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Pharmacology 1 > Empiric Antimicrobial Therapy > Flashcards

Empiric Antimicrobial Therapy Flashcards

1
Q

Identify the infectious conditions in each species where obligate anaerobes are likely involved.

A

Peritonitis, septic pleuritis, endocarditis, cellulitis, aspiration pneumonia, wounds, osteomyelitis, septic arthritis

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2
Q

When interpreting an in vitro MIC culture and susceptibility report, what do the designations “>,

A

> : if growth occurred in the highest concentration and everything below it = implies bacteria is very resistant to the drug

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3
Q

Name the most common drug used to treat uncomplicated first‐time UTIs.

A

Clavamox

- amoxicillin-clavulanic acid

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4
Q

Name the most common drug used empirically to treat pyelonephritis while awaiting culture and sensitivity results

A

Fluoroquinolone

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5
Q

You have a dog with diarrhea due to campylobacter.Name three antimicrobials you could treat it with.

A
  • macrolide
  • aminoglycoside (oral) –> common in use in puppies
  • fluoroquinolone
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6
Q

If an antibiotic is working in a UTI, the urine should be sterile as early as how many days?

A

7 days

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7
Q

Recurrent UTI or pyelonephritis can be difficult to cure. When should cultures be repeated to assure a relapse has not occurred?

A

7 days post-treatment

- if negative, repeat in one month

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8
Q

Presuming drug therapy was appropriate, what is the most common cause of relapse of a UTI due to the same organism?

A
  • inadequate treatment (selection or duration, usually owner compliance)
  • uroliths
  • fibrosis of bladder wall (microabscesses)
  • anatomical abnormalities (urachal diverticulum)
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9
Q

Presuming drug therapy was appropriate, what is the most common cause of reoccurrence of a UTI due to a different organism?

A
  • immunosuppression: diabetes, Cushings, steroids

- anatomical abnormalities: vulvar inversion

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10
Q

What drugs would be likely effective in a canine prostatitis while awaiting culture and sensitivity results?

A

Broad spectrum or gram negative

  • enrofloxacin: default drug of choice
  • chloramphenicol
  • trimethoprim-sulfonamide (if no organic matter is present)
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11
Q

Discuss the pros and cons of once daily treatment or methenamine treatment in keeping chronic UTIs in remission

A

Methenamine is not an antibiotic, but it is converted to formaldehyde in acidic urine
- con: must acidify urine first (ideal pH of 5.5, use acidifying diet plus a urinary acidifier), use for cystitis only
- pros: can keep infection subclinical and will keep animal comfortable
Once daily therapy: common use in older dogs, give standard dose but concern for resistance development

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12
Q

What would be the antifungal of choice in a renal aspergillosis?

A

Voriconazole

  • could use fluconazole if price is a concern
  • not many antifungals will enter the urine!
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13
Q

What antifungals are used in the topical treatment (lavage) of nasal aspergillosis in the dog?

A
  • enilconazole
  • clotrimazole
  • use under anesthesia, make sure cribriform plate is intact with radiographs!*
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14
Q

What is the primary bacterial agent in Kennel Cough complex in dogs?

A

Bordetella bronchoseptica

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15
Q

Most cases of Kennel Cough do not require antibiotics treatment.If you however were to treat the dog fearing progression to a pneumonia, what drug is most commonly used in adults and what drug is most commonly used in puppies?

A
  • adults: doxycycline/minocycline –> penetrates bronchial fluids well
  • puppies: clavamox –> does not penetrate bronchial fluids as well, but tetracyclines stain teeth of puppies
  • could try nebulized aminoglycoside to add moisture to the respiratory tract and thin secretions
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16
Q

Does evidence support the use of intratracheal injections of antimicrobials for the management of respiratory infections?

A

Does not help with pneumonia, no data on tracheitis

- has been tried on cattle, does not go into affected tissue, only enters ventrally to the healthy lung

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17
Q

TMS is the drug of choice to treat pulmonary nocardiosis.Because of the high dose and long
duration of therapy, bone marrow suppression is very common.What agent can be given to prevent this Type A adverse reaction?

