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OD2 S2 > wk5: AED - Antibacterial 1 > Flashcards

wk5: AED - Antibacterial 1 Flashcards

1
Q

What are the 6 considerations in therapeutic management?

A

1: Diagnosis (exclusion, provisional, reconsideration)
2: Drug, dose, frequency? (contraindications, interactions, other modifying factors)
3: Px instructions
4: Review schedule (when)
5: Treatment success? (side effects)
6: Sustain or alter approach?

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2
Q

Out of the following antibacterials used in ocular management, which ones are topical?: fluoroquinolones, aminoglycosides, tetracyclins, macrolides, penicillins, cephalosporins, glycopeptides, chloramphenicol, gramicidin, bacitracin, polymixin

A

Fluoroquinolones
Aminoglycosides
Chloramphenicol

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3
Q

When are sulphonamide drugs considered S3?

A

When at 10% or less

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4
Q

Can sulphonamide drugs come as eye drops?

A

yes

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5
Q

What are sulphonamides used against? (2)

A

Broad spectrum antibiotics - used against staph related blepharitis/conjunctivitis; chlamydial disease - now increasing resistance, other drugs first choice

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6
Q

When is the use of sulphonamides contraindicated? (5)

A

sulphur allergy
pregnancy (near term)
infants (less than 2 months)
interactions with other topical drugs (precipitation)
commonly irritants

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7
Q

Why is the use of sulphonamide contraindicated in pregnancy (near term and infants)?

A

these drugs displace bilirubin from protein binding sites in neonates, which can lead to hyperbilirubinemea in neonates (i.e. neonatal jaundice)

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8
Q

What is propamidine and what is it used against? (2)

A

A general ocular disinfectant. Used against conjunctivitis (drops) and blepharitis (ointment). [note: other drugs first choice]

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9
Q

What is povidone-iodine general ocular disinfectant and what percentage solution is available in Aus?

A

General ocular disinfectant. Betadine antiseptic solution (10%) is available in Aus (note: would have to dilute 1 in 2 with sterile saline)

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10
Q

What drug schedule classification is povidone-iodine listed in when containing:
A: 0.5% active iodine
B: 2.5% or more active iodine

A

A: No schedule classification
B: S2

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11
Q

When is povidone-iodine contraindicated? (1)

A

iodine sensitivity

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12
Q

What conditions/organisms is povidone-iodine useful for treating? (3)

A

Bacterial conjunctivitis
Chlamydial conjunctivitis
Adenovirus (jury still out on this one)

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13
Q

Describe the process of Povidone-iodine administration (4)

A

Apply local anaesthetic: up to 3 drops in conj. sac
Wait 1 minute with closed eye (wipe lid margins as well)
Then irrigate with saline (one off or can be repeated)
Treatment may spark inflammation

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14
Q

How can you manage inflammation from povidone-iodine administration? (2)

A

NSAID or soft steroid

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15
Q

What topical multi-use antibacterial formulations are available in Aus? (6)

A

Gentamicin
Tobramycin
Framycetin
Ciprofloxacin
Ofloxacin
Chloramphenicol

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16
Q

What topical single-use antibacterials are available in Aus? (2)

A

Gentamicin
Chloramphenicol

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17
Q

What antibacterial eye ointment formulations are available in Aus? (2)

A

Tobramycin
Chloramphenicol

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18
Q

What are ‘fortified eye drops’? What does it mean to fortify an eye drop?

A

strong antibiotic eye drops specifically made by a compounding pharmacy, used for bad infections like corneal ulcer. The act of fortifying an eye drop means to make to make the medication stronger or more intensified

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19
Q

Name 3 fortified antimicrobial eye drop formulations that are available in Aus

A

Gentamicin 1.3%, Tobramycin 1.3%, Cephazolin 5%

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20
Q

What conditions should you use fluoroquinolones for? (2)

A

Bacterial keratitis
Severe unresponsive bacterial conjunctivitis

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21
Q

What conditions should you use Aminoglycosides for? (5)

A

Prophylaxis (e.g. post-surgical/trauma)
Bacterial conjunctivitis
Blepharitis/External hordeola (as ointment)
Canaliculitis/Dacryocystitis (prophylactic)
Endophthalmitis (if amikacin)

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22
Q

What conditions should you use Tetracyclines for?

