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Chapter 5 Infections > Antibiotics their indications/ causative organism use/ MOA/ Drug class > Flashcards

Antibiotics their indications/ causative organism use/ MOA/ Drug class Flashcards

1
Q

antibiotic used exacerbations of chronic bronchitis

ACT

A

Amoxicillin
Clarithomycin
Tetracycline

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2
Q

antibiotic used for Uncomplicated community-acquired pneumonia

A

Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)

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3
Q

Pneumonia possibly caused by atypical pathogens

A

Clarithromycin

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4
Q

Hospital acquired pneumonia

A

Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

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5
Q

lower uti

A

Trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin

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6
Q

acute pyelonephritis

A

broad spec cephalosporin- ceftriaxone or quinolone

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7
Q

acute prostatis

A

quinolone or trimethoprim

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8
Q

Impetigo

A

Topical hydrogen peroxide, oral flucloxacillin or erythromycin if widespread

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9
Q

cellulitis

A

Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

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10
Q

Erysipelas

A

Flucloxacillin* (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

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11
Q

Animal or human bite

A

Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)

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12
Q

throat infections

A

Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic)

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13
Q

which Abx is used for pseudomonas aeruginosa

A

Gentamicin (aminoglycoside)

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14
Q

Which Abx should be used for streptococci

A

benzylpenicillin or phenoxypenicillin

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15
Q

Which Abx should be used for MRSA infections

A

Vancomycin

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16
Q

Which antibiotic should be used for anaerobic infections

A

Metronidazole

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17
Q

which abx should be used for staphylococci infections e.g impetigo, cellulitis, CAP

A

Flucloxacillin

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18
Q

What is the MOA and drug class of Clindamycin

A

It inhibits protein synthesis for Gram +ve bacteria and anaerobes. It is bacteriostatic and narrow spectrum
It is a Lincosamide

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19
Q

what is the MOA and drug class of Linezolid

A

It is an oxazolidinone and reversibly inhibits MAO
Inhibits protein synthesis. Only active against gram +ve bacteria e.g. MRSA and anaerobes (narrow-spectrum + bacteriostatic)​
Alternative to Vancomycin in MRSA infection.

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20
Q

What is the MOA of Chloramphenicol and when is it used

A

Chloramphenicol is a potent broad spectrum Abx, it is bacteriostatic and inhibits protein synthesis.
reserved for life-threatening infections due to s/e

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21
Q

What is the MOA of metronidazole

A

Inhibits DNA synthesis of anaerobic bacteria and protozoa. It is bactericidal and narrow spectrum

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22
Q

What are the uses of metronidazole

A

bacterial vaginosis, dental infections, antibiotic related colitis- H.pylori, rosacea
Protozoal infections: vaginal trichomoniasis, giardiasis

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23
Q

What is the MOA of Nitrofuratoin

A

Nitrofurantoin is a narrow-spectrum Abx that is only active against urinary pathogens, it is bactericidal and damages bacterial DNA.

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24
Q

what does bactericidal mean

A

Kills the bacteria by inhibiting bacterial nucleic synthesis

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25
Q

What is the MOA and drug class of ciprofloxacin. name other drugs in this class and indication

A

Inhibit DNA synthesis- broad spec and bactericidal
levofloxacin used for UTI
Ciprofloxacin used for LRTI
moxifloxacin prolongs QT, hepatoxic
norfloxacin
Ofloxacin
nalidixic acid (1st gen used for uncomplicated UTI but avoid if eGFR is under 20

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26
Q

With what type causative organism should quinolones be avoided

A

MRSA

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27
Q

what is the mechanism of action of tetraCYCLINES, others in drug class and indications

A

Inhibit bacterial protein synthesis; binds to ribosomal 30S subunit​
(Broad spectrum + bacteriostatic)​
Uses: Lower RTIs, Acne, Rosacea, Malaria and Chlamydia. ​

Examples:​
Demeclocyline​
Doxycycline (used in Malaria and Chlamydia: OD)​
Lymecycline​
Minocycline (broader spectrum but rarely used)​
Oxytetracycline​
Tetracycline​
Tigecycline (antibiotic structurally related to tetracycline)

