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Antibiotics Revision > Micro and Antibiotic man > Flashcards

Micro and Antibiotic man Flashcards

1
Q

what are gram -ve coliforms sensitive to

A

gentamicin and aztreonam

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2
Q

what is 47% of e. coli resistent to

A

amoxicillin

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3
Q

what covers 65% of e coli

A

co-trimoxazole

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4
Q

what are ESBL resistant to

A

most penicillins- co- amoxiclav, piperacillin/tazobactam and aztreonam

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5
Q

what covers ESBLs

A

temocillin, pivmecillinam

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6
Q

would you give metronidazole with pip-tazobactam/ co-amoxiclav

A

no as they both have anaerobic cover

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7
Q

do temocillin and ertapenem cover pseudomonas

A

no

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8
Q

do temocillin and aztreonam have aerobic or gram +ve cover

A

no have neither

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9
Q

what aee CPEs resistant to

A

pencillins, cephalosporins, pip-tazobactam, aztreonam, temocillin, carbapenems & often
other classes of antibiotics – gentamicin, ciprofloxacin, co-trimoxazole

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10
Q

what are anaerobes sesnitive to

A

metronidazole

also- co-amoxiclav, clindamycin, pip-tazobactam and meropenem

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11
Q

gram +ves like staph aureus (MSSA, MRSA), streps and enterococci are sensitive to what when there is a penicillin allergy

A

vancomycin (except VREs)

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12
Q

what is MRSA resistant to

A

all beta lactams (penicillins, flucloxacillin, piptazobactam, cephalosporins, meropenam)

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13
Q

what is VRE resistant to

A

vancomycin and meropenam

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14
Q

what are beta haemolytic streps (groups A, C and G) sensitive to

A

penicillin and flucloxacillin

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15
Q

what causes meningitis

A

pneumococcus, meningococcus

if >/= to 60 y/o then listeria

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16
Q

what causes encephalitis

A

herpes simplex

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17
Q

what are pneumococci and meningococci sensitive to

A

penicillin

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18
Q

what are the indications for IV anitbiotics

A

Specif ic inf ections e.g. endocarditis, septic arthritis, abscess, meningitis, osteomy elitis
• 2 or more criteria as abov e out with range (temperature, respiratory rate, pulse, WCC)
• Febrile with neutropenia or immunosuppression
• Oral route compromised
• Post surgery – unable to tolerate 1 litre of oral f luids
• No oral f ormulation av ailable

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19
Q

what must you consider in clarithromycin

A

interactions (e.g. with statins)

risk of OT interval prolongation

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20
Q

what should you do if IV therapy is still indicated after 72 hrs of gentamicin (or 24hrs with poor renal function)

A
  1. CHECK MICROBIOLOGY RESULTS & SENSITIVITIES
  2. CONSIDER SWITCH TO AZTREONAM
  3. IF REQUIRED ASK ID OR MICRO FOR ADVICE
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21
Q

when should aztreonam be used

A

only for certain patients as alternative to gentamicin

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22
Q

Tx for meningitis

A

ceftriaxone IV + dexamethasone IV

aciclovir IV if encephalitis suspected
add amoxicillin IV if >/= 60 / immunocompromised (to cover listeria)

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23
Q

what is herpes simplex sensitive to

A

IV aciclovir

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24
Q

what causes epiglotitis

A

H. influenzae, streptococci

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25
Q

what are all beta haemolytic strep (groups A, B, C and G) sensitive to

A

penicillin

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26
Q

what causes tonsilitis

A

group A strep

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27
Q

what causes sinusitis

A

pneumococcus

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28
Q

what cause AOM

A

pneumococcus, H. influenzae

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29
Q

what is the Tx for epiglottitis/ supraglottitis

A

ceftriaxone IV

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30
Q

what is h influenza sensitive to

A

amoxillin, doxycycline,

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31
Q

what are pneumococci and meningococci sensitive to

A

penicillin but amoxicillin better oral absorption

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32
Q

what causes mild/ mod CAP

A

pneumococcus (strep pneumonae), H influenzae

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33
Q

what causes mild/mod CAP

A

pneumococcus (strep pneumonae), H influenzae
coliforms and atypicals: legionella, mycoplasma, chlamydia pneumoniae, coxiella
S. aureus post influenza (PVL producing forms V severe in children/ YA)

