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Bugs and Drugs Exam 2 > Bug Treatments > Flashcards

Bug Treatments Flashcards

1
Q

MSSA

A

-ASP (resists NSBLs and BSBLs)
-Pen + BLI
-1st>2nd>3/4th>5th cephs
–>cephamycins aren’t great for staph
No aztreonam
All carbapenems (Dori most effective)
Vancomycin only use if patient has beta lactam allergy
Dapto and tela
2.5, 3, or 4 generation FQs may work, but other drugs are better and resistance develops quickly during therapy (MOR on plasmid that bug carries causing end treatment resistance)
-AGs …use gentamycin + nafcillin or cefazolin (AG gram positive activity trend: staph > strep > enterococci)
Macrolides and Clindamycin (unless developed resistance…save Clinda to avoid resistance development; use Clinda for MRSA)
Linezolid
Streptogramin
TMP-SMX
Nitrofurantoin: UTI

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2
Q

MRSA

A

-Ceftaroline (5th)
Vancomycin, dapt, and televancin
Resistant to AGs by unknown mechanism (maybe use Vanco + AG?)
Susceptible to Clindamycin only if passes D test (CA-MRSA)
Linezolid (oral too!)
Streptogramin (good for complicated, resistant SSTI)
Tetracycline works for CA-MRSA > HA-MRSA
TMP-SMX gets HA-MRSA and CA-MRSA, oral and IV forms about 75% effective. Often see TMP/SMX + Clindamycin for MRSA…together get 100%
TMP/SMX useful and appropriate for MRSA since oral and IV formulations

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3
Q

MSSE

A

-ASP
-Pen + BLI
-1st>2nd>3/4th>5th
No aztreonam
All carbapenems
Vanco if beta lactam allergy
Dapto and televancin but don’t use
2.5, 3, and 4th generation FQs work but do not use them
AG…use gentamycin + vancomycin +/- rifampin
Macrolides and Clindamycin (unless developed resistance)
Linezolid
Streptogramin
TMP-SMX

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4
Q

MRSE

A

-Ceftaroline (5th)
Vancomycin, dapto, and televancin
Resistant to AG by unknown mechanism (AG + vanco works)
Resistant to macrolides and clindamycin except Telithromycin
Linezolid
Streptogramin
TMP-SMX, oral and IV forms about 75% effective

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5
Q

PSSP

A

-Any penicillin (Pen G most appropriate)
-1st>2nd>3/4/5th (non-acid AKI group only)
No aztreonam
No carbapenems
Vancomycin if beta lactam allergy
Dapto and televancin work but don’t use
2.5 and up FQs work, (resistant to early gen FQs because they don’t bind PAR)
Streptococci display low-level resistance to AG, so use in combo with a BL (AG + ceftriaxone)
Macrolides work (use ERY, CLR for CA-RTIs)
Clinda not really used due to rapid resistance and ADRs
Linezolid
Streptogramin
Bug susceptible to TMP-SMX but doesn’t eradicate the pathogen so don’t use!! Also facultative bug that can hide in anaerobic compartments; drug only works when bug is actively multiplying

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6
Q

PRSP

A

-Penicillins are “inneffective”–>use high doses to overcome PBPs
-Cephs need to have non-acid AKI group
2nd: cefpodoxime and cefuroxime
3rd-5th: ceftriaxone, ceftaxime, cefepime, ceftaroline
No aztreonam
All carbapenems (Dori> Imi> the rest)
Vanco, dapto, and televancin
2.5 and up FQs (respiratory FQs)
AG + Pen G…allows us to lower the dose of Pen G needed. Or use with ceftriaxone
No macrolide or clindamycin works except Telithromycin
Linezolid
Streptogramin
Resistant to TMP-SMX

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7
Q

All other streptococci

A

-Any penicillin
-1st>2nd>3-5th (as long as non-acidic AKI group)
No aztreonam
All carbapenems
Vanco (especially for viridans)
Dapto and televancin
2.5 and up FQs (except cipro)
Streptococci display low-level resistance to AG, so use in combo with a BL (Strep pyogenes resistant to AGs alone)
For viridians: use gentamycin + Pen G
Macrolides work, Clinda not used due to rapid resistance
Marcolides can be cidal for streptococci at high concentrations
Streptogramin
Bug susceptible to TMP-SMX but doesn’t eradicate the pathogen so don’t use!! If you don’t eradicate strep it can transmit to baby through birth canal

