Antimicrobial therapy Flashcards
1
Q
Antimicrobial therapy - groups
A
- Cell wall synthesis
- Folic acid synthesis
- DNA topoisomerases
- Damage DNA
- mRNA synthesis
- Protein synthesis
- daptomycin
2
Q
Antimicrobial therapy - Cell wall synthesis drugs - divided to
A
- Peptidogylcan synthesis drugs
2. Peptidoglycan cross linking
3
Q
Antimicrobial therapy - peptidoglycan cross linking - Groups and drugs
A
- Penicillinae sensitive penicillins (amoxillin, ampicillin, Penicillin G and V)
- Penicillinase-resistant penicillins (Dicloxacillin, Nafcillin, Oxacillin, Methcillin)
- Antipseudomonals (Piperacillin, Ticarcillin)
- Cephalosporins (I-V)
- Carbapenems (Doripenem, Ertapenem, Imipenem, Meropenem)
- Monobactams (Aztreonam)
4
Q
Antimicrobial therapy - Penicillinae sensitive penicillins - drugs
A
- amoxillin
- ampicillin
- Penicillin G and V
5
Q
Prototype β-lactam antibiotics
A
Penicillin G and V
6
Q
Penicillin G vs V
A
Penicillin G –> IV and IM form
Penicillin V –> Oral
7
Q
Penicillin G and V - mechanism of action
A
D-Ala-Ala analog –> Bind penicillin-binding proteins (transpeptidas) –> blocks trasnpeptisase cross linking of peptidoglycan in cell wall –> inhibits cell wall synthesis –> Activate autolytic enzyme
BACTERICIDAL
8
Q
Penicillin G and V - clinical use
A
gram + cocci and robs, gram (-) cocci, spirochetes:
- gram (+) organisms (S. pneumoniae, S.pygoenes, Actinomyces)
- gram (-) cocci (mainly N. meningitidis)
- spirochetes (mainly T. pallidum)
9
Q
Penicillin G and V - toxicity
A
- Hyperesensitivity reactions
2. Hemolytic anemia
10
Q
Penicillin G and V - resistance
A
Penicillinae in bacteria (a type of β-lactamase) cleaves β-lactam ring
11
Q
aminopenicillins - drugs
A
- amoxillin
2. ampicillin
12
Q
aminopenicillins (amoxicillin, ampicillin) - mechanism of action
A
same as penicillin but WIDER SPECTRUM
13
Q
aminopenicillins (amoxicillin, ampicillin) - clinical use
A
extended spectrum penicillin: 1. H. infl 2. H. pylori 3. E. coli 4. Listeria 5. Proteus 6. Salmonella 7. Shigella 8. Entetococci MNEMONIC : HHELPSS + enterococci
14
Q
aminopenicillins (amoxicillin, ampicillin) - toxicity
A
- hypersensitivity reactions
- rash
- pseudomembranous colitis
15
Q
aminopenicillins (amoxicillin, ampicillin) - mechanism of resistance
A
penicillinase in bacteria (a type of β-lactamase) cleaves β-lactams ring–> combine with clavulanic acid
16
Q
Penicillinase-resistant penicillins - drugs
A
- Dicloxacillin
- Nafcillin
- Oxacillin
- Methcillin
17
Q
Penicillinase-resistant penicillins - mechanism of action
A
same as penicillin
NARROW SPECTRUM AND PENICILLINASE RESISTANT
18
Q
Penicillinase-resistant penicillins - mechanism of penicillinase resistance
A
Bulky R group blocks blocks access of β-lactase to lactam ring
19
Q
Penicillinase-resistant penicillins - drugs and clinical use
A
- Dicloxacillin2. Nafcillin 3. Oxacillin 4. Methcillin
S. aureus (except MRSA)
20
Q
MRSA - mechanism of resistance
A
altered penicillin binding protein target site
21
Q
Penicillinase-resistant penicillins - toxicity
A
- hypersensitivity reactions
2. interstitial nephritis
22
Q
Antipseudomonals - drugs
A
Piperacillin, Ticarcillin
23
Q
Antipseudomonals - mechansism of action
A
same as penicillin
Extended spectrum
24
Q
Antipseudomonals - clinical use
A
- psudomonas spp and gram-negative robs
2. gram (-) robs
25
Antipseudomonals - toxicity
hypersensitivity reaction
26
Antipseudomonals - resistance
susceptible to penicillinase --> use with β-lactamase
27
β-lactamase inhibitors - drugs
1. clavulanic acid
2. sulbactam
3. tazobactam
28
β-lactamase inhibitors - use
often added to penicillin antibiotics to protect the antibiotic from destruction by β-lactamase (penicillinase)
29
Cephalosporins - drugs
1st generation --> cefazolin, cephalexin
2nd generation --> cefoxitin, cefaclor, cefuroxamine
3rd generation --> ceftriaxone, cefotaxime, ceftazidime
4th generation --> cefepime
5th generation --> ceftraroline
30
Cephalosporins - mechanism of action
β- lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases - BACTERICIDAL
31
organisms typically not covered by Cephalosporins?
