Infectious Disease 1 Flashcards
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
How do I start?
- Recognize common organisms and groups of organisms
- Focus on resistant organisms and drugs that treat them
- Learn basic spectrum of coverage
- identify important points
Gram (+) cocci cluster organisms
Staphylococcus spp. (MSSA, MRSA)
Gram (+) cocci pairs & chain organisms
Streptococcus pneumoniae (diplococci)
Streptococcus spp. (including Streptococcus pyogenes)
Enterococcus spp. (Enterococcus faecalis, Enterococcus faecium)
Gram (+) rod organisms:
Listeria monocytogenes
Gram (+) Anaerobes:
Peptostreptococcus
Actinomyces spp
Clostridium spp
Gram (-) cocci organisms:
Neisseria spp.
Gram (-) rods [ organisms that colonize gut “enteric”]:
- Proteus mirabilis
- Escherichia coli
- Klebsiella spp.
- Serratia spp.
- Enterobacter cloacae
- Citrobacter spp.
Gram (-) rods [Do NOT colonize gut]:
- Pseudomonas aeruginosa
- Haemophilus influenzae
- Providencia spp.
Gram (-) anaerobes:
Bacteroides fragilis
Prevotella spp.
(generally, of the lower GI tract)
Gram (-) coccobacilli organisms:
Acinetobacter baumannii
Bordetella pertussis
Moraxella catarrhalis
Atypical organisms
Do NOT gram-stain well
Mycoplasma pneumoniae
Mycobacterium tuberculosis
Legionella spp.
Chlamydia spp.
Curved or spiral shaped Gram (-) rod organisms:
Groups of Organisms
HNPEK
Haemophilus. influenzae
Neisseria spp
Proteus mirabilis
Escherichia coli (E. coli)
Klebsiella spp
Groups of Organisms
CAPES
- Anytime we are covering for CAPES organisms, we are normally covering for another nosocomial type pathogen called ___________
Citrobacter
Acinetobacter
Providencia
Enterobacter
Serratia
- Pseudomonas aeruginosa**
Groups of Organisms
PEK
Proteus mirabilis
E. coli
Klebsiella spp
1) Identify the organism
- Collect specimen, Gram stain, culture
2) Determine the minimum inhibitory concentration (MIC)
- susceptibility testing
- lowest concentration with no growth
3) Interpretation
MIC is compared to the breakpoint and the organism is determined to be
(S) susceptible
(I) intermediate
(R) resistant to the antibiotic
(S)- means yeah we can use that antibiotic to treat IF
- the antibiotic penetrates the site of infection/area within human body once given
- if patient doesn’t have any contraindications to its use [allergies, renal/hepatic function, ]
- ## if it is the narrowest spectrum antibiotic available to give compared to other antibiotics that work.
** Do NOT compare the MIC of one antibiotic to the MIC of another antibiotic. Those are specific to those particular antibiotics.
You are looking for a drug that is susceptible AND has the Narrowest Spectrum of Activity that follows Guidelines.
Common Resistant Pathogens:
**remember*- - “Kill Each And Every Strong Pathogen”
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis/faecium (VRE)
Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa
[ESBL-extended-spectrum beta-lactamase]
[CRE-carbapenem-resistant enterobacteriaceae]
[VRE-vancomycin resistant Enterococcus]
[Methicillin Resistant Staphylococcus aureus]
Synergy-
when you are using 2 to get a bigger benefit than using either one alone.
Mechanisms of resistence:
Selection pressure- resistance occurs when antibiotics kill of susceptible
bacteria, leaving behind more resistant strains to multiply.
-
Acquired resistance.
- bacterial DNA containing resistant genes can be transferred between different species and/or picked up from dead bacterial fragments in the environment.
Resistant pathogens require careful antibiotic selection.
ESBL producing bacteria:
Use carbapenem antibiotics.
CRE producing bacteria:
- difficult to treat
- bacteria are (MDR) Multidrug resistant to penicillin’s, most cephalosporins and carbapenems.
All Antibiotics have a warning for__________
the risk of (CDI) Clostridioides difficile infection, but the risk is highest with broad spectrum penicillin’s and cephalosporins, quinolones, carbapenems, and clindamycin, which has a boxed warning.
Antibiotic Stewardship Programs: 26min lec 1
Cell Membrane Inhibitors:
- Polymyxins
- Daptomycin
- Telavancin
- Oritavancin
Cell Wall Inhibitors:
- Beta lactams (penicillin’s, cephalosporins, carbapenems)
- Monobactams (aztreonam)
- Vancomycin, Dalbavancin. telavancin, oritavancin
Folic Acid Synthesis Inhibitors:
- Sulfonamides
- Trimethoprim
- Dapsone
Protein Synthesis Inhibitors:
- Aminoglycosides
- Macrolides
- Tetracyclines
- clindamycin
- Linezolid, tedlizolid
- quinupristin/dalfopristin
DNA & RNA inhibitors:
-Quinolones
- metronidazole, tinidazole
- rifampin
Hydrophilic agents:
- essentially are going to stay in the intravascular space more
- good for blood stream infections
- aminoglycosides
- beta lactams
- daptomycin
- glycopeptides - vancomycin
- polymyxins
- vancomycin
Lipophilic agents:
- going to distribute more in the tissues
- good for infections in the tissues
- Chloramphenicol
- Linezolid
- Macrolides
- Quinolones
- rifampin
- ## Tetracycline
Hydrophilic agents:
- Small Vd
- since hydrophilic, easily eliminated in the kidneys
- remember drugs need to be more polar to get through the kidneys
- Low intracellular concentrations “tissue concentrations”
- With Sepsis, variability with how drugs are cleared
- Increased Clearance in Sepsis
- Poor-moderate bioavailability
