Antimicrobial Deck 3 Flashcards
Gram + Cocci
SSE
staph, strep, enterococcus
Gram - Cocci
H.Flu
Neisseria
Moxaxella
Gram - Bacilli
EKP
ESP
Escherichia coli
Klebsiella pnemonaie, Klebsiella oxytoca
Proteus mirabilis
Enterobacter sp. Serratia marcescens Providencia stuartii Salmonella enteritis Shigella sp.
Psudomonas
Psudomonas
Anaerobes
Bacteroides
Mycoplasms
– Mycoplasma: CAP
– Ureaplasma: GU
community acquired pneumona
Chlamydia
– GU
– Respiratory
– Eye
dies when outside of the cell
Ricketssias
• Ricketssias
– Ricketssia: Rocky Mountain Spotted fever
– Ehrlichia: tick‐borne
• Acid‐fast
– Mycobacterium tuberculosis
– Nocardia
• Fungal‐like
– Actinomyces
Spirochetes
Borrelia burgdorferie (Lyme Disease) Treponema P llid a um (S hili ) (Syphilis)
• Borrelia burgdorferie (Lyme Disease) treatment
– Doxycycline, Amoxicillin
– Cephalosporin 3rd/4th Gen
Treponema P llid a um (S hili ) (Syphilis) treatment
– Pen G 2.4 million units
– PCN Allergy: Doxy/Tetracycline
– Azithromycin but multiple resistant strains
Gram Positive
thick peptidoglycan layer in the cell - purple
thicker cell wall
no porin channels
simpler organism
Gram negative
does not have a peptidoglycan layer - pink
thinner cell wall
lipopoysaccharide outer membrane
porin channels
more complex
Staph clinical associations
skin, soft tissue
Strep clincial associations
respiratory
enterococcus clinical manifications
GI/GU
H.Flu Clinical Associations
AOM, sinusitis, bronchitis
Neisseria clinical associations
Meningitis
GU
Morxella clinical associations
AOM, sinusitis, bronchitis
EKP clinical associations
Infection: UTI, GI
ESP clinical associations
GI
Salmonella, shigella clinical associations
GI
Pseudomonas clinical associations
pneumonia, various
Bacteroides clinical associations
GI, Aspiration pneumonia
Goal of Using the Simplified Pathogen
List
Match the drug to the bug
• Identify the most likely pathogen
• Describe the spectrum of activity of an antibiotic (or
antibiotic class)
• Develop a simplified “drugs of choice” list
• Gram + activity
Staph, Strep
• Some Gr‐ activity
EKP(E. coli, Klebsiella, Proteus)
• Good Gr – activity
ESP
(Enterobacter Enterobacter, Serratia Serratia, Providencia Providencia)
• +/‐ pseudomonas
Anaerobic activity
Bacteroides
Factors to Consider When Prescribing
Antimicrobials
- Site of Infection
- Pathogen
- Extent of Infection
- Purpose
- Host
Host Criteria
– Immune status – Comorbidities – Age – Genetic Factors – Allergies – Pregnancy and Lactation
Systematic Approach for Selecting
Antimicrobial Agents
Confirm the presence of infection
Identification of the likely pathogen
Selection of presumptive therapy
Monitor therapeutic response
Broad Spectrum
• Broad activity
against Gram + and
Gram – Organisms
Examples of broad
• Tetracyclines, phenicols, fluoroquinolones, “third‐generation” and “fourth‐ generation” cephalosporins
Narrow Spectrum
• Limited activity and are primarily
only useful against particular
species of microorganisms
Narrow Glycopeptides PCNs are mainly affective
against Gram+ bacteria
Narrow polymixins are usually only effective against
Gram‐ bacteria
Narrow aminoglycosides and sulfonamides are mainly effective against
aerobic organisms
Narrow nitroimidazoles are generally only effective
for anaerobes
Penicillin Ampicillin Amoxicillin Penicillin G Treats
Gram + (SSE)
Strep, Staph, Enterococcus
Skin, soft tissue, respiratory
Penicillin Extended
Spectrum
Treats
Less Gr+, more Gr‐ (EKP, ESP)
E‐coli, Shigella, Salmonella,
Proteus
β lactamase Gr +
GU
G
Skin/soft tissue, resp y iratory
Tetracyclines
Doxycycline
Minocycline
Treats
Gr – Atypicals, MRSA chlamydiae, mycoplasmas, and rickettsiae, and protozoan parasites Propionibacterium acnes Gr+ Strep pneumonaie Skin GU/GI Respiratory Sulfonamide TMP‐SMX Gr‐ E coli, Proteus, Klebsiel
Cephalosporins
1st Generation
cephadroxil
Cephalexin
Treats
Gram + Staph, Strep,
Enterococcus (SSE)
Resp, skin/soft tissue
Cephalosporins 2nd Generation cefprozil cefaclor cefuroxime
Treats
Gr+, weak Gr‐
Staph, Strep, Enterococcus
(SSE)
Resp
3rd Generation cefotaxime cefpodoxime cefdinir ceftazidime ceftriazone
Treats
Weak Gr+, Gr‐ β lactamase H‐Flu, E‐coli, Klebsiella, Proteus (EKP) ESP
Resp, GU, GI
4th Generation
Cefepime
Treats
β lactamase
Enhanced Gr‐, polymicrobial
infections (ESP, EKP, SSE)
Resp, GI, GU
5th Generation
Ceftaroline
Treats
Gr+, Gr‐
MRSA , DRSP
GI, GU, Skin, Resp
