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Advanced Pharma > Antimicrobial Selection > Flashcards

Antimicrobial Selection Flashcards

1
Q

culture

A

24hr

most definitive method for dx & tx of an infection

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2
Q

gram stain

A

+ or - based on the organisms ability to retain stain [ purple/blue or red] indicating the makeup of its cell wall

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3
Q

morphology

A

cocci, rod, etx

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4
Q

CAP associated w/

A

S. pneumoniae [Gm+ diplococci]

and

H. influenxa [Gm- coccobacilli]

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5
Q

antibiotic selection based on

A

organism morphology

&

what organism are “typically” associated w/ infections at a given site

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6
Q

colonization

A

organisms do not invade the host but are part of the normal flora

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7
Q

sm & lg intestine normal flora includes

A

lactobacillus
streptococcus
enterococcus
Enterobacteriaceae
peptostreptococcus
bacteriodes
anaerobes

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8
Q

common skin flora species

A

staphylococcus

not found in the GI

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9
Q

epithelial cells

A

presence of a large # indicates contamination

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10
Q

infection

A

organisms invade the host and pt has s/sx’s of infectious process

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11
Q

contamination

A

the isolated organisms came from the pt’s skin or the environment

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12
Q

virulence

A

ability of an agent to produce disease

-measure of the severity of the disease it causes

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13
Q

pathogenicity

A

ability of an organism to cause disease (ie harm the host)

represents genetic component of the pathogen and the overt damage done to the host is a property of the host-pathogen interactions

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14
Q

extent of virulence is usually correlated with the

A

ability of the pathogen to multiply w/i the host and may be affected by otehr factors

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15
Q

MIC

A

lowest concentration of drug that will inhibit visible growth

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16
Q

MBC

A

lowest concentration of drug that fails to show growth or results in 99.9% reduction of the initial inoculum

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17
Q

antibacterial combinations

A

synergy: greater activity than the sum of either agent alone

antagonism: activity that is worse than either agent alone

additive/indifferent: activity that is neither synergistic or antagonistic

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18
Q

time dependent killers

A

killing is dependent on the time an organism is in contact w/ the drug

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19
Q

concentration dependent killers

A

killing is dependent on the concentration of the drug that the organism is exposed to

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20
Q

steps of bacterial infection

A

bind
colonize
produce

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21
Q

mechanisms of bacterial resistance

A

ability of a microbe to resist the effects of medication previously used to treat them

eg.
-porin channels adapt to prevent drug entry (Gr-)
-drug-metabolizing enzymes (beta-lactamases)
-ATP-driven P-glycoprotein efflux pumps changes in drug-binding proteins (B-lactams)

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22
Q

empiric treatment

A

initial broad antimicrobial spectrum before identification of the organisms directed against the organisms know to cause the infection in question based on pt’s presentation

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23
Q

definitive treatment

A

antimicrobials selected based on clear identification of the organism(s) and proven sensitivity of the organism(s)

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24
Q

prophylactic treatment

A

antimicrobial directed against a single pathogen or multiple pathogens to prevent an infection from occurring (short term=before surgery, dental procure)

