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Infection > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

What are the principles of prescribing antimicrobial therapy? (7 points)

A
  1. indications
  2. making a clinical diagnosis (type of infection, severity)
  3. patient characteristics
  4. antimicrobial selection
  5. regimen selection
  6. liaison with lab (causative organism)
  7. antimicrobial stewardship
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2
Q

What are the indication for antimicrobials?

A

Based on microbiology results

Prophylaxis:
Primary: antimalarial, immunosuppressed, pre-op, post-exposure (e.g. HIV)
Secondary: to prevent a second episode

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3
Q

How is diagnosis and severity assessed?

A

Clinical, lab based diagnosis

Severity: e.g. sepsis assessed by qSOFA

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4
Q

What patient characteristics are considered when prescribing antimicrobials?

A 
Age
Renal and liver function
Immunocompromised
Pregnancy
Known allergies
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5
Q

What factors are considered for antimicrobial selection?

A 
Individualised therapy:
Likely organism(s)
Empirical therapy (without microbiology results) or result based
Bactericidal vs. bacteriostatic drug
Single agent vs. combination
Potential adverse effects
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6
Q

What are the common causative bacteria in soft tissue infections?

A 
Strep. pyogenes
Staph aureus
Strep group C or G
E. Coli
Pseudomonas
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7
Q

What are the common causative bacteria in pneumonia?

A

Streptococcus pneumonia
Haemophilus influenzae
Staphylococcus aureus
Klebsiella pneumonia

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8
Q

What are the considerations for single vs. combination therapy?

A

Single: simpler, fewer side effects, fewer drug interactions

Combination: HIV and TB therapy, severe sepsis, mixed organisms

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9
Q

What is the regimen selection?

A

Route of administration, dose, adverse effects, duration, IV to oral switch therapy, inpatient or outpatient therapy

Therapeutic drug monitoring is important

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10
Q

What are the factors to decide IV or oral antimicrobial administration?

A

Oral route only if they are not vomiting, no shock, no organ dysfunction and normal GI function

IV route for severe or deep infection and when oral route is not reliable

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11
Q

What is the different between bactericidal or bacteriostatic?

A

Bactericidal: act on well wall, kill organisms, indications e.g. meningitis, endocarditis

Bacteriostatic: inhibit protein synthesis, prevent colony growth, require host immune system to ‘mop up’ residual infection, useful in toxin-mediated illness

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12
Q

What are the types of adverse effects from microbial therapy?

A

Immediate hypersensitivity: anaphylactic shock

Delayed hypersensitivity: rash, drug fever, serum sickness, erythema nodosum

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13
Q

What are the types of adverse effects relating to specific systems?

A

GI: nausea, vomiting, diarrhoea due to C. diff infection

Candida (thrush)- caused by broad spectrum penicillins

Liver SE- esp caused by tetracyclines, TB drugs

Renal SE: gentamicin, vancomycin

Neurological:
Ototoxicity- gentamicin, vancomycin
Optic neuropathy- TB drug
Convulsions, encephalopathy- penicillins, cephalosporin
Peripheral neuropathy- isoniazid (TB), metronidazole
Haematological- marrow toxicity
+ anaemia caused by cotrimoxazole

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14
Q

What communication occurs with the laboratory during microbial infections?

A

Send culture/ serology
Receive results- sensitivity results
Monitoring- disease activity, therapeutic drug monitoring

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15
Q

What are the principles of antimicrobial stewardship?

A

Follow antimicrobial guidelines
Audit of quality of antimicrobial prescribing
Education

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16
Q

What are the 4 C’s associated with clostridium difficile infection?

What is the importance of them?

A

Ceftriaxone
Co-amoxiclav
Clindamycin
Ciprofloxacin

Outbreaks of C. diff due to overuse of broad spectrum Abx, therefore use needs restricted

17
Q

What are some classes of antibiotic therapy?

A 
B-lactams (penicillins + cephalosporins)
Aminglycosides
Macrolides
Quinolones
Glycopeptides
18
Q

What are the mechanisms of action of antibiotics?

A

Inhibition of cell wall synthesis= B lactams and Glycopeptides
Inhibiting protein synthesis within cell= akinglycosides, macrocodes, tetracyclines
Inhibition of nuclei acid synthesis= trimethoprim, sulphonamides, quinolones

19
Q

Give examples of penicillins and examples of their main uses

A

Benzylpenicillin= soft tissue infection, pneumococcal, meningococcal

Amoxicillin= UTI, RTI

Flucloxacillin= Staph. aureus

Co-amoxiclav= UTI, RTI, soft tissue infection, surgical wound infections. (note= C. diff risk)

20
Q

Give examples of Cephalosporins and examples of their main uses

A

Cefradine (1st generation)= UTI, soft tissue (note= resistance issue)

Cefuroxime (2nd)= UTI, RTI, surgical PPx

Ceftriaxone= HAI (note= MRSA + C. diff risk)

21
Q

Give example of an Aminoglycoside and examples of its main uses

A

Gentamicin= serious gram negative infections

Need to measure therapeutic levels: renal + ototoxicity

22
Q

Give examples of Macrolides and examples of their main uses

A

Clarithromycin= resp infection, soft tissue, STD

Erythromycin= as above

Azithromycin= chlamydia

23
Q

Give examples of Quinolones and examples of their main uses

A

Ciprofloxacin= complicated UTI, complicated HA pneumonia, some GI infections (note= C. diff risk + may affect growing cartilage)

Levofloxacin= 2nd/3rd line agent for pneumonia
(side effects same as above)

24
Q

Give an examples of a Glycopeptide and examples of its main uses

A

Vancomycin= MRSA, patients allergic to penicillin, C. diff infection (give oral vancomycin)

regular therapeutic monitoring due to nephrotoxicity

25
Q

Study the other specific Abx examples on word document

A 
e.g.
trimethoprim
co-trimoxazole
clindamycin
Doxycycline/ tetracycline
Rifampicin
Metronidazole
Linezolid
26
Q

What are the types of anti fungal drugs + their uses?

A

Azoles= candida + aspergillus
(e.g. Fluconazole)

Polyenes= candida + aspergillus
(e.g. Amphotericin)

Echinocandins= candida + aspergillus

Terbinafine= tinea, nails

27
Q

Describe how antivirals work

A

They target several stages of virus life cycle (mainly intracellular stages)

Most are nucleoside analogues (inhibit nucleic acid synthesis)

They do NOT eradicate virus from latently infected cells, e.g. herpes viruses, so after treatment of overt infection, suppressive treatment may be needed

28
Q

What types of antiviral treatments are there?

A

Prophylaxis
Pre-emptive (before symtpoms)
Overt disease (symptomatic)
Suppressive therapy (to limit viral replication)

29
Q

Give examples of antivirals in practice (what they are used for)

A

Aciclovir= HSV 1+2, VZV, CMV
Interferon/Ribavirin= Hep B+C
Oseltamivir, Zanamivir= influenza, RSV

30
Q

What cells do aciclovir drugs work on?

A

Aciclovir-like drugs are only active in herpes infected cell so that there is a low toxicity for uninfected cells

31
Q

All antivirals have significant toxicity. Therefore what examples should they be used in?

A

Only in life or sight-threatening infections

e.g. HIV patients: CMV retinitis, colitis
Transplant patients: pneumonitis

32
Q

What antiviral therapy is used for HIV?

A

Combination anti-retroviral therapy (cART)

33
Q

What antivirals are used for Hepatitis B + C?

A

Hep B= Pegylated interferon alpha, nucleoside analogues

Hep C= Pegylated interferon alpha + protease inhibitor

Infection (12 decks)

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