Antimicrobial Chemotherapy Flashcards by Jam E

What is empiric therapy for antimicrobials?

Without microbiology results

Directed - based on antimicrobial results

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What are the indications of antimicrobials?

Therapy

Prophylaxis

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What are the components of qSOFA?

Systolic BP less than 10, altered mental, respiratory rate greater than 22

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What aspects of the patient do you need to consider when prescribing?

Age

Renal function

Liver function

Immunocompromised

Pregnancy

Known allergies

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What are the causative bacteria for soft tissue infection?

Streptococcus pyogenes

Staphylococcus aureus

Streptococcus group C or G

E. coli

Pseudomonas aeruginosa

Clostridium species

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What are the causative bacteria for pneumonia?

Streptococcus pneumonia

Haemophilus influenzae

Staphylococcus aureus

Klebsiella pneumonia

Moraxella catarrhalis

Mycoplasma pneumonia

Legionella pneumonia

Chlamydia pneumonia

These are atypical

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What are the functions of cidal drugs?

Act on cell wall

Kill organisms

e.g - beta lactams

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What are the indications for cidal drugs?

Neutropenia, meningitis and endcarditis

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What are the functions of static drugs?

e.g macrolides

Inhibit protein synthesis

Prevent colony growth

Requires host immunity to mop up residual infection

Useful in toxin-mediated illness

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What are indications for combination therapy?

HIV

Severe sepsis (febrile neutropenia)

Mixed organisms (faecal peritonitis)

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What is oral bioavailability?

Ratio of a drug level when given orally compared with level when given IV

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When is oral route indicated?

If not vomiting, normal GI function, no shock, no organ dysfunction

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When are IV antibiotics indicated?

For severe or deep-seated infection, and when oral route is not reliable

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What are the features of immediate hypersensitivity and delayed hypersensitivity?

Immediate - anaphylactic shock

Delayed - rash, drug fever, serum sickness, erythema nodosum, stevens-Johnson syndrome

Mostly with penicillins and cephalosporins

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What are the GI adverse effects?

nausea, vomiting, diarrhoea

Clostridium difficile infection

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What is likely to cause candida (thrush)?

Broad spectrum penicillins, cephalosporins

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What drugs cause liver toxicity?

All drugs, particulary tetracyclines, TB drugs

More likely if pre-existing liver disease

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What drugs cause adverse renal effects?

Gentamicin, vancomycin

More like if pre-existing renal disease or on nephrotoxic meds

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What drugs cause ototoxicity?

Gentamicin and vancomycin

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What drug causes optic neuropathy?

Ethambutol

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What drugs cause convulsions, encephalopathy?

Penicillins, cephalosporin

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What antibiotics cause peripheral neuropathy?

Isoniazid (TB) and metronidazole

Nitrofurantoin?

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What are the haematological adverse effects of antimicrobials?

Marrow toxicity

Megaloblastic anaemia (folate metabolism) - cotrimoxazole

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What liasing is required with the laboratory?

Sending appropriate specimens (for culture, direct detection, serology)

Receiving results (preliminary culture results, sensitivity results, final results)

Monitoring (disease activity, therapeutic drug monitoring)

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Who is on the antimicrobial management team?

Antibiotic pharmacists Infectious diseases Acute medicine Medical microbiology Infeciton prevention and control General practice Public partner

What are the ways we can ensure correct prescribing of antibiotics?

Antimicrobial guidelines and policies Audit of quality of antimicrobial prescribing Education

What are the 4 antibiotics assocaited with C diff?

Ceftriaxone Co - amoxiclav Clindamycin Ciprofloxacin

Which drugs are involved in the inhibition of cell wall synthesis?

Beta lactams (penicillins and cephalosporins) Glycopeptides (vancomycin and teicoplanin)

hich antibiotics are involved in the inhibition of protein synthesis?

Aminoglycosides: gentamicin Macrolides (clairithromycin) tetracyclines (doxycycline) Oxazolidinones: Linezolid

What drugs inhibit nucleic acid synthesis?

Trimethoprimm Sulfonamides (sulfamethoxazole) Quinolones (ciprofloxacin)

What are the main uses of benzylpenicillin, amoxicillin, flucloxacillin, co-amoxiclav, piperacillin/tazobactam?

