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Year 3 - CR > Antibiotics in cardio-respiratory infections > Flashcards

Antibiotics in cardio-respiratory infections Flashcards

1
Q

Name some upper respriatory tract symptoms

A
  • sinustitis
  • ottis media
  • rhinitis
  • tonillitis
  • pharyngitis
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2
Q

What is the common microogranisms that is in the upper respriatory tract

A
  1. normal flora such as viridans streptococci
  2. temporary colonisers such as staph aureus and candida
  3. pathogens
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3
Q

Name a organisms in the normal flora of the upper respiratory tract

A

viridans streptococci

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4
Q

Name some temporary colonisers of the upper respiratory tract

A

staph aureus and candida

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5
Q

Name some common bacteria in the URTI

A

= Strep pyogenes = group A
= strep pneumoniae
= haemophilus influenzae

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6
Q

Name 7 common URTI viruses

A
  1. rhinovirus
  2. influenza/parainfluenza
  3. cornavirus
  4. adenovrius
  5. RSV = respiratory syncytial virus
  6. Coxsackie
  7. enterovirus
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7
Q

what are uncommon causes of URTI

A
  • corynebacterium diphtheriae

- nisseria menigitidis

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8
Q

What are the symptoms of influenza

A
  • fever
  • coryza
  • systemic symptoms - headache, malaise, myalgia, arthralgia, and GI symptoms
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9
Q

What defines an influenza as complicated

A

Requires hospital admission

and/or

  • pneumonia/hypoxaemia
  • CNS - menigitis
  • Exacerbation of co-morbdity
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10
Q

How do you treat complicated influenza

A

if the perosn is not severely immunosupressed

  • 1st line is = oseltamivir, PO/NG
  • 2nd line = zanamivir iNH, NEB or IV
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11
Q

How do you treat uncomplciated influenza

A

If they are previously healthy
- No treatment
or
- oseltamivir PO if physician feels patietn is a serious risk of developing complciations

If they are in an at risk group
- Are they severely immunosupressed
If no to immunosupressed
- oseltamivir PO within 48 hours of onset or later at clinical discretion

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12
Q

How do you prevent influenza

A
  • Vaccinations of patients
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13
Q

How do you investigate influenza

A
  • Primary care - not needed

- secondary care - nasopharygneal swab for flu PCR

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14
Q

in influenza you should not

A
  • confirm the infection before treating
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15
Q

What is the treatment for influenza

A
  • within 48hr of start of symptoms

- oseltamivir 75mg bd oral/NG x 5 days

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16
Q

What bacteria causes pharyngitis

A
  • Group A, B, C streptococci
  • Mycoplasma pneumoniae
  • Neisseria gonorrhoea
  • Corynebacterium diptheriae
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17
Q

What is the most common bacteria that causes pharyngitis

A

Group A streptococci

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18
Q

What virus can cause a pharyngitis

A
  • 7 common URTI viruses
  • EBV
  • CMV
  • HSV
  • Measles, HIV etc
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19
Q

Is bacteria or virus most common cause of pharyngitis

A

Virus

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20
Q

What are the symptoms of scarlet fever

A
  • sore throat, fever, felt ill
  • tonsillar exudate
  • tender cervical nodes
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21
Q

How do you treat scarlet fever

A
  • Penicillin V for 10 days
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22
Q

What criteria is used to help GPs if patients benefit from antibitoics for pharyngitis

A

Centor criteria

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23
Q

How do you work out the centor criteria

A

One point for

  1. tonsillar exudate
  2. tender cervical lymph noes
  3. absence of cough
  4. fever

if 1 or 2 points there is a 20% chance of Group A Strep - no anitbotics is given
if 3 or 4 point there is a 50% chance of Group A Strep - antibitoics are given

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24
Q

How do you treat Group A Strep

A
  • all are penicillin senstiive
  • majority erythromycin senstiive - for penicillin allergic people
  • penicillin V 500mg QDS or 1g BD for 5-10 days OR clarithromycin 500mg BD for 5 days
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25
Q

What are the complications for group A strep

A
  • rheumatic fever

- glomerulonephritis

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26
Q

What are the symptoms of EBV

A
  • sore throat, fever, felt ill
  • tonsillar exudate
  • tender cervical nodes
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27
Q

How do you treat EBV

A

penicillin V (or clarithromycin)

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28
Q

If you give amoxicillin to an EBV patient what can happen

A

amoxicillin frequently causes a rash in patients with EBV

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29
Q

DO NOT GIVE AMOXICILLIN FOR

A

SORE THROAT

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30
Q

What causes otitis media virus or bacteria more?

