NO Stentrophomona
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9
Q

What is the spectrum of action of Sulbactam and Clavulante?

A

Class A beta-lactamase and some ESBL (clavulante only); but not including KPCs

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10
Q

What SOA does piperacillin/tazobactam have?

A
  • Many Enterobacterales
  • Pseudomonas
  • H. influenzae
  • N. meningitis
  • Limited for Acinetobacter
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11
Q

What SOA does piperacillin/tazobactam NOT have?

A

NO Stenotrophomonas

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12
Q

What are the 1st generation cephalosporin?

A

Cefazolin, Cephalexin, Cefadroxil

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13
Q

What SOA does 1st Gen Cephs organisms do have?

A
  • Staphylococcus aureus/MSSA
  • Streptococci (GAS, GBS)
  • Some Enterobacterales (E.coli, Klebsiella pneumoniae, Proteus mirabilis)
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14
Q

What SOA do 1st Gen Cephs NOT have?

A

S. pneumoniae and anaerobic activity

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15
Q

What are the 2nd generation cephalosporin?

A

Cefuroxime, Cefaclor, and Cefprozil

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16
Q

What SOA do 2nd Gen Cephs have?

A
  • Some Enterobacterales
  • H. influenzae
  • N. meningitis
  • Narrow simple BLs
  • S. pneumoniae (more reliable)
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17
Q

What SOA do 2nd Gen Cephs NOT have?

A

MSSA and no anaerobic activity

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18
Q

What are the 2nd generation cephamycins (cephalosporins) and why are they a rule-breaker of the second generation?

A
  • Cefotetan and Cefoxitin
  • Because their SOA are H. influenzae, N. meningitidis, some Enterobacterales, and Anaerobes, and are stable to ESBL
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19
Q

What are the 3rd generation cephalosporin?

A
  • Ceftriaxone, Cefotaxime, Cefpodoxime, and Cefixime
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20
Q

What SOA do 3rd Gen Cephs have?

A
  • H. influenzae
  • N. meningitis
  • many Enterobacterales (=some Enterobacterales + Citrobacter and Serratia)
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21
Q

What is the rule breaker of the 3rd generation of cephalosporin and what are their SOA?

A
  • Ceftazidme
  • SOA: H. influenzae, N. meningitis, many Enterobacterales, and Pseudomonas
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22
Q

What SOA does Ceftazidme NOT have?

A

Staphlycoccus and streptococcal activity

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23
Q

What is the 4th generation cephalosporin?

24
Q

What SOA does Cefepime have?