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28
Q

what is the mechanism of action of aMINoglycosides, drugs in class and indications

A

Bind irreversibly to bacterial ribosomes. Active against gram -ve aerobe; pseudomonas aeruginosa. (Broad-spectrum + bactericidal)​
Aminoglycosides are broad spectrum Abx, they work by binding irreversibly to bacterial ribosomes, and are bactericidal, although this effect is likely due to additional mechanisms that are not completely understood.Gentamicin (choice; active against pseudomonas aeruginosa)
Tobramycin (via inhaler for pseudomonal infection in cystic fibrosis)
Streptomycin (active against mycobacteria reserved for TB)
Neomycin (parenterally toxic. Use in bowel sterilisation)
Amikacin (gentamicin-resistant gram -ve bacilli)
Used in severe sepsis, pyelonephritis, endocarditis and UTI

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29
Q

which ABx’s are given as blind therapy in an undiagnosed serious infections

A

Gentamicin to cover gram -ve pseudomonas aeruginosa

metronidazole and penicillin to cover the anaerobes, haemolytic streptococci and pneumococci

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30
Q

what is the MOA, drugs in class and indcation of glycopeptides

A

Inhibits cell wall synthesis (by inhibiting the cross-linking of peptidoglycan chains in the cell wall) of aerobic and anaerobic gram +ve bacteria It is narrow spectrum
Vancomycin- active against MRSA
Teicoplanin
Telavancin only in HAP when other antibiotics are unsuitable

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31
Q

What are the indactions of Vancomycin

A

antibiotic associated colitis, MRSA

Given parenterally when a serious infection

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32
Q

What is MOA, drugs in class of Macrolides

A 
Inhibits the bacterial protein synthesis by binding subunit 50S subunit of the ribosome- broad spectrum and bacteriostatic.
Azithromycin
Clarithromycin
Erythromycin
Telithromycin
Spiramycin
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33
Q

what is the MOA and drug in class for penicillins

A

they are bactericidal- inhibit cell wall synthesis.
narrow spectrum are beta-lactamase sensitive e.g benzylpenicillin, phenoxymethylpenicillin
broad spectrum inactivated by beta-lactamases e.g amoxicillin, ampicillin, flucloxacillin, pipercillin, ticaricillin meaning it is active against beta-lactamases strains

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34
Q

Name the antipseudomonal penicillins and what their uses

A

Piperacillin and tazobactam- they are extended spectrum
ticaricillin and clavulanic acid
used for serious infections e.g septicaemia, complicated UTI, HAP
Effective against pseudomonas aeroginosa
tazobactam and clavulanic are beta lactamase inhibitors

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35
Q

what is the indication for benzylpenicillin (ben pen)

A

Meningitis - meningococcal infections

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36
Q

what is the indication for phenoxymethylpenicillin (pen V)

A

Usedf for streptococcal infections such as RTI in children such as tonsillitis or strep throat

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37
Q

Uses of flucloxacillin

A

it is penicillinase resistant so used for pen resistant staphylococcal infections except for MRSA
e.g Impetigo, cellulitis

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38
Q

why should penicillins not be given blindly for sore throats

A

causes maculopapular rash in glandular fever

39
Q

what are the indications for ampicillin

A

highly resistant so consider before blindly prescribing

Uses: UTI’S, Otitis media, acuter COPD exacerbations

40
Q

what type of strains of bacteria are amoxicillin active against

A

beta lactamase strains

41
Q

What are tazobactam and clavulanic acid used as

A

tazobactam and clavulanic are beta lactamase inhibitors

42
Q

what is the MOA and drugs in class of cephalosporins

A

Interefers with the bacterial wall synthesis - broad spectrum and bactericidal
Used for UTI (Pregnancy) sinusitis, otitis media

43
Q

name the 1st gen cephalosporins ‘cefa’

A

Cefalexin
Cefadroxil
Cefadrine

44
Q

name the 2nd gen cephalosporins ‘2 foxes for tea’

A

Cefuroxime

cefaclor- causes skin reactions in children

45
Q

Name the 3rd gen cephalosporins and which two treat meningitis

A

Cefixime
Ceftriaxone- Treats meningitis
Cefotaxime- treats meningitis
Ceftazidime

