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Host Defense & Microbiology > Antimicrobials > Flashcards

Antimicrobials Flashcards

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2
Q

At what 3 points should an antimicrobial agent be administered/evaluated?

A
  1. empirical therapy choice based on patient assessment; 2. pathogen-specific therapy once pathogen is identified; 3. adjust for resistance once drug suscepitibilities known
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3
Q

how is empirical therapy selected?

A

consider probably/possible pathogens associated with type of disease process in your patient, factoring in personal risk factors, and decide on a broad spectrum antimicrobial

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4
Q

what are the 4 major factors that should be considered when choosing an empirical antimicrobial?

A

disease process, pathogen, host/patient, potential drugs

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5
Q

what sites are difficult to treat?

A

CNS, eye, infected vegetation on heart, bone

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6
Q

what type of antibiotic is most effective against diseases with toxin involvement?

A

antibiotics that inhibit protein synthesis (e.g. clindamycin)

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7
Q

what two components of the history are especially important in determining the etiologic agent?

A

exposure hx (travel, foods, animals, ill contacts) & infectious disease hx (recent infections, colonization with resistant pathogens)

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8
Q

what public health concerns are important to consider?

A

possible role of therapy to decrease duration of shedding or period of infectivity

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9
Q

aspects of patient demographic that are especially important when selecting empirical therapy

A

1) AGE, 2) Co-morbidities, 3) drug allergies & interactions

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10
Q

Don’t give _________ to someone with renal or liver dysfunction.

A

vancomycin, gentamicin

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11
Q

Don’t give _________ to someone with GI disease/abnormalities.

A

oral medications

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12
Q

Impact of the Antibiotic/Drug: What to Consider

A

side-effects, cost, administration, spectum of activity

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13
Q

General features of amoxicillin

A

Beta-lactam penicillin (inhibits wall synthesis); oral only

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14
Q

Amoxicillin is effective against?

A

many Streptococci, enterococcus, Gram negatives like haemophilus, E coli, Pasteurella

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15
Q

Use amoxicillin for?

A

minor respiratory infections such as otitis media, sinusitis, mild pneumonia

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16
Q

What are the best IV drugs for MSSA?

A

oxacillin/nafcillin

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17
Q

General features of augmentin

A

beta-lactam penicillin (amox) + beta-lactamase inhibitor (clav acid); oral formation

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18
Q

Augmentin is effective against?

A

same drugs as amoxicillin + anaerobes, MSSA

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19
Q

Use augmentin for?

A

minor respiratory infections, also dog/cat bites, pathogens resistant to amox due to beta-lactamase production

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20
Q

What is the IV equivalent for augmentin (oral)?

A

ampicillin/sulbactam (Unasyn)

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21
Q

Piperacillin/tazobactam (Zosyn) should be used against?

A

more resistant Gram negative bacteria and anaerobes

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22
Q

General features of ceftriaxone (Rocephin)

A

beta-lactam cephalosporin, 3rd generation; IV (or IM)

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23
Q

Ceftriaxone is effective against?

A

Gram neg rods, streptococci, some Gram + (but not MRSA, pseudomonas)

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24
Q

Use ceftriaxone for?

A

severe infections, including CNS infections (can add vanc if need more gram + coverage)

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25
Q

Ceftazidime and cefepime work well against?

A

pseudomonas

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26
Q

cephalexin (Keflex)

A

common oral 1st generation cephalosporin

27
Q

General features of azithromycin

A

macrolide (protein synthesis inhibitor); oral (also an IV form)

28
Q

Azithromycin is effective against?

A

mycoplasma, chlamydia, pertussis, “atypical” bacteria, respiratory bacteria (altho resistance problem)

29
Q

Use azithromycin for?

A

penicillin allergy, mycoplasma pneumoniae, chlamydia trachomatis, pertussis, etc.

