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Infection > Antimicrobial Chemotherapy > Flashcards

Antimicrobial Chemotherapy Flashcards

1
Q

Indications of antivirals

A
  • Therapy: empiric, directed

- Prophylaxis: primary, secondary

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2
Q

Diagnosis

A
  • Diagnosis: clinical, lab

- Severity: sepsis, septic shock

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3
Q

Patient characteristics

A
  • Age
  • Renal function
  • Liver function
  • Immunocompromised
  • Pregnancy
  • Known allergies
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4
Q

Antimicrobial selection

A
  • Guideline/”individualised” therapy
  • Likely organisms
  • Empirical or result-based
  • Bactericidal vs bacteriostatic
  • Single agent/combination
  • Potential adverse effects
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5
Q

Bactericidal

A

E.g. beta-lactams

  • Act on cell wall
  • Kill organisms
  • Indications: neutropenia, meningitis, endocarditis
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6
Q

Bacteriostatic

A

E.g. macrolides

  • Inhibit protein synthesis
  • Prevent colony growth
  • Require host immune system to “mop up” residual infection
  • Useful in toxin-mediated illness
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7
Q

Prescribing

A
  • Route of administration
  • Dose
  • Adverse effects
  • Duration
  • IV to oral switch therapy
  • Inpatient or outpatient therapy
  • Therapeutic drug monitoring
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8
Q

IV to oral switch

A

Oral bioavailability

  • Ratio of drug level when given orally compared to IV
  • Oral: not vomiting, normal GI, no shock, no organ dysfunction
  • IV: severe infection, when oral not available
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9
Q

Antibiotic resistance

A
  • Bacteria adapt and rapidly (generate resistance) rapidly
  • 4 mechanism
    enzymatic inactivation of drug, modified drug targets, reduced permeability to drug, efflux of drug
  • Genetics: chromosomal and plasmid mediated
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10
Q

Chromosomal mediated resistance

A
  • Mutation in gene coding for drug target or membrane transport system
  • Frequency of spontaneous
  • < frequency of acquisition of plasmids
  • Basis for using multi-drug therapy
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11
Q

Plasmid mediated resistance

A
  • Replicate independent of cell chromosome
  • Carry 1 or more resistance genes for enzymes which degrade antibiotics/modify membrane transport systems
  • Bacteria conjugate, transfer resistance genes to other species
  • Certain bacteria can take up plasmids by transformation
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12
Q

Antibiotic Intolerances and Adverse Effects of Beta-Lactams

A

Mostly with penicillin and cephalosporin.
Immediate and delayed hypersensitivity
- Type I: IgE mediated specific immunoglobulin, stimulates pro-inflammatory. (Anaphylaxis)
- Type II: IgG or IgM, haematological reactions or interstitial nephritis
- Type III: IgG or IgM, lodging results in serum sickness, drug-related fever
- Type IV: T-cell causes localised inflammation

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13
Q

All drugs particularly tetracyclines and TB drugs

A
  • Liver toxicity particularly pre-existing liver disease
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14
Q

Ethambutol (TB) side effects

A

Optic neuropathy

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15
Q

Isoniazid (TB)

A

Peripheral neuropathy

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16
Q

Resistance

A

Inability of antibiotic to kill bacteria

- Measured using MIC (minimum inhibitory concentration) levels

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17
Q

Reasons for resistance

A
  • Inadequate dose
  • Inappropriate route
  • Non-compliance
  • Bacteria walled off in abscess cavity
  • Foreign bodies
  • Poor penetration of drug to site of infection
18
Q

Important Resistant Organisms

A
  • MRSA
  • VRE
  • ESBL
  • CPE
  • C. diff
19
Q

Antibiotic stewardship

A
  • Right antibiotic, right indication, right duration
  • Use only suspected/proven bacteria
  • Use as per guidelines and review results
  • Review prescriptions regularly and stop soon as possible
  • Limit broad-spectrum use to seriously ill
20
Q

