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Infectious Disease > Intro to Antimicrobial Therapy Part 2 > Flashcards

Intro to Antimicrobial Therapy Part 2 Flashcards

1
Q

Three primary schemes are used for classification of antimicrobial drugs. WHat are they?

A
  1. Classification by Susceptible Organism
  2. Classification by Mechanism of Action
  3. Classification on whether drugs inhibit bacterial growth or are lethal to bacterial cells
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2
Q

What are the classifications of susceptible organisms?

5

A

Antibacterial Drugs—active against bacteria

Antifungals —active against fungi
Antivirals —active against viruses
Antiprotozoal
Antihelminthic

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3
Q

What are the types of antibacterial classifications for susceptible organisms?
2

A

Narrow-spectrum—drugs active against only a few microorganisms.
Broad-spectrum—active against a wide variety of microorganisms

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4
Q

How is selective toxicity achieved?

6

A

Inhibition of cell wall synthesis

Protein synthesis inhibitors

DNA synthesis inhibitors

RNA synthesis inhibitors

Mycolic acid synthesis inhibitors

Folic acid synthesis inhibitors

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5
Q

Protein Synthesis inhibitors: Inhibit 30s Subunit
are what classes and what drugs?
2 with three each

A

Aminoglycosides

Gentamicin
Tobramycin
Amikacin

Tetracyclines

Tetracycline
Doxycycline
Minocycline

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6
Q

Protein synthesis inhibitors: 50s Subunit
are what classes and what drugs?
2 with three and four drugs

A

Macrolides

Erythromycin
Clarithromycin
Azithromycin

Others:
Chloramphenicol
Clindamycin
Linezolid
Streptogramins
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7
Q

DNA synthesis inhibitors?
Two classes
and 6 drugs

A 
Fluoroquinolones
Ciprofloxacin
Oflaxacin
Norfloxacin
Levofloxacin
Gatiflocacin
Moxifloxacin

Metronidazole

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8
Q

RNA synthesis inhibitors

A

Rifampin

TB drug

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9
Q

Folic acid synthesis inhibitors

2

A

Sulfonamides

Trimethoprim

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10
Q

What locations in the body are normally free of florA?

3

A

The blood, brain, muscle and cerebrospinal fluid are normally free of flora

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11
Q 
Endocarditis
Patient history of-
Native valve: 2 and 4
IV drug user: 2 and 1
Prosthetic valve: 3 and 3
What will be the causitive agent and what antibiotic will we use?
A
  1. Strep viridans (30-40%), “other Strep”(15-25%)
  2. Pen G or
    Amp + Nafcillin or oxacillin + gentamicin
  3. Staph aureus (MSSA and MRSA) All others rare
  4. vancomycin
  5. S. epidermidis, S. aureus, S. viridans and others
  6. vancomycin + rifampin + gentamicin
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12
Q

Intraabdominal infections
Diverticulitis, perirectal abscess, peritonitis: 4 and 3
What will be the causitive agent and what antibiotic will we use?

A
  1. E Coli
  2. occasionally P. aeruginosa
  3. (Anerobes) Bacteroides sp.
  4. Enterococci

TMP-SMX-DS (Bactrim) or Cipro or
Levofloxacin
+
Metronidazole

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13
Q 
Skin and Soft Tissue Infections
Generalized cellulitis: 2 and 4
Diabetic ulcer: 3 and 3
Animal bites: 1 and 1
Necrotizing fasciitis: 2 and 5
What will be the causitive agent and what antibiotic will we use?
A 
1. 
Staph aureus
Strep
2. 
Staph: MSSA: Cephalexin
Staph: MRSA: TMP-SMX-DS or Clindamycin
Strep: Cephalexin
1. 
Staph (assume MRSA)
Strep (Group B) or pyogenes
2. 
Doxy or TMP-SMX-DS
Or Clinda
  1. Pasturella multocida (cat)
  2. Amox-clav (Augementin)
  3. GABS, C. perfringens
  4. PCN G, cefoxitin, chloramphenicol, clindamycin, metronidazole
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14
Q

Urinary tract
What will be the causitive agent and what antibiotic will we use?
4 and 6

A 
1. 
E. Coli
Gram (-) aerobic bacilli
Enterococcus
Staph Saprophyticus
  1. TMP-SMX-DS
    Nitrofurantoin
    Fosfomycin

If > 20% resistance to TMP-SMX-DS then can use

Cipro, Levo, Moxi

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15
Q

Respiratory tract special considerations:
What will be the causitive agent and what antibiotic will we use?

