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Pediatrics > Bacteria And Antibiotics > Flashcards

Bacteria And Antibiotics Flashcards

1
Q

List some of the important gram positive structures and the typical findings

A

Gram positive cocci in pairs: strep pneumonia
Gram positive cocci in chains:
- Beta-hemolytic strep: strep pyogenes (GAS), strep agalactiae (GBS)
- alpha-hemolytic strep: strep viridans
- enterococcus
Gram positive cocci in clusters: staph aureus (coagulase +), coagulase negative staph
Gram positive bacilli:
- clostridium sp are big rods
- listeria are small rods

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2
Q

Name some of the important gram negative bacteria features

A 
Cocci:
- in pairs: n meningitides, n gonarrheae
- moraxella catarrhalis
Cocci-bacilli: haemophilus influenza
Bacilli (aerobic)
- enterobacteriaceae: e. Coli, kliebsella, enterbacter, salmonella, shigella
- pseudomonas
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3
Q

Name the mechanism of action of each of the common antibiotics

A 
Cell wall synthesis:
- Beta-lactams: penicillins, cephalosporins, carbapenems
- glycopeptides: vancomycin
30S Ribosome inhibitors:
- aminoglycosides
- tetracyclines
50S Ribosome inhibitors
- macrolides
- clindamycin
DNA inhibitors
- fluroquinolones
- rifampin
- metronidazole
Anti-metabolite:
- TMP-SMX
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4
Q

List the spectrum of Penicillins and common side effects

A 
Drugs: Penicillin G IV/IM, Penicillin V PO
Spectrum:
- Beta-hemolytic strep
- strep pneumonia
- strep viridans
- anaerobes from mouth
- neisseria meningitides 
- treponema palladium (syphilis)
Side effects:
- rash
- diarrhea
- fever
- interstitial nephritis, hepatitis, neutropenia
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5
Q

Discuss the spectrum and common side effects of aminopenicillins

A 
Drugs: Amoxicillin PO, Ampicillin IV
Spectrum:
- same as Penicillin +
- enterococcus
- listeria
- haemophilus influenza 
Side effects
- rash
- diarrhea
- fever
- interstitial nephritis, hepatitis, neutropenia
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6
Q

Discuss the spectrum and side effects of anti-staphylococcal penicillins

A 
Drugs: cloxacillin IV/PO
Spectrum:
- methicillin sensitive staph aureus
Side effects
- rash
- fever
- diarrhea
- interstitial nephritis, hepatitis, neutropenia
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7
Q

Discuss the spectrum of penicillins with Beta-lactamase

A 
Amoxicillin-clavulanate PO: 
- same as amoxicillin +
- MSSA
- haemophilus influenza
- enterbacteriaceae
- anaerobes from gut
Piperacillin-tazobactam
- amoxicillin +
- pseudomonas
- MSSA
- enterobacteriaceae
- GN coverage
- anaerobes from gut
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8
Q

Discuss the spectrum and side effects of cephalosporins

A 
First Generation: Cefazolin (Ancef) IV, Cephalexin (Keflex) PO
- MSSA
- beta-hemolytic strep
Second Generation: Cefuroxime PO/IV
- MSSA
- beta-hemolytic strep
- strep pneumonia
- h flu
- moraxella catarrhalis
- enterobacteriaceae 
Third Generation: Ceftriaxone IV/IM, cefotaxime IV
- strep pneumonia
- beta hemolytic strep
- GN (CNS penetration)
- enterobacteriaceae 
Side effects
- rash
- diarrhea
- fever
- insteritial nephritis, hepatitis, neutropenia
- ceftriaxone not use in neonates due to bilirubin
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9
Q

Discuss the spectrum and side effects of carbapenems

A 
Drugs: ertapenem, meropenem, imipenem
Spectrum:
- MSSA
- b-hemolytic strep
- strep pneumo
- h flu
- GN including pseudomonas
- enterobacteriaceae
- anaerobes
- meropenem have CNS penetration
Side effects:
- rash
- diarrhea
- fever
- interstitial nephritis, hepatitis, neutropenia
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10
Q

