ID I: BACKGROUND Flashcards
What antibiotic has a BBW for c diff?
clindamycin
Small Vd (poor tissue penetration)
Renel elimination
Low intracellular concentration, not active vs atypical
Increase CL/distribution during sepsis
Poor-moderate bioavailability
HYDROPHILLIC AGENTS
beta-lactams
AG
glycopeptides
daptomycin
polymyxins
What abx are lipophilic agents?
Quinolones
Macrolides
Rifampin
Linezolid
Tetracyclines
What possible organisms?
Gram stain: purple
cocci pairs & chains:
strep pneumoniae
streptococcus spp (including strep pyogenes)
enterococcus spp (including VRE)
AG + beta-lactams are commonly used in synergy treating what
gram positive infections (infective endocarditis)
Which abx are hydrophilic agents?
beta-lactams
AG
glycopeptides
daptomycin
polymyxins
Intra-abdominal organisms?
Enteric GNR (Proteus, E. coli, Klebsiella, Enterobacter) Enterococci/streptococci bacteroides species
The preferred agent for MSSA soft tissue, bone and joint, endocarditis and bloodstream infections?
anti staphylococcal penicillins
What drugs are concentration dependent (Cmax:MIC)
AG
Quinolones
Daptomycin
LARGE dose!!! High peak!! continues to kill after fallen below MIC
gram stain provides what information?
quick, preliminary results (not an actual organism) so it will give a description – rod, gram -/+
What possible organisms?
Gram stain: pink
cocci:
Neissera spp
Skin soft tissue organisms?
APE pasturella +/- anaerobic GNR diabetes
staph aureus
strep pyogenes
staph epidermidis
pasturella multocida +/- anaerobic GNR (diabetes)
HNPEK
haemophilus,
neisseria,
proteus,
e coli,
klebisella
What possible organisms?
Gram stain: purple
anaerobes:
peptostreptococcus
Actinomyces spp
clostridium (clostridiodes)
What drugs are time dependent (Time>MIC)
Beta lactams (penicillins, cephalosporins, carbapenems)
*want drug level >MIC for most of dosing interval
What organisms are in the heart/endocarditis?
SESE + MRSA
Staphylococcus aureus (including MRSA)
Staphylococcus epidermidis
Streptococci
Enterococci
Lower respiratory (hospital) organisms?
staph aureus (MRSA)
pseudomonas aurginosa
Enteric GNR (Proteus, E. coli, Klebsiella, Enterobacter)
Strep pneumoniae
Mouth organisms?
Mouth flora - peptostreptococcus, actinomyces
Anaerobic GNR (Prevotella)
Viridans group streptococcu
what is CRE?
carbapenem-resistant enterobacteriaceae
MDR gram negative (klebsiella, e coli)
tx: polymyxins
Large Vd (good tissue penetration)
Hepatic metabolism
high intracellular concentrations (active against atypical)
CL/distribution is changed minimally in sepsis
Excellent bioavailability 1:1
LIPOPHILLIC AGENTS
Quinolones
Macrolides
Rifampin
Linezolid
Tetracyclines
What possible organisms?
Gram stain: pink
curved or spiral shaped
H pylori
Campylobacter
Treponema spp
Borrelia spp
Leptospira spp
DNA/RDNA inhibitors
Quinolones (DNA gyrase, topoisomerase IV)
Metronidazole, tinidazole
Rifampin
What organisms are in the CNS/Meningitis?
SNL HG
S. pneumoniae
N. meningitis
H. influenzae
Group B streptococcus/E. coli (young)
Listeria (young/old)
MOA: Cell membrane inhibitors
polymyxins
daptamycin
telavancin oritavancin
What possible organisms?
Gram stain: pink
rods –> colonize gut
Proteus mirabilis
Escherichia coli
Klebsiella spp
Serratia spp
Enterobacter cloacae
Citrobacter spp
Lower respiratory (community) organisms?
streptococcus pneumoniae
Haemophilus influenzae
Atypicals: legionella, mycoplasma
Enteric GNR (Proteus, E. coli, Klebsiella, Enterobacter) – alcoholic, IC
thin cell wall take up the safranin counterstain pink or reddish
gram negative piNk
What are the different types of antibiotic resistance?
intrinsic selection pressure (VRE)
enzyme inactivation (ESBL, CRE)
What organisms are in the upper respiratory?
SMHS
Streptococcus. pyogenes
Streptococcus. pneumoniae
Haemophilus. influenzae
Moraxella catarrhalis
What are common resistant pathogens?
Kill Each And Every Strong Pathogen
Klebsiella pneumoniae (ESBL, CRE)
E coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis, Enterococcus faecium (VRE)
S. aureus (MRSA)
Pseudomonas aeruginosa
What possible organisms?
Gram stain: purple
cocci clusters:
staphylococcus spp. (including MRSA, MSSA)
What color do atypical stain?
they don’t, they don’t have a cell wall
How are drugs that are concentration-dependent killing dosed?
less frequently, higher dose to maximize concentration above the MIC
What is used to treat ESBL infections?
carbapenems or cephalosporin/beta-lactamase inhibitors
MOA: cell wall inhibitors
BMV
Beta-lactams [penicillins, cephalosporins, carbapenems]
Monobactams
Vancomycin [dalbavancin, telavancin, oritavancin]
PEK
proteus
e coli
klebisella
How are drugs that are time-dependent killing dosed?
more frequently, longer duration administration to maximize time above MIC
Urinary tract organisms?
E. coli,
Proteus,
Klebsiella
Staphylococcus
saprophyticus
streptocci
enterocci
What possible organisms?
Gram stain: purple
diplococci:
strep pneumoniae
What possible organisms?
Gram stain: purple
Rods:
gram positive rods: listeria monocytogenes
What possible organisms?
Gram stain: did not stain well
ATYPICALS!!! *think doxy
Chlamydia spp
legionella spp
mycoplasma pneumoniae
mycobacterium tuberculosis
What possible organisms?
Gram stain: pink
Anaerobes:
Bacteroides fragilis
Prevotella spp
thick cell wall dark purple or bluish
stain from the crystal violet stain
gram positive organisms
Purple
What possible organisms?
Gram stain: pink
rods –> do not colonize in gut
pseudomonas aeruginosa
haemophilus influenzae
providencia spp
MOA: folic acid synthesis inhibitors
STD
Sulfonamides
Trimethoprim
Dapsone
MOA: Protein synthesis inhibitors
MATCLQ AG
Macrolides
Tetracyclines
Clindamycin
Linezolid, tedizolid
Quinupristin/Dalfopristin
What should be considered when deciding empiric treatment?
local resistance patterns (antibiogram) antibiotic use guidelines likely organisms basked on location
What possible organisms?
Gram stain: pink
coccibacilli:
Acinetobacter baumannii
Bordetella pertussis
Moraxella catarrhalis
CAPES
Citrobacter
Acinetobacter
Providencia
Enterobacter
Serratia
Bone & joint organisms?
staph aureus
staph epidermis
streptococci
neiserra gonorrhoeae GNR (only in specific situations)