mnemonic: LAME
Listeria, Atypicals (Chlamydia, Mycoplasma) MRSA, Entrococci
exception. Ceftaroline (5th) covers MRSA
32
1st generation cephalosporins - drugs and clinical use
```
cefazolin, cephalexin
1. gram + cocci
2. Proteus
3. E. coli
4. Klebsiella
cefazolin used prior to surgery to prevent S. aureus wound infection
```
33
cefazolin used prior to surgery to
prevent S. aureus wound infection
34
2nd generation - drugs and clinical use
cefoxitin, cefaclor, cefuroxamine
1. like 1st generation (gram + cocci, proteus, E.coli, Klebsiella)
2. H. infuenzae
3. Enterobacter aerogenes
4. Neisseria spp
5. Serratia marcescens
35
3rd generation - drugs and clinical use
ceftriaxone, cefotaxime, ceftazidime
serious gram (-) infections resistant to other β-lactams
- ceftriaxone --> meningitis, gonnorrhea, disseminated Lyme disease
- Ceftazimide --> Pseudomonas
36
4th generation - drugs and clinical use
cefepime
gram (-) organism, with high activity against Pseudomonas
2. gram (+)
37
5th generation - drugs and clinical use
```
ceftaroline
1. broad gram (+)
2. borad gram (-)
INCLUDING MRSA
DOES NTO COVER PSEUDOMONAS
```
38
Cephalosporins - toxicity
1. hypersensitivity reactions
2. autoimmune hemolytic anemia
3. disulfiram-like reaction
4. vitamin K deficiency
5. exhibit cross-reactivity with penicillins
6. Increases aminoglycosides mediated nephrotoxicity
39
Cephalosporins - mechanise of resistance
structural change in penicillin-binding proteins (transpeptidase)
40
Carbapenems - drugs
1. Imipenem
2. Meropenem
3. Doripenem (newer)
4. Ertapenem (newer)
41
Carbapenems - mechanism of action
broad spectrum, β-lactamase-resistant β-lactam
ALWAYS ADMINISTRATED WITH CILASTATIN (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubule --> meropenem is stable to cilastatin
42
cilastatin - mechansim of action
inhibitor of renal dehydropeptidase I
43
Carbapenems - clinical use
1. Gram (+) cocci
2. Gram (-) robs
3. anaerobes
WIDE spectrum but significant side effects limit use of life threatening infection or after other drugs have failed
Ertapenem has limited pseudomonas coverage
44
Carbapenems - toxicity
1. GI distress
2. skin rash
3. CNS toxicity (seizurs) at high plasma levels (less risk with meropenem)
45
Monobactams - drugs
Aztreonam
46
Monobactams (Aztreonam) - mechansim of action
Bind penicillin-binding proteins 3 (transpeptidas) --> blocks trasnpeptisase cross linking of peptidoglycan in cell wall --> inhibits cell wall synthesis --> Activate autolytic enzyme
LESS SUSCEPTIBLE TO β-lactamases
47
Monobactams (Aztreonam) - 2 special characteristics
