Antibiotics in Pulmonary Diseases Flashcards
Cell Wall Synthesis Inhibitors
For organisms that need peptidoglycan
MOA: bind D-ala-D-ala portion preventing peptidoglycan synthesis (Ex: vancomycin); bind to Penicillin Binding Protein and prevent peptidoglycan cross-linking (Ex: beta lactams)
Protein Synthesis Inhibitors
mnemonic (Buy AT 30 CCEL at 50)
30S: Aminoglycosides, Tetracyclines
50S: Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linezolid
DNA Topoisomerase Inhibitors
MOA: Inhibit II & IV
Ex: fluoroquinolones
Mechanisms of Bacteria Resistance
Beta-lactams: beta lactamases, carbapenemases, MRSA has altered Penicillin Binding Proteins (PBP)
Beta Lactams Adverse Effects
Hypersensitivity, Type I IgE reactions, rash, hemolysis
Chlamydiophyla
Atypical
Technically gram -
Covered by FQ, macrolides, clindamycin, chloramphenicol, tetracyclines
Haemophilus influenzae
Typical
Gram - rod
Covered by: aminopenicillins, piperacillin, carbapenems, aztreonam, FQ, cephalosporins, GNATS, macrolides, tetracyclines, TMP/SMX
Klebsiella
Typical Gram - rods Primarily nosocomial Alcoholics Covered by: 3rd Gen cephalosporins (ceftriaxone), FQ, piperacillin, carbapenems
Legionella
Atypical
Gram - rod but doesn’t stain w/ common reagents!
Covered by: FQ, macrolides, SMX/TMP, tetracyclines
Mycoplasma pneumoniae
Atypical (no peptidoglycan wall)
Most common atypical
Covered by: FQ, macrolides, tetracyclines, tigecycline
Pseudomonas aeruginosa
Typical
Gram - rods
Covered by: Piperacillin/tazobactam, imipenem, aztreonam, FQ (cipro, levo), GNATS
Staph aureus (MSSA)
Typical
Gram + cocci
Coveredy by: antistaph penicillins, amoxicillin-clavulanate, carbapenems, FQ, GNATS, macrolides, tetracyclines, vancomycin, SMX/TMP
Staph aureus (MRSA)
Typical
Gram + cocci
Covered by: Tetracyclines, Vancomycin, SMX/TMP, FQ (community acquired only)
Strep pneumoniae
Typical
Gram + cocci
Covered by: beta lactams, FQ (not cipro!!!), clindamycin, macrolides, tetracyclines, vancomycin, TMP/SMX
Acute pharyngitis
Viral in 80-95% Reserve abx for confirmed GABHS Penicillin or amoxicillin 1st gen cephalosporin for minor allergy Clindamycin for severe allergy
Acute Bacterial Rhinosinusitis
Abx given when: persistent & not improving > or = 10 days Severe (> or = 3-4 days) or worsening Typically Strep pneumo or H. influenzae Treat with Amoxicillin-clavulanate
Kids allergic to penicillin
Give Cefixime plus Clindamycin with non type I reaction
Give Levofloxacin if type I hypersensitivity
CAP in Adults
Typicals: S. pneumo, H. influenzae, viruses (influenza A and B, adenovirus, RSV, parainfluenza), atypicals: M. pneumo, C. pneumo
CAP (inpatient non-ICU)
S. pneumo, M. pneumo, C. pneumo, H. influenzae, Legionella, aspiration, viruses
CAP (inpatient ICU)
S. pneumo, S. aureus, legionella, gram negative bacilli, H. influenzae
Empiric Therapy (outpatient)
Healthy: macrolide or doxycycline
Comorbidities: resp FQ + macrolide
Empiric Therapy (inpatient non-ICU)
Resp FQ + macrolide
Empiric Therapy (inpatient ICU)
Beta-lactam + azithromycin or resp FQ
Empiric Therapy (Pseudomonas risk)
Piperacillin/tazobactam + cipro or levo
Pip/taz + aminoglycoside and azithromycin
