Chapter 23 Flashcards
who developed the first antibiotic
alexander fleming, penicillin
How many years supplement as discovery that antibiotics develop resistance
10 years
Personnel and penicillin non-susceptible pneumococcus was identified in
The 1960s
MDR
Multidrug resistance
World War III organization reported an estimated ____ cases of MDR in 2014
480,000
Factors that contribute to MDR
Increasing populations of immunocompromised patients, increases in the number and complexity of invasive medical procedures, and increased survival of patients chronic diseases
Just spread of resistant organisms in the community has been associated with
Take care for young children, overcrowding, travel, and the use of antibiotics in agriculture
The leading risk factor for having a drug-resistant pathogen include the use of
Antibiotics, age younger than two years or older than 65 years, day care center attendance, exposure to young children, multiple medical comorbidities, recent hospitalizations, immunosuppression
CDC core elements of antibiotic stewardship
Commitment
action for policy and practice
tracking and reporting
education and expertise
sensitivty
that drug will be sensitive to that drug
Commitment
Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety.
Action for policy and practice
Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed.
Tracking and reporting
Monitor antibiotic prescribing practices, and offer regular feedback to clinicians, or have clinicians assess their own antibiotic prescribing practices themselves.
Education and expertise
Provide educational resources to clinicians and patients on antibiotic prescribing, and ensure access to needed expertise on optimizing antibiotic prescribing
What does a beta lactum group do
inhibits the biosynthesis of the petidoglycan bacterial cell wall
Sensitivity
Natural PCNs
Streptococcus, some Enterococcus strains, some non–penicillinase-producing Staphylococcus
Sensitivity Aminopenicillins
greater activity against gram-negative bacteria because of enhanced ability to penetrate the outer-membrane organisms
Penicillin is a
bata-lactam
amino penicillin used for
Used for gram-negative urinary and gastrointestinal (GI) pathogens – Escherichia coli, Proteus mirabilis, Salmonella, some Shigella species, and Enterococcus faecalis; active against the common gram-negative respiratory pathogens Moraxella catarrhalis (and Haemophilus influenzae type B)
Combination with beta-lactamase inhibitors do what and give an example
they broaden their spectrum: clavnate, sulbactam, tazobactam combined with amoxicillin are used under the trade name augmenten (clavnuate and amoxycillin)
PCN are well absorbed in the
GI tract
Example of a PCN that is not well absorbed in the GI tract and would not be given orally
ampicillin
Probenecid prolongs
half-life and increases the risk of toxicity
PCN ADR
Allergic reactions, rash, GI, Fungal Overgrowth, C-diff
how quickly can immediate allergic reaction occur from PCN
2 to 30 minutes
Common reaction to PCN
rash that happens 7 to 10 days after start
The longer a patient is on an antibiotic the greater the chance of
c-diff/colitis
Beat lactums PCN are ___ for pregnancy
safe, they are a category b
first line therapy for acute otitis media and sinusitis
Amoxicillin
first line therapy for infection following bites, including human
amoxicillin/calvulanate
Pt education
Resistance, ADRs, completing course
Beta-Lactum: Cephalosporins
simlar to PCN, inhibit mucopeptide synthesis in the bacterial cell wall.
Cehplaosporins have how many generations
four
chephalosporins first generations used for
Used for skin and soft tissue infections
Primarily active against gram-positive bacteria, S. aureus and S. epidermidis
cephlosporin second gen used for
Active against same as first generation, plus Klebsiella, Proteus, E. coli
cephlosporin third gen used for
Used for broader indications
More active against gram-negative bacteria
cephlosporin fourth gen used for
Primarily active against gram-positive bacteria
cephlosporin fifth gen used for
Similar to third generation, except active against methicillin-resistant S. aureus (MRSA)
Ceph fourth gen is used when there is resistance to
other beta lactamase groups
Ceph fifth gen
Cetaroline
if someone is penicillin allergic can you prescribe a cephlosporin
most of the time yes. The time you wouldn’t is if there is a type 1 anaphalacitc reaction
Cephalosporin, how is it absobed, what is is bound to and where is it excreted
gi tract, proteins, kidneys
Cephalosporin ADR
allergies, skin rashes, arthralgia, coagulation abnormalities, anemia, neutropenia, leukopenia, thrombocytosis, fever, seizures, renal/hepatic failure
Cephalosporins is commonly used in theraputic faliure of
Acute Otitis Media
Firrst gen use of Cephalosporins
strp, skin infiections
Cephalexin, cefpodoxime, cefixime: can be prescribed as second-line drugs for
for urinary tract infection (UTI)
Ceftriaxone and cefixime: used for
used for general condition in Gonococcus (GC)/Chlamydia infection
Cefpodoxime, cefuroxime, or parenteral cetriaxoone by oral cefpodoxime used for
used for community-acquired pneumonia.
Cephalosporin monitor for
diarrhea
renal function, if prolonged therapy
cephalosporn patient education
use as prescribed