A
  • H. influenzae
  • N. meningitis
  • most Enterobacterales (Enterobacter, K. aerogenes including AmpC)
  • Pseudomonas
  • MSSA, streptococcal activity, S. pneumoniae
25
What is the 5th generation of Cephalosporin and why is it a rule-breaker?
* Ceftaroline * Because it has **activity against MRSA**, H. influenzae, some-many Enterobacterales
26
What SOA does Ceftolozane/tazobactam have?
* H. influenzae * Most Enterobacterales * Pseudomonas (+ including DTR)
27
What SOA does Ceftolozone/tazobactam NOT have?
* ESBL * N. meningitidis
28
What is the SOA of ceftolozone?
Can go against Pseudomonas Amp C cepholosporinase * Not affected by porin loss (OprD) and efflux pump activity
29
What is the SOA of Ceftazidime/Avibactam?
* H. influenzae * N. meningitis * Most Enterobacterales (**+ including ESBL, CRE-KPC, CRE-OXA-48, AmpC**) * Pseudomonas (including DTR)
30
What is the SOA of Cefiderocol?
* Most Enterobacterales (including ESBL, CRE, AmpC) * Pseudomonas (DTR) * **Acinetobacter (+CRAB)** * **Stenotrophomonas**
31
Does Ceftriaxone require renal dosing?
**Does NOT require renal dosing**
32
Ceftazidme
* 3rd gen rule breaker * 1st antipseudomonal cephalosporin * **Induces AmpC**
33
What are the adverse effects of ceftriaxone?
* Calcium drug crystallization (fatal lung, kidney precipitates) in neonates * Biliary sludge
34
What are the five cephalosporins that have anti-pseudomonal activity?
* 3rd gen: Ceftazidme * 4th gen: Cefepime * Ceftolozane/tazobactam * Ceftazidme/avibactam * Cefiderocol
35
Cefepime
* 4th gen * **Neurotoxicity potential prominent-careful dosing adjustment with kidney impairment required** * **Has a high "dose-dependent susceptibility" definition (SDD)-need higher doses with certain MIC**
36
Avibactam
Non-beta BLI with broader spectrum compared to tazobactam, sulbactam or clavulanate due to unique bridged bicyclic urea core structure
37
What is Avibactam's susceptibility?
* Class A beta-lactamases, including ESBLs and KPCs * Class C beta-lactamases (AmpC) * Some class D beta-lactamases (notably OXA-48 carbapenemases) * Does NOT inhibit MBLs
38
Cefiderocol
* Unique MOA: "Trojan horse" * Catechol side chain at R2 function as a siderophore--> binds free host iron enabling outer membrane passage via iron transport systems along with the attached cephalosporin moiety--> gains access to PBP site of action * Requires iron supplemented growth media for susceptibility testing
39
What are the carbapenems?
* Ertapenem * Imipenem/cilastatin * Meropenem * Meropenem/vaborbactam * Imipenem/cilastatin/relebactam
40
T/F: ALL carbapenems are parenteral, also have activity against Anaerobes, are neurotoxic and interact with valproic acid
T
41
What SOA does Ertapenem have?
* MSSA, Penicillin-susceptible Streptococci, * Enterobacterales (+ESBL, AmpC) * H. influenzae * N. meningitis
42
What SOA does Ertapenem NOT have?
* Enterococcus *** Pseudomonas** * Acinetobacter, * Stenotrophomonas
43
Imipenem/Cilastatin
* Considered to be more epileptogenic (induce seizures) than others in class * Imipenem is metabolized in the kidneys to a nephrotoxin * Dose: based on imipenem; careful adjustment required with renal impairment
44
What SOA does imipenem/cilastatin have?
* MSSA, Penicillin-susceptible streptococci, some Enterococci * Enterobacterales (+ESBL, AmpC) * **Pseudomonas** * **Acinetobacter** * H. influenzae * N. meningitis
45
What SOA does Imipenem/Cilastatin NOT have?
* Stenotrophomonas * Unreliable for Proteus, Providencia, and Morganella
46
What SOA does Meropenem have?
* MSSA, penicillin-susceptible streptococci, some Enterococci * Enterobacterales (+ESBL, AmpC) * Pseudomonas * Acinetobacter * H. influenzae * N. meningitis
47
What SOA does meropenem NOT have?
Stenotrophomonas
48
Vaborbactam
* Broad spectrum non-beta lactam BLI
49
What is the SOA of vaborbactam?
* Class A beta-lactamases, including ESBLs and KPC carbapenemase * Class C beta-lactamases * **Does NOT inhibit MBLs or Class D carbapenemases, including OXA-48**
50
What SOA does Meropenem/vaborbactam have?
* Enterobacterales (+ESBLs, AmpC, CRE-KPC) * Pseudomonas * Acinteobacter
51
What SOA does meropenem/vaborbactam NOT have?
* P. aeruoginosa-DTR * A. baumannii-CRAB
52
Relebactam
Broad spectrum non-beta-lactam BLI
53
What is Relebactam's SOA?
* Class A beta-lactamases including ESBLs and KPC carbapenemase * Class C beta-lactamases * Some class D beta-lactamases (**NOT OXA-48**) *** Does NOT inhibit MBLs**
54
What is Imipenem/cilastatin/relebactam's SOA?
* Enterobacterales (+ESBL, AmpC, CRE) * Pseudomonas (+DTR) * Acinetobacter
55
What SOA does Aztreonam have?
* Enterobacterales (+CRE-MBL) * Pseudomonas
56
What SOA does Aztreonam NOT have?
* Acinetobacter * Stenotrophomonas * Gram-pos activity

Infectious Disease 2 (7 decks)

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