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PHAY0010 > Infections and Antimicrobials > Flashcards

Infections and Antimicrobials Flashcards

1
Q

What four factors needs to be considered when selecting an appropriate antibiotic?

A

Patient
Drug characteristics
Type of infection/causative organism
Society

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2
Q

What antibiotic is most appropriate for society?

A

One that is cheap, effective and minimises resistance

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3
Q

What are the advantages of narrow spectrum antibiotics?

A

Minimised disturbance to the normal gut flora
Minimises risk of superinfections
Avoids unnecessary selection pressure (–> causes resistance)

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4
Q

What is antimicrobial stewardship?

A

An organisation or healthcare-system wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness.

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5
Q

What is antimicrobial resistance?

A

Loss of effectiveness of any anti-infective medicine including antiviral, antifungal, antibacterial and anti parasitic medicines.

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6
Q

What should we consider before knowing if an antibiotic is indicated?

A

Is it likely to be BACTERIAL infection?
What can we do before prescribing antibiotics?
Is an antibiotic necessary?

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7
Q

What are some surgical interventions that can be done before prescribing antibiotics?

A

Removal of foreign material
Abscess drainage - difficult for antibiotics to get to centre of infection due to their being a lack of vasculature.
Debridement of infected tissue - removal of ulcer as this contains a majority of bacteria - reducing antimicrobial use and better penetration
Wound hygiene - keeping wounds clean and changing dressings

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8
Q

When may an antibiotic not be necessary?

A

Self limiting infections
If infection is VIRAL - only use antibiotics if there is a SECONDARY BACTERIAL INFECTION
Host defences function - antibiotics only needed in immunosuppressed patients.

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9
Q

What are the three types of evidence of infection?

A

Clinical , Laboratory and Imaging

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10
Q

What are some examples of clinical evidence of an infection?

A

Fever
Swelling
Pus
Tachycardia
Tachypnoea
Pain

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11
Q

What are some examples of laboratory evidence of an infection?

A

WBC count
CRP (inflammation)
Microscopy
Culture and sensitivity

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12
Q

What are some examples of imaging evidence of an infection?

A

X-ray (e.g. chest and lungs for signs of consolidation)
Ultrasound
MRI
CT

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13
Q

How can we ensure safe, rational and cost effective prescribing (FOR SOCIETY) using FROGS?

A

Formulary
Restricted list of antibiotics
Organisational policies - IV to oral, BROAD to NARROW, stop orders
Guidelines for EMPIRICAL treatment
Selective reporting of antibiotics sensitivities (e.g. checking sensitivity/resistance to first line treatment only)

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14
Q

What does APACHE II stand for and how does this help us select an appropriate antibiotic for the patient?

A

Age and gender (metabolism, side effects, likely conditions such as UTI in women)
Pregnancy/ breastfeeding
Antibiotic Exposure (e.g. do not want to give trimethoprim for UTI if already taking for prophylaxis)
Cautions/contraindications
Hypersensitivities/allergies
Elimination (hepatic and renal impairment)

Interactions (consider other medications)
Immunity (vaccine schedule, natural immune response, immunosuppression)

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15
Q

Which antibiotics are to be used with caution in epilepsy?

A

quinolones and imipenem : can lower seizure threshold

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16
Q

When are quinolones contraindicated?

A

Previous history of tendon disorders RELATED TO quinolone use.

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17
Q

If a patient has mild hypersensitivity to a penicillin what other antibiotics should be given in caution

A

cephalosporins - risk of cross sensitivity
If patient only experiences a mild rash may be able to give cephalosporins with an antihistamine BUT DO NOT GIVE IN ANAPHYLAXIS

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18
Q

Why are tetracylines contraindicated in children under 12?

A

Staining of teeth as it binds to calcium in teeth

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19
Q

Why are aminoglycosides contraindicated in myasthenia gravis?

A

Can impair neuromuscular transmission

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20
Q

What are two high risk antibiotics in renal impairment?

