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Year 3 - Infection > Antimicrobials - Bacteria and Fungi > Flashcards

Antimicrobials - Bacteria and Fungi Flashcards

1
Q

What are the principles of prescribing antimicrobials?

A
  1. Indications for antimicrobials
  2. Making a clinical diagnosis
  3. Patient characteristics
  4. Antimicrobial selection
  5. Regimen selection
  6. Liaison with laboratory
  7. Antimicrobial Stewardship
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2
Q

What are the principles of prescribing - Indications for antimicrobials?

A

Therapy:
> Empiric - Without microbiology results
> Directed - Based on microbiology results

Prophylaxis:
> Primary:
- Anti-malarial; immunosuppressed patients
- Pre-operative surgical 
- Post-exposure e.g. HIV, meningitis

> Secondary:
- To prevent a second episode e.g. PJP

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3
Q

What are the principles of prescribing - Diagnosis?

A

Diagnosis of infection:

  • Clinical
  • Laboratory
  • None (No treatment)

Severity assessment:

  • Sepsis?
  • Septic shock?
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4
Q

What are the principles of prescribing - Patient characteristics?

A 
> Age
> Renal function
> Liver function
> Immunocompromised
> Pregnancy
> Known allergies
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5
Q

What are the principles of prescribing - Antimicrobial selection?

A 
> Guideline or “individualised” therapy
> Likely organism(s)
> Empirical therapy or result-based therapy
> Bactericidal vs. bacteriostatic drug
> Single agent or combination
> Potential adverse effects
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6
Q

What should antibiotic selection be based on?

A

The known or likely causative organism(s)

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7
Q

What are the most likely causative bacteria in soft tissue infection?

A 
> Streptococcus pyogenes
> Staphylococcus aureus
> Streptococcus group C or G
> E coli
> Pseudomonas aeruginosa
> Clostridium species
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8
Q

What are the most likely causative bacteria pneumonia?

A 
> Streptococcus pneumonia 
> Haemophilus influenza
> Staphylococcus aureus 
> Klebsiella pneumonia 
> Moraxella catarrhalis 
> Mycoplasma pneumonia 
> Legionella pneumonia 
> Chlamydia pneumonia
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9
Q

Bactericidal?

A

> Eg Beta-lactams
Act on the cell wall
Kill organisms
Indications: neutropenia, meningitis and endocarditis

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10
Q

Bacteriostatic?

A 
> Eg Macrolides
> Inhibit protein synthesis
> Prevent colony growth 
> Require host immune system to "mop up" residual infection 
> Useful in toxin-mediated illness
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11
Q

When would combination antimicrobial therapy be used?

A

> HIV and TB therapy
Severe sepsis (febrile neutropenia)
Mixed organisms (faecal peritonitis)

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12
Q

What is the advantage of single over combination antimicrobial therapy?

A

> Simpler
Fewer side effects
Fewer drug interactions

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13
Q

What are the principles of prescribing - regimen selection?

A

> Route of administration
Dose
Adverse effects (side effects/toxicity)
Duration
Intravenous to oral SWITCH therapy
Inpatient or Outpatient therapy: - Outpatient parenteral antimicrobial therapy (OPAT)
Therapeutic drug monitoring

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14
Q

When would the oral route for antimicrobials be selected?

A

> No vomiting
Normal GI function
No shock
No organ dysfunction

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15
Q

When would the intravenous route for antimicrobials be selected?

A

> Severe or deep-seated infection

> Oral route is not available

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16
Q

What is oral bioavailability?

A

> Ratio of drug level when given orally compared with level when given IV
Varies widely, E.g:
- Flucloxacillin 50-70%
- Linezolid 100%

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17
Q

Types of adverse effects of antimicrobials?

A 
> Allergic reactions
> Gastrointestinal
> Candida (Thrush)
> Liver
> Renal
> Neurological
> Haematological
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18
Q

Types of adverse effects of antimicrobials - Allergic reactions?

A

> Immediate hypersensitivity:
- Anaphylactic shock

> Delayed hypersensitivity:

  • Rash
  • Drug fever
  • Serum sickness
  • Erythema nodosum
  • Stevens-Johnson syndrome

Most likely caused by penicillins and cephalosporins

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19
Q

Types of adverse effects of antimicrobials - Gastrointestinal?

A

> Nausea, vomiting, diarrhoea

> Clostridium infection

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20
Q

Types of adverse effects of antimicrobials - Candida (thrush)?

A

Caused by broad spectrum penicillins, cephalosporins

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21
Q

Types of adverse effects of antimicrobials - Liver?

