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Respiratory II, Test 2 > Antiobiotics > Flashcards

Antiobiotics Flashcards

1
Q

which drugs inhibit cell wall synth?

A

Vancomycin, Bacitracin, Penicillins, Cephalosporins, carbapenems

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2
Q

Ampicillin

A

Aminopencillin

extended spectrum, often administered with B-lactamase inhibitor

Gram +: streptococcus and staphylococcus (not MRSA)
Gram -: H. influenza, E. Coli, Proteus miribalis
Randoms: Listeria monocytogenes

Use: upper resp. tract infections (of S. pyogenes, S. pneumoniae, H. influenzae), sinusitis, otitis media, enterococcal infections

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3
Q

Amoxicillin

A

Aminopenicillin - just PO

extended spectrum, often administered with B-lactamase inhibitor

Gram +: streptococcus and staphylococcus (not MRSA)
Gram -: H. influenza, E. Coli, Proteus miribalis
Randoms: Listeria monocytogenes

Use: upper resp. tract infections (of S. pyogenes, S. pneumoniae, H. influenzae), sinusitis, otitis media, enterococcal infections

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4
Q

Piperacillin

A

Anti-Psudeomonal penicilin

Extended spectrum:
Gram pos: streptococcus and staphylococcus (not MRSA)

Gram negs: H. influenza, E. Coli, Proteus miribalis

Randoms: Listeria monocytogenes

And Extended to more serious gram negatives:
- to Pseudomonas aeruginosa, Enterobacter, and Proteus spp

Therapeutic use: serious gram-negative infections, hospital acquired pneumonia (HAP), immunocompromised patients, bacteremia, burn infections, UTI
.

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5
Q

Cefriaxone

A

third gen. cephalosporin

Less active against gram positive, but more active against gram negatives.
** active against Enterobacteriaceae (i.e. Klebsiella pneumonia, proteus mirabalis, providencia, serratia) and Haemophilus influenza

Therapeutic use:
DOC for for serious gram-negative infections (Klebsiella, Enterobacter, Proteus, Providencia, Serratia, Haemophilus),
- Ceftriaxone DOC for all forms of gonorrhea and severe Lyme’s disease, meningitis

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6
Q

Ceftazidime

A

third gen. cephalosporin

Less active against gram positive, but more active against gram negatives.

    • active against Enterobacteriaceae (i.e. Klebsiella pneumonia, proteus mirabalis, providencia, serratia) and Haemophilus influenza
  • ** ACTIVE AGAINST PSEUDOMONAS **

Use:
DOC for for serious gram-negative infections (Klebsiella, Enterobacter, Proteus, Providencia, Serratia, Haemophilus)
- Ceftazidime covers Pseudomonas

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7
Q

Cefepime

A

Fourth generation Cephalosporin

Spectrum: extends beyond third-generation (some gram +, enterobacteria gram negs), useful in serious infections in HOSPITALIZED PATIENTS. Effective against Pseudomonas

Therapeutic use: empirical treatment of nosocomial infections (infections aqd in hospital)

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8
Q

meropenem

A

carbapenem

  • Very broad spectrum

Covers: aerobic and anaerobic, gram positives, Enterobacteriaceae, Pseudomonas, Acinetobacter

Therapeutic use: UTI, lower respiratory tract infection (LRTI), intra-abdominal, gynecological, SSTI, bone and joint infections – very broad spectrum, should be used VERY sparingly, only In very serious infections!!!

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9
Q

Ertapenem

A

carbapenem

  • Very broad spectrum

Covers: aerobic and anaerobic, gram positives, Enterobacteriaceae, Pseudomonas, Acinetobacter

Therapeutic use: UTI, lower respiratory tract infection (LRTI), intra-abdominal, gynecological, SSTI, bone and joint infections – very broad spectrum, should be used VERY sparingly, only In very serious infections!!!