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8
Q

Enterococcus faecalis

A

-APs work the best, but Pen G can work too (synergy with AG)
-ASPs will not work (PBP doesn’t bind)
-Piperacillin works, but not great
-Ticarcillin not effective
-No cephs (due to modified PBPs)
No aztreonam
All carbapenems except ertapenem
Vanco is AOC in serious infections
Dapto?
Telavancin
No FQs (but more susceptible than faecium)
Functionally resistant to AGs alone; must use in combo with BL (ampicillin or pen G) or vanco for BL allergic
No macrolide or clindamycin works…limited entry and modified ribosomes
Linezolid (works for VRE too!)
Streptogramin DOESN’T WORK!!! BUG developed all 3 MOR!
Tetracycline doesn’t work
Appear susceptible to TMP-SMX but NEVER use; bugs are scavengers!!
Nitrofurantoin: UTI

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9
Q

Enterococcus faecium

A

-less susceptible than faecalis
-AP>Pen G (synergy with AG)
-Piperacillin works but not great
All glycopeptides
Can only use Gentamicin in combo with a BL (Tobra and Ami don’t work, even with a BL!)
No macrolide or clindamycin works
Streptogramin works!!!
Tetracycline doesn’t work
Appear susceptible to TMP-SMX but NEVER use; bugs are scavengers!!

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10
Q

Listeria monocytogenes

A

-AP>Pen G (synergy with AGs)
-Pen V does not work
-ESPs work (a little)
Vanco IV for gram + meningitis
Dapto and televancin
3rd or 4th gen FQ
Display low-level resistance to AG, so use in combo with a BL (AG + ampicillin)
Marcolides and clindamycin work!
Linezolid
TMP-SMX AOC for Gram + bacilli (Listeria meningitis!)

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11
Q

Corynebacterium

A

All glycopeptides
Usually susceptible to AGs (use with Pen G)  Pen G + AG = AOC
Linezolid!!
TMP-SMX AOC for Gram + bacilli

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12
Q

Bacillus

A
  • Vancomycin for Bacillus cereus

- All other bacillus are susceptible to Pens/Beta-lactams

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13
Q

Acinetobacter

A

-AP/ESP + BLI may be effective but never use it alone
-3rd/4th gen cephs maybe, but not reliable
-not ceftaroline (5th)
-no Aztreonam
All carbapenems can kill 75% of these except ertapenem
Susceptible to FQs (always want to recommend multiple drugs for this bug such as carbapenem+ FQ)
AG might kill 70%…best to combine with FQ and carbapenem
NOT Streptogramin
Resistant to TMP; SMX effective but only 10-30%; don’t use

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14
Q

Moraxella catarrhalis

A

-AP + BLI or ESP + BLI
-2nd-5th gen cephs (when possible, use 2nd gen with AKI): cephamycins will work but want to save these for other infections
Aztreonam works
All carbapenems
All FQs
AG works but never use! Other drugs are better!
Macrolide works, clindamycin doesn’t
Streptogramin works but never use
Resistant to TMP, SMX effective but only 10-30%; don’t use

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15
Q

Neisseria gonorrhea

A

-NP + BLI maybe will work…but probably has really high MIC so don’t use
-AP + BLI or ESP + BLI will work
-2nd-5th gen cephs–>ceftriaxone (3rd) is AOC because of long t1/2
-3rd>2nd but can use either
-others listed: cefuroxime, cefpodoxime, cefixime
Aztreonam works
All carbapenems
FQ resistant so don’t use
AG (Streptomycin > Gentamicin)….not used in combo
Azithromycin gets this the best because of two basic amine groups, it distributes best of macrolides (ERY, CLAR work too)
Use azithromycin (low MIC and long half life!)
Clindamycin ineffective
Spectinomycin alone for AG if N. gonorrhoeae doesn’t respond to BL
Tetracyclines like to be resistant
Resistant to TMP, SMX effective but only 10-30%; don’t use