A

> All drugs, particularly tetracyclines, TB drugs

> More likely if pre-existing liver disease

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22
Q

Types of adverse effects of antimicrobials - Renal?

A

> Gentamicin, Vancomycin

> More like if pre-existing renal disease or on nephrotoxic meds

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23
Q

Types of adverse effects of antimicrobials - Neurological?

A

> Ototoxicity - Gentamicin, Vancomycin

> Optic neuropathy - Ethambutol (TB)

> Convulsions, encephalopathy - Penicillins, cephalosporins

> Peripheral neuropathy - Isoniazid (TB), Metronidazole

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24
Q

Types of adverse effects of antimicrobials - Neurological caused by gentamicin?

A

Ototoxicity

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25
Q

Types of adverse effects of antimicrobials - Neurological caused by vancomycin?

A

Ototoxicity

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26
Q

Types of adverse effects of antimicrobials - Neurological caused by Ethambutol (TB)?

A

Optic neuropathy

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27
Q

Types of adverse effects of antimicrobials - Neurological caused by penicillins?

A

Convulsions, encephalopathy

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28
Q

Types of adverse effects of antimicrobials - Neurological caused by cephalosporins?

A

Convulsions, encephalopathy

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29
Q

Types of adverse effects of antimicrobials - Neurological caused by Isoniazid (TB)?

A

Peripheral neuropathy

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30
Q

Types of adverse effects of antimicrobials - Neurological caused by metronidazole?

A

Peripheral neuropathy

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31
Q

Types of adverse effects of antimicrobials - Heamatological?

A

> Marrow toxicity

> Megaloblastic anaemia (folate metabolism) - Co-trimoxazole

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32
Q

Types of adverse effects of antimicrobials - Penicillins?

A

> Allergic reactions
Candida
Convulsions, encephalopathy

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33
Q

Types of adverse effects of antimicrobials - cephalosporins?

A

> Allergic reactions
Candida
Convulsions, encephalopathy

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34
Q

Types of adverse effects of antimicrobials - gentamicin and vancomycin?

A

> Renal

> Ototoxicity

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35
Q

What are the principles of prescribing - liaison with laboratory?

A

> Sending appropriate specimens:

  • culture
  • direct detection
  • serology

> Receiving results

  • preliminary culture results
  • sensitivity results
  • final results

> Monitoring

  • disease activity
  • therapeutic drug monitoring
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36
Q

What are the principles of prescribing - antimicrobial stewardship?

A

> Antimicrobial Guidelines & Policies
Audit of quality of antimicrobial prescribing
Education

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37
Q

Who is involved in the antimicrobial management team?

A 
> Pharmacists
> Infectious diseases
> Acute medicine
> Medical microbiology 
> Infection prevention and control 
> General practice 
> Public partner
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38
Q

Outbreaks of Clostridium difficile infections often occurs due to what?

A

Broad spectrum antibiotics

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39
Q

What are the 4 C’s that are linked to C difficile?

A 
4 antibiotics:
> Ceftriaxone (and other cephalosporins)
> Clindamycin
> Co-amoxiclav
> Ciprofloxacin (and other quinolones)
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40
Q

The antimicrobial classes?

A 
> Penicillins (β-lactams)
> Cephalosporins (β-lactams)
> Aminoglycosides
> Macrolides
> Quinolones
> Glycopeptides
> Others
> Antifungals
> Antivirals
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41
Q

Mechanism of action - Inhibition of cell wall synthesis?

A

> Beta-lactams:

  • Penicillins
  • Cephalosporins

> Glycopeptides:

  • Vancomycin
  • Teicoplanin
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42
Q

Mechanism of action - Beta-lactams?

A

Inhibition of cell wall synthesis

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43
Q

Mechanism of action - Penicillins?

A

A beta lactam - Inhibition of cell wall synthesis

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44
Q

Mechanism of action - Cephalosporins?

A

A beta lactam - Inhibition of cell wall synthesis

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45
Q

Mechanism of action - Glycopeptides

A

Inhibition of cell wall synthesis

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46
Q

Mechanism of action - Vancomycin?

A

A Glycopeptides - Inhibition of cell wall synthesis

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47
Q

Mechanism of action - Teicoplanin?

A

A Glycopeptides - Inhibition of cell wall synthesis

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48
Q

Mechanism of action - Inhibition of Protein Synthesis?

A

> Aminoglycosides: gentamicin
Macrolides: clarithromycin
Tetracyclines: doxycycline
Oxazolidinones: linezolid

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49
Q

Mechanism of action - Aminoglycosides

A

Inhibition of Protein Synthesis

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50
Q

Mechanism of action - gentamicin?

