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Respiratory > Respiratory Antibiotics > Flashcards

Respiratory Antibiotics Flashcards

1
Q

What antibiotics are cidal?

A

Cell wall inhibitiors
Aminoglycocides
Quinolones

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2
Q

What antibiotics are static?

A

Protein synthesis inhibitors

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3
Q

What are the categories of the beta-lactams?

A

Penicillins
Cephalosporins
Carbapenems
Monobactams

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4
Q

What do you use to treat atypical pneumonia (legionella)?

A

Azithromycin

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5
Q

What do you use to treat anaerobes?

A

Treat with Metronidazole/Clindamycin
Only second generations cephalosporins (so not ceftriaxone)

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6
Q

What do you do use if the patient is penicillin-allergic?

A

Aztreonam – Monobactam are safe

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7
Q

What are the big bugs for Community Acquired Pneumonia (CAP)?

A

Outpatient: S. pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Clamydophilia pneumoniae,, Respiratory viruses
Inpatient also are susceptible to Legionella (non-ICU) or S. aureus and gram-neg (ICU)

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8
Q

What do we use for healthy outpatient CAP?

How about if they have co-morbidities?

A

Previously healthy: Macrolide (not azithromycin ideally), Doxycycline

Co-morbidities: Alpha-pneumococcal fluoroquinolone (FQ), beta-lactam plus macrolide

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9
Q

What drugs for inpatient pneumonia(non-ICU)?
If they are PCN allergic?

A

No PCN allergy: Beta-lactam plus macrolide
PCN Allergy: FQ

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10
Q

What drugs for inpatient ICU pneumonia?
With allergy?

A

No PCN allergy: Beta-lactam plus macrolide or FQ
PCN allergy: FQ plus aztreonam

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11
Q

What do we use if we are afraid of pseudomonas pneumonia?
MRSA pneumonia?
Aspirated?

A

Pseudomonas concern: Piperacillin-tazobactam, cefepime, meropenem (alpha-pneumococcal, alpha-pseudomonal beta-lactam) plus an FQ

MRSA: Vancomycin or linezolid

Aspiration suspected: Add clindamycin to cover oral anaerobes

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12
Q

What is the indication for MSSA?

A

All beta lactams except PCN, Ampicillin
Nafcillin and Cefazolin are drugs of choice

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13
Q

What antibiotics are used for pneumococcus? (Beta lactams)

A

Ceftiraxone (adults)

Cefotaxime (children)

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14
Q

Which beta-lactams for pseudomonas?

A

Piperacilin/Tazobactam, Ceftazadime, Cefepime, Meropenem/Impipenem, Aztreonam

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15
Q

What do macrolides treat?

A

Respiratory gram positive and gram negative bacteria; intracellular atypical pathogens (mycoplasma, chlamydia, legionella)

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16
Q

What is moxifloxacin indicated for?
Levo?
Cipro?

How about other general FQ indications?

A

Anti-pnuemococcal

Anti-pneumococcal, anti-pseudomonal

Anti-pseudomonal

Intracellular atypical pathogens (mycoplasma, chlamydia, legionella), secondary mycobacterial species

17
Q

What are the teracyclines indicated for?

How do their efficacies stack up?

A

Wide range of gram-positive and gram-negative bacteria in RT
Atypicals such as chlamydia, mycoplasma, legionella
Tet least eff., Dox and Mino most eff.

18
Q

What is vancomycin indicated for?

A

Resistant Gram Positives
Not VRE
IV formulation for resistants

19
Q

What is linezolid indicated for?
What is a risk with use?

A

Resistant Gram Positives
Bone marrow suppression and neuropathy with prolonged use

20
Q

What is daptomycin indicated for?

A

Resistant Gram Positives
Not for use in pneumonia – bound by surfactant

21
Q

What is the treatment protocol for CAP?

A

Treat for a minimum of five days
Before stopping therapy patient should be afebrile for 48 to 72 hours, breathing without supplemental oxygen and have no more than one clinical instability factor (HR > 100, RR > 24, SBP < 90)
Longer duration if culture positive for coagulase positive Staphyloccus or Pseudomnoas

22
Q

What are the risk factors for multidrug resistant organisms?

A

Current hospitalization of > 5 days
Hospitalization in an acute care hospital for > 2 days within the past 90 days
Residents of a nursing home or long-term care facility
Recipients of recent IV antibiotics, chemotherapy or wound care within the past 30 days
Chronic dialysis within 30 days
Family member with multidrug-resistant pathogen

23
Q

What is the empiric antibiotic thearpy for HCAP?

A

No risk factors for MDROs: Ceftriaxones OR Amp/Sulbactam OR Ertapenem OR Fluoroquinolone

Yes risk factors for MDROs: Anti-psuedomonal beta-lactam PLUS (FQ or Aminoglycoside) PLUS (Vancomycin or Linezolid if MRSA suspected)

24
Q

What immunocompromised pneumonias are associated with:
Early HIV
Late HIV
Transplantation

A

HIV Infection Early: S. pneumonia

HIV Infection (late): Pneumocystis jiroveci
Non-TB mycobacteria
Histoplasma

Transplantation: CMV
RSV
Aspergillus
Mucormycosis

25
Q

Pneumonia due to:

Bird exposure?

Rabbit exposure?

Farm exposure?

SW US exposure?

Structural lung disease?

A 
Bird exposure: Chlamydophila psittaci (parrots)
Avian influenza (poultry)

Rabbit exposure: Francisella tularensis

Exposure to farm or parturient animals: Coxiella burnetti (Q fever)

Travel to SW United States: Coccicioides
Hantavirus

Structural Lung Disease: Pseudomonas
S. aureus
Non-TB mycobacteria
Aspergillus

26
Q

What is CURB-65?

What does it stand for?

A

Criteria for teratment and admission

Confusion – 1
Blood Urea Nitrogen > 19 mg per dL – 1
RR > 30 – 1
Systolic blood pressure < 90 mm Hg or Diastolic blood pressure < 60 mm Hg – 1
Age > 65 – 1

27
Q

What do CURB-65 scores indicate doing?

A

0 – Low risk, consider home Rx
1 –Low risk, consider home Rx
2 – Short inpt Rx or closely observed OP Rx
3 – Severe pneumonia, admit/consider ICU
4 or 5 – Severe pneumonia, admit/consider ICU

28
Q

What are risk factors for PCN Resistant S. pneumonia?

A

Age > 65 years
Beta-lactam
Alcoholism
Multiple medical comorbidities (e.g. immunosuppressive illness or medications)
Exposure to a child in a day care center

29
Q

What are the stages of PCN resistance for S. pneumonia and what drugs are used to treat them?

A

Penicillin susceptible (MIC < 0.1 mcg/ml): Penicillin G, amoxicillin

Penicillin resistant (0.1 < MIC < 1.0 mcg/ml): High dose pencillin G or ampicillin, cefotaxime/ceftriaxone

Penicillin resistant (MIC \> 2.0 mcg/ml):Vancomycin w/w/o rifampin
High dose cefotaxime tried in meningitis
Non-meningeal infection: cefotaxime/ceftriaxone, high dose ampicillin, carbapenems, or fluoroquinolone (levofloxacin, moxifloxacin)

Multidrug resistant (MDRSP, resistant to any 2 of the following: penicillins, erythromycin, tetracycline, macrolides, cotrimoxazole)
Vancomycin w/w/o rifampin
Clindamycin, levofloxacin, moxifloxacin could be tried
Linezolid

Respiratory (31 decks)

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