A

Blepharitis (oral, as doxycycline)
Chlamydial eye disease (oral)
Chlamydial eye disease keratoconjunctivitis (topically, as adjunct tx)

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23
Q

What type of blepharitis is tetracycline particularly useful in treating?

A

Meibomianitis/acne rosacea

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24
Q

What conditions should you use Chloramphenicol for? (4)

A

Same as aminoglycosides, but bacteriostatic rather than bactericidal
(i.e. prophylaxis, bac conj, bleph/hordeola, canalic/dacryo)

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25
Q

What conditions should you use neosporin for? (4)

A

Same as aminoglycosides (i.e. prophylaxis, bac conj, bleph/hordeola, canalic/dacryo). Neosporin: excellent broad spectrum coverage, good for bacterial conjunctivitis

26
Q

Is Neosporinavailable in Aus?

A

No, not currently

27
Q

Name one disadvantage of neosporin

A

possible hypersensitivity response

28
Q

What conditions should you use macrolides for? (3)

A

Chlamydial disease (usually oral)
Blepharitis
Childhood bacterial conjunctivitis

29
Q

What conditions should you use penicillin for? (2)

A

Canaliculitis
chronic conjunctivitis (oral)

30
Q

What conditions should you use Cephalosporins for? (1)

A

Bacterial keratitis (oral IM)

31
Q

What conditions should you use Glycopeptides for? (1)

A

Endophthalmitis (use vancomycin) (oral IM)

32
Q

How safe are the following drugs during pregnancy/lactation:
Fluoroquinolones
Aminoglycosides
Chloramphenicol
Tetracycline

A

Fluoroquinolones: avoid use pregnant/lactation
Aminoglycosides: caution in pregnant; ok in lactation
Chloramphenicol: safe in pregnant/lactation
Tetracycline: contraindicated in pregnant + probably lactation

33
Q

How safe are the following drugs during pregnancy/lactation:
Neosporin
Macrolides
Penicillins
Cephalosporins
Glycopeptides

A

Neosporin: caution
Macrolides: caution 2/3 trimester and lactation
Penicillins: All safe
Cephalosporins: safe
Glycopeptides: unsafe preg, ok in lactation

34
Q

How safe are the following drugs in kids?
Fluoroquinolones
Aminoglycosides
Chloramphenicol
Tetracycline

A

Fluoroquinolones: ok
Aminoglycosides: ok
Chloramphenicol: ok (unless family hx blood dyscrasia)
Tetracycline: causes tooth discolouration in kids, so avoid

35
Q

How safe are the following drugs in kids?
Neosporin
Macrolides
Penicillins
Cephalosporins
Glycopeptides

A

Neosporin: caution
Macrolides: ? fine
Penicillin: ? fine
Cephalosporin: ? fine
Glycopeptides: ? fine

36
Q

Describe general bacterial susceptibilities to the following drugs:
Macrolides (3)
Penicillins
Cephalosporins
Glycopeptides

A

Macrolides: mainly gram +ve (and chlamydia), azithromycin good for strep and haemophilus

37
Q

Describe general bacterial susceptibilities to the following drugs:
Penicillins (2)

A

Penicillins: narrow or broad spectrum

38
Q

Describe general bacterial susceptibilities to the following drugs:
Cephalosporins (3)

A

Cephalosporins: moderate or broad spectrum ?possibly better gram+ve - cephazolin more gram +ve

39
Q

Describe general bacterial susceptibilities to the following drugs:Gram
Glycopeptides (1)

A

Gram +ve only

40
Q

How can you still kill bacteria even though it’s resistant?