Discuss the spectrum and side effects of aminoglycosides

A 
Drugs: gentamicin, tobramycin
Spectrum:
- GN bacilli (pseudomonas)
- used with b-lactatams for severe infections with gram positive 
Side effects:
- nephrotoxicity
- ototoxicity
- must follow drug level if use >48 hrs
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11
Q

Discuss the spectrum and side effects of fluoroquinolones

A 
Drugs:
- Ciprofloxacin: GN (pseudo), 
- levofloxacin: GN (pseudo), strep pneumo, atypical bacteria
- moxifloxacin: GN (no pseudo), strep pneumo, anaerobes
Side effects:
- C diff
- QTc prolongation
- tendinitis
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12
Q

Discuss the spectrum and side effects of vancomycin

A 
Spectrum: GP
- MRSA
- coagulase negative staph
- enterococcus
- c diff (PO only)
- strep pneumo
Side effects:
- red man synergy due to histamine release
- nephrotoxic
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13
Q

Discuss the spectrum and side effects of clindamycin

A 
Spectrum: GP only
- MSSA and MRSA
- strep
- anaerobes
- used with b-lactatams for severe GP infection releasing endotoxins
Side effects
- rash
- c diff
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14
Q

Discuss the spectrum of macrolides

A 
Drugs: erythromycin (PO), clarithromycin (PO), azithromycin (IV/PO)
Spectrum:
- atypical bacteria
- bordetalla pertussis
- chlamydia trachomatis
- neisseria gonarrheae
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15
Q

Discuss the spectrum of doxycycline

A 
Spectrum: weird bugs
- borrelia burgdorferi (Lyme)
Side effects
- esophagitis
- photosensitivity
- teeth discolouration
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16
Q

Discuss the spectrum and side effects of TMP-SMX

A 
Spectrum:
- GP: MRSA, staph, listeria
- GN: enterobacteriaceae 
- mycobacterium
- parasites
- fungi
Side effects
- kernicterus in neonates
- agranulocytosis
- Steven-Johnson syndrome
17
Q

Discuss the spectrum and side effects of metronidazole

A 
Spectrum:
- anaerobes
- parasites
Side effects:
- neurologic toxicity
18
Q

When should parents seek medical attention for a fever?

A

Infant 0-3 months
Infant 3-6 months with irritability, lethargy or appears uncomfortable >1 day
Infant 6 monts - 2 years for fever that doesn’t respond to medication after 1 day
Children >2 with lethargy or significant discomfort or fever that does not respond to medication or lasts >3 days

19
Q

When do you perform a lumbar puncture of an infant with a fever?

A
  • age <1 month
  • ill appearence
  • high risk of bacterial infection
  • prior Abx
  • clinically evident invasive infection
  • seizure
20
Q

What are the Rochester criteria

A
  • infant appears well
  • previously healthy: born at term, no perinatal antimicrobial, no treatment for hyperbilirubinemia, no previous antimicrobial therapy, no previous hospitalization, no chronic illness, not hospitalized longer than mother
  • no evidence of infection
  • WBC between 5-15, <10 WBC on urine, <5 WBC in stool
21
Q

What is the management of fever in the different age ranges?

A

0-28 days
- admit with full septic workup (CSF, blood and urine culture)
- initiate empiric Ampicillin and Gentamycin or Cefotaxime
1-3 months
- low risk based of Rochester: do not need to admit and can follow up within 24 hrs. If add Abx must do cultures first
- high risk admit for full septic work up. Add vancomycin if considering meningitis
3 mon - 3 years
- toxic then full septic work up and possible CXR if respiratory distress or WBC >20
- Temp <39 do urinalysis and follow up
- Temp >39 then CBC, blood culture, urinalysis and culture if <2. provide empiric ceftrixone

Pediatrics (18 decks)

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