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ESA 5 - Pharmacology > Antibiotic Prescribing > Flashcards

Antibiotic Prescribing Flashcards

1
Q

What is unique about antimicrobials, compared to other drugs?

A

They target microbial biochemistry, rather than the human host

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2
Q

What is the main characteristic of an ideal antibiotic?

A

It has no direct effect on the patient

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3
Q

How do antibiotics work to not have a direct effect on the patient?

A

Through a process of selective toxicity, whereby they bind to bacterial macrostructures and inhibit their function or structure

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4
Q

What are the potential stages in a bacterias life-cycle that antimicrobials can target?

A
  • DNA synthesis
  • Protein synthesis
  • Cell wall synthesis
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5
Q

Give two classes of antibiotics that inhibit DNA synthesis

A
  • Quinolones
  • Folic acid antagonists
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6
Q

What is the mechansim of action of quinolones?

A

They inhibit DNA gyrase

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7
Q

Give an example of a quinolone

A

Ciprofloxacin

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8
Q

What is the mechanism of action of folic acid antagonists?

A

They inhibit the production of DNA precursors

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9
Q

Give two examples of folic acid antagonists

A
  • Trimethoprim
  • Sulphonamides
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10
Q

Give three classes of antibacterials that inhibit protein synthesis

A
  • Aminoglycosides
  • Macrolides
  • Tetracyclines
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11
Q

Give an example of an aminoglycoside

A

Gentamicin

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12
Q

Give an example of a macrolide

A

Erythromicin

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13
Q

Give two classes of antibiotics that inhibit cell wall synthesis

A
  • Beta-lactams
  • Glycopeptides
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14
Q

What is the mechanism of action of beta-lactams?

A

They interfere with the ability to build a cell wall, and so the cell wall becomes leaky

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15
Q

Give three examples of beta-lactams

A
  • Penicillins
  • Cephalosporins
  • Carbapenems
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16
Q

Give an example of a glycopeptide

A

Vancomycin

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17
Q

What are the good reasons to use antibiotics?

A
  • Prevention of infections
  • Therapy of significant bacterial infections
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18
Q

What are the categories of antibacterial prophylaxis?

A
  • Peri-operative
  • Short term
  • Long term
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19
Q

What would happen to surgery without effective prophylaxis?

A

There would be a significant decrease in the scope of surgery

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20
Q

Why is antibiotic prophylaxis required peri-operatively?

A

To prevent surgical site infections

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21
Q

Are prophylactic antibiotics given after surgery?

A

No, once the wound is closed, there is no need for further doses (with some exceptions), the majority of surgeries only need one dose to last the duration of the surgery

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22
Q

Give an example of when short term prophylactic antibiotics may be necessary

A

For meningitis contacts

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23
Q

How long are meningitis contacts given prophylactic antibiotics for?

A

2-3 days

24
Q

Give two examples of where people would require long term antibiotics

A
  • Asplenia
  • Immunodeficiency
25
Q

When are antibiotics used in the therapy of bacterial infections?

A
  • Treatment of culture proven infection
  • Empirical treatment of suspected infection, when reasonable grounds for suspicionm, and difference in moderate/long term outcomes
26
Q

Why is a lot of antibiotic prescribing empirical?

A

Because it can take 24-48hours to wait for bacteriology results

27
Q

What questions should be asked when empirically prescribing antibiotics?

A
  • What is the likely organism?
  • Which antibiotics are likely to be effective
  • Which one is the best choice?
28
Q

What aspects of an infection should be considered when deciding on the most likely organism?

A
  • Anatomical site
  • Duration of illness
  • Past medical history
  • Occupational history
  • Travel history
  • Time of year
  • Age
  • Personal background
  • Anatomical site
29
Q

What information can be considered when deciding the likely susceptibility of an infecting bacteria?

A
  • Community or healthcare onset
  • Severity of infection
  • Baseline rate of resistance
  • Immune status of patient
30
Q

What should be considered when deciding what antibiotic is the best choice?