A

Aminoglycosides
Glycopeptides

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21
Q

Which antibiotics may require dose adjustment in hepatic impairment?

A

Chloramphenicol
Isoniazid
Metronidazole
Rifampicin

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22
Q

Which antibiotics should be avoided/ monitored closely in hepatic disease?

A

Macrolides
Co-amoxiclav (over 2 weeks use) and flucloxacillin

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23
Q

Which antibiotics can be affected by enzyme inhibitors?

A

Erythromycin
Clarithromycin
Isoniazid
Metronidazole
Ciprofloxacin

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24
Q

Which antibiotic can be affected by enzyme inducers?

A

Rifampicin - used in osteomyelitis and tuberculosis

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25
Q

Which antibiotics should not be taken with antacids/calcium?

A

Tetracyclines and quinolone

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26
Q

What antibiotics can interact with warfarin?

A

Broad spectrum antibiotics (can increase INR)

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27
Q

Which antibiotics are nephrotoxic?

A

Aminoglycosides
Glycopeptides
Colistin IF ALSO TAKING loop diuretics or ciclosporin

28
Q

Which antibiotics can cause QT interval prolongation?

A

Erythromycin
Quinolones

29
Q

Linezolid is a MAOI, what can it interact with?

A

Antidepressants (especially other MAOIs)
Tyramine rich foods should be avoided such as cheese, salami and marmite - can cause an increase in blood pressure.

30
Q

When taking which antibiotic should the use of alcohol be COMPLETELY AVOIDED?

A

Metronidazole can cause:
severe vomiting
flushing/ redness
headache

31
Q

What are some general side effects caused by most antibiotics?

A

Nausea
Vomiting
Diarrhoea
Rashes
Thrush

32
Q

Aminoglycosides and glycopeptides ca cause which side effects?

A

nephrotoxicity and ototoxicity.

33
Q

Clostridium difficile colitis can occur with which anitbiotics?

A

CLINDAMYCIN - any signs of diarrhoea STOP taking and go to GP
cephalosporins

34
Q

Which antibiotics can cause chloestatic jaundice?

A

flucloxacillin and co-amoxiclav - monitor live function and look out for yellowing skin and pruritus.

35
Q

How can peripheral neuropathy caused by isoniazid be minimised?

A

with pyridoxine

36
Q

Limiting linezolid treatment to two weeks can help minimised the risk of…

A

Myelosupression

37
Q

Why should macrolides be avoided in people with cardiac conduction disorders?

A

can cause QT interval prolongation

38
Q

What side effect of rifampicin may worry patients but is usually harmless?

A

Bodily fluids turn red - urine may look bloody

39
Q

Long term use of trimethoprim can result in…

A

Anaemia

40
Q

Vacomycin can cause “Red Man” syndrome. How does this arise?

A

Vacomycin is normally given intravenously. If infused to quickly a reaction can occur leading to inflammatory vasodilation

41
Q

Oral vancomycin can be used to treat which infection due to it not being absorbed well from the GI tract?

A

Clostridium difficile

42
Q

What monitoring is required for aminoglycosides and glycopeptides?

A

Renal function - serum creatinine and urine output
Plasma drug levels (TDM) - high levels needed as killing is concentration dependent BUT need to be removed from body quickly.

43
Q

What should be done to the dose and dose interval if giving an aminoglycoside in renal impairment?

A

Use a lower dose and increase dosing interval

44
Q

WhWhat monitoring is required for rifampicin?

A

Liver function tests

45
Q

What monitoring is required for long term use or high doses of flucloxacillin or co-amoxiclav?

A

Bilirubin and ALP - CAN CAUSE CHOLESTATIC JAUNDICE

46
Q

What monitoring is required for Linezolid and septrin (co-trimoxazole)?

A

Full blood counts
Linezolid can cause myelosuppresion is used for more than 2 weeks
septrin (co-trimoxazole) contains Trimethoprim which can cause anaemia

47
Q

What counselling must be given to patients starting clindamycin?

