Antibiotic Flashcards by Yuko Porter

Mechanism
First choice
penicillin and cephalosporins

Cell wall synthesis inhibitors

P revent C ell wall

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Mechanism
Rifampin and Fluoroquinolones

RNA and DNA synthesis inhibitors

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Mechanism
Tetracycline and Macrolides

Protein synthesis inhibitors

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Mechanism
Sulfonamides

Antimetabolites

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Prophylactic therapy

Prevention!!
ex) Before after surgery

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Empiric therapy

suspected infection where the organism not known

We don’t know what exactly, so cover everything

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Definitive/ directed therapy

Antibiotics used after culture and sensitivity known
Narrowing therapy

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Guidelines
Use the most a_________ agent appropriate for the patient’s infection

narrow spectrum

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Host defenses
Bactericidal vs Bacteriostatic

Bactericidal
-abx kills bacteria
Bacteriostatic
-prevent bacteria from growing/replicated

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If pt is immunocompromised, which one we need to use?
Bactericidal or Bacteriostatic?

Bactericidal
Because their immune system cannot kill the bacteria

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Gram positive pathogen 3

Staphylococcus
Streptococcus
Enterococcus

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Gram Negative Pathogens
Enterobacteriaceae

E. coli
Klebsiella
Proteus
Shigella
Salmonella

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SPACE bugs

Serratia
Pseudomonas
Acinetobacter
Citrobacter
Enterobacter

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Gram Negative Pathogens
Respiratory

Haemophilus influenza(H flu)
-causes most of upper respiratory tract infection
Moraxella catarrhalis

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Gram Negative Pathogens
Neisseria

N. meningiditis
N. gonorrhoeae

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“Atypical” Pathogens?
what is that?

Have unique things that makes it hard to treat.
And all are involved in respiratory tract infection

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Atypical Pathogens
Name of pathogen
a) Must infect another cell to reproduce
b) No cell wall

a) Chlamydophila pneumoniae
b) Mycoplasma pneumoniae

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Anaerobic Pathogens

Bacteroides
Clostridium (c-diff)

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Bacteria possess many mechanisms for a_________________

a) antibiotic resistance

Bacteria always mutating　突然変異
Always make resistance

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Beta- Lactams

a) All beta-lactams cause?
b) All beta-lactams are?
c) They most lack activity against?

a) hypersensitivity reactions
rush, fever
b) bactericidal
c) MRSA

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Beta- Lactams is a______ dependent killing

Time
Give small, frequent doses, multiple times per day
Goal is to get drug levels above MIC
(Minimal inhibition concentration)

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a_______ can result from very high doses of any beta-lactam

Seizures
-Most often occurs in patient with renal
dysfunction

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PCN allergy
symptoms are drug fever or rash, what to do?

Cross-reactivity with ß-lactams
- 3 to 5% (likelihood)
May safely give other ß-lactams

Only 3 to 5% get worsen rash, but so what?? better than dyeing

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PCN allergy
symptoms are hives or anaphylaxis
what to do?

Do NOT give ß-lactams with potential cross reactivity
Give aztreonam instead

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Penicillin Characteristic

Very short half-lives and therefore are dosed multiple times per day Many are poorly absorbed –Can lead to diarrhea –Will likely have different oral vs IV doses

Natural Penicillin Spectrum

Streptococcus Enterococcus Gram + NOT Staphylococcus

Natural Penicillin a) Commonly found in? b) All Penicillin is?

a) bread mold b) bactericidal

Parenteral Natural PCNs Aqueous PCN G

Most common Penetrates CSF Neuro Syphilis Short duration every 4hr

Parenteral Natural PCNs Procaine PCN G

IM only detectable levels 12-24 hrs used to treat gonorrhea dosed q12-24h

Parenteral Natural PCNs Benzathine PCN G

IM only detectable levels 15-30 days used to treat syphilis, pharyngitis Very think solution and pain

Penicillinase-Resistant Spectrum

Gram + Staph aureus

Penicillinase-Resistant Parenteral agents

nafcillin -Most active -Best CNS penetration methicillin -nephrotoxic oxacillin

Penicillinase-Resistant Oral

dicloxacillin -Good oral absorption cloxacillin -Best oral absorption

Aminopenicillin Spectrum

Gram + and Gram - NSHEPS

Aminopenicillin Spectrum name for NSHEPS

N. meningitidis Salmonella H. influenzae E. coli P. mirabilis Shigella But they develop beta-lactamase

Aminopenicillin ampicillin combo

ampicillin ampicillin/sulbactam Unasyn®

ampicillin ADRs amoxicillin ADRs

ampicillin -Diarrhea and rash amoxicillin -Better absorption -Less GI problems

Aminopenicillin amoxicillin combo

amoxicillin/clavulanic acid Augmentin® Clavulanic acid is a beta-lactamase inhibitor More GI side effects