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10
Q

ampicillin-sublactam

A

B-lactamase inhibitor

MOA: prevent destruction of B-lactam antibiotics

S. Serratia spp
P. Pseudomonas aeruginosa
I. Indole + (Acinetobacter, Morganella, Proteus [not mirabilis])
C. Citrobacter spp
E. Enterobacter cloacae
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11
Q

amoxicillin-clavulanic acid

A

B-lactamase inhibitor

MOA: prevent destruction of B-lactam antibiotics

S. Serratia spp
P. Pseudomonas aeruginosa
I. Indole + (Acinetobacter, Morganella, Proteus [not mirabilis])
C. Citrobacter spp
E. Enterobacter cloacae
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12
Q

Piperacillin-tazobactam

A

B-lactamase inhibitor

MOA: prevent destruction of B-lactam antibiotics

S. Serratia spp
P. Pseudomonas aeruginosa
I. Indole + (Acinetobacter, Morganella, Proteus [not mirabilis])
C. Citrobacter spp
E. Enterobacter cloacae
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13
Q

Vancomycin

A

glycopeptide

MOA: inhibits cell wall synthesis binding with high affinity to D-Ala-D-Ala terminal of cell wall precursor units

Spectrum: broad gram-positive coverage
S. aureus (including MRSA), S. epidermidis (including MRSE), Streptococci, Bacillus, Corynebacterium spp, Actinomyces, Clostridium

Therapeutic use: osteomyelitis, endocarditis, MRSA, Streptococcus, enterococci, CNS infections, bacteremia, orally for Clostridium difficile (only oral indication for Vanc)

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14
Q

ciproflaxacin

A

fluoroquinolone

MOA: targets bacterial DNA gyrase & topoisomerase IV. Prevents relaxation of positive supercoils

Spectrum: E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp.

Therapeutic use: UTI, prostatitis, STI (chlamydia, Neisseria gonorrhoeae), traveler’s diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections

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15
Q

Levoflaxacin

A

Fluoroquinolone

MOA: targets bacterial DNA gyrase & topoisomerase IV. Prevents relaxation of positive supercoils

Spectrum: E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp.

Therapeutic use: UTI, prostatitis, STI (chlamydia, Neisseria gonorrhoeae), traveler’s diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections

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16
Q

Moxifloxacin

A

Fluoroquinolone

MOA: targets bacterial DNA gyrase & topoisomerase IV. Prevents relaxation of positive supercoils

Spectrum: E. coli, Salmonella, Shigella, Enterobacter, Campylobacter, Neisseria, Pseudomonas aeruginosa, S. aureus (not MRSA), limited coverage of Streptococcus spp.

** this one is metabolized by the liver, so it does not need to be dose adjusted for those with renal failure!

Therapeutic use: UTI, prostatitis, STI (chlamydia, Neisseria gonorrhoeae), traveler’s diarrhea, shigellosis, bone, joint, SSTI infections, diabetic foot infections

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17
Q

Gentamicin

A

Aminoglycoside

MOA: binds 30S

Spectrum: aerobic gram-negative bacteria, limited action against gram-positive, synergistic bactericidal effects in gram-positive with cell wall active agent (like Beta lactam or Vanc)

Therapeutic use: UTI (not uncomplicated), used if resistance to other agents, seriously ill patients, pneumonia (infective against S. pneumoniae and anaerobes), HAP, peritonitis, synergy in bacterial endocarditis, tobramycin inhalation in CF

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18
Q

Doxycycline

A

tetracycline/glycylcylclines

Spectrum: wide range of aerobic/anaerobic gram + and gram - (as well as Rickettsia, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia spp, Legionella, atypical mycobacterium, Plasmodium, Borrelia burgdorferi (Lyme’s disease), Treponema pallidum (syphilis)

** Pseudomonas not covered ***

Therapeutic use: CAP, atypical CAP coverage, community acquired SSTIs, community acquired MRSA, acne, Rickettsial infections (Rocky Mountain Spotted Fever), Q fever, anthrax

