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Y2 infection > antimicrobial chemotherapy 2 - optional > Flashcards

antimicrobial chemotherapy 2 - optional Flashcards

1
Q

which antibiotics inhibit cell wall synthesis

A 
cycloserine 
vancomycin 
bacitracin 
penicillins 
cephalosporins 
monobactams 
carbapenems
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2
Q

which abx act on folic acid metabolism

A

trimethoprim

sulfonamides

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3
Q

which abx act on the cytoplasmic membrane structure

A

polymyxins

daptomycin

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4
Q

which abx act on DNA gyrase

A

quinolones: nalidixic acid, ciprofloxacin,, novobiocin

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5
Q

which abx act on RNA elongation

A

actinomycin

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6
Q

which abx act on DNA directed RNA polymerase

A

rifampicin

streptovaricins

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7
Q

which abx are protein synthesis 50S inhibitors

A

erythromycin (macrolides)
chloramphenicol
clindamycin
lincomycin

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8
Q

which abx are protein synthesis 30S inhibitors

A 
tetracyclines
spectinomycin 
streptomycin 
gentamycin 
kanamycin 
amikacin 
nitrofurans
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9
Q

which abx act on protein synthesis (tRNA)

A

mupirocin

puromycin

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10
Q

6 examples of penicillin abx

A 
benzylpenicillin 
penicillin V
amoxicillin 
flucloxacillin 
co-amoxiclav 
piperacillin/tazobactam
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11
Q

activity of benzylpenicillin, penicillin V

A

streptococci
Neisseria
spirochetes

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12
Q

main uses of benzylpenicillin, penicillin V

A 
soft tissue 
pneumococcal 
meningococcal 
gonorrhoea
syphilis
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13
Q

benefits of benzylpenicillin, penicillin V

A

IV/IM usage

cheap

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14
Q

activity of amoxicillin

A

broad spectrum but resistance is common

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15
Q

main uses of amoxicillin

A

UTI

RTI

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16
Q

benefits of amoxicillin

A

cheap

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17
Q

activity of flucloxacillin

A

staphylococci

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18
Q

main uses of flucloxacillin and benefits

A

S. aureus

cheap

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19
Q

activity of co-amoxiclav

A

broad spectrum

incl. anaerobes

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20
Q

main uses of co-amoxiclav

A

UTI
RTI
soft tissue infections
surgical wound infections

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21
Q

disadvantages of co-amoxiclav

A

C. difficile infection

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22
Q

action of piperacillin/tazobactam

A

broad spectrum incl. pseudomonas and anaerobes

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23
Q

main uses of piperacillin/tazobactam

A

neutropenic sepsis

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24
Q

route of administration of piperacillin/tazobactam

A

IV only

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25
Q

5 examples of cephalosporin abx and their generation

A

1st - cefradine
2nd - cefuroxime
3rd - ceftriaxone/cefotaxime, ceftazidime
4th - ceftaroline/ceftobiprole - anti-MRSA

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26
Q

cefradine activity

A

broad spectrum

resistance +

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27
Q

main uses of cefradine

A

UTI

soft tissue infection

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28
Q

advantages of cefradine

A

oral

cheap

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29
Q

activity of cefuroxime

A

broad spectrum

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30
Q

main uses of cefuroxime

A

UTI
TRI
surgical prophylaxis

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31
Q

activity of ceftriaxone/cefotaxime

A

broad spectrum esp good against gram -ve bacilli

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32
Q

main uses of ceftriaxone/cefotaxime

A

hospital infections e.g. bacteraemia pneumonia, abdo sepsis

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33
Q

disadvantages of ceftriaxone/cefotaxime

A

risk factor for MRSA, C diff

IV/IM only

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34
Q

activity of ceftazidime

A

like ceftriaxone but also active against pseudomonas

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35
Q

main uses of ceftazidime

A

pseudomonal infections in hospital and in CF

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36
Q

disadvantages of ceftazidime

A

risk factor for MRSA, C diff

IV only

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37
Q

ceftaroline/ceftobiprole activity

A

broad spectrum
less gram -ve cover
MRSA

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38
Q

main uses of ceftaroline/ceftobiprole

A

skin and soft tissue infection

endocarditis resistant to other treatment

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39
Q

disadvantages of ceftaroline/ceftobiprole

A

risk factor for development of C diff
expensive
IV only

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40
Q

2 examples of aminoglycoside abx

A

gentamicin

amikacin

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41
Q

activity of gentamicin and

amikacin

A

gram -ve bacilli

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42
Q

main uses of gentamicin and

amikacin

A

serious gram -ve infections e.g. bacteraemia, endocarditis, neutropenic sepsis

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43
Q

disadvantages of gentamicin and amikacin

A

IV? and IM only
renal and ototoxicity
measuring levels is essential

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44
Q

3 examples of macrolide abx

A

clarithromycin
erythromycin
azithromycin

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45
Q

activity of clarithromycin

A 
streptococci
staphylococci
mycoplasma 
chlamydia 
legionella
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46
Q

