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Pharmacology > Exam 4: Empiric Antimicrobial Therapy > Flashcards

Exam 4: Empiric Antimicrobial Therapy Flashcards

1
Q

Identify the infectious conditions in small animals where obligate anaerobes are likely involved

A 
Peritonitis
Septic pleuritis
Endocarditis
Aspiration pneumonia
Wounds
Osteomyelitis
Septic arthritis
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2
Q

Identify the infectious conditions in equine where obligate anaerobes are likely involved

A 
Peritonitis
Pleuropneumonia
Aspiration pneumonia
Osteomyelitis
Septic arthritis
Cellulitis
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3
Q

Identify the infectious conditions in bovine where obligate anaerobes are likely involved

A 
Peritonitis
Pericarditis
Osteromyelitis
Septic arthritis
Cellulitis
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4
Q

When interpreting an in vitro MIC culture and susceptibility report, what do the designations “< or equal to” and “>” imply as to the relative susceptibility of that organism to that antimicrobial?

A

“< or equal to” implies that it was tested at the lowest dilution possible and the organism is susceptible to the drug at the lowest dilution tested
“>” implies that the MIC is greater than the value and is resistant

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5
Q

Name single antimicrobials that provide 4-quadrant coverage in small animals. Compare them relative to differences in utility for the dog versus cats where it exists. Identify which ones have a probability of susceptibility in the high 90% such that they are good choices in the critically ill patient (where your choice must be correct or the animal may die)

A 
Clavamox (does not work against E. coli)
Cefoxitin or cefotetan
Chloramphenicol
Pradofloxacin (only in cats)
Potentiated sulfonamides:
Ticarcillin + clavulanic acid (Timentin)
Piperacilline + tazobactam (Zosyn)
Meropenem (high 90s susceptibility
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6
Q

Name combinations antimicrobials that provide 4-quadrant coverage in small animals

A

TMS
Amoxicillin or Pen G (pasteurella, staph, strep, anaerobe)
Fluoroquinolone or aminoglycoside (E. coli, pasteurella, staph)
Metronidazole (anaerobes, B. fragilis)
Clindamycin (staph, strep, anaerobe, B. fragilis)
Clavamox or cefoxitin (E. coli, pasteurella, staph, strep, anaerobe, B. fragilis)

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7
Q

What is the most common drug used to treat uncomplicated first-time UTIs?

A

Amoxicillin or clavamox

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8
Q

What is the most common drug used empirically to treat pyelonephritis while awaiting culture and sensitivity results?

A

Fluoroquinolone

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9
Q

You have a dog with diarrhea due to campylobacter. Name 3 antimicrobials you could treat it with

A

Macrolide
Aminoglycoside orally
Fluoroquinolone

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10
Q

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

A

3 days

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11
Q

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

A

Culture 7 days post-treatment. If negative, repeat culture again in one month if dealing with recurrent UTI or pyelonephritis

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12
Q

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

A

Uroliths are the most common

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13
Q

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

A

Immunosuppression

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14
Q

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

A

Enrofloxacin is default DOC in prostatitis, pending culture results

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15
Q

What are the pros and cons of once daily treatment in keeping chronic UTIs in remission?

A

Pro: give standard dose, but only once daily
Con: can get resistance, but usually this is for renal failure patients

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16
Q

What are the pros and cons of methenamine treatment in keeping chronic UTIs in remission?

A

Pro: not an antibiotic, but has bactericidal effect
Con: must acidify urine and used for cystitis only

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17
Q

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

A

Voriconazole

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18
Q

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

A

Topical under anesthesia:
Enilconazole
Clotrimazole

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19
Q

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

A

Bordetella bronchoseptica

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20
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/minocucline
Puppies: Clavamox

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21
Q

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

A

There is not much data to support this
It does not really help- a pneumonic lung is clogged up so the injection just gets into the healthy lung and doesn’t do anything.

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22
Q

What is the drug of choice for pulmonary nocardiosis?

A

TMS

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23
Q

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

Folinic acid

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24
Q

Dogs with malasessia dermatitis often have what concomitant disease?

A

Immunosuppression, such as Cushing’s disease (50% have this)

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25
Q

Name 2 drugs commonly used to treat a clostridial enteritis

A

Oral amoxicillin or ampicillin

Metronidazole

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26
Q

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

A

At presentation, >90% positive on culture with mix of gram positive, gram negative, and obligate anaerobes

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27
Q

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

A

There is a major infection of the soft tissue. This is a surgical emergency and you need surgery immediately along with 4-quadrant coverage antibiotics

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28
Q

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

A

Gram negative anaerobes: bacteroides, porphyromonas, prevotella

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29
Q

Name 4 otic solutions, 2 commercial and 2 compounded, which are believed safe to use despite a ruptured ear drum?

A

0.5% or 1% silver sulfadiazine
Baytril otic (enrofloxacine, silver sulfadiazine)
Posatex (orbifloxacin, mometasone, Posaconazole)
Tris-EDTA + Timentin

30
Q

What are the indications for performing a myringotomy?