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16
Q

Neisseria meningitidis

A

-NP (Pen G) or AP–>all penicillins work but Pen G is AOC
–>caution with high Pen G doses and seizures
-3rd>2nd gen–>ceftriaxone is AOC
Aztreonam works
All carbapenems (do not use imipenem because it can cause seizures)
No FQ because can cause seizures
AG works (for super serious patient use Pen G + AG  see casebook)
No macrolides or clindamycin
Streptogramin works but never use

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17
Q

Haemophilus influenza

A

-AP + BLI or ESP + BLI
-2nd-5th gen cephs will work: want to use 2nd gen when you can (except in meningitis, use 3rd)
Aztreonam
All carbapenems
All FQs
AG works but never use! Other drugs are better!
Macrolide works (CLR, TEL, AZI)
Erythromycin MIC is high
clindamycin doesn’t work
Clarithromycin used for RTIs!
Streptogramin works but never use
Variable susceptibility to TMP-SMX but there are better drugs

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18
Q

Pasturella/Eikenella

A

-All penicillins except ASPs (ASPs don’t get any G-)
-Pasturella=NP
-Eikenella=AP
***prefer to use amox/clav to cover staph as well
-Penicillins work better than cephalosporins, but all cephalosporins are active (5th>2nd>all rest)
Aztreonam
All carbapenems
All FQs
AG works but never use! Other drugs are better!
Macrolide works
Tetracycline (but use a BL!)

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19
Q

E. coli

A

-AP + BLI or ESP + BLI
*clavulanate is the only BLI that inhibits ESBLs
-NP and ASPs wont work
-2nd-5th gen cephs can work…but really 3rd-5th are best (2nd not likely to be effective)
Aztreonam
All carbapenems (mero and dori are the best)
All FQs (although seeing more resistance)
AG works
Macrolide doesn’t work
Tetracyclines can get in (have intrinsic activity) but many Enterobacteriacea have become resistant.
In general, FQ > Tetra > Macs for GNB
TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area.
Nitrofurantoin: UTIS

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20
Q

Salmonella

A

-AP alone likely effective (ampicillin alone is AOC)
-AP + BLI or ESP + BLI
-NP and ASP won’t work
-2nd-5th gen cephs work: 3rd>2nd
-All FQs
AG works
Macrolide doesn’t work
Chloramphenicol
TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. Also this is probably a serious infection so probably want a cidal killer

21
Q

Shigella

A

-AP alone likely effective (ampicillin alone is AOC)
-AP + BLI or ESP + BLI
-NP and ASP won’t work
-2nd-5th gen cephs work: 3rd>2nd
Aztreonam
All carbopenems
All FQs
AG works
Macrolide doesn’t work
TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. Generally effective for Shigella and E. coli, not so much for Salmonella

22
Q

Proteus mirabilis

A

-AP or ESP (+BLI if it makes BSBL, but not very likely)
-3rd-5th gen>2nd gen cephs
Aztreonam
All carbapenems
All FQs
AG works
Macrolide doesn’t work
TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. Also this is probably a serious infection so probably want a cidal killer

23
Q

Proteus vulgaris

A 
Aztreonam
-All FQs
AG works (use gentamycin)
Macrolide doesn’t work
TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. Also this is probably a serious infection so probably want a cidal killer
24
Q

Klebsiella

A

-ESP + BLI (if it’s not ESBL)
-AP + BLI (??) (if it’s not an ESBL)
-3rd-5th ceph (if it’s not an ESBL)
Aztreonam if not ESBL, AmpC or carbapenemase producing
All carbapenems unless producing carbapenemase
All FQs
AG works (use Gent in combo with ESP or TGC)
Macrolide doesn’t work
TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. Also this is probably a serious infection so probably want a cidal killer
Nitrofurantoin: UTIS