A

Virus

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31
Q

What bacteria can cause otitis media

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Mycoplasma pneumoniae
  • Streptococus pyogenes
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32
Q

How do you treat otitis media in children

A

No anitbiotics unless

  • under 2 years
  • symptoms persist longer than 48 hours
  • high fever
  • bilateral
  • otorrhea
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33
Q

What antibitoics is used for otitis media for children

A
  • Amoxicillin for 5-7 days

- clarithromycin for 5-7 days

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34
Q

in adults otitis media is more likely to be

A

bacterial than viral

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35
Q

How do you treat otitis media in adults

A
  • Amoxicillin

- Clarithromycin

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36
Q

What complications do you get in otitis media that is untreated

A
  • decreased hearing
  • mastoditis
  • brain abscess
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37
Q

is it bacteiral or viral that causes sinustitis more

A

Virus

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38
Q

What is the bacterial cause of sinusitis

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae (unencapsulated)
  • Moraxella catarrhalis
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39
Q

How do you treat sinustitis

A

Treatment is not usually as it is viral
but if it is bad
- consider penicilin V or clarithromycin
- Co-amoxiclav if systemically unwell

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40
Q

Name the lower respiratory tract infections

A
  • Pneumonia
  • Chronic bronchitis
  • Bronchiectasis and cystic fibrosis
  • emphysema
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41
Q

What are the types of pneumonia

A

Community acquired

  • typical
  • atypical

Hosptial acquired

Aspiration

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42
Q

What are the two types of community acquired pneumonia

A
  • Typical

- Atypical

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43
Q

what are the causes of typical penumonia

A
  • strep pneumoniae
  • haemophilus influenzae
  • staph aureus
44
Q

What are the causes of atypical pneumonia

A
  • Mycoplasma pneumoniae
  • Legionella
  • Chlamydia
    pneumoniae
  • Chlamydia psittac
45
Q

What are the risk factors for pneumoccoal pneumonia

A
  • Influenza
  • Alcohol
  • Smoking /COPD
  • HIV
46
Q

What is the most common cause for pneumonia

A

Pneumoccoal pneumonia

47
Q

What are the first line and 2nd line antibitoics for strep pneumoniae (pneumococcal pneumonia)

A

1st line

  • amoxicillin
  • doxycycline
  • leveofloxacin

2nd line

  • ceftriazone
  • tecioplanin
  • vancomycin
48
Q

What should you always ask in the history of someone with pneumonia

A
  • Take a travel history as if they picked up the pnemonia from another country they could be resistant to certain antibiotics
49
Q

what are the two main causes of atypical pneumonia

A
  • Mycoplasma pneumoniae

- legionella species

50
Q

why is Mycoplasma pneumoniae not visible on gram stain

A
  • Has no cell wall
  • therefore not visible on gram stain
  • therefore unaffected by cell wall antibitoics
51
Q

When does myoplasma pneumoniae typically act

A
  • autumn to winter

- casues a dry cough

52
Q

What do patients with myoplasma pneumoniae present with

A
  • Dry cough
  • +/- pharyngitis, rhinorrhea, otalgia
  • +/- hepatitis, meningitis
53
Q

What antibitoics do you use for mycoplasma pneumonia

A
  • Macrolides (clarithromycin or erythromycin)
  • Quinolones (levofloxacin)
  • tetracyclines (doxycycline)
54
Q

describe the structure of legionella spp (penumonia cause)

A
  • Gram negative rods
  • Require special media for growth
  • Slow growth (3-5days)
55
Q

What is the most common type of legionella spp

A

L pneumophila

56
Q

How do you treat legionella spp causing pneumonia

A
  • Cell wall antibiotics clinically not effective

- Quinolones >Macrolides>tetracyclines effective

57
Q

What are the risk factors of S aureus penumonia

A

More comon

  • colonisation of URT
  • Viral URT
58
Q

what does a PVL-toxin strains in s aureus penumonia cause

A
  • Severe disease

- necrotising/abscess formation

59
Q

what is treatment of pneumonia based on

A

CURB65

60
Q

Describe the different part of the scores that make up the CURB65

A
  • Confusion
  • Urea greater than 7mmol/l
  • Respiratory rate greater than 30/min
  • Blood pressure hypotensive
  • aged over 65

Score

  • 0-1 = low severity, risk of death is less than 3% so treat as an outpatient
  • 2 = moderate severity, risk of death is 9%, admit, have microbioloigcal investigations, IV antibitoics
  • 3-4 = high severity, risk of death is 15-40%, urgent admission
61
Q

