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Infection > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

Factors to consider with regard to principles of prescribing

A 
Indication for antimicrobials 
Clinical diagnosis and severity assessment 
Patient characteristics 
Antimicrobial selection
Regimen selection 
Liaison with laboratory
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2
Q

Common side effects/toxicities of antimicrobials

A 
Allergic reactions 
GI 
Candida 
Liver 
Renal 
Neurological 
Haematological
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3
Q

Mechanisms of antibiotic resistance

A

Alteration of target site to reduce/eliminate the binding of a drug
Destruction or inactivation of antibiotic
Blockage of transport of antibiotic into the cell
Metabolic bypass

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4
Q

Pathogens with increasing resistance in hospitals

A

MRSA (methicillin resistant staph aureus)
MRSE (methicillin resistant staph epidermidis)
VRE (vancomycin resistant enterococcus)
VISA/GISA (vancomycin intermediate staph aureus)
ESBL (extended spectrum beta-lactamase gram -ve)
Multiresistant TB

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5
Q

Pathogens with increasing resistance in the community

A 
HIV 
Food borne e.g. salmonella, shigella, H. pylori 
Malaria 
Pneumococcus 
Hep B and C 
E. coli O157 
Lyme disease 
Legionnaire's
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6
Q

Antimicrobial therapy options

A

Empiric - without microbiology results

Directed - based on microbiology results

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7
Q

Antimicrobial prophylaxis options

A

Primary e.g. antimalarial, post-op, PEP

Secondary e.g. to prevent second episode

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8
Q

Methods of diagnosis

A

Clinical
Laboratory
Severity assessment

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9
Q

Patient characteristics affecting prescription

A 
Age 
Renal function 
Liver function 
Immunocompromised
Pregnancy 
Known allergies
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10
Q

Factors to consider when selecting antimicrobial

A 
Guideline or individualised therapy 
Likely organism 
Empirical therapy or result-based therapy 
Bactericidal vs bacteriostatic drug 
Single or combination therapy 
Potential adverse effects
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11
Q

What should antibiotic selection be based on?

A

The known, or likely, causative organism

Likelihood of antibiotic resistance should also be considered

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12
Q

Features of bactericidal antimicrobials

A

Kill the bacteria
Act on cell wall
Indications include neutropenia, meningitis and endocarditis

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13
Q

Features of bacteriostatic antimicrobials

A

Inhibit bacterial replication by inhibiting protein synthesis and prevent colon growth
Require the host immune system to “mop up” residual infection
Useful in toxin-mediated illness

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14
Q

Give an example of a class of bactericidal and bacteriostatic antimicrobial

A

Bactericidal - beta-lactams

Bacteriostatic - macrolides

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15
Q

Advantages of single therapy

A

Simpler
Fewer side effects
Fewer drug interactions

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16
Q

Circumstances in which combination therapy is indicated

A

HIV and TB therapy
Slow organism turnover
Severe sepsis
Mixed infecting organisms

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17
Q

Factors to consider in regimen selection of antimicrobial therapy

A 
Route of administration 
Dose 
Adverse effects 
Duration 
IV to oral SWITCH therapy 
Inpatient or outpatient therapy 
Therapeutic drug monitoring
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18
Q

Contraindications for oral therapy

A 
Difficulty swallowing 
Malnourishment 
Vomiting 
Abnormal GI function 
Shock
Organ dysfunction
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19
Q

What is the oral bio-availability

A

Ratio of drug level when given orally compared with the level when given IV

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20
Q

When is the IV route advisable

A

Severe or deep-seated infection

Where oral route is not reliable

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21
Q

When is liaison with laboratory necessary

A

Sending appropriate and relevant specimens
Receiving results
Monitoring

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22
Q

What is antimicrobial stewardship?

A

Making the best use of current antimicrobials

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23
Q

Antimicrobial management team

A 
Antibiotic pharmacists 
Infectious disease doctors 
Acute medicine
Medical microbiology 
Infection prevention and control 
GP
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24
Q

Classes of antimicrobials commonly used

A 
Penicillins 
Cephalosporins 
Aminoglycosides 
Glycopeptides 
Macrolides 
Quinolones 
Other antibiotics 
Antifungals 
Antivirals 
Immunoglobulin
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25
Q

Mechanisms of action of antimicrobials

A

Inhibition of cell wall synthesis
Inhibition of protein synthesis
Inhibition of nucleic acid synthesis