25
Citrobacter (Morganella, Providencia)
-ESP + BLI (if it's not AmpC) -3rd-5th ceph (if not ESBL) All FQs aren’t great for providencia retigeri, although they all work well against providencia stuartii FQs work best for citrobacter Cipro best for Morganella AG works Macrolide doesn’t work TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area.
26
Enterobacter
-ESP + BLI (if it's not AmpC) -3rd-5th ceph (if not ESBL)-->cefepime, ceftazidime AG works (use Gent in combo with ESP or TGC) Macrolide doesn’t work TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. Also this is probably a serious infection so probably want a cidal killer Nitrofurantoin: UTIS
27
Serratia
-ESP + BLI (if it's not AmpC) -3rd-5th ceph (if not ESBL) Aztreonam if not above BSBL All carbapenems Cipro>Levo>Gati/moxi AG works (use Gent in combo with ESP or TGC) Macrolide doesn’t work TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. Also this is probably a serious infection so probably want a cidal killer
28
Pseudomonas aeruginosa
-Only use ESP + BLI *only tazobactam covers AmpC -Cefoperazone, ceftazidime, cefepime, ceftaroline (+ tazo for AmpC) Aztreonam- inhalation product for CF patients All carbapenems except ertapenem (mero has highest PBO affinity) Cipro is FQ with the best activity for this bug however all FQs could work but have more resistance Tobramycin is the best AG (effective against AmpC…best to use in combo with ESP+tazo or anti-pseudo ceph) Macrolide doesn’t work Streptogramin doesn’t work for this or for Enterobacteriacae Tetracycline doesn’t work Resistant to TMP (efflux pump) but susceptible to SMX (only get mono-therapy, not synergy so need LOTS of SMX. Better to use anti-psedo drug)
29
Stenotrophomonas maltophilia
-no beta-lactams Resistant to AG Macrolide doesn’t work TMP-SMX…resistant to TMP but SMX works!!!
30
Burkholderia cepacia
``` Meropenem works Functionally resistant to FQs Resistant to AG Macrolide doesn’t work TMP-SMX…resistant to TMP but SMX works!!! ```
31
Legionella pneumophilia
Moxi/Gati>Levo>Cipro (use later gen FQs for respiratory infections Macrolides work, clindamycin doesn’t (Clar and Azri are great) Streptogramin works but never use Tetracyclines (use BL, then FQ, then tet/mac for resp. infection) Variable susceptibility to TMP-SMX but there are better drugs
32
Campylobacter jejuni
Enteric gram – bug least susceptible to FQs (moxi then levo) | AG works
33
Brucella abortus
-no beta-lactams Use streptomycin alone or combo with Doxycycline (or gentamycin) Tetracycline in combo with rifampin or streptomycin
34
Franciscella tularensis
-no beta-lactams Use streptomycin alone or combo with Doxycycline (or gentamycin) Tetracycline
35
Vibrio
Tetracyclines = AOC | TMP-SMX works for this and for Aeromonas hydrophilia
36
Yersinia pestis
-no beta-lactams Use streptomycin alone or combo with Doxycycline (or gentamycin) Tetracycline TMP-SMX susceptible, but increasing resistance. Know the bug strain in your area. (Yersina enterocolitica infections can be killed with TMP-SMX!)
37
Helicobacter pylori
-Patient will be on a 3-4 drug anitibiotic regimen (i.e. amoxicillin + clarithromycin +lansoprazole) Clarithromycin the best (6’ -0CH3 makes acid stable) Macrolides work (AZI, ERY, CLR), clindamycin doesn’t Tetracycline works in combo Metronidazole + tetracycline + bismuth Amoxicillin + clarithromycin + lansoprazole Variable susceptibility to TMP-SMX but there are better drugs Metronidazole works (bug has a PFOR system)
38
Bacteroides fragilis
-AP + BLI or ESP + BLI *use AP + BLI first, if it works -2nd gen cephamycins only (-OCH3 group) All carbapenems No FQs, if forced use moxi (but don’t trust FQ alone) Anaerobes intrinsically resistant to AG Clindamycin only macrolide that gets this (Clindamycin ONLY gets gram NEGATIVE anaerobes) Metronidazole Linezolid?? Streptogramin works but never use Innately resistant to TMP-SMX Metronidazole
39
Fusobacterium/Prevotella