1. no cross-allergenicity with penicillins
| 2. Synergistic with aminoglycosides
48
Monobactams (Aztreonam) - clinical use
1. Gram (-) robs ONLY (no anaerobesm no gram (+))
| For penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides
49
Monobactams (Aztreonam) - side effects
usually nontoxin --> occasional GI upset
50
Monobactams (Aztreonam) - β-lactamases
less susceptible
51
Carbapenems (Doripenem, Ertapenem, Imipenem, Meropenem) - β-lactamases
resistant
52
Antimicrobial therapy - Cell wall synthesis drugs - divided to
1. Peptidogylcan synthesis drugs
| 2. Peptidoglycan cross linking
53
Antimicrobial therapy - Cell wall synthesis drugs - groups and drugs
glycopeptides:
1. Bacitracin
2. Vancomycin
54
Vancomycin - mechanism of action
inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors
BACTERICIDAL
not susceptible to β-lactamases
55
Vancomycin - clinical use
```
gram (+) bugs only:
serious Multidrug resistance organisms, including:
- MRSA
- S. epidermidis
- Clostiridium difficle (oral)
- Enterococcus species
```
56
Vancomycin - toxicity
well tolerated
1. nephrotoxicity
2. ototoxicity
3. thrombophlebitis
4. red man syndrom (diffuse flushing)
57
red man syndrom - appearance, caused by, solution
- diffuse flushing
- it is caused by vancomycin
- pretreatment with antihistamines and slow infusion rate
58
Vancomycin - mechanism of resistance
occurs in bacteria via amino acid modification of D-ala D-ala to D-ala D-lac
59
Antimicrobial therapy - DNA topoisomerases - drugs
Fluroroquinolones: (-FLOXACIN) + enoxacin
1. CIPRO-
2. NOR-
3. LEVO-
4. O-
5. MOXI
6. GEMI-
7. ENOXACIN
60
Fluroroquinolones - drug that i not -floxacin
enoxacin
61
Fluroroquinolones - mechanism of action
inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV
BACTERICIDAL
62
Fluororoquinolones - clinical use
1. gram (-) robs of urinary and GI tracts (including Pseudomonas)
2. Neisseria
3. some gram (+)
63
Fluororoquinolones - toxicity
1. GI upset
2. superinfections
3. skin rash
4 .headache/dizziness
5. leg cramps and myalgias (less commonly)
6. Prolonged QT
7. tendonitis or tendon rupture (if >60 or prednisone)
8. contraindicated in pregnancy, nursing mothers, children under eighteen --> possible damage to cartilage
64
Fluororoquinolones - mechanism of resistance
1. chromosome encoded mutation in DNA gyrase
2. plasmid mediated resistance
3. efflux pumps
65
Antimicrobial therapy - damage DNA drug
metronidazole
66
metronidazole - mechanism of action
Forms toxic free radical metavolites in the bacterial cell that damage DNA.