A
  • sulfonamide
  • doxycycline/minocycline
  • penicillin
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18
Q

Dogs with malasessia dermatitis often have what concomitant disease?

A

Cushing’s disease

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19
Q

Name two drugs commonly used to treat a clostridial enteritis

A
  • oral amoxicillin or ampicillin

- metronidazole

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20
Q

The most likely etiology(ies) for infected dog‐on‐dog bite wounds is/are?

A

> 90% are a mix of gram-pos, gram-neg, and obligate anaerobes

- require 4 quadrant coverage

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21
Q

What role does surgery play in the management of necrotizing cellulitis/fasciitis?

A

Is a surgical emergency!

- need to remove the infected leg before the toxin enters the bloodstream

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22
Q

Periodontal disease is most commonly due to what group of bacteria?

A

Gram negative obligate anaerobes

  • bacteroides
  • porphyromonas
  • prevotella
23
Q

Name four otic solutions, two commercial and two compounded, which are believed safe to use despite a ruptured ear drum.

A
  • 0.5% or 1% silver sulfadiazine (need to clean the canal)
  • tris-EDTA + timentin
  • baytril otic (enrofloxacine, silver sulfadiazine)
  • posatex (orbifloxacin, mometasone, posaconazole)
24
Q

What are the indications for performing a myringotomy?

A

Done if you need to treat an otitis media and the ear drum is still intact

25
Q

What etiologic differences for osteomyelitis occur in veterinary patients as compared to human infections?

A
  • human: Staph aureus

- animals: mixed infections with facultative aerobes and anaerobes (start with 4 quadrant coverage and culture)

26
Q

What noninfectious disease is intravitreal injection of gentamicin sometimes used in?

A

Glaucoma

- gentamicin kills the ciliary body

27
Q

Name two topical antimicrobials that will cross the cornea into the anterior chamber

A
  • chloramphenicol

- fluoroquinolone

28
Q

What is the usual drug of choice for treating actinomycosis in small animals?Comment on the relative dose used (high, low) and duration of therapy (days, weeks, months).

A

Penicillin (ex: amoxicillin)

  • needs an aggressive, high dose, and long-term (months) treatment
  • often combine treatment with surgical debridement
29
Q

You have a dog with peritonitis due to Enterococcus faecium.Name two treatments in common use in veterinary medicine that likely would be successful.

A

Enterococcus faecium is typically more resistant!

  • penecillin + aminoglycoside (only effective in combination)
  • chloramphenicol (at high doses, watch for bone marrow suppression)
30
Q

What role do vancomycin and linezolid play as antimicrobials in small animals?Note the limitations.

A
  • vancomycin: vancomycin resistant enterococci is increasing public health concern –> nephrotoxicity and ototoxicity are an issue (last resort in humans for multi-resistant enterococcal and staph infections)
  • linizolid: MRSA and vancomycin resistant (gram positives), injectable and tablet form (very pricey!)
31
Q

Which antibiotics cross the blood‐brain barrier w/o inflammation such that they make good empiric choices in the management of meningitis?

A
  • human 3rd gen cephalosporins (cefotaxime, ceftriaxone)
  • meropenem/imipenem
  • chloramphenicol
  • fluoroquinolone
  • TMS
32
Q

What antibiotics, either alone or in combination, would be appropriate for use in horses to provide 4‐quadrant coverage?

A
  • fluoroquinolong/aminoglycoside + ampicillin/pen G + metronidazole
  • fluoroquinolone/aminoglycoside + unasyn/cefoxitin
  • TMS + ampicillin/pen G
  • chloramphenicol
33
Q

Name four antibiotics contraindicated in horses.

A
  • tylosin
  • tilmicosin
  • lincomycin and clindamycin
  • florfenicol
  • ionophores
34
Q

Name three antibiotics used cautiously in horses.

A
  • fluoroquinolones
  • erythromycin in adults
  • tetracyclines
35
Q

Penicillin with gentamicin is a common 4‐quardrant drug combo we use in horses.In pleuropneumonia, a third antibiotic is often used.What is it and why is it added?

A

Metronidazole to treat obligate anaerobes

36
Q

What antimicrobials would likely be used to control an outbreak of strangles in a barn of horses?

