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Medd 422 > Infectious Disease and Antibiotics > Flashcards

Infectious Disease and Antibiotics Flashcards

1
Q

Beta-Lactams MOA

A

cell wall inhibitor

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2
Q

Beta-Lactams - 3 drug classes

A

Penicillins
Cephalosporins
Carbapenems

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3
Q

Penicillins (examples, spectrum, best clinical use)

A 
Penicillin G (IV)
Penicillin V or K (PO)
Benzathine Penicillin (IM)

Gram (+) aerobes/anaerobes, some gram (-)
Not for S. aureus, Bacteroides

Best for: Syphillis (benzathine penicillin), dental infections, Group A strep pharyngitis

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4
Q

Anti-staph penicillins (examples, spectrum, best clinical use)

A

Cloxacillin (IV/PO)
Methacillin

Methicillin-sensitive S. aureus (MSSA)

MSSA

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5
Q

Aminopenicillins

A

Amoxicillin (PO)
Ampicillin (IV)
Amoxicillin-clavulanate

Gram (+) and gram (-) aerobes/anaerobes
Amox/ampi = no S.aureus, bactericides, mycoplasmaplasma
Amoxi-clav = no pseudomonas, MRSA, mycoplasma

Amoxi, ampi = for URI, GBS prophylaxis, GI infection, rarely used empirically except for meningitis
Amoxi-clav = bite infections, aspiration pneumonia, GI/GU infections, COMPLICATED infections

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6
Q

Extended-spectrum penicillins

A

Piperacillin-tazobactam
Gram (+) and gram (-) aerobes/anaerobes
Empiric coverage for severe infections, pseudomonas

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7
Q

1st generation cephalosporins

A

Cephalexin (Keflex) PO
Cefazolin (Ancef) IV

Gram (+) and gram (-) aerobes (Proteus, E. Coli, Klebsiella)
No pseudomonas, MRSA, Enterococcus, Listeria, anaerobes

Skin infections, MSSA, PEcK, pre-op prophylaxis

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8
Q

2nd generation cephalosporins

A

Cefuroxime (PO and IV) - same as 1st gen but better H.influenza coverage; good for pneumonia, COPD
Cefoxitin (IV) - same as 1st gen but better Bacteroides coverage; good for GI/GU surgery prophylaxis

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9
Q

3rd generation cephalosporins

A

Ceftriaxone (IV) - better gram (-) aerobe coverage; good for meningitis, pyelonephritis, MSSA, group A strep, gram -ves
Ceftazidime - same as ceftriaxone but pseudomonas coverage

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10
Q

4th generation cephalosporins

A

Cefepime (IV) - same as ceftazidime; good for gram (-) and pseudomonas infections

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11
Q

Carbapenems

A

Ertapenem (IV) - gram (+) and gram (-) aerobes/anaerobes; no enterococcus, pseudomonas, MRSA; tx of ESBL infections needing outpt therapy

Meropenem (IV), imipenem (IV) - same as ertapenem but Pseudomonas and some Enterococcus coverage; empiric coverage for severe infections, Pseudomonas, ESBL; NO MRSA

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12
Q

Vancomycin MOA

A

GLYCOPEPTIDE

Disrupts cell wall by preventing peptidoglycan synthesis

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13
Q

Vancomycin

A

Gram (+) aerobes/anaerobes
For MRSA, Enterococcus, CoNS, C.diff colitis (PO)
NOT GOOD AGAINST STAPH AUREUS

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14
Q

Daptomycin MOA

A

CYCLIC LIPOPEPTIDE

Depolarizes cell membrane causing lysis

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15
Q

Daptomycin

A

Gram (+) aerobes

MRSA, VRE (Vancomycin-resistant enterococci)

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16
Q

Fluoquinolones MOA

A

DNA gyrase inhibitor

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17
Q

Fluoroquinolones

A

Ciprofloxacin - gram (-) aerobes, pseudomonas, MSSA, Mycobacteria tuberculosis, limited Strep; NOT FOR anaerobes, Enterococcus, MRSA
Levofloxacin - same as copra but better strep coverage and poor pseudomonas coverage
Moxifloxacin - same as levofloxacin but good anaerobic and some Enterococcus coverage (GI/GU infections)