What is the negative to do with the CURB65 score

A
  • may underestimate how severe pneumonia is in someone who is young as they tend to have there blood pressure controlled until they are really ill
62
Q

What is the treatment used for pneumonia based on the CURB 65 score

A
  • 0-1 : Oral amoxicillin 500mg TDS OR doxycycline 100mg OD
  • 2 : IV benzylpenicillin 1.2g QDS & doxycycline 100mg BD
  • > 2 : IV Co-amoxiclav 1.2g TDS & doxycycline 100mg BD
    OR IV ceftriaxone 2g OD & doxycycline 100mg BD
63
Q

What is hospital acquired pneumonia

A
  • pneumonia that develops 48 hours after admission or within 2 weeks of admission
64
Q

hospital acquired pneumonia is

A

3rd commonest nosocomial infection but has the highest mortality

65
Q

What are the predisposing factors for hospital acquired pneumonia

A
  • Abnormal conscious state/ intubation and ventilation

- immunosuppresion

66
Q

How do you treat hospital acquired pneumonia

A

Mild/moderate
– doxycycline

Severe
○ Early onset (<5 days) – co-amoxiclav
○ Late onset (>5 days)- piperacillin-tazobactam

67
Q

what is the microbiology for hospital acquired pneumonia comapred to community

A
  • hospital acquired also includes gram negative organisms such as E.coli, Klebsiella and pseudomonas
68
Q

What causes aspiration pneumonia

A
  • can involve bacteria from the upper respiratory tract or stomach - usually low virulence

can be polymicrobial
- invovles aerobic streptococci and anaerobes

69
Q

How do you treat aspriation pneumonia

A
  1. Amoxicillin & metronidazole(need anaeorbe cover from metronidazole)
  2. Levofloxacin & metronidazole (need anaeorbe cover from metronidazole)
  3. Co-amoxiclav - has got anaerobe activity in it
  4. Piperacillin-tazobactam - has got anaerobe activity in it
70
Q

What is ECOPD

A
  • Exacerbation of COPD
71
Q

What are the symptoms of ECOPD

A

Worsening of symptoms

  • shortness of breath
  • cough
  • sputum
72
Q

What are the triggers for ECOPD

A
  • viruses
  • bacteria
  • pollution
  • CCF (congestive cardaic failure)
  • VTE
  • aspriation
  • in a 1/3rd of cases it is not known
73
Q

What are the bacterial causes of ECOPD

A
  • Haemophilus influenzae
  • moraxella catarrhalis
  • streptococcus pneumoniae
  • pseudomonas aeruginosa
  • chlamydia pneumniae
74
Q

What are the viral causes of ECOPD

A
  • Rhinovirus
  • influenza/parainfluenza
  • adenovirus
  • RSV
  • metapneumovirus
  • coronavirus
75
Q

What are antibotics only effective in ECOPD

A

if they have a history of 2 or more of

  • increased dyspnoea
  • increased sputum purulence
  • increasd sputum volume
76
Q

What is the treatment of ECOPD

A
  • Doxycycline or clarithromycin
  • duration of treatment is 5 days
  • if relapse/recurrence within 3 months then antibotics with alternative agent
  • if consolidation on CXR then treat as for CAP/HAP
77
Q

What is bronchiectasis

A
  • abnormal dilatation of the major bronchi and bronchioles
  • chronic daily cough with viscid sputum production
  • on CT see bronchila wall thickening and luminal dilatation
78
Q

What is cystic fibrosis

A
  • congenital

- abnormal secrtions resulting in chronic infections and bronchiectasis

79
Q

What organisms can caue bronchiectasis

A
  • Viral
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Staph aureus
  • Strep pneumoniae
  • Pseudomonas aeruginosa
80
Q

How do you treat bronchiectasis

A
  • If no pseudomonas – Rx clarithromycin or doxycycline or co-amoxiclav
  • If pseudomonas – Rx po ciprofloxacin or IV pip-taz
81
Q

What is the prophyalxis for bronchiectasis and cystic fibrosis

A
  • Chest physiotherapy /postural drainage

Oral azithromycin

  • For recurrent exacerbations only
  • After excluding non-tuberculous mycobacterial infection