or long term = AIRDs

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25
pneumonia is commonly caused by
Streptococcus pneumoniae Haemophilus influexae gram neg bacilli Staphylococcus aureaus
26
true aspiration pneumonia caused by
less virulent bacteria - anaerobes
27
risk factors for pneumonia
-reduced consciousness resulting in a compromise of the cough reflex and glottic closure (alcohol & drugs) or anesthesia or generalized seizures -dysphagia from neurologic deficits -esophageal disease, surgery of upper airways/esophagus, GERD -mechanical disruption of the glottic closure or cardiac sphincter due to trach, etc -pharyngeal anesthesia; vomiting, large-volume tube feedings, recumbent position, drowning
28
pneumonia: other potential risk factors
-inc age -M -smoking -DM -recurrent vomiting -oropharyngeal colonization -poor oral hygiene / dental infection
29
do PPI or h-2RAs increase risk of pneumonia
do not increase risk of aspiration but may alter gastric pH allowing growth of potentially pathogenic organisms w/i gastric aspirations
30
interventions to prevent aspiration esp in older adults and stroke pts
-positioning -dietary changes -oral hygiene -tube feeding
31
pneumonia tx: community acquires
for both streptococci and anaerobes dosing for adults w/ normal renal fn clinda 300mg PO 4x daily or 600mg IV q8hr beta-lactam/beta-lactamse inhibitors such as amoxicillin-clavulanate 875mg orally twice or ampicillin-sulbactam 1.5-3 g IV q6h
32
pneumonia tx: HAI
based on suspected pathogens options w/ anaerobic coverage piperacillin-tazobactam 4.5g q6h or ampicillin-sulbactam 1.5g-3g q6h meropenem 1g q8h cefepime 1-2g q8-12h or ceftazidime 1g q8-12h plus metronizadole 500mg IV q8h or clinda 600mg-2.7g IV daily plus vanc 15mg/kg q12h or linezolid if MRSA is suspect
33
HAP pneumonia
occurs 48h after admission and did not appear to be incubating at the time of admission
34
HAP: general risk factors
older age lg volume aspiration chronic lung disease intubation thoracic surgery recent prior hospital admin CKD depressed consciousness anemia malnutrition use of antacids central nervous system disease
35
risk factors for infection w/ potentially MDR organisms
IV antibiotic use w/i 90 days structural lung disease, such as bronchiectasis or cystic fibrosis (Pseudomonas species)
36
VAp pneumonia risk factors
-duration of mechanical ventilation -M -multiple intubations -gastric aspiration -preexisting pulm disease -coma -AIDS -head trauma -multiple-organ system failure -necessity of neurosurgery -monitoring of ICP
37
VAP: risk factors for infection w/ MDR organisms
-IV antimicrobial therapy w/i previous 90-day period -septic shock at time of VAP onset -acute resp distress syndrome preceding VAP -current hospitalization >5d -acute renal replacement therapy prior to VAP onset
38
VAP: IV antimicrobial therapy w/i previous 90-day period associated w/
inc risk of methicillin-resistant Staphylococcus aureus and MDR Pseudomonas
39
healthcare-associated pneumonia (HCAP)
occurs in a non-hospitalized pt w/ extensive healthcare contact -30 days: IV therapy, wound care, IV chemo; attendance at a hospital or hemodialysis clinic -hospitalization in acute care hospital for 2+ days w/i the prior -residence in nursing home or other long-term care facility
40
multi-drug resistance (MDR) becomes important concern
-in critically ill pts -receiving abx before pneumonia -institutions where pathogens are frequent
41
HCAP: early onset five or less days
S. pneumonia H. influenzae MSSA Gm - 3rd generation cephalosporin, resp quinolone amp/sulb OR ertapenem
42
HCAP: late onset or risk of MDR organisms
P. aeruginosa ESBL k pneumonia Acinobacter spp MRSA 4th generation cephalosporin carbapenem (drug class for severe bacterial infections) beta-lactams (enzymes produced by bacteria that open beta-lactam ring beta lactam inhibitor resp quinolones +/- AMGs
43
if MRSA is concern, add
vanc or linezolid add to late-onset therapy (pneumonia)
44
CAP: predominant pathogen
Streptococcus pneumoniae others: -Haemophilus influenzae -Moraxella catarrhalis -atypical bacteria (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella spp) -resp viruses
