Dr. Cluck Treatment Flashcards
S. aureus
-most virulent Gram (+)
-Staph. -> produces β-lactamase
-Only coagulase-positive Staphylococci -> Abscess
-causes bacteremia, skin soft tissue infections, endocarditis, pneumonia, abscesses, osteomyelitis, food-borne illness, toxic shock syndrome
NEVER a contaminant
Treat S. aureus (MSSA)
If severe (in the blood) > IV
MSSA: Antistaph. bc they are ß-lactamase resistant
-> C D M N O OR 1st Gen Cephalosporin
IV: Nafcillin, Cefazolin
PO: Dicloxacillin, Cephalexin
Treat S. aureus (MRSA)
MRSA:
IV: Vancomycin OR Linezolid, Tigecycline Daptomycin, Ceftaroline
PO: Doxycycline, Clindamycin, TMP-SMX
Staphylococcus epidermidis
-CoNS: coagulase negative
-can cause disease. but is often a contaminant
-bloodstream infections, endocarditis, and prosthetic device infections -> BIOFILM
Treat Staphylococcus epidermidis
-MRSA
I-f truly infected: Vancomycin
Staphylococcus saprophyticus
-often UTI in young females
-does NOT produce ß-lactamase (EXCEPTION)
-> So treat with PNC, TMP-SMX or FQ
Streptococcus pyogenes - Gr A
-do not produce a β-lactamase
-strep throat and cellulitis
-can cause necrotizing fasciitis (emergency - dead tissue) and toxic shock
-post-infection sequelae: glomerulonephritis and rheumatic fever
Treat Streptococcus pyogenes - Gr A
NO ß-L
-no resistance
-Penicillin
-In case of necrotizing fasciitis PNC and Clindamycin (against toxins, decrease inflammation)
-PNC allergic: Clindamycin, TMP-SMX
Streptococcus agalactiae Gr B
-Normal inhabitant of the GI tract and lower GU tract
-neonatal infections (eg meningitis)
-colonizer of the vagina
Treat Streptococcus agalactiae Gr B
No ß-L
Penicillin
Streptococcus bovis/S. gallolyticus
Gr D
-Normal in GI
-marker of colonic neoplasia if found in the blood
-can cause infective endocarditis
Treat Streptococcus bovis/S. gallolyticus
No ß-L
-Penicillin
Streptococcus pneumoniae
-Captain of the men of death
-AUT Syndrome: meningitis, endocarditis, and pneumonia
-Virulence increased by capsule
Treat Streptococcus pneumoniae
No-ß-L
-Penicillin resistance at 30%
-β-lactam or FQ
Viridans streptococci
-normal GI flora (including oral cavity)
-endocarditis, poor dentition, damaged heart valves
-Streptococcus anginosus belongs to this group (causes abscesses)
Treat Viridans streptococci
Penicillin
-ß-lactam resistance is rising
Enterococcus
-Normal bowel flora
-wound infections, endocarditis, and UTIs (NOT pneumonia)
-E. faecalis is often more drug-susceptible
-E. faecium is more drug-resistant
Treat Enterococcus faecalis
ß-lactams are only static against Enterococcus
-Amino penicillins plus an aminoglycoside (Ampicillin + Gentamycin - SYNERGY)
OR linezolid, daptomycin
Treat Enterococcus faecium
ß-lactams are only static against Enterococcus
-Vancomycin OR linezolid, daptomycin
Mycobacteria
-causes (tuberculosis, leprosy - lepra -skin, nerves)
-it has a lipid-rich cell wall causing it to stain poorly -> “acid-fast”
Treat Mycobacteria
-M. tuberculosis requires 4 drug therapy
-Non-tuberculosis Mycobacteria (NTM) have variable susceptibilities -> may be resistant to anti-tuberculosis agents
-NTM: M. chelonae, M. abscessus, M. fortuitum, M. marinum
Bacillus
-known are B. anthracis, B. cereus
-B. cereus produces an enterotoxin (Chinese food)
Treat Bacillus
only supportive, antibiotics are not necessary
(for B. cereus foodborne illness)
B. anthrax: Ciprofloxacin?
Listeria monocytogenes
-found in soil, water, and the GI tract of animals, home-made cheese, unpasteurized milk
-cause meningitis
Treat Listeria monocytogenes
if invasive: Ampicillin or TMP-SMX
VNC or Meropenem
NO Cephalosporin is active against Listeria
Clostridium
Anaerob Garam (+) rod
-C. perfringens: food-borne illness and gas gangrene
-C. difficile: pseudomembranous colitis
-C. tetani and C. botulinum: different typed paralysis
Treat C. diff
ORAL VNC - the only one to treat with PO VNC!!
