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MBChB - Y2 - Infection > Antimicrobial Chemotherapy > Flashcards

Antimicrobial Chemotherapy Flashcards

1
Q

What is empiric therapy for antimicrobials?

A

Without microbiology results

Directed - based on antimicrobial results

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2
Q

What are the indications of antimicrobials?

A

Therapy

Prophylaxis

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3
Q

What are the components of qSOFA?

A

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

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4
Q

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

A

Age

Renal function

Liver function

Immunocompromised

Pregnancy

Known allergies

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5
Q

What are the causative bacteria for soft tissue infection?

A

Streptococcus pyogenes

Staphylococcus aureus

Streptococcus group C or G

E. coli

Pseudomonas aeruginosa

Clostridium species

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6
Q

What are the causative bacteria for pneumonia?

A

Streptococcus pneumonia

Haemophilus influenzae

Staphylococcus aureus

Klebsiella pneumonia

Moraxella catarrhalis

Mycoplasma pneumonia

Legionella pneumonia

Chlamydia pneumonia

These are atypical

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7
Q

What are the functions of cidal drugs?

A

Act on cell wall

Kill organisms

e.g - beta lactams

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8
Q

What are the indications for cidal drugs?

A

Neutropenia, meningitis and endcarditis

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9
Q

What are the functions of static drugs?

A

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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10
Q

What are indications for combination therapy?

A

HIV

TB

Severe sepsis (febrile neutropenia)

Mixed organisms (faecal peritonitis)

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11
Q

What is oral bioavailability?

A

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

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12
Q

When is oral route indicated?

A

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

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13
Q

When are IV antibiotics indicated?

A

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

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14
Q

What are the features of immediate hypersensitivity and delayed hypersensitivity?

A

Immediate - anaphylactic shock

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

Mostly with penicillins and cephalosporins

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15
Q

What are the GI adverse effects?

A

nausea, vomiting, diarrhoea

Clostridium difficile infection

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16
Q

What is likely to cause candida (thrush)?

A

Broad spectrum penicillins, cephalosporins

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17
Q

What drugs cause liver toxicity?

A

All drugs, particulary tetracyclines, TB drugs

More likely if pre-existing liver disease

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18
Q

What drugs cause adverse renal effects?

A

Gentamicin, vancomycin

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

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19
Q

What drugs cause ototoxicity?

A

Gentamicin and vancomycin

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20
Q

What drug causes optic neuropathy?

A

Ethambutol

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21
Q

What drugs cause convulsions, encephalopathy?

A

Penicillins, cephalosporin

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22
Q

What antibiotics cause peripheral neuropathy?

A

Isoniazid (TB) and metronidazole

Nitrofurantoin?

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23
Q

What are the haematological adverse effects of antimicrobials?

A

Marrow toxicity

Megaloblastic anaemia (folate metabolism) - cotrimoxazole

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24
Q

What liasing is required with the laboratory?

A

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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25
Q

Who is on the antimicrobial management team?

A

Antibiotic pharmacists

Infectious diseases

Acute medicine

Medical microbiology

Infeciton prevention and control

General practice

Public partner

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26
Q

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

A

Antimicrobial guidelines and policies

Audit of quality of antimicrobial prescribing

Education

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27
Q

What are the 4 antibiotics assocaited with C diff?

A

Ceftriaxone

Co - amoxiclav

Clindamycin

Ciprofloxacin

28
Q

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

A

Beta lactams (penicillins and cephalosporins)

Glycopeptides (vancomycin and teicoplanin)

29
Q

hich antibiotics are involved in the inhibition of protein synthesis?

A

Aminoglycosides: gentamicin

Macrolides (clairithromycin)

tetracyclines (doxycycline)

Oxazolidinones: Linezolid

30
Q

What drugs inhibit nucleic acid synthesis?

A

Trimethoprimm

Sulfonamides (sulfamethoxazole)

Quinolones (ciprofloxacin)

31
Q

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

A

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

32
Q

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

A

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

33
Q

What are the main uses of gentamicin?

A

Serious gram negative infections - bacteraemia, endocarditis, neutropenic sepsis

Gram negative bacilli

34
Q

What is the activity of clairithromycin and erythromycin?

A

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

35
Q

What are the main uses of clairithromycin and erythromycin?

A

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

36
Q

What is the activity of azithromycin?

A

Relatively better for gram negative (haemophilus, chlamydia)

37
Q

What are the main uses of azithromycin?

38
Q

What is the activity of ciprofloxacin? and levofloxacin?

(these are quinolones)

A

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

39
Q

What are the main uses for ciprofloxacin?

A

Complicated UTI

Complicated hospital acquired pneumonia

Some Gi infections

40
Q

What are the uses of levofloxacin?

A

2nd or third line for pneumonia

41
Q

What is the activity of vancomycin and teicoplanin?

A

Gram positive bacteria only (staph and strep)

42
Q

What are the main uses for glycopeptides?

A

MRSA

Patients allergic to penicillin

C.Diff

43
Q

What is the activity of trimethoprim?

A

Gram negative bacilli - some activity against staph and strep

44
Q

What are the main uses of trimethoprim?

A

UTI

Respiratory infection

MRSA

45
Q

What is the activity of co trimoxazole?

A

Broad spectrum

Pneumocystis jiroveci

46
Q

What are the main uses of co-trimoxazole?

A

Respiratory infection

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

47
Q

What is the activity of clindamycin?

A

Streptococci

Staphylococcus

Anaerobes

48
Q

What is clindamycin used for?

A

Soft tissue infection

Gangrene

49
Q

What are tetracycline and doxycycline active against?

A

Streptococci

Staphylococci

Chlamydia

Rickettsiae

Brucella

50
Q

What is tetracycline and doxycycline used to treat?

A

Q fever

Brucellosis

Chlamydia

Atypical pneumonia

MRSA

51
Q

What are the main uses of rifampicin?

A

TB

MRSA

Meningococcal prophylaxis

Somplicated staph infections

52
Q

What is the activity of rifampicin?

A

Mycobacteria

Miningococcus

Staphylococcus

53
Q

What is the activity for meropenem?

A

Broad spectrum - including anaerobes, pseudomonas

54
Q

What are the main uses of meropenem?

A

2nd or 3rd line for hospital infections

55
Q

What is the activity of metronidazole?

A

Anaerobes

Protoza

Diardia

56
Q

What are the main uses of metronidazole?

A

Surgical infections

Giardiasis

Amoebiasis

Trichomonal infections

57
Q

What is the activity of linezolid?

A

Gram positive bacteria only

(streptococci, staphylococci, enterococci)

2nd line agent for MSSA, MRSA, VRE

58
Q

What are the main uses of metrodonidazole?

A

2nd line agent for MSSA, MRSA, VRE

59
Q

What is the activity of daptomycin?

A

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

60
Q

What are the main uses of daptomycin?

A

2nd line agent for MSSA, MRSA, VRE

61
Q

What is the activity of tigecycline?

A

Very broad spectrum including MRSA, ESBL, anaerobes

62
Q

What are the main uses of tigecycline?

A

3rd line inta-abdominal sepsis, soft tissue infections

63
Q

What are the azoles and what are they active against?

A

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

64
Q

What are polyenes and what are they active against?

A

Amphotericin - candida and aspergillus

Nystatin - candida

65
Q

What are the echinocandins and what are they effective against?

A

caspofungin, anidulafungin, micafungin: Candida, Aspergillus

66
Q

What is terbinafine effective against?

A

Tinea, nails

MBChB - Y2 - Infection (17 decks)

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