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J3 > Beestjes wk 6 > Flashcards

Beestjes wk 6 Flashcards

1
Q

Name a bacteriostatic antibiotic

A

clarithromicin

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2
Q

Antibiotic Spectrum

A

the range of bacterial species effectively treated by the antibiotic

NB: Important to distinguish between lack of activity and resistance. Spectrum normally refers to wild type bacteria (i.e. those that haven’t yet acquire resistance genes)

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3
Q

Broad Spectrum Abx

A

Antibiotics that are active against a wide range of bacteria

downside- also have a substantial effect on colonising bacteria. tend to cause other infections like C. diff and candida

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4
Q

Narrow Spectrum

A

Antibiotics that are active against a limited range of bacteria

Useful only where the cause of the infection is well defined

Have a much more limited effect on colonising bacteria

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5
Q

Guided therapy

A

Depends on identifying the cause of infection and selecting agent based on sensitivity testing

Used principally for relatively mild infections for which treatment can be delayed until the results of a lab culture are available

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6
Q

Empirical therapy

A

Used when therapy cannot wait for culture, i.e. in patients with more severe infections:

  • Sepsis
  • Bacterial meningitis

Use antibiotic which has extensive action against any bacteria which might be causing infection

Need to penetrate broadly throughout body because the site of infection may be unknown or the infection may be disseminated.

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7
Q

Prophylactic therapy:

A

Used to prevent an infection before it begins

May be used in healthy people who have been exposed to:

  • Surgery → e.g. hip replacements, bone marrow transplants, colorectal surgery
  • Injury
  • Infective material

Also used in immunocompromised individuals:

  • HIV
  • Transplantation
  • Splenectomy
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8
Q

β-lactam antibiotics

A

Defined by the presence of a beta-lactam ring

This ring is structurally analogous to peptidoglycan that makes up the bacterial cell wall

Beta lactam antibiotics are penicillin binding protein inhibitors → stop the development of the cell wall

Interfere with peptidoglycan metabolism, and impair the bacteria’s ability to lay down the cell wall by inhibiting cross-linking

Beta lactams cause cell lysis -> bactericidal

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9
Q

Classes of β-lactam antibiotics

A

1) penicillins
2) cephalosporins
3) Carbapenems (usually the broadest spectrum)
4) Monobactams
5) Combinations

PCCMC

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10
Q

List 3 penicillins

A

1) benzylpenicillin
2) amoxicillin
3) flucloxacillin

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11
Q

Name a cephalosporin

A

Ceftriaxone

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12
Q

Name a carbepenem

A

meropenem

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13
Q

Name a monobactam

A

aztreonam

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14
Q

Name two beta lactam combination drugs

A

1) co-amoxiclav = Amoxicillin/clavulanic acid (Augmentin)

2) Piperacillin/tazobactam (Tazocin)

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15
Q

Beta lactamases

A

Enzymes that lyse and inactivate beta-lactam drugs

Confer high level resistance to antibiotic

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16
Q

what classes of bacteria commonly secrete beta lactams?

A

Gram negatives and S.aureus

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17
Q

Beta lactam absorption

A

Most β-lactams poorly absorbed from GI tract:

must be given IV

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18
Q

Which β-lactams can eb given orally?

A

1) amoxicillin
2) flucloxacillin

NB: vomiting limits dose

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19
Q

β-lactam excretion

A

Usually excreted unchanged in urine, some also via bile

renal function is therefore the key determinant in beta lactam dosing

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20
Q

β-lactam adverse effects

A

By and large very safe even in very high doses.