46
Q

name the 5th gen cephalosporins ans its indication

A

Ceftaroline

used in CAP and complicated skin/ soft tissue infections

47
Q

Which antibiotics are used first and second line for c. diff infections

A

first episode of mild-moderate infection = oral vancomycin 125mg qds 10-14 days
Subsequent episodes/ severe episodes = Fidoxamicin

48
Q

Which antibiotics are most likely to cause antibiotic- associated colitis (c.diff)

A

Clindamycin- the msot
Ampicillin/Amoxicillin
2nd/3rd gen cephalosporins
Quinolones

49
Q

Which groups are most likely to get antibiotic associated colitis (c.diff)

A

Elderly, Women

50
Q

What are the treatment options for endocarditis

A

Amoxicillin and add low dose gentamicin
if MRSA/ pen allergy use Vancomycin
If Staphylococcal use flucloxacillin
If streptococcus use benzylpenicillin

51
Q

What is the treatment for CAP

A

Treatment for 7 days
mild severity- amoxicillin
Alternatively Clarithromycin or Doxycycline
Moderate severity: Amoxicillin and Clarithromycin
OR Doxycycline alone
High severity: Benzylpenicillin and Clarithromycin
Add Flucloxacillin if Staphylococcus suspected AND treatemngt for 14 days
Add Vancomycin if MRSA

52
Q

What is the treatment for HAP

A 
Early onset (under 5 days of being in hospital) use Co-amoxicillin or Cefuroxime
Severe or over 5 days use an antipseudomonal penicillin or broad spec cephalosporin or Quinolone
Add Vancomycin if MRSA
Add Aminoglycoside for pseudomonas aeriginosa
53
Q

what are the antibiotics used for meningitis or meningococcal septicaemia
causative agent Neisseria meningtidis

A

Benzylpencillin
Cefotaxime if pen allergy
Chloramphenicol if immediate pen allergy

54
Q

what are the abx used for osteomyelitis

A

flucloxacillin
clindamycin if pen allergies
if MRSA suspected Vancomycin

55
Q

What are Abx used for conjuctivitis

A

bacterial- chloramphenicol

56
Q

What are Abx used for Impetigo

causative agent is staphylcocci aureus

A

Fusidic acid 7 days if small areas

Flucloxacillin for 7 days if larger areas

57
Q

What are Abx used for cellulitis

causative agent is staphylcocci aureus

A

Flucloxacillin

58
Q

What are Abx used for animal and human bites

causative agent is staphylcocci aureus

A

co-amoxiclav or

Doxycycline and metronidazole

59
Q

What are Abx used for mrsa (skin and soft tissue)

causative agent is staphylococci aureus

A 
Tetracycline OR
Sodium fusidate and rifampicin
Alternatively  Clindamycin 
If severe use glycopeptide 
if this is unsuitable Linezolid
60
Q

What are Abx used for gingivitis: acute necrotising ulcerative/ periapical/ peridontal abcess periodontitis

A

Dental treatment are usually treated with Metronidazole
Alternatively they can be treated with doxcycline (peridontitis) or amoxicillin
change abx if no change in 48 hrs : may combine penicillin or macrolide with metronidazole

61
Q

What are Abx used for sore throat

causative agent streptococci

A

phenoxymethylpenicillin
if severe try benzylpenicillin
clarithromycin if pen allergic

62
Q

What are Abx used for sinusitis

A

Amoxicillin or
Clarithromycin or\
Doxycycline

63
Q

What are Abx used for otitis externa

causative agent staphylococci aureus

A

flucloxacillin
clarithomycin if pen allergic
treat is sytemically unwell

64
Q

What are Abx used for otitis media

A

Amoxicillin
Clarithromycin if pen allergic
treat if no improvement in 72 hrs or under 2 years old or earlier systemic symtoms

