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Inflammation > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

What are the types of antimicrobials?

A

Antibacterials => bactericidal, bacteriostatic
Antifungals => yeasts, moulds
Antivirals
Antiparasitics => helminths, protozoa, parasiticides

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2
Q

What are the 3 non pharmacological methods of treating infection?

A

Symptomatic relief only

Surgery/drainage => remove dead tissue and pus, send samples to lab to confirm cause

Improve host immunity or reduce/avoid immunosuppression

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3
Q

What are the consequences of inappropriate prescribing

A

Risk of increasing antimicrobial resistance
Side effects
Using IV when PO is more appropriate => increased risk of infection, costs
Unecassery costs

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4
Q

When should you use antibiotics

A

Essential for

  • limiting tissue spread, collateral damage
  • high mortality infections
  • shortening duration of pain, suffering
  • reduce complications of uncontrolled infection
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5
Q

How would you manage these common overprescription problems?

  • total course is too long
  • too much given IV
  • too broad spectrum
  • misuse of prophylaxis
A

Total course is too long => specific indication and stop date

Too much given IV => switch to PO at earliest opportunity

Too broad spectrum => select narrow spectrum agents

Misuse of prophylaxis => surgical prophylaxis (only needed immediately before and after)

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6
Q

What are the causative organisms for these infections

  • Gonorrhoea
  • Syphilis
  • Malaria
  • Typhoid
  • Lyme disease
  • TB
A 
Gonorrhoea => neisseria gonorrhoeae
Syphilis => treponema pallidum
Malaria => plasmodium species
Typhoid => salmonella typhi
Lyme disease => borrelia species
TB => mycobacterium tuberculosis
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7
Q

How would we test for antimicrobial susceptibility

A

Disc testing => test for sensitivity or resistance against antibiotics

Minimum inhibitory concentration
-lowest concentration of antibiotic that inhibits growth

Minimum bactericidal concentration
-lowest concentration that kills

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8
Q

How would you choose the drugs for treatment

-considerations you must make

A

Sensitivity of likely causative organism

Will drug reach the site of infection

What route is the most appropriate

Side effects and adverse effects of combinations

Cost

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9
Q 
What 3 drug classes are b lactams
How do they work
What types of bacteria do they work on?
Excretion?
Adverse reactions?
Resistance?
A

G+ve, -ve, anaerobic

Penicillins
Cephalosporins
Carbapenems

Anti cellwall activity => bactericidal

Renal

Crossreactivity with cephalosporins and carbopenems

Beta lactamase resistance

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10
Q

Which penicilins are

  • narrow spectrum
  • broad spectrum

What 3 penicillins are PO and IV

A

Narrow

  • Penicillin V (PO)
  • Penicillin G (IV)
  • Flucloxacillin (PO, IV)

Broad

  • Tazocin (IV) => against pseudomonas aeruginosa)
  • Amoxicillin, co-amoxiclav (PO, IV)
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11
Q

Which cephalosporins are

  • narrow spectrum
  • broad spectrum

What 2 cephalosporins are IV only
What cephalosporin is IV and PO

What risks are associated with cephalosporin use

A

Narrow

  • Cefalexin (PO)
  • Cefadroxil (PO)

Broad

  • Ceftazidime (IV) => against pseudomonas aeruginosa)
  • Ceftriaxone, cefotaxime (IV)
  • Cefuroxime (PO and IV)

Use increases risk of C diff colonisation

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12
Q

Which 2 carbapenems are

-broad spectrum

A

Broad

  • Ertapenem (IV)
  • Meropenem (IV) => pseudomonas aeruginosa
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13
Q

How do macrolides work

  • Gram?
  • Excretion?
  • Adverse reactions?
  • Resistance?
  • when would you use these

Name the 3 main macrolides
-which 2 have longer half lives and fewer SE

A

Binds to 50S ribosomal subunit => bacteriostatic

G+ve, -ve

  • penicillin allergies
  • vs staphylococci, streptococci (skin, throat infections)
  • atypical pneumonias

Hepatic

GI side effects

  • diarrhoea, nausea, vomiting, abdo pain
  • hepatitis

Alter target sites

Erythromycin (IV, PO)
Have longer half lives and fewer SE
-Clarithromycin (IV, PO)
-Azithromycin (PO)

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14
Q

How do tetracyclines work

  • Gram
  • Excretion?
  • Adverse reactions?
  • Resistance?
  • when would you use these

Name the 3 main tetracyclines

A

Bind to 30s ribosomal subunits => bacteriostatic

G+ve cocci, rods, atypicals

  • used in penicillin allergies with macrolide SE
  • resp tract, soft tissue infections
  • acts on atypical respiratory pathogens

