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EV ACVD Study > Antibiotic resistance in SA (NAVDF Papich) > Flashcards

Antibiotic resistance in SA (NAVDF Papich) Flashcards

1
Q

Which animals are more likely to have resistant strains of fecal bacteria (E coli)

A

*Previously hospitalized
*Previous antibiotic tx within 1 year

Also: raw meat diet, dogs in shelters/breeders

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2
Q

Which antibiotic may be associated with antibiotic resistant E coli in dogs

A

Fluoroquinolones

(Also amoxicillin, clavamox, cephalosporins)

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3
Q

T or F: The amount of resistant bacteria will return to pre-treatment levels within days to weeks after antibiotics are discontinued

A

True

But the resistant bacteria can linger in small numbers for a very long time

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4
Q

T or F: It has been reported that there is transfer of resistant E coli from humans to their dogs and back

A

True

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5
Q

Biggest risk factor for developing MRSP in dogs

A

Previous antibiotic exposure

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6
Q

T or F: MRSP from pets is a serious health risk for humans

A

False. They CAN have transfer of MRSP to humans, but infection is unlikely.

Only a few isolated reports

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7
Q

Do pets give their owners MRSA

A

Pets can be transient carriers for MRSA (from a human origin)

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8
Q

T or F: resistance genes from E coli can be spread to other Enterobacteriaceae bacteria

A

True

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9
Q

Can pets transmit Salmonella, Campylobacter, Clostridium difficile?

A

Yes, but usually from contaminated meat or the environment. Healthy pets can be carriers. BUT not related to antibiotic administration.

No evidence dog spread of these bacteria are associated with drug-resistant strains in people.

Salmonella CAN be spread to people. Control measures when Salmonella outbreaks are identified

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10
Q

T or F: evidence has shown spread of antibiotic-resistant Pseudomonas from a dog to humans

A

FALSE. No evidence as of yet

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11
Q

T or F: large animals can be a source of a “serious threat” for drug resistant bacteria (Campylobacter, ESBL E coli)

A

TRUE. But not seen in small animals

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12
Q

Cause of Staphylococcal methicillin resistance (gene, protein)

A

mecA gene
Altered Penicillin-binding protein (PBP-2a)

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13
Q

T or F: Adding a beta lactamase inhibitor can overcome methicillin resistance

A

False

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14
Q

T or F: methicillin resistant Staph are very likely to be resistant to other antibiotics

A

True.
>90% are resistant to >4 drugs

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15
Q

T or F: most MRSP are susceptible to TMS, clindamycin, FQs

A

FALSE. This is different than community acquired MRSA in humans, where these antibiotics usually work

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16
Q

Rifampin: describe lipo vs hydrophiliic, volume of distribution, absorption

A

Lipophilic
Good volume of distribution
Good absorption

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17
Q

Which antibiotic is a good options for Mycobacterium (intracellular bacteria)

A

Rifampin

(also macrolides)

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18
Q

Should rifampin be combined with other antibiotics to minimize MRSP?

A

No. Can be used as effectively as a monotherapy

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19
Q

Rifampin can induce cytochrome p450 enzymes, for faster clearance of other drugs. How long after discontinuing rifampin does it take for the enzyme effects to recover?

A

4 weeks in people

Can inhibit intestinal transport of other meds too! Which really limits the amount of active medications

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20
Q

When doxycycline is compounded into an aqueous suspension, how potent is it at 14 days

A

20%!

Stable at 7 days though

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21
Q

T or F: doxycycline can cause dental enamel discoloration and chelates with calcium-containing oral products

A

False. But that is a concern with other tetracyclines

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22
Q

Other than Staphylococcus, what other bacteria is chloramphenicol often used for

A

Enterococcus

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23
Q

AEs chloramphenicol in dogs

A

*GI disturbance = common
*Decreased protein synthesis in Bone marrow with chronic use (esp CATS!)
*Hind limb weakness, ataxia -> peripheral neuropathy. Large breed dogs

*Drug interactions! Cytochrome p450 and CYP2B11 inhibitor!

Aplastic anemia in humans, irreversible

24
Q

Implications of combining chloramphenicol with other drugs

A

*Cytochrome p450 and CYP2B11 inhibitor!

Increases concentration of opiates, barbituates, propofol, salicylate

25
Q

T or F: gentamicin is absorbed well SC and IM

A

True. Water soluble. BUT painful

26
Q

Are aminoglycosides better for gram negative bacteria or gram positive (like Staphylococcus)

A

Gram negative. They disrupt gram - outer membrane.

