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Antimicrobials > Antibiotic Spectrum > Flashcards

Antibiotic Spectrum Flashcards

1
Q

Gram positive bacteria

A

Staph aureus
Coag negative staphylococcus
Streptococci (S. pneumoniae, s. viridans, group A = s. pyogenes, group B streptococci)
Enterococcus (faecais & faecium), listeria monocytogenes

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2
Q

Gram negative

A

Proteus spp, E. Coli, Klebsiella spp (PEcK)
H. Influenzae
Moraxella catarrhalis, neiserria gonorrhoeae, N. meningitidis
Seratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacter (SPACE)
Providencia spp, Indole-positive Proteus spp. (SPICE)

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3
Q

Atypicals?

A

Legionella
Mycoplasma
Chlamydia

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4
Q

Anaerobes?

A

Oral: peptostreptococcus, fusobacterium, prevotella

Gut: bacteroides fragilis, clostridium species

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5
Q

Example of time-dependent killing abx

A

Beta lactams
Macrolides
Vancomycin

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6
Q

Example of concentration-dependent killing abx

A

Quinolones

Aminoglycosides

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7
Q

Example of post-ABX effect (PAE)

A

Aminoglycosides

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8
Q

Drugs to avoid in P/L

A

“Safe Fetus Means Avoid These Now”
Septra - CI near term, avoid 1st/3rd tri
Fluoroquinolones - CI all tris
Metronidazole/macrolides - avoid in 1st tri
Aminoglycosides - avoid in all tri’s
Tetracyclines - CI all tri’s
Nitrofurantoin - CI at term and during labor

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9
Q

Community acquired pneumonia bugs

A 
S. Pneumoniae
Respiratory viruses 
M. Pneumoniae
C. Pneumoniae
H. Influenzae
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10
Q

CAP drugs

A

Macrolides
Beta lactams (eg high dose amoxi) +- macrolide
Respiratory fluoroquinolone

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11
Q

Acute otitis media bugs

A

S. Pneumoniae
H. Influenzae
M. Catarrhalis

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12
Q

Acute OM drugs

A

Amoxicillin
Amoxi/clav
2nd gen cephalosporins

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13
Q

UTI bugs

A

E.coli
Proteus spp.
S. saprophyticus

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14
Q

Penicillin spectrum

A

Aerobic gram positive: beta henolytic streptococci, E. faecalis, and S. viridans (if sensitive)
Neisseria meningitidis (if sens), treponema palladium (if sens)
Oral anaerobes
Gut anaerobes: clostridium spp (C. Tetani, C. perfringens)

NO longer s. aureus or n. gonorrhoeae

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15
Q

Aminopenicillins coverage

A

Everything penicillin covers PLUS:
Gram negative: H. influenzae (beta-lactamase -ve), proteus mirabillis, E. coli, streptococci
Listeria monocytogenes, E. facalis
Oral anaerobes (no gut)

NO COVERAGE: Kleb, s. aureus, atypicals

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16
Q

Amoxi/clav coverage

A

Everything amoxi covers PLUS
BL producing H. Influenzae, PEcK, M. Catarrhalis,
E. Faecalis, staphylococcus (MSSA), stretococcus
SOME coverage of gut (B. fragilis)

17
Q

Pip/taz coverage

A

Everything amoxi covers PLUS
BL producing H. Influenzae, PEcK, M. Catarrhalis,
E. Faecalis, staphylococcus (MSSA), stretococcus
Gut and oral anaerobes
PSEUDOMONAS COVERAGE

DO NOT us for definitive SPACE/SPICE therapy even tho beta-lactam-i added

18
Q

1st gen cephalosporin coverage

A

Gram positive cocci, MSSA, streptococci (very good)
S. epidermidis
Oral anaerobes

NO activity against H. influenzae, M. catarrhalis, anerobes, SPACE, listeria, MRSA, MRSE, atypicals

19
Q

2nd gen cephalosporins coverage

A

Cefuroxime/cefaclor: H. influenzae (incl. BL producing), M. catarrhalis, oral anaerobes, streptococci

Cefoxitin: PEcK plus gut anaerobes (B. fragilis)
NO activity against MRSA/MRSE, Enterococcus spp., listeria spp., anaerobes (except cefoxitin, atypicals)

Cefaclor/cefuroxime: URTI
Cefoxitin: uncomplicated intra-abdo infections, PID & surgical procedures, infections due to gram -ve plus anaerobes

20
Q

3rd gen cephalosporins coverage

A

PEck, H. influenzae, M. catarrhalis, oral anaerobes
Ceftriaxone: good strep coverage including penicilin resistant S. pneumoniae
Ceftazidime: some gram -ve activity compared to ceftriaxone but NO gram +ve activity, use if concern for pseudomonas and not if concern for gram +ve
Cefixime: good activity for N. gonorrhoeae (poor activity against streptococcus or staphylococcus)

NOT recommended for SPICE infections
No activity against MRSA/MRSE, Enterococci, Listeria spp, gut anaerobes, legionella,

21
Q

4th gen cephalosporin coverage

A

Evergthing ceftriaxone covers,
Improved gram +ve (staphylococcus/streptococcus) coverage, good gram -ve coverage (incl pseudomonas)
Retains activity for SPACE organisms (eg. has activity against broad spectrum BL producing gram -ve (Amp C betalactamase, and maybe Class A ESBLs)

NO activity against gut anaerobes

22
Q

Carbapenems coverage

A

For difficult to treat organisms with multi-resistance such as SPACE/SPICE, ESBLs; good for mixed infections (G-ve, G+ve, pseudomonas)
DO NOT use ertapenem for pseudomonas spp or acinetobacte spp (no/unreliable coverage)

