Antimicrobials

Question 1

Is bactericidal better than bacteriostatic?

Answer 1

Nope! Equal

Question 2

Do greater concentrations kill bacteria faster or in greater numbers?

Answer 2

NOPE

Question 3

Does vancomycin work on gram-positive or gram-negative bacteria?

Answer 3

gram-positive

Question 4

What are the 3 main nosocomial infections?

Answer 4

Urinary
Respiratory
Blood

Question 5

What devices are associated with nosocomial infections?

Answer 5

Ventilator
Vascular access catheter
Urethral catheter

Question 6

Which central lines cause the most infections?

Answer 6

Femoral> I.J. >Subclavian

Question 7

Primary cause of c-diff?

Answer 7

clindamycin

Question 8

What is the treatment for c-diff?

Answer 8

Oral vancomycin

Dificid (fidaxomicin)- similar cure rates as vanco, reduced recurrence for moderate to severe infection

Question 9

What are the risk factors for c-diff?

Answer 9

Antimicrobial use
Acid suppressant therapy
Inappropriate handwashing and cleaning techniques

Question 10

Do you always need surgical antibiotic prophylaxis?

Answer 10

NO.

Also, usually not necessary to continue past the 1st Post-op day

Usually use 1st generation cephalosporin (cefazolin)

Question 11

Wound classification

Answer 11

Class I: Clean (1.3-2.9%)
Atraumatic
No break in sterile technique
Respiratory, G.I., and G.U. tracts not entered

Class II: Clean-Contaminated (2.4-7.7%)
Surgery in areas known to harbor bacteria
no spillage of contents

Class III: Contaminated (6.4-15.2%)
Major break in sterile technique
Surgery on traumatic wounds
Gross G.I. spillage
Entrance into an infected biliary or G.U. tract

Class IV: Dirty-Infected (7.1-40%)
Infection existed before the surgery
Old wound with devitalized tissue
Perforated viscera

Question 12

Is prophylaxis for fungal infections proven to always work?

Answer 12

Efficacy of prophylaxis is difficult to prove

Question 13

When do you give ancef, and when do you give vanco for prophylaxis?

Answer 13

Ancef 60 minutes
Vanco 120 minutes

Question 14

Is increasing duration of antimicrobial prophylaxis associated with higher odds of AKI and C difficile infection in a duration-dependent fashion?

Answer 14

YES. Increasing prophylaxis is bad.

Question 15

What is the half life of cefazolin, clindamycin, and vanomycin?

Answer 15

Cefazolin: 2 hrs, so dose at 4hrs
Clindamycin: 3 hrs, so dose at 6 hrs
Vancomycin: 12 hours..so..unecessary

Question 16

Do beta-lactamase Inhibitors have any antimicrobial effect on their own?

Answer 16

NO

Question 17

Which group of antibiotics causes Jarisch-Herxheimer rxn – looks like a tick infection (high fevers and rash)?

Answer 17

Penicillins

Question 18

Do patients with a penicillin allergy have an increased risk of SSI?

Answer 18

YES, about 50% higher

Question 19

Which antibiotic can you give if someone has a penicillin allergy?

Answer 19

Cefazolin
Vancomycin

Question 20

Which infections are higher in patients with a penicillin allergy?

Answer 20

MRSA and C.difficile

Question 21

What are the two strongest cephalosporins that cover basically everything?

Answer 21

Ceftaroline (Teflaro) and Cefiderocol (Fetroja)

Question 22

What is the drug of choice for MRSA?

Answer 22

Vanco

Question 23

Side effects of vanco?

Answer 23

Red-Man, nephrotoxicity, ototoxicity, TTP (thrombocytopenia)

Question 24

Which antibiotic can cause serotonin syndrome because of an interaction with MAO, and also causes myelosuppression (anemia, leukopenia)?

Answer 24

Linezolid (Zyvox)

Question 25

Which antibiotic can cause QT prolongation?

Answer 25

Azithromycin (Zithromax)

Macrolides (azithromycin, clarithromycin, erythromycin)

Question 26

Which antibiotic is a potent inhibitor of cyp3a4?

Which antibiotic can prolong QT?

Answer 26

Cypa3a4 - Clarithromycin (Biaxin)

Prolong QT - azithromycin

Macrolide family

Question 27

Which antibiotic has increases the risk for tendonitis – rupture of achilles tendon, neurologic – seizures, confusion, and severe hypoglycemia and increased Morbidity/mortality

Answer 27

Fluoroquinolones

Question 28

Which antibiotic should be last line because of the multiple FDA warnings?

Answer 28

Fluoroquinolones

Question 29

Which fluroquinolone is the first fluoroquinolone antibiotic with activity against methicillin-resistantStaphylococcus aureus(MRSA) and, unlike the other fluoroquinolones, is not associated with QT prolongation or photosensitivity.

Answer 29

Delafloxacin (Baxdela)

Dela”firstfluroquinolone”oxacin

Question 30

Which antibiotic causes inhibition of bone growth (2nd/3rd trimester through the age of 8), hepatotoxicity, tooth discoloration and enamel hypoplasia

Answer 30

Tetracyclines

(doxycycline)

Question 31

Which antibiotic works on acne but has a host of negative side effects?

Answer 31

Doxycycline (Vibramycin)

Tetracycline family

Question 32

Which antibiotic interferes with DNA synthesis….Not enough folic acid

Answer 32

Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

Aminoglycoside

Question 33

Which med is used for patients with implanted device that is growing biofilms over it

Answer 33

Rifampin and Rifabutin

Also a potent inducer of the CYP 450 system with significant interactions
Rare hepatotoxicity, **orange-red body fluids
*Mostly for TB and prosthetics

Question 34

Which antibiotics are safest for use in pregnancy?

Answer 34

Penicillins, Cephalosporins, Erythromycin

Question 35

Which antibiotic in pregnant women is associated with acute fatty necrosis of the liver, pancreatitis, and possible renal injury?

Answer 35

Tetracycline

Question 36

Which antibiotics should you avoid in pregnancy?

Answer 36

Metronidazole, ticarcillin, rifampin, trimethoprim, fluoroquinolones, and tetracyclines

Question 37

What should you think when you hear antifungals?

Answer 37

anti-fungal – think drug interactions