Antimicrobials & SSTIs Flashcards by Sara Bojarski

Therapeutic balance of ID
Maximize ____ and minimize ___

Maximize bacterial killing, safety, and efficacy
Minimize toxicity & resistance

How well did you know this?

Not at all

Perfectly

ecological adverse effects of antibiotic therapy, specifically selection of drug-resistant organisms and the unwanted development of colonization or infection with MDR organisms

collateral damage

How well did you know this?

Not at all

Perfectly

collateral damage risks associated with cephalosporin

-subsequent infections with VRE
-extended spectrum B-lactamase producing K. pneumoniae
-B-lactam resistant Acinetobacter species
-C. diff

How well did you know this?

Not at all

Perfectly

the lowest concentration of an antibiotic that completely inhibits the growth of a microorganism in vitro

MIC

How well did you know this?

Not at all

Perfectly

the lowest concentration of the antibiotic which results in a 99.9% reduction in colony forming units in a given time

MBC

How well did you know this?

Not at all

Perfectly

species that is
-gram + cocci
-clusters (catalase -)
-coagulase +

S. aureus

How well did you know this?

Not at all

Perfectly

species that is
-gram + cocci
-clusters (catalase -)
-coagulase -

S. epidermidis

How well did you know this?

Not at all

Perfectly

species that is
-gram + cocci
-pairs (catalase +)
-alpha

S. pneumoniae

How well did you know this?

Not at all

Perfectly

species that is
-gram + cocci
-chains
-beta

Group A strep (S. pyogenes)
Group B strep (S. agalactiae)
Group C, G, F strep

How well did you know this?

Not at all

Perfectly

species that is
-gram + cocci
-chains
-gamma

enterococcus species
E. faecalis
E. faecium

How well did you know this?

Not at all

Perfectly

drugs for MSSA (S. aureus, 50%)

nafcillin, oxacillin, dicloxacillin

How well did you know this?

Not at all

Perfectly

drugs for MRSA (S. aureus, 50%)

vancomycin, linezolid, daptomycin, Bactrim, clindamycin

How well did you know this?

Not at all

Perfectly

drugs for MSSE (S. epidermidis, 20%)

nafcillin, oxacillin, dicloxacillin (same as MSSA)

How well did you know this?

Not at all

Perfectly

drugs for MRSA (S. epidermidis, 80%)

vancomycin, linezolid, daptomycin, Bactrim, clindamycin (same as MRSA)

How well did you know this?

Not at all

Perfectly

drugs for PCN (S) S. pneumoniae (90%)

penicillin G/V, nafcillin

How well did you know this?

Not at all

Perfectly

drugs for PCN (R) S. pneumoniae (10%)

vancomycin, Bactrim

How well did you know this?

Not at all

Perfectly

drugs for PCN (S) streptococcus

penicillin G/V, nafcillin (same as S. pneumoniae)

How well did you know this?

Not at all

Perfectly

drugs for PCN (R) streptococcus

vancomycin, Bactrim (same as S. pneumoniae)

How well did you know this?

Not at all

Perfectly

drug options for enterococcus species (E. faecalis, E. faecium)

ampicillin +/- gentamicin
vancomycin +/- gentamicin
linezolid, daptomycin

How well did you know this?

Not at all

Perfectly

drug for gram positive aerobe cocci

clindamycin

How well did you know this?

Not at all

Perfectly

drug for gram positive aerobe bacilli

metronidazole

How well did you know this?

Not at all

Perfectly

gram - cocci PEK species

Proteus mirabilus
Escherichia coli
Klebsiella pneumoniae

How well did you know this?

Not at all

Perfectly

gram - cocci HEM species

Haemophilus influenzae
Enterobacteriaceae (salmonella, shigella)
Monexella catanthalis

How well did you know this?

Not at all

Perfectly

gram - cocci SPACE species

Serratia marcesens
Pseudomonas aeruginosa
Acinetobacter baumannii
Citrobacter
Enterobacter

How well did you know this?

Not at all

Perfectly

cephalosporins that cover PEK bacteria

cefazolin, cephalexin, cefadroxil

cephalosporins that cover PEKHEM bacteria

1) cefuroxime, cefaclor 2) cephamycins, cefoxitin, cefotetan cefmetazole

cephalosporins that cover PEKHEM S_ACE bacteria

1)Ceftriaxone, cefpodoxime proxetil anti-pseudomonal: ceftazidime, cefoperazone 2) cefepime 3) ceftaroline

which cephalosporin is best for SPACE organisms

ceftazidime

which drugs are used for pseudomonas

combinations including: -piperacillin/tazobactam -carbapenems (meropenem, imipenem) -ceftazidime

PKPD indices for antibiotic effect

Cmax:MIC %T>MIC AUC:MIC

which drugs follow: -time dependent killing -min/mod persistent effects

penicillins cephalosporins carbapenems macrolides oxazolidinones

what is the PKPD index that influences time dependent killing and min/mod persistent effects

%T/MIC

which drugs follow: -concentration dependence -prolonged persistent effects

aminoglycosides quinolones

which PKPD indices influence concentration dependence and prolonged persistent effects