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26
Q

Antimicrobial classes which inhibit cell wall synthesis

A

Beta lactams

Glycopeptides

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27
Q

Antimicrobial classes which inhibit protein synthesis

A

Aminoglycosides
Macrolides
Tetracyclines
Oxazolidinones

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28
Q

Antimicrobial classes which inhibit nucleic acid synthesis

A

Trimethoprim
Sulphonamides
Quinolones

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29
Q

Activity and main uses of bezylpenicillin/penicillin V

A

Streptococci
Neisseria
Spirochetes

Soft tissue, pneumococcal, meningococcal, gonorrhoea and syphilis infections

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30
Q

Activity and main uses of amoxicillin

A

Broad spectrum

UTI
RTI

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31
Q

Activity and main uses of flucloxacillin

A

Staphylococci

Staph aureus infection

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32
Q

Activity and main uses of co-amoxiclav

A

Broad spectrum (including anaerobes)

UTI
RTI
Soft tissue and surgical wound infections

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33
Q

Activity and main uses of piperacillin/tazobactam

A

Broad spectrum (including pseudomonas and anaerobes)

Neutropenic sepsis

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34
Q

Activity and main uses of Cefradine

A

Broad spectrum

UTI and soft tissue infection (first line)

35
Q

Activity and main uses of Cefuroxime

A

Broad spectrum

UTI, RTI, surgical prophylaxis

36
Q

Activity and main uses of Ceftriaxon/cefotaxime

A

Broad spectrum, especially effective against gram negative bacilli

Hospital infections e.g. bacteraemia, pneumonia, abdominal sepsis

37
Q

Activity and main uses of Ceftazidime

A

Broad spectrum, particularly against gram negative bacilli and also active against pseudomonas

Pseudomonal infections in hospital patients and in cystic fibrosis patients

38
Q

Activity and main uses of gentamicin/amikacin

A

Gram negative bacilli

Serious gram negative infections e.g. bacteraemia, endocarditis, neutropenic sepsis

39
Q

Activity and main uses of clarithromycin/erythromycin

A

Streptococci, staphylococci, mycoplasma, chlamydia, legionella

Respiratory and soft tissue infection (if penicillin allergic)
STD

40
Q

Activity and main uses of azithromycin

A

Relatively better for gram negatives such as haemophilus, chlamydia

Chlamydia

41
Q

Activity and main uses of ciprofloxacin

A

Gram negative bacilli including pseudomonas, some activity against staphylococci and streptococci

Complicated UTI
Complicated hospital acquired pneumonia
Some GI infections

42
Q

Activity and main uses of levofloxacin/moxifloxacin

A

Enhanced activity against staph/strep, less against pseudomonas
Active against pneumococcus, mycoplasma, chlamydia and legionella

