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Pulmonology > Treatment of Bacterial Lung Infections > Flashcards

Treatment of Bacterial Lung Infections Flashcards

1
Q

Treatment of Pneumonia caused by Legionella

A
  • Erythromycin is the only one labelled for use.
  • More commonly is Azithromycin or Clarithromycin plus a respiratory quinolone such as Levofloxacin.
  • *For very ill patients, use Rifampin.
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2
Q

Drugs for CAP

A

Macrolides, Tetracyclines, Fluoroquinolones, Penicillins, Carbopenems, Cephalosporins, Aminoglycosides

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3
Q

Macrolides

A
  • “mycins”
  • 50s ribosomal inhibitor that blocks transcription.
  • Erythromycin, Azithromycin, Clarithromycin
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4
Q

Tetracyclines

A

“cyclines”

  • 30s ribosomal inhibitor blocking protein synthesis.
  • Doxycycline
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5
Q

Fluoroquinolones

A

“floxacins”

  • DNA gyrase inhibitor preventing DNA replication.
  • Levofloxacin
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6
Q

Penicillins

A

“cillins”

  • blocks cell wall synthesis by inhibiting PBP
  • Axoicillin + Clavulanic Acid (Augmentin)
  • Pipercillin +Tazobactam (Zosyn)
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7
Q

Carbopenem

A
  • Blocks cell wall cross linking

* Meropenem

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8
Q

Cephalosporins

A

“cefs” or “cephs”

  • Inhibits cell wall cross linking
  • Cefazolin
  • Cefuroxime
  • Cefatriaxone or Cefepime (anti pseudomonal activity)
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9
Q

Aminoglycosides

A
  • 30s ribosomal inhibitor

* Gentamicin

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10
Q

Mechanism of Resistance for the Macrolides

A

Ribosomal methylation and mutation of the 23s rRNA.

Active reflux.

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11
Q

Tetracyclines

A

Decreased entry into and increased efflux.

Target insensitivity.

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12
Q

Fluoroquinolones

A

Mutation of DNA gyrase.

Active efflux.

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13
Q

Penicillins

A

Beta lactamases.

Altered PBP’s

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14
Q

Cephalosporins

A

Decreased permeability of gram negative outer membrane.

Active efflux.

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15
Q

Aminoglycosides

A

Drug inactivation.
Decreased permeability of gram negative outer membrane.
Active efflux.
Ribosomal methylation.

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16
Q

Nosocomial Pneumonia

A

Usually Gram negative organisms.

  • Indicated: Impinem/Cilastin, Azotrenam, Ceftazidime
  • Alternative: Meropenem, Pip/Tazo, Cefepime
  • *Vancomycin can be given IV in worse case scenario.
  • *Meropenem has less side effects than Impinem.
  • *Cefepime is 4th gen and can work when Ceftazidime.
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17
Q

Aspiration Pneumonia

A

Usually gram negative bacilli.

  • Indicated: Clindamycin
  • Alternative: Ampicillin/ Sulfabactam
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18
Q

Clindamycin MOA and Resistance

A

MOA: 50s ribosomal inhibitor blocking translocation.
Resistance: Methylation of binding site, enzymatic inactivation.

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19
Q

Vancomycin MOA and Resistance

A

MOA: Binds D-alanyl-D-alanine terminus of peptide precursor units, inhibiting peptidoglycan polymerase and transpeptidation reactions.
Resistance: Replacement od D-ala by D-lactate

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20
Q

What is the problem with using serum levels for drug safety measurements?

A

Apart from interstitial tissue, serum levels do not mirror levels of the drug in the tissue. Therefore, some microbes may benefit from pharmacological sanctuary due to things such as poor penetration, prevailing pH, or local factors leading to increased rates of drug inactivation.
**Because of this drugs should be categorized as concentration dependent of time dependent.

