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Infection > Antimicrobials and Antimicrobial Stewardship > Flashcards

Antimicrobials and Antimicrobial Stewardship Flashcards

1
Q

What are the potential systems that could be used to classify antimicrobials?

A
  • Bactericidal vs. Bacteriostatic
  • Broad vs. Narrow Spectrum
  • Target site/ Mechanism of action
  • Chemical structure “Class”
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2
Q

Why is classification by bactericidal/bacteriostatic activity not the best way to classify antibmicrobials?

A

Depending on the dose, the same antimicrobial can act either of these ways

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3
Q

Why is the spectrum of antibiotic not the best way to classify such drugs?

A

“Spectrum” is not an absolute term

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4
Q

What are the four targets for antimicrobials to destroy pathogens?

A
  • Block cell wall synthesis
  • Block protein synthesis
  • Block nucleic acid synthesis
  • Block/disrupt cell membrane function
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5
Q

Name four classes of antimicrobial that inhibit cell wall synthesis and some examples

A

Beta- Lactams:
Penicillins e.g. Penicillin, Amoxicillin, Flucloxacillin
Cephalosporins e.g. Cetriaxone
Carbapenems e.g. Meropenem

Glycopeptides e.g. Vancomycin

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6
Q

Name three classes of antimicrobial that inhibit protein synthesis in order to destroy the pathogen.
Give some examples

A

Tetracyclines - Tetracycline, doxycycline
Aminoglycosides - Gentamicin
Macrolides - Erythromycin

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7
Q 
Name a class of antimicrobials that destroy pathogens by preventing nucleic acid synthesis 
Give an some examples
A

Quinolones - Trimethaprim, Ciprofloxacin

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8
Q 
Name a class of antimicrobials that kill the target cell through inhibiting or disrupting cell membrane function 
Give an example
A

Polymixins e.g. Colistin

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9
Q

Penicillin is particularly effective against which microorganism?

A

Streptococci

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10
Q

Amoxicillin is particularly effective against which type of bacteria?

A

Gram positive (also some action against gram negative)

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11
Q

Flucloxacillin is particularly active against what microorganism/s?

A

Staphylococcus and Streptococci

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12
Q

What is an advantage and a disadvantage of Cephalosporins?

A

Advantage: Active in CSF
Disadvantage: Associated with C. Diff infection

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13
Q

Tetracyclines are particularly effective against what type of bacteria?

A

Gram positive

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14
Q

Tetracyclines cannot be given to patients under what age?

A

12years

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15
Q

Gentamicin has good activity against what type of bacteria and where?

A

Gram positive bacteria

In blood and urine

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16
Q

What are the mechanisms by which Ciprofloxacin and Trimethoprim inhibit nucleic acid synthesis?

A

Ciprofloxacin: inhits DNS gyrase
Trimethoprim: inhibits folic acid

17
Q

Name two classes of antifungals and their mechanism of action

A

Azoles- inhibit cell membrane synthesis e.g. Fluconazole

Polyenes- inhibit cells membrane function e.g. Nystatin, Amphotericin

18
Q

How does aciclovir act as an antiviral?

A

Inhibits viral DNA polymerase

19
Q

Name three types of antibiotic resistance and what this means in respect to these methods of antimicrobial resistance

A

Intrinsic- has never worked, usually permanent
Acquired- did work but doesn’t now(new genetic material, mutation), usually permanent
Adaptive- organism responds to a stress and some are able to survive and have the potential to withstand some conditions, usually reversible

20
Q

What are the three mechanisms that antimicrobials use to avoid killing by antimicrobials and infer resistance?

A

Drug inactivating enzymes e.g. Beta-lactamase
Altered target e.g. MRSA
Altered uptake- decreased permeability or efflux if antibiotic e.g.tetracyclines

21
Q

What are the two stages to the mechanisms by which antibiotics acquire resistance?

A
  1. Chromosomal gene mutation - mutation by chance, if beneficial this dominant strain will persist in the population
  2. Horizontal gene transfer - genetic material from the mutant strain transmitted to other bacteria
22
Q

What are the 3 methods of horizontal gene transfer?

A
  1. Conjugation - genetic material exchanged during temporary union between two cells
  2. Transduction - transmission of genetic material via a bacteriophage
  3. Transformation - prokaryotes take up fragments of DNA (often as plasmids) from environment
23
Q

How can antibiotic activity be measured?

A
  1. Disc Sensitivity

2. Minimum Inhibitory Concentration

24
Q

True or False: all exposure of bacteria to antimicrobials infers antimicrobial resistance

A

True

25
Q

What are the main consequences of antimicrobial resistance?

A

Treatment failure
Prophylaxis failure
Economic Costs

26
Q

What is meant by the term “Multi-drug resistant” (MDR)?

A

Non-susceptibility to at least one agent in 3 or more antimicrobial categories

27
Q

What does it mean if a microbe is “Extensively drug resistant” (XDR)?

A

Non-susceptibility to at least one agent in all but 2 or fewer antimicrobial categories

28
Q

What does it mean if a microbe is “Pan drug resistant” (PDR)?

A

Non- susceptibilty to ALL agents in all antimicrobial categories

29
Q

What types of evidence are there that antimicrobials cause resistance?

A

Laboratory evidence- provides biological plausibility
Ecological studies- levels of use and resistance in population (high levels of use not associated with high rates of low-level resistance, something else going on)
Individual level data- systematic review and meta-analysis looking at relationship between prior abx use and resistance in individual patients

30
Q

What do individual level studies show about antibiotic resistance and how it relates to prior antimicrobial exposure?

A

Longer durations and multiple courses of abx are associated with higher resistance rates

31
Q

What are antimicrobial stewardships?

A

Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of optimal drug regime, dose, duration and route of administration

32
Q

What is the aim of using antimicrobial stewardships?

A 
Appropriate use of antimicrobials
Achieve optimal clinical outcomes 
Reduce costs
Limit selection for antimicrobial resistant strains
Minimise toxicity/ADRs
33
Q

What elements are involved in antimicrobial stewardship?

A

MDT
Surveillance
Intervention

34
Q

There are 3 stewardship intervention types, what do they involve?

A

Persuasive- education, audit, feedback

Restrictive- restricted susceptibility reporting, prior authorisation, automatic stop orders

Structural- Computerised records, rapid lab tests, quality monitoring

Infection (12 decks)

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