Benzylpenicillin - soft tissue, pnuemococcal, meningococcal, gonorrhoea, syphilis infections Amoxicillin - UTI, RTI Flucloxacillin - Staph aureus Co-amoxiclav - UTI, RTI, soft tissue infections, surgical wound infections Piperacillin/tazobactam - neutropenic sepsis

Cephalosporins include cefradine, cefuroxime, ceftriaxone amd ceftazidime. Give examples of main uses for each

Cefradine - UTI and soft tissue infection Cefuroxime - UTI, RTI, surgical prophylaxis Ceftriaxone - hospital infections eg bacteraemia, pneumonia, abdominal sepsis Ceftazidime (like ceftriaxone but also effective against pseudomonas) - pseudomonal infections in hospital and in cystic fibrosis

What are the main uses of gentamicin?

Serious gram negative infections - bacteraemia, endocarditis, neutropenic sepsis Gram negative bacilli

What is the activity of clairithromycin and erythromycin?

Clairithromycin and erythromycin - streptococci, staphylococci, mycoplasma, chlamydia and legionella

What are the main uses of clairithromycin and erythromycin?

Respiratory infection, soft tissue infection (if penicillin allergic), STD

What is the activity of azithromycin?

Relatively better for gram negative (haemophilus, chlamydia)

What are the main uses of azithromycin?

Chlamydia

What is the activity of ciprofloxacin? and levofloxacin? (these are quinolones)

Gram negative bacili including pseudomonas - some activity against staphylococci and streptococci Levofloxacin - enhanced activity against staphylococci and streptococci - less against pseudomonas Active against pneumococcus, mycoplasma, chlamydia, legionella

What are the main uses for ciprofloxacin?

Complicated UTI Complicated hospital acquired pneumonia Some Gi infections

What are the uses of levofloxacin?

2nd or third line for pneumonia

What is the activity of vancomycin and teicoplanin?

Gram positive bacteria only (staph and strep)

What are the main uses for glycopeptides?

MRSA Patients allergic to penicillin C.Diff

What is the activity of trimethoprim?

Gram negative bacilli - some activity against staph and strep

What are the main uses of trimethoprim?

UTI Respiratory infection MRSA

What is the activity of co trimoxazole?

Broad spectrum Pneumocystis jiroveci

What are the main uses of co-trimoxazole?

Respiratory infection PCP - pneumocystics pneumonia, caused by the yeast like fungus pneumocystis jiroveci

What is the activity of clindamycin?

Streptococci Staphylococcus Anaerobes

What is clindamycin used for?

Soft tissue infection Gangrene

What are tetracycline and doxycycline active against?

Streptococci Staphylococci Chlamydia Rickettsiae Brucella

What is tetracycline and doxycycline used to treat?

Q fever Brucellosis Chlamydia Atypical pneumonia MRSA

What are the main uses of rifampicin?

TB MRSA Meningococcal prophylaxis Somplicated staph infections

What is the activity of rifampicin?

Mycobacteria Miningococcus Staphylococcus

What is the activity for meropenem?

Broad spectrum - including anaerobes, pseudomonas

What are the main uses of meropenem?

2nd or 3rd line for hospital infections

What is the activity of metronidazole?

Anaerobes Protoza Diardia

What are the main uses of metronidazole?

Surgical infections Giardiasis Amoebiasis Trichomonal infections

What is the activity of linezolid?

Gram positive bacteria only (streptococci, staphylococci, enterococci) 2nd line agent for MSSA, MRSA, VRE

What are the main uses of metrodonidazole?

2nd line agent for MSSA, MRSA, VRE

What is the activity of daptomycin?

Gram-positive bacteria only (strep, staph and enterococci)

What are the main uses of daptomycin?

2nd line agent for MSSA, MRSA, VRE

What is the activity of tigecycline?

Very broad spectrum including MRSA, ESBL, anaerobes

What are the main uses of tigecycline?

3rd line inta-abdominal sepsis, soft tissue infections

What are the azoles and what are they active against?

fluconazole: Candida, some resistance itraconazole: Candida & Aspergillus voriconazole: Candida & Aspergillus

What are polyenes and what are they active against?

Amphotericin - candida and aspergillus Nystatin - candida

What are the echinocandins and what are they effective against?

caspofungin, anidulafungin, micafungin: Candida, Aspergillus

What is terbinafine effective against?

Tinea, nails