Introduction To Abx Flashcards
Penicillins are used to treat which bugs? (5)
Strep pyogenes: GAS, erysipelas, glomerulonephritis, pharyngitis
Strep viridans: found in mouth, causes endocarditis
Oral anaerobes: but less efficient than Clindamycin
Syphillis
Leptospirosis: kidney and liver disease
[P.VALS]
Ampicillin and amoxicillin both cover the same organisms than penicillin plus …
E.Coli: they can be used for UTI in pregnancy as they are safe for the foetus
Penicillin exists in 3 forms
Penicillin G: IV
Penicillin VK: oral
Benzothine: long acting IM used for syphillis
Which gram negative bacterias are covered by amoxicillin?
H.Influenza E.coli Listeria Proteus Salmonella [HELPS]
Amoxicillin is the best initial tx for (6)
Otitis media Dental infection, endocarditis prophylaxis Lyme limited to 7th CN, rash, joint UTI in pregnancy Listeria Enterococci
Oxacillin, cloxacillin, nafcillin, dicloxacillin can be used for tx of
Skin infections: cellulitis (bc it is staph)
Endocarditis, meningitis and bacteremia from staph
Osteo and septic arthritis when proven sensitive
NOT against MRSA or enterococcus
Piperacillin and Ticacillin cover which organisms?
Gram neg bacilli (E.coli and proteus)
Enterobacteriae
Pseudomonas
Piperacillin and Ticacillin are the best therapy for (6)
Cholecystitis Ascending cholangitis Pyelonephritis Bacteremia Hospital acquired or ventilator assoc. pneumo Neutropenia (absolute neutrophil count
Piperacillin, ticacillin, azlocillin, mezlocillin are generally combined with?
A beta-lactamase inhibitor such as taxobactam or clavulonic acid
Taxobactam and clavulonic acid add …. coverage to piperacillin and ticacillin
Staph
Cross reaction between penicillin and cephalosporins is
3-5%
Can you use cephalosporin in a penicillin allergic patient?
If pt only has a rash: yes
If anaphylaxis: no beta lactams
Which organisms are covered by any class of cephalosporins?
Group A, B and C strep Strep viridans E.coli Klebsiella Proteus
Which organisms are resistant to all forms of cephalosporins? (3)
Listeria
MRSA
Enterococcus
Name 4 first generation cephalosporins
Cefazolin, cephalexin, cephradrine, cefadroxyl
First generation cephalosporins are used to treat
Staph (methicillin sensitive)
Strep (but not enterococcus)
Some gram neg like E.coli but not pseudomonas
Osteomyelitis, septic arthritis, endocarditis, cellulitis
Name 6 second generation cephalosporins
Cefotetan, cefoxitin, cefaclor, cefprozil, cefuroxime, loracarbef
Second generation cephalosporins cover
Cover the same organisms than first generation (staph and strep if methicillin sensitive) but a little more anaerobes (specially cefotetan and cefoxitin) and gram neg bacilli
Cefotetan and cefoxitin (2nd generation cephalosporins) are the best initial therapy for …. But increase risk of … and …
PID combined with doxy
Bleedind and disulfiram like reaction with alcohol
Cefotetan and cefoxitin should not be taken with… ; why?
Alcohol
Disulfiram like reaction
Cefuroxime, loracarbef, cefprozil, cefaclor (2nd gen cephalosporins) are used for which conditions?
Respiratory infections (NOT PNEUMO) bronchitis, otitis media, sinusitis
Name three third generations cephalosporins
Ceftriaxone, cefotaxime, ceftazidime
Ceftriaxone (3rd generation ceph)is first line tx for (5)
Pneumococcus, including partially insensitive organisms: meningitis, CAP (combine with macrolide), gonorrhea, lyme involving heart or brain
In whom ceftriaxone should be avoided?
Neonates, anaphylaxis to penicillin
Cefotaxime (3rd generation ceph) is better than ceftriaxone in which population?
In which disease?
Has better … Coverage
Impaired hepatic metabolism (cefotaxime does not require metabolism by liver): Neonates
Spontaneous bacterial peritonitis
Pseudomonal
Cefepime (4th gen ceph) has better … Coverage than third generation and is used for…
Staph
Used for : neutropenia and fever, ventilator associated pneumonia
What cephalosporin covers MRSA?
