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PHARMACOOO > Principles of microbial use > Flashcards

Principles of microbial use Flashcards

1
Q

To avoid in children:

A
  • Tetracyclines (calcification)

- Fluroquinolones (arthropathy)

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2
Q

Avoid in G6PD:

A
  • Sulfonamides
  • Cotrimoxazole
  • Nitrofurantoin
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3
Q

Avoid in penicillin allergy

A

Have cross reactivity with carbapenems + cephalosporins

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4
Q

Avoid in pregnancy/BF:

A
  • Cotrimoxazole
  • Fluroquinolones
  • Tetracyclines
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5
Q

Avoid in renal impairment:

A
  • Aminoglycosides

- High dose vancomycin

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6
Q

Avoid in hepatic impairment

A
  • Pyrazinamide

- Amoxicillin/clavulanate

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7
Q

Immunocompromised:

A

Use bacteriostatic drugs

  • B-lactam
  • Fluroquinolones
  • Aminoglycosides
  • Vancomycin
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8
Q

MSSA

A

• Penicillinase resistant penicillins (Flucloxacillin, cloxacillin)

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9
Q

MRSA

A
  • Vancomycin
  • Ceftaroline
  • Ceftobiprole
  • Tetracyclines
  • Glycylcycline
  • Clindamycin
  • Co-trimoxazole
  • Linezolid
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10
Q

P.aeruginosa

A
  • Piperacillin
  • Ceftazidime
  • Ceftobiprole
  • Carbapenem (x erta)
  • Aztreonam
  • FQ
  • Aminoglycosides
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11
Q

ESBL

A
  • Carbapenem
  • Aminoglycosides
  • 4th gen cephalosporin
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12
Q

Amp-C-producing enterobacterales:

A

4th gen cephalosporin

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13
Q

Anaerobic:

A
  • Carbapenem
  • Piperacillin+tazobactam
  • Clindamycin
  • Metronidazole
  • Amoxicillin-clavulanic
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14
Q

Enterococcus

A

Ampicillin + Gentamicin/ Ceftriaxone

Cotrimoxazole

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15
Q

Does not achieve adequate CSF conc (AMC)

A
  • 1st & 2nd gen cephalosporin
  • Aminoglycosides
  • Macrolides
  • Clindamycin
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16
Q

For CNS infections (all cell wall inhibitor)

A
  • Penicillins
  • Ceftriaxone
  • Ceftazidime
  • Cefepime
  • Meropenem
  • Vancomycin
17
Q

Prostatitis

A
  • Ciprofloxacin

* Co-trimoxazole

18
Q

To avoid in pneumonia

A

Daptomycin as it is inactivated by lung surfactant

19
Q

To avoid in abscesses

A

aminoglycoside as it does not distribute well

20
Q

Good oral F drugs? (FMLC)

A
  • FQ
  • Metronidazole
  • Linezolid
  • Cotrimoxazole
21
Q

General steps to antimicrobial use?

A
  1. Confirm presence of infection
  2. Identification of pathogen
  3. Selection of microbial regime
  4. Monitor response
22
Q

How to confirm presence of infection?

A 
Look at: 
Risk factors for infection
Subjective evidence (symptoms)
Objective evidence 
- Vital signs 
- Lab test 
- Radiological imaging
23
Q

What vital signs to look out for to confirm presence of infection?

A 
Fever >38'C
Tachypnea RR >22bpm 
Hypotension SBP <100mmHg
tachycardia HR >90bpm
Mental status
24
Q

What lab test to look out for to confirm presence of infection?

A 
Non-specific 
E/D total white (4-10 x 10^9/L) 
CRP (>40mg/L)
Increase neutrophils (>90%)
Erythrocyte sedimentation rate (bone & joint) 
Increase procalcitonin
25
Q

Example of colonisers

A

Yeast in urine

26
Q

What to look out for in radiological imaging

A

Tissue changes, collections, abscess, obstructions

27
Q

Examples of contaminants?

A

Staphylococcus epidermis, bacillus spp

28
Q

Advnatge of combination therapy?

A
  1. Extend spectrum of activity
    o Empirical or definitive therapy of polymicrobial infections
     Piperacillin-tazobactam for gram-
     Vancomycin for hospital-acquired pneumonia
    o Empirical tx to cover all resistant strains of the same organism
     Piperacillin-tazobactam + ciprofloxacin to cover Pseudomonas aeruginosa in ventilator associated pneumonia
  2. Achieve synergistic bactericidal effect
    o Ampicillin + gentamicin/ampicillin + ceftriaxone for Enterococcus
    o Trimethoprim + sulfamethoxazole against various organisms
  3. Prevent development of resistance
    o Antimicrobial combinations against M. tuberculosis, HIV
29
Q

Disadvantages of combination therapy

A
  1. Increased risk of toxicity & allergic reactions
  2. Increased risk of drug interactions
  3. Increased cost
  4. Selection of multi-drug resistant bacteria
  5. Increased risk of superinfections
    o E.g. fungal infections CDAD (2nd infection superimposed on earlier on)
  6. Concern for antagonistic effect
30
Q

Drug factors?

A 
Spectrum of activity 
Ability to reach the site 
PK-PD char 
ROA
Side effects 
DDI 
Cost
31
Q

PK-PD char of drugs?

A

Conc-dep bacterial killing (AG/FQ)
- dep on antibx conc
Time-dependent bacterial killing w/ no persistent effect (Penicillins, cephalosporins, carbapenems)
- dep on dosing interval 40-70% > MIC
Time-dependent bacterial killing w/ persistent effect (Vancomycin)
- AUC:MIC ratio

PHARMACOOO (5 decks)

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