main uses of clarithromycin

A

resp infection
soft tissue infection (if penicillin allergic)
STD

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47
Q

activity of erythromycin

A 
streptococci
staphylococci
mycoplasma 
chlamydia 
legionella
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48
Q

main uses of erythromycin

A

resp infection
soft tissue infection (if penicillin allergic)
STD

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49
Q

disadvantages of erythromycin

A

GI intolerance

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50
Q

advantages of clarithromycin

A

better tolerated

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51
Q

activity of azithromycin

A

better for gram -ve e.g. haemophilus

chlamydia

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52
Q

main uses of azithromycin

A

chlamydia

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53
Q

2 examples of quinolones

A

ciprofloxacin

levofloxacin/moxifloxacin

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54
Q

activity of ciprofloxacin

A

gram -ve bacilli
pseudomonas
some activity against staphylococci and streptococci

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55
Q

main uses of ciprofloxacin

A

complicated UTI
complicated hospital acquired pneumonia
some GI infections

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56
Q

disadvantages of ciprofloxacin

A

C. diff

may affect growing cartilage

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57
Q

activity of levofloxacin/moxifloxacin

A 
enhanced activity against staphylococci/streptococci 
less against pseudomonas 
active against pneumococcus 
mycoplasma 
chlamydia 
legionella
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58
Q

main uses of levofloxacin/moxifloxacin

A

2nd/3rd line agent for pneumonia

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59
Q

disadvantages of levofloxacin/moxifloxacin

A

C. diff

may affect growing cartilage

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60
Q

2 examples of glycopeptide abx

A

vancomycin

teicoplanin

61
Q

activity of vancomycin and teicoplanin

A

gram +ve bacteria only (streptococci and staphylococci)

62
Q

main uses of vancomycin and teicoplanin

A

MRSA
pts allergic to penicillin
C. difficile (oral vanc)

63
Q

disadvantages of vancomycin and teicoplanin

A

IV/IM only (except for C. diff)
regular levels required
nephrotoxicity

64
Q

activity of trimethoprim

A

gram -ve bacilli

some activity against streptococci and staphylococci

65
Q

main uses of trimethoprim

A

UTI
resp infection
MRSA

66
Q

advantages of trimethoprim

A

cheap

67
Q

what 2 drugs make up co-trimoxazole

A

trimethoprim

sulphamethoxazole

68
Q

uses of co-trimoxazole

A

broad spectrum

pnemocysititis jiroveci

69
Q

main uses of co-trimoxazole

A

resp infection

PCP

70
Q

disadvantages of co-trimoxazole

A

rashes

71
Q

activity of clindamycin

A

streptococci
staphylococci
anaerobes

72
Q

main uses of clindamycin

A

soft tissue infection

gangrene

73
Q

disadvantages of clindamycin

A

associated w/ C. diff

74
Q

activity of tetracycline and doxycycline

A 
streptococci
staphylococci 
chlamydia 
rickettsiae
brucella
75
Q

main uses of tetracycline and doxycycline

A 
Q fever
brucellosis 
chlamydia 
atypical pneumonia 
MRSA
76
Q

disadvantages of tetracycline and doxycycline

A

CI in pregnancy and childhood (effects on teeth and bones)

77
Q

activity of rifampicin

A

mycobacteria
meningococcus
staphylococci

78
Q

main uses of rifampicin

A

TB
MRSA
meningococcal prophylaxis
complicated staphylococcal infections

79
Q

disadvantages of rifampicin

A

drug interactions -enzyme inducer

80
Q

activity of meropenem

A

broad spectrum incl. anaerobes

pseudomonas

81
Q

main uses of meropenem

A

2nd or 3rd line for hospital infections

82
Q

advantages of meropenem

A

good CNS penetration

but IV only

83
Q

activity of metronidazole

A

anaerobes

protozoa e.g. giardia

84
Q

main uses of metronidazole

A

surgical infections
giardiasis
amoebiasis
trichomonal infections

85
Q

disadvantages of metronidazole

A

antabuse - reaction w/ alcohol

86
Q

activity of linezolid

A

gram +ve bacteria only: streptococci, staphylococci, enterococci

87
Q

main uses of linezolid

A

2nd line agent for MSSA, MRSA, VRE

88
Q

route of administration for linezolid

A

oral and iV

89
Q

disadvantages of linezolid

A

blood and optic neuropathy

S/Es

90
Q

activity of daptomycin

A

gram +ve bacteria only (streptococci, staphylococci, enterococci)