SID dosing is based on gram neg bacteria. May need more frequent injections if used for gram + bacteria.

27
Q

What can inhibit the efficacy of aminoglycosides

A

Pus, cell debris

(ears, wounds)

28
Q

What increases the risk of aminoglycoside toxicity

A

Renal disease
Dehydration
Electrolyte imbalances (Na, K)
Septicemia

Persistent drug levels (esp high trough concentrations —> nephrotox can be decreased with extended dosing intervals

29
Q

How is vancomycin administered

A

IV only

30
Q

Vancomycin: bacteriocidal or bacteriostatic?

A

Bacteriocidal

31
Q

Vancomycin: time or concentration dependent?

A

Time dependent

32
Q

What happens if vancomycin is giving RAPIDLY IV?

A

HISTAMINE RELEASE
*Flushing of skin
*Pruritus
*Tachycardia

ALSO: nephrotoxicity, ototoxicity

33
Q

What happens if vancomycin is given IM?

A

Painful, irritating

34
Q

Which antibiotics are concentration dependent

A

*Fluoroquinolones
*Metronidazole
*Aminoglycosides

35
Q

Which antibiotics are time dependent

A

*Beta lactams
*Macrolides
*Glycopeptides
*Tetracyclines

36
Q

What class of antibiotics is linezolid in

A

Oxazolidinones

37
Q

Is Linezolid better for gram + or gram - bacteria

A

Gram +

38
Q

How does resistance occur in Linezolid

A

Multiple sequential mutations, so incredibly rare

39
Q

How can linezolid be administered

A

PO or IV

100% absorbed when given PO, not affected by food

40
Q

MOA of linezolid

A

Mild, reversible inhibitor of monoamine oxidases A and B

41
Q

AE of linezolid long term

A

Reversible, mild bone marrow suppressio, if given >14d in humans

Not reported in dogs, cats.

42
Q

Caution linezolid with what other medications

A

Adrenergic agents: Phenylpropanolamine, selegiline

Other MAO drugs: SSRIs, TCAs

Has not been studied

43
Q

T or F: cefpodoxime can be effective for Pseudomonas and Enterococcus

A

False

44
Q

T or F: Cefovicin has a lower MIC for Staphylococcus than first gen cephalosporins

A

TRUE. Also better for gram - infections.

45
Q

How do cefovicin and cefpodoxime work for gram negative infections compared to injectable 3rd gen antibiotics (ie ceftazidime)

A

Poorer activity than IV antibiotics

46
Q

Which cephalosporins are effective against Pseudomonas

A

*IV 3rd gen (Ceftazidime > cefoperazone)
*IV/SC/IM 4th gen (cefepime)

47
Q

Which beta lactam antibiotics have the greatest activity against Enterobacteriaceae (E coli, Klebsiella) and Pseudomonas

A

Carbapenems (imipenem, meropenem)

Ertapenem does not have anti-Pseudomonas activity

48
Q

Why is imipenem given with cilastatin?

A

To minimize renal tubular metabolism

49
Q

Should imipenem be used against MRSP or Enterococcus

A

No

50
Q

Why does imipenem have high antimicrobial activity?

A

*Stable against most beta latamases (including ESBL)
*Penetrates porin channels that exclude most drugs

51
Q

Are carbapenems or cephalosporins more likely to induce release of endotoxin from gram negative sepsis?

A

Cephalosporins

52
Q

Are carbapenems or cephalosporins more rapidly bactericidal

A

Carbapenems

53
Q

Does imipenem or meropenem have greater antibacterial activity

A

Meropenem

54
Q

Does imipenem or meropenem have more CNS AEs (seizures)

A

Meropenem

55
Q

What penicillin is effective against Pseudomonas, Enterobacter (including ESBL), and gram negative bacteria?

A

Ureidopenicillins– ie Piperacillin-tazobactam

Needs to be given IV q6hr. No PO option

56
Q

Antibiotics for gram negative infections (like Pseudomonas) E coli, Klebsiella

A

*Aminoglycosides (amikacin, tobramycin)
*IV 3rd and 4th gen cephalosporins; ceftazidime, cefperazone, cefepime
*Carbapenem (Imipenem-cilastatin, Meropenem)
*Ureidopenicillins (piperacillin-tazobactam)

57
Q

Antibiotics for MRSP

A

*Rifampin
*Tetracyclines
*Chloramphenicol
*Aminoglycosides (gentamicin, amikacin; but best for gram neg!)
*Glycopeptides, vancomycin
*Oxazolidinones; Linezolid

EV ACVD Study (52 decks)

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