Inhaled abx
- Nebulised gentamicin, tobramycin, colistin

82
Q

What is empyema

A

complicated parapneumonic effusion

83
Q

what is parapneumonic effusion

A

effusion into the pleural space adjacent to bacterial pneumonia

84
Q

How do you treat a normal parapneumonic effusion

A
  • resolve with treatment of pneumonia
85
Q

What happens in complicated parapneumonic effusion

A
  • Bacteria invade pleural space

- Empyema develops

86
Q

How do you treat empyema

A

 Drainage

  • Antibiotics until XR resolution
  • Usually 2-4 weeks
87
Q

What diseases can you get vaccinations to

A
  • Influenza
  • Pneumococcal
  • Haemophilus influenzae
  • Pertussis
  • Diptheria
88
Q

where can infective endocarditis occur on

A
  • normal valves
  • abnormal native valves
  • prosthetic valves
89
Q

in infective endocarditis the

A

site determines the likley organism

90
Q

On a normal native valve what are the organisms that cause infective endocarditis

A

High virulence

  • Staphylococcus aureus
  • strep pneumoniae
91
Q

What are the risk fators for infective endocarditis on a normal valve

A

infected cannulae
- normaly S aureus

IVDA (IV drug abuse) - often leads to right sided endocarditis

  • S aureus
  • Yeasts
  • Pseudomonas spp
92
Q

What causes infective endocarditis in an abnormal native valve

A
  • rheumatic fever
  • degenerative (calcific) disease
  • congenital defects (especially turbulent flow)
  • mitral valve prolapse (5-10 x risk)
93
Q

What bacteria causes infective endocarditis

A

infection due to low virulence bacteria

  • oral streptococci
  • endterococcus spp
  • HACEK group of organisms
  • occasionally - coxiella burnetti, chlamydia spp, mycoplasma spp, bartonella spp
94
Q

What causes infective endocarditis in the prosthetic valve in the 1st year after surgery

A
  • in first year after surgery risk is 1-2%
    commonly
  • Stap aureus - immediately post op
  • coagulase negative staphylococci - later presentation
95
Q

What causes infective endocarditis in the prosthetic valve in the after 1st year post surgery

A
  • risk is 0.5%
    Commonly
  • oral streptococci
  • enterococcus spp
96
Q

What is the treatment of infective endocarditis

A
  • Vegetation is hard to treat as it is impenetrable by phagocytoes
  • surgicial backup is essential
  • IV therapy is essentila - 4 weeks native valve IE, 6 weeks prostehtic valve IE
  • need to know what bug is causing it
97
Q

What are the two types of antibitoic senstivity teting

A
  • Disc diffusion tests

- MIC tests (E-test)

98
Q

What is a disc diffusion test

A
  • qualitative measurement to see if it is sensitive or resistant
  • uses an ajar plate - put on a paper disc that has antibiotic in it
  • over 12-24 horus the anitbiotic goes over the plate and kills bacterai that is senstivie to it
99
Q

How does MIC test work

A
  • on agar plate place a paper strip that has antibitoic on it
  • at the top of the strip there is the highest concentration of antibitoic and as you go down the antibiotic concentration decreases
  • tells you how much anitbioitc is required to kill the microorganisms
  • quantitative measurement to see how sensitive/resistant the microorgansim is
100
Q

What does MIC stand for

A
  • minimum inhibitory concentration
  • lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation
101
Q

What does MBC stand for

A
  • minimum bactericidal concentration
  • lowest concentration of antimicrobial that will prevent the growth of an organism after subculture on to antibiotic-free media.
  • dont really use in clinical practise
102
Q

What is the treatment for infective endocarditis on the native and prosthetic valve

A

Native

  • Vancomycin and gentamicin
  • or vancomycin and meropenem (if risk of gram negative spesis)

Prosthetic

  • vanocmycin and gentamicin and rifampicin
  • 6 week course
  • poor prognosis
  • add oral rifampicin to treat biofilm
103
Q

What do you use to treat each of these microorganisms in infective endocarditis

  • Staphylococcus
  • streptococci
  • enterococci
A

Staphylococcus

  • Flucloxacillin - 4 hourly
  • MRSA - vancomycin

Streptococci

  • Benzylpenicillin 4 hourly
  • If pencillin resistance - vancomycin and gentamicin

Enterococci
- amoxicillin 4 hourly and gentamicin

104
Q

What is a biofilm

A

a cluster of bacteria in an extracellular matrix (slime) attached to a surface

105
Q

describe how a biofilm forms

A
  • adhesion to the surface
  • formation of monolayer and production of slime
  • microcolony formation with multi layering cells
  • mature biofilm with characterstic mushroom formed of polysaccharide

Year 3 - CR (44 decks)

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