91
Q

main uses of daptomycin

A

2nd line agent for MSSA, MRSA, VRE

92
Q

disadvantages of daptomycin

A

IV only
inactive in lung
myositis S/E

93
Q

activity of tigecycline

A

very broad spectrum incl. MRSA, ESBL, anaerobes

94
Q

main uses of tigecycline

A

3rd line intra-abdo sepsis

soft tissue infections

95
Q

disadvantages of tigecycline

A

IV only

ineffective against pseudomonas

96
Q

indications for antimicrobials

A

therapy

prophylaxis

97
Q

what is empirical therapy

A

w/o microbiology results

98
Q

what is directed therapy

A

based on microbiology results

99
Q

what is 1y prophylaxis

A

anti-malarial, immunosuppressed pts
pre-operative surgical
post-exposure e.g. HIV, meningitis

100
Q

what is 2y prophylaxis

A

prevent a 2nd episode e.g. PJP

101
Q

how is a diagnosis of infection made

A

clinical
laboratory
none - no treatment

102
Q

severity assessment of infection

A

? sepsis (qSOFA)

Septic shock

103
Q

qSOFA criteria

A

syst BP <100
altered mental state
RR >22

104
Q

patient characteristics to consider when prescribing

A 
age 
renal function 
liver function 
immunocompromised
pregnancy 
known allergies
105
Q

things to consider when making antimicrobial selection

A 
guideline or individualised therapy 
likely organism 
empirical therapy or result based
bactericidal vs bacteriostatic drug 
single agent or combination 
potential adverse effects
106
Q

30% rule of prescribing abx

A

30% of all hospitalised inpatients at any given time recieve abx
>30% of abx are prescribed inappropiately in the community
up to 30% of all surgical prophylaxis is inappropriate
10-30% of pharmacy costs can be saved by antimicrobial stewardship programmes

107
Q

how does abx resistance occur

A

natural phenomenon
bacteria adapt to survive
bacteria rapidly multiply and can generate resistance very quickly

108
Q

4 main mechanisms of resistance

A

enzymatic inactivation of drug
modified targets for drugs
reduced permeability to drug
efflux of drug

109
Q

genetics of resistance

A

chromosomally mediated

plasmid mediated

110
Q

chromosomally mediated resistance

A

mutation in gene coding for drug target or membrane transport system
frequency of spontaneous mutations 10^-7 to 10^-9
much lower than frequency of acquisition to plasmids
less of a problem clinically
basis for multi drug therapy e.g. TB

111
Q

what is binary fission

A

DNA replicates
cell elongates
divides in 2
2 identical bacteria

112
Q

plasmid mediated resistance

A

plasmid = extra-chromosomal strand of DNA
replicate independent of cell chromosome
carry genes for enzymes which degrade abx and modify membrane transport systems
may carry 1 or more resistance gene

113
Q

how is plasmid mediated resistance passed on

A

bacteria have ability to conjugate
can transfer resistance genes to other species of bacteria
certain bacteria can take up plasmids by transformation

114
Q

5 medically important resistant organisms

A 
MRSA
VRE
ESBL 
CPE 
Clostridium difficile
115
Q

methicillin

A

methicillin is a penicillinase resistant penicillin (e.g. similar to flucloxacillin)
used in lab to determine whether organisms are sensitive to flucloxacillin

116
Q

MRSA

A

methicillin resistant staphylococcus aureus
MRSA has an altered binding protein compared w/ MSSA
resistant to flucloxacillin

117
Q

clinical effects of MRSA

A

most often colonisation w/o infection
can cause severe invasive infections e.g. osteomyelitis, endocarditis
mortality in pts w/ MRSA bacteraemia = 2x that of MSSA bacteraemia
carriage of MRSA is promoted by use of abx

118
Q

VRE

A

vancomycin resistant enterococci
enterococci are intrinsically only sensitive to a limited number of abx
VRE are only sensitive to 1 or 2 abx
VRE colonise GI tract in pts exposed to multiple abx
can cause invasive disease (e.g. endocarditis) esp in pts w/ prosthetic devices

119
Q

ESBL producing enterobacteraciae

A

extended spectrum beta lactamase
confer a range of resistance mechanisms, enzymatic degradation of antibiotic, reduced porins, increased efflux
resistant to beta-lactam abx, often cephalosporins
may be associated w/ further resistance mechanisms such as resistance to aminoglycosides and carbapenems

120
Q

CPE

A 
carbapenem producing enterobacteriacae
multiple resistant bacteria 
typically only sensitive to a few abx of last resort
can colonise gut of healthy individuals 
associated w/ high mortality 
can colonise healthcare environment
121
Q

factors influencing abx resistance

A

widespread abx use encouraging selective pressure
abx use by medical professions, veterinary practices, farming
pts surviving longer w/ more medical conditions and hospital contact
more invasive procedures and prosthetic devices
increased bed pressure in UK encourages spread of resistant organisms