A
  • Efficacy
  • Cost
  • Administration route
  • Safety
31
Q

What should be considered when determining the safety of an antibiotic?

A
  • Age
  • Toxicity
  • Drug interactions
  • Allergies
  • Pregnancy, breast feeding
  • Organ function
32
Q

Is the toxicity of an antibiotic always the same?

A

No, toxicity may have different severities in different groups of people

33
Q

What are the characteristics of an ideal antibiotic therapy?

A
  • Clean kill of infecting bacteria
  • No effects on the patient
34
Q

What is meant by a ‘clean kill of infecting bacteria’?

A
  • No resistance in any surviving pathogens
  • Minimal impact on non-target commensal organisms
35
Q

What are the potential antibiotic adverse effects?

A
  • Phamacological effects, e.g. toxicities and drug interactions
  • Allergic reactions
  • Impact on normal flora
36
Q

What might be caused by an antibiotics impact on normal flora?

A

Clostridium difficile infection

37
Q

What does therapeutic drug monitoring ensure?

A
  • An adequate dose is being given
  • A non-toxic dose is being given
38
Q

What is therapeutic drug monitoring used with?

A
  • Aminoglycosides, including gentamicin
  • Vancomycin
39
Q

How can antibiotic activity be tested?

A

Disc sensitivity testing

40
Q

What is the genetic basis of antibiotic resistance emergence?

A
  • Chromosomal gene mutation
  • Horizontal gene transfer
41
Q

What happens in chromosomal gene mutation?

A
  • A mutated gene conferring resistance is present in one bacteria
  • Antibiotic is applied, killing all but the resistant bacteria
  • The resistant bacteria divides, producing a population of monoclonal resistant bacteria
42
Q

How does horizontal gene transfer occur?

A
  • A bacteria with a resistance gene carried on a plasmid gives off a pili to another cell, transfering the plasmid
  • The plasmid is integrated into the bacterial DNA
  • When the cell divides, it irreversibly becomes part of the cells DNA
43
Q

What are the mechanisms of antibiotic resistance?

A
  • Antibiotic inactivation
  • Alteration of target site
  • Alteration of metabolic pathways
  • Reduced intracellular antibiotic accumulation
44
Q

Give an example of an antibiotic affected by antibiotic inactivation

A

Beta-lactamase

45
Q

Give an example of a binding site that can be altered in antibiotic resistance

A

Penicillin binding protein

46
Q

Give an example of an alteration of a metabolic pathway that can occur to give antibiotic resistance

A

Para-aminobenzoid acid is normally required by bacteria, but some can use preformed folic acid instead

47
Q

Give two examples of how a reduced intracellular antibiotic accumulation can be achieved

A
  • Active efflux mechanisms
  • Decreased permeability
48
Q

What are the steps in the emergence of antibiotic resistance?

A
  1. Local selection
  2. Clonal dissemination
  3. Global spread
49
Q

How can problems with antibiotic resistance be avoided?

A
  • Antimicrobial stewardship
  • Infection control
50
Q

What are the concepts involved in antimicrobial stewardship?

A
  • Right antibiotic
  • Right time
  • Right dose, frequency, and duration
  • Right route
51
Q

What determines the blood and tissue antibiotic concentrations?

A
  • Administration - oral or intravenous
  • Distribution
  • Elimination/metabolism - renal or hepatic
52
Q

What does successful treatment require in time dependant killing?

A

Prolonged antibiotic presence at the site of infection, but not high concentration

53
Q

What does successful treatment require in concentration dependant killing?

A

High antibiotic concentration at site of infection, but not for long

54
Q

How can bacterial exposure to antibiotics be prevented?

A
  • Minimise risk of infection
  • Monitor and control antibiotic prescribing
55
Q

How can the spread of recognised resistant bacteria be prevented?

A
  • Isolation or cohorting
  • Hand hygiene
  • Decolonisation of patients

ESA 5 - Pharmacology (28 decks)

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