GI effects are the most common - nausea, vomiting, diarrhoea, cholestasis

Other:

  • hypersensitivity t1 = urticaria, anaphylaxis (rare)
  • t2 hypersensitivity -= haemolytic anaemia
  • t3 = vasculitis
  • t4 hypersentsitivity - mild to severe = 4th day rash to stevens johnson syndrome
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21
Q

β-lactam allergy

A

1/10 reports penicillin allergy

Often reported hypersensitivity syndrome is non-allergic

cross reactivity = Patients allergic to a penicillin will usually be allergic to other penicillins

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22
Q

Benzylpenicillin administration

A

IV

NB: oral agent (Penicillin V) is similar but not often used

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23
Q

Benzylpenicillin spectrum/activity

A

Narrow spectrum

first choice antibiotic for serious streptococcal infection

also has good activity against neisseria

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24
Q

first choice antibiotic for serious streptococcal infection

A

Benzylpenicillin

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25
Q

Amoxicillin administration

A

Much more orally bioavailable than natural penicillins

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26
Q

most commonly used beta lactam

A

Amoxicillin

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27
Q

Amoxicillin spectrum/activity

A

principally used against streptococci because of extensive resistance

e.g. in upper respiratory tract infections

also has good activity against enterococci

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28
Q

Flucloxacillin

A

Synthetic penicillin developed to be resistant to beta-lactamase produced by staphylococci

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29
Q

Flucloxacillin spectrum/activity

A 
highly active against
 Staphylococcus aureus (not MRSA)

Streptococci (mildly effective)

No activity at all against gram negative organisms

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30
Q

Flucloxacillin administration

A

Can be given orally but nausea limits dose

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31
Q

Effect of Beta-lactamase inhibitors

A

Effectively inhibit some beta-lactamases

Greatly broadens spectrum of penicillins against Gram negatives and S. aureus

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32
Q

How does the susceptibility of cephalosporins to beta lactmases compare to that of penicillins?

A

Less Susceptible To beta-lactamases than penicillins because of the presence of a side chain (their structure is more complicated)

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33
Q

Carbapenems spectrum and use

A

Ultra-broad spectrum beta-lactam antibiotics

should be held back for patients in who it is really necessary

Excellent spectrum of activity against Gram +ves and Gram –ves

No activity against MRSA
Resistant to beta- lactama

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34
Q

What are CPEs?

A

cabapenemase producing Enterobacteriaceae

New beta-lactamases that lyse carbapenems

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35
Q

Which beta lactam can be given to patients who are penicillin allergic?

A

Aztreonam (monobactam)

structure is very different to penicillin therefore no cross reactivity to penicillins (except anaphylactic allergy)

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36
Q

Aztreonam administration

A

Only given IV – no oral absorption

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37
Q

Which drug can be used as a substitute for gentamicin in patients who can’t have gentamicin due to renal toxicity?

A

Aztreonam

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38
Q

Vancomycin mechanism of action

A

Inhibits cell wall formation in Gram +ves only

no Gram –ve action - the molecule is too large to get through the outer membrane

Not dependent on PBP (penicillin binding proteins) binding so effective against resistant organisms who have mutated their penicillin binding protein

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39
Q

Vancomycin spectrum

A

Broad-spectrum antibiotic

  • clostridium
  • streptococcus
  • enterococcus
  • staphylococcus
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40
Q

Vancomycin administration/uses

A

Indicated for penicillin-allergic patients who cannot receive, or who have failed to respond to penicillin/cephalosporin-antibiotics

Main use is in the treatment of MRSA infection

Not absorbed from GI tract so almost always given IV

Careful drug monitoring is required due to narrow therapeutic index. Main issue in clinical use is underdosing

Oral route only used for treatment of C. diff

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41
Q

vancomycin toxicity

A

1) Nephrotoxicity – more likely with higher doses
2) hypersensitivity - red man syndrome and anaphylaxis
3) ototoxicity (rare)

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42
Q

Which antibiotic would you prescribe for cellulitis?