Single or combination

A 
Single 
- Simple 
- Fewer side effects/drug interactions 
Combination
- HIV/TB, severe sepsis, mixed organisms
21
Q

Penicillins (beta-lactams)

- illin/clav

A

Inhibition of cell wall synthesis

  • Benzylpenicillin
  • Penicillin V
  • Amoxicillin
  • Flucloxacillin
  • Co-amoxiclav
  • Piperacillin
  • Tazobactam

Side effects:
Candida, convulsions, encephalopathy

22
Q

Benzylpenicillin

Penicillin V

A
  • Streptococci, Neisseria, Spirochetes
  • Soft tissue, pneumococcal, meningococcal, gonorrhoea, syphilis
  • IV/IM
  • Cheap
23
Q

Amoxicillin

A
  • Broad spectrum
  • Resistance common
  • UTI, RTI
  • Cheap
24
Q

Flucloxacillin

A
  • Staphylococcal e.g.
    S. aureus
  • Cheap
25
Q

Co-amoxiclav (4C’s)

A
  • Broad spectrum
  • Anaerobes
  • UTI, RTI, soft tissue, surgical wounds
  • C. diff (4C’s)
26
Q

Piperacillin/tazobactam

A
  • Broad spectrum
  • Pseudomonas, anaerobes
  • Neutropenic sepsis
  • IV only
27
Q

Cephalosporins (4C’s) (beta-lactams)

  • ime
A

Inhibition of cell wall synthesis

  • Cefradine (1)
  • Cefuroxime (2)
  • Ceftriaxone/Cefotaxime (3)
  • Ceftazidime (3)
  • Ceftaroline/Ceftobiprole (4)

Side effects: Candida, convulsions and thrush

28
Q

Cefradine

A
  • Broad spectrum
  • UTI, soft tissue
  • Oral, cheap but resistance +
29
Q

Cefuroxime

A
  • Broad spectrum

- UTI, RTI, surgical prophylaxis

30
Q

Ceftriaxone/ceftaxime

A
  • Broad spectrum
  • Especially good against Gram -ve bacilli
  • Hospital infections e.g. bacteraemia, pneumonia, sepsis
  • Risk for: MRSA, C.diff, VRE
  • IV/IM only
31
Q

Ceftazidime

A
  • Broad spectrum
  • Especially good against gram -ve bacilli
  • Pseudomonas (Hospital and CF)
  • Risk for: MRSA, C. diff, VRE
  • IV only
32
Q

Ceftaroline/Ceftabiprole

A
  • Broad spectrum
  • Less gram -ve
  • Anti-MRSA
  • Good biofilm activity
  • Skin and soft tissue
  • Endocarditis
  • Resistant to other treatment
  • Risk factor for C. diff, VRE
  • Expensive
  • IV only
33
Q

Aminoglycoside

-cin

A

Inhibition of protein synthesis

  • Gentamicin
  • Amikacin

IV? IM only
Renal and ototoxicity

34
Q

Gentamicin and Amikacin

A
  • Serious gram -ve bacilli

e. g. bacteraemia, endocarditis, neutropenic sepsis

35
Q

Macrolide

-mycin

A

Inhibition of protein synthesis

  • Clarithromycin
  • Erythromycin
  • Azithromycin
36
Q

Clarithromycin

A
  • Streptococci, staphylococci, mycoplasma, chlamydia, legionella
  • RTI, soft tissue, STD
37
Q

Erythromycin

A
  • Streptococci, staphylococci, mycoplasma, chlamydia, legionella
  • RTI, soft tissue, STD
  • GI intolerance
38
Q

Azithromycin

A
  • Better for gram -ve e.g. haemophilus, chlamydia

- Once daily or stat

39
Q

Quinolones

  • floxacin
A

Inhibition of nucleic acid synthesis

  • Ciprofloxacin
  • Levofloxacin
  • Moxifloxacin

Associated with C. diff, MRSA
May affect growing cartilage

40
Q

Ciprofloxacin

A
  • Gram -ve bacilli

Infection (13 decks)

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