45
risk factors for developing pnemonia
-current/former smokers -consumption of >80g alcohol/day or hx of alcohol abuse -underweight -household size >10 individuals -regular contact w/ children -freq visits to general practitioner -incidence of CAP higher in pts taking PPI
46
risk factors for development of MDR pneumonia
-age >65 -beta-lactam, macrolide, or fluoroquinolone therapy w/i past 3-6months -alcoholism -medical comorbidities -immunosuppressive illness or therapy -exposure to a child in a daycare center
47
double coverage: adult outpt w/o comorbidities / no ABs in past 3 months
amoxicillin (high dose) doxycycline or macrolides (if local rates of macrolide-resistant Strep. pneumoniae <25%
48
double coverage: -adult outpt w/ comorbidities or AB use in past 3 months
resp quinolone (levofloxacin, moxifloxacin) OR high dose amoxicillin or amoxicillin/clavulanic acid PLUS macrolide (azithromycin, clarithromycin) OR high dose amoxicillin or amoxicillin/clavulanic acid PLUS doxycycline
49
adult pt (not ICU)
respiratory quinolones (levofloxacin, moxifloxacin) or 3rd generation ceephalosporin or ertapenem PLUS macrolide or doxy
50
adult inpatient (ICU, no pseudomonas)
3rd gen cephalosporins PLUS azithromycin or respiratory quinolone
51
adult inpatient (ICU, pseudomonas)
cefepime or ceftazidime or piperac/tazob or imipenem or meropenem + quinolone or AMG if AMG, add azithromycin or quinolone
52
if CA-MRSA is concern
add vanco or linezolid or (if suspectible) clinda to aboe
53
AOM abbr
acute otitis media
54
AOM pathogen
S. pneumoniae others: H. influenza, M. catarrhalis
55
AOM risk factors
anatomic defects daycare attendance GERD immunodeficiency lack of breast-feeding low socioeconomic status Male Native American or Inuit ethnicity pacifier use
56
amoxicillin
drug choice in most patients high dose: if amoxicillin has not been received in the past 30 days does not have concurrent purulent conjunctivitis not allergic to penicillin
57
amox/tr-clv
antibiotic w/ additional beta-lactamase coverage (amoxicillin-clavulanate) is recommended if child has received amoxicillin in the past 30 days has concurrent purulent conjunctivitis hx of recurrent AOM unresponsive to amoxicillin
58
cefuroxime, cefpodoxime or cefdinir (14mg/kg/d child)
-reasonable with mild hypersensitivity reactions -mild delayed hypersensitivity reactions (type II, II, IV) to penicillin appear after more than one dose, typically after days of treatment -lack features of immunoglobulin E (IgE)-mediated reaction (eg. anaphylaxis, angioedema, bronchospasms, urticaria) and serious/life-threatening delayed drug reactions
59
ALT
macrolide, clindamycin OR smz/tmp reasonable alternative w/ anaphylaxis or IgE mediate reaction to penicillin/cephalosporin
60
adjunctive therapies / pain management
pain common in AOM acetaminophen or ibuprofen decongestants and antihistamines external application of heat or cold, instillation of olive oil or herbal extracts
61
ARS abbr
acute rhinosinusitis inflammation of nasal cavity and paranasal sinuses lasting less than 4 weeks
62
ARBs pathogens
H. influenzae S. pneumoniae M. catarrhalis
63
ARS: preferred, no risk of resistance, or children mild/mod dx
standard dose amoxicillin +/- tr-clv
64
ARS: preferred, risk of resistance, or children w/ severe dx
high dose amox +/- tr-clv
65
ARS: alt adult
respiratory quinolone, doxy, OR clinda (+) cefixime or cefpodoxime
66
ARS: alt child
cefpodoxime, cefdinir, levofloxacin
67
which classes are not recommended for empiric therapy bc of his rates of resistance of S. pneumoniae (and H. influenxae for trimethoprim-sulfamethoxazole)
macrolides smz-tmp second or third generation cephalosporins
68
avoid tetracyclines
such as doxy in children = discoloration of teeth (yellow-gray-brown)
69
pharyngitis
caused by group A streptococcus (GAS) most treatable agents
70
Streptococcal pharyngitis (URI)
Pen V (or amox in children) 1st generation cephalosporin (if allergic to PCN, but not type I) Azithromycin or clindamycin (if allergic to PCN, type I)

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