122
Q

quinolones - example and resistance

A

ciprofloxacin
levofloxacin
associated w/ C diff
overuse associated w/ increased MRSA rates

123
Q

macrolides - example and resistance

A

clarithromycin
erythromycin
limited spectrum of activity not for severe infections

124
Q

licosamides - example and resistance

A

clindamycin only gram +ve and anaerobic activity
high risk of C diff
resistance reasonably common in staph and strep

125
Q

co-trimoxazole

A

limited IV supply
good spectrum of coverage
less active against strep pneumoniae
caution in renal dysfunction, marrow toxicity

126
Q

aminoglycosides

A

gentamicin
potent antimicrobial use limited by renal and ototoxicity
not used as single agent in gram +ve infection

127
Q

glycopeptides

A 
vancomycin 
teicoplanin 
need monitoring to achieve therapeutic agents
less active against staph aureus
no gram -ve cover
128
Q

daptomycin

A

only gram +ve activity
toxicities include eosinophilic pneumonia and myositis
can’t be used in pneumonia

129
Q

tetracycline

A

doxycycline
GI intolerance common
not used in bacteraemic infection

130
Q

tigecycline

A

broad spectrum of coverage

not used in bacteraemic illness

131
Q

oxazolidinones

A

restricted antibiotic

marrow toxicities

132
Q

types of hypersensitivity reactions

A 
type I 
anaphylaxis 
type II
type III 
type IV
133
Q

type I hypersensitivity reactions

A

IgE mediated
stimulates pro-inflammatory release
uritcaria, laryngeal oedema, bronchospasm, circulatory collapse

134
Q

anaphylaxis and penicillin

A

occurs in 4-15/100 000 penicillin treatment courses

135
Q

type II hypersensitivity reactions

A

beta lactam specific IgG or IgM antibodies
bind to circulating blood cell
haematological reactions or interstitial nephritis

136
Q

type III hypersensitivity reactions

A

circulating beta lactam specific IgG or IgM
bind to beta lactam antigens fixing compliment
lodge in tissues
serum sickness and drug related fever

137
Q

type IV hypersensitivity reactions

A

not antibody mediated

T cell recognises antigen leading to localised inflammation e.g. contact dermatitis

138
Q

management of a pt w/ beta lactam allergy

A

5-20% of pts give hx of beta lactam allergy
less that 1% of those will have type 1 penicillin allergy
difficult to confirm - lack of available testing
good hx is important

139
Q

define resistance

A

inability of antibiotic to kill bacteria
can be detected in the lab by measuring MIC levels - minimum inhibitory conc
clinical failure may occur despite lab reports of sensitivity

140
Q

reasons for failure of therapy

A

inadequate dose of antibiotic
inappropriate route
non-compliance
bacteria walled off in abscess cavity
foreign bodies e.g. surgical implants, prosthesis
poor penetration of drug to site of action

141
Q

name 3 abx w/ good biofilm availability

A

rifampicin
daptomycin
ceftobiprole

142
Q

what is antibiotic stewardship

A

using the right antibiotic for the right indication for the right duration of time

143
Q

how to achieve antibiotic stewardship

A

use an antibiotic only if suspected or proven bacterial infection
use abx as per guidelines and review w/ results of microbiology
review antibiotic prescriptions regularly and stop ASAP
limit use of broad spectrum blind antibiotic therapy to seriously ill patients

144
Q

when to consider switching patients from IV to oral abx

A 
after 48hrs provided that: 
pt is improving clinically and is able to tolerate an oral formulation 
i.e. all of the following: 
able to swallow and tolerate fluids
temp 36-38C for at least 48hrs
HR <100bpm for prev 12hrs
WCC between 4 and 12x10^9L
145
Q

when would you not switch to oral abx

A 
yes to any of the following: 
oral route compromised - vomiting, nil by mouth, steatorrhoea, swallowing disorder, unconscious 
continuing sepsis 
special indication 
febrile neutropenia 
hypotension/shock
146
Q

special indications for not switching to oral abx

A 
endocarditis 
meningitis 
staph. aureus bacteraemia 
immunosuppression 
bone/joint infection 
deep abscess
CF
prosthetic infection
147
Q

alert microbials

A

restricted use only under the authorisation of a microbiologist or infectious disease specialist
and/or
according to approved indications within local guidelines/policies

148
Q

how to help prevent antibiotic resistance

A

use abx only when prescribe
prescribe abx only when neccesary and appropriate
complete the full course
never share abx or use leftover prescriptions

Y2 infection (15 decks)

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