BACTERICIDAL, ANTIPROTOZOAL
67
metronidazole - clinical use
1. Giardia
2. Entamoeba
3. Trichomonas vaginalis
4. Garndenella vaginalis
5. Anaerobes (Bacteroides, C. difficile)
6. H. pylori
68
metronidazole - adverse effects
1. Disulfiram-like reaction (severe flushing, tachycardia, hypertension) with alcohol
2. headache
3. metallic taste
69
Daptomycin - mechanism of action
lipopeptide that disrupt cell membrane of gram (+) cocci
70
Daptomycin - clinical use
1. S. aureus SKIN infection (esp MRSA)
2. bacteremia
3. endocarditis
4. VRE
71
Daptomycin to pneumonia
not used --> avidly binds to and is inactivated by surfactant
72
Daptomycin - toxicity
1. Myopathy
| 2. rhabdomyolysis
73
Antimicrobial therapy - protein synthesis - divisions and drugs
50S --> 1. Chloramphenicol 2. Clindamycin 3. Linezolid 4. Macrolides 5. Streptogramins
30S --> 1. aminoglycosides 2. Tetracyclines
74
Antimicrobial therapy - protein synthesis - mechanism of action
specifically target smaller bacterial ribosome (70S=30S+50S), leaving human ribosome (80S) unaffected
75
Aminoglycosides - drugs
1. Gentamycin
2. Neomycin
3. Amikacin
4. Tobramycin
5. Streptomycin
76
Aminoglycosides - mechanism of action
- irreversible inhibition of initiation complex through binding of the 30S subunit
- mRNA misreading
- Block translocation
BACTEROCIDAL /REQUIRE O2 FOR UPTAKE
77
Aminoglycosides - clinical use
1. severe gram (-) rob infection
2. Synergistic with β-lactam antibiotics
3. Neomycin for bowel surgery
78
Aminoglycosides - side effects
1. nephrotoxicity (worse with cephalosporins)
2. Neuromascular blockage
3. Ototoxicity (esp with loop diuretics)
4. Teratogen
79
Aminoglycosides - ototoxicity espc with
loop diuretics
80
Aminoglycosides - mechanism of resistance
Bacterial tranferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation
81
Tetracyclines - drugs
- CYCLINE
- tetracycline
- doxycycline
- minomycline
82
Tetracyclines - mechanism of action
bind 30S (A-site tRNA binding) and prevent attachment of aminoacyl-tRNA
BACTERIOSTATIC
LIMITED CNS PENETRATION
83
Tetracyclines - cns
limited penetration
84
doxycycline - special characteristic
it is fecally eliminated and can be used in patients with renal failure
85
Tetracyclines - co-administrations
do not take tetracyclines with milk (Ca2+), antiacids (Ca2+ or Mg2+), pr iron-containing preparations --> divalent cations inhibit drug's absorption in the gut
86
Tetracyclines - clinical use
1. Borrelia bugdorferi
2. M. pneumoniae
3. Rickettsia
4. Chlamydia
5. acne
6. Ehrichiosis/Anaplasmosis
7. Q fever
87
Tetracyclines - effective against Rickettsia and chlamydia because of
their ability to accumulate intracellulary
88
Tetracyclines - renal failure
doxycycline is fecally eliminated and can be used in patients with renal failure
89
Tetracyclines - toxicity
1. GI distress
2. discoloration of teeth and inhibition of bone growth in children
3. photosensitivity
4. Contraindicated in pregnancy
90
Tetracyclines - mechanism of resistance
decreased uptake or increased efflux out of bacterial cells by plasmid-encoded transport pumps
91
Antimicrobial therapy - protein synthesis - 30S inhibitors (and bactericidal or bacteriostatic)
```
1. Aminoglycosides (bactericidal)
2 Tetracyclines (bacteriostatic)
```
92
chloramphenicol - mechanism of action
block peptidyltranferase at 50S ribosomal subunit
| Bacteriostatic
93
chloramphenicol - clinical use
1. meningitis (H. infl, N. meningitis, S. pneumoniae)
2. Rocky Montain spoted fever (R. ricketsi)
Limited use owing to toxicities but often still used in developing countries (low cost)
94
chloramphenicol - toxicity
1. anemia (dose dependent)
2. aplastic anemia (dose independent)
3. gray baby syndrome
95
chloramphenicol - gray baby syndrome - mechanism
in premature infants because they lack liver UDP-glucuronyl tranferase
96
chloramphenicol - mechanism of resistance
plasmid-encoded acetyltranferase inactivates the drug
97
Clindamycin - mechanism
blocks peptide transfer (translocation) at 50S ribosomal subunit.