Ceftaroline
Carbapenems cover
Gram negative bacilli Anaerobes Staph and strep Neutropenia and fever Pseudomonas (except ertapenem)
Ertapenem is different than other carabapenems because
It does not cover pseudomonas
Axtreonam is used exclusively for
Gram negative bacilli, like E.coli, enterobacter, citrobacter, pseudomonas
Can you use aztreonam in a penicillin allergic patient?
Yes, there is no cross reaction
Name 4 fluoroquinolones
Ciprofloxacon
Gemifloxavin
Levofloxacin
Moxifloxacin
Fluoroquinolones are first line treatment for…
CAP: including penicillin resistant pneumococcus (except cipro!)
Gram negative bacilli including pseudomonas
Ciprofloxacin is number one drug for
Cystitis and pyelonephritis
Mocifloxacin is used for
It is the only quinolone covering
Lungs infections, diverticulitis and GI infections (no need to be combined with metronidazole)
It covers anaerobes
Quinolones adverse effects
Bone growth abnormalities in children and pregnant woman (do not use them in kids and preg)
Tendonitis and achilles tendon rupture
Gentamicin, tobramycin, amikacin (aminoglycosides) cover
Gram negative bacilli (bowel, urine, bacteremia): e.coli, enterobacter, citrobacter, pseudomonas, morganella, ceressia
+ synergistic with beta lactams for enterococci and staph
Aminoglycoside are synergistic with … For … And … Infections
Beta lactams
Enterococci and staph
Aminoglycoside no not cover
Anaerobes: they need oxygen to work
Aminoglycoside side effects
Nephrotoxic : acute tubular necrosis
Ototoxic
Doxycycline is a drug of choice for
Chlamydia
Lyme disease rash, joint, 7th CN palsy
MRSA of the skin
Rickettsia (rocky mountain spotted fever)
Syphillis primary and secondary but ONLY if allergic to penicillin
Borrelia (lyme), ehrlichia (also tick borne) and mycoplasma
Adverse effects of doxy
Tooth discoloration (children)
Fanconi syndrome (type II RTA proximal)
Photosensitivity
Esophagitis (sit and drink a lot of water)
TMP/SMX is used for
Cystitis (3d if uncomplicated)
Pneumocystis pneumonia tx and prophylaxis
MRSA of skin and soft tissue (not heart and brain!)
TMP/SMX S.E
rash (sulfa drug)
Hemolysis, specially in G6PD deficiency
Bone marrow suppression (folate antagonist)
Nitrofurantoin is used for
Cystitis in pregnancy
Amoxicillin clavulonate
Ticacillin/clavulonate
Add what coverage?
Staph, covers only sensitive staph though
Best initial tx for sensitive staph or strep?
Oxacillin, cloxacillin, nafcillin, dicloxacillin
(Ox and naf IV)
1st gen cephalo
Fluoroquinolones
Macrolides (axithromycin, claithro, erythro): less efficacy than ox or cephalo and erythro is more toxic
Methicillin resistant staph first line tx?
Vancomycin Linezolid (careful, reversible BM tox) Daptomycin (NOT for lung) Tigecycline (does not cover pseudomonas) Ceftaroline
S.E of linezolid?
Reversible bone marrow toxicity (platelets!)
Tx for minor MRSA infections of the skin (not for blood, brain or heart)
TMP/SMX
Clindamycin
Doxycycline
Tx for anaerobes infections
Oral (above diaphragm) : penicillin (G, VK, ampi, amoxi), clindamycin
Under diaphragm: metronidazole (safe in pregnancy)
Piperacillin, carbapenems, second gen ceph also cover anaerobes
Diseases caused and tx for gram neg bacilli (e.coli, enterobacter, pseudomonas, klebsiella, proteus, citrobacter)
Bowel (peritonitis, diverticulitis)
Urinary tract (pyelonephritis)
Cholecystitis or cholangitis
Quinolones, aminoglycosides, carbapenems, piperacillin, tocacillin, aztreonam, cephalosporins (not pseudomonas in first gen)
Name beta lactams group of drugs (4)
Penicillins
Cephalosporins
Carbapenems
Aztreonams