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19
Q

Azithromycin

A

macrolide/ketolide

MOA: inhibits translocation of 50s subunit

Use: : respiratory tract infections (due to coverage of S. pneumoniae, H. influenzae, and atypicals: Mycoplasma, Chalmydophilia, Legionella), alternative for otitis media, sinusitis, bronchitis, and SSTIs. Pertussis, gastroenteritis, H. pylori, Mycobacterial infections

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20
Q

Clindamycin

A

Lincosamide

MOA: binds 50S subunit

Spectrum: pneumococci, S. pyogenes, viridans Streptococci, MSSA, anaerobes (B. fragilis)
(all gram negs are resistant)

Use:
SSTIs, necrotizing SSTIs, lung abscesses, anaerobic lung and pleural space infections, topically for acne vulgaris

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21
Q

Linezolid

A

oxazalidinone:

MOA: inhibits synth binding P site of 50S

Spectrum: : gram-positive Staphylococcus (MSSA, MRSA, VRSA), Streptococcus (penicillin resistant S. pneumoniae), enterococci (VRE), gram-positive anaerobic cocci, gram-positive rods (Corynebacterium, L. monocytogenes)

Use: VRE faecium (SSTI, UTI, bacteremia), nosocomial pneumonia caused by MSSA and MRSA, CAP, complicated/uncomplicated SSTI infections

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22
Q

Oseltamivir

A

Antiviral- “Tamiflu”

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23
Q

Flucanazole

A

Antifungal

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24
Q

Itraconazole

A

Antifungal

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25
Q

Voriconazole

A

Antifungal

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26
Q

Empiric Therapy

A

Provide therapy to a symptomatic patient without identification of infecting organism

Example: initiating antimicrobials for community-acquired pneumonia (CAP) based on knowledge of most likely infecting pathogen

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27
Q

Extended-spectrum:

A

active against gram-positive bacteria but also against significant number of gram-negative bacteria

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28
Q

Broad-spectrum:

A

: act on a wide variety of bacterial species, including both gram-positive and gram-negative

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29
Q

MOA of Beta- lactams

A

i.e. penicillins

B-lactams are structural analogs of D-Ala-D-Ala; they covalently bind penicillin-binding proteins (PBPs), inhibiting the last transpeptidation step in cell wall synthesis

Resistance: through drug destruction and inactivation of B-lactamases

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30
Q

Penicillin

A

A type of beta-lactam

- effective against gram-positive cocci: narrow spectrum against streptococcus pneumoniae and meningitis

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31
Q

Penicillin

A

Beta-lactam

Spectrum: highly effective against gram-positive cocci (GPC) but easily hydrolyzed by penicillinase

Therapeutic use: narrow-spectrum, Streptococcus pneumoniae pneumonia and meningitis.

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32
Q

AE’s of penicillins?

A
  • Allergic reactions (0.7-10%)
  • Anaphylaxis (0.004-0.04%) – this is rare, and completely CI
  • Interstitial nephritis (rare)
  • Nausea, vomiting, mild to severe diarrhea
  • Pseudomembranous colitis
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33
Q

AE’S of cephalosporins?

A

1% risk of cross-reactivity to penicillins

Diarrhea

Intolerance to alcohol (disulfram-like reaction due to MTT group of cefotetan)

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34
Q

AE’s of Carbapenems

A

Adverse effects:
Nausea/vomiting (1-20%)
Seizures (1.5%)
Hypersensitivity

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35
Q

AE’s of glycopeptides?

A

i.e. vancomycin

Macular skin rash, chills, fever, rash

Red-man syndrome (histamine release): extreme flushing, tachycardia, hypotension

Ototoxicity, nephrotoxicity (33% with initial tr > 20 mcg/mL)

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36
Q

AE’s of fluoroquinolones?

