Antibiotics Flashcards
What are the four categories of beta lactams?
Penicillins
Cephalosporin
Carbopenam
Monobacrams
How do beta lactams work?
Inhibits the cell walls synthesis of the bacteria therefore they are bacterial
Name the natural penicillins.
What drug class do they belong to?
Penicillin G
Penicillin V (PO)
Penicillins are beta lactams
List the anti-staphylococcal penicillins
Oxacillin IV
Nafcillin IV
Dicloxacillin PO
List the amino, penicillin drugs, and what class they belong to
Amoxicillin
Ampicillin
Typically, combined with a beta ectomy inhibitor due to beta bacteria in activating amino penicillins
Ampicillin/sulbactam (Unasyn) IV
Amoxicillin /clavulanate (Augmentin) PO
These drugs are considered beta lactams
What are the four types of penicillin?
Natural penicillins
Anti-staphylococcal penicillin
Amino penicillin
Antipseudomonal penicillin
What are the antipseudomonal penicillins?
Piperacillin
Combined with Tazobactam (a beta lactamase inhibitor)
Trade Name: Zosyn
How many generations of cephalosporin are there and what kind of drug are they considered?
Five generations
Beta lactams
What are the first generation cephalosporins?
Cefazolin (Ancef) IV
Cephalexin (Keflex) PO
What are the third generation cephalosporin?
Ceftriaxone (Rocephen) IV
Cefotexime
Ceftazidime
** workhorse generation **
What are the fourth generation cephalosporin?
Cefepime (maxipime)
List the carbapenems and the class of drugs they belong to
Pneumonic DIME
D: Doeipenum
I: Imipenem
M: Meropenem
E: Ertrapenem
Very broad and very strong
What generation of fluoroquinolones are the respiratory name them?
Second generation
Levofloxacin
Gemifloxacin
Moxifloxacin
Name the macrolide antibiotics
Azithromycin
Erythromycin
Clarithromycin
Name the tetracycline antibiotics
Doxycycline
Tetracycline
Name the most common gram-positive bacteria
Methicillin sensitive, staphylococcus aureus (MSSA)
Methicillin-resistant staphylococcus aureus (MRSA)
Streptococcus pneumonia
Group A streptococcus: streptococcus pyrogen
Group B streptococcus: streptococcus agalactiae
What antibiotics are most effective against methicillin sensitive Staphylococcus aureus (MSSA)?
Anti-staphylococcal penicillin
- oxacillin
- dicloxacillin
1st gen cephalosporins
-cefazolin (Ancef) ***
- fluroquinolines
MRSA antibiotics
Vancomycin
Clindamycin
Linezolid
Doxycycline
Daptomycin (skin infections; right sided endocarditis)
What antibiotics cover streptococcus pneumonia?
Penicillin
Amino penicillins
-ampicillin/sub (Unasyn)
Third generation cephalosporins
-ceftriaxone
Fluoroquinolones
-moxifloxacin
-levofloxacin
Macrolides
Clindamycin
What is the pneumonic to remember gram-negative organisms? What are they?
HENS PECK
Hamophilius influenzae
Enterobacter
Nesseria gonorrhoeae & meningitides
Serratia
Proteus
ESCHERICHIA COLI
Klebsiella
What antibiotic covers all gram-negative organisms
Antipseudomonal penicillin:
Piperacillin-tazobactam
2nd & 4th gen cephalosporins:
Ceftriaxone
Cefepime
What are the most common pathogens that cause community acquired pneumonia?
Streptococcus pneumonia (+)
H.influenza (-)
M.catarhalis (-)
Atypicals:
Legionella (-)
Mycoplasma
Chlamydia
What is the empiric ABx therapy for CAP without underlying issues?
Beta lactam
-Ceftriaxone 2gm IV QD
PLUS
Macrolide
-Azithromycin 1gm IV x1 then 500mg qd.
Or flouroquinoline
-levofloxacin 750mg IV qd
Treat 5-7 days
Work-up for pneumonia
History: smoking, recent virus, comorbid conditions, such as COPD or diabetes, immuno, suppression, recent hospitalization, or recent antibiotic use.
CXR
CBC
BMP
LFTS
Procal (elevated in bacterial)
CRP (used to monitor treatment response)
ABG
Sputum cx and gram stain
Blood cultures
Urine Antigen tests (checks for legionella and streptococcus)
Nasal PCR
What patient population should be covered for pseudomonas pneumonia in the general impair treatment of cap
-Hospitalized patients
-Patients on ventilators
-COPD
-Chronic lung disease -immunocompromised from disease or medication
-Recent antibiotic treatment with broad spectrum antibiotic
-Previous history of pseudomonas
What is the impaired treatment of pseudomonas pneumonia is suspected
Antipseudomonal, beta lactam:
Piperacillin-tazobactam (Zosyn) 4.5g IV Q6 hrs OR
Cefepime (Maxipime)1-2g IV Q12 hrs OR
Meripenem 1gm IV q8hrs
PLUS
Fluroquinolone
-levofloxacin 750mg IV QD
-CiproFloxin 400mg IV q12 hrs
Gram negative organisms
HENS PECK
Hemophillius influenzas
Enterobacter
Neisseria Gonorrhoeae
Serratia
Proteus
Escherichia Coli
Klebsiella
Emperic therapy for CAP
1st choice Ceftriaxone and azithromycin
2nd choice (if macrolide contraindicated)
Ceftriaxone and levofloxacin
Alternative choice (cephalosporin allergy)
Aztreonam AND Zithromax or Aztreonam and levofloxacin
Antibiotics for pseudomonas
Cefepime 2g q8 hrs or pipercillin
Plus levofloxacin
What antibiotics cover gram negative bacteria
Anti-pseudomonas pcn
- piperacillin-tazobactam
2nd, 3rd, 4th generation cephalosporins
- 3rd Ceftriaxone
- 4th Cefepime
Carbapenems
- meropenum
Pseudomonas coverage
Anti-pseudomonas pcn
-piperacillin-tazobactam
3rd gen cephalosporin
- ceftazidime
4th gen cephalosporin
- Cefepime
Carbopenums
Fluoroquinolones
What type of bacteria is resistant to beta lactams?
ESBL
-Enterobactor
-ecoli
- Klebsiella
What is the antibiotic of choice for ESBL?
Carbapenums
-meropenem 500mg IV q6hrs