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18
Q

Metronidazole MOA

A

Disrupts DNA by free radical production

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19
Q

Metronidazole

A

Anaerobes, protozoa (Giardia, Trichomonas, Entamoeba, Blastocystis)
C diff colitis, anaerobic infections, protozoa

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20
Q

Macrolides, lincomycin MOA

A

Inhibit protein synthesis by binding 50S ribosomal subunit and preventing translocation

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21
Q

Macrolides

A

Clarithromycin (PO) - S. pneumonia, H. influenza, Mycoplasma, Chlamydophila, Legionella, Moraxella, Mycobacterium avium ( MAC), H.pylori; good for URI, pneumonia, MAC, H.pylori

Azithromycin (PO/IV) - Gram+ and Gram - Atypical pneumonias, chlamydia, H. Pylori (+ clarithromycin), MAC, traveller’s diarrhea

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22
Q

Aminoglycosides MOA

A

Inhibit protein synthesis by binding to 30S ribosomal subunit and preventing translocation

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23
Q

Aminoglycosides

A

Gentamicin (IV) - gram (-) aerobes, MSSA; good for combo therapy for invasive gram (-), MSSA and enterococcus infections

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24
Q

Tetracycline MOA

A

Inhibit protein synthesis by binding to 30S ribosomal subunit and preventing translocation