A

-oxacin

GI 3-17% (mild nausea, vomiting, abdominal discomfort)
CNS 0.9-11% (mild headache, dizziness, delirium, rare hallucinations)
Rash, photosensitivity, Achilles tendon rupture (CI in children)

DON’T USE IN CHILDREN UNLESS TOTALLY NECESSARY!

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37
Q

AE’s of aminoglycosides?

A

ex. gentamicin

Ototoxicity (may be as high as 25%)
Nephrotoxicity (8-26%)
Neuromuscular block and apnea

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38
Q

AE’s of tetracyclines?

A 
GI (epigastric burning, abdominal discomfort, nausea, vomiting, diarrhea)
Superinfections of C. difficile
Photosensitivity
Teeth discoloration
Thrombophlebitis
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39
Q

AE’s of Macrolides/ketolides

A

Azithromycin

  • Arrythmia, QT prolongation
  • Hepatotoxicity: CYP3A4 inhibition – prolongs effects of digoxin, warfarin….
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40
Q

AE’s of lincosamides?

A

clindamycin

GI diarrhea (2-20%)
Pseudomembranous colitis (0.01-10%) 
Due to C. difficile
Skin rashes (10%)
Reversible increase in aminotransferase activity
May potentiate neuromuscular blockade
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41
Q

AE’s of Oxazolidinones

A

Myelosuppression [anemia, leukopenia, pancytopenia, thrombocytopenia (2.4%)]
Headache
Rash

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42
Q

empiric tx previously healthy pt?

A

Azithromycin or Doxycycline

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43
Q

empiric tx of outpatients at risk for DRSP?

A

fluoroquinolone or Beta lactam (ceftriaxone or ampicillin) + Azithromyocin

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44
Q

empiric tx of non ICU inpatient?

A

levofloxacin/moxifloxacin

or

Beta lactam (ceftriaxone) + azithromyocin

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45
Q

empiric tx of ICU patients?

A

Beta lactam (ceftraixone or ampicillin) + azithromyocin

or

Beta lactam (ceftriaxone) + levofloxacin/moxifloxacin

NOTE: use aztreonam in case of penicillin allergy (anaphylaxis) for the Beta Lactam

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46
Q

tx of pseudomonas aeruginosa?

A

anti-pseudomonal B lactam (piperacillin-tazobactam, cefepime, meropenem) + cipro/levofloxacin

OR

B lactam + gentamicin AND azithromycin

OR

B lactam + gentamicin and anti-pseudomonal fluoroquinolone

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47
Q

tx of MRSA?

A

Vancomycin IV or linezolid

48
Q

tx of MRSA/necrotizing pneumonia?

A

clindamyacin or linezolid

49
Q

what is minimum amount of time to receive Ab?

A

5 days, though most take it for 7 - 10 days

50
Q

how long must you tx pseudomonas

A

at least 8 day course (though 15 is shown to be more effective)

51
Q

aerobic gram negatives seen in HAP/VAP/HCAP?

A

P. aeruginosa
E. Coli
K. pneumoniae
Acinetobacter spp

52
Q

gram positive cocci seen in HAP/VAP?

A

MRSA - more common in DM, head trauma, those in ICU

53
Q

oronpharyngeal bugs seen in HAP/VAP?

A

Viridans
Coagulase-negative staph
Neisseria
corynebacterium

54
Q

Emperic therapy to early onset pneumonia?

A 
possible pathogens:
S. pneumoniae
H. influenza
MSSA
gram negs: E. coli, K. pneumoniae, Enterobacter, Proteus, Serratia

Tx: Ceftiaxone OR FQ OR ampicillin OR ertapenem

55
Q

Late onset pneumonia or known risk factors for MDR pathogens?