Antipseudomonal Penicillin Parenteral Spectrum

Pseudomonas -Kill Pseudomonas

Antipseudomonal Penicillin This combo for kill pseudomonas and unknown organisum

Piperacillin/tazobactam Zosyn®

First Generation Cephalosporins Spectrum

Gm+

First Generation Cephalosporins agents

Anspor® Ancef® Keflex® Duracef®

Second Generation Cephalosporins Spectrum

Similar work as aminopenisillin Kill good Gram + and Gram - -H.influenzae -M,catarrhalis -N.meningitidis -N.gonorrhoeae

Second Generation Cephalosporins agents

cefoxitin cefotetan cefuroxime cefprozil cefaclor loracarbef

Third Generation Cephalosporins Spectrum

Kill good Gram -

Third Generation Cephalosporins agents

Cefditoren pivoxil Cefdinir Cefdibuten Cefotaxime (Claforan®) Ceftriaxone (Rocephin®) Ceftazidime (Fortaz®)

Third Generation Cephalosporins Clinical use

Pneumonia Bacteremia UTI

Fourth Generation Cephalosporins Spectrum

Very BROAD spectrum antibiotic Gram+ and Gram - Good for empiric therapy

Fourth Generation Cephalosporins Agents

Maxipime® Ancef®(1st) + Fortaz® (3rd) (VERY BROAD)

Fifth Generation Cephalosporins Spectrum

Kill RESISTANCE gram + MSSA, MRSA

Fifth Generation Cephalosporins agent

Teflaro®

Monobactams agent

Aztreonam Gram - only

Aztreonam Spectrum

Type I PCN allergies For pt who had hives/anaphylaxis to other B-lactams!

Carbapenems agent

Imipenem Meropenem Ertapenem Doripenem *penem*

Carbapenems Clinical uses

Wide range of bacterial infections *Empiric therapy systemic infections mixed infections

Glycopeptides agents

Vancomycin Telavancin

Glycopeptides Spectrum

Gram + only c-diff MASA!!!

Vancomycin ADRs

Red man syndrome -histamine release -dilation, redness, itching very bad Serious nephrotoxicity Ototoxicity Neutropenia Phlebitis

Cyclic Lipopeptides agent

Daptomycin Vancomycin

Daptomycin BBW

SHOULD NOT be used in the treatment of pneumonia!! Death rate and serious cardiorespiratory adverse events were significantly higher

Fluoroquinolones agents

ciprofloxacin ofloxacin levofloxacin moxifloxacin gemifloaxcin "floxacin"

Fluoroquinolones Spectrum

Good staph, moderate strep Excellent for some Gram- (H.flu, P.aeruginosa) Bactericidal

Fluoroquinolones Waring

Tendons rupture Acute sinusitis acute bronchitis UTI

Macrolides agents

erythromycin clarithromycin azithromycin Bacteristatic, bactericidal at high doses

Macrolides Spectrum

Gm+ Gm- (H. flu)

Which macrolides work best? a) Mycoplasma pneumonia b) Helicobacter pylori

a) azithromycin b) clarithromycin

Macrolides indication

Mycoplasma infections Chlamydia infections during pregnancy URI/LRI STD Acne

Tetracyclines Spectrum

Gm+ Gm- bacteriostatic

Tetracyclines agents a) short-acting b) long-acting

a) tetracycline b) doxycycline, minocycline

Metronidazole Spectrum

Bactericidal Gm+ and Gm-

Clindamycin a) Spectrum b) indication

a) Bacteriostatic Gm+ and Gm- b) B. fragilis acne vulgaris Toxoplasmosis

SMX-TMP a) Spectrum b) indication

a)Bactericidal Gm+ and Gm- b)UTI URI –Salmonella, Shigella Travelers Diarrhea PCP Infections

Aminoglycosides a) Spectrum b) ADRs

a) Powerful Gm- activity b) Nephrotoxicity, ototoxicity

Aminoglycosides agengts

gentamicin tobramycin neomycin

Fidaxomicin/Dificid® used for?

Clostridium difficile infection C. Diff!!! –Can cause severe diarrhea and serious bowel inflammation –Typically seen after treatment with antibiotics –Normally treated with oral vancomycin (cheaper)