A

Flucloxacillin

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43
Q

Protein synthesis inhibitors targeting the 50S Ribosomal Subunit

A

1) macrolides -> erythromycin, clarithromycin, azithromycin
2) clindamycin
3) chloramphenicol

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44
Q

Protein synthesis inhibitors targeting the 30S Ribosomal Subunit

A

1) aminoglycosides -> gentamycin

2) tetracyclines - > doxycycline

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45
Q

Protein synthesis inhibitors

A

1) macrolides
2) aminoglycosides
3) tetracyclines

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46
Q

macrolides spectrum

A

Good activity against Gram positive pathogens and respiratory Gram negatives (haemophilus and moraxella)

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47
Q

Most commonly used macrolide

A

clarithromycin

Active against “atypicals” i.e. organisms causing atypical pneumonia, which is nonresponsive to penicillins

1) Legionella
2) Mycoplasma
3) Chlamydia

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48
Q

Clarithromycin adverse effects

A

Diarrhoea & Vomiting
QT prolongation
Hearing loss with long term use

Drug interactions

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49
Q

Clarithromycin Drug interactions

A

over 400 drug interactions

binds to and inhibits CYP-3A4

Statins - Avoid co-prescription. Temporarily stop simvastatin to avoid simvastatin toxicity

Warfarin

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50
Q

Which drug should be stopped if clarythromycin is prescribed?

A

Statins

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51
Q

clindamycin activity

A

Principle action against Gram positives

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52
Q

What is useful about clindamycin?

A

highly effective at stopping exotoxin production because it is such a potent ribosome inhibitor

Added to patients with Gram positive toxin mediated disease because it is thought to add prognostic benefit:

  • Toxic shock syndrome
  • Necrotising fasciitis
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53
Q

Which antibiotic is given to patients with Gram positive toxin mediated disease to minimise toxin production?

A

clindamycin

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54
Q

C. Differgic Antibiotics

A

4C antibiotics:

1) Clindamycin
2) Co-amoxiclav
3) Cephalosporins
4) Ciprofloxacin

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55
Q

Chloramphenicol

A

inhibits the 50S ribosome

Excellent Broad spectrum of activity

Very toxic:

  • Bone marrow suppression
  • Aplastic anaemia
  • Optic neuritis

Only used for topical therapy to eyes or in bacterial meningitis with beta lactam allergy

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56
Q

Aminoglycosides

A

30s inhibitors

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57
Q

Aminoglycoside example

A

gentamicin

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58
Q

Gentamicin mechanism of action

A

Two mechanisms

1) Bactericidal action on the cell membrane at high concentrations
2) bateriostatic action by binding to 30s ribosomes, causes a prolonged post-antibiotic effect

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59
Q

Gentamicin toxicity

A

1) Nephrotoxicity - particularly with prolonged use

2) Ototoxicity - common:
Hearing loss
Loss of balance
Oscillopsia

3) Neuromuscular blockade:
can exacerbate myaesthenia gravis

60
Q

Gentamicin dosing

A

Once-daily dosing

high initial dose

long dosing interval (24-48hrs) to minimise toxicity

Give for 3 days only

61
Q

Tetracyclines

A

30s inhibitors

Relatively non-toxic

Avoid in children and pregnant women:
Bone abnormalities
Tooth discolouration

62
Q

Which populations should not be given tetracyclines?

A

children and pregnant women:

Bone abnormalities
Tooth discolouration

63
Q

Tetracycline example

A

doxycycline

64
Q

Which classes of antibiotics affect DNA Repair and Replication?

A

1) Quinolones
Ciprofloxacin
Levofloxacin

2) Rifampicin

65
Q

Quinolones

A

Broad spectrum, bactericidal antibiotics

Very widely used

DNA gyrase inhibitors

excellent oral bioavailability

66
Q

Commonly used Quinolones

A

ciprofloxacin (stronger gram - action)

levofloxacin (stronger gram + action)

67
Q

Quinolones toxicity

A

Gastrointestinal toxicity
QT prolongation
Tendonitis

68
Q

Rifampicin indications

A

Tuberculosis (in combination therapy)

In addition to another antibiotic in serious Gram positive infection (esp. Staph. aureus)

