Antibiotics, AMR Flashcards
Empiric treatment for bacteremia with S.aureus
- Vanco
- Dapto
- De-escalate to anti-staph B-lactams, e.g.:
- Cefazolin
- Oxacillin
- Nafcillin
Empiric treatment for bacteremia with coagulase-negative staphylococci?
If hospitalized: (?MSSE)
- Vanco
- Dapto
If B-lactamase:
- Oxacillin
- Nafcillin
If non-B-lactamase:
- Penicillin
Empiric treatment for bacteremia with Enterococcus spp.
- Vanco
- Ampicillin (usually ok but not always, but greater killing activity than Vanco)
Intrinsic resistance of Enterococcus spp.
- Cephalosporins
- Macrolides
- Clindamycin
Which GPC are intrinsically resistant to Vancomycin?
- E. casseliflavus
- E. gallinarum
- Leuconostoc
- Lactobacillus (80%)
- Pediococcus
- Erysipelothrix
- Weissella confusa
(And the GPB Clostridium innocuum)
Which bacteria contain AmpC resistance?
- Serratia
- Providencia + Pseudomonas
- Indole+ Proteus (=vulgaris; but this is debatable since it’s a different class, = Class A ceph’ase)
- Citrobacter freundii complex
- Enterobacter (esp. E.cloacae)
- K. aerogenes
- Hafnia alvei
- Acinetobacter baumannii
- Morganella morgannii
Can also have in plasmid (uncommon), seen with E.coli + Klebsiella
For which organisms are cephalosporins ineffective?
“LAME”
- Listeria
- Atypicals (e.g.Mycoplasma, Chlamydia)
- MRSA
- Enterococci
Which antibiotic classes are enterococci intrinsically resistant to?
- Cephalosporins
- Aminoglycosides (low-level)
Unlike AmpC’s, ESBL’s are characteristically susceptible to…
Cefoxitin (and other cephamycins)
What is the empiric abx treatment for MRSA?
Which abx are NOT acceptable?
Empiric:
- Vanco
Avoid:
- Beta lactams (acquired R)
- Cipro (poor GP coverage)
What is the empiric abx treatment for MSSA?
Which abx are NOT acceptable?
Empiric:
- Cefazolin
- Anti-staphylococcal BLms
Avoid:
- Cipro (poor GP coverage)
What is the empiric abx treatment for E.faecalis?
Which abx are NOT acceptable?
Empiric:
- Penicillin
- Vanco
Avoid:
- Cipro (poor GP coverage)
What is the empiric abx treatment for streptococci?
Which abx are NOT acceptable?
Empiric:
- Non-VGS = Penicillin
- VGS = CRO
Avoid:
- SXT ({})
- Cipro (poor GP coverage)
Beta-lactam antibiotics: Overall traits + MOA Classes
Cidal vs. CW synthesis 1. Penicillins 2. Cephalosporins 3. Carbapenems 4. Monobactams
Good abx for Pseudomonas
PIP/TAZO CFTAZ CFEP MERO CIP TOB