A

potential pathogens: P. aeruginosa, K. pneumoniae, Actinobacter, MRSA

Tx: 
Antipseudomonal cephalosporin (Cefepime, ceftazidime) OR antipsuedomonal carbapenem (meropenem) OR B-lactam (piperacillin-tazobactam)

+

Antipsuedomonal FQ (cipro/levofloxacin) OR aminoglycoside (gentamicin)

+

Linezolid or Vanc

Treat for 7 days

56
Q

tx for strep pneumoniae?

A

penicillin G or amoxicillin

57
Q

tx fo Penicillin resistant strep pneumoniae?

A

ceftriaxone

58
Q

tx for non beta lactamase producing H. influenzae?

A

amoxicillin

59
Q

tx. for beta lactamase producing H. influenzae?

A

second or third generation cephalosporin or amoxicillin

60
Q

tx for Mycoplasma pneumoniae?

A

azithromyocin or doxycycline

61
Q

tx for Chlamydophila pneumoniae?

A

azithromyocin or doxycycline

62
Q

tx. for legionella species?

A

FQ (cipro/levo/moxifloxacin) or azithromycin

63
Q

tx for chlamydophila psittaci

A

tetracycline (i.e. doxycycline)

64
Q

tx for enterobacteriaceae (klebsiella, E. Coli, Enterobacter, Proteus)

A

3rd or fourth generation cephalosporin (ceftriaxone, ceftiazidime, cefepime) or carbapenem (meropenem, ertapenem)

65
Q

tx for pseudomonas aeruginosa?

A

antipseudomonal B lactam (pipercillin) + cipro/levofloxacin or gentamicin

66
Q

tx for anaerobic aspiration?

A

i.e. bacteriodes, fusobacterium, peptostreptococcus = Beta lactam, clindamyacin

67
Q

tx for methicillin susceptible staph aureus?

A

penicillin

68
Q

tx for MRSA?

A

Vancomyocin or linezolid

69
Q

tx for bordatella pertussis?

A

azithromyocin

70
Q

tx for infleunza virus?

A

oseltamivir or zanamivir (tamiflu)

71
Q

tx for histoplasmosis/blastomycosis?

A

itraconazole

72
Q

tx for mycobacterium tuberculosis?

A

Isoniazid + rifampin + ethambutol + pyrazinamide

73
Q

which drugs bind 30S?

A

aminoglycosides (gentamicin)

Tetracyclines (Doxycycline)

74
Q

56 y/o male presents due to fever, chills, productive cough and confusion. gram stain shows abundant neutrophils and gram + dipplococci?

A

most common is strep pneumoniae* - need empiric coverage

previously healthy patient? recommend azithromycin or doxycycline

75
Q

which drug binds 50S?

A

macrolides - azithromycin
lincosamides - clindamycin
oxazolidinones - linezolid

76
Q

binds DNA gyrase preventing relaxation of DNA supercoids?

A

fluoroquinolones

77
Q

blocs protein synth by inhibiting translocation?

A

macrolides, clindamycin

78
Q

disrupts cell membrane structure

A

polmyxins, daptomycin

79
Q

prevents initiation of protein synth

A

aminoglycosides, linezolid

80
Q

what do you treat resistance strep pneumo with high level resistance to penicillin?

A

Levofloxacin - high resistance should give an HAP Ab

81
Q

what is mechanism of resistance for strep pneumonia?

A

alteration of Penicillin binding protein

82
Q

what bacteria would you see if on a cruise or in a hotel room?

A

legionella

83
Q

risk factors for DRSP?

A

old age >65, B-lactam use within 3 mos, alcoholism, Immunosuppressive illness, exposure to child at day care

84
Q

Which bug most often uses Beta lactamases as resistance mechanism?

A

think of as resistance to staph aureus

85
Q

68 y/o female in ED with hx of productive cough and fever, c/o SOB and sharp pains, was tx with ciprofloxacin for UTI 3 weeks prior, has left lower lobe infiltrate

which regimin is most appropriate if tx with CAP?