65
Q

when is amikacin used

A

for gentamicin resistant gram -ve bacilli

66
Q

when is neomycin used

A

bowel sterilisation

it is parenterally toxic

67
Q

when is streptomycin used

A

used for mycobacterium in TB

68
Q

When and how is tobramycin administered

A

by inhalaltion for pseudomonal infections in cyctic fibrosis

69
Q

what are the plasma monitoring requirements for gentamicin

A

monitor after 3-4 doses and a dose change

more frequently and earlier in renal impairment

70
Q

what is the treatment used for tuberculosis

RIPE

A 
Initial Phase: For 2 months
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol 
Continuation phase: 4 months
Rifampicin
Isoniazid
71
Q

What medications are used for oral thrush

A

Nystatin (POM)

Miconazole oral gel (P) daktarin oral gel

72
Q

which medications are used for vulval or vaginal thrush

A

Oral fluconazole 150mg for one dose or a topical imidazole e.g clotrimazole

73
Q

which medications are used for tinea capatis, corporis, cruris and pedis

A

miconazole, clotrimazole or terbinafine (for athletes foot)

74
Q

which medication is used for tinea ungiium (fungal nail infection)

A

Amorolfine

75
Q

Which medication is used for HSV-1

A

Aciclovir

76
Q

what are the treatment options for malaria (falciparum malaria)

A

quinine
malarone
riamet (artemether with Lumefantrine

77
Q

what is the name of the drug used for non-falciparum malaria

A

chloroquine

78
Q

which of the anti-malarial tablets are taken once weekly

A

mefloquine and chloroquine

79
Q

which of the anti-malarial tablets are taken once daily

A

malarone, proguanil and doxycyline

80
Q

which of the malaria prophylaxis medications are POM

A

Malarone, Doxycycline, Mefloquine

81
Q

which of the malaria prophylactic medications are P

A

Proguanil, chloroquine and chloroquine with proguanil

82
Q

what is Olseltamivir used for

A

prophylaxis of influenza symptoms by 1 day for at risk groups: 65 +, immunocompromised, diabetes mellitus etc

83
Q

what are the s/e associated with cephalosporins

A

hypersensitivity- don’t give in history of pen hypersensitivity. If essesntial give cefuroxime
antibiotic associated colitis- most common in 2nd and 3rd cephalosporins

84
Q

what are the s/e associated with most penicillin’s

A

pen allergy-rash
Atopic allergies: higher risk of anaphylatic reactions
true allergy: immediate rash, hives
if infection is serious then do not hold
don’t use other beta lactams such as cephalosporins, carbapenems, monobactams

85
Q

why should penicillin’s not be given intrathecally

A

encephalopathy- cerebral irritation which can be fatal

86
Q

what are the s/e associated with amoxicillin

A

cholestatic jaundice- don’t take for over 14 days

87
Q

should ampicillin be taken before or after food

A

before

88
Q

what are the s/e associated with flucloxacillin

A

cholestatic jaundice and hepatitis up to 2 months after treatment
risk is increased with age and exceeding 14 days of treatment

89
Q

should flucloxacillin be taken before food or after food

A

before food

90
Q

what are the S/E associated with vancomycin when given parenterally

A

Nephrotoxicity
ototoxicity
Red mans syndrome: flushing of upper body caused by rapid infusion. can be associated with hypotension and bradycardia
Blood dyscrasias: thrombocytopenia, agranulocytosis
Stevens- Johnson’s syndrome: itching, rashes, toxic epidermal necrolysis
Thrombophlebitis: pain and inflammation of the veins at the infusion site

91
Q

Monitoring requirements for parenteral vancomycin

A

renal function
auditory function
FBC

92
Q

What are the s/e associated with macrolides

A 
GI effects
N&V, abdo discomfort and diarrhoea 
(mostly with erythromycin)
QT prolongation- risk factors include: bradycardia, heart disease, hypokalaemia, hypomagnesaemia, concomitant use of QT prolonging drugs
Hepatoxicity
ototoxicity at high doses
93
Q

Mnemonic to remember moa of drugs that work on 30 subunit and 50 subunit
Buy AT 30 CELL at 50

A 
Aminoglycosides
Tetracyclines 
Chloramphenicol/clindamycin
Erythromycin- macrolides
Linezolid

Chapter 5 Infections (3 decks)

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