69
Q

TB therapy - problems

A

1) Slow growing infection - requires much longer antibiotic courses
2) High bacterial burden
3) poor penetration to the site of infection - Limited access of drugs to granuloma (no vascular supply)

70
Q

TB therapy

A

Prolonged courses of therapy (usually 6 months)

Combination therapy

RIPE
R - rifampicin
I - isoniazid
P - pyrazinamide
E - ethambutol (bacteriostatic)
71
Q

Inhibitors of Folate synthesis

A

Trimethoprim

Co-trimoxazole

72
Q

Trimethoprim

A

orally administered

Good range of action against Gram +ves and Gram –ves

73
Q

Trimethoprim use

A

limited to use in uncomplicated UTI

74
Q

Co-trimoxazole

A

Combination antibiotic with trimethoprim and sulphamethoxazole

synergistic effect of two folate synthesis inhibitors

Significant additional toxicity

75
Q

Metronidazole

A

Effective Against Most anaerobic bacteria

Added Therapy in intra-abdominal infections

Unpleasant reaction with alcohol

Peripheral Neuropathy with long term use

76
Q

Treatment of lower UTI

A

Treatment only needs to sterilise urine

No need for systemic activity

Low risk infection so can often wait for culture results - good evidence that given an ibuprofen prescription is as good as antibiotics

77
Q

Antibiotic Treatment of lower UTI

A

1) Trimethoprim
first line agent for most cases
Avoid in 1st trimester of pregnancy
Penetrates well into prostate so good choice for men

2) Nitrofurantoin:
Excellent, broad spectrum of activity
Concentrated in urine
Avoid in renal failure

78
Q

Most common cause of UTI

A

E coli

other coliforms

79
Q

Treatment of complicated UTI

A

Ciprofloxacin

80
Q

Treatment of complicated UTI if severely unwell

A

Amoxicillin

Gentamicin

81
Q

Abx Thought to be safe

in pregnancy

A

Most beta-lactams
Macrolides
Anti-tuberculants

82
Q

Abx Thought to be unsafe

in pregnancy

A

Tetracyclines - Bone/tooth abnormalities

Trimethoprim - Neural tube defects (1st Tri)

Nitrofurantoin - Haemolytic anaemic (3rd Tri)

Aminoglycosides - Ototoxicity (2nd/3rd Tri)

Quinolones - Bone/joint abnormalities

83
Q

What type of bacteria tend to cause UTIs?

A

gram negative rods, e.g. E. coli, Kleibsella

84
Q

Typical causes of pneumonia

A

Haemophilus influenzae

Streptococcus pneumoniae

85
Q

Atypical causes of pneumonia

A

Staphylococcus aureus
Mycoplasma pneumoniae
Legionella

86
Q

Most common cause of cellulitis

A

Staphylococcus aureus

other gram positive cocci

87
Q

Most common causes of intra-abdominal infections

A

gram negative rods

Anaerobes

88
Q

Gram positive cocci

A 
Chains = streptococcus
Clusters = staphylococcus
89
Q

Gram negative cocci

A

Neisseria meningitidis
Neisseria gonorrhoea

kidney bean shaped

90
Q

Gram negative rods

A 
E. coli
Kleibsella
pseudomonas aueroginosa
salmonella
shigella
proteus
serratia
91
Q

Common treatment for penumonia

A

amoxicillin and clarithromycin

doxycyxline can give gram positive and gram negative cover

92
Q

Which antibiotics need dose monitoring?

A

gentamicin
vancomycin

Both have a narrow therapeutic window

93
Q

Gram positive rods

A 
Clostridium difficle
clostridium tetani
Bacillus cereus
Listeria monocytogenes
Corynebacteria diptheria
Propionobacterium acnes
94
Q

Name two common contaminants in blood cultures

A

coagulase negative staphylococci (most common)

staphylococcus aureus

NB: streptococci in blood cultures are not commonly contaminants

95
Q

Which antibiotic provides cover for the majority of gram positive cocci?

