Antibiotics for Bacterial Pneumonia

Question 1

Selection straegy

Answer 1

Cover the infecting and avoid unneccesaary coverage

Question 2

Amox/Clavulanic

Piperacilliin/Tazo

Answer 2

Amino with beta-lact inhibitors (O)

Anti-pseduo plus beta lact (I)

Question 3

MOA, Bact spectrum, PKs, adverse effects of peniccilins

Answer 3

Inhibitors of cell wall synthesis

Covers many gram - and pos

Pip is better for pseudomonos

Amox - main couce for outpatient pnuemonia…not used ofr atypical because tought to penetrate…also can’t use for MRSA

HS reactions

Question 4

Amox-pip entry into cells

Answer 4

INto gram negative bacteria throug porins

Have side chains that increase porin trnaposrtation

Can enter gram positive due to lack of outer membrane

Question 5

Beta-lactamases

Answer 5

INhibit the peniccilins by breaking beta-lactam ring

Inhibitors bind to catalytic site inhibiting selected beta-lactamase

Question 6

Ceftriaxone and cefepine

Answer 6

3 - ceftriax
4- cefepime

Both IV

Question 7

MOA, spectrum, PK, Adverse of cephalosprin

Answer 7

Beta-lactams

Broad spectrum and differ in gram-

Distributed widely but poo intracellular penetration

Occassional cross-hypersensitivity with penicillins

Question 8

Ceftriaxone vs cefepin

and how different than penicillins

Answer 8

triax - excelltnt for more serious gram- bacilli

cefepime - more psudomonas activity

More stable against lactamses, but some enterobacteriaceae express ESBLs which can destroy many cephalosporis

Question 9

Meropenem MOA, spectrum PL, adverse

Answer 9

Beta-lactam

Borad spectrum but important for resistant gram negative rods

Distributed widely but poor intracellular

Possible cross-HS with penicillins

Question 10

Carbapenem use

Answer 10

ESBL-esxpressing enterobacteriacae and multi-drug resistant pseudomonas which are both resistant to most cephalosporins

CRE exists and may need specialized ABs

Question 11

Respiratory FQs and antipsuedo FQs

Answer 11

Levofloxacin

Bacteriocidal…fragmentation of bacterial DNA

Broad coverage but differes for pneumo and pseudo

Excels at cellular penetration (atypical)

Can prolong QT on ECG…caution with cardiac…tendinopathies and tendon rupture so caution with children and elderly

Question 12

Antipseudomonal and respiratory FQs

Answer 12

Anti-pesudo includes cirpo and levo

Levo, moxi, gemi are considered respiratory because their more potent MICs against pnuemoccocus and atypical

Anti-pseudo better for gram - bacilli

Question 13

Azithromyinc

Answer 13

Most effective with fexer effects

Bacteriostatic protein synthesis inhibitors

Broad specturm and includes atypical IC pathogens

Excells at bentration…hepatic elimination so long T1/2

Heart QT…clarithromycin and erythromycin are CYP3A4 inhibitors

Question 14

Azith coverage

Answer 14

Gram+, Gram -, drug of choice for broad coverage of atypicals (myco and chlamydophila)

Some pneumococcus can cause problems

Also have anti-inflammatory properties

Question 15

Vancomycin

Answer 15

Glycopeptide

Bactericidal inhibitor of cell wall synthesis

Narrow spectrum (gram+)

Poor GI absorption and poor penetration..renal elimination

POtential neprhotoxicity

Red-mansyndrome upon injection due to hisamine release

Question 16

MRSA reisstant to

Answer 16

ALL B-lactams due to mutated drug receptors

Vanc replaces beta-lactams for MRSA as it inhibtis synthesis through transglycosylase and is insensitivie to beta-lactamases

Question 17

Tobramycin

Answer 17

More potent against pseudomonos

Bacteriocidial protein synthesis inhibitors

Most used for gram -

Poor coverage of atypicals

Renal elimination

Very nephrotixoc…oto and vestibular toxicity are also well-characterize

Question 18

Coverage for aminoglycosides

Answer 18

Gram+, gram - (important entero and pseudo)

NO atypical coverage