A

CURB-65: confusion, uremia, respiration, low BP- 65? she has two of these (age and increased RR) –> admit as an inpatient to hospital with ddx of CAP

Had been on Cipro in the past - thus tx as you would inpatient non-ICU: ceftriaxone + azithromycin

if had Beta lactam allergy: would give respiratory FQ

86
Q

what do you use if allergic to Beta lactams with inpatient in ICU?

A

for ICU patients who are admitted with previous hx of anaphylaxis to penicillin - have to use a beta lactam + FQ /macrolide - this would be an indication for use of aztreonam

USE: aztreonam + FQ/azithromycin

87
Q

which antimicrobials cover atypicals?

A

azithromycin, doxycyclines- these are major empiric txs

levofloxacin, moxifloxacin

88
Q

which drugs do not need to be dose adjusted if prescribed to patients with poor renal fn?

A

ceftriaxone - this is the only beta lactam thats eliminated half in urine and half in bile and it is not effected by poor renal fn.

moxifloxacin - is the other drug that doesn’t have to be dose adjusted for renal impairement

89
Q

76 y/o man, post CABG developed fever with increasing O2 demands, high temp, high WBCs, right lower love infiltrate, sputum shows WBC and gram negative bacilli. ddx? Is still on the ventilator….

A

ventilator associated pneumonia - think pseudomonas aeruginosa (the gram positives you would think of would be staph aureus and MRSA)

tx with piperacillin/tazobactam + gentamicin

90
Q

55 y/o male with 6 hour hx of bloody nose - unable to stop bleeding, has multiple bruises, INR is 5.8 - was recently prescribed Ab for pneumonia….. chart review shows recent mycoplasma pneumonia…. what is ddx?

A

ddx? macrolide - thinking of Azithromycin reaction with warfarin (this binds the 50S ribosomal subunit)

91
Q

CF patient who is 25 that has had increasing yellow green sputum production, showing sx of CF exacerbation - shows staph and psuedomonas. What would empiric therapy be if she has pseudo and MRSA?

A

patients who are younger than 16: see staph aureus
patients who are over 18: see psuedo aeruginosa

tobramycin + piperacillin/tazobactam + vancomycin
- want to pick two antipseudomonal agents that are sensitive, plus a drug that tx MRSA

92
Q

8 y/o with CAP. wants to be tx as outpatient. what do you not use?

A

levofloxacin - achilles rupture, not approved under age 16

doxycycline - teeth discoloration

cefotaxime - only given IV

use amoxicillin or azithromycin

93
Q

aspiration pneumonia in an 85 y/o - admit for CAP, which beta lactam has anaerobic activity? which drug inhibits protein synth and tx aspiration pneumonia?

A
  1. ampicillin/sublactam - ampicillin and amoxicillin are extended spectrum penicillins (they cover anaerobes when combined with beta-lactamases)
  2. Clindamycin
94
Q

47 y/o male with RA is maintained on prednisone for 6 years, has fevers, n/s, anorexia, w/l, raises chickens, most likely ddx is?

A

histoplasma capsulatum - treat with itraconazole which works by inhibiting ergosterol synthetase

95
Q

voriconazole AE?

A

visual changes - “see flashing lights” or photophobia/color changes

96
Q

What Respiratory FQ’s to use?

A

Use Ciprofloxacin when suspect P aeruginosa

Use levofloaxacin/meoxifloxacin when suspect strep pneumonia, but not pseudomonoas aeruginosa

97
Q

tx for patients at risk for DRSP?

A

comorbities, age >65 y/o, age <2 y/o, use of antimicrobials in past 3 mos (Beta lactams), alcoholism, immunosuppression, exposure to child at day care

use levofloxacin or Beta lactam (amoxicillin) + azithromycin

98
Q

when do you use aztreonam?

A

when patient has penicillin anaphylaxis but is an inpatient in the ICU (thus will use aztreonam + azithromycin/levofloxacin)

99
Q

resistance mechanisms of gram + vs gram - organisms?

