Antibiotics for Bacterial Infections of the Bladder and Kidney Flashcards
Goals for ABs
Cure infection and minimize collateral damage
Example of side effects
AIN - penicillins
Lung and neuro - nitrofurantoin
Tnedonitis and seizures - FQs
Skin, especially with sulfa drugs
Normal flora benefits
Defend against pathognens
Vit K form E coli
Pathogens associated with decrerased normal flora
Clostridium difficile
Vaginal - candida
Fecal bacteria colonize vagina and ascend to bladder - cystitis
Vit K and normal flora
Dec in E coli…less Vit K…dec vitamin K —-excessive anticoagulation and increased bleeding risk…warfarin
Empiric tx
Start based on clinical scenario and most likely organisim if clinical scenario is very convincing and elay in RX would lead to sginificant problem
If cultre is available and susceptible to more than 1 drug
Chose most narrow spectrum, fewest risks and not allergic
If you start empiric, when culture returns, then de-escalate
Tx of cystitis
Nitrofuranton
Bactrim
Fosfomycin
Nitrofurantoin
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
Nitrofurantoin adverse effective
Lung toxicity (fibrosis) Neurotocic Hemolyitc anemia if G6PD def
Bactrim
Sulfonamide inhibit dihydropteroate syntehtase
Trimeprhotim - dihydrofolate reductase inhibitor
Bactrim clinical
2 step inhibito of folate ysnthesis
May be allergic
If not tested and delay in tx not risky, okay to try TMP alo9ne
Bactrim spectrum
Strep pneumo
Staph (MRSA)
Gram neg rods except pseudomonoas
SMX main risks
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
Fixed drug eruption
Immune mediated and same place each time drug taken
Genitalia or motuh
Separation of epidermis from dermis
Delayed HS rxn
Name depends on how much…less than 10% - SJS
Over 30% - toxic epidermal necrolyssi
SJS and TEN
Warn pts about prodrome
Very dangerous
Fosfomycin
INhibitor of peptidgolycan syntehsis
Not same that beta-lactams target
Usual specturm - E coli, enterococcus faecalis
Fosfomycin clinical use
Cystitis only***
SIngle dose into water and drink
Avoid if preg of lactating
Beta lactams
Inhibits DD-transpeptidase enzymes
Aminopenicillins
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
Bacterial resistance to Blatctams
B lactamases
Altered DD-transpeptidades which have less binding (use higher dose) or don;t bind at all (MRSA)
Amox+clavulante
Clav inhibts beta lactamase
Do NOT combine if it is susceptible to amoxicillin
Cephalosporins
Very different between generations
MRSA reistant until 5th
OKay to use during preg
Ceftriazone
Strep, not entero
Staph except MRSA
Gram neg except psuedomonoas
Neisseria honorr
Use for empiric cystitis - alternate
Emperic pyeloneprhotis
Drugs NOT routinely use to cystitis
Aminopenicillins - many are resistant…can use if susceptibel
FQs - effective but risky
Pyelonprhitis only
FQs ,
AMinoglycosides
Carbapenems
FQs
Inhibit bacterial enzymes
Most gram negative rds including pseudomonas but increase reisstance
Some gram+ but variable
FQs and UTIs
Ciprofloxicin
Good for outatient because good tissue penetration and oral bioavailbality
NOT for uncomplication cystitis unless no other options
FQ adverse rxn
Tendonitis - achilles rupture
Seizures - displaces GABA…more likely if taking NSAIDs, avoid if epileptic
May cause false+ urine opiate test
Aminoglycosides
Inhibit ribosomal protein syntehsis
Must give IV
Most gram - including pesuodomonas
Think of these for gram -
AG adverse rxns
Kidney
Ear
NM blockade (avoid in MG)
Carbapenems
Must give IV
Reistant to most Beta-lactamses
Very broad
Disadvantages - more change in normal flora nad risk of superbugs