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1st Year - Principles > Microbiology 5 - Antibiotic therapy > Flashcards

Microbiology 5 - Antibiotic therapy Flashcards

1
Q

What is the difference between bactericidal and bacteriostatic antibiotics?

A

Bactericidal = kill bacteriaBcteriostatic = inhibit bacterial growth

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2
Q

Why must antibiotics be selectively toxic?

A

In order to kill the bacteria without damaging the host

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3
Q

How are antibiotics usually administered?

A

Usually orally or IV (rarely intramuscularly)

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4
Q

When antibiotics are given orally, when will they reach peak serum levels?When given IV?

A

Approx. 1 hour laterWithin 15 minutes

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5
Q

Where are antibiotics excreted?

A

Unchanged antibiotic = in the faecesAbsorbed antibiotic = either in the urine or via the liver, binary tract and into the faeces

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6
Q

Why are antibiotics sometimes given in combination? (3)

A

To cover a broad range of possible infecting organismsTo prevent the development of resistance e.g. in the treatment of TBFor the synergistic effect of the combination (i.e. 1 + 1 = 3) e.g. in the treatment of some cases of endocarditis

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7
Q

What are the 3 main ways in which antibiotics can work?

A

Acting on bacterial cell wallAffecting the bacterial ribosomeActing on bacterial DNA directly(all of these structures differ in bacteria and mammalian cells)

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8
Q

What are the 3 groups of antibiotics that act on the bacterial cell wall?

A

The penicillinsThe cephalosporinsThe glycopeptides

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9
Q

Name the 6 penicillins?

A

PenicillinFlucloxacillinAmoxicillinTemocillinCo-amoxiclavPiperacillin/ tazobactam = Tazocin

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10
Q

Name a cephalosporin?

A

Ceftriaxone

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11
Q

Name 2 glycopeptides?

A

VancomycinTeicoplanin

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12
Q

How do the penicillins work?

A

They inhibit cell wall synthesis by preventing the cross-linking of peptidoglycan subunits

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13
Q

Are the penicillins bactericidal or bacteriostatic?

A

Bactericidial

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14
Q

Amount of side effects of penicillins?Narrow or broad spectrum?Excreted by?

A

Very fewRange from narrow to broad spectrumRapidly via the kidneys

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15
Q

Are the penicillins safe in pregnancy?

A

Yes

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16
Q

What are the 2 main drawbacks of the penicillins?

A

-some patients are hypersensitive to the penicillins. An allergy to one penicillin means allergy to all penicillins (and sometimes also the cephalosporins)-rapid excretion via the kidney means frequent dosing (usually 4-6 times daily) is necessary

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17
Q

What are the 3 forms of penicillin available? How is each given?

A

Benzylpenicillin (penicillin G, IV)Phenoxymethyl penicillin (penicillin V, oral)Benzathine penicillin (long actin, IM)

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18
Q

Do organisms that are sensitive to penicillin itself tend to be sensitive to most of the penicillin group of antibiotics?

A

Yes

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19
Q

What does the penicillin nucleus look like?

A

A house and a garage

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20
Q

What penicillin is given to gram positive organisms? How can this be given?

A

Flucloxacillin (IV, oral)

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21
Q

What penicillins are given to both gram positive and gram negative organisms? How re these given?

A

Amoxicillin (IV, oral)Co-amoxiclav (IV, oral)”Tazocin” - IV only (piperacillin/ tazobactam)

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22
Q

What penicillin is given to gram negative organisms?

A

Temocillin (IV only)

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23
Q

How is flucloxacillin given?

A

IV and oral

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24
Q

Spectrum of flucloaxicillin?

A

Very narrow Useful only for staphylococci and streptococci)

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25
Q

What is flucloxacillin used to treat?

A

Staphylococci and streptococci infections only e.g.Skin and soft tissue infectionWound infectionCellulitis

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26
Q

How can amoxicillin be given?

A

IV, oral

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27
Q

Why has amoxicillin become less effective over the years?

A

Many organisms produce beta-lactamse (an enzyme that destroys amoxicillin)

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28
Q

What is co-amoxiclav?When is it used?

A

Amoxicillin plus clavulanic acid which is a beta-lactadase inhibitor Used when there is an antibiotic resistance to amoxicillin

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29
Q

How can co-amoxiclav be given?

A

oral and IV

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30
Q

What is tazocin made up of?

A

Piperacillin (antibiotic)Tazobactam (beta-lactamase inhibitor)

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31
Q

How is tazocin given?

A

IV only

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32
Q

How is temocillin given?

A

IV only

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33
Q

What type of bacteria can temocillin be used to treat?

A

Colifroms

34
Q

Can temocillin be used to treat beta-lactamase producing bacteria?

A

Yes, it is used to treat extended spectrum beta-lactamase producing organisms

35
Q

What do all cephalosporins have in their name?

A

“ceph” or “cef”

36
Q

How do cephalosporins work?Bactericidal or bacteriostatic?

A

inhibit cell wall synthesis and are bactericidal (like penicillins)

37
Q

How are cephalosporins excreted?Few or many side effects?Safe in pregnancy?

A

Excreted via kidneys and urineFew side effectsSafe in pregnancy

38
Q

Appearance of a cephalosporin nucleus?

A

House + garage + garden

39
Q

Do cephalosporins have a broad or narrow spectrum?

