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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
Q

pneumonia is commonly caused by

A

Streptococcus pneumoniae
Haemophilus influexae
gram neg bacilli
Staphylococcus aureaus

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26
Q

true aspiration pneumonia caused by

A

less virulent bacteria - anaerobes

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27
Q

risk factors for pneumonia

A

-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

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28
Q

pneumonia: other potential risk factors

A

-inc age
-M
-smoking
-DM
-recurrent vomiting
-oropharyngeal colonization
-poor oral hygiene / dental infection

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29
Q

do PPI or h-2RAs increase risk of pneumonia

A

do not increase risk of aspiration but may alter gastric pH allowing growth of potentially pathogenic organisms w/i gastric aspirations

30
Q

interventions to prevent aspiration esp in older adults and stroke pts

A

-positioning
-dietary changes
-oral hygiene
-tube feeding

31
Q

pneumonia tx: community acquires

A

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
Q

pneumonia tx: HAI

A

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
Q

HAP pneumonia

A

occurs 48h after admission and did not appear to be incubating at the time of admission

34
Q

HAP: general risk factors

A

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
Q

risk factors for infection w/ potentially MDR organisms

A

IV antibiotic use w/i 90 days

structural lung disease, such as bronchiectasis or cystic fibrosis (Pseudomonas species)

36
Q

VAp pneumonia risk factors

A

-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
Q

VAP: risk factors for infection w/ MDR organisms

A

-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
Q

VAP: IV antimicrobial therapy w/i previous 90-day period associated w/

A

inc risk of methicillin-resistant Staphylococcus aureus and MDR Pseudomonas

39
Q

healthcare-associated pneumonia (HCAP)

A

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
Q

multi-drug resistance (MDR) becomes important concern

A

-in critically ill pts
-receiving abx before pneumonia
-institutions where pathogens are frequent

41
Q

HCAP: early onset five or less days

A

S. pneumonia
H. influenzae MSSA
Gm -

3rd generation cephalosporin,
resp quinolone
amp/sulb
OR
ertapenem

42
Q

HCAP: late onset or risk of MDR organisms

A

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
Q

if MRSA is concern, add

A

vanc
or
linezolid
add to late-onset therapy (pneumonia)

44
Q

CAP: predominant pathogen

A

Streptococcus pneumoniae

others:
-Haemophilus influenzae
-Moraxella catarrhalis
-atypical bacteria (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella spp)
-resp viruses

45
Q

risk factors for developing pnemonia

A

-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
Q

risk factors for development of MDR pneumonia

A

-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
Q

double coverage: adult outpt w/o comorbidities / no ABs in past 3 months

A

amoxicillin (high dose)
doxycycline

or

macrolides (if local rates of macrolide-resistant Strep. pneumoniae <25%

48
Q

double coverage: -adult outpt w/ comorbidities or AB use in past 3 months

A

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
Q

adult pt (not ICU)

A

respiratory quinolones (levofloxacin, moxifloxacin)

or

3rd generation ceephalosporin

or ertapenem PLUS macrolide or doxy

50
Q

adult inpatient (ICU, no pseudomonas)

A

3rd gen cephalosporins PLUS azithromycin or respiratory quinolone

51
Q

adult inpatient (ICU, pseudomonas)

A

cefepime or ceftazidime or piperac/tazob or imipenem or meropenem + quinolone or AMG

if AMG, add azithromycin or quinolone

52
Q

if CA-MRSA is concern

A

add vanco or linezolid or (if suspectible) clinda to aboe

53
Q

AOM abbr

A

acute otitis media

54
Q

AOM pathogen

A

S. pneumoniae

others: H. influenza, M. catarrhalis

55
Q

AOM risk factors

A

anatomic defects
daycare attendance
GERD
immunodeficiency
lack of breast-feeding
low socioeconomic status
Male
Native American or Inuit ethnicity
pacifier use

56
Q

amoxicillin

A

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
Q

amox/tr-clv

A

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
Q

cefuroxime, cefpodoxime or cefdinir (14mg/kg/d child)

A

-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
Q

ALT

A

macrolide, clindamycin OR smz/tmp

reasonable alternative w/ anaphylaxis or IgE mediate reaction to penicillin/cephalosporin

60
Q

adjunctive therapies / pain management

A

pain common in AOM

acetaminophen or ibuprofen
decongestants and antihistamines
external application of heat or cold, instillation of olive oil or herbal extracts

61
Q

ARS abbr

A

acute rhinosinusitis

inflammation of nasal cavity and paranasal sinuses lasting less than 4 weeks

62
Q

ARBs pathogens

A

H. influenzae
S. pneumoniae
M. catarrhalis

63
Q

ARS: preferred, no risk of resistance, or children mild/mod dx

A

standard dose amoxicillin +/- tr-clv

64
Q

ARS: preferred, risk of resistance, or children w/ severe dx

A

high dose amox +/- tr-clv

65
Q

ARS: alt adult

A

respiratory quinolone, doxy, OR clinda (+) cefixime or cefpodoxime

66
Q

ARS: alt child

A

cefpodoxime, cefdinir, levofloxacin

67
Q

which classes are not recommended for empiric therapy bc of his rates of resistance of S. pneumoniae (and H. influenxae for trimethoprim-sulfamethoxazole)

A

macrolides
smz-tmp
second or third generation cephalosporins

68
Q

avoid tetracyclines

A

such as doxy in children = discoloration of teeth (yellow-gray-brown)

69
Q

pharyngitis

A

caused by group A streptococcus (GAS)
most treatable agents

70
Q

Streptococcal pharyngitis (URI)

A

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)

Advanced Pharma (27 decks)

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