Week 1 - Antibiotics Flashcards
Common pathogens of Community Acquired Pneumonia
- S. pnuemoniae
- Mycoplasma spp
- H influenzae
- Staphylococcus aureus
First line treatment for community acquired pneumonia for previously healthy adults
- Amoxicillin
- Doxycycline
- Macrolides
What to give for community acquired pneumonia if first line treatments weren’t effective?
For resistant strains:
a cephalosporin like ampicillin
What is the treatment for M. Pneumonaie in a pediatric patient?
Macrolides
- Erythromycin
- Azithromycin
- Clarithromycin
How is community acquired pneumonia treated in pregnancy?
A combination of amoxicillin or amoxicillin/clavulanate (augmentin) plus azithromycin
If someone has been treated with an antibiotic in the previous 90 days of contracting community acquired pneumonia what would they be treated with?
A quinolone
Examples of penicillins
Narrow-spectrum penicillinase sensitive:
- Penicillin G and V
Narrow-spectrum penicillinase resistant:
- nafcillin, oxacillin, dicloxacillin
Broad spectrum:
- ampicillin, amoxicillin
Extended spectrum:
- piperacillin
Penicillin/Beta-Lactamase combinations:
- ampicillin/sulbactam (unasyn),
- amoxicillin/clavulanate (augmentin),
- piperacillin/tazobactam (zosyn)
Examples of Cephalosporins
1st Gen – Cephalexin (Keflex)
2nd Gen – Cefoxitin (Mefoxin)
3rd Gen – Cefotaxiime (Clarforan)
4th Gen – Cefepime (Maxipeme)
5th Gen – Ceftaroline (Teflaro)
Examples of Fluoroquinolones
- Ciprofloxacin
- Ofloxacin
- Levofloxacin
- Moxifloxacin
Examples of Tetracyclines
- Tetracycline
- Doxycycline
- Demeclocycline
- Ervacycline
Examples of Macrolides
- Azithromycin
- Erythromycin
- Clarithromycin
Examples of Sulfonamides
- Sulfadiazine
- Sulfamethoxazole
- Trimethoprim
- Nitrofurantoin
Examples of Aminoglycosides
- Amikacin
- Gentamycin
- Tobramycin
Examples of Carbepenems
- Ertapenem
- Imipenem
- Doripenem
- meropenem
Treatment of chlamydial pneumonia in infants
Erythromycin (macrolides)
When to use a broad spectrum antibiotic
Use a broad spectrum when it is a common pathogen or before it is identified
When to use a narrow spectrum antibiotic
If you have done a culture/sensitivity then use the drug that the microbe is sensitive to (narrow spectrum)
What are empiric antibiotics?
Broad spectrum antibiotics used as first line of therapy before the microbe is identified and therapy can be tailored to the appropriate pathogen.
When do we prescribe empiric antibiotics?
When symptoms of an infection are severe and treatment needs to start before culture/sensitivity results are determined.
How do we treat Clostridium difficile diarrhea?
Stop the antibiotic the person is taking that is causing the infection and start either:
- vancomycin
- Fixaxomicin
OR
- Narrow spectrum macrolide or metronidazole (if oral vanco of Fidaxomicin are not available)
What drug classes are known to promote development of C. diff?
- Clindamycin
- Second and third generation cephalosporins
Patients with penicillin allergies may have cross-sensitivity reactions to which drug class?
All other penicillins and cephalosporins.
When can we prescribe penicillin for pregnant patients?
Cannot prescribe in the second or third trimester due to fetal risk.
What patient education should be given when prescribing a cephalosporin?
- Must not take alcohol in any form, can cause disulfiram effect)
- Interfere with drugs that promote bleeding (NSAIDS, anticoagulants, thrombolytics, antiplatelet agents)
What cephalosporins are appropriate for pregnant patients?
- cefaclor
- cephalexin
What patient education is needed when prescribing tetracyclines?
- Avoid prolonged sun exposure, wear protective clothing, apply sunscreen
- avoid taking antacids/supplements - Ca, Mg, Fe, milk as these will interfere with medication
What are the concerns for prescribing tetracyclines for pregnant patients?
Tetracyclines are contraindicated for pregnant women.
When taken after the fourth month of gestation they can cause yellow/brown staining of deciduous teeth of the infant (will not affect permanent teeth)
What patient education is needed when prescribing macrolides?
Taken on an empty stomach, if taken with food it decreases drug absorption.
What patient education is needed when prescribing aminoglycosides?
Stop taking if you have tinnitus, persistent headache or both (risk for irreversible ototoxicity) – report hearing changes to doctor immediately
What patient education is needed when prescribing sulfonamides?
- Drink at least 8-10 glasses of water per day (can cause buildup in the kidneys)
- Avoid prolonged exposure to sunlight, wear protective clothing, apply sunscreen, avoid tanning beds
What risks are associated with prescribing sulfonamides to pregnant women?
May cause birth defects in the first trimester
If taken near term the infant may develop kernicterus
- Deposition of bilirubin in the brain
Do not administer to pregnant women after 32 weeks of gestation
What renal adjustments are needed when prescribing gentamicin?
Use in caution with decreased renal function, can bind to renal tissues leaving levels 50 times higher than in the serum.
Bacteriostatic
Inhibits bacterial proliferation and the host’s immune system kills the bacteria
Bactericidal
Directly kills bacteria
Which antibiotics are safe during pregnancy?
- PCNs
- Cephalosporins
- Erythromycin