A

Use high enough dose

41
Q

Rate the severity of bacterial gram stain sensitivity to the following drugs: Chloramphenicol, Aminoglycoside, Fluoroquinolones

A

gram +ve gram -ve
Chlor. +++ ++
Amin. + +++
Fluoro. ++. +++

(note: . = tiny +)

42
Q

Name some factors to consider when deciding between oral and topical medication (3)

A

Topical good for many ocular surface infections
Some surface manifestations can extend to sites topicals can’ reach in therapeutic conc.
Oral drugs = greater risk of side effects

43
Q

Name 3 conditions that can extend to sites topical medication can’t reach

A

blepharitis
chlamydial conjunctivitis
dacryocystitis

44
Q

What ideal features do you want for a prohylactic antibiotic? (4)

A

broad spectrum cover, but based on likely pathogens
quick attainment of protective levels (consider loading dose)
restrict use to where proven effective
treat until risk of infection past

45
Q

What ideal features do you want for a therapeutic antibiotic? (4)

A

should target specific organism (if known)
quick attainment of therapeutic levels
restrict use to where proven effective
therapy continues until organism eliminated

46
Q

How frequently are prophylactic antibiotics taken (e.g. post trauma)?

A

Typically qid for just beyond duration of risk (i.e. 2 days after). Can last for up to 2 weeks (depends on how long risk lasts)

47
Q

What 2 antibacterials are particularly good for prophylaxis?

A

Chlorampheniol
Aminoglycoside (in CL wearer. used for gram -ve coverage, pseudomonas)

48
Q

What is MIC90?

A

Minimum Inhibitory Concentration required to inhibit the growth of 90% of organisms

49
Q

How long do commercial concentrations of aminoglycosides remain in the tear film above MIC90 for common susceptible organisms?

A

around 4 hours

50
Q

How long do commercial concentrations of aminoglycosides remain in tear film above MIC50 for common susceptible organisms?

A

around 6 hours

51
Q

How good are commercially available Aminoglycosides at reaching therapeutic levels in the cornea? What factors contribute to reaching these levels? (2)

A

Pretty poor (if intact corneal epithelium) (can overcome this by fortfying, or by administering frequently)

52
Q

Define loading dose

A

an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose

53
Q

What type of drugs are loading doses most useful for?

A

drugs that are slowly eliminated from the body. (long half life). Without the initial high dose, it’d take a long time to reach therapeutic level. And since eliminated slowly, you only need a very low maintenance dose to keep it at therapeutic level

54
Q

Outline 2 primary uses for a loading dose

A
  1. to more rapidly achieve steady state in therapeutic range
  2. to achieve steady state above standard therapeutic level (e.g. to exceed MIC range in sight threatening condition where organism unknown)
55
Q

In what types of bacterial conjunctivitis is lab testing mandatory? (7)

A

severe chronic
hyperacute
ophthalmia neonatorum
membranous
parinauds ocuoglandular sndrome
post-operative infection
assoc. corneal ulcer

56
Q

In what types of bacterial conjunctivitis is lab testing recommended (but not mandatory)? (5)

A

any chronic (unless severe, then mandatory)
secondary to canaliculitis or dacryocystitis
secondary to eczemmatous or ulcerative blepharitis
unresponsive to therapy
suspected medicamentosa

57
Q

Name 7 common causative organisms for bacterial conjunctivitis

A

G+ve: S. aureus, S. pneumoniae
G-ve: H. influenzae/aegypticus, N.gonorrheae, P. aeruginosa, Enterobac., M. lacunata

58
Q

Outline the clinical findings you’d expect to see in a case of acute bacterial conjunctivitis (6)

A

unilteral, then bilateral in days
irritation with hyperaemia
hyperaemia doesn’t extend to limbu
mucopurulent/purulent discharge after 24 hours
tarsal papillae (variable)
initially nasal location

59
Q

is acute bacterial conjunctivitis self limiting?

A

yes

60
Q

is it useful to lab test acute bacterial conjunctivitis?

A

Not particularly, limited value

61
Q

Describe the clinical findings you’d expect to see in a case of hyperacute bacterial conjunctivitis (8)

A

sudden, rapid onset (12hours or so)
unilateral or bilateral
pain/tenderness
copious purulent discharge
lid oedema or preseptal cellulitis
severe hyperaemia/chemosis
often n. gonorrhoea in adults
also assoc with n. meningitidis

OD2 S2 (63 decks)

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