30
Q

General features of clindamycin

A

lincosamide (protein synthesis inhibitor) that is given both orally and IV

31
Q

Clindamycin is effective against?

A

Lots of Gram+, many MRSA, anaerobes, NOT enterococcus

32
Q

Use clindamycin for?

A

Oral/dental infections, some Staph, toxin-producing bacteria

33
Q

Which drug is responsible for the majority of C. diff acquisition?

A

clindamycin!

34
Q

General features of vancomycin

A

glycopeptide (inhibits wall synthesis), IV (oral only for C diff)

35
Q

Vancomycin is effective against?

A

Most Gram+ bacteria, including MRSA and C. diff (except VRE)

36
Q

Use vancomycin for?

A

severe infections due to Gram + bacteria (add a cephalosporin for gram negative coverage)

37
Q

General features of metronidazole (Flagyl)

A

produces toxic nitrates in anaerobic bacteria; oral and IV

38
Q

Metronidazole is effective against?

A

Anaerobes

39
Q

Use metronidazole for?

A

Gut anaerobes, C. diff (if susceptible), combine to cover Gram neg gut

40
Q

General features of trimethoprim/sulfamethoxazole (Bactrim, Septra)

A

sulfonamide (inhibits folate synthesis), oral (also IV form)

41
Q

TMP-SMX is effective against?

A

variety of gram+ and gram-, some atyptical (pneumocystis-PCP)

42
Q

Use TMP-SMX for?

A

ear infections, UTI, staph skin infection, PCP prophylaxis

43
Q

General features of gentamicin

A

aminoglycoside (inhibits protein synthesis); IV only

44
Q

Gentamicin is effective against?

A

many gram-, some gram+ (synergistic with ampicillin)

45
Q

Use gentamicin for?

A

gram negative coverage; synergy against gram positives

46
Q

General features of levofloxacin

A

fluoroquinalone (impacts bacterial DNA synthesis), Oral & IV

47
Q

Levofloxacin is effective against?

A

Many Gram+ and Gram-

48
Q

Use levofloxacin (or ciprofloxacin) for?

A

adults with sinopulmonary infections, UTI, some skin infections

49
Q

Possible etiologic agents for lobar pneumonia

A
  1. Strep pneumoniae, 2. staph aureus; others: strep pyogenes, oral anaerobes, atypical pneumonias
50
Q

What empirical antibiotic should be used for lobar pneumonia?

A

Ceftriaxone (penicillin-resistant pneumococcae) + vancomycin (resistant gram+)

51
Q

Possible etiologic agents post-appendix rupture

A
  1. Gram negative enterics (E. Coli), 2. Anaerobes, 3. Enterococci
52
Q

What empirical therapy should be used for a ruptured appendix?

A

Amp+Gent+Metro or Zosyn

53
Q

Probable infectious etiologies for a bite wound

A

Pasteurella, Staph aureus, GAS, anaerobes

54
Q

Treat bite wound with?

A

augmentin unless found to be MRSA

55
Q

Empirical therapy for bacteremia, possible septic shock

A

vancomycin (gram +) + cefepime (for gram- rods)

56
Q

Probable infectious etiologies for pharyngitis

A
  1. strep pyogenes, 2. adenovirus, 3. EBV, etc.
57
Q

Empirical therapy for a patient with pharyngitis

A

Throat Culture/Rapid Strep Test –> if positive for RST then treat with penecillin, amox, etc.

58
Q

Treat GC with?

A

ceftriaxone

59
Q

Treat chlamydia with?

A

azithromycin (short course, less likelihood of yeast infection)

60
Q

Empirical therapy for osteomyelitis

A

MRSA treatment – vancomycin

61
Q

Possible etiologic agents in infant meningitis

A

E. Coli, GBS, listeria, HSV

62
Q

Empirical Rx for infant meningitis

A

Ampicillin + gentamicin or cefotaxime (ceftriaxone contraindicated in newborns)

Host Defense & Microbiology (19 decks)

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