HIPSHER Antibiotics Q1-18 Flashcards
List the factors that should be considered when choosing an antimicrobial regimen
- Consider the Site, severity, organisms suspected, does it require a bactericidal agent
- Consider the pt: Allergies*, age, renal function, co-morbids
- Avoid redundancy
- Cost effective
- Convenience: (Use PO agents ASAP when able) Home infusions that require infrequent dosing
What are common colonizers/contaminants in cultures that are not ultimately the true culprit/problem in the infection?
Coag Negative staph and diphtheroids
How do you get the most reliable diabetic foot ulcer, lung and urine culture/samples?
Diabetic Ulcer - surgical culture that is deep
Lung - bronchoscopy to avoid mouth flora
Urine - mid stream
When should and should you not hold antibiotics until a specimen is obtained?
DO NOT WAIT TO START ABX IF SEPTIC/UNSTABLE
infections requiring surgery & long-term abx therapy, abx should be withheld in stable pts until accurate surgical samples can be obtained
○ = Example: prosthetic joint, post-op infections after spinal surgery w/ hardware replacement, osteomyelitis
What infections require empiric anaerobe coverage?
Intra-abdominal, DM foot ulcers, Gas gangrene, aspiration pneumonia, dental infection, pelvic, inflammatory dz
What agents empirically cover anaerobes?
ampicillin-sulbactam
pip-tazo
all carbapenems
clindamycin
metronidazole
moxifloxacin
What infections need to be empirically covered for pseudomonas?
Nosocomial pneumonia,
nosocomial UTI
post-op meningitis (following neuro sx)
severe DM foot ulcer
puncture wound through the shoe
burns
What agents empirically covers pseudomonas?
pip-tazo
ceftazidime
cefepime
cipro,
levaquin
all carbapenems except ertapenem
What infections require empiric MRSA coverage?
purulent cellulitis
post-op wound infx
nosocomial pneumonia
nosocomial meningitis
What agents empirically cover MRSA?
clindamycin
bactrim doxycycline
linezolid vancomycin
What infections require empiric enterococcus coverage?
Intra-abdominal infx (especially bilary tract)
UTI
CLABSI - central line associated blood stream infection
What agents empirically cover enterococcus?
o PCN o augmentin o pip-tazo o ampicillin-sulbactam o vanco o daptomycin o linezolid o ciprofloxacin, levofloxacin, nitrofurantoin for UTI
What MOA are beta lactams and what are their ADRs?
MOA: bactericidal to cell wall
ADR: rash, drug fever, thrombocytopenia, sz
What is a contraindication of PCN?
previous allergic rx or anaphylaxis to other beta-lactam classes
What is a contraindication of Aminopenicillins + B-lactamase inhibitors?
empiric intra-abdominal infections due to increasing Bacteriodes resistance
What is a CI to Cephalosporin (3rd gen) Cefazidime?
: empiric coverage of GN infections (increasing resistance
What is a CI to Carbapenems?
lowers the sz threshold, avoid in head trauma or seizure history
What is a CI to monobactams?
overall costly, assoc. with phlebitis and increased LFTS… try to not use if really needed
What drugs are in the drug class of PCN?
• Penicillin: potent bactericidal
o Pencillin G IV
o PenVK PO
o Benzathine penicillin IM
What drugs are in the drug class anti-staph PCN?
• Anti-staphylococcal PCN
o Nafcillin
o Oxacillin
o Dicloxacillin
What drugs are in the drug class aminopenicillins?
o Ampicillin
o Amoxicillin
What is the extended spectrum PCN?
Pip-Taz (Zosyn)
What are the B-lactam/Beta lactamase Inhibitors?
o Ampicillin-Sulbactam [Unasyn]
o Amoxicillin-Clavulanate [Augmentin]
What species does cephalosporins not cover?
enterococcus and anarobes
What ARDs are associated with cephalosporins?
- Fever
- Rash
- Seizures
- Biliary sludge
What are the 2 first generation cephalosporins and what microbes do they cover and when are they indicated?
• Cefazolin [Ancef]
Cephalexin [Keflex]
Antimicrobial spectrum:
• MSSA
• Strep
Indications:
• Surgical prophylaxis
• Non-purulent skin infections
Recall the cephalosporins which are second generation, their antimicrobial spectrum, and their most common uses
- Cefoxitin [Mefoxitin] - IV
- Cefuroxime [Ceftin] - IV and PO (*MC for treatment for 2nd gen)
- Cefaclor [Ceclor] - PO
Antimicrobial spectrum:
• Same as 1st generation (MSSA, strep species and some GN)
• Improved GN activity
Indications:
• Surgical prophylaxis if they cover anaerobes
• URI
. Recall the cephalosporins which are third generation by trade and generic name, their antimicrobial spectrum and their most common uses.
- Ceftriaxone [Rocephin] -IV (MC used IV agent)
- Cefuroxime [Ceftin] - IV and PO
- Cefaclor [Fortaz]
Antimicrobial spectrum:
• Coverage varies, depends on the agent
• Generally - MSSA and other strep species, great Strep pneumo coverage and overall more GN coverage than 1st and 2nd gen
• Ceftriaxone is MC used IV agent
• Ceftazidime - Pseudomonas but does not have good GP activity
Indications:
• Empiric UTI
• Pneumonia
• Meningitis
Recall the cephalosporins which are 4th gen and their antimicrobial spectrum.
• Cefepime [Maxipime]
Antimicrobial spectrum:
• Good GP and GN coverage, including Pseudomonas
• Doesn’t work for ESBL, enterococcus, MRSA or anaerobes
Recall the cephalosporins which are 5th gen and their antimicrobial spectrum.
• Ceftaroline [Teflaro]
Antimicrobial spectrum:
• Good GN and GP coverage
• Only cephalosporin that covers MRSA
• No Pseudomonas coverage
Recall the carbapenems, their antimicrobial spectrum, and their adverse events
- Imipenem/Cilastatin [Primaxin]
- Meropenem [Merrem]
- Ertapenem [Invanz]
Antimicrobial spectrum - broadest of all abx classes
• Covers GP and GN, ESBL’s and anaerobes
ADE:
• Seizures - especially imipenem
• Fever
• Rash
- Recall the antimicrobial spectrum of Monobactam [Azotrenam].
• Covers ONLY GN (including Pseudomonas)
