Infectious Diseases (Antibiotics) Flashcards
What is the most accurate diagnostic test for infectious diseases?
Culture
What bacteria are covered by amoxicillin?
HELPS: H. Influenzae, E. Coli, Listeria, Proteus, and Salmonella
For which illnesses are penicillins the “best initial therapy”
Otitis media
Dental infection and endocarditis prophylaxis
Lyme disease limited to rash, joint, or CNVII involvement
UTI in pregnant women
Listeria Monocytogenes
Enterococcal infections
What are the penicillinase-resistant penicillins
Oxacillin
Cloxacillin
Dicloxacillin
Nafcillin
What are the penicillinase-resistant penicillins used to treat?
Skin infections (cellulitis, impetigo, erysipelas) Endocarditis, meningitis, and staphylococcal bacteremia Osteomyelitis and septic arthritis when organism is sensitive
Which penicillins cover gram negative bacilli?
Piperacillin, ticarcillin, azlocillin, mezlocillin
Piperacillin, ticarcillin, azlocillin, mezlocillin are the best initial therapies for…
Cholecystitis and ascending cholangitis Pyelonephritis Bacteremia Hospital-acquired/ventilator-associated pneumonia Neutropenia and fever
The only cephalosporin that will cover MRSA is…
Ceftaroline
______, ______, and ______ are resistant to all forms of cephalosporins
Listeria, MRSA, Enterococcus
What are the first generation cephalosporins?
Cefazolin, Cephalexin, Cephadrine, Cefadroxyl
What are first generation cephalosporins used to treat?
Staphylococci (methicillin sensitive)
Streptococci (except enterococcus)
E. Coli (but not Pseudomonas)
Osteomyelitis, septic arthritis, endocarditis, cellulitis
What are the second generation cephalosporins?
Cefotetan, Cefoxitin, Cefaclor, Cefprozil, Cefuroxime, Loracarbef
Second generation cephalosporins cover all the same organisms as 1st generation cephalosporins and add coverage for…
anaerobes and more gram-negative bacilli
Which are the only cephalosporins that cover anaerobes?
Cefoxitin and Cefotetan
What is the best initial therapy for pelvic inflammatory disease when combined with doxycycline?
Cefoxitin or Cefotetan
What are the risks of Cefotetan and Cefoxitin?
Increase risk of bleeding (deplete prothrombin) and give a disulfiram like reaction with alcohol
What are the third generation cephalosporins?
Ceftriaxone, Cefotaxime, Ceftazidime
Ceftriaxone is first line for…
Pneumococcus, Meningitis, CAP (in combination with macrolides), Gonorrhea, Lyme disease involving brain or heart
Why should you avoid ceftriaxone in neonates? What should you use instead?
Because of impaired biliary metabolism; Cefotaxime
Which third generation cephalosporin has pseudomonal coverage?
Ceftazidime
What is the fourth gen cephalosporin? What is its advantage over the 3rd generation?
Cefepime; has better staphylococcal coverage compared with the 3rd gen cephalosporins
What is the 5th gen cephalosporin? What does it treat?
Ceftaroline; Treats gram-negative bacilli and MRSA
What are the Carbapenems? What are they used to treat?
Imipenem, Meropenem, Ertapenem, Doripenem; Used to treat neutropenia and fever
What is the only monobactam drug?
Aztreonam
Aztreonam is exclusively for…
Gram-negative bacilli (including pseudomonas)
What is the best therapy for community acquired pneumonia (CAP)?
Fluoroquinolones
What fluoroquinolone is used for cystitis and pyelonephritis?
Ciprofloxacin
What is covered by fluorquinolones?
Gram negative bacilli including most psuedomonads
Which Fluoroquinolone is the only one that can be used as a single agent for diverticulitis
Moxifloxacin (all others require metronidazole)
Risks of quinolones?
Bone growth abnormalities in children and pregnant women
Tendonitis and achilles tendon rupture
What are the aminoglycosides?
Gentamicin, Tobramicin, Amikacin
What do aminoglycosides cover?
Gram negative bacilli
Why do aminoglycosides have NO EFFECT against anaerobes?
They need oxygen to work
Aminoglycosides have what types of toxicity?
Nephrotoxicity and ototoxicity
What can Doxycycline be used to treat?
Chlamydia
Lyme disease (limited to rash, joint of CNVII palsy)
Rickettsia
MRSA of skin and soft tissue
Primary and secondary syphilis (if allergic to penicillin)
Borrelia, Ehrlichia, and Mycoplasma
What are the adverse effects of doxycycline?
Tooth discoloration, Fanconi syndrome (type II RTA proximal), Photosensitivity, Esophagitis/ulcer
What is TMP/SMX used to treat?
Cystitis
Pneumocystitis pneumonia (tx and prophylaxis)
MRSA of skin and soft tissue (cellulitis)
What are some adverse effects of TMP/SMX?
Rash, Hemolysis with G6PD deficiency, bone marrow suppression (folate antagonist)
What are the beta lactam/beta lactamase combinations?
Amoxicillin/Clavulanate
Ticarcillin/Clavulanate
Ampicillin/Sulbactam
Piperacillin/Tazobactam
Beta lactam/beta lactamase combinations are the first choice for…
Mouth and GI abscess
Gram positive cocci (Staph and Strep) are best treated with…(4)
Penicillins: Oxacillin, Cloxacillin, Dicloxacillin, Nafcillin
1st Gen Cephalosporins
Fluorquinolones
Macrolides (3rd line agents)
MRSA is best treated with… (6)
Vancomycin Linezolid Daptomycin Tigecycline Ceftaroline Telvancin
All the beta lactam/beta lactamase combinations cover _____ with equal efficacy to metronidazole
Anaerobes
How are anaerobes treated when…
Above the diaphragm (oral):
Abdominal/GI:
Above the diaphragm (oral): Penicillin; Clindamycin
Abdominal/GI: Metronidazole or beta lactam/beta lactamase combination
What are the gram negative bacilli?
E. Coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Citrobacter
Which antibiotics cover gram negative bacilli? (6)
Quinolones Aminoglycosides Carbapenems Piperacillin, ticarcillin Aztreonam Cephalosporins
What is the one indication for Nitrofurantoin?
Cystitis