A

Stop taking treatment and see a healthcare professional if they get diarrhoea (risk of C.diff and toxic megacolon)

48
Q

What does PS stand for and how can we use this to select an apporpriate antibiotic based on the infection?

A

Pathogen: what is the pathogen? Sensitivities? Resistant strains?

Severities: how unwell is the patient?

49
Q

What types of bacteria commonly exist as part of the natural flora of the upper respiratory tract? MOSTLY GRAM POS

A

Staphylococcus (+)
Streptococcus (+)
Haemophilus (-)
Neisseria (-)
Anaerobes
Atypicals (mycoplasma)

50
Q

Why do mycoplasma not have a gram stain?

A

because they are too small

51
Q

What types of bacteria commonly exist as part of the natural flora of the upper respiratory tract? MOSTLY GRAM POS

A

Staphylococcus (+)
Coryne bacteria (diphtheroids)
Propionibacterium

52
Q

What can happen after MRSA eradication?

A

MRSA can regrow so this should be considered in treatment.

53
Q

What types of bacteria commonly exist as part of the natural flora of the genital tract?

A

Lactobacillus (-)
Streptococcus (+)

54
Q

What types of bacteria commonly exist as part of the natural flora of the gastrointestinal tract? ANAEROBES and GRAM NEGATIVE

A

E.coli
Klebsiella
Lactobacillus
Streptococcus
Enterococcus
Candida

55
Q

What does BRASS stand for and how can we use this to select an appropriate antibiotic based on the drug?

A

Bioavailability/ route
Resistance (look at local data)
Access to site of infection (e.g. drug for meningitis needs to reach CSF)
Spectrum/mechanism of action
Side effects

56
Q

What are some broad spectrum antibiotics?

A

Amoxicillin
Chloramphenicol
Meropenem and Imipenem
Piperacillin
Tazobactam
Cephalosporins
Tetracyclines
Ciprofloxacin
Rifampicin
Nitrofurantoin

57
Q

What are some narrow spectrum antibiotics that can target GRAM POSITIVE organisms?

A

Fusidic acid
Flucloxacillin
BEnzylpenicillin
Vancomycin
Clindamycin
Erythromycin

58
Q

What are some narrow spectrum antibiotics that can target GRAM NEGATIVE organisms?

A

Gentamicin
Colistin
Trimethoprim

59
Q

What antibiotic is commonly used against anaerobic pathogens (e.g. in dental abscesses or C.diff)

A

Metronidazole

60
Q

How is antimicrobial stewardship achieved?

A

Promoting the selection of optimal antimicrobials, drug regimens, dose, duration and route of administration

61
Q

What is WHO AwARe?

A

Splits antimicrobials into three groups.

Access

Watch

Reserve

62
Q

What is the WHO ACCESS group?

A

first or second choice antibioticss
best therapeutic value with minimised potential for resistance
e.g. amoxicillin

63
Q

What is the WHO WATCH group?

A

first or second choice anitbiotics BUT only indicated in a limited number of conditions as more likely to be a target of resistance
e.g. ceftriaxone

64
Q

What is the WHO RESERVE group?

A

Last resort antibiotics for patients with life threatening infections and multi drug resistant bacteria
e.g. meropenem

65
Q

What are the 5 categories in the Antimicrobial Stewardship toolkit for switching from IV to oral?

A

Timing - review every 24 hrs
Clinical signs and symptoms
Infection markers - Temp, EWS score, WBC
Special considerations - deep seated infections

66
Q

Why is a patient’s antibiotic allergy status important?

A

May be non-allergy/ADR reported as allergy.
Ensure complete and accurate drug history is taken.
Penicillin allergy de-labelling where appropriate.
Morbidity, mortality and economic cost associated with penicillin allergy and may have to go from access or watch to reserve groups

67
Q
A

PHAY0010 (27 decks)

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