Covers: G-ve (PEcK, SPACE/SPICE), G+ve (streptococcus/staphylococcus), anaerobes (gut/oral)
Some E. faecalis with imipenem (but increase failure rate)

NO ACTIVITY: MRSA, atypical organism (mycoplasma spp, chlamydia spp), C. difficile

23
Q

Macrolides coverage

A

G+ve incl streptococcus spp (S. Pneumoniae), weak staphylococcus spp.,
H. influenzae and M. catarrhalis (not erythromycin)
Excellent attpical coverage: Chlamydophila, legionella, mycoplasma pneumoniae;
N. gonorrhea, B. pertussis, Campylobacter, Lyme, H. pylori, MAC

NO ACTIVITY: MRSA, Enterococcus spp, gut anaerobes, most G-ve.

24
Q

Lincosamides coverage (clindamycin)

A 
G+ve: Staphylococci, streptococcus viridans, strep pyogenes, strep pneumoniae, MRSA
Gut anaerobes (B. Fragilis, Clostridium spp.)
Oral anaerobes (peptostreptococcus, fusobacterium, clostridia)

NO ACTIVITY: Enterococcus, most G-ve

25
Q

Aminoglycosides coverage

A

Pseudomonas,
Enterobacter
Mycobacterium tuberculosis,
G-ve (SPACE organisms): gentamicin best activity for Serratia & Klebsiella, tobramycin best for pseudomonas, Amikacin usually lower resistance rates

NO ACTIVITY: G+ve, atypical organism, anaerobes

Genatmicin used for synergy with Penicillin or vancomycin for MSSA/MRSA and enterococcus;
Useful for difficult to treat G-ve organisms such as pseudomonas & urosepsis, bacteremis, in combination with other drugs for multi-resistant organisms

26
Q

Tetracyclines coverage

A 
G+ve (S. aureus, some MRSA, streptococci incl. S. pneumoniae) 
G-ve (H. Influenzae, M. catarrhalis)
B. anthracis,
Mycoplasma, 
Chlamydophila sp., 
Lyme disease, 
Rickettsia,
Helicobacter pylori

NO ACTIVITY: anaerobes, hard to kill G-ve

27
Q

Tigecycline coverage

A

Useful for MRSA when vanco/dapto/linezolid is not an option
G+ve (S. aureus, MRSA, Streptococci, Enterococcus incl. VRE)
G-ve (H. influenzae, M. catarrhalis, E. coli)
Excellt Atypical (Mycoplasma, Chlamydia, Legionella)
Gut anaerobes

NO ACTIVITY: proteus, providencia, and pseudomonas

28
Q

Fluoroquinolones coverage

A

G-ve (PEcK, H. influenzae, M. catarrhalis, SPACE/SPICE, Neisseria gonorrhoeae, Salmonella, Shigella)
Atypical (Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophilia)
G+ve streptococci incl. penicillin-resistant strains (only respiratory FQ: levo, moxi, gem)
Moxifloxacin also covers anaerobes (only quinolone with anaerobic coverage)
Moxi DOES NOT penetrate urine (not for UTI)

NO ACTIVITY: MRSA, Pseudomonas spp (escrpt cipro/levo), G+ve (unless respiratory FQ); variable against enterococcus

29
Q

Metronidazole coverage

A

oral anaerobes (Peptostreptococcus spp, Fusobacterium spp,)
Gut anaerobes (B. fragilis, Clostridium spp.)
Other protozoa
H. pylori

NO ACTIVITY: G+ve, most G-ve, atypical

30
Q

Septra coverage

A

G+ve: Staphylococcus, Streptococcus, (S. aureus possibly including MRSA);
Listeria, Nocardia;
G-ve: PEcK, H. influenzae, M. catarrhalis, SPACE/SPICE but NOT pseudomonas
Strenotrophomonas maltophilia, PCP and toxiplasmosis (in HIV pt)

NO ACTIVITY: Enterococci, atypicals, anaerobes, Pseudomonas; poor against S. pneumoniae

31
Q

Vancomycin coverage

A

G+ve (S. aureus, MRSA, S. epidermidis, Streptococcus spp, Enterococcus spp, Listeria)
C. difficile (when used PO)

NO ACTIVITY: G-ve (except Neisseria), atypical, anaerobes

32
Q

Daptomycin coverage

A

G+ve (S. aureus, MRSA, Streptococcus spp, Enterococcus spp incl. VRE (both faecium and faecalis)

NO ACTIVITY: G-ve, atypical, anaerobes

33
Q

Linezolid coverage

A

G+ve (S. aureus, MRSA, Streptococcus spp incl. penicillin-resistant S. pneumoniae (PRSP), Enterococcus spp incl. VRE (both faecium and faecalis)

NO ACTIVITY: G-ve, atypical, anaerobes

34
Q

Nitrofurantoin covers?

A

PEcK, S. aureus, S. saprophyticus, S. agalactiae, Enterococcus spp & faecalis

NO ACTIVITY: atypical, anaerobes, pseudomonas

35
Q

Fosfomycin

A

G+ve: Staphylococcus spp., S. aureus (MRSA), Enterococcus spp.;
G-ve: E. coli, Enterobacter spp., Citrobacter spp., Klebsiella spp., Proteus spp., Providencia spp., P. aeruginosa

NO ACTIVITY: atypical, anaerobes

Antimicrobials (2 decks)

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