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34
Q

what causes an acute exacerbation of COPD

A

pneumococcus, H. influenzae

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35
Q

Tx for mild/mod CAP

A

amoxicillin IV/PO (5 days)

if penicillin allergic doxycycline PO or clarithromycin IV

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36
Q

Tx for severe CAP

A

co-amoxiclav IV + doxycyline PO

if penicillin allergic IV levofloxacin
if ICU/HDU/NBM then Co-amoxiclav IV + clarithromycin IV

step down to doxycycline for all

(total 7 days)

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37
Q

what is H influenza sensitive to

A

amoxicillin

doxycycline

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38
Q

why do you give co-amoxiclav in severe CAP

A

as covers both H influenae and coliforms

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39
Q

why do you give doxycycline in severe CAP

A

atypical cover

pneumococci sensitive to it

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40
Q

what does levofloxacin cover in CAP

A

legionella

aslo covers MSSA, h infleunzae, pneumococci and coliforms

41
Q

what has better atypical cover in severe CAP: clarithromycin or doxycyline

A

doxycycline

clarithromycin used in penicillin allergies

42
Q

what causes HAP

A

pneumococcus, H influenzae and coliforms

legionella

43
Q

what tests should you do in pneumonia

A

if mild/ mod can rely on clinical picture

bood cultures, clotted blood for atyptical bacteria, throat swab in viral transport medium,
sputum for bacterial culture, BAL or tracheal aspirates as indicated clinically (suitable for PCR for Legionella and PCR for
PCP if induced sputum cannot be done), urine (white topped sterile universal) for Legionella antigen serogroup 1

44
Q

Tx for non severe hospital acquired pneumonia

A

PO amoxicillin (doxycyline if penicillin allergic) (5 days)

45
Q

Tx for severe HAP

A

IV amoxicillin + gentamicin
(if penicillin allergic IV co trimoxazole + gentamicin)

step down PO co-trimoxazole

(total 7 days)

46
Q

Tx for non severe aspiration pneumonia

A

PO amoxicillin + metronidazole

(if penicillin allergic PO doxycyline and metronidazole)

(total 5 days)

47
Q

Tx for severe aspiration pneumonia

A

IV amox + met + gent

(if penicillin allergic replace amox with PO doxycycline or IV clarithromycin)

step down PO amoxicillin + metronidazole (allergic replace amox with doxycycline)

total 7 days

48
Q

Tx for exacerbation of COPD

A

only antibiotics in increased sputum purulence/ consolidation on CXR/ signs of pneumonia

1st line amoxicillin
2nd line doxycycline

5 days

49
Q

Tx for acute cough/ acute bronchitis

A

only in frail elderly
1st line amoxicillin
2nd line doxycycline

5 days

50
Q

what causes acute native valve endocarditis

A

s aureus

51
Q

what should you do in acute native valve endocarditis

A

2 sets of blood cultures and start antibiotics within the hour

52
Q

what causes native valve subacute endocarditis

A

viridans strep, enterococci

53
Q

what should you do in native valve subacute endocarditis

A

take 3 sets of blood cultures

6 hours apart if patient stable

54
Q

what causes prosthetic valve endocarditis

A

MRSA, coagulase negative strep

55
Q

Tx for native valve indolent (subacute) endocarditis

A

IV amoxicillin + gentamicin

56
Q

Tx for native valve severe sepsis (acute)

A

IV flucloxacillin

57
Q

Tx for prosthetic valve/ suspected MRSA endocarditis

A

IV vancomycin + IV gentamicin (can add rifampicin)

58
Q

how you you need to give antibiotics to treat endocarditis

A

high doses, prolonged duration (4-6 weeks), bacteriocidal, IV, to eliminate bacteraemia, penetrate vegetations and reduce septic emboli risk

59
Q

where should you take samples from CVC related infection

A

blood cultures from peripheral and line site, swab exit site

60
Q

what causes peritonitis/ biliary tract sepsis/ intraabdominal infections

A

polymicrobial coliforms, anaerobes and eneterococci

61
Q

tx for peritonitis/ biliary tract/ intra-abdominal infections

A

IV am + met + gent
step down PO co-trimoxazole + met

(if penicillin allergic IV vanc + met + gent- step down PO co-tri + met)

(total days)