Renally, GI

Esophageal ulceration
Photosensitivity
Incoorporated into children’s teeth

Broad spectrum but prone to resistance
Doxycycline
Oxytetracycline
Tigecycline

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15
Q

How do trimethoprim and co-trimoxazole work
-when would you use each one

What are the side effects of sulphonamides

A

Block synthesis of bacterial nucleotides in G+ve, G-ve

Trimethoprim => UTIs (bacteriostatic in isolation)
Co-trimoxazole (trimethoprim + sulfamethoxazole) => PJP, nocardias (bacteriocidal in combination)

Sulphonamides (sulfamethoxazole)

  • Steven Johnson syndrome
  • BM suppresion, aplasia
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16
Q

How do quinolones work

  • Gram?
  • Excretion
  • Adverse effects
  • Resistance
  • which 2 are better at handling G+ve
A

Bactericidal => inhibits DNA gyrase

G+ve, G-ve

Renal

CDiff risk

Quinolone cannot bind to mutated DNA gyrase

Ciprofloxacin
Respiratory quinolones (better G+ve cover)
-levofloxacin
-moxifloxacin

17
Q

How do aminoglycosides work

  • Gram?
  • Main use
  • Adverse effects
  • Excretion
  • Methods of resistance

Name the 4 main ones

A

Bactericidal => binds to 30S ribosomal unit in G-ve

G-ve septicemia, sepsis
Bacterial endocarditis
-synergistic with B lactams

  • reversible nephrotoxic => intrinsic AKI
  • permanenet ototoxic => VIII palsy
  • NMJ blockade => paralysis

Renal

Inactivated by aminoglycoside modifying enzymes

Gentamicin
Amikacin
Neomycin
Tobramicin

18
Q

How do glycopeptides work

  • Gram
  • Uses
  • Excretion
  • Adverse effects
  • Resistance

What are the 2 main ones

A

Inhibit cellwall peptidoglycan synthesis

G+ve only

FIRST LINE FOR MRSA, CDiff

Renal

Nephrotoxic
Ototoxic

Vancomycin cannot bind to altered cell wall peptides

Vancomycin
Teicoplanin

19
Q

Metronidazole

  • what kind of microbes would be affected
  • excretion
A

-Anerobes (trichomonas vaginalis), amoeba, protozoa

Destabilises bacterial DNA

Renal

20
Q

What bacteria do these ABx work on
Linezolid
-what kind of microbes would be affected

Daptomycin
-what is it effective against

Rifampicin

  • what is it effective against
  • in what 2 situations would you use this
A

G+ve

Linezolid

  • MRSA
  • glycopeptide resistant entercocci (VRE)

Daptomycin

Rifampicin

  • prosthetic infections
  • TB regimen
21
Q

Chloramphenicol

  • when would you use it
  • why is this not commonly used
A

Eye, ear infections
Life threatening haem influenza, typhoid infections

Bone marrow toxicity

22
Q

Fosfomycin
-when would you use it

Colistin
-what is the only indication for its use

A

Fosfomycin
-multi resistant G-ve infections (UTIs)

Colistin
Last line for G-ve

23
Q

Fidaxomicin

-what is the only indication for its use

A

Only for selected cases of severe/recurrent CDiff diarrhoea

24
Q

Fusidic acid

  • what is the only use
  • when would you use this in combination
A

Staphylococcal infection only

-if systemic, use with another anti staph drug

25
Q

Why do we have antibiotic resistant bacteria

Why do we face a massive problem

A

Rapid evolution via mutation
-DNA acquisition

ABx overuse

  • patient’s expectations
  • high dependency users

Lack of novel compounds

26
Q

What are the 3 methods of acquiring resistance genes

A

Conjugation => sex pili used to transfer genetic material
Transformation => uptake of free DNA
Transduction => DNA transfer via bacteriophages

27
Q

What are the 2 most common yeasts

  • where would they cause infection
  • in what situations would they cause infection
A

Candida albicans
Candida glabrata

Urinary tract
Intra abdo
Bloodstream

Immunocompromised due to

  • Solid organ transplant
  • Critical care environmnets
28
Q

What moulds would you have to be aware of

  • where would they cause infection
  • in what environments would infection be likely
A

Aspergillus

Sinusitis
Pulmonary
Disseminated

Immunocompromised due to

  • transplant
  • haematooncology
29
Q

What are the 3 groups of antifungals for systemic infections

-name some examples

A

Azoles

  • fluconazole
  • itraconazole
  • voriconazole
  • posaconazole

Echinocandins

  • caspofungin
  • anidulafungin
  • micafungin

Polyenes
-amphotericin

Inflammation (51 decks)

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