A

vancomycin

96
Q

Which antibiotic provides good cover for gram negative bacteria?

A

gentamicin

97
Q

How are streptococci classified?

A

according to their ability to haemolyse blood agar

1) alpha-haemolytic
2) beta-haemolytic
3) gamma-haemolytic (non-haemolytic)

98
Q

Which is the most common streptococcus species associated with bacterial endocarditis?

A

step viridans

99
Q

What can group A streptococcus pyogenes cause?

A

wound infections

local infections - tonsilitis, pharyngitis

serious systemic infections - necrotising fasciitis, fulminant shock with bacteraemia

100
Q

How would you treat streptococcal endocarditis of a native heart valve?

A

4 weeks therapy

benzylpenicillin + gentamicin (for 2 weeks)

synergisitc actio, benpen disrupts the cell wall, allowing gentamicin to enter the cell

101
Q

What antibiotic would you use to treat anaerobes?

A

metronidazole

102
Q

Which antibiotic provides gram positive cover?

A

amoxicillin

103
Q

Which antibiotic provides gram negative cover?

A

gentamicin

104
Q

What antibiotic would you use to treat an infection in a patient with a history of ESBL producing coliforms?

A

meropenem or imipenem (carbapenems)

105
Q

Common causes of necrotising fasciitis

A

Type I - synergistic infection with aerobes and anaerobes

  • anaerobes -> bacteriodes, peptostreptococcus
  • aerobes -> streptococci, enterobacteriaciae

Type II: infection with Group A Streptococci

  • s. pyogenes
  • s. aureus (occasional)
106
Q

Which antibiotic provides staphylococcus cover?

A

flucloxacillin

107
Q

Which antibiotic provides streptococcus cover?

A

benzylpenicillin

108
Q

What surgical prophylaxis would you give to a patient who is MRSA colonised?

A

vancomycin or teicoplanin

109
Q

What would you give to a patient newly regonised as MRSA colonised?

A

nasal mupirocin - 5 days

chlorhexidine wash - 5 days

110
Q

Name 2 opportunistic infections

A

coagulase negative staph

aspergillus

111
Q

which antibiotics are usually used to treat gastroenteritis (in the rare event that antibiotic therapy is indicated)?

A

quinolones -> ciprofloxacin

112
Q

What types of bacteria is flucloxacillin active against?

A

streptococci and staphylococci

113
Q

What types of bacteria is benzylpenicillin active against?

A

streptococci

114
Q

What types of bacteria is amoxicilline active against?

A

some gram negatives and anaerobes

115
Q

Addition of what compound can improve the activity of amoxicillin?

A

clavulanic acid - beta lactamase inhibitor

116
Q

What should you prescribe for a Lower respiratory tract infection?

A

amoxicillin or doxycycline

117
Q

What should you prescribe for a UTI?

A

trimethoprim or nitrofurantoin

118
Q

What should you prescribe for mild cellulitis?

A

Flucloxacillin or doxycycline

119
Q

What should you prescribe in the case of a severe/life-threatening infection?

A

Usually IV combination treatment (Beta lactam + Gentamicin) initially

e.g. amoxicillin + gentamicin

120
Q

What should you prescribe in the case of a severe/life-threatening infection & staphylococcus aureus infection was suspected?

A

IV amoxicillin + gentamicin

ADD IV flucloxacillin

121
Q

What should you prescribe in the case of a severe/life-threatening infection & MRSA infection was suspected?

A

IV gentamicin + vancomycin

122
Q

What should you prescribe in the case of a severe/life-threatening infection & penicillin allergy?

A

IV gentamicin + vancomycin

123
Q

What should you prescribe in the case of a severe/life-threatening infection & severe streptococcal infection was suspected?

A

IV amoxicillin + gentamicin

ADD IV clindamycin

124
Q

Which antibiotic(s) would you prescribe for a lower UTI and for how long?