A

An aminoglycoside - Inhibition of Protein Synthesis

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51
Q

Mechanism of action - Macrolides?

A

Inhibition of Protein Synthesis

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52
Q

Mechanism of action - clarithromycin?

A

A macrolide - Inhibition of Protein Synthesis

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53
Q

Mechanism of action - Tetracyclines?

A

Inhibition of Protein Synthesis

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54
Q

Mechanism of action - doxycycline?

A

A tetracycline - Inhibition of Protein Synthesis

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55
Q

Mechanism of action - Oxazolidinones?

A

Inhibition of Protein Synthesis

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56
Q

Mechanism of action - linezolid?

A

An oxazolidinones - Inhibition of Protein Synthesis

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57
Q

Mechanism of action - Inhibition of Nucleic acid synthesis?

A

> Trimethoprim
Sulfonamides: sulfamethoxazole
Quinolones: ciprofloxacin

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58
Q

Mechanism of action - Trimethoprim

A

Inhibition of Nucleic acid synthesis

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59
Q

Mechanism of action -Sulfonamides

A

Inhibition of Nucleic acid synthesis

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60
Q

Mechanism of action - sulfamethoxazole?

A

A Sulfonamide - Inhibition of Nucleic acid synthesis

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61
Q

Mechanism of action - Quinolones?

A

Inhibition of Nucleic acid synthesis

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62
Q

Mechanism of action - ciprofloxacin?

A

A Quinolone - Inhibition of Nucleic acid synthesis

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63
Q

Use of benzylpenicillin?

A 
> Soft tissue 
> pneumococcal
> meningococcal
> gonorrhoea
> syphilis infections
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64
Q

Use of penicillin V?

A 
> Soft tissue 
> pneumococcal
> meningococcal
> gonorrhoea
> syphilis infections
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65
Q

Pathogens targeted by benzylpenicillin?

A

> Streptococci,
Neisseria
Spirochetes

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66
Q

Pathogens targeted by penicillin V?

A

> Streptococci,
Neisseria
Spirochetes

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67
Q

Use of amoxicillin?

A

> UTI

> RTI

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68
Q

Pathogens targeted by amoxicillin?

A

Broad spectrum but resistance is common

69
Q

Pathogens targeted by flucloxacillin?

A

Staphylococci (S aureus)

70
Q

Pathogens targeted by co-amoxiclav?

A

> Broad spectrum

> Anaerobes

71
Q

Use of Co-amoxiclav?

A

> UTI
RTI
Soft tissue infections
Surgical wounds

72
Q

Risk of using co-amoxiclav?

A

C difficile

73
Q

An example of a 1st generation cephalosporin?

A

Cefradine

74
Q

Pathogenic activity of a 1st generation cephalosporin (Cefradine)?

A

> Broad spectrum

> Resistance

75
Q

Uses of a 1st generation cephalosporin (Cefradine)?

A

> UTI

> Soft Tissue infection

76
Q

An example of a 2nd generation cephalosporin?

A

Cefuroxime

77
Q

Pathogenic activity of a 2nd generation cephalosporin (cefuroxime)?

A

Broad spectrum

78
Q

Uses of a 2nd generation cephalosporin (cefuroxime)?

A

> UTI
RTI
Surgical prophylaxis

79
Q

An example of a 3rd generation cephalosporin?

A

> Ceftriaxone
Cefotaxime
Ceftazidime

80
Q

Pathogenic activity of a 3rd generation cephalosporin (ceftriaxone/
cefotaxime)?

A

> Broad spectrum esp good against Gram-neg bacilli
Ceftazidime
for Pseudomonas

81
Q

Uses of a 3rd generation cephalosporin (ceftriaxone/

cefotaxime)?

A

Hospital infections eg bacteraemia, pneumonia, abdo sepsis

82
Q

Uses of a 3rd generation cephalosporin (Ceftazidime)?

A

> Hospital infections eg bacteraemia, pneumonia, abdo sepsis

> Pseudomonal infections in hospital and in cystic fibrosis

83
Q

Pathogenic activity of a 3rd generation cephalosporin (Ceftazidime)?

A

> Broad spectrum esp good against Gram-neg bacilli

> Pseudomonas

84
Q

What are the risks of using 3rd generation cephalosporins?

A

Risk factor for MRSA, C. diff, VRE;

85
Q

An example of an aminoglycoside?