Cmax:MIC AUC:MIC

which drugs follow: -time dependent killing -prolonged persistent effects

vancomycin azithromycin tetracycline

which PKPD index influences time dependent killing and prolonged persistent effects

AUC:MIC

how do pH changes alter PK

altered drug ionization

how do changes in organ blood flow alter PK

altered drug CL

how to fluid shifts alter PK

altered Vd

how do changes in albumin alter PK

changes in free drug

hydrophilic antimicrobials

aminoglycosides beta lactams (carbapenems, cephalosporins, penicillins) glycopeptides lipopeptides

lipophilic antimicrobials

fluoroquinolones glyclcycline ketolides lincosamides macrolides metronidazole streptogramins tetracyclines

how do hydrophilic drugs alter PK

tissue distribution limited to extracellular space inc LD and inc/dec MD

how do lipophilic drugs alter PK

tissue distribution with intracellular accumulation no change to LD or MD

how does infection in blood alter PK

inc Vd and CL

how does infection in lung alter PK

impaired permeability

how does infection in soft tissue alter PK

variable by composition

how does infection in bone alter PK

impaired permeability

how does infection in the CNS alter PK

impaired permeability

fluid shifts in sepsis do what to CL, Vd, and drug conc?

can lead to high or low Vd, impaired or augmented CL, and too high or too low drug conc

antibiotics that do not need renal dose adjustment

ceftriaxone clindamycin oxacillin moxifloxacin metronidazole azithromycin nafcillin doxycycline erythromycin dalfopristin/quinupristin tigecycline linezolid

decisions for which drug to use should be made based off

S, R, or I.... NOT the number

greater outcomes were seen for fluoroquinolones with an AUC:MIC

>125

target AUC24,ss:MIC for vancomycin

>400 ng*h/L

types of purulent infections

cutenous abscess, furuncle, carbuncle

presentation of purulent infection

painful, fluctuant red nodules, topped with pustule, rim of erythematous swelling

common microbial cause of purulent infection

S. aureus

General treatment approach for purulent infections

must do I&D antibiotics if there are systemic signs of infection, do not respond to I&D, etc (SIRS criteria, mod to sev)

IV drugs for purulent MRSA infections (empiric)

vancomycin, daptomycin, ceftaroline, dalbavancin/oritavancin

oral drugs for purulent MRSA infections (empiric)

Bactrim, doxycycline, linezolid

IV drugs for purulent MSSA infections (de-escalate)

ampicillin/sulbactam, nafcillin/oxacillin, cefazolin

oral drugs for purulent MSSA infections (de-escalate)

amox/clav, dicloxacillin, cephalexin, clindamycin

duration of therapy purulent infection

5-10 days following I&D

types of nonpurulent infection

cellulutis, erysipelas

presentation of nonpurulent infection

red, warm, swollen, painful

common microbial cause of nonpurulent infection

streptococcus species, some S. aureus

general treatment approach for nonpurulent infection

antibiotics oral for mild oral or IV for moderate IV for severe

oral drugs for nonpurulent infection (strep)

penicillin VK, amoxicillin, amox/clav, cephalexin, clindamycin (allergy)

IV drugs for nonpurulent infection (strep)

penicillin G, cefazolin, ceftriaxone, clindamycin (allergy) severe allergy- clindamycin, vancomycin, linezolid, daptomycin

treatment duration for nonpurulent infection

5 days if mild, 10-14 if mod-sev

deep infection involving the superficial fascia comprising all tissue between the skin and muscle

necrotizing fasciitis

microbial causes of necrotizing fasciitis

mono: S. pyogenes, S. aureus, Clostridium poly: mixed aerobic/anaerobic

general treatment approach for necrotizing fasciitis

surgery broad spectrum antibiotics started then de-escalated

drug for necrotizing fasciitis that covers MRSA

vancomycin +

drug for necrotizing fasciitis that covers gram -

pip-tazo, carbapenems, cefepime +, ciprofloxacin +

drug for necrotizing fasciitis that covers anaerobes

pip-tazo, carbapenems, metronidazole, clindamycin

microbial species common in infected animal bites

pasturella species

oral and IV drugs for bite wounds

IV- ampicillin/sulbactam Oral- amox/clav Alt- 2nd/3rd gen cephalosporins + metronidazole, levofloxacin + metronidazole

presentation for DFIs

redness, warmth, swelling, tenderness, pain, purulent drainage (from ulcer) (need 2 or more to be infected)

microbes that cause DFIs

gram + cocci: staphylococcus and streptococcus gram - bacilli: pseudomonas anaerobes: may be seen in mod-sev

mild oral therapy for DFI

MSSA/strep- cephalexin, amox/clav, clindamycin MRSA- bactrim, doxycycline

mod-severe IV therapy for DFI

MSSA/strep/gram neg/anaerobes- amp/sulbact, cefoxitin, ceftriaxone + metro, cipro + clindamyc, moxifloxacin, ertapenem MRSA- vancomycin, linezolid, daptomycin pseudomonas- pip/tazo, cefepime