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25
Tetracycline
Doxycycline - gram (+) and (-) aerobes, | Atypical pneumonias, chlamydia, tick/lyme disease, community MRSA
26
Linezolid MOA
Inhibit protein synthesis by binding to 50S ribosomal subunit and preventing translocation
27
Linezolid
Gram (+) aerobes; good for MRSA, VRE
28
Trimethoprim-sulfamethozazole MOA
Disrupt folate synthesis by sequentially inhibiting enzymes needed for bacterial production of THF
29
Trimethoprim-sulfamethozazole
Gram (+) and gram (-) aerobes, protozoa; not for anaerobes, enterococcus, group A strep, pseudomonas; good for skin infections, MRSA, UTI, prophylaxis for immunocompromised
30
2 common Gram + cocci in chains
Streptococcus or enterococcus
31
Empiric tx for streptococcus
Ceftriaxone
32
Empiric tx for enterococcus
Ampicillin or linezolid
33
1 common gram + cocci in cluster
Staphylococcus
34
Empiric tx for staphylococcus
Vancomycin
35
2 common Gram + bacilli
Clostridium | Listeria
36
Common gram + bacilli that you do not need to be concerned about
Propionibacterium acnes Bacillus Corynebacterium Coagulase negative staphylococci (CoNS)
37
Empiric tx for clostridium (anaerobic)
Metronidazole or Piperacillin-tazobactam
38
Empiric tx for listeria
Ampicillin
39
Bacteria that are never contaminants
Staph aureus Gram - bacilli Yeast
40
Common gram - cocci
Neisseria
41
Empiric tx of Neisseria
Ceftriaxone
42
Infection commonly caused by Neisseria
Meningitis | NB - look for purpura fulminans with neisseria meningitides
43
Common gram - coccobacilli
Haemophilus
44
Infection commonly caused by Haemophilus
URTI
45
Gram - bacilli
``` Klebsiella Enterobacter E. Coli Proteus Serratia Bacteroides Pseudomonas ```
46
Gram - coliform bacilli
Klebsiella Enterobacter E. Coli Serratia
47
Empiric tx for gram - coliforms
Ceftriaxone, piperacillin-tazobactam, meropenem
48
Empiric tx for pseudomonas
Piperacillin-tazobactam or meropenem Critically ill pts may need double coverage with amino glycoside or ciprofloxacin ALWAYS HAVE PSEUDOMONAS COVERAGE IF SEVERE INFECTION (not needed for mild-moderate)
49
Empiric tx for bacterioides (anaerobic)
Metronidazole or pipercerallin-tazobactam
50
Organisms associated with infective endocarditis
S. aureus, Enterococcus, viridans group streptococci
51
Common infections caused by Staphylococcus aureus
Soft tissue infections, endocarditis, catheter associated BSI, bone/joint infections, hospital acquired pneumonia, surgical site infections, prosthetic material infections
52
Streptococcus pneumoni
Gram + cocci in pairs
53
Common infections caused by streptococcus pneumoni
Otitis media, community acquired pneumonia, leading cause of bacterial meningitis
54
Empiric therapy for bacterial meningitis
Ceftriaxone + vancomycin + dexamethasone
55
Group A Strep
Streptococcus pyrogens
56
Common infections caused by streptococcus pyogene
STREP PHARYNGITIS AND CELLULITIS | pneumonia, empyema, necrotizing fasciitis, toxic shock
57
Non-infectious complications caused by streptococcus pyogene
rheumatic fever | glomerulonephritis
58
Viridans group streptococci
Gram + cocci in chains
59
Common infections caused by Viridans group streptococci
Abscess (brain, lung, pleura, liver, abdo), aspiration pneumonia (common in oral flora), can cause endocarditis (repeat blood cultures after 48h to ensure cleared)
60
Empiric therapy for viridans group streptococci
Ceftriaxone
61
2 common types of enterococcus
E. faecalis: more common in community infections | E. faecium: more common in hospital-onset infections
62
Common infections caused by enterococcus
UTI, hepatobiliary infections, endocarditis (repeat blood culture in 48h)
63
Empirix tx for E. faecalis
Ampicillin
64
Empiric tx for E. faecium
Linezolid
65
Common infections caused by coliforms/enterobacteriaciae
UTI, hepatobiliary infection, intra-abdominal infection, health-care associated infections
66
Empiric tx for community acquired coliform infection in non-septic pt
Ceftriaxone
67
Empiric tx for community acquired coliform infection in septic pt
Piperacillin-tazobactam or meropenem
68
Common infections caused by candida
Oral thrush, vaginal candidiasis, cutaneous Serious infections usually healthcare associated Endocarditis seeding to eyes (endopthlamitis)
69
Empiric tx for candida
Fluconazole if not critically ill, no prev anti fungal tx and not neutropenic Micafungin for everyone else
70
Main resistance pathways of beta lactams
Enzymatic destruction (beta lactamases), altered target (PBP mutation), decreased uptake (porin channel alterations)
71
Beta lactamases MOA
Hydrolysis of betalactam ring
72
Beta lactamases examples
ESBL, AMPC, KPC, Penicillinase
73
ESBL examples
E.coli and other Enterobacteriaceae (ie. Klebsiella, Proteus)
74
AmpC examples
E. coli and other enterobacteriaceae
75
Penicillinase examples
Staph aureus
76
KPC (K. Pneumonia carbapenemase) examples
E. coli and other enterobacteriaceae
77
Beta-lactam resistance: PBP mutating bacteria
MRSA
78
Beta-lactam resistance: OPR-D porin channel altering bacteria
P. aeruginosa (resistance to imipenem)
79
