IID 08: Bugs and Drugs Flashcards
What are the gram-positive bacteria in the drug bug table? (5)
- strep
- staph
- MRSA-CA
- MRSA-Hosp
- enterococcus
What are the easy gram-negative bacteria in the drug bug table? (1)
(all in one column)
- E. coli, H. influenza, klebsiella pneumoniae
What are the hard gram-negative bacteria in the drug bug table? (2)
SPACE/HECK Yes
- serratia, acinetobacter, hafnia alvei, enterobacter, cloacae, citrobacter, klebsiella, aerogenes, yersinia
- pseudomonas
What are the anaerobic bacteria in the drug bug table? (2)
- pepto-streptococcus, P. melaninogenica, actinomyces (above the diaphragm)
- bacteroides
What are the 8 beta-lactam drugs in the drug bug table?
- penicillin
- ampicillin/amoxicillin
- amoxicillin-clavulanate
- cloxacillin
- piperacillin-tazobactam
- 1st generation cephalosporin
- 2nd generation cephalosporin
- 3rd and 4th generation cephalosporin
What bugs does penicillin cover?
gram-positive
- strep
- enterococcus
anaerobes:
- pepto-streptococcus, P. melaninogenica, actinomyces (above the diaphragm – great for dental stuff)
What bugs does ampicillin/amoxicillin cover?
gram-positive:
- strep
- enterococcus
easy gram-negative:
- E. coli, H. influenza, klebisuella, pneumoniae
anaerobes:
- peptostreptococcus, P. melaninogenica, actinomyces – common for HEENT
What bugs does amoxicillin-clavulanate cover?
gram-positive
- strep
- staph
- enterococcus
easy gram-negative
- E. coli, H. influenza, klebsiella pneumoniae
anaerobes:
- pepto-streptococcus, P. melaninogenica, actinomyces (above the diaphragm)
What does clavulanate do?
inhibits beta-lactamase
What is the sepctrum of cloxacillin?
- very narrow spectrum
- resistance is rare
What bugs does cloxacillin cover?
gram-positive:
- strep
- staph
What is the drug of choice for staph?
cloxacillin
What bugs does piperacillin-tazobactam cover?
everything except:
- MRSA-CA (gram-positive)
- MRSA-Hosp (gram-positive)
What is the spectrum of piperacillin-tazobactam?
- very broad spectrum
- reserved for special cases
What bugs do 1st generation cephalosporins cover?
gram-positive:
- strep
- staph
easy gram-negative:
- +/- (covers, but starting to see some resistance)
What are some 1st generation cephalosporins?
- cephalexin (oral)
- cefazolin (IV)
What bugs do 2nd generation cephalosporins cover?
gram-positive:
- strep
- staph
easy gram-negative:
anaerobes:
- pepto-streptococcus, P. melaninogenica, actinomyces – cefoxitin only
- bacteroides – cefoxitin only
What are some 2nd generation cephalosporins?
- cefuroxime
- cefprozil
What bugs do 3rd and 4th generation cephalosporins cover?
gram-positive:
- strep
- staph
easy gram-negative:
hard gram-negative:
- serratia, acinetobacter, hafnia alvei, enterobacter, cloacae, citrobacter, klebsiella, aerogenes, yersinia
- pseudomonas – ceftaxidine, cefipime only
What bugs do carbapenems/imipenem/meropenem cover?
everything except:
- MRSA-CA (gram-positive)
- MRSA-Hosp (gram-positive)
What bugs does erythromycin cover?
gram-positive:
- strep
- staph
- MRSA-CA (covers, but starting to see some resistance)
- MRSA-Hosp (covers, but starting to see some resistance)
easy gram-negative:
- E. coli, Klebsiella pneumoniae
- NOT H. influenza
What bugs does clarithro/azithromycin cover?
gram-positive:
- strep
- staph
- MRSA-CA (covers, but starting to see some resistance)
- MRSA-Hosp (covers, but starting to see some resistance)
easy gram-negative:
- E. coli, H. influenza, Klebsiella pneumoniae
What bugs do resp fluoroquinolones and moxi/levofloxacin cover?
gram-positive:
- strep
- staph (covers, but starting to see some resistance)
easy gram-negative:
hard gram-negative:
- serratia, acinetobacter, hafnia alvei, enterobacter, cloacae, citrobacter, klebsiella, aerogenes, yersinia
- pseudomonas (covers, but starting to see some resistance)
What bugs does ciprofloxacin cover
easy gram-negative:
hard gram-negative:
- serratia, acinetobacter, hafnia alvei, enterobacter, cloacae, citrobacter, klebsiella, aerogenes, yersinia
- pseudomonas (only oral antibiotics)
What is the spectrum of aminoglycosides?