A
  • pen G (most common), ampicillin sodium, ceftiofur
  • macrolides
  • TMS (inferior)
37
Q

Fluoroquinolones are second‐line antibiotics in horses due to the risk of arthropathy. When used, the horse should be at least what age and the duration of therapy should be no longer than how many days?

A

Horses should be greater than 1 year old, and therapy should not last longer than 10 days

38
Q

Name the treatment of choice for treating Dermatophilus in horses and cattle.

A

Procaine pen G

- dermatophilus is very responsive to penicillin!

39
Q

Be able to pick from a list which antimicrobials are prone to give false positive in vitro susceptibility results against Salmonella.

A
  • gentamicin

- amikacin

40
Q

Oral antibiotics not normally used in cattle can be used if they bypass the rumen and pass directly to
the abomasum.At what age does a calf definitely behave in this manner and at what age is it known this no longer can be done?

A

Calves less than 1 week of age can be treated similar to dogs
- rumen-reticulum groove closes at 6 weeks of age

41
Q

For subconjunctival injections, why is the size of the needle used for the injection important?

A

A smaller needle will keep high drug concentrations locally

- 25 G or greater

42
Q

What antimicrobial for cattle consistently crosses the BBB w/o inflammation?

A

Florfenicol

- used in listeriosis and in calves who are septicemic from umbilical infections or enteropathogenic E. coli infections

43
Q

Name single agent and drug combination used in cattle with 4‐quadrant coverage.Do not include drugs that are either banned or unavailable.

A
  • florfenicol

- ceftiofur + lincomycin

44
Q

Name four systemic antibiotics effective against bovine pinkeye

A
  • oxytetracycline
  • tulathromycin
  • ceftiofur
  • florfenicol
45
Q

Name two drugs possibly effective against septicemic salmonella in cattle

A
  • florfenicol (50:50 against salmonella)
  • flurorquinolone (if there is no extra label violation)
  • ceftiofur (may show false susceptibility)
46
Q

Compare and contrast the most common gram‐positive and gram‐negative etiologies causing UTIs in the dog, horse, and cow.

A
  • cattle: corynebacteria renale (gram pos), e coli (gram neg)
47
Q

Which topical antifungals would be appropriate to treat a Malassezia (yeast) otitis externa?

A
  • ketoconizole shampoo
  • selenium sulfide
  • acetic acid
  • lime sulfur
48
Q

Choose antimicrobials appropriate for treating TEME in cattle and the relative role bacterial resistance to these antimicrobials plays in treatment.

A

TEME due to Histophilus somnus

  • florfenicol
  • BRDC antibiotics may be effective (PPG)
  • disease is often caught too late to treat
49
Q

What is the etiologic agent most involved in bovine foot rot and what antimicrobials would be appropriate for its treatment

A

Fusobacter necrophorum

  • ceftiofur
  • florfenicol
  • PPG
  • oxytetracycline
  • sulfonamides
50
Q

Be able to identify whether an extra‐label treatment in a cow meets AMDUCA requirements.

A
  • EEDI: sole use is as an iodine supplement, not approved for managing foot rot
  • griseofulvin: illegal, possible carcinogen
  • captan: plant antifungal, carcinogen, cannot be used legally in ELUD manner
51
Q

What are the etiological agents most commonly involved in sinus or guttural pouch infections in horses and what antimicrobials would be appropriate for its treatment?

A

Streptococcus and Actinobacillus

  • pen G –> gelatin infused into guttural pouch, ceftiofur (1st choices)
  • TMS (2nd choice)
52
Q

When might bladder infusion of an antimicrobial be considered as a treatment for cystitis in large animals and what are its disadvantages

A

Use as last resort if concerned about resistance

- chance of introducing bacteria during catheter placement

53
Q

Pick from a list those intramammary infusions that would be appropriate to treat a Staph, Strep, or coliform infections.

A 
Strep
- intramammary pen G
- amoxicillin
- ceftiofur
- cephapirin
- hetacillin
- pirlimycin
Staph
- pirlimycin
- novobiocin (dry cow)
- cephapririn
- ceftiofur
- cloxicillin
- hetacillin
Coliform
- ceftiofur, hetacillin

Pharmacology 1 (15 decks)

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