Main resistance pathway to glycopeptides (vancomycin)
``` Altered target (cell wall precursor mutation: d-ala-d-ala --> d-ala-d-lac = decreases vanco binding) ```
80
Examples of vancomycin resistant bugs
``` VRSA = Vanco resistant staph aureus VRE = Vanco resistant enterococcus ```
81
Main resistance pathways to aminoglycosides (gentamicin)
Enzymatic modification (AG changes --> decrease ribosome binding), altered target (mutational changes on ribosomal binding site), decreased uptake (porin channel alterations)
82
Examples of AG modifying enzymes
Gram + and - resistance to AGs
83
AG resistance: example of ribs binding site mutating bacteria
Enterococcal resistance to streptomycin
84
AG resistance: porin channel altering bacteria
Gram - resistance to AGs
85
Main resistance pathways to quinolones (ciprofloxacin, levofloxacin)
Decreased uptake (porin channel alteration), increased efflux, altered target (mutational changes in DNA gyrase subunit)
86
Quinolone resistance: examples of porin channel altering bacteria
Gram - resistance to quinolones
87
Quinolone resistance: examples of efflux altering bacteria
Gram - resistance to quinolones (ie. multi drug efflux pump in P. aeruginosa), staphylococcal
88
Quinolone resistance: examples of DNA gyrase mutating bacteria
Gram + and - resistance to quinolones
89
Main resistance pathways to macrolides (erythromycin, azithromycin, clarithromycin)
Increased efflux, altered target (ribosomal alteration decreasing macrolide binding)
90
Macrolide resistance: examples of increased efflux bacteria
Various staphylococcus and streptococcus
91
Macrolide resistance: examples of ribosomal altering bacteria
Various staphylococcus and streptococcus
92
Alternative Abx for ESBL
Carbapenem, Aminoglycoside (gentamicin - NB renal dysfunction), Ciprofloxacin, Pip-tazo, TMP-SMX
93
Alternative Abx for VRE
Daptomycin, Linezolid
94
Classic empiric antibiotic combo for severe infection and very little idea of culprit organism
Piperacillin-Tazobactam + Vancomycin
95
Top 3 causes of community acquired blood stream infection
1. E. Coli 2. Staph aureus 3. Strep pneumo
96
Top 3 causes of hospital acquired blood stream infection
1. Coagulase negative staphylococci 2. Staph aureus 3. Enterococcus / candida
97
Coagulase negative staph IE tx
Vancomycin (resistant to B-lactams, treat like MRSA)
98
Staph lugdunensis IE tx
Cloxacillin (treat like MSSA)
99
Staph aureus IE tx
SUSCEPTIBLE 1. Cloxacillin 2. Cefazolin Prosthetic: Cloxacillin + Rifampin + 2 weeks of gentamicin RESISTANT 1. Vancomycin 2. Daptomycin Prosthetic: Vancomycin + Rifampin + 2 weeks of gentamicin All for 6 weeks (unless susceptible right-sided IE in IDU = 2-4 wks)
100
Viridans group strep and S. bovis IE tx
Susceptible: 4 wks Penicillin G OR ceftriaxone OR 2 wks of penicillin G or ceftriaxone AND Gentamicin Prosthetic valve: 6 wks of Penicillin G OR ceftriaxone +/- Gentamicin for 2 weeks Resistant: Penicillin G + 2 wks of Gentamicin or Ceftriaxone alone Prosthetic valve: Penicillin or Ceftriaxone AND gentamicin for 6wks
101
Enterococcus faecalis IE common cause
Nosocomial infection
102
Coagulase negative staph IE common cause
Prosthetic valve
103
Viridans group strep IE common cause
Non-IVDU, poor dentition
104
Streptococcus bovis IE common cause
Colonic lesion
105
Enterococcus facaelis/facecium IE tx
Ceftriaxone + Ampicillin | Alt: Penicillin G or Ampicillin + Gentamicin but b/c of nephrotoxicity, avoid gentamicin
106
Top common causes of native-valve non-IDU IE
1. Staph aureus 2. Viridans Group Strep 3. Enterococcus
107
Empiric regimen for native-valve non-IDU IE
Penicillin G + Cloxacillin OR Ampicillin + Gentamicin
108
Empiric regimen for native-valve IDU IE
Most common cause = Staph aureus | Vancomycin until you know MRSA vs MSSA
109
Top common causes of prosthetic valve IE
1. Staph aureus and CoNS 2. Viridans Group Strep 3. Enterococcus
110
Empiric regimen for prosthetic valve IE
Vancomycin + Gentamicin + Rifampin
111
HACEK organisms
``` Often give -ve result in IE testing b/c fastidious growth Haemophilus sp Aggregatibacter sp Cardiobacterium hominis Eikenella corrodens Kingella sp ```
112
Tx for HACEK organism IE
Ceftriaxone for 4-6wks
113
True culture negative IE likely culprits
Coxiella --> Doxycycline + hydroxychloroquine x 18mo | Bartonella --> Ceftriaxone + Gentamicin + Doxycycline x 6wks
114
Candida IE tx
Micafungin IV for >6wks Surgery If no surgery, lifelong fluconazole suppression
115
Directed tx against Neisseria meningitides
Penicillin G for ~7-14d
116
MRSA tx options
Oral: TMP-SMX, doxycycline, clindamycin | Parenteral (severe): Vancomycin, daptomycin, linezolid
117
4 different types of penicillins
1. Penicillin 2. Aminopenicillins 3. Cloxacillin 4. Piperacillin
118
Types of 30s ribosomal subunit inhibitors
1. Aminoglycosides | 2. Tetracycline
119
Lincosamide
Clindamycin: Gram (+) aerobes/anaerobes; no enterococcus; MRSA, skin and dental infections (anaerobe coverage ABOVE the diaphragm), for its with penicillin allergies A/W C.diff

Medd 422 (4 decks)

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