- narrow spectrum
- not absorbed orally – IV only
- tobramycin/gentamycin reserved due to toxicities
What bugs do aminoglycosides cover?
gram-positive:
- staph (synergy)
- MRSA-CA (synergy)
- MRSA-Hosp (synergy)
- enterococcus (synergy)
easy gram-negative:
hard gram-negative:
- serratia, acinetobacter, hafnia alvei, enterobacter, cloacae, citrobacter, klebsiella, aerogenes, yersinia
What bugs does SMX/TMP cover?
gram-positive:
- strep
- staph
- MRSA-CA (covers, but starting to see some resistance)
- MRSA-Hosp (covers, but starting to see some resistance)
easy gram-negative:
hard gram-negative:
- serratia, acinetobacter, hafnia alvei, enterobacter, cloacae, citrobacter, klebsiella, aerogenes, yersinia
What do tetracyclines include?
- tetracycline
- minocycline
- doxycycline
What population are tetracyclines not used in?
children < 8
- due to side effects
What bugs do tetracyclines/monocyclines/doxycyclines cover?
gram-positive:
- strep
- staph
- MRSA-CA (covers, but starting to see some resistance)
easy gram-negative:
- (covers, but starting to see some resistance)
anaerobes:
- pepto-streptococcus, P. melaninogenica, actinomyces
Describe the absorption of vancomycin.
not systematically absorbed
What does vancomycin target?
gram-positive bacteria
What bugs does vancomycin cover?
gram-positive: (all)
- strep
- staph
- MRSA-CA
- MRSA-Hosp
- enterococcus
anaerobes:
- bacteroides – C. diff only (via oral formulation)
What is linezolid used for?
reserved for vancomycin resistance
What bugs does linezolid cover?
gram-positive: (all)
- strep
- staph
- MRSA-CA
- MRSA-Hosp
- enterococcus
What does clindamycin target?
- gram-positive
- anaerobes
What bugs does clindamycin cover?
gram-positive:
- strep
- staph
- MRSA-CA (covers, but starting to see some resistance)
- MRSA-Hosp (covers, but starting to see some resistance)
anaerobes:
- pepto-streptococcus, P. melaninogenica, actinomyces (above the diaphragm)
- bacteroides
What is daptomycin used for?
reserved for vancomycin resistance
What bugs does daptomycin cover?
gram-positive: (all)
- strep
- staph
- MRSA-CA
- MRSA-Hosp
- enterococcus
What is the spectrum of metronidazole?
- narrow spectrum only
- anaerobe activity only
- IV/oral
What bugs does metronidazole cover?
- pepto-streptococcus, P. melaninogenica, actinomyces
- bacteroides (including C. diff)
What drugs cover strep?
all except:
- ciprofloxacin
- aminoglycosides
- metronidazole
What drugs cover staph?
all except:
- penicillin
- ampicillin/amoxicillin
- ciprofloxacin
- metronidazole
What drugs cover MRSA-CA?
- erythromycin
- clarithro/azithromycin
- aminoglycosides
- SMX/TMP
- tetracyclines
- vancomycin
- linezolid
- clindamycin
- daptomycin
What drugs cover MRSA-Hosp?
(same as MRSA-CA except not tetracycline)
- erythromycin
- clarithro/azithromycin
- aminoglycosides
- SMX/TMP
- vancomycin
- linezolid
- clindamycin
- daptomycin
What drugs cover enterococcus?
- penicillin
- ampicillin/amoxicillin
- amoxicillin-clavulanate
- piperacillin-tazobactam
- carbapenems/imipenem/meropenem
- aminoglycosides
- vancomycin
- linezolid
- daptomycin
What drugs cover easy gram-positive bacteria (E. coli, H. influenza, Klebsiella pneumoniae)?
all except:
- penicillin
- cloxacillin
- erythromycin does not cover H. influenza
- vancomycin
- linezolid
- clindamycin
- daptomycin
- metronidazole
What drugs cover serratia, acinetobacter, hafnia alvei, enterobacter, cloacae, citrobacter, klebsiella, aerogenes, yersinia (hard gram-negative)?
- piperacillin-tazobactam
- 3rd and 4th generation cephalosporin
- carbapenem/imipenem/meropenem
- resp fluoroquinolones, moxi/levofloxacin
- ciprofloxacin
- aminoglycosides
- SMX/TMP
What drugs cover Pseudomonas (hard gram-negative)?
- piperacillin-tazobactam
- 3rd and 4th generation cephalosporins (ceftazidine and cefepime only)
- carbapenem/imipenem/meropenem
- resp fluoroquinolones, moxi/levofloxacin
- ciprofloxacin (oral only)
What drugs cover pepto-streptococcus, P. melaninogenica, actinomyces (anaerobes)?
- penicillin
- ampicillin/amoxicillin
- amoxicillin/clavulanate
- piperacillin-tazobactam
- 2nd generation cephalosporins (cefoxitin only)
- carbapenem/imipenem/meropenem
- tetracyclines
- clindamycin
- metronidazole
What drugs cover bacteroides (anaerobes)?
- piperacillin-tazobactam
- 2nd generation cephalosporins (cefoxitin only)
- carbapenem/imipenem/meropenem
- vancomycin (targets C. diff only)
- clindamycin
- metronidazole
