Antibiotics for Respiratory Tracts Flashcards
What is ticarcillinused to treat
gram + and some anaerobes
gram negative broadened spectrum including psuedomonas
What is piperacillin used to treat?
gram negative spectrum like ticarcillin but also
pseudomonas and klebsiella
incl. those that are ticarilis-resistance
What are teh two beta-lactamase inhibitors?
clavulanic acid
tazobactam
What are the cephalosporins that reach csf?
3rd generation
What is a monoatam that use to treat patients with life-threatening penicillin allergy?
aztreonam
What is imipenem used to treat?
broad spectrum. gram pos and neg
ressistant to many beta-lactamases
What is vancomycin used to treat?
gram positives only but of all type
What re the side effects of vancomycin?
red man
nephro toxic
ototoxic
phelebitis
What is the mechanism of action of daptomycin?
binds to bacterial cytoplasmic membrane, casing rapid membrane depolarization
What is daptomycin used for?
gram pos spectrum
bacteremia
complicated skin infections but
NO PNEUMONIA bc of interaction with surfacant
What is ciprofloxacin used to treat
best treatment for psuedomonas and other respiratory gram negative infecitons as well as UTI, diarrhea, bone, skin
What is moxifloxacin used to treat?
complex, inpt, Community acquired pneumonia has excellent gram positive spectrum
What are the side effect of quinolones?
dizziness, depression seizures rashes EKG irregularities (prolonged T interval) perippheral neuropathy arthotopathy
What is metronidazoles mechanism of action?
anaerobes reduce nitro group resulting in damage/disruption of dna
What is metronidazole used to treat?
anaerobes
C. diff
Heliobacterpylori
What are aminoglycosides mechanism of action?
bind to several ribosomal sites
What are aminoglycosides used to treat?
primarily for gram neg aerobics
as well as some gram positive activity
What are the side effects of aminoglycosides?
nephrotoxic and ototoxic
What are the three aminoglycosides?
gentamicin, tobramicin, amikaci
What are tetracyclines usually used to treat?
preferred agents for unusual bugs
and broad spectrum
What is tigecycline used for?
skin structure infection
complication intra-abdominal infection
community acquired pneumonia
very wide spectrum including anaerobes
What is a macrolides?
binds to 50s subunit, blocks translocation along ribosomes
What is clarithromycin used to treat?
broad spectrum mainly gram pos including penicillin ressitant strep pneumoniae
What are the adverse effects of clarithromycin?
some CV risk, prolongs QT interval
What is azithromycin used to treat?
very common for outpatient resp tract infections
+chlamydia and ceftriaxone
What is clindamycin used to treat?
gram pos cocci
many anaeroes incl. bacterioides fragiles
What is linezolid used for?
gram positive spectrum broad; inhibits 50 S ribosomal subunit
What are the side effects of linezolid
bone marrow suppresion
can cause serotonin syndrome; non selective inhibitor of MAO
What is empiric antibiotic treatment?
broad spectrum and sould be chosen based on the likely pathogen/diagnosis,, pt exposure history, patient alelrgy history
What are a variety of ways that antibiotics are misused?
given when not needed continued when no longer necessary wrong dose broad spectrum used to treat susceptible bacteria wrong antibiotic for infection
What is the definition of antibioitic stewardship?
a system of informatics, data collection, personnel, and polcy procedures which promote the optimal selection, dosina nd duration of therapy for antimicrobial agents throughout the course of use
What are the goals of anitibiotic stewardship?
reduce antibiotic consumption and innappropiate use
reduce C. diff
improve pts outcomes
increase adherence of tx guidelines
reduce adverse events
decrease/limit antibioti cresistance
What treatment should be used to treat outpt CAP? in previously healthy or with co-morbidiites?
healthy-macrolide
-doxycycline
co-morbidities -alpha-pneumococcal Fluoroquinine or
beta lacatm plus macrolide
What are the antibiotic choice for inpt Rx of community acquired pneumonia?
Beta-lactam plus macrolide
or
alpha-pneumococcal fluoroquinolone
What are the ICU treatments for community acquired pneumoniia?
beta-lactam plus either macrolide or
alpha-pneumococcal Fluorquinone
or
alpha-pneumococcal Fluoroquinone plus aztreonam
What is the inpt treatment for CAP when pseudomonas is considerred?
alpha-pseudomonal, pneumococcal beta-lactam plus alpha-psedudomonoal fluroquinolone
If MRSA is suspected what should you use to treat Community acquried pneumonia?
add vancomycin or linezolid to treatment
If aspiratoion is suspected in community acquired pneumonia what should you add to treatment?
clindamycin
What penicillins are used to treat MSSA?
all except PCN, ampicillin
Nafcillin and cefazolin are drugs of choice
What beta lactams are used to treat pneumococcus?
cefotaxime and ceftriaxone
What beta lactams are used to treat pseudomonas aeruginosa?
piperaclilin/tazobactam, ceftazadime, cefepine, meropenem/imipenem
axtreonam
What is teh antimicrobial spectrum of maccrolides?
respiratory gram positive and gram negative bacteria as well as intracellular atypical pathogens
What is the anti-pneumococcal fluroquinolones?
moxifloxacin and levofloxacin
What are the anti-pseudomonal fluroquinolones?
ciprofloxacin and levofloxacin
What is the antimicrobial spectrum of tetracyclines?
wide range of gram positive and gram negative bacteria in respiratory tract as well as most effective atypical organism coverage
What are the drugs for resistant gram positive bacteria?
vancomycin
linezolid
-but has bone marrow suppression, neuropathy and possible serotonin syndrom
daptomycin but not sued for pneumonia; doesn’t work
What isthe duration for treatment of CAP?
min 5 days; afebrile for 48-72 hours, breathing wihtout oxxygen, vitals normal
longer duration if culture positive for coag pos staph or psuedomonas
What are the risk factors for multi-drug resistant organisms?
hospitalization for >5 days
hospitalization for 2 days within last 90 days
resident of nursing home
recipient of IV antibiotic therapy, chemo or wound care in last 30 days
chronic dialysis
fam member with MDRO
What treatment do you use to treat HCAP with no risk factors for MDROs?
ceftriaxone or amp/sulfbactam or ertapenem or fluoroquinolone
What is the treatment for empiric antibiotic therapy for HCAP with risk factors for MDROs?
anti-psuedomonal beta-lactam plus anti-psuedomonal fluoroquinolone or aminoglycoside plus
vanco or linezolid if MRSA suspected
What increases CURB score?
confusion
BUN>19 mg/dL
RR>30
systolic65
A curb score greater than what should consider inpt stay?
2 or greater with >3 consider ICU
