Antibiotics Flashcards
What antibiotics are suitable in pregnancy?
Penicillins and Cephalosporins
What are the indications for aminoglycosides?
Used for serious infections
CNS infections e.g meningitis
TB (streptomycin)
Pyelonephritis, pneumonia, endocarditis
What is the therapeutic range for gentamicin?
5-10mg/L
Which aminoglycoside is given orally? and why?
Neomycin- too toxic for IV use
What are the side effects of aminoglycosides? (3)
1) Nephrotoxicity
2) Ototoxicity
3) Peripheral neuropathy
Aminoglycosides shouldn’t be used in…? (2)
1) Myasthenia gravis (impairs neuromuscular transmission)
2) Pregnancy (ear damage)
Aminoglycosides interact with what drugs?
1) Loop diuretics and Vancomycin (ototoxicity)
2) Cisplatin, Ciclosporin and vancomycin (nephrotoxicity)
IV treatment with aminoglycosides should not exceed how many days?
7 days
Monitoring requirements for aminoglycosides? (3)
1) Plasma concentration (18-24 hours after dose)
2) Renal function (especially during periods of dehydration)
3) Auditory and vestibular function
Common bacteria in meningitis? (3)
1) Neisseria meningitidis
2) Streptococcus pneumoniae
3) Haemophilius influenza
Antibiotics used in meningitis?
Benzylpenicillin, cefotaxime, chloramphenicol
Name 8 cephalosporins?
1) Cefalexin
2) Cetrotide
3) Cefaclor
4) Cefuroxime
5) Cefixime
6) Ceftriaxone
7) Ceftaroline
8) Fosamil
Are cephalosporins broad spectrum?
Yes
Indications for cephalosporins?
2nd or 3rd line treatment for UTI and RTI
IV for severe resistant organisms
Pneumonia, meningitis, gonorrhoea
Side effects of cephalosporins? (2)
1) GI effects
2) Penicillin hypersensitivity (avoid in known allergy)
Do IV cephalosporins require approval by a microbiologist?
YES and are now mainly restricted to antibiotic associated colitis
Does warfarin interact with cephalosporins? if so, how?
YES, cephalosporins kill the gut flora responsible for synthesizing vitamin K this results in a reduction in the production of vitamin K dependent blood clotting factors-results in increased anticoagulant effect of warfarin.
What is the first line antibiotic group for MRSA?
Glycopeptides e.g vancomycin, Teicloplanin etc
What indications are glycopeptides generally used for?
MRSA
C.diff
endocarditis
surgical prophylaxis (MRSA risk)
What are the main side effects of glycopeptides? (5)
1) Nephrotoxicity
2) Blood disorders
3) Ototoxicity
4) ‘Red man syndrome’
5) Thrombophlebitis (IV)
When would you avoid using glycopeptides?
elderly, history of deafness, renal impairment, pregnancy (ear damage)
What are the monitoring requirements for glycopeptides? (5)
1) FBC
2) WCC
3) Hepatic and renal function
4) Urinalysis
5) Auditory function in elderly
What drugs do glycopeptides interact with?
Ciclosporin, cisplatin, aminoglycosides, loop diuretics
Suxamethonium- (Increases vancomycin conc)
What are the indications for clindamycin (lincosamide)? (3)
1) Staphylococcal joint and bone infections
2) Intra abdominal sepsis
3) Cellulitis and skin and soft tissue infections (effective against penicillin resistant streptococci)
Important side effects of clindamycin? (4)
1) Antibiotic associated colitis-REPORT diarrhoea
2) Esophageal disorders
3) Jaundice
4) SJS, rash
In what patient groups is clindamycin CI?
Existing diarrhoea
Caution in middle aged/ elderly women after an operation
What are the indications for macrolides?
Respiratory infections (in addition to penicillin), Lyme disease, severe pneumonia (added to penicillin), skin and soft tissue infections (alternative to penicillin)
Important side effects of macrolides? (4)
1) Antibiotic associated colitis
2) QT prolongation
3) Ototoxicity
4) Cholestatic jaundice
Why would you avoid using macrolides in myasthenia gravis?
Macrolides cause electrolyte abnormalities which can aggravate myasthenia gravis
Main CI for macrolides?
1) Hepatic impairment (cholestatic jaundice)
2) Arrhythmia (QT prolongation)
What drugs interact with macrolides?
1) CYP450 substrates
2) Drugs that prolong QT interval
What are the main indications of metronidazole? and appropriate doses? (3)
1) Antibiotic associated colitis (400mg TD 5 days)
2) Oral infections (200mg TD 3 days for gingivitis)
3) Gynecological infections e.g trichomonas vaginal infection
Main side effects associated with metronidazole? (3)
1) Neurological effects e.g peripheral and optic neuropathy
2) Mouth-Taste disturbance, furred tongue and mucositis
3) Hearing loss
Is metronidazole a CYP450 inhibitor?
NO, it is a substrate of CYP450
What happens if you drink alcohol while taking metronidazole?
‘di-sulfram like’ reaction will occur. Metronidazole inhibits the clearing of acetylaldehyde (intermediary metabolite)- this causes flushing, headache, tachycardia
How long after stopping metronidazole should you avoid alcohol?
2 days
What drugs does metronidazole interact with? (4)
1) CYP450 inhibitors
2) CYP450 inducers
3) CYP450 substrates
4) Lithium (reduces clearance of lithium resulting in toxicity)
What effect will ketoconazole have on metronidazole?
Ketoconazole is a CYP450 inhibitor, metronidazole is a substrate of CYP450 therefore ketoconazole will reduce the metabolism of metronidazole. Metronidazole is a pro-drug so this will reduce the efficacy of metronidazole.
What duration of treatment with metronidazole requires FBC and hepatic monitoring?
10 days
Are penicillins broad spectrum?
Yes
What are the main indications for penicillins? (7)
1) Tonsillitis (streptococcal)
2) Otitis media
3) Cellulitis
4) RTI
5) Meningitis
6) Tetanus (C.diff)
7) Skin and soft tissue infections
Main side effects of penicillin’s? (2)
1) Penicillin allergy
2) CNS toxicity (convulsions, coma)-do not give intrathecal injection