A

Trimethoprim or Nitrofurantoin

Women - 3 days
Men - 7 days

125
Q

Which antibiotic(s) would you prescribe for an upper UTI and for how long?

A

Gentamicin

126
Q

Indications for IV abx therapy

A

Sepsis syndrome, SIRS or rapidly progressing infection

Special conditions:

1) Infective endocarditis
2) CNS infection
3) Bacteraemia (S. aureus)
4) Osteomyelitis (initially)

Mod-severe skin and soft tissue infection
Infection and oral route compromised
No oral formulation of antibiotic available

127
Q

How would you manage a case of cellulitis?

A

Flucloxacillin monotherapy

leg elevation

IV therapy usually required until significant reduction in heat, erythema, swelling and induration

on average 3-4 days IV

Oral 5 days if mild

IV-IVOST if moderately severe 7-10 days total

In very severe add IV Clindamycin and Gentamicin

128
Q

What organism(s) most commonly cause(s) cellulitis?

A

Beta haemolytic Streptococci

Group A is most common

Staph aureus most commonly causes infection of surgical wounds

129
Q

What organism(s) most commonly cause(s) necrotising fasciitis?

A

Beta haemolytic Streptococci

Group A is most common

Staph aureus

130
Q

How would you manage a case of S. aureus bacteraemia

A

Flucloxacillin 2g 6 hourly

If true penicillin allergy - Vancomycin

Transoesophageal echo if fever persists/there is a further positive blood culture

IV therapy for ≥2 weeks

131
Q

How would you manage a COPD exacerbation

A

Antibiotic Rx only if purulent sputum (60% = viral)

Do not give dual antibiotic therapy first line

Use amoxicillin or doxycycline

132
Q

Common pathogens in septic arthritis

A

Staphylococcus aureus (MSSA/MRSA)

Haemophilus Influenzae (common in children)

Neissaria gonorrhoeae (disseminated gonorrhoea)

133
Q

Common pathogens in osteomyelitis

A

Staphylococcus aureus (90% of cases)

Haemophilus Influenzae

Salmonella

134
Q

Common pathogens in Cellulitis

A

S.aureus

strep pyogenes

135
Q

Common pathogens in Necrotising fasciitis

A

beta-haemolytic streps Gp A&raquo_space; B, C, G

S.aureus

136
Q

Antibiotic management of Necrotising fasciitis

A

Fuck Bad GMC (mnemonic)

Flucloxacillin, Benzylpencillin, Gentamicin, Metronidazole, Clindamycin

Clincamycin is good at switching off exotoxin production and thus improves mortality.

137
Q

most common causes of typical CAP

A

Streptococcus pneumoniae (50%)

Haemophilus Influenzae

Moraxella catharralis

Typical CAP present with cough, fever, sputum and pleuritic chest pain

138
Q

most common causes of atypical CAP

A

Mycoplasma pneumoniae

Legionella pneumophila

Chlamydophila pneumoniae/psittaci

Presents with flu-like symptoms: malaise, headache, myalgia

139
Q

Treatment of TB

A 
RIPE:
• Rifampicin (has interactions - CYP450 inducer)
• Isoniazid
• Pyrazinamide (stop after 2 months)
• Ethambutol (stop after 2 months)
  • Long duration - 6 months
  • Combination of drugs to reduce the rise of resistance
140
Q

How will Neiserria gonorrhoea infection look under the microscope?

A

gram negative intracellular diplococcus

141
Q

What is the treatment for chlamydia?

A

Azithromycin + Doxycyclin

142
Q

What is the treatment for gonorrhoea?

A

Ceftriaxone + Azithromycin

143
Q

What condition does Treponema pallidum cause?

A

syphillis

144
Q

What is the treatment for syphillis?

A

Penicillin injection

145
Q

Which antibiotics cause tendinopathy?

A

Quinolones (e.g. ciprofloxacin)

J3 (18 decks)

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