Antimicrobial Flashcards
List GRAM POSITIVE COCCI
Gram Positive Cocci
Staphylococcus
Streptococcus
Enterococcus
AEROBIC
GRAM POSITIVE BACILLI
“IM GRAM POSITIVE “
“Rhodo Likes Bacic Cory”
Ryan – Rhodococcus sp.
Likes – L. Monocytogenes
BACIC- - Bacillus anthracis
Cory – Corynebacterium sp.
GRAM NEGATIVE
AEROBIC COCCI
Almost all cocci are positive except
N. Gonorrhoeae
N. Meningitidis
N. Catarrhalis
GRAM NEGATIVE
AEROBIC BACILLI
SPACE
KEHPS
Gram POSITIVE ANAEROBES
COCCI/RODS
+ COCCI
“PEPTO”
+ RODS
C.DIFF
C. PERFRINGENS
GRAM (-) ANAEROBES
B. FRAGILIS
FUSOBACTERIUM SPP
ATYPICAL
- CHLAMYDIA
- MYCOPLASMA
- LEGIONELLA
What are the very common bacteria?
Strep A to F is skin flora.
What’s common in abdominal cases?
enterococcus
What are time-dependent antibiotics?
Carbapenem
Cephalosporin
Penicillin
Aztreonam
– beta lactams –
Example of drugs that are concentration-dependent
Daptomycin
Aminoglycosides
Metronidazole
Medication sample for both properties
(AUC/MIC)
- Fluroquinolones*
- Linezolid*
- Macrolides*
- Polymyxins*
- Tetracycline*
- Tigecycline*
- Vancomycin*
What are the Beta-lactams?
Beta-Lactam Antibiotics
works on the cell wall on the microbe and disrupt cell wall structure.
Penicillin
Cephalosporin
Carbapenems
Monobactams
Anti-Staphylococcal Penicillins
Oxacillin, Nafcillin, Dicloxacillin
Some staphylococcus aureus
Some Staph epidermidis
No enterococcus - GI BUG
NAFCILLIN –> DRUG OF CHOICE FOR MSSA
USED FOR HOSPITAL SETTINGS
CLINICAL: Having Nafcillin as an intraop atbx for a GI procedure is not enough because it does not have an enterococcus coverage.
Amino-penicillin
Ampicillin
Clinical:
Meningitis guidelines recommend Ampicillin
it has good Listeria coverage and good CNS penetration
—> not picked for gram-negative because of resistance
–> DO NOT USE FOR ABDOMINAL COVERAGE
Beta-lactamase Inhibitors
Amoxicillin-clavulanate (Augmentin®) Ampicillin-sulbactam (Unasyn®)
Anaerobic coverage: Bacteroides [massive bowel perf]
ampicillin- sulbactam has a robust coverage !!
NO C.DIFF COVERAGE
Piperacillin-tazobactam (Zosyn®)
Pseudomonal activity!!!
drug of choice among penicillins.
–> almost the same as ampicillin-sulbactam except the pseudomonal coverage
Your patient is undergoing debridement for a superficial wound this antibiotic is enough to cover it.
First Generation Cephalosporins
Cefazolin IV– in the OR we use this gram + skin flora, MSSA
abscess debridement
will never cover anaerobes
GRAM (-) [UTI]
e. coli
Klebsiella
Proteus
Second Generation Cephalosporins
Cefuroxime (Ceftin®) – PO/IV Cefoxitin (Mefoxin®) - IV
Cefoxitin (Mefoxin®) - IV
NOT AS GOOD FOR MSSA
COVERS ANAEROBS REALLY WELL
GYN CASE
Third Generation Cephalosporins
Ceftazidime (Fortaz®) – IV Ceftriaxone (Rocephin®) – IV Cefpodoxime (Vantin®) – PO Cefdinir (Omnicef®) - PO
Ceftriaxone –> used for PNA tx
gram + similar NOT AS GOOD FOR MSSA
ceftazidime –> covers Pseudomonas!
Fourth Generation Cephalosporins
Cefepime (Maxipime®) – IV
Cefepime –> gram negative
Pseudomonas aeruginosa
if there’s resistance usually cefepime can take care of some of those
Ceftaroline
PNA usually gram negative rods and happen to have an MRSA infection on top of it
Ceftolozone / tazobactam
Ceftazidime/ avibactam
- superbug (invasive) Klebsiella infection
- CARBAPENEM - RESISTANT ENTEROBACTERIACEAE
- PSEUDOMONAS AEURUGINOSA
- EXTENDED SPECTRUM BETA LACTAMASE PRODUCING ORGANISMS
CarbaPENEMs
Ertapenem (Invanz®) – IV, IM
Meropenem (Merrem®) – IV Imipenem/cilastatin (Primaxin®) – IV Doripenem (Doribax®) - IV
WILL IT COVER PSEUDOMONAS?