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21
Q

Time above MIC

A

Penicillins, Cephalosporins, Carbapenems

22
Q

24hr AUC/MIC

A

AMinoglycosides, Fluoroquinolones, Tetracyclines, Vancomycins, MAcrolides, Clindamycin

23
Q

Peak/MIC

A

Aminoglycosides, Fluoroquinolones

24
Q

Drugs with Renal Elimination

A 
**Adjustment need when renal impairment present. 
"Aunt Annie Can Clearly C Gentlemen In Lovely Plaid Vests"
Amoxicillin
Ampicillin
Cefazolin 
Cefapime
Cefatrazidime
Gentamicin
Impinem
Levofloxacin
Piperacillin
Vancomycin
25
Q

Drugs with Biliary Elimination

A

**No adjustment needed for renal impairment.
“No ADE is required if the liver does the work”
Azithromycin
Doxycycline
Erythromycin

26
Q

Drugs with dual renal and biliary elimination

A

Cefatriaxone
Clindamycin
Meropenem (adjustment required in renal impairment)

27
Q

Toxicity of Amoxicillin and Ampicillin

A

Cross reactivity with penicillin allergy
GI Distress
Maculopapular Rash

28
Q

Toxicity of Azithromycin

A

Cholestatic jaundice.

***QT prolongation.

29
Q

Toxicity of the Cephalosporins

A 
Cross-reactivity across the whole class and partial with penicillin allergy.
**Cefatriaxone causes GI distress.
30
Q

Toxicity of Clindamycin

A

GI Distress

31
Q

Toxicity of Doxycycline

A

GI Distress
**Teeth discoloration.
Photosensitivity
Decreased bone growth.

32
Q

Toxicity of Erythromycin

A
  • *CYP3A4 inhibitor.
  • *Jaundice.
  • *QT Prolongation.
33
Q

Toxicity of Gentamicin

A

Nephrotoxicity
**Ototoxicity
Neuromuscular paralysis

34
Q

Toxicity of Impinem

A

Partial cross reactivity with pen/ceph allergies.

*Seizures.

35
Q

Toxicity of Levofloxacin

A
  • Tendon rupture in adults

* Cartilage damage in young children

36
Q

Toxicity of Linezolid

A

Bone marrow suppression.

**Non-specific MAO inhibitor

37
Q

Toxicity of Meropenem

A

Partial cross reactivity with pen/ceph allergy.

*Seizures.

38
Q

Toxicity of Piperacillin.

A

Partial cross reactivity with ceph hypersensitivity.

**Decreased coagulation.

39
Q

Toxicity of Vancomycin

A

Nephrotoxic
*Ototoxic
“Red Man’s” Syndrome

40
Q

Augmentin

A

Amoxicillin + Clavulanic Acid

41
Q

Zosyn

A

Piperacillin + Tazobactam

42
Q

Unasyn

A

Ampicillin + Sulbactam

43
Q

Primaxin

A

Impinem + Cilastin

44
Q

Should Daptomycin be used to treat pneumonia??

A

NO!

45
Q

Treatment of Bronchitis

A
  • Mostly viral in young
  • Bacterial more common in older patients or those with comorbities.
  • Indicated: Augmentin, Azithromycin, Clarithromycin, Doxycycline
  • If resistance is present, us Ciprofloxacin.
  • *If very severe, doxy and cipro may be used IV.
46
Q

Treatment of Lung Abscesses

A
  • Clindamycin (superior to penicillin against becteroides)
  • Metronidazole + Ceftriaxone (for nosocomial infections)
  • *Metronidazole should not be used alone due to incomplete coverage.
47
Q

Should you wait to treat?

A

NO. Earlier is better.

48
Q

What is the usual course of therapy?

A

IF bad enough, can start on IV and transition to oral as improvement is seen.

49
Q

Best Treatment for CAP?

A 
A macrolide (azithromycin) or quinolone (levofloxacin) is first choice.
Augmentin can also be used.
50
Q

How do you approach a nosocomial infection?

A

First treat with broad spectrum and then tailor once the infective agent is known.

51
Q

How do you approach treatment for abscess or aspiration pneumonia?

A

Treat for oral anaerobes.

Pulmonology (5 decks)

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