BACTERIOSTATIC
98
Clindamycin - clinical use
1. anaerobic infections in aspiration pneumonia, lung abscess, oral infection
2. invasive A streptococcal infection
3. Gardenella vaginalis
99
metronidazole vs clincamycin according to clinical use
treats anaerobic infection below diaphragm with metronidazole and above diaphragm with clindamycin
100
Clindamycin - toxicity
1. pseudomembranous colitis
2. fever
3. diarrhea
101
Oxalinezolid - drugs
Linezolid
102
Linezolid - mechanism of action
it inhibits protein synthesis by binding to 50S subunit and preventing formation of the initiation complex
103
Linezolid - clinical use
gram (+) species MRSA and VRE
104
Linezolid - toxicity
1. bone marrow suppression (esp thrmbocytopenia)
2. peripheral neuropathy
3. seretonin syndrome
105
Linezolid - mechanism of resistance
point mutation of ribosomal RNA
106
Macrolides - drugs
1. Azythromycin
2. Clarithromycin
3. Erythromycin
107
Macrolides - mechanism of action
bind to the 23S rRNA of the 50S ribosomal subunit
--> inhibit protein synthesis by blocking translocation
BACTERIOSTATIC
108
Macrolides - clinical use
1. Atypical pneumonias (Mycoplasma, chlamydia, legionalla
2. STI (chlamydia)
3. Gram (+) cocci (streptococcal infections in patients allergic to penicillin)
4. B. pertusis
109
Macrolides - resistance
methylation of 23S rRNA-binding site prevents binding of drug
110
Macrolides - side effects
1. GI uspet 2
2. Arrhytmia (long QT)
3. Acute cholestatic hepatitis
4. Rash
5. eosinophilia
6. increased serum levels of theophyllines, oral anticoagulants
7. inhibit P-450 (clarithromycin and erythrmicycin)
8. contraindicated in pregnancy (embryotoxic)
111
macolides - P-450
clarithromycin and erythrmicycin inhibit P-450
112
Antimicrobial therapy - protein synthesis - divisions and drugs (bactericidal or bacteriostatic)
50S --> 1. Chloramphenicol (bacteriostatic) 2. Clindamycin (bacteriostatic) 3. Linezolid (variable) 4. Macrolides (bacteriostatic) 5. Streptogramins
30S --> 1. aminoglycosides (bactericidal 2. Tetracyclines (bacteriostatic)
113
Streptogramins - drugs
1. Dalfopristin
| 2. Quinupristin
114
Antimicrobial therapy - Folic acid synthesis - drugs
1. Sulfonamides: a. sulfadiazine b. sulfamethoxazole (SMX)
c. sulfisoxazole
2. Trimethoprim (or pyrimethamine)
3. dapsone
115
Tetrahydrofolic acid (THF) synthesis pathway
```
PABA + Pteridine --> Dihydropteroic acid (Dihydropteroate syntase) --> Didhydrofolic acid -->
Tetrahydrofolic acid (THF) (Dihydrofolate reductase)
```
116
Tetrahydrofolic acid (THF) can give rise to
1. Purines (DNA, RNA)
2. Thymidine (DNA)
3. Methionine (Protein)
117
Trimethoprim - mechanism of action
inhibits bacterial dihydrofolate reductase
| BACTERIOSTATIC
118
dihydrofolate reductase - action
```
Didhydrofolic acid -->
Tetrahydrofolic acid (THF)
```
119
Trimethoprim - clinical use
in combination with sulfonamides (TMP-SXM) --> seqential block of folate syntesis -->
1. UTI 2. Shigella 3. Salmonella 4. P. jorovecii (treatment and prophyaxis) 5. toxoplasmosis prophylaxis
120
Trimethoprim - toxicity
1. megaloblastic anemia
2. leukopenia
3. granulocytopenia
MAY ALLEVIATE WITH SUPPLEMENTAL FOLINIC ACID
121
Tetrahydrofolic acid (THF) synthesis pathway - PABA?