GREAT SKIN FLORA COVERAGE
– THE REASON WHY WE USE THIS IN PRACTICE IS BECAUSE
OF RESISTANCE AND ITS GRAM NEGATIVE PROPERTIES
– BELLY CASE ITLL BE JUST FINE
only ERTAPENEM WILL NOT COVER PSEUDOMONAS
FLUOROQUINOLONES
Ciprofloxacin (Cipro®) – IV, PO Levofloxacin (Levaquin®) – IV, PO
you can use if you have beta-lactam allergy
ATYPICAL COVERAGE
- Chlamydia and Chlamydophila
Mycoplasma Pneumoniae
Legionella spp
GRAM NEGATIVE: CIPROFLOXACIN IS MOSTLY GRAM NEGATIVE
_PSEUDOMONAS*_
_STENOTROPHOMONAS MALTOPHILIA*_
Your patient has PCN, Cephalosporin, and Carbapenem allergy. He grew pseudomonas on his gram stain what antibiotic can you use?
Aztreonam
its a beta-lactam but can be used when people has severe allergy to PCN
super narrow; cover gram negatives
Drug of choice for MRSA
VANCOMYCIN
DOES IV VANC COVER C. DIFF?
NO.
ONLY PO VANC
IT NEVER GETS ABSORBED
When will Daptomycin be used?
it covers MRSA
VRE
– inactivated by lung surfactant
Your patient grew MRSA. Upon a careful review of his chart, you noted that he had a severe anaphylactic reaction to Vanco. What medication will you use? While typing your orders the lab called you for the same patient and notified you that the same patient grew VRE what will you use?
Daptomycin
Your patient has a massive bowel perforation.
gram stains grew: Enterococci** and **Bacteroides spp.
what antibiotic will you use?
Ampicillin- Sulbactam
Your patient that had a massive bowel perf.
He is scheduled for surgery , upon reading his gram stains you noted that it grew
Enterococci, Bacteroides spp. , and Pseudomonas what antibiotic will you use among the penicillin class?
Piperacillin - tazobactam
WHICH CEPHALOSPORIN WILL COVER ENTEROCOCCUS?
NONE
NO CEPHALOSPORIN WILL EVER COVER ENTEROCCOCUS AT ALL
The IV drug of choice for C.Diff
Metronidazole
Your patient grew MRSA and VRE in his lungs what will you use to treat it? He is on his way to get GI surgery.
TIGECYCLINE
Covers MRSA and covers VRE
covers: bacteroides fragilis and many other anaerobs
your patient is taking MAOIs and is growing MRSA and VRE
what medication will you avoid?
Linezolid
Adverse SE of Aminoglycosides
Renal injury and ototoxocity
Adverse SE Amphotericin
Renal dysfunction
Overdose of Beta Lactams
SEIZURE
SE; CEFTRIAXONE
BILIARY SLUDGING
ASSOCIATED WITH C, DIFF RISK
CLINDA
what do you monitor when you start Dapto?
monitor for CPK
may cause Rhabdo
big problem for Fluoroquinolones
QTc prolongation and c. diff risk
If a patient has thrombocytopenia what would you expect to see if you put them on a course of Linezolid
platelets getting even lower due to bone marrow suppression
SE: Metronidazole
Dark urine, peripheral neuropathy, disulfuram – like reaction with ingestion of alcohol
- vomiting
Macrolides causes?
Qtc prolongation , inhibition of CYP 450 (erythromycin, clarithromycin)
Polymyxins
Renal dysfunction
- causes acute neuromuscular blockade
- similar structure to Ach
SE: Trimethoprim/ Sulfamethoxazole
hyperkalemia, thrombocytopenia, leukopenia, rash
Pharmacokinetics
Daptomycin
Micafungin
Nitrofurantoin
Oral Vanco
Polymyxins
Tigecycline
What are the drugs that treat MSSA?
Only Cephalosporin that covers MRSA
CEFTAROLINE
WHAT ARE THE DRUGS THAT TREAT MRSA?
What is the drug of choice?
IV Vanc is drug of choice for MRSA
- CEFTAROLINE
- DAPTOMYCIN
- LINEZOLID
- TIGECYCLINE
What are the drugs that treat VRE
Daptomycin (DOC) - can cause Rhabdo
Linezolid (DOC)
Tigecycline – doesn’t concentrate in blood [not good for super sick person]
BURN THIS IN YOUR BRAIN
PSEUDOMONAS COVERAGE
Beta-lactamase Inhibitor
Monobactams
Cephalosporins
Carbapenems
Fluoroquinolones
Aminoglycosides
Polymyxins
What covers anaerobes?
esp. belly cases
If you had an intraabdominal case, which one would be reasonable?
What are your usual organisms?
What will be your antibiotic therapy?
review chart!
Ceftriaxone IV +- Metronidazole IV/PO
Alternative: Levofloxacin IV/PO +- Metronidazole
review chart!
know this chart
Intraabdominal infections
What is reasonable management for intraoperative bowel perp
Community-Acquired PNA drug of choice
