T3-L7: Pathogen-Antibiotic Matching 2 Flashcards
Which antibiotic would you choose in the following pneumonia scenarios?
Medium severity: Sputum culture result growing Streptococcus pneumoniae
A- Amoxicllin and clarithromycin, B-Amoxicillin, C: Clarithromycin
B or C - you know the pathogen. You don’t need to add in the treatment for the atypical cell wall.
Which antibiotic would you choose in the following pneumonia scenarios?
Low severity: Pneumonia not better on amoxicillin after 7 days
A: Amoxicillin, B: Clarithromycin, C-Levofloxacin
B - suggests the infection is resistant or the infection is caused by another bacteria therefore either B or C to change spectrum of activity.
Diagnosis:
You make a diagnosis of community acquired pneumonia after a flu like illness.
S. aureus is a pathogen in post viral pneumonia, in addition to the other causes of community acquired pneumonia.
MRSA results in antibiotic resistance to all commonly used beta-lactam antibiotics
What antibiotics would you prescribe?
In a patient who can take PO antibiotics give doxycycline. It is commonly used to treat pneumonia of mild to moderate severity.
In a patient who can only take IV antibiotics give 2-Vancomycin and doxycycline or ciprofloxacin.
What do we normally use to treat UTIs?
Nitrofurantoin, trimethoprim and amoxicillin-clavulanic acid, are options.
Other optionsinclude:
- Fosfomycin
- Pivmecillinam
- Cephalexin
What do you use in a systemic kidney infection?
Ciprofloxacin, IV cefuroxime, ertapenem, meropenem, gentamicin, IV amoxicillin-clavulanic acid, piperacillin-tazobactam and aztreonam are all options.
What do we use in the treatment of ESBL?
A carbapenem - there is a low prevalence of CPEs and so most patients with a ESBL a carbapenem will be okay - such as Meropenem and Imipenem
What do we use in the treatment of CPEs?
CPE - Carbapenemase producing Enterobacteriaceae - they lead to very broad resistance to a number of antibiotics including carbapenems which are usually last line and very broad. They also pick up other things on the plasmids. They can therefore be difficult or untreatable.
You would therefore need to seek further advice from microbiology.
What drugs are used in the treatment of gram negative antibiotics?
Antibiotics that are mostly used to provide cover for Gram negative bacteria
- Aztreonam
- Ciprofloxacin
- Gentamicin
What drugs are used in the treatment of gram positive bacteria?
Antibiotics that are mostly used to provide cover for Gram positive pathogens
- Teicoplanin
- Vancomycin
- Flucloxacillin
- Linezolid
- Macrolides e.g. clarithromycin
- Penicillin/Amoxicillin (streptococcus mainly)
Give examples of broad spectrum antibiotics.
Antibiotics and combinations that are used to provide cover for gram positives, gram negatives, and anaerobes:
- Amoxicillin-clavulanic acid
- Piperacillin-tazobactam
- Meropenem/Ertapenem
- Cefuroxime and metronidazole
- Teicoplanin1, Ciprofloxacin and metronidazole
- Amoxicillin, Ciprofloxacin and metronidazole
- Amoxicillin, Gentamicin and metronidazole
What scoring chart is used in community acquired pneumonia?
CURB-65
What antibiotics are used in the treatment of antibiotics according to the CURB-65 score?
Low severity - Amoxicillin PO (Doxycycline PO or Clarithromycin PO in allergy)
Medium - Amoxicillin and clarithromycin PO (Doxycycline or levofloxacin in allergy)
High - Co-amoxiclav IV and Clarithromycin (levofloxacin in allergy)