A

gram positive: strep resistance due to PBP binding resistance (staph sometimes due to B-lactamases)

gram negative = due to beta lactamases

100
Q

What maintenance therapy may be initiated that acts as an anti-inflammatory and may decrease the virulence of Pseudomonas aeruginosa?

A

azithromycin

101
Q

AIDS pt. with difficulty breathing?

A

pneumocytstis jirovecii = fungi

tx: preferred is “Bactrim” trimethoprim/sulfamethoxazole

102
Q

use of penicillinG/penicillin V?

A

streptococcus and syphilis

103
Q

use of oxacillin/naficillin?

A

anti-staph Abs

104
Q

use of amoxicillin/ampicillin?

A

“extended spectrum” - covers gram-positive in addition to a few gram-negative organisms, also covers enterococci and Listeria monocytogenes

105
Q

use of piperacillin?

A

Bottom-line: serious gram-negative infections (Pseudomonas, Enterobacter, Klebsiella), anaerobes

106
Q

use of ceftriaxone/ceftazidime?

A

Bottom-line: less active against gram-positives, much more active against Enterobacteriaceae

107
Q

use of cefepime?

A

Bottom-line: good gram-positive in addition to serious gram-negative infections (Pseudomonas)

108
Q

use of carbapenems?

A

Bottom-line: very broad spectrum! Aerobic and anaerobic gram-positive and gram-negative bacteria. Ertapenem has inferior activity against Pseudomonas.

109
Q

use of vancomycin?

A

Bottom-line: no gram-negative or mycobacterium coverage. Broad gram-positive (MRSA, MRSE, enterococci)

110
Q

use of FQ’s?

A

Bottom-line: good gram-negative coverage (ciprofloxacin covers Pseudomonas), MSSA, “respiratory FQ’s” cover Streptococcus spp. (levofloxacin)

111
Q

use of gentamicin?

A

no anaerobic coverage (requires 02 dependent transport into bacterial cell), broad aerobic gram-negative coverage (tobramycin most active against Pseudomonas)

112
Q

use of minocycline/doxycycline?

A

Bottom-line: wide aerobic and anaerobic gram-positive and gram-negative activity, MRSA, atypical bacteria, Rickettsia, Coxiella burnetii, syphilis. Gap: Pseudomonas.

113
Q

use of azithromycin?

A

Bottom-line: aerobic gram-positive cocci and bacilli, atypical organisms, inactive against most gram-negatives (except H. influenzae, N. meningitides, Bordetella pertussis)

114
Q

use of clindamycin?

A

Bottom-line: gram-positive S. pyogenes, Streptococci, MSSA, CA-MRSA, anaerobes. No aerobic gram-negative coverage.

115
Q

use of linezolid?

A

Bottom-line: gram-positive Staphylococcus (MSSA, MRSA, VRSA), Streptococcus (DRSP), enterococci (VRE), gram-positive anaerobic cocci, gram-positive rods

116
Q

all drugs that cover pseudomonas?

A 
Piperacillin/tazobactam
Ceftazidime
Cefepime
Meropenem
Aztreonam
Tobramycin
Gentamicin
Ciprofloxacin
117
Q

72 y/o female, presents to ED from nursing home, high temp, high RR, low BP, rales in right lower lobe with right lower lobe infiltrate…what is curb-65 score? what is the treatment for empiric therapy of late onset pnuemonia in this case for HAP?

A

ddx: HCAP

CURB-65: confusion, respiratory, BP, 65 = 4 - admit to ICU
confusion, BUN>20, RR>30, BP 90/60, age 65

nasal swab shows +MRSA - suspect pneumonia though need sputum or BAL, and blood cultures

tx: ceftazidime/cefepime OR meropenem OR Piperacillin-tazobactam
\+ 
Ciprofloxacin OR Gentamycin 
\+ 
Vanc/Linezolid

Respiratory II, Test 2 (9 decks)

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