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Microbio Gram Pos > Cell Wall Antibiotics > Flashcards

Cell Wall Antibiotics Flashcards

1
Q

Environment for metronidazole

Use

A

Anaerobic

Good for brain or abdomen

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2
Q

Environment for Aminoglycosides

A

Aerobic

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3
Q

“The Usual” AB treatment

A

Combo of extended spectrum penicillin, beta lactamase inhibitor, and vancomycin

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4
Q

General mechanisms of resistance

A

Enzyme inactivation, alteration of target site, altered bacterial membrane, efflux pumps, and environmental

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5
Q

What type of bacteria is resistant to almost all AB’s?

A

Carbapenem resistant enterobacteriacae
Most common in Klebsiella
Klebsiella producing carbapenemase (KPC)
New Delhi Metallo-beta-lactamase 1 (NDM)

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6
Q

What is mechanism of methicillin resistance?

A

Altered PBPs

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7
Q

Which bugs use efflux pumps?

Against which drugs?

A

Gram Neg and S pneumoniae

Tetracyclin, quinolones, and macrolides

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8
Q

4 families of beta lactams

A

penicillins, cephalosporins, carbapenems, and monobactams

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9
Q 
Penicillins
Type of killing
Subtypes
Resistance due to?
Adverse rxns
A

Time-dependent killing (short half life)
Natural penicillins, aminopenicillins, Semi-synthetic penicillins, extended spectrum penicillins, penicillin / beta lactamase inhibitor combinations
Resistance caused by beta lactamase, changes in outer membrane porins, or altered PBPs
Advers rxns: rash, hypersensitivity, diarrhea, cytopenia, renal impairment.

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10
Q

Natural penicillins
Drugs
Spectrum
DOC for which conditions?

A
  • Penicillin G Benzathine (IM) – Low concentrations over many weeks. Tx syphilis.
  • Penicillin G (IV) – High serum concentrations. Tx endocarditis or brain abscess.

SPECTRUM
•Gram-positives: streptococci (DOC), most enterococci, most pneumococci, Peptostreptococcus, Listeria, Clostridia (gas gangrene, add clindamycin)
•Gram-negatives: Pasturella (caused by animal bites), Neisseria meningitidis
•Spirochetes: Treponema pallidum (syphilis), Borrelia species (Lyme disease)
•Periodontal infections

DOC for Streptococci and Syphillis

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11
Q 
Aminopenicillins
Comparison to natural penicillins
Drugs
Spectrum
Resistance
Use
A

Better Gram (-) coverage than natural penicillins.
•Amoxicillin (oral)
•Ampicillin (IV) – not on list
•Spectrum same as natural penicillins + some Gram Neg (E coli, Proteus mirablis, Haemophilus).
Does not work for bugs w/ beta-lactamase.
•Use – Upper and lower respiratory infections (pharyngitis, otitis, sinusitis, pneumonia), UTI, enterococcus, listeria, endocarditis prophylaxis for dental work

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12
Q

Semi-synthetic penicillins
Drugs
Use
Spectrum

A

Dicloxacillin (oral) – tx mild infections such as cellulitis
Oxacillin (IV) – tx more severe Staph infections such as endocarditis or osteomyelitis. Good CNS penetration
DOC for Staph (non-MRSA or MRSE). Treat bacteria w/ beta-lactamase properties, such as Staph aureus, which are resistant to natural penicillins.
•Spectrum – Narrow. Only used for Staph.

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13
Q 
Penicillin / Beta-Lactamase Inhibitors
Drugs
Spectrum
What if H influenzae does not make beta lactamase?
Use
A
  • Amoxicillin-clavulanic acid (oral) – Tx outpatient infections. Bites.
  • Piperacillin-tazobactam (IV) – Tx nosocomial infections. Pseudomonas.
  • Spectrum – Same as penicillin + beta-lactamase organisms: S aureus, E coli, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella, Bacteriodes, anaerobes
  • 70% of H influenzae does NOT make beta-lactamase. Use amoxicillin.
  • Use – Upper and lower respiratory tract infections, head / neck infections, SSTI’s (cellulitis), animal / human bites, intraabdominal infections, pseudomonas
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14
Q 
Cephalosporins
Type of killing
Mechanism
Resistance
Adverse effects
Which bugs do cephalosporins NOT work for?
Which drugs do / do not enter CSF?
A

Time-dependent killing
Beta lactam inhibits cell wall synthesis
Resistance due to beta lactamase, changes in outer membrane porins, or altered PBP
Adverse Rxns - Few. Rash, cross-rxn w/ penicillin, diarrhea
Do NOT work for enterococci, Listeria, Chlamydia, or Mycoplasma
3rd gen (Ceftriaxone and Ceftazadime) and 4th ten (Cefepime) enter CSF. 1st and 2nd generation do not.

