deck_6776960 Flashcards
what do the beta-lactams do?
inhibit cell wall synthesis
what are the sub-classes of beta-lactams?
penicillins
cephalosporins
carbapenems
monobactams
which classes of antibiotics inhibit bacterial protein synthesis?
macrolides (50s)
aminoglycosides (30s)
tetracyclines (30s)
what class of antibiotics inbhitis DNA gyrase?
quinolones
what are the major members of the Penicillin family?
penicillin, oxacillin, nafcillin, dicloxacillin
what is the coverage for penicillin?
gram positives
some anaerobes
NO STAPH COVERAGE
what can oxacillin/nafcillin/dicloxacillin cover that penicillin can not?
MSSA (staph aureus)
what is unasyn?
ampicillin/sulbactam
what are the similarities in coverage for augmentin and unasyn?
both cover gram positive, gram negtive and some anaerobes
***Neither covers pseudomonas
How is unasyn administered?
IV
what can you use from the penicillin family to cover pseudomonas?
piperacillin
pip/tazo (zosyn)
Ticar/clav (timentin)
what are the 1st gen cephalosporins and what do they cover?
cefazolin (Ancef)
cephalexin (Keflex)
cover gram positive
what are the second generation cephalosporins and what do they cover?
cefuroxime, cefoxitin
gream neg, and some gram positive
what are the 3rd generation cephaolsporins and what do they cover?
ceftriaxone (Rocephin)
ceftadzidime
gram positive and gram negative and ceftazadime has pseudomonas coverage
what are the 4th generation cephalosporins and what do they cover?
Cefepime, covers gram positive and gram negative, plus MSSA and pseudomonas
what are the 5th generation cephalosporins and what do they cover?
ceftaroline (MRSA but NOT pseudomonas)
which of the carbapenems cover anerobes, including pseudomonas and other resistant organisms?
meropenem
imipenem
(both are IV only)
what are the common macrolides?
erythromycin
clarithromycin
azithromycin
what do the macrolides cover?
gram positive
gram negative diplococci and coccobacilli
atypicals
what do the quinolones cover?
gram positive (levo more than cipro)
gram negative (good coverage)
atypicals
pseudomonas (levo and cipro ONLY)
what do the aminoglycosides typically cover?
gram negatives including pseudomonas
which tetracycline is good for resistant gram negatives?
tigecycline
which tetracycline is used for tick borne disease?
doxycycline
many of the tetracyclines are good coverage for what organisms?
atypicals
MSSA
P. acnes (doxy esp.)
which abx give good anerobic coverage?
clindamycin
metronidazole
augmentin
unasyn
zosyn
carbapenems
what is the first line drug choice for treating MRSA?
Vancomycin
Linezolid
tidezolid
daptomycin
what can be used to treat vancomycin resistant enterococci (VRE)?
linezoid, tidezolid
daptomycin (but not in the lungs!)
What can you treat PCP or toxoplasmosis with?
Bactrim (TMP/SMX)
A 6 y/o presents with sore throat with a strawberry appearance and fever, no cough, headache and with a rapid strep test. How would you like to treat this patient?
penicillin x 10 days
amoxacillin (kids)
clindamycin, azithromycin (PCN allergy)
what are the complications of Group A strep infections?
scarlet fever
rheumatic fever (why we treat)
glomerulonephritis
31 y/o female patient at 25 weeks gesttation presents to ob/gyn with dysuria and urinary frequency, afebrile. UA clean catch dips positive. Now what?
Don’t gram stain - waste of time
Nitrofurantoin is the drug of choice here
what’s the problem with prescribing Bactrim to a pregnant woman with a UTI?
it interferes with folate metabolism
what can you prescribe in any patient with a UTI? What additional options are available for a nonpregnant patient?
oral cephalosporin
nitrofurantoin?
Amox/Clav (augmentin)
Nonpregnant: Bactrim, Doxy, Quinolones
what are the most common bacteria in acute otitis media?
Strep pneumo
H. influenza
M. catarrhalis
what is the first line drug in acute otitis media?
Amoxicillin (assuming no penicillin allergy)
what if you see AOM in a child who just had finished antibitoics?
augmention
oral cephalosporins
what antibiotic would be your first choice in community-acquired pneumonia with diffuse infiltrates (atypical pneumonia)?
azithromycin (macrolides)
(could also do doxy, quinolones that are anti-pneumococcus like levoflox, augmentin + macrolide)
what is a good treatment for bacterial meningitis a person 1mo -50 years old with unknown organism?
ceftriaxone + vancomycin (covers positive and negative including resistant strep. pneumo)
consider whether to add dexamethasone
add ampicillin for listeria in >50 or immunocompromised
what are the typical organisms that cause bacterial meningitis in neonates?
Group B strep
E. Coli
Listeria
what are the antibiotics used in baterial meningitis in neonates?
ampicillin plus ceftaxime plus gentamicin
what are the common pathogens of post-op wound infections?
Staph aureus
Group A, B, C, G streps
Enterococcus
(add gram negatives if near the abdomen)
what is a good first-choice antibiotic for a surgical site infection?
Augmentin
1st gen cephalosporin
dicloxacillin
clindamycin (good if pen/ceph. allergic)
what’s the treatment for chlamydia again?
azithromycin 1 gram
OR Doxycycline (according to her)
what is good for treating bacterial vaginosis or trichomonas?
metronidazole
If you have a positive RPR, what do you use to treat for syphilis?
Penicillin G IM
what do you use to treat LGV (lynphogranuloma venereum) or granculoma inguinale (Donovanosis)?
doxycycline or azithroymcin
what are the most common causative organisms in hospital acquired pneumonia?
staph aureus
gram negative rods (pseudomonas/coliforms)
anerobes
strep pneumo
enterococci
what is a good choice of antibiotic to cover empiric treatment for hospital acquired pneumonia?
pip/tazo +/- vanc or +/- aminoglycoside or quinolone
or cefepime
impipenem or meropenem
what can you use to treat C. diff?
metronidazole
or oral vancomycin
patient with signs of early sepsis from a decubitus ulcer (extended hospitalization) shows up at the ER. What do you give him
IVF + meropenem + vancomycin
how do you want to treat acute bacterial sinusitis?
augmentin +
saline irrigation and decongestants
quinolones are an option
or doxy (for PCN allergy)
when should you treat for acute bacterial sinusitis?
symptoms > or equal to 10 days
severe symptoms (fever, facial pain) > 3-4 days
symptoms after URI
how do you diagnose bronchitis?
clinical - history and PE (bilateral rhonchi)
what is the therapy for bronchitis?
antitussive, NSAIDS and inhaled bronchodilator
if it fails to respond, then investigate bacterial