A

Broad-spectrum

40
Q

What is the major disadvantage of cephalosporins?

A

As they are broad spectrum, they significantly affect the normal bowel floraThey kill the normal gut bacteria allowing overgrowth of clostridium difficile which causes a nasty gastroenteritisMany hospitals now try to avoid using them meaning they have very limited indications for use in Tayside

41
Q

How are the glycopeptides (vancomycin and teicoplanin) given?

A

Both IV

42
Q

How does vancomycin work?Are the glycopeptides bactericidal or bacteriostatic?

A

Cell-wall active antibiotics but in a slightly different way to the penicillins and cephalosporinsBinds to the end of the growing pentapeptide chain during peptidoglycan synthesis preventing cross-linking and weakening the bacterial cell wallBactericidal

43
Q

How are the glycopeptides excreted?

A

Via the kidneys and urine

44
Q

What can happen to patients taking vancomycin with kidney failure?

A

Toxic levels can build up in the blood causing further kidney damage

45
Q

What type of organisms are glycoproteins active against?

A

Only gram positive cell walls - active against all (most?) gram positive bacteria

46
Q

What antibiotic can treat MRSA?

A

Vancomycin (if becomes resistant to this, we would have very few options to treat it)Gentamicin

47
Q

Antibiotics that inhibit protein synthesis? (5)

A

The macrolidesThe tetracyclinesThe aminoglycosidesOthers (Clindamycin, chlorampheicol)

48
Q

What are 3 macrolides?

A

ErythromycinClarythromycinAzinthromycin

49
Q

What is an example of a teracycline?

A

Doxycycline

50
Q

What is an example of an aminoglycoside?

A

Gentamicin

51
Q

How do antibiotics inhibit protein synthesis?

A

By attaching to bacterial ribosomes (structurally different from mammalian ribosomes)

52
Q

Are antibiotics that inhibit protein synthesis (act on ribosomes) bactericidal or bacteriostatic?Why?What is the exception to this?

A

BacteriostaticUsually protein synthesis can resume when the antibiotic is removedThe amino glycoside group - binding of these antibiotics to ribosome are lethal

53
Q

How are the macrocodes excreted?

A

Via the liver, biliary tract and into the gut

54
Q

Is Erythromycin safe in pregnancy?

A

Yes

55
Q

What type of infections are macrolides especially useful for treating?

A

As the antibiotics are lipophilic they can pass through the cell membranes easilyThey are therefore useful for treating certain infections where bacteria hide from the host’s immune system by getting into the host cell

56
Q

What kind of bacterial infections is erythromycin/ clarythromycin useful for treating?

A

Clostridium spp.Streptococcus spp.Staph. aureusNeisseria spp. (partly sensitive)Haemophils infleunzae (partly sensitive)

57
Q

Why must gentamicin be given IV?

A

It is not absorbed from the gut

58
Q

What is gentamicin used to treat?

A

Active mainly against gram negative aerobic organisms such as coliforms and Pseudomonas aeruginosaUsed in hospital for treating serious gram negative infeciton

59
Q

How is gentamicin excreted?

A

In the urine

60
Q

What can gentamicin cause?

A

Causes damage to kidneys and VIIIth cranial nerve (deathless and dizziness) so need to monitor blood levels of ahminoglycosides

61
Q

Examples of antibiotics that act on material DNA? (3)

A

MetronidazoleTrimethoprim (+/- sulphonamide) - shown to cause synergy in the labFluoroquinolones

62
Q

How can metronidazole be given?

A

Oral or IV

63
Q

How does metronidazole work?

A

Causes strand breakage of bacterial DNA

64
Q

What type of infections is metronidazole used to treat?

A

Anaerobic (and some protozoal) infections

65
Q

How if Trimethoprim given?

A

Oral

66
Q

How does trimethoprim work?

A

It inhibits bacterial folic acid synthesis

67
Q

What is the name when trimethoprim is given in combination with sulphamethoxazole?How is this given?

A

Co-trimoxazole (septrin)IV or orally

68
Q

How is trimethoprim excreted?

A

Via the urine

69
Q

What type of bacteria does trimethoprim have activity against?

A

Some gram negative and some gram positive bacteria

70
Q

What are 2 examples of fluoroquinolones?How are each given?

A

Ciprofloxacin (IV, oral)Levofloxacin (IV)

71
Q

How do fluoroquinolone act?

A

By preventing “supercoiling of bacterial DNA”

72
Q

Are fluoroquinolones bactericidal or bacterostatic?

A

Bactericidal

73
Q

Why is the use of Fluoroquinolones severely restricted in tayside?

A

In an attempt to reduce the risk of clostridium difficile

74
Q

How are fluoroquinolones excreted?

A

Via the urine

75
Q

What are the common side effects of all antibiotics?

A

Nausea, vomiting and diarrhoea (all antibiotics disrupt the gut bacterial flora)

76
Q

What antibiotic causes renal and VIII nerve damage?

A

Gentamicin

77
Q

What antibiotic causes tendonitis?

A

Ciprofloxacin

78
Q

What antibiotic interacts with alcohol?

A

Metronidazole

79
Q

What group of antibiotics increase the risk of C. diff. in elderly patients?

A

Broad spectrum antibiotics

80
Q

What 4 antibiotics do we try to avoid?Why?

A

CephalosporinsCo-amoxiclavCiprofloxacinClindamycin

1st Year - Principles (37 decks)

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