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15
Q

1st Generation Cephalosporins
Drugs
Spectrum
Use

A
  • Cephalexin (oral)
  • Cefazolin (IV) – perioperative AB prophylaxis
  • Spectrum – Gram Pos cocci including Strep and MSSA
  • Use – SSTI from Strep and Staph. Perioperative AB prophylaxis
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16
Q

2nd Generation Cephalosporins
Unique feature
Drugs, spectrum, and uses

A

Only cephalosporin w/ anaerobic activity
•Cefuroxime group – Used for upper / lower respiratory infections
•Cefoxitin – same as 1st gen + anaerobes and some Gram Neg. Used for intra-abdominal / pelvic infections

17
Q

3rd Generation Cephalosporins
Drugs w /uses and side effects
Spectrum
DOC for what?

A

•Ceftriaxone (IV) – long half life allows for once daily dosing. Good for gonorrhea. May cause biliary sludging w/ long term use. Used for seriuous infections such as meningitis, CAP, viridans strep endocarditis, intra-abdominal (need to add drug for anaerobes, such as metronidazole), UTIs.
•Ceftazadime (IV) – works against Pseudomonas
•Spectrum – Gram negative, Strep, N gonorrhoeae
DOC for gonorrhea

18
Q

4th Generation Cephalosporins
Drugs w/ uses and side effects
Spectrum

A
  • Cefepime – very broad spectrum. Tx serious nosocomial infections caused by Pseudomonas as well as febrile neutropenia. May cause mental status changes (be careful w/ elderly)
  • Spectrum – Gram Pos and Neg including S aureus, Strep, GNR aerobes, Pseudomonas and ESBL (extended spectrum beta lactamase). Not MRSA or anaerobes.
19
Q

5th Generation Cephalosporins
Drugs
Spectrum
Use

A
  • Ceftaroline (IV) – only cephalosporin that treats MRSA (except CAP)
  • Spectrum – Mainly Gram Pos. Some Gram Neg and anaerobes. MRSA, MRSE (coag-neg), strep.
  • Use – SSTI’s, CAP (not MRSA for this)
20
Q

Which class has broadest spectrum of all AB’s?

A

Carbapenems

21
Q 
Carbapenems
Drugs
Mechanism
Reason they're so good
Spectrum
Resistance
Adverse rxns
A

Meropenem
•Mechanism – inhibits cell wall synthesis (beta lactam). Time dependent killing.
•Reason they’re so good: molecules are small so can get through porins of Gram Neg, resistant to most beta-lactamases, and have high affinity for PBPs
•Spectrum – Most Gram Pos, Gram Neg (including ESBL), Pseudomonas, and anaerobes. Not MRSA, MRSE, Enterococcus faecium, C diff, Stenostrophomas, or Burkholderia
•Resistance – beta-lactamases, alterations in porins, changes in PBPs.
•Adverse effects – rash, hypersensitivity, cross-rxn w/ penicillins, seizures

22
Q 
Monobactam
Drugs
Mechanism
Spectrum
Resistance
Adverse Rxns
A

Aztreonam
•Mechanism – inhibits cell wall synthesis (beta lactam). Time dependent killing.
•Spectrum – Aerobic Gram Neg Rods, such as Pseudomonas aeruginosa. Can be used in pxs allergic to penicillin or other beta-lactams.
•Resistance – beta-lactamases
•Adverse rxns – rash and hypersensitivity

23
Q 
Vancomycin
Type of AB
Mechanism
Spectrum
Resistance
Uses
Adverse Rxns
A

Glycopeptide
•Mechanism – Binds d-alanyl-D-alanine peptide precursor to prevent peptidoglycan polymerase / transpeptidation → autolysis. Slowly cidal (slower than beta-lactams). Time-dependent killing.
•Spectrum – Aerobic and anaerobic Gram Pos including MRSA, MRSE (Coag-Neg Staph), enterococci (not VRE), Strep, and corynebacteria.
•Resistance – Enterococcal resistance (VRE) due to peptidoglycan precursor w/ lower affinity for vancomycin. Some Staph aureus resistance as well (VRSA)
•Uses – IV form used for systemic infections. Oral form is not absorbed well in gut, which is good for C diff. MRSA, Coag-Neg Staph, Enterococcal infections that are resistant to ampicillin, P pneumoniae meningitis, penicillin allergy.
•Adverse rxns – neutropenia, renal impairment (monitor trough levels), ototoxicity, Red Man Syndrome

24
Q 
Daptomycin
Type of AB
Mechanism
Dosing
Spectrum
Resistance
Uses
Adverse Rxns
A

Cyclic lipopeptide
•Mechanism – lipid portion inserts into cell membrane and causes rapid depolarization → protein inhibition and DNA synthesis inhibition → cell death (“blows up” cells). Concentration-dependent killing.
•Llong half life allows for once daily dosing (IV only).
•Spectrum – Gram (+). Does NOT work for CAP due to inactivation by pulmonary surfactant
•Resistance – some Staph aureus and E faecium. Does not work for CAP.
•Uses – Serious MRSA, VRE, Coag-Neg Staph, including bacteremia and endocarditis
•Adverse Rxns – Myopathy. Elevated CK.

25
Q

Pseudomonal agents (7)

A

Pipericillin, ceftazidime (3rd gen), cefepime (4th gen), aztreonam, merapenem, aminoglycoside, quinolone (ciprofloxacin)

Microbio Gram Pos (11 decks)

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