Antibiotics for Bacterial Infections of the Bladder and Kidney

Question 1

Goals for ABs

Answer 1

Cure infection and minimize collateral damage

Question 2

Example of side effects

Answer 2

AIN - penicillins
Lung and neuro - nitrofurantoin
Tnedonitis and seizures - FQs
Skin, especially with sulfa drugs

Question 3

Normal flora benefits

Answer 3

Defend against pathognens

Vit K form E coli

Question 4

Pathogens associated with decrerased normal flora

Answer 4

Clostridium difficile

Vaginal - candida
Fecal bacteria colonize vagina and ascend to bladder - cystitis

Question 5

Vit K and normal flora

Answer 5

Dec in E coli…less Vit K…dec vitamin K —-excessive anticoagulation and increased bleeding risk…warfarin

Question 6

Empiric tx

Answer 6

Start based on clinical scenario and most likely organisim if clinical scenario is very convincing and elay in RX would lead to sginificant problem

Question 7

If cultre is available and susceptible to more than 1 drug

Answer 7

Chose most narrow spectrum, fewest risks and not allergic

If you start empiric, when culture returns, then de-escalate

Question 8

Tx of cystitis

Answer 8

Nitrofuranton
Bactrim
Fosfomycin

Question 9

Nitrofurantoin

Answer 9

Reduced by nitrofuran reductse…reactive intermediate damage DNA

Active against E coli and staph saprophyticus

Gets into urine only, no tissue…good because less vaginits and diarrhea
Bad bc not for pyeloneprhitis

Question 10

Nitrofurantoin adverse effective

Answer 10

Lung toxicity (fibrosis)
Neurotocic
Hemolyitc anemia if G6PD def

Question 11

Bactrim

Answer 11

Sulfonamide inhibit dihydropteroate syntehtase

Trimeprhotim - dihydrofolate reductase inhibitor

Question 12

Bactrim clinical

Answer 12

2 step inhibito of folate ysnthesis

May be allergic

If not tested and delay in tx not risky, okay to try TMP alo9ne

Question 13

Bactrim spectrum

Answer 13

Strep pneumo
Staph (MRSA)
Gram neg rods except pseudomonoas

Question 14

SMX main risks

Answer 14

Avoid if pregnant…displaces bilirubin from albumin and leads to encephalopathy in newborn

Hemolytic anemia (G6P)

Skin reactons - spearate epidermis from dermis

Fixed drug eruption

Question 15

Fixed drug eruption

Answer 15

Immune mediated and same place each time drug taken

Genitalia or motuh

Question 16

Separation of epidermis from dermis

Answer 16

Delayed HS rxn

Name depends on how much…less than 10% - SJS
Over 30% - toxic epidermal necrolyssi

Question 17

SJS and TEN

Answer 17

Warn pts about prodrome

Very dangerous

Question 18

Fosfomycin

Answer 18

INhibitor of peptidgolycan syntehsis

Not same that beta-lactams target

Usual specturm - E coli, enterococcus faecalis

Question 19

Fosfomycin clinical use

Answer 19

Cystitis only***

SIngle dose into water and drink

Avoid if preg of lactating

Question 20

Beta lactams

Answer 20

Inhibits DD-transpeptidase enzymes

Question 21

Aminopenicillins

Answer 21

AMoxicillin

NOT okay for empiric cystitis tx but okay to use if culture shows suscetiblity

Covers some gram pos and neg…not stpah or pseudomonas….many E coli are resitant

OKay to use in pregnancy

Cause AIN

Question 22

Bacterial resistance to Blatctams

Answer 22

B lactamases

Altered DD-transpeptidades which have less binding (use higher dose) or don;t bind at all (MRSA)

Question 23

Amox+clavulante

Answer 23

Clav inhibts beta lactamase

Do NOT combine if it is susceptible to amoxicillin

Question 24

Cephalosporins

Answer 24

Very different between generations
MRSA reistant until 5th

OKay to use during preg

Question 25

Ceftriazone

Answer 25

Strep, not entero Staph except MRSA Gram neg except psuedomonoas Neisseria honorr Use for empiric cystitis - alternate Emperic pyeloneprhotis

Question 26

Drugs NOT routinely use to cystitis

Answer 26

Aminopenicillins - many are resistant...can use if susceptibel FQs - effective but risky

Question 27

Pyelonprhitis only

Answer 27

FQs , AMinoglycosides Carbapenems

Question 28

FQs

Answer 28

Inhibit bacterial enzymes Most gram negative rds including pseudomonas but increase reisstance Some gram+ but variable

Question 29

FQs and UTIs

Answer 29

Ciprofloxicin Good for outatient because good tissue penetration and oral bioavailbality NOT for uncomplication cystitis unless no other options

Question 30

FQ adverse rxn

Answer 30

Tendonitis - achilles rupture Seizures - displaces GABA...more likely if taking NSAIDs, avoid if epileptic May cause false+ urine opiate test

Question 31

Aminoglycosides

Answer 31

Inhibit ribosomal protein syntehsis Must give IV Most gram - including pesuodomonas Think of these for gram -

Question 32

AG adverse rxns

Answer 32

Kidney Ear NM blockade (avoid in MG)

Question 33

Carbapenems

Answer 33

Must give IV Reistant to most Beta-lactamses Very broad Disadvantages - more change in normal flora nad risk of superbugs