A

> gentamicin

> amikacin

86
Q

Pathogenic activity of an aminoglycoside?

A

Gram-neg bacilli

87
Q

Pathogenic activity of an aminoglycoside?

A

Serious Gram-negative infections eg bacteraemia, endocarditis, neutropenic sepsis

88
Q

What are the risks of using an aminoglycoside?

A

Renal and ototoxicity; measuring levels essential

89
Q

What are the risks of using gentamicin?

A

Renal and ototoxicity; measuring levels essential

90
Q

What are the risks of using amikacin?

A

Renal and ototoxicity; measuring levels essential

91
Q

Pathogenic activity of gentamicin?

A

Serious Gram-negative infections eg bacteraemia, endocarditis, neutropenic sepsis

92
Q

Pathogenic activity of amikacin?

A

Serious Gram-negative infections eg bacteraemia, endocarditis, neutropenic sepsis

93
Q

Pathogenic activity of gentamicin?

A

Gram-neg bacilli

94
Q

Pathogenic activity of amikacin?

A

Gram-neg bacilli

95
Q

“…romycin”

A

Macrolide

96
Q

“…acillin”

A

Penicillin

97
Q

“…floxacin”

A

Quinolones

98
Q

Examples of macrolides

A

> Clarithromycin
Erythromycin
Azithromycin

99
Q

Pathogenic activity of clarithromycin?

A 
> Streptococci
> Staphylococci
> Mycoplasma
> Chlamydia
> Legionella
100
Q

Main uses of clarithromycin?

A

> Respiratory infection
Soft tissue infection (if penicillin allergic)
STD

101
Q

Pathogenic activity of erythromycin?

A 
> Streptococci
> Staphylococci
> Mycoplasma
> Chlamydia
> Legionella
102
Q

Main uses of erythromycin?

A

> Respiratory infection
Soft tissue infection (if penicillin allergic)
STD

103
Q

Pathogenic activity of azithromycin?

A

Rel better for Gram-neg e.g. Haemophilus; Chlamydia

104
Q

Main uses of azithromycin?

A

Chlamydia

105
Q

Risk of erythromycin?

A

GI intolerance

106
Q

Is erythromycin or clarithromycin better tolerated?

A

Clarithromycin

107
Q

Pathogenic activity of ciprofloxacin?

A

Gram-negative bacilli:
> Pseudomonas

> some activity against staphylococci and streptococci

108
Q

Pathogenic activity of levofloxacin/

moxifloxacin?

A 
> Enhanced activity against staphylococci/
streptococci
> Pneumococcus, 
> Mycoplasma
> Chlamydia
> Legionella
> Less against Pseudomonas
109
Q

Main uses of ciprofloxacin?

A

> Complicated UTI
Complicated hospital acquired Pneumonia
GI infections

110
Q

Main uses of levofloxacin/

moxifloxacin?

A

2nd or 3rd line agent for pneumonia

111
Q

Risk of Quinolones?

A

> Associated with C. difficile

> May affect growing cartilage

112
Q

Examples of quinolones?

A

> ciprofloxacin
levofloxacin
moxifloxacin

113
Q

Examples of glycopeptides?

A

> vancomycin

> teicoplanin

114
Q

Pathogenic activity of vancomycin and teicoplanin?

A

Gram-positive bacteria only
(streptococci,
staphylococci)

115
Q

Main uses of vancomycin and teicoplanin?

A

> MRSA - patients allergic to penicillin (IV Vanc)

> C.difficile (oral vanc)

116
Q

Risk involved with glycopeptides?

A

Regular drug levels required; nephrotoxicity

117
Q

Examples of glycopeptides?

A

> Vancomycin

> Teicoplanin

118
Q

Pathogenic activity of trimethoprim?

A

> Gram-neg bacilli;

> Some activity against Streptococci and staphylococci

119
Q

Main uses of trimethoprim?

A

> UTI
Resp infection
MRSA

120
Q

Pathogenic activity of Co-trimoxazole

(trimethoprim-sulphamethoxazole)?

A

> Broad spectrum

> Pneumocystis jiroveci

121
Q

Main uses of Co-trimoxazole

(trimethoprim-sulphamethoxazole)?

A

> Respiratory infection

> PCP

122
Q

Risk involved with Co-trimoxazole

(trimethoprim-sulphamethoxazole)?

A

Rashes

123
Q

Risk involved with clindamycin?

A

Associated with C. difficile

124
Q

Main uses of clindamycin?

A

> Soft tissue infection

> gangrene

125
Q

Pathogenic activity of clindamycin?