-Any penicillin will work except ASP -Any ceph will work (1st gen least likely) All carbapenems No FQs, if forced use moxi (but don’t trust FQ alone) Anaerobes intrinsically resistant to AG Innately resistant to TMP-SMX Metronidazole
40
Clostridium (G+)
-Any penicillin (ASPs least effective...actually Chapter 6 says no ASP even though Ch 5 says it's ok) -Any ceph (cephamycins and 1st gens are best) All carbapenems Vanco dapto and tela work No FQs, if forced use moxi (but don’t trust FQ alone) Anaerobes intrinsically resistant to AG Marcolides and Clindamycin work Linezolid Streptogramin works but never use Innately resistant to TMP-SMX Metronidazole
41
Clostridium difficile (G+)
-No penicillin works (Ampicillin known to cause this infection) -No cephalosporins work (3rd gen cephs can cause CDAD) No carbapenems No dapto and tela because can’t be given orally *Vanco oral works Vanco also orally effective for Staph enterocolitis (Metronidazole drug of choice) Anaerobes intrinsically resistant to AG Fixadomicin works!! Drug effective against gram-positive aerobes and anaerobes but ONLY use for C. diff No macrolides or clindamycin (clinda can cause C.diff!!) Metronidazole #1 drug (then vanco, then fixado)
42
Peptostreptococcus, Propionibacterium (G+)
-Any penicillin works -Any ceph will work (cephamycins>1st/5th>2nd/3rd) All carbapenems Vanco, dapto, and televancin No FQs, if forced use moxi (but don’t trust FQ alone) Anaerobes intrinsically resistant to AG Macrolides get acne (Ery, Azi) Linezolid Streptogramin works but never use Tetracyclines good for acne but remember skin adrs! Innately resistant to TMP-SMX Metronidazole
43
T. pallidum, Borrelia (spirochetes)
-Any penicillin works-->use Pen G (most appropriate) *can give IM dose of benzathine salt (slowly absorbed, very susceptible) -Cephs will work...but use Pen G Any Pen (use Pen G!)  can give IM dose of benzathine salt (very susceptible, slow absorption) Cephs would work, but use Pen G Tetracyclines Not susceptible to TMP-SMX because they make dTMP via another pathway
44
Chlamydia/Rickettsia
-No beta-lactams (because bugs are OIPs) Moxi/Gati>levo>cipro Azithromycin AOC for C. trachomatis Erythromycin AOC for C. pneumonia Streptogramin works but never use Tetracyclines!!  great for rickettsia and atypical pneumonia and non-gonoccal urethritis (chlamydia) Not susceptible to TMP-SMX because they make dTMP via another pathway
45
Mycoplasma (Ureaplasma)
-No beta-lactams (becuase bug doesn't have a cell wall) Azithromycin AOC for ureaplasma (single dose, long half-life) Erythromycin AOC for M. pneumonia Streptogramin works but never use Tetracyclines (atypical pneumonia, acute bronchitis) Not susceptible to TMP-SMX because they make dTMP via another pathway
46
Mycobacteria (Nocardia)
-No beta-lactams Moxi/gati>levo>cipro (gati has lower MIC, cipro MIC slightly greater than cut off point so don’t pick Tuberculosis: Streptomycin in combo with isoniazid, rifampin, and pyrazinamide Avium: amikacin in combo with multiple drugs and clarithryomycin Macrolides/Clindamycin don’t work for conventional TB, but Clarithromycin works for TB see in AIDS patients!! Mycobaceria not susceptible to TMP-SMX because they make dTMP via another pathway but nocardia is TMP-SMX susceptible
47
Fungi/Parasites
-No beta-lactams TMP/SMX AOC in PCP (Pneumocystis jiroveci) in HIV patients!!!!!!!!! TMP/SMX can kill head lice (pediculosis capitis) TMP/SMX great for Isospora, Cyclospora ``` Metronidazole: • Gardnerella vaginalis (GNB) • Trichomonas vaginalis • Giardiasis lamblia • Entamobea Histoylitca ```
48
Viruses
-No anti-microbial drugs!
49
Entamoeba histolytica
Paromomycin not in combo (oral prep that stays in gut) If infection spreads to liver need to use injectable AG Erythromycin good if spreads systemically because it distributes to liver however it won’t kill the bug; only static Tetracyclines get intestinal amebiasis that goes systemic Metronidazole

Bugs and Drugs Exam 2 (4 decks)

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