Aspiration pneumonia: 2 and 3
Lower/hospital acquired: 2 and 4
History of HIV: 2 and 2

A
  1. Anaerobic and aerobic mouth flora
  2. Clindamycin or Ampicillin-Sulbactam or A carbapenem
  3. Pseudomonas aeruginosa
    Gram(-) aerobic bacilli
  4. Imipenem-cilastatin or meropenem add Ciprofloxacin or Tobramycin if suspect pseudomonas
  5. Pneumocystis carinii
    S pneumoniae
  6. Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Pentamadine

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16
Q

Respiratory Tract
What will be the causitive agent and what antibiotic will we use?
Sinusitis: 7 and 6
CAP: 3 and 4

A 
1. 
S. Pneumoniae 33%
H. Influenzae 32%
M. Catarrhalis 9%
Anarobes 6%
Grp A Strep 2%
Viruses 15-18%
S. Aureus 10%
2. 
Peds: Amox or Amox-Clav 
PCN allergy: Clinda
Adult: Amox-Clav
PCN allergy:  Levo or Doxy
1. 
All of the above plus the atypicals
Klebsiella pneum.
Mycoplasma pneum.
Chlamydia pneum.
2. Azithromycin, Clarithromycin, Doxycycline, or 
Respiratory FQ (if comorbidities)
17
Q

Meningitis in children
What will be the causitive agent and what antibiotic will we use?

Child

A 
1. 
E coli
Enterococcus spp.
GBS
Listeria monocytogenes
anerobes (bacteroides fragilis)
Gram(-) aerobic bacilli
  1. Ampicillin + gentamicin
  2. Strep pneumoniae
    Neisseria meningitis
    Haemophilus influenzae
  3. Vancomycin + cefriaxone or cefotaxime

neonates are susceptible to normal vaginal flora becoming pathogenic

18
Q

Meningitis
Age 1 mo to 50 years: 2 and 3
Age

A
  1. S. Pneumoniae
    Meninogococci
  2. Cefotaxime or Ceftriaxone + vancomycin
1. 
Group B Strep 49%
E Coli 18%
Misc Gm + 10%
Misc Gm – 10%
  1. Ampicillin + Cefotaxime or Gentamycin
19
Q

What antibiotic should be administered before the surgery begins via IV
Often used to irrigate the surgical site as well?
DOC and Alt?

A

Cefazolin (Ancef) 1-2 gram IV (30 minutes before skin incision)
For penicillin allergic patients can use vancomycin 1-1.5g (1 hour infusion)

20
Q

Certain individuals are susceptible to developing bacterial endocarditis
?
2

A

Prosthetic heart valves

Congenital heart disease

21
Q

Bacterial endocarditis prophylaxis?
30-60 min prior to dental procedures using what?
Whats the alternative? 3

A

Amoxicillin 2 grams PO

For penicillin allergy
Clindamycin 600 mg
Azithromycin 500 mg
Clarithromycin 500 mg

22
Q

Here are a few of MANY complications from antibiotic therapy?
5

A
  1. Toxicity
  2. C. difficile diarrhea
  3. Alteration of gut flora and change in vitamin K levels leading to difficulty managing warfarin therapy
  4. Candida overgrowth
  5. Serious side effects
23
Q

C. Difficile diarrhea and colitis is a major complication of antibiotic therapy.
Frequent: 4
Infrequent: 4
Rare: 3

A

Ampicillin/amoxicillin
Cephalosporins
Clindamycin
Quniolones

Chloramphenicol
Macrolides
Sufonamides/Trimethoprim
Tetracycline

Metronidazole
Aminoglycosides
Vancomycin

Infectious Disease (29 decks)

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