A

> Streptococci
Staphylococci
anaerobes

126
Q

Pathogenic activity of tetracycline and

doxycycline?

A 
> Streptococci
> Staphylococci
> Chlamydia
> rickettsiae
> brucella
127
Q

Main uses of tetracycline and

doxycycline?

A 
> Q fever
> Brucellosis
> chlamydia
> atypical pneumonia
> MRSA
128
Q

Risk involved with tetracycline and

doxycycline?

A

Contraindicated in pregnancy and childhood (effects on teeth/bones)

129
Q

Main uses of linezolid?

A

2nd line agent for MSSA, MRSA, VRE

130
Q

Pathogenic activity of linezolid?

A

Gram-positive bacteria only:
> Streptococci
> Staphylococci
> Enterococci

131
Q

Risk involved linezolid?

A

Blood and optic neuropathy S/Es

132
Q

Risk involved daptomycin?

A

Inactive in lung

Myositis S/E.

133
Q

Pathogenic activity of daptomycin?

A

Gram-positive bacteria only:
> Streptococci
> Staphylococci
> Enterococci

134
Q

Main uses of daptomycin?

A

2nd line agent for MSSA, MRSA, VRE

135
Q

Main uses of tigecycline?

A

3nd line,

Intra-abdominal sepsis, soft tissue infections

136
Q

Pathogenic activity of tigecycline?

A

Very broad spectrum:
> MRSA
> ESBL
> anaerobes

137
Q

Pathogenic activity of Metronidazole?

A

> Anaerobes

> protozoa (eg giardia)

138
Q

Main uses of Metronidazole?

A

> Surgical infections;
giardiasis
amoebiasis
trichomonal infections

139
Q

Risk involved Metronidazole?

A

“Antabuse” reaction with alcohol

140
Q

Risk involved meropenem?

A

Iv only; goof CNS penetrations

141
Q

Risk involved rifampicin?

A

Drug interaction – enzyme inducer

142
Q

Main uses of meropenem?

A

2nd and 2rd line for hospital infections

143
Q

Main uses of rifampicin?

A 
> TB
> MRSA
> meningococcal
>prophylaxis
> complicated staphylococcal infections
144
Q

Pathogenic activity of meropenem

A

Broad spectrum:
> anaerobes
> pseudomonas

145
Q

Pathogenic activity of rifampicin

A

> Mycobacteria
Meningococcus
Staphylococci

146
Q

Pathogenic activity of linezolid?

A

Gram-positive bacteria only:
> Streptococci
> Staphylococci
> Enterococci

147
Q

Pathogenic activity of daptomycin?

A

Gram-positive bacteria only:
> Streptococci
> Staphylococci
> Enterococci

148
Q

Pathogenic activity of tigecycline?

A

Very broad spectrum, including:
> MRSA
> ESBL
> anaerobes

149
Q

Main uses of linezolid?

A

2nd line agent for MSSA, MRSA, VRE

150
Q

Main uses of daptomycin?

A

2nd line agent for MSSA, MRSA, VRE

151
Q

Main uses of tigecycline?

A

3nd line,

Intra-abdominal sepsis, soft tissue infections

152
Q

Risk involved linezolid?

A

Blood and optic neuropathy S/Es

153
Q

Risk involved daptomycin?

A

Inactive in lung

Myositis S/E

154
Q

Risk involved tigecycline?

A

Ineffective against

Pseudomonas.

155
Q

Examples of azoles (antifungal)?

A

> Fluconazole
Itraconazole
Voriconazole

156
Q

Main uses of azoles?

A

Candida and aspergillus

157
Q

Main uses of fluconazole?

A

Candida, some resistance

158
Q

Main uses of itraconazole?

A

Candida and aspergillus

159
Q

Main uses of voriconazole

A

Candida and aspergillus

160
Q

Examples of polyenes (Antifungals)?

A

> Amphotericin

> Nystatin

161
Q

Main uses of amphotericin?

A

Candida and aspergillus

162
Q

Main uses of nystatin?

A

Candida

163
Q

Examples of Echinocandin (Antifungals)?

A

> Caspofungin
Anidulafungin
Micafungin

164
Q

Main uses of Echinocandin?

A

Candida and Aspergillus

165
Q

Main uses of Caspofungin?

A

Candida and Aspergillus

166
Q

Main uses of Anidulafungin?

A

Candida and Aspergillus

167
Q

Main uses of Micafungin?

A

Candida and Aspergillus

168
Q

Main uses of terbinafine?

A

Tinea, nails

Year 3 - Infection (16 decks)

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