62
Q

Tx for non severe C diff

A

metronidazole PO 10 days

63
Q

Tx for severe C diff

A

vancomycin PO/NG 10 days

64
Q

what defines recurrent c diff

A

positive CDI in previous 8 weeks

65
Q

Tx for acute gastroenteritis

A

none

66
Q

Tx for acute pancreatitis

A

none

67
Q

what causes spontaneous bacterial peritonitis

A

coliforms +/- anaerobes, sometimes strep pneumoniae

68
Q

what should you do for an intra abdominal infection

A

send blood cultures, pus/ other intra abdominal samples

69
Q

who gets HUS

A

people with ecoli 0157 infection
aged <5 or >65
most develop 6-8 days post onset of symptoms
more common in those with bloody diarrhoea/ who are unwell

70
Q

why do you not give antibiotics for e coli 0157

A

might precipitate HUS

71
Q

what should you do in e coli 0157

A

notify public heath
faeces fro culture
heamotolofy: FBC, film for HUS/ confimed 0157
biochem: U&E, LDH, CRP

72
Q

what are coliforms sensitive to

A

getamicin and aztreonam

73
Q

Tx for a mild proven spontaneous bacterial peritonitis

A

co-trimoxazole PO (5-7 days)

74
Q

Tx for a severe proven spontaneous bacterial peritonitis

A

piperacillin/tazobactam IV

step down PO co-trimoxazole (5-7 days)

75
Q

cause of female uncomplicated lower UTI

A

coliforms, enterococci

76
Q

what causes a male UTI

A

coliforms, enterococci

77
Q

what causes (complicated UTI) pyelonephritis, urosepsis

A

coliforms, pseudomonas aeruginosa, enterococci

78
Q

what should you do for UTIs

A

blood cultures and urine cultures if complicated or male

females no culture unless recurrent

do not send catheter urine samples unless you thin this is a source of infection and they have signs of infection

79
Q

Tx for catheterised UTI

A

do not treat unless signs/ symptoms of infection
same as complicated UTI

IV amox + gent

(if penicillin allergic IV com-trimoxazole + gent)
strep down PO co-trimoxazole

(total 7 days)

80
Q

Tx for UTI in older patients

A

do not treat unless signs/ symptoms of infection

treat same as male/female Tx

81
Q

Tx for complicated UTI/pyelonephritis/ urosepsis

A

IV amox + gent

(if penicillin allergic IV com-trimoxazole + gent)
strep down PO co-trimoxazole

(total 7 days)

82
Q

Tx for uncomplicated female lower UTI

A

nitroflurantoin or trimethoprim (3 days)

83
Q

Tx for uncatheterised male lower UTI

A

nitroflurantoin or trimethoprim (7 days)

84
Q

when is nitrofurantion not excreted in the urine

A

in renal impairment (also has no kidney penetration so only ever used for uncomplicated lower UTIs in females and uncatheterised males)

85
Q

cause of cellulitis

A

s aureus, group A strep and other beta haemolytic strep

86
Q

Tx for cellulitis

A

flucloxacillin (in penicillin allergic doxycycline PO) total 7 days

87
Q

cause of diabetic foot acute

A

staph aureus

88
Q

cause of diabetic foot on acute on chronic polymicrobial

A

s aureus, coliforms and anaerobes

89
Q

Tx for mild diabetic foot infection

A

flucloxacillin or doxycycline 7 days

90
Q

Tx for moderate diabetic foot infection

A

flucloxacillin + metronidazole

or doxycycline + met

7 days

91
Q

what should you do in skin or soft tissue infection

A

if severe/ systemic take blood cultures
swab wounds- these will not be able to distinguish infection for colonisation
previous antibiotics will select out coliforms and pseudomonas

92
Q

does flucloxacillin cover beta haemolytic strep

A

yes

93
Q

does co-trimoxazole cover MRSA

A

yes

94
Q

Tx for open fracture prophylaxis

A

IV co-amoxiclav (or IC co-trimoxazole) + metronidazole

start within 3 hours for max 72 hours

95
Q

Tx for acute septic arthritis/ osteomyelitis

A

IV flucloxacillin

96
Q

Tx for severe systemic infection source unkown

A

Iv amox met and gent
(if PWID add IV flucloxacillin for s aureus)

if penicillin allergy Iv vanc + met + gent

97
Q

cause of septic arthritis/ osteomyelitis

A

s aureus

98
Q

what should you do in septic arthritis/ osteomyelitis

A

blood cultures before antibiotics, joint aspirates/ washouts and bone samples
consider distant focci of infection

99
Q

how do you need to give antibiotics in septic arthritis/ ostepmyelitis

A

high doses IV, prolonged duration (4-6 weeks), bactericidal to penetrate joint and tissue, elimante bacteraemia and reduce septic emboli risk

Antibiotics Revision (2 decks)

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