Para-aminobenzoic acid
122
Tetrahydrofolic acid (THF) synthesis pathway
```
PABA + Pteridine --> Dihydropteroic acid (Dihydropteroate syntase) --> Didhydrofolic acid -->
Tetrahydrofolic acid (THF) (Dihydrofolate reductase)
```
123
Antimicrobial therapy - Folic acid synthesis - drugs
1. Sulfonamides: a. sulfadiazine b. sulfamethoxazole (SMX)
c. sulfisoxazole
2. Trimethoprim (or pyrimethamine)
124
Sulfonamides - drugs
a. sulfadiazine
b. sulfamethoxazole (SMX)
c. sulfisoxazole
125
Sulfonamides - mechanism of action
```
PABA antimetobolites (analog) inhibit dihydropteroate synthase
BACTERIOSTATIC (BACTERICIDAL when combined with trimethoprim)
```
126
Sulfonamides - clinical use
1. Gram-positives
2. Gram-negatives
3. Nocardia
4. Chlamydia
5. simple UTI (TRIPLE SULFAS or SMX)
127
Sulfonamides - toxicity
1. hypersensitivity 2. G6PD hemolysis
3. nephrotoxicity (tumbulointestinal nephritis)
4. photosensitivity 5. kernicterus (infants)
6. displace other drug from albumin (eg. warfarin)
128
Sulfonamides displaces other drugs from albumin - example
warfarin
129
Sulfonamides - nephrotoxicity?
tumbulointestinal nephritis
130
Sulfonamides - mechanism of resistance
1. altered enzyme (bacterial dihydropteroate syntase)
2. decreased uptake
3. increased PABA synthesis
131
Dapsone mechanism of action and side effects
similar to sulfonamides, but structurally distinct agent
| Hemolysis if G6PD deficiency
132
Dapsone clinical use
1. Leprosy (leptromatous and tuberculoid)
| 2. Pneumocystis jorovecii prophylaxis
133
botulism treatment
antitoxin
134
pseudomembranous colitis - treatment
metronidazoleo or oral vancomycin
| For recurrent cases, consider repeating prior regimen, fidaxomicin, or fecal microbiota transplant
135
Listeria monocytogenes - treatment
1. gastroenteritis is self limited
| 2. ampicillin in infants, immunocompromised, and the elderly as empirical treatment of meningitis
136
actinomyces vs Nocardia according to treatment
MNEMONIC: SNAP --> Sulfa - Nocardia / Actinom - Penicillin
Acinomyces --> penicillin
Nocardia --> sulfonamides
137
C. tetani - therapy
Prevent with tetanus vaccine
| treat with antitoxin +/- vaccine booster and diazepam (for muscle spasms)
138
neisseria gonococci vs neisseria meningitis - treatment
neisseria gonococci --> ceftriaxone + (azithromycin or doxycycline) for possible chlamydial coinfection
neisseria meningitis --> ceftraxone or penicillin G
139
neisseria gonococci vs neisseria meningitis - prevention
neisseria gonococci --> condoms (for STD), erythromycin ointment (neonatal transmision)
neisseria meningitis --> Rifampin, ciprofloxacin or ceftriaxone prophylaxis in close contacts
140
H. influenza - treatment/prophylaxis
1. mucosal infection --> amoxicillin +/- clavulanate
2. meningitis --> ceftriaxon.