2nd or 3rd line for pneumonia

43
Q

Activity and main uses of vancomycin/teicoplanin

A

Gram positive bacteria only

MRSA
Patients allergic to penicillin
C. difficile

44
Q

Activity and main uses of trimethoprim

A

Gram negative bacilli, some activity against staph/strep

UTI
Respiratory infection
MRSA

45
Q

Activity and main uses of co-trimoxazole

A

Broad spectrum, pneumocystis jiroveci

Soft tissue infection, gangrene

46
Q

Activity and main uses of clindamycin

A

Strep, staph, anaerobes

Soft tissue infection, gangrene

47
Q

Activity and main uses of tetracycline/doxycycline

A

Strep, staph, chlamydia, rickettsiae, brucella

Q fever 
Brucellosis 
Chlamydia 
Atypical pneumonia 
MRSA
48
Q

Activity and main uses of Rifampicin

A

Mycobacteria, meningococcus, staph

TB
MRSA
meningococcal prophylaxis
complicated staph infections

49
Q

Activity and main uses of meropenem

A

Broad spectrum (broadest) including anaerobes and pseudomonas

2nd or 3rd line for hospital infections

50
Q

Activity and main uses of metronidazole

A

Anaerobes, protozoa

Surgical infections, giargiasis, amoebiasis, trichomonal infections

51
Q

Activity and main uses of linezolid

A

Gram positive bacteria only

2nd line agent for MSSA, MRSA, VRE

52
Q

Activity and main uses of daptomycin

A

Gram positive bacteria only

2nd line agent for MSSA, MRSA, VRE

53
Q

Activity and main uses of tigecycline

A

Very broad spectrum including MRSA, ESBL and anaerobes

3rd line for intra-abdominal sepsis
Soft tissue infections

54
Q

Allergic reaction types

A

Immediate hypersensitivity e.g. anaphylactic shock

Delayed hypersensitivity e.g. rash, drug fever, SJS

55
Q

Common GI adverse effects

A

Nausea
Vomiting
Diarrhoea
C. diff infection

56
Q

Causes of candida infections

A

Broad spectrum penicillins, cephalosporins

57
Q

Causes of liver adverse effects

A

All drugs, particularly tetracyclines and TB drugs

More likely if pre-existing liver disease

58
Q

Causes of renal adverse effects

A

Gentamicin and vancomycin

More likely if pre-existing renal disease or on nephrotoxic medications

59
Q

Neurological adverse effects and their causes

A

Ototoxicity - gentamicin, vancomycin

Optic neuropathy - ethambutol

Convulsions, encephalopathy - penicillins and cephalosporins

Peripheral neuropathy - isoniazid, metronidazole

60
Q

Haematological adverse effects and their causes

A

Marrow toxicity

Megaloblastic anaemia - co-trimoxazole

61
Q

What kind of pathogens are viruses?

A

Obligate intracellular

62
Q

How do viruses replicate?

A

Utilise host cell enzymes in order to replicated

63
Q

What stages of virus life cycle do most antivirals target?

A

Intracellular stages

64
Q

What type of drug are most antivirals?

A

Nucleoside analogues (inhibit nucleic acid synthesis)

65
Q

When might antiviral treatment be given?

A

Prophylaxis e.g. acyclovir for herpes
Pre-emptive therapy e.g. interferon/ribavarin for HCV
Overt disease e.g. acyclovir, oseltamivir
Suppressive therapy e.g. antiretrovirals

66
Q

In what diseases is suppressive treatment needed?

A 
Herpes viruses HSV1 and 2, VZV, CMV
HIV 
Hepatitis B 
Hepatitis C 
Respiratory e.g. influenza
67
Q

In what circumstances are antivirals used for herpes simplex?

A

Mucocutaneous involvement e.g. oral, genital, eyes
Encephalitis
Immunocompromised patients

68
Q

In what circumstances are antivirals used for chickenpox?

A

In those at increased risk of complications or in the immunocompetent adult (within 24 hours of rash onset)

69
Q

In what circumstances are antivirals used for shingles?

A

Within 72 hours of onset of symptoms

70
Q

Antivirals used for HSV and VZV

A

Aciclocir
Valaciclovir
Famciclocir
Foscarnet

71
Q

Aciclovir mode of action

A

Converted by viral thymidine kinase to ACVMP
ACVMP converted by host cell kinases to ACV-TP
ACV-TP completely inhibits and inactivated HSV-specific DNA polymerase

72
Q

When have antivirals to be used in CMV?

A

Only to treat life-threatening or sight-threataening CMV infections
In neonates with symptomatic congenital CMV infection

73
Q

Antivirals used for CMV

A

Ganciclovir
Valganciclovir
Cidofovir
Foscarnet

74
Q

Antivirals used for chronic hepatitis B

A 
Pegylated interferon alpha 
Nucleoside/nucleotide analogues
Tenofovir
Adefovir
Entecavir
Lamivudine
Emtricitabine
Telbivudine
75
Q

Antivirals for chronic hepatitis C

A

Pegylated interferon alpha and ribavarin (may also add protease inhibitor e.g. telaprevir or boceprevir)

Daclatasvir, sofosbuvir, simeprevir

76
Q

Antivirals used for influenza A or B

A

Oseltamivir

Zanamivir

77
Q

Antiviral used in HSV and CMV resistant to aciclovir

A

Foscarnet

78
Q

When is HIV resistance testing performed?

A

At a baseline diagnosis, failing therapy, or as a new treatment approach required for other reasons

79
Q

When do trough and peak levels for aciclovir need to be monitored?

A

In patients with renal impairment

80
Q

Classes of antifungals

A

Azoles
Polyenes
Echinocandins
Terbinafine

81
Q

Uses of Azoles

A

Fluconazole - candida
Itraconazole - candida and aspergillus
Voriconazole - candida and aspergillus

82
Q

Uses of polyenes

A

Amphotericin - candida and aspergillus

Nystatin - candida

83
Q

Uses of echinocandins

A

Caspofungin, anidulafungin, micafungin - candida and aspergillus

84
Q

Uses or terbinafine

A

Tinea, nail infection

Infection (14 decks)

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