A

Otoitis media

31
Q

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

A

In vet med, it is commonly mixed populations

In humans, it is just a staph infection

32
Q

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

A

Glaucoma- you destroy the ciliary body of the eye when the owner does not want to do enucleation

33
Q

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

A

Chloramphenicol

Fluorquinolone

34
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

DOC is penicillin (e.g. amoxicillin)

The therapy often warranted is aggressive (high dose) and long-term (months)

35
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

Penicillin + aminoglycoside

Chloramphenicol

36
Q

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

A

Vancomycin:drug of last resort in MRSA and there’s a rise in resistant to vaoncmycin itself so humans don’t want animals using it.

Linizolid: used in MRSA and vancomycin resistant enterococci; again, people don’t want it used in animals for concern of resistance

37
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 generation cephalosporins: cefotaxime, ceftriaxone
Meropenem/imipenem
Chloramphenicol
Fluoroquinolone
TMS
38
Q

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

A

(fluoroquinolone or aminoglycoside) with (amipicillin or Pen G) with (metronidazole)
(fluoroquinolone or aminoglycoside) with (unasyn or cefoxitin)
(ampicillin or Pen G) with (TMS)
Chloramphenicol

39
Q

Name 6 antibiotics contraindicated in horses

A 
Tylosin
Tilmicosin
Lincomycin
Clindamycin
Florfenicol
Ionophores
40
Q

Name 3 antibiotics used cautiously in horses

A

Fluoroquinolones (age and duration)
Erythromycin in adult horses
Tetracyclines

41
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 is added to get the obligate anaerobes

42
Q

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

A

Pen G, ampicillin sodium, ceftiofur
Macrolides
TMS

43
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 that how many days?

A

Should be at least 1 year old and do not use for over 10 days

44
Q

What is the treatment of choice for treating dermatophilus in horses and cattle?

A

PPG

45
Q

Which antimicrobials are prone to give false positive in vitro susceptibility results against Salmonella?

A

Gentamicin or amikacin

46
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 that are one week in age or less

47
Q

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

A

The bigger the hole, the more that will leak out. So, if you use an 18 gauge needle, more of the medicine will leak out of the eye than if you use a 26 gauge needle. If you use too big of a needle, you won’t get the correct dosing and coverage needed.

48
Q

What antimicrobial for cattle consistently crosses the BBB without inflammation?

A

Florfenicol

49
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 with lincomycin

50
Q

What are 4 systemic antibiotics effective against bovine pinkeye?

A

Oxytetracycline
Tulathromycin
Ceftiofur
Florfenicol

51
Q

Name 3 drugs possibly effective against speticemic salmonella in cattle

A

Florfenicol
Fluoroquinolone if not extra-label violation
Cceftiofur

52
Q

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

A

Cow: corynebacterial, E. coli
Horse: E. coli, streptococcus
Dog: Staphylococcus, E. Coli

53
Q

What is the DOC for dermatophilus in horses?

A

PPG

54
Q

What is the DOC for chlamydial respiratory infection in a parrot?

A

Doxycycline

55
Q

What is the DOC for clostridial disease in a cow?

A

Pen G

56
Q

What is the DOC for pulmonary nocardiosis in a dog?

A

TMS

57
Q

What is the DOC for rickettisal disease in a dog?

A

Doxycycline

58
Q

What is the DOC for streptococcal infection (beta hemolytic, not an enterococcus)?

A

Pen G

59
Q

What is the DOC for toxoplasmosis in a cat?

A

Clindamycin

60
Q

What is the DOC for Woody tongue in cattle due to Actinobacillus lignieresii?

A

Sodium iodide IV

61
Q

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

A

EDTA or azole antifungal therapy

62
Q

Which antimicrobial are appropriate for treating TEME in cattle?

A

Florfenicol

PPG may be effective, but often diagnoses too late to effectively treat

63
Q

What is the etiologic agent most involved in bovine foot rot?

A

Fusobacter necrophorum

64
Q

What antimicrobials are appropriate for treatment of bovine foot rot?

A

Ceftiofur, florfenicol, PPG, oxytetracycline

65
Q

Look at AMDUCA requirements for extra-label treatment in cows

A

Look at AMDUCA requirements for extra-label treatment in cows

66
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

Strep and Actinobacillus
1st choice: Pen G, ceftiofur
2nd choice: TMS

67
Q

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

A

When there is multi-drug resistant infection

Disadvantages: potentially introducing a secondary infection into the bladder

68
Q

Which intramamamry infusions are appropriate to treat strep?

A 
Intrammamary penicillin G
Amoxicillin
Ceftiofur
Cephapirin
Hetacillin
Pirlimycin
69
Q

Which intramamamry infusions are appropriate to treat staph?

A 
Pirlimycin
Novobiocin (only in dry cow)
Erythromycin
Cephapirin
Ceftiofur
Cloxicillin
Hetacillin
70
Q

Which intramamamry infusions are appropriate to treat coliform?

A

Hetacillin

Ceftiofur

Pharmacology (17 decks)

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