mild to moderate: PO VNC or fidaxomicin
severe: PO VNC + IV metronidazole
Moraxella catarrhalis
-colonizer of the upper respiratory tract
-may cause many diseases: Comm. ac. pneumonia, otitis media, sinusitis
-produce ß-lactamase inconsistently
Haemophilus influenzae
-similar to Moraxella
-colonizer of the upper respiratory tract
-Type B capsule versus non-typeable strain
-Vaccination available
Treat Moraxella catarrhalis
-Amoxicillin
typically doesn’t produce ß-lactamase
Acinetobacter spp.
-Essentially ubiquitous (isolated from food, hospitals, soil, skin)
-highly resistant and deadly
-ß-lactamase doesn’t work
-sulbactam (protects the ß-lactam drug - usually has no activity) here: has microbial activity
Treat Acinetobacter spp.
-multiple ways to treat
-Carbapenems
Neisseria
-N. gonorrhea and N. meningitidis
-N. meningitidis causes meningitis
-N. gonorrhoeae causes gonorrhea (STI) and PID (pelvic inflammatory disease)
-Both encapsulated
Treat Neisseria
-N. meningitidis with 3rd Gen Cephalosporin/sometimes with Pen G bc some do not produce ß-lactamase
-N. gonorrhoeae with Cephalosporins
Alternative: FQ, Macrolides (high dose)
Enterics
-belong to the family of Enterobacterales
-Salmonella and Shigella are NOT part of
normal human flora
-Ecoli and Klebsiella produce ESBL (ESBLs hydrolyze 3rd GEN cephalosporins)
-Enterobacter is the prototype organism for AmpC (ß-lactamases cutting many ß-lactams)
Treatment Enterics
(E.coli, Enterobacter, Citrobacter)
-Treatment depends on the characteristics of the drug, the context of the patient
-Therapy should be broad
-piperacillin-tazobactam, cefepime, or a carbapenem -> depends on the case
Treat E. coli and Klebsiella
Carbapenem
Pseudomonas aeruginosa
-aerobic gram (-) rod
-multidrug-resistant
Anaerobes
-often in a harmless commensal relationship with the host
-Trauma or immunocompromised can cause infection
Treating Anaerobes
Metronidazole, Clindamycin, Carbapenem
Zoonotics
Treat Zoonotics
-Doxycycline 100mg BID for 7 days - NOT in pregnancy
-In pregnancy: chloramphenicol
Borrelia burgdorferi
causes Lyme disease
-transmission via an arthropod vector – ticks
-Treat with doxycycline or a β-lactam
Chlamydophila
causes atypical pneumonia (Chlamydophila pneumoniae)
treat with Doxycycline
Chlamydia
-STD
Treat with high intracellular concentrations such as macrolides or tetracycline
Which drug class is excreted via glomerular filtration (kidney)
Aminoglycosides and Tetracyclines
Which drug is associated with Disulfiram reaction as an adverse effect?
Metronidazole
Which drug class is appropriate for respiratory infections?
Macrolides
Which drug class is associated with Nephrotoxicity - Ototoxicity - Neuromuscular blockade (N-O-N)
Aminoglycosides
Which drug lacks activity to Acinetobacter - Pseudomonas - Enterococcus
Ertapenem
Which drug can result in Falconi syndrome, when taken after expiration date?
Tetracyclines
Which organisms are NOT covered by tigecycline?
-Pseudomonas
-Proteus
-Providencia
-Morgonella
Which drug is associated with an increase in potassium level?
-Trimethoprim-sulfamethoxazole
-Trimethoprim structure is similar to triamterene = potassium-sparing diuretic)
