powerpoint on gram negative Flashcards
25 year old female diagnosed with uncomplicated acute bacterial cystitis. what is the drug of choice and duration of treatment.
what is most likely pathogen?
what do you give if complicated? what do those symptoms look like?
what do you give for pyelonephritis. what do those s/s look like?
when do you not treat a UTI?
uncomplicated: otherwise healthy
complicated: abnormal anatomy, renal stones, DB, pregnant, catheter
pyelonephritis: flank pain and fever
Take culture when not uncomplicated. pyelonephritis has longer duraiton of antibiotics (longer than a week)
most likely pathogen is e.coli or staph saprophyticus
don’t treat with asymptomatic elderly or if indwelling catheter without symptoms
first line: 3-5 days
nitrofurantoin, TMP-SMX, trimethoprim, fosfomycin
second line: ciprofloxaxin and beta-lactam.
sulfa allergy (3%) can still take nonsulfonylarylamines or sulfonamide moiety agents
drug of choice for pyelonephritis
ciprofloxacin
TMP-SMX (bactrim) or (septra)
SMX: TMP is 5:1
what is chronic UTI prophylaxis
what is drug of choice
what if intolerant to that?
what if bacteria is resistant
what is active against enterococus in urine?
more than 3 episodes in 1 yr
TMP-SMX
trimethorpim alone if intolerant to SMX
fluoroquinolone
nitrofurantoin (must take with food) ; greater chance of pneumonitis or drug induced liver injury
three classifications of sulfa drugs
sulfonylarylamines
nonsulfonylarylamines
sulfonamide moiety containing drugs
treat for urinary pain and urgency not the infection
and side effects
phenazopyridine (colors urine and clothes red-orange)
flavoxate (anticholinergic adverse effects)
acute prostatitis
if insneisitve and gram neg what do you use?
how long
TMP-SMX durg of choice
if insensitive use fluoroquinolone
4 weeks
chronic prostatitis
howis this different than acute prostatitis?
recurrent UTI in men.
must give for 6-12 weeks
TMP-SMX first
then fluoroquinolones
ruptured appendix with fever and abdominal pain. start emprici antibiotic regimen
what are usual suspects?
what is the new resistance to gram neg mechanism
recommended agents?
usual suspects: gram neg- Ecoli, Klebsiella, proteus, if hospital then pseudomonas (just think UTI)
gram +: enterococcus
also anaerobic bacteria
ESBL: extended spectrum beta lactamase: plasma mediated resistance that you must use a carbapenem with especially
Carbapenemases: CRE includes some enterobacteriae and klebsiella. is resistant to carbapenem
piperacillin-tazobactam (zosyn) “piper drinks tea” b/c this agent has anaerobic and gram neg /positive coverage
doripenem is also a is used because it is an imipenem but has no enterococcus activity
can also use cefriaxone or cefotaxime with metronidazole but no enterococcus activity
levoflaxacin or moxiflaxin plus metronidazole
azetreonam plus metronidazole
what do you have to think about for anerobic infections of:
GI
respiratory
skin and soft tissues?
gastrointestinal- bacteroides fragilis- distal bowel and colon *must always assume lower GI tract infections involve this bacteria
respiratory: peptostreptococcus - aspiration pneumonia from upper GI flora
skin and soft tissues: c perfringes- gas gangrene
treat c difficilie
what antibiotics cause it?
caused by clindamycin and cephalosporins
- discontinue causing antibiotic
- oral metronidazole - for colon plus IV metronidazole
what is metronidazole for?
what is it not good for?
excellent CNS tissue pentration,
rapidly bacteriCIDAL
antiinflammatory activity in GI
alcohol intolerance “can’t drink on metro”
bc inhibit aldehyde dehydrogenase
clindamycin
good anaerobic activity, but more adverse effects include antibiotic associated diarrhea and potential c diff infection
male with cystic fibrosis is admitted to ICU with pseudomonas infection.
what is treatment
aminoglycoside- tobramycin, amikacin, getamicin
limited use bc of renal toxicity and ototoxicity
treat psudomonas aeruginosa
UTI
Systemic
pulmonary
UTI: ciprofloxacin
Systemic: piper+tazo;
add tobramycin to:
- ceftazidime or cefepime
- meropenem or doripenem
pulmonary: same as abovebut add aminoglycosides
STD
chlamydia
chlamydia:
azithromycin or doxycyline
or erythromycin or levoflaxin
*doxycyline and levoflaxacin contraindicated in pregnancy.