prophylaxis --> rifampin
141
Legionella - treatment
macrolide or quinolone
142
Pseudomonas aeroginosa - treatment
1. extended spectrum β-lactams (eg piperacillin, ticarcillin, cafepime)
2. Carbapenems (eg imipenem, meropenem)
3. Monobactams (eg aztreonam)
4. Fluoroquinolones (eg ciprofloxacin)
5. Aminoglycosides (eg. gentamycin, tobramicin)
6. For multidrug resistant stains --> colistin, polymyxin B
143
typhoid fever - treatment
ceftriaxone or flouroquinolone
144
Helicobacter pylori - treatment
MC initial treatment:
| PROTON PUMP INHIBITOR + CLARITHROMYCIN + AMOXICILLIN (or metronidaxzole if penicillin allergy)
145
Lyme disease - treatment
1. doxycycline
| 2. ceftriaxone
146
how to prevent congenital syphilis
treat mother early in pregnancy, as placental transmission occurs after first trimester
147
patients with + culture of Streptococcus agalactiae -->
receive intrapartum penicillin for prophylaxis
148
Gardnerella vaginalis - treatment
metronidazole or clindamycin
149
Typhus treatment
all vector-borne illness - rash common and rash rare diseases --> doxycycline
150
Q fever treatment
all vector-borne illness - rash common and rash rare diseases --> doxycycline
151
Chlamydia - treatment
azythromycin (favored because in time treatment) or doxycycline
152
Lymphogranuloma venereum - treatment
doxycycline
153
Mycoplasma pneumoniae - treatment
macrolides, doxycycline, or fluoroquinolone
154
antimicrobial prophylaxis - high risk for endocarditis and undergoing surgical or dental procedures
amoxicillin
155
antimicrobial prophylaxis - exposure to gonorrhea
ceftriaxone
156
antimicrodial prophylaxis -history of reccurent UTIs
TMP-SMX
157
antimicrobial prophylaxis - exposure to meningococcal infection
ceftriaxone, ciprofloxacin or rifampin
158
antimicrodial prophylaxis - Pregnant woman carrying group B strep
Penicillin G
159
antimicrobial prophylaxis - prevention of gonococcal conjuctivitis in newborn
Erythomycin oitment
160
antimicrobial prophylaxis - prevention of postsurgical infection due to S. aureus
Cefazolin
161
antimicrobial prophylaxis - prophylaxis of strep pharyngitis in child with prior rheumatic fever
Benzathine penicillin G
or
oral penicillin V
162
antimicrobial prophylaxis - Exposure to syphilis
Benzathine penicillin G
163
antibiotic for bowel surgery
neomycin
164
Antibiotics to avoid in pregnancy (and why)
1. Sulfonamides --> Kernicterus
2. Amniglycosides --> Ototoxicity
3. Fluoroquinolones --> Cartilage damage
4. macrolides --> embryotoxic
5. tetracyclines --> DIscolored teeth, inhibiton of growth
6. Chloramphenicol --> Gray babe syndrome
7. Griseofluvin --> teratogenic
8. Ribavirin (antiviral)
165
non bacterial antibiotics to avoid in pregnancy
1. Griseofluvin --> teratogenic
| 2. Ribavirin (antiviral)
166
antibiotic that causes kernicterus if used during pregnancy
Sulfonamides
167
Treatment of highly resistant bacteria
MRSA: vancomycin, daptomycin (esp skin), linezolid, tigecycline, ceftaroline
VRE: linezolid and streptogramins (quinupristin, dalfopristin)
Multidrug-resistant P. aeruginosa: polymixins B and E (Colistin)
Multidrug-resistant Acinetobacter baumannii: polymixins B and E (Colistin)
168
Treatment of MRSA
vancomycin, daptomycin (esp skin), linezolid, tigecycline, ceftaroline
169
treatment of VRE
linezolid and streptogramins (quinupristin, dalfopristin)
170
treatment Multidrug-resistant P. aeruginosa
polymixins B and E (Colistin)
171
treatment of Multidrug-resistant Acinetobacter baumannii
polymixins B and E (Colistin)
172
antibiotics - prophylaxis in HIV patients (and why)
CD4 under 2 hundred --> TMP-SMX (pneumocysts)
CD4 under 1 hundred --> TMP-SXM (pneumocysts and toxoplasmosis)
CD4 under fifty --> Azithromycin or clarythromycin (M. avium complex)
173
antibiotics - prophylaxis in HIV patients (and why) - under 2 hundred
TMP-SMX (pneumocysts)
174
antibiotics - prophylaxis in HIV patients (and why) - under 1 hundred
TMP-SXM (pneumocysts and toxoplasmosis)
175
antibiotics - prophylaxis in HIV patients (and why) - under fifty
Azithromycin or clarythromycin (M. avium complex)
